Gaik Si Quah; Guy Eslick
ANZ Journal of Surgery. 86():65, MAY 2016
Issn Print: 1445-1433
Publication Date: 2016/05/01
Purpose: Transvaginal cholecystectomy is one of the newest methods of performing cholecystectomy and its efficacy and safety has been controversial. The aim of this systemic review and meta-analysis was to review the available data comparing the safety and outcomes of transvaginal cholecystectomy (TVC) to the gold standard approach of laparoscopic cholecystectomy (LC).
Methodology: A comprehensive search of the online databases identified three prospective randomized studies and thirteen case- controlled studies or cohort studies that contained sufficient data on TVC. Data were extracted and pooled for analysis. We calculated pooled odds ratios (ORs) and 95 % confidence intervals using a random-effects model.
Results: The TVC group showed fewer overall complications (OR = 0.61, 95 % CI = 0.38 – 0.96, P = 0.03), post-operative complications (OR = 0.52, 95 % CI = 0.28 – 0.96, P = 0.04) including wound infections (OR = 0.29, 95 % CI = 0.09 – 0.99, P = 0.05) and reduced pain on day 1 – post-operative (p = 0.05). There was increased operative time in the TVC group (68.8 minutes vs 52.3 minutes, p = 0.03). There was no difference in rate of conversions, reoperations, biliary or hepatic injuries, time of return to normal activities or pain on day 3 post-operative.
Conclusions: This meta-analysis of the current published data establishes the safety of TVC when performed by experienced surgeons and is associated with reduced overall complications and wound infections.
Several fields of medicine are focused on the unique needs of infants, children and adolescents. Obstetricians and neonatologists work with infants, pediatricians are general practitioners for young patients, and several medical specialties have pediatric subdisciplines. This includes several branches of the surgical profession. Children’s bodies are physically smaller and less robust, presenting special challenges for surgeons. Pediatric surgeons earn correspondingly higher salaries than many of their peers.
General pediatric surgery is a subspecialty of general surgery. General pediatric surgeons perform most routine surgical procedures for children, though they’ll often refer complex cases to specialists in other subdisciplines such as pediatric cardiac or neurologic surgery. A physician salary survey performed in 2016 by the American Medical Group Association reported a median salary of $524,030 for pediatric surgeons, while the Hawkins Merritt’s 2017 survey reported salaries over $400,000 for pediatric specialties like surgery. The corresponding figures for general surgeons were $413,824 and $411,000 per year.
Pediatric cardiovascular surgeons treat children with heart-related birth defects or congenital heart diseases, often returning them to full health. Working at the junction of two highly specialized forms of surgery, pediatric cardiovascular surgeons earn some of the highest incomes in all of medicine. Pediatric neurosurgeons treat children for physical illnesses and malfunctions of the brain and nervous system, as well as their supporting systems of blood vessels. They also bring in high salaries. The AMGA’s salary survey reported average annual salaries of $669,271 for pediatric cardiovascular surgeons in 2016, more than the $645,112 average for non-pediatric cardiovascular surgeons. Harlequin Recruiting’s Neurosurgeon Compensation Update for 2016 reported the average income for pediatric neurosurgeons as $778,853 per year, a substantial figure and higher than the $736,924 average of adult neurosurgeons.
Pediatric orthopedic surgeons deal with the musculoskeletal systems of children. They perform surgery for limb and spine and deformities, broken bones and bone or joint infections or tumors. Like their cardiovascular and neurology colleagues, pediatric orthopedic surgeons earn high salaries even by medical standards. The same AMGA study reported their average income as $545,000 per year, a substantial figure but lower than the $582,056 average of adult orthopedic surgeons. MedSource Consultants found an average salary of $364,964 for orthopedic surgeons across the board, including both pediatric and general surgeons.
Although pediatric surgery is a well-paid profession, it’s not one to undertake lightly. Becoming a pediatric surgeon requires a substantial investment in time and money. The career begins with a four-year premedical degree, followed by four years of medical or osteopathic college. After those eight years of schooling, newly created doctors must spend four to five years in a general surgical residency. Surgeons must then pass their board certification exams and complete a further one or two years in a pediatric surgical fellowship. Finally, they must pass another board certification exam in pediatric surgery. The entire process can take up to 15 years.