Surgical Internet at a Glance:Volume IV

Jeff Allen, MD, Louisville, Kentucky

The web page at http://www.laparoscopy.com is aprofessionally done site with the purpose of educat-ing physicians and patients in minimally invasive

surgery. Under the “welcome” heading, it is stated that thepage has goals to provide “an interactive, enjoyable, mul-timedia database to inform about the advancing technol-ogy of laparoscopic surgery and other micro-invasive tech-niques.” Without question this world wide web siteaccomplishes those goals.

To fully appreciate http://www.laparoscopy.com, clickon the pictures, movies, or radio sections. The content ineach of these utilizes plug-ins, which are additional pro-grams that computers need to view special multimedia files.Fortunately, all of the plug-ins are readily available fromwww.laparoscopy.com.

Under “pictures” are case presentations of 26 topics inminimally invasive surgery. These are presented in slide-show format. Included in each show are the names of theauthors, their background, and their e-mail address. Exam-ples of topics covered in this format are minimally invasivesaphenous vein harvest and lumbar discetomy. The saphe-nous vein harvest presentation consists of 11 illustrationsand photographs detailing this method, which uses twosmall incisions and a balloon dissector system. The lapa-roscopic lumbar fusion presentation reports a retroperito-neal, “gasless,” endoscopic approach to exposure of thediseased lumbar disk and fusion with an allograft femoralring.

The “movies” section is a must-see, for here the power ofthe internet to deliver on-demand video instructionals isbeginning to be realized. There are eight available moviesto view: Nissen fundoplication, Heller myotomy, rectalrepair, Dor procedure (anterior hemifundoplication), hia-toplasty, lesser sac exposure, esophageal exposure, and vir-tual colonoscopy. The virtual colonoscopy movie is un-usual for this page in that it is in the “mpeg” format. It isa large file, nearly 1.3 MB, and requires 9 minutes todownload at 33,600 BPS. It does, however, afford arguablythe best visual demonstration of this new technology,which uses computerized tomographic images recon-structed in the form of colonoscopy. Most of the movies areavailable in the Real Video format. The Real Video playermay be downloaded from the http://www.laparoscopy.comweb page. The rectal repair Real Video, for example, de-tails an endoscopic procedure to repair a rectal stricture. It

is 3 minutes 45 seconds and includes sound to complimentoperating room and endoscopic footage. Moreover, it ispresented in a format that allows the user to view the firstportion of the presentation prior to the whole file loading.This “streaming” technology makes download time seemmuch shorter. Although these movies are all instructional,they do expose the current limitations in technology forcomputerized motion pictures: they are jumpy, occasionallyinaudible, and have a low resolution of the picture. Nev-ertheless, they represent the next wave of surgical educa-tion.

The “radio” section is a collection of phone interviewsobtained from several authorities on minimally invasivesurgery. The interviews are broadcast in the form of round-table discussions. Utilization of this feature requires theTrueSpeech plug-in software, which is available for down-load on the web page. Recent topics include laparoscopyand the trauma patient, thoracoscopy and lung reductionfor emphysema, and mandatory laparoscopic certification.

A referral form is available for physicians to fill out. Bysubmitting simple information such as name, e-mail ad-dress, geographical location, and surgical field of interest,the physician is able to join a large online database. In thisway doctors are connected to potential patients. Patientsare able to search this database in the “are you sick?”section and find a physician who has a special interest intheir surgical problem. The “are you sick?” portion is theonly section directed at patients; the rest are written withscientific language directed at physicians.

Other sections of the web page include a chat room, aguest book, a search engine, and a presentation on thetechnology that allows monitoring of vital signs on com-mercial airliners during in-flight medical emergencies. Theguest book is in “letter to the editor” format and uponexamining it, it is apparent that the worldwide response tothe page has been great. The web page also includes adetailed, illustrated history section. Here the viewer canlearn about everything from Bozzini’s 1806 “Lichtleiter” toVeress’ 1938 spring-loaded needle to Mouret’s 1987 firstvideo laparoscopic cholecystectomy.

Produced by Dr. Alex Gandsas and Dr. Yuan Silva andsponsored by General Surgical Innovations and GRE Dy-namics, http://www.laparoscopy.com is a popular site. Un-der the statistics section, it is noted that the page has beenvisited more than 130,000 times and has transferred 954million bytes of information. By the time of this publica-tion, the site will have transferred more than 1 billionbytes. The page has been recognized as a Magellan four-starsite and as the top 5% of all web pages by Lycos, Inc. Thepage contains a wealth of information and is one that iscertainly worth bookmarking.

Next time: http://www.transweb.org

Am J Surg. 1998;176:1.Address correspondence to Jeff Allen, MD, 1114 Everett Ave-

nue, Louisville, Kentucky 40204.E-mail address: jeffa@iglou.com

SURGICAL INTERNET

© 1998 by Excerpta Medica, Inc. 0002-9610/98/$19.00 1All rights reserved. PII S0002-9610(98)00112-3