Thirteen shortcuts in office surgery

To Sir, With Love

In this biography, the life of William Hugh Isbister is traced through three continents, where he planted the seeds of academic surgery into a generation of leaders in colorectal surgery. This ultimately improved the care for thousands of patients. His last station in Saudi Arabia made a huge impact on the country. I hope this article inspires others to write about their mentors who were important in their development as surgeons and physicians. Short biographies of these important figures will serve as a valuable historical record for generations to come.

Routine histological examination of epidermoid cysts; to send or not to send?

Backround

The diagnosis of epidermoid cyst is seldom in doubt, and associated malignancy extremely rare, yet it is commonplace for the lesion to be sent to the pathology laboratory for analysis. The aim of this study was to evaluate our current practice with regards to diagnostic accuracy among clinicians, and assess risk of not routinely sending suspected epidermoid cysts for histological examination. Potential cost savings were also estimated and calculated.

Methods

Retrospective analysis of clinical and pathology data on all suspected epidermoid cysts excised from a Scottish district general hospital over a 5-year period between January 2011 and October 2015.

Results

Five hundred and thirty-six suspected epidermoid cysts were excised during the study period. Three hundred and ninety-six were sent for histological examination which confirmed a diagnosis of epidermoid cyst in 303 (76.5%) cases. There was good agreement between preoperative suspicion and final histological diagnosis: 80.8% (257/318) among referring clinicians, 81.9% (289/353) among reviewing surgeons, and 88.4% (243/275) where there was preoperative agreement between both. There were no malignant lesions. An average of 80 clinically apparent epidermoid cysts were excised and sent for histology each year at a cost of £4800 per annum.

Conclusion

There was close agreement between clinical and final histological diagnosis of epidermoid cyst. Where a characteristic, odorous, toothpaste-like material is present on transection intra-operatively, the diagnosis is confirmed and the lesion can be discarded. We argue that significant cost savings can be achieved by adopting this approach.

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Epidermoid cysts are common but malignant transformation extremely rare.

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Good association between a clinical diagnosis and a final pathology diagnosis of epidermoid cyst.

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Intra-operative transection of resected specimen may improve confidence in diagnosis.

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Where classical features are present clinically and on excision, the specimens do not require histological examination.

Vulvar pilonidal sinuses: treatment of a rare cause of vulvar pain

It is hoped that if cases of vulvar pilonidal sinus (PS) are known to readers of this article, they will be called to the writer's attention and that further studies of the origin and cause of these anterior pathologic developments will result. A delay in diagnosis and treatment of this relatively harmless condition can lead to complications like abscess formation. Early diagnosis, complete excision and elimination of the anatomical factor that cause accumulation of hair fragments are followed by an excellent prognosis.

Laser marsipulization of epidermal cysts: avoiding linear scars

OBJECTIVE

We describe a simple technique in which the prominent surface of the cyst is vaporized by a carbon dioxide (CO(2)) laser, thus avoiding linear scarring and reducing postoperative complications.

BACKGROUND DATA

Epidermal cysts are commonly excised in outpatient clinics under local anaesthesia. The procedure usually entails an elliptical skin incision to include the puncture of the cyst. This may lead to infection, scarring or recurrence.

MATERIALS AND METHODS

The cyst is marsupilized using a scanning CO(2 )laser under local anaesthetic.

RESULTS

Surgical results assessed by pre- and postoperative photographic records confirmed smaller scars the absence of linear scars.

CONCLUSION

In cosmetically sensitive areas, laser marsipulization of epidermal cysts represents a viable alternative to conventional dissection.