ObjectiveThis study provides the first objective assessment of a complete patient population undergoing laparoscopic cholecystectomy in the steady state. The authors determined the frequency of complications, particularly bile duct, bowel, vascular injuries, and deaths. Summary Background Data

The specialty of plastic surgery has witnessed an explosion of novel procedures with the advent of endoscopy. Surgeons are making more aggressive attempts to reduce the length of scars and subsequent morbidity associated with traditional "open" procedures. Our purpose is to present a new technique of endoscopic abdominoplasty that has largely replaced traditional "full open" techniques at our institution. Since 1985, 85 patients have undergone a procedure that we call the endoscopic intracorporal abdominoplasty. This technique combines traditional abdominal wall liposuction with endoscopic intracorporal plication of the rectus fascia by using a series of horizontal mattress sutures. The procedure is performed using three 1-cm incisions and a series of midline and lateral skin nicks. These 85 patients were compared with 25 patients who underwent traditional open abdominoplasty with anterior plication of the rectus fascia. Average length of surgery was 127 minutes compared to 149 minutes with the open techniques. Length of hospitalization at our institution was 1 postoperative day compared to an average of 3 days with open techniques. No drains were used with the endoscopic techniques, and all of the open procedures had two drains placed. The perioperative rate of morbidity for the intracorporal abdominoplasty was 15 percent (13 of 85 patients) and with the open abdominoplasty cases it was 24 percent (6 of 25 patients). Our conclusion is that the endoscopic intracorporal abdominoplasty reduces operative scars and effectively plicates the rectus fascia, thereby reducing abdominal wall laxity. It has a rate of morbidity in a skilled laparoscopist's hands no greater than with traditional open abdominoplasty.

The events of September 11, 2001 identified a need for health care institutions to develop flexible, creative, and adaptive response mechanisms in the event of a local, regional, or national disaster. The 3 major health care institutions in Bethesda, MD-the National Naval Medical Center (NNMC), the Suburban Hospital Healthcare System (SHHS), and the National Institutes of Health Clinical Center (NIHCC)-have created a preparedness partnership that outstrips what any of the institutions could provide independently by pooling complementary resources. The creation of the partnership initially was driven by geographic proximity and by remarkably complementary resources. This article describes the creation of the partnership, the drivers and obstacles to creation, and the functioning and initial accomplishments of the partnership. The article argues that similar proximity and resource relationships exist among institutions at academic centers throughout the United States and suggests that this partnership may serve as a template for other similarly situated institutions.