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Significant insights into how we teach and learn have been made over the past 50 years. Cognitive load theory and the acquisition of expert performance through the role of deliberate practice are just 2 of those insights important to surgical education.

Laparoscopic removal of the spleen following embolization for blunt trauma is safe and should be considered in patients that have persistent bleeding or are at risk for delayed bleeding, as well as patients in whom complications of infarction and abscess formation develop.

Evaluating the quality of a scientific article has proven to be an elusive task. The most widely used bibliometric value currently used for this purpose, the journal impact factor, was not originally designed to determine the quality of research in a scientific article. Nevertheless, it has morphed into a surrogate to delineate the quality of a journal and even to represent the quality of individual articles in that that journal. Early 21 st century advances in computer technology have seen an explosive revolution in scientific publication that have included open access, online publication, and world-wide accessibility to these publications. These developments have made it obvious that more sophisticated tools are required to delimit the quality of material present in the scientific literature. Usage data, which is measured as the number of full-text downloads of a specific article, is just one new method to evaluate the source of the vast material available that can be leveraged to more fully evaluate the merit of scientific literature.

The basis of laparoscopic transabdominal preperitoneal repair (LTPR) of herniae rests upon the utilization of a prosthetic screen to cover hernia defects. Preperitoneal prosthetic screen interposition reproduces the effect of the inguinal shutter mechanism. In this 3-year longitudinal study, one surgeon performed 224 laparoscopic hernia repairs (LTPR) on 164 patients. These patients have been examined postoperatively by that surgeon and a trained research assistant according to an established protocol. Patient mean age was 50.6 years; 45 cases involved bilateral inguinal herniae (21.5%); 20 laparoscopic repairs were for failed open repair (9.6%); and 46 herniae were incarcerated (22%) at the time of laparoscopic repairs. There were no intraoperative complications. Two procedures required conversion to open repair, the first because of uncertainty regarding incarcerated bowel viability and the second for massive abdominal-wall adhesions. Two laparoscopic repairs recurred and required subsequent repair.