Abstract
Theoretical surgery is defined as a nonoperative decision analysis and clinical and basic research supporting system for surgery. It developed to meet the needs of academic surgeons to coordinate communication with basic science disciplines.
This article summarizes the development of this idea at the University of Marburg where theoretical surgery has reached departmental and institutional proportions. Its objectives and methods are described. Central to its operation are permanent working teams of 2 clinical surgeons, 1 basic scientist (theoretical surgeon), 1–2 technicians, and 1–2 students focusing on one problem in a joint interdisciplinary manner. Decision analysis with classification methods and the creation of decision trees and algorithms are central to the operation of this experiment.
Lessons learned from this academic experiment and the accomplishments during the past 20 years are summarized on 3 levels of efficacy: performance, changing strategies, and outcome.
Résumé
La chirurgie théorétique se définit comme un système d'analyse décisionnelle non opératoire associé à un système de recherche clinique et de sciences chirurgicales fondamentales.
Elle est née de la nécessité de trouver un moyen de communication et de correspondance entre la chirurgie académique et les progrès des sciences fondamentales. Cet article résume le développement de cette idée à l'Université de Marburg où la chirurgie théorétique a acquis l'envergure d'une véritable science universitaire. Les objectifs et les méthodes employées sont présentées. Un travail d'ensemble est assuré par une équipe permanente composée de 2 chirurgiens cliniques, d'un professeur de sciences fondamentales (chirurgien théoréticien), d'un ou deux techniciens, et d'un ou deux étudiants travaillant sur un problème de manière interdisciplinaire. L'analyse décisionnelle avec classification des méthodes, et la création d'arbres décisionnels sont essentielles dans le déroulement de l'opération.
Les leçons de cette expérience académique et les résultats obtenus ces 20 dernières années sont résumées selon 3 critères d'efficacité: performance, changement de stratégie, et résultat.
Resumen
La cirugía teórica es definida como un sistema de soporte del análisis para la toma de decisiones no operativo y de la investigación clínica y básica en cirugía. Fue desarrollado para responder a las necesidades de los cirujanos académicos en cuanto a la capacidad de coordinar la comunicación con las disciplinas científicas básicas.
Este artículo resume el desarrollo de esta idea en la Universidad de Marburgo, donde la cirugía teórica como función institucional ha alcanzado proporciones de departamento y de instituto. Se describen sus objetivos y métodos. Como núcleo central para su operatión hay equipos permanentes de trabajo compuestos por 2 cirujanos clínicos, 1 científico básico (cirujano teórico), 1–2 técnicos, y 1–2 estudiantes; cada problema determinado es enfocado por el grupo en forma conjunta e interdisciplinaria. El análisis para la toma de decisiones con métodos de clasificación, y la creatión de esquemas o árboles de flujo de decisión y de algorritmos, son de importancia central para la operación de este experimento.
Las lecciones aprendidas en este experimento académico y sus realizaciones en el curso de los últimos 20 años son resumidos en 3 niveles de eficacia: credibilidad, estrategias variables, y resultado.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Zenker, R., Reichel, K., Lorenz, W., Haendle, H., Feifel, G.: Zur Wahl der operativen Eingriffe bei unkomplizierten Magen- und Zwölffingerdarmgeschwüren. Chirurg39:488, 1968
Doenicke, A., Lorenz, W.: Histaminfreisetzung und anaphylaktische Reaktionen bei Narkosen. Biochemische und klinische Aspekte. Anaesthesist19:413, 1970
Lorenz, W., Hamelmann, H., Troidl, H.: Marburg experiment on surgical research: A five-year experience on the cooperation between clinical and theoretical surgeons. Klin. Wochenschr.54:927, 1976
Lorenz, W., Röher, H.D.: Fifteen years of the Marburg experiment on surgical research. Part I: Change from experimental to theoretical surgery. Theor. Surg.1:21, 1986
Lorenz, W., Röher, H.D.: Entwicklung wissenschaftlicher Aussagen. In Chirurgie im Wandel der Zeit 1945–1983, H.W. Schreiber, G. Carstensen, editors, Berlin-Heidelberg-New York, Springer-Verlag, 1983, pp. 28–35
Suttmann, H., Doenicke, A., Lorenz, W., Ennis, M., Müller, O.A., Dorow, R., Ackenheil, M.: Is perioperative stress a real surgical phenomenon or merely a drug-induced effect? Theor. Surg.1:119, 1986
Kassirer, J.P., Moskowitz, A.J., Lau, J., Pauker, G.: Decision Analysis: A Progress Report. Ann. Intern. Med.106:275, 1987
Weinstein, M.C., Fineberg, H.V.: Clinical Decision Analysis, Philadelphia, W.B. Saunders, 1980, pp. 1–351
Lorenz, W., Thon, K., Ohmann, C., Röher, H.D.: Symptomloses und kompliziertes Ulcus pepticum als extreme Erscheinungsform der Ulkuskrankheit: Konsequenzen für die Wahl zwischen konservativer und chirurgischer Therapie. Langenbecks Arch. Chir.366: 69, 1985
Lorenz, W., Ohmann, C., Stöltzing, H., Thon, K.: Grundlagen chirurgischer Indikationen: Hilfen zur Entscheidungsfindung. Langenbecks Arch. Chir.369:57, 1986
Thon, K., Stöltzing, H., Ohmann, C., Lorenz, W., Röher, H.D.: Medical decision making and clinical problem solving in upper gastrointestinal bleeding. Theor. Surg.2:185, 1988
Ohmann, C., Thon, K., Stöltzing, H., List, E., Zaczyk, R., Ennis, M., Lorenz, W., Röher, H.D.: The personal computer as an aid to documentation of upper gastrointestinal endoscopy. Theor. Surg.1:69, 1986
Ohmann, C., Yang Qin, Künneke, M., Stöltzing, H., Thon, K., Lorenz, W.: Bayes theorem and conditional dependence of symptoms: Different models applied to data of upper gastrointestinal bleeding. Methods Inf. Med.27:73, 1988
Ohmann, C., Künneke, M., Zaczyk, R., Thon, K., Lorenz, W.: Selection of variables using “Independence Bayes” in computeraided diagnosis of upper gastrointestinal bleeding. Stat. Med.5:503, 1986
Lorenz, W., Dick, W., Junginger, T., Ohmann, C., Doenicke, A., Rothmund, M.: Biomedizinische und klinimetrische Ansätze in der Ursachenforschung beim perioperativen Risiko: Erstellung einer deutschen ASA-Klassifikation. Langenbecks Arch. Chir.372:199, 1987
Lorenz, W., Fischer, M., Rohde, H., Troidl, H., Reimann, H.-J., Ohmann, C.: Histamine and stress ulcer: New components in organizing a sequential trial on cimetidine prophylaxis in seriously ill patients and definition of a special group at risk (severe polytrauma). Klin. Wochenschr.58:653, 1980
Lorenz, W., Doenicke, A.: H1 + H2 = blockade: A prophylactic principle in anaesthesia and surgery against histamine-release responses of any degree of severity. N. Engl. Reg. Allergy Proc. Part I:6:37, 1985, Part II:6:174, 1985
Thon, K.P., Lorenz, W., Ohmann, C., Weber, D., Rohde, H., Röher, H.D.: Sample-taking problems in measuring actual histamine levels of human gastroduodenal mucosa: Specific and general relevance in clinical trials on peptic ulcer pathogenesis and selective proximal vagotomy. Gut26:1165, 1985
Neugebauer, E., Lorenz, W., Maroske, M., Barthlen, W., Ennis, E.: The role of mediators in septic/endotoxic shock. A metaanalysis evaluating the current status of histamine. Theor. Surg.2: 1, 1987
Lorenz, W.: Palliative nephrostomy in patients with incurable cancer: The first debate on medical ethics in theoretical surgery. Theor. Surg.1:117, 1986
Lorenz, W., Troidl, H.: The Marburg Experiment. In Principles and Practice of Research, H. Troidl, W.O. Spitzer, B. McPeek, D.S. Mulder, M.F. McKneally, editors, Berlin-Heidelberg-New York, Springer-Verlag, 1986, pp. 137–148
Loop, J.W., Lusted, L.B.: American college of radiology diagnostic efficacy studies. Am. J. Roentgenol.131:173, 1978
Rohde, H., Troidl, H., Lorenz, W.: Systematic follow-up: A concept for evaluation of operative results in duodenal ulcer patients. Klin. Wochenschr.55:925, 1977
Seidel, W., Troidl, H., Lorenz, W., Rohde, H., Richter, H., Drews, H., Hamelmann, H.: Eine prospektive, kontrollierte Studie zur selektiven Vagotomie beim chronischen Duodenalulkus: Frühergebnisse mit einer standardisierten Operationsauswahl und Operationstecknik. Klin. Wochenschr.51:477, 1973
Barth, H., Lorenz, W., Troidl, H.: Effect of amodiaquine on gastric histamine methyltransferase and on histamine stimulated gastric secretion. Br. J. Pharmacol.55:321, 1975
Doenicke, A., Lorenz, W., Beigl, R., Bezecny, H., Uhlig, G., Kalmar, L., Praetorius, B., Mann, G.: Histamine release after intravenous application of short-acting hypnotics: A comparison of etomidate, althesin (CT 1341) and propanidid. Br. J. Anaesth.45: 1097, 1973
Author information
Authors and Affiliations
Additional information
Dedicated to Alfred Doenicke on the occasion of his 60th birthday.
Part of this work was reported at the First Congress on Surgical Efficiency and Economy, August 31-September 4, 1987, Lund, Sweden.
Supported by grant of Deutsche Forschungsgemeinschaft (Lo 199/14-3).
Rights and permissions
About this article
Cite this article
Lorenz, W., Rothmund, M. Theoretical surgery: A new specialty in operative medicine. World J. Surg. 13, 292–299 (1989). https://doi.org/10.1007/BF01659037
Issue Date:
DOI: https://doi.org/10.1007/BF01659037