accepted for publication in Medical Computing Today August 1997
July 1998

The Internet can be likened to a vast desert, which from a distance appears to be unlimited in scope and static in appearance. Up close, however, the sand dunes are constantly shifting and changing under the influence of winds and weather. Life teems both on and underneath its surface. So it is with the Internet: much of the Web seems to be an endless collection of commercial sites, with a constant din of hucksterism and self-promotion. Underneath this commercial veneer there are many useful, informative, and educational Web sites. One of the challenges that faces the medically and surgically-oriented surfer is staying in touch with useful and/or favorite sites, which often change not only their content but their address or URL.
 
The development of endoscopic and laparoscopic approaches to previously fairly static surgical procedures has been an absolute revolution for General Surgery, and it has led to a rethinking of almost every disease process and operative procedure in the specialty. It is against this background that this annotated sampling of General Surgery sites for the medical professional on the World Wide Web was originally written.
 

Laparoscopy & Endoscopy Sites

• Laparoscopy.com
  This is a commercial site sponsored by a number of laparoscopic vendors. It has some interesting features, the most significant being one of the most interesting and complete reviews of the history of laparoscopy that I have seen, either on the Web or in books or journals. This year, the site has a much richer selection of clinical data with both annotated picture archives of laparoscopic procedures and full-color sound movies (the latter in RM format, viewable with the Real Player plug-in). Patients can seek out the names of surgeons who perform various laparoscopic procedures, from listings that are self-placed without any external review of competence, ability, or experience. That criticism aside, this is a useful, educational, and improved site.
   
  
• Online Laparoscopic Technical Manual
  This commercially sponsored site is a fairly comprehensive and useful site for both the beginning and experienced laparoscopist. It contains an Online Laparoscopic Technical Manual covering most of the major laparoscopic procedures -- an excerpt from the book "Interventional Laparoscopy: The State of the Art for the New Millennium" by Philippe J. Quilici, MD, FACS (1997, Transmed Network). The site content is essentially unchanged except for the addition of a News section with listings for some meetings and reports from the literature. Unfortunately there are few hyperlinks from these various items to the original sources, losing one of the greatest benefits of Web-based communication. Overall, a good site but losing its content luster as the material grows stale with time.
   
  
• Society of American Gastrointestinal Endoscopic Surgeons (SAGES)
  The SAGES site is the premier Endoscopy/Laparoscopy site on the Web, from the academic organization that creates guidelines and standards for this burgeoning field. This year it has revamped its look and feel with a Java-script site map arranged like a file directory. It has also greatly improved both its content and ease of use. The site now contains an extensive guidelines section (in HTML format), patient information, a newsletter section (in PDF format), applications for SAGES membership, and extensive listings of fellowship programs and endorsed programs in laparoscopic procedures. There are also a number of calendars for other surgical societies and organizations, plus links to other related Web sites. For the surgeon with a significant professional interest in laparoscopic surgery, this is still the best site for knowledge and information.
   
  
• Society of Laparoendoscopic Surgeons
  This site -- from the Society of Laparoendoscopic Surgeons -- is much more humdrum than the SAGES site, both in content and visual appeal. Its one interesting and unique feature is MentorMatch, which promises to match an inexperienced surgeon with a more experienced endoscopic/laparoscopic surgeon for assistance and possibly training. SAGES would do well to adopt such a useful and valuable feature.
  

General Surgery Organizations

• American College of Surgeons
  A year ago this was a flashy yet attractive Web site aimed at the general surgeon or surgical subspecialist; this year the site has been revamped somewhat, with improvements in both navigation and overall content. It provides information about the ACS, its clinical and legislative activities, the ACS Clinical Congresses, ACS policies, and ACS publications. The socioeconomic and guidelines sections are especially strong and make for interesting and worthwhile reading. Here one can also sample and order the Surgical Education and Self-assessment Program (SESAP) -- useful for a general surgeon about to take the American Board of Surgery exam. The Web links, although few in number, connect to surgically important sites.
  

Trauma Care

• American Association for the Surgery of Trauma
  Last year this was one of the least impressive Web sites I visited. This year the site's content has improved, especially with the inclusion of injury scoring tables that anyone involved in trauma care will find useful. Unfortunately this site still loads very slowly even at 28.8 Kilobaud. There are also a number of pages remaining under construction, or that have broken links. The Web links page is still worthwhile.
   
  
• Trauma.org
  This site is a worthwhile destination for those interested or involved in the management of the injured patient. Features include a unique online trauma moulage that provides two realistic clinical trauma scenarios with feedback on the outcome of various clinical decisions, plus a trauma bank with both archived trauma topics from Web-based discussions and trauma scoring pages. There is also a database of radiologic images in the form of a teaching file. A large list of trauma and other surgical links round out this information-filled site.
  

Cancer Care

• CANSEARCH: Guide to Cancer Resources on the Internet
  The URL for this site has changed to the National Coalition for Cancer Survivorship. This is basically a site with hyperlinks to other cancer sites, organized by cancer types and other cancer-related issues. The site is minimally changed since my last visit. While geared mostly to patients and their families, there are plenty of links here that a surgeon caring for patients with cancer will find useful. I recommend it highly to both surgeons and their patients.
   
  
• National Cancer Institute (NCI) PDQ Treatment Statements for Physicians
  The URL to this important site has changed, but it is an excellent site for the surgeon with up-to-date information about most major types of cancer, their clinical staging, and both surgical and nonsurgical treatment options. Literature citations are also included, and there are extensive statements for cancer patients and their families regarding screening and prevention, treatment, and supportive care. This Web site should be in the bookmark list of every physician who cares for cancer patients, and patients and their families who are living with cancer.
  

Miscellaneous Surgery Sites

• BLADES (Buckeye Link Academic Discussion for the Education of Surgeons)
  Last year I found this interesting site, published on the Web by the Ohio State Department of Surgery. Surgical Grand Rounds cases were presented with pertinent clinical information, imaging, pathology, and faculty discussion. The site illustrates some of the newer uses for this new medium of communication. Unfortunately there have been few improvements in either presentation, or most importantly in the case content. Currently there are only six cases on the site. The potential to create a great site remains largely unfilled.
   
  
• International Museum of Surgical Science
  I stumbled upon this Web site accidentally last year. It is sponsored by the College International de Chirurgiens (International College of Surgeons). The content is essentially unchanged except for a very brief bibliography of surgical history. The main attraction is the Interactive Antique Illness series of pages where a patient living in the rural America of the 1860's has a surgical problem that the visitor assists in solving. Can the patient be saved by turpentine? Now there is a counter that dutifully reports that 115350 visitors have survived the illness and 163644 people have died. It remains lots of fun.
   
  
• International Society for Computer Aided Surgery
  This site is devoted to the new field of Computer Aided Surgery. It is rather spare, with a goals and mission statement, plus minutes of the past two international board meetings. The site also contains a link to the journal Computer Aided Surgery (formerly the Journal of Image Guided Surgery) which is available on line. Not much here at the moment, but this may be where surgery is heading.
   
  
• Medline (MEDlars onLINE)
  The ultimate surgical information database. Medline is now available to everyone over the World Wide Web for free. Search using PubMed or Internet Grateful Med. How much information can a surgeon use (we have to operate sometime!)? Highly recommended.
  

of other articles
 
Other Surgery on MCToday:

• Surgical Boards Review Software
• Musings on Surgery