I would like to look back on my career as a clinical surgeon and discuss the progress of surgical technology and some of the current problems facing surgery.
  Surgical advancements have been supported by developments in other fields such as anesthesiology, radiology (diagnostic imaging), pharmacology and mechanical engineering. The spread of evidence-based medicine, pre and post-operative patient care improvement, and the reduction of surgical site infection and hospital-acquired infection have also contributed. These advancements added to the progress of surgical procedures and the improvement of surgical outcomes.
  The transition to minimal invasive surgery such as endoscopic and sentinel node navigation surgery is inevitable along with the progress of science and technology. I would also like to refer to remote-controlled and robotic operations.

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  Recently, workplace stress has increasingly become a major health problem in hospitals, because of a whirlwind of technologial innovation, longer working hours stemming from a manpower shortage, lawsuit jitters over compensation for medical accidents, etc. Thus, the number of medical workers with stress-related diseases has increased greatly.
  Four panelists reported the mental health care activities tried in their hospitals. The activities included counseling and/or support for psychosomatically disordered workers, to return to work.
  Medical institutions in Japan are far behind from other industries in mental health care of hospital employees. Such being the situation, the government as well as hospital owners are called upon to introduce stress-management measures to help medical workers including burned-out employed doctors and nurses to cope with workplace stress.

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  PEG is an operation for enteral feeding. Its indications and contraindications have to be sufficiently considered with possible medical complications as well as ethical aspects taken into account. Patients who use PEG are rarely treated, managed and observed in only one department. Underlying diseases are treated in the department for psychosomatic diseases or neurosurgery. The creation and management of the stoma are done in the department of gastrointestinal disease or gastrointestinal surgery. Since the diseases are mostly chronic, patients are often referred to convalescent wards and care and welfare institutions, or discharged for care services. At the time of preparation of a PEG and during the period of its management on the ward, sufficient explanations need to be given to the patients' family members. Team management using a critical path, where staff members share the information, is very important.
  Once the stoma is built, it is often managed regionally. Therefore, it is important that through academic societies or via case review meetings, or else employment of regional cooperative PEG passes, a system of close cooperation between hospitals, clinics, welfare institutions, families, and administration has to be built, so that the entire region can take care of the patients and provide support for life.

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  Recently, palliative care has been provided by a team of health professionals organized within a core hospital in an area. But, the operation is limited because of shortages of doctors and nurses. Under the circumstances, the leaders of the palliative care team have to take it upon themselves to give education, conduct a survey, and enlighten community members on the idea of palliative care. Teamwork is most important for palliative care. In future, cooperation between the palliative care team and small-scale medical institutions including private practitioners will be more important.

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  A 55-year-old male complained about urinary frequency, micturition pain, and right abdominal pain. Ultrasonography, computed tomography, and magnetic resonance imaging revealed severe vesicorectal fistula which was induced by either bladder carcinoma or rectal carcinoma. Total pelvic exenteration was performed. Histopathological examination revealed rectal adenocarcinoma with invasion of the urinary bladder. Twelve months after the surgery, the patient exhibited no sign nor symptom of local recurrence or metastatic disease.

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  A look at the reports of accidents or near accidents in our hospital revealed that the incidence of falls or stumbles in children was at the top of the list in frequency. In the past five years, our pediatric ward has experienced an average of about 10 such cases annually. Regarding the risk of falling, advice is given by nurses to parents during the orientation session when their babies and little children are hospitalized. However,the advice was entirely subjective - not going by any rule or guidelines. Recently, an assessment score sheet for the risk factors for falling and a preventive measure against falls was drafted and trial used, with the result that changes were observed in the way the nurses in their 20s watch and take care of the little patients. Moreover, they became able to look after the infants according to their age, developmental stage and disposition. The use of the common pamphlet helped the young nurses gain selfconfidence even though they are inexperienced in child-rearing and nursing.
  From these results, we concluded that the uniform guideline and order of priority led to the improvement of the quality of nursing in the nurses in their 20s.

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