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1.
Background
Average costs associated with common procedures can vary by surgeon without a corresponding variation in outcome or case complexity.Methods
De-identified cost and equipment utilization data were collected from our hospital for elective laparoscopic cholecystectomy performed by 17 different surgeons over a 6-month period. A group of surgeons used this data to design a standardized equipment pick list that became optional (not mandated) for laparoscopic cholecystectomy. Cost and consumable surgical supply utilization data were collected for six months prior to and following the creation of the standardized pick-list.Results
280 elective laparoscopic cholecystectomies were performed during the study interval. In the 6 months after standardized pick list creation, the cost of disposable supplies utilized per case decreased by 32%.Conclusions
Surgical cost savings can be achieved with standardized procedure pick lists and attention to the cost of consumable surgical supplies. 相似文献2.
Nathan Tanoue Lev N. Korovin Melissa Carton Carlos A. Galvani Iman Ghaderi 《American journal of surgery》2018,215(2):288-292
Background
Surgical training requires development of both technical and cognitive skills. The study analyzed feedback by faculty and residents' self-assessments during a laparoscopic training course to identify structure of feedback in this context and compared the focus of trainees to faculty.Methods
This study collected assessments by surgical residents and faculty during an intensive laparoscopic training course at a single institution. The residents' operative performance was assessed using validated assessment tools including free text feedback. Assessments were completed immediately following procedures. Feedback was analyzed using qualitative method.Results
Eighty (80) residents participated. Three themes were identified: Assessment, instruction and occasion. Faculty provided significantly more feedback than trainees. Moreover, the content of feedback was different. Residents focused on technical performance, while faculty commented on technical and cognitive skills, efficiency and level of independence. Errors were mainly addressed by faculty.Conclusion
This study demonstrated differences in cognitive focus of trainees and faculty. Text feedback is informative in understanding perceived challenges. Faculty provided explicit assessment and instruction for improvement. The effectiveness of self-assessment and feedback should be further studied. 相似文献3.
Introduction
The positive effect of feedback has long been recognized in surgical education. Surgical educators convey feedback to improve the performance of the surgical trainees. We aimed to review the scientific classification and application of feedback in surgical education, and to propose possible future directions for research.Methods
A literature search was performed using Pubmed, OVID, CINAHL, Web of science, EMBASE, ERIC database and Google Scholar. The following search terms were used: ‘feedback’, ‘feedback in medical education’, ‘feedback in medical training’ and ‘feedback in surgery’. The search was limited to articles in English.Results
From 1157 citations, 12 books and 43 articles met the inclusion criteria and were selected for this review.Conclusion
Feedback comes in a variety of types and is an essential tool for learning and developing performance in surgical education. Different methods of feedback application are evolving and future work needs to concentrate on the value of each method as well as the role of new technologies in surgical education. 相似文献4.
Heather E. Hoops Caleb Haley Laszlo N. Kiraly Elena An Karen J. Brasel Donn Spight 《American journal of surgery》2018,215(5):880-885
Background
Although expert proficiency times for Fundamentals of Laparoscopic Surgery (FLS) tasks exist, these times are not always attainable for junior residents. We hypothesize that post-graduate year (PGY)-specific benchmarks will improve resident performance of FLS tasks.Methods
In 2014, PGY-specific benchmarks were developed for FLS tasks for PGY1-PGY4 general surgery residents by averaging completion times for each task from 2007 to 2013. Resident performance on each FLS task and overall performance was compared for PGY1-PGY4 residents in the 2007–2013 group and the 2014–2016 group, before and after implementation of PGY-specific benchmarks.Results
There was a significant improvement in FLS performance in the 2014–2016 group at the PGY1 (p?=?0.01), PGY2 (p?<?0.01), and PGY3 (p?=?0.01) levels, but no difference at the PGY4 level (p?=?0.71).Conclusions
PGY-specific benchmarks may improve efficacy of laparoscopic skills training for junior residents, increasing the efficiency of skill development. 相似文献5.
Background
The global rise in infectious disease has led the Center for Disease Control and Prevention and the World Health Organization to release new guidelines for the prevention of surgical site infection.Methods
In this article, we summarize current recommendations based on level of evidence, review unresolved and unaddressed issues, and supplement them with new literature.Results
Although the guidelines discuss major issues in reducing surgical site infection, many questions remain unanswered.Conclusion
These guidelines will hopefully help in setting a standard of care based on best evidence available and focus investigators on areas where evidence is lacking. 相似文献6.
Monti Khatod 《The Journal of arthroplasty》2018,33(6):1649-1651
Background
Total joint arthroplasty is a successful operation with increasing prevalence in the United States. Kaiser Permanente has been using multiple tools to optimize patient outcomes while keeping health-care expenditures in check.Methods
We describe the patient, surgeon, and hospital perspective toward the delivery of sustainable arthroplasty care for a growing elderly population. Quality metrics for each stakeholder are presented.Results
Kaiser Permanente optimizes value for the patient, surgeon, and hospital with the use of evidence-based integrated care pathways and a national joint arthroplasty registry.Conclusion
A continued focus on value-driven care will provide continued efficiency in a time of growth with maintenance of excellent outcomes. 相似文献7.
Tarik D. Madni David E. Leshikar Christian T. Minshall Paul A. Nakonezny Canon C. Cornelius Jonathan B. Imran Audra T. Clark Brian H. Williams Alexander L. Eastman Joseph P. Minei Herb A. Phelan Michael W. Cripps 《American journal of surgery》2018,215(4):625-630
Background
Gallbladders (GBs) with severe inflammation have longer operative times and an increased risk for complications. We propose a grading system using intraoperative images to better stratify GB inflammation.Methods
After reviewing the intraoperative images of GBs obtained during several hundred laparoscopic cholecystectomies, we developed a five-tiered grading system based on anatomy and inflammatory changes. Fifty intraoperative photographs were taken prior to dissection and then distributed to 11 surgeons who rated each GB's severity per the grading system. The two-way random effects Intraclass Correlation Coefficient (ICC) was used to assess the reliability among the raters.Results
The ICC among the raters of GB severity was 0.804 (95% CI: 0.733 to 0.867; p = 0.0001). Nineteen GB images had greater than 82% agreement and 16 were clustered around GBs with severe inflammation (grades 3–5).Conclusion
This study proposes a simple, reliable grading system that characterizes GB complexity based on inflammation and anatomy. 相似文献8.
Objective
The objective of this study was to introduce a new framework, called IDEAL (idea, development, exploration, assessment, and long-term study), to guide physicians, investigators, and regulatory agencies through the life cycle of device development and procedural refinement.Methods
This review describes the IDEAL framework and illustrates its application for treatment of uncomplicated type B dissection (uTBD) as an example of this process.Results
Components of IDEAL are summarized and applied to devices used to treat uTBD. Treatment of uTBD is currently in the exploration phase, with concurrent assessment and long-term study being facilitated by detailed registries.Conclusions
The application of IDEAL to the development and monitoring of technologies standardizes the nomenclature, facilitates evidence-based practice, and enhances the innovation process. 相似文献9.
The correlation between fundamental characteristics and first-time performance in laparoscopic tasks
Cuan M. Harrington Richard Bresler Donncha Ryan Patrick Dicker Oscar Traynor Dara O. Kavanagh 《American journal of surgery》2018,215(4):618-624
Background
The ability of characteristics to predict first time performance in laparoscopic tasks is not well described. Videogame experience predicts positive performance in laparoscopic experiences but its mechanism and confounding-association with aptitude remains to be elucidated. This study sought to evaluate for innate predictors of laparoscopic performance in surgically naive individuals with minimal videogame exposure.Methods
Participants with no prior laparoscopic exposure and minimal videogaming experience were recruited consecutively from preclinical years at a medical university. Participants completed four visuospatial, one psychomotor aptitude test and an electronic survey, followed by four laparoscopic tasks on a validated Virtual Reality simulator (LAP Mentor?).Results
Twenty eligible individuals participated with a mean age of 20.8 (±3.8) years. Significant intra-aptitude performance correlations were present amongst 75% of the visuospatial tests. These visuospatial aptitudes correlated significantly with multiple laparoscopic task metrics: number of movements of a dominant instrument (rs ≥ ?0.46), accuracy rate of clip placement (rs ≥ 0.50) and time taken (rs ≥ ?0.47) (p < 0.05). Musical Instrument experience predicted higher average speed of instruments (rs ≥ 0.47) (p < 0.05). Participant's revised competitive index level predicted lower proficiency in laparoscopic metrics including: pathlength, economy and number of movements of dominant instrument (rs ≥ 0.46) (p < 0.05).Conclusion
Multiple visuospatial aptitudes and innate competitive level influenced baseline laparoscopic performances across several tasks in surgically naïve individuals. 相似文献10.
11.
Patrick E. Georgoff Gabrielle Shaughness Lisa Leininger Vahagn C. Nikolian Gurjit Sandhu Rishindra Reddy David T. Hughes 《American journal of surgery》2018,215(2):293-297
Background
Medical students often report dissatisfaction with the feedback they receive on their clerkships. This study evaluates the performance of the Minute Feedback System (MFS), a web-based tool designed to facilitate medical student acquisition of same day written feedback from surgery residents and faculty.Methods
System-generated data, targeted surveys, and end of clerkship questionnaires were used to evaluate MFS performance over a one-year period.Results
170 students made 3190 feedback requests and received 1978 responses (62% response rate). Students felt the system was easy to use (90%), provided useful feedback (74%), and allowed them to obtain more feedback than they would have in its absence (81%). Concerns were raised regarding the quality of electronic feedback and whether the data generated would be used for summative assessment.Conclusions
The MFS encourages same-day assessment and increases documented medical student feedback. Further development is required to improve feedback quality, response rates, and feedback application. 相似文献12.
Study Design
Case series.Introduction
Hand injuries are the most common injury observed in hurling although compliance in wearing protective gloves is reportedly low.Purpose of the Study
To devise a glove that offers comfort, protection and freedom of movement, using the bespoke capabilities of 3-dimensional (3D) printing.Methods
Each player's “catching” hand was imaged using a 3D scanner to produce a bespoke glove that they later trialed and provided feedback.Results
Nine players provided feedback. On average, the players favorably rated the glove for the protection offered. The average response on comfort was poor, and no players reported that glove aided performance during play.Discussion
This feasibility study explores the versatility of 3D printing as a potential avenue to improve player compliance in wearing protective sportswear. Feedback will help refine glove design for future prototypes.Conclusions
Hurling is the primary focus in this study, but knowledge gains should be transferable to other sports that have a high incidence of hand injury.Level of Evidence
4. 相似文献13.
O.K. Serrano R.D. Cunha T. Mettler D.E.R. Sutherland R. Kandaswamy 《Transplantation proceedings》2017,49(1):221-224
Introduction
Variceal hemorrhage from sinistral portal hypertension has never been reported as a complication of live pancreas donation.Case Report
We present a 68-year-old patient who underwent a simultaneous live-donor laparoscopic segmental pancreatectomy and nephrectomy for the purposes of donating to her daughter. Her postoperative course was significant for an episode of acute pancreatitis with a pseudocyst formation. More than a decade later, she presented with variceal hemorrhage from sinistral portal hypertension, which after a diagnostic work-up, prompted a laparoscopic splenectomy.Discussion
Sinistral portal hypertension is a long-term complication of live-donor pancreas donation. 相似文献14.
C. Margreiter M. Gummerer V. Gallotta S. Scheidl D. Öfner K. Kienzl-Wagner H.T. Maier R. Oberhuber R. Margreiter S. Schneeberger 《Transplantation proceedings》2018,50(10):3199-3203
Background
The primary objective in living donor kidney transplantation is donor safety. In laparoscopic living donor nephrectomy, most centers prefer the left kidney for donation given the shorter renal vein, higher rate of thromboses, and more difficult surgical procedure for right kidney retrieval. The goal of this study was to demonstrate the feasibility of a hybrid technique using a Satinsky clamp in right-sided living donor nephrectomy to obtain maximal renal vein and to compare the outcome with standard left-sided laparoscopic donor nephrectomies.Material and Methods
Between 2005 and 2013, 77 patients underwent a left (group L) and 54 a right (group R) living donor nephrectomy. In group R, after laparoscopic dissection and mobilization of the right kidney, two 12-mm trocar incisions in the right upper quadrant were connected in a 5–7 cm subcostal incision. The caval vein was partially clamped under direct vision prior to dissection of the renal vein. The venotomy was then closed with a running 4-0 Prolene suture. The two groups were compared with regard to surgical complications, graft function, and graft survival.Results
Using this technique, no significant difference with regard to complications or graft function was observed. Serum creatinine at discharge in donor group L was 1.23 (±0.43) mg/dL and in donor group R 1.21 (±0.37) mg/dL (P = .71). Graft survival at one year was 100% in both groups.Conclusion
Open management of the renal vein is a safe alternative in laparoscopic right-sided donor nephrectomy and ensures maximal length of the vein. 相似文献15.
A.K. Gardner E.M. Ritter B.J. Dunkin D.S. Smink J.N. Lau J.T. Paige R. Phitayakorn R.D. Acton D. Stefanidis D.W. Gee 《American journal of surgery》2018,215(2):259-265
Background
The role of simulation-based education continues to expand exponentially. To excel in this environment as a surgical simulation leader requires unique knowledge, skills, and abilities that are different from those used in traditional clinically-based education.Methods
Leaders in surgical simulation were invited to participate as discussants in a pre-conference course offered by the Association for Surgical Education. Highlights from their discussions were recorded.Results
Recommendations were provided on topics such as building a simulation team, preparing for accreditation requirements, what to ask for during early stages of development, identifying tools and resources needed to meet educational goals, expanding surgical simulation programming, and building educational curricula.Conclusion
These recommendations provide new leaders in simulation with a unique combination of up-to-date best practices in simulation-based education, as well as valuable advice gained from lessons learned from the personal experiences of national leaders in the field of surgical simulation and education. 相似文献16.
Background
Renal artery aneurysms are increasingly being detected incidentally during diagnostic imaging using magnetic resonance imaging, computed tomography, or angiography performed for evaluation of other diseases. Our understanding of their natural history and surgical management has evolved significantly during the past two decades.Patients and Methods
Three patients with incidentally identified renal artery aneurysms have been referred to our renal transplantation program in the last 3 years. All three had aneurysms located at renal artery branches making endovascular repair challenging and thus underwent hand-assisted laparoscopic nephrectomy with ex vivo aneurysmectomy, with heterotopic autotransplantation in two cases and allotransplantation in the third case.Results
All three cases resulted in successful renal artery aneurysm repair and reimplantation and good renal function of the implanted kidney.Conclusions
Laparoscopic nephrectomy with ex vivo aneurysm repair and reimplantation can be a successful approach to surgical management, especially in cases where the aneurysm involves multiple artery branches and endovascular repair is challenging. Given the excellent results with this surgical approach, living and deceased donor kidneys with aneurysms should be strongly encouraged if deemed reparable. 相似文献17.
Background
Historical studies suggest no difference in disease outcome between neoadjuvant and adjuvant approaches in breast cancer. We hypothesize neoadjuvant chemotherapy (NCT) may offer several benefits, possibly improving quality of life outcomes.Methods
Retrospective review of Tumor Registry data of breast cancer patients from 2011 to 2015. Pathologists reviewed cases from 2012 to 2013 to provide additional RCB (residual cancer burden) scores.Results
From 2011 to 2015 there were 2707 breast cancer cases and 455 patients received NCT. RCB score was documented in 348 with excellent outcome in 41% (pCR in 115 patients, 28 RCB I). There were 137 RCB II and 68 RCB III. Clinically positive nodes were present in 202 of 455 and 77 (38%) had clearance of nodal disease. Of these 45 had axillary dissections.Discussion
Neoadjuvant therapy was associated with excellent response rates. Thirty eight percent of patients with positive nodes converted to node negative although over 50% underwent axillary dissection. Higher utilization of NCT could decrease need for axillary dissection thereby lowering incidence of lymphedema and improving quality of life for survivors. 相似文献18.
Avinash Bhakta Owen Glotzer Ashar Ata Marcel Tafen Steven C. Stain Paul T. Singh 《American journal of surgery》2018,215(4):643-646
Background
Postoperative pain management is a major contributor to recovery and discharge in bariatric surgery. Local anesthetic agents are of particular interest: they're non-sedating and may reduce postoperative pain and hospital length of stay (LOS).Design
Researchers queried the Bariatric Surgery Service Database for patients undergoing laparoscopic weight loss surgery from January 2012–December 2014. Patients were divided between those who did and did not receive liposomal bupivacaine intra-operatively. Measures included demographics, narcotic use, LOS, antiemetic use, and pain scales.Results
The liposomal group consisted of 233 patients and the PCA group consisted of 243 patients. The liposomal group had significantly less narcotic use than the PCA group in terms of IV morphine equivalents. This did not translate into a reduction in LOS in the liposomal group.Conclusions
TAP block using liposomal bupivacaine provides effective analgesia comparable to PCA. 相似文献19.
John L. Falcone 《American journal of surgery》2018,215(2):341-346