Publication patterns and the impact of self-citation among minimally invasive surgery fellowships

Introduction

The h-index is a widely utilized academic metric that measures both productivity and citation impact. The purpose of this study is to define the impact of self-citation among minimally invasive surgery (MIS) fellowship program directors.

Anaesthesia and minimally invasive surgery

Minimally invasive surgery is commonly performed because of various advantages such as reduced postoperative pain, faster recovery, and reduced postoperative pulmonary complications. However, anaesthesia for laparoscopy can be difficult and potentially hazardous in long, complex surgical procedures and in sick patients. Establishment of CO₂ pneumoperitoneum produces adverse pathophysiological changes due to increased intra-abdominal pressure and hypercapnia, and these are further altered by postural changes. Laparoscopy is also associated with potential complications such as extraperitoneal gas insufflation and pneumothorax. It is important for the anaesthetist to understand the advantages and potential risks. General anaesthesia with endotracheal intubation is the most common anaesthetic technique, but supraglottic airway devices can sometimes be used. Neuroaxial anaesthesia has been used in some laparoscopic procedures as the sole anaesthetic technique. This article will focus on the pathophysiological changes caused by CO₂ pneumoperitoneum, the anaesthetic management for patients undergoing laparoscopy, and potential complications.     

Anaesthesia and minimally invasive surgery

Minimally invasive surgery is commonly performed because of various advantages such as reduced postoperative pain, faster recovery, and reduced postoperative pulmonary complications. However, anaesthesia for laparoscopy can be difficult and potentially hazardous in long, complex surgical procedures and in those with significant co-morbidity. Establishment of carbon dioxide (CO₂) pneumoperitoneum produces adverse pathophysiological changes due to increased intraabdominal pressure and hypercapnia, and these are further altered by postural changes. Laparoscopy is also associated with potential complications such as extraperitoneal gas insufflation and pneumothorax. It is important for the anaesthetist to understand the advantages and potential risks. General anaesthesia is most commonly used but neuraxial anaesthesia is possible, although spontaneous ventilation may be difficult. Endotracheal intubation has been a popular technique but supraglottic airway devices are less traumatic, easier to insert and more modern versions provide a good airway seal as well as gastric drainage, should it be required. This article will focus on the pathophysiological changes caused by CO₂ pneumoperitoneum, the anaesthetic management for patients undergoing laparoscopy, and potential complications.     

Anaesthesia and minimally invasive surgery

As with so many different forms of anaesthesia, anaesthesia for minimally invasive surgery is dependent on the type of surgery being performed and the impact of the surgical procedure itself on the human body. With an increase in the number of surgical specialties embracing laparoscopic procedures, anaesthetists must consider the risks and benefits to the patient. On the whole, laparoscopic procedures are well tolerated. The advantages of laparoscopic surgery compared with open procedures are associated with reduced morbidity and mortality. The reductions in acute pain and postoperative respiratory tract infections and ileus allow earlier mobilization and lead to earlier discharge. Laparoscopy also improves the cosmetic appearance. It improves the view of the operative field and enables alternative anatomical views to be seen. Anaesthesia per se is fairly standard in minimally invasive surgery, but it is the comprehension of the effects of the position of the patient and that of the pneumoperitoneum that can make the difference between a successful or less elegant outcome.     

Transanal minimally invasive surgery: a giant leap forward

Background  

Our novel approach is a hybrid between transanal endoscopic microsurgery (TEM) and single-port laparoscopy that we have termed TransAnal Minimally Invasive Surgery (TAMIS). We report the clinical application of this technique and present preliminary data that show TAMIS to be an effective tool for resection of both malignant and benign lesions of the rectum.     

Bringing order to the chaos: developing a matching process for minimally invasive and gastrointestinal postgraduate fellowships

BACKGROUND: Since 1993, there has been an increase in the number of postgraduate fellowships in minimally invasive and gastrointestinal (GI) surgery; from 9 in 1993 to more than 80 in 2004. Early on, there was no supervision or accreditation of these fellowships, and they varied widely in content, structure, and quality. This was widely recognized as being a bad situation for fellow applicants and reflected poorly on the specialties of minimally invasive (MI) and GI surgery. In an effort to bring order to this chaotic situation, the Minimally Invasive Surgery Fellowship Council (MISFC) was founded in 1997. METHOD: In 2003, the MISFC was incorporated with 77 founding member programs. The goal of the MISFC was to develop guidelines for high-quality fellowship training, to provide a forum for the directors of MI and GI fellowships to exchange ideas, formulate training curricula; to establish uniform application and selection dates; and to create an equitable computerized match system for applicants. RESULTS: In 2004, the MISFC has increased to 95 members representing 154 postgraduate fellowship positions. The majority of these positions are primarily laparoscopic in focus, but other aspects of GI surgery including bariatric, general GI, flexible endoscopy, and hepatopancreatobiliary are also represented. Uniform application and selection dates were agreed on in 2001; and in 2003, the Council established a computerized Match, administered by the National Resident Match Program, which was used for the 2004 fellowship selection. A total of 113 positions were open for the match. A total of 248 applicants formally applied to MISFC programs and 130 participated in the match. Ninety-nine positions matched on the December 10th match day, and the remaining 14 programs successfully filled on the following scramble day. Seventeen applicants did not match to a program. Post match polling of program directors and applicants documented a high degree of compliance, usability, and satisfaction with the process. CONCLUSION: The MISFC has been successful at realizing its goals of bringing order to the past chaos of the MIS and GI fellowship situation. Its current iteration, the Fellowship Council, is in the process of introducing an accreditation process to further ensure the highest quality of postgraduate training in the fields of GI and endoscopic surgery.     

Femoroacetabular impingement: minimally invasive hip surgery

Minimally invasive hip surgery is an innovative surgical technique mainly used in femoroacetabular impingement (FAI). The purpose of the surgical correction in FAI deformity is to eliminate the etiologic factor in the development of the so-called idiopathic hip osteoarthritis. Decisive for the success of joint preservation is the preoperative assessment of the deformity and the possible damage to the cartilage. The optimal intervention in the presence of substantial cartilage damage is joint replacement. The patient's history and the findings of physical examination with detailed radiographs and magnetic resonance imaging based on a sagittal oblique localizer optionally using intra-articular contrast prevent underestimation of the stage of the disease. Knowledge about the options and techniques of minimally invasive hip surgery helps to identify patients appropriate for other interventions like surgical dislocation of the hip and the periacetabular osteotomy.     

理念革新:微创外科新视角

腹腔镜视觉平台的发展与革新,推动了整个外科从开腹手术到微创手术的理念革新与技术变革。从最初利用烛光反射镜装置窥视人体内部的内镜雏形,到高清、超高清腹腔镜视觉系统,从腹腔镜胆囊切除术,到腹腔镜下包括肿瘤根治手术在内的各类普通外科手术的普及与推广,外科手术因微创技术而发生巨大变革。进入新时代,3D、4K腹腔镜的应用,再次给微创外科带来新视角,从而推动手术朝着精准解剖和功能保护方向发展。未来,新型冠状病毒后疫情时代带来的理念革新,有可能使第5代移动通信技术加持下的虚拟现实技术和机器人手术,及在此基础上的远程医疗与远程教学成为微创外科发展的新视角。     

Extending the limits: minimally invasive surgery

Minimally invasive technology is being applied to an increasing number of surgical procedures. It remains to be seen which techniques will eventually become a 'gold standard' as has the laparoscopic cholecystectomy, and which will fall by the wayside. In the meantime, anesthesiologists must be aware of the unique requirements and complications of laparoscopic surgery.     

Liver tumors and minimally invasive surgery: a feasibility study.

Laparoscopic liver resection has not yet been established, although recent reports document that liver resection can be performed safely by the laparoscopic approach. Other interventional procedures like cryoablation have also been introduced in treatment of liver metastases. In this report 11 liver resections performed laparoscopically in eight patients are presented. Six patients had colorectal metastases, one a metastases from a malignant melanoma, and one patient had focal nodular hyperplasia. Two patients received synchronous cryoablation of remaining liver metastases. During follow up, two patients received percutaneous cryoablation of liver recurrences monitored by an open configuration magnetic resonance scanner. All except one of the tumors we attempted to remove had free resection margins (re-resection of new metastasis). No complications occurred except an atelectasis of the left lower pulmonary lobe in one patient. Median postoperative hospital stay was 3 days, and median postoperative opioid-dependent days was 1. The report demonstrates that minimally invasive techniques may safely be combined in hepatic intervention, and that the advantages of minimally invasive surgery, such as reduced hospital stay and less patient discomfort, also applies to liver resections.     

Anesthesia for minimally invasive surgery

Canadian Journal of Anesthesia/Journal canadien d'anesthésie -     

Outcomes assessment and minimally invasive surgery

Background: Outcomes assessment is being used increasingly to shape practice patterns in all areas of medicine. Although outcomes assessment is not a new concept, the widespread application of outcomes measurement for modifying practice is novel. Instead of focusing on results of interventions in highly controlled environments, outcomes studies usually report results as they occur in uncontrolled, real-world environments. Recently, the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) has initiated a society-wide initiative to monitor outcomes in patients undergoing various laparoscopic operations. Methods: Pertinent literature is reviewed as it relates to outcomes assessment. The historical background underpinning the modern interest in outcomes is outlined. Definitions of terms useful for understanding outcomes research are given. The impact of outcomes assessment on minimally invasive surgery, both positive and negative, are examined. The SAGES outcome initiative is introduced. Conclusions: Although outcomes studies usually do not provide information on the causes of observations made, they have gained in popularity because they provide information about patient perceptions of disease, disability, and treatment. Minimally invasive surgical procedures often are reported in terms of outcomes assessment because a controlled clinical trial was rendered impossible by early and widespread application of laparoscopic surgery. The SAGES outcomes initiative will provide the necessary tools for the participation of surgeons in the process of practice profiling. Received: 17 December 1999/Accepted: 4 April 2000/Online publication: 29 August 2000     

Ultrasonic dissectors and minimally invasive surgery

As increasingly complex operations are performed laparoscopically, new problems arise regarding basic tasks such as dissection and retraction. Emerging technologies continue to reduce the technical demands of minimally invasive surgery. Recent studies have shown that ultrasonic devices have the potential to replace electrocautery without compromising safety in minimally invasive operations. With the combination of several functions into a single instrument, significant reductions in operative time and expense are possible and should increase the acceptance of this new technology.     

Oncologic surgery: the advantages and disadvantages of minimally invasive surgery

For the last 15 years, the minimalized traumatization of laparoscopic surgical procedures has changed the treatment of numerous diseases. As a result, the method has also become an interesting therapeutic alternative for oncological indications, too. Nevertheless, its use in the special field of oncology, in particular when applied in curative intent, continues to give rise to controversial discussion. This paper takes a look at the potential advantages and disadvantages of the laparoscopic modality with regard to immune function and staging laparoscopy. In view of the fact that, at the present time, curative resections are being carried out in relevant numbers, in particular in the field of colorectal surgery, the technical feasibility, oncological radicality and oncological long-term outcomes are discussed on the basis of the data reported in the relevant literature on laparoscopic colorectal surgery.