Surgeon-directed HPB ultrasound: clinical practice, certification, and beyond

Abstract

Background: Ultrasound (US) in hepato-pancreato-biliary (HPB) surgery is inarguably an indispensable tool. In 2012, HPB ultrasound training was established through the Americas Hepato-Pancreato-Biliary Association (AHPBA). At the AHPBA annual meetings, a formal day-long post-graduate HPB US course has been offered to up to 30 practicing surgeons and surgical trainees. The purpose of this work was to identify why and how North American surgeons’ use of US has changed since the completion of the AHPBA HPB US course, while identifying challenges encountered to incorporate US into practice. Methods: To explore surgeon’s practices, experiences, and perceptions of the use of operative ultrasound, a qualitative research design was chosen using a survey method of open-ended questions. An anonymous on-line survey was sent to the previous participants of the AHPBA HPB US course to collect responses to questions in addition to surgeon demographics. Survey responses were collected between August and September 2018. Qualitative data were analyzed from the responses received from the North American (United States and Canada) practicing surgeons, using a grounded theory approach. A content analysis was conducted to identify common themes and sub-themes. Summary and descriptive statistics were applied. Results: Between 2010 and 2018, a total of 69 surgeons from the United States (91.3%) and Canada (8.7%) took the HPB US course. Fifteen (15) of the 69 surgeons (21.7%) returned the on-line survey. The area of clinical specialty of the respondents included transplantation (26.7%), surgical oncology (40%), HPB (20%), and general surgery (13.3%). Two dominant themes were identified regarding the surgeons’ motivations to take the HPB US course, which included issues related to training/experience (77.4%) and issues related to US certification (16.1%). Most surgeons (80%) reported a change in their practice as a result of the HPB US course, including an improvement in knowledge or skills (64.3%) and/or a change in the use of ultrasound (35.7%). Most surgeons (80%) also reported challenges in incorporating US into practice. The most common theme was issues related to US system (73.3%), and sub-themes reflecting cost issues were dominant (64%). (Figure) Conclusion: Costs of the US system are among the most important challenges to incorporating US into an HPB surgical practice. Importantly, this study has found that although HPB surgeons are motivated to seek US training to enhance knowledge and skills in US, they are also interested in obtaining certification in surgical US, a finding which has not been previously reported. A certification process in HPB surgical US is currently under development, which will be a step forward as there is a clear desire for US certification on the behalf of the HPB surgical community.