Assistant Surgeon Research Articles

The Development of a New Uterine Manipulation Method during Minimally Invasive Radical Hysterectomy

The use of a vaginal uterine manipulator may compromise the oncological outcomes of patients with cervical cancer undergoing minimally invasive radical hysterectomy (MIS-RH). We aimed to describe the safety and efficacy of a novel uterine manipulation device during MIS-RH. Retrospective study. A university hospital and a tertiary care hospital. Patients with early-stage cervical cancer who were treated with MIS-RH. We developed the U-traction, a new device that consists of a 65-mm half-curved cutting needle with a 2.5-mm polyester tape (45-cm long), and investigated its utility to manipulate the uterus during MIS-RH. This study describes the utility and safety of the U-traction for uterine manipulation during laparoscopic or robotic RH in 8 patients with cervical cancer. Uterine manipulation was successfully and safely performed using the U-traction during laparoscopic or robotic RH in patients with cervical cancer without any complications. The application time was less than 5 minutes. In all cases, the use of a vaginal manipulator, an additional incision for an extra port, or the need for assistant surgeons for uterine manipulation was avoided. The novel U-traction device allows for easy and reproducible uterine manipulation during MIS-RH. With this device, the use of a vaginal uterine manipulator can be avoided, and MIS-RH can be safely performed without the need for an assistant surgeon for uterine manipulation.

Internet of Things For Surgery Process Using Raspberry Pi

The development of the internet of things makes all objects interconnected, making it the next technical revolution. It has been applied extensively in various sectors, including agriculture, smart parking, and industrial places, and most importantly, in the health monitoring process.[1] To monitor or its application in surgery procedure is one of its uses in healthcare. This project proposes a system aimed to solve sudden occurrences and emergencies during the operation process. The system's objective is to minimize deaths and other possible effects of the phenomena by connecting the surgeon with an online specialist all over the world. The proposed system architecture is based on medical sensors measuring the patient's physical parameters utilizing wireless sensor networks. The sensors send the parameters to the Raspberry Pi, which converts them to digital data. The digital data is transferred over the wireless network to the server, which is then sent to the cloud environment using the internet of things. Additionally, In case of any problem, the system works by sending the surgeon a voice signal to open the system and record the message and send it with the video that was recorded by the Raspberry pi cameras through the server to all the surgeons involved in the system through the Internet of things all over the world. Then the surgeons from across the globe communicate according to his specialty of assistant surgeon to communicate with the surgeon inside the operating room through headset and microphone.

Nurse-physician collaboration in surgical units: A questionnaire study

Abstract Purpose This study aimed to evaluate the attitudes of surgical unit nurses and assistant surgeons toward nurse-physician collaboration. Methods The sample population included 195 nurses and assistant surgeons in three university hospitals in western Turkey. Data was collected using a Personal Information Form and the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration. Frequency, percentage, mean, standard deviation, Mann-Whitney U, and Chi-Square tests were used for analysis. Results Nurses were more inclined to collaborate than physicians. Physicians agreed that nurses should be seen as collaborators rather than assistants; however, this positive attitude conflicted with common self-perception that they are still the dominant authority in patient care. Despite physician's contradictory attitudes toward nurse-physician collaboration, both nurses and physicians support educational activities for the purpose of increasing teamwork between nurses and physicians. Conclusion Physician-nurse collaboration was found to be suboptimal and in need of improvement.

Hand-assisted robotic surgery in the abdominal phase of robot-assisted oesophagectomy.

Robot-assisted minimally invasive oesophagectomy (RAMIE) has been developed to overcome the technical limitations of conventional thoracoscopic oesophagectomy. Hand-assisted laparoscopic surgery (HALS) is used as a practical and useful technique during the abdominal phase of thoracoscopic oesophagectomy. During RAMIE, a robotic vessel sealer cannot be used with HALS; another vessel sealer or ultrasonic coagulating device for laparoscopic surgery is required. We report an initial experiment using hand-assisted robotic surgery (HARS) for abdominal manipulation during RAMIE as a novel method. Under the pneumoperitoneum induced by insufflating the abdomen to 10 mmHg with carbon dioxide, the assistant surgeon lifted the stomach and greater omentum using the left hand through a 7 cm upper abdominal midline incision at approximately 2 cm below the xiphoid. Subsequently, gastric mobilisation was performed by robot-assisted surgery. Between January 2019 and February 2020, eight patients with thoracic oesophageal cancer underwent RAMIE with HARS at our hospital. The median operative time for extracorporeal manipulation and preparation for the roll-in of the robot was 39.5 min. The median console time was 47.5 min. There were no intraoperative or postoperative complications related to the use of the robot and no in-hospital mortality. In conclusion, HARS seems to be feasible and safe for abdominal manipulation during oesophageal cancer surgery.

The economic value of an on-call neurosurgical resident physician.

The cost of training neurosurgical residents is especially high considering the duration of training and the technical nature of the specialty. Despite these costs, on-call residents are a source of significant economic value, through both indirectly and directly supervised activities. The authors sought to identify the economic value of on-call services provided by neurosurgical residents. A personal call log kept by a single junior neurosurgical resident over a 2-year period was used to obtain the total number of consultations, admissions, and procedures. Current Procedural Terminology (CPT) codes were used to estimate the resident's on-call economic value. A single on-call neurosurgical resident at the authors' institution produced 8172 work relative value units (wRVUs) over the study period from indirectly and directly supervised activities. Indirectly supervised procedures produced 7052 wRVUs, and directly supervised activities using the CPT modifier 80 yielded an additional 1120 wRVUs. Using the assistant surgeon billing rate for directly supervised activities and the Medical Group Management Association nationwide median neurosurgery reimbursement rate, the on-call activities of a single resident generated a theoretical billing value of $689,514 over the 2-year period, or $344,757 annually. As a program, the on-call residents collectively produced 39,550 wRVUs over the study period, or 19,775 wRVUs annually, which equates to potential reimbursements of $1,668,386 annually. Neurosurgery residents at the authors' institution theoretically produce enough economic value exclusively from on-call activities to far exceed the cost of their education. This information could be used to more precisely estimate the true overall cost of neurosurgical training and determine future graduate medical education funding.

Real-time location of surgical incisions in cataract phacoemulsification

Phacoemulsification is an important surgical treatment for cataracts. The location of the surgical incision affects the surgically induced astigmatism, and the typical surgical incision for phacoemulsification is located on the steepest meridian direction of the limbus. The real-time location of the surgical incision during the cataract phacoemulsification can reduce doctors’ workloads and the potential for human error. A real-time surgical incision location algorithm in microscopic images is proposed in this paper. It is a two-part algorithm that consists of an iris external boundary detection algorithm and a rotation angle calculation algorithm. The steps in the iris external boundary detection algorithm include image space conversion, image segmentation, filtering, and least square based circle detection. The eye rotation angle calculation algorithm utilizes the SURF algorithm. Experiments on six phacoemulsification videos show that the algorithm can locate surgical incisions in microscopic videos accurately and quickly. The distance error of the iris external boundary algorithm is 2.45 ± 0.136, and the area error is 2.69 ± 0.184. The average running time of this algorithm for one image is 65.1 ± 4.80 ms; a demonstration video, the S1 Video, is available. The algorithm proposed in this paper can determine the surgical incision location in cataract phacoemulsification in real-time based on a personal computer and can provide assistance for ophthalmology surgeons.

Assembling the Team: An Analysis of Partner Selection and Performance in Robot-Assisted Surgery

Similarity, competence and familiarity are recognized team assembly mechanisms – general principles that individuals adopt to choose others with whom they want to work. According to the principle of similarity, individuals are more likely to choose partners that are similar to themselves along contextually relevant dimensions. According to the competence principle, social selection is driven mainly by an evaluation of compatibility between individual skills and requirements of the task. Finally, the principle of familiarity implies that people who have worked together in the past are more likely to repeat their collaboration in the future. In this paper we use data that we have collected on Health Care Action (HCA) teams composed by one main and one assistant surgeon to explore how the effects of the team assembly mechanisms implied by these generic principles: (i) are embedded in known network self-organizing mechanisms that link internal team members to shared external partners, (ii) are contingent on the complexity of the task that the team faces and (iii) affect team performance. Relational event models estimated on more than one thousand surgeries provide evidence that, while similarity and familiarity-based mechanisms affect partner selection, the strongest predictor for team performance is represented by a variety of competence-based factors. The analysis also reveals that the effects of social selection mechanisms on performance outcomes are contingent on the complexity of the team task, which in our sample is determined by the clinical conditions of patients entering surgery. We discuss implications based on the mismatch between team assembly heuristics and effective configuration strategies.

Cancer incidence in Madras Presidency in 1892-1901: William Niblock's commentary of 1902.

William J. Niblock (WJN), an Assistant Surgeon at the Madras General Hospital (MGH), published a paper 'Cancer in India' (2 pages of text and 3 pages of tables) in the Indian Medical Gazette in 1902. He appears to have been a popular surgeon in Madras who surgically treated mouth cancers, testicular filariasis, and calcareous stones in the liver, gall bladder, and kidney. His 'Cancer in India' article is a compilation of numerical data of different cancers recorded in MGH from 1892 to 1901 mostly, and from 1896 to 1901 occasionally. In this article, WJN refers to cancers of different internal organs and external parts. He attributes the mouth cancers to constant chewing of 'betel' (the betel quid), which he explains as giving rise to leukoplakia, forerunner of buccal carcinoma. He supplies many, easily comparable, paired tables. These tables are made of raw numbers about the diverse human populations living in Madras, such as the Indians (Hindus and Muslims), Europeans, and Eurasians (Anglo-Indians) extracted from the 10-year records of MGH. None of the tables has been analyzed statistically. Nevertheless, he supplies the total numbers of admissions into MGH, which serve usefully as denominators in this study; occasionally, he presents data as percentages. Despite the lack of parametric statistical analysis, WJN's article, written in 1902, impresses as a useful contribution, because it provides a cross-sectional view of cancer incidence in Madras, particularly in defiance of Saldanha's supposition that cancers do not manifest in dark-skinned people, such as Indians.

Incidence and risk factors for surgical glove perforation in small animal ophthalmic surgery.

To determine the incidence of perforation of surgical gloves and identify associated risk factors that contribute to glove perforation in small animal ophthalmic surgery. Observational cohort study. Surgical gloves (n=2000) collected following 765 small animal ophthalmic procedures. All the gloves were tested for perforation at the end of the procedure using a water leak test. The potential risk factors for glove perforation were recorded, and associations between these risk factors and perforation were explored using univariable (Fisher's exact test) and mixed effect logistic regression analysis. Results were considered significant if P<.05. Glove perforation was detected in 6% of procedures. Glove perforation was 1.97 (95% CI: 0.98-4.22) times more likely in extraocular than in intraocular surgeries (7.3% vs 3.9%; P=.0462). The incidence of perforations was not statistically different between main and assistant surgeon (P=.86). No significant association was found between the risk of glove perforation and duration of the procedure (P=.13). Perforation of the nondominant hand was 2.6 (95% CI: 1.38-4.98) times more likely than the dominant hand (74% vs 26%; P=.0028). Only 22% of the perforations were detected intraoperatively. Multivariable analysis identified only extraocular surgery as a risk factor for perforations. There is a low incidence of glove perforation in small animal ophthalmic surgery, but extra care of the nondominant hand is required, especially during extraocular procedures.

Exploring the use of high and low demand simulation for human performance assessment during multiorgan retrieval with the joint scrub practitioner

IntroductionThe National Organ Retrieval Service (NORS) 2015 review recommended a Joint Scrub Practitioner for abdominal and cardiac teams during combined organ retrieval. To evaluate the feasibility of this role, and...

Use of a compact high-definition two-dimensional exoscope in surgical treatment of large vestibular schwannoma

Background:Extra-corporeal video telescope operating monitor system provides a necessary instrument to perform high-precision neurosurgical procedures that could substitute or supplement the traditional surgical microscope. The present study was designed to evaluate a compact high-definition two-dimensional exoscope system for assisting in surgical removal of large vestibular schwannoma (VS), as an alternative to a binocular surgical microscope.Methods:Patients with Koos grade 3 and grade 4 VS undergoing surgery were enrolled in this prospective cohort study between January 2013 and June 2018. The demographics and tumor characteristics (size, Koos grade, composition [cystic or solid mass]) were matched between the two groups of patients. The following outcome measurements were compared between the two groups: duration of surgery, volume of blood loss, extent of tumor resection, number of operating field adjustments, pre- and post-operative facial and cochlear nerve function evaluated at 3 months post-surgery, complications and surgeons’ comfortability.Results:A total of 81 patients received tumor resection through the retrosigmoid approach under either an exoscope (cases, n = 39) or a surgical microscope (control, n = 42). Patients in the two groups had comparable tumor location (P = 0.439), Koos grading (P = 0.867), and composition (P = 0.891). While no significant differences in the duration of surgery (P = 0.172), extent of tumor resection (P = 0.858), facial function (P = 0.838), and hearing ability (P = 1.000), patients operated on under an exoscope had less blood loss (P = 0.036) and a fewer field adjustments (P < 0.001). Both primary and assistant surgeons reported a high level of comfort operating under the exoscope (P = 0.001 and P < 0.001, respectively).Conclusions:The compact high-definition two-dimensional exoscope system provides a safe and efficient means to assist in removing large VSs, as compared to a surgical microscope. After the acquaintance with a visual perception through a dynamic hint and stereoscopically viewing corresponding to the motion parallax, the exoscope system provided a comfortable, high-resolution visualization without compromising operational efficiency and patient safety.

Robotic-assisted transmaxillary approach for removal of juvenile nasopharyngeal angiofibroma of the pterygopalatine and infratemporal fossa.

Endoscopic transmaxillary approaches to remove juvenile nasopharyngeal angiofibromas (JNAs) have been described previously and are used for tumors that extend laterally in the pterygopalatine fossa (PPF) and infratemporal fossa (ITF). There is no previous description of robotic-assisted JNA removal in the literature. The video will demonstrate the success of this technique. Robotic transmaxillary approaches to the lateral PPF and ITF are easily achieved through an extended Caldwell-Luc antrostomy. Total operative time was 519 minutes. Total robotic operative time was 283 minutes. The endoscopic approach provided no assistance in tumor dissection or removal. Robotic-assisted transmaxillary JNA removal allows the operating surgeon to control the endoscope and to operate free of collisions from the robotic console while having an active assistant surgeon at the patient bedside. A video demonstrating the technique is found on Head & Neck's web site.

Usability assessment of Versius, a new robot-assisted surgical device for use in minimal access surgery

ObjectivesVersius is a teleoperated surgical robotic system intended for use in minimal access surgery. This study aimed to validate the safety and effectiveness of the Versius user interface in the...

Conservation of personal protective equipment for head and neck cancer surgery during COVID-19 pandemic.

BackgroundCOVID‐19 pandemic has led to a global shortage of personal protective equipment (PPE). This study aims to stratify face shield needs when performing head and neck cancer surgery.MethodsFifteen patients underwent surgery between March 1, 2020 and April 9, 2020. Operative diagnosis and procedure; droplet count and distribution on face shields were documented.ResultsForty‐five surgical procedures were performed for neck nodal metastatic carcinoma of unknown origin (n = 3); carcinoma of tonsil (n = 2), tongue (n = 2), nasopharynx (n = 3), maxilla (n = 1), and laryngopharynx (n = 4). Droplet contamination was 57.8%, 59.5%, 8.0%, and 0% for operating, first and second assistant surgeons, and scrub nurse respectively. Droplet count was highest and most widespread during osteotomies. No droplet splash was noted for transoral robotic surgery.ConclusionFace shield is not a mandatory adjunctive PPE for all head and neck surgical procedures and health care providers. Judicious use helps to conserve resources during such difficult times.

Parieto-Occipital Interhemispheric Transfalcine, Trans-Bitentorial Approach for Radical Resection of Falcotentorial Meningiomas.

Falcotentorial meningioma occurs close to the falcotentorial edges and the confluence of the vein of Galen. The posterosuperior approach conventionally used to reach this site does not allow direct visualization of the tumor matrix, making detachment difficult. Meningiomas at this location are therefore among those that are not well amenable to radical resection. We devised an alternative anterolateral approach that, when used in addition to the posterosuperior approach, provides an operating field which allows to overview large, bilaterally extending tumors. We report this parieto-occipital interhemispheric transfalcine, trans-bitentorial approach, together with associated procedural modifications. We used the approach in four patients with falcotentorial meningioma between February 2008 and July 2017. We began by extending a parieto-occipital craniotomy slightly beyond the midline, to pass across the most caudal bridging vein on the rostral side. We then created a fan-shaped fenestration as large as possible in the falx, between the superior sagittal sinus and the inferior sagittal and straight sinuses (window 1). We further performed wedge-shaped resections of both tentorial edges to the left and right of window 1 (windows 2 and 3). Tumor debulking was then carried out via these three windows (the triple-window method). Finally, we detached the tumor in the area of the falcotentorial edges and the confluence of the vein of Galen. To obtain a superorostral operating field as wide as possible from laterally, thereby exposing the potential blind spots, the operating surgeon used both hands while retracting the precuneus, and the assistant surgeon used both hands to turn over the falcotentorial edges (twosome four-hand retractorless microsurgery). The wide operating field provided by this parieto-occipital interhemispheric transfalcine, trans-bitentorial approach and twosome four-hand retractorless microsurgery provides a direct view of delicate structures at the falcotentorial edges and the confluence of the vein of Galen, a site that is most likely to be a blind spot in conventional approaches. Retraction of the precuneus on the nondominant side enabled radical resection with no neurologic deficit in any of the patients. The parieto-occipital interhemispheric transfalcine, trans-bitentorial approach with the triple-window method opens an anterolateral operating field in addition to a posterosuperior operating field in large tumors located in the falcotentorial and pineal region, extending anteroposteriorly and bilaterally. The twosome four-hand retractorless technique via this approach enables visualization of the tumor matrix at sites, which are barely visible with the conventional approach. Thus, the tumor can be removed more radically and safely.

Endoscopic-Assisted Lateral Orbitotomy for Large Orbital Roof Dermoid Cysts With Dural Invasion.

To demonstrate the technique and report the results of endoscopic-assisted lateral orbitotomy for 6 patients with huge intraorbital dermoid cyst causing orbital roof bone erosion and dural invasion. Patients had unilateral cystic tumor with proptosis and hypoglobus for more than 6 months. There was no compressive optic neuropathy. Lateral orbitotomy procedure was performed from 2004 to 2016 by 1 surgeon. Cysts were dissected, and fluid content was aspirated to reduce the size. Solid contents were then suctioned, its cavity was repeatedly irrigated, and orbital part of epithelial lining was removed. The remained epithelial lining and keratinized content at the orbital roof (abutting the dura) were removed using the rigid endoscope lenses (4 mm, 0° and 30°) and curettage. Orbital tissue was pulled away from the roof (inferior) by an assistant surgeon to make a space for introducing the lens and curette. The surgical field was frequently irrigated. No orbital drain was used, and all the patients were discharged on the same day after 8-10 hours of observation. Skin sutures were removed 1 week later. They were 4 men and 2 women with age range of 19-48 years. A large superolateral orbital tumor with roof erosion and dural invasion was observed on imaging. Procedures were performed uneventfully. Dermoid was the pathological diagnosis. While one patient lost to follow up after 1 week, others had 6-18 months follow-up time with no recurrence. Endoscopic-assisted lateral orbitotomy approach provided a good field of view, illumination, and magnification to totally remove all the content and epithelial lining of very large orbital roof dermoid cysts with dural invasion.

MP34-20 INFLUENCE OF HIERARCHY IN THE OPERATING ROOM ON RISK COMMUNICATION DURING ROBOT-ASSISTED SURGERY

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment I (MP34)1 Apr 2020MP34-20 INFLUENCE OF HIERARCHY IN THE OPERATING ROOM ON RISK COMMUNICATION DURING ROBOT-ASSISTED SURGERY Taylor Kunkes, Lora Cavuoto, Jeff Higginbotham, Ann Bisantz, Mohammad Durrani*, Naif Aldhaam, Samantha Maley, Amanda Pasquini, Semiah Smith, Aaron Gorsline, Ahmed Elsayed, Ahmed Hussein, and Khurshid Guru Taylor KunkesTaylor Kunkes More articles by this author , Lora CavuotoLora Cavuoto More articles by this author , Jeff HigginbothamJeff Higginbotham More articles by this author , Ann BisantzAnn Bisantz More articles by this author , Mohammad Durrani*Mohammad Durrani* More articles by this author , Naif AldhaamNaif Aldhaam More articles by this author , Samantha MaleySamantha Maley More articles by this author , Amanda PasquiniAmanda Pasquini More articles by this author , Semiah SmithSemiah Smith More articles by this author , Aaron GorslineAaron Gorsline More articles by this author , Ahmed ElsayedAhmed Elsayed More articles by this author , Ahmed HusseinAhmed Hussein More articles by this author , and Khurshid GuruKhurshid Guru More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000878.020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is paucity of data about the hierarchical culture among the operating room (OR) staff. In this study, we aimed to identify how the surgical team’s hierarchical relationships affect the frequency and timing (proactive vs. reactive) of risk utterances and their influence on situational awareness in the OR. METHODS: Audio-visual recordings and transcriptions of 10 robot-assisted radical prostatectomies were examined for risk utterances between the surgeon, assistant surgeon, bedside assistant, and scrub nurse. Utterances were classified based on the sender-recipient pair (e.g. surgeon to bedside assistant), their timing (proactive vs. reactive), and the NOTECHS situational awareness score. Proactive utterances were produced with the intent to avoid a problem. Reactive utterances were produced with the intent to correct a problem. Utterances made by the surgeon or assistant surgeon were also classified based on their on-console status. Chi-square tests and ANOVAs were used to determine associations between hierarchical status, utterance timing, on-console status, and NOTECHS scores. RESULTS: Of 4,583 examined utterances, 275 (7%) were risk-related. Of these, 64% risk utterances occurred from individuals of higher hierarchal status to individuals of lower status (Table 1). Utterances were significantly more reactive than proactive (p < 0.01). Proactive utterances (M = 2.48) had significantly higher NOTECHS scores than reactive utterances (M = 1.76) (p < 0.01). 52% of the surgeon and trainee surgeon’s utterances were made on-the-console. Utterances were more reactive when on the console and more proactive off the console (p < 0.05). Utterances made by the surgeon or trainee surgeon had significantly higher NOTECHS situational awareness scores when they were off-the-console (M = 2.42) rather than on (M = 1.78). CONCLUSIONS: On-console status has the greatest influence on frequency, timing, and rating of risk utterances, rather than the assumed hierarchical status based on traditional surgical practice. Source of Funding: Roswell Park Alliance Foundation © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e511-e511 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Taylor Kunkes More articles by this author Lora Cavuoto More articles by this author Jeff Higginbotham More articles by this author Ann Bisantz More articles by this author Mohammad Durrani* More articles by this author Naif Aldhaam More articles by this author Samantha Maley More articles by this author Amanda Pasquini More articles by this author Semiah Smith More articles by this author Aaron Gorsline More articles by this author Ahmed Elsayed More articles by this author Ahmed Hussein More articles by this author Khurshid Guru More articles by this author Expand All Advertisement PDF downloadLoading ...

Henry Hurry Goodeve (1807-1884), the first professor of Anatomy in India.

Henry Goodeve was appointed assistant surgeon to the Bengal Principality of the East India Company in 1831 and in 1835 was appointed assistant to Dr MJ Bramley, who was the newly appointed Superintendent of the Calcutta Medical School. Later that year, Goodeve was appointed Professor of Medicine and Anatomy and in 1845 accompanied four Indian students to London where they underwent further training at University College. Returning to Calcutta two years later, he was appointed Professor of Midwifery and retired in 1853, returning to England. Goodeve was appointed Senior Physician to the Rentkioi Hospital at the end of the Crimean war in 1855. After this he spent the rest of his life in Bristol. He built a large mansion and became a magistrate and was on numerous committees. He had many publications including Hints on Children in India that went to 14 editions and was the co-editor of one of the Calcutta Medical Journals.

The development of a robotic gynaecological surgery training curriculum and results of a delphi study

BackgroundTechnology for minimal access surgery is rapidly progressing in all surgical specialities including Gynaecology. As robotic surgery becomes established in increasing numbers of hospitals, there is no set curriculum for training in robotic gynaecological surgery or the assistant role in use in the UK. The purpose of this study was to determine a list of competencies that could be used as the basis of a core robotic gynaecological surgery curriculum, to explore its acceptability and the level of interest in undertaking training in robotics among obstetrics & gynaecology (O&G) trainees.MethodsA four-round Delphi study was conducted using members and associates of British & Irish Association of Robotic Gynaecological Surgeons (BIARGS). In Round 1 respondents were asked to propose standards that could be used in the curriculum. In the following three rounds, the respondents were asked to score each of the standards according to their opinion as to the importance of the standard. Items that scored a mean of 80% or above were included in the final proposed curriculum. Following this, a national survey was conducted to explore the interest among O&G trainees in undertaking a formal robotic training for the first assistant and console surgeon roles.ResultsThe items proposed were divided into three separate sections: competencies for a medical first assistant; competencies for a console surgeon; continued professional development for trained console surgeons. From the national survey; 109 responses were received of which 60% were interested in undertaking a formal training for the first assistant role, and 68% are expressing interest in training for the console surgeon role.ConclusionUndertaking a Delphi exercise to determine a core gynaecological robotic training curriculum has enabled consensus to be achieved from the opinions of BIARGS members/associates. There is interest among O&G trainees at all levels of training to gain experience and develop their skills in robotic surgery by undertaking a formal training in robotic surgery at both the first assistant and console surgeon level.

Impact of First Assistant Surgeon Experience on the Perioperative Outcomes of Laparoscopic Hepatectomies.

Introduction: This study aims to evaluate the impact of first assistant surgeon experience on the outcomes of laparoscopic hepatectomies in a university-affiliated teaching hospital. Methods: This is a retrospective study comparing outcomes of laparoscopic hepatectomies with first assistant surgeons of varying experience levels. Three hundred and eighty-five consecutive laparoscopic hepatectomies performed in a tertiary university-affiliated teaching hospital from 2012 to 2018 were included and stratified into three cohorts-Group 1 in which assistants were residents, Group 2 for fellows, and Group 3 for attendings. Baseline clinicopathologic variables and outcome measures were analyzed using the augmented inverse probability of treatment weighting approach, which is a propensity score-based method that combines aspects of covariate adjustment and inverse probability weighting. Results: Group 3 comprised a greater proportion of advanced- and expert-level surgeries based on the Iwate criteria; 33.8%, 32.2%, and 46.0% of patients underwent advanced- and expert-level surgeries in Groups 1, 2, and 3, respectively. Group 3 had consistently higher operative times as well as more frequent use and longer duration of Pringle's maneuver (P < .05). The median operative times for Groups 1, 2, and 3 were 195, 195, and 290 minutes, respectively. Pringle's maneuver was applied in 26.9%, 33.9%, and 60.2% of patients with a corresponding median duration of 35, 36, and 45 minutes, respectively. None of the other perioperative and postoperative outcomes demonstrated statistically significant differences. Conclusion: With an appropriate selection of cases, participation of residents as first assistants in laparoscopic hepatectomies can be encouraged without compromise in perioperative outcomes.