Association For Endoscopic Surgery Research Articles

A Concern for Intraoperative Distractions and Interference: An Observational Study Identifying, Measuring, and Quantifying Both within the Operating Theatre.

Background Modern surgical research has broadened to include an interest into the investigation of surgical workflow. Rigorous analysis of the surgical process has a particular focus on distractions. Operating theatres are inherently full of distractions, many not pertinent to the surgical process. Distractions have the potential to increase surgeon stress, operative time, and complications. Our study aims to objectively identify, classify, and quantify distractions during the surgical process. Methods 46 general surgical procedures were observed within a tertiary Irish hospital between June 2019 and October 2019. An established observational tool was used to apply a structured observation to all operations. Additionally, a nine-point ordinal behaviourally anchor scoring scale was used to assign an interference level to each distraction. Results The total operative observation time was 4605 minutes (mean = 100.11 minutes, std. deviation: 45.6 minutes). Overall, 855 intraoperative distractions were coded. On average, 18.58 distractions were coded per operation (std. deviation: 6.649; range: 5–34), with 11.14 distractions occurring per hour. Entering/exiting (n = 380, 42.88%) and case irrelevant communication (n = 251, 28.32%) occurred most frequently. Disruption rate was highest within the first (n = 275, 32%) and fourth operative quartiles (n = 342, 41%). Highest interference rates were observed from equipment issue and procedural interruptions. Anaesthetists initiated CIC more frequently (2.72 per operation), compared to nurses (1.57) and surgeons (1.17). Conclusion Our results confirm that distractions are prevalent within the operating theatre. Distractions contribute to significant interferences of surgical workflow. Steps can be taken to reduce overall prevalence and interference level by drawing upon a systems-based perspective. However, due to the ubiquitous nature of distractions, surgeons may need to develop skills to help them resume interrupted primary tasks so as to negate the effects distraction has on surgical outcomes. Data for the above have been presented as conference abstract in 28th International Congress of the European Association for Endoscopic Surgery (EAES) Virtual Congress, 23–26 June 2020.

No Uniformity in the References of Clinical Practice Guidelines for Bariatric Surgery: a Review of 3 Similar Guidelines Published in 2020.

In 2020, updated versions of the clinical practice guidelines of the European Association for Endoscopic Surgery, the Canadian Adult Obesity Clinical Practice Guidelines and the Dutch Federation for Medical Specialist clinical practice guidelines on bariatric surgery were published. We systematically reviewed and compared them on recommendations and references. Although the authors would have had access to the same literature, only 5 out of 655 unique references were used by all 3 guidelines and just 49 references by any combination of 2 guidelines. These findings attest to the subjectivity involved in clinical practice guidelines development and could be the cause for the observed differences in recommendations. International cooperation in guideline development might be a conceivable solution.

The impact of EAES Fellowship Programme: a five-year review and evaluation

BackgroundThe European Association of Endoscopic Surgery (EAES) fellowship programme was established in 2014, allowing nine surgeons annually to obtain experience and skills in minimally invasive surgery (MIS) from specialist centres across the Europe and United States. It aligns with the strategic focus of EAES Education and Training Committee on enabling Learning Mobility opportunities. To assess the impact of the programme, a survey was conducted aiming to evaluate the experience and impact of the programme and receive feedback for improvements.MethodsA survey using a 5-point Likert scale was used to evaluate clinical, education and research experience. The impact on acquisition of new technical skills, change in clinical practice and ongoing collaboration with the host institute was assessed. The fellows selected between 2014 and 2018 were included. Ratings were analysed in percentage; thematic analysis was applied to the free-text feedbacks using qualitative analysis.ResultsAll the fellows had good access to observing in operating theatres and 70.6% were able to assist. 91.2% participated in educational activities and 23.5% were able to contribute through teaching. 44.1% participated in research activities and 41.2% became an author/co-author of a publication from the host. 97.1% of fellows stated that their operative competency had increased, 94.3% gained new surgical skills and 85.7% was able to introduce new techniques in their hospitals. 74.29% agreed that the clinical experience led to a change in their practices. The most commonly suggested improvements were setting realistic target in clinical and research areas, increasing fellowship duration, and maximising theatre assisting opportunities. Nevertheless, 100% of fellows would recommend the fellowship to their peers.ConclusionEAES fellowship programme has shown a positive impact on acquiring and adopting new MIS techniques. To further refine the programme, an individualised approach should be adopted to set achievable learning objectives in clinical skills, education and research.

Insight into the methodology and uptake of EAES guidelines: a qualitative analysis and survey by the EAES Consensus & Guideline Subcommittee.

Over the past 25years, the European Association for Endoscopic Surgery (EAES) has been issuing clinical guidance documents to aid surgical practice. We aimed to investigate the awareness and use of such documents among EAES members. Additionally, we conceptually appraised the methodology used in their development in order to propose a bundle of actions for quality improvement and increased penetration of clinical practice guidelines among EAES members. We invited members of EAES to participate in a web-based survey on awareness and use of these documents. Post hoc analyses were performed to identify factors associated with poor awareness/use and the reported reasons for limited use. We further summarized and conceptually analyzed key methodological features of clinical guidance documents published by EAES. Three distinct consecutive phases of methodological evolvement of clinical guidance documents were evident: a "consensus phase," a "guideline phase," and a "transitional phase". Out of a total of 254 surgeons who completed the survey, 72% percent were aware of EAES guidelines and 47% reported occasional use. Young age and trainee status were associated with poor awareness and use. Restriction by colleagues was the primary reason for limited use in these subgroups. The methodology of EAES clinical guidance documents is evolving. Awareness among EAES members is fair, but use is limited. Dissemination actions should be directed to junior surgeons and trainees.

Colorectal Surgery in Romania during the COVID-19 Pandemic.

As the COVID-19 pandemic extends, its negative consequences on the effectiveness of therapeutic programs - previously assumed by the medical community and imperatively suspended for a difficult-to-predict period of time - are becoming increasingly worrying. In this context, as the evidence-based recommendations are not possible, most of the national and international scientific societies tried to develop balanced recommendations (1-4). The Romanian Society of Coloproctology (SRCP) and the Romanian Association for Endoscopic Surgery (ARCE) have created a working group that, taking into account recent publications, the statements of international academic societies, the national legislative context and the unique experience of countries severely affected by this pandemic (China, Italy, Spain, USA, etc.) proposes for Romania, the following recommendations for medical practice in colorectal surgery during the COVID-19 pandemic. These recommendations are subjected to continuous review, depending on the global and national situation of the pandemic, the particular needs of each hospital, the recommendations of the competent authorities and the evolution of the literature that publishes the conclusions of ongoing clinical trials.

Current State of Training and Evaluation of Laparoscopic Surgical Skills

__Objective:__ The aim of this study is to understand the current state of training practices and evaluation in laparoscopic surgery in a global context. __Design:__ An open-ended three part questionnaire was designed to gather the opinions about the current state of, adequacy of, and the need for a standard in laparoscopic surgical training. __Participants:__ Members of the European Association for Endoscopic Surgery (EAES), Endoscopic and Laparoscopic Surgeons of Asia (ELSA) and Association of Surgeons of India (ASI) were asked to participate in the survey. __Results:__ Of the 663 responses received, 83.6% were surgeons (64.6% in a teaching position) and 12.6% were surgical residents in training. Most respondents (75.4%) had performed over 200 laparoscopic procedures. Most (72.1%) training programs were approved/endorsed by local surgical associations or government health authorities and of the courses taught by surgical associations the majority had certified trainers (71.1%). In lower Human Development Index (HDI) countries significantly less courses are taught by certified trainers (68.2% versus 54.6%, p<0.001). Only 26.8% stated that their respective government health authorities participated in the certification of laparoscopic surgery; certification was considered important by 63.6%. However, only 17.8% of government health authorities contributed to ensure the quality of laparoscopic training, mostly in very high HDI. Only 3.3% of respondents considered the laparoscopic training and education in their country to be optimal and 51.9% rated it insufficient. Most respondents (86.3%) stated that there is a need for the standardization of laparoscopic training and 88.3% stated that standardization of laparoscopic training is important. __Conclusion:__ Regardless of demographic and experience factors, there was a general consensus that that there is a need for standardisation in mandatory training of laparoscopic surgical skills, although currently not obligatory in most countries.

23rd International Congress of the European Association for Endoscopic Surgery (EAES) Bucharest, Romania, 3-6 June 2015 : Oral Presentations.

23rd International Congress of the European Association for Endoscopic Surgery (EAES) Bucharest, Romania, 3-6 June 2015 : Oral Presentations.

23rd International Congress of the European Association for Endoscopic Surgery (EAES) Bucharest, Romania, 3-6 June 2015 : Video Presentations.

23rd International Congress of the European Association for Endoscopic Surgery (EAES) Bucharest, Romania, 3-6 June 2015 : Video Presentations.

14th World Congress of Endoscopic Surgery and 22nd International Congress of the European Association for Endoscopic Surgery (EAES), Paris, France, 25-28 June 2014 : Video Presentations.

14th World Congress of Endoscopic Surgery and 22nd International Congress of the European Association for Endoscopic Surgery (EAES), Paris, France, 25-28 June 2014 : Video Presentations.

21st International Congress of the European Association for Endoscopic Surgery (EAES) Vienna, Austria, 19–22 June 2013

21st International Congress of the European Association for Endoscopic Surgery (EAES) Vienna, Austria, 19–22 June 2013

21st International Congress of the European Association for Endoscopic Surgery (EAES) Vienna, Austria, 19–22 June 2013

21st International Congress of the European Association for Endoscopic Surgery (EAES) Vienna, Austria, 19–22 June 2013

Video-assisted anal fistula treatment: technical considerations and preliminary results of the first brazilian experience

BackgroungAnorectal fistula represents an epithelized communication path of infectious origin between the rectum or anal canal and the perianal region. The association of endoscopic surgery with the minimally invasive approach led to the development of the video-assisted anal fistula treatment.AimTo describe the technique and initial experience with the technique video-assisted for anal fistula treatment.TechniqueA Karl Storz video equipment was used. Main steps included the visualization of the fistula tract using the fistuloscope, the correct localization of the internal fistula opening under direct vision, endoscopic treatment of the fistula and closure of the internal opening which can be accomplished through firing a stapler, cutaneous-mucosal flap, or direct closure using suture.ResultsThe mean distance between the anal verge and the external anal orifice was 5.5 cm. Mean operative time was 31.75 min. In all cases, the internal fistula opening could be identified after complete fistuloscopy. In all cases, internal fistula opening was closed using full-thickness suture. There were no intraoperative or postoperative complications. After a 5-month follow-up, recurrence was observed in one (12.5%) patient.ConclusionVideo-assisted anal fistula treatment is feasible, reproducible, and safe. It enables direct visualization of the fistula tract, internal opening and secondary paths.

20th International Congress of the European Association for Endoscopic Surgery (EAES) Brussels, Belgium, 20–23 June 2012

20th International Congress of the European Association for Endoscopic Surgery (EAES) Brussels, Belgium, 20–23 June 2012

19th International Congress of the European Association for Endoscopic Surgery (EAES) Torino, Italy, 15–18 June 2011 Oral Presentations

19th International Congress of the European Association for Endoscopic Surgery (EAES) Torino, Italy, 15–18 June 2011 Oral Presentations

19th International Congress of the European Association for Endoscopic Surgery (EAES) Torino, Italy, 15–18 June 2011 Poster Presentations

19th International Congress of the European Association for Endoscopic Surgery (EAES) Torino, Italy, 15–18 June 2011 Poster Presentations

18th International Congress of the European Association for Endoscopic Surgery (EAES) Geneva, Switzerland, 16–19 June 2010

18th International Congress of the European Association for Endoscopic Surgery (EAES) Geneva, Switzerland, 16–19 June 2010

18th International Congress of the European Association for Endoscopic Surgery (EAES) Geneva, Switzerland, 16–19 June 2010

18th International Congress of the European Association for Endoscopic Surgery (EAES) Geneva, Switzerland, 16–19 June 2010

18th International Congress of the European Association for Endoscopic Surgery (EAES) Geneva, Switzerland, 16–19 June 2010

18th International Congress of the European Association for Endoscopic Surgery (EAES) Geneva, Switzerland, 16–19 June 2010

Laparoscopic colorectal cancer resection: examining lymph nodes or standardizing surgery?

There is now debate about how many lymph nodes should be dissected during colorectal cancer (CRC) by surgery and subsequently retrieved from the specimen and examined by pathologists. Appropriate lymphadenectomy is crucial for the patient’s oncological outcome for two reasons. First, it reduces the risk of residual nodal disease, and second, examination of only a large number of lymph nodes allows for accurate nodal staging. The pathological tumor-nodemetastasis (pTNM) staging by examining a sufficient number of lymph nodes allows an accurate estimation of the ratio between positive and total number of lymph nodes evaluated. This global nodal status information is necessary for making a decision about adjuvant systemic chemotherapy. Recent guidelines from scientific associations and organizations, including the American College of Surgeons (ACS), the National Quality Forum (NQF), the National Comprehensive Cancer Network (NCCN), and the American Society for Clinical Oncology (ASCO), recommend that a minimum of 12 lymph nodes should be removed and histopathologically examined for appropriate treatment of patients with CRC [1]. However, two large retrospective studies question this strategy. Based on a retrospective analysis of the national Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database (19952005) of patients in the U.S. (n = 30625) who underwent colectomy for nonmetastatic colon cancer, Wong et al. [2] came to the provocative conclusion that ‘‘Efforts by payers and professional organizations to increase node examination rates may have limited value as a public health intervention.’’ In another more recent retrospective analysis of 24,477 stage III colon cancer patients identified from the SEER cancer registry, Wang et al. [3] found that the total number of lymph nodes examined is not a reliable prognostic factor for stage III colon cancer. How many lymph nodes should be removed in laparoscopic CRC surgery? This question is relevant because laparoscopic resection has been increasingly used in dayto-day clinical practice not only for CRC but also other gastrointestinal cancers [4–8]. In a current review [9] and an international survey of surgeons about laparoscopic rectal surgery [10] it was found that there was more emphasis on the optimal extent of surgery rather than the number of lymph nodes retrieved. Indeed, most surgeons in the European Association for Endoscopic Surgery (EAES), the Indian Association of Gastrointestinal Endo-Surgeons (IAGES), and the Society of Laparoscopic Surgeons (SLS) and renowned surgeons who perform laparoscopic total mesorectal excision (LTME) agreed on the necessity and utility of standardized laparoscopic surgery. For example, standardization of the highly demanding laparoscopic low anterior resection with high ligation of the inferior mesenteric artery at its origin, splenic flexure mobilization, and TME with safety distal resection margins of at least 2 cm provides the greatest possibility for the good oncological and quality-of-life outcomes [9, 10]. In the January 2010 issue of this journal, El-Gazzaz et al. [11] added important information on laparoscopic CRC surgery. The authors emphasized assessing the number of lymph nodes dissected during surgery and examined by the pathologists after laparoscopic or open surgery. The authors compared 243 patients who underwent laparoscopic surgery C. Hottenrott (&) Chirurgische Klinik, St. Elisabethenkrankenhaus, Ginnheimer Strase 3, 60487 Frankfurt, Germany e-mail: info@gastricbreastcancer.com

17th International Congress of the European Association for Endoscopic Surgery (EAES) Prague, Czech Republic, 17–20 June 2009

Introduction: Laparoscopic splenectomy (LS) is the preferred choice for elective removal of normal and moderate sized spleens, but in the patients with spleen malignancies and with massive splenomegaly (MS) is still controversial. The aim of this prospective study was to analyse and compare the safety and efficacy of LS for benign and malignant splenic disease in the settings of the spleen enlargement. Methods: In the past 5 years operative and postoperative data were prospectively collected in 23 patients submitted to LS due to benign (15) and malignant (8) splenic disease. Results: There were no differences in the mean age between malignant and benign group. Mean spleen size in both groups was 19, 6 cm (range 11-28 cm) and total conversion rate 8, 6% (2 malignant group patients). Mean operative time in malignant group was not statistically longer (163, 8 ±43, 3 min vs 143, 3 ±28, 9 min, p = 0.1878) as well as the need for accessory incision for spleen retrieval (3 of 8 vs 2 of 15 patients, p = 0, 2076). Eight (35%) patients required intraoperative blood transfusion, 3 (37%) in malignant and 5 (33%) in benign group, with more blood replacement in benign group (428, 67 ml vs. 157, 5 ml, p = 0, 305). Estimated blood loss was significantly higher in this group (252 98 ml vs 151, 3 ml, p = 0.023) due to low platelet count. The length of hospital stay was the same for both groups. In MS (diameter > 20cm) operativetime was significantly longer (165, 45 ±34, 67 min vs 136, 67 ± 30, 56 min, p = 0, 0464). There were no differences between MS and moderate splenomegaly in requiring blood transfusion, blood replacement (425, 56 - 695, 11 ml vs. 428, 89 - 621, 72 ml, p = 0, 9904) and the length of hospital stay. Only one laparoscopic reoperation due to bleeding was performed. Conclusion: LS offers major clinical advantages but requires great technical care particularly in patients with malignant splenic disease and massive splenomegaly. It seems that there are no significant differences in operative time, need for accessory incision and the length of hospital stay as well as complication rate whether LS is preformed for benign or malignant disease.