Education Of Surgeons Research Articles

Perception and Practice of Bariatric Surgery and Reproductive Health in Women: a Cross-sectional Study of Chinese Bariatric Surgeons.

Western studies have explored bariatric surgeons concerning their views on bariatric surgery (BS) and reproductive health, but Asian data were lacking. The aim of this study was to explore the perception and practice of bariatric surgeons on the reproductive health of female patients who underwent BS in China to better guide clinical practice and improve clinical outcomes. An online questionnaire of 31 questions developed by bariatric surgeons was collected by sending to one online communication group (WeChat group) whose members are Chinese bariatric surgeons. A total of 87 bariatric surgeons from mainland China were surveyed. Almost all (97.7%, 85/87) surgeons considered the reproductive health conversation for women who underwent BS to be important or very important. Only 1/4 of surgeons routinely discuss reproductive health-related issues with patients, and only 56% of doctors always ask patients for postoperative contraception. Less than 20% of bariatric surgeons have full knowledge of postoperative contraception, and nearly 40% of them believe that gynecologists should be responsible for providing contraception. More than 35% of bariatric surgeons have never been involved in the co-management of pregnancy in patients with a history of BS. Although most bariatric surgeons are aware of the importance of female reproductive health, there is a large gap in the perception and clinical practice of bariatric surgeons in terms of reproductive health. It is necessary to further strengthen the education of bariatric surgeons and enhance multidisciplinary cooperation with gynecology, obstetrics, and other disciplines to bring better clinical outcomes.

Satisfaction and attrition in Canadian surgical training program leadership: a survey of program directors.

Surgical program directors (PDs) play an integral role in the well-being and success of postgraduate trainees. Although studies about medical specialties have documented factors contributing to PD burnout, early attrition rates and contributory factors among surgical PDs have not yet been described. We aimed to evaluate Canadian surgical PD satisfaction, stressors in the role and areas institutions could target to improve PD support. We administered a cross-sectional survey of postgraduate Canadian surgical PDs from all Royal College of Physicians and Surgeons of Canada accredited surgical specialties. Domains we assessed included PD demographics and compensation, availability of administrative support, satisfaction with the PD role and factors contributing to PD challenges and burnout. Sixty percent of eligible surgical PDs (81 out of 134) from all 12 surgical specialties responded to the survey. We found significant heterogeneity in PD tenure, compensation models and available administrative support. All respondents reported exceeding their weekly protected time for the PD position, and 66% received less than 0.8 full-time equivalent of administrative support. One-third of respondents were satisfied with overall compensation, whereas 43% were unhappy with compensatory models. Most respondents (70%) enjoyed many aspects of the PD role, including relationships with trainees and shaping the education of future surgeons. Significant stressors included insufficient administrative support, complexities in resident remediation and inadequate compensation, which contributed to 37% of PDs having considered leaving the post prematurely. Most surgical PDs enjoyed the role. However, intersecting factors such as disproportionate time demands, lack of administrative support and inadequate compensation for the role contributed to significant stress and risk of early attrition.

Learning trauma surgery through cytoreductive surgery

ObjectivesRegarding war surgery (WS), the initial and continuing education of French military gastrointestinal surgeons (FMGIS) is considered flawed and inappropriate. This results from the low incidence of gastrointestinal (GI) trauma, its predominantly non-surgical management, and a daily surgical practice that strongly differs from WS. Conversely, cytoreductive surgery (CRS) of peritoneal metastases has similarities with WS which led us to assess its potential contribution to the initial and continuing education of FMGIS in WS. MethodsWe reported the activities of the GI surgery departments of the military teaching hospitals of Percy and Begin. The first one dedicated to traumatology and the second to CRS. We then specifically looked into the surgical procedures conducted by the FMGIS during deployment from January 2004 to December 2014. ResultsAmongst the 600 severe trauma patients admitted to the Percy trauma center between January 2019 and December 2020, 17 underwent abdominal surgery with a total of 25 procedures performed. During the same period, 61 patients undertook CRS in Begin with an average of 7 surgical processes per patient carried out and a total of 418 abdominal surgical procedures. Outside abdominal packing and nephrectomy (not performed in CRS), the numbers of splenectomy, gastrointestinal / gynecological resections (hysterectomy and/or adnexectomy), or liver resection were higher during CRS compared to abdominal trauma surgery with 10 times less patients (10 vs 1, 43 vs 9, 20 vs 0, 6 vs 0, respectively). ConclusionCRS, through its similarities with WS, seemed to be an appropriate tool for the initial and continuing education of FMGIS in WS and, to an extent, of civilian trauma surgeons who could eventually treat terrorist attacks casualties on the national territory.

Educating Surgeons to Construct Valved Conduits: What Does It Take to Achieve Reproducible Results?

BackgroundDespite the demonstrated utility of surgeon-fashioned polytetrafluoroethylene (PTFE) valved conduits, methods for educating surgeons to reproducibly construct these conduits are lacking. We present a surgeon education process and early outcomes for children receiving surgeon-fashioned PTFE valved conduits during the initial learning curve. MethodsThe educational curriculum included 4 hours of proctored instruction/supervised valve construction, followed by 2 hours of individual practice. A surgeon with prior mastery of the technique provided templated designs, videos, and follow-up consultation. A retrospective medical record review (2017-2022) described early outcomes and valve function for patients receiving surgeon-fashioned PTFE right ventricle-to-pulmonary artery conduits. ResultsTwo surgeons were educated using the method described. Fifteen valved conduits were implanted in 14 patients (median patient age, 38 months; conduit size range, 10-24 mm). At discharge, no patient had more than mild stenosis or regurgitation, and 12 of 15 valves (80%) had none or trivial regurgitation. Median follow-up was 14 months (range, 1-52 months). At the last follow-up, median peak conduit gradient of the 15 valves was low (18 mm Hg), 1 (7%) had moderate stenosis, and 1 (7%) had mild-moderate regurgitation. Two conduits were replaced concomitantly during repair of associated lesions at 14 and 38 months (sizes 10 and 12 mm, respectively). There were no deaths and no infectious complications. ConclusionsFour hours of proctored surgeon education plus deliberate practice is an effective method for teaching valved PTFE conduit construction and is associated with excellent early valve function. This study provides educational methods and initial evidence of safety for congenital surgeons wishing to learn and adopt this technique.

Relevance of a Simulation Model to Microvascular Surgery for Military Surgical Residents.

Microsurgical training is an asset for deployed military orthopaedic surgeons who frequently treat hand or nerve injuries in the field. The objective of this study was to evaluate a microvascular surgery simulation model intended to prepare residents prior to their enrolment in conventional microsurgery degree training. An experimental study was conducted to evaluate technical progress and satisfaction of military surgical residents using a model based on Japanese noodles with four tests of increasing difficulty. Objective endpoints included instruments handling, distribution, and quality of stitches, as well as anastomoses duration. Responses to the Structured Assessment of Microsurgery Skill self-assessment questionnaire were also analyzed. Nine residents from different specialties participated in the study. Their anastomoses quality and average satisfaction significantly increased between the first and the last session (p < 0.05). Conversely, the average operating time decreased significantly over the sessions (p < 0.001). This simulation model seems to constitute a satisfactory initiation to microsurgery and could limit the use of animal models. It could also be included in the continuing education of military surgeons who have an occasional microsurgical practice during deployments.

Paediatric surgeons’ current knowledge and practices of obtaining assent from adolescents for elective reconstructive procedures

PurposeAdolescents develop their decision-making ability as they transition from childhood to adulthood. Participation in their medical care should be encouraged through obtaining assent, as recommended by the American Academy of...

Why the military committee is important to SAGES?

SAGES established a military committee in 2009 and since that time. It may not be readily clear why a traditionally laparoscopic and endoscopic surgical society should have a military committee whose members' primary mission is combat surgery. Military surgeons have a second mission, though, which is to provide care for all its beneficiaries in all the surgical subspecialties. They also have a third mission, which is to train the next generation of military surgeons. The aim of this paper is to discuss the relationshipwith SAGES that enables the military to succeed in these missions and the benefits it provides to SAGES. A historical review of the military committee and its activities since its inception in 2009. Through SAGES, military surgeons have a cost-effective means of developing professionally and receiving education in surgical areas outside of the battlefield arena, which the DOD does not provide. For 13years, SAGES has also provided an academic venue for research in these specialties. With the addition of military members, SAGES can access more surgeons and surgical innovation like surgery in space and worldwide telemedicine. The military committee also gives SAGES an opportunity to directly contribute to the care of military service members, retirees, and VA beneficiaries, which benefits the United Statesas a whole. SAGES and the military have enjoyed a mutually beneficial relationship. The contributions of SAGES have undoubtedly saved and improved US service member and beneficiary lives. It has also improved the education and academic advancements of the military surgeons. SAGES also reaches more surgeons and has another platform for surgical innovation. The relationship should continue and be allowed to grow.

Predictors of 30-Day Readmission Following Cervical Laminoplasty in 3,085 Patients: An American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Database Study.

Background Cervical laminoplasty is a surgical alternative to laminectomy and fusion for treating multi-level cervical spondylotic myelopathy. There is limited evidence evaluating readmission incidence and risk factors following cervical laminoplasty. Here, we provide a retrospective review evaluating preoperative risk for 30-day readmission following cervical laminoplasty. Methodology The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients undergoing laminoplasty as defined by Current Procedural Terminology codes 63050 and 63051. Patients were then categorized based on whether 30-day readmission occurred, and preoperative risk factors were examined. Continuous and categorical variables were analyzed using Student's t-test or Fisher's exact test. Multivariate regression analysis was performed for each variable, with p-values of <0.05 considered significant. Results In total, 3,085 patients were identified as undergoing posterior cervical laminoplasty. Of these, 2,938 patients did not require readmission, and 147 patients were readmitted, representing a 4.77% 30-day readmission rate. For all patients, sepsis (odds ratio (OR) = 5.58, p = 0.03), dialysis (OR = 3.46, p = 0.01), American Society of Anesthesiologists class >2 (OR = 1.69, p = 0.011), and hypertension (OR = 1.51, p = 0.04) were predictive of readmission. A subgroup analysis was performed for all geriatric patients (aged >65). In total, 1,353 patients were identified, of whom 76 were readmitted, demonstrating a readmission rate of 5.62%. For the elderly patients, hypertension (OR = 1.98, confidence interval (CI) = 1.04-3.75, p = 0.04) and independent status (OR = 0.39, CI = 0.21-0.74, p = 0.004) were predictive of readmission. Conclusions Assessment of predictors for readmission is important for patient education and setting appropriate clinical expectations for surgeons and providers. Preoperative hypertension, dialysis, and sepsis were risk factors for 30-day readmission following cervical laminoplasty, with functional status being a unique risk factor for elderly patients.

Transgender gender-affirming surgery consultation among patients seeking care in the Midwestern United States.

Gender-affirming surgery (GAS) is among the most rapidly growing and expanding subfields in plastic surgery due to increased awareness, decreased stigma, rising demand, and improved access for transgender and gender non-conforming individuals (TGNC). In order to address potential barriers and facilitators in GAS education and training, there is a need to explore the experiences of TGNC individuals. The purpose of this study was to qualitatively explore the factors that influence TGNC patient experiences in surgical consultation for GAS. Targeted recruitment was used to recruit and enroll participants who identified as TGNC and who had undergone consultation with a surgeon to discuss GAS. Semi-structured interviews were used to explore patient experiences with GAS. Recorded audio from these interviews was later transcribed verbatim. Open coding of these transcripts was then performed independently by 3 individual members of the research team using the consensual qualitative coding methods. Fifteen interviews were conducted (transmale, n = 7; transfemale, n = 4; gender non-conforming/non-binary, n = 4). Participants frequently expressed worry and frustration over insurance coverage and exorbitant out-of-pocket expense, whether actual or perceived. Logistical barriers were the most frequently cited category of barriers. The majority of participants made at least 1 reference to relying on others during the process of insurance pre-authorization. The majority of participants described their interactions with surgeons as positive, indicating that they felt comfortable during consultation and that their surgeons ensured their understanding. Our findings provide important insight into this often stressful and challenging process. Ensuring a welcoming, safe, and gender-affirming environment and experience for these individuals is essential. These findings may help to guide future education for medical students, trainees, clinic staff, and surgeons, as well as to direct changes necessary to improve the patient experience in clinics and hospitals for TGNC individuals undergoing consultation for GAS.

Clinical application of 3D reconstruction in pancreatic surgery: a narrative review

Progress in medicine requires not only innovation and development in the medical field but also the integration of the technology of other fields into the medical field. As an important technological advancement, three-dimensional (3D) reconstruction transforms traditional two-dimensional images into 3D images that are more consistent with the physiological habits of human eyes. It has been applied to the bones, heart, liver, and maxillofacial area, promoting the progress of medical technology and surgeons. This article introduces the progress of 3D reconstruction technology in the clinical application of pancreatic surgery, from the preoperative, intraoperative, and postoperative perspectives, as well as the education of young surgeons. It also puts forward new ideas for the further development of pancreatic surgery.

Joint International SILACO, SICCMII, ISASS Symposium as a Model for a Collaborative Framework to Create Literature on Advances in Spine Surgery, Patient Care, and Policy.

International collaborations can be the key to overcoming innovation implementation hurdles. The authors report on a joint symposium between the International Society For The Advancement of Spine Surgery (ISASS) and La Sociedad Iberolatinoamerica de Columna (SILACO), and La Sociedad Interamericana de Cirurgia de columna de Minima invasión (SICCMII) aimed at improving joint surgeon education programs. The symposium highlighted that patient-related spine care issues are similar across geographical, cultural, and language barriers. The sustainability of such programs depends on funding and mutually respectful relationships orchestrated by multi-lingual leaders who will bridge gaps created by geographical, cultural, and language barriers to effectively develop clinical research content focused on advancing surgeon education and improving patient outcomes across the Americas.

Geographical variation in orthopedic procedures in Norway: Cross-sectional population-based study.

Standardized surgery rates for common orthopedic procedures vary across geographical areas in Norway. We explored whether area-level factors related to demand and supply in publicly funded healthcare are associated with geographical variation in surgery rates for six common orthopedic procedures. The present study is a cross-sectional population-based study of hospital referral areas in Norway. We included adult admissions for arthroscopy for degenerative knee disease, arthroplasty for osteoarthritis of the knee and hip, surgical treatment for hip fracture, and decompression with/without fusion for lumbar disk herniation and lumbar spinal stenosis in 2012-2016. Variation in age and sex standardized rates was estimated using extremal quotients, coefficients of variation, and systematic components of variation (SCV). Associations between surgery rates and the socioeconomic factors urbanity, unemployment, low-income, high level of education, mortality, and number of surgeons and hospitals were explored with linear regression analyses. Knee arthroscopy showed highest level of variation (SCV 10.3) and decreased in numbers. Variation was considerable for spine surgery (SCV 3.8-4.9), moderate to low for arthroplasty procedures (SCV 0.8-2.6), and small for hip fracture surgery (SCV 0.2). Higher rates of knee arthroscopy were associated with more orthopedic surgeons (adjusted coefficient 24.8, 95% confidence interval (CI): 2.7-47.0), and less urban population (adjusted coefficient -13.3, 95% CI: -25.4 to -1.2). Higher spine surgery rates were associated with more hospitals (adjusted coefficient 22.4, 95% CI: 4.6-40.2), more urban population (adjusted coefficient 2.1, 95% CI: 0.4-3.8), and lower mortality (adjusted coefficient -192.6, 95% CI: -384.2 to -1.1). Rates for arthroplasty and hip fracture surgery were not associated with supply/demand factors included. Arthroscopy for degenerative knee disease decreased in line with guidelines, but showed high variation of surgery rates. Socioeconomic factors included in this study did not explain geographical variation in orthopedic surgery.

Novel Microvascular Clamps to Aid Trainee Surgeon Education: Smarter Than Acland Micro Clamps?

Summary Amongst the common microsurgical errors by trainees-Inadvertent backwall suturing and incomplete bites account for 21.7% and 19.6% of the total number of errors respectively. These errors are attributed to poor visibility of the suture and needle within the vessel lumen. We aimed to analyze and compare the errors during microvascular anastomosis with the use of an adventitia holding microvascular-clamp (AHM) and a regular Acland microvascular-clamp.We performed twenty-five vascular anastomoses, twelve using the AHM clamp and thirteen controls. Overall, sixteen were venous anastomosis performed for free flaps and nine were arterial anastomosis following arterial injury. The 3 jaw adventitia holding microvascular clamp was a versatile instrument during microsurgery, as it reduced the time required for anastomosis, the need for assistance, prevented backwall sutures, and the need to flip the clamp.

Invisible Work: Advanced Practice Providers’ Role in the Education of Surgeons

As the composition and work of surgical teams evolve, the role of advanced practice providers (APPs) has expanded. We explored how APPs influence the training experience of surgeons from the perspectives of faculty, residents, and APPs. Qualitative data were obtained from semi-structured open-ended interviews. A codebook was developed blending deductive and inductive logics. Dyads independently coded the transcripts using a constant comparative approach; differences were reconciled by consensus. During 2-day site visits to 15 general surgery programs, 393 individual and small focus group interviews were conducted with residents, faculty, staff, and program leadership. Forty transcripts representing 51 interviewees (15 APPs, 23 residents, 13 faculty) were collected. We identified 4 major themes:1 APP as Educator: APPs play a significant role in resident education to ensure seamless patient care while allowing trainees room for clinical growth.2 Canary in the Coal Mine: APPs often are the first to notice a surgical trainee's mood and provide support to improve wellness.3 Division of Labor: Distribution of clinical workload has a direct impact on surgical trainees' educational experience and APP job satisfaction.4 Second-Class Citizen: APPs described experiences in which their expertise was disrespected, and their contributions were unrecognized. APPs have an active and essential role in the well-being and education of surgeons during training. Surgical residency programs and hospitals have an opportunity to decrease the "invisibility" of the work of APPs through increased recognition of these roles and elevation of APP expertise through formal career development pathways.

Mesentery in Transanal TME.

Oncological adequacy in rectal cancer surgery mandates not only a clear distal and circumferential resection margin but also resection of the entire ontogenetic mesorectal package. Incomplete removal of the mesentery is one of the commonest causes of local recurrences. The completeness of the resection is not only determined by tumor and patient related factors but also by the patient-tailored treatment selected by the multidisciplinary team. This is performed in the context of the technical ability and experience of the surgeon to ensure an optimal total mesorectal excision (TME). In TME, popularized by Professor Heald in the early 1980s as a sharp dissection through the avascular embryologic plane, the midline pedicle of tumor and mesorectum is separated from the surrounding, mostly paired structures of the retroperitoneum. Although TME significantly improved the oncological and functional results of rectal cancer surgery, the difficulty of the procedure is still mainly dependent on and determined by the dissection of the most distal part of the rectum and mesorectum. To overcome some of the limitations of working in the narrowest part of the pelvis, robotic and transanal surgery have been shown to improve the access and quality of resection in minimally invasive techniques. Whatever technique is chosen to perform a TME, embryologically derived planes and anatomical points of reference should be identified to guide the surgery. Standardization of the chosen technique, widespread education, and training of surgeons, as well as caseloads per surgeon, are important factors to optimize outcomes. In this article, we discuss the introduction of transanal TME, with emphasis on the mesentery, relevant anatomy, standard procedural steps, and importance of a training pathway.

Teachers: 2021 Upchurch Lecture.

Examples of influential teachings are drawn from the 6 decades of a single surgeon's education.

Development of Artificial Intelligence for Parathyroid Recognition During Endoscopic Thyroid Surgery.

We aimed to establish an artificial intelligence (AI) model to identify parathyroid glands during endoscopic approaches and compare it with senior and junior surgeons' visual estimation. A total of 1,700 images of parathyroid glands from 166 endoscopic thyroidectomy videos were labeled. Data from 20 additional full-length videos were used as an independent external cohort. The YOLO V3, Faster R-CNN, and Cascade algorithms were used for deep learning, and the optimal algorithm was selected for independent external cohort analysis. Finally, the identification rate, initial recognition time, and tracking periods of PTAIR (Artificial Intelligence model for Parathyroid gland Recognition), junior surgeons, and senior surgeons were compared. The Faster R-CNN algorithm showed the best balance after optimizing the hyperparameters of each algorithm and was updated as PTAIR. The precision, recall rate, and F1 score of the PTAIR were 88.7%, 92.3%, and 90.5%, respectively. In the independent external cohort, the parathyroid identification rates of PTAIR, senior surgeons, and junior surgeons were 96.9%, 87.5%, and 71.9%, respectively. In addition, PTAIR recognized parathyroid glands 3.83 s ahead of the senior surgeons (p=0.008), with a tracking period 62.82 s longer than the senior surgeons (p=0.006). PTAIR can achieve earlier identification and full-time tracing under a particular training strategy. The identification rate of PTAIR is higher than that of junior surgeons and similar to that of senior surgeons. Such systems may have utility in improving surgical outcomes and also in accelerating the education of junior surgeons. 3 Laryngoscope, 132:2516-2523, 2022.

Global geographical discrepancy in numerical distribution of cardiovascular surgeries and human resource development in South Asia

ObjectiveThe region South Asia is in the south-central part of the Asian continent. The 8 countries of the area, Afghanistan, Bangladesh, Bhutan, India, Nepal, The Maldives, Pakistan, and Sri Lanka collectively possess 1.8 billion people living in 5.1 million square miles. Covering 2.96% of World's surface, this area is inhabited by 23.9% of the world population. The objective of this study was to observe the number of cardiac operations in South Asia and the human resource development facilities of cardiac surgery in the region. MethodsInformation was collected from the surgeons and anesthetists through personal visits, phone calls, and emails. The websites of various organizations were also checked. ResultsThe estimated number of cardiac operations collectively performed in the South Asian countries was between 250,000 and 300,000 as of 2019. With more than 6 times the US population, these nations combined performed less than half of the annual number of cardiac operations performed in the United States. The number of operations per million population ranged from 62 to 271 in different countries. This indicates that there should be more capacity-building of surgeons to meet the growing demand of operations. India, Pakistan, Bangladesh, Sri Lanka, and Nepal have their own education and training systems for cardiovascular surgeons. A substantial portion of the seats available for cardiovascular surgery courses remained vacant in South Asia these days. ConclusionsFive countries have their various surgical education and training programs. There should be coordinated efforts to increase the production of new cardiac surgeons in the region.

Formalin-free soft embalming of human cadavers using N-vinyl-2-pyrrolidone: perspectives for cadaver surgical training and medical device development.

The traditional apprenticeship approach to surgical skill education for young surgeons has drastically changed to more systematic surgical training using cadavers. Cadavers fixed with formalin are not suitable for surgical training because of their associated health hazards and overhardening. Recently, we established a formalin-free soft preservation method for human cadavers using N-vinyl-2-pyrrolidone. Since 2012, 61 cadavers have been embalmed with pyrrolidone in our institution. Tissues of pyrrolidone-embalmed cadavers are soft and pliable, and their bodies can be preserved for as long as 37months without any signs of corruption. In this review, we introduce our recent attempts to apply pyrrolidone-embalmed cadavers in surgical and medical procedure training, including endotracheal intubation, motion physiology of the vocal folds, laparoscopic surgery, endoscopic skull base surgery, and development of novel medical devices. Future research perspectives on pyrrolidone embalming are discussed.

The Most-Cited Publications in Gender-Affirming Surgery: A Cross-Sectional Bibliometric Analysis.

Background: Gender-affirming surgery is becoming more common among reconstructive surgeons. Bibliometric analyses are statistical evaluations of published scientific correspondence and are a validated method of measuring influence in the scientific community. As no such bibliometric analysis has been done as of yet, the purpose of this study is to identify the characteristics of the 50 most-cited peer-reviewed articles on gender-affirming surgery. Methods: The Scopus abstract and citation database was utilized in April 2020 to search for English-language publications related to gender-affirming surgery. The 50 most-cited publications that met inclusion criteria were reviewed for various metric tabulations. Results: The 50 publications have been cited a total of 4402 times. Thirty-one (62%) were published in 2000 or later. Phalloplasty was the most discussed surgical technique, and 18 of the articles focused on female-to-male (FtM) patients. Case series (46%) and review articles (24%) were most common and there were no Level I or Level II studies. The Netherlands contributed the most, with 13 articles. Among the most frequent keywords in the 50 abstracts were "flap" and "complication". The earliest author keywords used were "transsexual" and "sex reassignment". Conclusions: The keyword usage in these abstracts over time seems to follow the trend of a more socially inclusive lexicon. A focus on studies with a higher level of evidence may optimize surgeon education and more appropriately guide clinical practice. This study reveals that the most influential and commonly referenced studies may not be sufficient to appropriately guide clinical practices.