Group Of Experienced Surgeons Research Articles

Mandibular second molar impaction: introducing a novel and validated 3D classification system

BackgroundMandibular second molar (M2M) impaction is a clinically significant manifestation of eruption disturbance in dental development. The primary aim of this study was to investigate the impact of the three-dimensional (3D) characterization on clinical and therapeutic decisions for M2M impaction. The secondary aim was to introduce a validated 3D classification system incorporating both surgical and orthodontic parameters.MethodsBidimensional (2D) and 3D radiological records of 15 impacted M2M were collected and deidentified. Ten experienced clinicians (5 oral surgeons;5 orthodontists) categorized each case, first based on 2D records and then with 3D scans. The degree of orthodontic and surgical difficulty in treating impacted M2M was evaluated using a novel classification system based on anatomical and radiological features. The primary outcome variable was the assessment of differences in diagnosis and decision-making protocol using 2D or 3D records, where clinical relevance ranged from 0 to 4. The secondary outcome variable was the validation analysis of the proposed 3D classification system to determine the concordance among the clinicians. Descriptive statistics and multivariable inferential analysis based on Akaike information criterion (AIC) were performed (α = 0.05).Results3D examination allowed a better visualization of M2M impaction with higher clinical relevance for diagnosis of M2M root relationship to alveolar nerve and lingual plate, height to alveolar crest, depth, and inclination relative to the first molar and position relative to the third molar (range:2.69–3.43). The proposed 3D classification of M2M impaction changed clinical decisions regarding surgical-orthodontic approach, biomechanics, patient education, and treatment time estimate (range:2.59–3.33). In the validation analysis of the classification, no evidence of inter- or intra-group (surgeon/orthodontist) bias in score attribution occurred: the model with the minimum AIC was the null model (AIC = 718.04).Conclusion3D evaluation of impacted M2Ms could enhance diagnostic accuracy, and a classification system was proposed and validated by a group of experienced surgeons and orthodontists with high concordance.

The Impact of Surgeon Experience on Surgical Parameters and Complication Rates for the Surgical Management of Adult Spinal Deformities: A Systematic Review and Meta-Analysis

The surgical management of adult spinal deformities (ASDs) involves a wide variety of complex and technically challenging operative techniques. Despite numerous publications examining the relationship between surgeon experience and outcomes in ASD, no systematic review or meta-analysis exists. This first-time systematic review and meta-analysis examines the impact of surgeon experience on the surgical parameters and complication rates for the surgical management of ASD. Four databases were used for the initial search of this study from database inception until 22 September 2023. The inclusion criteria required articles that examined the outcomes for surgery for ASD, stratified outcomes by surgeon experience and/or the learning curve as a proxy for surgeon experience, and utilized adult patients (>18 years of age). Seven articles met the criteria for final inclusion. Patients in the Experienced Surgeon group had statistically significantly lower levels of EBL with no significant difference in operative time after surgery for ASD compared to patients in the Inexperienced Surgeon group via a meta-analysis of three articles. Patients in the Experienced Surgeon group had a statistically significantly lower total complication rate compared to patients in the Inexperienced Surgeon group via a meta-analysis. Increased surgeon experience resulted in lower levels of EBL, without a significant difference in the operative time after surgery for ASD.

Discrepancies in recommendations for return to regular activities after cervical spine surgery: A survey study

BackgroundThe recommended timing for returning to common activities after cervical spine surgery varies widely among physicians based on training background and personal opinion, without clear guidelines or consensus. The purpose of this study was to analyze spine surgeons’ responses about the recommended timing for returning to common activities after different cervical spine procedures. MethodsThis was a survey study including 91 spine surgeons. The participants were asked to complete an anonymous online survey. Questions regarding their recommended time for returning to regular activities (showering, driving, biking, running, swimming, sedentary work, and nonsedentary work) after anterior cervical decompression and fusion (ACDF), cervical disc replacement (CDR), posterior cervical decompression and fusion (PCDF), and laminoplasty were included. Comparisons of recommended times for return to activities after each surgical procedure were made based on surgeons’ years in practice. ResultsFor ACDF and PCDF, there were no statistically significant differences in recommended times for return to any activity when stratified by years in practice. When considering CDR, return to non-sedentary work differed between surgeons in practice for 10 to 15 years, who recommended return at 3 months, and all other groups of surgeons, who recommended 6 weeks. Laminoplasty surgery yielded the most variability in activity recommendations, with earlier recommended return (6 weeks) to biking, non-sedentary work, and sedentary work in the most experienced surgeon group (>15 years in practice) than in all other surgeon experience groups (3 months). ConclusionsWe observed significant variability in surgeon recommendations for return to regular activities after cervical spine surgery.

Pancreatoduodenectomy combined with intestinal de-rotation as a complete artery-first approach for inexperienced surgeons.

Recent technical advances have reduced the incidence of intraoperative complications associated with pancreatoduodenectomy (PD). We aimed to determine whether inexperienced surgeons (ISs) would be as successful as experienced surgeons (ESs) when performing the complete artery-first approach using the intestinal de-rotation method of PD. Seventy patients who underwent PD using the intestinal de-rotation method in Tokushima University Hospital were enrolled in the present study. Intra- and post-operative parameters were compared between patients operated on by ESs (n=20) or ISs (n=50). The surgical procedure lasted longer in the IS group (ES : 402 }68 min vs. IS : 483 }51 min, p<0.0001), but the volume of blood loss was similar (p=0.7304). There was no mortality in either group, and the incidences of postoperative complications with a Clavien-Dindo grade of>III did not differ between the groups. Grade B postoperative pancreatic fistulae developed in 20.0% of patients in the ES group and 22.0% in the IS group (p=0.9569). Finally, the postoperative hospital stay of the IS group (32 }33 days) was equivarent to that of the ES group (33 }16 days) (p=0.9256). ISs were able to perform similarly successful PDs using the intestinal de-rotation method to ESs. J. Med. Invest. 71 : 75-81, February, 2024.

Three Dimensional Printing as a Tool For Anatomical Training in Lung Surgery

ObjectivePulmonary anatomy is challenging, due to the high variability and its three-dimensional (3D) shape. While demands in thoracic oncologic surgery are increasing, the transition from open to thoracoscopic surgery is hampering anatomical understanding. This study analyzed the value of a 3D printed lung model in understanding and teaching anatomy.MethodsA 3D pulmonary model was created and tested among different levels of proficiency: 10 experienced surgeons, 10 fellow surgeons and 10 junior residents. They were tested in interpretation of anatomy based on thoracic CT-scans, either using the 3D model or a 2D anatomical atlas. Accuracy of the given answers, time to complete the task and the self-reported level of certainty were scored in each group.ResultsIn the experienced surgeons group there was no difference in between the 2D-model or 3D-model with a high rate of correct answers in both groups, and no differences in time or certainty. Fellow surgeons highly benefitted from the 3D-model with an improved accuracy from 26.6% to 70.0% (p = 0.001). Time to complete the task was shorter (207 versus 122 s, p < 0.0001) and participants were more secure (median of 4 versus 3, p = 0.007). For junior residents time to complete the task was shorter, the level of certainty was higher, but there was no improvement in accuracy.Conclusions3D printing may benefit in understanding anatomical relations in the complex anatomy of the bronchiopulmonary tree, especially for surgeons in training and could benefit in teaching anatomy.

The Individual Surgeon is an Independent Risk Factor for Morbidity after Cholecystectomy. A Multivariate Analysis of 710 Patients Operated on by Experienced Surgeons

In sophisticated surgical procedures, e.g. colectomy, cardiac surgery, arterial reconstruction and liver resection, the individual surgeon is a major influence on postoperative morbidity. For the everyday procedure of cholecystectomy, clear data on the morbidity related to the individual surgeon are lacking. To assess the individual impact on the outcome of cholecystectomy in a cohort of experienced surgeons. The analysis covered n=710 consecutive patients who had received cholecystecomy between January 2014 and December 2018 - performed by experienced surgeons (> n=300 cholecystectomies before entry in the study and >5 years after specialty registration). In a univariate analysis, the influence of patient characteristics, laboratory findings and surgical data on postoperative morbidity were investigated. Variables with statistical significance were entered into a multivariate logistic regression. Mortality was 5/710 (0.7%), and morbidity was 58/710 (8.2%), including 37/710 patients with surgical morbidity and 21/710 patients with non-surgical morbidity. In a multivariable analysis the independent risk factors for overall morbidity were creatinine level (OR 1.29, CI 1.01-1.648, p=0.042), GOT (OR 1.005, CI 1-1.01, p=0.03), open/conversion surgery (OR 4.134, CI 1.587-10.768, p=0.004) and the individual surgeon (OR up to 40.675, p=0.001). In the analysis of surgical complications, open/conversion surgery (OR 8.104, CI 3.03-21.68, p<0.001) and the individual surgeon (OR up to 79.69, p=0.005) remained of significant influence. The individual surgeon is of major influence on the outcome after an everyday procedure such as cholecystectomy in a group of experienced surgeons with specialty registration. The individual outcome of each surgeon should be measured as a basis of targeted improvement programs.

Quantifying surgical skill in macular surgery.

To evaluate the relationship between patient outcome and surgical experience by developing an objective quality measure of macular hole surgery based on forceps damage to the inner retina. We retrospectively examined 3 macular hole case series >1 year after pars plana vitrectomy, internal limiting membrane peeling and gas tamponade. The patients were operated by (1) a novice surgeon (<20 cases), (2) an intermediate (150+ cases) and (3) an experienced surgeon (2000+ cases). Primary outcome was inner retinal volume defect as segmented from optical coherence tomography (GCL++: thickness from internal limiting membrane to inner plexiform layer). Secondary outcome was retinal function measured by confocal microperimetry using a custom scanning protocol. Thirty-two patients were examined: 11, 10 and 11 patients in the novice, intermediate and experienced surgeon group, respectively. Median GCL++ volume defect was 23.68 × 106 μm3 (IQR: 22.77 × 106 -44.81 × 106 μm3 ), 8.42 × 106 μm3 (IQR: 4.86 × 106 -10.03 × 106 μm3 ) and 3.55 × 106 μm3 (IQR: 1.44 × 103 -7.94 × 106 μm3 ) in the novice, intermediate and experienced surgeon group, respectively (p = 0.0004). The novice surgeon volume defect differed significantly from the intermediate and experienced surgeon (p = 0.016 and p = 0.0002, respectively). A subset of 12 patients underwent microperimetry measurements demonstrating correlation between inner retinal volume defect and reduced retinal sensitivity (p = 0.02). Forceps induced inner retinal damage commonly occurs during initiation of internal limiting membrane peeling in macular hole surgery. Damage to the structure and function of the inner retina seems to correlate to surgical experience.

Influence of operator volume on early outcomes of septal myectomy for isolated hypertrophic obstructive cardiomyopathy.

BackgroundGuidelines on the diagnosis and management of hypertrophic cardiomyopathy (HCM) recommend that septal myectomy be performed by experienced operators. However, the impact of operator volume on surgical treatment outcomes for isolated HCM has been poorly investigated.MethodsFrom 2002 to 2014, 435 consecutive patients with isolated HCM undergoing myectomy at the Fuwai Hospital were retrospectively enrolled. All 29 surgeons were divided into beginner surgeons (operator volume ≤20) and experienced surgeons (operator volume >20) according to the guidelines for the diagnosis and treatment of HCM. Propensity score matching of patients in the two groups was performed.ResultsBaseline differences included advanced New York Heart Association classification and older age in the experienced surgeon group. After matching, in the beginner surgeon group (107 cases), residual obstruction (18.7% vs. 0.9%, P<0.001) was more common, and the postoperative left ventricular outflow tract pressure gradient (20.7±15.1 vs. 14.3±7.4 mmHg, P<0.001) was higher than that of the experienced surgeon group. In the experienced surgeon group (107 cases), the incidence of mitral valve replacement (1.9% vs. 11.2%, P<0.001) and permanent pacemaker implantation (1.9% vs. 3.7%, P<0.001) was significantly lower than that in the beginner surgeon group. However, there was no difference in procedural mortality (1.9% vs. 1.9%) between the two groups.ConclusionsOperator volume is an important factor in achieving better obstruction obliteration after septal myectomy in patients with isolated HCM.

Association Among Surgeon Experience, Patient Risk, and Outcomes in Coronary Artery Bypass Grafting

There is an association between surgeon experience and outcomes after cardiac surgery. However, this association is not well studied in the context of patient risk. The purpose of this single-center, retrospective, observational study was to describe how surgeon experience relates to patient risk in isolated coronary artery bypass grafting (CABG) surgery and how this impacts patient outcomes. Surgeon experience was defined as time between the surgeon finishing fellowship and date of the patient's surgery. Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (PROM) was used to define patient risk. The Kaplan-Meier method was used to calculate long-term survival, and multivariable Cox proportional hazards regression was used to determine the effect of surgeon experience on survival. Between 2002 and 2018, 7652 patients underwent isolated CABG. STS PROM was 1.35% (interquartile range [IQR], 0.70%-2.80%), 1.55% (IQR, 0.79%-3.34%), 1.78% (IQR, 0.84%-3.84%), and 1.19% (IQR, 0.62%-2.41%) in surgeon experience quartiles 1 (0.01-6.05 years), 2 (6.05-11.5 years), 3 (11.5-16.6 years), and4 (16.6-32.1 years), respectively (P < .001). For patientsin the lowest PROM quartile, Kaplan-Meier survival was similar across surgeon experience groups (P= .66). For patients in the highest PROM quartile, increasing surgeon experience was associated with better survival (P < .001). Cox regression identified surgeon experience as a protective factor (hazard ratio, 0.99, P=.027). In the least experienced surgeon group, increased ejection fraction was a protective factor for long-term survival (hazard ratio, 0.97; 95% confidence interval, 0.95-0.99). Increasing surgeon experience is associated with higher-risk patients, but the most experienced surgeons take on lower-risk patients. Greater experience correlates with improved outcomes, especially with higher-risk cases.

Accuracy of acetabular cup placement using an angle-adjusting alignment guide with laser pointer in total hip arthroplasty.

To evaluate cup-positioning accuracy in total hip arthroplasty (THA) using a novel angle-adjusting alignment guide with laser pointer and determine whether level of surgical experience affects accuracy of cup placement or not. We included 117 hips in 104 patients who underwent THA using the novel guide. We retrospectively reviewed 44 hips in 40 patients who underwent THA before the novel guide was introduced. We compared differences in cup angles between the novel guide group and the conventional guide group as well as the discrepancies in targeted angles between the experienced surgeon group and the inexperienced surgeon group. There were 114/117 hips (97.4%) within the Lewinnek safe zone in the novel guide group and 32/44 hips (72.7%) within the safe zone in the conventional guide group. There were significantly fewer outliers in the novel guide group (p < 0.001). In the experienced surgeon group, the mean absolute errors in inclination and anteversion were 2.0 ± 1.7° and 2.1 ± 2.3°, respectively; which were not significantly different from those in the inexperienced surgeon group (2.3 ± 2.1° and 2.8 ± 2.3°, respectively). The novel angle-adjusting alignment guide with laser pointer is a simple tool that provides better accuracy of cup position than that obtained using conventional guides. Accurate cup placement is possible using the novel guide, regardless of surgeons' experience.

Oncological safety of transanal total mesorectal excision (TaTME) for rectal cancer: mid-term results of a prospective multicentre study.

There is no consensus regarding the gold standard technique for rectal cancer as Total Mesorectal Excision (TME) may be safely performed either by open or minimally invasive surgery. The laparoscopic approach, however, may carry technical difficulties. For this reason, a novel technique has emerged in the last decade combining a dual laparoscopic dissection (abdominal and transanal) to perform the TME technique (TaTME). When focusing on oncological outcomes, there is a lack of literature regarding mid-long term results. The aim of this study is to evaluate the mid-term oncological impact of TaTME for treating rectal cancer. A prospective multicentre study was performed in four tertiary centres including consecutive patients who underwent TaTME for mid-low rectal cancer by the same group of experienced surgeons. The analysed data included pathological results on the quality of TME and mid-term oncological outcomes. In total, 173 patients were included throughout a study period of 6years. Our series included 70% males and 68% of patients with neoadjuvant treatments. The median follow-up was 23 [15-37.5] months. Regarding pathological results, a complete TME was achieved in 72.8%, while circumferential and distal margins were affected in 1.4 and 1.1%, respectively. Five patients developed local recurrences (3%) and 8.1% presented distant disease during the follow-up. The 2-year disease-free survival and the overall survival rates were 88% and 95%, respectively. There is currently a lack of evidence in the literature regarding TaTME and oncological outcomes with no data available from randomized clinical trials. In the meantime, the reported results from different multicentre series are controversial. This study showed positive mid-term outcomes at 2 years of follow-up and supported notable oncological outcomes with TaTME. However, it must be emphasized that previous experience in minimally invasive and transanal surgeries is essential for surgeons before intending to perform TaTME.

Retzius-sparing Robotic Radical Prostatectomy for Surgeons in the Learning Curve: A Propensity Score–matching Analysis

BackgroundSeveral authors claimed that the Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) needs a prolonged learning curve, and outcomes during this phase could be suboptimal. ObjectiveTo verify the safety and outcomes of RS-RARP performed by young surgeons during the learning curve. Design, setting, and participantsWe conducted a retrospective analysis of the pre-, intra-, and postoperative features of all the patients who underwent RS-RARP from 2013 to 2017. We divided our patients into two groups: patients operated by two experienced surgeons (ESs) with >100 procedures and patients operated on by five younger surgeons in the learning curve (LCSs). LCSs had no previous experience in radical prostatectomy, and the very first RS-RARP procedures of each LCS case are included in the analysis. Outcome measurements and statistical analysisPerioperative, oncological, and functional data were analyzed. Short-term oncological results were reported as positive surgical margins (PSMs) and 1-yr disease-free survival. Complications were graded according to the Clavien-Dindo system. Potency was defined as erections sufficient for intercourse; continence was defined as no pad or one safety liner. A propensity score–matching analysis was used to adjust the difference in baseline preoperative parameters between the groups. Results and limitationsWe obtained two homogeneous groups of 256 patients each. After the matching, preoperative variables were similar in the two groups. The mean console time was longer for younger surgeons (98 vs 122 min, p < 0.001). Postoperative course, complications, and functional results were similar in the two groups; the final pathological analysis showed a worse T stage in the ES group (p = 0.017). PSMs and 1-yr disease-free survival did not differ between the groups. ConclusionsRS-RARP can be safely performed by inexperienced surgeons who have received adequate training. Patient summarySurgeons in the learning curve can perform Retzius-sparing robot-assisted radical prostatectomy safely, with similar early oncological results and functional outcomes.

Ten-Year Experience With the Anterior Approach to Total Hip Arthroplasty at a Tertiary Care Center

BackgroundThe anterior approach (AA) to total hip arthroplasty (THA) has advantages for patients and healthcare providers. However, some studies have reported high rates of adverse events when introducing AA-THA. This was not consistent with our center’s experience, where 4 senior surgeons safely introduced AA-THA into practice. The purpose of this study is to define the adverse event rates associated with the introduction of AA-THA by a group of experienced surgeons at a single tertiary care center and define experiential factors that may modify adverse event rates. MethodsRetrospective review of prospectively collected data for an observational cohort of all patients undergoing a THA between 2006 and 2017 was conducted. Four senior surgeons at a single institution operated on 1087 primary elective hips using AA-THA. ResultsBetween 2006 and 2016, AA-THA rose from 1.5% to 53.2% of annual THA. Adverse events included intraoperative events, early postoperative periprosthetic fractures, dislocation, implant failure, early infection, and wound complications. We observed an overall 90-day adverse event rate of 6.4% (of 1087 hips). The adverse event rate was 41.6% (of 12 hips) in the first 12 months of the study period and 3.6% (of 166 hips) in the final 12 months of the study period reviewed. Sixty hips (5.5%) required a reoperation with or without revision of components, 1 (8.3%) in the first 12 months of the study period and 1 (0.6%) in the final 12 months of the study period. Infection and wound complications were the most common causes of reoperation at 1.8% for all cases (20 hips). Higher rates of adverse events are associated with early procedures (n ≤ 15) for all surgeons but showed no statistically significant impact on 5-year survival rate. ConclusionOur experience demonstrates that AA-THA can be introduced into practice with an acceptable adverse event rate when compared with other approaches to THA. As expected the incidence of adverse events is higher in the early part of the learning curve. Surgeon mentoring in the first 20 cases should be considered to minimize risk of adverse events. Level of EvidenceTherapeutic Level III.

Objective classification of psychomotor laparoscopic skills of surgeons based on three different approaches.

The determination of surgeons' psychomotor skills in minimally invasive surgery techniques is one of the major concerns of the programs of surgical training in several hospitals. Therefore, it is important to assess and classify objectively the level of experience of surgeons and residents during their training process. The aim of this study was to investigate three classification methods for establishing automatically the level of surgical competence of the surgeons based on their psychomotor laparoscopic skills. A total of 43 participants, divided into an experienced surgeons group with ten experts (> 100 laparoscopic procedures performed) and non-experienced surgeons group with 24 residents and nine medical students (< 10 laparoscopic procedures performed), performed three tasks in the EndoViS training system. Motion data of the instruments were captured with a video-tracking system built into the EndoViS simulator and analyzed using 13 motion analysis parameters (MAPs). Radial basis function networks (RBFNets), K-star (K*), and random forest (RF) were used for classifying surgeons based on the MAPs' scores of all participants. The performance of the three classifiers was examined using hold-out and leave-one-out validation techniques. For all three tasks, the K-star method was superior in terms of accuracy and AUC in both validation techniques. The mean accuracy of the classifiers was 93.33% for K-star, 87.58% for RBFNets, and 84.85% for RF in hold-out validation, and 91.47% for K-star, 89.92% for RBFNets, and 83.72% for RF in leave-one-out cross-validation. The three proposed methods demonstrated high performance in the classification of laparoscopic surgeons, according to their level of psychomotor skills. Together with motion analysis and three laparoscopic tasks of the Fundamental Laparoscopic Surgery Program, these classifiers provide a means for objectively classifying surgical competence of the surgeons for existing laparoscopic box trainers.

The Safety and Efficacy of Total Laparoscopic Distal Gastrectomy With Delta-Shaped Anastomosis Compared With Laparoscopic-Assisted Distal Gastrectomy

Aim: To evaluate the safety and short-time benefits of enhanced recovery after surgery on hospital stay, recovery of gastrointestinal function and complications after total laparoscopic distal gastrectomy (TLDG) with delta-shaped anastomosis, comparing with laparoscopic-assisted distal gastrectomy (LADG). Methods: A retrospective analysis was performed in 134 patients with gastric cancer who were treated at Wuhan General Hospital of Guangzhou Military Area Command from November 2013 to August 2015. A total of 70 patients underwent TLDG, and 64 patients underwent LADG. All patients were performed elective standard D2 total gastrectomy by 1 group of experienced surgeons. The short-term therapeutic benefits, including duration of flatus and defecation, postoperative pain, duration of postoperative stay, and complications between the 2 groups were analyzed. Results: Compared with LADG, TLDG had shorter time to the first flatus (74.09 ± 11.08 hours versus 84.11 ± 12.18 hours, P &amp;lt; 0.001), earlier postoperative liquid diet intake (98.83 ± 10.63 hours versus 108.58 ± 13.08 hours, P &amp;lt; 0.001), less dosage of pain killers (2.01 ± 0.85 versus 2.41 ± 0.85, P = 0.009), faster recovery with a shorter postoperative hospital stay (8.14 ± 0.3.43 days versus 9.97 ± 4.53 days, P = 0.009), There were no significant difference in operation time, blood loss, the number of lymph nodes retrieved, or the incidence of postoperative complications (anastomotic bleeding or leakage, wound infection, digestive tract dysfunction, thrombosis, or death; P &amp;gt; 0.05). Conclusions: TLDG with delta-shaped anastomosis is a safe and effective fast-tract surgical approach for earlier gastric cancer, which would probably achieve the short-term curative effect. Further studies based on larger volumes and long-term effects are required to confirm these findings.

The Safety and Efficacy of Total Laparoscopic Distal Gastrectomy With Delta-Shaped Anastomosis Compared With Laparoscopic-Assisted Distal Gastrectomy

Aim: To evaluate the safety and short-time benefits of enhanced recovery after surgery on hospital stay, recovery of gastrointestinal function and complications after total laparoscopic distal gastrectomy (TLDG) with delta-shaped anastomosis, comparing with laparoscopic-assisted distal gastrectomy (LADG). Methods: A retrospective analysis was performed in 134 patients with gastric cancer who were treated at Wuhan General Hospital of Guangzhou Military Area Command from November 2013 to August 2015. A total of 70 patients underwent TLDG, and 64 patients underwent LADG. All patients were performed elective standard D2 total gastrectomy by 1 group of experienced surgeons. The short-term therapeutic benefits, including duration of flatus and defecation, postoperative pain, duration of postoperative stay, and complications between the 2 groups were analyzed. Results: Compared with LADG, TLDG had shorter time to the first flatus (74.09 ± 11.08 h versus 84.11 ± 12.18 h, P &amp;lt; 0.001), earlier postoperative liquid diet intake (98.83 ± 10.63 h versus 108.58 ± 13.08 h, P &amp;lt; 0.001), less dosage of pain killers (2.01 ± 0.85 versus 2.41 ± 0.85, P = 0.009), faster recovery with a shorter postoperative hospital stay (8.14 ± 0.3.43 d versus 9.97 ± 4.53 d, P = 0.009), There were no significant difference in operation time, blood loss, the number of lymph nodes retrieved, or the incidence of postoperative complications (anastomotic bleeding or leakage, wound infection, digestive tract dysfunction, thrombosis, or death; P &amp;gt; 0.05). Conclusions: TLDG with delta-shaped anastomosis is a safe and effective fast-tract surgical approach for earlier gastric cancer, which would probably achieve the short-term curative effect. Further studies based on larger volumes and long-term effects are required to confirm these findings.

10: Validation of an educational simulation model for vaginal hysterectomy training

Our aim was to evaluate the validity and reliability of the Miya Model for vaginal hysterectomy skills assessment and training. Video recordings of physicians at varied levels of training and experience were objectively assessed performing vaginal hysterectomy upon the Miya model using a modified 10-item Vaginal Surgical Skills Index (VSSI). Participants included OB/GYN residents and faculty gynecologists from 5 different institutions. The research protocol was reviewed by each IRB participating in the study and found to be exempt. Surgeons were instructed to perform a vaginal hysterectomy. Each participant was given a maximum of 60 minutes and had one surgical assistant. All procedures involving the simulated vaginal hysterectomy were video recorded and then assessed by a group of experienced surgeons. The surgeons evaluating the video performances were divided into groups such that none would be evaluating participants from their separate institutions. All evaluating surgeons were blinded to the participant’s level of training. A total of 54 surgeons were assessed. The average composite score was 24.1, (SD 10.4; (range1 to 40). The internal consistency of the VSSI was excellent (Cronbach's alpha = 0.97). Convergent validity was very good. The composite VSSI score correlated highly with the GRS (Pearson r = 0.92, P < .001). Using a cutoff of 27 as the lowest passing score, agreement was very good with the current pass/fail result. Of 126 assessments, 2 failed under the current standard but had a composite score >=27, and 13 passed under the current standard but had a composite score <27, for an 88% overall agreement. Interrater reliability of VSSI, as measured by the intra-class correlation coefficient, was moderate to good and ranged from .485 to .951. In comparison, interrater reliability of GRS ranged from .50 to .87. Both scales were able to discriminate not only between novice and expert surgeons but also discriminated between training levels (table 1). The correlation between the VSSI total score and training level was .81 (p<001) and between the GRS scores was .74 (p<0.001). This study demonstrates the Miya Model is a useful tool for assessing vaginal hysterectomy skills. We successfully demonstrated good interrater reliability and validity of the MIYA model as an assessment and training tool. We were able to demonstrate that experts were more skillful at performing vaginal hysterectomies than novices as assessed using VSSI and the global rating scales. VSSI and GRS scores were also correlated with postgraduate years, which was significant.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Three-dimensional force analysis of surgical manipulations at the long process of the incus.

Surgical manipulation with application of inappropriate force may damage middle ear structures leading to hearing loss. This work analyzes the forces applied in simulated otosurgical exercises in a laboratory set-up by measuring the spatial components of applied forces with objective assessment criteria. With these criteria, the individual force characteristics applied by the surgeon can be quantified and an objective feedback can be given about their surgical maneuvers. A natural size model of the human incus was mounted on a load cell to measure the spatial forces in all three directions during different manipulation tasks performed under the microscope by ten surgeons from our department having different levels of experience in otosurgery. The motions of the incus model and the instrument tip were recorded simultaneously with a video camera. Independent of surgical experience, a three-dimensional force pattern could be detected with components transverse to the desired force directions. The measured forces applied by trainees showed larger variations in magnitude, in spatial distribution and in temporal course than those applied by experienced surgeons. A better repeatability of identical tasks, constancy of force patterns and low peak force values could be seen in the group of experienced surgeons. The laboratory system presented in this study using simultaneous video and 3-D force registration allows the objective assessment of surgical manipulations, e.g., at the long process of the incus. Training with video and force feedback provides information about surgical techniques and skill development of surgeons and has the potential to shorten the learning curve and to diminish intra-operative risks to patients.

Youth and Experience: The Effect of Surgeon Experience on Outcomes in Cerebral Palsy Scoliosis Surgery

BackgroundSeries on the learning curve in spinal deformity surgery have been published, but none has addressed neuromuscular spinal deformity, comprised of arguably the most complex cases. We present the first multi-center analysis of the impact of surgeon experience on neuromuscular spinal deformity surgery. MethodsA multi-center prospective study of spinal deformity surgery for cerebral palsy (CP) with at least 2 years of follow-up provided the dataset for assessment. Surgeons were categorized into one of two groups based on their self-reported first year of practice: an experienced surgeons (ES) group included those with at least 10 years of experience at the time of surgery and a young surgeons (YS) group included those with fewer than 10 years of experience at time of surgery. Groups were compared in multiple pre-operative, operative, and post-operative outcomes. ResultsThe YS group had 8 surgeons who performed 59 surgeries; the ES group had 13 surgeons who performed 103 cases, with one surgeon's cases distributed in both groups. The YS group had a greater proportion of patients with severe mental retardation (89.7% vs. 68.6%, p = .01). Duration of surgery was greater in the YS group (456 vs. 344 minutes, p < .001). The mean number of levels fused was greater in the ES group (15.9 vs. 15.6, p = .024), caused by increased variation in the upper level of fusion among the ES group. No significant differences were found between groups for estimated blood loss, length of hospitalization, or in percentage of Cobb correction. Years of experience of the operating surgeon was inversely correlated with duration of surgery (rho = −0.476, p < .001). ConclusionsIn performing scoliosis surgery on CP patients, surgeons with fewer than ten years of practice experience demonstrate significantly greater average operative time and decreased mean number of levels fused, yet produce similar clinical outcomes to more experienced surgeons. Level of EvidenceLevel III, therapeutic.

Intraocular surgery - assessment and transfer of skills using a virtual-reality simulator.

Intraocular surgery - assessment and transfer of skills using a virtual-reality simulator.