New Generation Of Surgeons Research Articles

Educational challenges and opportunities for the future generation of surgeons: a scoping review.

Surgery offers exciting opportunities but comes with demanding challenges that require attention from both surgical program administrators and aspiring surgeons. The hashtag #NoTrainingTodayNoSurgeonsTomorrow on 𝕏 (previously Twitter) underscores the importance of ongoing training. Our scoping review identifies educational challenges and opportunities for the next generation of surgeons, analyzing existing studies and filling gaps in the literature. Following the PRISMA guidelines, MEDLINE/PubMed was searched in February 2022, using the MeSH terms "surgeons/education," for articles in English or German on general, abdominal, thoracic, vascular, and hand surgery and traumatology targeting medical students, surgical residents, future surgeons, and fellows. The initial search yielded 1448 results. After a step-by-step evaluation process, 32 publications remained for complete review. Three main topics emerged: surgical innovations and training (n = 7), surgical culture and environment (n = 19), and mentoring (n = 6). The articles focusing on surgical innovations and training mainly described the incorporation of structured surgical training methods and program initiatives. Articles on surgical culture examined residents' burnout, well-being, and gender issues. Challenges faced by women, including implicit bias and sexual harassment, were highlighted. Regarding mentoring, mentees' needs, training challenges, and the qualities expected of both mentors and mentees were addressed. At a time of COVID-19-driven surgical innovations, the educational and working environment of the new generation of surgeons is changing. Robotic technology and other innovations require future surgeons to acquire additional technological and digital expertise. With regard to the cultural aspects of training, surgery needs to adapt curricula to meet the demands of the new generation of surgeons, but even more it has to transform its culture.

There is a need for a paradigm shift in laparoscopic surgical training: results of a nationwide survey among teaching hospitals in Switzerland.

Surgical training curricula have changed little over the past decades. Current advances in surgical techniques, especially in minimally invasive surgery, as well as the rapidly changing socioeconomic environment pose a major challenge for the training of young surgeons. The aim of this survey was to provide a representative overview of the surgical training landscape in Switzerland focusing on laparoscopic surgical training: How do department chairs of teaching hospitals deal with the above challenges, and what should a future training curriculum look like? This is a prospective, questionnaire-based, cross-sectional study among the heads of departments of all certified surgical teaching hospitals in Switzerland. The overall response rate was 56% (48/86) and 86% (19/22) for tertiary centers. Two-thirds of the centers (32) organize themselves in training networks. Laparoscopic training courses are offered in 25 (52%) hospitals, mainly in tertiary centers. Self-training opportunities exist in 40 (83%) hospitals. In addition to commercial (27) and self-built (7) box trainers, high-fidelity trainers are available in 16 (33%) hospitals. A mandatory training curriculum exists in 7 (15%) facilities, and a training assessment is performed in 15 (31%) institutions. Thirty-two (65%) heads of departments indicated that residents have sufficient practical exposure in the operating room, but the ability to work independently with obtaining the specialist title is seen critically (71%). They state that the surgical catalog does not adequately reflect the manual skills of the resident (64%). The desire is for training to be restructured from a numbers-based to a performance-based curriculum (53%) and for tools to assess residents' manual skills (56%) to be introduced. Department chairs stated that the existing curriculum in Switzerland does not meet the requirements of a modern training curriculum. This study highlights the need to create an improved, competency-based curriculum that ensures the training of a new generation of surgeons, taking into account the growing evidence of the effectiveness of state-of-the-art training modalities such as simulation or proficiency-based training.

Robotic pyeloplasty learning curve for a pediatric surgeon without previous laparoscopic pyeloplasty experience.

Robotic pyeloplasty has become a technique of choice for pyelo-ureteral junction syndrome treatment in children. Less invasive than open surgery, robotic pyeloplasty also has a lower learning curve than laparoscopic pyeloplasty. This is how a new generation of surgeons without previous laparoscopic pyeloplasty experience has begun training in robotics. To assess the robotic assisted pyeloplasty learning curve for a pediatric surgeon only trained in open pyeloplasty, and to investigate if that mode of practice is safe and effective. Data were collected from all children operated on for pyelo-ureteral junction syndrome by the same surgeon in our center between 2015 and 2021. Cases were divided into 4 groups of 14 consecutive procedures to analyze the learning curve. Fifty-six patients were operated on, with a median (IQR) age, weight, and hospital stay of 9years and 1month old (3.5), 29kg (17.3), and 3days (2), respectively. The mean ± SD operative times were 146.5 ± 39.3, 123.2 ± 48.1, 103.1 ± 29.5, and 141.7 ± 25.0min, with a unique significant difference between groups 1 and 3 (p = 0.007**). Only two intraoperative and nine postoperative complications were observed. The surgery was successful in 98% cases. Our study shows that a significant improvement in surgical time could be achieved in the first 30 cases, safely and efficiently even without previous laparoscopic pyeloplasty experience.Level of evidence: III.

Increasing Levels of Evidence in Rhinoplasty: Stepping Up Our Role as Leaders in the Specialty.

Increasing Levels of Evidence in Rhinoplasty: Stepping Up Our Role as Leaders in the Specialty.

Ileal pouch-anal anastomosis; 18 years of experience and outcomes across two generations of surgeons at a tertiary center in Sweden

Aim Reconstructive surgery with ileal pouch-anal anastomosis (IPAA) is the standard procedure after colectomy in patients with Ulcerative Colitis (UC) and Familial Adenomatous Polyposis (FAP). It is of interest to understand how a generation shift of the surgeons performing IPAA has affected patients’ outcomes. Method All consecutive patients who underwent IPAA in the period 1999–2016 at Sahlgrenska University Hospital/Östra, Gothenburg, Sweden, were included. Surgeons representing two different generations performed the surgeries during this period. The following 6-year time periods were assigned for surgeries performed by: experienced surgeons (1999–2004; Period 1); the new generation of surgeons undergoing training (2005–2010; Period 2); and the new generation of experienced surgeons (2011–2016; Period 3). The primary endpoint was post-operative complications (Clavien-Dindo ≥3b), and the secondary endpoints were the functional outcome, failure of the pouch, and mortality. Logistic analyses of the results were performed. Results Overall, 281 patients were included in the study. The rate of post-operative severe complications was lower in Period 1 [Odds Ratio (OR) 0.137; p = .01]. There was no difference in functional outcome between the groups. Conclusion This study implicates that the risk of post-operative complications after IPAA is lower when the surgery is performed by a generation of more-experienced surgeons. This might support literature that concludes that surgical units that have a high throughput of patients and are staffed by surgeons who perform many procedures provide better outcomes.

CORR Insights®: No Difference in Functional, Radiographic, and Survivorship Outcomes Between Direct Anterior or Posterior Approach THA: 5-Year Results of a Randomized Trial.

CORR Insights®: No Difference in Functional, Radiographic, and Survivorship Outcomes Between Direct Anterior or Posterior Approach THA: 5-Year Results of a Randomized Trial.

Experience of the Orthopedic Surgeon in the Management of War Victims

Surgery for victims of war is different from surgery for civilian injuries. War wounds are always extremely contaminated, and missiles may cause massive destruction of soft tissues, bones, and other structures. The principles of surgery for war wounds have been known for decades but need to be relearned by each new generation of surgeons working in a war situation. People were not at all prepared for a physical fight. Similarly, the medical institutes were not specially prepared for such a sea of casualties all of a sudden. The study’s aim was to analyze the result of the experience in the surgical management of the gunshot patients admitted to Al-Bayda teaching hospital during the first month of the Libyan revolution of February 2011. The total number of patients admitted to Al-Bayda teaching hospital in the period from 16\2\2011 to 16\3\2011 was 288 patients. Debridement and repair of the wounds and fixation of fractures in different settings and follow-up was carried out for 7 months. Orthopedic morbidity rate was 9 %, and infection was recorded in 30 patients 21%. As a team of orthopedic, vascular, and general surgeons, very good exposure and experience was gained to manage war or civilian unrest victims.

To a New Normal: Surgery and COVID-19 During the Transition Phase.

To a New Normal: Surgery and COVID-19 During the Transition Phase.

A Survey of Heads of Surgery and Residents on Accessibility and Employment in Liver Transplant Teams in Spain

IntroductionThe access of surgeons to liver transplant teams in Spain is heterogeneous. This study aims to portray the current human resources of Spanish transplant teams, distribution of transplant duties among team members, how transplant team members acquire their skills, their leaders’ view of their future, as well the motivations of Spanish General Surgery residents to choose transplantation as their future career choice. MethodsTwo different surveys were created, one for head surgeons and one for residents, about the number of team members and their training, recruitment, organization of tasks and motivation to work in transplantation. The questionnaires were e-mailed to both the transplant program directors and the surgical residents. ResultsThere are on average 8 surgeons in each transplant unit. More than four surgeons perform the hepatectomy in 54.2% of the groups, while the graft implantation is performed by more than 4 surgeons at just 25% of the centers. Forty-two percent of the transplant chiefs advocated a fellowship training system, and 87.5% believe that generational turnover is guaranteed.Out of 525 residents, 101 responded. Regarding training, 12.8% had no interest in transplantation. Concerning their work preferences, 37.6% were not interested in transplantation because it is excessively demanding, and 52.5% would not like to be part of a liver transplant team in the future. ConclusionsThe generational turnover seems to be guaranteed according to liver transplant program directors. The new generations of surgeons generally opt for other areas of surgery other than transplantation. Studies with a greater number of responses are necessary to validate these results.

Encuesta a los jefes de Unidad y residentes de Cirugía sobre la accesibilidad y el trabajo en los equipos de trasplante hepático en España

IntroductionThe access of surgeons to liver transplant teams in Spain is heterogeneous. This study aims to portray the current human resources of Spanish transplant teams, distribution of transplant duties among team members, how transplant team members acquire their skills, their leaders’ view of their future, as well the motivations of Spanish General Surgery residents to choose transplantation as their future career choice. MethodsTwo different surveys were created, one for head surgeons and one for residents, about the number of team members and their training, recruitment, organization of tasks and motivation to work in transplantation. The questionnaires were e-mailed to both the transplant program directors and the surgical residents. ResultsThere are on average 8 surgeons in each transplant unit. More than four surgeons perform the hepatectomy in 54.2% of the groups, while the graft implantation is performed by more than 4 surgeons at just 25% of the centers. Forty-two percent of the transplant chiefs advocated a fellowship training system, and 87.5% believe that generational turnover is guaranteed.Out of 525 residents, 101 responded. Regarding training, 12.8% had no interest in transplantation. Concerning their work preferences, 37.6% were not interested in transplantation because it is excessively demanding, and 52.5% would not like to be part of a liver transplant team in the future. ConclusionsThe generational turnover seems to be guaranteed according to liver transplant program directors. The new generations of surgeons generally opt for other areas of surgery other than transplantation. Studies with a greater number of responses are necessary to validate these results

From bedside to bench: an evaluation of expectations and challenges encountered by young surgeons facing basic science

Background: The evolution of surgical practice may lead to increasing difficulties for surgeons to perform fundamental research. The aim of this study was to evaluate the expectations and the challenges encountered by young surgeons when starting basic science.Methods: A qualitative study was conducted in France. A written questionnaire was anonymously filled by the participants attending to the Master Degree in surgical science.Results: The study included 47 participants (median age: 28 years, 59.6% of men); 37 (78.7%) participants had applied for a grant for their salary and 32 (68.1%) had obtained it. Nine (19.1%) participants had planned to keep their usual clinical activity. The main motivations were the perspective to embark on an academic career (55.3%) and improvement of knowledge in science (38.3%). The main barriers encountered were the lack of time (70.2%), the lack of interest (27.7%), the lack of financial support (23.4%) and administrative difficulties (12.8%).Conclusion: This study identified main barriers that young surgeons have to face when getting involved in basic science underlining the need to improve institutional and financial support to ensure involvement of new generations of surgeons in surgical research.

Journal's Award in 2018: Andrii V. Kopchak, ScD, Professor

Andrii V. Kopchak, Doctor of Medical Sciences (ScD), Professor serves in the Bogomolets National Medical University as: • Professor, Department of Dentistry, Institute of Postgraduate Education. • Director, Dental Medical Center. Also Dr. Kopchak does his best as a Director in the Center of Maxillofacial Surgery and Dentistry, Kyiv Regional Clinical Hospital. From 2019 Dr. Kopchak headed a Kyiv Branch of the Association of Dentists of Ukraine. With a whole editorial staff we are more than grateful for an amazing assistance to the Journal that Dr. Kopchak does not only with the inspiring articles (co-authors: Romanova and Mykhailenko), (Hresko, Chernohorskyi, and Vereshchagin) but also in his work at a position of Section Editor─Osteosynthesis of Facial Bones from the Issue 3─4, 2017. So, we feel so humbled when we gave the Journal`s honorary plaque to Professor Kopchak. But we find the next words: “For the unique skills in organization of OMS meetings, uniting and educating the new generations of surgeons sincere thanks and appreciation.”

What is the best strategy program to acquire video-assisted thoracoscopic surgery lobectomy technique?

I would like to thank Konge et al . (1) for the interest and comment about my article. I take this opportunity to voice our point of view on the need of the specific video-assisted thoracoscopic surgery (VATS) lobectomies training program, whose methods focused on the different opinions of surgeons. While in the past VATS approach represented only the smallest part of total lobectomies, today this is around 90% of total interventions in high-volume centers. The new generations of surgeons are faced with the necessity to quickly acquire the mastery of this technique, with the best planning which still arouses debate and controversy among experienced colleagues.

From the Terminology Based on Eponyms in Surgery, to the International Anatomical Terminology: A Great Abyss that Can Be Avoided

In surgical sciences the use of language based on morphological eponyms, which have no descriptive or informative value of an anatomical structure is common, perhaps because these professionals know or have forgotten that there is a anatomical terminology that seeks to unify communication and facilitate learning. Eradicating the eponymous form the surgical sciences is a difficult task, because their use is still reinforced in textbooks, scientific papers and conferences, among others, thus promoting the use of a chaotic and confusing language. Therefore, the need arises to strengthen the use of Anatomical Terminology in new generations of surgeons, as clearer and more accurate communication will be achieved between health professionals and will also facilitate the teaching-learning process.

Future strategy of surgical simulations in video-assisted thoracic surgery

Video-assisted thoracic surgery (VATS) has come to be the primary operative procedure in thoracic surgery as the method of choice for the treatment of a variety of lung diseases. As VATS has acquired widespread favor with the development of techniques and instrumentation, indications for VATS have further expanded. However, many facilities have yet to adopt this approach for anatomical lung resections. In terms of building VATS educational platforms, standardization of the training programs that is based on risk-free based teaching strategies is essential. Today, surgical simulations have a pivotal role in increased patient safety and reduction of the risk of surgical errors as a desired part of the training model for not only residents but also consultants who need to acquire new techniques. There are two different categories of surgeons requiring skills of thoracoscopic procedure who must be considered: (I) surgeons who had experienced a period of transition from open thoracotomy to VATS, and (II) the new generation of surgeons being trained after the exponential development of VATS. The evolution of simulation programs such as cadavers, live animals, black-boxes, and three-dimensional virtual reality simulators can compensate for their limited-operating room-based training opportunities and aid them in the acquisition of necessary skills in a brief time. We will discuss the types of simulators focusing on the desired programs to allow the new generation of surgeons to master VATS lobectomy with a shorted learning curve and a future strategy of surgical simulations in VATS.

Great Start and the Albanian College of Surgeons.

The organizing and publishing a journal takes enormous efforts from scientific community, takes trust by all of us, and hard work. In a view of new industry of open access journals, this becomes even harder. Surgical journals, most frequently are publishers and are supported by membership organization such as ASTES. The importance of this conference, that has been changed now to The Congress of Trauma and Emergency Surgery, above all is not only the scientific merits, but the fact that has initiated a multidisciplinary meeting of all clinical and pre-hospital services services and providers who care for trauma and injured patients and those who are are in need for an emergency surgery. In ad-dition, the AJTES , as it continue to build an co-alition of partners, will elevate not only scientific consciousness, but will spearhead the building of the organization of the scientific and political mi-lieu and become an important voice and adviser the government in leading and influencing the training, education and wellbeing of new gen-eration of surgeons, anesthesiologist, intensivist, emergency medicine providers, and overall sub-stantially effect strategic developments of health-care system.

Restorative proctocolectomy: an example of how surgery evolves in response to paradigm shifts in care.

Surgical technique constantly evolves in response to the pressure of progress. Ileal pouch anal anastomosis (IPAA) is a good example. We analysed the effect of changes in practice on the technique of IPAA and its outcomes. Patients undergoing primary IPAA at this institution were divided into three groups by date of the IPAA: those operated from 1983 to 1993, from 1994 to 2004 and from 2005 to 2015. Demographics, patient comorbidity, surgical techniques, postoperative outcomes, pouch function and quality of life were analysed. In all, 4525 patients had a primary IPAA. With each decade, increasing numbers of surgeons were involved (decade I, 8; II, 16; III, 31), patients tended to be sicker (higher American Society of Anesthesiologists score) and three-staged pouches became more common. After an initial popularity of the S pouch, J pouches became dominant and a mucosectomy rate of 12% was standard. The laparoscopic technique blossomed in the last decade. 90-day postoperative morbidity by decade was 38.3% vs 50% vs 48% (P<0.0001), but late morbidity decreased from 74.2% through 67.1% to 30% (P<0.0001). Functional results improved, but quality of life scores did not. Pouch survival rate at 10years was maintained (94% vs 95.2% vs 95.2%; P=0.06). IPAA is still evolving. Despite new generations of surgeons, a more accurate diagnosis, appropriate staging and the laparoscopic technique have made IPAA a safer, more effective and enduring operation.

3D printing materials and their use in medical education: a review of current technology and trends for the future.

3D printing is a new technology in constant evolution. It has rapidly expanded and is now being used in health education. Patient-specific models with anatomical fidelity created from imaging dataset have the potential to significantly improve the knowledge and skills of a new generation of surgeons. This review outlines five technical steps required to complete a printed model: They include (1) selecting the anatomical area of interest, (2) the creation of the 3D geometry, (3) the optimisation of the file for the printing and the appropriate selection of (4) the 3D printer and (5) materials. All of these steps require time, expertise and money. A thorough understanding of educational needs is therefore essential in order to optimise educational value. At present, most of the available printing materials are rigid and therefore not optimum for flexibility and elasticity unlike biological tissue. We believe that the manipuation and tuning of material properties through the creation of composites and/or blending materials will eventually allow for the creation of patient-specific models which have both anatomical and tissue fidelity.

Minimally invasive liver surgery: an update.

It is a great pleasure for us to introduce this special issue of Updates in Surgery focused on ‘‘Minimally Invasive Surgery of the Liver’’ (MILS). Indeed, this area has recently developed and grown thanks both to advances in new technologies and to efforts done by a new generation of surgeons: in 2015, minimally invasive liver surgery has proved its safety and efficacy when performed by teams with good experience in both laparoscopic and hepatic surgery, allowing a significant reduction of intraoperative blood loss, need for portal clamping, postoperative morbidity and shortening postoperative hospitalization, as a result of a more rapid functional recovery. Initial skepticisms regarding technical challenges and oncological adequacy have been overcome, and great enthusiasm has been raised in this newborn field. In 2014, the 2nd consensus conference on MILS was held in Morioka, Japan, and recommendations based on the strength of scientific evidences have been provided. Many training opportunities are now available for surgeons who want to get specific experience. Overall, the future of MILS seems to be promising. Despite this, many topics still deserve in-depth study: this monographic volume tries to reply to many open issues and to certify and codify what has already been acknowledged in clinical practice; we are witnesses of a dramatic change in the way of approaching many liver diseases and have the duty of offer the best available treatment to our patients. We have the honor of including an Editorial from Professor Wakabayashi who describes current trends of laparoscopic liver surgery and its evolution from Louisville to Morioka. The volume is then structured into two sessions, thanks to the contribution of Italian and international authors: in the first one, four review articles are provided, focusing on hot topics like HCC surgery, definition of segmentectomies, robotic approach and difficulty scores; in the second part, by means of original articles, contributions are provided to scientific knowledge on issues that are still debated, such as indications and contraindications of major resections, resections of posterosuperior segments, outcomes of metastases resection, MILS in highand low-volume Italian centers, advantages and limitations of robotic approach, learning curve and accuracy of laparoscopic ultrasound. We therefore wish to thank all the authors for their effort in providing a better insight into the present and future time of this revolutionary approach to liver surgery. We do hope that this editorial effort may help Italian and foreign colleagues willing to develop their activity in minimally invasive MILS according to the principles of scientific knowledge and evidence-based medicine. Luca Aldrighetti Fulvio Calise

Instrumentation of the posterior thoracolumbar spine: from wires to pedicle screws.

Over the past 120 years, spinal stabilization has advanced immensely. An updated review highlighting these advancements has not been performed in the past 20 years. The objective of this report is to provide a historical assessment of the decades outlining various key innovators, their techniques, and instrumentation. It is important to provide new generations of surgeons and students with historical evidence of the value of developing new techniques and instrumentation to improve patient care and outcomes.