Skilled Surgeon Research Articles

Comparative Analysis of Laparoscopic Versus Open Procedures in Specific General Surgical Interventions.

Laparoscopic and open surgeries are two distinct surgical approaches with significantly different procedures and outcomes. Minimally invasive surgery, also known as laparoscopic surgery, utilizes small incisions and specialized instruments like the laparoscope to perform procedures. This contrasts with open surgery, which requires larger incisions to directly access the surgical site. Open surgery was the preferred approach for any invasive procedure until the introduction of new technological advances in the form of laparoscopy. While laparoscopy is still evolving, preliminary results demonstrate promise for various operations. Open surgery provides the healthcare professional with more liberty in the form of increased visualization, but it also increases tissue damage and hospital stays. Laparoscopic and open procedures are both valuable surgical methods with advantages and disadvantages. While open surgery is favored for difficult patients, laparoscopic surgery offers a quicker recovery and fewer scars. The choice between the two approaches depends on the patient's condition, surgical demands, and the surgeon's skills. As these methods develop, they become increasingly important for offering safe and efficient surgical treatments across a range of medical specialties.

TEMPORARY REMOVAL: Mortalité maternelle par hémorragie obstétricale en France 2016–2018

Between 2016 and 2018, 20 maternal deaths were related to obstetric haemorrhage, excluding haemorrhage in the first trimester of pregnancy, representing a mortality ratio of 0.87 per 100,000 live births (95% CI 0.5 -1.3). Obstetric haemorrhage is the cause of 7.4% of all maternal deaths up to 1 year, 10% of maternal deaths within 42 days, and 21% of deaths directly related to pregnancy (direct causes). Between 2001 and 2018, maternal mortality from obstetric haemorrhage has been considerably reduced, from 2.2 deaths per 100,000 live births in 2001-2003 to 0.87 in the period presented here. Nevertheless, obstetric haemorrhage is still one of the main direct causes of maternal death, and remains the cause with the highest proportion of deaths considered probably (53%) or possibly (42%) preventable according to the CNEMM's collegial assessment (see chapter 3). The preventable factors reported are related to inadequate content of care in 94% of cases and/or organisation of care in 44% of cases. In this triennium, maternal death due to haemorrhage occurred mainly in the context of caesarean delivery (65% of cases, i.e. 13/20), and mostly in the context of emergency care (12/13). The main causes of obstetric haemorrhage were uterine rupture (6/20) in unscarred uterus or in association with placenta accreta, and surgical injury during the caesarean delivery (5/20). Every maternity hospital, whatever its resources and/or technical facilities, must be able to plan any obstetric haemorrhage situation that threatens the mother's vital prognosis. Intraperitoneal occult haemorrhage following caesarean section and uterine rupture require immediate surgery with the help of skilled surgeon resources with early and appropriate administration of blood products.

Attach importance to the orderly development of different corneal transplant procedures

There are various surgical methods for corneal transplantation, each requiring precise treatment tailored to the characteristics and different layers of corneal opacity or lesions. These layers include the corneal epithelium, stroma (lamellar), and corneal endothelium, with options for full-thickness (penetrating) corneal transplantation or artificial corneal transplantation. However, a current issue in clinical practice is that, regardless of the degree of corneal disease, the availability of corresponding eye bank support, or surgical conditions, classic penetrating (full-thickness) corneal transplantation is universally performed. Alternatively, there is a trend toward adopting technically demanding procedures such as endothelial transplantation and artificial corneal transplantation. This trend has led to increased postoperative complications and the wastage of corneal donor materials. Choosing the appropriate corneal transplant procedure can offer advantages such as preserving more healthy corneal tissue, conserving corneal donors, facilitating rapid vision recovery, and minimizing the risk of immune rejection. Corneologists need to master the indications for various corneal transplant surgeries and systematically perform different corneal transplant procedures based on the surgeon's skills, hospital conditions, and eye bank conditions. This approach aims to enhance the success rate of the surgery.

Unsuspected Limitations of 3D Printed Model in Planning of Complex Aortic Aneurysm Endovascular Treatment.

Static 3-dimensional (3D) printing became attractive for operative planning in cases that involve difficult anatomy. An interactive (low cost, fast) 3D print allowing deliberate surgical practice can be used to improve interventional simulation and planning. Endovascular treatment of complex aortic aneurysms is technically challenging, especially in case of narrow aortic lumen or significant aortic angulation (hostile anatomy). The risk of complications such as graft kinking and target vessel occlusion is difficult to assess based solely on traditional software measuring methods and remain highly dependent on surgeon skills and expertise. A patient with juxtarenal AAA with hostile anatomy had a 3-dimensional printed model constructed preoperatively according to computed tomography images. Endovascular graft implantation in the 3D printed aorta with a standard T-Branch Cook (Cook® Medical, Bloomington, IN, USA) was performed preoperatively in the simulation laboratory enabling optimized feasibility, surgical planning and intraoperative decision making. The 3D printed aortic model proved to be radio-opaque and allowed simulation of branched endovascular aortic repair (BREVAR). The assessment of intervention feasibility, as well as optimal branch position and orientation was found to be useful for surgeon confidence and the actual intervention in the patient. There was a remarkable agreement between the 3D printed model and both CT and X-ray angiographic images. Although the technical success was achieved as planned, a previously deployed renal stent caused unexpected difficulty in advancing the renal stent, which was not observed in the 3D model simulation. The 3D printed aortic models can be useful for determining feasibility, optimizing planning and intraoperative decision making in hostile anatomy improving the outcome. Despite already offering satisfying accuracy at present, further advancements could enhance the 3D model capability to replicate minor anatomical deformities and variations in tissue density.

11. UPDATED VALIDATION OF 3D PRINTING-BASED TRAINING TOOLS FOR TRANSANAL SURGERY

Abstract Introduction Due to the complexity of colorectal surgery, the development of specialised training tools is necessary to improve the technical skills of surgeons in a controlled environment. In the framework of the MIREIA Project, this study proposes an updated design of a toolkit to provide a safe and effective environment for colorectal surgery training. Methods Work was carried out on the design of a silicone colon model using injection moulds, consisting of two components (the colon model and its wrap), using the fused deposition 3D printing technique. Two layers of silicone were added to simulate the mucosal and muscular layers. A group of surgeons evaluated the formative utility of the model in transanal surgery, performing resection and suturing of polyps inside the model. Results According to the results of the validation study, the silicone colon model showed adequate behaviour during insufflation and a positive haptic response to contact with laparoscopic forceps. This model accurately reproduces the layers of the colon and allows customisation for each patient. In addition, polyp removal is realistic and the elastic layers support stitches, providing greater realism during surgery. Conclusion A realistic simulator has been developed for training in transanal laparoscopic surgery, but improvements in the final design are needed for widespread implementation. The application of an aqueous gel on the mucosal layer is proposed to improve the realism of the training.

Results of a Pilot Virtual Microsurgery Course for Plastic Surgeons in LMICs.

The Plastic Surgery Foundation's Surgeons in Humanitarian Alliance for Reconstruction, Research and Education (SHARE) program seeks to expand surgical capacity worldwide through mentorship and training for local plastic surgeons. This study aims to define the need for microsurgery training among SHARE global fellows and describe results of a pilot course. Ten participants of the SHARE Virtual Microsurgical Skills Course were asked to complete an anonymous survey. Pre- and post-course response rates were 100% and 50.0%, respectively. There was a high incidence of microsurgical problems encountered in the clinical setting. Resource availability was varied, with high access to loupes (100%), yet limited access to microsurgery instruments (50%), medications (40%), operating microscope (20%), skilled nursing (0%) and appropriate peri-operative care settings (0%). Participants identified vessel preparation, instrument selection, and suture handling as priority learning objectives for a microsurgery skills course. Post-course satisfaction with learning objectives was high (60% "very good," 40% "excellent"). Participants reported high levels of improvement in suture handling (Likert 4.60±0.55), end-to-end anastomosis (4.40±0.55), instrument selection (4.20±0.45), vessel preparation (4.20±0.45), and economy of motion (4.20±0.45). This study demonstrates a high frequency of reconstructive problems encountered by global fellows yet low access to appropriate resources to perform microsurgical procedures. Initial results from a pilot virtual microsurgery course demonstrate very high satisfaction and high self-rated improvement in key microsurgical skills. The virtual course is an effective and accessible format for training surgeons in basic microsurgery skills and can be augmented by providing longitudinal opportunities for remote feedback.

The technique and application of individualized tympanic membrane flap in the repair of tympanic membrane under endoscopy ear surgery

Objective:To investigate the technique of personalized flap making under otoscopy and its clinical application. Methods:The clinical data of patients who underwent 301 Military Hospital myringoplasty in the Department of otoendoscopic surgery, Department of Otorhinolaryngology, head and neck surgery, Department of Otorhinolaryngology, from October 2022 to 2023 August were analyzed retrospectively, all enrolled patients were performed independently by the same skilled otoendoscopic surgeon. The patients' general condition, medical history, tympanic membrane perforation scope, perforation size, need for tympanic cavity exploration, thickness of skin flap, tympanic cavity lesion scope, skin flap making method and postoperative rehabilitation were collected. Results:Many factors such as the location of tympanic membrane perforation, the thickness of the skin flap, the degree of curvature or stricture of the ear canal and the extent of the lesion in the tympanic cavity should be considered in the manufacture of the individualized tympanic membrane skin flap, the way of skin flap making does not affect the long-term postoperative rehabilitation, but it can effectively avoid unnecessary ear canal skin flap injury and improve the operation efficiency. Conclusion:Scientific flap fabrication is important for improving surgical efficiency and enhancing surgical confidence.

Tongue base schwannoma: a case report

Schwannoma is a benign, slow growing tumor which is most commonly seen in the VIII cranial nerve. Schwannoma was first described by Verocay in 1910. We have reported a case of a 52 year old female who presented to the hospital with complaints of difficulty swallowing, change of voice and a growth on the posterior one third of the tongue. Biopsy was done and sent for histopathological evaluation which confirmed the diagnosis of Schwannoma. She underwent Lip Split with Mandibulotomy surgery which was done with a awake fiberoptic nasal intubation followed by general anesthesia. The tumor was excised in toto. Her postoperative period was uneventful. Mandibulotomy with lip split provides more than adequate visualization of the masses on the posterior region of the tongue, allowing better maneuvering, ease and precise results for a skilled surgeon. Transoral approach may be the most widely used technique but the decision should be based on the clinical evaluation such as the size, shape and the anatomy of the patient. Narrowing down to the technique of choice should be done after a comprehensive evaluation of that patient. A team of various specialities like Otolaryngologist, Anaesthetist and radiologist is required for optimal execution for this surgery. To enhance our understanding a literature review between 2006 and 2023 was done which included the reports on tongue base schwannoma. A large number of them underwent transoral excision of the mass with a minority choosing mandibulotomy with lip split. A limited array of literature is available for tongue base schwannoma cases.

Surgical Sabermetrics: A Scoping Review of Technology-enhanced Assessment of Nontechnical Skills in the Operating Room.

To evaluate the current evidence for surgical sabermetrics: digital methods of assessing surgical nontechnical skills and investigate the implications for enhancing surgical performance. Surgeons need high-quality, objective, and timely feedback to optimize performance and patient safety. Digital tools to assess nontechnical skills have the potential to reduce human bias and aid scalability. However, we do not fully understand which of the myriad of digital metrics of performance assessment have efficacy for surgeons. A systematic review was conducted by searching PubMed, EMBASE, CINAHL, and PSYCINFO databases following PRISMA-ScR guidelines. MeSH terms and keywords included "Assessment," "Surgeons," and "Technology". Eligible studies included a digital assessment of nontechnical skills for surgeons, residents, and/or medical students within an operative context. From 19,229 articles screened, 81 articles met the inclusion criteria. The studies varied in surgical specialties, settings, and outcome measurements. A total of 122 distinct objective, digital metrics were utilized. Studies digitally measured at least 1 category of surgical nontechnical skill using a single (n=54) or multiple objective measures (n=27). The majority of studies utilized simulation (n=48) over live operative settings (n=32). Surgical Sabermetrics has been demonstrated to be beneficial in measuring cognitive load (n=57), situation awareness (n=24), communication (n=3), teamwork (n=13), and leadership (n=2). No studies measured intraoperative decision-making. The literature detailing the intersection between surgical data science and operative nontechnical skills is diverse and growing rapidly. Surgical Sabermetrics may provide a promising modifiable technique to achieve desirable outcomes for both the surgeon and the patient. This study identifies a diverse array of measurements possible with sensor devices and highlights research gaps, including the need for objective assessment of decision-making. Future studies may advance the integration of physiological sensors to provide a holistic assessment of surgical performance.

High-fidelity, low-cost synthetic training model for fetoscopic spina bifida repair

Fetoscopic spina bifida repair is increasingly being practiced, but limited skill acquisition poses a barrier to widespread adoption. Extensive training in relevant models, including both ex vivo and in vivo models may help. To address this, a synthetic training model that is affordable, realistic, and that allows skill analysis would be useful. This study aimed to create a high-fidelity model for training in the essential neurosurgical steps of fetoscopic spina bifida repair using synthetic materials. In addition, we aimed to obtain a cheap and easily reproducible model. We developed a 3-layered, silicon-based model that resemble the anatomic layers of a typical myelomeningocele lesion. It allows for filling of the cyst with fluid and conducting a water tightness test after repair. A compliant silicon ball mimics the uterine cavity and is fixed to a solid 3-dimensional printed base. The fetal back with the lesion (single-use) is placed inside the uterine ball, which is reusable and repairable to allow for practicing port insertion and fixation multiple times. Following cannula insertion, the uterus is insufflated and a clinical fetoscopic or robotic or prototype instruments can be used. Three skilled endoscopic surgeons each did 6 simulated fetoscopic repairs using the surgical steps of an open repair. The primary outcome was surgical success, which was determined by water tightness of the repair, operation time <180 minutes and an Objective Structured Assessment of Technical Skills score of ≥18 of 25. Skill retention was measured using a competence cumulative sum analysis of a composite binary outcome of surgical success. Secondary outcomes were cost and fabrication time of the model. We made a model that can be used to simulate the neurosurgical steps of spina bifida repair, including anatomic details, port insertion, placode release and descent, undermining of skin and muscular layer, and endoscopic suturing. The model was made using reusable 3-dimensional printed molds and easily accessible materials. The 1-time startup cost was €211, and each single-use, simulated myelomeningocele lesion cost €9.5 in materials and 50 minutes of working time. Two skilled endoscopic surgeons performed 6 simulated, 3-port fetoscopic repairs, whereas a third used a Da Vinci surgical robot. Operation times decreased by more than 30% from the first to the last trial. Six experiments per surgeon did not show an obvious Objective Structured Assessment of Technical Skills score improvement. Competence cumulative sum analysis confirmed competency for each surgeon. This high-fidelity, low-cost spina bifida model allows simulated dissection and closure of a myelomeningocele lesion. VIDEO ABSTRACT.

Comparing both Open and Closed Techniques in Rhinoplasty

Rhinoplasty is a surgical technique used to restore and modify nasal tissues for both functional and aesthetic reasons. There are two primary methods for doing a rhinoplasty: open and closed. While both methods change the bone and cartilage, there are variations in the ways that the nasal components are reached. Both open and closed rhinoplasty have changed significantly over the past 20 years due to the introduction of various cartilage transplants, sutures, and improvements in surgical technology. Rhinoplasty is a very difficult procedure that calls for a high level of expertise and training from physicians. Because of the lifelong learning curve, the surgeon's skill set—rather than their technique—determines the best possible patient outcomes.

A prolonged wait: The impact of COVID-19 on elective surgeries in India, a prospective study

Background The continuing Coronavirus Disease 2019 (COVID-19) pandemic has had a massive impact on healthcare systems all around the globe. There is no exception in the demographics of elective surgery also. Like any other medical professionals, surgeons and post-graduates are redirected to the management of patients with COVID-19. The purpose of this study is to determine how the COVID-19 pandemic affected elective surgeries, surgeon skills, and post-graduate training. Methods This prospective study was done among 320 participants through a 15-question online cross-sectional survey sent primarily to surgeons practicing in six states of India that were most affected by the pandemic according to recent statistics and also to surgeons in other states via email or other online messaging services carried out from June 2021 to July 2021. Results 320 surgeons participated from various states in India. Overall, 59.7% of those participants who agreed that there was a reduction in bed availability, 70.4% of those participants who agreed that there was a shortage of oxygen, 78.8% of those participants who agreed that there was a shortage of PPE kits, 60.7% of those participants who agreed that there was a delay in procurement of surgical implants and 64% of participants also agreed that the COVID-19 pandemic had affected the post-graduate teaching program. Conclusions All these factors showed significant p-values with statistical significance, thereby indicating the impact of the COVID-19 pandemic on the healthcare system and healthcare delivery. The pandemic also had a significant impact on post-graduate training.

Identifying key predictors for uterine manipulator use in robotic simple hysterectomy: a retrospective cohort analysis.

Robotic simple hysterectomy (RSH) is the most common robotic gynecologic surgery in the United States. Uterine manipulators are commonly used to handle the uterus during laparoscopic surgery, but few studies have examined their necessity in RSH. This study retrospectively compares RSH cases with and without the use of manipulators, and identifies predictors for their intraoperative use. This retrospective cohort study included patients undergoing RSH for benign pathologies at Kawasaki Medical School from October 2020 to December 2022. Patients with malignancies were excluded. The robotic surgeries were performed by three skilled surgeons using the four-arm da Vinci Xi surgical system. Data on perioperative and operative parameters were collected, including age, body mass index (BMI), history of abdominal surgery, disease type, presence of ovarian cysts, and operative time. Statistical analyses were performed using EZR software, with multivariate logistic regression to identify predictive factors for uterine manipulator use. The study included 113 patients who underwent RSH without a uterine manipulator and 58 with one. Patients without a manipulator were older, while those with a manipulator had higher BMIs and a higher prevalence of ovarian chocolate cysts and Douglas obliteration. Operating time was shorter without a manipulator. Independent predictors for manipulator use were higher BMI, presence of ovarian endometrioid cysts, and Douglas obliteration. RSH without a uterine manipulator is feasible and can reduce the need for surgical assistants. Predictors for manipulator use include higher BMI, ovarian cysts, and Douglas obliteration. The use of a fourth robotic arm can enhance surgical independence and resource efficiency. Further research is needed to assess the long-term cost-effectiveness and outcomes of this approach.

Structured spine fellowship programs in India: Current trends and perceptions

Abstract Introduction: The present study aimed to assess the quality of training provided during Structured Spine Fellowships (SSF) and explore the expectations of candidates. The study sought to investigate the utility of SSFs and emphasized the importance of evaluating the fellowship center’s curriculum as well as trainees’ surgical and theoretical competency. Materials and Methods: A retrospective descriptive study was conducted on 100 spine surgeons, 66 from Fellow of the National Board and 34 from the Association of Spine Surgeons of India, using a questionnaire. The survey had three parts, assessing pre-fellowship demographics, feedback on the fellowship conducted, and post-fellowship settlement. Results: The hands-on experience was the most important factor affecting the choice of center, and the average work time was 14 h per day. Nearly 50% of fellows were doing independent cervical dorsal and lumbar surgeries by the end of the fellowship. Academics were mainly in the form of regular case presentations for 55% of fellows, and the average number of publications done was 1.6. Most fellows settled near their native city, practiced exclusive spine surgery, and did a mean of 2.6 additional fellowships. Conclusion: This study provides a comprehensive overview of the structured spine fellowship programs in India. The findings highlight the need for standardization and quality control measures in these programs to ensure that they provide a comprehensive and uniform education to the fellows. The study also underscores the importance of ongoing evaluation and assessment to improve the effectiveness of these programs in producing skilled and competent spine surgeons.

Development of Systematizing Neuroendovascular Surgical Planning of Skilled Surgeon Using AI Technology

Development of Systematizing Neuroendovascular Surgical Planning of Skilled Surgeon Using AI Technology

Way Forward in Improving Rhinoplasty Outcomes.

Rhinoplasty is an elective surgical procedure to attain an aesthetic and functional improvement of the nose. The level of expectation of the patient-and the surgeon-regarding the outcome of a rhinoplasty is usually high, and any result that is less than perfect can be seen as a failure. To achieve consistently good results in rhinoplasty, the surgeon should be meticulous at every step of the procedure. Fully understanding the patient's desires, careful preoperative evaluation of the face, and proper selection of patients are crucial to achieving improved outcomes. Furthermore, an individually tailored surgical planning according to the unique features of the specific case, preferring remodeling over resection and reinforcing the nasal framework support, and careful surgical execution will likely ensure a satisfactory and long-lasting surgical outcome. Rhinoplasty requires lifelong dedication of the surgeon for providing the best outcomes to patients entrust their noses to the surgeon's surgical skills. The rhinoplasty surgeon has been labeled an "eternal student," and this should reflect the delicateness and humbleness of the rhinoplasty surgeon.

Machine Learning Analysis of Gaze Data for Enhanced Precision in Diagnosing Oral Mucosal Diseases.

The diagnosis of oral mucosal diseases is a significant challenge due to their diverse differential characteristics. Risk assessment of lesions by visual examination is a complex process due to the lack of definitive guidelines. This study aimed to improve this process by creating a diagnostic algorithm using gaze data acquired during oral mucosal disease examinations. A total of 78 dentists were included in this study. Tobii Pro Nano® (Tobii Technology) was used to acquire gaze data during clinical photographic visual examinations. Advanced analysis tools such as support vector machines and heatmaps were used to visualize the gazing tendencies of a group of skilled oral surgeons, focusing on the number of gazes per region and the gazing time ratios. The preliminary findings showed the possibility of visualizing gazing tendencies and identifying areas of importance for diagnosis. The classification of intraoral photographs based on gross features revealed the existence of an optimal examination method for each category and diagnostically significant areas. This novel approach to analyzing gaze data has the potential to refine diagnostic techniques and increase both accuracy and efficiency.

The occurrence, precaution and treatment strategies of postoperative fecal incontinence in rectal and anal diseases

In the surgical treatment of hemorrhoids, rectal prolapse, rectal cancer, anal fissures, or anal fistulas, inadvertent damage to the nerves or muscles responsible for bowel control may potentially lead to varying degrees of fecal incontinence (FI). Surgeons need to conduct preoperative assessments based on the patient's individual condition to select an appropriate surgical plan, aiming to minimize the incidence of postoperative FI and improve the patient's postoperative quality of life as much as possible while effectively treating the disease. Additionally, the proficiency of the surgeon's skills, appropriate preoperative dietary adjustments for the patient, regular bowel habits, and exercises targeting the pelvic floor muscles all contribute to reducing the incidence of postoperative FI in patients. For patients who have already developed FI after surgery, on the basis of suitable diet, regular bowel habits, and medication, clinical practitioners can adopt such methods as biofeedback, pelvic floor muscle exercise, sacral nerve stimulation, percutaneous tibial nerve stimulation, acupuncture, injectable bulking agents, anal or vaginal inserts, transanal irrigation, surgical interventions, psychological support, etc., to individualized treatment for patients' conditions. This article, combining the literature, summarizes the current status of common diseases that may lead to postoperative FI. It elaborates on strategies for the prevention and treatment of postoperative FI, aiming to serve as a reference for peers in the field.

Analyzing Surgical Technique in Diverse Open Surgical Videos With Multitask Machine Learning

To overcome limitations of open surgery artificial intelligence (AI) models by curating the largest collection of annotated videos and to leverage this AI-ready data set to develop a generalizable multitask AI model capable of real-time understanding of clinically significant surgical behaviors in prospectively collected real-world surgical videos. The study team programmatically queried open surgery procedures on YouTube and manually annotated selected videos to create the AI-ready data set used to train a multitask AI model for 2 proof-of-concept studies, one generating surgical signatures that define the patterns of a given procedure and the other identifying kinematics of hand motion that correlate with surgeon skill level and experience. The Annotated Videos of Open Surgery (AVOS) data set includes 1997 videos from 23 open-surgical procedure types uploaded to YouTube from 50 countries over the last 15 years. Prospectively recorded surgical videos were collected from a single tertiary care academic medical center. Deidentified videos were recorded of surgeons performing open surgical procedures and analyzed for correlation with surgical training. The multitask AI model was trained on the AI-ready video data set and then retrospectively applied to the prospectively collected video data set. Analysis of open surgical videos in near real-time, performance on AI-ready and prospectively collected videos, and quantification of surgeon skill. Using the AI-ready data set, the study team developed a multitask AI model capable of real-time understanding of surgical behaviors-the building blocks of procedural flow and surgeon skill-across space and time. Through principal component analysis, a single compound skill feature was identified, composed of a linear combination of kinematic hand attributes. This feature was a significant discriminator between experienced surgeons and surgical trainees across 101 prospectively collected surgical videos of 14 operators. For each unit increase in the compound feature value, the odds of the operator being an experienced surgeon were 3.6 times higher (95% CI, 1.67-7.62; P = .001). In this observational study, the AVOS-trained model was applied to analyze prospectively collected open surgical videos and identify kinematic descriptors of surgical skill related to efficiency of hand motion. The ability to provide AI-deduced insights into surgical structure and skill is valuable in optimizing surgical skill acquisition and ultimately improving surgical care.

IBC-Oxford University2023_BJSPoster_11Early Results and Postoperative Complications in Bariatric International Centers of Reference for Weight Loss Surgery

Abstract Background Metabolic/Bariatric Surgery (MBS) is worldwide recognized as the best treatment option for obesity. Medical insurance restrictions, better financing conditions and social media easy access make persons with obesity look for international centers of reference to make possible their access to weight loss surgery. These kinds of surgeries are frequently performed in Tijuana, Baja California, Mexico, where there are dedicated specialized high-volume hospital centres. Like any major surgery, bariatric procedures are not exempt from complications, which need to be considered and adequately treated as they can compromise the patient's well-being. Will be presented here the early results and complications from 4 centres of excellence as part of Baja California College of Bariatric and Metabolic Surgeons. Methods This is an observational, descriptive, and retrospective study based on medical records of patients who underwent primary MBS in specialized high-volume hospital centres in Tijuana, Baja California, Mexico, from March to September 2022. The following information of interest will be collected: age, gender, comorbidities, BMI, type of surgery performed, surgical time, length of stay, trans/postoperative complications, and hospital readmission in a 30-day postoperative observational time. Once the data collection process is completed, a descriptive analysis will be conducted using SPSS version 26 software for MacOS. Means and standard deviations will be obtained for quantitative variables, while frequencies and percentages will be calculated for qualitative variables. Results A total of 3906 patients were included, with 85.8% being female and 14.2% being male. The average weight and BMI in females and males were 113.6 kg and 138.8 kg, and 42.3 kg/m2 and 44.7 kg/m2, respectively. Hypertension was reports in 961 individuals (31%), while 383 reported type-2 diabetes (12%). Sleeve gastrectomy (LSG) was performed in 90% of the patients, 5.1% were Roux-en-Y gastric bypass (RYGB), and 3.6% were one anastomosis gastric bypass (OAGB). The average surgical time per procedure was 59 minutes in general with 40 (± 9) min, 94 (± 19) min and 70 (± 27) min respectively for LSG, RYGB and OAGB. A total of 15 patients (0.38%) experienced some form of early postoperative complication, with the majority (8 cases) being postoperative bleeding. Additionally, there were 4 leaks, 1 sleeve migration, 1 sleeve obstruction, and 1 intestinal obstruction. Out of these, 13 patients (0.33%) required a surgical reintervention before discharge (7 cases of bleeding, 4 cases of leaks, sleeve migration, and sleeve obstruction). 12 out of the 13 reinterventions occurred following sleeve gastrectomy, while the remaining reintervention was a result of intestinal obstruction in a RYGB patient. Length of stay varies from 2 to 4 days with an average of 2.2 days. Conclusion Complications are very low in international MBS centres of excellence in Tijuana, Mexico. The experience and skill of the bariatric surgeon are directly related to the number of surgeries performed in their professional practice, which, in turn, helps prevent the occurrence of short-term postoperative complications and to allow the early diagnosis and prompt treatment adoption.