Course Of Surgery Research Articles

Quality control in a training course of off-pump coronary artery bypass grafting surgery

ObjectivesOff-pump coronary artery bypass grafting (OPCAB) surgery is controversial in part because of the surgeon’s experience, which correlates with how the surgeon is trained. Because the training model of OPCAB is not uniform, the quality control in the training process seems to be more important and needs to be further discussed. MethodsNine surgeons accepted and completed an OPCAB training course at a single center to become independent surgeons. This training program is characterized by 6 progressive levels supervised by experienced trainers. In total, 2307 consecutive cases of OPCAB performed by the 9 trainee surgeons were analyzed for monitoring and evaluation in quality control. The funnel plots and cumulative summation (CUSUM) analysis method were used to evaluate the performance of each surgeon. ResultsThe mortality and complications of each surgeon were all within the 95% confidence interval of funnel plots. The CUSUM learning curves of first 3 trainees was analyzed and showed that the trainees need to complete approximately 65 cases to cross the CUSUM learning curve to reach a steady state. ConclusionsThe trainees can directly receive the OPCAB training course under the guidance of experienced surgeons with a rigorous schedule. It is feasible to perform quality control by funnel plots and CUSUM method in OPCAB surgery to ensure the safety of the training course.

MP25-01 AN ETHICAL ROBOTIC SURGICAL TRAINING CURRICULUM USING SIMULATION AND 3D PRINTED SYNTHETIC ORGANS

You have accessJournal of UrologyCME1 Apr 2023MP25-01 AN ETHICAL ROBOTIC SURGICAL TRAINING CURRICULUM USING SIMULATION AND 3D PRINTED SYNTHETIC ORGANS Daniel Costello, Dean Driscoll, Ahmed Ghazi, and Anthony Costello Daniel CostelloDaniel Costello More articles by this author , Dean DriscollDean Driscoll More articles by this author , Ahmed GhaziAhmed Ghazi More articles by this author , and Anthony CostelloAnthony Costello More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003253.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It is no longer necessary to rely on live animals or cadavers for surgical training. We used 3D printing technology and injection moulding to produce realistic hydrogel synthetic organs for robotic surgery training. These synthetic organ models were a key pillar in a novel multistep robotic surgery curriculum. Phase 1 included an online learning program the first robotic surgery course accredited by the Royal Australasian College of Surgeons. This course included access to a catalogue of live 3D video accessible through VR headsets. Participants then proceeded to VR simulation training, dry lab exercises and human factors training in preparation for procedural training on hydrogel organs. When proficiency was achieved finally live human surgery. Following are results from the synthetic organ robotic procedures. METHODS: Three different synthetic organ models were fabricated for this study; an anatomically correct insufflatable anterior abdominal wall for port placement, a robot assisted partial nephrectomy model and a robot assisted radical prostatectomy model. These models were fabricated using 3D digital models segmented from patient CT images using computer aided-design software. These models were uploaded to 3D printers to generate negative moulds, which were injected with polyvinyl alcohol, a low-cost hydrogel. These positive casts went through freeze thaw cycles achieving different tissue consistencies. These casts were layered in anatomically correct positions creating multi-step procedural models with clinically relevant objective surgical performance metrics. Metrics include blood loss, nerve injury measured by digital strain gauges, cancer margins using fluorescence, anastomosis leak tests, operative time and video based skill assessment. RESULTS: Twenty surgeons performed robotic surgery on 5 synthetic abdomens, 10 hydrogel partial nephrectomies and 30 radical prostatectomies. Participants ranged in experience from novice to experts. Clinically relevant performance metrics were recorded and GEARS video tool was used to assess proficiency. Preliminary validity assessments demonstrate face, content, construct, concurrent and predictive validity. CONCLUSIONS: We demonstrated feasibility and preliminary educational validity of realistic synthetic human organ models for urological robotic surgery. These models offer a viable alternative to live animal and cadaver surgery training, without associated cost, ethical and accessibility drawbacks. Source of Funding: An equipment grant was provided by Intuitive Surgical for simulation surgeries © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e342 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Costello More articles by this author Dean Driscoll More articles by this author Ahmed Ghazi More articles by this author Anthony Costello More articles by this author Expand All Advertisement PDF downloadLoading ...

Objective measurement of retention of laparoscopic skills, a prospective cohort study.

There has been an overall growth of 462 percent in laparoscopic procedures performed by surgical residents between 2000 to 2018. Therefore, training courses in laparoscopic surgery are advocated in many postgraduate programs. While the immediate effect is determined in some cases, the retention of acquired skills is rarely investigated. The objective of this study was to objectively measure the retention of laparoscopic technical skills to offer a more personalized training program. First year general surgery residents performed two fundamental laparoscopic skills tasks (Post and Sleeve and the ZigZag loop) on the Lapron box trainer. Assessment was performed before, directly after and 4 months after completing the Basic Laparoscopy Course. Force, motion and time were the measured variables. A total of 29 participants were included from 12 Dutch training hospitals and 174 trials were analyzed. The 4 months assessment of the Post and Sleeve showed a significant improvement in force (P=0.004), motion (P≤ 0.001) and time (P≤ 0.001) compared to the baseline assessment. The same was true for the ZigZag loop: force (P≤ 0.001), motion (P=0.005) and time (P≤ 0.001).Compared to the 4 months assessment, skill deterioration was present for the Post and Sleeve in the mean force (P=0.046), max impulse (P=0.12) and time (P=0.002). For the ZigZag loop, skill decay was observed for force (P=0.021) motion (P=0.015) and time (P≤ 0.001) parameters. Acquired laparoscopic technical skills decreased 4 months after the Basic Laparoscopy Course. Compared to baseline performance, subjects showed significant improvement, however deterioration was observed compared to post course measurements. To preserve acquired laparoscopic skills, it is recommended to incorporate maintenance training, preferably with objective parameters, in training curricula.

The potential role of preoperative cystoscopy for determining the depth of invasion in the placenta accreta spectrum.

This study aims to determine the role of preoperative cystoscopy in specifying the degree of placental invasion to the bladder in the placenta accreta spectrum (PAS), especially in percreta. This prospective observational cohort study included 78 PAS patients. All included patients underwent the preoperative cystoscopy before the cesarean hysterectomy operation. The preoperative cystoscopy procedure identified markers of PAS as neovascularization, arterial pulsatility in neovascularized zones, and posterior bladder wall bulging. Then the patients were divided into subgroups according to the histopathological results of their cesarean hysterectomy specimens. Finally, the histopathological subgroups of PAS were estimated using preoperative cystoscopy signs in the designed logistic regression analysis model. The preoperative cystoscopic signs such as neovascularization, the posterior bladder wall bulging, and the arterial pulsatility in neovascularized zones were approximately associated with a 17-fold [OR = 16.9 (95% CI, 5.7-49.8)], 26-fold [OR = 26.1 (95% CI, 8.17-83.8)], and 9-fold [OR = 8.94 (95% CI, 2.94-27.1)] increase in the likelihood of placenta percreta, respectively. Preoperative cystoscopy may significantly contributions to other standard imaging modalities to identify the degree of placental invasion, especially placenta percreta. Experienced obstetricians trained in hysteroscopic visualization may safely perform this preoperative cystoscopy procedure under the guidance of a specialist urologist. Accordingly, it may be possible to estimate the degree of invasion and the course of surgery in patients with PAS using the preoperative cystoscopy procedure.

Errata: Volume 10; Issue 4, 2022

The following items published in the International Journal of Medical Students (IJMS) Volume 10, Issue 4 of 2022 were corrected on February 20, 2023: "A Cross-Sectional Study of p66Shc Gene Expression in Liquid Biopsy of Diabetic Patients. Is it Possible to Predict the Onset of Renal Disease?" was corrected for capitalization errors in the title.1 "Elective Courses in Global Surgery for Undergraduate Medical Students: A Narrative Review and a Proposal for European Universities" contained an error in the DOI on the footer of page 395. The correct DOI is: 10.5195/ijms.2022.1598.2 "Why the Furor about Polio?" was corrected for a spacing error in the title in the PDF version.3 In the article entitled "Research Experience of Medical Students Collaborating in an International Peer Research Mentorship Program", there were errors in the fourth and fifth authors’ names. The correct names are: Aysha Zulfiqar and Tejaswini Ashok.4 "‘First, Do No Harm'… A Call to Re-evaluate the Wellbeing of Healthcare Staff" was corrected for a spacing error in the title.5

Insonation angle impact on micro-Doppler evaluation in cerebrovascular surgery: technical note

Introduction: The insonation angle consideration is important in the Doppler-sonographic evaluation of blood flow velocities and volume, however, the concept is rarely applied to the intraoperatively used micro-Doppler.This technical note aims to emphasize the possibility and necessity of insonation angle correction and preservation for the blood flow assessment in cerebrovascular surgery.Methods: Bi-directional surgical Doppler with a 20MHz flexible bayonet 1.2mm diameter probe was used for the intraoperative blood flow assessment, with the variable insonation angle on the straight parts of the arteries, and the results were recorded to demonstrate the importance.Results: The measurements performed confirmed that the blood flow features, including the direction, velocity, and especially the volume, are highly susceptible to the insonation angle variations. Although there were significant alterations, positioning the probe at an angle of ~60 degrees resulted in the variable but less altering measurements.Conclusion: Positioning the probe at ~60 degrees is desirable; however, it appears that it is even more important to maintain the same insonation angle and probe position when assessing the vessels repeatedly for blood flow alterations that might occur in the course of cerebrovascular surgery.

Diagnosis, surgical and conservative treatment of unstable sacral fractures (literature review)

Background. In the structure of severe combined trauma, injuries to the pelvic bones, especially the sacrum, are relatively rare but increase steadily with the scientific and technological progress and the urbanization. Despite the widespread use of modern diagnostic methods, such as computer and magnetic resonance imaging, and the ubiquity of X‑ray diagnostics, sacral fractures are diagnosed not in all patients or not in full. In 50 % of patients, sacral fractures are not diagnosed during the initial examination, including anteroposterior X‑ray examination. In addition, in 30 % of the patients, sacral fractures are recognized on a pelvic X‑ray film incorrectly, and the long‑term outcomes of their treatment are unsatisfactory from 30 to 60 % of the cases.Aim. To analyze scientific published sources on the issues of diagnosis, clinical picture, and treatment of patients with severe combined trauma and unstable sacral fractures.Materials and methods. The data of 232 domestic and foreign publications from 1971 to 2020. We present the epidemiology of combined trauma and unstable sacral fractures, consider various classifications, and describe the clinical course and tactics in conservative and surgical treatment of vertically unstable fractures in the posterior pelvic ring.Results. Many foreign publications describe both diagnostics and various methods of treatment for unstable pelvic ring injuries. The publications cover various aspects of diagnosis, clinical course, management tactics, extent and timing of surgery, and conservative treatment for sacral fractures. However, only a few publications in Russian discuss features of diagnostic search, the timing and extent of surgery, as well as the choice of the final tactics to treat patients with sacral fractures.Conclusions. It is necessary to study the problem of diagnosis and treatment of severe combined trauma and vertically unstable fractures of the posterior pelvic ring to develop optimal diagnostic algorithms and final treatment tactics aimed at reduction of the frequency of errors, complications, and deaths, and at improvement in the quality of life of such patients.

Operative Trauma Courses: A Scoping Review to Inform the Development of a Trauma Surgery Course for Low-Resource Settings.

A multitude of operative trauma courses exist, most of which are designed for and conducted in high-resource settings. There are numerous barriers to adapting such courses to low- and low-middle-income countries (LMICs), including resource constraints and contextual variations in trauma care. Approaches to implementing operative trauma courses in LMICs have not been evaluated in a structured manner. We conducted a scoping review of the literature including databases (e.g., PubMed, Web of Science, EMBASE), grey literature repositories, and structured queries of publicly available course materials to identify records that described operative trauma courses offered since 2000. The search identified 3,518 non-duplicative records, of which 48 relevant reports were included in analysis. These reports represented 23 named and 11 unnamed operative trauma courses offered in 12 countries. Variability existed in course format and resource requirements, ranging from USD 40 to 3,000 per participant. Courses incorporated didactic and laboratory components, which utilized simulations, cadavers, or live animals. Course content overlapped significantly but was not standardized. Data were lacking on course implementation and promulgation, credentialing of instructors, and standardized evaluation metrics. While many operative trauma courses have been described, most are not directly relatable to LMICs. Barriers include cost-prohibitive fees, lack of resources, limited data collection, and contextual variability that renders certain surgical care inappropriate in LMICs. Gaps exist in standardization of course content as well as transparency of credentialing and course implementation strategies. These issues can be addressed through developing an open-access operative trauma course for low-resource settings.

Use of a Caprine Model for Simulation and Training of Endoscopic Ear surgery.

The objective of this study was to evaluate the utility of a caprine model in endoscopic ear surgical education using the index procedures of tympanoplasty and ossiculoplasty. Specifically, this study assessed the face and content validity of the caprine model, and the potential impact of anatomical differences on trainee understanding of human middle ear anatomy. Twelve otolaryngology trainees attended a 3-hour endoscopic ear surgery course utilizing the caprine model in which they completed canalplasty, tympanoplasty, and ossiculoplasty. Prior to the course, the trainees completed a self-reported needs assessment and knowledge assessment of human middle ear anatomy. Following the course, the trainees repeated the knowledge assessment and completed evaluation and validation questionnaires. Five-point Likert scores were used for the needs assessment and validation questionnaire. Of the 12 trainees, 9 participated in the study. All domains of the learner needs assessment showed an average improvement of 1 point on the post-course evaluation with 6 of 9 domains being significantly improved using the Wilcoxon signed-rank test (P< .05). The model achieved validation in the domains of face, content, and global content validity with an average Likert score > 4. Knowledge assessment scores increased by 7% (P=.23) after the course compared to before. The caprine model offers an effective surgical simulation model for endoscopic ear surgery training with good face and content validity. We find it to be readily available and affordable. We currently use it routinely to give otolaryngology residents the experience of endoscopic ear surgery before operating on patients.

Practice Patterns of Antithrombotic Therapy during the Early Postoperative Course of Cardiac Surgery

The current practices regarding the management of antithrombotic therapy during the early postoperative course of cardiac surgery are not well described. An online survey with multiple-choice questions was sent to cardiac anesthesiologists and intensivists from France. The response rate was 27% (n = 149), with 2/3 of the respondents having less than 10 years of experience. A total of 83% of the respondents reported using an institutional protocol for antithrombotic management. A total of 85% (n = 123) of the respondents regularly used low-molecular-weight heparin (LMWH) during the immediate postoperative course. For 23%, 38%, 9%, and 22% of the physicians, LMWH administration was initiated between the 4th and 6th hour, between the 6th and 12th hour, between the 12th and 24th hour, and on postoperative day 1, respectively. The main reasons for not using LMWH (n = 23) were a perceived increased risk of perioperative bleeding (22%), poor reversal compared with unfractionated heparin (74%), local habits and the refusal of surgeons (57%), and its overly complex management (35%). The modalities of LMWH use were widely varied among the physicians. Chest drains were mostly removed within 3 days of surgery with an unchanged dose of antithrombotic therapy. Regarding temporary epicardial pacing wire removal anticoagulation, 54%, 30%, and 17% of the respondents left the dose unchanged, suspended the anticoagulation, or lowered the anticoagulation dose, respectively. LMWH was inconsistently used after cardiac surgery. Further research is warranted to provide high-quality evidence regarding the benefits and safety of LMWH use early after cardiac surgery.

Early tracheostomy after cardiac surgery improves intermediate- and long-term survival

ObjectiveComplicated post-cardiac surgery course, can lead to both prolonged ICU stay and ventilation, and may require a tracheostomy. This study represents the single-center experience with post-cardiac surgery tracheostomy. The aim of this study was to assess the timing of tracheostomy as a risk factor for early, intermediate, and late mortality. The study’s second aim was to assess the incidence of both superficial and deep sternal wound infections. DesignRetrospective study of prospectively collected data. SettingTertiary hospital. PatientsPatients were divided into 3 groups, according to the timing of tracheostomy; early (4−10 days); intermediate (11−20 days) and late (≥21 days). InterventionsNone. Main variables of interestThe primary outcomes were early, intermediate, and long-term mortality. The secondary outcome was the incidence of sternal wound infection. ResultsDuring the 17-year study period, 12,782 patients underwent cardiac surgery, of whom 407 (3.18%) required postoperative tracheostomy. 147 (36.1%) had early, 195 (47.9%) intermediate, and 65 (16%) had a late tracheostomy. Early, 30-day, and in-hospital mortality was similar for all groups. However, patients, who underwent early- and intermediate tracheostomy, demonstrated statistically significant lower mortality after 1- and 5-year (42.8%; 57.4%; 64.6%; and 55.8%; 68.7%; 75.4%, respectively; P < .001). Cox model demonstrated age [1.025 (1.014–1.036)] and timing of tracheostomy [0.315 (0.159−0.757)] had significant impacts on mortality. ConclusionsThis study demonstrates a relationship between the timing of tracheostomy after cardiac surgery and mortality: early tracheostomy (within 4−10 days of mechanical ventilation) is associated with better intermediate- and long-term survival.

Predicting difficulty in laparoscopic cholecystectomy preoperatively using modified Randhawa scoring system

Background: Laparoscopic cholecystectomy is a low-risk, minimally invasive operation and currently the standard for treatment of gallstone and gallbladder disease. Preoperative assessment of difficulty is required to prevent problems, ensure readiness, and ensure an effective course of surgery. Methods: In our work, we attempted to use a modified grading system developed by Randhawa et al. to preoperatively predict a difficult laparoscopic cholecystectomy. Age, gender, illness duration, history of prior GB disease, BMI, abdominal scar location (infra or supraumbilical), palpable gallbladder, and sonographic findings (gall bladder wall thickness, pericholecystic collection, and impacted stone) were assessed in patients who had been diagnosed with GB stones and required LC. Depending on the individual surgeon's assessment, a procedure is rated as easy, difficult, or very difficult. Results: On comparison of the test group difficulty level predicted with the gold standard of difficulty level intra op the test group has a sensitivity of 51.9 % and specificity of 100%. The test has a positive predictive value of 100% and Negative predictive value of 91.5%. The test and the gold standard agree on 154 out of 167 having a diagnostic accuracy of 92.21%. The Kappa value of 0.644 indicates very good agreement with a p value of &lt;0.001. Area under the curve indicates 96.1% of the difficulty is predicted by the Total score and significant with p value of &lt;0.001 Conclusions: The current modified Randhawa and Pujahari scoring method is useful and appropriate for forecasting operative outcome in laparoscopic cholecystectomy.

Impact of adipose-derived stem cells on aortic tensile strength in a model of abdominal aortic aneurysm

IntroductionAbdominal Aortic Aneurysm (AAA) is a highly morbid condition and is the 11th leading cause of death in the United States. Treatment options are limited to operative interventions, with minimal non-operative options. Prior literature has demonstrated a benefit to the use of mesenchymal stem cells (MSCs) in attenuating AAA formation. We demonstrate the utility of MSCs in treating AAA in swine, focusing on the mechanical and structural characteristics of aortic tissue after treatment. Methods16 Yorkshire pigs underwent retroperitoneal exposure of the infrarenal aorta, with subsequent induction of AAA with peri-adventitial elastase and collagenase. A 1 × 4 cm piece of Gelfoam, an absorbable gelatin-based hemostatic agent, was soaked in media or human MSCs and placed directly on the vessel for control and experimental animals. At postoperative day 21, animals were sacrificed and the infrarenal aorta at this location was harvested for analysis. Tensile strength was measured using a tensiometer, from which Young's modulus and maximum strain were calculated. ResultsAll animals survived the surgery and post-operative course. Young's elastic modulus for the aneurysm control group was 15.83 ± 1.61 compared to 22.13 ± 2.34 for the stem cell treated segment, p = 0.0316. There was no significant difference in the peak stress between groups. ConclusionsThis is the first study to demonstrate the mechanical effects of stem cell therapy on a model of AAA in swine. Young's modulus, which characterizes the intrinsic capacity of a tissue to withstand stress, was greater in the animals treated with MSCs compared to control animals with aneurysms. This methodology can be utilized in future large animal models to develop cell and drug-based therapies for AAA.

Evaluation of an Undergraduate Oral Surgery Curriculum - A Pilot Study.

Following curricular revisions at the Faculty of Dentistry of the Obafemi Awolowo University, no formal evaluation of its alignment and implementation has been carried out.This study aimed to evaluate the alignment of an Oral surgery curriculum and to determine students' learning experiences and perceptions of the curriculum. This was a mixed-method study conducted at Obafemi Awolowo University, Ile-Ife, Nigeria. This ethically approved study adopted a mixed-method descriptive approach to data collection and analysis. Data collection followed a sequential, phased approach comprising document analysis, curriculum mapping, questionnaire survey, and focus group discussions.Quantitative data collected via questionnaires were analyzed descriptively. Qualitative data from focus group discussions were analyzed using a hybrid deductive-inductive thematic analysis by the researchers to generate relevant themes. The curriculum data reveal that the oral surgery course is well-aligned. Furthermore, each course outcome utilizes different methods of assessments and teaching/learning activities (TLAs). Focus group discussions yielded four themes and two sub-themes. The main themes included curriculum alignment, implemented teaching and learning activities, feedback, and curriculum renewal, while the subthemes were recommended TLAs and student learning experiences. The curriculum evaluation identified strengths of the course as multiple student assessment methods and potential areas for improvement. These improvements included updating the content of the course and including more variety in teaching and learning methods. The authors identified potential learning gaps that require curriculum renewal. Evaluation of the entire program is recommended for comparison.

Surgical and Bioengineering Integration in the Anatomy Course of Medicine and Surgery High Technology: Knowledge and Perception of Anatomy

The Locomotor System Anatomy (LSA) course, placed in the first semester of the first year of the new Master’s degree in Medicine and Surgery High Technology (MSHT) at the Sapienza University of Rome, was integrated with surgical and bioengineering content. This study investigated the educational value and the students’ perceptions of the effectiveness of these two types of integration, comparing surgical integration (SI) with engineering integration (EI). Anatomy knowledge and students’ opinions attending the LSA course in MSHT degree (n = 30) were compared with those of students (n = 32) attending another medical and surgery course not comprising EI. Data show that students in the MSHT course like in-depth SI much more than in-depth EI. However, those who like in-depth SI also like in-depth EI. Significant differences were in anatomy knowledge between the two groups in the three sections of the test. There was no significant correlation between the three test scores and the levels of liking, while there was a significant correlation between students liking SI and those liking EI. A statistically significant correlation was also found in students who correctly responded to questions on the head and trunk, with students responding correctly to questions on the upper limbs. This study will be important in optimizing the deepening of SI and EI in the LSA course.

Ureteroscopic and Robot-Assisted Ureteroplasty with Buccal Mucosa Graft

Introduction and Objective: In this video we present a case of a ureteroscopic and robot-assisted redo ureteroplasty with buccal mucosa graft for a proximal ureteral stricture. Methods: Here, we present a case of 72-year-old female patient with a history of a right-sided proximal ureteral stricture after ureteroscopic stone treatment. For this stricture she underwent robotic end-to-end ureteroplasty. Two years later, she presented with recurrence of the stricture for which she underwent balloon dilatation and tandem stenting. Unfortunately, the stricture recurred rapidly. A redo ureteroplasty with buccal mucosa graft was planned. Results: Surgery and postoperative course were uneventful. Six weeks after surgery, the Double-J stent was removed and 4 months postoperatively, the patient is doing fine without evidence for recurrence of the ureteral stricture. Conclusions: The video illustrates how retrograde ureteroscopy in combination with FireFly fluorescence imaging can be a valuable contribution to identifying the ureter, which in redo cases is often surrounded by a lot of fibrotic tissue. Moreover, localization of the stricture site is facilitated by retrograde ureteroscopy. After onlay of the buccal mucosa graft, patency and watertightness of the ureteroplasty can easily be controlled. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. All authors declare no conflict of interest in connection with this video. Runtime of video: 3 mins 16 secs

Traumatic neuroma of the right posterior hepatic duct with an anatomic variation masquerading as malignancy: a case report

Traumatic neuroma (TN), also known as amputation neuroma, is a reactive hyperplasia of nerve fibers and connective tissue arising from Schwann cells after trauma or surgery. TN of the bile duct is usually asymptomatic, but rarely can lead to right upper quadrant pain, biliary obstruction, and acute cholangitis. It is very difficult to discriminate TN from malignancy before surgery, although doing so could avoid an unnecessary radical resection of the lesion. In the course of surgery, TN can be caused by unintentional injury of a nerve fiber near the common bile duct (CBD) and heat damage to an artery, complete ligation of an artery, and excessive manipulation of the CBD. Therefore, to prevent TN after cholecystectomy, surgery should be performed carefully with appropriate consideration of anatomic variations, and a cystic duct should not be resected too close to the CBD. The possibility of TN should be considered if a patient who has undergone CBD resection with hepaticojejunostomy or cholecystectomy long ago experiences symptoms of jaundice, cholangitis, or obliteration of the CBD. In this report, we present a case of TN mimicking cholangiocarcinoma that emerged from a cystic duct stump after cholecystectomy.

Analysing the Impact of an Elective Research Experience on Medical Students' Research Perceptions.

Physicians are at the centre of bench-to-bedside research, yet the number of physicians engaging in research is declining. One solution to overcome this alarming trend is exposing medical students to research. This study aims to assess the impact of engaging medical students in research, and the feasibility of conducting research solely using online communication. A pilot elective research opportunity was offered to medical students enrolled to the University of Malta Doctor of Medicine and Surgery course by a resident academic (summer 2021) of the same institute to assess the epidemiology of COVID-19 in Europe. An anonymous survey was distributed to seventy medical students recruited to participate in this elective research project. The data collected was analysed and interpreted. A response rate of 88.73% was achieved. "Career progression" and "lack of time" were the most reported motivating and hindering factors towards conducting research, respectively, before engaging in a research experience. Research experience helped overcome reported barriers (p < 0.01), while also challenging students' perceptions towards research. An increase in positive perceptions towards research was observed after conducting research. An overwhelming majority (90.47%) of participants reported that mentorship played an influential role in their overall experience, and 95.24% commented that they would like research opportunities to be made available by their faculty. Giving students the opportunity to conduct research demonstrated how research experience improves students' soft skills and the understanding of research. This study also portrayed how remote research opportunities are effective in engaging students and increased the number of students who would consider a career in research. The online version contains supplementary material available at 10.1007/s40670-023-01727-w.

Performance in the Fundamentals of Laparoscopic Surgery: Does it reflect global rating scales in the Objective Structured Assessment of Technical Skills in porcine laparoscopic surgery?

ObjectiveTo correlate the utility of the Fundamentals of Laparoscopic Surgery (FLS) manual skills program with the Objective Structured Assessment of Technical Skills (OSATS) global rating scale in evaluating operative performance. MethodsThe Asian Urological Surgery Training and Educational Group (AUSTEG) Laparoscopic Upper Tract Surgery Course implemented and validated the FLS program for its usage in laparoscopic surgical training. Delegates’ basic laparoscopic skills were assessed using three different training models (peg transfer, precision cutting, and intra-corporeal suturing). They also performed live porcine laparoscopic surgery at the same workshop. Live surgery skills were assessed by blinded faculty using the OSATS rating scale. ResultsFrom March 2016 to March 2019, a total of 81 certified urologists participated in the course, with a median of 5 years of post-residency experience. Although differences in task time did not reach statistical significance, those with more surgical experience were visibly faster at completing the peg transfer and intra-corporeal suturing FLS tasks. However, they took longer to complete the precision cutting task than participants with less experience. Overall OSATS scores correlated weakly with all three FLS tasks (peg transfer time: r=−0.331, r2=0.110; precision cutting time: r=−0.240, r2=0.058; suturing with intra-corporeal knot time: r=−0.451, r2=0.203). ConclusionFLS task parameters did not correlate strongly with OSATS globing rating scale performance. Although FLS task models demonstrated strong validity, it is important to assimilate the inconsistencies when benchmarking technical proficiency against real-life operative competence, as evaluated by FLS and OSATS, respectively.

An evaluation of Italian medical students attitudes and knowledge regarding forensic medicine

IntroductionThis study aims to assess students' knowledge of forensic medicine concepts and their opinions regarding the course taught during the degree course in Medicine and Surgery in an Italian university. Consequently, the study aims to assess the impact of the course on the students’ knowledge and attitude in choosing a medical residency. Materials and methodsA cross-sectional study was conducted through an anonymous web-based survey of medical students at the Università Cattolica del Sacro Cuore. Descriptive and univariate analysis were conducted. Results1166 students completed the survey. The forensic medicine course appears to be extremely important in providing training in the fundamental concepts of forensic medicine, especially professional liability, defensive medicine, and forensic pathology. Attending autopsies is important during the course, and their number should be more than ten. Additionally, univariate analysis demonstrates that students' awareness of forensic medicine topics, such as the function of the forensic physicians, professional liability, and defensive medicine, improves in the fifth or sixth year of the course. After the course, more students would choose to pursue a nonclinical and nonsurgical specialty, and forensic medicine specifically, for their residency. ConclusionsThe forensic medicine course has the task of defining the duties and responsibilities of forensic physicians, providing indispensable tools for future medical practitioners, regardless of their future specialisation, and limiting the increasing use of defensive medicine. In conclusion, we recommend further multicenter studies to evaluate the role and direct effect of undergraduate forensic medicine courses on students and on the quality of practice.