Surgical Care Research Articles

Malignant hyperthermia safety - A nationwide survey of publicly funded Swedish healthcare.

Malignant hyperthermia (MH) is a rare pharmacogenetic disorder that can lead to a life-threatening reaction during general anaesthesia with triggering agents. Prompt life-saving treatment includes the immediate administration of the antidote dantrolene. This study investigated Swedish healthcare providers' awareness and adherence to guidelines and recommendations with respect to MH and whether adherence to safe MH-praxis varies with hospital care-complexity level and private versus public management form. Agreements and procurement specifications between all 21 Swedish County Councils and privately run surgical care providers were reviewed alongside with questionnaire-aided collection of information from 62 publicly funded health care providers (both privately and publicly run). No procurement requirement specification or contract contained requirements on anaesthesia or aspects of MH. All publicly run hospitals stocked dantrolene and 28 out of 52 (54%) stocked the recommended amount. Seven out of nine (78%) of the privately run institutions stocked dantrolene, and one stocked the recommended amount. Publicly run hospitals adhered to recommendations to a greater extent than privately run institutions, both with respect to stocking of dantrolene (p = .02) and to stocking the recommended amount (p = .03). Contracts between Swedish county councils and private surgical care subcontractors rarely outline expectations of standards for the safe practice of anaesthesia such as preparedness to handle a life-threatening MH reaction. Among Swedish publicly funded anaesthesia providers there is room for improvement in adherence to the EMHG guideline on dantrolene availability. Publicly run hospitals seem to have better compliance with these recommendations than privately run institutions. Raising awareness about current guidelines is important to improve safety for known and unknown MH-susceptible individuals.

The 50th anniversary of corresponding member of the Russian Academy of Sciences Pavel N. Romashchenko

February 22, 2024, marks the 50th anniversary of Pavel N. Romashchenko, a famous scientist, specialist in the field of endocrine, abdominal surgery, and oncology, corresponding member of the Russian Academy of Sciences, Doctor of Medical Sciences, professor, and colonel of the medical service. For more than 30 years, his life has been inextricably linked with the S.P. Fedorov Faculty of Surgery of the Military Medical Academy names after S.M. Kirov, where he worked his way up from a cadet to the head of the department. In the walls of his alma mater, he evolved into a brilliant clinician, scientist, and leader, defended his doctoral dissertation, and received the title of professor. His fundamental work, as well as scientific research conducted in the clinic under his leadership, substantiated diagnostic and treatment algorithms and expanded the possibilities of using innovative and minimally invasive technologies in endocrine and abdominal surgery. Over the years of P.N. Romashchenko’s leadership of the department and clinic, much has been done to improve it with modern equipment, allowing it to perform various surgical and diagnostic interventions as part of the provision of specialized and high-tech surgical care. P.N. Romashchenko was awarded the honorary title “Honorary Doctor of the Russian Federation”. Under his leadership, 2 doctoral and 10 candidate dissertations were defended. P.N. Romashchenko is the author of more than 460 scientific works, including 14 monographs on various areas of endocrine and abdominal surgery. Currently, Pavel Nikolaevich successfully manages various scientific research as well as training scientific, pedagogical, and medical personnel.

History and Current State of Neurosurgery in the Gambia

BackgroundDespite global efforts to improve surgical care access, many low and middle-income countries, especially in neurosurgery, face significant shortages. The Gambia exemplifies this, with only one fully qualified neurosurgeon serving its population of 2.5 million people. This scarcity results in higher morbidity and mortality. ObjectiveWe aim to document the history and current state of neurosurgery in The Gambia to raise awareness and promote neurosurgery development. MethodsThe study reviews The Gambia's healthcare system, infrastructure, neurosurgical history, workforce, disease burden, and progress, with information derived from reference sources as well as author experience and interviews with key partners in Gambian healthcare. ResultsNeurosurgery in The Gambia began in the 1970s, facing constraints due to competing healthcare demands. Significant progress occurred much later in the early 2010s, marked by the initiation of Banjul Neuro-Missions and the establishment of a dedicated neurosurgery unit.We report significant progress with neurosurgical interventions in the past few years showcasing the unit's dedication to advancing neurosurgical care in the Gambia. However, challenges persist, including a lack of trained neurosurgeons, equipment shortages such as ventilators and diagnostic imaging. Financial barriers for patients, particularly related to the costs of CT scans, pose significant hurdles, impacting the timely diagnosis and intervention for neurological conditions. ConclusionNeurosurgery in Gambia is progressing, but challenges like equipment scarcity hinder further progress. We emphasize the need for addressing cost barriers, improving infrastructure, and fostering research. Engaging the government and international collaborations are vital for sustained development in Gambian neurosurgery.

IJCM_12A: Parental perception on surgical care in public and private health care systems

Background: The purpose of the study is to assess the perception of parents on surgical care in public and private healthcare systems. It encompasses factors like quality of care, convenience, and expenditure that provide satisfaction, which has a crucial role in shaping parental perception. Objective: To compare the perception of parents regarding the quality of care provided to children for surgical care in public and private health care systems. Methodology: The questionnaire was constructed in three languages and distributed to 125 patients. Details regarding the levels of perception among parents and its significance in the Public and Private sectors included 6 questions - Convenience of location, Length of time spent, Equipment, comfort, explanation of the condition, and overall stay. Results: Overall satisfaction was seen to be 54.67% for the households admitted in the private healthcare sector compared to 59.27% in the public healthcare sector. Comfort was 52.53% and 66.24% in private and public health care services respectively. The personal manner of doctors was 57.87% in private and 58.72% in the public health care sector. Conclusion: Overall satisfaction level in public hospitals was better when compared with the private sector, even though, the difference between the satisfaction level for the quality of care provided in public and private in our study was not significant.

Surgical critical care: Is work-life expectancy increasing? An analysis of American Board of Surgery recertification rates across subspecialties.

The practice of surgical critical care (SCC) has traditionally necessitated additional in-house, extended night and weekend clinical commitments, which can be viewed as less desirable for many surgeons. Therefore, the authors have observed that some SCC surgeons elect to transition their practice to focus solely on general surgery (GS) rather than continuing practicing both SCC and GS. We hypothesized that surgeons with a practice focused on SCC are more likely to make the transition to a GS practice than those who have certification in other subspecialties that are certified through the American Board of Surgery.

Территориальные особенности оказания экстренной хирургической помощи сельскому населению (на примере Республики Северная Осетия-Алания).

The need to modernize healthcare dictates the study of healthcare organization at all levels. Special attention is paid to the territorial accessibility of medical care, including to the rural population, which differs in many specific features. The purpose of the study: to study the territorial features of providing emergency surgical care to the rural population, taking into account the number, density of population settlement, road infrastructure, and transport security in the Republic of North Ossetia-Alania. Research methods. Analytical and statistical research methods were used. The performance indicators of surgical departments of rural district hospitals for 2019–2022 have been studied. The analysis of the obtained data was carried out by the method of their structural description according to the selected main characteristics affecting territorial accessibility. Results. The Republic of Ossetia-Alania is characterized by high density and compactness of population settlement in rural areas. The creation of a modern transport infrastructure ensures the territorial accessibility of medical care. The republic has a fairly high level of provision with surgeons (2,53 per 10 thousand population) and a surgical bed fund (4,7 per 10 thousand population). However, there is a need to increase the efficiency of using the bed stock of rural surgical hospitals. The organization of surgical care in the republic in 2020–2021 was extremely negatively affected by the pandemic of coronavirus infection COVID‑19. The reduction of surgical and anesthesiological teams, beds and the volume of planned care due to the opening of additional infectious diseases hospitals has reduced the availability and quality of emergency surgical care. In rural district surgical departments, the bed function decreased from 283 days in 2019 to 243 days in 2020, and surgical activity up to 38,8%. In 2020–2021, planned medical care in the «surgery» profile has significantly decreased. The share of emergency hospitalizations increased to 79,7%. Negative trends in the growth of emergency hospitalization for surgical beds led to an increase in the hospital mortality rate compared to 2019 from 0,6% to 3,1% in 2021. The postoperative mortality rate has increased by more than 5 times. Our data correlate with similar trends of 33% increase in hospital mortality in the Russian Federation during the pandemic. Due to the creation of modern road transport infrastructure in the republic, high availability of surgical beds and surgeons, there is a potential to improve the quality indicators of rural surgical hospitals by improving the material and technical equipment and qualifications of surgical personnel.

Specialty Neurosurgery Hospitalists: Neurosurgeons’ Perspectives

Neurosurgery is increasingly performed on patients with significant medical co-morbidities. These could both delay surgery and can lead to postoperative complications. This situation highlights the role played by internal medicine-trained physicians, which include both outpatient providers and hospitalists. In our experience, the best care is provided in close collaboration between neurosurgeons and internal medicine physicians. In this article, we provide the view from the standpoint of a neurosurgeon. Management of co-morbidities by internal-medicine physicians enables neurosurgeons to focus on surgical care, improves patient’s experience and leads to improved resident training.

276 Full Spectrum Town Hall Meetings - Advancing Clinician-Patient-Researcher Engagement for Hidradenitis Suppurativa (HS)

OBJECTIVES/GOALS: Full Spectrum Town Halls (FSTH) were organized to bring together patients, scientists, clinicians, advocates and others interested in Hidradenitis Suppurative (HS) – stakeholders across the spectrum of translational research – to infuse patient experiences and voices into designing HS research METHODS/STUDY POPULATION: The Rockefeller University (RU), Clinical Directors Network (CDN), and the HS Foundation organized three hybrid in-person/online HS FSTHs (2018-2023). The 2018 event focused on patients, describing the current state of HS knowledge and new research into HS biology (T2, T3). Patients shared lived experiences in testimonials and a panel discussion. Advocates described community and mental health resources (T4). The 2021 event returned research results (T2, T3) to the community and updates about treatments in the pipeline (T4). The 2023 FSTH targeted clinicians (T4) addressing a critical translational gap in HS care and presenting best practices in diagnosis, surgical, and medical treatments. RESULTS/ANTICIPATED RESULTS: Impact on science: FSTH attendees joined a Community Engagement Studio providing feedback used to refine study variables/procedures. Attendees joined research studies that advanced understanding HS mechanisms of disease, clinical course and treatment.Impact on patient experience: Participants appreciated having a forum to hear/share experiences of shame, mistrust, misdiagnosis and hope. Feedback improved practices for privacy, consenting, and returning study results. Impact on clinical practice and care: FSTH raised awareness of stigma, need for respect and empathy, and advanced learning about in disease mechanisms, effective biologics, importance of epithelial tunnels and surgical care. DISCUSSION/SIGNIFICANCE: HS is a stigmatizing, poorly understood disease. FSTHs fostered bidirectional learning among scientists, clinicians, patients and other stakeholders. Patients engaged with researchers to improve research design and participate in mechanistic and therapeutic clinical research, advancing the field.

Advances in Medical and Surgical Care of Acute Spinal Cord injury

Acute cervical spinal cord injury (SCI) represents a significant challenge, with substantial implications for individual well-being and societal costs. In this chapter, we highlighted the importance of early surgical intervention within a critical time frame following injury to mitigate the risk of secondary damage and optimize neurological recovery. The chapter also delineated the dichotomy of primary and secondary injuries in traumatic cervical SCI, elucidating the pathophysiological mechanisms underlying each phase. Insights into the inflammatory cascade and cellular responses offer a nuanced understanding of injury progression, paving the way for targeted therapeutic interventions. Therefore, we delved into the current landscape of traumatic cervical SCI, addressing the advances in the medical and surgical care. Regarding surgical management, attention was directed towards established practices such as immobilization, respiratory support, and optimal timing of surgery, alongside emerging modalities including intraspinal pressure management, stem cell therapy, and nerve/tendon transfer. Similarly, the medical management section highlighted the importance of spinal cord perfusion, neurogenic shock management, and the role of steroids, while also exploring novel avenues such as genetic modification for spinal recovery. Overall, this chapter underscored the dynamic nature of SCI care, advocating for a holistic approach that integrates traditional and innovative treatment modalities.

Association of Racial and Economic Privilege on Postoperative Outcomes Among Medicare Beneficiaries

BackgroundSocial determinants of health (SDOH) can play an important role in patients’ health. Privilege is a right, benefit, advantage, or opportunity that can positively affect all SDOH. We sought to assess variations in the prevalence of privilege among patient populations and define the association of privilege on post-operative surgical outcomes. MethodsMedicare beneficiaries who underwent elective coronary artery bypass grafting, abdominal aortic aneurysm repair, total hip arthroplasty, total knee arthroplasty, colectomy, and lung resection were identified. The Index of Concentration of Extremes (ICE), a validated metric of both social spatial polarization and privilege was calculated and merged with county-level data obtained from the American Community Survey. Textbook outcome (TO) was defined as absence of post-operative complications, extended length of stay, 90-day mortality and 90-day readmission. Multivariable regression analysis was performed to assess the relationship between ICE and TO. ResultsAmong 1,885,889 Medicare beneficiaries who met inclusion criteria, 655,980 (34.8%) individuals resided in areas with the highest privilege (i.e., White, high-income homogeneity), whereas 221,314 (11.7%) individuals resided in areas of the lowest privilege (i.e., Black, low-income homogeneity). The overall incidence of TO was 66.2% (n = 1,247,558). On multivariable regression, residence in the most advantaged neighbourhoods was associated with a lower chance of surgical complications (odds ratio (OR) 0.90, 95% confidence interval (CI) 0.88-0.91), a prolonged length of stay (OR 0.81, 95% CI 0.79-82), 90-day readmission (OR 0.94, 95% CI 0.92-0.95) and 90-day mortality (OR 0.71, 95% CI 0.68-0.74) (all p<0.001). Residence in the most privileged areas was associated with 19% increased odds of achieving TO (OR 1.19, 95% CI 1.18-1.21), as well as a 6% reduction in Medicare expenditures versus individuals in the least privileged counties (OR 0.94, 95%CI 0.94-0.94) (both p<0.001). ConclusionPrivilege, based on the ICE joint measure of racial/ethnic and economic spatial concentration, was strongly associated with the likelihood to achieve an “optimal” TO following surgery. As healthcare is a basic human right, privilege should not be associated with disparities in surgical care.

The Hip Fracture Assessment Tool: A Scoring System to Assess High Risk Geriatric Hip Fracture Patients for Post-Operative Critical Care Monitoring

IntroductionIntensive care unit risk stratification models have been utilized in elective joint arthroplasty; however, hip fracture patients are fundamentally different in their clinical course. Having a critical care risk calculator utilizing pre-operative risk factors can improve resourcing for hip fracture patients in the peri-operative period. MethodsA cohort of geriatric hip fracture patients at a single institution were reviewed over a three-year period. Non-operative patients, peri-implant fractures, additional procedures performed under the same anesthesia period, and patients admitted to the intensive care unit (ICU) prior to surgery were excluded. Pre-operative laboratory values, Revised Cardiac Risk Index (RCRI), and American Society of Anesthesiologists (ASA) scores were calculated. Pre-operative ambulatory status was determined. The primary outcome measure was ICU admission in the post-operative period. Outcomes were assessed with Fisher's exact test, Kruskal-Wallis test, logistic regression, and ROC curve. Results315 patient charts were analyzed with 262 patients meeting inclusion criteria. Age ≥ 80 years, ASA ≥ 4, pre-operative hemoglobin < 10 g/dL, and a history of CVA/TIA were found to be significant factors and utilized within a “training” data set to create a 4-point scoring system after reverse stepwise elimination. The 4-point scoring system was then assessed within a separate “validation” data set to yield an ROC area under the curve (AUC) of 0.747. Score ≥ 3 was associated with 96.8% specificity and 14.2% sensitivity for predicting post-op ICU admission. Score ≥ 3 was associated with a 50% positive predictive value and 83% negative predictive value. ConclusionUse of a hip fracture risk stratification scoring system utilizing pre-operative patient specific values to stratify geriatric hip patients to the ICU post-operatively can improve the pre-operative decision-making of surgical and critical care teams. This has important implications for triaging vital hospital resources. Level of EvidenceIII (retrospective study)

Surgical critical care certification: generally speaking-it's thriving!

Surgical critical care certification: generally speaking-it's thriving!

Effects of structured protocolized physical therapy on the duration of mechanical ventilation in patients with prolonged weaning

Purpose20% of patients with mechanical ventilation (MV) have a prolonged, complex weaning process, often experiencing a condition of ICU-acquired weakness (ICUAW), with a severe decrease in muscle function and restricted long-term prognosis. We aimed to analyze a protocolized, systematic approach of physiotherapy in prolonged weaning patients and hypothesized that the duration of weaning from MV would be shortened. MethodsICU patients with prolonged weaning were included before (group 1) and after (group 2) introduction of a quality control measure of a structured and protocolized physiotherapy program. Primary endpoint was the tested dynamometric handgrip strength and the Surgical Intensive Care Unit Optimal Mobilization Score (SOMS). Secondary endpoints were weaning success rate, ventilator-free days, hospital mortality, the prevalence of ICUAW, infections and delirium. Results106 patients were included. Both the SOMS and the handgrip test were significantly improved after introducing the program. Despite no differences in weaning success rates at discharge, the total length of MV was significantly shorter in group 2, which also had lower prevalence of infection and higher probability of survival. ConclusionsProtocolized, systematic physiotherapy resulted in an improvement of the clinical outcome in patients with prolonged weaning. Results were objectifiable with the SOMS and the handgrip test.

Characteristics and outcomes of diabetic foot ulcers treated with surgical debridement and standardized wound care.

Diabetic foot ulcers (DFUs) pose a significant clinical challenge, often leading to amputations and hospitalisation. This study aimed to investigate the characteristics and outcomes of DFUs treated with surgical debridement and standardised wound care. This descriptive cross-sectional study focused on diabetic patients with appropriate vascular conditions, as determined by an Ankle Brachial Index >0.9. Based on their infection status, participants were admitted to Poursina Hospital in Rasht, Iran, and subjected to initial supportive measures, antibiotic therapy and surgical debridement. The study incorporated primary treatment with wet bandages, silver spray and fibrinolysin ointment. Statistical analysis employed SPSS 22 software. Most patients were male (54.7%) and under 60 years old (50.7%). Overweight status was prevalent in 69.3% of diabetic ulcer patients, amongst whom 48% underwent wrist debridement. The 64% and 36% of the cases had grade III and grade II Texas index. Moreover, 96% of patients exhibited signs of infection and were classified as Stage Texas B. Reoperation was necessary for 34.7% of patients. The mean hospital stay was 8.5 ± 7.55 days, and the average recovery time was 15.2 ± 15.19 days. Out of 75 patients, 10 were unable to return to limb function due to disability. In this study, around one-third of patients required secondary repair with grafts and flaps. A small number of them were unable to recover because of underlying disability, and the mean recovery time in other cases was 24 days. Future studies should follow up with patients for longer periods to assess long-term therapeutic outcomes and quality of life.

Surgical and critical care management of earthquake musculoskeletal injuries and crush syndrome: A collective review

Earthquakes are unpredictable natural disasters causing massive injuries. We aim to review the surgical management of earthquake musculoskeletal injuries and the critical care of crush syndrome. We searched the English literature in PubMed without time restriction to select relevant papers. Retrieved articles were critically appraised and summarized. Open wounds should be cleaned, debrided, receive antibiotics, receive tetanus toxoid unless vaccinated in the last 5 years, and re-debrided as needed. The lower limb affected 48.5% (21.9%–81.4%) of body regions/patients. Fractures occurred in 31.1% (11.3%–78%) of body regions/patients. The most common surgery was open reduction and internal fixation done in 21% (0%–76.6%), followed by plaster of Paris in 18.2% (2.3%–48.8%), and external fixation in 6.6% (1%–13%) of operations/patients. Open fractures should be treated with external fixation. Internal fixation should not be done until the wound becomes clean and the fractured bones are properly covered with skin, skin graft, or flap. Fasciotomies were done in 15% (2.8%–27.2%), while amputations were done in 3.7% (0.4%–11.5%) of body regions/patients. Principles of treating crush syndrome include: (1) administering proper intravenous fluids to maintain adequate urine output, (2) monitoring and managing hyperkalemia, and (3) considering renal replacement therapy in case of volume overload, severe hyperkalemia, severe acidemia, or severe uremia. Low-quality studies addressed indications for fasciotomy, amputation, and hyperbaric oxygen therapy. Prospective data collection on future medical management of earthquake injuries should be part of future disaster preparedness. We hope that this review will carry the essential knowledge needed for properly managing earthquake musculoskeletal injuries and crush syndrome in hospitalized patients.

Стратегия эффективного административного контроля антимикробной терапии в отделении реанимации и интенсивной терапии хирургического профиля: ретроспективное пилотное исследование.

Objective: To evaluate a strategy for effective administrative control of targeted antimicrobial therapy in surgical intensive care unit (ICU) patients. Materials and methods. The study included 3522 patients who were treated in ICU No. 1 in the period 2022 to 2023. The first group (control), treatment period 2022, included 1764 patients. The second group (research), treatment period 2023, included 1758 patients. In both groups, the use of antimicrobial drugs (AMP) was carried out in accordance with the antibacterial therapy control strategy (ASCT); in group 2, systemic administrative control was additionally carried out in the form of the use of the “Effective Hospital” program and a developed analytical system with monitoring the financial stability of the unit, aimed at daily monitoring of operating activities. A comparative analysis of the frequency of use of various classes of antimicrobial agents, the incidence of infectious complications, mortality rates and financial costs between groups was performed. Results. There was a significant decrease in the consumption of AMPs of the carbapenem group from 8194 vials in 2022 to 6577 vials in 2023, which was a decrease of 19.7%; a decrease in the consumption of tetracycline group AMPs in 2023 compared to 2022, from 2338 bottles to 1581 bottles, which amounted to 32.4%; reduction in the consumption of vancomycin and linezolid in 2023 compared to 2022 from 562 vials to 313 vials, which amounted to 44.3%. There was a decrease in the incidence of VAP from 59.3 (57.6; 62.9) in 2022 to 48.1 (38.65; 61.9) units in 2023, which amounted to 10.8% (p = 0.053). The increase in the frequency of deaths from 10.9% (9.1; 12.4) in 2022 to 11.5% (10.5; 12.7) in 2023 did not have significant differences (p = 0.67). The total expenditure on AMP in 2023 significantly decreased by 22.3%, which allowed saving 1,477,205.53 rubles (p = 0.012). Conclusion. The use of a daily strategy of administrative control of operational activities and the use of antimicrobial therapy in the ICU can reduce the costs of expensive antimicrobial agents, reduce the incidence of nosocomial infectious and inflammatory complications without changing overall mortality.

Neoadjuvant Therapy Leads to Objective Response in Intrahepatic Cholangiocarcinoma

BackgroundIntrahepatic cholangiocarcinoma (iCCA) is the second most common hepatic malignancy and has a poor prognosis. Surgical resection is the standard of care for patients with resectable disease, representing 30-40% of cases. Increasingly, neoadjuvant systemic therapy is being utilized in patients due to high-risk anatomic or biologic considerations. However, data on the clinical effect of this approach are limited. We performed a cohort study to evaluate the effect of neoadjuvant therapy in patients with oncologically high-risk iCCA. MethodsICCA patients (n = 181) between the years 2014-2020 were reviewed for clinical, histopathologic, treatment, and outcome-related data. Tumor regression grade was scored as per CAP criteria for gastrointestinal carcinomas. Results47 iCCA patients received neoadjuvant therapy and 72 did not. Neoadjuvant treatment led to objective response and tumor regression by CAP score. After adjustment for age, clinical stage, and tumor size, the outcomes of patients who had neoadjuvant therapy followed by surgery were not significantly different from those patients who had surgery first. DiscussionIn conclusion, neoadjuvant therapy in iCCA facilitated surgical care. The progression-free and overall survival for surgical patients with and without neoadjuvant therapy were not significantly different suggesting this approach needs further exploration as an effective treatment paradigm.

Can ERAS help reduce health disparities and overcome barriers to equitable surgical care in marginalized communities?

Health inequities persist in surgical outcomes between different races and ethnicities. Enhanced Recovery after Surgery (ERAS) protocols are innovative perioperative management strategies that have improved outcomes and reduced costs of delivering care. Quality improvement tools embedded in the protocols allow for sequential improvements in compliance and outcomes. Standardization of perioperative care may reduce healthcare inequities and improve outcomes in marginalized communities. In this review, we describe the benefits of ERAS in surgical outcomes, discuss how implementation of ERAS could potentially reduce health disparities in pediatric surgical patients, demonstrate the barriers present in ERAS implementation, propose solutions to these implementation barriers (Table 1).

IJCM_277A: Awareness, Perception and Attitude of Medical Interns and Graduates Towards Robotic Surgery: A Cross-Sectional Study

Background: Robotic surgery is a novel venture in medical sciences that uses robotic systems to assist and carry out surgical procedures and is one of the most discussed topics in surgery today. However, there is paucity of information regarding awareness, attitude and perceptions related to robotic surgery among the future surgical care providers (i.e., interns and postgraduates). Methodology: This cross-sectional study was carried out among all the Medical Interns and the Postgraduates posted in the surgical Departments of KMC Mangalore (General Surgery, OBG, ENT, Ophthalmology, Orthopedics and Anaesthesia) using Universal sampling technique and data were collected using a semi-structured, pre-validated questionnaire consisting of two sections. The collected data were analyzed using SPSS software version 25. The results were summarized as percentages, tables and figures. For comparison across the groups chi-square test was used and a value less than 0.05 was considered statistically significant. Results: One hundred sixty-nine Interns and surgical Postgraduates were included in total in the study with a mean age of 25 years. Among the study participants,57.3% (n=59) of Interns and 57.6% (n=38) of Postgraduates have seen robotic surgery being performed in the past. More than half of the study participants, 66%(n=68) interns and 72.7%(n=48) postgraduates were aware of the Da Vinci robotic surgical system. Among the challenges for mainstreaming robotic surgery, cost was the most important concern among 53.3% (n=57) interns and 53%(n=35) postgraduates. Conclusion: In our study majority of the participants, Interns (64.1%) and Post graduates (84.8%) had a positive outlook towards robotic surgery &amp; believed cost (55.3 % Interns and 53% Post graduates) was one of the major constrains limiting its use

Neoadjuvant therapy leads to objective response in intrahepatic cholangiocarcinoma

BackgroundIntrahepatic cholangiocarcinoma (iCCA) is the second most common hepatic malignancy and has a poor prognosis. Surgical resection is the standard of care for patients with resectable disease, representing 30-40% of cases. Increasingly, neoadjuvant systemic therapy is being utilized in patients due to high-risk anatomic or biologic considerations. However, data on the clinical effect of this approach are limited. We performed a cohort study to evaluate the effect of neoadjuvant therapy in patients with oncologically high-risk iCCA. MethodsiCCA patients (n = 181) between the years 2014-2020 were reviewed for clinical, histopathologic, treatment, and outcome-related data. Tumor regression grade was scored per CAP criteria for gastrointestinal carcinomas. Results47 iCCA patients received neoadjuvant therapy and 72 did not. Neoadjuvant treatment led to objective response and tumor regression by CAP score. After adjustment for age, clinical stage, and tumor size, the outcomes of patients who had neoadjuvant therapy followed by surgery were not significantly different from those patients who had surgery first. DiscussionIn conclusion, neoadjuvant therapy in iCCA facilitated surgical care. The progression-free and overall survival for surgical patients with and without neoadjuvant therapy were not significantly different suggesting this approach needs further exploration as an effective treatment paradigm.