Surgical Chair Research Articles

Physician-Targeted Interventions Reduce Surgical Expense and Improve Value-Driven Health Outcomes

IntroductionIncreasing health-care costs in the United States have not translated to superior outcomes in comparison to other developed countries. The implementation of physician-targeted interventions to reduce costs may improve value-driven health outcomes. This study aimed to evaluate the effectiveness of physician-targeted interventions to reduce surgical expenses and improve care for patients undergoing total thyroidectomies. MethodsTwo separate face-to-face interventions with individual surgeons focusing on surgical expenses associated with thyroidectomy were implemented in two surgical services (endocrine surgery and otolaryngology) by the surgical chair of each service in Jun 2016. The preintervention period was from Dec 2014 to Jun 2016 (19 mo, 352 operations). The postintervention period was from July 2016 to January 2018 (19 mo, 360 operations). Descriptive statistics were utilized, and differences-in-differences were conducted to compare the pre and postintervention outcomes including cost metrics (total costs, fixed costs, and variable costs per thyroidectomy) and clinical outcomes (30-d readmission rate, days to readmission, and total length of stay). ResultsPatient demographics and characteristics were comparable across pre- and post-intervention periods. Post-intervention, both costs and clinical outcomes demonstrated improvement or stability. Compared to otolaryngology, endocrine surgery achieved additional savings per surgery post-intervention: mean total costs by $607.84 (SD: 9.76; P < 0.0001), mean fixed costs by $220.21 (SD: 5.64; P < 0.0001), and mean variable costs by $387.82 (SD: 4.75; P < 0.0001). ConclusionsPhysician-targeted interventions can be an effective tool for reducing cost and improving health outcomes. The effectiveness of interventions may differ based on specialty training. Future implementations should standardize these interventions for a critical evaluation of their impact on hospital costs and patient outcomes.

Patient-reported outcome measures (PROMs) of leucocyte and platelet-rich fibrin (L-PRF) or hemostatic agent application at palatal donor sites after free gingival graft harvesting: a randomized controlled clinical trial.

The aim of this study was to evaluate the patient's morbidity and post-surgical complications after treatment of palatal donor sites after free gingival graft (FGG) harvesting using Leucocyte-and Platelet Rich Fibrin (L-PRF) membranes or a hemostatic agent with oxidized and regenerated cellulose. Forty-two palatal donar sites after FGG haversting in 42 patients were randomly assigned to experimental (L-PRF membrane) or control procedure (hemostatic agent). The primary outcome was postoperative pain related to the wound located at palatal area, while the secondary outcomes were post-operative discomfort, inability to chew, post-operative stress, surgical chair time, thickness of palatal fibromucosa and thickness of FGG. The PROMs were recorded after one week. After one week, a statistically significant difference was found between groups in terms of post operative stress (p=0.0083). No statistically significant differences in terms of postoperative pain (p=0.326), patient discomfort (p=0.509), inability to chew (p=0.936), surgical chair time (p=0.932) were recorded between test and control group. No statistically significant differences were recorded in terms of thickness of palatal fibromucosa (p=0.647) and thickness of FGG (P=0.756) between groups. Post-surgical wound healing complications (i.e., necrosis or infections) were not observed in both groups. Within their limitations, the present outcomes indicated that the application of L-PRF membrane at palatal donor sites after FGG harvesting did not produce significant advantages for the patients.

Shattering Glass Ceilings: Three Black Women Surgeons Ascend to Chairs of Departments of Surgery.

Shattering Glass Ceilings: Three Black Women Surgeons Ascend to Chairs of Departments of Surgery.

Clinical research progress in the treatment of intrabony defect by minimally invasive periodontal surgery

Minimally invasive surgery develops rapidly in the periodontal treatments, especially in the periodontal regenerative treatment, in recent years. It supplements, to a certain extent, the insufficiency of the conventional periodontal regenerative treatment. The minimally invasive surgery has many advantages such as enhancing the healing process, reducing surgical chair time and minimizing patient discomfort, etc. It has been proved to improve the clinical effect and provide additional benefits compared to conventional approaches. At present, there are many studies on minimally invasive techniques used in tooth extraction or implant placement in China, but there are few reports on the application of periodontal minimally invasive surgical techniques. Thus based on the reviews of the literatures, this article describes the applications, advantages, indications, microsurgical instruments of minimally invasive periodontal surgery on the treatment of intrabony defect, including various minimally invasive surgical procedures. The review also demonstrates the therapeutic effects and research progress of minimally invasive periodontal surgery combined with biomaterials used in the treatments of intrabony defect. The present article may also provide reference for clinicians applying minimally invasive surgeries to treat intrabony defects.

Do male chairs of surgery have implicit gender bias in the residency application process?

IntroductionMedical students applying for general surgery residencies often require a letter of recommendation (LOR) from the Surgical Chair. However, LORs may reveal gender and ethnic bias. This study examines the presence of implicit bias in general surgery resident selection by evaluating chair LORs. MethodsA retrospective study of 149 LORs for categorical general surgery residents, at an academic institution, written by surgery chairs from 1980 to 2013 was performed. Two independent reviewers scored each letter for overall quality, mention of personality, academic deficiencies, technical skills, and standout adjectives. Scores were compared across gender and race and statistical analysis performed using SPSS. ResultsMales comprised 85% of the applicants; racial makeup was Caucasian (90%), black (4%), Asian (4%), and Hispanic (2%). Male chairs wrote all letters. Letters for female students received higher overall scores than males (4.13 ± 0.16, 3.59 ± 0.08, p = 0.005). Discussion of personality was significantly less for Asian students (1.28 ± 0.08, 1.83 ± 0.48, 0.5 ± 0.224, 1.67 ± 0.67, p 0.050). No difference was present in mention of academic deficiencies, technical skills, or standout adjectives. DiscussionFemale medical students invited to interview at a top academic general surgery residency had higher quality LORs than their male counterparts. Asian applicants had statistically significant less discussion of personality. Further examination of residency selection processes is necessary to implement changes that mitigate implicit bias in trainee selection.

Use of Mucograft Collagen Matrix® versus Free Gingival Graft to Augment Keratinized Tissue around Teeth: A Randomized Controlled Clinical Trial.

Objectives:This study aimed to evaluate the mucograft collagen matrix (CM) to increase keratinized tissue around teeth compared to free gingival graft (FGG).Materials and Methods:The present double-blind, randomized, controlled clinical trial studied 12 patients who had 2 mm or less keratinized gingiva bilaterally around mandibular premolars. The 6-month width of keratinized tissue, periodontal parameters (preoperatively and 1, 3, and 6 months postoperatively), color match, pain, and total surgical time were measured.Results:The mean dimensional change of keratinized gingiva 6 months postoperatively was 4.1±0.7 mm for FGG and 8±1.7 mm for CM. Periodontal parameters were not affected in the two groups. The CM group had a significantly lower pain, experienced less surgery time, and gained better aesthetics compared to the FGG group.Conclusion:CM appears to be a suitable substitute for FGG in procedures designed to increase keratinized tissue around teeth. It has remarkable benefits, such as acceptable keratinized tissue gain, less pain, less surgical chair time, and better aesthetics.

The road to academic surgical leadership: Characteristics and experiences of surgical chairpersons

BackgroundThe evolving landscape of academic surgery demands leaders who are not only effective clinicians and researchers, but also administrators able to navigate complex hospital organizations, financial pressures in the era of quality measures, and inclusion of an increasingly diverse workforce. The aim of this study was to characterize achievements and assess perspectives in becoming a surgical chair in order to guide young surgeons in their career trajectories to surgical leadership. MethodsA survey encompassing demographics, surgical training, nonmedical advanced degrees, academic advancement, and leadership experiences was sent via electronic mail to members of the American College of Surgeons Society of Surgical Chairs in December 2018. ResultsOf 191 Society of Surgical Chairs members, 52 (27.2%) completed the survey, with 6 (11.5%) women, 40 (76.9%) white, and the majority becoming chair between ages 46 and 60 (n = 39, 75.0%). Training beyond residency included fellowships (n = 41, 78.8%) and advanced nonmedical degrees (n = 15, 28.8%). Median H-index was 47 (range 10–120) with 126 (5–500) research publications, and grants received was 2 (0–38) for federal and 5 (0–43) for industry. Female chairs appear to have fewer nonmedical degrees (n = 1) and no difference in age at becoming chair (66.7% vs 79.6% between ages 46 and 60), H-index (26 [10–41] vs 49 [17–120]), or publications (93 [10–189] vs 150 [5,500]). Prior educational (n = 36, 69.2%) and clinical (n = 44, 84.6%) leadership roles were common, with 30 chairs (57.7%) having held both roles. Experiences which respondents felt have most helped them function as chair included serving as a clinical division director (n = 37, 71.2%), residency program director (n = 28, 53.8%), leadership courses (n = 28, 53.8%), a research career (n = 22, 42.3%), and being a vice/interim chair (n = 15, 28.8%). Personal traits felt to be most important in becoming a successful chair included being effective at communication (n = 37, 71.2%), collaborative (n = 35, 67.3%), trustworthy (n = 30, 57.7%), and a problem-solver (n = 27, 51.9%). ConclusionBecoming a department surgical chair often involves not only surgical subspecialty expertise, but also nonmedical training and prior leadership roles, which help facilitate development of skills integral to navigating the collaborative and diverse nature of academic surgery in the current era.

The changing paradigm in surgery is system integration: How do we respond?

With expansion of health care systems across the country, close relationships need to be developed between academic medical centers and their affiliated community hospitals. This creates opportunity to integrate surgical programs across different hospitals. Herein we describe a model of surgical integration at the system level of five large hospitals. We discuss utilizing advantages that both the academic and community hospital bring to the model. A close relationship between an interdisciplinary team, which includes the academic surgical chair, a regional director liaison who was embedded in the community, individual hospital leadership, and practice plan leaders was created. Three pillars as a foundation to success were physician leadership, the use of system infrastructure and development of new processes. This resulted in development of trust, leading to successful recruitments, models of employment and expansion into novel areas of patient safety. Once created, new opportunities for programming for surgical safety across the health care were identified.

Combining of ETHOS Operating Ergonomic Platform, Three-dimensional Laparoscopic Camera, and Radius Surgical System Manipulators Improves Ergonomy in Urologic Laparoscopy: Comparison with Conventional Laparoscopy and da Vinci in a Pelvi Trainer

BackgroundPosture, vision, and instrumentation limitations are the main predicaments of conventional laparoscopy. ObjectiveTo combine the ETHOS surgical chair, the three-dimensional laparoscope, and the Radius Surgical System manipulators, and compare the system with conventional laparoscopy and da Vinci in terms of task completion times and discomfort. Design, setting, and participantsFifteen trainees performed the three main laparoscopic suturing tasks of the Heilbronn training program (IV: simulation of dorsal venous complex suturing; V: circular suturing of tubular structure; and VI: urethrovesical anastomosis) in a pelvi trainer. The tasks were performed conventionally, utilizing the three devices, and robotically. Task completion times were recorded and the surgeon discomfort was evaluated using questionnaires. Outcome measurements and statistical analysisTask completion times were compared using nonparametric Wilcoxon signed rank test and ergonomic scores were compared using Pearson chi-square test. Results and limitationsThe use of the full laparoscopic set (ETHOS chair, three-dimensional laparoscopic camera, Radius Surgical System needle holders), resulted in a significant improvement of the completion time of the three tested tasks compared with conventional laparoscopy (p<0.001) and similar to da Vinci surgery. After completing Tasks IV, V, and VI conventionally, 12 (80%), 13 (86.7%), and 13 (86.7%) of the 15 trainees, respectively, reported heavy total discomfort. The full laparoscopic system nullified heavy discomfort for Tasks IV and V and minimized it (6.7%) for the most demanding Task VI. Especially for Task VI, all trainees gained benefit, by using the system, in terms of task completion times and discomfort. The limited trainee robotic experience and the questionnaire subjectivity could be a potential limitation. ConclusionsThe ergonomic laparoscopic system offers significantly improved task completion times and ergonomy than conventional laparoscopy. Furthermore, it demonstrates comparable results to robotic surgery. Patient summaryThe study was conducted in a pelvi trainer and no patients were recruited.

Kjetil Søreide: rising young surgeon, adept with pen and scalpel

Kjetil Søreide: rising young surgeon, adept with pen and scalpel

851 A NEW PLATFORM IMPROVING ERGONOMY OF LAPAROSCOPIC SURGERY: EXPERIMENTAL STUDIES AND INITIAL CLINICAL EVALUATION

INTRODUCTION AND OBJECTIVES: Distribution of laparoscopic surgery is handicapped due to significant ergonomic limitations. We want to present experimental and clinical evaluation of a new operating chair used as a platform for laparoscopic surgery. METHODS: The surgical chair (ETHOS-platform) consists of a saddle-like seat, an adjustable chest-support, two individually adjustable armrests, and footrests. We compared suturing standing laterally to pelvi-trainer (“Torero-position”) versus standing behind pelvi-trainer and sitting on ETHOS. Every participant and surgeon (N 18) filled out a questionnaire focusing on ergonomic issues. Since August 2010, we performed 164 laparoscopic and retroperitoneoscopic procedures using ETHOS involving four different surgeons. Two frequent procedures (radical prostatectomy, pyeloplasty) underwent detailed comparison to matched-paired patients from our laparoscopic database. RESULTS: Ex-vivo, there was no significant different anastomotic time standing behind pelvi-trainer and sitting on ETHOS; the difference became significant compared to Torero-position mimicking clinical scenario (44.4 vs. 37.6 minutes). Independent from laparoscopic experience and workload complaints (total score) were significantly less with ETHOS-assistance (31.6 vs. 13.9). In-vivo comparison did not show different OR-times, but revealed statistically significant differences with respect to anastomotic times of ETHOS and DaVinci (23 vs. 19 vs. 19 minutes). CONCLUSIONS: Ergonomics of laparoscopy may be significantly improved by new platforms supporting the sitting position of the surgeon with armrests and integrated foot pedals.

Using Topical Anesthesia for Standing Phacoemulsification Cataract Surgery and Intraocular Lens Implantation

Introduction: To report by using topical anesthesia for standing phacoemulsification and intraocular lens implantation for two patients who need cataract extraction but unable to lie flat with marked cervical kyphosis due to long-standing ankylosing spondylitis and chronic uveitis. Methods: Two patients are unable to lie flat respectively during phacoemulsification underwent this technique in Jingdong and Tonghai county Hospital of Yunnan province in China. Each patient was positioned erect or semirecumbent in a standard reclining cataract surgical chair. The ceiling-mounted microscope was rotated 60 degrees from the vertical to point toward the patient. Results: The intraoperative and postoperative periods were uneventful in two patients, with good visual outcomes after surgery. Conclusion: This technique is valuable for situations where the patient requires upright positioning because of the inability to recline flat, and should be considered for cases where standard surgical positioning is not possible.

Initial experience of a novel ergonomic surgical chair for laparoscopic pelvic surgery

We present the initial experience of a novel surgical chair for laparoscopic pelvic surgery, the ETHOS™ (Bridge City Surgical, Portland, OR). The ETHOS chair has an adjustable saddle height that ranges from 0.89 to 1.22 m high, an overall width of 0.89 m, and a depth of 0.97 m. The open straddle is 0.53 m and fits most OR tables. We performed 7 pelvic laparoscopy cases with the 1st generation ETHOS™ platform including 2 laparoscopic ureteral reimplantations, 5 laparoscopic pelvic lymphadenectomies for staging prostate cancer in which one case involved a laparoscopic radical retropubic prostatectomy, performed by 2 different surgeons. All 7 pelvic laparoscopic procedures were successful with the ETHOS™ chair. No conversion to open surgery was necessary. Survey done by surgeons after the procedures revealed minimal stress on back or upper extremities by the surgeons from these operations even when surgery was longer than 120 minutes. Conversely, the surgical assistants still had issues with their positions since they were on either sides of the patient stressing their positions during the procedure. The ETHOS chair system allows the surgeon to operate seated in comfortable position with ergonomic chest, arms, and back supports. These supports minimize surgeon fatigue and discomfort during pelvic laparoscopic procedures even when these procedures are longer than 120 minutes without consequence to the patient safety or detrimental effects to the surgical team.

Face-to-Face Seated Positioning for Phacoemulsification in Patients Unable to Lie Flat for Cataract Surgery

To describe a technique of phacoemulsification for patients unable to lie flat. Prospective interventional case report. Two patients unable to lie flat during phacoemulsification underwent this technique in a University Ophthalmology Department in the United Kingdom. Each patient was positioned erect or semirecumbent in a standard reclining cataract surgical chair. The ceiling-mounted microscope was rotated 60 degrees from the vertical to point toward the patient. The surgeon sat beside the patient, and while facing him or her, operated at nearly arm's length. The intraoperative and postoperative periods were uneventful in both patients, with good visual outcomes after surgery. This technique is valuable for situations where the patient or the eye requires upright positioning because of the inability to recline flat, and should be considered for cases where standard surgical positioning is not possible.

The Changing Roles of a Surgical Department Chair

was so honored by Dr Organ's invitation to write this article that I immediately accepted. Then, as I considered this subject-changes in the role of an academic surgical chair| I realized the difficulty I faced. Certainly, any such assessment by me alone is biased by my personal experience and particularly by my incomplete understanding of the roles of an academic surgical chair in the past. Nevertheless, as my wife, Shannon, would be quick to point out, incomplete knowledge of a subject has never stopped me from expounding about it.

The 100th birthday of Rudolf Nissen

Rudolf Nissen was born in Neisse, Schlesien, 9 September 1896. From 1921 to 1933 he was the favorite pupil of Ferdinand Sauerbruch in Munich and Berlin. 1930 he became professor of surgery at the Charité. The assumption of power by the Nazi-regime forced Nissen to resign his position and end his career in Germany. He took over the surgical chair in Istanbul, Turkey. Emigrating in 1939 to the USA, he held surgical positions in hospitals at New York and accepted in 1952 the chair of Surgery at the University of Basel, Switzerland. Nissen died in Riehen/ Basel on 22 January 1981. Nissen was a critical observant clinician, an efficient and popular physician, a teacher and a speaker. Of historical significance are pioneering works in thoracic surgery, the first successful pneumectomy in man, the classical works about the treatment of gastro-oesophageal reflux disease and hiatus hernia. The Nissen-Rossetti type of fundoplication has remained the standard procedure in Europe and the USA.

The design and evaluation of the neutral posture chair for surgeons.

A neutral posture chair was designed and evaluated to determine if it was a possible means for reducing or eliminating fatigue experienced by surgeons because of seated body posture during microsurgical procedures. The neutral body posture is defined as the posture found in weightlessness, where the muscle, tendon, and ligament systems acting over the joints are in total balance. The neutral posture chair is a unique combination of a forward-sloping cultivator seat and WI English saddle, with wraparound leg trough support. On subjective questionnaires, surgeons rated the neutral posture chair as being generally superior to a currently utilized surgical chair for general comfort, body-part comfort, and chair features.

Ophthalmic surgical operating chair.

Ophthalmic surgical operating chair.