Surgical Course Research Articles

Effects of Cyclic Peptide LXW7 Coating on Short-term Vascular Graft Patency Using a Porcine (Sus scrofa) Model

We previously identified LXW7, a specific integrin αvβ3 targeting ligand capable of selectively capturing endothelial progenitor cells and endothelial cells, and developed a parylene-based conformal coating technology to covalently present LXW7 to prosthetic materials. In previous in vitro and in vivo studies, LXW7-coated grafts have demonstrated successful capture of endothelial progenitor cells and endothelial cells, which then promotes re-endothelialization of these prosthetic materials. This study aims to assess the function of LXW7 coating on interposition expanded polytetrafluoroethylene (ePTFE) graft thrombus formation and patency in a large animal model. Eight female Yorkshire pigs underwent transperitoneal implantation of bilateral iliac artery interposition bypasses using control plain ePTFE grafts (inner diameter 6 mm) and LXW7-coated ePTFE grafts. Each animal served as its own control and the implanting surgeon and experimental team were blinded to treatment and evaluations. The animals underwent computed tomography angiography (CTA) immediately postoperatively and at 3 and 6 weeks postimplantation. After final CTA imaging, animals were sacrificed and interposition grafts were harvested for histological evaluation. The project proceeded following the approval of United States Air Force, David Grant Medical Center Institutional Animal Care and Use Committee. Six animals were included in final analysis, with two excluded due to complications during their surgical and postoperative course requiring euthanasia. Average native artery diameter was 4.08 mm for the control grafts and 4.17 mm for LXW7-coated grafts (P = .296). Average clamp time was similar between groups (60 minutes for the control grafts vs 52 minutes on the LXW7-coated grafts; P = .291). The immediate postprocedure CTA demonstrated procedural success for all six pigs with no evidence of thrombus or stenosis. At the 3-week imaging, all grafts remained patent. At the 6-week imaging, all six LXW7-coated grafts were patent without evidence of thrombus or stenosis while four of the six control grafts were either fully or partially thrombosed. Repeated measures mixed effects analysis demonstrated significantly improved patency over time with LXW7 coated grafts (P < .001) (Figure). This is the first study using CTA to investigate the impact of LXW7 coating on prosthetic vascular graft patency in a clinically relevant large animal model. The findings demonstrate significantly improved graft patency over time with use of LXW7 coating, suggesting promise as a potential adjunct to clinical outcomes with prosthetic grafts in vascular bypass applications.Fig 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)

(143) Hostile Field: Surgical Management Strategies After Multiple Explants of Artificial Urinary Sphincters

Abstract Introduction Placement of artificial urinary sphincters (AUS) is the gold standard treatment for moderate to severe stress urinary incontinence in men. Erosion, infection, and mechanical malfunction of the AUS are well known complications that require removal of the device. Replacement of AUS after several explants represents a surgical challenge and is performed by a minority of urologists. Objective We describe our experience with management of complex cases after multiple AUS complications. Methods Retrospective review of patients who underwent artificial urinary sphincter (AUS) removal after prior device explantations. Surgical and clinical data was collected, including demographic characteristics, indication for AUS explantation, number of prior AUS, presence of an IPP, and surgical outcomes and complications. Descriptive statistics were used for both categorical and nominal variables. Results Between 2017 and 2021, 8 patients presented with recurrent stress urinary incontinence (SUI) with a history of AUS with or without explant. 2 patients presented with one prior AUS, 1 patient with two prior, 4 patients with 3 prior AUS, and 1 patient with 4 prior AUS. 5/8 patients achieved &amp;gt;90% continence following one revision. The remaining patients underwent cuff downsizing. 1 patient failed multiple revisions and required urethral ligation with permanent suprapubic tube placement (SPT). Patient history and surgical course is summarized in Table 1. Conclusions AUS placement after multiple explants presents a surgical challenge. It is associated with a higher rate of complications and need for explant. It is however feasible and safe, and can provide resolution of incontinence to the majority of patients. In patients with a devastated urethra where additional AUS does not seem feasible a urinary diversion or urethral ligation with SPT may be a satisfactory alternative. Disclosure No

Intraoperative molecular imaging: 3rd biennial clinical trials update.

This third biennial intraoperative molecular imaging (IMI) conference shows how optical contrast agents have been applied to develop clinically significant endpoints that improve precision cancer surgery. National and international experts on IMI presented ongoing clinical trials in cancer surgery and preclinical work. Previously known dyes (with broader applications), new dyes, novel nonfluorescence-based imaging techniques, pediatric dyes, and normal tissue dyes were discussed. Principal investigators presenting at the Perelman School of Medicine Abramson Cancer Center's third clinical trials update on IMI were selected to discuss their clinical trials and endpoints. Dyes that are FDA-approved or currently under clinical investigation in phase 1, 2, and 3 trials were discussed. Sections on how to move benchwork research to the bedside were also included. There was also a dedicated section for pediatric dyes and nonfluorescence-based dyes that have been newly developed. IMI is a valuable adjunct in precision cancer surgery and has broad applications in multiple subspecialties. It has been reliably used to alter the surgical course of patients and in clinical decision making. There remain gaps in the utilization of IMI in certain subspecialties and potential for developing newer and improved dyes and imaging techniques.

O024 Development and validation of a “lab in a box” for remote delivery of core reconstructive surgical skills

Abstract Introduction Junior doctors and aspiring surgical trainees can have limited surgical exposure and developmental teaching because of rapid rotations, inconsistent rotas, reduced theatre time, and high working pressures. The global pandemic has also initiated a paradigm shift in education, and the methods we use to deliver education. Our aims are to assess the feasibility and validity of a low cost, remote plastic surgical skills course in comparison to the same course delivered face-to-face. Methods Our bench-model simulation “Lab in a Box” design was delivered to students remotely and in person. The essential and advanced plastic surgery course included suturing, excision, tendon repair, and local flap design. We undertook a pilot course facilitated by an online platform using a two-device set up. Equipment, including synthetic tendons and skin substitutes, were distributed to each participant. Quantitative evaluation included a global rating assessment and task specific criteria using a 1-5 Likert scale. Results were compared to the face-to-face control group. Qualitative feedback was also collected. Results A total of 40 students were recruited. A total cost of less than £30 was achieved. Quantitative feedback demonstrated comparable outcomes in remote training vs face-to-face training. Students reported excellent quality of audio-visual material and equipment, clear feedback, and 100% would recommend this course. Conclusion The simulation training course developed provides high-quality, engaging, reproducible and low-cost surgical skills training that can be delivered via distance learning. This model can be used to improve surgical skills training both in the UK and globally in resource poor environments.

With equity in mind: Evaluating an interactive hybrid global surgery course for cross-site interdisciplinary learners.

There is limited understanding of the role of transcultural, cross-site educational partnerships for global surgery training between high- and low- or middle-income country (LMIC) institutions. We describe the development, delivery, and appraisal of a hybrid, synchronous, semester-long Global Surgical Care course by global health collaborators from widely different contexts, and evaluate the equity of the collaboration. The course was collaboratively modified by surgical educators and public health professionals with emphasis on collaboration ethics. Faculty from high-income and LMICs were paired to deliver lectures. To collaborate internationally, students and faculty participated either onsite or online. Perceptions and knowledge gained were quantitatively evaluated through participant and faculty cross-sectional surveys, using Likert scales, prioritization rankings, and free text responses analysed qualitatively. Equity was assessed using the Fair Trade Learning rubric and additional probes. Thirty-five learners from six institutions participated. Teams produced mock National, Surgical, Obstetric, and Anaesthesia Plans (NSOAPs) for selected LMICs, and reported a 9% to 65% increase in self-reported global health competencies following the course. Online learners had favourable perceptions of learning, but experienced connectivity challenges. Barriers to effective group work included time differences and logistics of communication for dispersed team members. Individuals taking the course for academic credit scored significantly higher than other learners in peer assessments of participation (8.56±1.53 versus 5.03±3.14; p<0.001). Using the Fair Trade Rubric, 60% of equity indicators were ideal, and no respondents perceived neo-colonialism in the partnership. Blended, synchronous, interdisciplinary global surgery courses based on "North-South" partnerships with a focus on equity in design and delivery are feasible but require careful and deliberate planning to minimize epistemic injustice. Such programs should address surgical systems strengthening, and not create dependency. Equity in such engagements should be evaluated and monitored in an ongoing fashion to stimulate discussion and continuous improvement.

SurgTalk: A Novel Surgical Palliative Communication Course (QI128)

SurgTalk: A Novel Surgical Palliative Communication Course (QI128)

Atypical Chondroid Syringoma of the Toe.

Although chondroid syringoma rarely occurs outside the head and neck, the majority of malignant chondroid syringomas are identified in the extremities. Here, we present a case of atypical chondroid syringoma in the fifth toe. Diagnosis of chondroid syringoma with atypical cells was made following initial excisional biopsy and histology, necessitating repeated surgery for positive margins. In this case report, we examine the radiopathologic correlation of this diagnosis, detail the imaging findings of benign and malignant chondroid syringomas, and highlight how magnetic resonance imaging can be used to guide surgical planning and treatment course of this potentially malignant tumor.

Abstract 601: Effects Of Cyclic Peptide Lxw7 Coating On Short Term Vascular Graft Patency Using A Porcine ( Sus Scrofa) Model

Introduction: We previously identified LXW7, a specific integrin αvβ3 targeting ligand capable of selectively capturing endothelial progenitor cells (EPCs) and endothelial cells (ECs), and developed a parylene-based conformal coating technology to covalently bind LXW7 to prosthetic materials. LXW7-coated grafts have demonstrated successful capture of EPCs and ECs, which then promotes endothelialization of prosthetic materials. This study aims to assess the function of LXW7 coating on interposition polytetrafluoroethylene (ePTFE) graft thrombus formation and patency in a large animal model. Methods: 8 Yorkshire pigs underwent implantation of bilateral iliac artery interposition bypasses using control ePTFE grafts and LXW7-coated ePTFE grafts. Each animal served as its own control and the implanting surgeon and experimental team were blinded to treatment and evaluations. Computed Tomography Angiogram (CTA) immediately post-operatively, 3 weeks, and 6 weeks post-implantation. After final CTA, animals were sacrificed and grafts were harvested. The project proceeded following the approval of United States Air Force, David Grant Medical Center Institutional Animal Care &amp; Use Committee. Results: 6 animals were included in final analysis, with 2 excluded due to complications during their surgical and post-operative course requiring euthanasia. Native artery diameter was 4.08mm for the control grafts and 4.17mm for LXW7-coated grafts (p=0.296). Post-procedure CTA demonstrated procedural success for all 6 pigs with no evidence of thrombus or stenosis. At 3 week imaging, all grafts remained patent. 6 week imaging, all LXW7-coated grafts were patent without evidence of thrombus or stenosis while 4 of the 6 control grafts were either fully or partially thrombosed. Repeated measures mixed effects analysis demonstrated significantly improved patency over time with LXW7 coated grafts (p&lt;0.001). Conclusion: This is the first study investigating LXW7-coating on prosthetic vascular graft patency in a large animal model. We demonstrate significantly improved graft patency use of LXW7-coating, suggesting promise as an adjunct for prosthetic grafts in vascular bypass applications.

Select Patients with High-Risk IIH May Be Managed with Medical Therapy Alone (P2-9.009)

<h3>Objective:</h3> Measure visual outcomes in high-risk idiopathic intracranial hypertension (IIH), with particular attention to medical or surgical treatment course and disease recurrence. <h3>Background:</h3> In IIH, presentations with BMI &gt;40, high-grade papilledema, worse visual field mean deviation (VFMD), and worse visual acuity are associated with worse visual outcomes. In the absence of randomized data on high-risk patients, surgery is often recommended, but risks complications, infections, or surgical revision. <h3>Design/Methods:</h3> We retrospectively reviewed the charts of all IIH patients who presented to 3 providers between April 2019 and April 2022 with grade IV or V papilledema. Patients were treated at the discretion of their neuro-ophthalmologist. Outcomes were stratified by presenting VFMD. <h3>Results:</h3> 11 patients were evaluated. Average age was 25.8 years, 10/11 were female, and average BMI was 38.3 kg/m2. On presentation, VA was 20/30 or worse in 9/11 patients, but improved to 20/20 or better in 9/11 patients. Average presenting VFMD was −13.8 dB, but improved by an average of 7.1 dB in those with initial VFMD worse than −7.0 dB and 2.1 dB in those with initial VFMD better than −7.0 dB. 2 patients met published criteria for “fulminant” IIH, but both improved to 20/20 acuity OU with significant VFMD improvements on medical therapy alone. All patients received acetazolamide with rapid dose escalation. Average maximum dose was 2.75 g per day. 2 also received topiramate. 1 patient received a ventriculoperitoneal shunt 3 days after presentation. 1 patient received an optic nerve sheath fenestration 15 days after presentation. 1 patient on medical therapy had recurrent disease over an average of 352 days of follow up. <h3>Conclusions:</h3> Select patients with high-risk or “fulminant” IIH may be successfully managed without surgery. These patients required close monitoring and aggressive medical therapy. Reduced visual acuity on presentation recovered well in most patients. Larger cohorts with longer follow-up are needed. <b>Disclosure:</b> Dr. Gluckstein has nothing to disclose. An immediate family member of Dr. Rizzo has received personal compensation for serving as an employee of LIfeBiosciences. Dr. Rizzo has received intellectual property interests from a discovery or technology relating to health care. Dr. Rizzo has received intellectual property interests from a discovery or technology relating to health care. Dr. Chen has nothing to disclose.

Training in vascular trauma surgery for non-vascular surgeons: Vascular trauma surgery skills course.

The experience of general and trauma surgeons in vascular trauma management has decreased with sub-specialization of surgery and working hours restrictions. We introduce avascular trauma surgery skills course established to train German military surgeons prior to their deployment to conflict areas. The intention and implementation of the vascular trauma course for non-vascular surgeons is described in detail. In hands-on courses, participants learn and train basic vascular surgical techniques on more realistic extremity, neck, and abdominal models with pulsatile vessels. Afundamental and an advanced course each provide military as well as civilian surgeons from different non-vascular specialties with asurgical skill set including direct vessel sutures, patch angioplasty, anastomosis, thrombectomy, and resuscitative endovascular balloon occlusion of the aorta (REBOA) in order to render them capable of managing major vascular injuries. The experiences of this vascular trauma surgical skills course, initially established for military surgeons, can also be of use to all civilian general, visceral, and trauma surgeons occasionally facing traumatic or iatrogenic vascular injuries. Thus, the introduced vascular trauma course is valuable for all surgeons working in trauma centers.

Development and evaluation of an online surgical elective for medical students

BackgroundDecreased experiential learning opportunities exacerbated by the COVID-19 pandemic have increased development of online surgical educational courses. To what extent may such courses provide exposure to broad and accessible surgical education?MethodsSurge is a 6-week online surgical elective hosted within a virtual learning environment, covering all surgical specialties. Course content is mapped to the Royal College of Surgeons’ Undergraduate Curriculum in Surgery. Each week consultant surgeons discuss their specialty in short videos on anatomy, pathology and lifestyle of a surgeon. Students also engage with learning activities; further reading lists; formative quizzes and live sessions including suturing practice. Participants were medical students undertaking third-year electives at the University of Sheffield. Pre- and post-course questionnaires investigated student interest in surgery, understanding of steps required to pursue a surgical career and confidence in surgical environments. Qualitative data was collected via free-text responses and analysed with content analysis. Quantitative data was collected using 5-point Likert scales (1 = Strongly Disagree; 5 = Strongly Agree) and analysed using the Wilcoxon signed-rank test.ResultsTwenty-two students participated in Surge over five 6-week cohorts. Examination of free-text responses revealed students gained increased understanding of available surgical career options. Students felt better informed regarding different surgical specialties (median score 2.5 vs. 4, p = 0.000) and steps required to develop a surgical portfolio (median score 2 vs. 5, p = 0.000). Additionally, confidence in understanding of relevant intraoperative steps improved (median score 3 vs. 4, p = 0.000).ConclusionThese data demonstrate Surge increased student confidence and understanding of surgical careers despite reduced in-person opportunities to engage with surgical education. Surge will continue to be developed and evaluated on a larger scale.

Pain Management Knowledge and Attitudes for Surgical Nursing Students

BackgroundPain is considered as one of the most common factors that cause people to seek medical care. An important responsibility of health professionals is to manage pain, and nurses play a crucial role in it. Therefore, nursing students must have pain management knowledge and skills to fulfill this role. AimThe objective of the study was to examine pain management knowledge and attitudes of nursing students who had taken a surgical nursing course. MethodsThis descriptive, cross-sectional study was conducted with volunteer second-year undergraduate nursing students (n = 260) from two universities in Turkey. The Knowledge and Attitudes Survey Regarding Pain and a student demographic information form were used for data collection. Data were analyzed with descriptive statistics, t test and variance analysis. ResultsThe mean score on the Knowledge and Attitudes Survey Regarding Pain was 6.78 ± 2.23. Of all the students, 48.8% reported that they only preferred pharmacologic treatments for pain management. The mean score on the Knowledge and Attitudes Survey Regarding Pain significantly differed in terms of the type of high school (p = .044) and the unit for clinical education (p = .025). ConclusionsThe students had a moderate mean score on the Knowledge and Attitudes Survey Regarding Pain. The students who graduated from high school and those who received their clinical education in cardiovascular and thoracic surgery units had significantly higher mean scores on pain management knowledge and attitudes.

VALIDATION OF A VIRTUAL REALITY SIMULATOR FOR INTRAMEDULLARY FEMORAL NAIL APPLICATION DURING AN ORTHOPAEDIC SURGICAL COURSE

To investigate the utility of virtual reality (VR) simulators in improving surgical proficiency in Orthopaedic trainees for complex procedures and techniques.Fifteen specialty surgeons attending a London Orthopaedic training course were randomised to either the VR (n = 7) or control group (n = 8). All participants were provided a study pack comprising an application manual and instructional video for the Trochanteric Femoral Nail Advanced (TFNA) procedure. The VR group underwent additional training for TFNA using the DePuy Synthes (Johnson and Johnson) VR simulator. All surgeons were then observed applying the TFNA in a Sawbones model and assessed by a blinded senior consultant using three metrics: time to completion, 22-item procedure checklist and 5-point global assessment scale.Participant demographics for the VR and control groups were similar in context of age (mean [SD]: VR group, 31.0 [2.38] years; control group, 30.6 [2.39] years), gender (VR group, 5 [71%] men; control group, 8 [100%] men) and prior experience with TFNA (had applied TFNA as primary surgeon: VR group, 6 [86%]; control group, 7 [88%]). Although statistical significance was not reached, the VR group, on average, outperformed the control group on all three metrics. They completed the TFNA procedure faster (mean [SD]: 18.2 [2.16] minutes versus 19.78 [1.32] minutes; p&lt;0.189), performed a greater percentage of steps correctly (79% versus 66%; p&lt;0.189) and scored a higher percentage on the global assessment scale (75% versus 65%; p&lt;0.232).VR simulators offer a safe and accessible means for Orthopaedic trainees to prepare for and supplement their theatre-based experience. It is vital, therefore, to review and validate novel simulation-based systems and in turn facilitate their improvement. We intend to increase our sample size and expand this preliminary study through a second upcoming surgical course for Orthopaedic trainees in London.

Impacting surgical training: Role of surgical anatomy dissection courses

INTRODUCTION: Human anatomy is one of the fundamental pillars of basic medical sciences, which forms the cornerstone of the ever-evolving medical practice. It is, therefore, important to strengthen anatomy education at all stages of medical training. Since 2020, the Department of Human Anatomy, in collaboration with the Department of Surgery, organized surgical anatomy dissection courses to improve surgical practice safety and competence. This educational study aimed to share lessons learned from organizing anatomy dissection courses and measure the impact on knowledge and skills acquisition by surgical trainees. METHODS: Courses were designed with clear learning objectives and programs. A pre-test was administered to trainees before the dissection course, and a post-test was organized at the end of the course. Descriptive statistics were used to compare pre- and post-test scores. A p-value less than 0.05 was considered statistically significant. The Likert scale was used to measure trainees’ satisfaction at the end of every course.RESULTS: From August 2020 to December 2021, 11 cadaveric dissection courses were organized, and 173 trainees from 6 Surgical Residency programs: Plastic surgery, General surgery, Orthopedic surgery, Urology, Neurosurgery, ENT, and Obstetrics and Gynecology. Nineteen trainers from the Surgery Department and Anatomy Department were involved.There was a significant improvement in marks in the post-test test as compared to the pre-test score. The average increase in the mark was 26.4% with a 95% CI [23-0 – 29.7], p-value &lt; 0.001. There was a negative correlation (r=-0.8948, p-value &lt; 0.001) between the marks at pre-test and the improvement score, suggesting that the lowest performers on the pre-test had the biggest post-test improvement. Trainees’ satisfaction was at a high level. 87.6% of trainees reported a desire to pursue training to become anatomy educators in the future. CONCLUSION: Surgical anatomy dissection courses positively impacted surgical knowledge and skills acquisition, integrating anatomy into surgical training. Cadaver-based surgical procedures simulation should be encouraged and integrated into surgical curricula.

Developing an Anatomy Unit in Rwanda: Overcoming Challenges

Rwanda, the historical background reveals that anatomy was introduced into the medical program 6 years after the beginning of medical education. The development of the clinical anatomy unit started in 2002. Initially, the anatomical specimen was collected from amputated limbs and body organs from an autopsy.Growing the field of anatomy in Rwanda has been a long journey guided by a constant commitment by the pioneers. The process was based on a guiding philosophy of delivering anatomy relevant to the clinical practice. The cadaver dissection practice is a gold standard for a challenging task. It needs strategies to build a system that facilitates the acquisition of cadavers, its processing, and the use and disposal of remains in human conditions. A law that regulates the use of human bodies, organs, and tissues in teaching and research was promulgated in 2010, and signed MoU on the supply of cadavers for teaching purposes with various hospitals in Rwanda.In 2020, the Society of Clinical Anatomy of Rwanda (S-CAR) was founded to promote the growth of anatomical sciences and create a community for anatomy in Rwanda. The regular organization of surgical anatomy dissection courses has positively impacted the surgical trainees’ skills and anatomy delivery. Despite the challenges, anatomy is alive in Rwanda, as testified to by the successful organization of the First Anatomy Annual Congress in October 2022.

Temporary diverting stoma in therapy-refractory luminal colonic Crohn's disease: an alternative to immediate colorectal resection?

Creation of a diverting stoma in patients with Crohn's disease (CD) can counteract luminal inflammation. The clinical utility of a diverting stoma with the prospect of restoration of gastrointestinal continuity warrants further investigation. The aim of this work was to evaluate the long-term effects of creation of a diverting stoma on the disease course in patients with luminal colonic CD. In this retrospective, multicentre cohort study we investigated the disease course of patients who received a diverting stoma in the biological era. Clinical characteristics, medication use and surgical course were assessed at the time of creation of the diverting stoma and during follow-up. The primary outcome was the rate of successful and lasting reestablishment of gastrointestinal continuity. Thirty six patients with refractory luminal CD from four institutions underwent creation of a diverting stoma. Of the overall cohort, 20 (56%) patients had their gastrointestinal continuity reestablished after initial stoma creation and 14 (39%) who had their stoma reversed remained stoma-free during a median of 3.3 years follow-up (interquartile range 2.1-6.1 years). Absence of stoma reversal was associated with the presence of proctitis (p=0.02). Colorectal resection after creation of a diverting stoma was performed in 28 (78%) patients, with 7 (19%) having a less extensive resection and 6 (17%) having a more extensive resection compared with the surgical plan before stoma creation. A diverting stoma could potentially be an alternative to immediate definitive stoma placement in specific populations consisting of patients with luminal colonic CD, especially in the absence of proctitis.

Exploration of nursing students' views on the theory-practice gap in surgical nursing education and its relationship with attitudes towards the profession and evidence-based practice

AimThe aim of this study was to explore nursing students' views on the theory-practice gap in surgical nursing education and determine its relationship with attitudes towards the profession and evidence-based practice. BackgroundIn nursing education, the discrepancy between the theoretical knowledge and clinical practices is known as the “theory-practice gap”. Although this problem was defined many years ago, scientific information on the subject is very limited in terms of surgical nursing. MethodThis descriptive-analytical and cross-sectional study was carried out in three different universities in the Black Sea Region of Türkiye. The sample consisted of 389 nursing students. The data collection was carried out in May-July 2022 through the use of the following tools: The Attitude Scale for the Nursing Profession (ASNP), the Knowledge, Attitudes and Behaviors Questionnaire for Evidence-Based Practice (KABQ-EBP) and the researchers made form to determine students’ views on the theory-practice gap. The data were analysed with Student’s t-test, multiple linear regression analysis. Results72.8% of the students stated that they thought there was a discrepancy between their theoretical surgical nursing courses and clinical practice. While the total ASNP score of students who thought that there was a discrepancy between theoretical education and clinical practice was lower than that of the other students (p = 0.002), no difference was found among the students in terms of the total KABQ-EBP score (p > 0.05). In the multiple linear regression analysis, it was determined that thinking about gap (β = -0.125, p = 0.009), gender (β = -0.134, p = 0.006), willingness to choose the profession (β = 0.150, p = 0.002) and KABQ-EBP score (β = 0.247, p < 0.001) had significant effects on nursing students’ attitudes towards the profession. In the model, %12 of the total variance was explained by the variables. ConclusionThe study shows that the gap between theory and practice for the surgical nursing course is a problem perceived by most students. Also, students who thought that there was a theory-practice gap for the surgical nursing course had a more negative attitude towards the profession, while their attitudes towards evidence-based nursing were not different from others. The results of this study encourage further research to gain a better understanding of the impact of the gap between theory and practice on nursing students.

Surgical course of lateral femoral cutaneous nerve during anterior exposure of paediatric hips: an observational study.

Anterior approach to the hip joint is commonly used for paediatric hip disorders. Lateral femoral cutaneous nerve (LFCN) is always exposed and dissected in this approach before deep dissection is carried out. The course of this nerve has been described in adults but there is a lack of literature regarding this in the paediatric age group. This study aimed to find the surgical anatomy of LFCN in children during the anterior approach to the hip. A total of 51 paediatric hip surgeries were done in 45 children for various hip disorders. The anterior exposure was done by the Somerville approach (Bikini incision). During surgical exposure, LFCN was exposed and its relationship to anterior superior iliac spine (ASIS), inguinal ligament and sartorius muscle was observed. In most of the cases (45/51) it was found as a single trunk below the inguinal ligament and medial to the ASIS. In one hip, multiple branches of the nerve were found just below the inguinal ligament. In four hip exposures, the nerve was not found in the surgical field and in one case nerve was accidentally cut during surgery as it was lying adherent to ASIS. There was no significant correlation between the observational parameters of the nerve with anthropometric variables. Nerve was mostly seen in area 5-25 mm medial to ASIS and 10-50 mm below the ASIS in 80% of our surgical exposures where the nerve was isolated. We observed that once LFCN is dissected, the injury during further surgical procedures can be prevented.

Educational Scoring System in Laparoscopic Cholecystectomy: Is It the Right Time to Standardize?

Background and Objectives: Laparoscopic cholecystectomy (LC) is one of the most performed surgeries worldwide. Procedure difficulty and patient outcomes depend on several factors which are not considered in the current literature, including the learning curve, generating confusing and subjective results. This study aims to create a scoring system to calculate the learning curve of LC based on hepatobiliopancreatic (HPB) experts' opinions during an educational course. Materials and Methods: A questionnaire was submitted to the panel of experts attending the HPB course at Research Institute against Digestive Cancer-IRCAD (Strasbourg, France) from 27-29 October 2022. Experts scored the proposed variables according to their degree of importance in the learning curve using a Likert scale from 1 (not useful) to 5 (very useful). Variables were included in the composite scoring system only if more than 75% of experts ranked its relevance in the learning curve assessment ≥4. A positive or negative value was assigned to each variable based on its effect on the learning curve. Results: Fifteen experts from six different countries attended the IRCAD HPB course and filled out the questionnaire. Ten variables were finally included in the learning curve scoring system (i.e., patient body weight/BMI, patient previous open surgery, emergency setting, increased inflammatory levels, presence of anatomical bile duct variation(s), and appropriate critical view of safety (CVS) identification), which were all assigned positive values. Minor or major intraoperative injuries to the biliary tract, development of postoperative complications related to biliary injuries, and mortality were assigned negative values. Conclusions: This is the first scoring system on the learning curve of LC based on variables selected through the experts' opinions. Although the score needs to be validated through future studies, it could be a useful tool to assess its efficacy within educational programs and surgical courses.

Photodynamic therapy treatment of oral cavity cancer in patients with comorbidities

We report the experience of radical treatment by photodynamic therapy of patients with squamous cell carcinoma of oral cavity with serious side diseases. Completed treatment of two patients with serious side diseases (HIV infection with associated pulmonary hypertension of high degree and cardiac pathology) suffered from cancer of oral cavity. Extensive surgical treatment and/or aggressive course of chemoradiation therapy were not indicated to them due to concomitant pathology. Both patients were diagnosed with squamous cell carcinoma of oral cavity, with appropriate stage Ist. сT1N0M0. Patients received treatment by photodynamic therapy with chorine photosensitizer in dose 1 mg/kg. Options of photodynamic were: output power – 1.5W, power density – 0.31 W/cm2, light dose – 300 J/cm2. After one time session of photodynamic therapy, in both cases full response was diagnosed (according to RECIST 1.1). In one case the second session of photodynamic therapy was performed due to concomitant disease of oral cavity – multiply lesions of leukoplakia and after was diagnosed full remission of all lesions. Major adverse event was pain during the first 5-7 days after treatment, curable by painkillers. Follow-up (IQR) was 12 and 18 month respectively with no evidence of progression. It is available to avoid extensive surgical treatment and aggressive course of chemoradiation therapy (as an alternative) with the use of photodynamic therapy. Photodynamic therapy is minimally invasive method of radical treatment of localized squamous cell carcinoma of oral cavity with minimal adverse events, and could be especially relevant in patients with serious concomitant diseases.