Surgical Literature Research Articles

CUSUM learning curves: what they can and can't tell us.

There has been increased interest in assessing the surgeon learning curve for new skill acquisition. While there is no consensus around the best methodology, one of the most frequently used learning curve assessments in the surgical literature is the cumulative sum curve (CUSUM) of operative time. To demonstrate the limitations of this methodology, we assessed the CUSUM of console time across cohorts of surgeons with differing case acquisition rates while varying the total number of cases used to calculate the CUSUM. We compared the CUSUM curves of the average console times of surgeons who completed their first 20 robotic-assisted (RAS) cases in 13, 26, 39, and 52weeks, respectively, for their first 50 and 100 cases, respectively. This analysis was performed for prostatectomy (1094 surgeons), malignant hysterectomy (737 surgeons), and inguinal hernia (1486 surgeons). In all procedures, the CUSUM curve of the cohort of surgeons who completed their first 20 procedures in 13weeks demonstrated a lower slope than cohorts of surgeons with slower case acquisition rates. The case number at which the peak of the CUSUM curve occurs uniformly increases when the total number of cases used in generation of the CUSUM chart changes from 50 to 100 cases. The CUSUM analyses of these three procedures suggests that surgeons with fast initial case acquisition rates have less variability in their operative times over the course of their learning curve. The peak of the CUSUM curve, which is often used in surgical learning curve literature to denote "proficiency" is predictably influenced by the total number of procedures evaluated, suggesting that defining the peak as the point at which a surgeon has overcome the learning curve is subject to routine bias. The CUSUM peak, by itself, is an insufficient measure of "conquering the learning curve."

Modeling the Adoption of 5760 Clinical Studies Into Practice Across 5 Surgical Specialties

IntroductionNo studies exist that explore the factors that influence the process of synthesizing new knowledge into perioperative standards of care and the operating room. We sought to model the adoption of clinical research into surgical practice and identify modifiable factors influencing the latency of this translation. MethodsWe created a data set comprised of all UpToDate articles between 2011 and 2020, sampled at 3-mo intervals, to explore how research is incorporated at the point-of-care (POC)—studying 5760 new references from 204 journals across five surgical specialties, compared to all uncited articles published during the same interval. UpToDate authors serve as specialty curators of the vast surgical literature, with an audience of more than a million clinicians in over 180 countries across 3200 institutions. Unlike society guidelines, UpToDate also provides the necessary granularity to quantify the time in bringing research to the bedside. Our main outcomes are citation rates and time-to-citation, split by specialty, journal, article type, and topics. We also model the influence of impact factor, geography, and funding and, finally, propose new impact indices to help with prioritizing surgical literature. ResultsWe highlight variation in adoption of clinical research by specialty. We show, despite representing a lower quality of evidence, surgical case reports are one of the most cited article types. Furthermore, most clinical trials (94%-100%) in surgical journals are never incorporated into POC reference lists. While few, pragmatic trials were the most likely to be cited of any article type in any surgical specialty (40%). Journal impact factor did not correlate with time-to-citation or proportion of articles cited in three of five surgical specialties, suggesting differences in how specialties synthesize/value research from specialty journals. Our two metrics, the Clinical Relevancy and Immediacy Indices, were defined to capture this impact/relevance to surgical practice. Of the five surgical subspecialties, gynecology references were >5-fold more likely to get cited, had a larger fraction of higher quality evidence incorporated, and demonstrated more success with POC adoption of practice guidelines. We also quantified the cost of translating research to surgical practice per specialty and generated maps that highlight institutions successful in translating research to the POC. The higher expenditure of National Institutes of Health funding in gynecology may reflect the cost of higher quality research per citation. ConclusionsUnderstanding translational latency is the first step to exposing blocks that slow the adoption of research into everyday surgical practice and to understanding why increasing research funding has not yielded comparative gains in surgical outcomes. Our approach reveals new methods to monitoring the efficiency of research investments and evaluating the efficacy of policies influencing the translation of research to surgical practice.

Thirty-day surgical site complications following rhinoplasty with cartilage grafts

Surgical-site complications have been demonstrated to be one of the most common adverse events following rhinoplasty. In the surgical literature, functional disability is an independent predictor of postoperative morbidity. 1 McIsaac D.I. MacDonald D.B. Aucoin S.D. Frailty for Perioperative Clinicians: A Narrative Review. Anesth Analg. 2020; 130 (Jun): 1450-1460https://doi.org/10.1213/ane.0000000000004602 Crossref PubMed Scopus (0) Google Scholar However, the impact of functional disability with surgical-site complications after rhinoplasty remains unclear and had not been previously reported. Here, we aim to report the incidence of surgical-site complications and the association of functional disability with 30-day surgical-site complications following rhinoplasty in adult patients.

The robotic-surgery propositional bank

Robot-assisted minimally invasive surgery is the gold standard for the surgical treatment of many pathological conditions since it guarantees to the patient shorter hospital stay and quicker recovery. Several manuals and academic papers describe how to perform these interventions and thus contain important domain-specific knowledge. This information, if automatically extracted and processed, can be used to extract or summarize surgical practices or develop decision making systems that can help the surgeon or nurses to optimize the patient’s management before, during, and after the surgery by providing theoretical-based suggestions. However, general English natural language understanding algorithms have lower efficacy and coverage issues when applied to domain others than those they are typically trained on, and a domain specific textual annotated corpus is missing. To overcome this problem, we annotated the first robotic-surgery procedural corpus, with PropBank-style semantic labels. Starting from the original PropBank framebank, we enriched it by adding new lemmas, frames and semantic arguments required to cover missing information in general English but needed in procedural surgical language, releasing the Robotic-Surgery Procedural Framebank (RSPF). We then collected from robotic-surgery textbooks as-is sentences for a total of 32,448 tokens, and we annotated them with RSPF labels. We so obtained and publicly released the first annotated corpus of the robotic-surgical domain that can be used to foster further research on language understanding and procedural entities and relations extraction from clinical and surgical scientific literature.

A Review and Assessment of Open Access Surgery Journals

IntroductionOpen access publishing has exhibited rapid growth in recent years. However, there is uncertainty surrounding the quality of open access journals and their ability to reach target audiences. This study reviews and characterizes open access surgical journals. Materials and methodsThe directory of open access journals was used to search for open access surgical journals. PubMed indexing status, impact factor, article processing charge (APC), initial year of open access publishing, average weeks from manuscript submission to publication, publisher, and peer-review processes were evaluated. ResultsNinety-two open access surgical journals were identified. Most (n = 49, 53.3%) were indexed in PubMed. Journals established >10 y were more likely to be indexed in PubMed compared to journals established <5 y (28 of 41 [68.3%] versus 4 of 20 [20%], P < 0.001). 44 journals (47.8%) used a double-blind review method. 49 (53.2%) journals received an impact factor for 2021, ranging from <0.1 to 10.2 (median 1.4). The median APC was $362 United States dollar [interquartile range $0 – 1802 United States dollar]. 35 journals (38%) did not charge a processing fee. There was a significant positive correlation between the APC and impact factor (r = 0.61, P < 0.001). If accepted, the median time from manuscript submission to publication was 12 wk. ConclusionsOpen access surgical journals are largely indexed on PubMed, have transparent review processes, employ variable APCs (including no publication fees), and proceed efficiently from submission to publication. These results should increase readers’ confidence in the quality of surgical literature published in open access journals.

A227 The MBSAQIP in the surgical literature

A227 The MBSAQIP in the surgical literature

ID: 204123 Surgical Site Infection Risk In Diabetes Patients Undergoing Spinal Cord Stimulation: A Literature Review

Spinal cord stimulation (SCS) has become increasingly utilized for the treatment of various chronic pain conditions over the past two decades. However, despite these improvements, the same complications that were encountered in early SCS implantation surgery continue today, including postoperative surgical site infection (SSI). This literature review was conducted to review the surgical literature regarding the relationship between hemoglobin A1c (HbA1c), diagnosis of diabetes mellitus (DM), and risk of postoperative SSI.

The SUPER reporting guideline suggested for reporting of surgical technique: explanation and elaboration.

Surgical technique plays an essential role in achieving good health outcomes. However, the quality of surgical technique reporting remains heterogeneous. Reporting checklists could help authors to describe the surgical technique more transparently and effectively, as well as to assist reviewers and editors evaluate it more informatively, and promote readers to better understand the technique. We previously developed SUPER (surgical technique reporting checklist and standards) to assist authors in reporting their research that contains surgical technique more transparently. However, further explanation and elaboration of each item are needed for better understanding and reporting practice. We searched surgical literature in PubMed, Google Scholar and journal websites published up to January 2023 to find multidiscipline examples in various article types for each SUPER item. We explain the 22 items of the SUPER and provide rationales item by item alongside. We provide 69 examples from 53 literature that present optimal reporting of the 22 items. Article types of examples include pure surgical technique, and case reports, observational studies and clinical trials that contain surgical technique. Examples are multidisciplinary, including general surgery, orthopaedical surgery, cardiac surgery, thoracic surgery, gastrointestinal surgery, neurological surgery, oncogenic surgery, and emergency surgery etc. Along with SUPER article, this explanation and elaboration file can promote deeper understanding on the SUPER items. We hope that the article could further guide surgeons and researchers in reporting, and assist editors and peer reviewers in reviewing manuscripts related to surgical technique.

Involvement of the University of Rwanda in Medical and Surgical Research: A Bibliometric Analysis of Achievements and Gaps

Background: In the past few decades, global health research has grown incredibly quickly. The interest of scientists and medical professionals in evidence-based medicine (EBM), new drug and vaccine discovery are among the main reasons for the rapid increase of the scholarly literature in health research. The aim of this research is to analyse the scholarly literature published by UR - affiliated researchers, and discover the achievements and gaps in medical and surgical research at the University of Rwanda. Methods: The University of Rwanda was searched in Lens Scholarly Works, and all articles connected to the university were discovered. We filtered the initial results by field of study to locate materials that were published in medical and surgical fields. Except for co-authorship and keyword co-occurrence analysis which were done using VOSviewer software, all bibliometric analyses were carried out using Lens database. Results: For the initial search, University of Rwanda was associated with 2,821 articles. After careful assessment of publications based on their field of study, a total of 1, 220 and 106 publications were found to be in the medical and surgical fields respectively. The analysis was based on the category of scholarly work, the chemicals of focus of the study, the authors, the funders, and the journal that published the study. Journal articles constitute a sizable fraction of these publications, whereas conference articles, book chapters, reprints, and reports make up a far smaller portion. By comparing the numbers of publications, authors, and funding in the surgical and medical field, many gaps are apparent in surgical than medical research field. Conclusion: Although there is an increase in number of publications in the University of Rwanda, the number of medical and surgical literature in UR is still low. Improving mentorship to students and involving them in ongoing research projects; not restricting them to only data collection but allow them to participate in peer-reviewed publications are key measures to increase number of medical and surgical scholarly publications in University of Rwanda.

The Role of Admission Hyperglycaemia as a Risk Factor for Surgical Site Infection in Orthopaedic Trauma Patients

Introduction: Acute hyperglycemia following traumatic injury is common. Studies have shown that 20– 30% of trauma patients present following injury with blood glucose values ≥ 200 mg/dL, and that a majority of patients demonstrate values ≥ 150 mg/dL. The relationship between hyperglycemia and adverse outcomes, such as infectious complications, has been well described in the surgical literature. Post-traumatic hyperglycemia is less well-documented in orthopaedic trauma patients. Aim of the Study: The aim of this study was to evaluate the role of admission hyperglycaemia as a risk factor for surgical site infection in orthopaedic trauma patients. Methods: This was a retrospective observational study and was conducted in the Department of Orthopaedics Surgery of Brahmanbaria medical college Hospital, Brahmanbaria, Bangladesh during the period from October, 2020 to October, 2022. We included 130 patients who were admitted to orthopaedics surgery department. Result: Majority of our patients (41.54%) were aged 41-50 years and 65% patients were male compared to female (35%). The mean age was 45.69 ± 22.83 years. Majority (41.54%) of our patients had a preoperative American Society of Anesthesiologists (ASA) classification of II. Majority of patients 36.15% had type 1 open fracture. We found 45 patients with surgical site infection. Admission glucose more than 200 mg/dL was found higher (26.67%) in infected group. Among the hyperglycemic patients 36.36% were classified as ASA III &amp; the surgical site infection for 30 days was found 54.55%. Conclusion: We found that orthopaedic trauma patients without a history of diabetes showed a significant independent correlation between an admission BG value of ≥200 mg/dL and 30-day surgical site infection (SSI). Because of this, admission glucose readings in orthopaedic trauma patients may be a key indicator of the risk of infection.

80. The Over-tightened Neck: Causes, Complications, and Management

PURPOSE: The over-tightened neck following necklift procedures is a clinical problem that has received little attention in plastic surgical literature. Possibly, plastic surgeons are either reluctant to discuss it or see few cases. Also, an overtightened neck reflects both the subjective and objective opinions of the patient along with objective clinical findings. METHODS: A retrospective review of 250 consecutive necklift procedures from 2013 to 2020 was performed, of whom 211 (84%) had a submental crease incision with anterior neck tightening of platysmal bands combined with a lateral neck plication. Follow-up continued was at least one year. RESULTS: A total of five patients (2%) presented with complaints of an over-tightened neck that caused pain (5) and difficulty swallowing, interference with speech (1), dyspnea (1), and fat necrosis (1). Three patients had anatomical evidence of a long neck that measured 11cm. Three patients complained throughout and at the end of the first year. Two other patients who had a necklift elsewhere which included anterior platysmaplasty were referred for evaluation. Their procedures has been performed one and one and a half years previously. All five patients were evaluated by neck CT (3) and neck MRI (2). Two patients had videofluroscopy and barium swallow studies that were negative. CONCLUSION: The overtightened neck is an uncommon postoperative sequel to a necklift procedure that may be difficult to assess because of its subjective nature. It can, however, be associated with severe symptoms requiring recognition and appropriate diagnostic work-up.

The Practice of Fast-Track Liver Transplant Anesthesia.

Prior to the 1990s, prolonged postoperative intubation and admission to the intensive care unit was considered the standard of care following liver transplantation. Advocates of this practice speculated that this time allowed patients to recover from the stress of major surgery and allowed their clinicians to optimize the recipients' hemodynamics. As evidence in the cardiac surgical literature on the feasibility of early extubation grew, clinicians began applying these principles to liver transplant recipients. Further, some centers also began challenging the dogma that patients need to be cared for in the intensive care unit following liver transplantation and instead transferred patients to the floor or stepdown units immediately following surgery, a technique known as "fast-track" liver transplantation. This article aims to provide a history of early extubation for liver transplant recipients and offer practical advice on how to select patients that may be able to bypass the intensive care unit and be recovered in a non-traditional manner.

Gender differences in epigastric hernia repair: a propensity score matching analysis of 15,925 patients from the Herniamed registry.

In recent surgical literature, gender-specific differences in the outcome of hernia surgery has been analyzed. We already know that female patients are at higher risk to develop chronic postoperative pain after inguinal, incisional, and umbilical hernia surgery. In this study, we evaluated the impact of gender on the outcome after epigastric hernia surgery. A covariable-adjusted matched-paired analysis with data derived from the Herniamed registry was performed. In total of 15,925 patients with 1-year follow-up data were included in the study. Propensity score matching was performed for the 7786 female (48.9%) and 8139 male (51.1%) patients, creating 6350 pairs (81.6%). Matched-paired analysis revealed a significant disadvantage for female patients for pain on exertion (12.1% vs. 7.6%; p < 0.001) compared to male patients. The same effect was demonstrated for pain at rest (6.2% in female patients vs. 4.1% in male patients; p < 0.001) and pain requiring treatment (4.6% in female patients vs. 3.1% in male patients; p < 0.001). All other outcome parameters showed no significant differences between female and male patients. Female patients are at a higher risk for chronic pain after elective epigastric hernia repairs compared to the male patient population. These results complete findings of previous studies showing the same effect in inguinal, umbilical, and incisional hernia repair.

Updates on Enhanced Recovery after Surgery protocols for plastic surgery of the breast and future directions

Introduction Perioperative pain control is an important component of any plastic surgery practice. Due to the incorporation of Enhanced Recovery after Surgery (ERAS) protocols, reported pain level, opioid consumption, and hospital length of stay numbers have decreased significantly. This article provides an up-to-date review of current ERAS protocols in use, reviews individual aspects of ERAS protocols, and discusses future directions for the continual improvement of ERAS protocols and control of postoperative pain. ERAS components ERAS protocols have proven to be excellent methods of decreasing patient pain, opioid consumption, and postanesthesia care unit (PACU) and/or inpatient length of stay. ERAS protocols have three phases: preoperative education and pre-habilitation, intraoperative anesthetic blocks, and a postoperative multimodal analgesia regimen. Intraoperative blocks consist of local anesthetic field blocks and a variety of regional blocks, with lidocaine or lidocaine cocktails. Various studies throughout the surgical literature have demonstrated the efficacy of these aspects and their relevance to the overall goal of decreasing patient pain, both in plastic surgery and other surgical fields. In addition to the individual ERAS phases, ERAS protocols have shown promise in both the inpatient and outpatient sectors of plastic surgery of the breast. Conclusion ERAS protocols have repeatedly been shown to provide improved patient pain control, decreased hospital or PACU length of stay, decreased opioid use, and cost savings. Although protocols have most commonly been utilized in inpatient plastic surgery procedures of the breast, emerging evidence points towards similar efficacy when used in outpatient procedures. Furthermore, this review demonstrates the efficacy of local anesthetic blocks in controlling patient pain.

D43. The Over-tightened Neck: Causes, Complications, and Management

PURPOSE: The over-tightened neck following necklift procedures is a clinical problem that has received little attention in plastic surgical literature. Possibly, plastic surgeons are either reluctant to discuss it or see few cases. Also, an overtightened neck reflects both the subjective and objective opinions of the patient along with objective clinical findings. METHODS: A retrospective review of 250 consecutive necklift procedures from 2013 to 2020 was performed, of whom 211 (84%) had a submental crease incision with anterior neck tightening of platysmal bands combined with a lateral neck plication. Follow-up continued was at least one year. RESULTS: A total of five patients (2%) presented with complaints of an over-tightened neck that caused pain (5) and difficulty swallowing, interference with speech (1), dyspnea (1), and fat necrosis (1). Three patients had anatomical evidence of a long neck that measured 11cm. Three patients complained throughout and at the end of the first year. Two other patients who had a necklift elsewhere which included anterior platysmaplasty were referred for evaluation. Their procedures has been performed one and one and a half years previously. All five patients were evaluated by neck CT (3) and neck MRI (2). Two patients had videofluroscopy and barium swallow studies that were negative. CONCLUSION: The overtightened neck is an uncommon postoperative sequel to a necklift procedure that may be difficult to assess because of its subjective nature. It can, however, be associated with severe symptoms requiring recognition and appropriate diagnostic work-up.

CT IR Cyst Lumbar Rupture Efficacy (CIRCLE): A case series (P5-4.004)

<h3>Objective:</h3> Is CT IR synovial cyst lumbar rupture effective in symptomatic lumbar synovial cyst to avoid surgical intervention in 1 year? <h3>Background:</h3> Synovial cysts are associated with facet joint degeneration and can cause of radiculopathy, back pain, and neurogenic claudication. Although definitive surgical removal of the cyst has been the preferred treatment in surgical literature, percutaneous facet synovial cyst rupture under fluoroscopy has been offered to symptomatic patients, with varying degree of effectiveness. CT guided rupture has been sparsely studied. <h3>Design/Methods:</h3> <h3>Method of Data Collection:</h3> Electronic chart review, use of SlicerDicer EPIC application with data analysis, review of imaging modalities including MRI and CT <h3>Study Population:</h3> Adult patients (18 years old and greater) with lumbar synovial cysts resulting in radicular pain and have undergone cyst rupture via CT guidance for 1 year between 6/2015–6/2022 Characteristics reported include patient demographics, Clinical/neurological examination before and after procedure, Pain, MRI characteristics of cyst, other pain medication used, Patient past medical history, how many IR procedures done in 1 year, complications from procedure <h3>Results:</h3> Obtained 6 suitable patients for the study and 1 out of 6 patients had undergone surgical intervention. <h3>Conclusions:</h3> CT IR guided lumbar cyst rupture resulted in short term, mild to moderate improvement of radicular symptoms with 5 patients receiving multiple treatments with 1 patient undergoing surgery in less than 1 year. Characteristics of patients showed cysts were in L4–5 to L5-S1 location, pain as per visual analog scale score 8–10/10, in which afterward cyst rupture improved to &gt;4. Neurological examinations prior and post rupture were overall benign with no adverse events, except one undergoing surgery within 1 year. This patient showed foot adductor weakness prior to procedure, radicular sensory symptoms post laminectomy. This analysis may indicate that there is efficacy in undergoing lumbar cyst rupture to alleviate radicular symptoms for 1 year. <b>Disclosure:</b> Dr. Bernardo has nothing to disclose. Dr. Misra has nothing to disclose.

A Meta-analysis Investigating the Gender Distribution and Rank of Authorship in Surgical Literature: Towards Improving Representation &amp; Leadership of Women in Surgical Research

Journal of the American College of Surgeons 236(5):p S100, May 2023. | DOI: 10.1097/01.XCS.0000933172.02802.1a

Use of a relative motion flexion orthosis after epitendinous zone II flexor tendon repair: A case report

Study designCase report IntroductionRelative motion flexion (RMF) orthoses are emerging as an option for early active motion (EAM) postoperatively. Purpose of the studyTo describe the rationale and implementation of an RMF orthosis to manage a patient after partial zone II epitendinous flexor tendon repairs. MethodsThis case involves a female who sustained partial flexor tendon lacerations to her middle finger in zone II, 60% flexor digitorum superficialis (FDS) and 90% flexor digitorum profundus (FDP). After epitendinous repair she was referred to therapy for EAM with a no orthosis request. The unusual circumstances prompted the therapist, concerned about the risk of tendon rupture to engage in discussion with the surgeon. Following discussion, a decision was made to use an RMF orthosis for controlled EAM to protect the epitendinous zone II FDS and FDP repairs. Outcomes of range of motion (ROM), total active motion (TAM), %TAM, grip, and quickDASH are reported. ResultsNeither the FDP or FDS tendons ruptured, nor were there any joint contractures. “Good” %TAM outcomes were achieved at 12-week postoperatively. Quick DASH scores improved 61 points indicating a clinically meaningful difference of improved function. DiscussionThe lack of a multi-strand core suture repair is unusual in combination with EAM. The positive outcomes reported in this single patient have raised questions about the protective benefit of the RMF orthosis when used with a zone II epitendinous repair of a 90% FDP laceration. Epitendinous repair of a partial (60%) FDS injury, however, is not uncommon and often not repaired at all. ConclusionsIn this single case report the epitendinous repairs of zone II 90% FDP and 60% FDS with digital nerve involvement were successfully managed with an RMF only orthosis. The use of EAM with an epitendinous repair is in conflict to the current surgical and therapy literature.

MP37-19 TOWARDS A COMMON MINIMUM DATA SET FOR THE FEMALE SUI SURGICAL LITERATURE: RECOMMENDATIONS OF THE SUFU SUI PUBLICATION OUTCOMES WORKING GROUP

You have accessJournal of UrologyCME1 Apr 2023MP37-19 TOWARDS A COMMON MINIMUM DATA SET FOR THE FEMALE SUI SURGICAL LITERATURE: RECOMMENDATIONS OF THE SUFU SUI PUBLICATION OUTCOMES WORKING GROUP Eric Rovner, Christopher Chermansky, Roger Dmochowski, Ekene Enemchukwu, David Ginsberg, Geneviève Nadeau, and Phillippe Zimmern Eric RovnerEric Rovner More articles by this author , Christopher ChermanskyChristopher Chermansky More articles by this author , Roger DmochowskiRoger Dmochowski More articles by this author , Ekene EnemchukwuEkene Enemchukwu More articles by this author , David GinsbergDavid Ginsberg More articles by this author , Geneviève NadeauGeneviève Nadeau More articles by this author , and Phillippe ZimmernPhillippe Zimmern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Relevant, meaningful, and achievable data points are critical in objectively assessing quality, utility and outcomes in female SUI surgery. Adherence to the previously proposed minimum data set for future studies in female SUI surgery, outlined in the first AUA Guidelines on the Surgical Management of Female SUI in 1997, has been suboptimal. The SUFU SUI Publication Outcomes Working Group (SSPOWG) was tasked with creating a common minimum data set to be utilized by authors, investigators, journal editors, and reviewers in refereeing literature pertaining to SUI surgery. METHODS: The SSPOWG reviewed the minimum data set proposed in the 1997 AUA SUI Guideline document, and other relevant literature. The body of literature was examined in the context of the profound changes in the field over the past 25 years. Through an iterative process, a minimum data set was generated balancing the desire to have a number of meaningful and relevant data points against the burden of creating an excessively difficult or restrictive standard that would disincentivize widespread adoption. RESULTS: The minimum data set is sub-divided into 3 categories: 1. study features/design; 2. preoperative evaluation; 3. postoperative evaluation. Important study features include an accounting of all patients entered into the study and defined criteria for success. Preoperative evaluation should include relevant demographic, anatomical, and physiological characterization of the population under study and patient reported data in the form of a standardized questionnaire. Postoperative evaluation should include follow up data for all patients at a minimum of one year, at least one residual urine assessment and physical examination, a thorough accounting of intraoperative and postoperative complications/adverse events, outcomes related to the pre- defined criteria for success/failure, and a postoperative patient reported outcomes assessment measured with standardized questionnaire(s). CONCLUSIONS: A reasonable, achievable, and clinically meaningful minimum data set has been constructed. Such a structured framework will allow future surgical interventions for female SUI to be objectively scrutinized and compared in a clinically significant manner. Ultimately, such a data set, if adopted by the academic community, will improve the quality of the female SUI surgical literature. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e522 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Rovner More articles by this author Christopher Chermansky More articles by this author Roger Dmochowski More articles by this author Ekene Enemchukwu More articles by this author David Ginsberg More articles by this author Geneviève Nadeau More articles by this author Phillippe Zimmern More articles by this author Expand All Advertisement PDF downloadLoading ...

Anterior Endoscopic Cervical Discectomy: Surgical Technique and Literature Review.

The conventional surgical technique for radiculopathy with cervical disc herniation (CDH) is anterior cervical discectomy and fusion, with a good clinical outcome and fusion rate. However, significant perioperative morbidity related to extensive surgical exposure has been reported. Therefore, anterior endoscopic cervical discectomy (AECD) using a working channel endoscope has been developed to reduce surgical complications and tissue damage. The objective of this study was to describe a cutting-edge technique for AECD of soft CDH. The primary indication is cervical radiculopathy with or without axial neck pain due to soft CDH. The surgical procedure consists of 2 parts: (1) a safe anterior percutaneous approach under fluoroscopic control and (2) selective endoscopic discectomy and foraminal decompression using specialized mechanical tools under endoscopic visualization. The clinical outcomes are comparable to those of conventional surgery and show the benefits of minimally invasive spine procedure. Perioperative data revealed typical minimalism, including reduced muscle damage, blood loss, operative time, and recovery time. With technical advancements in surgical instruments and optics, AECD will become more practical and safer. AECD is effective in selected CDH cases with cervical radiculopathy. However, high-quality clinical studies are needed to verify the effectiveness of this endoscopic cervical spinal procedure.