Surgical Staff Research Articles

Radiation exposure in spine surgeries

Radiation exposure is a significant concern in spine surgeries due to the extensive use of fluoroscopic imaging. This review aims to evaluate the risks, consequences, and prevention strategies associated with radiation exposure in spine surgeries. The risks of radiation exposure include potential biological damage to patients and surgical staff, such as skin burns, cataracts, and an increased risk of developing cancer. The consequences of radiation exposure can have long-term health implications and may result in substantial healthcare costs. To mitigate the risks, various prevention strategies are recommended. These include optimizing the use of fluoroscopy by adopting low-dose imaging techniques, minimizing the duration of exposure, and ensuring proper shielding of personnel. Additionally, the use of alternative imaging modalities, such as intraoperative three-dimensional (3D) navigation systems, can reduce reliance on fluoroscopy and subsequently decrease radiation exposure. Furthermore, implementing a culture of radiation safety through education, training, and awareness programs is crucial. This involves educating surgeons, nurses, and other healthcare professionals about the potential risks, proper use of equipment, and radiation protection measures. Strict adherence to radiation safety guidelines and continuous monitoring of radiation doses are essential to ensure the well-being of both patients and healthcare providers. In short, radiation exposure in spine surgeries poses significant risks and potential consequences. However, with the adoption of appropriate prevention strategies, such as optimizing imaging techniques, implementing alternative modalities, and fostering a culture of radiation safety, the potential risks can be mitigated. By prioritizing radiation safety, healthcare facilities can provide better outcomes for patients and minimize the long-term health implications associated with radiation exposure in spine surgeries.

60 Surgical inpatient delirium: a re-audit of the documentation of the 4AT score

Abstract Background Postoperative delirium and perioperative neurocognitive disorder are the commonest postoperative complications in patients over 65. This has implications for brain health, hospital length of stay and incidences of morbidity and mortality. Our aim was to perform a re-audit of the documentation of 4AT scores for surgical inpatients >65 following educational sessions across key ward-based staff (medical, nursing, and allied-health). Methods Using the guidelines for Perioperative Care for People Living with Frailty undergoing Elective and Emergency Surgery from the Centre of Perioperative Care (CPOC) and the British-Geriatric-Society (BGS) as a standard, a re-audit of surgical inpatients >65 was performed on four surgical wards over two weeks. Data was collected on 4AT documentation on admission, day one and day three post-operatively, type-of-surgery, anaesthesia and risk factors for delirium (dementia, polypharmacy, opioid & benzodiazepine use, alcohol excess, ≥2 medical co-morbidities, number of ward moves and surgery >2 hours). Results Of the 55 surgical patients, the average age was 76 (65–93). 32.7% of patients presented for hip fracture surgery (n = 18), 40% abdominal/pelvic surgery (n = 22), 15% other surgeries (n = 15). 35% of patients (n = 19) had baseline 4AT documented preoperatively compared to 25%(n = 9) in the initial audit. 4AT score documentation during admission was 47.3%(n = 26) compared to 33%(n = 11). ≥2 surgical risk factors for delirium were found in all patients. The incidence of delirium was 14.5% with eight patients having a 4AT score > 4. Patients who developed delirium had 3–8 risk factors. Four of eight patients with delirium had pre-existing cognitive impairment and/or dementia. Conclusion There was an increase in frequency of 4AT assessments as a delirium screening tool in our cohort following successful collaboration between medical, surgical, anaesthesia, nursing and allied-health staff. Regular educational sessions to maintain awareness and screening of delirium peri-operatively in surgical patients >65 will be a focus for continued quality improvement.

328 From delirium detection to correction: enhancing peri-operative care for older patients

Abstract Background Delirium is a common peri-operative complications in older adults. It is associated with poorer outcomes including functional decline, increased length of hospital stays, increased admissions to long term care and higher mortality. Therefore, this project aimed to assess the peri-operative care of older patients admitted under the surgical service in accordance with the standards set by the Collaborative for Peri-operative Optimisation of People (CPOP) and British Geriatrics Society (BGS) Peri-operative Care for People Living with Frailty undergoing Elective and Emergency Surgery Guidelines. Methods The study examined four key aspects of the guidelines: (1) surgical staff training on delirium; (2) proactive screening in for delirium in surgical patients; (3) proactively documenting delirium and implementing delirium guidelines; and (4) documentation of delirium diagnosis in discharge summaries. Results Data were collected from 72 surgical admissions over a fourteen-day period, of which 26 patients were aged >65. Results indicated suboptimal adherence to the guidelines, with only 4/26 older patients (15.4%) being screened for delirium. Three of 4 of these patients screened positive for delirium using the 4AT. No patients had delirium mentioned in their discharge summaries. Additionally, a survey of surgical non-consultant hospital doctors revealed that only 4/16 (25%) had received formal training on delirium. Conclusion In response to these findings, interventions were implemented, including teaching at surgical grand rounds, hospital-wide education for World Delirium Awareness Day, introduction of delirium care bundles, and an updated discharge summary template for surgical patients to include a delirium diagnosis. A reaudit is underway to evaluate the impact of these interventions on guideline adherence and the peri-operative care quality for older patients. These initial findings underscore the need for improved staff education and adherence to CPOP and BGS guidelines. The reaudit will provide valuable insights into the effectiveness of the implemented interventions in enhancing the perioperative care experience for the older patient cohort.

What is the nature, extent and impact of bullying in surgical settings? Insights of surgeons in Australia and Aotearoa New Zealand.

A significant body of literature has examined the impact of verbal and non-verbal bullying in surgical settings, where a central focus has been on the experiences of trainee and junior members of the surgical team, women in surgery and other health professionals, such as nurses. Research on how surgeons' perceive or experience bullying is more limited. Therefore, this study aims to investigate the views of surgeons on negative and disrespectful verbal and non-verbal behaviour and bullying in surgical settings, including its impact on surgeons themselves and the surgical staff they oversee. Semi-structured interviews were undertaken with surgeons between February and November 2019. Questions explored surgeons' perceptions of interpersonal communication and behaviour in their surgical workplaces in the preceding 6-months. A narrative analysis approach was used to code, interpret, and report the interview data. Thirty-one interviews were conducted with surgeons (19 male and 12 female), from Australia (26) and Aotearoa New Zealand (5) from 10 surgical specialties. Three themes were identified with associated subthemes: bullying (five subthemes), non-verbal bullying (seven subthemes), and impact and outcomes of bullying (six subthemes). This study revealed a notable shift in the reported verbal and non-verbal bullying behaviour among surgeons, demonstrating a decrease in intensity, physicality and violence for the 6-months prior to interviews conducted in 2019, when compared with surgeons' historic experiences. Despite reported behaviour being more subtle and indirect, it nonetheless continues to have a marked impact on many surgeons as well as the staff they oversee.

Learning curves and procedural times in Senhance®-robotic assisted fundoplication: results from 237 consecutive patients undergoing robotic fundoplication in a single center as part of the European TRUST Robotic Surgery Registry Study.

Gastroesophageal reflux disease requiring an operative solution is common. Minimally invasive surgery to generate an anti-reflux barrier at the distal esophagus following the principle of the "floppy Nissen" technique has become the gold standard. Advanced robotic-assisted systems may deliver more consisted outcomes. This registry study analyzed safety and efficacy of the Senhance® surgical system in the surgical treatment of reflux disease and procedural proficiency. Data from 237 consecutive patients operated in a single center were evaluated. Historic standard laparoscopies from the same center were analyzed to compare robotic surgery learning curve effects. Using the Senhance® Surgical System, during the first 50 patients there was a significant decrease in surgery time which was maintained over the duration of study, pointing to the surgical staff's system-specific learning. After this phase, procedural times were comparable between the robotic-assisted and traditional laparoscopic surgery. The effect of learning was greater than for standard laparoscopy. For 237 patients, there were four conversions to laparoscopic surgery. Two serious adverse events were recorded, both cardiac in nature and not related to the use of the robot. Robotic fundoplication was swiftly implemented in a non-university hospital with 65 surgical beds. The operating time was no longer than in standard laparoscopy, the procedure was more standardized than open or laparoscopic surgery and hospitalization times may have been sustainably shortened. The autonomy at the system's digital platform (cockpit) to conduct robotic fundoplications is a big step forward in surgery.

A comparison of two CNN-based instrument detection approaches for automated surgical assistance systems

Abstract The shortage of operating room technicians has led to a growing demand for automated systems in the OR to maintain the quality of care. Robotic scrub nurse (RSN) systems are increasingly being developed, which perform tasks such as handling instruments and documenting the surgery. While research has focused on detecting instruments in the hands of surgical staff or recognizing surgical phases, there is a lack of research on detecting instruments on the instrument tray. Therefore, this study proposes and evaluates two distinct methodologies for instrument detection on the OR table using the deep learning approaches YOLOv5 and Mask R-CNN. The performance of the two approaches has been evaluated on 18 YOLOv5 models and twelve Mask R-CNN models, mainly differing in model size. Two sets of instruments were used to assess generalizability of the models. The results show a mean average precision (mAP) score of 0.978 for YOLOv5 and 0.846 for Mask R-CNN on the test dataset comprising three classes. An mAP of 0.874 and 0.707 have been computed respectively for the test dataset including six classes. The study provides a comparison of the performance of two suitable approaches for instrument detection on the instrument tray in the OR to enhance the development of RSN systems.

Neptune versus canister-based surgical waste management in Europe: results of the GREEN study.

Ineffective surgical fluid waste management in operating rooms (OR) creates a significant environmental burden, reduces OR efficiency, and adds physical challenges for surgical staff. There is a need for waste management systems that improve OR efficiency, safety, and sustainability. The GREEN study (Greening operating Rooms in EuropE comparing Neptune vs. canisters) was conducted to compare the impact of two fluid waste management systems. This 2-arm, nonrandomized, prospective service evaluation of fluid waste extraction was conducted using observational time series and surveys. Fluid waste-related data were collected from routine urologic and orthopedic surgeries across three European hospital sites. The primary endpoint of waste disposal impact was the volume of treated waste after surgery (kilograms) using Stryker's Neptune device (n=43) or canisters (n=41). The authors hypothesized that the surgical waste volume related to Neptune is less than the waste volume related to canisters. Secondary endpoints included time efficiency, user satisfaction, and staff ergonomics. The total weight of device-related treated waste products was reduced by 98.5% when using Neptune (0.2±0.7kg) compared with traditional canisters (13.2±16.6kg; P<0.001). Decreased waste weight also translated to enhanced ergonomic safety for surgical staff, as Neptune reduced surgical fluid weight handled by staff by an average of 34kg per procedure, a 96% reduction compared to canisters. Furthermore, the use of the Neptune system improved OR efficiency by reducing the number of staff required to manage the fluid suction device (P<0.001) and the time spent disposing of fluid waste (P<0.001). Stryker's Neptune waste management system significantly reduces the volume of treated waste per surgery and improves OR efficiency, staff safety, and user satisfaction over the traditional canister system. This is a more eco-responsible approach to OR fluid waste management and could be considered in any healthcare establishment that generates fluid waste.

Investigation of Stress-Inducing Factors and Preoperative Anxiety and Their Mitigation Strategies from Patients' Perspectives in Surgical Departments of Educational Medical Centers at Mazandaran University of Medical Sciences in 2023

Introduction: In light of the progress made in anesthesia and surgical procedures resulting in fewer complications and greater success rates, preoperative stress and anxiety persist among patients. This study aimed to evaluate stress-inducing factors and preoperative anxiety and explore strategies for their mitigation among surgical patients. Material and Methods: This descriptive-analytical study was conducted in 2023 on 375 surgical patients in the operating room departments of educational medical centers affiliated with Mazandaran University of Medical Sciences. Simple random sampling was employed and a questionnaire designed by the researchers was used to collect data (with Cronbach's alpha reliability coefficient of 0.81). The data were analyzed via SPSS 20 software. Results: The study revealed that 60% of the total participants were male, with a mean age of 40 years. Moreover, 72% of the participants were married. The preoperative stress factors had a mean score of 7.29, with the next most significant factors being stress-inducing factors related to the department (19.6%), followed by stress-inducing factors related to the surgical staff (13.2%), and stress-inducing factors from the physical environment of the operating room (11.4%). Conclusion: The final results of this study suggest that by identifying influential factors on preoperative stress and addressing them, it is possible to minimize preoperative anxiety. Therefore, it is recommended to develop educational programs for physicians and personnel to alleviate stress-inducing factors and provide patients with essential information about surgical complications, the surgical process, and anesthesia procedures.

146 WHO Surgical Checklist Compliance and Attention Rates Among Different Specialties and Years

Abstract Aim This study aims to evaluate the compliance of surgical staff to the WHO surgical safety checklist, excluding sign-out. The quality of surgical marks and inattentive rates of surgical staff during me-out were also investigated. Method Data was collected over 3 weeks using a fixed criteria in September 2022 within 3 hospitals consisting of 5 sites. A total of 105 procedures were observed. Mean and confidence intervals were calculated using SPSS. Results The mean compliance rate of the checklist was 97%. Sign-in (97%), Time-Out (96%), and Surgical mark rates (98%) all scored similarly. Among specialties observed, interventional cardiology scored the highest compliance rates, at 100%, while cardiothoracic surgery scored the lowest at 91%. In 38% of procedures observed, surgical staff were found to be inattentive during me-out. Among the inattentive surgical staff, 73% of surgical staff had mild inattentiveness (e.g. filling up drug charts), 18% had moderate inattentiveness (e.g. talking to other staff), 9.1% of them had severe inattentiveness (e.g. scrubbing in). Among the audit cycles from 2014 to 2022, there was an increase in sign-in rates from the previous cycle held in 2019 to 2022 from 82% to 97%. Inattentive rates increased from 33% in 2019 cycle to 38% in 2022 cycle. Conclusions This study reports high compliance rates and improvement with the checklist among all specialties, but also high inattentive rates by surgical staff. Improvements such as fostering a good culture among surgical staff on the WHO checklist and paying attention are key in never reducing events.

284 Eye Protection Compliance in the Operating Theatres of a Regional Major Trauma Centre

Abstract Aim Surgical procedures inherently involve risk of blood splatter. Various studies have consistently demonstrated significant (&amp;gt;40%) contamination of face masks worn by surgeons, though this may be macroscopically visible in fewer than half of cases; laparoscopic surgery is similarly not devoid of risk, with a comparable contamination profile. Nevertheless, routine use of eye protection by scrubbed surgical staff is inconsistent. This study audited the use of eye-protection by scrubbed surgical staff in a Major Trauma Centre. Method Local Trust guidelines mandated scrubbed surgical staff to wear eye-protection (namely disposable visor-masks or plastic glasses, not including spectacles). Operations over an initial 6-week cycle were audited to determine the rate of eye-protection use by surgical staff. Following a presentation to theatre staff, a further audit cycle was completed to assess for improvement in guideline compliance. Results 98 operations were recorded in the first cycle, 39 of which were open procedures. Compliance rates were measured for different staff grades. Across all operations, 301 staff were scrubbed (183 surgeons). 52.2% of scrubbed staff (35% of surgeons) wore the requisite eye protection. Re-audit involved 88 operations, including 31 open procedures, with a total of 243 scrubbed staff (146 surgeons). A demonstrable increase in compliance occurred across all staff grades with a total compliance rate of 67.5% (49% of surgeons). Conclusions Conjunctival contamination presents significant risk to surgeons without adequate protection. The results of this study demonstrate the inadequacy of current protective practice; increasing awareness of the necessity for adequate eye protection is thus a clinical priority.

Experimental analysis of airborne contaminant distribution in an operating room with different ventilation schemes

Experimental and numerical investigations were performed in a research operating room to compare laminar air flow and turbulent mixing ventilation systems in reducing the concentrations of airborne germs and surgical smoke in operating room air. In addition, measurements at scattered positions were conducted to find positions that are suited best for airborne monitoring in real-time during surgeries. In the experiments, particle counters were used to sample tracer aerosols originating from the wound area and the facial area of the thermal manikins representing surgical staff. The results showed that it is important to perform monitoring close to the areas with high hygiene requirements. Increasing the air change rate with turbulent mixing ventilation significantly reduced the number of airborne particles, however, not in the surgical microenvironment. Our findings show varying results considering the particle concentration using laminar air flow compared to turbulent mixing ventilation. With laminar air flow, higher contaminant levels are obtained in the areas with a high demand for contamination reduction. In contrast, laminar air flow was more effective in reducing the concentration of surgical smoke in the facial areas of the surgical staff. Regarding airborne germs, monitoring should be performed at the instrument tables and close to the wound area to evaluate the risk for surgical side infections. These results can support the development of guidelines and best practices for operating room ventilation design and maintenance to improve patient safety and reduce the risk of healthcare-associated infections.

Exploring Barriers and Facilitators to Reducing the Environmental Impact of the Operating Room

IntroductionThe operating room (OR) is a major contributor to greenhouse gas emissions both nationally and globally. Successful implementation of quality improvement initiatives requires understanding of key stakeholders' perspectives of the issues at hand. Our aim was to explore surgical, anesthesia, and OR staff member perspectives on barriers and facilitators to reducing OR waste. Materials and methodsIdentified stakeholders from a single academic medical center were interviewed to identify important barriers and facilitators to reducing surgical waste. Two team members with qualitative research experience used deductive logic guided by the Theoretical Domains Framework of behavior change to identify themes within transcripts. ResultsNineteen participants including surgeons (n = 3, 15.8%), surgical residents (n = 5, 26.3%), an anesthesiologist (n = 1, 5.3%), anesthesia residents (n = 2, 10.5%), nurse anesthetists (n = 2, 10.5%), nurses (n = 5, 26.3%), and a surgical technologist (n = 1, 5.3%) were interviewed. Twelve of the 14 themes within the Theoretical Domains Framework were discovered in transcripts. Barriers within these themes included lack of resources to pursue environmental sustainability in the OR and the necessity of maintaining sterility for patient safety. Facilitators included emphasizing surgeon leadership within the OR to reduce unused supplies and spreading awareness of the environmental and economic impact of surgical waste. ConclusionsInterviewed stakeholders were able to identify areas where improvements around surgical waste reduction and management could be made at the institution by describing barriers and facilitators to sustainability-driven interventions. Future surgical waste reduction initiatives at this institution will be guided by these important perspectives.

The Western Cape Surgical Recovery Project: experience at Groote Schuur Hospital

Background Data from six Western Cape secondary-level hospitals have shown that during the first wave of the COVID-19 pandemic (which lasted from May to July of 2020), total surgeries decreased by 44%, and elective surgeries by 74%, due to secondment of nursing, anaesthetic and surgical staff to COVID high-care and intensive-care services. At Groote Schuur Hospital, the loss of surgical output over the two years of the pandemic-related surgical service de-escalation (2020-2021) was estimated at 10 000 cases, with 6 000 patients with progressive disease waiting for elective surgical care. Methods In early May 2022, a Surgical Recovery Project was initiated; funding from the Western Cape Department of Health, and donations from the Gift of the Givers Foundation, private individuals, businesses, and other non-governmental organisations were used to build, staff, and equip a Day-Case Surgery Suite. Results By the Project midway point (end October 2022), a total of 800 extra cases had been completed, and the Project is currently on track to exceed the target of 1 500 cases in a calendar year by at least 10%. The largest number of procedures done were eye cases (n = 191), followed by cases involving surgery to the integumentary system (n = 141), and musculoskeletal system cases (n = 123). There were a total of 30 patient cancellations. While the Project expectedly had poorer on-time-start statistics in the first quarter of operation (range 0.0 - 6.9%), the percentage of on-time-start statistics improved markedly over the second quarter (range 43.3 - 56.5%). World Health Organization checklists were completed for 85.1% of operations performed at the Day-Case Surgery Suite, and no adverse incidents or mortalities were recorded at the Unit. Conclusions This project demonstrates that the volume of services provided in the public sector can be escalated with the use of external funding of capital for human resources, equipment and consumables. However, these services become truly effective when there is sufficient multi-disciplinary planning, alignment and support, at operational, strategic and executive levels of healthcare facilities.

SP3.10 Improvement of quality of operation notes. An audit was performed to assess operation notes in our hospital, detected multiple points commonly missed in the operation notes as well as illegibility of some. Implementation of electronic operation notes took place to improve service

Abstract Aim An audit was performed in November 2021 to assess completion of operation notes according to national guidelines. Methods 18 points were checked in accordance to Royal college of Surgeons guidelines. Results Percentage of completion ranged from 47% to 77% according to sub-specialty. Main points that were missed were time of operation, bloods loss and antibiotic prophylaxis. 29% of notes had illegible hand-writing which could not be read appropriately by two or more people. Electronic operation notes have been identified as the ideal plan to help avoid illegibility and to make sure all points are present. Multidisciplinary approach was done to implement electronic typed operation notes in the hospital involving surgical team, management, theatre staff and information technology (IT) specialist. This took place by providing extra computers in both elective and emergency theatres with appropriate software to allow for typed operation notes. Operation note templates were used to ensure all points are filled. Significant improvement in the operation notes was noticed once electronic notes have been used. The percentage of electronic notes went up from 9% to 34% in January 2023, legibility increased from 71% to 96%, time of operation documentation increased from 0% to 22%. There was 100% compliance each of the following; name of surgeons, mode of surgery, date of operation, operative procedure, operative findings and closure technique. Overall completion rate of operation notes improved from 72% to 82%. Conclusion it is inevitable that technology can be used to eliminate human error, provide clear documentation and create traceable information.

WTP6.9 Post-operative Management Study Day: Improving knowledge and confidence of senior medical students when managing post-operative patients

Abstract Aim Focus groups run by teaching facilitators with medical students highlighted a lack of confidence around how best to assess and manage post-operative patients. In response we aimed to provide a focussed study day covering key aspects of post-operative management, and complications for undergraduate medical students at St George's University. Methods A study day dedicated to the assessment and management of post-operative patients was created. The day incorporates different types of learning including case-based discussions, game-based learning and simulation. Topics covered are aligned with the curriculum for senior medical students at St George's University, including post-operative pain, bowel obstruction/ileus and haemorrhage. Information gathered from local clinical guidelines. Results Pre-course confidence scores on management of common post-operative complications were on average a 2 out of 5 (5 being very confident, and 1 being not confident at all). Post-course confidence scores increased to an average of 4 out of 5 for managing the majority of common post-operative complications. Feedback on the teaching and content of the course was good, with 95% of participants rating the session as 5 out of 5. Results Post-operative assessment and management is an area of teaching that students feel has been neglected within their prior years of study. This dedicated study day allows for in-depth discussion and practice at assessment of post-operative complications. Future development of the course may include opening the participants to foundation doctors, involvement of senior surgical staff in facilitation and assessment, and use in other local hospitals.

The compatibility of exoskeletons in perioperative environments and workflows: an analysis of surgical team members’ perspectives and workflow simulation

Surgical team members in perioperative environments experience high physical demands. Interventions such as exoskeletons, external wearable devices that support users, have the potential to reduce these work-related physical demands. However, barriers such as workplace environment and task compatibility may limit exoskeleton implementation. This study gathered the perspectives of 33 surgical team members: 12 surgeons, four surgical residents, seven operating room (OR) nurses, seven surgical technicians (STs), two central processing technicians (CPTs), and one infection control nurse to understand their workplace compatibility. Team members were introduced to passive exoskeletons via demonstrations, after which surgical staff (OR nurses, STs, and CPTs) were led through a simulated workflow walkthrough where they completed tasks representative of their workday. Five themes emerged from the interviews (workflow, user needs, hindrances, motivation for intervention, and acceptance) with unique subthemes for each population. Overall, exoskeletons were largely compatible with the duties and workflow of surgical team members.

Education Team Time Out in Oncologic Visceral Surgery Optimizes Surgical Resident Training and Team Communication–Results of a Prospective Trial

Surgical education is highly dependent on intraoperative communication. Trainers must know the trainee's training level to ensure high-quality surgical training. A systematic preoperative dialogue (Educational Team Time Out, ETO) was established to discuss the steps of each surgical procedure. Over 6 months, ETO was performed within a time limit of 3 minutes. Digital surveys on the utility of ETO and its impact on performance were conducted immediately after surgery and at the end of the study period among the staff of the participating disciplines (trainer, trainee, surgical nursing staff, anaesthesiologists, and medical students). The number of surgical substeps performed was recorded and compared with the equivalent period one year earlier. ETO was performed in 64 of the 103 eligible operations (62%). Liver resection (n = 37) was the most frequent procedure, followed by left-sided colorectal surgery (n = 12), partial pancreaticoduodenectomy (n = 6), right-sided hemicolectomies (n = 5), and thyroidectomies (n = 4). Anaesthesiologists most frequently reported that ETO had a direct impact on their work during surgery (90.9%). The influence scores were 46.8% for trainees, 8.8% for trainers, 53.3% for surgical nursing staff and 66.6% for medical students. During the implementation of ETO, a trend towards more assisted substeps in oncologic visceral surgery was seen compared to the corresponding period one year earlier (51% vs.40%; p = 0.11). ETO leads to improved intraoperative communication and more performed substeps during complex procedures, which increases motivation and practical training. This concept can easily be implemented in all surgical specialties to improve surgical education.

Spinal Navigation for Lateral Instrumentation of the Thoracolumbar Spine.

Three-dimensional imaging-based navigation in spine surgery is mostly applied for pedicle screw placement. However, its potential reaches beyond. In this study, we analyzed the incorporation of spinal navigation for lateral instrumentation of the thoracolumbar spine in clinical routine at a high-volume spine center. Patients scheduled for lateral instrumentation were prospectively enrolled. A reference array was attached to the pelvis, and a computed tomography scan was acquired intraoperatively. A control computed tomography scan was routinely performed after final cage placement, replacing conventional 2-dimensional X-ray imaging. 145 cases were enrolled from April to October 2021 with a median of 1 (1-4) level being instrumented. Indications for surgery were trauma (35.9%), spinal infection (31.7%), primary and secondary tumors of the spine (17.2%), and degenerative spine disease (15.2%). The duration of surgery after the first scan was 98 ± 41 (20-342) minutes. In total, 190 cages were implanted (94 expandable cages for vertebral body replacement (49.5%) and 96 cages for interbody fusion [50.5%]). Navigation was successfully performed in 139 cases (95.9%). The intraoperative mental load was rated on a scale from 0 to 150 (maximal effort) by the surgeons, showing a moderate effort (median 30 [10-120]). Three-dimensional imaging-based spinal navigation can easily be incorporated in clinical routine and serves as a reliable tool to achieve precise implant placement in lateral instrumentation of the spine. It helps to minimize radiation exposure to the surgical staff.

Experience of practicing obstetrician-gynecologists in a surgical training program in total laparoscopic hysterectomy

Advanced surgical techniques, such as total laparoscopic hysterectomy, are often challenging to acquire beyond fellowship training programs for practicing obstetrician-gynecologists. A lack of formative data currently exist for continuing medical education programs, limiting our understanding of how improvement in surgical skills and training programs occur. This study aimed to investigate how practicing obstetrician-gynecologists acting as trainees experience a program that aims to teach them total laparoscopic hysterectomy, and to assess whether their surgical skills improve according to data from formative assessment tools and qualitative data from open-ended survey questions and in-depth interviews. We report a process analysis of formative data collected during a pilot implementation trial of a surgical training program targeting practicing obstetrician-gynecologists. Eleven consultant obstetrician-gynecologists and 4 experienced surgical mentors participated in 4 hospitals in Queensland, Australia. Total laparoscopic hysterectomy was performed in 700 patients over the course of the study. A total laparoscopic hysterectomy surgical mentorship training program of 10 training days with up to 3 total laparoscopic hysterectomy procedures per day was performed. Both the obstetrician-gynecologists and the surgical mentor completed a formative assessment questionnaire analyzing the trainee's performance after each surgical procedure. Mentors were formatively assessed by the Structured Training Trainer Assessment Report (STTAR) and at the completion of the study by the mini-STTAR, a summative assessment of quality of mentorship. Obstetrician-gynecologists, mentors, hospital leaders, and surgical administrative staff participated in qualitative interviews about the training program. Over time, there was a demonstrated improvement in trainee performance reported by both mentors and trainees in all competency assessment tool domains as the case number increased, with mentors consistently rating trainees' performance higher than the trainees themselves. Most trainees were satisfied with their mentor in all 31 areas during formative assessment, and at the end of the training, structure, attributes, and role modeling were all rated high (average score >4.5; range, 3.79-5.00), whereas training behavior was rated slightly lower at 4.1 (range, 3.79-4.45). Qualitative interviews demonstrated that the trainees found the training to be a beneficial, hands-on experience. Formative assessment clearly documented improvement in surgical skills during a total laparoscopic hysterectomy training program for consultant obstetrician-gynecologists.

'Hurry up' syndrome harms surgical patients and staff.

'Hurry up' syndrome harms surgical patients and staff.