Surgical Theatre Research Articles

Bullying and undermining behaviours in surgery: A qualitative study of surgical trainee experiences in the United Kingdom (UK) & Republic of Ireland (ROI)

BackgroundBullying and undermining (B/U) behaviours are documented in the international surgical workplace. This study is the largest assessment of prevalence of B/U behaviours within UK & ROI surgical training to date. Materials and methodsUK & ROI surgical trainees were electronically surveyed in July 2017. The survey was open for one month and sent to all registered trainees at Core and Specialty level by the Joint Committee on Surgical Training (JCST) along with email and social media dissemination by the Association of Surgeons in Training (ASiT) and the British Orthopaedic Trainees Association (BOTA). A consensus session on the topic was conducted at the ASiT Conference in Edinburgh in March 2018. Standards for reporting of Qualitative Research were followed. Results1412 responses were received (26.6% response rate). All training regions, grades and specialties were represented. 60% of trainees (n = 837) reported witnessing or experiencing B/U behaviours in the surgical workplace. The most common reports related to sexism; 42% (n = 568) reported witnessing or experiencing sexist language/attitudes in the workplace. This was reported more by female respondents (66% compared to 27% male). 21% (n = 291) and 13% (n = 180) reported witnessing or personally experiencing racist and homophobic language or attitudes respectively. Consultants were identified as the most frequent perpetrators. The surgical wards or theatres were the most frequently reported areas that trainees either witnessed or experienced B/U behaviours. Of those trainees who had reported a personal experience of B/U behaviours (n = 344), 20% described their experiences of reporting as negative or very negative. 48.1% of respondents felt that surgery as a whole had a moderate, high or very high degree of a concern about B/U behaviours. ConclusionB/U behaviours are prevalent in the surgical domain. Urgent action is required to eradicate this unacceptable behaviour. A cross-specialty, intercollegiate response is required to tackle this issue and improve the working culture in surgery for all.

Bacteriological profile in microbiology surveillance of operation theatres: A retrospective study at a tertiary care teaching hospital in Rajsamand district, Rajasthan

Contamination of operation theatres and Intensive care units through air, surface or article vehicle is major cause of surgical site and hospital acquired infections leading to increased morbidity and mortality. The present study was conducted with aim to isolate and identify the nature of microbial contamination through air, surface and equipment of OT in a tertiary care teaching hospital. Six months (August 2019 – January 2020) retrospective analysis of data by random sampling of the six OT’s of the hospital was done. Air sampling was done by settle plate method. Surface samples were taken from different sites and equipments from the OT. Bacterial species were isolated and identified by conventional methods.: Total 300 samples were collected and analysed Out of which 116 samples (38.66%) were positive for bacterial growth. The predominant bacterial species isolated from surface or equipment was Bacillus (48.27%), followed by Coagulase Negative Staphylococcus (21.55%), Gram Negative bacilli i.e. Klebsiella (8.62%) and least commonly isolated bacterial species was Staphylococcus aureus 2(1.72%). Air quality analysis showed highest bacterial CFU rate of 75cfu/m3 from general surgical operation theatres and Ophthalmology OT recorded least bacterial cfu rate of 20cfu/m3. Most common isolated species was Baciilus followed by Coagulase Negative Staphylococcii.: The study revealed that the OT’s of our hospital showed a low bacterial contamination rate on surface swabbing and air quality CFU count per mm3 were within permissible limits. The present study emphasizes the need for periodic surveillance of OT’s and ICU’s and highlight the importance of early detection of bacterial contamination levels and prevention of hospital acquired infections.

Efficiency of some commonly used disinfectants on bacterial isolates from critical areas of tertiary care hospital

Aim of the study: Monitoring bacterial susceptibility to antimicrobials and disinfectants may help the management of nosocomial infection. Environmental surfaces are epidemiologically important reservoir of nosocomial bacterial species. The successful eradication of these pathogens with antibiotics has been complicated by the development of highly resistant strains as well as the appearance of new virulent pathogens. Materials and Methods: Mop water with added disinfectant was collected from critical areas of the hospital which were- surgical operation theatre, ophthalmology operation theatre, and intensive care unit of medicine. Isolates were tested by surface test method for efficacy of 6 commonly used disinfectants; Sodium hypochlorite, Phenyl black, Povidone iodine, Lysol (cresol) - benzalkonium chloride, Chloroxylenol & Chlorhexidine for recommended dilutions. Results: Majority of isolates were from M-ICU. Strains representative of GNB (gram negative bacilli) were most prevalent as compared to NFGNR. Recommended dilution of all the disinfectant was found satisfactory except phenyl black. Recommended dilution for phenyl black is 1:200 in water and as per our results of the study; MIC and MBC of organisms were found to be high. So it is recommended to use it in the critical areas of hospital with caution. Conclusion: The problem of hospital infection is a real one. Antibiotic resistant NFGNR, especially Pseudomonas spp. have played a predominant role. Antimicrobial activity of disinfectants may be influenced by their formation, level of organic load, synergy, temperature, dilution rate and tests methods. Disinfectant testing strategies should be part of any healthcare infection control policy. Keywords: Disinfectants, Bacteria, Surface test.

Use of Mixed Reality Visualization in Endoscopic Endonasal Skull Base Surgery.

Neuronavigation systems assist with spatial orientation during endoscopic transnasal skull base surgery, but they require a correlation of 3-dimensional (3D) views with 2-dimensional (2D) radiology studies. To outline an initial experience with a novel technology platform that provides intraoperative navigation using 3D reconstructions of patient anatomy for endoscopic surgery. A retrospective study of endoscopic anterior skull base and complex paranasal procedures was performed. Data from preoperative computed tomography and magnetic resonance imaging scans were fused to create 3D digital models of patient anatomy. Using the technology developed by Surgical Theater (Mayfield Village, Ohio), these reconstructions were designed to highlight particular anatomic regions of interest. The models were studied to guide the surgical approach and anticipate critical structures.The reconstructions were linked with the navigational technology created by Brainlab (Munich, Germany) during endoscopic surgery. A dynamic image of the reconstruction was displayed alongside a matching endoscopic camera view. These 2 views could be overlaid to provide an immersive, mixed reality image of the patient's anatomy. A total of 134 cases were performed. The pathologies included tumors of the anterior skull base or sinonasal cavity, inflammatory sinus disease, and cerebrospinal fluid leaks. Specific anatomic structures, such as the internal carotid arteries and optic nerves, were chosen for enhancement. Surgeons felt that the technology helped to guide the extent of bony dissection and to identify critical structures. We describe the first clinical series of complex skull base pathologies treated using a novel mixed reality platform.

Letter: Strategies for Prevention and Control of 2019 Novel Coronavirus Infection Among Medical Staff.

Letter: Strategies for Prevention and Control of 2019 Novel Coronavirus Infection Among Medical Staff.

Performance Anxiety in the Surgical Theater.

Performance Anxiety in the Surgical Theater.

Severe COVID-19 and healthcare-associated infections on the ICU: time to remember the basics?

Coronavirus disease 2019 (COVID-19) has posed a significant health care challenge globally, with intensive care unit (ICU) provision being of particular consequence [1]. In the UK, where ICU beds are already lower per head of population than in much of the rest of Europe [2], there has been a requirement to expand the ICU bed capacity rapidly in response. St George's Hospital is a 1000-bedded tertiary care hospital in South West London. From an initial ICU capacity of 60 beds spread over three purpose-built units, ICU beds expanded at peak surge in April 2020 to 83 COVID-19 beds and 13 non-COVID-19 beds (96 in total), involving additional space on two medical wards, a day unit and surgical theatres.

Evaluation of Operating Room Learning Environment for UAE Obstetrics and Gynecology Residents Using STEEM

Background The quality of the learning environment in the operating room (OR) is vital for the training of surgical residents. Tools with validity evidence exist to measure resident perceptions of the operative learning environment, yet to date no studies have assessed this environment for obstetrics and gynecology residency programs in the United Arab Emirates (UAE). Objective We explored perceptions of obstetrics and gynecology residents regarding their operative learning environment in 2 hospitals in Abu Dhabi, UAE. Methods Our cross-sectional study was conducted in 2018 using the validated Surgical Theater Educational Environmental Measure (STEEM) questionnaire for trainee assessments in the OR learning environment. The 4 STEEM subscales measure teaching and training, learning opportunities, overall atmosphere and supervision, workload, and support, respectively. Cronbach's alpha and intraclass correlation were used to establish the internal consistence and reliability of the questionnaire. We calculated an overall score and compared scores between the 2 institutions using Student's t test. Results Thirty-one residents completed the questionnaire (18 at Corniche Hospital and 13 at Al Ain Hospital). The overall average STEEM score was 142.1. The score for residents at Corniche Hospital was 134.9 and that for Al Ain Hospital was 152.2, with better overall scores on 3 STEEM domains at Al Ain Hospital. Conclusions Our study showed that obstetrics and gynecology residents in the UAE have a positive perception of their operative learning environment. We also identified areas for improvement.

Health-care waste segregation among surgical team groups: A new assessment method

BackgroundTo make it efficient, health care waste (HCW) segregation has to be done at the source. It must be simple, safe, well explained and understood by the personnel. To maintain good practice, regular training systems for old and new staff members and continuous assessment are essential to assure a high quality of waste management. Our objective is to create a new practical tool to assess the practice of surgical team members at our university hospital regarding the segregation of HCW. MethodsSurgical team members were divided into four groups and 9 subgroups. Nine different colors were assigned to each subgroup. Pictures of 30 surgical wastes were used instead of the items themselves. Each item was marked by one color from the population set of colors in a way that each subgroup of the sample has a complete set of the 13 wastes marked by the corresponding color. Five artificial empty waste containers were created using 5 colors. Sets were provided to the staff as they were entering the operating theater on the study days. Segregation of the items was done in an individual manner at the spot of the distribution. Data were collected into tables using Microsoft (MS) Excel 2016 and was checked twice. Descriptive statistic was used to analyze the data. Results64 health care professionals participated and 832 items were segregated. The mean wrong segregation rate was 12.6%. The operating theatre technician, residents, visitors, anesthetists, non-specialized nurses, nurse anesthetists, and surgeons got respectively 92.3%, 85.6%, 84.6%, 84.6%, 81.7%, 79.8% and 78.1% correct segregations. Each visitor (medical students from other centers), operating theater technician, nurse anesthetist, non-specialized nurse, surgeon, anesthetist, and resident had a 7.7%, 7.7%, 2.5%, 2.3%, 1.7%, 1.9% and 0.6% risk of incorrect segregation. In total, each member had a 0.3% risk of wrong segregation. ConclusionTo our knowledge, no similar study was done until now and no similar practice assessment method was used so far in the literature. We introduced a new experimental tool that permitted to conclude that the members of the team of our surgical theater have good knowledge reflected by the low rates of wrong segregations. The method was safe, fast, attracting and more comparable to the daily work rhythm at the department studied.

Tu1079 UN-TUTORED TRAINING PATHWAY TO ACHIEVE COMPETENCE IN ESOPHAGO-GASTRIC ENDOSCOPIC SUBMUCOSAL DISSECTION IN A WESTERN CENTRE

Endoscopic submucosal dissection (ESD) is a complex endoscopic procedure, which requires high level of skills and has a long learning curve. Training typically involves performance of procedures under expert supervision, which limits widespread dissemination of the technique. There is little data on un-tutored training pathway. This study aimed to assess the efficacy of an ESD unsupervised training model for experienced endoscopists. Following a visit to a high-volume centre, an endoscopist experienced in upper GI endoscopic resections underwent unsupervised training on an ex-vivo pig model until acquisition of adequate technical skills. The endoscopist advanced then to in-vivo human cases of upper GI ESD in the distal stomach, followed by progression to proximal gastric and esophageal cases. Indications for ESD were: i. gastric neoplastic lesion larger than 10mm or ii. Early esophageal or junctional adenocarcinoma with sessile morphology or suspicion of submucosal invasion; iii. Residual or recurrent esophageal neoplasia post EMR, unsuitable for repeat EMR; iv. Esophageal squamous cell carcinoma larger than 10mm; glandular neoplastic lesions. All human cases were performed in a surgical theatre under general anaesthesia . Performance measures were en-bloc resection, R0 resection and complication rates, as well as operative time (min/cm2). During a two-week visiting fellowship to the Tokyo National Cancer Centre 30 upper GI ESDs were observed. The endoscopists performed 15 unsupervised ESD procedures in the ex-vivo model, until 100% en-bloc resection and 0% perforation rates were achieved in the last 10 procedures. Five human cases of distal gastric ESDs were performed followed by 21 unselected esophago-gastric neoplastic lesions, which were referred for endoscopic treatment. Histopathological analysis showed invasive neoplasia in 80.7%, with submucosal involvement in 46.1% of cases. En-bloc and R0 resection were achieved in 91.6% and 78.3% of cases, respectively. Adverse events were recorded in 7.7%, including 1 perforation leading to surgery and 1 delayed bleeding. An additional case was converted to surgery as deemed to be technically unsafe. The operative time was 13.8 min/cm2 in stomach and 33.8 min/cm2 in the esophagus, with no definite evidence of learning curve when comparing the first and the second blocks of gastric and esophageal ESDs (p=0.24 and p=0.32, respectively). Un-tutored training for upper GI ESD is feasible and can allow endoscopists, who are experienced in therapeutic endoscopy, to achieve the required standards towards competency.

Common Sources of Pre-, Peri- and Post Surgical Site Infections (SSI) in Dogs during Clinical Students’ Surgical Practice

Surgical site infections (SSI) are important complication of Veterinary surgery. Pre, intra-, and post-surgical procedures are considered to be associated with SSI. An attempt to characterize veterinary SSI in small animal surgery practical was made. 15 dogs were grouped into 5 groups (with each group consisting of 3 dogs), in which skin-defect correction, caudectomy, cystotomy, orchidectomy, or ovariohysterectomy were performed by veterinary students under the guidance of qualified surgeons. Blood samples were obtained pre- and post-surgery. 120 swabs were taken from the following sites; students’ or surgeons’ hands (pre-/post-scrubbing), surgical tables, dog skin, random areas on surgical packs, kennels, and floors of surgical theatre. The microorganisms isolated were as follows; Staphylococcus aureus, Klebsiella spp, Micrococcus luteus, Enterobacter spp, and Bacillus subtilis, with Klebsiella being the highest. Leukocytosis, neutrophilia, monocytosis, increased bands, leukocytopenia, neutropenia, and lymphopenia were observed, with all being signs of infection. This study showed that the sources of SSI were numerous, including the followings; the dogs’ skin microflora, the students’ hands, surgical theater, surgical team, and the kennel. Proper scrubbing techniques should be adopted and maintained. The sterile field created should be kept and proper disinfection of the kennel should be ensured before returning the dogs after surgery.

Computer-guided contouring of craniofacial fibrous dysplasia involving the zygoma using a patient-specific surgical depth guide

The aim of this study was to introduce a new computer-guided technique for contouring and shaving of craniofacial fibrous dysplasia involving the zygoma. Computer-guided contouring was performed for five patients with unilateral craniofacial fibrous dysplasia involving the zygoma, using a patient-specific surgical depth guide. This patient-specific guide with depth holes was virtually designed for each patient based on mirroring of the unaffected side. The guide was printed using rapid prototyping. In the surgical theatre, the guide was seated in place and implant drills were inserted through the guide holes, creating depth holes according to the preoperative planning. Bone removal was then continued using surgical burs and/or bone chisels, connecting the guiding depth holes. Satisfaction with facial aesthetics was evaluated by the patients using a Likert scale, and by the surgeons using the Whitaker rating scale. All patients were satisfied with the postoperative facial aesthetics. Four patients were rated category I on the Whitaker rating scale, and one patient as category II. In conclusion, this patient-specific surgical depth guide appears to offer a solution for the unpredictability of conventional bone removal in unilateral craniofacial fibrous dysplasia, especially in three-dimensional multiplanar areas such as the zygoma. Further investigations are required.

360-Degree Virtual Reality Consultation for the Structural Heart Disease Patient

ABSTRACT Background : Given the need to improve upon physician-patient communication, we employed a 360-degree Virtual Reality (360°VR) visualization platform for face-to-face consultations for TAVR and LAAO procedures. The platform creates patient-specific 360°VR models from volumetric scans (e.g., CT, MRI) that can be manipulated and viewed from any angle. Methods : Forty-six patients were prospectively surveyed regarding their 360°VR consultation experience for aortic valve stenosis and atrial fibrillation. For each patient, a custom 360°VR model was created from their high-resolution CT scans using Precision VR® by Surgical Theater and utilized during the 360°VR consultation. The proposed procedure was simulated in VR to show the interaction of the specific implant with the patient’s anatomy. Patient conversion rate was also evaluated. Results : Compared to prior standard (non-VR) consultations for the same medical condition, patients reported significantly higher satisfaction with the 360°VR consultation and increased understanding of their pathology and proposed procedure. Additionally, 98% of patients agreed the physician communicated well using Surgical Theater. Patients also reported that experiencing 360°VR helped improve their understanding (98%) and comfort level (93%) with the proposed procedure. Importantly, 91% of patients agreed they felt included in decisions about their treatment. Additionally, 76% rated the hospital a 9 or 10 and 81% said they would recommend this hospital. Conversion rates after 360°VR consultations were higher than those for pre-360°VR consultations (100% vs 86%, TAVR; 92% vs 68%, Watchman). Conclusion : These findings support the 360°VR technology as a powerful tool to enhance patient education, engagement and satisfaction for structural heart disease patients. Abbreviations 360°VR: 360-degree Virtual Reality; TAVR: transcatheter aortic valve replacement; LAAO: left atrial appendage occlusion; HCAHPS: Hospital Consumer Assessment of Healthcare Providers and Systems; CMS: Centers for Medicare and Medicaid Services

Augmented and Virtual Reality in Surgery

Augmented and virtual reality are transforming the practice of healthcare by providing powerful and intuitive methods of exploring and interacting with digital medical data, as well as integrating data into the physical world to create natural and interactive virtual experiences. These immersive technologies use lightweight stereoscopic head-mounted displays to place users into simulated and realistic three-dimensional digital environments, unlocking significant benefits from the seamless integration of digital information with the healthcare practitioner and patient's experience. This review article explores some of the current and emerging technologies and applications in surgery, their benefits and challenges around immersion, spatial awareness and cognition, and their reported and projected use in learning environments, procedure planning and perioperative contexts and in the surgical theatre. The enhanced access to information, knowledge, and experience enabled by virtual and augmented reality will improve healthcare approaches and lead to better outcomes for patients and the wider community.

L’épaisseur de la surface articulaire d’une arthroplastie unicompartimentale du genou permet-t-elle de prédire l’importance de la perte osseuse tibiale en cas de révision au profit d’une prothèse tricompartmentale ?

BackgroundBone defects during revision procedures for failed UKA represent a challenge even for the most experienced surgeons; therefore, an accurate preoperative planning remains essential to prevent dramatic scenarios in the surgical theatre. HypothesisOur hypothesis is that bearing thickness used in original UKA represents a reliable predictor of severe tibial bone loss, requiring a metallic augment or constrained implant, during revision to TKA. Patients and methodsForty-two patients who underwent a total knee arthroplasty from failed UKA were identified from our institutional database and evaluated clinically using the Knee Society Score (KSS). A multivariate logistic regression analysis was performed using the presence of tibial augments or the need of varus-valgus constrained (VVC) prosthesis as depend variables, and patients’ gender, age at revision procedure, side (medial or lateral), UKA tibial tray (all-polyethylene or metal back), bearing thickness (composite thicknesses of the metal-backed tray and insert or all-polyethylene tibial component≤8mm or more than 8mm) and cause of failed UKA as independent variables. ResultsA posterior-stabilized prosthesis was used in 27 cases (64.3%). An augment was necessary in 12 patients (28.6%). Initial bearing thickness greater than 8mm was associated with greater likelihood of a VVC implant (OR=11.78, 95% CI: 1.6583 to 83.6484, p=0.0137) and a tibial augment (OR=9.59, 95% CI: 1.327 to 69.395, p=0.0251). Tibial tray design, patients’ gender or age during revision surgery, side or cause of failure were not associated to increased risk of augmentation or constrained implants. DiscussionSurgeons should be aware of the particular challenges that the conversion of a UKA to a TKA presents and be prepared to address them intraoperatively, with particular care to proper bone loss manage. Satisfying results can be achieved at mid-to-long-term follow-up, if these procedures are planned accurately, and a precise analysis of failed UKA components, in particular bearing thickness, represents a helpful support in this context. Level of evidenceIV, retrospective case series.

Innovative Device for Indocianyne Green Navigational Surgery

Dynamic reality has been integrated into developing surgical techniques, with the goals of providing increased intraoperative accuracy, easier detection of critical anatomical landmarks, and better general results for the patient. Enhancement of the reality in surgical theaters using single or multi sensorial augmenters (haptic, thermic and visual) has been reported with various degrees of success. This paper presents a novel device for navigational surgery and ancillary clinical applications based on the fluorescent properties of Indocyanine Green (ICG), a safe, FDA-approved dye that emits fluorescence at higher wavelengths than endogenous proteins. The latest technological developments and the aforementioned convenient quantum behavior of ICG allow for its effective identification in tissues by means of a complementary metal-oxide semiconductor (CMOS) infrared camera. Following fundamental research on the fluorophor in different biological suspensions and at various concentrations, our team has built a device that casts a beam of excitation light at 780nm and collects emission light at 810-830nm, filtering ambient light and endogenous autofluorescence. The emission light is fluorescent and infrared, unlike visible light. It can penetrate tissues up to 1.6cm in depth, providing after digitization into conventional imaging anatomical and functional data of immense intra-operative value.

Bearing thickness of unicompartmental knee arthroplasty is a reliable predictor of tibial bone loss during revision to total knee arthroplasty

BackgroundBone defects during revision procedures for failed UKA represent a challenge even for the most experienced surgeons; therefore, an accurate preoperative planning remains essential to prevent dramatic scenarios in the surgical theatre. HypothesisOur hypothesis is that bearing thickness used in original UKA represents a reliable predictor of severe tibial bone loss, requiring a metallic augment or constrained implant, during revision to TKA. Patients and methodsForty-two patients who underwent a total knee arthroplasty from failed UKA were identified from our institutional database and evaluated clinically using the Knee Society Score (KSS). A multivariate logistic regression analysis was performed using the presence of tibial augments or the need of varus-valgus constrained (VVC) prosthesis as depend variables, and patients’ gender, age at revision procedure, side (medial or lateral), UKA tibial tray (all-polyethylene or metal back), bearing thickness (composite thicknesses of the metal-backed tray and insert or all-polyethylene tibial component ≤8mm or more than 8mm) and cause of failed UKA as independent variables. ResultsA posterior-stabilized prosthesis was used in 27 cases (64.3%). An augment was necessary in 12 patients (28.6%). Initial bearing thickness greater than 8mm was associated with greater likelihood of a VVC implant (OR=11.78, 95% CI, 1.6583 to 83.6484, p=0.0137) and a tibial augment (OR=9.59, 95% CI, 1.327 to 69.395, p=0.0251). Tibial tray design, patients’ gender or age during revision surgery, side or cause of failure were not associated to increased risk of augmentation or constrained implants. DiscussionSurgeons should be aware of the particular challenges that the conversion of a UKA to a TKA presents and be prepared to address them intraoperatively, with particular care to proper bone loss manage. Satisfying results can be achieved at mid-to-long term follow-up, if these procedures are planned accurately, and a precise analysis of failed UKA components, in particular bearing thickness, represents a helpful support in this context. Level of evidenceIV, retrospective case series.

Assessing quality of newborn care at district facilities in Malawi

BackgroundMalawi is celebrated as one of the few countries in sub-Saharan Africa to meet the Millennium Development Goal of reducing under-5 mortality by two-thirds between 1990 and 2015. However, within this age range neonatal mortality rates are the slowest to decline, even though rates of facility births are increasing. Examining the quality of neonatal care at district-level facilities where most deliveries occur is warranted.ObjectiveThe objective of this paper is to evaluate the quality of neonatal care in three district hospitals and one primary health centre in southern Malawi as well as to report the limitations and lessons learned on using the WHO integrated quality of care assessment tool.MethodsThese facility assessments were part of the “Integrating a neonatal healthcare package for Malawi” project, a part of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative. The WHO integrated quality of care assessment tool was used to assess quality of care and availability and quantity of supplies and resources. The modules on infrastructure, neonatal care and labour and delivery were included. Facility assessments were administered in November 2017 and aspects of care were scored on a Likert scale from one to five (a score of 5 indicating compliance with WHO standards of care; one as lowest indicating inadequate care).ResultsThe continuum of labour, delivery and neonatal care were assessed to identify areas that required improvements to meet standards of care. Critical areas for improvements included infection control (mean score 2.9), equipment, supplies and setup for newborn care in the labor ward (2.3), in the surgical theater (3.3), and nursery (3.4 nursery facilities, 3.0 supplies and equipment), as well as for management of sick newborns (3.2), monitoring and follow-up (3.6). Only one of the 12 domains, laboratory, met the standards of care with only minor improvements needed (4.0).ConclusionThe WHO integrated quality of care assessment tool is a validated tool that can shed light on the complex quality of care challenges faced by district-level health facilities. The results reveal that the quality of care needs improvement, particularly for sick and vulnerable newborns.

Surgical Data Recording Technology: A Solution to Address Medical Errors?

: Reducing preventable medical errors remains a universal goal, yet implementing effective solutions remains a challenge. The development of surgical data recording technology shows promise to generate robust qualitative and quantitative data in the surgical theater. These data can allow physicians and their teams to capture specific sources of error and implement corrective interventions. Surgical data recording technology encompasses rudimentary data tabulation on notecards, to integrated audio-video systems containing cameras, microphones, and sensors, capturing and synthesizing intraoperative, environmental, and instrumentation information, along with devices tailored to robotic surgical systems. There is growing interest in the implementation of such technology in medical centers, particularly in the United States, Canada, and Europe, but existing medicolegal and regulatory challenges necessitate further research and clinical assessment in order for this technology to facilitate improved surgical patient safety.

Assessment of Port Site Complication in Laparoscopic Abdominal Surgery

Abstract Background Rapid expansion in the volume and complexities of laparoscopic surgeries has been accompanied by complications, many of which can be directly attributed to abdominal access with laparoscopic trocars including visceral injury, vascular injuries, air embolism, subcutaneous emphysema, port site infections, incisional hernia and metastasis occurred post operatively. Objectives This study aimed to detect the different port site complications encountered in laparoscopic abdominal surgery in terms of incidence and management. Patients and Methods This study was conducted in the surgical operating theatre of Ain-Shams University Hospitals (Demerdash and Ain Shams University Specialized Hospital), Cairo, Egypt, from January 2018 till July 2018. Results In this study complications occurred in 37 cases out of the 400 cases (Study subjects). The incidence of port site complications in our study was 9.25%. Vessel injury occurred in 19 out of the 400 cases with incidence 4.75%. Port site infection occurred in 11 out of the 400 cases with incidence 2.75%. Visceral injury occurred in 4 out of the 400 cases with incidence 1%. Port site hernia occurred in 3 out of the 400 case with incidence 0.75%. Conclusion Study incorporated 400 subjects operated for different indications laparoscopically and patients developing any kind of complications were recorded and analyzed. The results showed 3(0.75%) port site hernias, 11(2.75%) port site infections,19 (4.75%) vessel injury, 4 (1%) visceral injury and no port site metastasis was detected.