Theatre List Research Articles

BN SO43 - The impact of dedicated “hot cholecystectomy lists” on rates of early cholecystectomy and its outcomes

Abstract Background Surgical management of gallstone disease is evolving with NICE guidelines emphasising on early cholecystectomy following an index admission with biliary symptoms. Despite an attempt at adhering to these recommendations, many centres find operating theatre capacity as a potential significant constraint to offer a same admission or early cholecystectomy. We assess the impact of a dedicated theatre capacity provided by a specialist upper gastrointestinal surgical team on rates of early cholecystectomy and its outcomes. Method A pathway for patients presenting with symptomatic gallstone disease was designed and implemented trust wide, with two theatre lists per week dedicated to performing “hot cholecystectomies”. Retrospective analysis was performed from a prospectively maintained database of patients with symptomatic gallstone disease admitted to a district general hospital over two equal (30 days) but chronologically independent time periods. Data was collected from prior and after service reconfiguration and analysed with descriptive statistics. Results 19 patients (F:M ratio 0.82:1) were referred for the consideration of receiving a hot cholecystectomy. Nine of the 12 patients (75%) who were deemed to be suitable as per NICE guidelines underwent a cholecystectomy within the recommended time frame. There was a significant difference in the number of admissions over the two time periods with a shorter time from index admission to surgery (median 62 days to 5 days (P<0.01)); with correspondingly fewer re-admissions from 14 to 2 (P<0.01) following service reconfiguration. Conclusion With adequate theatre resources together with surgical expertise, early laparoscopic cholecystectomy can be proved to be an effective and sustainable model for the management acute biliary disease. Continue ahead, we aim to improve our computer-based referral system which will be better suited to record referrals, and the patient pathway. This data will be developed into a dashboard, thereby keeping a contemporaneous record of acute admissions and their management; subsequently improving the number and quality of referrals.

HPB SO65 - An audit of the day-case rate of laparoscopic cholecystectomies at a busy district general hospital and factors affecting this

Abstract Background The target day case rate of laparoscopic cholecystectomies at a busy district general hospital is 75%, as per Model Hospital Guidelines. The current rate at which day cases are achieved is 55%. This audit aims to identify factors relating to the DGH not reaching their day case target and explore potential solutions for these, with the intention to reduce patient’s hospital stay and, therefore, overall costs. Method 119 patients had undergone a laparoscopic cholecystectomy in the first five months of 2024. Exclusion criteria included hot cholecystectomies, common bile duct explorations and planned admissions. The remaining 85 patients were included in this audit. The data proforma included age, ASA, BMI, co-morbidities, Nassar grade, scheduled and actual time of operation and any reasons for delay. Results Of the 85 patients included in this audit, 34% (29) were not daycases. 11 remained an inpatient due to post-operative nausea or pain, 3 due to requiring an MRCP, 9 were kept in for monitoring, 2 had intraoperative bleeding, 3 had social issues and 1 required IV antibiotics. 58% of the 29 had afternoon operations. 48% of the 29 had a Nassar grade of greater than 1. 38% of the 29 had a BMI greater than 30. Conclusion Various reasons for a case to not achieve daycase status were found, with the most common being post-operative pain or nausea. It would prove beneficial to educate patients on common post-operative symptoms and focus on managing these symptoms effectively. Pre-operative appointments should aim to explore a patients home setting at the time of the operation and ensure to book inpatient stays for those who require it, in advance. Theatre lists should be optimised by giving high-risk patients morning slots.

AHP SO05 - First year experience of running a specialist pre-op clinic for patients undergoing a Whipple procedure that focuses on patient education and improving theatre utilisation

Abstract Background The Whipple’s pre-operative clinic was organised to ensure patients were fully aware of the impact of this operation. Additionally, it was implemented to reduce the risk of preventable theatre cancellations and unfilled operating theatre slots arising given the challenges currently faced in the current NHS climate. The primary aim of the clinic is to improve education to ensure the patients are aware of what the procedure and aftercare entails. A secondary aim is to identify correctable issues in the pre-operative period which could prevent surgery from proceeding safely. Method The clinic ran over 12 months in the tertiary HPB centre at University Hospital Southampton. The clinic has two elements: a 30min video appointment with a specialist nurse for each individual patient to provide comprehensive information regarding the procedure This was followed by a checklist to ensure there was appropriate up-to-date imaging available, as well as a review of the latest blood tests and current medications. Results There were a total of 105 patients reviewed in the clinic. Due to this new service, 21 (20%) essential interventions were made. These included requesting or reviewing new imaging (n=14) correcting anticoagulation plans (n=2) and admitting patients for optimisation prior to surgery (n=2). A total nine all day theatre lists were saved as a direct result of this clinic. Costing of each theatre is estimated at £12,000. Five (5%) patients had their surgeries cancelled in advance and all theatre slots were subsequently re-allocated. Four (4%) patients had interventions which directly prevented an on the day cancellation. Conclusion These results show that there are significant benefits from running a specialised pre-operative Whipple’s clinic. Multiple interventions have led to improving patient safety, optimising theatre utilisation and improving patient experience.

EGS SO10 - Restructuring of emergency surgical service in DGH leads to significant reduction in time to cholecystectomy for gallstone pancreatitis in line with international guidance

Abstract Background The International Association of Pancreatology guidelines suggest that patients with mild biliary pancreatitis undergo cholecystectomy during their initial hospital admission. A single-center retrospective study was conducted to examine adherence to this guideline following a significant overhaul of emergency surgical services. Our team, with support from the surgical ambulatory emergency care network, revolutionized care through an Emergency Surgery Unit (EmSU) system. This included surgical assessments with ambulation, coordinated radiology appointments, semi-emergency theatre lists twice a week in addition to NCEPOD theatre sessions, and an emergency roster split by patient gender, ensuring a balanced caseload for the surgeons on duty each week. Method A retrospective study of patients with mild biliary pancreatitis for three years before (n = 107) and after (n=108) the EmSU system. Cholecystectomy on index admission was recorded, as was overall time to surgery (days). Data was analysed using GraphPad Prism Version 9.5.1. Data is expressed as Mean ± SEM. Percentages underwent Arcsine transformation prior to inferential analysis. Groups of data were analysed using Students T-Tests. Results The percentage of patients operated on index admission increased 13.1-fold (4.8% to 62.9%; P < 0.01). Days to surgery saw a 10.1-fold reduction (332.5 ± 41.1 to 32.9 ± 6.3 days; P < 0.0001). Conclusion The adoption of our EmSU system has drastically improved care for patients with gallstone pancreatitis, bringing it much closer to best practice guidance. Further improvement is likely with increased buy-in from all members of staff.

HPB SO55 - Utilisation of Telephone Assessment Clinic for booking Laparoscopic Cholecystectomy: Analysis of outcomes and cancellations

Abstract Background Despite extensive efforts to increase productivity after the Covid pandemic, there still remain areas of limited capacity. Face-to-face outpatient clinic provision is yet to return to normal levels, despite significant increases in referrals. Telephone assessment clinics are attractive solutions as they can be performed outside 'standard' operating hours of the hospital and require fewer support staff, giving increased flexibility to consultant and trainee surgeons who perform them. However, it is unclear whether telephone assessment alone is sufficient to book patients onto operating lists. This study aimed to assess the effectiveness of telephone assessment alone when booking patients for laparoscopic cholecystectomy. Method A standardised telephone assessment process was developed which included mandatory information about symptoms, past medical and surgical history and body weight. All patients referred for consideration of cholecystectomy from January 2023 to January 2024 received either a telephone or face-to-face clinic appointment; those who received a telephone appointment were not routinely offered face-to-face assessment unless clinically indicated. Patients were listed for laparoscopic cholecystectomy from either clinic and all operations took place on pooled operating lists. Operative and clinical outcomes were recorded, including cancellations on the day and unexpected anatomy or procedures. Outcomes between telephone and face-to-face appointments were compared. Results Over the study period, 189 patients had a laparoscopic cholecystectomy from an elective clinic source. Other sources included those patients who had presented acutely and were discharged and those on semi-acute lists. 106 patients had a telephone assessment as their only prior engagement with surgical services prior to surgery. Of these patients, there was one cancellation on the day (due to absence of symptoms between clinic assessment and date of surgery). Nine patients required cholangiography which had not been initially booked. In contrast, three patients who had had face-to-face assessment were cancelled on the day. Conclusion Telephone assessment alone is sufficient to book patients onto an elective theatre list for laparoscopic cholecystectomy, with no adverse impact on cancellations and theatre utilisation. To ensure low cancellation rates and safe surgery, senior decision making is required for telephone assessment clinics (in this study, all appointments were carried out by consultant surgeons) and a standardised proforma to ensure all relevant information is recorded. The low rate of cancellations was maintained even though a 'pooled' operating list is utilised in our hospital. Telephone assessment clinics for first appointments are safe and effective and could help in reducing overall waiting times.

The impact of cosmetic tourism across one year on an NHS breast surgery unit

BackgroundThis is a review of patients managed by our single-site breast surgery service for complications of cosmetic surgeries performed abroad and within the UK, across September 2022-2023. MethodsA retrospective review of outpatient clinic and emergency theatre lists was used to identify patients; data was collected from their electronic records. Results25 patients (23 female) were identified, 20 had surgery abroad. Turkey was the most common destination that patients travelled to (n=15), with bilateral breast augmentation being the most common procedure (n=15). Post-operative infection and wound dehiscence (n=10 and n=8 respectively) were the most common complications; 72% (n=18) of patients presented within 8 weeks of their surgery. There was incomplete recording of surgical details including precise date (recorded for 48%), clinic name (8%), and name of the surgeon (0%). 17 microbiological samples were sent, with 11 resulting in a named organism - Staphylococcus Aureus was most common (n=5). 17 (68%) cases were treated conservatively, without radiological or surgical interventions. When surgical management occurred (n=6), it was for removal of breast implants (n=5) or evacuation of haematoma (n=1). The cost of managing these complications was at least £37,000. ConclusionComplications from cosmetic tourism present more commonly to the NHS than those resulting from private surgery performed in the UK. This has significant financial implications for the NHS. More accurate recording of relevant data, engagement in audits, and disseminating findings may help raise awareness of the risks and complications of cosmetic surgery performed abroad.

The Importance of Surgical Cutting Time as a Key Performance Indicator Alongside Touchtime Utilisation in Operating Theatre Efficiency Optimisation.

Aims The Getting It Right First Time(GIRFT) programme has set targets to achieve 85% touchtime utilisation by 2024/25. Touchtime utilisation is a measure of theatre productivity, defined as the time from the start of anaesthesia to the time a patient leaves the theatre for all cases on a defined theatre list as a percentage of total available theatre time. No published evidence examines touchtime utilisation as a measure of theatre efficiency and its correlation with surgical cutting time. This study aims to determine if there is a statistical relationship between touchtime utilisation and surgical cutting time, and whether the use of touchtime utilisation is sufficient to inform about surgical productivity. Methods A retrospective analysis of two orthopaedic theatres spanning 100 days at both a major trauma centre and an elective hospital in London was performed. Electronicrecords identifiedanaesthetic start time, knife-to-skin time, end-of-procedure time, and patient-leaving-theatre time. Time intervals were calculated and the relationship between touchtime utilisation and surgical cutting time was assessed using Pearson's correlation coefficient (r). Results The mean total touchtime was 403 minutes (SD, 84 minutes) at the major trauma centre and 383 minutes (SD, 103 minutes) at the elective hospital. The mean total surgical cutting time was 259 minutes(SD, 72 minutes) at the major trauma centre and 233 minutes (SD, 75 minutes) at the elective hospital, from a total available time of 510 minutes per list. There was a significant correlation between touchtime and surgical cutting time at both hospitals (elective hospital: r (198) = 0.815, p < 0.001; major trauma centre: r (198) = 0.892, p < 0.001). The mean touchtime utilisation was 79.31% for the major trauma centre and 75.20% for the elective hospital; however, the mean total surgical cutting time was 51% and 46%, respectively, of total available time. Conclusion Despite a good correlation between touchtime and surgical cutting time, the range between these measures suggests that using touchtime utilisation alone to measure theatre efficiency may not sufficiently inform about efficient practices. We suggest complementing touchtime utilisation data with surgical cutting time may provide more information to contextualise efficiencies or inefficiencies in an operating theatre.

ThP8.12 - To do or not to do-Temporal artery Biopsy in Giant Cell arteritis

Abstract Aims Temporal artery biopsy (TAB) remains the gold-standard diagnostic test for giant cell arteritis (GCA). Our aim is to evaluate the correlation between initiation of corticosteroid therapy, timing of biopsy, and histological diagnosis of GCA through TAB. Moreover, analyse the usefulness of this practice. Methods Operative notes of TABs performed by a Vascular Surgery department at a teaching hospital between August 2021 and January 2023 were reviewed. We looked into the relationship between histological findings and the timing of corticosteroid treatment initiation prior to TAB. Results A total of eight patients had a TAB, with a male-to-female ratio of 2:6. The median age of the patients was 68-years-old (range 53-84). TABs were performed within 16 days of the referral (range 2-16). All were performed on elective theatre lists and none on emergency theatre lists (CEPOD). All patients had started corticosteroids by the time they had TAB, with a median duration of 11.5 days before TAB (range 2-16). The histopathology report was positive for active GCA in 1 case (12.5%) where the TAB was performed on day 3. In another performed on day 16, histopathology showed signs of healed inflammation (12.5%). In all other cases the report was negative (75%). All patients completed a full weaning course of steroids regardless of histological findings. Conclusion GCA is a systemic inflammatory vasculitis. Prompt initiation of high-dose corticosteroids is the mainstay management to reduce risks of ischaemic-related complications. Our work suggests the timing of biopsy is a key determinant of histological diagnosis of GCA.

ThP4.8 - Establishing a Hot Gallbladder Pathway: An Optimal and Advantageous Intervention

Abstract Introduction NICE, AUGIS and Tokyo guidelines recommend early laparoscopic cholecystectomy (ELC) in symptomatic gallstone disease. We highlight our implementation of a hot gallbladder (HGB) pathway, dedicated to HGB cases in a district general hospital with a 550-bed capacity. Methods To implement a HGB service we established a formal evidence-based SOP alongside two theatre lists and six clinic slots a week. Ongoing retrospective data collection allowed us to analyse the efficacy of our interventions between January and December 2023 (n=244). Results In our cohort, biliary colic remains the commonest diagnosis (51.2%) versus acute cholecystitis (27.5%), with female predominance (80% v 20%). Prior to HGB pathway introduction in April (January–March, n=73), 13.7% underwent HGB surgery. After HGB pathway implementation (May–Dec, n=171), 28.7% had HGB surgery with a mean waiting time of 9.6 days from admission. There has additionally been an 18% decrease in patients awaiting cholecystectomy since HGB pathway implementation. Significant delays exist in obtaining an MRCP (8.48 days) and ERCP (5.87 days) when required. Complication and readmission rates were consistent with those published in literature. Conclusion Establishing a HGB pathway facilitated earlier treatment for patients and notably decreased the numbers awaiting cholecystectomy. Significant delays in obtaining MRCP/ERCP could be improved with dedicated MRCP or ERCP slots. Favourable patient outcomes alongside the almost double NHS tariff payments given to ELC compared to elective cholecystectomy, provides incentive for hospitals to implement HGB lists.

EP366 - A single surgeon experience of total extraperitoneal inguinal hernia repair in a district general hospital

Abstract Methods This was a retrospective review of a prospectively collected and maintained data on elective TEP hernia repairs. All theatre list has been collected prospectively. All patient who had inguinal hernia repair between 2004 and 2021 has been identified from the list. The notes of all Patients who had laparoscopic hernia repair were reviewed including the operative notes, postoperative complications, and any subsequent referral to the surgical department at the Trust to see any recurrence. The data collections included age, sex, type of the mesh, fixing device, primary or recurrent, unilateral or bilateral and conversion to open procedure. Since 2014 all notes were electronic and restored on evolve application. Result All patients records were retrieved from the electronic database system. Out of this cohort, some of patients records were missing. The mesh was not fixed in primary hernia if it was small or medium size, but it was fixed in primary large direct hernia to reduce the risk of blowing in of the mesh inside the defect. Our results showed a recurrence rate with acceptable incidence of post operative pain and wound related complications compliant with the NICE guidance. Conclusion A TEP repair for both primary and recurrent inguinal hernia has a minimal recurrence rate when performed by the specialists in this area giving full attention to the details.

WP7.14 - The change of a DGH emergency surgical service leads to marked improvements in timing of cholecystectomy for gallstone pancreatitis, in line with international guidance

Abstract Background International Association of Pancreatology (IAP) guidelines recommend that cholecystectomy should be performed on patients with mild biliary pancreatitis during their index admission. This retrospective study compares how a paradigm shift in the provision of emergency surgical services in one district general hospital (DGH) significantly improved ability to follow this guideline. With input from the surgical ambulatory emergency care network (SAEC), our team transformed care via an Emergency Surgery Unit (EmSU) system. This includes surgical assessment with ambulation, linked radiology slots, semi-emergency theatre lists twice weekly in addition to NCEPOD theatre and the emergency take divided in two according to sex of patient ensuring appropriate patient load for each of the surgeons of the week. Methods A retrospective study of patients with mild biliary pancreatitis for three years before (n = 107) and after (n=108) the EmSU system. Cholecystectomy on index admission was recorded, as was overall time to surgery (days). Data was analysed using GraphPad Prism Version 9.5.1. Data is expressed as Mean + SEM. Percentages underwent Arcsine transformation prior to inferential analysis. Groups of data were analysed using Students T-Tests. Results The percentage of patients operated on index admission increased 13.1-fold (4.8% to 62.9%; P &amp;lt; 0.01). Days to surgery saw a 10.1-fold reduction (332.5 + 41.1 to 32.9 + 6.3 days; P &amp;lt; 0.0001). Conclusions Adoption of our EmSU system has drastically improved care for patients with gallstone pancreatitis, now closer to best practice guidance. Further improvement is likely with increased buy-in from all members of staff.

2277 Predictive factors of delirium in neck of femur fracture and post-operative outcomes at Morriston hospital

Abstract Introduction Neck of femur fractures (NOF) remain a significant cause of mortality in the elderly, especially in those who develop delirium post operatively. The aim of our study is to identify risk factors that may contribute to developing a delirium. Method A prospective cohort study of 717 patients presenting to Morriston Hospital who underwent operative management for a NOF fracture. Results A total of 103 patients developed a post-operative delirium, an incidence of 14.4%. Clinical Frailty Score (CFS) and Abbreviated Mental Test Score (AMTS) proved to be significantly associated with developing delirium (p &amp;lt; 0.0001). Delirium was highly prevalent in patients with moderate frailty (CFS6≥) and an abnormal AMT score (&amp;lt;8), present in 70% and 73% respectively with individual odds ratios of 4.1 and 5.2. Delirious patients suffered higher inpatient mortality (16% v 5%, p 0.0004), an increased length of stay (32 vs 23 days, p &amp;lt; 0.0001) and were more likely to be directly institutionalised (10% vs 3% p 0.002) without rehabilitation. Admission inflammatory markers and prolonged waiting times for theatre were highly prevalent in both groups and not pursued. Conclusions Patients presenting with moderate frailty and abnormal AMTS were at greatest risk of developing a delirium which was associated with poorer outcomes. We propose identifying high-risk patients from the point of admission to ensure early targeting of potential reversible factors. A delirium toolkit could aid in identifying these patients and there may also be an argument for the prioritisation of high-risk individuals in theatre list given their increased mortality.

The carbon footprint of the perioperative transurethral resection of bladder tumour pathway.

To evaluate the carbon footprint of the perioperative transurethral resection of bladder tumour (TURBT) pathway from decision to treat to postoperative discharge, and model potential greenhouse gas (GHG) emissions reduction strategies. This process-based attributional cradle-to-grave life-cycle assessment (LCA) of GHG emissions modelled the perioperative TURBT pathway at a hospital in Southwest England. We included travel, energy and water use, all reusable and consumable items, and laundry and equipment sterilisation. Resource use for 30 patients undergoing surgery was recorded to understand average GHG emissions and the inter-case variability. Sensitivity analysis was performed for manufacturing location, pharmaceutical manufacturing carbon-intensity, and theatre list utilisation. The median (interquartile range) perioperative TURBT carbon footprint was 131.8 (119.8-153.6) kg of carbon dioxide equivalent. Major pathway categories contributing to GHG emissions were surgical equipment (22.2%), travel (18.6%), gas and electricity (13.3%), and anaesthesia/drugs and associated adjuncts (27.0%), primarily due to consumable items and processes. Readily modifiable GHG emissions hotspots included patient travel for preoperative assessment, glove use, catheter use, irrigation delivery and extraction, and mitomycin C disposal. GHG emissions were higher for those admitted as inpatients after surgery. This cradle-to-grave LCA found multiple modifiable GHG emissions hotspots. Key mitigation themes include minimising avoidable patient travel, rationalising equipment use, optimally filling operating theatre lists, and safely avoiding postoperative catheterisation and hospital admission where possible. A crucial next step is to design and deliver an implementation strategy for the environmentally sustainable changes demonstrated herein.

578 Optimising Emergency Theatre Efficiency with the Use of a Pre-Anaesthetic Holding Bay, a Quality Improvement Project

Abstract Aim An efficient emergency theatre depends on the coordination of multiple surgical specialties, anaesthetists, and theatre staff. The serial nature of an operating list leads to downtime between cases. We sought to reduce delays between emergency cases by implementing a pre-anaesthetic holding bay. Method Anonymised data was collected from a prospectively maintained mandatory database of theatre activity. Exclusion criteria were non-surgical procedures, first case, out-of-hours procedures, and critical care admissions. Suitability was determined from a period pre-implementation and a pre-defined trial period to ensure safe rollout. Pre-, trial, and post-implementation were compared. Results 349 emergency procedures were performed in three months post-implementation. After exclusion criteria 110 were suitable for pre-anaesthetic holding bay use, and in 35 (31.8%) it was utilised. Most cases were general surgery (61%), vascular surgery (15%), and gynaecology (12%). Holding bay use decreased time without a patient in the anaesthetic room from 50 to 5 minutes (p&amp;lt;.001) and the time between procedures from 86 to 43 minutes (p&amp;lt;.001). There was no difference in anaesthetic time between the groups (36 vs 38 minutes, p=.40). Over the three months 40 more in-hours cases were completed in 48 days with no difference in procedures across the periods. Conclusions Pre-anaesthetic holding bay use reduced theatre downtime by 90%, allowing more procedures to be performed in-hours. All specialties engaged with the holding bay but to varying extent, and ensuring investment from surgeons, anaesthetists, and theatre staff is essential. This intervention, implemented with no extra resources, has increased efficiency and improved safety in the emergency theatre list.

Creating Novel Standards for Datapoints on an Elective Orthopaedic Theatre List Document.

Orthopaedic theatre lists are an important tool which must convey essential information to all staff to run an effective and safe theatre list. However, there are no set standards or guidelines on the components of an Orthopaedic theatre list. The objective of this study is to formulate guidelines for elective Orthopaedic theatre lists which improve efficiency and reduce errors. We looked at 326 elective Orthopaedic theatre lists from October to November 2018. Various factors such as: theatre and patient demographics, surgical team, type of anaesthesia, Surgery, acronyms and finally extra information such as allergies. Additionally, a survey was distributed to a variety of theatre staff to understand their requirements from a theatre list. Thereafter, we created a proforma for waiting list coordinators. Subsequently, we re-audited six more weeks of theatre lists (255) from November to December 2019. The orthopaedic consultant in charge was noted for 100% of patients compared to 85% previously. There was an improvement in documenting the required anaesthesia such as noting 14.5% required spinal compared to 0.3% previously. Prosthesis/equipment was mentioned for 34% of patients compared to 23%. Fluoroscopy was noted as being required for 25% of patients compared to 11%. We believe standards should be in place in order for us to follow to ensure we carry out safe and efficient Orthopaedic theatre lists, and these standards should entail the parameters we have audited. The 'William Harvey theatre list standard' should be used as a gold standard for all elective Orthopaedic theatre lists.

Proximie in the operating theatre: evaluation of a virtual operating platform for medical student education.

Medical students often hesitate to enter the operating theatre because of poor visibility of the surgical field and anxiety about the theatre environment. In addition, ear, nose and throat (ENT) surgery is underrepresented in many medical curricula. Virtual systems like Proximie offer flexible viewing of surgeries with surgeon commentary, potentially addressing these issues. This descriptive survey study aimed to evaluate the use of Proximie as a surgical education tool for delivering ENT teaching to medical students. Live ENT procedures were recorded at the ENT Department of the John Radcliffe Hospital and shared with interested clinical medical students through Proximie accounts. Students were added to a private group chat to ask questions and provided feedback through structured forms, assessing procedural effectiveness and the platform's technology. Live-streaming and recording of procedures were facilitated by ENT surgeons providing commentary. Conducted over four virtual theatre days, the study gathered 52 responses: 96% of students rated Proximie's educational value as 4 of 5 or higher; 57% preferred the virtual experience over physical attendance because of its convenience and the improved view of the surgical field. Students valued the live commentary and showed interest in using Proximie for a broader range of surgeries. Suggested improvements included fixing technical issues, better communication of theatre lists, and expanding surgical specialty coverage. Proximie has been highly rated by medical students for its effective and engaging approach in the instruction of surgical skills, underscoring its value as an educational tool. Future research is needed to formally assess knowledge acquisition and retention across multiple surgical subspecialties. This work is the first step towards evaluating the utility of virtual operating theatre platforms for medical student education.

Emergency Haemorrhoidectomy in Acute Haemorrhoidal Crisis: A Tertiary Centre Experience

Acute haemorrhoidal crisis refers to painful, irreducible prolapsed haemorrhoids. On the best of hand, surgical treatment of acute haemorrhoidal crisis could still risk complications of bleeding and worse, incontinence. Our study aimed to look at the short-term outcomes of emergency excisional haemorrhoidectomy for acute haemorrhoidal crisis at a colorectal centre. This is a retrospective study conducted at a tertiary centre in the northern state of Malaysia from January 2015 to December 2020. The medical record was traced from the medical record unit and the operation theatre list for all patients with surgical treatment for an acute haemorrhoidal crisis. Sociodemographic data and complications rate were collected with 12 months follow-up. There were 51 patients identified from the registry and 29 out of those were male. The median age was 41 (20-82) years old. In addition, 26% (n=13) of the females were pregnant at presentation. Five patients had previous haemorrhoidal procedures performed. The median operating time was 35 (15-143) minutes with the length of hospital stays of 4 (2-10) days. The early complications were seen in 17 patients with bleeding (5.9%) and urinary retention (27%). The 12-month recurrence rate was 7.8% with median Wexner incontinence scores of 0 (0-3). The emergency excisional haemorrhoidectomy in acute haemorrhoidal crisis is safe and effective for immediate symptomatic relief with an acceptable low self-limiting complication rate.

Emergency surgery preoperative delays: realities, economic impacts and gains of a second emergency operating theatre.

Time-to-theatre (TTT) is a key performance indicator of theatre efficiency and delayed TTT incurs significant costs and poor clinical outcomes. An increasing Irish population in conjunction with an ageing population puts increasing pressure on emergency surgical services across Ireland. We examined our institution's experience with introducing a second emergency theatre and semi-elective theatre lists for acute surgical patients. A retrospective review of electronic, prospectively maintained databases was performed between 1 February 2018 and 31 January 2020. A cost analysis was conducted to assess the economic impact of delayed TTT. The cost-saving benefit of introducing a second emergency theatre and semi-elective Kaizen lists was then calculated and compared with 2012-2014 figures from our institution. In total, 6,679 procedures were performed. Overall mean TTT was 16h, 10h shorter than before the introduction of a second emergency theatre and Kaizen theatre lists (p < 0.001). Patients aged >65 years, who are historically a significantly disadvantaged group, had a shorter TTT following the introduction of a second emergency theatre. The economic advantage of a second emergency theatre resulted in a cost saving of €3,674,538 over 24 months. Investment in emergency surgical services resulted in more efficient access to emergency theatres. There was a reduction in out-of-hours operating across all specialties and across the more at-risk groups such as those over the age of 65, who had an overall reduction in TTT. This had significant financial benefits and likely reduced the clinical risk associated with delayed TTT and out-of-hours operating.

The 'take-5 theatre brief': Group mindfulness practice for operating theatre teams.

A surgical team works in a high-performance environment and is exposed to stress. Mindfulness practice is evidenced to reduce symptoms of stress, as well as burnout, which is high amongst health workers. The operating theatre is unique, with many job-roles, needs and time-critical tasks. It is plausible that group mindfulness may benefit the surgical team. This evaluates the take-5 theatre brief, consisting of a 'check-in' and short breathwork, when used by two surgical teams as part of the regular theatre team brief. The take-5 theatre brief was evaluated using domains of acceptability and implementation. Data were collected at two district general hospitals in the United Kingdom using5-point Likert scales hosted on electronic surveys Thematic analysis was performed of participant voice notes, strategic meeting notes and transcripts of interviews between key informants. There were 17 participants. Ten were from site A (59%), with the remainder being from site B (41%) and covered a range of roles within the theatre team. Participants found the take-5 theatre brief helpful (median Likert 5) and felt that it would benefit themselves (median Likert 5) as well as the team (median Likert 5) and that it fitted into the day easily (median Likert 4). There was a high demand, no financial investment was required and overall it was easy to implement; however, it became challenged in theatre lists that were late to start. The take-5 theatre brief is an acceptable initiative for these two operating theatre teams.

Developing Bespoke High Volume Low Complexity (HVLC) Theatre Lists With a Focus on Training to Address the Impact of COVID-19: A Pilot Study.

Introduction The COVID-19 pandemic has had an unprecedented impact on both healthcare delivery and surgical training. There have been significant efforts to manage the growing elective waiting list backlog whilst addressing the training deficit. We outline a successful pilot high volume low complexity (HVLC) program held at the Croydon Elective Centre between 2021-2022 which aimed to amalgamate training and elective recovery. Methods Two pilot HVLC training lists were carried out in June 2021 and March 2022. Three parallel theatre lists on each date were supervised by a single consultant floor trainer. All lists followed a standard pre-defined HVLC protocol. Trainees and trainers were invited to participate and encouraged to utilize these lists to sign off relevant work-based assessments. HVLC cases included hernia repairs and simple lesion excisions. Patient, theatre staff, and trainee experiences were collated via questionnaires. Results A total of one consultant supervisor, six trainers, and eight trainees participated in the pilot with a total of 34 elective procedures performed on 29 patients. The mean patient age was 52.4 years with 8 out of 29 patients being female. Of these patients 41.4% were American Society of Anaesthesiologists (ASA) Classification one, 51.72% were ASA two and 6.9% were ASA three. No patients to date werereadmitted to the hospital post-operatively or presented with post-operative complications. One hundred percent of trainees felt satisfied with the training and would recommend it to a colleague. Conclusion The training deficit that developed during the first COVID-19 pandemic wave has been compounded by the second and third waves, and trainees are concerned that further waves are anticipated. Returning to operating is vital and our approach has been shown to improve training, whilst maintaining patient safety and accelerating elective waiting list recovery.