Volume Setting Research Articles

Achievement of international benchmark outcomes for robotic pancreaticoduodenectomy in a low volume country

BackgroundRecently, there has been an increase in the utilisation of the robotic platform to perform minimally invasive pancreaticoduodenectomy in high volume centres, with the goal of reducing morbidity and improving patient outcomes. This study reports the successful implementation of a robotic pancreaticoduodenectomy (RPD) programme in the relatively low volume setting of Australia, measured against established, internationally accepted benchmarks for low-risk open pancreaticoduodenectomy (OPD). MethodsRetrospective review of a prospectively maintained database for consecutive RPD at two Brisbane hospitals was performed, comparing data to internationally established benchmarks for low-risk OPD. A structured RPD programme was implemented by two surgeons across a study period spanning May 2017 to December 2023. ResultsOver the study period, seventy-two consecutive RPDs were performed, with 79 % for malignancy. Perioperative outcomes for transfusions, conversion rate, postoperative fistula rate, morbidity, mortality and oncological outcomes were all within established benchmark cutoffs for low-risk open pancreaticoduodenectomy (OPD), although operative time exceeded the benchmark value by 0.7hrs. ConclusionA carefully implemented RPD programme in the low volume Australian setting is feasible, with high quality outcomes achievable when compared to established benchmarks for low-risk OPD and to reported RPD series published by high volume pioneering centres.

Anastomotic bleeding from invaginated pancreaticogastrostomy following pancreatoduodenectomy: incidence, risk factors, treatment and prevention.

Meta-analysis of 10 randomized prospective trials demonstrated a higher risk of postoperative bleeding from pancreaticogastrostomy (PG) compared with pancreatojejunostomy following pancreatoduodenectomy (PD). This study evaluated the incidence, risk factors, and treatment of anastomotic bleeding from invaginated PG. We retrospectively evaluated all consecutive PDs performed between April 1, 2011 and December 31, 2022 using invaginated PG by the double purse-string technique. Multivariate analysis identified risk factors for anastomotic PG bleeding. During the study, 695 consecutive patients with a median age of 66 years underwent PD; the majority was performed for ductal pancreatic adenocarcinomas. Simultaneous vascular resections were performed in 328 patients. Postoperative mortality was 4.1%. Bleeding from PG occurred in 33(4.6%) patients at a median interval of 5 days (range, 1-14) from surgery, leading to reoperation in 21(63%). PG bleeding-related mortality was 9.0%. Multivariate analyses identified a soft pancreatic texture and Wirsung duct > 3 or ≤ 3mm (Class C and D, respectively, of the ISGPS) (odds ratio [OR]: 2.17, 95% confidence interval [95% CI]: 1.38-3.44; P = 0.0009) and wrapping of the invaginated pancreas (OR: 0.37, 95% CI: 0.17-0.84; P = 0.01) as independent risk factors for PG bleeding. In a large volume setting, anastomotic bleeding from invaginated PG occurred in ~ 5% of patients and was associated with soft pancreatic parenchyma and small wirsung duct. The reduced rate of PG bleeding observed with wrapping of the invaginated pancreatic stump warrants further evaluation in a prospective randomized study.

Impact of surgeon variability on outcomes after total shoulder arthroplasty: an analysis of 2188 surgeons

BackgroundThere has been limited evaluation of surgeon-specific factors on outcomes after total shoulder arthroplasty (TSA). The goals of this study were (1) to determine the impact of surgeon procedural volume, career duration, practice type, and fellowship training on TSA outcomes at 2-year follow-up and (2) to evaluate the relative importance of surgeon variables in relation to patient variables in influencing outcomes. MethodsThe PearlDiver Mariner database was queried to identify all surgeons who performed a minimum of 11 TSA procedures from 2010 to 2018. An Internet search of publicly available data was performed to determine the career duration, practice type, and fellowship training of each surgeon. Multivariate logistic regression models were built to determine the relationship between surgeon-specific variables and 2-year surgical complications and revisions and 90-day readmissions. Variable importance of patient-specific and surgeon-specific factors was determined by the Akaike information criterion increase of these models. ResultsA total of 2188 surgeons who performed 93,122 TSA procedures were identified in this database. Higher reverse TSA surgical volume was associated with fewer surgical complications and revisions, although such a relationship was not observed for anatomic TSA. Revision after anatomic TSA was more common among surgeons who were in their first 5 years of practice. There was a higher risk of surgical complication and readmission among academic surgeons, but this did not equate with a higher risk of revision. The impact of these surgeon-specific factors on outcomes was small in relation to patient-level variables, such as age, sex, and number of medical comorbidities. ConclusionSurgeon procedural volume, career duration, and practice setting influence the surgical complication, revision, and readmission rates after TSA. The impact of surgeon factors was small relative to patient variables, highlighting the importance of patient selection in mitigating adverse outcomes.

Evaluation of Noise Exposure Levels in Pediatric ENT Operating Rooms.

Operating room (OR) sounds may surpass noise exposure thresholds and induce hearing loss. Noise intensity emitted by various surgical instruments during common pediatric otolaryngologic procedures were compared at the ear-level of the surgeon and patient to evaluate the need for quality improvement measures. Cross-sectional study. Single tertiary care center. Noise levels were measured using the RISEPRO Sound Level Meter and SoundMeter X 10.0.4 at the ear level of surgeon and patient every 5minutes. Operative procedure and instrument type were recorded. Measured noise levels were compared against ambient noise levels and the Apple Watch Noise application. Two hundred forty-two total occasions of noise were recorded across 62 surgical cases. Cochlear implantation surgery produces the loudest case at the ear-level of the patient (91.8Lq Peak dB; P < .001). The otologic drill was the loudest instrument for the patient (92.1Lq Peak dB; P < .001), while the powered microdebrider was the loudest instrument for the surgeon (90.7Lq Peak dB; P = .036). Noise measurements between surgeon and patient were similar (P < .05). Overall agreement between the Noise application and Sound Level Meter was excellent (intraclass correlation coefficient of 0.8, with a 95% confidence interval ranging from 0.32 to 0.92). Otolaryngology OR noises can surpass normal safe thresholds. Failure to be aware of this may unwittingly expose providers to noise-related hearing loss. Mitigation strategies should be employed. Quality improvement measures, including attention to surgical instrument volume settings and periodic decibel measurements with sound applications, can promote long-term hearing conservation. Otolaryngology OR noises can surpass normal safe thresholds. Failure to be aware of this may unwittingly expose providers to noise-related hearing loss. The duration, frequency of exposure, and volume levels of noise should be studied further. Mitigation strategies should be employed. Quality improvement measures, including attention to surgical instrument volume settings and periodic decibel measurements with sound applications, can promote long-term hearing conservation.

The development of patient-specific quality assurance (PSQA) for a proton wobbling nozzle using PTSim Monte Carlo code

The aim of this study is to develop a Monte Carlo-based platform for patient-specific quality assurance (PSQA) in the proton wobbling nozzle at Chang Gung Memorial Hospital. To efficiently reduce time usage and enhance simulated precision, this platform required an initial fine-tuning of the Guard volume (GV) and lateral displacement (LD) settings. Different GV sizes combined with LD modes were utilized to estimate depth dose profiles in a water phantom. The simulated central axis depth doses were then analyzed using PTSim and compared to measurement using a PTW MP3 water tank and a Markus ionization chamber type 34045. Treatment parameters for a liver case were extracted from the Eclipse DICOM RT Plan file. Simulated doses were compared to measurements using Zebra and MatriXX systems during PSQA process. Furthermore, a geometrical trigger technique was applied to assess the track positions in patient-specific components. The study found that the mean dose difference between measured and simulated values for the optimized LD/GV was below 1% at all depth positions. With passing rates of 97.4% at the middle SOBP and 90.3% at the proximal SOBP, the gamma analysis demonstrated satisfactory results. For the axial dose profile, SOBP flatness was within 2.5%. From the geometric trigger analysis, more than 95–98% of the dose was delivered through the range compensator, while approximately 2–5% originated from scattered protons from the Multi-Leaf Collimator (MLC) and block's edges. The PTSim simulation's performance in conducting PSQA demonstrated its capability and reliability.

Reconstructive Head and Neck Microsurgery in a High-Volume Cancer Center—Long-Term Impact of an Early Experience

Objectives The aim of this study was to evaluate a 16-year-long outcome of an evolving practical approach to reconstructive microsurgery in a high volume, resource-constrained, head and neck cancer care setting. Patients and Methods Seventy-three consecutive cases of free flap reconstruction done by the Head and Neck Surgical Oncology team of Regional Cancer Centre, Thiruvananthapuram, from October 2004 to May 2020 were prospectively studied for flap viability, cosmesis, morbidity, and oncologic safety. The cases were selected based on their “emphatic” superiority to the conventional alternative as determined by two or more surgeons of the head and neck team or the recommendations of the head and neck tumor board. Results With the long-term results, this article discusses and validates our strategy for controlled patient recruitment for reconstructive microsurgery to ensure the best resource utilization in a tertiary cancer care center. Conclusions Adequate training and optimal application are the key factors determining success in microvascular reconstructive surgery in resource-constrained, high-volume cancer care facilities.

Volume and Practice-Setting Shift of Laryngology Procedures During the COVID-19 Pandemic: A Reg-ENT Database Analysis.

The onset of the coronavirus disease 2019 (COVID-19) pandemic changed practice patterns throughout medicine. The purpose of this study is to evaluate changes in the volume and location setting of laryngology procedures after the onset of COVID-19. Retrospective database cohort study. Reg-ENT registry. Retrospective review from 2017 to 2022 of patients who underwent a laryngology procedure identified by procedure code categorized by site of service code-"ambulatory surgical" versus "office" setting. Based on March 2020 as the cutoff point, the procedures were designated as pre-COVID versus COVID time period. A total of 5989 patients underwent laryngology procedures. Forty-two percent more procedures were performed in the COVID period (n = 3780) versus pre-COVID (n = 2209). Pre-COVID, the procedure distribution between office and ambulatory surgical setting was 70% (n = 1546) compared with 30% (663). This shifted to 77% (n = 2920) and 23% (n = 860) during COVID, P = .9. The most common diagnoses associated with laryngology procedures during the study period were vocal fold paralysis 47% (n = 2831), dysphonia 33% (n = 1392), and laryngotracheal stenosis 14% (n = 838). These trends remained in both pre-COVID and COVID time periods. After the start of the pandemic, among patients undergoing laryngology procedures, there was a 93% increase (n = 284-549) in the diagnosis of laryngotracheal stenosis, 70% increase (n = 520-882 patients) in dysphonia and 69% increase (n = 1054-1777) in vocal fold paralysis. An increase in laryngology procedures performed after the onset of the COVID-19 pandemic was identified with an overall procedural shift to the office-setting.

Application Design for the Deaf Users of Trans Jogja Based on Android

Abstract This study proposes the design and development of an Android application tailored specifically for the deaf users of the Trans Jogja public transportation system. With the aim of enhancing accessibility and usability for this marginalized user group, the application integrates features that cater to their unique communication needs and challenges. Purpose: Universitas Nahdlatul Ulama Yogyakarta has a Disability Services Unit or ULD called GESI. This unit accommodates the accessibility needs of deaf students. Deaf students usually use Trans Jogja as a means of transportation to campus. An obstacle that students often face is missing the location of their destination bus stop. This happens because students are too busy playing with their cell phones, causing a loss of focus. Therefore, tools are needed as a reminder of the location of the destination bus stop. This research aims to design a tool application for deaf students using Android-based Trans Jogja public transportation. Methods/Study design/approach: This research methods uses a prototype which includes communication, quick plan and design modeling, construction of prototype, and development delivery feedback. Result/Findings: The results of this research are in the form of a prototype that has several features, namely searching for starting and destination stops, text to voice, word dictionary, volume settings, and distance settings. Novelty/Originality/Value: The design of an application to assist deaf people in using Trans Jogja based on Android is used for students with hearing impairments, especially for Trans Jogja public transportation.

Comparison of “Van Herick’s” method versus “Borrone’s” method for estimating narrow angles

Background: Strategies for indirectly assessing the iridocorneal angle aim to be reproducible, reliable, and comparable to gonioscopy for screening in cases of narrow angles and their clinical spectrum. Objectives: The objective of this study is to determine which of the indirect estimation methods of the iridocorneal angle, either the "Van Herick" method or the "Borrone" method, exhibits a higher correlation with gonioscopy in detecting narrow iridocorneal angles in patients at the Ophthalmology outpatient clinic of the Hospital San Borja Arriarán. Materials and methods: A cross-sectional study was conducted with a sample of 32 patients (64 eyes) who met the inclusion and exclusion criteria. Results were obtained through gonioscopy, identifying narrow angles in 16 eyes and open angles in 48 eyes. Sensitivity and specificity of both methods (Borrone and Van Herick) were calculated in comparison to gonioscopy, using a selected cutoff point. Results: The Borrone method showed a sensitivity of 96% and a specificity of 91%, with a 95% confidence interval, compared to gonioscopy. In contrast, the Van Herick method demonstrated a sensitivity of 77% and a specificity of 82% in relation to gonioscopy. Discussion: The high sensitivity and specificity of the “Borrone” method are attributed to its technical details and its dichotomous nature, making it easier for the operator to determine and interpret. This reduces variability and provides a high correlation with gonioscopy. Conclusions: In this study, the “Borrone” method was found to have a more significant correlation with gonioscopy compared to the “Van Herick” method. Therefore, the “Borrone” method is considered more reliable and reproducible for detecting possible narrow iridocorneal angles, especially in high patient volume settings, such as ophthalmology outpatient clinics.

A Spectral/hp-Based Stabilized Solver with Emphasis on the Euler Equations

The solution of compressible flow equations is of interest with many aerospace engineering applications. Past literature has focused primarily on the solution of Computational Fluid Dynamics (CFD) problems with low-order finite element and finite volume methods. High-order methods are more the norm nowadays, in both a finite element and a finite volume setting. In this paper, inviscid compressible flow of an ideal gas is solved with high-order spectral/hp stabilized formulations using uniform high-order spectral element methods. The Euler equations are solved with high-order spectral element methods. Traditional definitions of stabilization parameters used in conjunction with traditional low-order bilinear Lagrange-based polynomials provide diffused results when applied to the high-order context. Thus, a revision of the definitions of the stabilization parameters was needed in a high-order spectral/hp framework. We introduce revised stabilization parameters, τsupg, with low-order finite element solutions. We also reexamine two standard definitions of the shock-capturing parameter, δ: the first is described with entropy variables, and the other is the YZβ parameter. We focus on applications with the above introduced stabilization parameters and analyze an array of problems in the high-speed flow regime. We demonstrate spectral convergence for the Kovasznay flow problem in both L1 and L2 norms. We numerically validate the revised definitions of the stabilization parameter with Sod’s shock and the oblique shock problems and compare the solutions with the exact solutions available in the literature. The high-order formulation is further extended to solve shock reflection and two-dimensional explosion problems. Following, we solve flow past a two-dimensional step at a Mach number of 3.0 and numerically validate the shock standoff distance with results obtained from NASA Overflow 2.2 code. Compressible flow computations with high-order spectral methods are found to perform satisfactorily for this supersonic inflow problem configuration. We extend the formulation to solve the implosion problem. Furthermore, we test the stabilization parameters on a complex flow configuration of AS-202 capsule analyzing the flight envelope. The proposed stabilization parameters have shown robustness, providing excellent results for both simple and complex geometries.

Hemorrhage from invaginated pancreaticogastrostomy following pancreaticoduodenectomy in a large volume setting: incidence, risk factors and outcomes

Hemorrhage from invaginated pancreaticogastrostomy following pancreaticoduodenectomy in a large volume setting: incidence, risk factors and outcomes

Risky listening behaviour to music via headphones and its determinants – 7.5 years OHRKAN cohort study

Objective To examine risky leisure noise exposure from listening to music via headphones and to identify potential determinants with special focus on portable listening devices (PLDs) among adolescents over a period of 7.5-years. Design Data were collected by questionnaires at four equidistant time points (O1-O4). Music exposure via headphones was calculated based on self-reported volume setting and listening duration. Exceeding 85 dB(A) equivalent for a 40-hour working week was defined as risky noise exposure. Determinants of risky headphone and PLD exposure were investigated using generalised estimating equations and accounting for missing data by multiple imputation. Study sample Closed cohort of 2148 students attending 9th grade of any secondary school type in Regensburg (Germany), during 2009 to 2011. Results Risky noise exposure from headphone usage was almost twice as high in wave O1 and O2 (at age 15 or 18) compared with 20–23-year-olds in O3 and O4. Risky exposure to headphones and PLDs were associated with younger age, low and medium education, single-parent household and smoking, whereas good self-rated hearing showed a protective effect. Additionally, not being born in Germany was associated with risky PLD exposure. Conclusion Before harmful behaviours become entrenched, starting preventive efforts at a young age is essential.

Laser powder bed fusion (LPBF) of commercially pure titanium and alloy development for the LPBF process.

Laser powder bed fusion (LPBF) of titanium or titanium alloys allows fabrication of geometrically more complex and, possibly, individualized implants or osteosynthesis products and could thus improve the outcome of medical treatments considerably. However, insufficient LPBF process parameters can result in substantial porosity, decreasing mechanical properties and requiring post-treatment. Furthermore, texturized parts with anisotropic properties are usually obtained after LPBF processing, limiting their usage in medical applications. The present study addresses both: first, a design of experiments is used in order to establish a set of optimized process parameters and a process window for LPBF printing of small commercially pure (CP) titanium parts with minimized volume porosity. Afterward, the first results on the development of a biocompatible titanium alloy designed for LPBF processing of medical implants with improved solidification and more isotropic properties are presented on the basis of conventionally melted alloys. This development was performed on the basis of Ti-0.44O-0.5Fe-0.08C-0.4Si-0.1Au, a near-α alloy presented by the authors for medical applications and conventional manufacturing, with yttrium and boron additions as additional growth restriction solutes. In terms of LPBF processing of CP titanium grade 1 powder, a high relative density of approximately 99.9% was obtained in the as-printed state of the volume of a small cubical sample by using optimized laser power, scanning speed, and hatch distance in combination with a rotating scanning pattern. Moreover, tensile specimens processed with these volume settings and tested in the as-printed milled state exhibited a high average yield and ultimate tensile strength of approximately 663 and 747N/mm2, respectively, combined with a high average ductility of approximately 24%. X-ray diffraction results suggest anisotropic mechanical properties, which are, however, less pronounced in terms of the tested specimens. Regarding alloy development, the results show that yttrium additions lead to a considerable microstructure refinement but have to be limited due to the occurrence of a large amount of precipitations and a supposed higher propensity for the formation of long columnar prior β-grains. However, phase/texture and microstructure analyses indicate that Ti-0.44O-0.5Fe-0.08C-0.4Si-0.1Au-0.1B-0.1Y is a promising candidate to achieve lower anisotropy during LPBF processing, but further investigations on LPBF printing and Y2O3 formation are necessary.

Microvascular surgery training in a low volume setting: a single healthcare center experience

Microvascular surgery training in a low volume setting: a single healthcare center experience

ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies.

The aim of these guidelines is to update the 2017 clinical practice guideline (CPG) of the European Society of Intensive Care Medicine (ESICM). The scope of this CPG is limited to adult patients and to non-pharmacological respiratory support strategies across different aspects of acute respiratory distress syndrome (ARDS), including ARDS due to coronavirus disease 2019 (COVID-19). These guidelines were formulated by an international panel of clinical experts, one methodologist and patients' representatives on behalf of the ESICM. The review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and grade recommendations and the quality of reporting of each study based on the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) network guidelines. The CPG addressed 21 questions and formulates 21 recommendations on the following domains: (1) definition; (2) phenotyping, and respiratory support strategies including (3) high-flow nasal cannula oxygen (HFNO); (4) non-invasive ventilation (NIV); (5) tidal volume setting; (6) positive end-expiratory pressure (PEEP) and recruitment maneuvers (RM); (7) prone positioning; (8) neuromuscular blockade, and (9) extracorporeal life support (ECLS). In addition, the CPG includes expert opinion on clinical practice and identifies the areas of future research.

Laboratory-Developed Tests Account for a Small Minority of Tests Ordered in an Academic Hospital System.

To determine the frequency of use of laboratory-developed tests (LDTs) in an academic medical center system. Retrospective analysis of 2021 test order data from an academic medical center (hospital, outpatient clinics, and cancer center) was done. Measures included assay type, assay methodology, regulatory status, test order volume, inpatient vs outpatient setting, and provider medical specialty. Of the 3,016,928 tests ordered in 2021, 2,831,489 (93.9%) were tests cleared, approved, and/or authorized by the US Food and Drug Administration (FDA); 116,583 (3.9%) were LDTs; and 68,856 (2.3%) were standard methods. These test orders were performed using a total of 1,954 distinct assays. Of these, 983 (50.3%) were FDA assays, 880 (45.0%) were LDTs, and 91 (4.7%) were standard methods. Laboratory-developed tests were more commonly ordered in the outpatient vs inpatient setting and represented a higher proportion of the test volume at the cancer center compared with the university hospital (5.6% vs 3.6%, respectively). The top 167 LDT assays accounted for 90% of the LDT volume (104,996 orders). Among the 20 most frequently ordered LDTs were mass spectrometry assays and tests used in the care of immunocompromised patients. Internal/family medicine placed the greatest number of orders (1,044,642) and ordered one of the lowest proportions of LDTs (3.2%). Laboratory-developed tests made up a small percentage of the total laboratory tests ordered within the academic health system studied.

Validity of Variable Message Sign Information: Is It Influenced by Drivers’ Short-Term Memory?

Variable message signs (VMSs), as a key component of intelligent transportation systems, have been frequently used in the management of urban roads to provide drivers with real-time traffic information. Nevertheless, a lack of unified regulations for VMS design, makes it difficult to accurately determine the validity of VMS information. In practice, inappropriately designed VMSs (e.g., VMSs overloaded with information and long setting distances) are common. In this study, laboratory simulation trials were conducted to assess VMS information validity in relation to the short-term memory (STM) capacity of drivers. Specifically, drivers capacity to easily obtain and respond correctly to valid VMS information based on memorized target information. Sixty participants completed the trials and pre-/postquestionnaires. Subjective evaluation, dynamic information acquisition rate, accuracy, and memory reliability were analyzed to evaluate their relationship with VMS information validity. The results confirmed that STM considering the information demand rate significantly affected the validity of the VMS information. Information validity deteriorated as the information volume and VMS setting distance increased. Reasonable validity was found when memory reliability ranged between 0.85 and 1.5 and the information volume was no more than 90 bits, corresponding to a subjective evaluation of 1, an accuracy of at least 80%, and a suggested STM time of 43.46 s. These criteria would satisfy driver information demand and prevent information redundancy or wasting of resources. These findings provide a basis for determining the thresholds for VMS information to promote practical and user-friendly VMS designs on urban roads.

MICROWAVE-ASSISTED EXTRACTION OF PECTIN FROM BABY JAVA ORANGE (Citrus sinensis) PEEL AND ITS CHARACTERISATION

Baby java orange (Citrus sinensis) is the main ingredient for various products. Pectin as a baby java orange peel substance is extracted using various methods. Microwave-assisted extraction is a method that uses heat energy dissipated by the volume setting from the transmitting medium. The objective of the study was to evaluate the effect of orange peel powder: acid solution ratio (1:10, 1:15, 1:20 b/v) and extraction time (5, 10, 20 min) on characteristics of extracted pectin by using MAE (Microwave-Assisted Extraction) at 2.450 MHz. The best result was a 15-minute extraction time and 1:15 as the material: acid solution ratio. The treatment resulted in a 51.3% yield, 10.8% water content, 5% ash content, 775.41 equivalent weight, and 6.49 methoxyl content. The intense FTIR spectrum in the ―CO―CH3 and ―COOH groups showed the same result as the standardised pectin.

Learning to switch gears - Steering palliative care into emergency medicine.

Emergency care is largely seen as synonymous with resuscitation and saving lives. In most of the developing world where Emergency Medicine (EM) is still evolving, the concept of EM palliative care is alien. Provision of palliative care in such settings poses its own challenges in terms of knowledge gaps, socio-cultural barriers, dismal doctor-to-patient ratio with limited time for communication with patients, and lack of established pathways to provide EM palliative care. Integrating the concept of palliative medicine is crucial for expanding the dimension of holistic, value-based, quality emergency care. However, glitches in decision-making processes, especially in high patient volume settings, may lead to inequalities in care provision, based on socio-financial disparities of patients or premature termination of challenging resuscitations. Pertinent, robust, validated screening tools and guides may assist physicians in tackling this ethical dilemma.

Energy Device Preferences Among Gynecologic Surgeons.

Multiple vessel-sealing devices are available for use during laparoscopy. The objective of this study is to determine what surgeon-level and device characteristics influence the choice of advanced energy device during gynecologic laparoscopy. This is a national cross-sectional study of gynecologic surgeons conducted via social media, utilizing an online, publicly-available, anonymous survey. Gynecologic surgeons who had completed residency training were approached for participation in the survey. Survey completion was voluntary and involved no further follow-ups. The web-based survey consisted of six questions with the option to answer three additional questions if time permitted. The institutional review board determined that this study qualified for exemption. There were 92 respondents who participated in the survey. Of these, 81 completed the survey and were included in the analysis. Female respondents were younger and more frequently reported a glove size of 6.5 or less. Surgeon-level characteristics, including gender, age, glove size, case volume, region, and practice setting, were not significantly associated with preferred energy devices. Device availability in the operating room was the only characteristic associated with preferred energy devices (P-value = .0076). Other device-level characteristics such as optimal thermal spread, reduced plume, ease of use, device reliability, and teachability had no statistically significant association with preferred energy devices. Multiple advanced energy devices are available for use during gynecologic laparoscopy. These devices have varying energy profiles, thermal spread, and device size. Despite this diversity, only device availability in the operating room influenced the surgeon's preferred device selection.