Young Surgeons Research Articles

Using preoperative Virtual Reality simulation in liver surgery can help a young trainee surgeon.

Using preoperative Virtual Reality simulation in liver surgery can help a young trainee surgeon.

The value of mentorship to the young vascular surgeon

Mentorship is a cornerstone of a successful career in medicine and surgery. From medical school through our career, the opportunity to receive feedback, guidance, and support from mentors helps to shape our decisions, both clinical and professional, plays a role in our success. As vascular surgeons pivot from trainee to practicing surgeon, the nature and structure of their mentoring relationship will likely change as well. The purpose of this article was to outline the different types of mentoring, the ways in which it can be impactful in your career, and common barriers encountered among both mentors and mentees. We review the data that support the value of mentors to young vascular surgeons and offer resources available to individuals from the trainee to midcareer levels to make for lasting and productive mentor-mentee relationships.

The introduction of surgical simulation on three-dimensional-printed models in the cardiac surgery curriculum: an experimental project.

Training in congenital cardiac surgery has become more and more difficult because of the reduced opportunities for trainees in the operating room and the high patient anatomical variability. The aim of this study was to perform a pilot evaluation of surgical simulation on a simple 3D-printed heart model in training of young surgeons and its potential inclusion in the curriculum of residency programs. A group of 11 residents performed a surgical correction of aortic coarctation using a 3D-printed surgical model. After teaching the surgical procedure, a simulation was performed twice, at different times, and was evaluated quantitatively and qualitatively by a senior surgeon. A 3D model-based training program was then developed and incorporated into our cardiac surgery training program. A significant improvement in surgical technique was observed between the first and second surgical simulations: median of 65% [interquartile range (IQR) = 61-70%] vs. 83% (IQR = 82-91%, P < 0.001). The median time required to run the simulation was significantly shorter during the second simulation: 39 min (IQR = 33-40) vs. 45 min (IQR = 37-48; P = 0.02). Regarding the simulation program, a basic and an advanced program were developed, including a total of 40 different simulated procedures divided into 12 sessions. Surgical simulation using 3D-printing technology can be an extremely valuable tool to improve surgical training in congenital heart disease. Our pilot study can represent the first step towards the creation of an integrated training system on 3D-printed models of congenital and acquired heart diseases in other Italian residency programs.

Redes sociales y cirugía

During the last years, social media use has increased in the surgical community. Social media in surgery has created new challenges such as surgical education, patient privacy, professionalism, and the difference between the private and public virtual life. Facebook, YouTube or WebSurg are some of the main social media in the surgical field. Nevertheless, Twitter is the most common and relevant media for surgeons. Some Twitter Hashtag such as #SoMe4Surgery or #colorectalsurgery went viral and had a significant influence in the surgical community. Some of the uses of social media in surgery are education of younger surgeons, surgical research, and relationship between surgeons. However, not everything in social media is positive. Some negative issues of social media use in surgery are, for example, lack of privacy, intellectual property conflicts, conflicts of interest and mistakes in the published information. In this article, the main social media, the use of these media, the advantages and the possible risks and negative issues of social media are discussed.

Effect of intraoperative hand-grip position on surgical outcome of thumb carpometacarpal arthrodesis

BackgroundA variety of surgical techniques had been developed over the past few decades for treating thumb carpometacarpal joint (CMCJ) osteoarthritis (OA). However, there are currently no accepted consensus on the ideal treatment for thumb CMCJ OA. Arthrodesis was one of the widely popular treatment methods; however, studies have showed that non-union rates were as high as 50%, with higher complications such as osteoarthritis of neighbouring joints and higher revision surgeries required as compared to other surgical methods. Patients with arthrodesis were also reported to have decreased thumb range of motion and loss of opponens function. Currently, there are numerous intraoperative positioning techniques for arthrodesis which could be confusing for young surgeons. With recent developments of fixation plates and better understanding of the wrist anatomy, this retrospective review aimed to evaluate the efficacy of our intraoperative hand-grip positioning method for arthrodesis of thumb CMCJ OA. What are the postoperative functional outcomes of (1) T-hook plates and (2) our intraoperative hand-grip positioning method for Eaton III thumb CMCJ OA arthrodesis by evaluating pain visual analogue scale (VAS) score, Disabilities of the Arm, Shoulder and Hand questionnaires (DASH), Mayo Wrist scores, capability of thumb opposition (Kapandji score), and comparing pre- and postoperative grip and pinch strength?MethodsTwenty patients with CMCJ OA underwent arthrodesis using our intraoperative hand-grip positioning method and T-hook plates and screws (Acumed, USA). Patients were evaluated preoperatively and at 1, 3, 6 and 12 months postoperatively. Radiologic assessment including fusion evaluation, evaluation of radial and palmar abduction angles was done on hand X-rays.ResultsTwenty patients with a minimum follow-up duration of 12 months were included in this study. 100% fusion rate was achieved with only 1 case of complication involving radial sensory nerve neuropathy which was resolved after removal of implant and neurolysis. Significant improvement in pain and Mayo Wrist scores were noted 3 months postoperatively, whilst DASH score exhibited significant improvements after 6 months of follow-up (p < 0.05). Even though there were no significant differences observed between preoperative and postoperative grip strength, pinch strength and Kapandji scores, positive recovery trends were noted for all parameters with these functions surpassing preoperative levels after 12 months of follow-up. Significant improvements on hand X-rays were also noted for both postoperative radial and palmar abduction angles.ConclusionsThere is currently no consensus on the ideal treatment method for thumb CMCJ OA. In this study, we would like to propose a simple intraoperative hand-grip positioning method with T-hook plates for arthrodesis. As seen from our results, our technique was able to provide satisfactory and replicable postoperative results and thus we would like to propose our hand-grip positioning method with T-hook plates fixation for subsequent treatment of patients with Eaton stage III thumb CMCJ OA.

Questionnaire survey of virtual reality experiences of digestive surgery at a rural academic institute: A pilot study for pre-surgical education.

We developed a prototype VR platform, VECTORS L&M (VLM), aiming to enhance the understanding of digestive surgery for students, interns, and young surgeons by limiting costs. Its efficacy was assessed via questionnaires before implementation in surgical education. The VLM provides nine-minute VR views of surgeries, from both 180- and 360-degree angles. It was created with L.A.B. Co., Ltd. and incorporates surgery videos from biliary malignancy patients. Following VLM development, a survey was conducted among surgeons who had experienced it. Twenty-eight participants (32% of observers) responded to the survey. A majority (81%) reported positive experiences with the VR content and showed interest in VR video production, though some reported sickness. Most respondents were experienced surgeons, and nearly all believed VR was important for medical education with a mean score of 4.14 on a scale of up to 5. VR was preferred over 3D printed models due to its application versatility. Participants expressed the desire for future VR improvements, such as increased mobility, cloud connectivity, cost reduction, and better resolution. The VLM platform, coupled with this innovative teaching approach, offers experiential learning in intraabdominal surgery, effectively enriching the knowledge of students and surgeons ahead of surgical education and training.

The new checklist to evaluate educational value of YouTube surgical videos of transurethral resection of the prostate.

Transurethral resection of the prostate (TURP) is a widespread, effective way to treat benign prostatic hyperplasia (BPH). Many medical students and junior clinicians increasingly turn to easily accessible online resources to learn this technique, such as videos on YouTube. This study assessed the educational value of YouTube videos about TURP, which are popular among many young surgeons. We searched YouTube as of August 2, 2022 for videos fulfilling the search terms "transurethral resection of the prostate", "benign prostatic hyperplasia", "BPH", "TURP", "benign prostatic enlargement", "bladder outlet obstruction" and "lower urinary tract symptom". We assessed the educational value of the identified videos using a custom-designed checklist. We identified 47 relevant videos, 20 of which were posted after July 1, 2020. The average number of views was 576,379±208,535 (range, 54-1,385,713). The average quality score of the videos was 7.38±2.53 (range, 4-12) on a 15-point scale, and 20 were judged to be of low educational quality. Quality scores correlated positively with the number of likes (R=0.596, P<0.01). The educational value of most TURP videos on YouTube appears to be low, with most lacking detailed explanations of preoperative preparations and the surgical procedure. High-quality video resources about TURP need to be developed for medical students and junior surgeons. Standard quality criteria should also be developed and disseminated to ensure the production of accurate learning resources for junior clinicians.

Enhanced Recovery after Surgery Applied to Pediatric Laparoscopic Cholecystectomy for Simple Cholelithiasis: Feasibility and Teaching Insights.

Same-day discharge after a cholecystectomy is a common practice in the adult population and has been demonstrated as safe and viable for children as well. However, there is a lack of comprehensive teaching models for pediatric cholecystectomy. Drawing inspiration from standardized outpatient procedures, this study aimed to assess the clinical outcomes and feasibility of teaching programs and an Enhanced Recovery After Surgery (ERAS) protocol following ambulatory laparoscopic cholecystectomy in pediatric patients. In 2015, an ERAS pathway for laparoscopic cholecystectomy (LC) was implemented, focusing on admission procedures, surgery timing, anesthetic choices, analgesia, postoperative feeding, mobilization, and pain assessment. Day-case surgery was not applicable for acute cholecystitis, choledochal lithiasis, sickle cell disease, and hereditary spherocytosis cases. The protocol was employed for a group of attending surgeons and fellows, as well as a group of residents under the supervision of experienced surgeons. A retrospective analysis was conducted to evaluate the feasibility and effectiveness of ambulatory cholecystectomy in children and its utilization in training pediatric surgical trainees. Between 2015 and 2020, a total of 33 patients were included from a cohort of 162 children who underwent LC, with 15 children operated on by senior surgeons and 18 by young surgeons. The primary diagnoses were symptomatic gallbladder lithiasis (n = 32) and biliary dyskinesia (n = 1). The median age at the time of surgery was 11.3 years (interquartile range (IQR) 4.9-18), and the median duration of surgery was 54 min (IQR 13-145). One intraoperative complication occurred, involving gallbladder rupture and the dissemination of lithiasis into the peritoneal cavity. Three patients (9%) required an overnight stay, while no postoperative complications or readmissions within 30 days were observed. ERAS was successfully implemented in 30 patients (91%). No significant differences in surgical outcomes were noted between senior and young surgeons. At an average follow-up of 55 months, no long-term sequelae were identified. These findings align with the current trend of increasing use of outpatient laparoscopic cholecystectomy and underscore its feasibility in the pediatric population. The application of a structured ERAS protocol appears viable and practical for training the next generation of pediatric surgeons. Level III.

Comparison of Open Lichtenstein Repair and Laparoscopic Transabdominal Preperitoneal of Inguinal Hernia: A Pragmatic RCT in Bangladesh

Background: Laparoscopic inguinal hernia repair has emerged as an effective alternative to open Lichtenstein mesh repair for inguinal hernias. Objective: The purpose of the present study was to compare the surgical outcomes of laparoscopic trans-abdominal pre-peritoneal (TAPP) and open Lichtenstein mesh repair for the treatment of inguinal hernia. Methodology: This single centered, pragmatic randomized controlled trial was conducted in the Department of Surgery at 300 bed hospital, Narayanganj, Bangladesh from January 2018 to June 2020 for a period of two and half year. Patients who were presented with reducible, primary/recurrent, complete/incomplete inguinal hernias among male and female in more than or equal to 18 years of age were selected as study population. Lichtenstein mesh repair was performed which was compared with the laparoscopy group. Open Lichtenstein repair was done under spinal anesthesia with lightweight poly propylene mesh. Laparoscopy was performed by trans-abdominal pre-peritoneal (TAPP) technique under general anesthesia and heavy weight mesh was used. The hospital stay, operating time, post-operative complications like superficial wound infection, seroma formation, scrotal swelling as well as early recurrence and chronic groin pain were compared among these group. Results: A total number of 90 patients presented with inguinal hernia were recruited for this study of which TAPP was performed in 25 cases and 65 cases were undergone Lichtenstein repair. The mean age of laparoscopy and open group of patients were 49.28±9.9 years and 55.05±14.4 years respectively (p-0.03). The mean operation time was 85±10.31 minutes and 52.1±15.36 minutes in laparoscopy and open group respectively (p-0.000). The mean post-operative hospital stay was 2.9±0.78 days and 2.9±0.71 days in laparoscopy and open group respectively (p-0.94). In this study 21 (23.3%) patients developed 25 different early and late post-operative complications, out of which 15 (23.1%) in open group and 06 (23.3%) in laparoscopy group (p-0.52). One early recurrence was reported after 6 months follow up in laparoscopy group. Chronic groin pain was reported in 7 cases of which 5 (7.7%) cases in open group and only 2 (8.0%) cases in laparoscopy group (p-0.002). Conclusion: In conclusion the surgical outcomes of laparoscopic TAPP performed by a young surgeon in Bangladesh has given a clinically better result than open Lichtenstein repair considering hospital stay, seroma formation, wound infection, scrotal swelling and chronic groin pain. Journal of Current and Advance Medical Research, January 2023;10(1):35-40

Social media and surgery

During the last years, social media use has increased in the surgical community. Social Media in surgery has created new challenges such as surgical education, patient privacy, professionalism, and the difference between the private and public virtual life. Facebook, YouTube or WebSurg are some of the main social media in the surgical field. Nevertheless, Twitter is the most common and relevant Media for surgeons. Some Twitter Hashtag such as #SoMe4Surgery or #colorectalsurgery went viral and had a significant influence in the surgical community. Some of the uses of social media in surgery are education of younger surgeons, surgical research, and relationship between surgeons. However, not everything in social media is positive. Some negative issues of social media use in surgery are, for example, lack of privacy, intellectual property conflicts, conflicts of interest and mistakes in the published information. In this article, the main social media, the use of these media, the advantages and the possible risks and negative issues of social media are discussed.

Tele-proctoring for minimally invasive surgery across Japan: Aninitial step toward a new approach to improving the disparity of surgical care and supporting surgical education.

The aim of this study was to verify the clinical feasibility of tele-proctoring using our ultra-low latency communication system with shared internet access. Connections between two multiple remote locations at various distances were established through the TELEPRO® tele-proctoring system. The server records the latency between the two locations for tele-proctoring using the annotations. Questionnaires were administered to the surgeons, assistants, and medical staff. Respondents rated the quickness and quality of communication in terms of latency and disturbances in the audio, video, and usefulness of the live telestrations with annotation. Seven hospitals tele-proctored with Sapporo Medical University between January 2021 and September 2022. The median latency of annotation between the two locations ranged from 24.5 to 48.5 ms. No major technological problems occurred, such as streaming interruption, loss of video or audio, poor resolution. The video encoding time was 10 ms, and its decoding time was 0.8 ms. The total latency positively correlated with the distance between two locations (R = 0.55, p < 0.01). The quality of communication regarding latency, disturbance, and surgical education with intraoperative annotative instructions showed similar trends, with perfectly fine being the most common response. No significant differences in surgical quality, educational effect, or social impact were observed between the latency ≥30 and <30 ms groups for whether the size of latency affects surgical education. The feasibility of the tele-proctoring system is expected to be a sustainable approach to help education for young surgeons and surgical supports in rural areas, thereby reducing disparities in health care.

Construction and Exploration of Simulative Virtual Curriculum of Laparoscopy for Standardized Surgical Residency Training

Laparoscopic operations have become an indispensable therapeutic measure in surgical treatment due to the emerging trends of minimal invasiveness and precision in the field of surgery. Laparoscopic skills have gradually become part of the essential skills for young surgeons and hospitals at all levels are giving high priority to laparoscopic skills training. The innovation and development of simulative and virtual medical technology has given rise to effective ways and platforms for the training of laparoscopy surgeons in China. Based on the laparoscopy simulative virtual technology, our hospital gradually developed a systematic training and evaluation system for the laparoscopy training of surgical residents by offering theory courses on laparoscopy, conducting simulative and virtual systematic training, and developing assessment criteria for the training. Herein, we presented and shared our experience in applying laparoscopy simulative virtual technology in the training of surgical residents in order to promote the standardized residency training of laparoscopic skills in China and to provide reference for the implementation of standardized training of laparoscopic skills.

Finding Your First Job: Are Orthopedists in Training and Hiring Medical Practices on the Same Page?

A study of orthopedic surgeons in training and hiring practices that is designed to investigate the priorities of applicants and employers in the hiring process. Introduction: This study was designed to determine important factors to hiring practices when evaluating the application of a potential hire and compare them with the factors emphasized by candidates as most important to them in a job. Methods: This survey was designed to compare the priorities of hiring practices to job applicants with regards to several categories including: how applicants and jobs are identified, what factors might be important to a practice when evaluating job applicants and what factors might be important to a job applicant when applying. Hiring practices were further asked to elaborate on previous unsuccessful hires and the reasons for failure. Results: Hiring practices and applicants agree that personal or professional referrals are the most important resource for finding a job, but disagree in the utility of recruiters and social media. Hiring practices and potential applicants agree that the need for a particular subspecialty and recommendations are the most important factors for a practice to consider when choosing a new hire. Applicants tend to place a higher value on commitment to a region, personal connections and fellowship prestige, while practices are more interested in recommendations from residency directors, prior employers, operative ability and community involvement. Applicants and hiring practices both understand that the ability to practice within one’s subspecialty, salary potential and a candidate’s preference for location are critical. Hiring practices underestimate the importance of a starting salary and signing bonus to an applicant and overestimate the importance of practice reputation and the availability of ancillary services. Discussion/Conclusion: There are significant misunderstandings between young surgeons applying for their first job and hiring practices. To be successful young physicians should strive to understand the motivations of hiring groups. Similarly, orthopedic practices can save themselves significant time and money by understanding the motivations of surgeons entering the work force.

How Does Social Media Correlate With Clinical Appointments: A Quantitative Analysis.

Social media has become an important part of plastic surgeons' practices. Is it true that the more followers, the more efficient it is to the plastic surgeon's branding? This study is to verify the quantitative correlation between social media and clinical appointments and to optimize its utilization. One hundred and five plastic surgeons were divided into 3 groups according to titles. WEIBO served as a targeted platform and descriptive data, including numbers of followers and clinic appointments were collected for analysis. The promotive effect was quantified as and correlation analysis was conducted to quantify the relationship between followers and outpatient appointments. From this research, it was found that 62% of participants were social media users, while 38% were not. No statistical significance was found between them by comparing the number of clinic appointments. For surgeons with social media, a positive correlation was proven between followers and clinic appointments, whose Pearson's correlation was 0.266 (attending: 0.557, associate consultant: 0.315, consultant: 0.060). Meanwhile, the conversion rates in this study were 22.49±44.67% (attending), 13.10±24.57% (associate consultant), and 18.88±36.05% (consultant). Outpatient consultations of senior surgeons without social media (2652±14492) were significantly higher than young surgeons with social media (1800±1718, P <0.05). The regression equation was Clinical Appointments=ln (Followers)×316.906-992.588 ( R2 =0.270, P =0.023). In conclusion, this study proved that social media positively influenced clinic appointments but the traditional personal brandings like reputations, academic pedigree, and word of mouth still played an indispensable role in career development. Young surgeons benefited most from social media. The promotive effect of social media would reach its saturation when the followers were up to ∼50,000.

A Simplified Three-Layered Suturing Training Pad for Undergraduate Medical Students: A Technical Note.

Surgical training is a long process that requires a lot of commitment and effort. Basic surgical techniques are the foundation of every procedure, with suturing being one of them. Hence, it is of great importance for aspiring young surgeons to practice and develop their suturing skills. Quite many kinds of suturing training models have been used and proposed worldwide, ranging from commercial silicone pads to meat leftovers and various fruits. We have developed our own, simplified, and low-cost suturing training pad that consists of three layers and is based on the combined use of silicone sponge sheet and polyurethane foam. It is quite durable and elastic and has been applied in three suturing training workshops so far. For this reason, we would like to present our experience of a low-cost but effective way of promoting and achieving further surgical excellence.

Barriers to Academic Surgery in the US Armed Forces: A Study of the AAS Military Committee

IntroductionThe purpose of this study is to explore current perceptions within the military surgery community to stratify key obstacles to pursuing a career in academic surgery and identify opportunities for mitigation. MethodsAfter receiving institutional review board approval, an anonymous electronic survey was distributed to military surgeons across all branches. Survey response data were collected and analyzed using chi-square test. ResultsThe response rate was approximately 22%. Of those who responded to the survey, most are interested in an academic career (61.5%); however, 64% believe this to be much more difficult as a military surgeon than as a civilian surgeon. The top three perceived obstacles include administrative obstacles (76.4%), operational commitments (65.8%), and lack of funding for academic pursuits (62.7%). Most respondents indicated that they have never received formal education regarding how to apply for research funding (84.5%) and most do not have a research mentor (60.9%). Additionally, 42.9% state that obstacles to an academic career in surgery impact their decision to leave the military. Younger surgeons were more likely to leave the military upon completion of their service commitment (67.9% versus 46.4% aged 20-39 y, P = 0.02). ConclusionsWe characterized the perceived challenges to academic surgery within the military. These barriers between academic surgery and military service risk medical force attrition, particularly in future generations of surgeons. Dedicated faculty billets (positions) with limited operational demands as well as associated mentorship and research funding may enhance the retention and productivity of military surgeons.

First 100 total hip arthroplasties performed by a young surgeon using the direct anterior approach: learning curve and complications.

Most of the reported discussions about the learning curve for the direct anterior approach (DAA) in total hip arthroplasty (THA) have been by experienced surgeons. The study's aim was to describe the learning curve, short-term outcomes, complications, and adaptations to the DAA used in the first 100 THA cases experienced by a young surgeon who had received DAA training for trauma surgeries. This retrospective study summarizes the first 100 consecutive cases experienced by a young surgeon who performed the unilateral DAA for THA between 2019 and 2021. Cumulative sum (CUSUM) analysis was performed to evaluate the learning curve on the basis of operative time and overall complications. The demographics data, short-term outcomes, and complications of the first 50 and second 50 cases were compared. The CUSUM curve declined after 49 and 55 cases, measured by operative time and overall complications, respectively. The median operative time (104 vs. 80min) and intraoperative fluoroscopic time (38 vs. 12s) increased significantly in the first 50 cases compared with the times in the second 50 cases. Complications tended to occur in the first 50 cases (12% vs. 6%), and the overall rate was 9%. Major complications all occurred in the first 50 cases, with a rate of 4%. Only one case, which involved a complicated periprosthetic fracture around the stem that extended to the tip, required the intervention of a senior surgeon. Even after receiving training on the DAA for trauma surgeries, the young surgeon experienced a steep learning curve and more complications in the first 50 cases. The DAA for THA is a technically demanding procedure and may require guidance from an experienced surgeon to manage unexpected complications.

Step by Step of a Creative Template for Rhinoplasty Training in Chicken Breast

Introduction: Rhinoplasty is a challenging surgery and provides balance, harmony, and symmetry to the face, so it should always be following the exact measurements and plan. Variations in techniques, measurements, and photographic studies have represented the surgeon's work tripod to optimize the aesthetic and functional results of nasal surgery. Furthermore, the creative template for rhinoplasty training will provide the young surgeons improve their practice and develop manual skills. Objectives: To demonstrate the rhinoplasty surgical sequence in a cadaveric animal (chicken) with an objective, systematic, and reproducible way for training the young surgeons. To establish grafts measurements in a clear, readable, and effective way. Casuistic and Method: This research is a prospective study for training the rhinoplasty technique in a cadaveric animal (chicken). The systematization of the surgical sequence in the animal model manufacture grafts for rhinoplasty in an objective way to simulate the nose. The breasts of cadaveric chickens coated with leather were selected and treated in the laboratory in São Paulo, Brazil. The models were photographed and filmed to record the stages of the grafts creation, such as spreader graft, columellar strut graft, shield graft, onlay graft, septal extension graft, alar batten graft, lateral strut graft, alar rim graft, free diced cartilage, combined graft, cap graft, and pump graft. The surgical materials are the same used in rhinoplasty, only in a small amount. Result: Surgical simulation model chicken sternal cartilage provides enough cartilage to practice rhinoplasty sculpting without involving live humans or human cadavers. The cartilage is abundant and properly to simulate the nose. The creative template is a clear, legible, and effective training of rhinoplasty grafts in an animal model. Conclusion: This article provides possibilities for training, creating grafts, and developing rhinoplasty techniques with the chicken breast cartilage. The creative template application shows an objective, clear, and systematic manner of learning without fear the beauty of the rhinoplasty art. This study is specially designed for young surgeons with a very low cost, artistry, and a reproducible way. No competing financial interests exist. No funding was received for this article. Runtime of video: 6 mins 44 secs

"Role-sharing surgery": a new surgical education system that gives beginner surgeons more chances to operate while ensuring the surgical quality of robotic surgery.

It has been pointed out that robotic surgery is more time-consuming than laparoscopic surgery, and a major challenge for the future is educating young surgeons while maintaining the surgical quality. To solve these problems, we report a role-sharing surgery (RSS) approach in which the surgery is divided into several areas and timetabled, with roles shared by several operators. We performed RSS for 19 standard colorectal cancer surgeries. The surgery was completed within + 28min of the scheduled operation time, and a beginner robotic surgeon (BRS) was able to perform approximately 66% of the total surgery. There were no statistically significant differences in the short-term outcomes between the RSS and conventional surgery groups. Based on these findings, RSS has the potential to be the best practice for educating BRSs in robotic surgery, the use of which is expected to increase steadily in the future.

How does the surgical society (DGAV) support the continuing medical training in general and visceral surgery?

The medical councils (Ärztekammern) develop the contents of the further training regulations with the support of the specialist society. The hospitals with the training supervisors have to implement these contents for the trainees in continuing education and confirm the acquisition of competence for the individual tasks. Surveys of young surgeons in recent years have shown that many participants do not receive structured continuing education, so that there is general dissatisfaction. Therefore, the German Society for General and Visceral Surgery (DGAV) is required to provide assistance to its members to improve continuing education in the departments. For example, the DGAV organizes more than 100 surgical courses annually on all topics of visceral surgery, anatomy, skills courses and revision courses with the Further Education and Advanced Training Quality Center (WeiFoQ). This year acontinuing education curriculum was developed over the 6‑year continuing education period, so that a structured continuing education is achievable. The contents of the continuing education regulations are included in this continuing education curriculum with explanations, video clips, and graphics, thus providing quick information on each individual surgical clinical picture. Adigital surgical catalog provides aquick overview of the status of personal continuing education. It is planned to set up an interface to the eLogbook of the medical councils.