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Zheng YM, Luo ZY, Li ZY, Liu JJ, Ren ZX, Wang JJ, Yu PW, Shi Y, Zhao YL, Qian F. Comparison of totally robotic and totally laparoscopic gastrectomy for gastric cancer: a propensity score matching analysis. Surg Endosc 2024:10.1007/s00464-024-10924-6. [PMID: 38902410 DOI: 10.1007/s00464-024-10924-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/04/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND With the improvements in laparoscopic or robotic surgical techniques and instruments, a growing number of surgeons have attempted to complete all digestive tract reconstruction intracorporeally; these procedures include totally robotic gastrectomy (TRG) and totally laparoscopic gastrectomy (TLG). This study aimed to evaluate the safety and feasibility of the TRG and compare the short-term outcomes of the TRG and TLG in patients with gastric cancer. METHODS Between January 2018 and June 2023, 346 consecutive patients who underwent TRG or TLG at a high-volume academic gastric cancer specialty center were included. 1:1 propensity score matching (PSM) was performed to reduce confounding bias. The surgical outcomes, postoperative morbidity, and surgical burden were compared in PSM cohort. RESULTS After PSM, a well-balanced cohort of 194 patients (97 in each group) was included in the analysis. The total operation time of the TRG group was significantly longer than that of the TLG group (244.9 vs. 213.0 min, P < 0.001). There was no significant difference in the effective operation time between the 2 groups (217.8 vs. 207.2 min, P = 0.059). The digestive tract reconstruction time of the TRG group was significantly shorter than that of the TLG group (39.4 vs. 46.7 min, P < 0.001). The mean blood loss in the TRG group was less than that in the TLG group (101.1 vs. 126.8 mL, P = 0.014). The TRG group had more retrieved lymph nodes in the suprapancreatic area than that in the TLG group (16.6 vs 14.2, P = 0.002). The TRG group had a lower surgery task load index (38.9 vs. 43.1, P < 0.001) than the TLG group. No significant difference was found in terms of postoperative morbidity between the 2 groups (14.4% vs. 16.5%, P = 0.691). CONCLUSION This study demonstrated that TRG is a safe and feasible procedure, and is preferable to TLG in terms of invasion and ergonomics. The TRG may maximize the superiority of robotic surgical systems and embodies the theory of minimally invasive surgery.
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Affiliation(s)
- Yi-Ming Zheng
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Zi-Yan Luo
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Zheng-Yan Li
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China.
| | - Jia-Jia Liu
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Zhi-Xiang Ren
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Jun-Jie Wang
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Pei-Wu Yu
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Yan Shi
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Yong-Liang Zhao
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China
| | - Feng Qian
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Army Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China.
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Panwar KS, Huish EG, Law JL, Deans JT, Staples JR, Eisemon EO, Lum ZC. Revision Total Joint Arthroplasty Places a Disproportionate Burden on Surgeons: A Comparison Using the National Aeronautics and Space Administration Task Load Index (NASA TLX). J Arthroplasty 2024; 39:1550-1556. [PMID: 38218555 DOI: 10.1016/j.arth.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Perceived surgeon workload of performing primary and revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) is challenging to quantify. The National Aeronautics and Space Administration Task Load Index (NASA TLX) survey was developed to quantify experiences following aviation and has been applied to healthcare fields. Our purposes were to 1) quantify the workload endured by surgeons who are performing primary and revision TKA and THA and 2) compare these values to their Center for Medicare & Medicaid Services (CMS) reimbursement. METHODS A prospective cohort of 5 fellowship-trained adult reconstruction surgeons completed NASA TLX surveys following primary and revision TKA/THA cases. A total of 122 surveys consisting of 70 TKA (48 primaries and 22 revisions) and 55 THA surveys (38 primaries and 17 revisions) were completed. Patient demographics and surgical variables were recorded. Final NASA TLX workloads were compared to 2021 CMS work relative value units. RESULTS Compared to primary TKA, revision TKA had 176% increased intraoperative workload (P < .001), 233% increased mental burden (P < .001), and 150% increased physical burden (P < .001). Compared to primary THA, revision THA had 106% increased intraoperative workload (P < .001), 96% increased mental burden (P < .001), and 91% increased physical burden (P < .001). Operative time was higher in revision versus primary TKA (118 versus 84.5 minutes, P = .05) and THA (150 versus 115 minutes, P = .001). Based upon 2021 CMS data, revision TKA and THA would need to be compensated by an additional 36% and 12.3%, respectively, to parallel intraoperative efforts. CONCLUSIONS Revision hip and knee arthroplasty places a major mental and physical workload upon surgeons and is disproportionately compensated by CMS.
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Affiliation(s)
- Kunal S Panwar
- Department of Orthopedic Surgery, San Joaquin General Hospital, Stockton, California
| | - Eric G Huish
- Department of Orthopedic Surgery, San Joaquin General Hospital, Stockton, California
| | - Jesua L Law
- Department of Orthopedic Surgery, Doctors Medical Center, Modesto, California
| | - Justin T Deans
- Department of Orthopedic Surgery, Doctors Medical Center, Modesto, California
| | - Jonathon R Staples
- Department of Orthopedic Surgery, Memorial Medical Center, Modesto, California
| | - Eric O Eisemon
- Department of Orthopedic Surgery, Kaiser Permanente, Oakland, California
| | - Zachary C Lum
- Department of Orthopaedic Surgery, UC Davis Medical Center, University of California, Sacramento, California
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Wang Y, Ai Q, Zhao W, Gao Y, Liu Q, Shi T, Du S, Wang B, Fu W, Yuan Q, Jiang B, Ma X, Li H, Zhang X. Safety and Reliability of a Robot-assisted Laparoscopic Telesurgery System: Expanding Indications in Urological Surgery. Eur Urol 2024; 85:506-507. [PMID: 37977963 DOI: 10.1016/j.eururo.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Ye Wang
- Department of Urology, Third Center of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qing Ai
- Department of Urology, Third Center of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Wuyi Zhao
- Shenzhen Edge Medical Company, Shenzhen, China
| | - Yu Gao
- Department of Urology, Third Center of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qiming Liu
- Department of Urology, Hainan Hospital of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Taoping Shi
- Department of Urology, Hainan Hospital of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Songliang Du
- Department of Urology, Third Center of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Baojun Wang
- Department of Urology, Third Center of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Weijun Fu
- Department of Urology, Third Center of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qing Yuan
- Department of Urology, Third Center of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Bin Jiang
- Department of Urology, Third Center of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xin Ma
- Department of Urology, Third Center of the Chinese People's Liberation Army General Hospital, Beijing, China.
| | - Hongzhao Li
- Department of Urology, Third Center of the Chinese People's Liberation Army General Hospital, Beijing, China.
| | - Xu Zhang
- Department of Urology, Third Center of the Chinese People's Liberation Army General Hospital, Beijing, China.
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Ferrari D, Violante T, Novelli M, Starlinger PP, Smoot RL, Reisenauer JS, Larson DW. The death of laparoscopy. Surg Endosc 2024; 38:2677-2688. [PMID: 38519609 DOI: 10.1007/s00464-024-10774-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/24/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The introduction of laparoscopy in 1989 revolutionized surgical practices, reducing post-operative complications, and enhancing outcomes. Despite its benefits, limitations in laparoscopic tools have led to continued use of open surgery. Robotic-assisted surgery emerged to address these limitations, but its adoption trends and potential impact on open and laparoscopic surgery require analysis. METHODS A retrospective analysis used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases from 2012 to 2021. The study encompassed various abdominal procedures, employing Vector Autoregressive (VAR) models to analyze the dynamic relationships between surgical techniques. The models predicted future trends in open, laparoscopic, and robotic surgery until Q2 of 2025. RESULTS The analysis included 360,171 patients across diverse procedures. In urology, robotic surgery dominated prostatectomies (83.1% in 2021) and nephrectomies (55.1% in 2021), while the open approach remained the predominant surgical technique for cystectomies (72.5% in 2021). In general surgery, robotic colectomies were forecasted to surpass laparoscopy, becoming the primary approach by 2024 (45.7% in 2025). Proctectomies also showed a shift towards robotic surgery, predicted to surpass laparoscopy and open surgery by 2025 (32.3%). Pancreatectomies witnessed a steady growth in robotic surgery, surpassing laparoscopy in 2021, with forecasts indicating further increase. While hepatectomies remained predominantly open (70.0% in 2025), esophagectomies saw a rise in robotic surgery, predicted to become the primary approach by 2025 (52.3%). CONCLUSIONS The study suggests a transformative shift towards robotic-assisted surgery, poised to dominate various minimally invasive procedures. The forecasts indicate that robotic surgery may surpass laparoscopy and open surgery in colectomies, proctectomies, pancreatectomies, and esophagectomies by 2025. This anticipated change emphasizes the need for proactive adjustments in surgical training programs to align with evolving surgical practices. The findings have substantial implications for future healthcare practices, necessitating a balance between traditional laparoscopy and the burgeoning role of robotic-assisted surgery.
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Affiliation(s)
- Davide Ferrari
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
- General Surgery Residency Program, University of Milan, Milan, Italy
| | - Tommaso Violante
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
- School of General Surgery, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marco Novelli
- Department of Statistics, University of Bologna, Bologna, Italy
| | - Patrick P Starlinger
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rory L Smoot
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Janani S Reisenauer
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - David W Larson
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA.
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Harada S, Abe T, Furumido J, Takahashi K, Hori K, Abe N, Kon M, Murai S, Miyata H, Kikuchi H, Matsumoto R, Osawa T, Shinohara N. A prospective study of surgeons' workloads and associated factors in real-world practice. Sci Rep 2024; 14:9741. [PMID: 38679610 PMCID: PMC11056359 DOI: 10.1038/s41598-024-59596-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024] Open
Abstract
New technologies such as laparoscopic and robotic surgery are spreading, and there is a demand for physicians to keep up with novel methods. In contrast to the recent focus on healthcare professional burnout, the mental and physical costs during surgery are not well-understood. We aimed to quantify surgeons' workloads in daily urological surgical practice and clarify potential background factors associated with such workloads. Urologists in Hokkaido, Japan, were invited to this study. Between December 2020 and December 2021, participants repeatedly reported workloads, which were assessed using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX), after each surgery in conjunction with participants' names, patients' backgrounds, their roles (independent operator, operator under supervision, instructor, and 1st or 2nd assistant), and surgical outcomes, via SurveyMonkey®. Because of the heterogeneity among individuals, a linear mixed-effects model was utilized to analyze factors associated with NASA-TLX, calculating the parameter estimates (PE) of regression coefficients for each factor and their 95% confidence interval (CI). Sixty-five urologists (5 women) joined the study, and 2169 data were collected within 7 days after surgeries. A linear mixed-effects model revealed that female surgeons (PE + 15.56, 95% CI 2.36-28.77), urgent/emergency surgery (PE + 6.65, 95% CI 4.59-8.70), intraoperative complications (PE + 9.26, 95% CI 6.76-11.76), and near-miss incidents (PE + 3.81, 95% CI 2.27-5.36) were associated with higher workloads. Regarding the surgeons' role, operator under supervision (PE + 12.46, 95% CI 9.86-15.06) showed the highest workloads. Surgeons' workloads decreased as the number of previous cases of the same procedure increased. Surgeons' workloads were associated with various factors. Given that the highest workloads were for operators under supervision, instructors should be aware of trainees' high workloads and devise appropriate instructional interventions.
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Affiliation(s)
- Shigeru Harada
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
| | - Jun Furumido
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
- Department of Urology, Asahikawa Kousei Hospital, Asahikawa, Japan
| | - Keita Takahashi
- Department of Biostatistics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kanta Hori
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Noriyuki Abe
- Department of Urology, Asahikawa Medical University, Asahikawa, Japan
| | - Masafumi Kon
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Haruka Miyata
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
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Totonchilar S, Aarabi A, Eftekhari N, Mohammadi M. Examining workload variations among different surgical team roles, specialties, and techniques: a multicenter cross-sectional descriptive study. Perioper Med (Lond) 2024; 13:1. [PMID: 38167373 PMCID: PMC10763043 DOI: 10.1186/s13741-023-00356-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND A high workload may negatively impact the surgical team's performance and jeopardize patient safety. The aim of this study was to measure the workload of the surgical team across different surgical roles, specialties, and techniques in several hospitals. METHODS This cross-sectional multicenter study was performed in the operating rooms of eight teaching hospitals affiliated with Isfahan University of Medical Sciences, Iran. At the conclusion of each surgical procedure, all members of the surgical team completed the Surgery Task Load Index (SURG-TLX) questionnaire to assess workload levels. Descriptive statistics, analysis of variance (ANOVA), and Pearson correlations, were performed to compare surgical roles, specialties, techniques, and surgical time on workload overall and by subscale. RESULTS A total of 409 workload questionnaires were obtained from 76 surgical teams or cases, involving 346 surgical team members. The total workload among all participants was 32.41 ± 17.21. Surgical complexity, physical demands, and mental demands were the highest workload subscales and distraction was the lowest workload subscale. Cardiovascular specialty had a higher workload compared to other specialties. Open techniques resulted in a higher workload compared to minimally invasive techniques. Surgical technologists who act in both the role of circulating and scrub nurse (C&Ss) experienced the highest workload, followed by surgical residents and surgeons. CONCLUSIONS The results of the study showed that the workload for some members of the surgical team is disproportionately high and is influenced by factors such as specialty, technique, role, and surgical duration. By knowing the distribution of workload among the members of the surgical team, efforts can be made to optimize the team members' workload.
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Affiliation(s)
| | - Akram Aarabi
- Ardabil University of Medical Science, Ardabil, Iran.
- Isfahan University of Medical Sciences, Isfahan, Iran.
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Reder SR, Rohou A, Keric N, Beiser KU, Othman AE, Abello Mercado MA, Altmann S, Petrowski K, Brockmann MA, Brockmann C. Gender differences in self-assessed performance and stress level during training of basic interventional radiology maneuvers. Eur Radiol 2024; 34:308-317. [PMID: 37552256 PMCID: PMC10791781 DOI: 10.1007/s00330-023-09993-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/12/2023] [Accepted: 06/06/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES Gender differences have been reported to influence medical training. We investigated gender differences encountered during training in interventional radiology maneuvers. METHODS Catheter handling was analyzed under standardized conditions in 64 participants naïve to endovascular procedures (26 women, 38 men). Objective (e.g., catheter pathway, catheter movements, required time) and subjective parameters (stress level) were recorded. The NASA-Task Load Index (NASA-TLX; 1-20 points) was used to assess participants' stress levels and perceived workload. RESULTS In the easier tasks, no significant differences between male and female participants regarding catheter handling were observed. In the most complex task, female participants took themselves more time (688 ± 363 vs. 501 ± 230 s; p = 0.02), asked for help more frequently (n = 19 vs. n = 8) and earlier than men (203 ± 94 vs. 305 ± 142 s; p = 0.049), whereas men stood out by more agitated catheter handling (6.0 ± 1.8 vs. 4.8 ± 1.6 movements/s; p = 0.005). Overall, female participants perceived tasks to be more difficult (11.5 ± 4.2 vs. 9.6 ± 3.3; p = 0.016), perceived higher stress levels (8.9 ± 4.9 vs. 6.3 ± 4.4; p = 0.037), and rated their own performance lower (9.12 ± 3.3 vs. 11.3 ± 3.3; p = 0.009). However, female participants were able to correlate self-assessed with objective parameters correctly (r between -0.555 and -0.469; p = 0.004-0.018), whereas male participants failed to correctly rate their performance (p between 0.34 and 0.73). Stress levels correlated with objective parameters in males (r between 0.4 and 0.587; p < 0.005), but not in female participants. CONCLUSION Perceived stress levels, self-evaluation skills, and catheter handling differ greatly between untrained male and female participants trying to solve interventional radiological tasks. These gender-specific differences should be considered in interventional radiology training. CLINICAL RELEVANCE STATEMENT As psychological aspects may influence individual working strategies gender-specific differences in self-perception while learning interventional radiology maneuvers could be essential regarding success in teaching and treatment outcomes. KEY POINTS • After performing standardized training, 38 male and 26 female volunteers showed significant differences regarding objective and self-assessed performance, as well as in perceived workload while performing simulated endovascular catheter maneuvers. • After solving simulated endovascular radiological tasks, female participants were able to self-assess their objective performance much more accurately than male participants. • Women took more time to solve simulated endovascular tasks and asked earlier and more frequently for help than men.
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Affiliation(s)
- Sebastian R Reder
- Department of Neuroradiology, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Annaig Rohou
- Faculty of Psychology, University of Graz, Graz, Austria
| | - Naureen Keric
- Department of Neurosurgery, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Katja U Beiser
- Department of Neuroradiology, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Ahmed E Othman
- Department of Neuroradiology, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Mario Alberto Abello Mercado
- Department of Neuroradiology, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Sebastian Altmann
- Department of Neuroradiology, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Katja Petrowski
- Department of Medical Psychology and Medical Sociology, University Medical Centre of the Johannes Gutenberg-University, Duesbergweg 6, Mainz, 55128, Germany
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Carolin Brockmann
- Department of Neuroradiology, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, Mainz, 55131, Germany.
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Miura R, Okuya K, Akizuki E, Miyo M, Noda A, Ishii M, Ichihara M, Korai T, Toyota M, Ito T, Ogawa T, Kimura A, Takemasa I. World-first report of low anterior resection for rectal cancer with the hinotori™ Surgical Robot System: a case report. Surg Case Rep 2023; 9:156. [PMID: 37668746 PMCID: PMC10480373 DOI: 10.1186/s40792-023-01705-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/21/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND The hinotori™ Surgical Robot System was approved for use in colorectal cancer surgery in Japan in 2022. This robot has advantages, such as an operation arm with eight axes, an adjustable arm base, and a flexible three-dimensional viewer, and is expected to be utilized in rectal cancer surgery. Herein, we report the world's first surgery for rectal cancer using the hinotori™ Surgical Robot System. CASE PRESENTATION A 71-year-old woman presented to our hospital with bloody stools. A colonoscopy revealed type 2 advanced cancer in the rectum, and a histological examination exposed a well-differentiated adenocarcinoma. Abdominal enhanced computed tomography divulged rectal wall thickening without significant swelling of the lymph nodes or distant metastasis. Pelvic magnetic resonance imaging showed tumor invasion beyond the intrinsic rectal muscle layer. The patient was diagnosed with cStage IIa (cT3N0M0) rectal cancer and underwent low anterior resection using the hinotori™ Surgical Robot System. Based on an adequate simulation, surgery was safely performed with appropriate port placement and arm base-angle adjustment. The operating time was 262 min, with a cockpit time of 134 min. Subsequently, the patient was discharged 10 days postoperatively without complications. The pathological diagnosis was pStage IIA (cT3N0M0) and the circumferential resection margin was 6 mm. CONCLUSIONS We report the first case of low anterior resection for rectal cancer using the hinotori™ Surgical Robot System, in which a safe and appropriate oncological surgery was performed.
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Affiliation(s)
- Ryo Miura
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543 Japan
| | - Koichi Okuya
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543 Japan
| | - Emi Akizuki
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543 Japan
| | - Masaaki Miyo
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543 Japan
| | - Ai Noda
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543 Japan
| | - Masayuki Ishii
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543 Japan
| | - Momoko Ichihara
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543 Japan
| | - Takahiro Korai
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543 Japan
| | - Maho Toyota
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543 Japan
| | - Tatsuya Ito
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543 Japan
| | - Tadashi Ogawa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543 Japan
| | - Akina Kimura
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543 Japan
| | - Ichiro Takemasa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543 Japan
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9
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Zamudio J, Woodward J, Kanji FF, Anger JT, Catchpole K, Cohen TN. Demands of surgical teams in robotic-assisted surgery: An assessment of intraoperative workload within different surgical specialties. Am J Surg 2023; 226:365-370. [PMID: 37330385 PMCID: PMC11234353 DOI: 10.1016/j.amjsurg.2023.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Current approaches to assessing workload in robotic-assisted surgery (RAS) focus on surgeons and lack real-world data. Understanding how workload varies by role and specialty aids in identifying effective ways to optimize workload. METHODS SURG-TLX surveys with six domains of workload were administered to surgical staff at three sites. Staff reported workload perceptions for each domain on a 20-point Likert scale, and aggregate scores were determined per participant. RESULTS 188 questionnaires were obtained across 90 RAS procedures. Significantly higher aggregate scores were reported for gynecology (Mdn = 30.00) (p = 0.034) and urology (Mdn = 36.50) (p = 0.006) than for general (Mdn = 25.00). Surgeons reported significantly higher scores for task complexity (Mdn = 8.00) than both technicians (Mdn = 5.00) (p = 0.007), and nurses (Mdn = 5.00). CONCLUSIONS Staff reported significantly higher workload during urology and gynecology procedures, and experienced significant differences in domain workload by role and specialty, elucidating the need for tailored workload interventions.
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Affiliation(s)
- Jennifer Zamudio
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
| | - Jeffrey Woodward
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Falisha F Kanji
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
| | - Jennifer T Anger
- Department of Urology, University of California San Diego, La Jolla, CA, 92037, USA.
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Tara N Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
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10
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Choi SH, Kuchta K, Rojas A, Mehdi SA, Ramirez Barriga M, Hays S, Talamonti MS, Hogg ME. Residents perform better technically, have less stress and workload, and prefer robotic to laparoscopic technique during inanimate simulation. Surg Endosc 2023; 37:7230-7237. [PMID: 37395804 DOI: 10.1007/s00464-023-10216-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/11/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION With the widespread adoption of minimally invasive surgery, there is a growing need for surgical residents to be trained by a procedure-specific curriculum. This study aimed to evaluate the technical performance and feedback of surgical residents undergoing the robotic and laparoscopic hepaticojejunostomy (HJ) and gastrojejunostomy (GJ) biotissue modules. METHODS A total of 23 PGY-3 surgical residents participated in this study and performed the laparoscopic and robotic HJ and GJ drills, which were recorded and scored by two independent graders using the modified objective structured assessment of technical skills (OSATS). After completing each drill, all participants filled out the NASA Task Load Index (NASA-TLX), Borg Exertion Scale, and Edwards Arousal Rating Questionnaire. RESULTS Twenty-two (95.7%) residents had already received fundamentals of laparoscopic surgery certification. Eighteen (78.3%) residents had robotic virtual simulation training and the median (range) number of robotic surgery console experience was 4 (0-30). In the HJ comparison of the six OSATS domains, the robotic system was superior in Gentleness (p = 0.031). In the GJ comparison, the robotic system was superior in Time and Motion (p < 0.001), Instrument Handling (p = 0.001), Flow of Operation (p = 0.002), Tissue Exposure (p = 0.013), and Summary (p < 0.001). Participants answered significantly higher demand scores for laparoscopy on all six facets of NASA-TLX for both HJ and GJ (p < 0.05). The Borg Level of Exertion was > 2 points higher for laparoscopic HJ and GJ (p < 0.001). Residents rated more Nervousness and Anxiety for laparoscopic compared to robotic (p < 0.05) HJ and GJ. Additionally, when asked to score preference for robotic and laparoscopic approach in terms of technique and ergonomics, residents scored robot as better (laparoscopy worse) for both HJ and GJ in both domains. CONCLUSIONS The robotic surgical system provided a more favorable environment for trainees with less mental and physical burden for minimally invasive HJ and GJ curriculum.
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Affiliation(s)
- Sung Hoon Choi
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Walgreens Building - Floor 2, 2650 Ridge Road, Evanston, IL, 60201, USA
- Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Kristine Kuchta
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Walgreens Building - Floor 2, 2650 Ridge Road, Evanston, IL, 60201, USA
| | - Aram Rojas
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Walgreens Building - Floor 2, 2650 Ridge Road, Evanston, IL, 60201, USA
| | - Syed Abbas Mehdi
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Walgreens Building - Floor 2, 2650 Ridge Road, Evanston, IL, 60201, USA
| | | | - Sarah Hays
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Mark S Talamonti
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Walgreens Building - Floor 2, 2650 Ridge Road, Evanston, IL, 60201, USA
| | - Melissa E Hogg
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Walgreens Building - Floor 2, 2650 Ridge Road, Evanston, IL, 60201, USA.
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11
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Chauhan R, Ingersol C, Wooden WA, Gordillo GM, Stefanidis D, Hassanein AH, Lester ME. Fundamentals of Microsurgery: A Novel Simulation Curriculum Based on Validated Laparoscopic Education Approaches. J Reconstr Microsurg 2023; 39:517-525. [PMID: 36564048 DOI: 10.1055/a-2003-7425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Microsurgical techniques have a steep learning curve. We adapted validated surgical approaches to develop a novel, competency-based microsurgical simulation curriculum called Fundamentals of Microsurgery (FMS). The purpose of this study is to present our experience with FMS and quantify the effect of the curriculum on resident performance in the operating room. METHODS Trainees underwent the FMS curriculum requiring task progression: (1) rubber band transfer, (2) coupler tine grasping, (3) glove laceration repair, (4) synthetic vessel anastomosis, and (5) vessel anastomosis in a deep cavity. Resident anastomoses were also evaluated in the operative room with the Stanford Microsurgery and Resident Training (SMaRT) tool to evaluate technical performance. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) and Short-Form Spielberger State-Trait Anxiety Inventory (STAI-6) quantified learner anxiety and workload. RESULTS A total of 62 anastomoses were performed by residents in the operating room during patient care. Higher FMS task completion showed an increased mean SMaRT score (p = 0.05), and a lower mean STAI-6 score (performance anxiety) (p = 0.03). Regression analysis demonstrated residents with higher SMaRT score had lower NASA-TLX score (mental workload) (p < 0.01) and STAI-6 scores (p < 0.01). CONCLUSION A novel microsurgical simulation program FMS was implemented. We found progression of trainees through the program translated to better technique (higher SMaRT scores) in the operating room and lower performance anxiety on STAI-6 surveys. This suggests that the FMS curriculum improves proficiency in basic microsurgical skills, reduces trainee mental workload, anxiety, and improves intraoperative clinical proficiency.
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Affiliation(s)
- Ruvi Chauhan
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Christopher Ingersol
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - William A Wooden
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Gayle M Gordillo
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Dimitrios Stefanidis
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Aladdin H Hassanein
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mary E Lester
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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12
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Hosoya K, Maeda Y, Komachi T, Sato K, Okubo K. AQUACEL® Ag Advantage reduces the stress of postoperative packing removal after endoscopic sinus surgery. Braz J Otorhinolaryngol 2023; 89:101292. [PMID: 37579570 PMCID: PMC10448402 DOI: 10.1016/j.bjorl.2023.101292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 06/30/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVE After Endoscopic Sinus Surgery (ESS), packing plays an important role in wound healing and hemostasis. However, the effect of the packing removal procedure on physician stress has not been evaluated. The purpose of this study was to evaluate physician stress during packing removal for patients treated with AQUACEL® Ag Advantage versus KALTOSTAT®. METHODS This retrospective study included 15 patients who underwent packing with ESS for chronic rhinosinusitis performed at two centers; 9 were treated with AQUACEL® Ag Advantage and 6 were treated with KALTOSTAT®. Physician stress during packing removal was evaluated with the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). The time required to remove the packing and the number of instruments used in the procedure were recorded. Postoperative bleeding (Boezaart bleeding score) and wound healing were graded. Patient symptoms on the day after surgery and pain during packing removal were assessed using a visual analog scale. RESULTS Computed tomography scores, asthma complications, and blood eosinophil counts were significantly higher in the AQUACEL® Ag Advantage group. Patient symptoms on the day after surgery were not significantly different between the two groups. Physician stress during the task of packing removal was significantly lower in the AQUACEL® Ag Advantage group than in the KALTOSTAT® group (35.5 vs. 81.0, p=0.016) according to the NASA-TLX scores. The number of instruments used in the procedure was significantly lower in the AQUACEL® Ag Advantage group than in the KALTOSTAT® group (3.0 vs. 6.0, p=0.015). There were no significant differences in procedure time for packing removal, postoperative bleeding, wound healing, or patient pain at the time of packing removal between the groups. CONCLUSION Physicians feel stressed about packing removal. In addition, AQUACEL® Ag Advantage is useful for packing after ESS, requiring fewer instruments for the procedure than KALTOSTAT® and reducing physician stress about the procedure. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Kei Hosoya
- Musashi Kosugi Hospital, Nippon Medical School, Department of Otolaryngology, Nakahara-Ku, Kawasaki, Japan; Tama Nagayama Hospital, Nippon Medical School, Department of Otolaryngology, Tama, Tokyo, Japan
| | - Yohei Maeda
- Japan Community Health Care Organization Osaka Hospital, Department of Otorhinolaryngology, Fukushima, Osaka, Japan; Osaka University, Department of Otorhinolaryngology-Head and Neck Surgery, Suita, Japan.
| | - Taro Komachi
- Chiba Hokusoh Hospital, Nippon Medical School, Department of Otolaryngology, Inzai, Japan
| | - Kazuki Sato
- Tama Nagayama Hospital, Nippon Medical School, Department of Otolaryngology, Tama, Tokyo, Japan
| | - Kimihiro Okubo
- Nippon Medical School Hospital, Department of Otolaryngology, Head and Neck Surgery, Bunkyo-Ku, Tokyo, Japan
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13
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Obatake M, Hotchi M, Ishimura N, Kanzaki M, Yoshikawa M, Tokuda K, Watanabe M, Kotegawa H, Yoshiyama H, Ohtani H, Harada M. Propensity score-matched analysis of the short-term outcomes of robotic versus laparoscopic surgery for rectal cancer. Asian J Endosc Surg 2023. [PMID: 37076427 DOI: 10.1111/ases.13192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/05/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE The advantages of robot-assisted rectal surgery (RARS) over conventional laparoscope-assisted rectal surgery (LARS) remain controversial. This study was performed to compare the short-term outcomes of RARS and LARS. METHODS We retrospectively analyzed data of 207 patients who had undergone either RARS (n = 97) or LARS (n = 110) for rectal cancer (RC) from 2018 to 2020. A 1:1 matched propensity score-matched analysis was performed and the surgical outcomes of the two groups compared. RESULTS After matching, a well-balanced cohort of 136 patients was analyzed (n = 68 in each group), and there was no significant difference in the median operative time. The RARS group had less intraoperative blood loss than the LARS group. There were no significant differences in length of postoperative hospital stay or complication rate between the two groups. In the subgroup of lower RC, defined as the inferior edge of the tumor being within the rectum distal to the peritoneal reflection, the rate of sphincter preservation was higher in the RARS group (81.8% vs. 44.4%, p = 0.021). CONCLUSION This study shows that RARS is a safe and feasible approach for RC compared with LARS, RARS having the advantage of more often preserving the sphincter.
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Affiliation(s)
- Masayoshi Obatake
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Masanori Hotchi
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Naho Ishimura
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Masayuki Kanzaki
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Masato Yoshikawa
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Kazunori Tokuda
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Miya Watanabe
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Hiroshi Kotegawa
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Hirotsugu Yoshiyama
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Hiromi Ohtani
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Masamitsu Harada
- Division of Digestive Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
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14
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We Asked the Experts: Surgical Approach to Low Rectal Cancer-Where Innovation Happens. World J Surg 2023; 47:1071-1072. [PMID: 36310324 DOI: 10.1007/s00268-022-06823-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 10/31/2022]
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15
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Leitao MM, Kreaden US, Laudone V, Park BJ, Pappou EP, Davis JW, Rice DC, Chang GJ, Rossi EC, Hebert AE, Slee A, Gonen M. The RECOURSE Study: Long-term Oncologic Outcomes Associated With Robotically Assisted Minimally Invasive Procedures for Endometrial, Cervical, Colorectal, Lung, or Prostate Cancer: A Systematic Review and Meta-analysis. Ann Surg 2023; 277:387-396. [PMID: 36073772 PMCID: PMC9905254 DOI: 10.1097/sla.0000000000005698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess long-term outcomes with robotic versus laparoscopic/thoracoscopic and open surgery for colorectal, urologic, endometrial, cervical, and thoracic cancers. BACKGROUND Minimally invasive surgery provides perioperative benefits and similar oncological outcomes compared with open surgery. Recent robotic surgery data have questioned long-term benefits. METHODS A systematic review and meta-analysis of cancer outcomes based on surgical approach was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines using Pubmed, Scopus, and Embase. Hazard ratios for recurrence, disease-free survival (DFS), and overall survival (OS) were extracted/estimated using a hierarchical decision tree and pooled in RevMan 5.4 using inverse-variance fixed-effect (heterogeneity nonsignificant) or random effect models. RESULTS Of 31,204 references, 199 were included (7 randomized, 23 database, 15 prospective, 154 retrospective studies)-157,876 robotic, 68,007 laparoscopic/thoracoscopic, and 234,649 open cases. Cervical cancer: OS and DFS were similar between robotic and laparoscopic [1.01 (0.56, 1.80), P =0.98] or open [1.18 (0.99, 1.41), P =0.06] surgery; 2 papers reported less recurrence with open surgery [2.30 (1.32, 4.01), P =0.003]. Endometrial cancer: the only significant result favored robotic over open surgery [OS; 0.77 (0.71, 0.83), P <0.001]. Lobectomy: DFS favored robotic over thoracoscopic surgery [0.74 (0.59, 0.93), P =0.009]; OS favored robotic over open surgery [0.93 (0.87, 1.00), P =0.04]. Prostatectomy: recurrence was less with robotic versus laparoscopic surgery [0.77 (0.68, 0.87), P <0.0001]; OS favored robotic over open surgery [0.78 (0.72, 0.85), P <0.0001]. Low-anterior resection: OS significantly favored robotic over laparoscopic [0.76 (0.63, 0.91), P =0.004] and open surgery [0.83 (0.74, 0.93), P =0.001]. CONCLUSIONS Long-term outcomes were similar for robotic versus laparoscopic/thoracoscopic and open surgery, with no safety signal or indication requiring further research (PROSPERO Reg#CRD42021240519).
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Affiliation(s)
- Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, USA
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, NY, NY, USA
| | - Usha S Kreaden
- Biostatistics and Global Evidence Management, Intuitive Surgical, Sunnyvale, CA, USA
| | - Vincent Laudone
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Emmanouil P Pappou
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - John W Davis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - George J Chang
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emma C Rossi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - April E Hebert
- Biostatistics and Global Evidence Management, Intuitive Surgical, Sunnyvale, CA, USA
| | | | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, NY, NY, USA
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16
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Liang P, Li Z, Li J, Wei J, Li J, Zhang S, Xu S, Liu Z, Wang J. Impacts of complex electromagnetic radiation and low-frequency noise exposure conditions on the cognitive function of operators. Front Public Health 2023; 11:1138118. [PMID: 37033075 PMCID: PMC10076881 DOI: 10.3389/fpubh.2023.1138118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Background Both electromagnetic radiation (EMR) and low-frequency noise (LFN) are widespread and influential environmental factors, and operators are inevitably exposed to both EMR and LFN within a complex exposure environment. The potential adverse effects of such exposure on human health must be considered seriously. This study aimed to investigate the effects of EMR and LFN on cognitive function as well as their interaction effect, which remain unclear. Methods Sixty young male college students were randomly grouped and experiments were conducted with a 2 × 2 factorial design in a shielded chamber. Mental workload (MWL) levels of the study subjects were measured and assessed using the NASA-task load index (TLX) subjective scale, an n-back task paradigm, and the functional near-infrared spectroscopy (fNIRS) imaging technique. Results For the 3-back task, the NASA-TLX subjective scale revealed a statistically significant main effect of LFN intensity, which enhanced the subjects' MWL level (F = 8.716, p < 0.01). Behavioral performance revealed that EMR intensity (430.1357 MHz, 10.75 W/m2) and LFN intensity (0-200 Hz, 72.9 dB) had a synergistic interaction effect, and the correct response time was statistically significantly prolonged by the combined exposure (F = 4.343, p < 0.05). The fNIRS imaging technique revealed a synergistic interaction effect between operational EMR intensity and operational LFN intensity, with statistically significant effects on the activation levels in the left and right dorsolateral prefrontal cortex (DLPFC). The mean β values of DLPFC were significantly increased (L-DLPFC F = 5.391, p < 0.05, R-DLPFC F = 4.222, p < 0.05), and the relative concentrations of oxyhemoglobin in the DLPFC were also significantly increased (L-DLPFC F = 4.925, p < 0.05, R-DLPFC F = 9.715, p < 0.01). Conclusion We found a statistically significant interaction effect between EMR (430.1357 MHz, 10.75 W/m2) and LFN (0-200 Hz, 72.9 dB) when simultaneously exposing subjects to both for 30 min. We conclude that exposure to this complex environment can cause a statistically significant increase in the MWL level of operators, and even alterations in their cognitive function.
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Affiliation(s)
- Peng Liang
- Department of Rehabilitative Physioltherapy, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
- Hospital of No. 95007 Unit of PLA, Guangzhou, China
| | - Zenglei Li
- Department of Rehabilitative Physioltherapy, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Jiangjing Li
- Department of Anesthesiology, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Jing Wei
- Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Department of Radiation Medical Protection, School of Military Preventive Medicine, Fourth Military Medical University, Xi’an, China
| | - Jing Li
- Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Department of Radiation Medical Protection, School of Military Preventive Medicine, Fourth Military Medical University, Xi’an, China
| | - Shenghao Zhang
- Department of Neurosurgery, The 940th Hospital of PLA Joint Logistics Support Force, Lanzhou, China
| | - Shenglong Xu
- Department of Neurosurgery, The 940th Hospital of PLA Joint Logistics Support Force, Lanzhou, China
| | - Zhaohui Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
- *Correspondence: Zhaohui Liu,
| | - Jin Wang
- Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Department of Radiation Medical Protection, School of Military Preventive Medicine, Fourth Military Medical University, Xi’an, China
- Jin Wang,
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17
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Bell SW, Kong JCH, Clark DA, Carne P, Skinner S, Pillinger S, Burton P, Brown W. The National Aeronautics and Space Administration-task load index: NASA-TLX: evaluation of its use in surgery. ANZ J Surg 2022; 92:3022-3028. [PMID: 35674407 PMCID: PMC9796827 DOI: 10.1111/ans.17830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The technical difficulty an operation creates for a surgeon is difficult to measure. Current measures are poor surrogates. In both research and teaching settings it would be valuable to be able to accurately measure this degree of difficulty. The National Aeronautics and Space Administration Task Load Index (NASA TLX) is a multi-dimensional scale designed to obtain workload estimates relating to a task. This study aimed to evaluate the NASA TLX as an objective measure of technical difficulty of an operation. METHODS Seven surgeons performed 127 pre-defined operations (minimally invasive right hemicolectomy & re-do bariatric surgery) and recorded a NASA TLX score after each operation. These scores were compared to numerous clinical parameters and the score was correlated with the subjective measure of whether the surgeon categorized the operation as "easy", "moderate" or "difficult". RESULTS The NASA TLX score was significantly correlated with operative duration, blood loss, previous abdominal surgery and the surgeons' assessment of difficulty. It did not correlate with intra-operative or post-operative complications, conversion to open surgery or length of stay. CONCLUSIONS The NASA TLX score provides a graded numerical score that that correlated significantly with the surgeon's assessment of the technical difficulty, and with operative duration, intra-operative blood loss and previous abdominal surgery. This novel application of this tool could be employed in both research and teaching settings to score surgical difficulty and monitor a trainee's proficiency over time.
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Affiliation(s)
- Stephen W. Bell
- Department of Surgery, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia,Department of General SurgeryAlfred HospitalMelbourneVictoriaAustralia
| | - Joseph C. H. Kong
- Department of Surgery, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia,Department of General SurgeryAlfred HospitalMelbourneVictoriaAustralia
| | - David A. Clark
- Department of SurgerySt Vincent's Private Hospital NorthsideBrisbaneQueenslandAustralia
| | - Peter Carne
- Department of Surgery, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia,Department of General SurgeryAlfred HospitalMelbourneVictoriaAustralia,Department of SurgeryCabrini HospitalMelbourneVictoriaAustralia
| | - Stewart Skinner
- Department of Surgery, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia,Department of General SurgeryAlfred HospitalMelbourneVictoriaAustralia,Department of SurgeryCabrini HospitalMelbourneVictoriaAustralia,Department of SurgeryPeninsula Private HospitalMelbourneVictoriaAustralia,Department of SurgeryFrankston HospitalMelbourneVictoriaAustralia
| | - Stephen Pillinger
- Department of SurgerySydney Adventist HospitalSydneyNew South WalesAustralia
| | - Paul Burton
- Department of Surgery, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia,Department of General SurgeryAlfred HospitalMelbourneVictoriaAustralia,Department of SurgeryThe Avenue Private HospitalMelbourneVictoriaAustralia
| | - Wendy Brown
- Department of Surgery, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia,Department of General SurgeryAlfred HospitalMelbourneVictoriaAustralia,Department of SurgeryThe Avenue Private HospitalMelbourneVictoriaAustralia
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18
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Auswirkungen der COVID-19-Pandemie auf die robotische Viszeralchirurgie in Deutschland. DIE CHIRURGIE 2022; 93:765-777. [PMID: 35821304 PMCID: PMC9343279 DOI: 10.1007/s00104-022-01684-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/15/2022]
Abstract
Einleitung Der Einsatz roboterassistierter Operationen verzeichnet in der Viszeralchirurgie gegenwärtig einen stetigen Zuwachs. Im Jahr 2020 hat die COVID-19-Pandemie den klinischen und chirurgischen Alltag unerwartet wesentlich verändert. Wir haben in einer Umfrage den Status der roboterassistierten Viszeralchirurgie in Deutschland sowie die gegenwärtigen Ausbildungskonzepte evaluiert und deren Veränderungen unter dem Einfluss der COVID-19-Pandemie untersucht. Material und Methoden In einer umfangreichen Recherche wurden 89 Kliniken identifiziert, welche ein Robotersystem für die Viszeralchirurgie 2020 einsetzten. Diese Kliniken wurden über eine webbasierte anonyme Umfrage mit 35 Fragen dreimal kontaktiert. Die Fragen bezogen sich auf die Einsatzgebiete eines Operationsroboters in der Viszeralchirurgie, die dazugehörige klinische Ausbildung und den Einfluss der COVID-19-Pandemie auf das bestehende Programm. Ergebnisse Von den angeschriebenen Kliniken haben 22 (24,7%) eine Rückmeldung gegeben. Hiervon waren 17 (19,1%) Fragebögen auswertbar. Es beteiligten sich 58,8% Universitätsklinika, 17,6% Maximalversorger und 23,5% Schwerpunktkrankenhäuser an der Studie. Der Operationsroboter wurde am oberen Gastrointestinaltrakt (OGIT; 88,2%), am hepatopankreatikobiliären System (HPB; 82,4%) und im kolorektalen Bereich (KRK; 94,1%) sowie bei der Hernienversorgung (35,3%) eingesetzt. Der relative Anteil robotischer Eingriffe am operierten Gesamtkollektiv lag dabei zwischen 0,3% und 15,4%. Die Konversionsraten für 2020 lag im Mittel bei 4,6 ± 3,2%. Die Operationsroboter wurden zum Großteil im interdisziplinären Setting wechselweise mit anderen chirurgischen Disziplinen (82,4%) genutzt. Zu Lehrzwecken stand in sieben Kliniken (41,2%) eine zweite Konsole zur Verfügung. Die Ausbildungsstrukturen waren sehr heterogen und nur 13,2 ± 6,5% der Chirurg*innen pro Klinik waren in das Roboterprogramm involviert. In 82,4% existierten feste Teams, die sich aus Ober‑, Fach- und Assistenzärzt*innen zusammensetzen und in 76,5% wurden Ärzt*innen und Pflegepersonal über klinikinterne Ausbildungsprogramme geschult. Die COVID-19-Pandemie hatte einen Fallzahlrückgang robotischer Eingriffe im Vergleich zu 2019 bei 70% der Kliniken vor allem im zweiten Jahresquartal 2020 (64,7%) zur Folge. Dies wurde auf Personalmangel nichtchirurgischer Disziplinen (Anästhesie 35,3%, OP-Pflege 35,3%, Intensivmedizin 17,6%), interne Regularien (58,8%) und begrenzte Intensiv- oder Überwachungskapazitäten (47,1%) zurückgeführt. Die COVID-19-Pandemie führte in der robotischen Ausbildung teilweise bei der Assistenz am OP-Tisch (23,5%) und der Assistenz an der zweiten Konsole (42,9%) zu einem kompletten Ausbildungsstopp. Ausschlaggebend für diese Entwicklung war überwiegend der Rückgang der Operationszahlen. Schlussfolgerung Die Robotik wird mittlerweile in einem breiten Spektrum der Viszeralchirurgie an Kliniken mit unterschiedlichen Versorgungsschwerpunkten in Deutschland eingesetzt. Der relative Anteil der Eingriffe am Gesamtspektrum ist allerdings noch gering. Roboterassistierte Eingriffe sind expertenfokussiert und es bestehen sehr heterogene Ausbildungskonzepte. Ein Lernerfolg mit konstanten und niedrigen Konversionsraten ist nach wenigen Jahren mit zunehmender Erfahrung zu erkennen. Die COVID-19-Pandemie hatte insgesamt einen negativen Einfluss auf die robotischen OP-Fallzahlen und die damit verbundenen Ausbildungsmöglichkeiten bei freien chirurgischen Personalressourcen. Hier ist eine kreative Gestaltung optimierter Ausbildungsmodalitäten erforderlich.
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Ravindra C, Igweonu-Nwakile EO, Ali S, Paul S, Yakkali S, Teresa Selvin S, Thomas S, Bikeyeva V, Abdullah A, Radivojevic A, Abu Jad AA, Ravanavena A, Balani P. Comparison of Non-Oncological Postoperative Outcomes Following Robotic and Laparoscopic Colorectal Resection for Colorectal Malignancy: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e27015. [PMID: 35989760 PMCID: PMC9386330 DOI: 10.7759/cureus.27015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022] Open
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Maleczek M, Schebesta K, Hamp T, Burger AL, Pezawas T, Krammel M, Roessler B. ST-T segment changes in prehospital emergency physicians in the field: a prospective observational trial. Scand J Trauma Resusc Emerg Med 2022; 30:47. [PMID: 35841049 PMCID: PMC9288087 DOI: 10.1186/s13049-022-01033-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/30/2022] [Indexed: 12/03/2022] Open
Abstract
Aims Due to time-critical decision-making, physical strain and the uncontrolled environment, prehospital emergency management is frequently associated with high levels of stress in medical personnel. Stress has been known to cause ischemia like changes in electrocardiograms (ECGs), including arrhythmias and deviations in ST-T segments. There is a lack of knowledge regarding the occurrence of changes in ST-T segments in prehospital emergency physicians. We hypothesized that ST-T segment deviations occur in prehospital emergency physicians in the field.
Methods In this prospective observational trial, ST-T segments of emergency physicians were recorded using 12-lead Holter ECGs. The primary outcome parameter was defined as the incidence of ST-T segment changes greater than 0.1 mV in two corresponding leads for more than 30 s per 100 rescue missions. The secondary outcomes included T-wave inversions and ST-segment changes shorter than 30 s or smaller than 0.1 mV. Surrogate parameters of stress were measured using the NASA-Task Load Index and cognitive appraisal, and their correlation with ST-T segment changes were also assessed. Results Data from 20 physicians in 36 shifts (18 days, 18 nights) including 208 missions were analysed. Seventy percent of previously healthy emergency physicians had at least one ECG abnormality; the mean duration of these changes was 30 s. Significantly more missions with ECG changes were found during night than day shifts (39 vs. 17%, p < 0.001). Forty-nine ECG changes occurred between missions. No ST-T segment changes > 30 s and > 0.1 mV were found. Two ST-T segment changes < 30 s or < 0.1 mV (each during missions) and 122 episodes of T-wave inversions (74 during missions) were identified. ECG changes were found to be associated with alarms when asleep and NASA task load index. Conclusion ECG changes are frequent and occur in most healthy prehospital emergency physicians. Even when occurring for less than 30 s, such changes are important signs for high levels of stress. The long-term impact of these changes needs further investigation. Trial registration The trial was registered at ClinicalTrials.gov (NCT04003883) on 1.7.2019: https://clinicaltrials.gov/ct2/show/NCT04003883?term=emergency+physician&rank=2
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Affiliation(s)
- Mathias Maleczek
- Medical Simulation and Emergency Management Research Group, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Academic Simulation Center of Vienna, Vienna, Austria
| | - Karl Schebesta
- Medical Simulation and Emergency Management Research Group, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. .,Academic Simulation Center of Vienna, Vienna, Austria.
| | - Thomas Hamp
- Medical Simulation and Emergency Management Research Group, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Achim Leo Burger
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Thomas Pezawas
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Mario Krammel
- Emergency Medical Service Vienna, Vienna, Austria.,PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Bernhard Roessler
- Medical Simulation and Emergency Management Research Group, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Academic Simulation Center of Vienna, Vienna, Austria
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Stockheim J, Perrakis A, Sabel BA, Waschipky R, Croner RS. RoCS: Robotic Curriculum for young Surgeons. J Robot Surg 2022; 17:495-507. [PMID: 35810233 PMCID: PMC10076401 DOI: 10.1007/s11701-022-01444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/26/2022] [Indexed: 11/26/2022]
Abstract
Robotic-assisted procedures gain increasing acceptance for daily surgical routine. However, structured training programs are designed for surgeons with high expertise. Hence, a comprehensive training curriculum was established to ensure a basic competence in robotic abdominal surgery for young surgeons during their residency. The aim of the current work is to propose a feasible and effective training concept. The development process of this training curriculum is based on a comprehensive literature review which led to the concept of "robotic curriculum for young surgeons" (RoCS). It was implemented in the daily routine of a German university hospital starting in 2020. The robotic assessment questionnaire (RAQ) was used for electronic data collection. After the initial phase adjustments, it led to an improvement of the initial version of the curriculum. RoCS is a multimodal training program containing basic training through assistance at the operation table during robotic-assisted operations and basic console training. Key elements are the robotic team time-out (rTTO), perioperative process standardization including feasible personnel scheduling and useful procedure clustering into organ systems, procedural steps and procedural step complexity. Evaluation of standardized communication, performance assessment, patient factors and individual overall workload using NASA Task Load Index is realizable. Flexibility and adaptability to internal organization processes of surgical departments are the main advantages of the concept. RoCS is a strong training tool to meet the specific needs of young surgeons and evaluate their learning success of robotic procedural training. Furthermore, comparison within the different robotic systems should be considered. Further studies are needed to validate a multicenter concept design.
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Affiliation(s)
- Jessica Stockheim
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Aristotelis Perrakis
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Bernhard A Sabel
- Institute of Medical Psychology, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Robert Waschipky
- Department of Information Technology (IT) and Medical Engineering, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Roland S Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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22
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Li D, Hu Y, Liu S, Lu C, Zhang Y, Zhou J, Li J, Zhang Z. Developing an Integrated Evaluation Model for Physician Comprehensive Workload Tethered to Outpatient Practice: An Empirical Study From China. Front Public Health 2022; 10:847613. [PMID: 35664107 PMCID: PMC9162480 DOI: 10.3389/fpubh.2022.847613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Previous studies, often simply using either objective workload or mental workload as a measure of physician workload in various healthcare settings might have failed to comprehensively reflect the real workload among physicians. Despite this, there is little research that further explores a comprehensive workload evaluation framework with the integration of objective workload and mental workload to describe their comprehensive workload. Methods A comprehensive evaluation framework for physician workload was proposed based on the combination of objective workload and task-level mental workload also with the consideration of quality of provided medical services and served patient complexity; and accordingly, an integrated evaluation model for physician comprehensive workload (PCW) tethered to outpatient practice was developed and further applied to perform a PCW analysis using cross-sectional data on outpatient workload of 1,934 physicians mainly from 24 hospitals in 6 provinces in Eastern, Central, and Western China. Multiple linear regression and multinomial logistic regression analyses were established to identify significant factors influencing the PCW. Results Overall, the average score of PCW tethered to outpatient practice Chinese physicians experienced was 811.30 (SD=494.98) with concentrating on between 200 and 1,200. Physicians who were female, from Eastern or Western China, and those who worked >60 h per week and longer outpatient hours per week were more likely to experience a higher PCW. 11.2% of participating physicians were identified as very high PCW physicians, compared with 11.6% as low PCW physicians, 45.5% as medium PCW physicians and 30.7% as high PCW physicians. Those who were female, older, from Western China, those who had lower educational levels, lower professional titles and longer working years in the current institution, and those who worked in tertiary A hospitals and Internal or Surgical, and worked >60 h per week and longer outpatient hours per week were more likely to be very high PCW physicians. Conclusions Our work has a potential application for comprehensively assessing physician workload tethered to outpatient practice and could provide a solid foundation for hospital managers to further accurately determine and identify physicians with high workload, who would otherwise be missed in either objective workload or mental workload.
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Affiliation(s)
- Dehe Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinhuan Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Yinhuan Hu
| | - Sha Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuntao Lu
- Jingmen No. 2 People's Hospital, Jingmen, China
| | - Yeyan Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinghan Zhou
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiayi Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zemiao Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Li D, Hu Y, Liu S, Lu C, Li J, Zhou J, Zhang Y, Lu S. A Latent Profile Analysis of Chinese Physicians' Workload Tethered to Paperwork During Outpatient Encounters. Front Public Health 2022; 10:854772. [PMID: 35548081 PMCID: PMC9082025 DOI: 10.3389/fpubh.2022.854772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Physician dissatisfaction with more time spent on related paperwork but less time available for direct interaction with patients is increasing internationally. Increased physician workload resulting from paperwork might negatively affect their interaction with patients and increase the risk for burnout. This study aimed to investigate the level of physician workload tethered to paperwork during outpatient encounters and explore its latent workload subgroups among Chinese physicians. Methods A cross-sectional survey was conducted via online questionnaire primarily in 24 hospitals in 6 provinces in Eastern, Central, and Western China from November 2020 to February 2021. The Chinese physician mental workload scale developed by our research team was used for assessment of physician workload tethered to paperwork. Physicians were categorized into different subgroups of workload via latent profile analysis. Multinomial logistic regression was subsequently performed to examine how demographic variables differ among physicians belonging to different subgroups. Results A total of 1,934 valid questionnaires were received. Chinese physicians reported medium levels of workload while performing non-physician-patient communication work tasks characterized by paperwork during outpatient encounters. Four latent workload subgroups were identified: "low workload group" (8.8%), "medium workload group" (34.0%), "high workload group" (42.1%) and "very high workload group" (15.1%). Compared with the other latent workload subgroups, physicians belonging to the "very high workload group" were more likely to be younger, married, those who had worse health status, lower educational levels and lower average monthly incomes, those who worked more years in the current institution, more hours per week and longer outpatient hours per week, and those who worked in public general hospitals, tertiary B hospitals and Obstetrics and Gynecology, and saw more than 50 outpatients per day, with more time spent on per patient. Conclusions There exit four latent workload subgroups among Chinese physicians tethered to paperwork during outpatient encounters along with great individual variations among these subgroups. The characteristics of the latent "very high workload group" can help permit more targeted guidance for developing interventions with optimized human resource allocation to, in turn, increase the time available for direct interaction with patients, thereby resulting in improved quality of physician-patient interactions and decreased risk for physician burnout.
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Affiliation(s)
- Dehe Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinhuan Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sha Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuntao Lu
- Jingmen No. 2 People's Hospital, Jingmen, China
| | - Jiayi Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinghan Zhou
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yeyan Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaoyu Lu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Han AY, Naples R, French JC, Dragomirescu C, Tu C, Lipman JM. Operative teaching takes “GUTS”: Impact of Educational Time Out on trainee's cognitive load. Am J Surg 2022; 224:851-855. [DOI: 10.1016/j.amjsurg.2022.03.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/07/2022] [Accepted: 03/23/2022] [Indexed: 12/18/2022]
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Robotic transanal minimally invasive surgery: a single institutional experience. Updates Surg 2022; 74:1011-1016. [PMID: 35175536 DOI: 10.1007/s13304-021-01233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
Robotic transanal minimally invasive surgery (R-TAMIS) is a novel and evolving technique with limited reported outcomes in the literature. Compared to the laparoscopic approach, R-TAMIS provides enhanced optics, increased degrees of motion, superior ergonomics, and easier maneuverability in the confines of the rectum. We report a single institution experience at a large quaternary referral academic medical center with R-TAMIS using the da Vinci Xi® platform. This is a retrospective review of electronic medical records at the Mayo Clinic from September 2017 to April 2020. It includes all available clinical documentations for patients undergoing R-TAMIS at our institution. Patient demographics, intraoperative data (procedure time, tumor size and distance), complications, and pathology reports were reviewed. A total of 28 patients underwent R-TAMIS. Median follow-up was 23.65 months. Sixteen patients underwent R-TAMIS for endoscopically unresectable rectal polyps, eight for rectal adenocarcinoma, two for rectal gastrointestinal stromal tumor, and two for rectal carcinoid tumor. The mean size of the lesions was 4.1 cm (range 0.2-13.8 cm). The mean location of lesions was 7.8 cm (range 0-16 cm) from the anal verge. The mean operative time was 132.5 ± 46.8 min. There was one 30-day complication, and no deaths. Twenty-three (82%) patients were discharged the day of surgery. R-TAMIS is a safe, feasible, and effective technique for the surgical treatment of a variety of rectal pathology. A hybrid technique can be used for the resecting tumors extending into the anal canal.
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A miniature robotic steerable endoscope for maxillary sinus surgery called PliENT. Sci Rep 2022; 12:2299. [PMID: 35145155 PMCID: PMC8831515 DOI: 10.1038/s41598-022-05969-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/17/2022] [Indexed: 11/18/2022] Open
Abstract
In endoscopic maxillary sinus surgery, the maxillary sinus is accessed through the nasal cavity which constitutes a narrow and tortuous pathway. However, surgeons still use rigid endoscopes and rigid, straight or pre-bent instruments for this procedure. Resection of the uncinate process and creation of a medial antrostomy is warranted to access the pathology inside the maxillary sinus and depending on the location of the pathology (lateral, inferior or anterior wall), additional resection of healthy tissue and/or functional structures like the lacrimal duct and/or inferior turbinate is necessary to gain optimal access. In order to avoid this additional resection, a functional single-handed, steerable endoscope for endoscopic maxillary sinus surgery has been designed and built. This endoscope is, to our knowledge, the most slender active steerable endoscope ever reported for maxillary sinus surgery. The performance of the endoscope was validated by two surgeons on a cadaver. An increased field of view was found in comparison to currently used endoscopes. As a direct consequence, a reduced need for resection of healthy tissue was confirmed.
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Yu H, Yu T, Wang J, Wei F, Gong H, Dong H, He X, Wang Z, Yang J. Validation of a three-dimensional printed dry lab pancreaticojejunostomy model in surgical assessment: a cross-sectional study. BMJ Open 2022; 12:e052295. [PMID: 35105574 PMCID: PMC8808463 DOI: 10.1136/bmjopen-2021-052295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Until now, there have been few tools to evaluate whether a surgeon was technically ready to perform a safe pancreaticojejunostomy (PJ). In the current study, we aimed to evaluate whether a three-dimensional model could mimic a real surgical situation and distinguish between surgeons of different levels of experiences. DESIGN A three-dimensional PJ dry laboratory model was printed. Eight experienced pancreatic surgeons were tasked to evaluate the appearance and tactile sensation of the model. Proficiency was scored based on 15 surgeons with various levels of pancreatic experience performing a PJ on the three-dimensional model. Additionally, the time of manipulation and NASA Task Load Index (NASA-TLX) scores were recorded for each operation. SETTING Our study was conducted in multimedical centre in China. RESULTS Compared with real surgical situations, this model had similar appearance (3.96±0.55 out of five points) and tactile sensation (3.85±0.46 out of five points) according to the expert evaluation. Additionally, the chief surgeon group scored the best in proficiency (based on NASA-TLX scores and operative time), and there were statistical differences for performances among surgeons of various levels (p<0.05). CONCLUSION The three-dimensional PJ model could mimic a real surgical situation and can distinguish between surgeons of different levels of experiences.
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Affiliation(s)
- Hao Yu
- Key Laboratory of Laparoscopic Technology of Zhejiang Province, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
- Department of Thoracic Surgery, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Tunan Yu
- Key Laboratory of Laparoscopic Technology of Zhejiang Province, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, China
- Department of General Surgery, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Jiulong Wang
- Department of General Surgery, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Fangqiang Wei
- Department of Hepatobiliary and Pancreatic Surgery, Hangzhou Medical College, Hangzhou, China
| | - Haibo Gong
- Department of Research and Development, Ningbo Trandomed 3D Medical Technology Co., Ltd, Ningbo, Zhejiang, China
| | - Haiying Dong
- Department of Oncology, Hangzhou Medical College, Hangzhou, China
| | - Xinzhong He
- Department of Hepatobiliary and Pancreatic Surgery, The First People's Hospital of Tongxiang City, Jiaxing, Zhejiang, China
| | - Zhifei Wang
- Department of Hepatobiliary and Pancreatic Surgery, Hangzhou Medical College, Hangzhou, China
| | - Jin Yang
- Key Laboratory of Laparoscopic Technology of Zhejiang Province, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
- Department of General Surgery, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
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Li D, Hu Y, Chen H, Zhu X, Wu X, Li J, Zhang Z, Liu S. Identifying the Subtypes and Characteristics of Mental Workload Among Chinese Physicians in Outpatient Practice: A Latent Profile Analysis. Front Public Health 2021; 9:779262. [PMID: 34900919 PMCID: PMC8653799 DOI: 10.3389/fpubh.2021.779262] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/27/2021] [Indexed: 01/10/2023] Open
Abstract
Objective: The purpose of this study is to investigate the mental workload level of physicians in outpatient practice since the normalization of prevention and control of the COVID-19 pandemic in China and explore the subtypes of physicians regarding their mental workload. Methods: A cross-sectional survey of 1,934 physicians primarily in 24 hospitals in 6 provinces in Eastern, Central, and Western China was conducted from November 2020 to February 2021. A latent profile analysis was performed to identify clusters based on the six subscales of the Chinese version of physician mental workload scale developed by our research team. Chi-square tests were performed to explore the differences in demographic characteristics of the subtypes among the subgroups, and multinomial logistic regression analysis was further conducted to identify the determinants of the subtypes of physicians. Results: Overall, the participating physicians reported high levels of task load but with high self-assessed performance (68.01 ± 14.25) while performing communication work tasks characterized by direct patient interaction in outpatient clinics. About 33.8% of the participating physicians were identified as “high workload and high self-assessment” subtype, compared to 49.7% “medium workload and medium self-assessment” subtype and 16.4% “low workload and low self-assessment” subtype. Physicians in “high workload and high self-assessment” subtype had the highest mean mental workload score. Physicians who were female, younger, married, worse health status, those who had lower educational level and an average monthly income of 5,001–10,000 RMB, those who worked in tertiary A hospitals, more hours per week and more than 40 h per week in outpatient clinics, and those who saw more outpatients per day, and spent more time per patient but with higher outpatient satisfaction were more likely to belong to “high workload and high self-assessment” subtype. Conclusion: Our findings can help provide a solid foundation for developing targeted interventions for individual differences across physicians regarding their mental workload. We suggest the hospital managers should pay more attention to those physicians with characteristics of the “high workload and high self-assessment” subtype and strengthen the management of the workload of this subtype of physicians to reduce the risks of their mental health, and to maintain their high work performance in outpatient clinics.
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Affiliation(s)
- Dehe Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinhuan Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ximin Zhu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyue Wu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiayi Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zemiao Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sha Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Study protocol: a multicenter randomized controlled trial of the multifaceted workload reduction of the anti-adhesion barrier for diverting ileostomy in laparoscopic rectal surgery, YCOG 2005 (ADOBARRIER study). Int J Colorectal Dis 2021; 36:2763-2768. [PMID: 34545454 DOI: 10.1007/s00384-021-04032-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND There are few randomized controlled trials on the efficacy of spray-type anti-adhesion material during diverting ileostomy in laparoscopic rectal cancer surgery. PURPOSE This study will assess whether or not spraying an anti-adhesion material during diverting ileostomy could reduce the surgeon's multifaceted workload in ileostomy closure. METHODS Patients with laparoscopic or robotic surgery for rectal cancer scheduled for low anterior resection and diverting ileostomy will be enrolled in the ADOBARRIER study (multicenter, single-blind, randomized controlled trial). The target sample size is set at 120 cases, which will be randomly divided into an anti-adhesion material-using group and a non-using group at a ratio of 1:1. The primary endpoint is the multifaceted workload of the surgeon of ileostomy closure using SURG-TLX between groups with and without usage of the anti-adhesion material during diverting ileostomy construction; the secondly endpoint is the operative time, amount of intraoperative blood loss, degree of adhesions, and extent of intra-abdominal adhesions when the ileostomy is closed. CONCLUSIONS This RCT will evaluate the efficacy and safety of spray-type anti-adhesion material for diverting ileostomy construction. The results of this study are expected to facilitate decision-making regarding the use of anti-adhesion material. TRIAL REGISTRATION This trial was registered with the Japan Registry of Clinical Trials (jRCT) in October 2020 as jRCTs032200155.
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Zhu L, Liu Y, Hu M, Zhao Z, Li C, Zhang X, Tan X, Wang F, Liu R. Comparison of robotic and laparoscopic liver resection in ordinary cases of left lateral sectionectomy. Surg Endosc 2021; 36:4923-4931. [PMID: 34750706 DOI: 10.1007/s00464-021-08846-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Laparoscopy was considered the standard method of left lateral sectionectomy. The robotic approach showed advantages in complex cases of left lateral sectionectomy. However, the impact of the robotic system on ordinary cases is still unknown. METHODS Retrospective review of consecutive robotic left lateral sectionectomy (R-LLS) and laparoscopic left lateral sectionectomy (L-LLS) from January 2015 to December 2019. Univariate and multivariate logistic regression was used to determine the effects of surgical method and surgical complexity on postoperative length of stay, surgical and overall cost. RESULTS 258 consecutive patients who underwent minimally invasive left lateral sectionectomy were analyzed. L-LLS had comparable outcomes and decreased surgery (USD 2416.3 vs 4624.5; p < 0.001) and overall costs (USD 8004.5 vs 11897.1; p < 0.001) compared with R-LLS in the ordinary-case group, whereas R-LLS was associated with shorter postoperative LOS (5.0 vs 3.5 days; p = 0.004) in the complex-case group. On multivariable analysis, R-LLS was predictive of shorter postoperative LOS [odds ratio (OR) 0.388, 95% confidence interval (CI) 0.198-0.760, p = 0.006], whereas R-LLS was predictive of higher surgery (OR 65.640, 95% CI 17.406-247.535, p < 0.001) and overall costs (OR 102.233, 95% CI 22.241-469.931, p < 0.001). CONCLUSION Results of this study showed no clinical benefit to the R-LLS compared with L-LLS in ordinary cases. R-LLS had potential advantages in selected complex cases.
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Affiliation(s)
- Lin Zhu
- The First School of Clinical Medicine, Lanzhou University, No. 1, Donggangxi Rd, Chengguan District, Lanzhou, 730000, Gansu, China.,Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Yanzhe Liu
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Minggen Hu
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Zhiming Zhao
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Chenggang Li
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Xuan Zhang
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Xianglong Tan
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Fei Wang
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Rong Liu
- The First School of Clinical Medicine, Lanzhou University, No. 1, Donggangxi Rd, Chengguan District, Lanzhou, 730000, Gansu, China. .,Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China.
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Lund S, Yan M, D'Angelo J, Wang T, Hallbeck MS, Heller S, Zielinski M. NASA-TLX assessment of workload in resident physicians and faculty surgeons covering trauma, surgical intensive care unit, and emergency general surgery services. Am J Surg 2021; 222:1158-1162. [PMID: 34689977 DOI: 10.1016/j.amjsurg.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/25/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Higher workload is associated with burnout and lower performance. Therefore, we aim to assess shift-related factors associated with higher workload on EGS, ICU, and trauma surgery services. METHODS In this prospective cohort study, faculty surgeons and surgery residents completed a survey after each EGS, ICU, or trauma shift, including shift details and a modified NASA-TLX. RESULTS Seventeen faculty and 12 residents completed 174 and 48 surveys after working scheduled 12-h and 24-h shifts, respectively (response rates: faculty - 62%, residents - 42%). NASA-TLX was significantly increased with a higher physician subjective fatigue level. Further, seeing more consults or performing more operations than average significantly increased workload. Finally, NASA-TLX was significantly higher for faculty when they felt their shift was more difficult than expected. CONCLUSIONS Higher volume clinical responsibilities and higher subjective fatigue levels are independently associated with higher workload. Designing shift coverage to expand on busier days may decrease workload, impacting burnout and shift performance.
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Affiliation(s)
- Sarah Lund
- Mayo Clinic Department of Surgery, 200 1st Street SW, Rochester, MN, 55902, USA.
| | - Maria Yan
- Mayo Clinic Department of Plastic Surgery, 200 1st Street SW, Rochester, MN, 55902, USA
| | - Jonathan D'Angelo
- Mayo Clinic Department of Surgery, 200 1st Street SW, Rochester, MN, 55902, USA
| | - Tianke Wang
- Mayo Clinic Kern Center for the Science of Health Care Delivery, 200 1st Street SW, Rochester, MN, 55902, USA
| | - M Susan Hallbeck
- Mayo Clinic Department of Surgery, 200 1st Street SW, Rochester, MN, 55902, USA; Mayo Clinic Kern Center for the Science of Health Care Delivery, 200 1st Street SW, Rochester, MN, 55902, USA
| | - Stephanie Heller
- Mayo Clinic Division of Trauma, Critical Care, and General Surgery, 200 1st Street SW, Rochester, MN, 55902, USA
| | - Martin Zielinski
- Mayo Clinic Division of Trauma, Critical Care, and General Surgery, 200 1st Street SW, Rochester, MN, 55902, USA
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Nagyné Elek R, Haidegger T. Non-Technical Skill Assessment and Mental Load Evaluation in Robot-Assisted Minimally Invasive Surgery. SENSORS (BASEL, SWITZERLAND) 2021; 21:2666. [PMID: 33920087 PMCID: PMC8068868 DOI: 10.3390/s21082666] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND: Sensor technologies and data collection practices are changing and improving quality metrics across various domains. Surgical skill assessment in Robot-Assisted Minimally Invasive Surgery (RAMIS) is essential for training and quality assurance. The mental workload on the surgeon (such as time criticality, task complexity, distractions) and non-technical surgical skills (including situational awareness, decision making, stress resilience, communication, leadership) may directly influence the clinical outcome of the surgery. METHODS: A literature search in PubMed, Scopus and PsycNet databases was conducted for relevant scientific publications. The standard PRISMA method was followed to filter the search results, including non-technical skill assessment and mental/cognitive load and workload estimation in RAMIS. Publications related to traditional manual Minimally Invasive Surgery were excluded, and also the usability studies on the surgical tools were not assessed. RESULTS: 50 relevant publications were identified for non-technical skill assessment and mental load and workload estimation in the domain of RAMIS. The identified assessment techniques ranged from self-rating questionnaires and expert ratings to autonomous techniques, citing their most important benefits and disadvantages. CONCLUSIONS: Despite the systematic research, only a limited number of articles was found, indicating that non-technical skill and mental load assessment in RAMIS is not a well-studied area. Workload assessment and soft skill measurement do not constitute part of the regular clinical training and practice yet. Meanwhile, the importance of the research domain is clear based on the publicly available surgical error statistics. Questionnaires and expert-rating techniques are widely employed in traditional surgical skill assessment; nevertheless, recent technological development in sensors and Internet of Things-type devices show that skill assessment approaches in RAMIS can be much more profound employing automated solutions. Measurements and especially big data type analysis may introduce more objectivity and transparency to this critical domain as well. SIGNIFICANCE: Non-technical skill assessment and mental load evaluation in Robot-Assisted Minimally Invasive Surgery is not a well-studied area yet; while the importance of this domain from the clinical outcome's point of view is clearly indicated by the available surgical error statistics.
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Affiliation(s)
- Renáta Nagyné Elek
- Antal Bejczy Center for Intelligent Robotics, University Research and Innovation Center, Óbuda University, 1034 Budapest, Hungary;
- Doctoral School of Applied Informatics and Applied Mathematics, Óbuda University, 1034 Budapest, Hungary
| | - Tamás Haidegger
- Antal Bejczy Center for Intelligent Robotics, University Research and Innovation Center, Óbuda University, 1034 Budapest, Hungary;
- John von Neumann Faculty of Informatics, Óbuda University, 1034 Budapest, Hungary
- Austrian Center for Medical Innovation and Technology, 2700 Wiener Neustadt, Austria
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Are Surgeons Working Smarter or Harder? A Systematic Review Comparing the Physical and Mental Demands of Robotic and Laparoscopic or Open Surgery. World J Surg 2021; 45:2066-2080. [PMID: 33772324 DOI: 10.1007/s00268-021-06055-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Minimally invasive surgical techniques such as robotic surgical platforms have provided favourable outcomes for patients, but the impact on surgeons is not well described. This systematic review aims to synthesize and evaluate the physical and mental impact of robotic surgery on surgeons compared to standard laparoscopic or open surgery. METHODS A search strategy was developed to identify peer-reviewed English articles published from inception to end of December 2019 on the following databases: MEDLINE, PubMed, PsycINFO and Embase. The articles were assessed using a modified Newcastle-Ottawa tool. RESULTS Of the 6563 papers identified, 30 studies were included in the qualitative synthesis of this review. Most of the included studies presented a high risk of bias. A total of 13 and 21 different physical and mental tools, respectively, were used to examine the impact on surgeons. The most common tool used to measure physical and mental demand were surface electromyography (N = 9) and the NASA Task Load Index (NASA-TLX; N = 8), respectively. Majority of studies showed mixed results for physical (N = 10) and mental impact (N = 7). This was followed by eight and six studies favouring RS over other surgical modalities for physical and mental impact, respectively. CONCLUSION Most studies showed mixed physical and mental outcomes between the three surgical modalities. There was a high risk of bias and methodological heterogeneity. Future studies need to correlate mental and physical stress with long-term impact on the surgeons.
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Improving vision for surgeons during laparoscopy: the Enhanced Laparoscopic Vision System (ELViS). Surg Endosc 2021; 35:2403-2415. [PMID: 33650002 DOI: 10.1007/s00464-021-08369-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/09/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND For many abdominal surgical interventions, laparotomy has gradually been replaced by laparoscopy, with numerous benefits for the patient in terms of post-operative recovery. However, during laparoscopy, the endoscope only provides a single viewpoint to the surgeon, leaving numerous blind spots and opening the way to peri-operative adverse events. Alternative camera systems have been proposed, but many lack the requisite resolution/robustness for use during surgery or cannot provide real-time images. Here, we present the added value of the Enhanced Laparoscopic Vision System (ELViS) which overcomes these limitations and provides a broad view of the surgical field in addition to the usual high-resolution endoscope. METHODS Experienced laparoscopy surgeons performed several typical procedure steps on a live pig model. The time-to-completion for surgical exercises performed by conventional endoscopy and ELViS-assisted surgery was measured. A debriefing interview following each operating session was conducted by an ergonomist, and a System Usability Scale (SUS) score was determined. RESULTS Proof of concept of ELVIS was achieved in an animal model with seven expert surgeons without peroperative adverse events related to the surgical device. No differences were found in time-to-completion. Mean SUS score was 74.7, classifying the usability of the ELViS as "good". During the debriefing interview, surgeons highlighted several situations where the ELViS provided a real advantage (such as during instrument insertion, exploration of the abdominal cavity or for orientation during close work) and also suggested avenues for improvement of the system. CONCLUSIONS This first test of the ELViS prototype on a live animal model demonstrated its usability and provided promising and useful feedback for further development.
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Who is hurting? A prospective study of surgeon ergonomics. Surg Endosc 2021; 36:292-299. [PMID: 33523280 DOI: 10.1007/s00464-020-08274-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/24/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is a paucity of prospective data related to surgeon ergonomics, which affects career longevity. Robotic surgical systems may mitigate pain and workload. We hypothesized that ergonomic outcomes would vary based on surgeon height and gender, and the relative benefit of robotic surgery would vary based on these demographics. METHODS Surgeons received questionnaires to fill out immediately before and after surgery to enable calculation of pain scores and task load. Surgeons who were ≤ 66 inches tall were considered "short". Univariable and multivariable regression analyses were performed where appropriate using Stata-MP version 14.2 (StataCorp LLC, College Station, TX). RESULTS There were 124 questionnaires given to 20 surgeons; 97 (78%) were returned, and 12 (12%) laparoscopic operations were excluded, leaving 85 (69%) questionnaires for further analysis: 33 (38%) from short surgeons, and 24 (28%) from women, for 30 (35%) robotic and 55 (65%) open operations. There were 44/85 (52%) surgeons who reported worse pain after surgery. Overall pain scores (1.1 ± 2.6 vs 1.5 ± 2.6, p = 0.70) were similar for robotic and open operations. In multivariable analysis, greater surgeon pain scores were significantly associated with short surgeons (p < 0.001), male surgeons (p < 0.001), and long operative times (p = 0.03). Physical demand was lower for robot vs open operations (median 10 vs 13, p = 0.03). When short surgeons (p = 0.04) and male surgeons (p = 0.03) were examined as sub-groups, lower physical demand during robotic operations persisted, but was lost when only examining tall surgeons (p = 0.07) and female surgeons (p = 0.13). CONCLUSIONS Short surgeons and male surgeons reported significantly more pain after both open and robotic operations but had less physical demand when using the robotic system. Future work should focus on mitigation of surgeon height-related factors and seek to understand ergonomic gender differences beyond height.
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Enhanced Laparoscopic Vision Improves Detection of Intraoperative Adverse Events During Laparoscopy. Ing Rech Biomed 2020. [DOI: 10.1016/j.irbm.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Achilli P, Grass F, Larson DW. Robotic surgery for rectal cancer as a platform to build on: review of current evidence. Surg Today 2020; 51:44-51. [PMID: 32367173 DOI: 10.1007/s00595-020-02008-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023]
Abstract
Laparoscopy in colorectal surgery reduces the rate of postoperative complications, shortens the length of stay in hospital, and improves the quality of patient care. Despite these established benefits, the technical challenges of rectal resection for cancer have resulted in most operations being performed through open surgery in the USA. Moreover, controversy in the current literature questions the oncologic safety of a laparoscopic approach for rectal cancer. How then can surgeons innovate to overcome the technical challenges while preserving the critical oncological outcomes of high-quality rectal cancer surgery? Robotics may be a platform that allows us to overcome the technical challenges in the pelvis while maintaining both oncological outcomes and the benefits of a minimally invasive technique. Current evidence suggests that the quality of total mesorectal excision, the rates of circumferential margin involvement, and postoperative outcomes are comparable between robotic and laparoscopic surgery. While a robotic approach demonstrates lower conversion rates and reduced surgeon workload, the operative time is longer and initial costs are higher; however, time and future science will determine its true benefits. We review the current state of robotic surgery and its impact on rectal cancer surgery.
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Affiliation(s)
- Pietro Achilli
- Division of Colon and Rectal Surgery, Mayo Clinic Rochester MN, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Fabian Grass
- Division of Colon and Rectal Surgery, Mayo Clinic Rochester MN, 200 First Street SW, Rochester, MN, 55905, USA
| | - David W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic Rochester MN, 200 First Street SW, Rochester, MN, 55905, USA
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Hallbeck MS, Law KE, Lowndes BR, Linden AR, Morrow M, Blocker RC, Cain SM, Degnim AC, Hieken TJ, Jakub JW, Racz JM, Farley DR, Nelson H, Boughey JC. Workload Differentiates Breast Surgical Procedures: NSM Associated with Higher Workload Demand than SSM. Ann Surg Oncol 2020; 27:1318-1326. [PMID: 31916090 PMCID: PMC7138769 DOI: 10.1245/s10434-019-08159-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Indexed: 01/02/2023]
Abstract
Background Breast surgery has evolved with more focus on improving cosmetic outcomes, which requires increased operative time and technical complexity. Implications of these technical advances in surgery for the surgeon are unclear, but they may increase intraoperative demands, both mentally and physically. We prospectively evaluated mental and physical demand across breast surgery procedures, and compared surgeon ergonomic risk between nipple-sparing (NSM) and skin-sparing mastectomy (SSM) using subjective and objective measures. Methods From May 2017 to July 2017, breast surgeons completed modified NASA-Task Load Index (TLX) workload surveys after cases. From January 2018 to July 2018, surgeons completed workload surveys and wore inertial measurement units to evaluate their postures during NSM and SSM cases. Mean angles of surgical postures, ergonomic risk, survey items, and patient factors were analyzed. Results Procedural duration was moderately related to surgeon frustration, mental and physical demand, and fatigue (p < 0.001). NSMs were rated 23% more physically demanding (M = 13.3, SD = 4.3) and demanded 28% more effort (M = 14.4, SD = 4.6) than SSMs (M = 10.8, SD = 4.7; M = 11.8, SD = 5.0). Incision type was a contributing factor in workload and procedural difficulty. Left arm mean angle was significantly greater for NSM (M = 30.1 degrees, SD = 6.6) than SSMs (M = 18.2 degrees, SD = 4.3). A higher musculoskeletal disorder risk score for the trunk was significantly associated with higher surgeon physical workload (p = 0.02). Conclusion Nipple-sparing mastectomy required the highest surgeon-reported workload of all breast procedures, including physical demand and effort. Objective measures identified the surgeons’ left upper arm as being at the greatest risk for a work-related musculoskeletal disorder, specifically from performing NSMs.
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Affiliation(s)
- M Susan Hallbeck
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. .,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA. .,Department of Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Katherine E Law
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Bethany R Lowndes
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Anna R Linden
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Melissa Morrow
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Renaldo C Blocker
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Stephen M Cain
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Amy C Degnim
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Heidi Nelson
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Surgeon Workload in Colorectal Surgery: Perceived Drivers of Procedural Difficulty. J Surg Res 2019; 245:57-63. [PMID: 31401248 DOI: 10.1016/j.jss.2019.06.084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/11/2019] [Accepted: 06/20/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND To understand how surgeon expectation of case difficulty relates to workload for colon and rectal procedures and to identify possible surgeon-perceived drivers contributing to case difficulty. MATERIALS AND METHODS For 3 mo, surgeons were asked to complete a modified NASA-Task Load Index (NASA-TLX) questionnaire following each surgical case. Questions included items on distractions, fatigue, procedural difficulty, and expectation plus the validated NASA-TLX items. All but expectation were rated on a 20-point scale (0 = low, 20 = high). Expectation was rated on a 3-point scale (i.e., more difficult than expected, as expected, less difficult than expected). Surgeons also reported perceived drivers contributing to case ease or difficulty. Patient and procedural data were analyzed for procedures with completed surveys. RESULTS Seven surgeons (three female) rated 122 procedures over the research period using a modified NASA-TLX survey. Mean surgeon-perceived workload was highest for effort (mean [M] = 10.83, standard deviation [SD] = 5.66) followed by mental demand (M = 10.18, SD = 5.17), and physical demand (M = 9.19, SD = 5.60). Procedural difficulty varied significantly by procedure type (P < 0.001). Thirty-five percent of cases were considered more difficult than expected. Surgeon-perceived workload and most subscales differed significantly according to expectation level. There was no significant difference in patient factors by expectation level. Surgeons most frequently reported patient anatomy, body habitus, and operative team characteristics as drivers to difficulty and ease of cases. CONCLUSIONS Procedural difficulty significantly differed across procedure type. More than one-third of cases were more difficult than expected, during which surgeons attributed this to operative team characteristics as well as issues in patient anatomy and body habitus.
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Bohl MA, McBryan S, Spear C, Pais D, Preul MC, Wilhelmi B, Yeskel A, Turner JD, Kakarla UK, Nakaji P. Evaluation of a Novel Surgical Skills Training Course: Are Cadavers Still the Gold Standard for Surgical Skills Training? World Neurosurg 2019; 127:63-71. [DOI: 10.1016/j.wneu.2019.03.230] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/24/2022]
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