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Kim JH, Ryu JM, Bae SJ, Ko BS, Choi JE, Kim KS, Cha C, Choi YJ, Lee HY, Nam SE, Kim Z, Kang YJ, Lee MH, Lee JE, Park E, Shin HJ, Kim MK, Choi HJ, Kwon SU, Son NH, Park HS, Lee J. Minimal Access vs Conventional Nipple-Sparing Mastectomy. JAMA Surg 2024:2822315. [PMID: 39141399 PMCID: PMC11325243 DOI: 10.1001/jamasurg.2024.2977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Importance While nipple-sparing mastectomy (NSM) for breast cancer was only performed using the open method in the past, its frequency using endoscopic and robotic surgical instruments has been increasing rapidly. However, there are limited studies regarding postoperative complications and the benefits and drawbacks of minimal access NSM (M-NSM) compared with conventional NSM (C-NSM). Objective To examine the differences in postoperative complications between C-NSM and M-NSM. Design, Setting, Participants This was a retrospective multicenter cohort study enrolling 1583 female patients aged 19 years and older with breast cancer who underwent NSM at 21 university hospitals in Korea between January 2018 and December 2020. Those with mastectomy without preserving the nipple-areolar complex (NAC), clinical or pathological malignancy in the NAC, inflammatory breast cancer, breast cancer infiltrating the chest wall or skin, metastatic breast cancer, or insufficient medical records were excluded. Data were analyzed from November 2021 to March 2024. Exposures M-NSM or C-NSM. Main Outcomes and Measures Clinicopathological factors and postoperative complications within 3 months of surgery were assessed. Statistical analyses, including logistic regression, were used to identify the factors associated with complications. Results There were 1356 individuals (mean [SD] age, 45.47 [8.56] years) undergoing C-NSM and 227 (mean [SD] age, 45.41 [7.99] years) undergoing M-NSM (35 endoscopy assisted and 192 robot assisted). There was no significant difference between the 2 groups regarding short- and long-term postoperative complications (<30 days: C-NSM, 465 of 1356 [34.29%] vs M-NSM, 73 of 227 [32.16%]; P = .53; <90 days: C-NSM, 525 of 1356 [38.72%] vs M-NSM, 73 of 227 [32.16%]; P = .06). Nipple-areolar complex necrosis was more common in the long term after C-NSM than M-NSM (C-NSM, 91 of 1356 [6.71%] vs M-NSM, 5 of 227 [2.20%]; P = .04). Wound infection occurred more frequently after M-NSM (C-NSM, 58 of 1356 [4.28%] vs M-NSM, 18 of 227 [7.93%]; P = .03). Postoperative seroma occurred more frequently after C-NSM (C-NSM, 193 of 1356 [14.23%] vs M-NSM, 21 of 227 [9.25%]; P = .04). Mild or severe breast ptosis was a significant risk factor for nipple or areolar necrosis (odds ratio [OR], 4.75; 95% CI, 1.66-13.60; P = .004 and OR, 8.78; 95% CI, 1.88-41.02; P = .006, respectively). Conversely, use of a midaxillary, anterior axillary, or axillary incision was associated with a lower risk of necrosis (OR for other incisions, 32.72; 95% CI, 2.11-508.36; P = .01). Necrosis occurred significantly less often in direct-to-implant breast reconstruction compared to other breast reconstructions (OR, 2.85; 95% CI, 1.11-7.34; P = .03). Conclusions and Relevance The similar complication rates between C-NSM and M-NSM demonstrates that both methods were equally safe, allowing the choice to be guided by patient preferences and specific needs.
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Affiliation(s)
- Joo Heung Kim
- Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Jai Min Ryu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soong June Bae
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Beom Seok Ko
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Eun Choi
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Ku Sang Kim
- Department of Surgery, Kosin University College of Medicine, Gospel Hospital, Busan, Korea
| | - Chihwan Cha
- Department of Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Young Jin Choi
- Department of Surgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Hye Yoon Lee
- Department of Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Sang Eun Nam
- Department of Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Young-Joon Kang
- Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
| | - Moo Hyun Lee
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Jong Eun Lee
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Eunhwa Park
- Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Hyuk Jai Shin
- Department of Surgery, Myongji Hospital, Hanyang University Medical Center, Goyang, Korea
| | - Min Kyoon Kim
- Department of Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Hee Jun Choi
- Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Seong Uk Kwon
- Department of Surgery, Konyang University Hospital, Daejeon, Korea
| | - Nak-Hoon Son
- Department of Statistics, Keimyung University, Daegu, Korea
| | - Hyung Seok Park
- Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jeeyeon Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
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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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Zadeh SM, MacDermid J, Johnson J, Birmingham TB, Shafiee E. Applications of wearable sensors in upper extremity MSK conditions: a scoping review. J Neuroeng Rehabil 2023; 20:158. [PMID: 37980497 PMCID: PMC10656914 DOI: 10.1186/s12984-023-01274-w] [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: 02/18/2023] [Accepted: 10/30/2023] [Indexed: 11/20/2023] Open
Abstract
PURPOSE This scoping review uniquely aims to map the current state of the literature on the applications of wearable sensors in people with or at risk of developing upper extremity musculoskeletal (UE-MSK) conditions, considering that MSK conditions or disorders have the highest rate of prevalence among other types of conditions or disorders that contribute to the need for rehabilitation services. MATERIALS AND METHODS The preferred reporting items for systematic reviews and meta-analysis (PRISMA) extension for scoping reviews guideline was followed in this scoping review. Two independent authors conducted a systematic search of four databases, including PubMed, Embase, Scopus, and IEEEXplore. We included studies that have applied wearable sensors on people with or at risk of developing UE-MSK condition published after 2010. We extracted study designs, aims, number of participants, sensor placement locations, sensor types, and number, and outcome(s) of interest from the included studies. The overall findings of our scoping review are presented in tables and diagrams to map an overview of the existing applications. RESULTS The final review encompassed 80 studies categorized into clinical population (31 studies), workers' population (31 studies), and general wearable design/performance studies (18 studies). Most were observational, with 2 RCTs in workers' studies. Clinical studies focused on UE-MSK conditions like rotator cuff tear and arthritis. Workers' studies involved industrial workers, surgeons, farmers, and at-risk healthy individuals. Wearable sensors were utilized for objective motion assessment, home-based rehabilitation monitoring, daily activity recording, physical risk characterization, and ergonomic assessments. IMU sensors were prevalent in designs (84%), with a minority including sEMG sensors (16%). Assessment applications dominated (80%), while treatment-focused studies constituted 20%. Home-based applicability was noted in 21% of the studies. CONCLUSION Wearable sensor technologies have been increasingly applied to the health care field. These applications include clinical assessments, home-based treatments of MSK disorders, and monitoring of workers' population in non-standardized areas such as work environments. Assessment-focused studies predominate over treatment studies. Additionally, wearable sensor designs predominantly use IMU sensors, with a subset of studies incorporating sEMG and other sensor types in wearable platforms to capture muscle activity and inertial data for the assessment or rehabilitation of MSK conditions.
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Affiliation(s)
- Sohrob Milani Zadeh
- Biomedical Engineering, Physical Therapy, Western University, London, ON, Canada.
| | - Joy MacDermid
- Physical Therapy and Surgery, Western University, London, ON, Canada
- Clinical Research Lab, Hand and Upper Limb Center, St. Joseph's Health Center, London, ON, Canada
- Rehabilitation Science McMaster University, Hamilton, ON, Canada
| | - James Johnson
- Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
| | - Trevor B Birmingham
- Biomedical Engineering, Physical Therapy, Western University, London, ON, Canada
| | - Erfan Shafiee
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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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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Burns HR, McCarter JH, King BW, Yu JZ, Hwang RF. Robotic-Assisted Nipple Sparing Mastectomy. Semin Plast Surg 2023; 37:176-183. [PMID: 38444956 PMCID: PMC10911906 DOI: 10.1055/s-0043-1771047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Minimally invasive approaches to breast surgery have evolved from endoscopic techniques to recent developments in robotic-assisted mastectomies. Initial studies on robotic-assisted nipple-sparing mastectomy (RNSM) have shown improved patient satisfaction and aesthetic outcomes with similar complication rates and oncological outcomes in selected patients. This chapter reviews techniques used and available data on complications and clinical outcomes for RNSM. Currently, RNSM is an investigational technique in the United States and should be performed in clinical trials with U.S. Food & Drug Administration approval to rigorously evaluate the safety and effectiveness of this approach.
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Affiliation(s)
- Heather R. Burns
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jacob H. McCarter
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Brody W. King
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jessie Z. Yu
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rosa F. Hwang
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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6
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Teller P, Nguyen TT, Tseng J, Allen L, Matsen CB, Bellavance E, Kaufman D, Hieken T, Nagel S, Patten C, Pomerenke L, Tevis SE, Sarantou T. Innovation in Breast Surgery: Practical and Ethical Considerations. Ann Surg Oncol 2022; 29:6144-6150. [PMID: 35854028 DOI: 10.1245/s10434-022-12136-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/02/2022] [Indexed: 12/18/2022]
Abstract
The adoption of innovation is essential to the evolution of patient care. Breast surgical oncology advances through incorporating new techniques, devices, and procedures. Historical changes in practice standards from radical to modified radical mastectomy or axillary node dissection to sentinel node biopsy reduced morbidity without sacrifice in oncologic outcome. Contemporary oncoplastic techniques afford broader consideration for breast conservation and the potential for improved cosmetic outcomes. At present, many breast surgeons face the decision of which wireless device to use for localization of nonpalpable lesions. Consideration for future changes, such as robotic mastectomy, are on the horizon. No guideline exists to assist breast surgeons in the adoption of innovation into practice. The Ethics Committee of the American Society of Breast Surgeons acknowledges that breast surgeons confront many questions associated with onboarding innovation. This paper aims to provide a framework for asking relevant questions along with the ethical principles to consider when integrating an innovation into practice.
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Affiliation(s)
| | | | | | - Lisa Allen
- Capital Health Center for Comprehensive Breast Care, Pennington, NJ, USA
| | - Cindy B Matsen
- Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | | | - Tina Hieken
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Steven Nagel
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Caitlin Patten
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | - Terry Sarantou
- Department of General Surgery, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA
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Go J, Ahn JH, Park JM, Choi SB, Lee J, Kim JY, Park HS. Analysis of robot-assisted nipple-sparing mastectomy using the da Vinci SP system. J Surg Oncol 2022; 126:417-424. [PMID: 35622078 DOI: 10.1002/jso.26915] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/24/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND As patients tend to be diagnosed with breast cancer at an early stage, the demand for better cosmetic outcomes has increased. Several studies revealed that robot-assisted nipple-sparing mastectomy (RNSM) shows favorable outcomes. The aim of the study was to reveal the feasibility of RNSM using the da Vinci single-port (SP) system with a minimal incision, hidden in the arm. METHODS From 2018 to 2021, 81 cases (70 patients) were retrospectively reviewed. Clinicopathologic characteristics, operative outcomes, and postoperative complications were evaluated. The operative outcomes were analyzed using the Mann-Whitney U test. RESULTS The median age was 42 years (range, 26-60 years). Bilateral RNSM was performed in 11 (27.2%) patients. The median size of the initial skin incision was 40 mm (range, 20-55 mm). Immediate reconstruction with direct-to-implant was performed in 54 (66.7%) patients and deep inferior epigastric perforator (DIEP) flaps in 15 (18.5%) patients. Postoperative complications of Clavien-Dindo Classification III occurred in six (7.5%) patients. Patients reconstructed with a DIEP flap had large breasts with more severe ptosis, yet grade III complications did not occur. CONCLUSIONS RNSM using the SP system can be applied for curative and risk-reducing mastectomy, regardless of breast size or ptosis grade.
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Affiliation(s)
- Jieon Go
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Hyun Ahn
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Min Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Bo Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jeea Lee
- Department of Surgery, Uijeongbu Eulji Medical Center Eulji University, Gyeonggi-do, Korea
| | - Jee Ye Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Park HS, Lee J, Lai HW, Park JM, Ryu JM, Lee JE, Kim JY, Marrazzo E, De Scalzi AM, Corso G, Montemurro F, Gazzetta G, Pozzi G, Toesca A. Surgical and Oncologic Outcomes of Robotic and Conventional Nipple-Sparing Mastectomy with Immediate Reconstruction: International Multicenter Pooled Data Analysis. Ann Surg Oncol 2022; 29:6646-6657. [PMID: 35583693 DOI: 10.1245/s10434-022-11865-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/20/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Robotic nipple-sparing mastectomy (RNSM) has been developed to reduce conspicuous scar and increase the quality of life in women. This study aimed to evaluate the surgical and oncologic outcomes of RNSM with immediate breast reconstruction (IBR) compared with conventional nipple-sparing mastectomy (CNSM). PATIENTS AND METHODS This international multicenter, pooled analysis of individual patient-level data enrolled a total of 755 procedures in 659 women (609 had breast cancer and 50 underwent risk-reducing mastectomy) who underwent nipple-sparing mastectomy with IBR. Surgical and oncologic outcomes, including 30-days postoperative (POD 30d) complication rate, nipple necrosis rate, grade of Clavien-Dindo classification, disease-free survival, and overall survival, were evaluated. Propensity score-matched analyses were performed to adjust for confounding factors. RESULTS The median age of both the RNSM and CNSM groups was 45 years. The RNSM group had lower body mass index (BMI) and a higher proportion of benign disease compared with the CNSM group. POD 30d complications and postoperative complication grade III rates were lower in the RNSM group than in the CNSM group (p < 0.05). The nipple necrosis rate was 2.2% and 7.8% for RNSM and CNSM, respectively (p = 0.002). After propensity score matching, significantly lower rates of POD 30d complications, nipple necrosis, and postoperative complication grade III occurred in the RNSM group than in the CNSM group (all p < 0.05). Oncologic outcomes were not significantly different between the two groups. CONCLUSION RNSM can provide better cosmetic results with favorable surgical and oncologic outcomes for women with early breast cancer or BRCA mutation.
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Affiliation(s)
- Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jeea Lee
- Department of Surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Gyeonggi-do, Korea
| | - Hung-Wen Lai
- Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan.,Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan.,Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jung Mi Park
- Department of Biostatistics and Computing, Graduate School, Yonsei University, Seoul, Korea
| | - Jai Min Ryu
- Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Eon Lee
- Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jee Ye Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Emilia Marrazzo
- Breast Unit, Department of Surgery, Ospedale Maggiore di Lodi, ASST di Lodi, Lodi, Italy
| | | | - Giovanni Corso
- Division of Breast Surgery, School of Medicine, European Institute of Oncology IRCCS, University of Milan, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Filippo Montemurro
- Breast Surgery Strategic Program, Candiolo Cancer Institute, FPO - IRCCS, Str. Provinciale 142, Candiolo, Torino, Italy
| | - Guglielmo Gazzetta
- Breast Surgery Strategic Program, Candiolo Cancer Institute, FPO - IRCCS, Str. Provinciale 142, Candiolo, Torino, Italy
| | - Giada Pozzi
- Breast Surgery Strategic Program, Candiolo Cancer Institute, FPO - IRCCS, Str. Provinciale 142, Candiolo, Torino, Italy
| | - Antonio Toesca
- Breast Surgery Strategic Program, Candiolo Cancer Institute, FPO - IRCCS, Str. Provinciale 142, Candiolo, Torino, Italy.
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Yuan S, Li Y, Zhang L, Wang H. The Relationship Between the NSP and the Individual and Work Organizational Variables: A Cross-Sectional Study. Front Public Health 2022; 10:726826. [PMID: 35433581 PMCID: PMC9009827 DOI: 10.3389/fpubh.2022.726826] [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] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To investigate the characteristics of neck-shoulder pain (NSP) and explore the potentional relationship between the NSP and the individual and work organizational variables. Methods A cross-sectional study was performed in the tertiary general hospitals in Hunan Province, China between May 2019 and July 2019. A total of 2,030 healthcare workers were enrolled randomly in this study based on a three-stage stratified sampling method. The Neck Disability Index (NDI) was used to measure disability in subjects with neck pain. A self-administered questionnaire was used to assess the characteristics of individual and work organizational variables. The Mann-Whitney U test and the Kruskal-Wallis H test were applied to analyze the prevalence of pain intensity among groups. Multivariate linear regression analysis was performed to explore the potentional relationship between NSP and individual and work organizational variables using the NDI score as the dependent variable. Results 2,008 of 2,030 healthcare workers filled out the survey questionnaires online. In the past 12 months, 1,489 participants (74.2%) complained of pain in the cervical-shoulder region. NDI score increased by 0.10 for each year of age, with healthcare workers working in Obstetrics and Gynecology, and the Operating Room less likely to have NSP than those working in other departments. In contrast, female healthcare workers with a history of pregnancy were more likely to have NSP. In terms of organizational factors, workers who received concern from their supervisor about their health, who had the choice to change their shift status to off duty when they were not feeling well, or who were informed about WMSDs were less likely to have NSP. Conclusion The prevalence of NSP within the previous year was high in this population. Individual factors including history of neck-shoulder diseases, age, and history of pregnancy and organizational factors including being adequately informed regarding WMSDs, concern from supervisors about workers' health, and the ability of workers to change their shift status to off duty when they were not feeling well were shown to induce significant effects to NSP.
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Affiliation(s)
- Sue Yuan
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China
- Xiangya Nursing School, Central South University, Changsha, China
| | - Yunxia Li
- Xiangya Nursing School, Central South University, Changsha, China
| | - Lihui Zhang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China
- Xiangya Nursing School, Central South University, Changsha, China
| | - Honghong Wang
- Xiangya Nursing School, Central South University, Changsha, China
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Kopkash K. ASO Author Reflections: How Do We Improve Ergonomics for the Breast Surgeon During Nipple-Sparing Mastectomies? Ann Surg Oncol 2021; 29:553. [PMID: 34383192 DOI: 10.1245/s10434-021-10606-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Katherine Kopkash
- NorthShore University HealthSystem, Breast Surgery, Evanston, IL, USA. .,University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
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11
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Kopkash K, Novak K, Murphy R, Deliere A, Kuchta K, Rabbitt S, Pesce C, Winchester D, Yao K. Improving the Breast Surgeon's Ergonomic Workload for Nipple-Sparing Mastectomies Using Exercise and Operating Room Positioning Protocol. Ann Surg Oncol 2021; 28:5698-5706. [PMID: 34318384 DOI: 10.1245/s10434-021-10447-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/16/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The objective of this study was to examine whether an exercise program and standardized operating room positioning protocol (EOPP) would improve surgeon muscle workload and/or surgeon perception of mental/physical workload for nipple-sparing mastectomy (NSM). METHODS This prospective study analyzed muscle workload by EMG of four surgeons performing NSM before and after an EOPP. Surveys were administered assessing surgeon perception of mental/physical workload. EMG data were analyzed using repeated-measures ANOVA, controlling for surgeon, first assistant, duration and difficulty of procedure, left or right side, and sequence of the procedure. RESULTS A total of 56 NSM cases performed by 3 surgeons were analyzed. One surgeon was excluded because of muscle injury and undergoing active physical therapy during the study period. After implementation of the EOPP, the left (P = 0.005) and right (P = 0.020) upper trapezii muscles had a significant decrease in overall ergonomic workload but there was no significant change in overall ergonomic workload for the bilateral cervical erector spinae, anterior deltoid, and lumbar erector spinae muscle groups. When analyzing muscle group exertion by surgeon, there was significant variability in all muscles except the left cervical erector spinae. Following the EOPP, surgeons reported that the procedures were more physically (P = 0.01) and mentally (P = 0.002) demanding and visualization (P = 0.04) was worse. The breast laterality and sequence did not affect muscle exertion. CONCLUSIONS An EOPP decreased the overall ergonomic workload of one muscle group for surgeons performing NSM but did not impact surgeon perception of mental/physical workload. Further investigation is needed to improve surgeon ergonomics.
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Affiliation(s)
- Katherine Kopkash
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. .,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
| | - Kevin Novak
- Department of Neurophysiology, NorthShore University HealthSystem, Evanston, IL, USA
| | | | - Amanda Deliere
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Kristine Kuchta
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Sarah Rabbitt
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Catherine Pesce
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - David Winchester
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Katharine Yao
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
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12
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Asgeirsson KS, Dixon JM, Darrigues L, Sarfati B, Macmillan RD. Multicenter Evaluation of Hydrodissection-Assisted Mastectomy (HAM). Ann Surg Oncol 2021; 28:4780-4781. [PMID: 33861405 DOI: 10.1245/s10434-021-09932-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/17/2021] [Indexed: 11/18/2022]
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13
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Norasi H, Tetteh E, Money SR, Davila VJ, Meltzer AJ, Morrow MM, Fortune E, Mendes BC, Hallbeck MS. Intraoperative posture and workload assessment in vascular surgery. APPLIED ERGONOMICS 2021; 92:103344. [PMID: 33359926 DOI: 10.1016/j.apergo.2020.103344] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/31/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
Quantifying the workload and postural demand on vascular surgeons provides valuable information on the physical and cognitive factors that predispose vascular surgeons to musculoskeletal pain and disorders. The aim of this study was to quantify the postural demand, workload, and discomfort experienced by vascular surgeons and to identify procedural factors that influence surgical workload. Both objective (wearable posture sensors) and subjective (surveys) assessment tools were used to evaluate intraoperative workload during 47 vascular surgery procedures. Results demonstrate unfavorable neck and low back postures as well as high pain scores for those body segments. Additionally, workload from subjective surveys increased significantly as a function of operative duration, and mental workload was high across all procedure types. Neck postural risk exposure and physical demand were among the variables that increased with surgical duration, procedure type, and loupes used by the surgeons. Correlations among postural angles and pain scores showed consistency between the objective assessment and the subjective surveys for neck and trunk. The authors believe that the results of this study highlight the need for developing mitigating measures such as ergonomic interventions for vascular surgery.
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Affiliation(s)
- Hamid Norasi
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA; Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Emmanuel Tetteh
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA; Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Melissa M Morrow
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Emma Fortune
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - M Susan Hallbeck
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA; Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Department of Surgery, Mayo Clinic, Rochester, MN, USA.
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14
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Huang J, Wang M, Chagpar A. Factors Affecting Total Operating Time in Patients Undergoing Mastectomy With and Without Reconstruction. Am Surg 2020; 87:1107-1111. [PMID: 33307721 DOI: 10.1177/0003134820973372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Operating room (OR) time varies significantly in patients undergoing mastectomy. We sought to determine factors influencing OR time such that more accurate predictions could be made. METHODS Records of patients undergoing mastectomy at our institution between January 2010 and June 2018 were reviewed. Operating Room time was defined as time from incision to dressing. Nonparametric analyses were performed to determine factors associated with OR time. A predictive model using linear regression was created on a training set and evaluated in a separate testing set. RESULTS Our cohort included 1008 female patients who underwent either unilateral or bilateral mastectomy (BM), with or without reconstruction, and with or without concomitant axillary lymph node staging at our institution. The median OR time was 4.67 hours (range; .70-16.35 hours). To create a predictive model, we divided our cohort into a training set of 504 patients and a testing set of 504 patients. Across the training set, body mass index (BMI), BM, nonconventional mastectomies, intraoperative frozen sections, receipt of neoadjuvant chemotherapy, and reconstruction were associated with longer OR times on linear regression. A model generated from these findings on the training set was run on the testing set (Pearson correlation = .743 for predicted vs. actual OR times, P < .001). CONCLUSION A number of preoperative factors such as BMI, unilateral vs. BM, type of mastectomy and reconstruction, use of intraoperative frozen sections, and receipt of neoadjuvant chemotherapy can influence OR times. Accurate predictions can be made using a simple model incorporating these factors.
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Affiliation(s)
- Julian Huang
- Department of Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Melinda Wang
- Department of Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Anees Chagpar
- Department of Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
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15
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Park KU, Tozbikian GH, Ferry D, Tsung A, Chetta M, Schulz S, Skoracki R. Residual breast tissue after robot-assisted nipple sparing mastectomy. Breast 2020; 55:25-29. [PMID: 33310481 PMCID: PMC7726449 DOI: 10.1016/j.breast.2020.11.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction While the long-term oncologic safety of robot-assisted nipple sparing mastectomy (RNSM) remains to be elucidated, histologically detected residual breast tissue (RBT) can be a surrogate for oncologically sound mastectomy. The objective of this study is to determine the presence of RBT after RNSM. Methods Between August 2019–January 2020, we completed 5 cadaveric RNSMs. Full thickness biopsies from the mastectomy skin flap were obtained from predefined locations radially around the mastectomy skin envelop and nipple areolar complex to histologically evaluate for RBT. Results The first case was not technically feasible due to inability to obtain adequate insufflation. Five mastectomy flaps were analyzable. The average mastectomy flap thickness was 2.3 mm (range 2–3 mm) and the average specimen weight was 382.72 g (range 146.9–558.3 g). Of 70 total biopsies, RBT was detected in 11 (15.7%) biopsies. Most common location for RBT was in the nipple-areolar complex, with no RBT detected from the peripheral skin flaps. Conclusions In this cadaveric study, RNSM is feasible leaving minimal RBT on the mastectomy flap. The most common location for RBT is in the periareolar location consistent with previous published findings after open NSM. Clinical studies are underway to evaluate the safety of RNSM. Robot-assisted nipple sparing mastectomy (RNSM) is technically feasible. Residual breast tissue after RNSM is histologically detected only from the periareolar location. Further clinical trials are underway to determine oncologic safety of RNSM.
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Affiliation(s)
- Ko Un Park
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center James Cancer Hospital, Columbus, OH, USA.
| | - Gary H Tozbikian
- Department of Pathology, The Ohio State University Wexner Medical Center James Cancer Hospital, Columbus, OH, USA.
| | - David Ferry
- Robotic Surgery Program, The Ohio State University Wexner Medical Center James Cancer Hospital, Columbus, OH, USA.
| | - Allan Tsung
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center James Cancer Hospital, Columbus, OH, USA.
| | - Mathew Chetta
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center James Cancer Hospital, Columbus, OH, USA.
| | - Steven Schulz
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center James Cancer Hospital, Columbus, OH, USA.
| | - Roman Skoracki
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center James Cancer Hospital, Columbus, OH, USA.
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16
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Kilinc D, Shahraki N, Gel ES, Degnim AC, Hoskin T, Sir MY, Pasupathy KS. Using operative features to identify surgical complexity: a case in breast surgery practice. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:6070-6073. [PMID: 33019355 DOI: 10.1109/embc44109.2020.9176030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Increasing workload is one of the main problems that surgical practices face. This increase is not only due to the increasing demand volume but also due to increasing case complexity. This raises the question on how to measure and predict the complexity to address this issue. Predicting surgical duration is critical to parametrize surgical complexity, improve surgeon satisfaction by avoiding unexpected overtime, and improve operation room utilization. Our objective is to utilize the historical data on surgical operations to obtain complexity groups and use this groups to improve practice.Our study first leverages expert opinion on the surgical complexity to identify surgical groups. Then, we use a tree-based method on a large retrospective dataset to identify similar complexity groups by utilizing the surgical features and using surgical duration as a response variable. After obtaining the surgical groups by using two methods, we statistically compare expert-based grouping with the data-based grouping. This comparison shows that a tree-based method can provide complexity groups similar to the ones generated by an expert by using features that are available at the time of surgical listing. These results suggest that one can take advantage of available data to provide surgical duration predictions that are data-driven, evidence-based, and practically relevant.
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17
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Yang L, Wang T, Weidner TK, Madura JA, Morrow MM, Hallbeck MS. Intraoperative musculoskeletal discomfort and risk for surgeons during open and laparoscopic surgery. Surg Endosc 2020; 35:6335-6343. [PMID: 33083930 DOI: 10.1007/s00464-020-08085-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/03/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Surgeon workload is significant both mentally and physically and may differ by procedure type. When comparing laparoscopic surgery and open surgery, studies have reported contrasting results on the physical and mental workload assessed. METHODS Wearable posture sensors and pre-/post-surgical questionnaires were employed to assess intraoperative workload and to identify risk factors for surgeons using objective and subjective measures. RESULTS Data from 49 cases (27 open and 22 laparoscopic surgeries performed by 13 male and 11 female surgeons) were assessed. More than half the surgeons reported a clinically relevant post-surgical fatigue score. The surgeons also self-reported a significant increase in pain for the neck, upper back, and lower back during/after surgery. Procedural time had significant impacts on fatigue, body part pain, and subjective (NASA-TLX) workload. The objectively assessed intraoperative work postures using wearable sensors showed a high musculoskeletal risk for neck and lower back based on their posture overall. Open surgeries had significantly larger neck angles (median [IQR]: 40 [28-47]°) compared with laparoscopic surgeries (median [IQR]: 23 [16-29]°), p < 0.001) and torso (median [IQR]: 17 [14-22]° vs. 13 [10-17]°, p = 0.006). CONCLUSION Surgeons reported significantly higher levels of fatigue and pain in the neck and lower back during or after performing a surgical case. Longer procedural time resulted in more self-rated fatigue, pain, and subjective workload. Open surgery had higher postural risk. Overall, surgeons spent a disturbingly high percentage of time during surgery in high-risk musculoskeletal postures, especially the neck. These results show that intraoperative postural risk is very high and that interventions are necessary to protect surgeon musculoskeletal health for optimal surgeon performance and career longevity.
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Affiliation(s)
- Liyun Yang
- Department of Health Sciences Research, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Ergonomics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Tianke Wang
- Department of Health Sciences Research, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Tiffany K Weidner
- Department of General Surgery, Mayo Clinic, Phoenix, AZ, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Phoenix, AZ, USA
| | - James A Madura
- Department of General Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Melissa M Morrow
- Department of Health Sciences Research, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - M Susan Hallbeck
- Department of Health Sciences Research, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, 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.
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18
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Cavalcante FP. Nipple-Sparing Mastectomy: Outcomes Discussion. J Am Coll Surg 2020; 231:605. [PMID: 32951982 DOI: 10.1016/j.jamcollsurg.2020.08.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
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19
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Hallbeck MS, Law KE, Boughey JC. ASO Author Reflections: Poor Ergonomics During Surgical Procedures May Lead to Work-Related Pain and Early Retirement. Ann Surg Oncol 2020; 27:1327-1328. [PMID: 32112208 DOI: 10.1245/s10434-020-08277-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Indexed: 11/18/2022]
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
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