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Wuopio A, Baker BM, Koethe B, Goodman MD, Shin R, Bugaev N, Nepomnayshy D, Kim WC, Schnelldorfer T. Can Surgeons Reliably Identify Non-cirrhotic Liver Disease During Laparoscopic Bariatric Surgery? Obes Surg 2024; 34:769-777. [PMID: 38280161 DOI: 10.1007/s11695-024-07070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
INTRODUCTION Identification of liver disease during bariatric operations is an important task given the patients risk for occult fatty liver disease. Surgeon's accuracy of assessing for liver disease during an operation is poorly understood. The objective was to measure surgeons' performance on intra-operative visual assessment of the liver in a simulated environment. METHODS Liver images from 100 patients who underwent laparoscopic bariatric surgery and pre-operative ultrasound elastography between July 2020 and July 2021 were retrospectively evaluated. The perception of 15 surgeons regarding the degree of hepatic steatosis and fibrosis was collected in a simulated clinical environment by survey and compared to results determined by ultrasonographic exam. RESULTS The surgeons' ability to correctly identify the class of steatosis and fibrosis was poor (accuracy 61% and 59%, respectively) with a very weak correlation between the surgeon's predicted class and its true class (r = 0.17 and r = 0.12, respectively). When liver disease was present, surgeons completely missed its presence in 26% and 51% of steatosis and fibrosis, respectively. Digital image processing demonstrated that surgeons subjectively classified steatosis based on the "yellowness" of the liver and fibrosis based on texture of the liver, despite neither correlating with the true degree of liver disease. CONCLUSION Laparoscopic visual assessment of the liver surface for identification of non-cirrhotic liver disease was found to be an inaccurate method during laparoscopic bariatric surgery. While validation studies are needed, the results suggest the clinical need for alternative approaches.
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Affiliation(s)
- Alexandra Wuopio
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, 01805, USA
| | | | - Benjamin Koethe
- Tufts Clinical and Translational Science Institute, Tufts University, and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, 02111, USA
| | - Martin D Goodman
- Department of Surgery, Tufts Medical Center, Boston, MA, 02111, USA
| | - Reuben Shin
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, 01805, USA
| | - Nikolay Bugaev
- Department of Surgery, Tufts Medical Center, Boston, MA, 02111, USA
| | - Dmitry Nepomnayshy
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, 01805, USA
| | - Woon Cho Kim
- Department of Surgery, Tufts Medical Center, Boston, MA, 02111, USA
| | - Thomas Schnelldorfer
- Department of Surgery, Tufts Medical Center, Boston, MA, 02111, USA.
- Department of Translational Research, Lahey Hospital and Medical Center, Burlington, MA, 01805, USA.
- Surgical Imaging Lab, Tufts Medical Center, Boston, MA, 02111, USA.
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Ricard C, Plewa D, Vernamonti J, Scott EM, Nepomnayshy D, Benoit E. Needs Assessment for a Resuscitative Thoracotomy Curriculum for General Surgery Residents in the Northeast Region. J Surg Educ 2023; 80:1843-1849. [PMID: 37770295 DOI: 10.1016/j.jsurg.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/21/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Resuscitative thoracotomy (RT) is a high-acuity low occurrence (HALO) procedure with which general surgical resident (GSR) experience and confidence are unknown. We sought to identify and describe this educational gap by conducting a targeted needs assessment for an RT curriculum for GSRs. METHODS An online regional needs assessment survey was conducted for an RT curriculum for GSRs. The survey was developed by a group of trauma stakeholders and revised after being piloted on a small, representative group of GSRs. We surveyed GSRs in the Northeast region regarding their experience and confidence with RT; interest in an RT curriculum; and content, format, and scope for an RT curriculum. RESULTS The survey response rate was 43%, reflecting the viewpoints of GSRs at 8 major training centers across the Northeast. Only 13% of respondents were interested in pursuing a career in Trauma and Critical Care despite 97% of them training at a Level I Trauma Center. Twenty-nine percent and 33% of GSRs had ever assisted with or performed RT, respectively. Twenty-one percent of GSRs reported feeling confident performing RT. Most respondents (98%) agreed or strongly agreed that an RT curriculum would add value to their general surgery education. The most positively rated content topics were resuscitative maneuvers (100% positive responses [PR]), when to cease resuscitative efforts (100% PR), and morbidity and mortality associated with RT (98% PR). The most highly rated learning methods were individual RT simulation time (97% PR) and a tour of the trauma bay equipment (97% PR). CONCLUSIONS This needs assessment demonstrates a lack of experience and confidence with RT, a strong learner interest in an RT curriculum, and a desire for experiential learning methods. Learning objectives are defined herein, and the next steps involve developing educational materials for an RT curriculum for GSRs.
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Affiliation(s)
- Caroline Ricard
- Simulation Department, Lahey Hospital and Medical Center, Burlington, Massachusetts.
| | - Deanna Plewa
- Simulation Department, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Jack Vernamonti
- General Surgery Department, Maine Medical Center, Portland, Maine
| | - Erin M Scott
- General Surgery Department, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Dmitry Nepomnayshy
- Simulation Department, Lahey Hospital and Medical Center, Burlington, Massachusetts; General Surgery Department, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Eric Benoit
- General Surgery Department, Lahey Hospital and Medical Center, Burlington, Massachusetts; Trauma and Acute Care Surgery Department, Lahey Hospital and Medical Center, Burlington Massachusetts
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Seymour NE, Nepomnayshy D, De S, Banks E, Breitkopf DM, Campagna R, Gomez-Garibello C, Green I, Jacobsen G, Korndorffer JR, Minasi J, Okrainec A, Matthew Ritter E, Sankaranarayanan G, Schwaitzberg S, Soper NJ, Vassiliou M, Wagner M, Zevin B. What are essential laparoscopic skills these days? Results of the SAGES Fundamentals of Laparoscopic Surgery (FLS) Committee technical skills survey. Surg Endosc 2023; 37:7676-7685. [PMID: 37517042 DOI: 10.1007/s00464-023-10238-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 06/12/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION The Fundamentals of Laparoscopic Surgery (FLS) program tests basic knowledge and skills required to perform laparoscopic surgery. Educational experiences in laparoscopic training and development of associated competencies have evolved since FLS inception, making it important to review the definition of fundamental laparoscopic skills. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) assigned an FLS Technical Skills Working Group to characterize technical skills used in basic laparoscopic surgery in current practice contexts and their possible application to future FLS tests. METHODS A group of subject matter experts defined an inventory of 65 laparoscopic skills using a Nominal Group Technique. From these, a survey was developed rating these items for importance, frequency of use, and priority for testing for FLS certification. This survey was distributed to SAGES members, recent recipients of FLS certification, and members of the Association of Program Directors in Surgery (APDS). Results were collected using a secure web-based survey platform. RESULTS Complete data were available for 1742 surveys. Of these, 1143 comprised results for post-residency participants who performed advanced procedures. Seventeen competencies were identified for FLS testing prioritization by determining the proportion of respondents who identified them of highest priority, at median (50th percentile) of the maximum survey scale rating. These included basic peritoneal access, laparoscope and instrument use, tissue manipulation, and specific problem management skills. Sixteen could be used to show appropriateness of the domain construct by confirmatory factor analysis. Of these 8 could be characterized as manipulative tasks. Of these 5 mapped to current FLS tasks. CONCLUSIONS This survey-identified competencies, some of which are currently assessed in FLS, with a high level of priority for testing. Further work is needed to determine if this should prompt consideration of changes or additions to the FLS technical skills test component.
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Affiliation(s)
- Neal E Seymour
- Department of Surgery, University of Massachusetts Chan Medical School-Baystate Health, 759 Chestnut Street, Springfield, MA, 01199, USA.
| | - Dmitry Nepomnayshy
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Suvranu De
- College of Engineering, Florida A&M University, Tallahassee, FL, USA
| | - Erika Banks
- Department of Obstetrics & Gynecology, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Daniel M Breitkopf
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Ryan Campagna
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Isabel Green
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Garth Jacobsen
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - James R Korndorffer
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - John Minasi
- Bon Secours Medical Group, Greenville, SC, USA
| | - Allan Okrainec
- Department of Surgery, University of Toronto, Toronto, Canada
| | - E Matthew Ritter
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Steven Schwaitzberg
- Department of Surgery, University at Buffalo Jacobs School of Medicine & Biomedical Sciences, Buffalo, NY, USA
| | - Nathaniel J Soper
- Department of Surgery, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
| | | | - Maryam Wagner
- Institute of Health Sciences Education, McGill University, Montreal, Canada
| | - Boris Zevin
- Department of Surgery, Queen's University School of Medicine, Kingston, ON, USA
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Esposito AC, Coppersmith NA, White EM, Papageorge MV, DiSiena M, Hess D, LaFemina J, Larkin AC, Miner TJ, Nepomnayshy D, Palesty J, Rosenkranz KM, Seymour NE, Trevisani G, Whiting J, Oliveira KD, Longo WE, Yoo PS. Update on the Financial Well-Being of Surgical Residents in New England. J Am Coll Surg 2023; 236:953-960. [PMID: 36622076 DOI: 10.1097/xcs.0000000000000544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Poor personal financial health has been linked to key components of health including burnout, substance abuse, and worsening personal relationships. Understanding the state of resident financial health is key to improving their overall well-being. STUDY DESIGN A secondary analysis of a survey of New England general surgery residents was performed to understand their financial well-being. Questions from the National Financial Capability Study were used to compare to an age-matched and regionally matched cohort. RESULTS Overall, 44% (250 of 570) of surveyed residents responded. Residents more frequently reported spending less than their income each year compared to the control cohort (54% vs 34%, p < 0.01). However, 17% (39 of 234) of residents reported spending more than their income each year. A total of 65% of residents (152 of 234), found it "not at all difficult" to pay monthly bills vs 17% (76 of 445) of the control cohort (p < 0.01). However, 32% (75 of 234) of residents reported it was "somewhat" or "very" difficult to pay monthly bills. Residents more frequently reported they "certainly" or "probably" could "come up with" $2,000 in a month compared to the control cohort (85% vs 62% p < 0.01), but 16% (37 of 234) of residents reported they could not. In this survey, 21% (50 of 234) of residents reported having a personal life insurance policy, 25% (59 of 234) had disability insurance, 6% (15 of 234) had a will, and 27% (63 of 234) had >$300,000 worth of student loans. CONCLUSIONS Surgical residents have better financial well-being than an age-matched and regionally matched cohort, but there is still a large proportion who suffer from financial difficulties.
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Affiliation(s)
- Andrew C Esposito
- From the Yale School of Medicine, Department of Surgery, New Haven, CT (Esposito, Coppersmith, White, Papageorge, Oliveira, Longo, Yoo)
| | - Nathan A Coppersmith
- From the Yale School of Medicine, Department of Surgery, New Haven, CT (Esposito, Coppersmith, White, Papageorge, Oliveira, Longo, Yoo)
| | - Erin M White
- From the Yale School of Medicine, Department of Surgery, New Haven, CT (Esposito, Coppersmith, White, Papageorge, Oliveira, Longo, Yoo)
| | - Marianna V Papageorge
- From the Yale School of Medicine, Department of Surgery, New Haven, CT (Esposito, Coppersmith, White, Papageorge, Oliveira, Longo, Yoo)
| | - Michael DiSiena
- Berkshire Medical Center, Department of Surgery, Pittsfield, MA (DiSiena)
| | - Donald Hess
- Boston Medical Center, Department of Surgery, Boston, MA (Hess)
| | - Jennifer LaFemina
- the University of Massachusetts Chan Medical School, Department of Surgery, Worcester, MA (LaFemina, Larkin)
| | - Anne C Larkin
- the University of Massachusetts Chan Medical School, Department of Surgery, Worcester, MA (LaFemina, Larkin)
| | - Thomas J Miner
- Rhode Island Hospital, Warren Alpert Medical School, Department of Surgery, Providence, RI (Miner)
| | - Dmitry Nepomnayshy
- Lahey Hospital and Medical Center, Department of Surgery, Burlington, MA (Nepomnayshy)
| | - John Palesty
- Saint Mary's Hospital, Department of Surgery, Waterbury, CT (Palesty)
| | - Kari M Rosenkranz
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Lebanon, NH (Rosenkranz)
| | - Neal E Seymour
- Baystate Health, Department of Surgery, Springfield, MA (Seymour)
| | - Gino Trevisani
- the University of Vermont Medical Center, Department of Surgery, Burlington, VT (Trevisani)
| | - James Whiting
- Maine Medical Center, Department of Surgery, Portland, ME (Whiting)
| | - Kristin D Oliveira
- From the Yale School of Medicine, Department of Surgery, New Haven, CT (Esposito, Coppersmith, White, Papageorge, Oliveira, Longo, Yoo)
| | - Walter E Longo
- From the Yale School of Medicine, Department of Surgery, New Haven, CT (Esposito, Coppersmith, White, Papageorge, Oliveira, Longo, Yoo)
| | - Peter S Yoo
- From the Yale School of Medicine, Department of Surgery, New Haven, CT (Esposito, Coppersmith, White, Papageorge, Oliveira, Longo, Yoo)
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Rade M, Jayaram A, Birkett R, Ford H, Birkett D, Nepomnayshy D. A randomized, double-blinded, placebo-controlled trial of the effects of infusing local analgesia on post-operative pain during laparoscopic inguinal hernia repair. Surg Endosc 2023; 37:1970-1975. [PMID: 36266481 DOI: 10.1007/s00464-022-09697-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/29/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE While it is widely accepted that laparoscopic total extraperitoneal (TEP) inguinal herniorrhaphy has decreased post-operative pain, there are conflicting data as to whether instillation of local anesthetic into the preperitoneal space improves post-operative pain in these patients. We designed a prospective study to evaluate this. Secondary outcomes include time spent in the PACU, need for narcotic pain medication, and total amount of narcotics required postoperatively. METHODS Prospective, randomized, double-blind, placebo-controlled study which enrolled 70 patients with unilateral non-recurrent inguinal hernia from 09/2013 to 03/2019 and included immediate and 2-week post-operative follow-up. All patients received unilateral laparoscopic TEP inguinal hernia repair with control patients receiving 10 ml of 0.9% saline instilled into preperitoneal space while treatment group received 10-ml 0.5% bupivacaine without epinephrine. RESULTS A total of 70 patients [67 (96%) men and 3 women; mean age (SD), 57 years (13.8)] were enrolled, 35 randomized into each group. Demographics between the two groups were similar. No differences were found in post-operative pain between the control and test groups at 1 h [mean (SD) of 3.15(2.5) vs 3.21(2.9); P = 0.92], 2 h [3.39 (1.55) vs 2.74 (1.85) P = 0.18], or 1 day [4.79 (2.19) vs 4.39 (2.37); P = 0.13] postoperatively. Likewise, no significant differences were observed in usage of narcotic pain medication postoperatively, as 17 control patients (50%) and 16 (46%) study patients required narcotics within 2 h of surgery (P = 0.72). CONCLUSION Instilling local anesthetic into the preperitoneal space during laparoscopic TEP inguinal hernia repair did not result in statistically significant difference in post-operative pain (Rade et al. in NESS Annual Meeting, 2021). Trial registry ClinicalTrials.gov Identifier: NCT02055053.
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Affiliation(s)
- Matthew Rade
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA.
- Umass Memorial Medical Group General Surgery, 91 Water Street, Milford, MA, 01757, USA.
| | | | - Richard Birkett
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Heather Ford
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Desmond Birkett
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Dmitry Nepomnayshy
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
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Gabrysz-Forget F, Zahabi S, Young M, Nepomnayshy D, Nguyen LH. "It's a Big Part of Being Good Surgeons": Surgical Trainees' Perceptions of Error Recovery in the Operating Room. J Surg Educ 2021; 78:2020-2029. [PMID: 33888440 DOI: 10.1016/j.jsurg.2021.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 03/13/2021] [Accepted: 03/21/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The burden of surgical error is high - errors threaten patient safety, lead to increased economic costs to society, and contribute to physician and resident burnout. To date, the majority of work has focused on strategies for reducing the incidence of surgical error, however, total error eradication remains unrealistic. Errors are, to some extent, unavoidable. Adequate preparation for practice should include optimal ways to manage and recover from errors; yet, these skills are rarely taught or assessed. OBJECTIVES This study aims to explore residents' perceptions and experiences of surgical error recovery. More specifically, we documented participant definitions of error recovery, and explored factors that were perceived to influence error recovery experiences and training in the operating room. METHOD Guided by a qualitative descriptive approach, we conducted semi-structured interviews with residents and fellows in surgical specialties in Canada and the United States. Purposive and snowball sampling were used to recruit residents and fellows in postgraduate year 1 to 5. Interviews were transcribed, analyzed and inductively coded. RESULTS A total of 15 residents and fellows participated. When exploring the importance of error recovery for the trainees, competency and safety emerged as main themes, with error recovery being considered an indicator of overall surgical competency. Data concerning factors perceived to influence error recovery training were grouped under 4 major themes: (1) supervision (supervisor-related factors such as attending behaviors and reactions to errors), (2) self (factors such as self-assessed competency), (3) surgical context (factors related to the specific surgery or patient), and (4) situation safeness. Situational safeness was identified as a transversal theme describing factors to be considered when balancing between patient safety and the learning benefits of error recovery training. CONCLUSION Error recovery was considered to be an important skill for safe surgical practice and was considered an important educational target for learners during surgical training. Trainees' opportunities to learn to recover from technical errors in the OR are perceived to be influenced by several factors, leading to variable experiences and inconsistent opportunities to practice error recovery skills. Focusing on factors related to "supervision," "self," "surgery," and "situational safeness" may be an initial framework on which to build initial educational interventions to support the development of error recovery skills to better support safe surgical practice.
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Affiliation(s)
- Fanny Gabrysz-Forget
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Department of Medicine, Montreal, Quebec, Canada
| | - Sarah Zahabi
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Meredith Young
- Institute for Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Dmitry Nepomnayshy
- Center for Professional Development and Simulation, Lahey Health, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Lily Hp Nguyen
- Institute for Health Sciences Education, McGill University, Montreal, Quebec, Canada; Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.
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Gleason A, Singh G, Keffer L, Nepomnayshy D. General Surgery Going Viral: Current Trends in Social Media Utilization by General Surgery Residency Programs. J Surg Educ 2021; 78:e62-e67. [PMID: 34782270 DOI: 10.1016/j.jsurg.2021.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/09/2021] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study examined the current and changing trends in utilization of social media platforms by general surgery residency programs. DESIGN US general surgery residency programs were identified. Facebook, Instagram, and Twitter were surveyed for active accounts specific to an institution's general surgery residency program. Metrics for these accounts included: Date of first post/date of account creation, total number of posts, number of followers, number of posts categorized per year for 2017, 2018, 2019, 2020, and 2021. Active accounts were categorized into university based, university affiliated, or independent programs. Number of followers and the number of posts were compared among those categories. Data collection took place from 7/21/2021 - 8/2/2021. RESULTS 295 social media accounts were identified. 55% of all programs have at least one social media account. Instagram (47.8%) and Twitter (36.3%) make up the majority of the social media accounts. The majority of all social media accounts (51.2%) were created in 2020. Instagram saw the largest increase in activity in 2020 with posting increasing by 403.7% compared to 2019. Twitter accounts had the highest amount of posts in 2020 (9940). Instagram accounts have the highest follower base (113,499). Facebook also saw increased posting in 2020 but its overall account creation has remained stagnant. University based program accounts have higher on average followers and posts when compared to independent program accounts. CONCLUSION Social media accounts specific to general surgery residency programs have grown steadily in the past few years, with a dramatic rise of account creation and activity in 2020. Instagram and Twitter serve as the dominant platforms for new account creation and activity. University based programs attract more followers than independent programs on Instagram and Twitter.
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Affiliation(s)
- Augustus Gleason
- Lahey Hospital and Medical Center Simulation Lab, Lahey Hospital and Medical Center, Burlington, Massachusetts.
| | - Ganeev Singh
- Tufts University School of Medicine, Boston, Massachusetts
| | - Luke Keffer
- Tufts University School of Medicine, Boston, Massachusetts
| | - Dmitry Nepomnayshy
- Division of Bariatric and Minimally Invasive Surgery, LHMC Surgical Simulation Lab, Lahey Hospital and Medical Center, Burlington, Massachusetts
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Jayaram A, Nepomnayshy D, Brams DM, Tortorici S. Surgical Weight Loss Patient Experience with Telehealth During Covid-19: Should Telehealth Remain an Option after the Pandemic? J Am Coll Surg 2021. [PMCID: PMC8531611 DOI: 10.1016/j.jamcollsurg.2021.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gabrysz-Forget F, Young M, Zahabi S, Nepomnayshy D, Nguyen LHP. Surgical Errors Happen, but Are Learners Trained to Recover from Them? A Survey of North American Surgical Residents and Fellows. J Surg Educ 2020; 77:1552-1561. [PMID: 32694084 DOI: 10.1016/j.jsurg.2020.05.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/12/2020] [Accepted: 05/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Surgical training necessitates graded supervision and supported independence in order to reach competence. In developing surgical skills, trainees can, and will, make mistakes. A key skill required for independent practice is the ability to recover from an error or unexpected complication. Error recovery includes recognizing and managing a technical error in order to ensure patient safety and may be underrepresented in current educational approaches. OBJECTIVE The purpose of this study is to explore residents' experiences and perceptions of error recovery training in surgical procedures. METHOD An online survey was sent to surgical program directors in the United States and Canada using the Accreditation Council for Graduate Medical Education and the Royal College of Physicians and Surgeons of Canada distribution lists. Participating programs distributed the survey to their residents and fellows. The survey was composed of Likert-scale items, yes/no questions as well as open-ended questions focused on perceptions, experiences, and factors that influence to error recovery training in the operating room. RESULTS A total of 206 surveys were completed. Overall, 99% (n = 203) agreed or strongly agreed that error recovery is an important competency for future practice. This was reflected in free-text response: "Errors can be minimized but they are inevitable, so certainly believe a surgical curriculum that addresses error recovery is of paramount importance." While 83% (n = 170) feel confident recovering from minor errors, only 34% (n = 68) feel confident that they could recover from major errors that are likely to have serious consequences on patient safety. Overall, residents do not consider that they have adequate training in error recovery, with only 37% (n = 72) felt they were adequately trained to recover from major errors. It was also mentioned "The quality of learning regarding error recovery depends entirely on the attending." CONCLUSIONS Opportunities to learn to recover from technical errors in the operating room are valued by surgical trainees, but they perceive their training to be both inadequate and variable. This contributes to a lack of confidence in error recovery skills throughout their surgical training. There is a need to explore how best to integrate error recovery into more formal surgical curricula in order to better support learners and, ultimately, contribute to increased surgical safety.
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Affiliation(s)
- Fanny Gabrysz-Forget
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Center for Professional Development and Simulation, Lahey Health, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Meredith Young
- Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada; Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sarah Zahabi
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Dmitry Nepomnayshy
- Center for Professional Development and Simulation, Lahey Health, Beth Israel Lahey Health, Burlington, Massachusetts; Department of Surgery, Lahey Health, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Lily H P Nguyen
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada; Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada.
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Gabrysz-Forget F, Bonds M, Lovett M, Alseidi A, Ghaderi I, Nepomnayshy D. Practicing on the Advanced Training in Laparoscopic Suturing Curriculum (ATLAS): Is Mastery Learning in Residency Feasible to Achieve Expert-Level Performance in Laparoscopic Suturing? J Surg Educ 2020; 77:1138-1145. [PMID: 32184062 DOI: 10.1016/j.jsurg.2020.02.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/25/2020] [Accepted: 02/23/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Mastery learning assumes that given enough time and appropriate instructional strategies, most trainees will be able to achieve proficiency. Expert-level performance requires numerous hours of intensive and focus practice. We aimed to study whether it was possible for surgical trainees to achieve expert-derived proficiency level in laparoscopic suturing using the Advanced Training in Laparoscopic Suturing (ATLAS) curriculum over a short period of time. STUDY DESIGN A multicenter IRB approved prospective study included surgery residents and minimally invasive fellows. Participants underwent weekly supervised instruction and assessments of ATLAS skills and self-directed practice between sessions over 12 weeks. Participants were asked to practice until they achieved previously established proficiency benchmarks of expert laparoscopic surgeons. RESULTS Fifteen participants, PGY2 to PGY6, from 3 institutions practiced on the ATLAS curriculum. Three participants were able to achieve proficiency on the entire curriculum, with a cumulative practice time varying between 3.4 and 7.6 hours. Individual tasks had varying degrees of difficulty ranging from 85% proficiency on task 1 to 33.3% proficiency for task 6. Using a mixed-method model, the mean cumulative hours of practice to reach the benchmark threshold was estimated for each task and varied from 4.5 to 13.2 hours. The improved performance was associated with higher PGY level and proficiency in FLS. CONCLUSIONS This study demonstrates that it is possible for some senior surgical trainees to achieve proficiency in an expert-level laparoscopic suturing curriculum. This study establishes a learning curve for each ATLAS individual task. Some learners may not be able to achieve proficiency on the entire curriculum over a short period of practice. Additional studies are needed to assess how to shorten the learning curve with effective instructional methods such as expert-guided training with immediate feedback.
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Affiliation(s)
- Fanny Gabrysz-Forget
- Center for Professional Development and Simulation Training, Lahey Hospital, Burlington, Massachusetts
| | - Morgan Bonds
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington
| | - Marissa Lovett
- Department of Surgery, Arizona Simulation Technology and Education Center, University of Arizona, Tucson, Arizona
| | - Adnan Alseidi
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington
| | - Iman Ghaderi
- Deparment of Surgery, University of Arizona, Tucson, Arizona
| | - Dmitry Nepomnayshy
- Center for Professional Development and Simulation Training, Lahey Hospital, Burlington, Massachusetts.
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Rade M, Birkett D, Sherman J, Nepomnayshy D. Evaluation of a stand-alone robotic camera holding system: technology that improves laparoscopy. MINIM INVASIV THER 2020; 31:404-409. [PMID: 32852261 DOI: 10.1080/13645706.2020.1806078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In order to perform laparoscopic procedures, a surgeon requires an assistant to hold the camera. Problems with this approach include table crowding leading to poor ergonomics, and miscommunication leading to poor images. AutoLap is a novel FDA-approved camera navigation system. We present our experience with this device and compare it to human camera holders. MATERIALS AND METHODS The study design included an initial training period followed by a non-randomized allocation between robotic and human camera holder cohort. Data included set up time, ergonomics and usability (via nurse, surgeon and camera holder questionnaire) and image stability recorded via the Inertial Measurement Unit (IMU), describing linear acceleration (in unit gravity [g]) and horizontal acceleration (Angular Velocity in rad/s). RESULTS Twenty-six patients were equally divided between human and robotic camera holders. Image stability were significantly better for the robotic camera holder. Median angular velocity was 0.029 and 0.005 rad/s for human and the AutoLap system, respectively (p-value <.001). Linear acceleration was 0.011 and 0.007 [g] (p-value .015). Positive feedback for the robotic system included greater surgeon comfort (92%) and improved nurse - surgeon interaction (100%). CONCLUSIONS The AutoLap system provides improved image stability, team-work, and ergonomic comfort for the surgical team with minimum set-up time.
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Affiliation(s)
- Matthew Rade
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Desmond Birkett
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | | | - Dmitry Nepomnayshy
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
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Doyon L, Das S, Sullivan T, Rieger-Christ K, Sherman J, Roque S, Nepomnayshy D. Can genetics help predict efficacy of bariatric surgery? An analysis of microRNA profiles. Surg Obes Relat Dis 2020; 16:1802-1807. [PMID: 32737014 DOI: 10.1016/j.soard.2020.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/02/2020] [Accepted: 06/06/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is significant variability in weight loss after bariatric surgery. We hypothesize that part of this variability may be predetermined by genetic differences associated with metabolic homeostasis. MicroRNA (miRNA) are short pieces of RNA that regulate gene expression and are readily detectable in serum. They are implicated in numerous metabolic processes, including weight homeostasis. In this pilot study, we briefly review the role of miRNA, and assess the feasibility of using them in the clinical setting of obesity treatment. OBJECTIVES To evaluate the feasibility of using miRNA to predict weight loss after bariatric surgery. SETTING Academic medical center. METHODS Serum was collected from patients at the initial bariatric surgery consultation. Weight loss data were collected 6 to 12 months postoperatively. Individuals experiencing the least and the greatest amount of percentage of excess weight lost at 6 months were analyzed to assess for genetic differences in miRNA expression. RESULTS The median percentage of excess weight lost was 51% (range, 34%-63%) for those who lost the least and 87% (range, 82%-111%) for those who lost the most weight. Groups were similar in age, sex, diabetic status, and type of surgery. In total, of the 119 miRNA detected in the serum of the patients, 6 demonstrated potential for discriminating between the high and low weight loss groups. These miRNA have previously been implicated in regulation of fatty acid biosynthesis, adipocyte proliferation, type 2 diabetes, and obesity. CONCLUSIONS In this pilot study, we demonstrated the feasibility of identifying genetic differences between high and low weight loss groups by identifying distinct serum miRNA. In the near future, these biomarkers could facilitate informed decisions about surgery. In addition, these miRNA could open new genetic pathways that describe the pathophysiology of obesity, and provide targets for future treatment.
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Affiliation(s)
- Laura Doyon
- Department of Surgery and Center for Weight Loss, Concord, Massachusetts.
| | - Sanjna Das
- Translational Research Program, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Travis Sullivan
- Translational Research Program, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Kimberly Rieger-Christ
- Translational Research Program, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | | | | | - Dmitry Nepomnayshy
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
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Kim VC, Nepomnayshy D. Obesity: Surgical and Device Interventions. FP Essent 2020; 492:30-36. [PMID: 32383846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Bariatric surgery remains the most effective intervention for long-term sustained weight loss and resolution of comorbidities. It should be considered for patients with a body mass index of 40 kg/m2 or greater regardless of comorbidities and for patients with a body mass index of 30 kg/m2 with significant comorbidities, such as diabetes and sleep apnea. For these patients, laparoscopic bariatric surgery, including sleeve gastrectomy, Roux-en-Y gastric bypass, and duodenal switch, is safe with minimal perioperative risks of morbidity and mortality. Surgical management is associated with a survival benefit and resolution of common morbidities compared with nonsurgical management, despite the risk of postsurgical complications. These include gastroesophageal reflux disease, weight regain, bleeding, infection, and deep venous thrombosis. All patients who have undergone bariatric surgery require lifelong follow-up, including vitamin supplementation, annual laboratory testing, and multidisciplinary care (eg, dietary and psychological support). Bariatric surgery also has been shown to be safe in appropriate adolescent and elderly patients.
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Affiliation(s)
- Victor C Kim
- Winchester Hospital Medford, 75 Riverside Ave # 1, Medford, MA 02155
| | - Dmitry Nepomnayshy
- Lahey Hospital & Medical Center, 41 Burlington Mall Road Burlington, MA 01805
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Gabrysz-Forget F, Rubin S, Nepomnayshy D, Dolan R, Yarlagadda B. Development and Validation of a Novel Surgical Simulation for Parotidectomy and Facial Nerve Dissection. Otolaryngol Head Neck Surg 2020; 163:344-347. [PMID: 32204639 DOI: 10.1177/0194599820913587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present the development and validation of a low-cost novel model for training of parotid surgery. The model consists of a 3-dimensionally printed skeleton, silicone-based soft tissue, and facial nerve replicated with copper wire, circuited to indicate contact with instruments. The face validity of the simulator was evaluated with a 21-item 5-point Likert survey. Content validity was evaluated through a survey completed by the trainees after their first live parotidectomy following the simulation. Twelve residents and 6 faculty completed the simulated procedure of superficial parotidectomy after watching a video demonstration. Completion of 16 surgical steps evaluated by this model was graded for each participant. The mean ± SD total assessment score for faculty was 15.83 ± 0.41, as compared with 13.33 ± 2.06 for residents (P = .0081). The simulator as a training tool was well received by both faculty and residents (5 vs 4, P = .0206). Participants strongly agreed that junior residents would benefits from use of the model.
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Affiliation(s)
- Fanny Gabrysz-Forget
- Center for Professional Development and Simulation, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Samuel Rubin
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Dmitry Nepomnayshy
- Center for Professional Development and Simulation, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.,Department of Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Robert Dolan
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Boston University, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Bharat Yarlagadda
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Boston University, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
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Nochur S, Nepomnayshy D. Is the “July Effect” Real? An Appraisal of Teaching Surgical Services at an Academic Medical Center. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nepomnayshy D, Whitledge J, Fitzgibbons S, Nijjar B, Gardner A, Alseidi A, Birkett R, Deal S, Duvra RR, Anton N, Stefanidis D. Advanced laparoscopic skills: Understanding the relationship between simulation-based practice and clinical performance. Am J Surg 2019; 218:527-532. [DOI: 10.1016/j.amjsurg.2019.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/15/2019] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
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Cline C, Tortorici SJ, Brien PJO, Schnelldorfer T, Nepomnayshy D, Brams D. Outreach to laparoscopic adjustable gastric band patients: A quality improvement project. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Background and Objectives: There is a lack of consensus on the optimal repair technique and the definition of good outcomes in paraesophageal hernia (PEH) repair. We reviewed long-term patient-reported outcomes of open and laparoscopic PEH repair to assist with our future surgical consent process. Methods: This was a retrospective case–control study including all patients with PEH repair performed from 2000 through 2012 at a single center without the use of mesh. We mailed questionnaires to patients to assess reoperation, symptom control, and satisfaction. Results: Chart review identified 217 patients who underwent PEH repair. Nineteen died during the follow-up period. Of the 106 returning the questionnaire, 87 underwent laparoscopic repair, and 19 had open repair, with follow-up of 6.6 (SD 3.9) years and 7.0 (SD 4.1) years, respectively. Reoperation rates were 9.9% and 5.3%, respectively (P = .720). Dysphagia, heartburn, and regurgitation improved in 95.4% of patients after laparoscopic repair and 89.5% after open repair (P = .318). Medication for symptom control was necessary in 54.0% of patients after laparoscopic repair and 26.3% after open repair (P = .029). In each group, 90% stated that they would still choose to have the operation (P = .713). Conclusions: Long-term patient-specific outcomes showed comparable, encouraging results between open and laparoscopic repair of PEH without mesh reinforcement. However, half of those undergoing laparoscopic repair required the use of medication for symptom control. This study adds to the literature describing long-term patient-specific outcomes and can be useful when counseling patients about PEH repair.
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Affiliation(s)
- Damien J Lazar
- Tufts University School of Medicine, Boston, Massachusetts
| | | | | | | | - Christina Williamson
- Department of Cardiovascular and Thoracic Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
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Pantel H, Schnelldorfer T, Nepomnayshy D. Incentive Spirometry After Bariatric Surgery-Reply. JAMA Surg 2017. [PMID: 28636696 DOI: 10.1001/jamasurg.2017.1678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Haddon Pantel
- Department of General Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Thomas Schnelldorfer
- Department of General Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Dmitry Nepomnayshy
- Department of General Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
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Pantel H, Hwang J, Brams D, Schnelldorfer T, Nepomnayshy D. Effect of Incentive Spirometry on Postoperative Hypoxemia and Pulmonary Complications After Bariatric Surgery: A Randomized Clinical Trial. JAMA Surg 2017; 152:422-428. [PMID: 28097332 DOI: 10.1001/jamasurg.2016.4981] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The combination of obesity and foregut surgery puts patients undergoing bariatric surgery at high risk for postoperative pulmonary complications. Postoperative incentive spirometry (IS) is a ubiquitous practice; however, little evidence exists on its effectiveness. Objective To determine the effect of postoperative IS on hypoxemia, arterial oxygen saturation (Sao2) level, and pulmonary complications after bariatric surgery. Design, Setting, and Participants A randomized noninferiority clinical trial enrolled patients undergoing bariatric surgery from May 1, 2015, to June 30, 2016. Patients were randomized to postoperative IS (control group) or clinical observation (test group) at a single-center tertiary referral teaching hospital. Analysis was based on the evaluable population. Interventions The controls received the standard of care with IS use 10 times every hour while awake. The test group did not receive an IS device or these orders. Main Outcomes and Measures The primary outcome was frequency of hypoxemia, defined as an Sao2 level of less than 92% without supplementation at 6, 12, and 24 postoperative hours. Secondary outcomes were Sao2 levels at these times and the rate of 30-day postoperative pulmonary complications. Results A total of 224 patients (50 men [22.3%] and 174 women [77.7%]; mean [SD] age, 45.6 [11.8] years) were enrolled, and 112 were randomized for each group. Baseline characteristics of the groups were similar. No significant differences in frequency of postoperative hypoxemia between the control and test groups were found at 6 (11.9% vs 10.4%; P = .72), 12 (5.4% vs 8.2%; P = .40), or 24 (3.7% vs 4.6%; P = .73) postoperative hours. No significant differences were observed in mean (SD) Sao2 level between the control and test groups at 6 (94.9% [3.2%] vs 94.9% [2.9%]; P = .99), 12 (95.4% [2.2%] vs 95.1% [2.5%]; P = .40), or 24 (95.7% [2.4%] vs 95.6% [2.4%]; P = .69) postoperative hours. Rates of 30-day postoperative pulmonary complications did not differ between groups (8 patients [7.1%] in the control group vs 4 [3.6%] in the test group; P = .24). Conclusions and Relevance Postoperative IS did not demonstrate any effect on postoperative hypoxemia, Sao2 level, or postoperative pulmonary complications. Based on these findings, the routine use of IS is not recommended after bariatric surgery in its current implementation. Trial Registration clinicaltrials.gov Identifier: NCT02431455.
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Affiliation(s)
- Haddon Pantel
- Department of General Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - John Hwang
- Department of General Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - David Brams
- Department of General Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Thomas Schnelldorfer
- Department of General Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Dmitry Nepomnayshy
- Department of General Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
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Gardner AK, Steffes CP, Nepomnayshy D, Nicholas C, Widmann WD, Fitzgibbons SC, Dunkin BJ, Jones DB, Paige JT. Selection bias: Examining the feasibility, utility, and participant receptivity to incorporating simulation into the general surgery residency selection process. Am J Surg 2017; 213:1171-1177. [DOI: 10.1016/j.amjsurg.2016.09.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 09/14/2016] [Accepted: 09/16/2016] [Indexed: 11/28/2022]
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Gardner AK, Nepomnayshy D, Reickert C, Gee DW, Brydges R, Korndorffer JR, Scott DJ, Sachdeva AK. The value proposition of simulation. Surgery 2016; 160:546-51. [PMID: 27206331 DOI: 10.1016/j.surg.2016.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Simulation has been shown to improve trainee performance at the bedside and in the operating room. As the use of simulation-based training is expanded to address a host of health care challenges, its added value needs to be clearly demonstrated. Demonstrable improvements will support the expansion of infrastructure, staff, and programs within existing simulation facilities as well as the establishment of new facilities to meet growing needs and demands. Thus, organizational and institutional leaders, faculty members, and other stakeholders can be assured of the best use of existing resources and can be persuaded to make greater investments in simulation-based training for the future. METHODS A multidisciplinary panel was convened during the 8th Annual Meeting of the Consortium of the American College of Surgeons-Accredited Education Institutes (Simulation Centers) in March 2015 to discuss the added value of simulation-based training. Panelists shared the ways in which the value of simulation was demonstrated at their institutions. CONCLUSION The value of simulation-based training was considered and described in terms of educational impact, patient care outcomes, and costs.
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Affiliation(s)
- Aimee K Gardner
- University of Texas Southwestern Medical Center, Dallas, TX.
| | | | | | | | | | | | - Daniel J Scott
- University of Texas Southwestern Medical Center, Dallas, TX
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Ardestani A, Sheu EG, Nepomnayshy D, Rubin MS, Buchmiller TL, Jaklitsch MT, Tavakkoli A. Surgical skills competitions at ACS chapter meetings can increase resident engagement. Bull Am Coll Surg 2016; 101:44-45. [PMID: 27311235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Nepomnayshy D, Alseidi AA, Fitzgibbons SC, Stefanidis D. Identifying the need for and content of an advanced laparoscopic skills curriculum: results of a national survey. Am J Surg 2016; 211:421-5. [DOI: 10.1016/j.amjsurg.2015.10.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 09/25/2015] [Accepted: 10/02/2015] [Indexed: 11/30/2022]
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Stefanidis D, Grewal H, Paige JT, Korndorffer JR, Scott DJ, Nepomnayshy D, Edelman DA, Sievers C. Establishing technical performance norms for general surgery residents. Surg Endosc 2014; 28:3179-85. [DOI: 10.1007/s00464-014-3582-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
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Galitsky A, Sillin L, Brams DM, Wong S, Nepomnayshy D. P-01 Does depression affect outcomes of bariatric surgery. Surg Obes Relat Dis 2011. [DOI: 10.1016/j.soard.2011.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gersin KS, Rothstein RI, Rosenthal RJ, Stefanidis D, Deal SE, Kuwada TS, Laycock W, Adrales G, Vassiliou M, Szomstein S, Heller S, Joyce AM, Heiss F, Nepomnayshy D. Open-label, sham-controlled trial of an endoscopic duodenojejunal bypass liner for preoperative weight loss in bariatric surgery candidates. Gastrointest Endosc 2010; 71:976-82. [PMID: 20304396 DOI: 10.1016/j.gie.2009.11.051] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 11/30/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND The duodenojejunal bypass liner (DJBL) (EndoBarrier Gastrointestinal Liner) is an endoscopically placed and removable intestinal liner that creates a duodenojejunal bypass resulting in weight loss and improvement in type 2 diabetes mellitus. OBJECTIVE Weight loss before bariatric surgery to decrease perioperative complications. DESIGN Prospective, randomized, sham-controlled trial. SETTING Multicenter, tertiary care, teaching hospitals. PATIENTS Twenty-one obese subjects in the DJBL arm and 26 obese subjects in the sham arm composed the intent-to-treat population. INTERVENTIONS The subjects in the sham arm underwent an EGD and mock implantation. Both groups received identical nutritional counseling. MAIN OUTCOME MEASUREMENTS The primary endpoint was the difference in the percentage of excess weight loss (EWL) at week 12 between the 2 groups. Secondary endpoints were the percentage of subjects achieving 10% EWL, total weight change, and device safety. RESULTS Thirteen DJBL arm subjects and 24 sham arm subjects completed the 12-week study. EWL was 11.9% +/- 1.4% and 2.7% +/- 2.0% for the DJBL and sham arms, respectively (P < .05). In the DJBL arm, 62% achieved 10% or more EWL compared with 17% of the subjects in the sham arm (P < .05). Total weight change in the DJBL arm was -8.2 +/- 1.3 kg compared with -2.1 +/- 1.1 kg in the sham arm (P < .05). Eight DJBL subjects terminated early because of GI bleeding (n = 3), abdominal pain (n = 2), nausea and vomiting (n = 2), and an unrelated preexisting illness (n = 1). None had further clinical symptoms after DJBL explantation. LIMITATIONS Study personnel were not blinded. There was a lack of data on caloric intake. CONCLUSIONS The DJBL achieved endoscopic duodenal exclusion and promoted significant weight loss beyond a minimal sham effect in candidates for bariatric surgery. ( CLINICAL TRIAL REGISTRATION NUMBER NPT00469391.).
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Affiliation(s)
- Keith S Gersin
- Carolinas Medical Center, Charlotte, North Carolina 28203, USA
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Nepomnayshy D, Cross S, Pfeifer B, Magge S. Laparoscopic approach for lumbar spinal fusion. MINIM INVASIV THER 2006; 15:271-6. [PMID: 17062401 DOI: 10.1080/13645700600958374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Several recent articles suggest that utilization of the laparoscopic anterior lumbar interbody fusion (ALIF) is decreasing in this country. After reviewing the published evidence in support and in opposition to this approach, we felt that the topic warranted additional study. We began a prospective study utilizing the known techniques to help reduce serious complications. These techniques were previously reported but not widely utilized according to the available literature. We report our early results of eleven patients along with a detailed description of the approach itself with the emphasis aimed at the laparoscopic approach surgeon. One patient was converted to open, with adequate exposure achieved in all. No bleeding complications were seen. Early postoperative results are encouraging. Our conclusions are that the laparoscopic anterior approach to the lumbar spine can be safely performed by approach-surgeons skilled in advanced laparoscopic techniques and those who have also received additional training in laparoscopic anterior lumbar exposures. We feel that improvement over the open approach may be achievable with increased experience.
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Affiliation(s)
- Dmitry Nepomnayshy
- Department of General Surgery, Orthopedic Surgery and Neurosurgery, Lahey Clinic, Burlington, MA 01805, USA.
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Nepomnayshy D, Birkett D. Helicobacter pylori update(1). Curr Surg 2000; 57:296-301. [PMID: 11024236 DOI: 10.1016/s0149-7944(00)00223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D Nepomnayshy
- Department of General Surgery, Lahey Clinic, Burlington, Massachusetts, USA
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