scholarly journals P047 SUTURE-TOOL: A SUTURING DEICE FOR SWIFT AND STANDARDIZED ABDOMINAL APONEUROSIS CLOSURE

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Gabriel Börner ◽  
Marcus Edelhamre ◽  
Peder Rogmark ◽  
Agneta Montgomery
Keyword(s):  
Incisional Hernia ◽  
Learning Curve ◽  
Human Body Model ◽  
Needle Driver ◽  
Surgical Trainees ◽  
Hernia Formation ◽  
Vas Scores ◽  
Wound Rupture ◽  
Instructions For Use ◽  
Wound Length

Abstract Aim Introduction Surgeons can reduce incisional hernia formation by adhering to standardized techniques for incisional wound closure. This is often neglected by the time a long operation is to be ended and can lead to the risk of developing an incisional hernia or a wound rupture. To address this issue, a suturing machine (Suture-TOOL) was developed for swift and standardized abdominal closure. The aim was to compare the user safety, speed, and suturing quality between Suture-TOOL and manual Needle-Driver suturing. Material and Methods Fifteen surgeons who were specialists in surgery, urology, and gynaecology as well as surgical trainees were invited. The Suture-TOOL was presented to the surgeons who read the instructions for use before starting the test. Each surgeon closed nine 15-cm-long incisions in a human body model; six with Suture-TOOL and three with the Needle-Driver technique. Gloves were examined for puncture damage. Endpoints were suture-length/wound-length (SL/WL)-ratio, closure time, number of stitches, learning curve, and glove puncture rate. A VAS-evaluation concerning different Suture-TOOL user impressions was completed. Results SL/WL-ratio ≥4 was 98% for Suture-TOOL versus 69% for Needle-Driver (p < 0,001). Suture time was shorter for Suture-TOOL (p = 0,013). The median SL/WL-ratio was similar between the groups. The learning curve plateaued after three closures using Suture-TOOL. Two glove punctures were detected—all in the Needle-Driver group. Suture-TOOL received high VAS scores for all measured functionalities. Conclusions Suture-TOOL is a promising device for clinical use. It is safe, easy, and fast resulting in a high-quality suture lines with a short learning curve and a high functionality ranking.

scholarly journals 845 Flattening the Learning Curve: The Evaluation of Extended Laparoscopic Simulation Training for Novice Surgeons

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S A Joiya ◽  
M Hamid ◽  
Z Siddiqui
Keyword(s):  
Learning Curve ◽  
Skill Acquisition ◽  
Postoperative Recovery ◽  
Task Completion ◽  
Complication Rates ◽  
Novice Group ◽  
Surgical Trainees ◽  
Long Duration ◽  
Hospital Stays ◽  
Novice Surgeons

Abstract Introduction Associated with faster postoperative recovery, reduced length of hospital stays and scarring; laparoscopy has become the favoured approach for many surgical procedures across a range of specialties. However, due to its challenging learning curve, it has also been associated with increased theatre time and higher complication rates. Method A prospective, observational study with box trainers was carried out by novice medical students and trainees to evaluate the efficacy of long duration courses on skill acquisition. The novice group undertook a 5-week curriculum composed of lectures, demonstrations and spaced timed-assessments involving 3 tasks: hoop placement, stacking of sugar cubes and surgical cutting. Results Time taken for novice participants to complete a task individually and collectively improved markedly from the first to the third attempt, with an overall 44% reduction in time observed over the 5-weeks. We invited back 6 novice participants and 6 core surgical trainees after 4-weeks to complete the same tests. There was a further 18% time improvement in the novice group, with 44% faster task completion. Conclusions Given the success of this study and other simulation courses reported in the literature, we recommend more courses adopt a spaced-out approach; and a simulation curriculum for surgical trainees to cultivate greater skill acquisition.

Dehydrated Human Amniotic-Chorionic Membrane Reduces Incisional Hernia Formation in an Animal Model

2022 ◽  
Vol 270 ◽  
pp. 477-485
Author(s):  
Aran Yoo ◽  
Celia Short ◽  
Mandi J. Lopez ◽  
Catherine Takawira ◽  
Kazi N. Islam ◽  
...  
Keyword(s):  
Animal Model ◽  
Incisional Hernia ◽  
Hernia Formation ◽  
Chorionic Membrane

Training to proficiency in surgery using simulation: is there a moral obligation?

2022 ◽  
pp. medethics-2021-107678
Author(s):  
Conor Toale ◽  
Marie Morris ◽  
Dara O Kavanagh
Keyword(s):  
Learning Curve ◽  
New Technology ◽  
Training Paradigm ◽  
Surgical Ethics ◽  
Surgical Trainees ◽  
Simulation Based ◽  
Predetermined Level ◽  
Trainee Surgeon ◽  
The Right ◽  
To Receive

A deontological approach to surgical ethics advocates that patients have the right to receive the best care that can be provided. The ‘learning curve’ in surgical skill is an observable and measurable phenomenon. Surgical training may therefore carry risk to patients. This can occur directly, through inadvertent harm, or indirectly through theatre inefficiency and associated costs. Trainee surgeon operating, however, is necessary from a utilitarian perspective, with potential risk balanced by the greater societal need to train future independent surgeons.New technology means that the surgical learning curve could take place, at least in part, outside of the operating theatre. Simulation-based deliberate practice could be used to obtain a predetermined level of proficiency in a safe environment, followed by simulation-based assessment of operative competence. Such an approach would require an overhaul of the current training paradigm and significant investment in simulator technology. This may increasingly be viewed as necessary in light of well-discussed pressures on surgical trainees and trainers.This article discusses the obligations to trainees, trainers and training bodies raised by simulation technology, and outlines the current arguments both against and in favour of a simulation-based training-to-proficiency model in surgery. The significant changes to the current training paradigm that would be required to implement such a model are also discussed.

Incisional Hernia Risk after Hand-Assisted Laparoscopic Surgery

2012 ◽  
Vol 78 (8) ◽  
pp. 864-869 ◽  
Author(s):  
William S. Cobb ◽  
Alfredo M. Carbonell ◽  
Garrett M. Snipes ◽  
Brianna Knott ◽  
Viet Le ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Incisional Hernia ◽  
Operative Time ◽  
Group Versus ◽  
True Incidence ◽  
Hernia Formation ◽  
The Mean ◽  
Laparoscopic Techniques ◽  
Mean Time

Hand-assisted laparoscopic surgery (HALS) bridges traditional open surgery and pure laparoscopy. The HALS technique provides the necessary site for organ retrieval, reduces operative time, and realizes the postoperative benefits of laparoscopic techniques. Although the reported rates of incisional hernia should be theoretically low, we sought to determine our incidence of hernia after HALS procedures. A retrospective review of all HALS procedures was performed from July 2006 to June 2011. All patients who developed postoperative incisional hernias at the hand port site were confirmed by imaging or examination findings. Patient factors were reviewed to determine any predictors of hernia formation. Over the 5 years, 405 patients undergoing HALS procedures were evaluated: colectomy (264), nephrectomy (107), splenectomy/pancreatectomy (18), and ostomy reversal (10). The overall incidence of incisional hernia was 10.6 per cent. There were three perioperative wound dehiscences. The mean body mass index was significantly higher in the hernia group versus the no hernia cohort (32.1 vs 29.2 kg/m2; P = 0.001). The hernia group also had a higher incidence of renal disease (18.6 vs 7.2%; P = 0.018). Mean time to hernia formation was 11.4 months (range, 1 to 57 months). Follow-up was greater than 12 months in 188 (46%) of patients, in which the rate of incisional hernia was 17 per cent. The rate of incisional hernia formation after hand-assisted laparoscopic procedures is higher than the reported literature. Because the mean time to hernia development is approximately 1 year, it is important to follow these patients to this end point to determine the true incidence of incisional hernia after hand-assisted laparoscopy.

Impact of Experience on Quality Outcomes in Single-incision Cholecystectomy in Children

2015 ◽  
Vol 81 (9) ◽  
pp. 839-843 ◽  
Author(s):  
Sandra M. Farach ◽  
Paul D. Danielson ◽  
Ernest K. Amankwah ◽  
Nicole M. Chandler
Keyword(s):  
Regression Analysis ◽  
Learning Curve ◽  
Single Incision ◽  
Early Group ◽  
Quality Outcomes ◽  
Surgical Practice ◽  
Short Learning Curve ◽  
Surgical Trainees ◽  
Single Incision Laparoscopic Cholecystectomy ◽  
Late Group

Single-incision laparoscopic cholecystectomy (SILC) has been shown to be safe in children; however, factors that impact outcomes are not well understood. We report a retrospective review of 151 patients who underwent SILC between 2009 and 2013. Regression analysis was used to determine inflection of learning curve. Patients were grouped by early cases, late cases, and late case with surgical trainees. Mean age for all patients was 15 ± 3 years (5–20.5 year), and mean weight was 66.5 ± 21.3 kg (15–117 kg). There was a decrease in operative times between the early group (n = 15) and the late group (n = 100) (75.3 vs 56.1 minutes, P < 0.05). Surgical trainees were involved in 36 cases, and their introduction did not significantly increase operative times (56.1 vs 60.4 minutes, P = NS (Non-significant)). No difference in operative times between early cases and cases with trainees was identified (75.3 vs 60.4 minutes, P = NS). The complication was 6 per cent, with no significant differences between the groups. There were five conversions (3.3%). During the adoption of SILC, significantly decreased operative times were achieved after a short learning curve, and these were maintained with surgical trainees. Our results show that SILC can be safely introduced into a pediatric surgical practice.

Surgical gender gap: a curriculum concordance and career vector perspective

2018 ◽  
Vol 94 (1115) ◽  
pp. 483-488 ◽  
Author(s):  
Chris Brown ◽  
Rhiannon L Harries ◽  
Tarig Abdelrahman ◽  
Charlotte Thomas ◽  
M John Pollitt ◽  
...  
Keyword(s):  
Learning Curve ◽  
Gender Gap ◽  
Training Programme ◽  
Attrition Rate ◽  
Attrition Rates ◽  
Time To Completion ◽  
Publication Number ◽  
Surgical Trainees ◽  
Women's Participation ◽  
Academic Profiles

IntroductionWomen’s participation in medicine has increased dramatically during the last 50 years, yet Office for National Statistics data (2016) regarding annual pay continue to show an unequivocal 34% deficit in female doctors’ remuneration compared with their male counterparts. This study aimed to identify whether there are measurable differences in the training, career vectors and profiles of higher general surgical trainees (HSTs), related to gender.MethodThe Deanery roster supplemented with Intercollegiate Surgical Curriculum Programme and Scopus data was used to identify the profiles of 101 consecutive HSTs (38 women, 63 men, single UK deanery). Primary outcome measures were training programme attrition rate, time to completion of training and achievement of third level 4 competence (3L4C) in indicative operations. Secondary outcomes were publication number, citations and Hirsch Indices (HIs).ResultsAttrition rates were similar irrespective of gender (female n=3 (7.9%) vs male n=6 (9.5%), p=0.871). Training duration was on average 16 months longer in women (94 (72–134) months) than men (78 (72–112), p=0.002). Operative learning curve trajectories were similar; median operations required to achieve 3L4C was 380 (f) versus 410 (m, p=1.00). Academic profiles of men were stronger than women, specifically higher degrees; men (n=31, 83.8%), women (n=6, 16.2%, p=0.001); median (range) publication number 8 (0–57) versus 3 (0–38, p=0.003), citations 43 (0–1600) versus 9 (0–774, p=0.001), and HI 3 (0–26) versus 2 (0–12, p=0.002).ConclusionA complex variable gender gap was apparent related to time in training and academic profile, but not training attrition or operative learning curve trajectory.

scholarly journals The incidence of incisional hernias following ileostomy reversal in colorectal cancer patients treated with anterior resection

2017 ◽  
Vol 99 (4) ◽  
pp. 319-324 ◽  
Author(s):  
Balazs Fazekas ◽  
Bence Fazekas ◽  
J Hendricks ◽  
N Smart ◽  
T Arulampalam
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Incisional Hernia ◽  
Cancer Patients ◽  
Anterior Resection ◽  
Incisional Hernias ◽  
Hernia Formation ◽  
Reversal Time ◽  
Ileostomy Reversal ◽  
Colorectal Cancer Patients

INTRODUCTION The aim of this study was to identify the rate of incisional hernia formation following ileostomy reversal in patients who underwent anterior resection for colorectal cancer. In addition, we aimed to ascertain risk factors for the development of reversal-site incisional hernias and to record the characteristics of the resultant hernias. MATERIALS AND METHODS Using a prospectively compiled database of colorectal cancer patients who were treated with anterior resection, we identified individuals who had undergone both ileostomy formation and subsequent reversal of their ileostomies from January 2005 to December 2014. Medical records were reviewed to record descriptive patient data about risk factors for hernia formation, operative details and any subsequent operations. Computed tomography reports were reviewed to identify the number, site and characteristics of incisional hernias. RESULTS A total of 121 patients were included in this study; 14.9% (n = 18) developed an incisional hernia at the ileostomy reversal site; 17.4% (n = 21) at a non-ileostomy site and 6.6% (n = 8) developed both. The reversal-site hernias were smaller both in width and length compared with the non-ileostomy-site hernias. Risk factors for the development of reversal-site incisional hernias were higher body mass index (BMI), lower age, open surgery, longer reversal time and a history of previous hernias. We did not detect a difference in the size of the incisional hernias that developed in patients with these specific risk factors. CONCLUSIONS Incisional hernias are a significant complication of ileostomy reversal. Further evaluation of the use of prophylactic mesh to reduce the incidence of incisional hernias may be worthwhile.

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