Robotic Dual-Console Distal Pancreatectomy: Could it be Considered a Safe Approach and Surgical Teaching even in Pancreatic Surgery? A Retrospective Observational Study Cohort

Background The study aims to assess the safety and feasibility of the robotic dual-console during a robotic distal pancreatectomy Methods The data of the consecutive patients submitted to RDP from 2012 to 2019 at the Verona University were retrieved from a prospectively maintained database. The patients submitted to RDP were divided into the dual-console platform group (DG) and compared to the standard robotic procedure group (SG). Results In the study period, 102 robotic distal pancreatectomies were performed, of whom 42 patients (41%) belonged to the DG and 60 patients (59%) to the SG. Higher operation time was recorded in the DG compared to the SG (410 vs. 265 min, p < 0.001). The overall conversion rate of the series was 7% (n 7 patients). All the conversions were observed in the SG (p = 0.021). No differences in morbidity or pancreatic fistula rate were recorded (p > 0.05). No mortality events in the 90th postoperative days were reported in this series. Conclusions The robotic dual-console approach for distal pancreatectomy is safe, feasible, and reproducible. The postoperative surgical outcomes are comparable to the standard RDP with the single-console da Vinci Surgical System®. This surgical technique can widely and safely improve the robotic surgical training program.

Telemedicine Experience of General Surgery Trainees: Impact on Patient Care and Education

Objective The COVID-19 pandemic has had a significant impact on patient care, including the increased utilization of contact-free clinic visits using telemedicine. We looked to assess current utilization of, experience with, and opinions regarding telemedicine by general surgery residents at an academic university–based surgical training program. Design A response-anonymous 19-question survey was electronically distributed to all general surgery residents at a single academic university–based general surgery residency program. Setting University of Southern California (USC) general surgery residency participants: Voluntarily participating general surgery residents at the University of Southern California. Results The response rate from USC general surgery residents was 100%. A majority of residents (76%) had utilized either video- or telephone-based visits during their careers. No resident had undergone formal training to provide telemedicine, although most residents indicated a desire for training (57.1%) and acknowledged that telemedicine should be a part of surgical training (75.6%). A wide variety of opinions regarding the educational experience of residents participating in telemedicine visits was elicited. Conclusions The COVID-19 pandemic brought telemedicine to the forefront as an integral part of future patient care, including for surgical patients. Additional investigations into nationwide telemedicine exposure and practice among United States general surgery residencies is imperative, and the impact of the implementation of telemedicine curricula on general surgery resident telemedicine utilization, comfort with telemedicine technology, and patient outcomes are further warranted. Competencies Practice-based learning, systems-based practice, interpersonal and communication skills

The Mental Strategies of Surgeons: A Primer – Part I

It is Spring in Virginia, and that means that it is time for medical students to make their final decisions about which discipline of Medicine they will apply to for postgraduate training and to begin their application processes. I have long believed that most medical students with two hands and binocular vision can be successful in a surgical training program, if that is what they choose to do. However, obtaining a surgical residency is a competitive process, which means that the applicants must have their thoughts organized so that they can put their ‘best foot forward’ as they go through the application and selection process. The most challenging aspects of the application process for virtually everyone are writing personal statements and preparing for interviews, which will be even more complicated than usual, in the midst of the current pandemic. After more than four decades of helping students prepare for these daunting exercises, I have honed the advice that I give these applicants about the related challenges of writing about themselves and of answering questions in interviews. I believe that the candidates must convince the reviewers of their applications that they have, or can develop, the mental strategies necessary to become a capable surgeon. In this treatise, I will outline the mental strategies that I have found essential to achieving competency in a surgical discipline. The task of the applicants will be, therefore, to assert, with supporting evidence, that they are confident that they have, or can learn, these mental strategies.

Rural Surgical Training in the United States: Delineating Essential Components Within Existing Programs

Background Rural access to surgical care has reached crisis level. Practicing in rural America offers unique challenges with limited resources and specialists. Most training programs do not provide enough exposure to the endoscopic or the surgical subspecialty skills to prepare a resident for an isolated rural environment. As awareness has increased, many programs have modified curriculum to address this need. The Advisory Council on Rural Surgery (ACRS) of the American College of Surgeons set out to delineate important components of rural training programs and measure to what degree the existing heterogeneous programs contain these components. Study Design The ACRS identified 4 essential components of rural surgical training based on literature and expert opinion. These components included rotations in a rural setting, broad exposure to surgical specialties, endoscopy experience, and lack of competing specialty learners. A list of Accreditation Council for Graduate Medical Education programs from a prior publication was updated with the 2019 Fellowship and Residency Electronic Interactive Database self-identified “rural track” programs, reviewed, and categorized. Results We identified 39 programs that self-identified as having a rural emphasis. Depending on the extent of which 4 essential components were included, programs were categorized as either “Broad” (12 programs), “Basic” (20 programs), or “Indeterminate” (7 programs). Conclusion The ACRS described the optimal components of a rural surgical training program and identified which components are present in those surgical residencies which self-identified as having a rural focus. This information is valuable to students planning a future in rural surgery and benefits programs hoping to enhance their curriculum to meet this critical need.

Pelvic organ prolapse surgical training program in Bangladesh and Nepal improves objective patient outcomes

Introduction and hypothesis The DAK Foundation (Sydney) has facilitated pelvic organ prolapse (POP) repairs performed by local gynecologists for underprivileged women in Bangladesh and Nepal since 2014. Initially, there was no long-term patient follow-up. When 156 patients were examined at least 6 months after their surgery, an unacceptably high rate of prolapse recurrence and shortened vaginas was identified. This demonstrated the need for surgical up-skilling in both countries. Our hypothesis is that the introduction of a surgical training program in low-resource countries can significantly improve patient outcomes after pelvic floor surgery. Methods One-on-one surgical re-training was undertaken to up-skill the gynecologists in fascial vaginal repair and vaginal apical reconstruction utilizing sacrospinous fixation (SSF). Following the surgical up-skilling, a further 289 women (between 6 and 18 months post-operatively) were examined to determine patient outcomes. Outcome measures were: Prolapse recurrence: POPQ (pelvic organ prolapse quantification [1]) ≥ stage 2 Vaginal length < 4 cm Results Prior to implementation of the surgical training program, 76% of patients had recurrent prolapse ≥ stage 2, and 56% had a vagina < 4 cm in length. Following the training program, prolapse recurrence was reduced to 45% with significant reductions in the apical, anterior and posterior compartments. The incidence of unacceptable vaginal shortening was 4%. We could not rely on patient symptoms to determine whether they had recurrences. Conclusion Clinical patient follow-up to determine surgical outcome is essential in low-resource settings. We have demonstrated that surgical up-skilling in vaginal hysterectomy, vaginal repair and introduction of SSF were necessary to achieve acceptable prolapse recurrence rates in our programs in Bangladesh and Nepal.

“DETERMINANTS OF ACADEMIC SATISFACTION OF NEUROSURGERY RESIDENTS -BASED ON A CROSS SECTIONAL QUESTIONNAIRE SURVEY IN KERALA."

Surgical training is different from medical training where resident learns from doing surgeries and observing surgical skills from the senior faculty in addition to reading books. There is insufficient literature regarding the lacunae in current surgical training in our medical colleges. Aim of the survey is to identify the determinants of academic satisfaction of neurosurgery residents undergoing the present surgical training program in kerala.This survey determines the factors affecting academic satisfaction from a student perspective which will definitely be an eye opener regarding the benefits as well as drawbacks of the present curriculum in Kerala. MATERIALS AND METHODS A descriptive cross sectional survey of neurosurgery residents was done using a prevalidated questionnaire and send by email . It covered demographics ,the overall satisfaction and variables related to aspects of residency training like 1)surgery related 2)clinical care related 3) education related variables which are collected on a 5 point leikert score scale and scored. Responses obtained were enterd in SPSS data sheet and analysed . RESULTS The response rate was 60% .The average age of surgery residents in our survey was 30.4±2.59 years,majority being males (83%).Majority(41.7%) of residents who participated and responded to the survey were satisfied with the current surgical training. The residents were more satisfied if 1)faculty allowed residents to perform the important steps in the operations but without being overly supervised (p=0.049) 2)if they scrubbed more than 25 cases last month(p=.011); and 3) if they involve with the faculty in management decisions.(p=.032). CONCLUSION: The survey highlighted that faculty should support and give residents freedom to share a keyrole in patient management decisions .Improving resident satisfaction may help encourage more medical students to enter neurosurgical profession.Present survey will definetly guide curriculum management committees in health universities