Quantitative Assessment of 3D Printed Blood Vessels Produced with J750™ Digital Anatomy™ for Suture Simulation

Blood vessels anastomosis is one of the most challenging and delicate tasks to learn in many surgical specialties, especially for vascular and abdominal surgeons. Such a critical skill implies a learning curve that goes beyond technical execution. The surgeon needs to gain proficiency in adapting gestures and the amount of force expressed according to the type of tissue he/she is dealing with. In this context, surgical simulation is gaining a pivotal role in the training of surgeons, but currently available simulators can provide only standard or simplified anatomies, without the chance of presenting specific pathological conditions and rare cases. 3D printing technology, allowing the manufacturing of extremely complex geometries, find a perfect application in the production of realistic replica of patient-specific anatomies. According to available technologies and materials, morphological aspects can be easily handled, while the reproduction of tissues mechanical properties still poses major problems, especially when dealing with soft tissues. The present work focuses on blood vessels, with the aim of identifying – by means of both qualitative and quantitative tests – materials combinations able to best mimic the behavior of the biological tissue during anastomoses, by means of J750™ Digital Anatomy™ technology and commercial photopolymers from Stratasys. Puncture tests and stitch traction tests are used to quantify the performance of the various formulations. Surgical simulations involving anastomoses are performed on selected clinical cases by surgeons to validate the results. A total of 37 experimental materials were tested and 2 formulations were identified as the most promising solutions to be used for anastomoses simulation. Clinical applicative tests, specifically selected to challenge the new materials, raised additional issues on the performance of the materials to be considered for future developments.

Validation of Bench Training Model for Cleft Palate Surgery

Background Cleft palate is one of the most common congenital malformations worldwide. It can be non-syndromic or it can appear as a part of a syndrome or recurrence pattern. Aim of the Work To provide a valid life-size realistic training model of cleft palate surgery that aids in pre-operative training of residents and improvement of their skills in life surgery. Patients and Methods This interventional pilot study was done after approval of institutional ethics committee in Ain Shams University Hospitals operating theatres and in plastic surgery department’s skill lab for 6 months and obtaining an informed written consent from parents. It was designed to develop a bench model of cleft palate for pre-operative training of surgeons and assess its validity. Results In our study we found that the performance of trainees after using our developed bench model of cleft palate shows statistically significant improvement according to GRITS score by 63.2% compared to those who proceeded to live cases directly without training Conclusion This study further demonstrates the effective use of a novel cleft palate bench model as a training tool. After a single session, we observed improvement in cleft palate procedural skills, confidence, knowledge and time taken to finish the operation among trainees both with and without previous cleft experience. Additional research is needed to assess the durability of these improvements over time, and also the benefit of additional sessions with the bench model.

Safety in Electrosurgery as an Essential Skill in the Training of Surgeons

The analysis of 19 videotapes of laparoscopic cholecystectomy performed by accredited on the virtual simulator "LapSim" during the passage of the station "Planned Surgery" within the framework of primary specialized accreditation in the specialty "Surgery" was carried out. The mistakes made by those accredited in the application of high-energy methods at the stage of isolation of the elements of the hepatoduodenal ligament have been studied. Mistakes when using high-energy methods were made by 14 out of 19 accredited. The importance of training surgeons in the basics of electrosurgical safety is emphasized.

Introducing a novel model for simulating large loop excision of the transformation zone (LLETZ) using 3D printing technique

Purpose Electrosurgery is the gold-standard procedure for the treatment of cervical dysplasia. The quality of the outcome depends on the accuracy of performance, which underlines the role of adequate training of surgeons, especially, as this procedure is often performed by novice surgeons. According to our knowledge, medical simulation has up until now lacked a model, which focuses on realistically simulating the treatment of cervical dysplasia with the concerning anatomy. Methods and result In our work, we present a model created using 3D printing for holistically simulating diagnostic, as well as surgical interventions of the cervix, as realistically as possible. Conclusion This novel simulator is compared to an existing model and both are evaluated. By doing so, we aim to provide novice gynecologists with standardized and high-quality simulation models for practicing to improve their proficiency.

TELEMENTORING IN TIMES OF COVID-19 FOR TRAINING IN GENERAL SURGERY

INTRODUCTION Telemedicine applied to surgery is called telementorization (TM). It allows remote assistance by expert surgeons to others with less experience in certain techniques, thus guaranteeing learning that overcomes the barriers of time and location without being associated with a higher rate of complications. The objective is to publicize the use of this type of technology in our surgical department, particularly needed with the current restrictions. MATERIAL AND METHODS In our center, the Proximie platform (www.proximie.com) is used as a tool for TM. It allows to remotely broadcast live procedures performed by expert surgeons, as well as to create a virtual library of our own procedures that can be used as study and teaching tool by residents. This platform transmits not only bidirectional image and sound, but it also allows the active participation of a remote assistant with interactive features that are projected directly on the screen of the local surgeon. RESULTS The Proximie platform is being used frequently (and more intensively during this time of greatest restrictions) in advanced colorectal surgeries, with TM by remote experts and in our department for the continuing training program for residents. It also offers the possibility of conducting multidisciplinary sessions and webinars with subsequent availability control online. CONCLUSIONS TM and digital platforms such as Proximie provide important benefits in the practical learning and training of surgeons, especially with the current restrictions, being a safe technique and a teaching tool to be exploited.

In memoriam: Mr Jimmy James (1940–2019). His contribution to the training of surgeons in Malawi and the College of Surgeons of East Central and Southern Africa (COSECSA) region

John “Jimmy” James MB ChB FRCS Ed passed on the 4th December 2019, the day we had our COSECSA annual general meeting in Kampala, Uganda. He died after a short battle with metastatic prostate cancer.

LABOUR OF MEDICS OF PERM LAND DURING WORLD WAR II

During the years of the Second World War, Molotov Region (what is now called Perm Land) became the location of hospitals for wounded soldiers due to the presence of several medical universities. The article discusses the organisation of evacuation hospitals, the transfer of equipment to hospitals from civilian hospitals. The statistics of the return of the wounded, not only to ordinary life, but also to military activity, is refl ected, an increased percentage of return to duty in relation to the statistics of the USSR is substantiated. Particular attention is paid to the reprofi ling of medics to treat injuries and accelerated training of surgeons. Changes in the training of students in wartime are studied, the possibilities of using the labour of students in practical sanitary actions are demonstrated. On the basis of the donor movement in Molotov Region, the development of hematology and the advantages of blood transfusion in the USSR over Germany are refl ected. The article analyses the creation of the Academic Council for medical workers, which allowed redirecting the scientifi c interests of doctors to the realities of war. Specifi c biographies of medical scientists are refl ected, including the biography of the future academician Yevgeniy Vagner, in fact of German ethnicity himself. The article examines medical care in the Ural factories of military importance, refl ects the introduction of local raw materials into medical instruments.

Medical Malpractice Trends in Thyroidectomies among General Surgeons and Otolaryngologists

Objectives This study aims to examine litigation trends with thyroidectomies in the United States from 1984 to 2018. Methods We used the Westlaw legal database to collect data on the defendant, plaintiff, case demographics, alleged reasons for malpractice, additional complications, and case outcomes. Results The most common reason for litigation was vocal cord paralysis (51%, n = 28), with the majority ruling in favor of the defendant (64%, P = .042). Of those, 43% of cases (n = 12) were due to unilateral recurrent laryngeal nerve (RLN) injury, and 39% (n = 11) were due to bilateral RLN injury. Of the claims due to vocal cord paralysis that resulted in indemnity payment (36%), the majority included additional damages, such as lack of informed consent (30%) or subsequent damages from permanent tracheostomy (40%), which is usually a result of bilateral nerve paralysis. Conclusion RLN injury was the most common complication leading to trial, with most cases ruling in favor of the defense. However, most verdicts that favored the plaintiff or those that settled were due to subsequent damages from bilateral nerve paralysis, such as permanent tracheostomy. We encourage surgeons to consider a staged procedure in high-risk cases or cases with signal loss. There needs to be a bigger emphasis on informed consent in the training of surgeons. Surgeons should educate patients at high risk on potential surgical complications that may drastically affect their quality of life.