Converging rapid deployment prostheses with minimal access surgery: analysis of early outcomes

Background Sutureless prostheses may have added benefit when combined with minimal access surgery, although this has not been fully assessed in the literature. This study aims to provide a comparative analysis of the Perceval valve comparing median sternotomy (MS) with mini-sternotomy (MIS). Methods A retrospective analysis of prospectively collected data was conducted for all isolated aortic valve replacement (AVR), using the Perceval valve, for severe aortic stenosis cases in the period 2014 to 2019. Patients undergoing concomitant valve or revascularisation surgery were excluded. Results A total of 78 patients were included: MS group 41; MIS group 37. Operatively, bypass times were comparable between MS and MIS groups (mean 89.3 vs 83.4, p = 0.307), as were aortic cross clamp times (58.4 vs 55.9, p = 0.434). There were no operative deaths or new onset post-operative neurology. MIS was a predictor of reduced stay in the intensive care unit (coef − 3.25, 95% CI [− 4.93, − 0.59], p = 0.036) and hospital stay overall (p = 0.004). Blood transfusion units were comparable as were the incidence of heart block (n = 5 vs n = 3, p = 0.429) and new onset atrial fibrillation (n = 15 vs n = 9, p = 0.250). Follow-up echocardiography found a significant improvement in effective orifice area, left ventricular dimension and volume indices, and LVEF (p > 0.05) for all patients. Multivariate analysis found mini-sternotomy to be a predictor for reduced LV diastolic volume (coef − 0.35, 95% CI [− 1.02, − 0.05], p = 0.05). Conclusions The combination of minimal access surgery and sutureless AVR may enhance patient recovery and provide early LV remodelling.

EP.WE.31A snapshot audit on the current practice of minimal access surgery in the UK during COVID-19 pandemic

Aims COVID-19 is an ongoing global pandemic that poses potential increase in the risk of post-operative complications. Early guidelines placed an embargo on minimal access surgery, aiming to minimise risk to patients and the surgical team through aerolisation of the virus. We aimed to assess the practice of minimal access surgery during the peak of the pandemic and associated surgical outcomes. Methods An email link to an online questionnaire was distributed to a variety of surgical specialties via the Royal College of Surgeons COVID group and ALSGBI members. Data collection was carried out over a 4-month period. Data assessed included screening methods, case volume, surgical approach and patient outcomes. Results A total of 118 responses from a variety of surgical specialties were collected over 59 units, ranging in grade from Consultant to SHO/Core Trainee. The volume of minimal access procedures decreased during the pandemic from 94.9% of units to 39.0% (P < 0.001), with a greater percentage opting for an open approach (54.2% vs 39.0%, P < 0.001). Combining screening methods was a favoured approach, and it was frequently used alongside a designated ‘Clean’ theatre. A small proportion of patients suffered from post-operative COVID-19 complications (15.3%), but COVID-19 mortality was low. Conclusions Whilst the risk of COVID-19 infection was not completely abolished perioperatively throughout the pandemic, it appears to be minimised by use of adequate screening with designated clean areas. It would therefore support guidelines advocating continued use of minimal access surgery during peaks of COVID-19 if prudent peri-operative measures are taken.

Assessment of the training program for Versius, a new innovative robotic system for use in minimal access surgery

ObjectivesThe Versius surgical system has been developed for use in robot-assisted minimal access surgery (MAS). This study aimed to evaluate the effectiveness of the Versius training program.DesignA 3.5-day program following 10 hours of online didactic training. Participants were assessed during the technical training using the Global Evaluative Assessment of Robotic Skills (GEARS).SettingDry box exercises were conducted in classrooms, and wet lab sessions simulated an operating room environment using cadaveric specimens.ParticipantsSeventeen surgical teams participated; surgeons represented general, colorectal, obstetrics/gynecology, and urology specialties. All surgeons had previous laparoscopic MAS experience, while experience with robotics varied.Main outcomes measuresParticipants were scored on a five-point Likert Scale for each of six validated GEARS domains (depth perception, bimanual dexterity, efficiency, force sensitivity, autonomy, and robotic control). Additional metrics used to chart surgeon performance included: combined instrument path length; combined instrument angular path; and time taken to complete each task.ResultsParticipants demonstrated an overall improvement in performance during the study, with a mean GEARS Score of 21.0 (SD: 1.9) in Assessment 1 increasing to 23.4 (SD: 2.9) in Validation. Greatest improvements were observed in the depth perception and robotic control domains. Greatest differences were observed when stratifying by robotic experience; those with extensive experience consistently scored higher than those with some or no experience.ConclusionsThe Versius training program is effective; participants were able to successfully operate the system by program completion, and more surgeons achieved intermediate-level and expert-level GEARS scores in Validation compared with Assessment 1.

75 A Snapshot Audit on the Current Practice of Minimal Access Surgery in the UK During COVID-19 Pandemic

Aim COVID-19 is an ongoing global pandemic that poses potential increase in the risk of post-operative complications. Early guidelines placed an embargo on minimal access surgery, aiming to minimise risk to patients and the surgical team through aerolisation of the virus. We aimed to assess the practice of minimal access surgery during the peak of the pandemic and associated surgical outcomes. Method An email link to an online questionnaire was distributed to a variety of surgical specialties via the Royal College of Surgeons COVID group and ALSGBI members. Data collection was carried out over a 4-month period. Data assessed included screening methods, case volume, surgical approach and patient outcomes. Results A total of 118 responses from a variety of surgical specialties were collected over 59 units, ranging in grade from Consultant to SHO/Core Trainee. The volume of minimal access procedures decreased during the pandemic from 94.9% of units to 39.0% (P < 0.001), with a greater percentage opting for an open approach (54.2% vs 39.0%, P < 0.001). Combining screening methods was a favoured approach, and it was frequently used alongside a designated ‘Clean’ theatre. A small proportion of patients suffered from post-operative COVID-19 complications (15.3%), but COVID-19 mortality was low. Conclusions Whilst the risk of COVID-19 infection was not completely abolished perioperatively throughout the pandemic, it appears to be minimised by use of adequate screening with designated clean areas. It would therefore support guidelines advocating continued use of minimal access surgery during peaks of COVID-19 if prudent peri-operative measures are taken.

Gigli saw facilitates safe minimal access sagittal suturectomy in infants

The authors describe the use of the Gigli saw for craniectomy in minimal access surgery to address sagittal craniosynostosis. This modification allows for supine positioning and avoidance of potential brain compression with endoscopic instruments, and provides visually clear, safe, and facile removal of the fused suture and surrounding calvaria. The video can be found here: https://vimeo.com/511568750.