Development of a social cognitive career theory scale for measuring the intention to select surgery as a career.

Background: Surgeon shortages have emerged as a prominent global issue. Although various studies have explored the factors that influence medical students in choosing surgery as a career, addressing the need for surgeons requires a multifaceted approach. However, there is currently a lack of a theoretically grounded scale to evaluate the effectiveness of surgical career development or policy promotion. Thus, this study aimed to develop a questionnaire for assessing the preference for a surgical career by adopting the Social Cognitive Career Theory (SCCT). Materials and methods: The study aimed to develop the Social Cognitive Career Theory Scale toward Surgery (SCCTSS) by adopting the framework of SCCT. The questionnaire was created through expert consensus and the content validity index (CVI) calculation. Subsequently, a pilot version of the SCCTSS was administered to 222 medical students in their clinical clerkships, and the collected data underwent item analysis. Additionally, the validation of the SCCTSS by gender was performed. Results: The SCCTSS comprised 16 items that passed expert panel evaluation, with a CVI >0.8, mean ≥ 3.00, and an interquartile range ≤1. Item analysis demonstrated that the quality of the SCCTSS met the qualifying threshold. Furthermore, the SCCTSS questionnaire effectively validated gender differences in surgical career preference. Conclusions: We developed an internally consistent and reliable scale and validated it through an expert panel method and feedback from medical students. Further research is required to evaluate the targeted interventions that may assist in recruiting medical students into the field of surgery through the application of the SCCTSS.

Clinical assessment for non-reversal stoma and stoma re-creation after reversal surgery for patients with rectal cancer having undergoing sphincter-saving operation.

BACKGROUND: This study aimed to identify the risk factors for permanent stoma (PS) in patients who underwent sphincter-saving operations for rectal cancer. METHODS: We retrospectively reviewed 597 consecutive patients with rectal cancer from January 2012 to December 2020 at Taipei Medical University Hospital. Univariate and multivariable analyses were used to analyze risk factors for PS. RESULTS: After a mean follow-up of 47.3 months (range 7-114 months), 59 patients (15.1%) were alive with a PS, including 46 patients who did not undergo reversal surgery and 13 patients who underwent stoma re-creation after reversal surgery. The mean period between primary surgery and stoma reversal was 6.0 months. Multivariate analysis revealed that the risk factors for PS were local recurrence [odd ratio (OR), 25.58; 95% confidence interval (CI), 4.428-147.761; p < 0.001], perirectal abscess [OR, 154.34; 95% CI, 15.806 - >999; p < 0.001], anastomosis site stenosis [OR, 187.081; 95% CI, 22.193 - >999; p < 0.001], perineural invasion [OR, 4.782; 95% CI, 1.22-18.736; p = 0.025], and operation time (min) [OR, 1.008; 95% CI, 1.002-1.014; p = 0.01]. CONCLUSIONS: Local recurrence, perirectal abscess, anastomosis site stenosis, perineural invasion, and operation time were independent risk factors for PS. Therefore, before a patient undergoes surgery for rectal cancer, surgeons should consider the possibility of the need for a PS, and patients should be informed before the operation that closure of the temporary stoma may not always be possible.

Nomogram to predict permanent stoma in rectal cancer patients after sphincter-saving surgery.

BACKGROUND: Approximately 20 percent of patients with a tumour localized in the low rectum still encounter the possibility of requiring permanent stoma (PS), which can cause drastic changes in lifestyle and physical perceptions. AIM: To determine the risk factors for PS and to develop a prediction model to predict the probability of PS in rectal cancer patients after sphincter-saving surgery. METHODS: A retrospective cohort of 421 rectal cancer patients who underwent radical surgery at Taipei Medical University Hospital between January 2012 and December 2020 was included in this study. Univariate and multivariate analyses were performed to identify the independent risk factors for PS. A nomogram was developed according to the independent risk factors obtained in the multivariate analysis. The performance of the nomogram was assessed using a receiver operating characteristic curve and a calibration curve. RESULTS: The PS rate after sphincter-saving surgery was 15.1% (59/391) in our study after a median follow-up of 47.3 mo (range 7-114 mo). Multivariate logistic regression analysis demonstrated that local recurrence, perirectal abscess, anastomosis site stenosis, perineural invasion, tumor size and operative time were independent risk factors for PS. These identified risk factors were incorporated into the nomogram, and the concordance index of this model was 0.903 (95%CI: 0.851-0.955). According to the calibration curves, the nomogram represents a perfect prediction model. CONCLUSION: Several risk factors for PS after sphincter-saving surgery were identified. Our nomogram exhibited perfect predictive ability and will improve a physician's ability to communicate the benefits and risks of various treatment options in shared decision making.

Joint Effect of Heavy Vehicles and Diminished Light Conditions on Paediatric Pedestrian Injuries in Backover Crashes: A UK Population-Based Study.

Backover crashes cause considerable injuries especially among young children. Prior research on backover crashes has not assessed the joint effect of heavy vehicles and diminished light conditions on injuries. By analysing the United Kingdom STATS19 crash dataset from 1991 to 2020, this study focused on backover crashes involving paediatric cyclists or pedestrians aged ≤17 years and other motorised vehicles. By estimating the adjusted odds ratio (AOR) of multiple logistic regression models, pedestrians appeared to have 82.3% (95% CI: 1.78-1.85) higher risks of sustaining killed or serious injuries (KSIs) than cyclists. In addition, casualties involved in backover crashes with heavy vehicles were 39.3% (95% CI: 1.35-1.42) more likely to sustain KSIs than those involved in crashes with personal cars. The joint effect of heavy vehicles and diminished light conditions was associated with a 71% increased probability of sustaining KSIs (AOR = 1.71; 95% CI: 1.60-1.83). Other significant joint effects included young children (aged 0 to 5 years) as pedestrian (AOR = 1.92; 95% CI: 1.87-1.97), in diminished light conditions (AOR = 1.23; 95% CI: 1.15-1.31), and with heavy vehicle (AOR = 1.37; 95% CI: 1.28-1.47).

Streptococcal toxic shock syndrome after hemorrhoidectomy: A case report.

BACKGROUND: Streptococcal toxic-shock syndrome after hemorrhoidectomy is rare but may be catastrophic. Group A streptococci have produced various surface proteins and exotoxins due to genetic changes to fight the human body's immune response. Though life threatening infection after hemorrhoidectomy rarely occurs, all surgeons should be aware of the potential complications of severe sepsis after hemorrhoidectomy and keep in mind their clinical presenting features in order to diagnose early and administer appropriate and effective therapeutic drugs early. CASE SUMMARY: Here, we present a case of a 56-year-old man with a painful thrombotic external hemorrhoid who presented to our outpatient department for management. There was no history of systemic diseases or recent disease infection. Hemorrhoidectomy was suggested and performed. After surgery, the patient developed hypotension, tachycardia, fever with chills and renal function impairment on day 2 post-operation. The clinical condition progressed to severe septic shock and metabolic acidosis. The patient responded poorly to treatment and expired after 1 d even with use of extracorporeal membrane oxygenation. The results of the blood and wound cultures showed group A streptococcus pyogenes. CONCLUSION: Although extremely uncommon, all surgeons should be aware of these potential life-threatening septic complications and alert to the presenting features for patients receiving hemorrhoidectomy.

A pilot study comparing ergonomics in laparoscopy and robotics: beyond anecdotes, and subjective claims.

We aimed to use hand dexterity and grip strength test as objective measures to compare the difference in surgeon fatigue associated with robotic and laparoscopic colorectal surgery. We used the Purdue Pegboard Test to assess hand dexterity and the Camry Electronic Handgrip Dynamometer to assess hand grip strength. Eighteen patients were operated on, including 10 robotic and 8 laparoscopic cases. Statistical analysis revealed no difference in dexterity or muscle fatigue after operating with the robot. In contrast, there was a significant difference in the hand grip strength of both hands after laparoscopic surgery. Our results show that the resultant fatigue after laparoscopy affects both hands of the surgeon. In contrast, there was no difference in dexterity or muscle fatigue after operating with the robot. Given the demands of complex colorectal surgeries, robotics may be a means of optimizing surgeon performance by reducing fatigue.

Robotic Transanal Minimally Invasive Surgery for Rectal Lesions.

Background. Transanal minimally invasive surgery (TAMIS) was developed as a less aggressive alternative treatment for rectal lesions. The purpose of this study was to report the results of robotic TAMIS for such patients. Methods. Patients eligible for TAMIS were operated on using the da Vinci robotic surgical system and GelPOINT Path Transanal Access Platform. Patient demographics, lesion characteristics, perioperative data, complications, and follow-up of all patients were recorded retrospectively. Results. Between March 2015 and August 2018, 24 patients underwent robotic TAMIS by using the da Vinci Si or Xi. The median operative time was 129.6 minutes, and the estimated blood loss was minimal. The mean length of hospital stay was 4.6 days, with no operative complications and no 30-day mortality. There were no statistically significant differences in clinical results and pathological outcomes between the 2 generations of da Vinci systems. Conclusions. With the use of robotic technology, transanal local excision for rectal lesions can be performed with relative ease and safety and can be potentially decreasing the morbidity associated with more aggressive surgical techniques.

The Role of Active Engagement of Peer Observation in the Acquisition of Surgical Skills in Virtual Reality Tasks for Novices.

OBJECTIVE: Peer-assisted learning has been regarded as an adjunct to teaching modalities. It remains inconclusive regarding the benefits of peer observation in skills learning. Hence, we investigated whether the active engagement (AE) of peer observation in addition to expert demonstration would facilitate the performance in the virtual reality (VR) tasks. SETTING/DESIGN: The programs involved 4 VR tasks including basic (camera targeting), intermediate (energy dissection and energy switching), and advanced (suture sponge) tasks in the da Vinci Skills Simulators, which were set up in the operating room at Taipei Medical University Hospital. Fifty medical students participated in the study. The AE of the participants was defined as the total number of peer observations in addition to expert observation before their performance. We assessed the correlations between AE and surgical task performance using Pearson correlation and the concept of learning analytics. PARTICIPANTS: Medical students (sixth-year students in Taiwan, equivalent to fourth-year students in the US system) from Taipei Medical University were recruited. RESULTS: AE was correlated with the energy dissection task (r = 0.329, p = 0.02) and marginally associated with the energy switching task (r = 0.271, p = 0.057). However, AE was not correlated with either task scores for camera targeting (r = 0.096, p = 0.509) or task scores for suture sponge (r = -0.091, p = 0.529). CONCLUSIONS: Our findings suggest that AE of peer observation may facilitate learning energy dissection task, which is an intermediate-level task, but not in other basic or advanced tasks in a VR context. The study highlights the potential effect of AE of peer observation on surgical learning based on a distinct level of tasks. Tasks that fit the learners' level are recommended. Nevertheless, the effectiveness of peer observation on surgical training still has to be explored to ensure favorable results and optimal learning outcomes.

Robotic transanal minimally invasive surgery for rectal cancer after clinical complete response to neoadjuvant chemoradiation.

BACKGROUND: Full-thickness local excision (FTLE) for rectal cancer showing clinical complete remission (cCR) after neoadjuvant chemoradiation therapy (NCRT) is associated with good oncological results. The purpose of this study was to report the results of robotic transanal minimally invasive surgery for such patients. METHODS: Patients were treated with a 5-fluorouracil-based NCRT regimen. The determination of cCR was based on digital rectal examination, colonoscopy, and magnetic resonance imaging. RESULTS: Six patients underwent transanal FTLE using the da Vinci Xi surgical system. The median operative time was 106.5 minutes, and the estimated blood loss was minimal. The mean length of hospital stay was 4.2 days. After 18.2 months of follow-up, none of the patients developed local recurrences or distant disease. CONCLUSIONS: With the use of robotic technology, FTLE can be performed with relative ease and can be considered as a viable alternative to radical resection or a "Watch and Wait" strategy.

Transanal total mesorectal excision: is it necessary in the era of robots?

Transanal total mesorectal excision (taTME) has been proposed to overcome the limitations of laparoscopic TME. The robotic surgical platform has already established its benefits in providing superior ergonomics, and the purported advantages of taTME may play less important a role in the era of robots.

Anorectal complications after robotic intersphincteric resection for low rectal cancer.

BACKGROUND: Robotic intersphincteric resection (ISR) has been introduced for sphincter-preservation in the treatment of low rectal cancer. However, many patients experience anorectal symptoms and defecatory dysfunction after ISR. This study aims to evaluate the anorectal complications that develop after ISR. METHODS: The medical records of 108 patients who underwent robotic ISR at Taipei Medical University Hospital, Taipei, Taiwan between December 2011 and June 2016 were retrospectively reviewed. Photographic records of perineal conditions were documented at the following time intervals after surgery: 1 day, 2 weeks, 1, 2, 3 and 6 months. Clinical outcomes and treatment results were analysed. RESULTS: Eighty-five patients (78.7%) developed edematous hemorrhoids after surgery. These subsided at a median of 56 days after operation (range 23-89 days). Forty-six patients (42.6%) were found to have anal stenosis requiring anal dilatation. Sixteen patients (14.8%) had neorectal mucosal prolapse, which was noted to occur at an average of 98 days after surgery (range 41-162 days). Multivariate analysis showed that the occurrence of edematous hemorrhoids was associated with operating time (P = 0.043), and male gender was a significant risk factor for anal stenosis (P = 0.007). CONCLUSIONS: This is the first study reporting on the clinical outcomes of anorectal status after robotic ISR. Further studies are needed to assess the long-term effects of these anorectal complications.

Combined robotic transanal total mesorectal excision (R-taTME) and single-site plus one-port (R-SSPO) technique for ultra-low rectal surgery-initial experience with a new operation approach.

OBJECTIVE: Robot-assisted rectal surgery is gaining popularity, and robotic single-site surgery is also being explored clinically. We report our initial experience with robotic transanal total mesorectal excision (R-taTME) and radical proctectomy using the robotic single-site plus one-port (R-SSPO) technique for low rectal surgery. METHODS: Between July 2015 and March 2016, 15 consecutive patients with ultra-low rectal lesions underwent R-taTME followed by radical proctectomy using the R-SSPO technique by a single surgeon. The clinical and pathological results were retrospectively analyzed. RESULTS: The median operative time was 473 (range, 335-569) min, and the estimated blood loss was 33 (range, 30-50) mL. The median number of lymph nodes harvested was 12 (range, 8-18). The median distal resection margin was 1.4 (range, 0.4-3.5) cm, and all patients had clear circumferential resection margins. We encountered a left ureteric transection intraoperatively in one patient, and another patient required reoperation for postoperative adhesive intestinal obstruction. There was no 30-day mortality. CONCLUSION: R-taTME followed by radical proctectomy using the R-SSPO technique for patients with low rectal lesions is technically feasible and safe without compromising oncologic outcomes. However, there were considerable limitations and a steep learning curve using current robotic technology.

Robot-assisted intersphincteric resection for rectal submucosal tumour.

BACKGROUND: Rectal submucosal tumours are rare. The purpose of this study was to evaluate the safety and feasibility of robot-assisted rectal surgery. METHODS: Patients who received robot-assisted intersphincteric resection (ISR) were included in the present study. Clinical outcomes, operating time, length of hospital stay and pathological status were analysed. RESULTS: There were three patients with gastrointestinal tumours and three patients diagnosed with neuroendocrine tumours. The mean operating time was 369.2 min and the estimated blood loss was 66.7 ml. There were neither intraoperative complications nor conversions. On pathological examination, the mean number of lymph nodes harvested was 10.3 (range 3-16), the mean distal resection margin was 1.1 (range 0.1-3) cm and all six patients had the circumferential resection margins clear. CONCLUSIONS: Our data show that robotic surgery is feasible and safe, with no morbidity or mortality, and that ISR provides bowel continuity and eliminates the need for colostomy. Copyright © 2015 John Wiley & Sons, Ltd.

Sac ligation in inguinal hernia repair: A meta-analysis of randomized controlled trials.

BACKGROUND: Traditionally, hernia sac ligation during inguinal hernia repair is considered mandatory to prevent postoperative development of hernia. However, ligation may induce postoperative pain. The aim of this study was to evaluate the outcomes of hernia sac ligation after inguinal hernia repair. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials to investigate the outcomes of hernia sac ligation for open or laparoscopic inguinal hernia repair. Incidence of hernia recurrence was assessed following the surgery. The secondary outcomes included pain scores and postoperative complications. RESULTS: Five trials were selected and their results were summarized. These 5 trials were published between 1984 and 2014, and the sample sizes ranged from 50 to 467 patients. Four trials had recruited patients with inguinal hernia who underwent open repair, and one study enrolled patients who underwent laparoscopic procedures. We observed no difference in the incidence of hernia recurrence and postoperative complications between the sac ligation and nonligation groups. Postoperatively, the intensity of pain was significantly higher in the ligation group than in the nonligation group at Day 7 (Weight mean difference 1.46; 95% confident interval: 0.98-1.95). CONCLUSION: Hernia sac ligation was associated with higher postoperative pain, and did not show any benefit over sac nonligation regarding the incidence of recurrence and postoperative complications in patients undergoing open tension-free mesh repair or laparoscopic procedures.

The bioactive composite film prepared from bacterial cellulose and modified by hydrolyzed gelatin peptide.

The hydrolyzed gelatin peptides, obtained from the hydrolysis of Tilapia nilotica skin gelatin with alcalase and pronase E, were fractionated using an ultrafiltration system into hydrolyzed gelatin peptides-a (10 kDa membrane), hydrolyzed gelatin peptides-b1, and hydrolyzed gelatin peptides-b2 (5 kDa membrane) fractions. The highest oxygen radical absorbance capacity was observed in hydrolyzed gelatin peptides-b2, which contained more nonpolar amino acids than the other hydrolyzed gelatin peptides. Hydrolyzed gelatin peptides-b2 at a concentration of 12.5 mg/ml exhibited the highest proliferation ability and increased the expression of Type I procollagen mRNA, which indicated an enhanced collagen synthesis. Hydrolyzed gelatin peptides protected Detroit 551 cells from 2,2'-azobis(2-amidinopropane) dihydrochloride-induced oxidative damage and increased cell viability. Hydroxylpropylmethyl cellulose-modified bacterial cellulose and dried fabricated biofilm were less eligible for Detroit 551 cell proliferation than bacterial cellulose. The release of hydrolyzed gelatin peptides in bacterial cellulose film was slower than that in hydroxylpropylmethyl cellulose-modified bacterial cellulose and dried fabricated biofilm; thus, bacterial cellulose film and hydroxylpropylmethyl cellulose-modified bacterial cellulose and dried fabricated biofilm are suitable candidates for applications in delayed release type and rapid release type biofilms, respectively.

Dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing thyroidectomy: meta-analysis of randomized controlled trials.

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication after thyroidectomy. Steroids effectively reduce nausea, pain, and inflammation; therefore, preoperative administration of steroids ought to improve these surgical outcomes. METHODS: We conducted a systematic review of randomized controlled trials (RCTs) that compared preoperative single-dose administration of dexamethasone with no dexamethasone in patients undergoing thyroidectomy. The primary outcome was occurrence of PONV within 24 h, and the secondary outcomes were pain, use of analgesics, and steroid-related complications. RESULTS: Five RCTs were included with a total of 497 patients. A statistically and clinically significant difference in the incidence of PONV was found in favor of dexamethasone [relative risk (RR) 0.38; 95% confidence interval (CI) 0.30-0.49). The visual analog pain score was significantly diminished (weighted mean difference, WMD)-1.50; 95% CI-2.54 to -0.46) at 24 h. The incidence of analgesics use was also reduced (RR 0.61; 95% CI 0.41-0.90) in the dexamethasone group. No steroid-related complications were noted. CONCLUSIONS: A single preoperative administration of dexamethasone reduced the incidence of PONV and analgesic requirements in patients undergoing thyroidectomy. Prophylactic use of steroids for patients undergoing thyroidectomy is safe and should be considered for routine clinical practice.

Severe peritonitis due to Streptococcus viridans following adjustable gastric banding.

Late postoperative intra-abdominal infections after laparoscopic gastric banding are extremely rare and may or may not be associated with the device following uncomplicated adjustable gastric banding procedures. The spectrum of pathogens associated with intra-abdominal infections is diverse and depends on the origin of the infection. Streptococci is a significant cause of peritoneal dialysis peritonitis (6% to 16% of the cases), and S. viridans is reported to account for up to 93% of streptococci infections. However, peritonitis due to S. viridans in patients following adjustable gastric banding is very rare. We herein report a non-uremic case of a 38-year-old male patient with severe peritonitis due to S. viridans 5 years after an uneventful primary gastric banding procedure.