The Impact of Modified Two-Surgeon Technique for Laparoscopic Liver Resection on the Training of Surgeons-in-Training.

Introduction Although laparoscopic liver resection (LLR) has gained widespread acceptance over the last decade, it is associated with a much steeper learning curve than other laparoscopic procedures. We currently perform a modified two-surgeon technique for LLR. We assessed the effect of our LLR technique on the surgical outcome and the learning curve of surgeons-in-training when pure non-anatomical LLR was performed. Methods Between 2017 and 2021, 118 LLRs were conducted at our institution, 42 of which were pure non-anatomical LLRs performed by five surgeons-in-training (with a career of 6-13 years). The perioperative outcomes of these cases were compared to those performed by the board-certified attending surgeon. Regarding the learning curve of surgeons-in-training, the duration of operation was used as an index of the proficiency level, and the number of surgical cases in which the surgeons reached the median duration of operation was examined. Results Mortality was zero, and neither postoperative bleeding nor bile leak was experienced in the whole cohort. There were no differences between surgeons-in-training and the board-certified surgeon in the duration of the operation, intraoperative blood loss, rate of postoperative complications, or length of postoperative stay (LOS). Among the operations performed by five surgeons-in-training, the rate of LLR with a difficulty score of 4 or higher was 52% (30%-75%). Concerning the learning curve, all five surgeons-in-training gradually shortened the duration of operation for each additional case and reached the median duration (218 minutes) by experiencing a median of five cases (3-8 cases). Conclusion A modified two-surgeon technique during LLR is feasible, with a relatively low number of cases (five cases) required to shorten the duration of operation in non-anatomical LLR. This technique is safe and beneficial to the education of surgeons-in-training.

A cross-sectional national study of burnout and psychosocial work environment in vascular surgery in Denmark.

OBJECTIVE: Little is known about burnout among European vascular surgeons (VSs). In this study, the prevalence of burnout and its associated risk factors were investigated among all VSs and vascular surgeons in training (VSTs) in Denmark. METHODS: An anonymous electronic survey was distributed to all clinical active VSs and VSTs on January 1, 2020. Validated assessment tools were used to measure burnout and aspects of the psychosocial work environment. RESULTS: A total of 104 VSs and VSTs were invited to participate, and 82% (n = 85) completed the survey. The majority of the respondents were male (60%; n = 50) and VSs (67%; n = 61). Of the respondents, 82% (n = 70) reported either light (54%; n = 46), moderate (22%; n = 19), or severe (6%; n = 5) personal burnout. More than 50% (n = 47) reported work-related burnout, light (39%; n = 33), moderate (9%; n = 8), and severe (7%; n = 6), respectively, whereas 35% (n = 30) reported patient-related burnout, light (31%; n = 26), moderate (2%; n = 2), and severe (2%; n = 2), respectively. Respondents with more than four 24-hour on-call shifts per month had significantly higher work-related burnout scores, whereas respondents with home-living children and those aged 45 to 59 years showed significantly higher personal and patient-related burnout, respectively. There were strong associations between personal and work-related burnout and the psychosocial work environment, especially work organization and interpersonal relations, but not job demands. The prevalence of burnout was unevenly distributed across departments, with the most affected department having a burnout occurrence twice the least affected department. CONCLUSIONS: Based on a national survey conducted among all clinical active VSs and VSTs in Denmark, more than 80% (n = 70) suffered from burnout, of whom 28% (n = 24) suffered from moderate to severe personal burnout. The strong association with the psychosocial work environment, and the significant differences between departments, suggest that burnout is modifiable through changes in the work environment.

Why bother: usefulness and effect of young surgeon committees in surgical societies.

Work-time constraints during surgical residency along with managing a private life usually take up the majority of the time of young surgeons. For many, work with a surgical society seems like something neither generally promising nor personally worthwhile, thus raising the question, why bother? This article sets out to show examples of the effects that surgical societies and young surgeon committees can have on surgery and residency training. Additionally, we highlight the personal side of being active on a committee. Our aim is to raise interest in participating in societal work by showing the rewarding general effects as well as personal benefits. While this article is based primarily on experiences made in Germany, we believe that aspects can be transferred to other medical systems.

Evaluación del conocimiento anátomo-quirúrgico del sistema de la vena cava inferior por médicos residentes de cirugía general / Evaluation of anatomical and surgical understanding of the inferior vena cava system by general surgery interns

Las lesiones de vena cava inferior (VCI) han sido descritas como la lesión vascular abdominal mas frecuente encontradas en los centros de trauma. Puede lesionarse entre la supra e infrarrenal; y en el caso de lesión retrohepática, se asocia con alta mortalidad. En heridas penetrantes conllevan una elevada mortalidad. Hasta un 50 % de los individuos que experimentan estas lesiones muere antes de llegar al hospital; y la tasa de mortalidad entre los que llegan con vida a un centro de trauma varía entre 20­57 %. Se evaluaron a 12 cirujanos en formación, respecto de los conocimientos anatómicos del sistema de la VCI y sus relaciones, con material cadavérico formalizado mediante listas de verificación (Abril/2014). Luego de un período de entrenamiento mediante la disección anatómica de 10 cadáveres formolizados (Mayo/2014-Agosto/2014); se realizó una nueva evaluación de los médicos residentes de cirugía general en formación mediante listas de verificación, con material cadavérico fresco (Septiembre/2014). Durante la primera evaluación la vena iliaca común derecha e izquierda, fueron identificadas por 8 (66,66 %) residentes. Siete (58,33 %) mencionaron los segmentos de la VCI en intratorácico y abdominal. Seis (85,71 %) mencionaron la porción intrapericárdica y uno (14,29 %) la porción extrapericárdica. La porción o segmento subduodenal fue identificado como subhepático por siete (58,33 %) residentes; y solo dos (16,66 %) mencionaron los segmentos subduodenal, retroduodenopancreático y supraduodenopancreático como parte del segmento subhepático. Tres (25 %) no mencionaron los diferentes segmentos de la VCI (abdominal). El segmento retrohepático fue identificado por ocho (66,66 %). Durante la segunda evaluación la vena iliaca común derecha e izquierda, fueron identificadas por todos los residentes. Once (91,66 %) mencionaron los segmentos de la VCI en intratorácico y abdominal, además de la porción intrapericárdica y la porción extrapericárdica. El segmento subduodenal fue identificado como subhepático por dos (16,66 %) residentes; y nueve (75 %) mencionaron los segmentos subduodenal, retroduodenopancreático y supraduodenopancreático como parte del segmento subhepático. El segmento retrohepático fue identificado por once (91,66 %) residentes. La observación y disección anatómica de la VCI en material cadavérico durante la formación del cirujano general, brinda un importante método de enseñanza, capacitación y entrenamiento hacia el reconocimiento de las diferentes estructuras anatómicas de la región, pudiendo luego ser aplicado en cirugía. La metodología de supervisión y evaluación mediante listas de verificación, por médicos especialistas, es una opción a agregar a los programas de formación para mejorar el proceso de educación.

Injuries in the inferior vena cava (IVC) have been described as the most common vascular abdominal injury found in trauma. The injury may present between the suprarenal and the infrarenal; in the case of retrohepatic injuries, it is associated with a high mortality rate. In a penetrating wound, high mortality rates are reported. Up to 50% of the individuals who experience these injuries die before getting to the hospital, and the mortality rate among those who get to a healthcare facility alive, ranges from 20 to 57 %. The study involved the evaluation of 12 trainee surgeons concerning anatomical understanding of the inferior vena cava system and related areas, using corpses subject to 10 % formol via checklists (April 2014). After a training period with anatomical dissection of 10corpses subject to 10 % formol (May 2014-August 2014), the general surgery interns were reassessed via checklists using fresh corpses fresco (September 2014). During the first evaluation, the right and left common iliac vein were identified by 8 (66.66 %) interns: 7 (58.33 %) mentioned the segments of the IVC in the intrathoracic and abdominal area; 6 (85.71 %) referred to the intrapericardial portion, and 1 (14.29 %) mentioned the extrapericardial portion. The subduodenal portion or segment was identified as subhepatic by 7 (58.33 %) interns, and only 2 (16.66 %) referred to the subduodenal, retroduodenopancreatic and supraduodenopancreatic segments as part of the subhepatic segment. 3 (25 %) failed to mention the various segments of the (abdominal) IVC. The retrohepatic segment was identified by 8 (66.66 %) interns. During the second evaluation, the right and left common iliac vein were identified by 12 (100 %) interns: 11 (91.66 %) mentioned the segments of the inferior vena cava in the intrathoracic and abdominal areas; 11 (91.66 %) interns referred to the intrapericardial and the extrapericardial portions. The subduodenal segment was identified as subhepatic by 2 (16.66 %) interns, and 9 (75 %) of them mentioned the subduodenal, retroduodenopancreatic and supraduodenopancreatic segments as part of the subhepatic segment. The retrohepatic segment was identified by 11 (91.66 %) interns. Observation and anatomical dissection of the IVC in corpses when training a general surgeon provides a major teaching and training method to recognize the different anatomical structures of the area, for subsequent its application to surgery. The supervision and evaluation methodology consisting of the use of checklists by specialist physicians is an option that should be added to training programs in order to improve the educational process.

Visual outcomes and incidence of vitreous loss among third-year ophthalmology residents performing manual small incision cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To determine the visual outcome and the incidence of vitreous loss in patients undergoing manual small incision cataract surgery(MSICS)by third-year ophthalmology residents.METHODS:Hospital records of 799 consecutive patients undergoing MSICS at Department of Ophthalmology,Prapokklao Hospital by third-year ophthalmology residents between July 2005 and June 2007 were reviewed.Bestcorrected visual acuity(BCVA)were compared between the eyes operated by residents and those operated by the staffs.For the complication of vitreous loss,the study group(patients with vitreous loss)were compared with the control group(patients without vitreous loss)using analytic case-control study.RESULTS:One month postoperatively,91.0%of patients in resident group and 92.5%in the staff group had visual acuity of 6/18 or better.The difference in visual outcome between the two groups was not statistically significant(P =0.526).The incidence of vitreous loss among residents was 5.01%(20/399)and 1.00%(4/400)among the staff.The overall incidence of vitreous loss was 3.0%.The odds that the eyes in the resident group would have an intraoperative complication of vitreous loss were 5.22 times,the odds that the eyes in the staff group would have such a complication(P = 0.002,95%confidential interval(Cl)of relative risk =1.769-15.426).CONCLUSION:Good visual acuity can be achieved after resident perfoming MSICS.The vitreous loss rate in this study is high.