No Drain, No Problem: Serum-Based Marker Prediction of Clinically Relevant Postoperative Pancreatic Fistula.

BACKGROUND: Postoperative day (POD) 1 drain amylase concentration (DAC) is considered the most accurate predictor for the development of a clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD). Recent studies have associated drain placement with negative postoperative outcomes. This study aims to evaluate multiple biochemical markers and their associations with CR-POPF development in order to identify a reliable, non-drain dependent alternative to DAC. METHODS: This is a review of 53 consecutive PD patients between 2021 and 2022. Albumin, C-reactive protein (CRP), C-reactive protein-to-albumin ratio (CAR), DAC, white blood cell count, and procalcitonin values were compared by CR-POPF status. The discriminatory abilities of CAR, CRP, and DAC for CR-POPF were compared using receiver operating characteristic (ROC) curves. RESULTS: Six of 51 included patients developed a CR-POPF. Receiver operating characteristic curve analysis produced an area under the curve of .977 for POD 1 DAC (cut-off 5131.0 IU/L, sensitivity 100%, specificity 95.5%), .858 for POD 1 CRP (cut-off 52.5 mg/L, sensitivity 100%, specificity 72.7%), and 1.000 for POD 3 CAR (cut-off 99.2, sensitivity and specificity 100%). POD 3 CAR produced a positive and negative predictive value of 100%. CONCLUSION: The CAR and CRP provide early and accurate identification of patients with post-PD CR-POPFs. These markers offer a method of safe CR-POPF detection, when the gold standard DAC is unavailable, ultimately allowing for early intervention and patient rescue.

Teacher and Trainee Learning Together-Dual Console and the 3 Arms.

OBJECTIVE: The purpose of this paper is to propose a method by which the trainer and the trainee can overcome their learning curves together. DESIGN/SETTING/PARTICIPANTS: At a tertiary care facility where we have completely done away with the mandatory bedside procedure requirements, residents and fellows start all cases on the console and have graduated responsibilities assigned to them. Bedside assist cases were felt to take away from trainee precious console time when there were only on service for a limited period while providing laparoscopic skill training without any robot-specific experience. This is a cumulative experience of teaching residents and fellows under this system and its results. RESULTS: All trainees at a PG 3 level or greater were able to perform advanced hiatal dissection within 5 cases. CONCLUSIONS: The authors propose a paradigm that uses all 3 arms of the robot and a dual console system.