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1.
Ann R Coll Surg Engl ; 104(4): 288-294, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34931536

RESUMO

INTRODUCTION: Motor imagery and mental practice are important for the acquisition and mastery of surgical skills. The success of this technique relies on the use of a well-developed mental script. In this study, we shared how we developed a mental script for basic micro suturing training by using a low-fidelity rubber glove model. METHODS: This study applied the design and development research framework. Five expert surgeons developed a mental script by performing a cognitive walkthrough to repair a vertical opening in a rubber glove model, followed by hierarchical task analysis. A draft script was created, and its face and content validity assessed with a checking-back process. Twenty-eight surgeons used the Mental Imagery Questionnaire (MIQ) to assess the validity of the final script. RESULTS: The process of developing the mental script is detailed. The assessment by the expert panel showed the mental script had good face and content validity. The mean overall MIQ score was 5.2±1.1 (standard deviation), demonstrating the validity of generating mental imagery from the mental script developed in this study for micro suturing in the rubber glove model. CONCLUSION: The methodological approach described in this study is based on a design and development research framework to teach surgical skills. This model is inexpensive and easily accessible, addressing the challenges of reduced opportunities to practise surgical skills. However, although motor skills are important, the surgeon's other non-technical expertise is not addressed with this model. Thus, this model should act as one surgical training approach, but not replace it.


Assuntos
Competência Clínica , Cirurgiões , Humanos , Destreza Motora , Inquéritos e Questionários , Suturas
2.
Ulus Travma Acil Cerrahi Derg ; 28(8): 1109-1114, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35920427

RESUMO

BACKGROUND: Medical malpractice occurs in cases, where a patient experiences damage as a result of the doctor's deviation from the standard practice or care. As in all medical specialties, thoracic surgeons may face medical malpractice claims. METHODS: Among the files reviewed by the First Board of Specialization of the Council of Forensic Medicine between January 01, 2010, and December 21, 2015, cases with malpractice allegations against thoracic surgeons were analyzed retrospectively. RESULTS: Fifty-nine of the cases were male (72.8%), and 22 were female (27.2%). The mean age was 51.13±18.97 years, and the most common age range was >60 years (n=35, 43.2%). Medical malpractice was confirmed in 11 (13.6%) of the cases. A diagnostic error was the most common cause of error (n=7, 63.6%), and the most common cause of a diagnostic error was failure to diagnose a condition on time (n=4, 36.4%). The most frequent diagnosis was 'injuries due to trauma' (n=54, 66.7%), followed by lung cancer (n=9, 11.1%). It was found that 80.2% (n=65) of the doctors intervened with the patient as a consultant. Complications developed in 48 (59.3%) of the cases. The most common complication was pneumonia (n=7, 14.6%). CONCLUSION: This was the first study in Turkey that included cases of medical malpractice claims that involved thoracic surgeons. We think that examining cases with medical malpractice claims will help physicians not only better understand the characteristics of malpractice claims but also develop strategies to prevent malpractice claims.


Assuntos
Imperícia , Cirurgiões , Cirurgia Torácica , Feminino , Medicina Legal , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Ulus Travma Acil Cerrahi Derg ; 28(8): 1100-1108, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35920435

RESUMO

BACKGROUND: Mass trauma is an event in which the number of patients temporarily exceeds the capacity of medical personnel to provide optimal care. Looking at the global terrorism index, Syria is one of the most terrorism-affected countries in the Middle East, and the threat of terrorist attacks that can cause mass trauma persists. When it comes to dealing with mass trauma, the damage control approach has come to the forefront in recent years. In our study, we aimed to assess the awareness and training effectiveness of emergency physicians and surgeons on damage control surgery and resuscitation in Northwest Syria, where mass trauma due to terrorist attacks and social events is common. METHODS: A trauma team from Çobanbey Hospital in Northwest Syria conducted training on damage control and resuscitation. Syrian physicians who participated in this training were administered a damage control and resuscitation questionnaire before and after the training. RESULTS: A total of 43 subjects were enrolled in the study, and their mean age was 44.04±9.01 years. The majority of the physicians who participated in the training were from Elbab (23.3%), Afrin (23.3%), and Çobanbey (20.9%). The average work experience of the physicians was 14 years and the average number of non-elective surgeries performed in the last year was 47.5. While the average total score (pre-test) before the training was 67, the average total score (post-test) after the training increased to 72, and this difference was statistically significant (p=0.008). While the pre-test and post-test scores of those who were trained and had practiced placing intrathoracic clamp-wound clamp and trauma laparotomy were significantly higher than those who were not trained and had not used them (p<0.05), the difference between the pre-test and post-test scores of those who were not trained and had not used them was statistically significant (p<0.05). CONCLUSION: It is well known that there have been internal unrest and terrorist attacks in Northwest Syria for more than 10 years. It is important for physicians in this region to know the damage control strategies. In this regard, we have found that awareness among physicians has increased as a result of the training we have provided on damage control.


Assuntos
Cirurgiões , Terrorismo , Adulto , Hospitais , Humanos , Pessoa de Meia-Idade , Ressuscitação , Síria
4.
Neurosurg Focus ; 53(2): E11, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35916096

RESUMO

Neurosurgical education is a continually developing field with an aim of training competent and compassionate surgeons who can care for the needs of their patients. The Mayo Clinic utilizes a unique mentorship model for neurosurgical training. In this paper, the authors detail the historical roots as well as the logistical and experiential characteristics of this teaching model. This model was first established in the late 1890s by the Mayo brothers and then adopted by the Mayo Clinic Department of Neurological Surgery at its inception in 1919. It has since been implemented enterprise-wide at the Minnesota, Florida, and Arizona residency programs. The mentorship model is focused on honing resident skills through individualized attention and guidance from an attending physician. Each resident is closely mentored by a consultant during a 2- or 3-month rotation, which allows for exposure to more complex cases early in their training. In this model, residents take ownership of their patients' care, following them longitudinally during their hospital course with guided oversight from their mentors. During the chief year, residents have their own clinic, operating room (OR) schedule, and OR team and service nurse. In this model, chief residents conduct themselves more in the manner of an attending physician than a trainee but continue to have oversight from staff to provide a "safety net." The longitudinal care of patients provided by the residents under the mentorship model is not only beneficial for the trainee and the hospital, but also has a positive impact on patient satisfaction and safety. The Mayo Clinic Mentorship Model is one of many educational models that has demonstrated itself to be an excellent approach for resident education.


Assuntos
Internato e Residência , Neurocirurgia , Cirurgiões , Humanos , Masculino , Mentores
5.
Ear Nose Throat J ; 101(7): 474-478, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35916230

RESUMO

BACKGROUND: Otosclerosis is a disease of the osseous labyrinth. The disease causes 5% to 9% of all cases of hearing loss and 18% to 22% of conductive hearing loss. The treatment of choice is a surgery. The hearing improvement after the operation is determined by various factors. AIMS/OBJECTIVES: The aim of the analysis is to determinate changes in hearing after stapedoplasty in view of surgery side in the patients operated on otosclerosis by right-handed surgeons. MATERIAL AND METHODS: The analysis involved patients hospitalized and operated on otosclerosis between 2012 and 2018. Only patients with their first middle ear surgery due to otosclerosis were included in the study. The patients were operated by 2 right-handed surgeons who used the same surgical technique and had similar experience in otosclerosis surgery. The study included patients who were divided into 2 groups: with self-tightening prosthesis and with manually tightening prosthesis. RESULTS: The procedure performed by right-handed operators on the left side using prostheses requiring manual fixation on the incus was associated with poorer audiometric results compared to the results of surgeries on the right side. In patients with the self-tightening prostheses, the audiometric improvement of hearing was bilaterally comparable independently from operation side. CONCLUSION: (1) The dependence of hearing improvement on the surgery side was demonstrated in cases of surgeries performed on the left ear by right-handed surgeons, particularly with manually tightening prosthesis. (2) Self-tightening prostheses in stapedotomy limit the human factor, reducing the risk of complications after otosclerosis surgery and provide repeatable hearing improvement.


Assuntos
Prótese Ossicular , Otosclerose , Cirurgia do Estribo , Cirurgiões , Condução Óssea , Audição , Humanos , Otosclerose/complicações , Otosclerose/cirurgia , Estudos Retrospectivos , Cirurgia do Estribo/métodos
6.
Comput Math Methods Med ; 2022: 2332628, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35912156

RESUMO

Objective: Motion analysis of surgical instruments can be used to evaluate laparoscopic surgical skills, and this study assessed the validity of an optical tracking system for the assessment of laparoscopic surgical motor skills. Methods: Ten experienced surgeons and ten novices were recruited to complete the transferring tasks on a laparoscopic simulator. An optical tracking system, Micron Tracker, was used to capture the marker points on each instrument and to obtain the coordinates of the marker points and the corresponding instrument tip coordinates. The data are processed to create a coordinate system based on the laparoscopic simulator and to calculate the movement parameters of the instruments, such as operating time, path length, speed, acceleration, and smoothness. At the same time, the range of motion of the instrument (insertion depth and pivoting angle) is also calculated. Results: The position that the tip of the instrument can reach is a small, irregularly shaped spatial area. Significant differences (p < 0.05) were found between the surgeon and novice groups in parameters such as operating time, path length, mean speed, mean acceleration, and mean smoothness. The range of insertion depth of the instruments was approximately 150 mm to 240 mm, and the pivoting angles of the left and right instruments were 30.9° and 46.6° up and down and 28.0° and 35.0° left and right, respectively. Conclusions: The optical tracking system was effective in subjectively evaluating laparoscopic surgical skills, with significant differences between the surgeon and novice groups in terms of movement parameters, but not in terms of range of motion.


Assuntos
Laparoscopia , Cirurgiões , Competência Clínica , Humanos , Destreza Motora , Instrumentos Cirúrgicos
7.
Indian J Ophthalmol ; 70(8): 2956-2961, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35918952

RESUMO

Purpose: This study aims to assess the preferred surgical technique of Descemet membrane endothelial keratoplasty (DMEK) among corneal surgeons in India, and barriers in performing DMEK surgeries amongst the non-DMEK surgeons. Methods: An online, questionnaire-based, cross-sectional survey was conducted among members of the Cornea Society of India (CSI) (n = 500). Responses on their surgical experience, preferred technique, complications, and outcome of DMEK were collected and analyzed. Barriers in performing DMEK surgeries were assessed amongst the non-DMEK surgeons. Results: A total of 100 responses were obtained and response rate for the survey was 20%. DMEK was performed by 55% of the participants of whom only 40% had formal training in this technique. Surgical video-based learning was the most often used self-training method for others. Lack of training was the most common reason for not performing DMEK by the non-DMEK surgeons. Descemet stripping endothelial keratoplasty (DSEK) was the most common endothelial keratoplasty (EK) performed by both DMEK and non-DMEK surgeons. High volume (>50 cases) DMEK surgeries were reported by limited surgeons (n = 6). Nearly all the DMEK surgeons prepared the donor tissue by themselves on the day of the surgery, and majority felt that unrolling the graft in the anterior chamber was the most difficult surgical step. Nearly 80% of the DMEK surgeons were more comfortable with DSEK or Descemet stripping automated endothelial keratoplasty (DSAEK) when compared to DMEK. Conclusion: DMEK practice in India needs improvement with increased accessibility to DMEK training programs, wet lab facilities, and better support from eye banks.


Assuntos
Doenças da Córnea , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Cirurgiões , Doenças da Córnea/cirurgia , Estudos Transversais , Lâmina Limitante Posterior/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Endotélio Corneano , Humanos , Inquéritos e Questionários , Acuidade Visual
9.
Sci Rep ; 12(1): 11251, 2022 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-35788658

RESUMO

The surgical workforce, like the rest of the population, is ageing. This has raised concerns about the association between the age of the surgeon and their surgical outcomes. We performed a systematic review and meta-analysis of cohort studies on postoperative mortality and major morbidity according to the surgeons' age. The search was performed on February 2021 using the Embase, Medline and CENTRAL databases. Postoperative mortality and major morbidity were evaluated as clinical outcomes. We categorized the surgeons' age into young-, middle-, and old-aged surgeons. We compared the differences in clinical outcomes for younger and older surgeons compared to middle-aged surgeons. Subgroup analyses were performed for major and minor surgery. Ten retrospective cohort studies on 29 various surgeries with 1,666,108 patients were considered. The mortality in patients undergoing surgery by old-aged surgeons was 1.14 (1.02-1.28, p = 0.02) (I2 = 80%) compared to those by middle-aged surgeon. No significant differences were observed according to the surgeon's age in the major morbidity and subgroup analyses. This meta-analysis indicated that surgeries performed by old-aged surgeons had a higher risk of postoperative mortality than those by middle-aged surgeons. Thus, it necessitates the introduction of a multidisciplinary approach to evaluate the performance of senior surgeons.


Assuntos
Cirurgiões , Idoso , Estudos de Coortes , Humanos , Pessoa de Meia-Idade , Morbidade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
10.
Can J Vet Res ; 86(3): 165-171, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35794974

RESUMO

This experimental study compared leak pressures and completion time of intestinal anastomoses performed by novice veterinarians and a Board-certified surgeon using simple interrupted and simple continuous suture patterns. Grossly normal jejunal segments (n = 108) from 6 fresh canine cadavers were used to harvest 8-cm cooled canine cadaveric jejunal segments that were randomly assigned to a control group (12 segments) and 4 treatment groups (24 segments/group, 12 constructs/group): i) simple interrupted anastomoses performed by a Board-certified surgeon (BSI); ii) simple continuous anastomoses performed by a Board-certified surgeon (BSC); iii) simple interrupted anastomoses performed by novice veterinarians (NSI); and iv) simple continuous anastomoses performed by novice veterinarians (NSC). Median (range) initial leak pressure (ILP) for control was 400.2 mmHg (226.0 to 500.0 mmHg), BSI 37.4 (14.4 to 124.0), BSC 32.5 (13.4 to 91.0), NSI 36.5 (22.9 to 62.0), and NSC 47.5 (8.9 to 120.0). No difference was noted between experience (P = 0.73, P = 0.53), suture technique (P = 0.07, P = 0.38), or across treatment groups (P = 0.17, P = 0.94), for ILP or MIP (maximum intraluminal pressure), respectively. Time to construct completion differed based on suture technique (P < 0.0001) and experience (P < 0.0001). The median and mean ILP of all anastomoses exceeded physiologic intraluminal peristaltic pressures. Simple continuous anastomoses were faster to complete overall. Both handsewn anastomosis techniques are appropriate for intestinal anastomoses.


Cette étude expérimentale a comparé les pressions de fuite et le temps de complétion d'anastomoses intestinales réalisées par des vétérinaires novices et un chirurgien certifié comme spécialiste en utilisant des schémas de suture simples interrompus et continus simples. Des segments jéjunaux grossièrement normaux (n = 108) de six cadavres canins frais ont été utilisés pour prélever des segments jéjunaux cadavériques canins refroidis de 8 cm qui ont été assignés au hasard à un groupe témoin (12 segments) et à quatre groupes de traitement (24 segments/groupe, 12 constructions/groupe) : i) anastomoses simples interrompues réalisées par un chirurgien agréé par le Board (BSI); ii) des anastomoses continues simples réalisées par un chirurgien certifié par le Board (BSC); iii) les anastomoses simples interrompues réalisées par des vétérinaires novices (NSI); et iv) des anastomoses continues simples réalisées par des vétérinaires novices (NSC). La pression de fuite initiale médiane (plage) pour le témoin était de 400,2 mmHg (226,0 à 500,0 mmHg), BSI 37,4 (14,4 à 124,0), BSC 32,5 (13,4 à 91,0), NSI 36,5 (22,9 à 62,0) et NSC 47,5 (8,9 à 120,0). Aucune différence n'a été notée entre l'expérience (P = 0,73, P = 0,53), la technique de suture (P = 0,07, P = 0,38) ou entre les groupes de traitement (P = 0,17, P = 0,94), pour l'ILP ou la MIP (pression intraluminale maximale), respectivement. Le temps de complétion de l'assemblage différait en fonction de la technique de suture (P < 0,0001) et de l'expérience (P < 0,0001). L'ILP médian et moyen de toutes les anastomoses dépassait les pressions péristaltiques intraluminales physiologiques. Les anastomoses continues simples étaient globalement plus rapides à réaliser. Les deux techniques d'anastomose cousues à la main conviennent aux anastomoses intestinales.(Traduit par Docteur Serge Messier).


Assuntos
Doenças do Cão , Cirurgiões , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/veterinária , Animais , Cadáver , Cães , Humanos , Técnicas de Sutura/veterinária , Suturas
11.
BMC Med Educ ; 22(1): 527, 2022 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-35799171

RESUMO

BACKGROUND: The rapid development of video surgery and minimally invasive surgical techniques prompted many studies on the methods of teaching these techniques to young surgeons in training. However, the characteristics of a short-term course that is both easily accessible and efficient for this group of surgeons remain controversial. To investigate this issue, a short-term training method was proposed for first year surgery residents, using inexpensive handmade wooden simulation boxes with the students smartphones as cameras. Its effectiveness was evaluated, as well as possible factors that could influence student performance, such as gender and previous experience with video games. METHODS: Thirty-six first-year General Surgery residents, entering in 2019 and 2020, participated in the study: 21 were males and 15 were females with ages between 22 and 29 years old, (mean 25.47 years). All participants performed a pre-established exercise (placing two simple stitches using a laparoscopic simulator), which was timed and scored. They then participated in a short theoretical-practical course, consisting of an initial lecture followed by 4 exercises on handcrafted wooden laparoscopic video surgery simulators. Afterwards, they were asked to repeat the same exercise from the first step. Finally, they answered a questionnaire that included questions on previous videogame experience. The data were tabulated and submitted to statistical analysis. RESULTS: In the pre-training exercise, 15 (41.66%) participants were able to perform the two simple stitches in the simulator box within the maximum time limit of 5 minutes. After the short course, 22 (61.11%) of participants were able to perform the complete exercise. Improvement in the time to complete the practical exercise was statistically significant (p = 0.0296) after participating in the theoretical-practical course. A better pre- and post-training performance was demonstrated by the 17 participants with experience with video games (p = 0.0116), and a better post-training performance was demonstrated by female participants (p = 0.0405). CONCLUSION: This short-term inexpensive theoretical-practical course in laparoscopic training for surgeons in training was effective in reducing the execution time of a laparoscopic stitch in a simulation box. Previous experience with video games and/or female gender appear to be associated with improved performance.


Assuntos
Internato e Residência , Laparoscopia , Treinamento por Simulação , Cirurgiões , Adulto , Competência Clínica , Simulação por Computador , Currículo , Feminino , Humanos , Laparoscopia/educação , Masculino , Adulto Jovem
12.
BMC Med Educ ; 22(1): 516, 2022 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-35778704

RESUMO

BACKGROUND: Representation of specialist international medical graduates (SIMGs) in specific specialties such as surgery can be expected to grow as doctor shortages are predicted in the context of additional care provision for aging populations and limited local supply. Many national medical boards and colleges provide pathways for medical registration and fellowship of SIMGs that may include examinations and short-term training. There is currently very little understanding of how SIMGs are perceived by colleagues and whether their performance is perceived to be comparable to locally trained medical specialists. It is also not known how SIMGs perceive their own capabilities in comparison to local specialists. The aim of this study is to explore the relationships between colleague feedback and self-evaluation in the specialist area of surgery to identify possible methods for enhancing registration and follow-up training within the jurisdiction of Australia and New Zealand. METHODS: Feedback from 1728 colleagues to 96 SIMG surgeons and 406 colleagues to 25 locally trained Fellow surgeons was collected, resulting in 2134 responses to 121 surgeons in total. Additionally, 98 SIMGs and 25 Fellows provided self-evaluation scores (123 in total). Questionnaire and data reliability were calculated before analysis of variance, principal component analysis and network analysis were performed to identify differences between colleague evaluations and self-evaluations by surgeon type. RESULTS: Colleagues rated SIMGs and Fellows in the 'very good' to 'excellent' range. Fellows received a small but statistically significant higher average score than SIMGs, especially in areas dealing with medical skills and expertise. However, SIMGs received higher scores where there was motivation to demonstrate working well with colleagues. Colleagues rated SIMGs using one dimension and Fellows using three, which can be identified as clinical management skills, inter-personal communication skills and self-management skills. On self-evaluation, both SIMGs and Fellows gave themselves a significant lower average score than their colleagues, with SIMGs giving themselves a statistically significant higher score than Fellows. CONCLUSIONS: Colleagues rate SIMGs and Fellows highly. The results of this study indicate that SIMGs tend to self-assess more highly, but according to colleagues do not display the same level of differentiation between clinical management, inter-personal and self-management skills. Further research is required to confirm these provisional findings and possible reasons for lack of differentiation if this exists. Depending on the outcome, possible support mechanisms can be explored that may lead to increased comparable performance with locally trained graduates of Australia and New Zealand in these three dimensions.


Assuntos
Medicina , Cirurgiões , Austrália , Humanos , Nova Zelândia , Reprodutibilidade dos Testes
13.
J Med Life ; 15(5): 669-674, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35815092

RESUMO

An inferior alveolar nerve block is a usual practice by a dental practitioner. Panoramic radiography is a widely used technique in dentistry to get a clear and comprehensive view before planning any treatment. The study aimed to compare the morphometric localization of mandibular foramen (MF) on dry bones and orthopantomogram. The study was designed in two phases: a morphometric study on dry human mandibles (phase I) and orthopantomograms of the same dry human mandibles (phase II). The study materials were 200 dry north Indian human mandibles belonging to unknown sex obtained from the Department of Anatomy. Descriptive statistics, including range, mean±standard deviation, paired t-test to compare dry bones and orthopantomogram, Pearson's correlation coefficient, and measurement error, were used. T-test was applied separately to compare the right and left sides of dry bones. The distance of mandibular foramen from the posterior border and lower border is shorter on the right side than on the left. Its distance from the anterior border and the mandibular notch was greater on the right side. On panoramic radiographs, the distance of MF from nearby anatomical landmarks on the mandible was highly unreliable except for the mandibular notch. Our findings demonstrate a statistically significant difference between distances on dry bone and OPG but no statistically significant difference between MF-notch on both sides and MF-AB on the right side. As a result, a surgeon can rely upon a mandibular notch to locate mandibular foramen during clinical procedures. Magnification is an inbuilt property of OPG; for precise localization of MF, it is advisable to proceed with advanced three-dimensional techniques to protect viable anatomical structures.


Assuntos
Odontólogos , Cirurgiões , Humanos , Mandíbula/diagnóstico por imagem , Papel Profissional , Radiografia Panorâmica
16.
Obstet Gynecol ; 140(1): 39-47, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35849454

RESUMO

OBJECTIVE: To evaluate the accuracy of gynecologic surgeons' self-reflection across hysterectomy case volume, proportion of cases performed using a minimally invasive approach (minimally invasive rate), and complication rate and to assess whether accuracy is associated with specific surgeon or practice characteristics. METHODS: This was a cross-sectional cohort study of gynecologic surgeons at eight Canadian hospitals between 2016 and 2019. Surgeons estimated case volume, minimally invasive rate, and complication rate for hysterectomies for a 6-month period using an online survey. Kendall's tau-beta correlation coefficient (τ) measured association between estimated and actual performance. Differences (delta) between each surgeon's estimated and actual performance were calculated. The central tendency of differences among the cohort was represented by a median (median delta) and compared with 0 (perfect accuracy) using the Wilcoxon signed rank test. Differences in characteristics between surgeons classified as underestimators, accurate estimators, and overestimators by tertile of delta were evaluated using analysis of variance and χ2 tests. RESULTS: Eighty-four surgeons across eight hospitals were included. Association between estimated and actual performance was moderate for case volume (τ=0.46, P<.001) and minimally invasive rate (τ=0.52, P<.001) and weak for complication rate (τ=0.14, P=.080). Surgeons underestimated their complication rate (median delta -7.0%, 95% CI -11.0% to -3.5%, P<.001) but accurately estimated case volume (median delta 1.0, 95% CI 0.0-2.5, P=.082) and minimally invasive rate (median delta 4.0%, 95% CI -4.5% to 10.0%, P=.337). Surgeons who underestimated their complication rates had higher average complication rates (33.7%) than those who estimated accurately (12.1%, P<.001) or overestimated (7.7%, P<.001) and were more likely to be fellowship-trained (P<.001). CONCLUSION: Attending gynecologic surgeons inaccurately reflect on their complication rates, and those who most underestimate their complication rates have higher rates than their peers.


Assuntos
Benchmarking , Cirurgiões , Canadá , Estudos Transversais , Feminino , Humanos , Histerectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
17.
IEEE J Transl Eng Health Med ; 10: 3700212, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35865752

RESUMO

BACKGROUND: Over 5 billion people worldwide have no access to surgery worldwide, typically in low-resource settings, despite it being a primary life-saving treatment. Gas Insufflation-Less Laparoscopic Surgery (GILLS) can address this inequity, by improving current GILLS instrumentation to modern surgical standards. OBJECTIVE: to develop and translate a new Retractor for Abdominal Insufflation-less Surgery (RAIS) into clinical use and thus provide a context-appropriate system to advance GILLS surgery. METHODS: A collaborative multidisciplinary team from the UK and India was formed, embedding local clinical stakeholders and an industry partner in defining user and contextual needs. System development was based on a phased roadmap for 'surgical device design in low resource settings' and embedded participatory and frugal design principles in an iterative process supported by traditional medical device design methodologies. Each phase of development was evaluated by the stakeholder team through interactive workshops using cadaveric surgical simulations. A Commercialisation phase undertook Design to Manufacture and regulatory approval activities. Clinical validation was then conducted with rural surgeons performing GILLS procedures using the RAIS system. Semi-structured questionnaires and interviews were used to evaluate device performance. RESULTS: A set of user needs and contextual requirements were defined and formalised. System development occurred across five iterations. Stakeholder participation was instrumental in converging on a design which met user requirements. A commercial RAIS system was then produced by an industry partner under Indian regulatory approval. This was successfully used in clinical validation to conduct 12 surgical procedures at two locations in rural India. Surgical feedback showed that the RAIS system provided a valuable and usable surgical instrument which was appropriate for use in low-resource contexts. CONCLUSIONS: Using a context-specific development approach with close engagement of stakeholders was crucial to develop the RAIS system for low-resource regions. The outcome is translation from global health need into a fully realized commercial instrument which can be used by surgeons in low-resource regions across India.


Assuntos
Insuflação , Cirurgiões , Retroalimentação , Humanos , Participação dos Interessados , Inquéritos e Questionários
18.
BMC Surg ; 22(1): 279, 2022 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-35854297

RESUMO

Creating surgical access is a critical step in laparoscopic surgery. Surgeons have to insert a sharp instrument such as the Veress needle or a trocar into the patient's abdomen until the peritoneal cavity is reached. They solely rely on their experience and distorted tactile feedback in that process, leading to a complication rate as high as 14% of all cases. Recent studies have shown the feasibility of surgical support systems that provide intraoperative feedback regarding the insertion process to improve laparoscopic access outcomes. However, to date, the surgeons' requirements for such support systems remain unclear. This research article presents the results of an explorative study that aimed to acquire data about the information that helps surgeons improve laparoscopic access outcomes. The results indicate that feedback regarding the reaching of the peritoneal cavity is of significant importance and should be presented visually or acoustically. Finally, a solution should be straightforward and intuitive to use, should support or even improve the clinical workflow, but also cheap enough to facilitate its usage rate. While this study was tailored to laparoscopic access, its results also apply to other minimally invasive procedures.


Assuntos
Laparoscopia , Cirurgiões , Abdome/cirurgia , Humanos , Laparoscopia/métodos , Agulhas , Instrumentos Cirúrgicos
19.
Medicine (Baltimore) ; 101(26): e29830, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35777038

RESUMO

We aimed to compare the learning curves of 2 surgeons with different endoscopic bases when performing laparoendoscopic single-site myomectomy (LESS-M). We retrospectively analyzed and compared 2 groups of patients who underwent LESS-M performed by 2 surgeons with different bases in multi-port laparoscopic surgery (MLS) from October 2019 to December 2020 at West China Second Hospital of Sichuan University. Patients' characteristics and related surgical indicators were compared, and surgeons' learning curves were analyzed using a cumulative sum analysis. All of the patients completed LESS-M without converting to MLS or laparotomy, despite Surgeon A being MLS-unqualified and Surgeon B being MLS-qualified. There were no significant differences in patients' characteristics or surgical indicators between the 2 groups (P > 0.05 for all). Surgeons A and B crossed the learning curve after 21 and 18 cases, respectively. LESS-M is safe and feasible. Approximately 20 cases are required for surgeons to achieve LESS-M proficiency, and surgeons without MLS experience can still master LESS-M.


Assuntos
Laparoscopia , Cirurgiões , Miomectomia Uterina , Feminino , Humanos , Curva de Aprendizado , Estudos Retrospectivos
20.
World J Emerg Surg ; 17(1): 41, 2022 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-35879801

RESUMO

Emergency General Surgery (EGS) was identified as multidisciplinary surgery performed for traumatic and non-traumatic acute conditions during the same admission in the hospital by general emergency surgeons and other specialists. It is the most diffused surgical discipline in the world. To live and grow strong EGS necessitates three fundamental parts: emergency and elective continuous surgical practice, evidence generation through clinical registries and data accrual, and indications and guidelines production: the LIFE TRIAD.


Assuntos
Cirurgiões , Hospitais , Humanos , Sistema de Registros
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