JSLS : Journal of the Society of Laparoendoscopic Surgeons最新文献

{"title":"Prospective Study on the Use of Endo-Stapler for Enclosed Colpotomy to Prevent Tumor Spillage in Gynecologic Oncology Minimally Invasive Surgeries.","authors":"Dipak Limbachiya,&nbsp;Rajnish Tiwari,&nbsp;Rashmi Kumari","doi":"10.4293/JSLS.2023.00019","DOIUrl":"10.4293/JSLS.2023.00019","url":null,"abstract":"<p><strong>Background and objectives: </strong>This is a prospective trial of the endo-stapler application for vaginal closure before colpotomy in cases of carcinoma endometrium and carcinoma cervix, managed by minimally invasive surgery with due consideration of its surgical technique and short-term oncologic follow-up outcomes.</p><p><strong>Methods: </strong>This was a prospective, single center study completed between March 1, 2020 and December 31, 2022. A total of 62 patients (43 cases of carcinoma endometrium and 19 cases of carcinoma cervix) were recruited for the study. Oncologic survival outcomes at the end of 1 and 2 years were documented.</p><p><strong>Results: </strong>There were no major intraoperative bowel, urinary, or vascular injuries. None of the cases required conversion to laparotomy peroperatively. Our study had 8 patients with carcinoma endometrium (8/43) and 7 patients of carcinoma cervix (7/19) who have completed 24 months of follow-up without any recurrence to date.</p><p><strong>Conclusion: </strong>Endo-stapler application for enclosed colpotomy to prevent tumor spillage is a futuristic step in gynecologic oncology cases managed by laparoscopy.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10516263/pdf/e2023.00019.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41132081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technical Tips Following 850 Consecutive One Anastomosis Gastric Bypass (OAGB) Patients.","authors":"Mohit Bhatia,&nbsp;Sharmila Vijayan,&nbsp;Elia Azir,&nbsp;Shamsi El-Hasanii","doi":"10.4293/JSLS.2023.00024","DOIUrl":"10.4293/JSLS.2023.00024","url":null,"abstract":"<p><strong>Background: </strong>The surgical procedure One Anastomosis Gastric Bypass (OAGB) has become widely used worldwide. Since its inception, many modifications have been introduced to improve results.</p><p><strong>Objectives: </strong>The primary aim of this study was to share the modifications that we have introduced to our OAGB technique after reflecting on the problems and complications we have faced during the evolution of this procedure in our unit.</p><p><strong>Method: </strong>A total of 850 patients who underwent OAGB under the same surgical team at two different hospitals in the United Kingdom were displayed according to demography and comorbidities. All complications were reviewed and analysed to instigate the changes in our technique.</p><p><strong>Results: </strong>There were 756 (89%) primary and 94 (11%) revisional procedures. There were 596 females (70.11%) and 254 males (29.89%) in our study group. The body mass index range was 32-84 and the mean was 45. The pre-operative weight range was 89-274 kg and the mean was 126.4 kg.</p><p><strong>Conclusions: </strong>With experience and reflecting on our complications we have modified our surgical approach, and these alterations have helped us to adopt OAGB as the mainstream bariatric procedure. We want to share our experience with the bariatric community for the benefit of patient care.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10473180/pdf/e2023.00024.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10143373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbon Dioxide Emissions and Environmental Impact of Different Surgical Modalities of Hysterectomies.","authors":"Sangeeta Ramani,&nbsp;Josette Hartnett,&nbsp;Shweta Karki,&nbsp;Stephen M Gallousis,&nbsp;Mitchell Clark,&nbsp;Vaagn Andikyan","doi":"10.4293/JSLS.2023.00021","DOIUrl":"10.4293/JSLS.2023.00021","url":null,"abstract":"<p><strong>Background and objectives: </strong>The objectives of this study were to determine carbon dioxide (CO₂) emissions generated from nonreusable waste and compare across different types of hysterectomies for benign and malignant indications. Overall greenhouse gas emissions were not examined.</p><p><strong>Methods: </strong>This is a prospective cohort study that identified women undergoing a robotic assisted, laparoscopic, vaginal, or abdominal hysterectomy for any indication. The amount of waste generated was collected for each case, along with patient demographics, and details of the procedure. Weight of waste was converted to kilograms of CO₂ emissions using the following formula: <dispformula><math><mtext>Carbon dioxide emissions</mtext><mo> = </mo><mtext>Waste in pounds </mtext><mi>× 1 Short ton</mi><mo>/</mo><mn>2000</mn><mtext> pounds </mtext><mi>× Emission factor </mi><mfenced><mrow><mtext>kg C</mtext><msub><mrow><mtext>O</mtext></mrow><mrow><mn>2</mn></mrow></msub><mo>/</mo><mtext>short ton</mtext></mrow></mfenced><mtext>× Global  warming potential (GWP)</mtext></math></dispformula>We extrapolated the amount of CO₂ emissions produced to the number of hysterectomies performed annually in the United States.</p><p><strong>Results: </strong>We found that robotic hysterectomies generated the highest mean CO₂ emissions (12.01 kg CO₂), while vaginal hysterectomies produced the lowest mean CO₂ emissions of 4.48 kg (<i>p </i>< .0001).Our sample size of 100 hysterectomies was equivalent to 1099.4 kg CO₂ emissions. When our results were extrapolated, all hysterectomies in the United States produce 5.7 million kg of CO₂ emissions. This is equivalent to 234,513 airplane miles, and 95 trips cross-country across the USA from New York, New York to Los Angeles, California.</p><p><strong>Conclusion: </strong>Robotic hysterectomies generated a statistically significant majority of CO₂ emissions. Therefore, robotic surgery, as currently practiced, may offer a good initial opportunity for decreasing the carbon footprint of surgery.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10473183/pdf/e2023.00021.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10153232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robo-Lap Approach Optimizes Intraoperative Outcomes in Robotic Left and Right Hepatectomy.","authors":"Francesca Ratti,&nbsp;Rebecca Marino,&nbsp;Sara Ingallinella,&nbsp;Lucrezia Clocchiatti,&nbsp;Diletta Corallino,&nbsp;Marco Catena,&nbsp;Luca Aldrighetti","doi":"10.4293/JSLS.2023.00025","DOIUrl":"10.4293/JSLS.2023.00025","url":null,"abstract":"<p><strong>Background: </strong>The aim of the present study is to evaluate the possible advantages of the Robo-Lap (parenchymal transection by laparoscopic ultrasonic dissector and robotic bipolar forceps and scissors) compared with pure robotic technique (parenchymal transection by use of robotic bipolar forceps and scissors) in major anatomical liver resections with specific focus on intraoperative outcomes.</p><p><strong>Methods: </strong>Major liver resections performed by robotic approach between February 1, 2021 and March 31, 2023 were stratified into two groups according to the approach used to address the phase of liver transection; Pure Robotic Group (n = 21) versus Robo-Lap Group (n = 48). The two groups were compared in terms of intra- and postoperative outcomes and in terms of rate of achievement of intraoperative textbook outcomes.</p><p><strong>Results: </strong>Conversion rate was similar between the two groups while incidence of adverse intraoperative events (according to Satava classification) was higher in the Pure Robotic compared with the Robo-Lap group (85.7% vs 39.6%, p < 0.001). Time to perform parenchymal transection was significantly shorter in the Robo-Lap group (180 min) compared with the Pure Robotic Group (240 min), p = 0.003. Intraoperative textbook outcomes were achieved in a lower proportion of patients in the Pure Robotic compared with the Robo-Lap group.</p><p><strong>Conclusion: </strong>Outcomes of the present study suggest a favorable role of the Robo-Lap approach in robotic major resections as it allows an improvement of the intraoperative results, a greater probability of an uneventful conduction of the procedure, and therefore, better management of the operating room time.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10473182/pdf/e2023.00025.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10143374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and Cost of Stenting in Ureteral Injury in Colorectal Surgeries in the US: 2015 - 2019.","authors":"Ana Filipa Alexandre,&nbsp;Tomomi Kimura,&nbsp;Qi Feng,&nbsp;Wei Han,&nbsp;Emily Shortridge,&nbsp;Jason Schwartz,&nbsp;Steven D Wexner","doi":"10.4293/JSLS.2023.00023","DOIUrl":"10.4293/JSLS.2023.00023","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative ureteral injury (IUI) during colorectal surgery can have devastating consequences. This study aimed to assess the clinical and economic impact of pre-operative ureteral stenting in colorectal surgeries.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using United States hospital data (October 2015 - December 2019). IUI incidence was examined across selected inpatient surgery types (elective colectomy, enterectomy, proctectomy, enterostomy, other colorectal procedures; emergency colectomy). Stenting effectiveness was evaluated as the difference in IUI and intraoperative detection rates between propensity score-matched groups. The additional hospital cost for stenting was also estimated considering the savings from IUIs that were potentially avoidable or detected by stenting.</p><p><strong>Results: </strong>In total, 283,549 colorectal surgeries were analyzed. Across surgery types, stent use and IUI incidence ranged from 1.47% - 8.86% and from 0.91% - 2.90%, respectively. Stents were used in 6.75% of elective colectomy cases, where they were associated with an absolute reduction of 1.14 percentage points (95% CI: -1.85 to -1.03) in IUI rate and a 21.6 percentage point reduction in the intraoperative detection rate. Additional hospital costs for stenting ranged from $1,464 - $4,436 across surgery types. Additional results varied by case but were consistent with the colectomy example.</p><p><strong>Conclusions: </strong>While effective in limited settings, the IUI reduction attributed to stenting and ability to shift IUI detection to the intraoperative setting could not offset the hospital cost of stent placement during colectomy (and colorectal surgery, in general). There thus remains an ongoing need in colorectal surgery for a universal, cost-effective solution to prevent IUI.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10566578/pdf/e2023.00023.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41204338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Surgical Technique for Closure of 10 mm and Larger Laparoscopic Port Fascial Defects Using a Graham's Nerve Hook.","authors":"Francis Sangwon Lee,&nbsp;Alyxis Mah,&nbsp;Clare Hyunna Lee,&nbsp;Christina Wonna Lee","doi":"10.4293/JSLS.2023.00011","DOIUrl":"10.4293/JSLS.2023.00011","url":null,"abstract":"<p><strong>Background and objectives: </strong>In order to avoid potential complications from incisional hernias in patients undergoing laparoscopic or robotic procedures with 10 mm or larger ports, a surgeon closes the fascial defects using various techniques. We compared several different techniques of port site closure, which uses the open technique that can be performed with or without laparoscopic visualization. We modified the technique initially described by Dr. H. Aziz. We are introducing a new surgical technique to close the larger port site using Graham's nerve-hook. This new technique is easy to learn, replicate and implement for all body types.</p><p><strong>Methods: </strong>We use the commonly available Graham's nerve-hook and two S-retractors to visualize the entire layers of fascia and peritoneum and to pull up both layers to close the larger port site safely and securely with 0 polyglactin absorbable suture. We illustrated this new Lee's port site closure technique with eight separate drawings in this paper.</p><p><strong>Results: </strong>We performed 493 consecutive laparoscopic cases using this new technique. Four years follow up revealed only one incisional hernia using this technique. The patients are routinely followed in one month and six months and a year after the operation. However, not all of the patients are seen after six months unless there was a specific complaint.</p><p><strong>Conclusion: </strong>The new port site closure technique introduced in this paper is found to be easy to learn, fast, and very cost effective due to the reusable, commonly found S-retractors and Graham's nerve hook. After four years of consistent use, this new technique was found to be safe and effective in closure of 10 mm or larger port sites.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10371771/pdf/e2023.00011.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10284263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Evaluation of Extended Total Extraperitoneal Repair Versus Standard Total Extraperitoneal Repair and Transabdominal Preperitoneal Repair of Inguinal Hernias.","authors":"Nalin Kumar Srivastava,&nbsp;Albail Singh Yadav,&nbsp;Rajeev Sinha","doi":"10.4293/JSLS.2023.00004","DOIUrl":"https://doi.org/10.4293/JSLS.2023.00004","url":null,"abstract":"<p><strong>Background and objectives: </strong>Laparoscopic inguinal hernia repair (LIHR) includes transabdominal preperitoneal repair (TAPP), standard totally extraperitoneal repair (TEP), and now extended TEP (eTEP). However, there is still a paucity of well conducted, peer reviewed comparative studies regarding the advantages, if any, of eTEP. This study aimed to compare the data of eTEP repair with that of TEP and TAPP repair.</p><p><strong>Methods: </strong>Two hundred twenty patients were randomly assigned to one of three groups of eTEP (80), TEP (68), and TAPP (72) after matching for age, sex, and clinical extent of hernia. Permission of ethics committee was taken.</p><p><strong>Results: </strong>Comparison with TEP showed, mean operating time for eTEP was significantly longer in the first 20 patients, subsequently there was no difference. Conversion rates of TEP to TAPP was significantly higher. The other peroperative and postoperative parameters did not differ. Similarly, on comparison with TAPP, there was no difference in any of the parameters. eTEP, also had shorter operating time and less incidence of pneumoperitoneum when compared to published TEP and TAPP studies.</p><p><strong>Conclusion: </strong>All the three laparoscopic hernia approaches had similar outcomes. eTEP cannot be advocated as a substitute for TAPP or TEP.The choice of procedure should be the surgeon's choice. However, eTEP does combine the advantage of both TAPP, in the form of a large working space and of TEP, by being totally extraperitoneal. eTEP is also easier to learn and teach.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ad/b6/e2023.00004.PMC10178627.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9480263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late Hemorrhage Following Laparoscopic Cholecystectomy.","authors":"Rajeev Sinha,&nbsp;Arun Gupta","doi":"10.4293/JSLS.2023.00006","DOIUrl":"https://doi.org/10.4293/JSLS.2023.00006","url":null,"abstract":"<p><strong>Background: </strong>Excruciating generalized abdominal pain with features suggestive of shock, at the end of the first or early second week after laparoscopic cholecystectomy (LC), is a frightening and formidable diagnostic predicament. This is because the early known complications like biliary leak or vascular injuries are unlikely diagnoses. Hemoperitoneum, is not usually considered, but instead more common occurrences like acute pancreatitis, choledocholithiasis, and sepsis are suspected. A delay in diagnosis and subsequent management of hemoperitoneum could have disastrous consequences.</p><p><strong>Case studies: </strong>Two patients presented with hemoperitoneum, in the second week after laparoscopic cholecystectomy. The first was because of a leak from a pseudoaneurysm of the right hepatic artery and the other was a bleed from a subcapsular liver hemangioma as a part of Osler Weber Rendu syndrome. Initially, a clinical assessment in both the patients was diagnostically inconclusive. Ultimately the diagnosis could be made, based on computed tomography angiography and visceral angiography. In the second patient, a positive family history and genetic testing were helpful. The first patient was successfully managed by intravascular embolization, while the second patient was successfully managed conservatively with intraperitoneal drains and conservative management of comorbidities.</p><p><strong>Conclusions: </strong>The presentation is to generate awareness that hemorrhage could be a presentation, in the early second week, after LC. A common cause to be considered is a pseudo aneurysmal bleed. Secondary hemorrhage and other rare coincidental unassociated conditions could also be responsible for the hemorrhage. A high index of suspicion, and early and timely management are keys to a successful outcome.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10178626/pdf/e2023.00006.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9671535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing Esophageal-gastric Junction Outflow Obstruction with Hiatal Hernia.","authors":"Vitor Pelogi Arienzo,&nbsp;Tales Bianchi Edno,&nbsp;Daniel José Szor,&nbsp;Tustumi Francisco","doi":"10.4293/JSLS.2023.00002","DOIUrl":"https://doi.org/10.4293/JSLS.2023.00002","url":null,"abstract":"We read the article, “Esophagogastric Junction Outflow Obstruction and Hiatal Hernia: Is Hernia Repair Alone Sufficient?”. The study analyzed the relationship between esophagogastric junction outlet obstruction (EGJOO) and hiatal hernia (HH). The authors suggest that patients with HH and EGJOO should all be initially treated with only HH repair since that 76.9% of their patients had complete longterm symptomatic resolution with this approach. The authors defend that myotomy should be only considered if symptoms persist after HH repair.","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/29/a2/e2023.00002.PMC10178625.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9671537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Credentialing and Patient Safety in Robotic Gynecologic Surgery: Changes over the Last Eight Years.","authors":"R Gina Silverstein,&nbsp;Kristin J Moore,&nbsp;Erin T Carey,&nbsp;Lauren D Schiff","doi":"10.4293/JSLS.2023.00007","DOIUrl":"10.4293/JSLS.2023.00007","url":null,"abstract":"<p><strong>Background and objectives: </strong>Robotic gynecologic surgery has outpaced data showing risks and benefits related to cost, quality outcomes, and patient safety. We aimed to assess how credentialing standards and perceptions of safe use of robotic gynecologic surgery have changed over time.</p><p><strong>Methods: </strong>An anonymous, online survey was distributed in 2013 and in 2021 to attending surgeons and trainees in accredited obstetrics and gynecology residency programs.</p><p><strong>Results: </strong>There were 367 respondents; 265 in 2013 and 102 in 2021. There was a significant increase in robotic platform use from 2013 to 2021. Percentage of respondents who ever having performed a robotic case increased from 48% to 79% and those who performed > 50 cases increased from 25% to 59%. In 2021, a greater percentage of attending physicians reported having formalized protocol for obtaining robotic credentials (93% vs 70%, p = 0.03) and maintaining credentialing (90% vs 27%, p < 0.01). At both time points, most attendings reported requiring proctoring for 1 - 5 cases before independent use. Opinions on the number of cases needed for surgical independence changed from 2013 to 2021. There was an increase in respondents who believed > 20 cases were required (from 58% to 93% of trainees and 29% to 70% of attendings). In 2021, trainees were less likely to report their attendings lacked the skills to safely perform robotic surgery (25% to 6%, p < 0.01).</p><p><strong>Discussion: </strong>Greater experience with robotic platforms and expansion of credentialing processes over time correlated with improved confidence in surgeon skills. Further work is needed to evaluate if current credentialing procedures are sufficient.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f4/91/e2023.00007.PMC10371773.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10295154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}