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

{"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}

{"title":"Factors Associated with Mortality after Percutaneous Endoscopic Gastrostomy.","authors":"Diego Laurentino Lima,&nbsp;Luiz Eduardo Correia Miranda,&nbsp;Raquel Nogueira Cordeiro Laurentino Lima,&nbsp;Gustavo Romero-Velez,&nbsp;Ryan Chin,&nbsp;Phillip P Shadduck,&nbsp;Prashanth Sreeramoju","doi":"10.4293/JSLS.2023.00005","DOIUrl":"https://doi.org/10.4293/JSLS.2023.00005","url":null,"abstract":"<p><strong>Introduction: </strong>Percutaneous endoscopic gastrostomy (PEG) is a common procedure performed world-wide on patients with different comorbidities, with many indications and overall low morbidity. However, studies showed an elevated early mortality in patients undergoing PEG placement. In this systematic review, we review the factors associated with early mortality after PEG.</p><p><strong>Methods: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The methodological index for nonrandomized studies (MINORS) score system was used to perform qualitative assessment of all included studies. Recommendations were summarized for predefined key items.</p><p><strong>Results: </strong>The search found 283 articles. A refined total of 21 studies were included; 20 studies cohort studies and 1 case-control study. For the cohort studies, MINORS score ranged from 7 to 12 out of 16. The single case-control study scored 17 out of 24. The number of study patients ranged from 272 to 181,196. Thirty-day mortality rate varied from 2.4% to 23.5%. Albumin, age, body mass index, C-reactive protein, diabetes mellitus, and dementia were the most frequently associated factors to early mortality in patients undergoing PEG placement. Five studies reported procedure related deaths. Infection was the most commonly reported complication of PEG placement.</p><p><strong>Conclusions: </strong>PEG tube insertion is a fast, safe and effective procedure, but is not free of complications and can have a high early mortality rate as demonstrated in this review. Patient selection should be a key factor and the identification of factors associated with early mortality is important in the elaboration of a protocol to benefit patients.</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/ed/85/e2023.00005.PMC10256279.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9623735","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":"The Effect of Body Mass Index on Patients' Outcomes Following Robotic Distal Pancreatectomy and Splenectomy.","authors":"Harel Jacoby,&nbsp;Sharona Ross,&nbsp;Iswanto Sucandy,&nbsp;Cameron Syblis,&nbsp;Kaitlyn Crespo,&nbsp;Prakash Vasanthakumar,&nbsp;Michael Trotto,&nbsp;Alexander Rosemurgy","doi":"10.4293/JSLS.2022.00046","DOIUrl":"https://doi.org/10.4293/JSLS.2022.00046","url":null,"abstract":"<p><strong>Background and objectives: </strong>Obesity has increased over the past decade, yet the correlation among body mass index (BMI), surgical outcomes, and the robotic platform are not well established. This study was undertaken to measure the impact of elevated BMI on outcomes after robotic distal pancreatectomy and splenectomy.</p><p><strong>Methods: </strong>We prospectively followed patients who underwent robotic distal pancreatectomy and splenectomy. Regression analysis was utilized to identify significant relationships with BMI. For illustrative purposes, the data are presented as median (mean ± SD). Significance was determined at p ≤ 0.05.</p><p><strong>Results: </strong>A total of 122 patients underwent robotic distal pancreatectomy and splenectomy. Median age was 68 (64 ± 13.3), 52% were women, and BMI was 28 (29 ± 6.1) kg/m². One patient was underweight (< 18.5 kg/m²), 31 had normal weight (18.5-24.9 kg/m²), 43 were overweight (25-29.9 kg/m²), and 47 were obese (≥ 30 kg/m²). BMI was inversely correlated with age (p = 0.05) but there was no correlation with sex (p = 0.72). There were no statistically significant relationships between BMI and operative duration (p = 0.36), estimated blood loss (p = 0.42), intraoperative complications (p = 0.64), and conversion to open approach (p = 0.74). Major morbidity (p = 0.47), clinically relevant postoperative pancreatic fistula (p = 0.45), length of stay (p = 0.71), lymph nodes harvested (p = 0.79), tumor size (p = 0.26), and 30-day mortality (p = 0.31) were related to BMI.</p><p><strong>Conclusion: </strong>BMI has no significant effect on patients undergoing robotic distal pancreatectomy and splenectomy. BMI greater than 30 kg/m² should not defer proceeding with robotic distal pancreatectomy with splenectomy. Limited empirical evidence exists in the literature regarding patients with a BMI greater than 30 kg/m², and thus any proposed operative intervention should invoke sufficient planning and preparation.</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/88/3e/e2022.00046.PMC10256280.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9623738","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":"Gynecology Resident Experience with Office Hysteroscopy Training.","authors":"Lindsey Michel,&nbsp;Scott Chudnoff","doi":"10.4293/JSLS.2023.00009","DOIUrl":"10.4293/JSLS.2023.00009","url":null,"abstract":"<p><strong>Background: </strong>Hysteroscopy is the gold standard for evaluating intrauterine pathology. The majority of physicians currently perform hysteroscopy in the operating room. Lack of training has been cited as a barrier to performing office hysteroscopy; however, resident training in office hysteroscopy has not yet been evaluated.</p><p><strong>Methods: </strong>A prospective cross-sectional survey was performed. A validated 17 question survey tool was sent to 297 program directors of Accreditation Council for Graduate Medical Education accredited obstetrics and gynecology residency programs for distribution to their residents. The survey utilized a Likert scale to assess resident interest in learning office hysteroscopy, satisfaction in training, and perceived self-efficacy to perform office hysteroscopy independently upon graduation.</p><p><strong>Results: </strong>Two hundred and ninety-three obstetrics and gynecology residents responded. Of the respondents, 26.3% reported receiving training in office hysteroscopy. There was no statistically significant difference in training among postgraduate years or program regions. A greater proportion of male residents received training when compared to female residents (42.9% vs. 24.2%, <i>p </i>=<i> </i>0.019). Ninety-four percent of residents reported interest in learning office hysteroscopy. Satisfaction with hysteroscopy training in the operating room versus the office was 91.1% vs. 11.3% respectively. Of the fourth-year residents, 17.4% felt they could perform office hysteroscopy independently upon graduation and 14.5% reported feeling comfortable performing the procedure.</p><p><strong>Conclusions: </strong>Residency training in office hysteroscopy is lacking and residents are unprepared to perform the procedure after graduation. Enhanced residency training in office hysteroscopy would likely improve resident comfort and ability to perform office hysteroscopy in practice.</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/PMC10371772/pdf/e2023.00009.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10295153","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":"Association between Surgical Technical Skills and Clinical Outcomes: A Systematic Literature Review and Meta-Analysis.","authors":"Michael S Woods,&nbsp;Joshua N Liberman,&nbsp;Pinyao Rui,&nbsp;Emily Wiggins,&nbsp;Joan White,&nbsp;Bruce Ramshaw,&nbsp;Jonah J Stulberg","doi":"10.4293/JSLS.2022.00076","DOIUrl":"https://doi.org/10.4293/JSLS.2022.00076","url":null,"abstract":"<p><strong>Background: </strong>A systematic literature review and meta-analysis was conducted to assess the association between intraoperative surgical skill and clinical outcomes.</p><p><strong>Methods: </strong>Peer-reviewed, original research articles published through August 31, 2021 were identified from PubMed and Embase. From the 1,513 potential articles, seven met eligibility requirements, reporting on 151 surgeons and 17,932 procedures. All included retrospective assessment of operative videos. Associations between surgical skill and outcomes were assessed by pooling odds ratios (OR) using random-effects models with the inverse variance method. Eligible studies included pancreaticoduodenectomy, gastric bypass, laparoscopic gastrectomy, prostatectomy, colorectal, and hemicolectomy procedures.</p><p><strong>Results: </strong>Meta-analytic pooling identified significant associations between the highest vs. lowest quartile of surgical skill and reoperation (OR: 0.44; 95% confidence interval [CI]: 0.23, 0.83), hemorrhage (OR: 0.66; 95% CI, 0.65, 0.68), obstruction (OR: 0.33; 95% CI, 0.30, 0.35), and any medical complication (OR: 0.23, 95% CI, 0.19, 0.27). Nonsignificant inverse associations were noted between skill and readmission, emergency department visit, mortality, leak, infection, venous thromboembolism, and cardiac and pulmonary complications.</p><p><strong>Conclusions: </strong>Overall, surgeon technical skill appears to predict clinical outcomes. However, there are surprisingly few articles that evaluate this association. The authors recommend a thoughtful approach for the development of a comprehensive surgical quality infrastructure that could significantly reduce the challenges identified by this study.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d8/ca/e2022.00076.PMC9913064.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9287217","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}