Surgery in practice and science最新文献

{"title":"Utility of beta-lactam allergy assessment in patients receiving vancomycin for surgical prophylaxis","authors":"Kendall J. Tucker ,&nbsp;YoungYoon Ham ,&nbsp;Haley K. Holmer ,&nbsp;Caitlin M. McCracken ,&nbsp;Ellie Sukerman ,&nbsp;James S. Lewis II ,&nbsp;Jessina C. McGregor","doi":"10.1016/j.sipas.2023.100232","DOIUrl":"10.1016/j.sipas.2023.100232","url":null,"abstract":"<div><h3>Background</h3><p>Beta-lactam antibiotics are first-line agents for most patients receiving antimicrobial prophylaxis in surgical procedures. Despite evidence showing low cross-reactivity between penicillins and cephalosporins, patients with beta-lactam allergies commonly receive vancomycin as an alternative to avoid allergic reaction.</p></div><div><h3>Methods</h3><p>Adult patients receiving vancomycin for surgical prophylaxis with a reported beta-lactam allergy at our institution between August 2017 to July 2018 were retrospectively evaluated for potential eligibility for penicillin allergy testing and/or receipt of standard prophylaxis.</p></div><div><h3>Results</h3><p>Among 830 patients who received vancomycin for surgical prophylaxis, 196 reported beta-lactam allergy and were included in the analysis. Approximately 40 % of surgeries were orthopedic. Of patients receiving vancomycin as first-line therapy, 189 (96.4 %) were potentially eligible for beta-lactam prophylaxis.</p></div><div><h3>Conclusions</h3><p>Patients with beta-lactam allergies often qualify for receipt of a first-line antibiotic. An opportunity exists for improved allergy assessment as an antimicrobial stewardship intervention in surgical prophylaxis.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"16 ","pages":"Article 100232"},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000785/pdfft?md5=fb046a43043ffa7cf9a67c0f9f7597da&pid=1-s2.0-S2666262023000785-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139020262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of fecal diversion in Perineal Necrotizing Soft Tissue Infection on disease survival: A large retrospective study","authors":"Vincent MAYORAL ,&nbsp;Dorothée COQUEREL-BEGHIN ,&nbsp;Jean-Nicolas CORNU ,&nbsp;Valérie BRIDOUX ,&nbsp;Isabelle AUQUIT-AUCKBUR ,&nbsp;Christian PFISTER","doi":"10.1016/j.sipas.2023.100231","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100231","url":null,"abstract":"<div><h3>Introduction</h3><p>Colostomy is usually proposed during the acute phase of Fournier Gangrene, nevertheless its impact on disease outcome remains still debated. We conducted a retrospective study in an academic center to determine the impact of fecal diversion on disease morbidity and specific survival.</p></div><div><h3>Methods</h3><p>All medical charts of Fournier Gangrene cases in the past 30-years were reviewed. Mortality rate, hospitalization duration, time to complete healing and number of excision surgeries were compared between the stoma and the non-stoma groups. Time between initial diagnosis and stoma creation, type of fecal diversion, as well as specific morbidity were analyzed.</p></div><div><h3>Results</h3><p>Of 89 patients included, 59 had stoma creation. Stoma group had significant higher catecholamine drugs use. Mortality, time to complete healing and number of excision surgeries did not significantly differ between both groups. Hospitalization duration was significantly higher in the stoma group. Mortality and hospitalization duration were higher when loop transverse colostomy was performed, and when colostomy was done in the first 3-days. Morbidity occurred in 41 % of patients with colostomy, with 25 % life-threatening complications. 31 % of colostomies remained definitive, while median time to intestinal recovery was 159-days.</p></div><div><h3>Discussion</h3><p>Consistently with current literature, disease survival was not improved by colostomy creation although skewed. Colostomy creation was associated with a higher hospitalization duration and a significant morbidity including risk of definitive stoma. To limit over-indicated stoma and improve early results, a damage control strategy using colostomy creation is advised.</p></div><div><h3>Conclusion</h3><p>The benefit of colostomy during the acute phase of Fournier Gangrene was uncertain, with no clear impact on mortality. In fact, colostomy was associated with increased hospitalization duration and specific morbidity. Finally, when fecal diversion is deemed necessary, we advocate for coelioscopic delayed loop left colostomy. Alternative minimally invasive treatment as bowel catheters should also be discussed.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"16 ","pages":"Article 100231"},"PeriodicalIF":0.0,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000773/pdfft?md5=f2419ded28a5f45a7b26bbab3031477f&pid=1-s2.0-S2666262023000773-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138838688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of exercise in patients with colorectal cancer surgery: A systematic review","authors":"Ece Ekici ,&nbsp;Mehmet Özkeskin ,&nbsp;Fatih Özden","doi":"10.1016/j.sipas.2023.100227","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100227","url":null,"abstract":"<div><h3>Background</h3><p>Current reviews have primarily focused on the effect of exercise on colorectal cancer patient's functional abilities and cardiorespiratory performance. There is a need for more comprehensive studies to determine the effects of exercise on different components. We aimed to investigate recent pre-operative and post-operative exercise interventions conducted in patients undergoing or scheduled for colorectal cancer surgery.</p></div><div><h3>Methods</h3><p>The PRISMA guidelines were followed. PubMed, Web-of-Science (WoS) and Scopus databases were searched. The Physiotherapy Evidence Database (PEDro) tool provided the methodological quality and risk of bias for the included trials. The review findings are presented using the principles of narrative synthesis. The synthesis process encompasses steps such as “developing a preliminary synthesis, exploring relationships within and between studies, and assessing the robustness of the synthesis.”</p></div><div><h3>Results</h3><p>The combined use of aerobic and resistance exercises reduces hospital stay in the preoperative period, long-term exercise interventions significantly improve functional parameters, and progressive relaxation exercises performed during the preoperative and postoperative periods reduce anxiety.</p></div><div><h3>Conclusions</h3><p>Long-term and combined (relaxation, aerobic and resistance) rehabilitation in colorectal cancer surgery is essential to improve the physical and psychological parameters of patients. Further studies should focus on more comprehensive, long-term exercise programs and separately investigate the effects of each exercise type.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100227"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000736/pdfft?md5=b6c793e71cc82fee9d0192fcb82c3b59&pid=1-s2.0-S2666262023000736-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138490910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between direct oral anticoagulant concentrations and clinical outcomes: A systematic review and meta-analysis","authors":"Brandon Stretton ,&nbsp;Philip Harford ,&nbsp;Joshua Kovoor ,&nbsp;Stephen Bacchi ,&nbsp;Aashray Gupta ,&nbsp;Jaspreet Sandhu ,&nbsp;Hollie Moran ,&nbsp;Suzanne Edwards ,&nbsp;Jonathon Henry W. Jacobsen ,&nbsp;Guy Maddern ,&nbsp;Mark Boyd","doi":"10.1016/j.sipas.2023.100230","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100230","url":null,"abstract":"<div><h3>Introduction</h3><p>Current guidelines suggest preoperative direct oral anticoagulant levels of &lt; 30–50 ng/ml. However, there is limited evidence to guide this expert consensus. Reviewing assay titres and clinical outcomes may be able to inform perioperative care of the anticoagulated patient. This review aimed to determine whether DOAC assay plasma concentrations are associated with bleeding or systemic embolic events to better appreciate a possible therapeutic or hazardous reference range.</p></div><div><h3>Methods</h3><p>Systematic search, performed by an information specialist using a peer-reviewed search. Main search concepts were direct oral anticoagulant therapy for atrial fibrillation or venous thromboembolism. Data synthesised in narrative and tabular format whilst data that could be pooled was subjected to meta-analysis, using a random effects model. Meta regression was conducted for DOAC peak levels and clinical events. PRISMA guidelines were adhered to.</p></div><div><h3>Results</h3><p>Of 6717 retrieved publications, a total of 17 studies were included in the systematic review and 14 in the meta-analysis/regression. Studies report clinical outcome follow up ranging from 28 to 128 weeks. For every 10 ng/ml increase in DOAC assay trough and peak levels, the mean number of bleeding cases increases by 0.03(95 %CI: –0.32 –0.38, <em>P</em> = 0.84) and 0.09(95 %CI: –3.4 –5.3, <em>P</em> = 0.55) respectively, the mean number of major bleed cases increases by 0.01(95 %CI: –0.05 –0.07, <em>P</em> = 0.62) and 0.011(95 %CI: –0.32 –0.34, <em>P</em> = 0.74) respectively and the mean number of systemic embolic event cases decreases by 0.00039(95 %CI: –0.06 –0.0054, <em>P</em> = 0.88) and 0.04(95 %CI: –0.56 –0.48, <em>P</em> = 0.77) respectively.</p></div><div><h3>Conclusion</h3><p>There exists no significant, independent relationship, as determined by a univariate meta regression, between DOAC assay concentrations and a patient's risk of bleeding or systemic embolic embolism. This review also highlights the possibility of an absolute, patient specific DOAC assay concentration that may indicate adequate anticoagulation, above which further increases do not confer an increased risk of bleeding. However, further research to characterise this and its utility in the perioperative setting is required.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100230"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000761/pdfft?md5=1e85e8f844c1c4eeefc625019c2f54e8&pid=1-s2.0-S2666262023000761-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138549865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent trends in hand surgery fellowship applicants and programs","authors":"Christopher P. Bellaire ,&nbsp;Emily M. Graham ,&nbsp;Lauren M. Bracey ,&nbsp;Harrison R. Ferlauto ,&nbsp;Caleigh Weliver ,&nbsp;Shaun D. Mendenhall ,&nbsp;Eitan Melamed","doi":"10.1016/j.sipas.2023.100228","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100228","url":null,"abstract":"<div><h3>Background</h3><p>Hand surgery is a competitive fellowship that draws applicants from orthopedic, plastic, and general surgery. In 2010, recommendations from the American Academy of Orthopaedic Surgeons (AAOS) Board of Specialty Societies Match Oversight Committee and the American Society of Plastic Surgeons (ASPS) Plastic Surgery Workforce Task Force led to significant reforms to their respective workforces and training. This study characterizes trends in hand fellowship applicants and programs since these recommendations (2010–2023).</p></div><div><h3>Materials and methods</h3><p>We queried hand fellowship applicant and program data from the American Society for Surgery of the Hand (ASSH), the National Resident Matching Program (NRMP), and the Accreditation Council for Graduate Medical Education (ACGME).</p></div><div><h3>Results, discussion and conclusions</h3><p>From 2010 to 2023, the number of ACGME-accredited hand fellowship programs increased across specialties (orthopedic surgery, 58 to 74 (27.6 % increase, <em>R</em> = 0.97, <em>p</em> &lt; 0.001); plastic surgery, 14 to 19 (35.7 % increase, <em>R</em> = 0.91, <em>p</em> &lt; 0.001); general surgery, 1 to 2 (50 % increase, <em>R</em> = 0.71, <em>p</em> = 0.004). The number of available fellowship positions commensurately increased by 38.8 % over the same time period. The number of applicants did not significantly change between 2010 (155 applicants) and 2023 (198 applicants) (<em>R</em> = 0.32, <em>p</em> = 0.27). The ratio of applicants-to-positions significantly decreased from 2010 (1.12 applicants per position) to 2023 (1.04 applicants per position) (<em>R</em> = -0.74, <em>p</em> = 0.003). Yet, applicants ranked nearly twice as many programs in 2023 (14.9 programs per applicant) compared to in 2010 (7.5 programs per applicant) (<em>R</em> = 0.98, <em>p</em> &lt; 0.001). In light of the American Orthopaedic Association endorsing signal preferencing in the 2022–2023 residency Match, strategies to optimize rank lists in the fellowship application process should be further explored.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100228"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000748/pdfft?md5=a1c3593a9c1c08e75190861726667475&pid=1-s2.0-S2666262023000748-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138577636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The significance of isolated hyperbilirubinemia in detecting asymptomatic common bile duct stones in patients undergoing laparoscopic cholecystectomy","authors":"A. Aljorfi,&nbsp;M. Abdelkarim,&nbsp;M. Elaraby,&nbsp;A. Kotb,&nbsp;R. Morgan","doi":"10.1016/j.sipas.2023.100223","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100223","url":null,"abstract":"<div><h3>Aim</h3><p>The aim of this study was to evaluate the role of isolated hyperbilirubinemia in the detection of choledocholithiasis.</p></div><div><h3>Methods</h3><p>A retrospective cohort study focused on adult patients diagnosed with gallstone disease, and undergoing intra-operative cholangiogram for suspected choledocholithiasis. Those presenting with isolated hyperbilirubinemia were investigated for their risk of choledocholithiasis, and were compared with those with normal liver function tests.</p></div><div><h3>Results</h3><p>Out of the total 1274 patients undergoing intra-operative cholangiogram in the study period, only 18 exhibited isolated hyperbilirubinemia. Among these, four patients were found to have common bile duct (CBD) stones. This indicates that in approximately 22 % of patients, isolated hyperbilirubinemia may be associated with CBD stones. However, it is essential to note that the number of patients in the study with isolated hyperbilirubinemia was relatively small.</p></div><div><h3>Conclusion</h3><p>Although the incidence of isolated hyperbilirubinemia was limited in our study, the presence of CBD stones in some of these patients suggests a potential association. Isolated hyperbilirubinaemia should not be overlooked as a risk factor for CBD stones. Nonetheless, additional investigations with a larger sample size are needed to establish a more definitive understanding of the relationship between isolated hyperbilirubinemia and choledocholithiasis.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100223"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000694/pdfft?md5=569d5e5631807d501cfb0cee5bfb0f7a&pid=1-s2.0-S2666262023000694-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138577735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency laparotomy risk assessment: An audit of South Australian hospitals","authors":"Joseph N. Hewitt ,&nbsp;Thomas J. Milton ,&nbsp;Octavia Tz-Shane Lee ,&nbsp;Joshua Tinnion ,&nbsp;Antonio Barbaro ,&nbsp;Katarina Foley ,&nbsp;Ishraq Murshed ,&nbsp;Nick Georges ,&nbsp;Rippan Shukla ,&nbsp;Cameron Main ,&nbsp;Christopher Dobbins ,&nbsp;Markus I. Trochsler","doi":"10.1016/j.sipas.2023.100225","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100225","url":null,"abstract":"<div><h3>Background</h3><p>Emergency laparotomy (EL) is associated with high mortality rates and is performed on a heterogenous patient population. Pre-operative risk assessment is one tool which can assist with EL patient care. We aimed to characterise rates of pre-operative risk assessment for EL patients in South Australia.</p></div><div><h3>Methods</h3><p>A retrospective audit of all patients undergoing EL over one year in six participating hospitals in South Australia was undertaken. Patient demographics, operation details, risk assessments (e.g. NELA, POSSUM, ACS-NSQIP) and outcomes were recorded.</p></div><div><h3>Results</h3><p>422 ELs were audited. Preoperative risk assessments were recorded for 42 (10 %) operations. The 30-day mortality rate was 9 %. There was no difference in mortality rates for patients with or without a risk assessment documented. Hospital participation in the Australia and New Zealand Emergency Laparotomy Audit (ANZELA) was associated with increased rates of risk assessment. Increasing patient age and then presence of certain comorbidities were also associated with increased rates of risk assessment.</p></div><div><h3>Conclusions</h3><p>This audit shows poor uptake of recommendations for preoperative risk assessment in EL patients in South Australia. Comparable mortality rates to previously published Australian and international data are demonstrated. Factors associated with increased risk assessment rates are identified and are relevant to future quality improvement activities.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100225"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000712/pdfft?md5=ae629eeeb12d27d8542747ac0611d36c&pid=1-s2.0-S2666262023000712-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138472485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beveled vs. Perpendicular Incisions and The Effects on Wound Healing: A Review","authors":"Joseph De Leon,&nbsp;Mojtaba Wali,&nbsp;Georgios E. Romanos","doi":"10.1016/j.sipas.2023.100226","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100226","url":null,"abstract":"<div><p>Proper surgical technique is crucial for optimizing wound healing and reducing scar tissue formation. There are numerous measures a surgeon can take to improve wound healing; however, the angle of the incision made at the surgical site has been suggested to potentially play a role in wound healing, particularly between beveled and perpendicular incisions.</p></div><div><h3>Objectives</h3><p>The goal of this study was to analyze the literature and observe whether a discrepancy exists between using beveled vs perpendicular incisions in surgical procedures, as well as to understand the relationship between incision angles and physiologic wound healing.</p></div><div><h3>Methods</h3><p>Google Scholar, Pubmed, and MEDLINE searches regarding incision techniques were made to find relevant articles in the fields of plastic surgery, dermatologic surgery, periodontal surgery, and ophthalmic surgery which included studies from 2004 to 2023. The exclusion criteria consisted of studies that did not have a comparative design and/or were not revolved around incision angle.</p></div><div><h3>Results</h3><p>After filtering out irrelevant studies, we selected six studies that addressed the dichotomy between beveled and perpendicular incisions. Out of the six studies, four were in favor of beveled incisions, and the remaining studies either found no significant difference or reported benefits to some degree of using perpendicular cuts.</p></div><div><h3>Discussion</h3><p>The literature seems to suggest that beveled incisions have an advantage over perpendicular incisions in wound healing, particularly in the aspects of esthetic and accelerated wound healing. This is potentially due to the increased surface area of the dermis, preservation of hair follicles, and decreased incidence of infection.</p></div><div><h3>Conclusion</h3><p>Although the literature seems to favor beveled incisions, a definitive conclusion cannot be made as there is not sufficient evidence to support the superiority of one incision type over the other.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100226"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000724/pdfft?md5=d319c8fd396f0ad8eb53342ff0e47683&pid=1-s2.0-S2666262023000724-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138558572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-course instructional videos and home-based laparoscopic suturing simulation enhances the educational impact of a laparoscopic training course","authors":"Hansraj Mangray ,&nbsp;Sanele Madziba ,&nbsp;Shamaman Harilal ,&nbsp;Yashlin Govender ,&nbsp;Amanda Ngobese ,&nbsp;Damian L Clarke","doi":"10.1016/j.sipas.2023.100229","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100229","url":null,"abstract":"<div><h3>Introduction</h3><p>We developed a home-based laparoscopic suturing simulation (HBLSS) technique, which is intended to improve the impact of a structured laparoscopic training course.</p></div><div><h3>Method</h3><p>A group of sixteen students were provided with the educational video, and after two weeks, all students were observed and timed performing a laparoscopic reef knot. The students were then randomized into two cohorts. The exclusive video group continued using the video for a further two weeks. The second group were shown the HBLSS technique and told to use this in conjunction with the video for a further two weeks.</p></div><div><h3>Results</h3><p>The entire cohort had an initial median time to form an intracorporeal reef knot of 190 s (range 459, IQR 128). After two additional weeks of using the educational video exclusively, the median time was reduced to 85 s (range 282, IQR 125), whereas the HBLSS and educational video group had a median post-training time of 28.5 s (range 36, IQR 18.5). There was a clear statistical difference between the exclusive video group and the HBLSS and video group (<em>P</em> = 0.008). There was also an improvement from the movement of both instruments to one instrument, reduced crossing of instruments and reduced transverse movement in the HBLSS and video group.</p></div><div><h3>Conclusion</h3><p>A combination of video-based teaching and HBLSS was associated with improved laparoscopic intra-corporeal knot-tying skills in comparison to the exclusive video-based teaching. This reflects the importance of imparting both cognitive and psychomotor skills to students practising laparoscopic surgery.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100229"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266626202300075X/pdfft?md5=ab625f78fc3cb93faa841a5380d281df&pid=1-s2.0-S266626202300075X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138549923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of frozen section in sentinel lymph node biopsy in early breast cancer – An Australian single-centre experience","authors":"Elan Novis ,&nbsp;Tae Jun Kim ,&nbsp;Chahaya Gauci ,&nbsp;Jasmine Mui ,&nbsp;Yijun Gao ,&nbsp;Natalia Garibotto","doi":"10.1016/j.sipas.2023.100224","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100224","url":null,"abstract":"<div><h3>Introduction</h3><p>Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in patients with clinically lymph node negative early breast cancer, reducing the need for axillary lymph node dissection (ALND) and its associated risks. Intra-operative frozen section is a method of rapid pathological assessment of the sentinel node to identify the presence of metastatic disease and potentially avoid the need for a second operation in patient who will require an axillary lymph node dissection.</p></div><div><h3>Methods</h3><p>A retrospective review of a prospectively collected breast cancer database was performed. All patients with breast cancer who underwent SLNB and/or ALND at our institution, between May 1st 2017 to June 1st 2022 were identified. There were 565 patients who were included in the study.</p></div><div><h3>Results</h3><p>Intra-operative frozen section was able to accurately identify 71% of patients who had macrometastasis in their sentinel lymph node, thus allowing them to immediately proceed to ALND and avoid a second operation. In patient who had a false negative frozen section result, only 6.5% required ALND. The majority of false negative results were due to isolated tumour cells or micrometastasis, and therefore would not have required further intervention.</p></div><div><h3>Conclusion</h3><p>Intra-operative frozen section of sentinel lymph node biopsy in breast cancer is useful in reducing the need for a second operation, allowing staging of the axilla to occur more efficiently and with high diagnostic accuracy.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100224"},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000700/pdfft?md5=9d21e195f341f7eecb0e6cf234ac2084&pid=1-s2.0-S2666262023000700-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138430300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}