Total knee replacements (TKR) remain as one of the most effective procedures for restoring quality of life. Computer-navigated TKR (CN-TKR) have been consistently used for the last two decades whereas robotic-assisted TKR (RA-TKR) have been recently introduced into practice. The primary outcome of this study was to compare the early outcomes following RA-TKR and CN-TKR. This retrospective, single-centre, cohort study identified all the patients who underwent a TKR in the Golden Jubilee National Hospital by a single primary hip and knee replacement surgeon between 12th January 2021 and 22nd April 2022. Results were analysed for statistical significance. 111 patients underwent a TKR between January 2021 and April 2022. 26 patients underwent a RA-TKR using Stryker’s MAKO SmartRobotics and 85 patients underwent CN-TKR using B. Braun’s OrthoPilot®. Patients who had an RA-TKR were younger, with the average being 64 compared to 69. They also had a greater ROM pre-operatively, with an additional 9 degrees of movement on average. However, post-operatively there was no difference in ROM. There was no change in the mean length of stay (LOS), operation length, blood loss, Oxford score, EQ5-D score, and Forgotten Joint Score. At the 6-week follow-up, 96% of RA-TKR patients were either satisfied or very satisfied compared to 91% of CN-TKR patients. This study found no significant difference in short-term clinical outcomes between RA-TKR and CN-TKR. However, a small sample size and a relatively short time frame in which data was collected limits this study to some extent and further research is recommended.
{"title":"939 A Comparison of the Short-Term Outcomes Following Robotic-Assisted and Computer-Navigated Total Knee Replacements","authors":"G. A. Chen","doi":"10.1093/bjs/znae163.049","DOIUrl":"https://doi.org/10.1093/bjs/znae163.049","url":null,"abstract":"\u0000 \u0000 \u0000 Total knee replacements (TKR) remain as one of the most effective procedures for restoring quality of life. Computer-navigated TKR (CN-TKR) have been consistently used for the last two decades whereas robotic-assisted TKR (RA-TKR) have been recently introduced into practice.\u0000 The primary outcome of this study was to compare the early outcomes following RA-TKR and CN-TKR.\u0000 \u0000 \u0000 \u0000 This retrospective, single-centre, cohort study identified all the patients who underwent a TKR in the Golden Jubilee National Hospital by a single primary hip and knee replacement surgeon between 12th January 2021 and 22nd April 2022. Results were analysed for statistical significance.\u0000 \u0000 \u0000 \u0000 111 patients underwent a TKR between January 2021 and April 2022. 26 patients underwent a RA-TKR using Stryker’s MAKO SmartRobotics and 85 patients underwent CN-TKR using B. Braun’s OrthoPilot®. Patients who had an RA-TKR were younger, with the average being 64 compared to 69. They also had a greater ROM pre-operatively, with an additional 9 degrees of movement on average.\u0000 However, post-operatively there was no difference in ROM. There was no change in the mean length of stay (LOS), operation length, blood loss, Oxford score, EQ5-D score, and Forgotten Joint Score. At the 6-week follow-up, 96% of RA-TKR patients were either satisfied or very satisfied compared to 91% of CN-TKR patients.\u0000 \u0000 \u0000 \u0000 This study found no significant difference in short-term clinical outcomes between RA-TKR and CN-TKR. However, a small sample size and a relatively short time frame in which data was collected limits this study to some extent and further research is recommended.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141703541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The growing significance of minimally invasive procedures necessitates a shift in the traditional surgical training model towards a more apprenticeship-based approach. This requires the introduction of simulation training in surgical education to be more prominent. This study aimed to explore the effectiveness of a hands-on laparoscopic simulation on confidence in laparoscopic and surgical skills, giving insight into its use of teaching for doctors & medical students, as well as the correlation between confidence and practical skills. 83 medical students and foundation year doctors attended a laparoscopic simulation hands-on session and completed pre- and post-event questionnaires using a 5-point Likert scale assessing their confidence in practical skills and ability to perform laparoscopic surgical procedures. Attendees also rated how important they believe laparoscopic simulators are for improving surgical skills. Statistical significance & normality were determined using the one-tailed Shapiro–Wilk test and a follow-up T-test was conducted. Attendees had demonstrated a significant increase in confidence in the practical skills required in laparoscopic surgery after having done the simulation (average pre-event & post-event 2.11, 3.69 respectively, p = p = 2.99 10-19); as well as confidence in the ability to perform the procedures (average pre-event & post-event 1.71, 4.16 respectively, p = p = 2.99 10-23). The study has shown that laparoscopic simulations are effective in increasing the confidence of attendees in the practical ability of laparoscopic simulations and skills required for laparoscopic surgery, showing a positive impact of introducing laparoscopic simulation into surgical training. Further studies are required with long-term follow-up in order to measure sustainability.
微创手术的重要性与日俱增，因此有必要将传统的外科培训模式转变为更加以学徒为基础的方法。这就要求在外科教育中更多地引入模拟训练。本研究旨在探讨腹腔镜模拟实践对腹腔镜和手术技能信心的影响，深入了解其在医生和医学生教学中的应用，以及信心和实践技能之间的相关性。 83 名医科学生和基础年级医生参加了腹腔镜模拟实践课程，并使用 5 点李克特量表填写了活动前后的调查问卷，以评估他们对实践技能和腹腔镜手术能力的信心。与会者还对他们认为腹腔镜模拟器对提高手术技能的重要性进行了评分。使用单尾 Shapiro-Wilk 检验确定了统计意义和正态性，并进行了后续 T 检验。 参加者在进行模拟训练后，对腹腔镜手术所需实际技能的信心明显增强（活动前和活动后的平均值分别为 2.11、3.69，p = p = 2.99 10-19）；对手术能力的信心也明显增强（活动前和活动后的平均值分别为 1.71、4.16，p = p = 2.99 10-23）。 该研究表明，腹腔镜模拟能有效增强学员对腹腔镜模拟的实际操作能力和腹腔镜手术所需技能的信心，显示出将腹腔镜模拟引入外科培训的积极影响。还需要进一步开展长期跟踪研究，以衡量可持续性。
{"title":"756 Impact of Hands-on Laparoscopic Simulation on Confidence and Skills in Medical Trainees: A Prospective Study","authors":"H. Khan, N. Zilani","doi":"10.1093/bjs/znae163.068","DOIUrl":"https://doi.org/10.1093/bjs/znae163.068","url":null,"abstract":"\u0000 \u0000 \u0000 The growing significance of minimally invasive procedures necessitates a shift in the traditional surgical training model towards a more apprenticeship-based approach. This requires the introduction of simulation training in surgical education to be more prominent. This study aimed to explore the effectiveness of a hands-on laparoscopic simulation on confidence in laparoscopic and surgical skills, giving insight into its use of teaching for doctors & medical students, as well as the correlation between confidence and practical skills.\u0000 \u0000 \u0000 \u0000 83 medical students and foundation year doctors attended a laparoscopic simulation hands-on session and completed pre- and post-event questionnaires using a 5-point Likert scale assessing their confidence in practical skills and ability to perform laparoscopic surgical procedures. Attendees also rated how important they believe laparoscopic simulators are for improving surgical skills. Statistical significance & normality were determined using the one-tailed Shapiro–Wilk test and a follow-up T-test was conducted.\u0000 \u0000 \u0000 \u0000 Attendees had demonstrated a significant increase in confidence in the practical skills required in laparoscopic surgery after having done the simulation (average pre-event & post-event 2.11, 3.69 respectively, p = p = 2.99 10-19); as well as confidence in the ability to perform the procedures (average pre-event & post-event 1.71, 4.16 respectively, p = p = 2.99 10-23).\u0000 \u0000 \u0000 \u0000 The study has shown that laparoscopic simulations are effective in increasing the confidence of attendees in the practical ability of laparoscopic simulations and skills required for laparoscopic surgery, showing a positive impact of introducing laparoscopic simulation into surgical training. Further studies are required with long-term follow-up in order to measure sustainability.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141693507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Yiu, L. Biasi, T. Khan, D. Taylor, N. Price, R. Bell, M. Sallam
Written consent obtained for case report. A 59-year-old male who was 3-months post-EVAR repair under immunosuppression for kidney transplantation and anti-retroviral HIV treatment presented to ED in 2017 with abdominal pain and fever. CTAP revealed pyelonephritis in renal allograft. Blood cultures were positive for staphylococcus epidermidis. PETCT showed high-intensity uptake around endograft. Urgent explant of endograft and insitu biological aorto-biiliac graft reconstruction with bench prepared bilateral long saphenous veins were performed. The predicted challenges were locating source of infection, immunosuppressed state, and allograft preservation. Dacron graft was used as temporary perfusion shunt (left axillary artery to right superficial femoral artery) for renal allograft on right external iliac vessels. Endograft was removed via rooftop incision with visceral rotation. Supra-celiac and supra-superior mesenteric artery clamping times were 15 and 35 minutes. The source of infection was from infected appendix proximal to graft with erosion of right external iliac artery resulting in appendectomy in the same operation. Following 12-weeks of OPAT antibiotic-therapy, repeat PETCT revealed low-grade uptake around aortic graft and inflammatory markers were back to baseline. At 6 years in 2023, patient remains clinically well with ∼20% allograft function. Maintaining kidney allograft perfusion in the setting of elective non-infected aortic graft explant was previously reported, but with ENROUTE system (Rasheed et al., 2018). The satisfactory long-term outcomes discussed here demonstrated with MDT planning involving vascular surgery, infectious diseases, renal medicine and patient, explant of infected graft with insitu biological graft reconstruction in renal transplant patients presenting with complex aortic-graft infection is feasible.
{"title":"1004 Urgent Explant of Infected Aortic Stent Graft in a Patient with Kidney Transplant Using Biological Aortoiliac Reconstruction and a Temporary Axillo-Femoral Perfusion Shunt: 6-Year Follow-Up and Literature Review","authors":"J. Yiu, L. Biasi, T. Khan, D. Taylor, N. Price, R. Bell, M. Sallam","doi":"10.1093/bjs/znae163.103","DOIUrl":"https://doi.org/10.1093/bjs/znae163.103","url":null,"abstract":"\u0000 \u0000 \u0000 Written consent obtained for case report. A 59-year-old male who was 3-months post-EVAR repair under immunosuppression for kidney transplantation and anti-retroviral HIV treatment presented to ED in 2017 with abdominal pain and fever. CTAP revealed pyelonephritis in renal allograft. Blood cultures were positive for staphylococcus epidermidis. PETCT showed high-intensity uptake around endograft. Urgent explant of endograft and insitu biological aorto-biiliac graft reconstruction with bench prepared bilateral long saphenous veins were performed.\u0000 \u0000 \u0000 \u0000 The predicted challenges were locating source of infection, immunosuppressed state, and allograft preservation. Dacron graft was used as temporary perfusion shunt (left axillary artery to right superficial femoral artery) for renal allograft on right external iliac vessels. Endograft was removed via rooftop incision with visceral rotation. Supra-celiac and supra-superior mesenteric artery clamping times were 15 and 35 minutes. The source of infection was from infected appendix proximal to graft with erosion of right external iliac artery resulting in appendectomy in the same operation. Following 12-weeks of OPAT antibiotic-therapy, repeat PETCT revealed low-grade uptake around aortic graft and inflammatory markers were back to baseline. At 6 years in 2023, patient remains clinically well with ∼20% allograft function. Maintaining kidney allograft perfusion in the setting of elective non-infected aortic graft explant was previously reported, but with ENROUTE system (Rasheed et al., 2018).\u0000 \u0000 \u0000 \u0000 The satisfactory long-term outcomes discussed here demonstrated with MDT planning involving vascular surgery, infectious diseases, renal medicine and patient, explant of infected graft with insitu biological graft reconstruction in renal transplant patients presenting with complex aortic-graft infection is feasible.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141699668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Wagner, S. Falk, M. Callaway, R. Abbadi, G. Appanna, J. Rees, J. Skipworth, S. van Laarhoven
Stereotactic ablative body radiotherapy (SABR) is a highly focused radiation treatment that delivers an intense dose of radiation to a tumour whilst limiting exposure of surrounding tissues. SABR has been associated with improvement in survival and good rates of local control in non-surgical candidates with hepatocellular carcinoma (HCC). The aim of this study was to evaluate the outcomes of HCC patients treated with SABR after its introduction in a tertiary referral hepatobiliary centre. A total of 32 patients (median age 73 years {47 to 85}, 78% male) who received SABR for HCC liver lesions between July 2020 and August 2022 were retrospectively analysed. Patient, treatment, and follow-up details were obtained from online patient records and imaging. Overall Survival rate was 78% at a median follow-up of 12 months (range 4 to 30). Local control was achieved in 72%, while progression occurred in 31%. Median time to progression was 6 months (range 3 to 31). The rate of progression-free survival at 12 months was 62.5%. Only 31% reported toxicities. No patients in the study group experienced any Grade ³ 3 toxicities. Our experience following the introduction of SABR for patients with HCC is that SABR is a viable, well-tolerated and effective treatment option in this patient group. Further research is warranted to examine the clinical benefits of combination treatment with SABR and other treatment modalities to maximise disease control in patients with both early and advanced HCC.
{"title":"71 Stereotactic Ablative Radiotherapy Is a Safe and Feasible Treatment Option for Patients with Hepatocellular Carcinoma","authors":"B. Wagner, S. Falk, M. Callaway, R. Abbadi, G. Appanna, J. Rees, J. Skipworth, S. van Laarhoven","doi":"10.1093/bjs/znae163.167","DOIUrl":"https://doi.org/10.1093/bjs/znae163.167","url":null,"abstract":"\u0000 \u0000 \u0000 Stereotactic ablative body radiotherapy (SABR) is a highly focused radiation treatment that delivers an intense dose of radiation to a tumour whilst limiting exposure of surrounding tissues. SABR has been associated with improvement in survival and good rates of local control in non-surgical candidates with hepatocellular carcinoma (HCC). The aim of this study was to evaluate the outcomes of HCC patients treated with SABR after its introduction in a tertiary referral hepatobiliary centre.\u0000 \u0000 \u0000 \u0000 A total of 32 patients (median age 73 years {47 to 85}, 78% male) who received SABR for HCC liver lesions between July 2020 and August 2022 were retrospectively analysed. Patient, treatment, and follow-up details were obtained from online patient records and imaging.\u0000 \u0000 \u0000 \u0000 Overall Survival rate was 78% at a median follow-up of 12 months (range 4 to 30). Local control was achieved in 72%, while progression occurred in 31%. Median time to progression was 6 months (range 3 to 31). The rate of progression-free survival at 12 months was 62.5%. Only 31% reported toxicities. No patients in the study group experienced any Grade ³ 3 toxicities.\u0000 \u0000 \u0000 \u0000 Our experience following the introduction of SABR for patients with HCC is that SABR is a viable, well-tolerated and effective treatment option in this patient group. Further research is warranted to examine the clinical benefits of combination treatment with SABR and other treatment modalities to maximise disease control in patients with both early and advanced HCC.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141713071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to evaluate the effects of a student-organised conference on delegates’ motivation and understanding of orthopaedic surgery. This was a conference organised by students with the support of consultants from the Princess Elizabeth Orthopaedic Centre in The Royal Devon and Exeter Hospital. Identical questionnaires were completed immediately before and after the conference on google forms. The google forms were distributed to the delegates via their registered email address. The pre- and post-conference questionnaire had three sections comprising of understanding, motivations, and barriers to pursing orthopaedic surgery. Pre- and post-conference responses which were recorded on a Likert scale and were compared using Wilcoxon signed rank test. All data analysis performed was using IBM SPSS (v.28, USA). 62 delegates completed the questionnaires, the majority of which were medical students with 4 junior doctors. Understanding of orthopaedics showed a significant increase in the majority of questions (p<0.001), except the intention to pursue orthopaedics which showed no significant difference. Delegates were attracted to orthopaedics due to the work-life balance, prestige and salary (p<0.001), however they showed a reduced interest in case variety and private practice. There was no difference in the barriers to pursuing orthopaedic surgery, except lack of patient contact which showed a significant increase (p<0.001). Orthopaedic conferences improve delegates understanding, perceptions and motivations to pursue a career in orthopaedic surgery. We therefore encourage orthopaedic surgeons and educationalists to increase exposure to orthopaedics for undergraduates by supporting more student-led initiatives to promote recruitment into orthopaedic surgery.
{"title":"821 Impact of a One-Day Conference on Perceptions and Understanding of T&O - Outcomes of the South West Orthopaedic Conference 2023","authors":"W. Drake, M. El-hassan, C. Jones","doi":"10.1093/bjs/znae163.055","DOIUrl":"https://doi.org/10.1093/bjs/znae163.055","url":null,"abstract":"\u0000 \u0000 \u0000 This study aimed to evaluate the effects of a student-organised conference on delegates’ motivation and understanding of orthopaedic surgery.\u0000 \u0000 \u0000 \u0000 This was a conference organised by students with the support of consultants from the Princess Elizabeth Orthopaedic Centre in The Royal Devon and Exeter Hospital. Identical questionnaires were completed immediately before and after the conference on google forms. The google forms were distributed to the delegates via their registered email address. The pre- and post-conference questionnaire had three sections comprising of understanding, motivations, and barriers to pursing orthopaedic surgery. Pre- and post-conference responses which were recorded on a Likert scale and were compared using Wilcoxon signed rank test. All data analysis performed was using IBM SPSS (v.28, USA).\u0000 \u0000 \u0000 \u0000 62 delegates completed the questionnaires, the majority of which were medical students with 4 junior doctors. Understanding of orthopaedics showed a significant increase in the majority of questions (p<0.001), except the intention to pursue orthopaedics which showed no significant difference. Delegates were attracted to orthopaedics due to the work-life balance, prestige and salary (p<0.001), however they showed a reduced interest in case variety and private practice. There was no difference in the barriers to pursuing orthopaedic surgery, except lack of patient contact which showed a significant increase (p<0.001).\u0000 \u0000 \u0000 \u0000 Orthopaedic conferences improve delegates understanding, perceptions and motivations to pursue a career in orthopaedic surgery. We therefore encourage orthopaedic surgeons and educationalists to increase exposure to orthopaedics for undergraduates by supporting more student-led initiatives to promote recruitment into orthopaedic surgery.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141700591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. T. San, K. R. Rahman, J. Wongsikhee, K. Brahmbhatt, J. George, A. Mahmood, D. Bowrey
Despite rapid evolution of surgical robotics systems, training opportunities are very limited especially for medical students and junior doctors. We organised a free-of-charge regional robotics workshop in collaboration with CMR Surgical with the goal of increasing exposure to surgical robotics technology. We also evaluated the delegates’ perception on current surgical robotics training and the workshop. CMR Surgical was invited to exhibit their Versius® robot and Virtual-Reality trainer for a one-day workshop at Glenfield Hospital, Leicester. The workshop was advertised across universities and hospital trusts in East Midlands. Registration form included pre-workshop questionnaire which assessed the motivation and barriers to attending surgical robotics courses, and their familiarity with robotics surgery. After 1-hour hands-on exercise supervised by consultants and CMR Surgical trainers, delegates were asked to complete post-workshop questionnaire to evaluate shift in familiarity, interest, and confidence in basic robotic skills. 75 delegates registered with 93% having never attended similar workshop before and the barriers were perceiving that robotics surgery skills are for advanced surgeons only (37%), cost (26%), no accessible courses (24%), time constraints (9%) and others (4%). The primary motivation to attend this workshop were learning basic robotic skills (49%), exploring innovative technology (44%) and networking (7%). 30 delegates were shortlisted for 1-hour hands-on experience into six groups consisting of 18 students and 12 junior doctors. Post-workshop feedback showed a positive shift in familiarity, interest, and confidence in basic robotic skills. Delegates also expressed increased interest in surgical specialties after this workshop. They also found VR station was enjoyable and believed it has potential in training future robotic surgeons. These findings highlight the feasibility and importance of creating accessible training opportunities to bridge the gap in surgical robotics education.
{"title":"1170 Bridging the Gap in Surgical Robotics Education","authors":"N. T. San, K. R. Rahman, J. Wongsikhee, K. Brahmbhatt, J. George, A. Mahmood, D. Bowrey","doi":"10.1093/bjs/znae163.051","DOIUrl":"https://doi.org/10.1093/bjs/znae163.051","url":null,"abstract":"\u0000 \u0000 \u0000 Despite rapid evolution of surgical robotics systems, training opportunities are very limited especially for medical students and junior doctors. We organised a free-of-charge regional robotics workshop in collaboration with CMR Surgical with the goal of increasing exposure to surgical robotics technology. We also evaluated the delegates’ perception on current surgical robotics training and the workshop.\u0000 \u0000 \u0000 \u0000 CMR Surgical was invited to exhibit their Versius® robot and Virtual-Reality trainer for a one-day workshop at Glenfield Hospital, Leicester. The workshop was advertised across universities and hospital trusts in East Midlands. Registration form included pre-workshop questionnaire which assessed the motivation and barriers to attending surgical robotics courses, and their familiarity with robotics surgery. After 1-hour hands-on exercise supervised by consultants and CMR Surgical trainers, delegates were asked to complete post-workshop questionnaire to evaluate shift in familiarity, interest, and confidence in basic robotic skills.\u0000 \u0000 \u0000 \u0000 75 delegates registered with 93% having never attended similar workshop before and the barriers were perceiving that robotics surgery skills are for advanced surgeons only (37%), cost (26%), no accessible courses (24%), time constraints (9%) and others (4%). The primary motivation to attend this workshop were learning basic robotic skills (49%), exploring innovative technology (44%) and networking (7%). 30 delegates were shortlisted for 1-hour hands-on experience into six groups consisting of 18 students and 12 junior doctors. Post-workshop feedback showed a positive shift in familiarity, interest, and confidence in basic robotic skills. Delegates also expressed increased interest in surgical specialties after this workshop. They also found VR station was enjoyable and believed it has potential in training future robotic surgeons.\u0000 \u0000 \u0000 \u0000 These findings highlight the feasibility and importance of creating accessible training opportunities to bridge the gap in surgical robotics education.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141716002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The objective of this systematic review was to assess the effectiveness of different surgical techniques in the removal of benign parotid tumours. The analysis focused on three specific postoperative complications including: recurrence rate, temporary and permanent facial nerve palsy (FNP) and Frey's syndrome. In this systematic review, patients who underwent extracapsular dissection (ECD) were compared to those who underwent superficial parotidectomy (SP) or partial superficial parotidectomy (PSP). OVID, Cochrane Library, PubMed, and Scopus databases were searched. Inclusion and exclusion criteria were applied resulting in seven papers; all of which were retrospective cohort studies. A total of 2282 patient data was pooled (1174 ECD-treated and 1108 SP and PSP-treated patients). Statistical analysis showed there was no significant difference in the rate of recurrence (log odds ratio (LOR) = -0.15, 95% confidence interval (CI): -1.11, 0.80). There were lower rates of both temporary facial nerve injury (LOR = -1.76, 95% CI: -2.75,-0.76) and Frey’s syndrome (LOR = -1.63, 95% CI: -2.90,-0.37) in the ECD treated patients. There is reasonable statistical significance suggesting that ECD has lower rates of Permanent FNP (LOR=-1.00, 95% CI: -2.35, 0.35). Despite the results showing ECD favourability in terms of FNP and Frey’s syndrome, it is important to understand the limitations of this study. Confounding factors such as, tumour size and placement, patient age and gender and surgical cosmetic outcomes were not analysed in this systematic review (SR). Future research should focus on a prospective cohort study, directly comparing the different surgical techniques.
{"title":"983 A comparison of the Post-operative Complications Rates in the Removal of Benign Parotid Tumours: Extracapsular Dissection Versus Superficial Parotidectomy and Partial Superficial Parotidectomy","authors":"J. Collard, S. Akhtar","doi":"10.1093/bjs/znae163.021","DOIUrl":"https://doi.org/10.1093/bjs/znae163.021","url":null,"abstract":"\u0000 \u0000 \u0000 The objective of this systematic review was to assess the effectiveness of different surgical techniques in the removal of benign parotid tumours. The analysis focused on three specific postoperative complications including: recurrence rate, temporary and permanent facial nerve palsy (FNP) and Frey's syndrome. In this systematic review, patients who underwent extracapsular dissection (ECD) were compared to those who underwent superficial parotidectomy (SP) or partial superficial parotidectomy (PSP).\u0000 \u0000 \u0000 \u0000 OVID, Cochrane Library, PubMed, and Scopus databases were searched. Inclusion and exclusion criteria were applied resulting in seven papers; all of which were retrospective cohort studies.\u0000 \u0000 \u0000 \u0000 A total of 2282 patient data was pooled (1174 ECD-treated and 1108 SP and PSP-treated patients). Statistical analysis showed there was no significant difference in the rate of recurrence (log odds ratio (LOR) = -0.15, 95% confidence interval (CI): -1.11, 0.80). There were lower rates of both temporary facial nerve injury (LOR = -1.76, 95% CI: -2.75,-0.76) and Frey’s syndrome (LOR = -1.63, 95% CI: -2.90,-0.37) in the ECD treated patients. There is reasonable statistical significance suggesting that ECD has lower rates of Permanent FNP (LOR=-1.00, 95% CI: -2.35, 0.35).\u0000 \u0000 \u0000 \u0000 Despite the results showing ECD favourability in terms of FNP and Frey’s syndrome, it is important to understand the limitations of this study. Confounding factors such as, tumour size and placement, patient age and gender and surgical cosmetic outcomes were not analysed in this systematic review (SR). Future research should focus on a prospective cohort study, directly comparing the different surgical techniques.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141695446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Rai, P. Patel, H. Khan, S. Shukla, N. Mehtani, V. Acharya, N. Tolley
This research employs the HoloLens2™ and a variety of models to evaluate the impact on the confidence and preparedness of ST3 trainees following their engagement in simulated otolaryngology cases. A total of 29 ST3 trainees engaged in ten 1-hour long simulation stations across a span of two days. The participants engaged in both technical and non-technical skills within elective, emergency, and ward-based scenarios. Questionnaires were used to document self-reported confidence and preparedness before and after each simulation. Primary outcomes included change in trainee confidence and preparedness pre- and post-station. The participants reported a significant increase in confidence (p<0.001) and preparedness (p<0.001) after all stations. The greatest improvements in comparison to all other stations were self-preparedness in the rigid bronchoscopy station and self-confidence in the sphenopalatine artery (SPA) ligation station. A significant improvement in self-confidence (p<0.001) and self-preparedness (p<0.0001) was observed after the non-technical HoloLensTM session. The use of Otolaryngology simulation stations improved confidence and preparedness of managing common ENT presentations in the ward, elective, and emergency settings for ENT ST3 trainees. This approach serves as a valuable supplement to the conventional surgical apprenticeship, facilitating the acquisition of both technical and non-technical skills. The implementation of mixed reality technology creates an immersive environment to develop trainees’ non-technical skills. However, future work is required to assess the impact on the long-term benefits of trainee skill retention and clinical proficiency.
{"title":"141 Simulation Training: The Impact on the Confidence and Preparedness of Novice Otolaryngology ST3 Registrars","authors":"A. Rai, P. Patel, H. Khan, S. Shukla, N. Mehtani, V. Acharya, N. Tolley","doi":"10.1093/bjs/znae163.022","DOIUrl":"https://doi.org/10.1093/bjs/znae163.022","url":null,"abstract":"\u0000 \u0000 \u0000 This research employs the HoloLens2™ and a variety of models to evaluate the impact on the confidence and preparedness of ST3 trainees following their engagement in simulated otolaryngology cases.\u0000 \u0000 \u0000 \u0000 A total of 29 ST3 trainees engaged in ten 1-hour long simulation stations across a span of two days. The participants engaged in both technical and non-technical skills within elective, emergency, and ward-based scenarios. Questionnaires were used to document self-reported confidence and preparedness before and after each simulation. Primary outcomes included change in trainee confidence and preparedness pre- and post-station.\u0000 \u0000 \u0000 \u0000 The participants reported a significant increase in confidence (p<0.001) and preparedness (p<0.001) after all stations. The greatest improvements in comparison to all other stations were self-preparedness in the rigid bronchoscopy station and self-confidence in the sphenopalatine artery (SPA) ligation station. A significant improvement in self-confidence (p<0.001) and self-preparedness (p<0.0001) was observed after the non-technical HoloLensTM session.\u0000 \u0000 \u0000 \u0000 The use of Otolaryngology simulation stations improved confidence and preparedness of managing common ENT presentations in the ward, elective, and emergency settings for ENT ST3 trainees. This approach serves as a valuable supplement to the conventional surgical apprenticeship, facilitating the acquisition of both technical and non-technical skills. The implementation of mixed reality technology creates an immersive environment to develop trainees’ non-technical skills. However, future work is required to assess the impact on the long-term benefits of trainee skill retention and clinical proficiency.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141703231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The accessibility and availability of the internet has allowed people to increasingly seek health information online, and therefore it plays an essential role in the decision-making process of the patient. The study aimed to assess the quality and readability of online health information on TMJ dysfunction. The search was conducted on Google using keywords: jaw pain, jaw locking, jaw discomfort, jaw clicking, jaw popping, temporomandibular joint, TMJ dysfunction, TMD and temporomandibular disorder. Ensuring Quality Information for Patient (EQIP) tool was used to assess quality of information and the application of readability score reflected through Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level(FKGL), Gunning-Fog Index(GFI) and Simple Measure of Gobbledygook(SMOG). 134 websites were eligible for assessment. The overall median EQIP score was 23, with an IQR of 7 and maximum score of 30. The most common source of information was healthcare industry (n=60; 45%), followed by news services (n=19; 14%), with a median EQIP score of 20 and 25 respectively. Statistically significant differences in overall EQIP scores were found between different sources of information (p=0.004). Only 31(23%) websites achieved the recommended 6th grade or below readability level, and only 14 (10%) discussed complication rates with none mentioning mortality rates at all. Most online information on TMJ dysfunction is of suboptimal quality and readability. This study identified areas for improvements when producing patient material regarding TMJ dysfunction. To improve patient education and awareness, content creators should strive to be informative, accurate, and patient-centric.
{"title":"20 An Evaluation of the Quality and Readability of Online Information Regarding TMJ Dysfunction","authors":"D. J. Y. Tan, T. K. Ko, K. S. Fan","doi":"10.1093/bjs/znae163.142","DOIUrl":"https://doi.org/10.1093/bjs/znae163.142","url":null,"abstract":"\u0000 \u0000 \u0000 The accessibility and availability of the internet has allowed people to increasingly seek health information online, and therefore it plays an essential role in the decision-making process of the patient. The study aimed to assess the quality and readability of online health information on TMJ dysfunction.\u0000 \u0000 \u0000 \u0000 The search was conducted on Google using keywords: jaw pain, jaw locking, jaw discomfort, jaw clicking, jaw popping, temporomandibular joint, TMJ dysfunction, TMD and temporomandibular disorder. Ensuring Quality Information for Patient (EQIP) tool was used to assess quality of information and the application of readability score reflected through Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level(FKGL), Gunning-Fog Index(GFI) and Simple Measure of Gobbledygook(SMOG).\u0000 \u0000 \u0000 \u0000 134 websites were eligible for assessment. The overall median EQIP score was 23, with an IQR of 7 and maximum score of 30. The most common source of information was healthcare industry (n=60; 45%), followed by news services (n=19; 14%), with a median EQIP score of 20 and 25 respectively. Statistically significant differences in overall EQIP scores were found between different sources of information (p=0.004). Only 31(23%) websites achieved the recommended 6th grade or below readability level, and only 14 (10%) discussed complication rates with none mentioning mortality rates at all.\u0000 \u0000 \u0000 \u0000 Most online information on TMJ dysfunction is of suboptimal quality and readability. This study identified areas for improvements when producing patient material regarding TMJ dysfunction. To improve patient education and awareness, content creators should strive to be informative, accurate, and patient-centric.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141713265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tracheomalacia can be a fatal airway disease with limited treatment options. Three-dimensional (3D) printing has led to various patient-specific tracheal stents and splints. However, these are limited by mismatched stiffness and resulting granulation tissue formation and fibrosis. We aimed to develop a non-toxic and biodegradable polycaprolactone expandable tracheal splint by 3D printing. By fine-tuning mechanical properties, we hypothesised that the splint would match the native trachea and accommodate tracheal growth in tracheomalacia patients. We designed splints consisting of concave topological patterns with varying angles and aspect ratios. Fabrication occurred using polycaprolactone filaments in a 3D fuse deposition modelling printer. Uniaxial tensile studies were performed on splints to assess Young’s Modulus, Toughness, Ultimate strain, Strength, and Poisson ratio. Splints displaying optimal mechanical properties were tested for human lung fibroblast cell viability, proliferation, and morphology. On a mechanical testing rig, uniaxial tensile studies confirmed that splint designs with smaller angles and negative Poisson ratios of up to strains of 25%, better mimicked mechanical properties of native human trachea, accommodating tracheal growth. In vitro studies using these tracheal splints demonstrated successful human lung cell proliferation with low cell toxicity. This study characterised 3D printed bespoke tracheal splints with various 2D structures, showing mechanical properties that match the native trachea. However, in vivo studies investigating cellular interactions on our splint must be performed to further evaluate the ability for endogenous tissue formation.
气管瘘是一种致命的气道疾病，但治疗方法有限。三维（3D）打印技术催生了各种患者专用的气管支架和夹板。然而，这些产品因硬度不匹配、肉芽组织形成和纤维化而受到限制。我们的目标是通过三维打印技术开发一种无毒、可生物降解的聚己内酯可扩张气管夹板。通过微调机械性能，我们假设该夹板能与原生气管相匹配，并能适应气管异位症患者的气管生长。 我们设计的夹板由不同角度和长宽比的凹形拓扑图案组成。在三维熔融沉积模型打印机中使用聚己内酯长丝进行制作。对夹板进行了单轴拉伸研究，以评估杨氏模量、韧性、极限应变、强度和泊松比。对显示最佳机械性能的夹板进行了人肺成纤维细胞活力、增殖和形态测试。 在机械测试台上进行的单轴拉伸研究证实，角度较小、负泊松比高达 25% 的夹板设计能更好地模拟原生人体气管的机械特性，从而适应气管的生长。使用这些气管夹板进行的体外研究表明，人肺部细胞增殖成功，细胞毒性低。 该研究对具有各种二维结构的 3D 打印定制气管夹板进行了表征，显示出与原生气管相匹配的机械性能。不过，要进一步评估内源性组织形成的能力，还必须进行体内研究，调查细胞在我们的夹板上的相互作用。
{"title":"152 Three-Dimensional Printing Bespoke Polycaprolactone Tracheal Splint for Treatment of Tracheomalacia","authors":"S. Gnanalingham, L. Wu, W. Song","doi":"10.1093/bjs/znae163.010","DOIUrl":"https://doi.org/10.1093/bjs/znae163.010","url":null,"abstract":"\u0000 \u0000 \u0000 Tracheomalacia can be a fatal airway disease with limited treatment options. Three-dimensional (3D) printing has led to various patient-specific tracheal stents and splints. However, these are limited by mismatched stiffness and resulting granulation tissue formation and fibrosis. We aimed to develop a non-toxic and biodegradable polycaprolactone expandable tracheal splint by 3D printing. By fine-tuning mechanical properties, we hypothesised that the splint would match the native trachea and accommodate tracheal growth in tracheomalacia patients.\u0000 \u0000 \u0000 \u0000 We designed splints consisting of concave topological patterns with varying angles and aspect ratios. Fabrication occurred using polycaprolactone filaments in a 3D fuse deposition modelling printer. Uniaxial tensile studies were performed on splints to assess Young’s Modulus, Toughness, Ultimate strain, Strength, and Poisson ratio. Splints displaying optimal mechanical properties were tested for human lung fibroblast cell viability, proliferation, and morphology.\u0000 \u0000 \u0000 \u0000 On a mechanical testing rig, uniaxial tensile studies confirmed that splint designs with smaller angles and negative Poisson ratios of up to strains of 25%, better mimicked mechanical properties of native human trachea, accommodating tracheal growth. In vitro studies using these tracheal splints demonstrated successful human lung cell proliferation with low cell toxicity.\u0000 \u0000 \u0000 \u0000 This study characterised 3D printed bespoke tracheal splints with various 2D structures, showing mechanical properties that match the native trachea. However, in vivo studies investigating cellular interactions on our splint must be performed to further evaluate the ability for endogenous tissue formation.\u0000","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141696289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：