Journal of Surgical Research最新文献

{"title":"Correlation Between Postoperative Complications and Number of Colorectal Liver Metastases Resected","authors":"Faisal S. Jehan MD ,&nbsp;Peyton Seda BS ,&nbsp;Apoorve Nayyar MD ,&nbsp;Hassan Aziz MD, FACS","doi":"10.1016/j.jss.2025.01.004","DOIUrl":"10.1016/j.jss.2025.01.004","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to describe the relationship between the number of colorectal liver metastases (CRLM) resected and the rate of postoperative complications and to determine a threshold level, if any, for which the risk of postoperative complications outweighs the benefit of resection of metastatic disease.</div></div><div><h3>Methods</h3><div>This is a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database from 2019 to 2021. Patients were divided into three major groups: one to two, three to four, and more than five CRLM.</div></div><div><h3>Results</h3><div>A total of 5124 patients had CRLM. Compared to patients with one to two and three to four CRLM, patients with 5+ resections were at increased risk of any complication (1655 [50% for one to two CRLM <em>versus</em> 697 [65%] for three to four CRLM <em>versus</em> 437 [76%] for 5+ LM; <em>P</em> = 0.001), surgical complications (1305 [40%] <em>versus</em> 556 [52%] <em>versus</em> 349 [60%]; <em>P</em> = 0.001), and medical complications (350 [10%] <em>versus</em> 141 [13%] <em>versus</em> 88 [16%]; <em>P</em> = 0.001).</div></div><div><h3>Conclusions</h3><div>Our data demonstrate a significant increase in any surgical complications with three to four tumors resected and a significant increase in any surgical and medical complications and length of stay &gt;5 ds with five or more tumors resected.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 465-473"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An In-Depth Analysis of the State Laws That License International Medical Graduates Without American Residency Training","authors":"Malke Asaad MD ,&nbsp;Khaled Erekat MD ,&nbsp;Aashish Rajesh MBBS","doi":"10.1016/j.jss.2024.12.029","DOIUrl":"10.1016/j.jss.2024.12.029","url":null,"abstract":"<div><div>International medical graduates (IMGs) have been integral to the United States (US) healthcare system and have helped tackle physician shortages for over a century. Current data suggest that by 2030, almost half the states will suffer from physician shortage and estimate a deficit of almost 139,000 physician jobs nationally. These numbers raise concern and call for innovative strategies to mitigate the potential problem. Against this background, the state of Tennessee has passed a law that allows IMGs licensed in a foreign country to obtain provisional licensure to practice in the United States, <em>without</em> the completion of a US-based residency. After the Senate bill SB 1451 was passed in Tennessee, several other states (including Arizona, Florida, Idaho, Illinois, Iowa, Virginia, and Wisconsin) have followed suit and started the legislative process to pass laws that provide a new entry point for IMGs seeking to practice medicine in the United States. Each of these laws comes with a unique set of stringent specifications and requirements for individuals who wish to use these novel pathways. Through this article, we highlight the pathways that have opened for IMGs to directly enter clinical practice in the United States (without residency or fellowship training) and explore their implications on patient care and diversity of physician workforce in America.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 524-532"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Review of Long-Term Outcomes of Liver Transplantation Using Extended Criteria Donors in the United States","authors":"Mahmoudreza Moein MD ,&nbsp;Amin Bahreini MD ,&nbsp;Ali Razavi BS ,&nbsp;Samantha Badie BS ,&nbsp;Steven Coyle BS ,&nbsp;Mahsa Abedini MS ,&nbsp;Marjan Abedini BS ,&nbsp;Reza Saidi MD","doi":"10.1016/j.jss.2024.12.055","DOIUrl":"10.1016/j.jss.2024.12.055","url":null,"abstract":"<div><h3>Introduction</h3><div>Utilizing the marginal livers for transplantation has gained more attention recently, but there are still some doubts regarding the outcomes. This study focuses on the outcomes of extended criteria donor liver transplants (LTs) in the United States, in order to assess the feasibility of these types of livers utilization.</div></div><div><h3>Materials and methods</h3><div>A retrospective registry analysis of the Organ Procurement and Transplantation Network/United Network for Organ Sharing database was done for LTs that were performed in the United States from January 2001 to April 2020.</div></div><div><h3>Results</h3><div>The study divided into two subgroups, based on the transplantation year; patients who received an LT from January 2001 until the end of December 2010 (<em>n</em> = 50,928), and those who received an LT, from January 2011 to April 2020 (<em>n</em> = 59,643). The data analysis showed a significant overall 10-y graft survival improvement in the 2011-2020 group compared to the 2001-2010 group, from a mean of 58% in 2001-2010 to a mean of 68% in 2011-2020 (<em>P</em> &lt; 0.001). Not only the overall 10-y graft survival has improved in the 2011-2020 group but also the graft survival has significantly improved in the extended criteria donors (ECDs) group compared to the 2001-2010 cohort, in which the 10-y graft survival is even higher in the 2011-2020 ECD group than non-ECD group in 2001-2010.</div></div><div><h3>Conclusions</h3><div>With all the surgical techniques and postoperation improvements, ECD livers can prove to be a meaningful solution to overcome long waiting times and current underutilization in order to improve the short- and long-term quality of life in the patients who are in need of liver transplant.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 561-569"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Activation Failure: Factors Associated With Undertriage of Pediatric Major Trauma Victims","authors":"Jillian Gorski MD, MS ,&nbsp;Seth Goldstein MD, MPhil ,&nbsp;Suhail Zeineddin MD ,&nbsp;Sriram Ramgopal MD","doi":"10.1016/j.jss.2024.12.008","DOIUrl":"10.1016/j.jss.2024.12.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Undertriage of children contributes to poorer clinical outcomes. The objective of this study was to determine factors associated with undertriage of pediatric major trauma victims.</div></div><div><h3>Methods</h3><div>We performed a retrospective cross-sectional study of children (aged &lt; 16 ys) using the 2021 American College of Surgeons National Trauma Data Bank. We identified children who met the definition of major trauma defined by the Standard Triage Assessment Tool. We performed multivariable logistic regression to determine factors associated with undertriage, defined as encounters which met criteria, but did not receive highest-level activation.</div></div><div><h3>Results</h3><div>Of 97,812 included children, 5.3% met major trauma criteria. Undertriage occurred in 34.4% of encounters with major trauma. Factors associated with undertriage included fall and striking mechanisms, missing blood pressure, private vehicle arrival, and incoming interfacility transfers. Hypotension, decreased level of consciousness, prehospital and in-hospital intubation, tachycardia, hypothermia, penetrating mechanism, presentation to a pediatric level 2 or adult level 1 trauma center relative to pediatric level 1 center, and arrival by flight were associated with lower odds of undertriage.</div></div><div><h3>Conclusions</h3><div>Many children with major trauma were undertriaged, particularly those presenting with lower-risk histories, such as private vehicle arrivals and fall mechanisms. Future work should seek to develop risk-stratification systems that can better identify children with major trauma, with an emphasis on those with blunt traumatic mechanisms.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 68-76"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a Modified Pain, Inspiration, Cough Protocol in Patients With Traumatic Rib Fractures","authors":"Elysa Margiotta MD ,&nbsp;Isaac E. Wenger MD, MM ,&nbsp;Jonathan Henglein PA-C ,&nbsp;Yen-Hong Kuo PhD ,&nbsp;Paul Boland MBA, PA-C ,&nbsp;Nicholas Martella MS, PA-C ,&nbsp;Alejandro Betancourt-Ramirez MD, MBA, FACS ,&nbsp;Shannon F.R. Small MD, FACS, CNSC","doi":"10.1016/j.jss.2024.11.028","DOIUrl":"10.1016/j.jss.2024.11.028","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Patients with blunt chest wall injuries and rib fractures are known to have high rates of atelectasis, pneumonia, pulmonary contusion, and can develop acute respiratory distress syndrome. This can lead to ventilator requirement and dependence, deconditioning secondary to uncontrolled pain, and increased hospital length of stay (LOS). Many studies in the literature have developed triage algorithms in patients with rib fractures to guide disposition and management, and several institutions have gone on to describe their institution-specific management protocols to decrease complications related to traumatic rib fractures. The purpose of our study was to examine rates of in-hospital complications in patients with traumatic rib fractures before and after the implementation of a modified PIC (pain, inspiration, cough, designated as mPIC) protocol at our institution.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective review of patients presenting to our hospital with traumatic rib fractures were reviewed between 2019 and 2022, with inclusion of 820 patients. Information was collected on patients’ demographics, mPIC score, components of their multimodal pain regimen, whether a local nerve block was performed, LOS, intubation rates, and early mobilization. Statistical analyses were performed and all results with a value of &lt;em&gt;P&lt;/em&gt; value of &lt;0.05 deemed statistically significant.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Our results show that implementation of our mPIC protocol was associated with dramatically reduced rates of intubation in patient with traumatic rib fractures (18.2% &lt;em&gt;versus&lt;/em&gt; 3.0%, &lt;em&gt;P&lt;/em&gt; &lt; 0.001), regardless of patient's age, sex, race, or number of rib fractures. Furthermore, we also observed that patients with an Injury Severity Score (ISS) greater than 25 were less likely to be intubated after protocol implementation, (65.0% &lt;em&gt;versus&lt;/em&gt; 16.7%, &lt;em&gt;P&lt;/em&gt; &lt; 0.001). We were able to see an associated significant decrease in overall LOS after implementation of the protocol, 5 d &lt;em&gt;versus&lt;/em&gt; 4 d (&lt;em&gt;P&lt;/em&gt; &lt; 0.001); this association was seen even when stratified by race, age, number of rib fractures, sex, and ISS. We noted that with the addition of a multimodal pain regimen, other than the use of oxycodone, there was no associated overall difference in LOS preprotocol or postprotocol implementation. We also found that the implementation of early mobilization also correlated with a decreased overall LOS (&lt;em&gt;P&lt;/em&gt; &lt; 0.001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Patients with traumatic rib fractures have many pulmonary complications that lead to increased use of hospital resources, increased hospital LOS and increased ventilator dependence. With implementation of our standardized mPIC protocol at our institution, we observed factors such as multimodal analgesia and early mobilization contributed to an associated statistically significant decrease in hospital LOS, even when ","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 1-9"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors, Trends, and Outcomes of Parathyroid Autotransplantation in Pediatric Total Thyroidectomy","authors":"Gabriel J. Ramos-Gonzalez MD ,&nbsp;Jose A. Canas MD ,&nbsp;Alyssa Green MD ,&nbsp;Nicole M. Chandler MD ,&nbsp;Christopher W. Snyder MD","doi":"10.1016/j.jss.2024.12.023","DOIUrl":"10.1016/j.jss.2024.12.023","url":null,"abstract":"<div><h3>Introduction</h3><div>Assess temporal utilization trends, identify predictors, and compare early postoperative outcomes of parathyroid autotransplantation (PTAT) in pediatric total thyroidectomy (TT) patients.</div></div><div><h3>Methods</h3><div>Patients &lt;18 y undergoing TT between 2015 and 2021 were obtained from the National Surgical Quality Improvement Program–Pediatric database. Characteristics and outcomes were described and stratified by extent of node dissection. Temporal trends and predictors of PTAT were evaluated by multivariable logistic regression. Propensity score matching was used to compare PTAT clinical outcomes.</div></div><div><h3>Results</h3><div>Among 2444 children (median age 14.9 y), 78% had thyroidectomy alone, 17% had thyroidectomy with central lymph node dissection, and 5% had thyroidectomy with modified radical neck dissection. Of the 150 patients who underwent PTAT, 62% were transplanted in the neck and 38% in the forearm. Overall, 0.6% had nerve injury/repair, 14% had prolonged postoperative hospitalization, and 0.9% was readmitted for hypocalcemia. Utilization of PTAT decreased over time. Predictors included adult general surgery/otolaryngology subspecialty (odds ratio 2.0, 95% confidence interval 1.3-3.2, <em>P</em> = 0.005) and extent of node dissection (odds ratio 3.2, 95% confidence interval 1.9-5.5, <em>P</em> &lt; 0.0001). No significant differences in prolonged hospitalization (18% <em>versus</em> 13%, <em>P</em> = 0.10) or readmission for hypocalcemia (2.7% <em>versus</em> 1.1%, <em>P</em> = 0.23) were observed on propensity score matching.</div></div><div><h3>Conclusions</h3><div>PTAT in pediatric TT is more commonly performed by adult subspecialty surgeons and in the setting of more extensive node dissections. PTAT utilization decreased over time. No significant differences in early postoperative outcomes were observed between cohorts. Further studies are needed to guide optimal parathyroid preservation strategies in children.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 26-32"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship of Time to First Therapy and Survival Outcomes of Neoadjuvant Chemotherapy Versus Upfront Surgery Approach in Resectable Pancreatic Ductal Adenocarcinoma","authors":"Qusai Al Masad MD ,&nbsp;Aryanna Sousa MD ,&nbsp;Paola Pena MD ,&nbsp;Cara J. Sammartino PhD, MSPH ,&nbsp;Ponnandai Somasundar MD, MPH, FACS, FSSO ,&nbsp;Thaer Abdelfattah MD ,&nbsp;N. Joseph Espat MD, MS, FACS, FSSO ,&nbsp;Abdul S. Calvino MD, MPH, FACS, FSSO ,&nbsp;Steve Kwon MD, MPH, FACS, FSSO","doi":"10.1016/j.jss.2024.12.007","DOIUrl":"10.1016/j.jss.2024.12.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Evidence demonstrating overall survival benefit of neoadjuvant chemotherapy (NAC) followed by surgical resection over upfront surgical resection for resectable pancreatic ductal adenocarcinoma (PDAC) has been mixed. The time to first therapy (TTFT) variable has not been studied as a contributing factor.</div></div><div><h3>Methods</h3><div>A nationwide retrospective analysis using the National Cancer Database to evaluate patients with clinical stage T1 and T2 PDACs from 2010 to 2020. Cox proportional hazards model was used to evaluate the impact of NAC followed by definitive surgery compared to upfront surgery on overall survival with and without TTFT.</div></div><div><h3>Results</h3><div>Total of 43,174 patients were included—9874 patients with clinical stage T1 and 33,300 patients with T2 PDACs. There were increasing trends in the NAC approach from 2.9% in 2010 to more than 25% by 2020 and decreasing trends in the upfront surgery approach from 69.34% in 2010 to 31.87% by 2020. There were significant differences in TTFT according to the treatment choice with upfront surgery group having a significantly shorter TTFT—proportion of those receiving first treatment within the first week was 24.32% in the upfront surgery compared to 4.22% in the NAC group. In the adjusted cox regression without the TTFT variable, there was a 25% higher rate of death in the upfront surgery compared to the NAC group (hazard ratio 1.25, 95% confidence interval 1.19-1.30). When the adjusted regression was performed with addition of a TTFT interaction term, there was survival disadvantage of upfront surgery approach in patients whose TTFT occurred after 1 wk, but not in those with TTFT occurring in less than 1 wk (hazard ratio 1.01, 95% confidence interval 0.86-1.17).</div></div><div><h3>Conclusions</h3><div>Our study emphasizes the importance of incorporating TTFT variable when comparing NAC <em>versus</em> upfront surgery approach in PDAC. Future studies comparing NAC to upfront surgery in resectable PDAC should consider incorporating the TTFT variable.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 111-121"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Iatrogenic Error–Related Mortality in the US From 1999 to 2020: Age–Period–CohortAnalysis","authors":"Rayaan Imran MBBS ,&nbsp;Zoya Aamir MBBS ,&nbsp;Arusha Hasan MBBS ,&nbsp;Mahrosh Kasbati MBBS ,&nbsp;Nimrah Iqbal MBBS ,&nbsp;Carter J. Boyd MD, MBA","doi":"10.1016/j.jss.2024.11.036","DOIUrl":"10.1016/j.jss.2024.11.036","url":null,"abstract":"<div><h3>Introduction</h3><div>There is a noticeable lack of information on iatrogenic error (IE)–related deaths in the United States. To address this, we conducted a retrospective analysis examining temporal, regional, urbanization, and age-related trends in IE-related mortality from 1999 to 2020.</div></div><div><h3>Methods</h3><div>Utilizing the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research database, we identified crude and age-adjusted mortality rates (AAMR) per 100,000 persons. We calculated annual percentage changes (APCs) via the Joinpoint regression program.</div></div><div><h3>Results</h3><div>From 1999 to 2020, a total of 531,792 IE-related deaths were reported, with an overall decline in mortality rates. From 2015 to 2020, an increase in AAMR by an APC of 17.19% was noted. Similar trends were seen in the 65-85+ age group from 2015 to 2020 (18.39%). The largest percentage increase in death rates occurred in Noncore metropolitan areas. Significant disparities were observed among states, with mortality rates ranging from 4.45 of 100,000 in Massachusetts and 10.43 of 100,000 in Mississippi. Other states with high AAMR values include New Mexico and Wyoming. In addition, the West census region demonstrated the greatest increase in APC in mortality rates (APC: 25.36%) from 2015 to 2020 followed by the South, Midwest, and lastly Northeast regions.</div></div><div><h3>Conclusions</h3><div>The data indicate a notable fluctuation in mortality rates over the years, underscoring the importance of targeted interventions to address the regional and age-specific disparities. Investigating the causes of mortality variations offers crucial opportunities to reduce IEs.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 77-84"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Inanimate Intracorporeal Anastomosis Model With Real-Time Force Feedback: An Initial Study","authors":"A. Masie Rahimi MD ,&nbsp;Sem F. Hardon MD ,&nbsp;Joost Stael MD ,&nbsp;Sajanuka Ampalavanar MD ,&nbsp;H. Jaap Bonjer MD, PhD ,&nbsp;Freek Daams MD, PhD","doi":"10.1016/j.jss.2024.11.027","DOIUrl":"10.1016/j.jss.2024.11.027","url":null,"abstract":"<div><h3>Introduction</h3><div>Laparoscopic intestinal anastomosis requires specific technical skills and should be trained in a safe simulation environment before performing surgery in daily practice. However, anastomosis simulation training with objective feedback is not widely available. This study aimed to analyze a laparoscopic intestinal anastomosis training task that utilizes objective force, motion, and time measurements.</div></div><div><h3>Methods</h3><div>With the feedback of laparoscopic experts, an artificial tissue reproducible intestinal anastomosis training task was designed and developed. Novices and experts performed the training task four times using two running suture techniques, with a multifilament braided suture and a barbed suture. The laparoscopic box trainer (Lapron box trainer, Amsterdam Skills Centre, Amsterdam, the Netherlands) provided objective force, motion, and time feedback. The mean values of the parameters were calculated and analyzed using the Mann–Whitney <em>U</em> test.</div></div><div><h3>Results</h3><div>A total of 212 intestinal anastomosis repetitions were performed by 35 novices and 18 experts from 14 European teaching hospitals. For the multifilament braided sutures, experts showed significant lower maximal impulses (19.80 <em>versus</em> 12.90 Ns, <em>P</em> = 0.004), shorter total path length (23,545 mm <em>versus</em> 15,266 mm, <em>P</em> ≤ 0.001) and required less time to finish the task compared to novices (448 s <em>versus</em> 297 s, <em>P</em> ≤ 0.001). Using the barbed sutures, experts used significantly lower maximal forces (2.93 N <em>versus</em> 2.31 N, <em>P</em> = 0.032), had a shorter total path length (13,608 mm <em>versus</em> 8551 mm, <em>P</em> ≤ 0.001), and needed less time to execute the training task compared to novices (253 s <em>versus</em> 166 s, <em>P</em> ≤ 0.001).</div></div><div><h3>Conclusions</h3><div>The development of a modular and reproducible laparoscopic intestinal anastomosis training task with established construct validity for force, motion, and time-based assessment of technical skills allows for repetitive training of advanced skills. These outcomes can now be utilized to assess translation of these skills into the operating room.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 144-151"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher Rates of Visualization for Axillary Reverse Mapping Using Indocyanine Green Fluorescence Compared With Blue Dye","authors":"Sydney A. Jupitz PhD ,&nbsp;Christie Lin PhD ,&nbsp;Tisha Kawahara MS ,&nbsp;Grace McKinney MPH ,&nbsp;Adam J. Uselmann PhD ,&nbsp;Heather B. Neuman MD, MS, FACS","doi":"10.1016/j.jss.2024.11.043","DOIUrl":"10.1016/j.jss.2024.11.043","url":null,"abstract":"<div><h3>Introduction</h3><div>Successful axillary reverse mapping (ARM) during lymph node surgery for breast cancer has the potential to reduce risk of lymphedema. Standard of care uses blue dye for ARM; however, recent imaging advances with near-infrared indocyanine green (ICG) fluorescence has demonstrated potential to improve intraoperative ARM imaging. The objective was to determine the feasibility of using ICG fluorescence through the OnLume Avata System for ARM.</div></div><div><h3>Methods</h3><div>Breast cancer patients undergoing axillary lymph node dissection and were to undergo ARM were enrolled. Lymphatic structures were visualized using ICG fluorescence and blue dye. Real-time fluorescence images were acquired with the OnLume Avata System preincision, intraoperatively, and post dissection during the ARM. Preincision images were quantitatively analyzed for lymphatic fluorescence signal in terms of contrast-to-noise ratio. Imaging data were evaluated in terms of binary visualization rates and signal-to-background ratio.</div></div><div><h3>Results</h3><div>Lymph nodes, lymphatic vessels, and lymph pooling were observed with fluorescence more frequently than blue dye. For seven out of eight cases, at least one vessel was visualized near the axilla preincision. In all eight cases, ICG fluorescence was noted during the procedure with five cases visualizing intact lymphatics at the end of the procedure. The ambient-light compatibility of the imager allowed the surgeon to operate with image guidance throughout the ARM procedure.</div></div><div><h3>Conclusions</h3><div>The Avata demonstrated superior identification and visualization with ICG when compared to blue dye for visualizing lymphatic structures in real time with minimal disruption to the clinical workflow.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 290-298"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}