Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

Introduction: ChatGPT is a sophisticated AI model capable of generating human-like text based on the input it receives. ChatGPT 3.5 showed an inability to pass the FRCS (Tr&Orth) examination due to a lack of higher-order judgement in previous studies. Enhancements in ChatGPT 4.0 warrant an evaluation of its performance.

Methodology: Questions from the UK-based December 2022 In-Training examination were input into ChatGPT 3.5 and 4.0. Methodology from a prior study was replicated to maintain consistency, allowing for a direct comparison between the two model versions. The performance threshold remained at 65.8 %, aligning with the November 2022 sitting of Section 1 of the FRCS (Tr&Orth).

Results: ChatGPT 4.0 achieved a passing score (73.9 %), indicating an improvement in its ability to analyse clinical information and make decisions reflective of a competent trauma and orthopaedic consultant. Compared to ChatGPT 4.0, version 3.5 scored 38.1 % lower, which represents a significant difference (p < 0.0001; Chi-square). The breakdown by subspecialty further demonstrated version 4.0's enhanced understanding and application in complex clinical scenarios. ChatGPT 4.0 had a significantly significant improvement in answering image-based questions (p = 0.0069) compared to its predecessor.

Conclusion: ChatGPT 4.0's success in passing Section One of the FRCS (Tr&Orth) examination highlights the rapid evolution of AI technologies and their potential applications in healthcare and education.

Background: The surgical team should be as harmonious and focussed as possible in the operating theatre. Whilst there is evidence of benefit for the use of music in the perioperative period for patient, little exists to inform of impact on those doing the surgery or anaesthesia. This review focuses on the perspectives of surgeons and anaesthetists, their views and opinions on the effect and impact of music during surgery.

Methods: A systematic review was conducted using narrative synthesis. The PRISMA guidelines were followed with the use of PICO and PRISMA guided search strategy. PubMed, CINAHL and Medline were searched but filtered to only published English language papers.

Results: Of 329 papers identified 42 duplicates were removed. 287 were screened; of which 276 were excluded and 11 sought for retrieval. Of these, 8 were excluded for wrong population or study design, leaving 3 for analysis. Narrative synthesis revealed three themes to guide discussion: (1) Views of surgeons and anaesthetists and the effect on music; (2) effect of music on other staff members; and (3) differences in music choices and balance of power.

Conclusion: Music has an overall beneficial effect on surgeons and anaesthetists, especially with regards improved concentration. As an intervention, it has global generalisability and requires little resource. Investigation across different surgical specialities and use of flexible control models in terms of choosing music is a natural subsequent research question.

Background: Appendicitis is a frequently encountered surgical condition, yet its diagnosis can be challenging. There is increasing research on the safety of leaving macroscopically normal appendices in situ, the necessity of routine histopathological assessment, and the impact of the intra-operative assessment on the post-operative course. We aimed to determine the sensitivity and specificity of the surgeon's intra-operative diagnosis of appendiceal pathology, which is an important factor in answering these questions.

Methods: Medline, Embase, the Cochrane Library and Web of Science were searched for studies listing the corresponding intra-operative and histopathological diagnoses of appendicectomies performed for suspected appendicitis. The primary outcome was the sensitivity and specificity of the surgeon at recognising an abnormal appendix, which we subjected to meta-analysis. Subgroup analysis was performed for paediatric and adult populations. Incidence of unexpected findings and if they were recognised intra-operatively was recorded.

Result: 42 articles were included in the systematic review. 26 studies featuring 17,374 patients were included in the meta-analysis, which found that surgeons' intra-operative diagnosis was 95.2 % (95 % CI 94.8-95.5 %) sensitive and 60 % (95 % CI 58.1-62 %) specific. Surgeons are slightly more sensitive and specific in paediatric populations (sensitivity 95.7 % (95 % CI 95-96.4 %), specificity 64.1 % (95 % CI 60-68 %)) compared with adult populations (sensitivity 93 % (95 % CI 91.3-94.5 %), specificity 56.5 % (95 % CI 50.1-62.6 %)), however, this difference was only statistically significant in sensitivity. 1.7 % of appendicectomy specimens had unexpected histopathological findings, of which very few were suspected intra-operatively.

Conclusion: Surgeons are highly sensitive but not very specific at recognising abnormal appendices intra-operatively.

Background: Rectal division during minimally invasive surgery including robotic assisted surgery remains challenging, with current techniques often requiring multiple stapler firings to achieve effective transection.

Aims: We propose a novel technique which allows the use of a Contour® Curved Cutter Stapler to achieve rectal division during robotic assisted surgery.

Methods: The stapler is inserted through the routinely made pfannenstiel incision and a glove, over an Alexis® port used to create an airtight seal.

Conclusion: This simple technique enables reliable perpendicular single stapler firing to achieve rectal transection during colorectal robotic assisted surgery without the requirement for any further incisions.

Introduction: Gallstone disease is prevalent and carries substantial implications for morbidity and healthcare resource utilization. While early laparoscopic cholecystectomy (LC) is often preferred, its feasibility may be limited in some cases. As a result, many patients undergo conservative management.

Aims: To conduct a systematic review of the current literature to identify studies reporting on clinical predictors of recurrence in patients who undergo non-operative management of acute cholecystitis.

Methods: A systematic review was performed as per PRISMA and MOOSE guidelines. Studies comparing variables in patients who had acute cholecystitis recurrence (ACR) were included.

Results: Three studies were included in the review. There were 678 patients in total with a 28.5 % recurrence rate. Age, history of biliary disease, and severity of cholecystitis were identified as potential predictors of ACR. Biochemical results, such as inflammatory markers, white cells, and albumin levels, may also play a role. Radiological findings, including gallbladder wall thickness and stone characteristics, showed potential as predictors.

Conclusion: Identifying patients at risk of recurrent cholecystitis is important in guiding clinical decision-making. While certain findings show promise as predictors, the available evidence is limited and inconclusive. Larger studies are needed to develop risk stratification tools for better management of gallstone disease.

Purpose: The objective of this research was to explore the role of surgeon relationships with their colleagues on career satisfaction.

Methods: This qualitative study employed a thematic analysis based on the core elements of The Grounded Theory Method. Forty-two pediatric neurosurgeons, cardio-thoracic surgeons and ophthalmologists were recruited from 9 countries around the globe and interviewed in-depth about the role of their collegial relationships on their career satisfaction. Data was coded line-by-line to extract themes and to identify patterns across the interviews.

Results: Career satisfaction was greatly enhanced by having a cohesive and healthy team. 'Healthy' teams were described as those that were emotionally supportive of each other, where colleagues could be trusted to back each other up, where communication was open and transparent, and where collaboration was the departmental norm. Career satisfaction was greatly diminished when there were interpersonal conflicts and personality clashes between surgeons, where there was poor departmental leadership creating a culture of fear and insecurity, when colleagues were perceived as egotistical, in competitive departments, where there was perceived to be an unequal distribution of work, and when surgeons felt alone and unsupported.

Conclusions: Our study found that healthy teams had very specific qualities that could be cultivated and enhanced on surgical teams by making a conscious effort to improve the workplace culture and psychological safety among the team. In the conclusions, a number of recommendations are made on how to go about achieving this goal.

Background: Synovial sarcoma (SS) is typically diagnoses in young adults and usually appears in the extremities and soft tissues. However, it can sometimes arise in visceral organs. This study examines the differences in patient demographics, clinical features, and survival rates between soft tissue and visceral synovial sarcoma.

Methods: We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database spanning 2000-2018. ANOVA (analysis of variance) was used to identify significant factors for multivariate analysis. Cox regression modeling was used to determine independent risk factors for survival.

Results: Of the 2,776 SS patients included, the median age was 39.0 years, predominating male (53.0 %) and white (81.3 %). Bone and soft tissue sarcomas were more common, accounting for 86.4 % of cases (p-value<0.001), while the rest were diagnosed as visceral sarcomas. Visceral SS patients were typically older (p-value<0.001), male (56.8 %), and white (84.8 %). They also presented more frequently with distant metastasis (HR 3.8, 95 % CI, 2.4-6.1), had larger tumors on average (HR for tumors >10 cm: 2.9, 95 % CI, 2.0-4.1), and were less likely to undergo surgery (HR 0.4, 95 % CI, 0.3-0.6). Despite receiving multimodal treatments, including surgery, radiation, and/or chemotherapy, visceral SS patients exhibited poorer overall survival compared to their bone and soft tissue SS counterparts (p-value<0.001).

Conclusion: Visceral SS often presents in older patients with advanced-stage and larger tumor size as compared to bone and soft tissue SS, which likely contributes to poorer survival. Advanced age, regional spread, and larger tumor size were all found to worsen outcomes, while surgery and radiation were found to be protective factors.