Preceptorship in robotic colorectal surgery: experience from the Australian private sector.

This article describes a post-fellowship preceptorship training program to train sub-specialty colorectal surgeons in gaining proficiency in robotic colorectal surgery using a dual-surgeon model in the Australian private sector. The Australian colorectal surgeon faces challenges in gaining robotic colorectal surgery proficiency with limited exposure and experience in the public setting where the majority of general and colorectal surgery training is currently conducted. This training model uses graded exposure with a range of simulation training, wet lab training, and clinical operative cases to progress through both competency and proficiency in robotic colorectal surgery which is mutually beneficial to surgeons and patients alike.

Aorto-bronchial fistula masquerading as haematemesis: a rare late complication of thoracic aortic vascular grafts.

Aorto-bronchial fistula is an exceedingly rare pathology with high mortality. Late vascular graft infection may occur secondary to haematogenous seeding of bacteria from a distant source such as gastrointestinal infection. We present an unusual case of aorto-bronchial fistula masquerading as haematemesis in a patient with sigmoid diverticulitis, and review the pathophysiology, diagnosis, surgical and endovascular management of aorto-bronchial fistulas.

Colonic Perforation in Polyarteritis Nodosa With Concurrent Perforated Sigmoid Diverticulitis.

Polyarteritis nodosa (PAN) is a medium-sized vasculitis with neuropathy, cutaneous manifestation, and gastrointestinal tract symptoms. An acute surgical abdomen is a severe but rare development of gastrointestinal involvement of PAN, with large bowel involvement and subsequent perforation being sporadic. Here we present a rare case of PAN who had large bowel involvement with perforation due to newly diagnosed PAN, who also had concurrent and separately perforated sigmoid diverticulitis, confusing the clinical picture.

Survival and morbidity outcomes after pelvic exenteration for pelvic sarcoma: an institutional series.

Background: To describe our institutional experience in the management of locally advanced primary, and recurrent pelvic sarcoma through pelvic exenteration (PE).

Methods: Patients undergoing PE for locally advanced primary or recurrent pelvic sarcoma between 2003 and 2017 were identified from a prospectively maintained database at a single quaternary referral hospital in Sydney, Australia were eligible for review. The primary outcomes measured were surgical resection margin and survival.

Proctorship in Minimally Invasive Colorectal Surgery.

Teaching an established surgeon in a novel technique by a colleague who has acquired a level of expertise is often referred to as "proctoring" or "precepting." Surgical preceptorships can be defined as supervised teaching programs, whereby individual or groups of surgeons (proctors) experienced in a certain technique support a colleague who wants to adopt this technique (sometimes referred to as "delegates" or "preceptees"). Preceptorship programs really focus on a specific technique, technology, or skill which is required to broaden, complement, or transform an established surgeon's practice.

Surgical Competencies Required in Newly Commencing Colorectal Surgeons: an Educational and Training Spectrum.

Purpose: Surgical training models have changed from master-apprentice to competency-based training. We aimed to determine the relative importance and peak periods of acquiring these competencies in newly commencing colorectal surgeons.

Methods: A mailed questionnaire to all current Colorectal Surgical Society of Australia and New Zealand (CSSANZ) members was conducted between October and December 2016 assessing the relative importance of each competency and the period or activity of learning or training contributing most to achieving that competency.

Treatment of hemorrhoids: A survey of surgical practice in Australia and New Zealand.

Background: Hemorrhoidal disease is the most common anorectal disorder. Hemorrhoids can be classified as external or internal, according to their relation to the dentate line. External hemorrhoids originate below the dentate line and are managed conservatively unless the patient cannot keep the perianal region clean, or they cause significant discomfort.

Current practices and barriers to referral for cytoreductive surgery and HIPEC among colorectal surgeons: A binational survey.

Introduction: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has gained traction for the management of peritoneal metastases. The number of specialist units globally offering CRS/HIPEC is increasing. The aim of this survey was to assess current practices and barriers to referral for CRS/HIPEC among colorectal surgeons in Australia and New Zealand (ANZ).

Congenital peritoneal encapsulation: A review and novel classification system.

Congenital peritoneal encapsulation (CPE) is a very rare, congenital condition characterised by the presence of an accessory peritoneal membrane which encases a variable extent of the small bowel. It is unclear how CPE develops, however it is currently understood to be a result of an aberrant adhesion in the peritoneal lining of the physiological hernia in foetal mid-gut development. The condition was first described in 1868, and subsequently there have been only 45 case reports of the phenomenon.

Karydakis procedure can be effectively performed in the lateral position.

Background: Karydakis published a large pilonidal series in 1992, reporting a recurrence rate of less than 1% and complication rate of 8.5%. The aim of this study was to compare the outcomes of Karydakis procedure (KP) performed in the lateral versus the prone position in a consecutive series.

Peritoneal encapsulation as a cause of chronic recurrent abdominal pain in a young male.

This case report describes an otherwise well 20-year-old male who presented to hospital with vague, long-standing abdominal symptoms and was found to have peritoneal encapsulation.

Coaching Experts: Applications to Surgeons and Continuing Professional Development.

Surgery is a science and an art, which is mastered through years of training and refined by the accumulation of individual experience and preference. Continuing professional development (CPD) is a concept that emphasizes a self-directed approach to education. Coaching is a process that leads to increased utilization of a person's current skills and resources without counselling or advising.

Colorectal surgeon consensus with diverticulitis clinical practice guidelines.

Aim: To determine the application of clinical practice guidelines for the current management of diverticulitis and colorectal surgeon specialist consensus in Australia and New Zealand.

Methods: A survey was distributed to 205 colorectal surgeons in Australia and New Zealand, using 22 hypothetical clinical scenarios.

Results: The response rate was 102 (50%).

Incidental detection of colorectal lesions by FDG PET/CT scans in melanoma patients.

Background: Increased use of PET/CT scans in oncology patients has raised detection of Colorectal incidentalomas (CIs). The frequency and diagnostic outcomes of identifying these lesions in melanoma patients have not previously been studied. This studies primary objective was to determine the prevalence of CIs found on PET/CT scans in melanoma patients.

Hypothesized summative anal physiology score correlates but poorly predicts incontinence severity.

Aim: To explore the relationship between such a construct and an existing continence score.

Methods: A retrospective study of incontinent patients who underwent anal physiology (AP) was performed. AP results and Cleveland Clinic Continence Scores (CCCS) were extracted.

Surgical Supervisor Feedback Affects Performance: A Blinded Randomized Study.

While performing a simple task of following: a suture while closing a surgical wound in a simulated environment, we hypothesized that negative reinforcement results in increased procedural errors, longer operating time and poorer trainee satisfaction. We aimed to measure the effect on participant performance and the perception of the instructor, following positive or negative supervisor feedback during the task. A blinded randomized study was conducted assessing positive and negative supervisor feedback styles on participant performance in a simulated operation room.

Making decisions using radiology in lower GI hemorrhage.

Acute lower gastrointestinal bleeding (LGIB) is a common diagnosis in current practice that may warrant hospitalization and invasive management. There is a shift in the paradigm in the management of this condition away from traditional extensive operative intervention to minimally invasive radiological techniques. These newer modalities offer an opportunity to provide more accurate information on location of bleeding and subsequent management.

How to decide on stent insertion or surgery in colorectal obstruction?

Colorectal cancer is one of the most common cancers in western society and malignant obstruction of the colon accounts for 8%-29% of all large bowel obstructions. Conventional treatment of these patients with malignant obstruction requiring urgent surgery is associated with a greater physiological insult on already nutritionally replete patients. Of late the utility of colonic stents has offered an option in the management of these patients in both the palliative and bridge to surgery setting.

Paclitaxel drug-eluting balloons to recurrent in-stent stenoses in autogenous dialysis fistulas: a retrospective study.

Purpose: To assess the effect of the Medtronic paclitaxel drug-eluting balloon (DEB) on re-intervention to in-stent stenoses in autogenous dialysis arteriovenous fistulas (AVFs).

Background: AVF is the optimum haemodialysis access. The commonest problem is stenosis, preventing maturation, causing inadequate dialysis or precipitating occlusion.

How to decide to undertake a randomized, controlled trial of stent or surgery in colorectal obstruction.

Background: Colorectal stents have been available as a management option in obstruction for 23 years, yet there is little randomized evidence of their effectiveness. This study investigated current surgeon-related barriers to conducting a randomized, controlled trial (RCT) of colorectal stent insertion for obstruction in patients with colorectal cancer.

Methods: A binational survey of current members of the Colorectal Surgical Society of Australia and New Zealand was conducted by a mailed questionnaire assessing perceived barriers to adoption of colonic stents and willingness to participate in future multicentre randomized controlled trials, and surgeons' treatment preferences in 16 hypothetical clinical scenarios.