Perceptions of Competition-Based Learning After a Brief Experience at a National Surgical Meeting.

Background: Competition-based learning (CBL) facilitates learning through competitions. At the 2022 & 2023 Annual SAGES meetings, we evaluated a CBL experience (TOP GUN Shootout) developed from a modified version of the previously validated TOP GUN Laparoscopic Skills and Suturing Program. The project sought to evaluate the TOP GUN Shootout's (TGS) ability to enhance participant engagement in pursuit of laparoscopic surgical skills.

Addressing the gap in laparoscopic common bile duct exploration training for rural surgeons: imparting procedural ability is not enough.

Background: Laparoscopic common bile duct exploration (LCBDE) is an underutilized therapy for choledocholithiasis. The driving factors of this practice gap are poorly defined. We sought to evaluate the attitudes and practice patterns of surgeons who underwent training courses using an LCBDE simulator.

A simulator-based resident curriculum for laparoscopic common bile duct exploration.

Background: Laparoscopic common bile duct exploration (LCBDE) remains an underused treatment for choledocholithiasis, likely in part because of a lack of exposure to the procedure during surgery residency. In this study, we implemented a resident LCBDE curriculum using a previously validated procedural simulator.

Methods: Senior surgery residents underwent a curriculum consisting of deliberate practice using the LCBDE simulator.

Symptomatic and physiologic outcomes one year after peroral esophageal myotomy (POEM) for treatment of achalasia.

Background: Peroral esophageal myotomy (POEM) is a new endoscopic operation for the treatment of achalasia. Here, we report 1-year physiologic and symptomatic outcomes following the procedure.

Methods: POEM patients from a single-institution series who were more than 1 year removed from surgery were studied.

Analysis of a learning curve and predictors of intraoperative difficulty for peroral esophageal myotomy (POEM).

Background: Peroral esophageal myotomy (POEM) is an endoscopic surgical operation for achalasia. Here, we analyze a single-series POEM learning curve and examine which preoperative patient factors are predictive of operative difficulty.

Methods: Two surgeons performed all POEM procedures conjointly.

Management of intraoperative hemorrhage during NOTES: a prospective, randomized comparison.

Background: The optimal strategy to manage intraoperative hemorrhage during NOTES is unknown. A randomized comparison of three instruments for hemorrhage control was performed [prototype endoscopic bipolar hemostasis forceps (BELA) vs. prototype endoscopic clip (E-CLIP) applier versus laparoscopic clip (L-CLIP) applier].

Comparison of perioperative outcomes between peroral esophageal myotomy (POEM) and laparoscopic Heller myotomy.

Background: Peroral esophageal myotomy (POEM) is a novel endoscopic operation for the treatment of achalasia. Few POEM outcome data exist, and no study has compared POEM with the surgical standard, laparoscopic Heller myotomy (LHM).

Methods: Perioperative outcomes were compared between POEM and LHM performed in a nonrandomized fashion.

Fundamentals of laparoscopic surgery (FLS) manual skills assessment: surgeon vs nonsurgeon raters.

Objective: The American Board of Surgery has recently started requiring completion of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) fundamentals of laparoscopic surgery (FLS) program for board certification in general surgery. Although most SAGES Testing Centers utilize nonsurgeons as FLS proctors, the effectiveness of using nonsurgeons as FLS proctors has not been evaluated.

Methods: Surgeons and nonsurgeons attending FLS proctor training workshops were studied.

Comparison of short-term outcomes between transvaginal hybrid NOTES cholecystectomy and laparoscopic cholecystectomy.

Introduction: A natural orifice transluminal endoscopic surgery (NOTES) approach offers the potential of reducing pain and convalescence after intra-abdominal operations. We present a single-institution series of transvaginal hybrid NOTES cholecystectomies (TVC) and compare outcomes with patients undergoing standard laparoscopic cholecystectomy (LC).

Methods: Patients had an indication for elective cholecystectomy and met the following institutional review board-approved inclusion criteria: female gender, age >18 years, body mass index ≤35, ASA Classification I or II, and absence of acute cholecystitis.

Development and evaluation of a laparoscopic common bile duct exploration simulator and procedural rating scale.

Introduction: Laparoscopic common bile duct exploration (LCBDE) is an effective, single-stage treatment for choledocholithiasis. However, LCBDE requires specific cognitive and technical skills, is infrequently performed by residents, and currently lacks suitable training and assessment modalities outside of the operating room. To address this gap in training, a simulator model for transcystic and transcholedochal LCBDE was developed and evaluated.

Effect of training and instrument type on performance in single-incision laparoscopy: results of a randomized comparison using a surgical simulator.

Purpose: Single-incision laparoscopy (SIL) is potentially less invasive compared with standard laparoscopic surgery (LAP); however, it may be more technically challenging and have a longer learning curve. A two-phase study was conducted to examine the performance of standardized tasks on a surgical simulator by novices during a distributed training period. Phase 1 examined the effect of LAP-specific or SIL-specific training on skill acquisition for both techniques.

Development of a feasible transrectal natural orifice transluminal endoscopic surgery (NOTES®) approach in a cadaveric appendectomy model: anterior is better.

Background: The transrectal natural orifice transluminal endoscopic surgery (NOTES) approach is a potentially promising alternative to transgastric or transvaginal approaches for intraperitoneal procedures. However, whether the optimal transrectal approach for intraperitoneal surgery is anterior or posterior remains unknown. To evaluate this, a prospective comparison of anterior and posterior transrectal NOTES approaches in a cadaveric appendectomy model was performed.

Natural orifice translumenal endoscopic surgery (NOTES(®)): a technical review.

Introduction: The clinical NOTES literature continues to grow. This review quantifies the published human NOTES experience to date, examines instrument use in detail, and compiles available perioperative outcomes data.

Methods: A PubMed search for all articles describing human NOTES cases was performed.

Natural orifice translumenal endoscopic surgery: progress in humans since white paper.

Since the first description of the concept of natural orifice translumenal endoscopic surgery (NOTES), a substantial number of clinical NOTES reports have appeared in the literature. This editorial reviews the available human data addressing research questions originally proposed by the white paper, including determining the optimal method of access for NOTES, developing safe methods of lumenal closure, suturing and anastomotic devices, advanced multitasking platforms, addressing the risk of infection, managing complications, addressing challenges with visualization, and training for NOTES procedures. An analysis of the literature reveals that so far transvaginal access and closure appear to be the most feasible techniques for NOTES, with a limited, but growing transgastric, transrectal, and transesophageal NOTES experience in humans.

Preoperative ultrasound measurements predict the feasibility of gallbladder extraction during transgastric natural orifice translumenal endoscopic surgery cholecystectomy.

Background: Extraction of a gallbladder through an endoscopic overtube during natural orifice translumenal endoscopic surgery (NOTES) transgastric cholecystectomy avoids potential injury to the esophagus. This study examined the rate of successful gallbladder specimen extraction through an overtube and hypothesized that preoperative ultrasound findings could predict successful specimen passage.

Methods: Gallbladder specimens from patients undergoing laparoscopic cholecystectomy were measured, and an attempt was made to pull the specimens through a commercially available overtube with an inner diameter of 16.

Single-incision laparoscopic surgery (SILS™) versus standard laparoscopic surgery: a comparison of performance using a surgical simulator.

Background: Single-incision laparoscopic surgery (SILS™) is a potentially less invasive approach than standard laparoscopy (LAP). However, SILS™ may not allow the same level of manual dexterity and technical performance compared to LAP. We compared the performance of standardized tasks from the Fundamentals of Laparoscopic Surgery (FLS) program using either the LAP or the SILS™ technique.

Steroid hypopyon following intravitreal triamcinolone acetonide injection in a pseudophakic patient.

Purpose: A 64-year-old woman presenting with the complaint of 'white stuff' in her left eye one day after intravitreal triamcinolone injection for chronic pseudophakic cystoid macular edema after cataract extraction and anterior chamber intraocular lens implant is presented.

Methods: Differential diagnosis included post-injection endophthalmitis versus 'steroid hypopyon.'

Results: The patient was observed closely and the hypopyon cleared in four days.