SAGES SAFE CHOLE program changes surgeons practice in France-results of the FCVD implementation of SAFE CHOLE in France.

Background: With the Society of Gastrointestinal and Endoscopic Surgeons supervision, the Safe Cholecystectomy Task Force (SAFE CHOLE) was translated into French by the the Federation of Visceral and Digestive Surgery (FCVD) and adopted to run on its national e-learning platform for surgical continuing medical education (CME). The objective of this study was to assess the impact of the SAFE CHOLE (SF) program on the knowledge and practice of French surgeons performing cholecystectomy and participating in the FCVD lead CME activity.

Methods: To obtain CME certification, each participant must fill out three FCVD validated questionnaires regarding (1) the participants' routine practice for cholecystectomy, (2) the participants' knowledge and practice after successful completion of the program, and (3) the educational value of the SC program.

An Unmodulated Very-Low-Voltage Electrosurgical Technology Creates Predictable and Ultimate Tissue Coagulation: From Experimental Data to Clinical Use.

We analyzed the underlying principles of an unmodulated very-low-voltage (VLV) mode, designated as "soft coagulation" in hemostasis, and demonstrate its clinical applications. . While the advantage of the VLV mode has been reported across surgical specialties, the basic principle has not been well described and remains ambiguous.

Public reporting and transparency: a primer on public outcomes reporting.

Introduction: Healthcare consumers seeking accurate information about where to find quality surgical care face a confusing constellation of rating systems that lack transparency or consistency of opinion. For example, a 2016 report in Health Affairs demonstrated that no hospital was rated as a high performer by all four prominent national ratings systems: Consumer Reports, Leapfrog, Healthgrades and U.S.

Estimating the Incidence of Stray Energy Burns during Laparoscopic Surgery based on Two Statewide Databases and Retrospective Rates: An Opportunity to Improve Patient Safety.

Background: The growth of laparoscopic surgery has increased the use of laparoscopic electrosurgical devices based on radiofrequency current. Despite an improvement in most post-operative outcomes, the use of these devices can be associated with inadvertent thermal or mechanical injuries, also called accidental punctures and lacerations (APLs). APLs can occur through either operator error or system error, including insulation failure or capacitive coupling resulting in stray energy burns.

Incidental Gallbladder Carcinoma Discovered after Laparoscopic Cholecystectomy: Identifying Patients Who will Benefit from Reoperation.

Background: Despite an early radical reoperation, recurrence and poor survival are observed in up to 40% of patients with an incidentally discovered gallbladder carcinoma (I-GBC) after undergoing a laparoscopic cholecystectomy (LC). This study seeks to identify prognostic factors after re-I-GBC resection.

Methods: A retrospective review of a prospectively maintained patient database with patients who were undergoing resection for I-GBC from January 1995 to March 2017 was performed.

The SAGES Fundamental Use of Surgical Energy program (FUSE): history, development, and purpose.

Background: Adverse events due to energy device use in surgical operating rooms are a daily occurrence. These occur at a rate of approximately 1-2 per 1000 operations. Hundreds of operating room fires occur each year in the United States, some causing severe injury and even mortality.

Prognostic value of venous invasion in resected T3 pancreatic adenocarcinoma: Depth of invasion matters.

Background: Incomplete evaluation of venous invasion has led to conflicting results regarding the prognosis of patients undergoing pancreatectomy with a synchronous venous resection. This study evaluates the prognostic value associated with the presence and the depth of venous invasion in T3 pancreatic adenocarcinoma.

Methods: This study evaluated retrospectively 181 consecutive pancreatoduodenectomies performed for T3N0M0 and T3N1M0 pancreatic adenocarcinomas (stages IIA and IIB) from January 2006 to December 2014.

Fundamental Use of Surgical Energy (FUSE): An Essential Educational Program for Operating Room Safety.

Operating room (OR) safety has become a major concern in patient safety since the 1990s. Improvement of team communication and behavior is a popular target for safety programming at the institutional level. Despite these efforts, essential safety gaps remain in the OR and procedure rooms.

Quantifying inadvertent thermal bowel injury from the monopolar instrument.

Background: Insulation defects are observed in 3-39 % of laparoscopic instruments. Electrosurgical injuries due to insulation defects or capacitive coupling remain an issue in laparoscopic surgery with a prevalence of 0.6-5 per thousand cases.

Outcomes of liver resection for haemorrhagic hepatocellular adenoma.

Background: Intratumoral bleeding and/or intraperitoneal rupture occurs in up to 20% of patients with hepatocellular adenoma (HCA). Hepatectomy in the presence of haemorrhagic HCA has been associated with increased morbidity and mortality rates. This study evaluates the outcomes of hepatectomy for haemorrhagic HCA at a single institution.

Fundamental Use of Surgical Energy (FUSE) certification: validation and predictors of success.

Introduction: The Fundamental Use of Surgical Energy (FUSE) program includes a Web-based didactic curriculum and a high-stakes multiple-choice question examination with the goal to provide certification of knowledge on the safe use of surgical energy-based devices. The purpose of this study was (1) to set a passing score through a psychometrically sound process and (2) to determine what pretest factors predicted passing the FUSE examination.

Methods: Beta-testing of multiple-choice questions on 62 topics of importance to the safe use of surgical energy-based devices was performed.

Long-term knowledge retention following simulation-based training for electrosurgical safety: 1-year follow-up of a randomized controlled trial.

Background: Despite the value of simulation for surgical training, it is unclear whether acquired competencies persist long term. A prior randomized trial showed that structured simulation improves knowledge of the safe use of electrosurgery (ES) amongst trainees up to 3 months after the curriculum (Madani et al. in Surg Endosc 28(10):2772-2782, 2014).

Fundamental Use of Surgical Energy (FUSE): Closing a Gap in Medical Education.

Traditional medical education curricula for students, residents and trainees do not address the rapidly growing number of technological devices that are fundamentally changing health care delivery today. This is most relevant in those medical specialties that rely heavily on the use of advanced technologies and devices, for example minimally invasive surgery, interventional radiology, gastroenterology, cardiology and anesthesia. Health care professionals in these domains are increasingly sharing procedures that use energy devices of many different designs and functionality without training in their fundamental use and safety.

Resection of Borderline Resectable and Locally Advanced Pancreatic Adenocarcinomas after Neoadjuvant Chemotherapy.

Objective: To report the outcomes of surgical resection of borderline resectable (BL) and locally advanced (LA) 'unresectable' pancreatic cancer after neoadjuvant chemotherapy.

Methods: A review of a prospectively maintained database for pancreatic resections was undertaken to identify patients undergoing resection for BL and LA pancreatic cancer after neoadjuvant chemotherapy between January 2007 and December 2012. Clinicopathological, surgical and survival outcomes were analyzed.

Predicting early intrahepatic recurrence after curative resection of colorectal liver metastases with molecular markers.

Background: The aim of this case-control study was to identify clinicopathological factors and test three relevant biomarkers for their ability to predict early intrahepatic recurrence after curative liver resection for colorectal liver metastases (CLM).

Methods: Of the 184 patients with CLM undergoing hepatectomy between January 2007 and December 2009, thirty patients had intrahepatic disease recurrence within 6 months. The control group was randomly selected from a cohort of patients between April 1997 and December 2005 who have survived without disease recurrence after CLM resection for over 5 years.

Impact of a hands-on component on learning in the Fundamental Use of Surgical Energy™ (FUSE) curriculum: a randomized-controlled trial in surgical trainees.

Background: While energy devices are ubiquitous in the operating room, they remain poorly understood and can result in significant complications. The purpose of this study was to estimate the extent to which adding a novel bench-top component improves learning of SAGES' Fundamental Use of Surgical Energy™ (FUSE) electrosurgery curriculum among surgical trainees.

Methods: Surgical residents participated in a 1-h didactic electrosurgery (ES) course, based on the FUSE curriculum.

Safety and outcome of combined liver and pancreatic resections.

Background: In Western countries, combined liver and pancreatic resections (CLPR) are performed rarely because of the perceived high morbidity and mortality rates. This study evaluated the safety and outcomes of CLPR at a tertiary European centre for hepatopancreatobiliary surgery.

Methods: A review of two prospectively maintained databases for pancreatic and liver resections was undertaken to identify patients undergoing CLPR between January 1994 and January 2012.

Use of a temporary intraoperative mesentericoportal shunt for pancreatic resection for locally advanced pancreatic cancer with portal vein occlusion and portal hypertension.

Background: Our aim was to evaluate the perioperative morbidity and survival of a selected group of patients with locally advanced pancreatic ductal adenocarcinoma (PDAC) and malignant obstruction of portal axis inducing portal hypertension (PH) who underwent a curative intent pancreatic resection, after neoadjuvant chemotherapy, adopting a new type of temporary intraoperative mesentericoportal shunt (TMPS).

Methods: We analyzed the perioperative data and survival outcome of 15 patients with locally advanced PDAC and PH who underwent pancreatoduodenectomy combined with vascular resections between October 2008 and October 2012 using this TMPS.

Results: There was no perioperative mortality.

Rationale for the fundamental use of surgical Energy™ (FUSE) curriculum assessment: focus on safety.

Background: Almost all surgical procedures involve the use of devices that apply energy to tissue. Adverse events can occur if the devices are not used appropriately. The SAGES' Fundamental Use of Surgical Energy™ (FUSE) program will include a curriculum and certification examination to address this safety issue.

Pancreatic fistula after a pancreaticoduodenectomy for ductal adenocarcinoma and its association with morbidity: a multicentre study of the French Surgical Association.

Backgrounds: A pancreatic fistula (PF) is the most relevant complication after a pancreaticoduodenectomy (PD). This retrospective multicentric study attempts to elucidate the risk factors and complications of a PF in a large cohort of patients undergoing a PD for ductal adenocarcinoma.

Methods: Using a survey tool, clinical data of 1325 patients undergoing a PD for ductal adenocarcinoma at 37 institutions, between January 2004 and December 2009, were collected.

Reoperative surgery after repair of postcholecystectomy bile duct injuries: is it worthwhile?

Background: Repeat repair of bile duct injuries (BDIs) after cholecystectomy is technically challenging, and its success remains uncertain. We retrospectively evaluated the short- and long-term outcomes of patients requiring reoperative surgery for BDI at a major referral center for hepatobiliary surgery.

Methods: Between January 1991 and May 2011, we performed surgical BDI repairs in 46 patients.