Robotic sleeve gastrectomy has higher complication rates compared to laparoscopic: 8-year analysis of robotic versus laparoscopic primary bariatric surgery.

Background: Robotic-assisted bariatric surgery is growing rapidly. The optimal approach to minimize complications remains unclear.

Objective: Assess robot utilization and compare 30-day outcomes for laparoscopic and robotic primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.

Leveraging Lean Methodology to Improve Compliance With Work-Hour Restrictions.

Importance: Since work-hour restrictions were instituted in 2003, sustainably complying with duty-hour regulations remains a challenge for general surgery residency programs across the nation.

Objective: To determine whether industry-based process improvement techniques could be leveraged to increase compliance with work-hour restrictions within a general surgery residency.

Design, Setting, And Participants: This quality improvement project using Lean methodology was conducted from October to November of the 2021 to 2022 academic year.

Examining the Factor Structure and Validity of the Depression Anxiety Stress Scale-21.

Background: The prevalence of mental health disorders calls for valid and reliable instruments that are easy to administer and assess for clinicians and researchers. The Depression Anxiety Stress Scale-21 (DASS-21) is a commonly used instrument to assess psychological distress; however, model fit and internal reliability issues have been reported. Our objective was to assess the factorial and structural validity of the DASS-21.

The effects of mindfulness-focused mental performance coaching on a general surgery residency program.

Background: Burnout is a proven challenge in surgeons and surgical trainees, associated with higher rates of attrition compared to other medical specialties. Here we report the impact of a mental performance coaching program as it relates to surgery trainee wellbeing.

Methods: A mixed-format mental performance coaching program was implemented at a large academic medical center's general surgery residency over a single academic year.

Atmospheric particulates over the northwestern Pacific during the late Holocene: Volcanism, dust, and human perturbation.

Mineral aerosols form a key component of Earth's dynamic biogeochemical systems, yet their composition and mass are variable in time. We reconstruct patterns in mineral aerosol flux from East Asia, the second largest global dust source, in a peat mire in northern Japan. Using geochemical fingerprinting, we show for the past ~3600 years that high but variable tephra flux dominated regional aerosol loads.

Robotic availability, not payor status, determines access to robotic emergency general surgery hernia repair in California and Florida.

Background: Previous studies have demonstrated that access to robotic surgery is influenced by socioeconomic factors, including insurance status. The 2010 Affordable Care Act established an avenue for states to expand Medicaid coverage, which has increased access to surgical care for many conditions. We hypothesized that socioeconomic disparities in access to robotic repair of non-elective emergency general surgery (EGS) hernias are less prevalent in California, a Medicaid expansion state, compared to Florida, which has not adopted Medicaid expansion.

The Long Haul to Surgery: Long COVID Has Minimal Burden on Surgical Departments.

Many patients infected with the SARS-CoV-2 virus (COVID-19) continue to experience symptoms for weeks to years as sequelae of the initial infection, referred to as "Long COVID". Although many studies have described the incidence and symptomatology of Long COVID, there are little data reporting the potential burden of Long COVID on surgical departments. A previously constructed database of survey respondents who tested positive for COVID-19 was queried, identifying patients reporting experiencing symptoms consistent with Long COVID.

A Team-Based American Board of Surgery In-Training Examination (ABSITE) Competition Improves Exam Performance.

Objective: The American Board of Surgery In-Training Examination (ABSITE) is an important factor in general surgery resident career development. The use of practice question banks for ABSITE preparation improves exam scores and completing more practice questions results in higher scores. The objective of this study is to describe the design of a novel, team-based ABSITE competition implemented into our residency program and analyze its effect on exam performance.

Early Experience With a Novel Super-Hydrophilic Laparoscopic Scope Cleaning Device and Narrative Review of Available Cleaning Strategies.

Background: Impaired visibility is a challenge in laparoscopic surgery. Frequent scope removal increases operative time, reduces efficiency, and potentially compromises patient safety. We examine our initial experience with a novel cleaning device that applies cold plasma to the scope lens and review current available laparoscope cleaning methods.

Robotic bariatric surgery reduces morbidity for revisional gastric bypass when compared to laparoscopic: outcome of 8-year MBSAQIP analysis of over 40,000 cases.

Introduction: Robotic-assisted metabolic and bariatric surgery (MBS) is gaining popularity. Revisional MBS is associated with higher perioperative morbidity compared to primary MBS. The optimal surgical approach to minimize complications in these complex cases is unclear.

Stromal-Like Cells Are Found in Peripheral Blood of Patients With Inflammatory Bowel Disease and Correlate With Immune Activation State.

Introduction: Recent studies have identified a critical role of stromal-immune cell interactions in immunity and immune tolerance. Transcriptomic profiling has implicated stromal cells in immune-mediated disorders including the 2 common forms of inflammatory bowel disease (IBD), Crohn's disease (CD), and ulcerative colitis (UC). Stromal-immune interactions may edify inflammatory state and the development of IBD-related complications such as fibrosis, yet the lack of protein markers has hampered studying stromal-immune perturbation.

Effects of Marijuana Use in Patients Undergoing Abdominal Free Flap Breast Reconstruction.

Background: Marijuana use has been associated with vascular inflammation and clotting, resulting in endothelial damage and arteritis. As marijuana use rises in the United States, few studies have evaluated its impact on surgical outcomes and wound healing in free flap breast reconstruction.

Methods: A retrospective cohort study of patients undergoing abdominal free flap breast reconstruction between 2016 and 2022 at a large metropolitan healthcare system was performed.

Maximizing mesh mileage: evaluating the long-term performance of a novel hybrid mesh for ventral hernia repair.

Purpose: The objective of this study is to evaluate the safety and long-term outcomes of GORE Synecor™ in ventral hernia repair (VHR).

Methods: This retrospective, single-center case review analyzed outcomes in patients who underwent VHR with Synecor from May 2016 to December 2022. Primary outcomes were hernia recurrence and mesh infection rates.

The chronology of Gezer from the end of the late bronze age to iron age II: A meeting point for radiocarbon, archaeology egyptology and the Bible.

The ancient southern Levantine city of Gezer is well-known from Egyptian, Biblical and Assyrian sources, associated with power struggles, conquests, and intriguing tales involving figures such as Milkilu and Amenhotep III, Merneptah, the Philistines, Solomon and his unidentified pharaonic father-in-law, and Shishak / Sheshonq I. Since the identity of Gezer with "Tell Jezer" is quite literally 'set in stone' by some dozen boundary inscriptions, along with impressive Bronze and Iron Age remains, research at this site provides a unique opportunity to compare text and archaeology, as well as bring to light the undocumented everyday lives of the city's inhabitants. In this endeavour, independent scientific dating is crucial for anchoring the remains chronologically.

Distinguishing characteristics of xanthogranulomatous cholecystitis and gallbladder adenocarcinoma: a persistent diagnostic dilemma.

Background: Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis which can resemble gallbladder adenocarcinoma (GAC) on preoperative imaging and present technical challenges in the performance of cholecystectomy. We examined our experience with each pathology to identify distinguishing characteristics that may guide patient counseling and surgical management.

Methods: A retrospective review of all pathologically confirmed cases of XGC and GAC following cholecystectomy between 2015 and 2021 at a single institution was performed.

Provider adherence to aspirin prophylaxis prescription guidelines for preeclampsia.

Objective: To evaluate provider adherence to aspirin prophylaxis prescription guidelines for patients at risk.

Study Design: A retrospective chart review was performed at Henry Ford Health (HFH) between October 2015 and December 2020. In October 2015, low-dose aspirin was recommended for women who met high risk criteria for preeclampsia at HFH; in February 2019, aspirin recommendation expanded to include women who met either moderate or high-risk criteria.

What are essential laparoscopic skills these days? Results of the SAGES Fundamentals of Laparoscopic Surgery (FLS) Committee technical skills survey.

Introduction: The Fundamentals of Laparoscopic Surgery (FLS) program tests basic knowledge and skills required to perform laparoscopic surgery. Educational experiences in laparoscopic training and development of associated competencies have evolved since FLS inception, making it important to review the definition of fundamental laparoscopic skills. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) assigned an FLS Technical Skills Working Group to characterize technical skills used in basic laparoscopic surgery in current practice contexts and their possible application to future FLS tests.

Efficacy and Safety of Aspirin 162 mg for Preeclampsia Prophylaxis in High-Risk Patients.

Objective: The aim of this study was to compare the safety and efficacy of aspirin 162 mg to the standard recommended dose of 81 mg for preeclampsia prevention.

Study Design: A retrospective cohort study of patients at risk for preeclampsia who delivered between January 2013 and December 2020 at Henry Ford Health was performed. Patients were divided into three groups: a no aspirin group, a group treated under an 81 mg aspirin preeclampsia prophylaxis protocol, and a group treated under a 162 mg protocol.

The effects of diet and beauty products on the uptake and storage of C in hair and nails: ramifications for the application of bomb pulse dating to forensic anthropological casework.

Radiocarbon dating is a useful tool in the examination of unknown human remains. Recent studies have shown that the analysis of hair and nail samples can provide a highly accurate estimation of the year of death (YOD). However, little research has examined factors that may influence the uptake and storage of C in these tissues, such as diet, or the use of beauty products.

Bite by byte: can fitness wearables help bariatric patients lose more weight after surgery?

Background: Multidisciplinary approaches to weight loss have been shown to improve outcomes in bariatric patients. Few studies have been performed assessing the utility and compliance of fitness tracking devices after bariatric surgery. We aim to determine whether use of an activity tracking device assists bariatric patients in improving postoperative weight loss behaviors.

The physiology of intraoperative error: using electrokardiograms to understand operator performance during robot-assisted surgery simulations.

Background: No platform for objective, synchronous and on-line evaluation of both intraoperative error and surgeon physiology yet exists. Electrokardiogram (EKG) metrics have been associated with cognitive and affective features that are known to impact surgical performance but have not yet been analyzed in conjunction with real-time error signals using objective, real-time methods.

Methods: EKGs and operating console point-of-views (POVs) for fifteen general surgery residents and five non-medically trained participants were captured during three simulated robotic-assisted surgery (RAS) procedures.