Structured Resident Training in Robotic Surgery: Recommendations of the Robotic Surgery Education Working Group.

Objective: A universal resident robotic surgery training pathway that maximizes proficiency and safety has not been defined by a consensus of surgical educators or by surgical societies. The objective of the Robotic Surgery Education Working Group was to develop a universal curriculum pathway and leverage digital tools to support resident education.

Design: The two lead authors (JP and YN) contacted potential members of the Working Group.

Physician-Targeted Interventions Reduce Surgical Expense and Improve Value-Driven Health Outcomes.

Introduction: Increasing health-care costs in the United States have not translated to superior outcomes in comparison to other developed countries. The implementation of physician-targeted interventions to reduce costs may improve value-driven health outcomes. This study aimed to evaluate the effectiveness of physician-targeted interventions to reduce surgical expenses and improve care for patients undergoing total thyroidectomies.

Common Components of General Surgery Robotic Educational Programs.

Objective: Robotically assisted surgery has become more common in general surgery, but there is limited guidance from the Accreditation Council for Graduate Medical Education (ACGME) regarding this type of training. We sought to determine common elements and differences in the robotic educational curricula developed by general surgery residency programs.

Design: Robotic educational curricula were obtained from the 7 individuals who presented at the workshop, "Robotic Education in General Surgery" at the 2023 Association of Program Directors in Surgery annual meeting.

The Obesity Paradox in Thyroid Surgery: Is Higher BMI Protective Against Hypoparathyroidism?

Background: With a demonstrated association between adiposity and parathyroid hormone (PTH) levels, we hypothesized that patients with a higher body mass index (BMI) would have lower rates of postoperative hypoparathyroidism following total thyroidectomy.

Methods: retrospective review of patients undergoing total thyroidectomy from 2015 to 2021. Demographics, BMI, surgical indications, and laboratory data including pre- and postoperative PTH values were examined.

Surgical Treatment of Hyperthyroidism Can Be Performed Safely Before a Euthyroid State is Achieved.

The 2016 American Thyroid Association guidelines recommend that hyperthyroid patients should be euthyroid before thyroidectomy. This recommendation is based on low-quality evidence. In this retrospective cohort study, we compare peri- and post-operative outcomes of patients with hyperthyroidism who were controlled versus uncontrolled at the time of thyroidectomy.

Modification of a Transvalvular Microaxial Flow Pump for Instantaneous Determination of Native Cardiac Output and Volume.

Background: The current Impella cardiopulmonary (CP) pump, used for mechanical circulatory support in patients with cardiogenic shock (CS), cannot assess native cardiac output (CO) and left ventricular (LV) volumes. These data are valuable in facilitating device management and weaning. Admittance technology allows for accurate assessment of cardiac chamber volumes.

Postoperative Hypocalcemia in Hyperthyroid Patients: The Parathyroids Aren't Always to Blame.

Introduction: Hypocalcemia is commonly reported after thyroidectomy and has multiple possible etiologies including: parathyroid devascularization, reactive hypoparathyroidism from relative hypercalcemia in thyrotoxicosis, and abrupt reversal of thyrotoxic osteodystrophy. In patients that are actively hyperthyroid and undergoing thyroidectomy, it is not known how many experience hypocalcemia from nonhypoparathyroidism etiologies. Therefore, our aim was to examine the relationship among thyrotoxicosis, hypocalcemia, and hypoparathyroidism.

Association Between Surgical Indication and Outcomes for Outpatient Adrenalectomy.

Introduction: Despite a favorable risk-benefit profile, inpatient admission postoperatively for minimally invasive adrenalectomy (MIA) has remained common. Prior studies have shown that outpatient MIA was not associated with an increased 30-day complications or readmission. However, this has not been explored in-depth by adrenalectomy indication.

Concurrent Validity Evidence for Entrustable Professional Activities in General Surgery Residents.

Background: A subset of Entrustable Professional Activities (EPAs) has been developed for general surgery. We aim to contribute validity evidence for EPAs as an assessment framework for general surgery residents, including concurrent validity compared to ACGME milestones, the current gold standard for evaluating competency.

Study Design: This is a cross-sectional study in a general surgery training program within a tertiary academic medical center.

Comparison of Perioperative Outcomes Between Single-Port and Multi-Port Robotic Adrenalectomy.

Background: Single-port (SP) robotic surgery has been utilized in several surgical procedures. We aim to describe our institution's approach and perioperative experience with SP robotic adrenalectomy and compare it to the traditional multi-port (MP) approach.

Methods: We retrospectively reviewed all patients who underwent robotic adrenalectomy by a single surgeon between March 2019 and March 2020.

Smart Drain for Post-Cardiac Surgery Left Ventricular Volumes Evaluated in Large Animal Models.

Background: Open heart surgeries for coronary arterial bypass graft and valve replacements are performed on 400,000 Americans each year. Unexplained hypotension during recovery causes morbidity and mortality through cerebral, kidney, and coronary hypoperfusion. An early detection method that distinguishes between hypovolemia and decreased myocardial function before onset of hypotension is desirable.

Patient Satisfaction is Equivalent for Inpatient and Outpatient Minimally-Invasive Adrenalectomy.

Introduction: Same-day surgery in the carefully selected patient decreases costs, improves inpatient capacity, and decreases patient exposure to hospital-acquired conditions. Outpatient adrenalectomy has been shown to be safe and effective, but patients' perspectives have yet to be addressed. This study compares patient satisfaction following inpatient and outpatient adrenalectomy.

Mediastinal parathyroidectomy: Utilization of a multidisciplinary, robotic-assisted transthoracic approach in challenging cases.

Background: The majority of ectopic mediastinal parathyroid adenomas are accessible transcervically and those not amenable to this approach pose a significant clinical and technical challenge.

Methods: Retrospective review of transthoracic robot-assisted mediastinal parathyroidectomy (TTRMP) for primary hyperparathyroidism between 2012 and 2019 at a single institution.

Results: 16 patients underwent TTRMP, 63% were female with a mean age of 64 ± 2.

Prevalence, Bias, and Rank List Impact of Illegal Questions in Surgical Specialty Residency Interviews.

Objective: The purpose of this study is to characterize illegal questions as defined by federal law and to assess their impact on applicants' rank lists across four surgical specialties.

Design: A survey was developed and sent to surgical specialty residency applicants. The survey asked demographics, the frequency of questions about age, gender, religion, sexual orientation, family status and impact on final rank list.

THE NOVEL USE OF STEREOTACTIC RADIOTHERAPY FOR REMNANT ADRENAL TISSUE IN NELSON SYNDROME.

Objective: Recurrent Cushing disease (CD) is a rare complication that occurs in patients who have undergone bilateral adrenalectomy (BLA). We report a case of recurrent CD in a patient with Nelson syndrome and adrenalectomy due to remnant adrenal tissue, and a novel treatment strategy using stereotactic body radiation therapy (SBRT) to the adrenal glands.

Methods: We report a case of recurrent CD in a woman with Nelson syndrome and adrenalectomy and describe her clinical course and management.

Safety of outpatient adrenalectomy across 3 minimally invasive approaches at 2 academic medical centers.

Background: Outpatient adrenalectomy has the potential to decrease costs, improve inpatient capacity, and decrease patient exposure to hospital-acquired conditions. Still, the practice has yet to be widely adopted and current studies demonstrating the safety of outpatient adrenalectomy are limited by sample size, extensive exclusion criteria, and no comparison to inpatient cases. We aimed to study the characteristics and safety of outpatient adrenalectomy using the largest such sample to date across 2 academic medical centers and 3 minimally invasive approaches.

Sleep and stress before and after duty across residency years under 2017 ACGME hours.

Introduction: Residents may differentially experience high stress and poor sleep across multiple post-graduate years (PGYs), negatively affecting safety. This study characterized sleep and stress among medical and surgical residents across multiple PGYs and at specific times surrounding duty.

Method: Thirty-two medical and surgical residents (M = 28.

Why low-voltage shock impedance measurements fail to reliably detect insulation breaches in transvenous defibrillation leads.

Background: Implantable cardioverter-defibrillators (ICDs) use low-voltage measures of shock impedance (LVSZ) to monitor integrity of leads.

Objective: To determine the separation distance between conductors required for LVSZ to detect insulation breaches that produce short circuits during shocks, causing failed defibrillation.

Methods: We simulated in-pocket insulation breaches between the ICD generator (CAN) and cables to the distal coil of 10 leads from 2 manufacturers.

Is Frozen-Section Analysis During Thyroid Operation Useful in the Era of Molecular Testing?

Background: With the increased use of molecular testing of thyroid fine-needle biopsies, the frequency and extent of thyroid resection for thyroid nodules has changed. Although the role of frozen-section analysis of the thyroid has been reduced markedly in recent years, many surgeons still routinely use it intraoperatively. We sought to determine the utility of frozen section during thyroidectomy in the era of molecular testing.

Growing Human Parathyroids in a Microphysiological System: A Novel Approach to Understanding and Developing New Treatments for Hyperparathyroidism.

We developed a novel model for studying hyperparathyroidism by growing ex vivo 3-dimensional human parathyroids as part of a microphysiological system (MPS) that mimics human physiology. The purpose of this study was to validate the parathyroid portion of the MPS. We prospectively collected parathyroid tissue from 46 patients with hyperparathyroidism for growth into pseudoglands.

Reducing cost and improving operating room efficiency: examination of surgical instrument processing.

Background: Operating room efficiency can be compromised because of surgical instrument processing delays. We observed that many instruments in a standardized tray were not routinely used during thyroid and parathyroid surgery at our institution. Our objective was to create a streamlined instrument tray to optimize operative efficiency and cost.