From the simulation center to the bedside: Validating the efficacy of a dynamic haptic robotic trainer in internal jugular central venous catheter placement.

Background: The objective of this study was to validate the transfer of ultrasound-guided Internal Jugular Central Venous Catheterization (US-IJCVC) placement skills from training on a Dynamic Haptic Robotic Trainer (DHRT), to placing US-IJCVCs in clinical environments. DHRT training greatly reduces preceptor time by providing automated feedback, standardizes learning experiences, and quantifies skill improvements.

Methods: Expert observers evaluated DHRT-trained (N = 21) and manikin-trained (N = 36) surgical residents on US-IJCVC placement in the operating suite using a US-IJCVC evaluation form.

Morbidity after tonsillectomy in children with autism spectrum disorders.

Objectives: As the incidence of autism spectrum disorder (ASD) increases, otolaryngologists are more likely to encounter patients from this population during tonsillectomy. The purpose of this study was to examine whether outcomes differ between pediatric patients with and without ASD in a national cohort of children undergoing tonsillectomy. Understanding these differences may be used to inform future approaches to improve clinical outcomes and healthcare costs.

Peritoneal encapsulation: a rare cause of small bowel obstruction.

Peritoneal encapsulation syndrome (PES) is a rare cause of small bowel obstruction (SBO) in patients with no prior history of abdominal surgery. First described by Cleland in 1868, PES is a congenital condition characterised by small bowel encasement in an accessory, but otherwise normal peritoneal membrane. A result of abnormal rotation of the midgut during early development, the condition causes fibrous encapsulation of the intestines, thus preventing bowel distention.

Can Haptic Simulators Distinguish Expert Performance? A Case Study in Central Venous Catheterization in Surgical Education.

Introduction: High-tech simulators are gaining popularity in surgical training programs because of their potential for improving clinical outcomes. However, most simulators are static in nature and only represent a single anatomical patient configuration. The Dynamic Haptic Robotic Training (DHRT) system was developed to simulate these diverse patient anatomies during Central Venous Catheterization (CVC) training.

Prognostic Significance of Tumor Deposits in Stage III Colon Cancer.

Background: The American Joint Committee on Cancer includes extranodal tumor deposits in the tumor-node-metastasis classification of colon cancer. However, it is unclear how tumor deposits compare with lymph node metastases in prognostic significance. This study evaluated the survival impact of tumor deposits relative to lymph node metastases in stage III colon cancer.

Investigating the Effect of Simulator Functional Fidelity and Personalized Feedback on Central Venous Catheterization Training.

Objective: To compare the effect of simulator functional fidelity (manikin vs a Dynamic Haptic Robotic Trainer [DHRT]) and personalized feedback on surgical resident self-efficacy and self-ratings of performance during ultrasound-guided internal jugular central venous catheterization (IJ CVC) training. In addition, we seek to explore how self-ratings of performance compare to objective performance scores generated by the DHRT system.

Design: Participants were randomly assigned to either manikin or DHRT IJ CVC training over a 6-month period.

Time to Surgery: a Misguided Quality Metric in Early Stage Pancreatic Cancer.

Background: Longer time to surgery is associated with worse outcomes in several cancers. We sought to identify disparities in time from diagnosis to surgery in pancreatic cancer and whether delays to surgery correlated with worse survival.

Methods: The US National Cancer Database (2003-2011) was reviewed for patients with clinical stages I-II pancreatic adenocarcinoma who underwent surgical resection.

Robotic versus standard laparoscopic elective colectomy: where are the benefits?

Background: Robotic approaches for colorectal surgery have been growing in popularity as experience with the new technology develops, but are frequently associated with longer operative time. It is unclear whether prolonged operative duration in robotic cases translates to increased morbidity. This study aims to compare the outcomes of non-emergent laparoscopic and robotic colon resections.

Correlation of clinical and pathological staging and response to neoadjuvant therapy in resected pancreatic cancer.

Background: Neoadjuvant therapy (NAT) has been increasingly employed to optimize outcomes in pancreatic cancer; however, little is known about its pathologic impact.

Methods: The National Cancer Data Base (2003-2011) was retrospectively reviewed for patients with pancreatic carcinoma who underwent initial surgery or NAT followed by resection. Response to NAT, determined by comparing clinical and pathologic stage, and survival were evaluated.

Integrating Cadaver Needle Forces Into a Haptic Robotic Simulator.

Accurate force simulation is essential to haptic simulators for surgical training. Factors such as tissue inhomogeneity pose unique challenges for simulating needle forces. To aid in the development of haptic needle insertion simulators, a handheld force sensing syringe was created to measure the motion and forces of needle insertions.

Greater Lymph Node Retrieval Improves Survival in Node-Negative Resected Gastric Cancer in the United States.

Purpose: Guidelines in western countries recommend retrieving ≥15 lymph nodes (LNs) during gastric cancer resection. This study sought to determine whether the number of examined lymph nodes (eLNs), a proxy for lymphadenectomy, effects survival in node-negative disease.

Materials And Methods: The US National Cancer Database (2003-2011) was reviewed for node-negative gastric adenocarcinoma.

Robotic versus laparoscopic colectomy for stage I-III colon cancer: oncologic and long-term survival outcomes.

Background: While short-term data suggest that robotic resections are safe for oncologic operations, long-term outcomes remain uncertain. This study evaluates the impact of robotic and laparoscopic approaches on oncologic and survival outcomes in partial and total colectomies for colon cancer.

Methods: The US National Cancer Database (2010-2012) was reviewed for patients with stage I-III adenocarcinoma of the colon, who underwent robotic and laparoscopic partial or total colectomies.

Prognostic impact of carbohydrate antigen 19-9 level at diagnosis in resected stage I-III pancreatic adenocarcinoma: a U.S. population study.

Background: Pancreatic adenocarcinoma is a highly aggressive cancer, with surgical resection and systemic therapy offering the only hope for long-term survival. Carbohydrate antigen 19-9 (CA 19-9) has been used as a prognostic marker after resection; however, the relationship between survival and pre-treatment CA 19-9 level remains unclear. This study evaluates pre-treatment serum CA 19-9 level as a predictor for long-term survival.

Greater lymph node retrieval and lymph node ratio impacts survival in resected pancreatic cancer.

Background: Surgical resection is the mainstay of pancreatic cancer treatment; however, the ideal lymphadenectomy remains unsettled. This study sought to determine whether number of examined lymph nodes (eLNs) and lymph node ratio (LNR) impact survival.

Methods: The U.

Minimally invasive surgical approaches offer earlier time to adjuvant chemotherapy but not improved survival in resected pancreatic cancer.

Background: Pancreatic surgery encompasses complex operations with significant potential morbidity. Greater experience in minimally invasive surgery (MIS) has allowed resections to be performed laparoscopically and robotically. This study evaluates the impact of surgical approach in resected pancreatic cancer.

Utilization and trends in palliative therapy for stage IV pancreatic adenocarcinoma patients: a U.S. population-based study.

Background: Pancreatic adenocarcinoma is an aggressive malignancy, with most patients diagnosed with advanced or metastatic disease. Palliative therapies comprise an important, but underutilized, aspect of care. This aim of this study was to characterize the trends, factors, and outcomes associated with utilization of palliative therapies.

Sarcopenia related to neoadjuvant chemotherapy and perioperative outcomes in resected gastric cancer: a multi-institutional analysis.

Background: This study's objective was to evaluate the change in sarcopenia score following neoadjuvant chemotherapy (NAC) and to correlate both sarcopenia and change in score with perioperative outcomes in patients with advanced resected gastric cancer.

Methods: Multi-institutional analysis of patients with gastric cancer who underwent NAC and resection from 2000-2015 was performed. Demographic and perioperative data were included.

Training Surgical Residents With a Haptic Robotic Central Venous Catheterization Simulator.

Ojective: Ultrasound guided central venous catheterization (CVC) is a common surgical procedure with complication rates ranging from 5 to 21 percent. Training is typically performed using manikins that do not simulate anatomical variations such as obesity and abnormal vessel positioning. The goal of this study was to develop and validate the effectiveness of a new virtual reality and force haptic based simulation platform for CVC of the right internal jugular vein.

Impact of chromogranin A, differentiation, and mitoses in nonfunctional pancreatic neuroendocrine tumors ≤ 2 cm.

Background: Small pancreatic neuroendocrine tumors (PNETs) are a unique subset of pancreatic neoplasms. Chromogranin A (CgA) levels, mitotic rate, and histologic differentiation are often used to characterize PNET behavior. This study evaluates the impact of these factors on survival in patients with PNETs.

Impact of perineural invasion on survival in node negative colon cancer.

Perineural invasion (PNI) has been implicated as a poor prognostic indicator in many cancers. The National Comprehensive Cancer Network recommends consideration of observation or adjuvant therapy in the presence of PNI in early colon cancer. These recommendations are based on single institutional studies that fail to evaluate PNI within the context of adjuvant chemotherapy.

Trends in utilization of neoadjuvant therapy and short-term outcomes in resected pancreatic cancer.

Background: Surgical resection and chemotherapy offer the only chance of long-term survival for pancreatic cancer. Neoadjuvant therapy (NAT) is increasingly used to optimize outcomes. Trends in NAT utilization and short-term outcomes in resected pancreatic cancer were evaluated.

Survival impact of neoadjuvant therapy in resected pancreatic cancer: A Prospective Cohort Study involving 18,332 patients from the National Cancer Data Base.

Background: Pancreatic cancer carries a dismal prognosis, with surgical resection and adjuvant therapy offering the only hope for long-term survival. Recently, neoadjuvant therapy (NAT) has been employed to optimize outcomes. This study evaluates the impact of NAT in resected pancreatic cancer.

Time to the initiation of adjuvant chemotherapy does not impact survival in patients with resected pancreatic cancer.

Background: Surgical resection with adjuvant chemotherapy is the standard of care for patients with pancreatic cancer, but to the authors' knowledge, little is known regarding the temporal relationship between chemotherapy initiation and survival. The current study analyzed the impact of time to the initiation of adjuvant chemotherapy.

Methods: The National Cancer Data Base (2003-2011) was retrospectively reviewed for patients with clinical American Joint Committee on Cancer stages I to III resected pancreatic carcinoma.