SAGES consensus recommendations on surgical video data use, structure, and exploration (for research in artificial intelligence, clinical quality improvement, and surgical education).

Background: Surgery generates a vast amount of data from each procedure. Particularly video data provides significant value for surgical research, clinical outcome assessment, quality control, and education. The data lifecycle is influenced by various factors, including data structure, acquisition, storage, and sharing; data use and exploration, and finally data governance, which encompasses all ethical and legal regulations associated with the data.

Potential Role for Observation in Small Solid Pseudopapillary Neoplasm (SPN).

Background: Solid pseudopapillary neoplasms (SPN) are rare tumors of the pancreas, typically affecting young women. Resection is the mainstay of treatment but is associated with significant morbidity and potential mortality. We explore the idea that small, localized SPN could be safely observed.

SAGES video acquisition framework-analysis of available OR recording technologies by the SAGES AI task force.

Background: Surgical video recording provides the opportunity to acquire intraoperative data that can subsequently be used for a variety of quality improvement, research, and educational applications. Various recording devices are available for standard operating room camera systems. Some allow for collateral data acquisition including activities of the OR staff, kinematic measurements (motion of surgical instruments), and recording of the endoscopic video streams.

Streamlining and Consistency in Surgery: Lean Six Sigma to Improve Operating Room Efficiency.

Background: Improving perioperative efficiency helps reduce unnecessary surgical expenditure, increase operating room throughput, improve patient safety, and enhance staff and patient satisfaction. Lean Six Sigma (LSS) is a quality improvement model that has been successfully applied to eliminate inefficiencies in the business sector but has not yet been widely adopted in medicine. This study investigates the adaptation of LSS to improve operative efficiency for plastic surgery procedures.

Does Surgeon Experience Correlate with Crowd-Sourced Skill Assessment in Robotic Bariatric Surgery?

Background: The Global Evaluative Assessment of Robotic Skills (GEARS) rubric provides a measure of skill in robotic surgery. We hypothesize surgery performed by more experienced operators will be associated with higher GEARS scores.

Method: Patients undergoing sleeve gastrectomy from 2016 to 2020 were analyzed.

Pancreatic Cancer Patient-derived Organoids Can Predict Response to Neoadjuvant Chemotherapy.

Objective: To evaluate if patient-derived organoids (PDOs) may predict response to neoadjuvant (NAT) chemotherapy in patients with pancreatic adenocarcinoma.

Background: PDOs have been explored as a biomarker of therapy response and for personalized therapeutics in patients with pancreatic cancer.

Methods: During 2017-2021, patients were enrolled into an IRB-approved protocol and PDO cultures were established.

Objective assessment of robotic surgical skills: review of literature and future directions.

Background: Evaluation of robotic surgical skill has become increasingly important as robotic approaches to common surgeries become more widely utilized. However, evaluation of these currently lacks standardization. In this paper, we aimed to review the literature on robotic surgical skill evaluation.

S157-a structured early intervention program in patients with predicted poor long-term outcome following bariatric surgery: a prospective randomized study.

Background: Early postoperative weight loss can be predictive of one-year outcomes. It is unclear if poor performers identified in the first post-operative month can have improvement in outcomes with additional support and education.

Purpose: To evaluate the impact of a structured targeted support program for patients with lower-than-average early post-operative weight loss on 1-year outcomes.

Thriving or surviving? A critical examination of funding models for fellowship council fellowships.

Background: Since 1997, the Fellowship Council (FC) has evolved into a robust organization responsible for the advanced training of nearly half of the US residency graduates entering general surgery practice. While FC fellowships are competitive (55% match rate) and offer outstanding educational experiences, funding is arguably vulnerable. This study aimed to investigate the current funding models of FC fellowships.

Acute Gastrointestinal Injury and Feeding Intolerance as Prognostic Factors in Critically Ill COVID-19 Patients.

Background: Although acute gastrointestinal injury (AGI) and feeding intolerance (FI) are known independent determinants of worse outcomes and high mortality in intensive care unit (ICU) patients, the incidence of AGI and FI in critically ill COVID-19 patients and their prognostic importance have not been thoroughly studied.

Methods: We reviewed 218 intubated patients at Stony Brook University Hospital and stratified them into three groups based on AGI severity, according to data collected in the first 10 days of ICU course. We used chi-square test to compare categorical variables such as age and sex and two-sample t-test or Mann-Whitney U-tests for continuous variables, including important laboratory values.

D-Dimer-Driven Anticoagulation Reduces Mortality in Intubated COVID-19 Patients: A Cohort Study With a Propensity-Matched Analysis.

Examine the possible beneficial effects of early, D-dimer driven anticoagulation in preventing thrombotic complications and improving the overall outcomes of COVID-19 intubated patients. To address COVID-19 hypercoagulability, we developed a clinical protocol to escalate anticoagulation based on serum D-dimer levels. We retrospectively reviewed all our first 240 intubated patients with COVID-19.

International Delphi Expert Consensus on Safe Return to Surgical and Endoscopic Practice: From the Coronavirus Global Surgical Collaborative.

Objective: The aim of this work is to formulate recommendations based on global expert consensus to guide the surgical community on the safe resumption of surgical and endoscopic activities.

Background: The COVID-19 pandemic has caused marked disruptions in the delivery of surgical care worldwide. A thoughtful, structured approach to resuming surgical services is necessary as the impact of COVID-19 becomes better controlled.

An Evolving Clinical Need: Discordant Oxygenation Measurements of Intubated COVID-19 Patients.

Since the first appearance of the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) earlier this year, clinicians and researchers alike have been faced with dynamic, daily challenges of recognizing, understanding, and treating the coronavirus disease 2019 (COVID-19) due to SARS-CoV-2. Those who are moderately to severely ill with COVID-19 are likely to develop acute hypoxemic respiratory failure and require administration of supplemental oxygen. Assessing the need to initiate or titrate oxygen therapy is largely dependent on evaluating the patient's existing blood oxygenation status, either by direct arterial blood sampling or by transcutaneous arterial oxygen saturation monitoring, also referred to as pulse oximetry.

Pregnant patients requiring appendectomy: comparison between open and laparoscopic approaches in NY State.

Introduction: Even though acute appendicitis is the most common general surgical condition encountered during pregnancy, the preferred approach to appendectomy in pregnant patients remains controversial. Current guidelines support laparoscopic appendectomy as the treatment of choice for pregnant women with appendicitis, regardless of trimester. However, recent published data suggests that the laparoscopic approach contributes to higher rates of fetal demise.

Considering delay of cholecystectomy in the third trimester of pregnancy.

Introduction: Current guidelines support laparoscopic cholecystectomy as the treatment of choice for pregnant women with symptomatic gallbladder disease, regardless of the trimester. Early intervention has remained the standard of care, but recent evidence has challenged this practice in pregnant women. We sought to compare surgical and maternal-fetal outcomes of antepartum versus postpartum cholecystectomy in New York State.

Evaluating readmissions following laparoscopic cholecystectomy in the state of New York.

Introduction: Hospital readmissions constitute an important component of associated costs of a disease and can contribute a significant burden to healthcare. The majority of studies evaluating readmissions following laparoscopic cholecystectomy (LC) comprise of single center studies and thus can underestimate the actual incidence of readmission. We sought to examine the rate and causes of readmissions following LC using a large longitudinal database.

Incidence of colon resections is increasing in the younger populations: should an early initiation of colon cancer screening be implemented?

Introduction: The American Cancer Society recently lowered the recommended age for screening of colorectal cancer (CRC) to age 45 due to recent data showing increased incidence of CRC in younger populations. The purpose of this study was to evaluate if younger patients have increased likelihood of resection for CRC through the use of a statewide longitudinal database.

Methods: The New York SPARCS administrative database was used to identify all patients with diagnosis of colon cancer undergoing colorectal resections from 2000 to 2016.

Impact of bariatric surgery on the development of diabetic microvascular and macrovascular complications.

Background: While bariatric surgery has been shown to improve type 2 diabetes (DM) control in the obese population, the effect on long-term DM complications has been less thoroughly investigated. The purpose of this study was to assess the development of microvascular and macrovascular complications in obese DM patients undergoing bariatric surgery.

Methods: New York patients' records from the SPARCS database in years 2006-2012 were used to identify obese patients with DM.

Trends in the utilization and perioperative outcomes of primary robotic bariatric surgery from 2015 to 2018: a study of 46,764 patients from the MBSAQIP data registry.

Background: Utilization of robotic surgery has increased over time. Outcomes in bariatric surgery have been variable. This study used the Metabolic and Bariatric Surgery Accreditation Quality and Improvement Program (MBSAQIP) dataset to compare nationwide trends in utilization and outcomes improvement for robotic and laparoscopic bariatric surgery over a four-year period.

Development of cancer after bariatric surgery.

Background: Although bariatric surgery has been associated with a reduction in risk of obesity-related cancer, data on the effect of bariatric interventions on other cancers are limited.

Objectives: This study aimed to examine the relationship between bariatric interventions and the incidence of various cancers after bariatric surgery.

Setting: Administrative statewide database.

Tracheobronchial Slough, a Potential Pathology in Endotracheal Tube Obstruction in Patients With Coronavirus Disease 2019 (COVID-19) in the Intensive Care Setting.

Background: A novel coronavirus (COVID-19) erupted in the latter part of 2019. The virus, SARS-CoV-2 can cause a range of symptoms ranging from mild through fulminant respiratory failure. Approximately 25% of hospitalized patients require admission to the intensive care unit, with the majority of those requiring mechanical ventilation.

The role of surgeons during the COVID-19 pandemic: impact on training and lessons learned from a surgical resident's perspective.

Background: Surgeons are trained as "internists that also operate," bringing an important skillset to patient management during the current COVID-19 pandemic. A review was performed to illustrate the response of surgical staff during the pandemic with regard to patient care and residency training.

Methods: The evaluation and assessment of the changes enacted at Stony Brook Medicine's Department of Surgery is illustrated through the unique perspective of surgical residents.

Clinical course of patients presenting to the emergency department with small bowel obstruction in New York State.

Introduction: Small Bowel Obstruction (SBO) is a common reason for emergency department (ED) visits in the United States. However, little is known regarding the clinical course of these patients. This study aims to identify all patients presenting to the ED in New York State with SBO and follow their clinical course.

Correction: Direct therapeutic targeting of immune checkpoint PD-1 in pancreatic cancer.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.