A cost-conscious establishment of a robotic abdominal wall reconstruction program in a publicly funded healthcare system.

Purpose: Despite reports of better short-term outcomes, the main criticism for the adoption of the robotic surgery platform for abdominal wall reconstruction (AWR) has been the associated cost, especially in countries with a publicly funded healthcare system such as Canada. We describe our experience in implementation of robotic AWR while ensuring cost-effectiveness.

Methods: This is a retrospective cohort analysis of all patients with ventral hernias ranging between 5 to 15 cm who underwent either open or robotic AWR between January 2020 to August 2022.

North Pacific Surgical Association Presidential Address 2017- From Cayman to Vancouver: One surgeon's journey.

This is the Presidential Address at the 104th Annual Meeting of the North Pacific Surgical Association held in Vancouver, BC, Canada, November 10-11, 2017.

Timing of cholecystectomy following endoscopic sphincterotomy: a population-based study.

Background: Choledocholithiasis is commonly treated initially with endoscopic sphincterotomy, followed by cholecystectomy to definitively address the underlying problem of cholelithiasis. While the benefits of early cholecystectomy have been realized in other populations, the preferred timing for this subset of patients is less well established. We performed a large, population-based analysis to determine the frequency, benefits, and practice variance in regard to early cholecystectomy on a provincial level.

Surgical team composition differs between laparoscopic and open procedures.

Background: Performing laparoscopic procedures requires different skill sets and team dynamics compared with open procedures. We evaluated team composition and procedure time between these two surgical approaches using data collected from hospitals in the United State and Canada.

Methods: A total of 1,260 general surgical cases were reviewed retrospectively, recording the number of operation personnel, procedure complexity, and the procedure time.

Early versus delayed cholecystectomy following endoscopic sphincterotomy for mild biliary pancreatitis.

Background: The recommended treatment for patients presenting with mild acute biliary pancreatitis is early cholecystectomy performed during the index admission. However, the data are less clear in regards to patients who undergo endoscopic sphincterotomy prior to surgery. While it has been shown that these patients still benefit from cholecystectomy, the optimal timing of this intervention is not well defined.

Workload assessment of surgeons: correlation between NASA TLX and blinks.

Background: Blinks are known as an indicator of visual attention and mental stress. In this study, surgeons' mental workload was evaluated utilizing a paper assessment instrument (National Aeronautics and Space Administration Task Load Index, NASA TLX) and by examining their eye blinks. Correlation between these two assessments was reported.

Quantifying mental workloads of surgeons performing natural orifice transluminal endoscopic surgery (NOTES) procedures.

Background: During natural orifice transluminal endoscopic surgery (NOTES), surgeons often have difficulties orienting the surgical view and manipulating instruments accurately, which increases their level of mental and physical fatigue. This study quantified mental workload by measuring the spared mental resources of surgeons performing NOTES training tasks.

Methods: Assessment of mental workload was conducted in both a benchtop and a hybrid animal model.

Hand-assisted laparoscopic splenectomy versus open splenectomy for massive splenomegaly: 20-year experience at a Canadian centre.

Background: Multiple techniques for splenectomy are now employed and include open, laparoscopic and hand-assisted laparoscopic splenectomy (HALS). Concerns regarding a purely laparoscopic splenectomy for massive splenomegaly (> 20 cm) arise from potentially longer operative times, higher conversion rates and increased blood loss. The HALS technique offers the potential advantages of laparoscopy, with the added safety of having the surgeon's hand in the abdomen during the operation.

Maintaining forward view of the surgical site for best endoscopic practice.

Endoscopic surgery performed through patients' natural orifices (NOTES procedures) often require some degree of retroflexion of the operating system. This can cause a misalignment between the displayed image and the actual work plane, leading to performance difficulties. This study investigated the impact of retroflexion on task performance in a simulated environment.

Canadian consensus conference on the development of training and practice standards in advanced minimally invasive surgery: Edmonton, Alta., Jun. 1, 2007.

Despite the complexities of minimally invasive surgery (MIS), a Canadian approach to training surgeons in this field does not exist. Whereas a limited number of surgeons are fellowship-trained in the specialty, guidelines are still clearly needed to implement advanced MIS. Leaders in the field of gastrointestinal surgery and MIS attended a consensus conference where they proposed a comprehensive mentoring program that may evolve into a framework for a national mentoring and training system.

Perioperative analysis of laparoscopic versus open liver resection.

Background: Over the past decade there has been an increasing trend toward minimally invasive liver surgery. Initially limited by technical challenges, advances in laparoscopic techniques have rendered this approach safe and feasible. However, as health care costs approach 50% of some provincial budgets, surgical innovation must be justifiable in costs and patient outcomes.

Feasibility of using intraoperatively-acquired quantitative kinematic measures to monitor development of laparoscopic skill.

The objective of this paper is to present the initial results of a study aimed at showing the feasibility of using kinematic measures to distinguish skill levels in manipulating surgical tools. Through a simulated surgical task (dissection of a mandarin orange), we acquired motor performance data from three sets of subjects representing different stages of surgical training. We computed the average lateral, axial and vertical tooltip velocities for each of the two main subtasks ('Peel Skin' and 'Detach Segment').

Assessing cognitive & motor performance in minimally invasive surgery (MIS) for training & tool design.

The objective of this paper is to present the development of a new modelling diagram (MCMD) to represent MIS procedures in terms of both motor and cognitive actions. Through observation and analysis of several laparoscopic cholecystectomy procedures and based on task analysis techniques, we created a diagram language composed of six primary symbols: processes, decisions, interrupt service routines (ISRs), options points and AND and OR gates. We then tested and refined them during 10 new cases until no further changes seemed necessary, we have since applied this approach to 6 laparoscopic colorectal surgeries and have found that no further symbols were necessary though the procedural representation was naturally different.

Morbidity and mortality associated with intraperitoneal chemotherapy for Pseudomyxoma peritonei.

Background: Many centers include intraperitoneal chemotherapy for treatment of pseudomyxoma peritonei. This study documented the morbidity of intraperitoneal chemotherapy in a single institution.

Methods: A retrospective review of pseudomyxoma peritonei over a 6-year period was undertaken.