Rectourethral Fistula Repair Using Robotic Transanal Minimally Invasive Surgery (TAMIS) Approach.

Background: Small nonirradiated rectourethral fistula (RUF) without tissue necrosis or peri-fistula abscess are often treated via a trans-sphincteric or transperineal approach. Attempts at transanal rectal advancement flap to reduce associated morbidity have been widely abandoned due to poor visualization, inability to close the urethral defect in a watertight fashion, and compromise of rectal flap vascularity. Robotic transanal minimally invasive surgery (R-TAMIS) has emerged as a useful tool to address distal rectal lesions as it provides enhanced visualization and surgical dexterity.

Oncological outcome of peripartum colorectal carcinoma-a single-center experience.

Objectives: This study aimed to analyze disease presentation, management, and oncological outcomes of patients diagnosed with peripartum colorectal cancer (CRC).

Methods: Retrospective cohort study of all consecutive women of childbearing age (18-45 years) between 2002 and 2014 diagnosed with CRC adenocarcinoma at a tertiary academic institution. Patients who experienced pregnancy within 12 months of their diagnosis (peripartum period, group 1) were compared to the remaining patients of the cohort (group 2).

Influencing Mindsets and Motivation in Procedural Skills Learning: Two Randomized Studies.

Objectives: An incremental (growth) theory of intelligence (mindset), compared with an entity (fixed) mindset, has been associated with improved motivation and performance. Interventions to induce incremental beliefs have improved performance on non-surgical motor tasks. We sought to evaluate the impact of 2 brief interventions to induce incremental beliefs in the context of learning a surgical task.

Validation of the American Association for the Surgery of Trauma's emergency general surgery breast infection grading system.

Background: The American Association for the Surgery of Trauma (AAST) developed emergency general surgery (EGS) grading systems for multiple diseases to standardize classification of disease severity. The grading system for breast infections has not been validated. We aimed to validate the AAST breast infection grading system.

Minimal cosmetic revision required after minimally invasive pectus repair.

Background: Despite surgical correction procedures for pectus deformities, remaining cosmetic asymmetry may have significant psychological effects. We sought to evaluate factors associated with plastic surgery (PS) consultation and procedures for these deformities at an academic institution.

Methods: We reviewed patients aged 0-21 diagnosed with a pectus excavatum or carinatum deformity at our institution between January 2001 and October 2016.

Personalized video feedback improves suturing skills of incoming general surgery trainees.

Background: The American Board of Surgery encourages graduating medical students to prepare for surgical residency before day 1. We sought to determine the impact of personalized video feedback on an advance preparation task.

Methods: We conducted a nonrandomized study comparing video feedback versus no feedback.

Surgery Website as a 24/7 Adjunct to a Surgical Curriculum.

Objective: Successfully teaching duty hour restricted trainees demands engaging learning opportunities. Our surgical educational website and its associated assets were assessed to understand how such a resource was being used.

Design: Our website was accessible to all Mayo Clinic employees via the internal web network.

The ACGME Case Log System May Not Accurately Represent Operative Experience Among General Surgery Interns.

Objective: To assess if the Accreditation Council for Graduate Medical Education (ACGME) case log system accurately captures operative experience of our postgraduate year 1 (PGY-1) residents.

Design: ACGME case log information was retrospectively obtained for 5 cohorts of PGY-1 residents (2011-2015) and compared to the number of operative cases captured by an institutional automated operative case report system, Surgical Access Utility System (SAUS). SAUS automatically captures all surgical team members who are listed in the operative dictation for a given case, including interns.

A Comparison of Objective Assessment Data for the United States and International Medical Graduates in a General Surgery Residency.

Objective: To compare objective assessment scores between international medical graduates (IMGs) and United States Medical Graduates. Scores of residents who completed a preliminary year, who later matched into a categorical position, were compared to those who matched directly into a categorical position at the Mayo Clinic, Rochester.

Design: Postgraduate year (PGY) 1 to 5 residents participate in a biannual multistation, OSCE-style assessment event as part of our surgical training program.

At Home Preresidency Preparation for General Surgery Internship: A Pilot Study.

Objective: To create a novel "at-home" preresidency preparatory adjunct for medical students entering surgical residency.

Design: Preparatory resources were mailed to match medical students before residency matriculation in 2015. This included "how-to" videos, low-cost models, and surgical instruments for 5 "stations" (arterial blood gas analysis, anatomy and imaging knowledge, knot tying ability, and suturing dexterity) of our program's biannual general surgery intern objective assessment activity (Surgical Olympics: total 13 stations, 10 points each).

Trends in P Value, Confidence Interval, and Power Analysis Reporting in Health Professions Education Research Reports: A Systematic Appraisal.

Purpose: To characterize reporting of P values, confidence intervals (CIs), and statistical power in health professions education research (HPER) through manual and computerized analysis of published research reports.

Method: The authors searched PubMed, Embase, and CINAHL in May 2016, for comparative research studies. For manual analysis of abstracts and main texts, they randomly sampled 250 HPER reports published in 1985, 1995, 2005, and 2015, and 100 biomedical research reports published in 1985 and 2015.

Needle Decompression of Tension Pneumothorax with Colorimetric Capnography.

Background: The success of needle decompression for tension pneumothorax is variable, and there are no objective measures assessing effective decompression. Colorimetric capnography, which detects carbon dioxide present within the pleural space, may serve as a simple test to assess effective needle decompression.

Methods: Three swine underwent traumatically induced tension pneumothorax (standard of care, n = 15; standard of care with needle capnography, n = 15).

Risk factors for postoperative hematoma after inguinal hernia repair: an update.

Background: We recently sensed an increase in the frequency of groin hematoma after inguinal hernia repair (IHR) at our institution. The aim of this study was to provide a more updated assessment of the risk factors inherent to this complication.

Methods: We performed a case-control study of all adult patients (age ≥ 18 y) who developed a groin hematoma after IHR at our institution between 2003 and 2015.

Tube thoracostomy: Increased angle of insertion is associated with complications.

Introduction: Tube thoracostomy (TT), considered a routine procedure, has significant complications. Current recommendations for placement rely on surface anatomy. There is no information to guide operators regarding angle of insertion relative to chest wall.

Survival following synchronous colon cancer resection.

Background: Synchronous colon cancers, defined as two or more primary colon cancer detected simultaneously at the time of initial diagnosis, account for up to 5% of all colon cancer diagnoses. Management principles and outcomes remain largely undefined.

Methods: A retrospective institutional review of patients undergoing curative intent resection for colon adenocarcinoma (Stages I-III) from 1995 to 2007 was performed.

Infected hardware after surgical stabilization of rib fractures: Outcomes and management experience.

Background: Surgical stabilization of rib fracture (SSRF) is increasingly used for treatment of rib fractures. There are few data on the incidence, risk factors, outcomes, and optimal management strategy for hardware infection in these patients. We aimed to develop and propose a management algorithm to help others treat this potentially morbid complication.

Laparoscopic esophagomyotomy for achalasia in children: A review.

Esophageal achalasia in children is rare but ultimately requires endoscopic or surgical treatment. Historically, Heller esophagomyotomy has been recommended as the treatment of choice. The refinement of minimally invasive techniques has shifted the trend of treatment toward laparoscopic Heller myotomy (LHM) in adults and children with achalasia.

Catch me if you can…early simulation efforts affect fundamental surgical skill assessment scores.

Background: We evaluated whether early exposure to a simulation curriculum enhances acquired surgical skills.

Methods: The "Surgical Olympics" evaluates interns on basic surgical skills and knowledge. After the Summer Olympics (July), interns were randomly divided into groups: "A" participated in a 7-week curriculum once a week, whereas "B" attended 7 weeks of lectures once a week.

Endovascular treatment of distal thoracic aortic transection associated with severe thoracolumbar spinal fracture.

Endovascular repair has become the first line of treatment in most patients with blunt aortic injury. The most common mechanism is deceleration injury affecting the aortic isthmus distal to the origin of the left subclavian artery. Injuries of the distal thoracic aorta are uncommon.

Adenomas of the ampulla of Vater: a comparison of outcomes of operative and endoscopic resections.

Background: Data comparing operative and endoscopic resection of adenomas of the ampulla of Vater are limited. Our aims were to evaluate and compare the long-term results and outcomes of endoscopic and operative resections of benign tumors of the ampulla of Vater as well as to determine which features of benign periampullary neoplasms would predict recurrence or failure of endoscopic therapy and therefore need for operative treatment.

Methods: Retrospective review of all patients treated for adenomas of ampulla of Vater at our institution from 1994 to 2009.

Bisphosphonate-related osteonecrosis of the jaw: the role of actinomyces.

The etiology of bisphosphonate-related osteonecrosis of the jaw is unknown but was initially postulated to be mediated by bisphosphonate accumulation within the jaws, resulting in avascular necrosis. Bisphosphonates may not be the primary cause. Actinomyces are an underrecognized agent in pathogenesis, and timely actinomycosis-specific treatment may improve outcome.

Eptifibatide overdose.

Background: Eptifibatide is a glycoprotein (GP) IIb/IIIa inhibitor used globally, but there is little information on overdose. We report a case of eptifibatide overdose with no consequence to the patient.

Methods: We searched for eptifibatide overdose on PubMed, British National Formulary, Thomson Micromedex, EudraPharm, Toxbase, and the Medicines and Healthcare products Regulatory Agency and Food and Drug Administration websites.