Stray energy injury during robotic versus laparoscopic inguinal hernia repair: a randomized controlled trial.

Background: Stray energy transfer from monopolar instruments during laparoscopic surgery is a recognized cause of potentially catastrophic complications. There are limited data on stray energy injuries in robotic surgery. We sought to characterize stray energy injury in the form of superficial burns to the skin surrounding laparoscopic and robotic trocar sites.

Perioperative Clerkship Design for Students with Physical Disabilities: A Model for Implementation.

Objective: Disability inclusion is an important and growing area of focus for medical education that may be stymied by stereotypes about disabilities, lack of knowledge about accommodations for students with physical disabilities, or outdated technical standards that preclude participation of people with mobility disabilities. To support the inclusion of students with physical disability in surgical clerkships, we describe a proactive, progressive approach to the accommodations process for a student with a thoracic spinal cord injury entering a surgical clerkship.

Design: Working proactively, medical school leadership, disability professionals and the clerkship team collaborated on the development of reasonable accommodations for a student with a thoracic spinal cord injury entering a surgical clerkship.

Surgeons Underestimate the Importance of Surgical Topics for Non-Surgeons: Results of a National Survey.

Objective: To determine if surgeons and non-surgeons agree on the importance of surgical topics covered in the surgical clerkship to the daily practice of non-surgeons.

Design: An IRB-approved anonymous survey ranking the relative importance of 35 topics drawn from surgical clerkship curricula asking physicians to rank the relative importance of each topic, using a five-point Likert scale, to the daily practice of non-surgeons.

Setting: Online anonymous survey.

"Bedside Anatomy": A Tool to Contextualize Learning and Introduce Surgical Careers.

Background: Many medical students cite an unwelcoming culture in surgery and perceive surgeons as arrogant or unfriendly. These perceptions have been reported as factors discouraging medical students from applying to surgical residency programs. This highlights an opportunity early in medical education to address these negative stereotypes and create opportunities for positive interactions with surgeons.

What stress coping strategies are surgeons relying upon during surgery?

Background: The objective of this study was to determine sources of intraoperative stress, impact on surgical outcomes, coping strategies, and surgeon interest in stress management training.

Methods: An anonymous survey was electronically distributed to surgeons at a tertiary care hospital. Respondents were asked to rate the perceived impact of 9 stressors on operative performance, identify stress coping strategies, list witnessed stress-related complications, and opine on the perceived need for stress management training.

SAGES research agenda in gastrointestinal and endoscopic surgery: updated results of a Delphi study.

Background: Research in gastrointestinal and endoscopic surgery has witnessed unprecedented growth since the introduction of minimally invasive techniques in surgery. Coordination and focus of research efforts could further advance this rapidly expanding field. The objective of this study was to update the SAGES research agenda for gastrointestinal and endoscopic surgery.

Blend mode reduces unintended thermal injury by laparoscopic monopolar instruments: a randomized controlled trial.

Background: The purpose of this study was to compare histologic evidence of thermal injury at the epigastric and umbilical incisions after elective laparoscopic cholecystectomy performed using the monopolar "Bovie" instrument set on the higher voltage coag mode versus the lower voltage blend mode. We hypothesized that the higher voltage coag mode would create more unintended thermal tissue injury at the epigastric trocar's incision.

Methods: A prospective blinded randomized controlled trial of patients undergoing elective laparoscopic cholecystectomy was performed.

Ergonomic considerations in endoscopic sinus surgery: lessons learned from laparoscopic surgeons.

Background: Endoscopic sinus procedures are increasingly common, and more technically difficult procedures are being undertaken to provide patients with minimally invasive alternatives to traditional open surgical techniques. However, such endoscopic approaches have increasing physical demands on the surgeon. The aim of this review is to summarize current literature on surgical ergonomic principles as they relate to endoscopic sinus and skull base surgery and focus on future needs for our specialty.

Evaluation of an innovative, cordless ultrasonic dissector.

Ultrasonic thermal energy is commonly used for dissection and vessel ligation. This study compared HARMONIC ACE and Sonicision Cordless Ultrasonic Dissector (SCUD). The devices were used in an in vivo porcine model to coagulate 189 arteries up to 5 mm.

Selection, mentorship, and subsequent placement of preliminary residents without a designated categorical position in an academic general surgery residency program.

Background: Academic general surgery residency programs face a reduction in clinical hours for residents at a time of expanding educational material/clinical programs. To meet these challenges, clinical staffing includes additional faculty, physician extenders, or additional residents. Categorical resident expansion is difficult but there is an ample pool of preliminary first year resident (R1) candidates every match week, and this pool is projected to increase markedly as all medical schools have increased enrollment without any real change to the demographics of available categorical residency positions.

Radiofrequency energy antenna coupling to common laparoscopic instruments: practical implications.

Background: Electromagnetic coupling can occur between the monopolar "Bovie" instrument and other laparoscopic instruments without direct contact by a phenomenon termed antenna coupling. The purpose of this study was to determine if, and to what extent, radiofrequency energy couples to other common laparoscopic instruments and to describe practical steps that can minimize the magnitude of antenna coupling.

Methods: In a laparoscopic simulator, monopolar radiofrequency energy was delivered to an L-hook.

Effect of monopolar radiofrequency energy on pacemaker function.

Background: This study aimed to quantify the clinical parameters of mono- and bipolar instruments that inhibit pacemaker function. The specific aims were to quantify pacer inhibition resulting from the monopolar instrument by altering the generator power setting, the generator mode, the distance between the active electrode and the pacemaker, and the location of the dispersive electrode.

Methods: A transvenous ventricular lead pacemaker overdrive paced the native heart rate of an anesthetized pig.

Lysostaphin-coated mesh prevents staphylococcal infection and significantly improves survival in a contaminated surgical field.

Mesh and wound infections during hernia repair are predominantly caused by Staphylococcus aureus. Human acellular dermis (HAD) is known to lose its integrity in the face of large bacterial loads. The goal of this study was to determine if lysostaphin (LS), a naturally occurring anti-Staphylococcal protein, can protect HAD mesh from S.

Simulator training to automaticity leads to improved skill transfer compared with traditional proficiency-based training: a randomized controlled trial.

Objective: We hypothesized that novices will perform better in the operating room after simulator training to automaticity compared with traditional proficiency based training (current standard training paradigm).

Background: Simulator-acquired skill translates to the operating room, but the skill transfer is incomplete. Secondary task metrics reflect the ability of trainees to multitask (automaticity) and may improve performance assessment on simulators and skill transfer by indicating when learning is complete.

Single incision laparoscopic surgery (SILS) is associated with poorer performance and increased surgeon workload compared with standard laparoscopy.

Little is known about the effectiveness and challenges of single incision laparoscopic surgery (SILS). We hypothesized that SILS would lead to decreased performance and increased surgeon workload compared with standard laparoscopy and that the use of angulated instruments during SILS would be beneficial. General surgery residents and fellows (n = 14) voluntarily performed the Fundamentals of Laparoscopic Surgery task 1 (peg transfer) using 1) standard laparoscopic instruments and port position, 2) standard laparoscopic instruments through a SILS port, and 3) angulated instruments through a SILS port in random order.

Reported excess weight loss after bariatric surgery could vary significantly depending on calculation method: a plea for standardization.

Background: The percentage of excess weight loss (%EWL) is a common metric for reporting weight loss after bariatric surgery. The %EWL can vary depending on the definitions of ideal body weight (IBW) used and the preoperative weight. The present study examined the effect of variations in IBW and the preoperative weight on the %EWL at a tertiary care teaching hospital.

Insulation failure in laparoscopic instruments.

Background: Electrosurgery is used in virtually every laparoscopic operation. In the early days of laparoscopic surgery, capacitive coupling, associated with hybrid trocars, was thought to be the major cause of laparoscopic electrosurgery injuries. Modern laparoscopy has reduced capacitive coupling, and now insulation failure is thought to be the main cause of electrosurgical complications.