The Impact of Interactions with Nonsurgical Staff on the Surgical Resident Experience in the Nonoperative Clinical Learning Environment: A Qualitative Study.

Objective: Residents interact, collaborate with, and learn from nurses, advanced practice providers, and physicians in multiple specialties. Both positive and negative experiences in the clinical workspace can affect residents' well-being, their ability to learn, and their development into effective, independent physicians. The aim of this study is to evaluate the general surgery resident experience in the nonsurgical clinical learning environment to identify how interactions outside of the operating room affect resident well-being and their ability to learn.

Characterizing patterns of opioid prescribing after outpatient ventral hernia repair with mesh.

Purpose: Despite efforts to minimize opioid prescribing, outpatient ventral hernia repair (VHR) with mesh remains notoriously painful, often requiring postoperative opioid analgesia. Here, we aim to characterize patterns of opioid prescribing for the heterogenous group of patients and procedures that comprise mesh-based, outpatient VHR.

Methods: The Abdominal Core Health Quality Collaborative registry was queried for patients undergoing VHR with mesh who were discharged the same or next day between January 2019 to October 2023.

General surgery resident robotic training curriculum: evaluation six years after implementation.

Background: The surge of robotic surgery over the last decade emphasizes the need for a robotics curriculum during general surgery residency. We hypothesized that the implementation of a robotic surgery resident training curriculum would have a positive impact on the general surgery residency experience during and post-graduation.

Materials/methods: Current post-graduate year 1 through 5 residents and previously graduated residents were surveyed regarding their robotic curriculum experience during residency and post-graduation.

Current status of resident simulation training curricula: pearls and pitfalls.

Background: Residency programs are required to incorporate simulation into their training program. Ideally, simulation provides a safe environment for a trainee to be exposed to both common and challenging clinical scenarios. The purpose of this review is to detail the current state of the most commonly used laparoscopic, endoscopic, and robotic surgery simulation programs in general surgery residency education, including resources required for successful implementation and benchmarks for evaluation.

Identifying the optimal STOP-Bang screening score for obstructive sleep apnea among bariatric surgery patients.

Background: Undiagnosed obstructive sleep apnea (OSA) increases the risk of perioperative complications in bariatric patients. Validated screening methods exist, but are not specific to patients with severe obesity.

Objectives: Determine the ideal OSA screening tool for bariatric surgery patients balancing accuracy and cost-effectiveness.

Robotic Repair: An Alternative Technique for Rectus Diastasis and Abdominal Bulge Following DIEP Flap Breast Reconstruction.

Background: The deep inferior epigastric artery perforator (DIEP) flap is the gold standard in autologous breast reconstruction. Despite advances in perforator dissection, abdominal morbidity still occurs. Traditional rectus diastasis (RD), abdominal bulge, and hernia repair with open techniques are associated with higher complication rates and recurrence.

Bariatric Surgeon Ergonomics: A Comparison of Laparoscopy and Robotics.

Introduction: Bariatric surgery is routinely performed using laparoscopic and robotic approaches. Musculoskeletal injuries are prevalent among both robotic and laparoscopic bariatric surgeons. Studies evaluating ergonomic differences between laparoscopic and robotic bariatric surgery are limited.

The Association of Preoperative Food Insecurity With Early Postoperative Outcomes After Bariatric Surgery.

Introduction: To assess the rate of food insecurity in patients undergoing bariatric surgery. To compare the rates of 30-d postoperative complications based on food security status.

Methods: Patients undergoing primary Roux-en-Y gastric bypass or sleeve gastrectomy between 7/2020 - 3/2022 were screened for food insecurity via telephone using questions from the Accountable Health Communities Health-Related Social Needs Screening Tool.

The Minimally Invasive Inguinal Hernia: Current Trends and Considerations.

Inguinal hernias are one of the most common surgical pathologies faced by the general surgeon in modern medicine. The cumulative incidence of an inguinal hernia is around 25% in men and 3% in women. The majority of inguinal hernias can be repaired minimally invasively, utilizing either robotic or laparoscopic approaches.

Gender Disparities in General Surgery Resident Subspecialization.

Background: There are an increasing number of women entering medical school and general surgery residency. Despite this, there remains an underrepresentation of women in some surgical specialties. The purpose of this study is to examine gender differences in fellowship subspecialization of recent general surgery graduates.

Preparing for and passing the fundamentals of laparoscopic surgery (FLS) exam improves general surgery resident operative performance and autonomy.

Background: The American Board of Surgery made the Fundamentals of Laparoscopic Surgery (FLS) exam a prerequisite for board certification in 2009. Some residency programs have questioned the need for a continued FLS testing mandate given limited evidence that supports the impact of FLS on intraoperative skills. The Society for Improving Medical Professional Learning (SIMPL) app is a tool to evaluate resident intraoperative performance.

Effectiveness of Body Mass Index-Based Prophylactic Enoxaparin Dosing in Bariatric Surgery Patients.

Introduction: Enoxaparin is administered for venous thromboembolic (VTE) prophylaxis in bariatric surgery patients. There is concern whether body mass index (BMI)-based enoxaparin dosing consistently achieves prophylactic targets in patients with severe obesity.

Methods: This retrospective study included patients who underwent bariatric surgery at an academic medical center from Jan 2015-May 2021 and had an anti-Xa level drawn 2.

Medical students and mattering on the surgery clerkship rotation.

Background: Mattering is a psychosocial construct that describes an individual's perception that they make a difference in the lives of others and that they are significant in the world. The purpose of this study was to explore the current perception of behaviors that impact mattering among third year medical students on their surgery clerkship with the goal of improving the clerkship experience.

Methods: A qualitative interview study was conducted during the 2019-2020 academic year.

Robotic simulation: validation and qualitative assessment of a general surgery resident training curriculum.

Background: The da Vinci skills simulation curriculum has been validated in the literature. The updated simulator, SimNow, features restructured exercises that have not been formally validated. The purpose of this study is to validate the SimNow resident robotic basic simulation curriculum.

Auto-diuresis Predicts Return of Bowel Function.

Purpose: Feeding a ventral hernia repair (VHR) patient before the return of bowel function (ROBF) can lead to distention and emesis. Many patients spontaneously diurese after surgery. We hypothesized that this auto-diuresis would signal ROBF.

Implementation of a standardized multimodal pain regimen significantly reduces postoperative inpatient opioid utilization in patients undergoing bariatric surgery.

Background: Routine opioid use in surgical patients has received attention given the opioid epidemic and a renewed focus on the dangers and drawbacks of opioids in the postoperative setting. Little is known about opioid use in bariatric surgery, especially in the inpatient setting. We hypothesize that a standardized opioid-sparing protocol reduces postoperative inpatient opioid use in bariatric surgery patients.

Enhancing robotic efficiency through the eyes of robotic surgeons: sub-analysis of the expertise in perception during robotic surgery (ExPeRtS) study.

Background: Robotic technology affords surgeons many novel and useful features, but two stereotypes continue to prevail: robotic surgery is expensive and inefficient. To identify educational opportunities and improve operative efficiency, we analyzed expert commentary on videos of robotic surgery.

Methods: Expert robotic surgeons, identified through high case volumes and contributions to the surgical literature, reviewed eight anonymous video clips portraying key portions of two robotic general surgery procedures.

Laparoscopic versus robotic inguinal hernia repair: 1- and 2-year outcomes from the RIVAL trial.

Introduction: Robotic inguinal hernia repair is growing in popularity among general surgeons despite little high-quality evidence supporting short- or long-term advantages over traditional laparoscopic inguinal hernia repair. The original RIVAL trial showed increased operative time, cost, and surgeon frustration for the robotic approach without advantages over laparoscopy. Here we report the 1- and 2-year outcomes of the trial.

Transversus abdominis plane blocks for complex abdominal wall reconstruction decrease hospital length of stay compared to epidurals.

Background: Complex abdominal wall reconstruction for ventral and incisional hernias can be quite painful with prolonged length of stay (LOS). There are a variety of options to manage post-operative pain after a ventral hernia repair, including epidural catheters, transversus abdominis plane (TAP) blocks, and intravenous narcotic pain medications (IVPM). We hypothesized that TAP blocks with liposomal bupivacaine decrease the LOS compared to epidurals and IVPM.

Robotic surgery training curricula: prevalence, perceptions, and educational experiences in general surgery residency programs.

Background: Utilization of robotics in general surgery has increased exponentially in the past decade. The purpose of this study was to provide an updated analysis of the prevalence of robotic training curricula among general surgery residency programs across the United States.

Methods: A 19-item survey was distributed to program directors of the Association of Program Directors in Surgery email list.

The evolution of the general surgery resident operative case experience in the era of robotic surgery.

Background: Robotic-assisted general surgery procedures are becoming commonplace, requiring more residency programs to establish training curricula for residents. Concerns exist regarding the impact this will have on surgical residents' operative case distribution in laparoscopic and open surgery. This study aimed to analyze the impact of a growing robotic operative case volume and established robotic surgery training curriculum on the general surgery resident operative experience.

Robotic-assisted Resection of a Diaphragmatic Metastasis of a Gastrointestinal Stromal Tumor.

Gastrointestinal stromal tumors (GISTs) are relatively rare mesenchymal tumors. The treatment of these tumors has drastically changed based on molecular treatment methods, namely tyrosine kinase inhibitors, which have led to impressive survival benefits. While medical management has enhanced patient outcomes, surgery is still the standard of care for stable, completely resectable primary tumors or metastases that are >2 cm.

The Impact of Hemoglobin A1c on Post-operative Outcomes in Bariatric Surgery Patients.

Introduction: Pre-operative hemoglobin (Hb) A1c levels ≥ 8% can lead to increased post-operative complications. In bariatric surgery patients, attaining a pre-operative HbA1c < 8% can be a challenge. The purpose of this study was to identify the association of pre-operative HbA1c on post-operative outcomes in bariatric surgery patients.