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Article: Characterizing individual trainee learning curves in surgical training: Challenges and opportunities.

Toale, C / O'Byrne, A / Morris, M / Kavanagh, D O

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

2022 Volume 21, Issue 5, Page(s) 285–288

Abstract: The surgical learning curve is an observable and measurable phenomenon. In the era of competency-based approaches to surgical training, monitoring the trajectory of individual trainee competence attainment could represent a meaningful method of formative ...

Abstract	The surgical learning curve is an observable and measurable phenomenon. In the era of competency-based approaches to surgical training, monitoring the trajectory of individual trainee competence attainment could represent a meaningful method of formative and summative assessment. While technology can assist this approach, a number of significant barriers to the implementation of such assessment methods remain, including: accurate data collection, standard setting, and reliable assessment. Translating individual learning curve data into quantifiable case minimum targets in training poses further difficulties, and may not be possible for all procedures, particularly those that are less frequently performed and assessed. In spite of these challenges, significant benefits could be realized through an individualized approach to competency assessment using trainee learning curve data. Tracking competence acquisition against criterion-referenced standards could allow for targeted training and remediation, conforming with modern theories of adult education and empowering trainees to take control of their own learning. Learning curve data could also be used to assess the effects of educational interventions such as simulation-based training on subsequent competence acquisition rates. Ultimately, the individual learning curves of trainees could be used to inform personalised decisions regarding entrustment, credentialing, and certification, allowing training programmes to move beyond minimum operative experience targets as a crude proxy measure of competence.
MeSH term(s)	Adult ; Humans ; Learning Curve ; Clinical Competence
Language	English
Publishing date	2022-11-26
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/j.surge.2022.11.003
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Article: Small Bowel Gastrointestinal Bleeding Diagnosis and Management-A Narrative Review.

Murphy, B / Winter, D C / Kavanagh, D O

Frontiers in surgery

2019 Volume 6, Page(s) 25

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2019-05-16
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2019.00025
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Article: Emergency laparotomy research methodology: A systematic review.

Nally, D M / Sorensen, J / Kavanagh, D O

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

2019 Volume 18, Issue 2, Page(s) 80–90

Abstract: Background: Emergency abdominal surgery is associated with poorer clinical outcomes than similar procedures in the elective setting. Research into emergency laparotomy (EL) care is moving from observational studies which simply measure EL outcomes to ... ...

Abstract	Background: Emergency abdominal surgery is associated with poorer clinical outcomes than similar procedures in the elective setting. Research into emergency laparotomy (EL) care is moving from observational studies which simply measure EL outcomes to interventional research evaluating the implementation of care strategies designed to improve the quality and outcomes from EL care. There is no consensus as to the optimal approach to conducting research in this sphere. The primary objective of this review was to examine how mortality and other outcome measures were reported in previous EL research and to identify what might be the most appropriate methods in future outcome research. Methods: A systematic review was performed in accordance with the PRISMA principles. Electronic databases were interrogated with a pre-specified search strategy to identify English language studies addressing outcomes from EL care. Retrieved papers were screened and assessed according to pre-defined eligibility criteria. The mortality and other outcomes reported in each paper were extracted and examined. Results: 16 studies were included. They demonstrated significant heterogeneity in case definition, outcome reporting and data processing. A wide range of mortality and other outcome measures were applied and reported. Only few studies included on patient-reported outcomes measures. Conclusion: The heterogeneity in EL research, demonstrated by this review must be considered when EL outcomes are compared. A standardized approach with respect to case definition, outcome measurement, and data analysis would provide for more valid and comparable evaluation of EL outcomes. Future EL research should include more patient centred outcomes.
MeSH term(s)	Biomedical Research ; Emergencies ; Humans ; Laparotomy/methods ; Laparotomy/mortality ; Outcome Assessment, Health Care
Language	English
Publishing date	2019-07-22
Publishing country	Scotland
Document type	Journal Article ; Systematic Review
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/j.surge.2019.06.003
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Article ; Online: Impact of COVID-19 on operative experience of junior surgical trainees.

Joyce, D P / Ryan, D / Kavanagh, D O / Traynor, O / Tierney, S

The British journal of surgery

2021 Volume 108, Issue 1, Page(s) e33–e34

MeSH term(s)	COVID-19/epidemiology ; Clinical Competence ; Elective Surgical Procedures/statistics & numerical data ; Humans ; Internship and Residency/methods ; Ireland/epidemiology ; SARS-CoV-2
Language	English
Publishing date	2021-03-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znaa079
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Article: Close rectal dissection in benign diseases of the rectum: A review.

Nally, D M / Kavanagh, D O / Winter, D C

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

2018 Volume 17, Issue 2, Page(s) 119–126

Abstract: Purpose: Total mesorectal excision (TME) is the gold standard resectional strategy for rectal cancer to minimize loco-regional recurrence and optimize oncological outcomes. This plane is described by many as 'bloodless' but it does contain important ... ...

Abstract	Purpose: Total mesorectal excision (TME) is the gold standard resectional strategy for rectal cancer to minimize loco-regional recurrence and optimize oncological outcomes. This plane is described by many as 'bloodless' but it does contain important pelvic neural plexuses and dissection may be close to the ureters and major vascular structures, particularly in inflammatory conditions of the distal colon and rectum. In such benign diseases a more conservative excision, so-called close rectal dissection, has been advocated to minimize damage to these structures. Methods: A review of the literature was conducted to document the evolution of this procedure. Contemporary literature was interrogated to ascertain how this approach is adopted in minimally invasive surgery. Post-operative outcomes are compared to those from TME surgery. Results: From early descriptions in 1956, this procedure has been adapted for use in laparoscopic surgery. It may be particularly useful in trans-anal mesorectal surgery. Reported benefits include reduced nerve injury and pelvic sepsis. However, this must be balanced against risks of mesorectal bleeding, rectal injury, and ongoing inflammation from the retained mesorectum. Conclusion: Rectal surgery in inflammatory conditions is technically challenging. Close rectal dissection is an alternate approach available to colorectal surgeons in these cases to minimize pelvic morbidity and optimize postoperative outcomes.
MeSH term(s)	Dissection/methods ; Humans ; Mesocolon/surgery ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Proctectomy/adverse effects ; Proctectomy/methods ; Rectal Diseases/surgery
Language	English
Publishing date	2018-07-18
Publishing country	Scotland
Document type	Journal Article ; Review
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/j.surge.2018.06.002
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Article ; Online: Efferent limb stimulation prior to loop ileostomy closure: a systematic review and meta-analysis.

Lloyd, A J / Hardy, N P / Jordan, P / Ryan, E J / Whelan, M / Clancy, C / O'Riordan, J / Kavanagh, D O / Neary, P / Sahebally, S M

Techniques in coloproctology

2023 Volume 28, Issue 1, Page(s) 15

Abstract: Background: Postoperative ileus (POI) remains a common phenomenon following loop ileostomy closure. Our aim was to determine whether preoperative physiological stimulation (PPS) of the efferent limb reduced POI incidence.: Methods: A PRISMA-compliant ...

Abstract	Background: Postoperative ileus (POI) remains a common phenomenon following loop ileostomy closure. Our aim was to determine whether preoperative physiological stimulation (PPS) of the efferent limb reduced POI incidence. Methods: A PRISMA-compliant meta-analysis searching PubMed, EMBASE and CENTRAL databases was performed. The last search was carried out on 30 January 2023. All randomized studies comparing PPS versus no stimulation were included. The primary endpoint was POI incidence. Secondary endpoints included the time to first passage of flatus/stool, time to resume oral diet, need for nasogastric tube (NGT) placement postoperatively, length of stay (LOS) and other complications. Random effects models were used to calculate pooled effect size estimates. Trial sequential analyses (TSA) were also performed. Results: Three randomized studies capturing 235 patients (116 PPS, 119 no stimulation) were included. On random effects analysis, PPS was associated with a quicker time to resume oral diet (MD - 1.47 days, 95% CI - 2.75 to - 0.19, p = 0.02), shorter LOS (MD - 1.47 days, 95% CI - 2.47 to - 0.46, p = 0.004) (MD - 1.41 days, 95% CI - 2.32 to - 0.50, p = 0.002, I2 = 56%) and fewer other complications (OR 0.42, 95% CI 0.18 to 1.01, p = 0.05). However, there was no difference in POI incidence (OR 0.35, 95% CI 0.10 to 1.21, p = 0.10), the requirement for NGT placement (OR 0.50, 95% CI 0.21 to 1.20, p = 0.12) or time to first passage of flatus/stool (MD - 0.60 days, 95% CI - 1.95 to 0.76, p = 0.39). TSA revealed imprecise estimates for all outcomes (except LOS) and further studies are warranted to meet the required information threshold. Conclusions: PPS prior to stoma closure may reduce LOS and postoperative complications albeit without a demonstrable beneficial effect on POI. Further high-powered studies are required to confirm or refute these findings.
MeSH term(s)	Humans ; Ileostomy/adverse effects ; Flatulence/complications ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Ileus/etiology
Language	English
Publishing date	2023-12-14
Publishing country	Italy
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	2083309-X
ISSN	1128-045X ; 1123-6337
ISSN (online)	1128-045X
ISSN	1123-6337
DOI	10.1007/s10151-023-02875-2
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Article ; Online: Early vs. standard reversal ileostomy: a systematic review and meta-analysis.

O'Sullivan, N J / Temperley, H C / Nugent, T S / Low, E Z / Kavanagh, D O / Larkin, J O / Mehigan, B J / McCormick, P H / Kelly, M E

Techniques in coloproctology

2022 Volume 26, Issue 11, Page(s) 851–862

Abstract: Background: Formation of a defunctioning loop ileostomy is common after mid and low rectal resection. Historically, they were reversed between 3 and 6 months after initial resection. Recently, earlier closure (< 14 days) has been suggested by some ... ...

Abstract	Background: Formation of a defunctioning loop ileostomy is common after mid and low rectal resection. Historically, they were reversed between 3 and 6 months after initial resection. Recently, earlier closure (< 14 days) has been suggested by some current randomised controlled trials. The aim of this study was to investigate the effect of early stoma closure on surgical and patient outcomes. Methods: A systematic review of the current randomised controlled trial literature comparing early and standard ileostomy closure after rectal surgery was performed. Specifically, we examined surgical outcomes including; morbidity, mortality and quality of life. Results: Six studies met the predefined criteria and were included in our analysis. 275 patients underwent early stoma closure compared with 259 patients having standard closure. Overall morbidity was similar between both groups (25.5% vs. 21.6%) (OR, 1.47; 95% CI 0.75-2.87). However, there tended to be more reoperations (8.4 vs. 4.2%) (OR, 2.02, 95% CI 0.99-4.14) and small bowel obstructions/postoperative ileus (9.3% vs. 4.4%) (OR 0.44, 95% CI 0.22-0.90) in the early closure group, but no difference across the other domains. Conclusions: Early closure appears to be a feasible in highly selective cases after good perioperative counselling and shared decision-making. Further research on quality of life outcomes and long term benefits is necessary to help define which patients are suitable candidates for early closure.
MeSH term(s)	Humans ; Ileostomy/adverse effects ; Ileostomy/methods ; Ileus ; Postoperative Complications/epidemiology ; Quality of Life ; Randomized Controlled Trials as Topic ; Rectal Neoplasms/surgery
Language	English
Publishing date	2022-05-21
Publishing country	Italy
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	2083309-X
ISSN	1128-045X ; 1123-6337
ISSN (online)	1128-045X
ISSN	1123-6337
DOI	10.1007/s10151-022-02629-6
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Article ; Online: A rare cause of low back pain: report of a tailgut cyst.

Joyce, E A / Kavanagh, D O / Winter, D C

Case reports in medicine

2012 Volume 2012, Page(s) 623142

Abstract: Tailgut cysts, also known as retrorectal cystic hamartomas, are rare developmental abnormalities that typically occur in the retrorectal space. They are believed to arise from remnants of the embryonic hindgut (Hjermstad and Helwig, 1988). They can ... ...

Abstract	Tailgut cysts, also known as retrorectal cystic hamartomas, are rare developmental abnormalities that typically occur in the retrorectal space. They are believed to arise from remnants of the embryonic hindgut (Hjermstad and Helwig, 1988). They can present as incidental findings during routine examination but over half of patients are thought to present with symptoms. MRI has become the modality of choice to image these frequently misdiagnosed cysts. Biopsy is not recommended. Complete intact surgical excision is advised to avoid the potential complications of these cysts which include infection, fistula formation, and the possibility of malignant transformation (Hjermstad and Helwig (1988), Mathis et al. (2010)). We describe the case of a 46-year-old female who presented with a 6-month history of low back pain. CT and MRI imaging demonstrated a complex retrorectal lesion with supralevator and infralevator components. This was removed using a combined transperineal and transabdominal approach. Histology confirmed a tailgut cyst.
Language	English
Publishing date	2012-02-08
Publishing country	United States
Document type	Case Reports
ZDB-ID	2502642-2
ISSN	1687-9635 ; 1687-9627
ISSN (online)	1687-9635
ISSN	1687-9627
DOI	10.1155/2012/623142
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Article: A systematic review of the role of re-laparoscopy in the management of complications following laparoscopic colorectal surgery.

Chang, K H / Bourke, M G / Kavanagh, D O / Neary, P C / O'Riordan, J M

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

2016 Volume 14, Issue 5, Page(s) 287–293

Abstract: The benefits of laparoscopic versus open surgery for patients with both benign and malignant colorectal disease have been well established. Re-laparoscopy in patients who develop complications following laparoscopic colorectal surgery has recently been ... ...

Abstract	The benefits of laparoscopic versus open surgery for patients with both benign and malignant colorectal disease have been well established. Re-laparoscopy in patients who develop complications following laparoscopic colorectal surgery has recently been reported by some groups and the aim of this systematic review was to summarise this literature. A literature search of PubMed, Medline and EMBASE identified a total of 11 studies that reported laparoscopic re-intervention for complications in 187 patients following laparoscopic colorectal surgery. The majority of these patients required re-intervention in the immediate postoperative period (i.e. less than seven days). Anastomotic leakage was the commonest complication requiring re-laparoscopy reported (n = 139). Other complications included postoperative hernia (n = 12), bleeding (n = 9), adhesions (n = 7), small bowel obstruction (n = 4), colonic ischaemia (n = 4), bowel and ureteric injury (n = 3 respectively) and colocutaneous fistula (n = 1). Ninety-seven percent of patients (n = 182) who underwent re-laparoscopy had their complications successfully managed by re-laparoscopy, maintaining the benefits of the laparoscopic approach and avoiding a laparotomy. We conclude that re-laparoscopy for managing complications following laparoscopic colorectal surgery appears to be safe and effective in highly selected patients.
MeSH term(s)	Colonic Diseases/surgery ; Colorectal Surgery/adverse effects ; Evidence-Based Medicine ; Humans ; Laparoscopy/adverse effects ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Postoperative Period ; Rectal Diseases/surgery ; Reoperation ; Risk Factors ; Treatment Outcome
Language	English
Publishing date	2016-10
Publishing country	Scotland
Document type	Journal Article ; Review
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/j.surge.2015.12.003
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Article: Robotic assisted laparoscopic colectomy.

Pandalai, S / Kavanagh, D O / Neary, P

Irish medical journal

2010 Volume 103, Issue 6, Page(s) 181–182

Abstract: Robotic surgery has evolved over the last decade to compensate for limitations in human dexterity. It avoids the need for a trained assistant while decreasing error rates such as perforations. The nature of the robotic assistance varies from voice ... ...

Abstract	Robotic surgery has evolved over the last decade to compensate for limitations in human dexterity. It avoids the need for a trained assistant while decreasing error rates such as perforations. The nature of the robotic assistance varies from voice activated camera control to more elaborate telerobotic systems such as the Zeus and the Da Vinci where the surgeon controls the robotic arms using a console. Herein, we report the first series of robotic assisted colectomies in Ireland using a voice activated camera control system.
MeSH term(s)	Aged ; Aged, 80 and over ; Cholecystectomy, Laparoscopic/instrumentation ; Colectomy/methods ; Colonic Neoplasms/surgery ; Female ; Humans ; Ireland ; Liver Neoplasms/surgery ; Male ; Robotics/instrumentation ; Treatment Outcome
Language	English
Publishing date	2010-06
Publishing country	Ireland
Document type	Case Reports ; Journal Article
ZDB-ID	193134-9
ISSN	0332-3102 ; 0021-129X
ISSN	0332-3102 ; 0021-129X
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