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  1. Article ; Online: Is the robotic revolution stunting surgical skills?

    Lazar, Damien J / Ferzli, George S

    Surgery open science

    2024  Volume 19, Page(s) 63–65

    Abstract: This perspective piece aims to examine the impact of the growing utilization of robotic platforms in general and minimally invasive surgery on surgical trainee experience, skill level, and comfort in performing general surgical and minimally invasive ... ...

    Abstract This perspective piece aims to examine the impact of the growing utilization of robotic platforms in general and minimally invasive surgery on surgical trainee experience, skill level, and comfort in performing general surgical and minimally invasive procedures following completion of training. We review current literature and explore the application of robotic surgery to surgical training, where minimum case thresholds and breadth distribution are well defined, and where development of surgical technique is historically gained through delicate tissue handling with haptic feedback rather than relying on visual feedback alone. We call for careful consideration as to how best to incorporate robotics in surgical training in order to embrace technological advances without endangering the surgical proficiency of the surgeons of tomorrow.
    Key message: The large-scale incorporation of robotics into general and minimally invasive surgical training is something that most, if not all, trainees must grapple with in today's world, and the proportion of robotics is increasing. This shift may significantly negatively affect trainees in terms of surgical skill upon completion of training and must be approached with an appropriate degree of concern and thoughtfulness so as to protect the surgeons of tomorrow.
    Language English
    Publishing date 2024-03-27
    Publishing country United States
    Document type Journal Article
    ISSN 2589-8450
    ISSN (online) 2589-8450
    DOI 10.1016/j.sopen.2024.03.009
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Concussion Prevalence in Competitive Ultimate Frisbee Players.

    Lazar, Damien J / Lichtenstein, Jonathan D / Tybor, David J

    Orthopaedic journal of sports medicine

    2018  Volume 6, Issue 3, Page(s) 2325967118759051

    Abstract: Background: Ultimate Frisbee (ultimate) is a fast-growing, popular sport played nationally by over 4 million athletes. While several studies have examined injury rates in ultimate, no work has investigated the prevalence of concussions specifically or ... ...

    Abstract Background: Ultimate Frisbee (ultimate) is a fast-growing, popular sport played nationally by over 4 million athletes. While several studies have examined injury rates in ultimate, no work has investigated the prevalence of concussions specifically or players' knowledge and management of those injuries.
    Purpose: To estimate the lifetime prevalence of concussions in ultimate and to assess players' knowledge of concussions as well as their concussion management behaviors.
    Study design: Descriptive epidemiology study.
    Methods: From June to November 2015, we collected ultimate-related concussion data via an anonymous web-based survey, the Concussion in Ultimate Frisbee Survey, from a convenience sample of 787 male and female ultimate players across the United States.
    Results: There were 553 male and 234 female respondents included in the analysis; 26.58% of men and 24.79% of women reported that they had sustained at least 1 concussion while playing ultimate, with 45.58% and 43.10% of those men and women, respectively, reporting multiple concussions. A total of 67.81% of men and 78.21% of women stated that they would remove themselves from play after sustaining a given concussion, although 45.99% of men and 37.62% of women indicated that they had returned to play in the same game or practice.
    Conclusion: Our preliminary data suggest that concussions do commonly occur in competitive ultimate and that better education and management of concussions in ultimate athletes are needed. This study is an important first step in deepening our understanding of these issues.
    Language English
    Publishing date 2018-03-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2706251-X
    ISSN 2325-9671
    ISSN 2325-9671
    DOI 10.1177/2325967118759051
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  3. Article ; Online: Early Ambulation is Associated with Improved Outcomes Following Colorectal Surgery.

    Rosowicz, Andrew / Brody, Jason S / Lazar, Damien J / Bangla, Venu G / Panahi, Armon / Nobel, Tamar B / Dexter-Meldrum, Jacob / Divino, Celia M

    The American surgeon

    2022  Volume 89, Issue 12, Page(s) 5225–5233

    Abstract: Background: The Enhanced Recovery After Surgery (ERAS) society lists early mobilization as one of their recommendations for improving patient outcomes following colorectal surgery. The level of supporting evidence, however, is relatively weak, and ... ...

    Abstract Background: The Enhanced Recovery After Surgery (ERAS) society lists early mobilization as one of their recommendations for improving patient outcomes following colorectal surgery. The level of supporting evidence, however, is relatively weak, and furthermore, the ERAS guidelines do not clearly define "early" mobilization. In this study, we define mobilization in terms of time to first ambulation after surgery and develop an outcome-based cutoff for early mobilization.
    Methods: This is a retrospective cohort study comprised of 291 patients who underwent colorectal operations at a large, academic medical center from June to December 2019. Three cutoffs (12 hours, 24 hours, and 48 hours) were used to divide patients into early and late ambulation groups for each cutoff, and statistical analysis was performed to determine differences in postoperative outcomes between the corresponding groups.
    Results: Multivariate analysis showed no difference between the early and late ambulation groups for the 12-hour and 48-hour cutoffs; however, ambulation before 24 hours was associated with a decreased rate of severe complications as well as fewer adverse events overall. Patients who ambulated within 24 hours had a 4.1% rate of severe complications and a 22.1% rate of experiencing some adverse event (complication, return to the emergency department, and/or readmission). In comparison, 11.8% of patients who ambulated later experienced a severe complication (
    Conclusions: Ambulation within 24 hours after colorectal surgery is associated with improved postoperative outcomes, particularly a decreased rate of severe complications.
    MeSH term(s) Humans ; Early Ambulation ; Retrospective Studies ; Colorectal Surgery ; Postoperative Complications/epidemiology ; Digestive System Surgical Procedures
    Language English
    Publishing date 2022-11-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 202465-2
    ISSN 1555-9823 ; 0003-1348
    ISSN (online) 1555-9823
    ISSN 0003-1348
    DOI 10.1177/00031348221142590
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  4. Article ; Online: Variations in postoperative opioid prescribing by day of week and duration of hospital stay.

    Lazar, Damien J / Zaveri, Shruti / Khetan, Prerna / Nobel, Tamar B / Divino, Celia M

    Surgery

    2020  Volume 169, Issue 4, Page(s) 929–933

    Abstract: Background: Studies demonstrate wide variation in postoperative opioid prescribing and that patients are at risk of chronic opioid abuse after surgery. The factors that influence prescribing, however, remain obscure. This study investigates whether day ... ...

    Abstract Background: Studies demonstrate wide variation in postoperative opioid prescribing and that patients are at risk of chronic opioid abuse after surgery. The factors that influence prescribing, however, remain obscure. This study investigates whether day of the week or the postoperative day at the time of discharge impacts prescribing patterns.
    Methods: We identified patients who underwent commonly performed procedures at our institution from January 2014 through April 2019 and analyzed the relationship between postoperative opioids prescribed (oral morphine milligram equivalents) and both the day of the week and the postoperative day at discharge.
    Results: In ambulatory operations (n = 13,545), each day progressing from Monday was associated with increased morphine milligram equivalents prescribed on discharge (P = .0080). For inpatient cases (n = 10,838), surgeons prescribed more morphine milligram equivalents at discharge in the latter half of the week and during the weekend (P = .0372). Every additional postoperative day at discharge was associated with a +19.25 morphine milligram equivalent prescribed (P < .0001).
    Conclusion: More opioids were prescribed on discharges later in the week and after prolonged hospital stays perhaps to avoid patients running out of medication. Providers may unintentionally allow such non-clinical factors to influence postoperative opioid prescribing. Increased awareness of these inadvertent biases may help decrease excess prescribing of potentially addicting opioids after an operation.
    MeSH term(s) Adult ; Aged ; Analgesics, Opioid/administration & dosage ; Drug Prescriptions/statistics & numerical data ; Duration of Therapy ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Opioid-Related Disorders/epidemiology ; Opioid-Related Disorders/etiology ; Pain Management ; Pain, Postoperative/drug therapy ; Pain, Postoperative/epidemiology ; Postoperative Care ; Practice Patterns, Physicians' ; Risk Factors
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2020-07-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 202467-6
    ISSN 1532-7361 ; 0039-6060
    ISSN (online) 1532-7361
    ISSN 0039-6060
    DOI 10.1016/j.surg.2020.05.047
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Uk I Zs.129: Show issues Location:
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  5. Article ; Online: Long-Term Patient-Reported Outcomes of Paraesophageal Hernia Repair.

    Lazar, Damien J / Birkett, Desmond H / Brams, David M / Ford, Heather A / Williamson, Christina / Nepomnayshy, Dmitry

    JSLS : Journal of the Society of Laparoendoscopic Surgeons

    2017  Volume 21, Issue 4

    Abstract: Background and objectives: There is a lack of consensus on the optimal repair technique and the definition of good outcomes in paraesophageal hernia (PEH) repair. We reviewed long-term patient-reported outcomes of open and laparoscopic PEH repair to ... ...

    Abstract Background and objectives: There is a lack of consensus on the optimal repair technique and the definition of good outcomes in paraesophageal hernia (PEH) repair. We reviewed long-term patient-reported outcomes of open and laparoscopic PEH repair to assist with our future surgical consent process.
    Methods: This was a retrospective case-control study including all patients with PEH repair performed from 2000 through 2012 at a single center without the use of mesh. We mailed questionnaires to patients to assess reoperation, symptom control, and satisfaction.
    Results: Chart review identified 217 patients who underwent PEH repair. Nineteen died during the follow-up period. Of the 106 returning the questionnaire, 87 underwent laparoscopic repair, and 19 had open repair, with follow-up of 6.6 (SD 3.9) years and 7.0 (SD 4.1) years, respectively. Reoperation rates were 9.9% and 5.3%, respectively (
    Conclusions: Long-term patient-specific outcomes showed comparable, encouraging results between open and laparoscopic repair of PEH without mesh reinforcement. However, half of those undergoing laparoscopic repair required the use of medication for symptom control. This study adds to the literature describing long-term patient-specific outcomes and can be useful when counseling patients about PEH repair.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Female ; Follow-Up Studies ; Hernia, Hiatal/surgery ; Herniorrhaphy/methods ; Humans ; Laparoscopy ; Male ; Middle Aged ; Patient Reported Outcome Measures ; Patient Satisfaction ; Reoperation/statistics & numerical data ; Retrospective Studies ; Young Adult
    Language English
    Publishing date 2017-11-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2011211-7
    ISSN 1938-3797 ; 1086-8089
    ISSN (online) 1938-3797
    ISSN 1086-8089
    DOI 10.4293/JSLS.2017.00052
    Database MEDical Literature Analysis and Retrieval System OnLINE

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