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  1. Article ; Online: Management Strategies for Malignant Left-Sided Colonic Obstruction: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials and Propensity Score Matching Studies.

    McHugh, Fiachra T / Ryan, Éanna J / Ryan, Odhrán K / Tan, Jonavan / Boland, Patrick A / Whelan, Maria C / Kelly, Michael E / McNamara, Deirdre / Neary, Paul C / O'Riordan, James M / Kavanagh, Dara O

    Diseases of the colon and rectum

    2024  

    Abstract: Background: The optimal treatment strategy for left-sided malignant colonic obstruction remains controversial. Emergency colonic resection has been the standard of care; however, self-expanding metallic stenting as a bridge to surgery may offer short- ... ...

    Abstract Background: The optimal treatment strategy for left-sided malignant colonic obstruction remains controversial. Emergency colonic resection has been the standard of care; however, self-expanding metallic stenting as a bridge to surgery may offer short-term advantages, although oncological concerns exist. Decompressing stoma may provide a valid alternative, with limited evidence.
    Objective: To perform a systematic review and Bayesian arm random effects model network meta-analysis comparing the approaches for management of malignant left-sided colonic obstruction.
    Data sources: A systematic review was conducted from inception to August 22, 2023, of PubMed, Embase, Cochrane Library, and Google Scholar databases.
    Study selection: Randomized controlled trials and propensity score matched studies.
    Interventions: Emergency colonic resection, self-expanding metallic stent, decompressing stoma.
    Main outcome measures: Oncologic efficacy, morbidity, successful minimally invasive surgery, primary anastomosis, and permanent stoma rates.
    Results: Nineteen articles from 5225 identified met our inclusion criteria. Stenting (risk ratio 0.57, 95% credible interval: 0.33, 0.79) and decompressing stomas (risk ratio 0.46, 95% credible interval: 0.18, 0.92) both resulted in a significant reduction in the permanent stoma rate. Stenting facilitated minimally invasive surgery more frequently (risk ratio 4.10, 95% credible interval: 1.45, 13.13) and had lower overall morbidity (risk ratio 0.58, 95% credible interval: 0.35, 0.86). A pairwise analysis of primary anastomosis rates showed an increase in stenting (risk ratio 1.40, 95% credible interval: 1.31, 1.49) as compared with emergency resection. There was a significant decrease in the 90-day mortality with stenting (risk ratio 0.63, 95% credible interval: 0.41, 0.95) when compared with resection. There were no differences in disease-free and overall survival rates, respectively.
    Limitations: There is a lack of randomized controlled trial and propensity score matching data comparing short and long-term outcomes for diverting stomas compared to self-expanding metallic stents. Two trials compared self-expanding metallic stents and diverting stomas in left-sided malignant colonic obstruction.
    Conclusion: This study provides high-level evidence that bridge-to-surgery strategy is safe for the management of left-sided malignant colonic obstruction, and may facilitate minimally invasive surgery, increase primary anastomosis rates, and reduce permanent stoma rates and postoperative morbidity as compared to emergency colonic resection.
    Language English
    Publishing date 2024-04-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1097/DCR.0000000000003256
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  2. Article ; Online: Comparison of Restorative Proctocolectomy with and Without Defunctioning Loop Ileostomy in Patients with Ulcerative Colitis: A Systematic Review and Meta-analysis.

    Donnelly, Mark / Ryan, Odhrán K / Ryan, Éanna J / Bass, Gary A / Kelly, Michael E / McNamara, Deirdre / Whelan, Maria / Neary, Paul C / O'Riordan, James M / Kavanagh, Dara O

    Journal of Crohn's & colitis

    2023  Volume 17, Issue 6, Page(s) 876–895

    Abstract: Background: Restorative proctocolectomy [RPC] without a defunctioning loop ileostomy [DLI] in patients with ulcerative colitis [UC] remains controversial.: Aim: To compare safety and efficacy of RPC with and without DLI in patients exclusively with ... ...

    Abstract Background: Restorative proctocolectomy [RPC] without a defunctioning loop ileostomy [DLI] in patients with ulcerative colitis [UC] remains controversial.
    Aim: To compare safety and efficacy of RPC with and without DLI in patients exclusively with UC.
    Methods: A systematic review was performed according to PRISMA/MOOSE guidelines. Dichotomous variables were pooled as odds ratios [OR]. Continuous variables were pooled as weighted mean differences [WMD]. Quality assessment was performed using the Newcastle-Ottawa score [NOS].
    Results: A total of 20 studies [five paediatric and 15 adult] with 4550 UC patients [without DLI, n = 2370, 52.09%; with DLI, n = 2180, 47.91%] were eligible for inclusion. The median NOS was 8 [range 6-9]. There was no increased risk of anastomotic leak [AL] (OR 1.13, 95% confidence interval [CI]: 0.92, 1.39; p = 0.25), pouch excision [OR 1.01, 95% CI: 0.68, 1.50; p = 0.97], or overall major morbidity [OR 1.44, 95% CI, 0.91, 2.29; p = 0.12] for RPC without DLI, and this technique was associated with fewer anastomotic strictures [OR 0.45, 95% CI: 0.29, 0.68; p = 0.0002] and less bowel obstruction [OR 0.73, 95% CI: 0.57, 0.93; p = 0.01]. However, RPC without DLI increased the likelihood of pelvic sepsis [OR 1.68, 95% CI: 1.03, 2.75; p = 0.04] and emergency reoperation [OR 1.74, 95% CI: 1.22, 2.50; p = 0.002].
    Conclusion: RPC without DLI is not associated with increased clinically overt AL or pouch excision rates. However, it is associated with increased risk of pelvic sepsis and emergency reoperation. RPC without DLI is feasible, but should only be performed judiciously in select UC patient cohorts in high-volume, specialist, tertiary centres.
    MeSH term(s) Humans ; Proctocolectomy, Restorative/adverse effects ; Proctocolectomy, Restorative/methods ; Ileostomy/adverse effects ; Colitis, Ulcerative/complications ; Anastomotic Leak/etiology ; Sepsis/etiology ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery
    Language English
    Publishing date 2023-02-28
    Publishing country England
    Document type Meta-Analysis ; Systematic Review ; Journal Article
    ZDB-ID 2390120-2
    ISSN 1876-4479 ; 1873-9946
    ISSN (online) 1876-4479
    ISSN 1873-9946
    DOI 10.1093/ecco-jcc/jjad021
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  3. Article ; Online: Mechanical bowel preparation and antibiotics in elective colorectal surgery: network meta-analysis.

    Tan, Jonavan / Ryan, Éanna J / Davey, Matthew G / McHugh, Fiachra T / Creavin, Ben / Whelan, Maria C / Kelly, Michael E / Neary, Paul C / Kavanagh, Dara O / O'Riordan, James M

    BJS open

    2023  Volume 7, Issue 3

    Abstract: Background: The use of intravenous antibiotics at anaesthetic induction in colorectal surgery is the standard of care. However, the role of mechanical bowel preparation, enemas, and oral antibiotics in surgical site infection, anastomotic leak, and ... ...

    Abstract Background: The use of intravenous antibiotics at anaesthetic induction in colorectal surgery is the standard of care. However, the role of mechanical bowel preparation, enemas, and oral antibiotics in surgical site infection, anastomotic leak, and other perioperative outcomes remains controversial. The aim of this study was to determine the optimal preoperative bowel preparation strategy in elective colorectal surgery.
    Methods: A systematic review and network meta-analysis of RCTs was performed with searches from PubMed/MEDLINE, Scopus, Embase, and the Cochrane Central Register of Controlled Trials from inception to December 2022. Primary outcomes included surgical site infection and anastomotic leak. Secondary outcomes included 30-day mortality rate, ileus, length of stay, return to theatre, other infections, and side effects of antibiotic therapy or bowel preparation.
    Results: Sixty RCTs involving 16 314 patients were included in the final analysis: 3465 (21.2 per cent) had intravenous antibiotics alone, 5268 (32.3 per cent) had intravenous antibiotics + mechanical bowel preparation, 1710 (10.5 per cent) had intravenous antibiotics + oral antibiotics, 4183 (25.6 per cent) had intravenous antibiotics + oral antibiotics + mechanical bowel preparation, 262 (1.6 per cent) had intravenous antibiotics + enemas, and 1426 (8.7 per cent) had oral antibiotics + mechanical bowel preparation. With intravenous antibiotics as a baseline comparator, network meta-analysis demonstrated a significant reduction in total surgical site infection risk with intravenous antibiotics + oral antibiotics (OR 0.47 (95 per cent c.i. 0.32 to 0.68)) and intravenous antibiotics + oral antibiotics + mechanical bowel preparation (OR 0.55 (95 per cent c.i. 0.40 to 0.76)), whereas oral antibiotics + mechanical bowel preparation resulted in a higher surgical site infection rate compared with intravenous antibiotics alone (OR 1.84 (95 per cent c.i. 1.20 to 2.81)). Anastomotic leak rates were lower with intravenous antibiotics + oral antibiotics (OR 0.63 (95 per cent c.i. 0.44 to 0.90)) and intravenous antibiotics + oral antibiotics + mechanical bowel preparation (OR 0.62 (95 per cent c.i. 0.41 to 0.94)) compared with intravenous antibiotics alone. There was no significant difference in outcomes with mechanical bowel preparation in the absence of intravenous antibiotics and oral antibiotics in the main analysis.
    Conclusion: A bowel preparation strategy with intravenous antibiotics + oral antibiotics, with or without mechanical bowel preparation, should represent the standard of care for patients undergoing elective colorectal surgery.
    MeSH term(s) Humans ; Anti-Bacterial Agents/therapeutic use ; Surgical Wound Infection/prevention & control ; Anastomotic Leak/etiology ; Anastomotic Leak/prevention & control ; Colorectal Surgery/adverse effects ; Colorectal Surgery/methods ; Network Meta-Analysis ; Preoperative Care/methods
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2023-05-30
    Publishing country England
    Document type Systematic Review ; Meta-Analysis ; Journal Article
    ISSN 2474-9842
    ISSN (online) 2474-9842
    DOI 10.1093/bjsopen/zrad040
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  4. Article ; Online: Conservative surgery versus colorectal resection for endometriosis with rectal involvement: a systematic review and meta-analysis of surgical and long-term outcomes.

    O'Brien, Luke / Morarasu, Stefan / Morarasu, Bianca Codrina / Neary, Paul C / Musina, Ana Maria / Velenciuc, Natalia / Roata, Cristian Ene / Dimofte, Mihail Gabriel / Lunca, Sorinel / Raimondo, Diego / Seracchioli, Renato / Casadio, Paolo / Clancy, Cillian

    International journal of colorectal disease

    2023  Volume 38, Issue 1, Page(s) 55

    Abstract: Purpose: The optimal surgical approach for removal of colorectal endometrial deposits is unclear. Shaving and discoid excision of colorectal deposits allow organ preservation but risk recurrence with associated functional issues and re-operation. Formal ...

    Abstract Purpose: The optimal surgical approach for removal of colorectal endometrial deposits is unclear. Shaving and discoid excision of colorectal deposits allow organ preservation but risk recurrence with associated functional issues and re-operation. Formal resection risks potential higher complications but may be associated with lower recurrence rates. This meta-analysis compares peri-operative and long-term outcomes between conservative surgery (shaving and disc excision) versus formal colorectal resection.
    Methods: The study was registered with PROSPERO. A systematic search was performed on PubMed and EMBASE databases. All comparative studies examining surgical outcomes in patients that underwent conservative surgery versus colorectal resection for rectal endometrial deposits were included. The two main groups (conservative versus resection) were compared in three main blocks of variables including group comparability, operative outcomes and long-term outcomes.
    Results: Seventeen studies including 2861 patients were analysed with patients subdivided by procedure: colorectal resection (n = 1389), shaving (n = 703) and discoid excision (n = 742). When formal colorectal resection was compared to conservative surgery there was lower risk of recurrence (p = 0.002), comparable functional outcomes (minor LARS, p = 0.30, major LARS, p = 0.54), similar rates of postoperative leaks (p = 0.22), pelvic abscesses (p = 0.18) and rectovaginal fistula (p = 0.92). On subgroup analysis, shaving had the highest recurrence rate (p = 0.0007), however a lower rate of stoma formation (p < 0.00001) and rectal stenosis (p = 0.01). Discoid excision and formal resection were comparable.
    Conclusion: Colorectal resection has a significantly lower recurrence rate compared to shaving. There is no difference in complications or functional outcomes between discoid excision and formal resection and both have similar recurrence rates.
    MeSH term(s) Female ; Humans ; Endometriosis/surgery ; Reoperation ; Rectovaginal Fistula ; Abdominal Abscess ; Colorectal Neoplasms
    Language English
    Publishing date 2023-02-27
    Publishing country Germany
    Document type Meta-Analysis ; Systematic Review ; Journal Article
    ZDB-ID 84975-3
    ISSN 1432-1262 ; 0179-1958
    ISSN (online) 1432-1262
    ISSN 0179-1958
    DOI 10.1007/s00384-023-04352-6
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    Zs.A 2121: Show issues Location:
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  5. Article ; Online: Obesity, Sarcopenia and Myosteatosis: Impact on Clinical Outcomes in the Operative Management of Crohn's Disease.

    Donnelly, Mark / Driever, Dorothee / Ryan, Éanna J / Elliott, Jessie A / Finnegan, John / McNamara, Deirdre / Murphy, Ian / Conlon, Kevin C / Neary, Paul C / Kavanagh, Dara O / O'Riordan, James M

    Inflammatory bowel diseases

    2023  

    Abstract: Background: Obesity, sarcopenia, and myosteatosis in inflammatory bowel disease may confer negative outcomes, but their prevalence and impact among patients with Crohn's disease (CD) have not been systematically studied. The aim of this study was to ... ...

    Abstract Background: Obesity, sarcopenia, and myosteatosis in inflammatory bowel disease may confer negative outcomes, but their prevalence and impact among patients with Crohn's disease (CD) have not been systematically studied. The aim of this study was to assess nutritional status and body composition among patients undergoing resectional surgery for CD and determine impact on operative outcomes.
    Methods: Consecutive patients with CD undergoing resection from 2000 to 2018 were studied. Total, subcutaneous, and visceral fat areas and lean tissue area (LTA) and intramuscular adipose tissue (IMAT) were determined preoperatively by computed tomography at L3 using SliceOmatic (Tomovision, Canada). Univariable and multivariable linear, logistic, and Cox proportional hazards regression were performed.
    Results: One hundred twenty-four consecutive patients were studied (ileocolonic disease 53%, n = 62, biologic therapy 34.4% n = 43). Mean fat mass was 22.7 kg, with visceral obesity evident in 23.9% (n = 27). Increased fat stores were associated with reduced risk of emergency presentation but increased corticosteroid use (β 9.09, standard error 3.49; P = .011). Mean LBM was 9.9 kg. Sarcopenia and myosteatosis were associated with impaired baseline nutritional markers. Myosteatosis markers IMAT (P = .002) and muscle attenuation (P = .0003) were associated with increased grade of complication. On multivariable analysis, IMAT was independently associated with increased postoperative morbidity (odds ratio [OR], 1.08; 95% confidence interval (CI), 1.01-1.16; P = .037) and comprehensive complications index (P = .029). Measures of adiposity were not associated with overall morbidity; however, increased visceral fat area independently predicted venous thromboembolism (OR, 1.02; 95% CI, 1.00-1.05; P = .028), and TFA was associated with increased wound infection (OR, 1.00; 95% CI, 1.00-1.01; P = .042) on multivariable analysis.
    Conclusion: Myosteatosis is associated with nutritional impairment and predicts increased overall postoperative morbidity following resection for CD. Despite its association with specific increased postoperative risks, increased adiposity does not increase overall morbidity, reflecting preservation of nutritional status and relatively more quiescent disease phenotype. Impaired muscle mass and function represent an appealing target for patient optimization to improve outcomes in the surgical management of CD.
    Language English
    Publishing date 2023-10-20
    Publishing country England
    Document type Journal Article
    ZDB-ID 1340971-2
    ISSN 1536-4844 ; 1078-0998
    ISSN (online) 1536-4844
    ISSN 1078-0998
    DOI 10.1093/ibd/izad225
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    Zs.A 4530: Show issues Location:
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  6. Article ; Online: Robotic versus laparoscopic anterior resections for rectal and rectosigmoid cancer: an institutional experience.

    Donlon, Noel E / Nugent, Tim S / Free, Ross / Hafeez, Adnan / Kalbassi, Resa / Neary, Paul C / O'Riordain, Diarmuid S

    Irish journal of medical science

    2021  Volume 191, Issue 2, Page(s) 845–851

    Abstract: Introduction: Colorectal surgery has evolved with the advent of laparoscopic techniques and now robotic-assisted surgery. There is significant literature supporting the use of laparoscopic techniques over open surgery with evidence of enhanced post- ... ...

    Abstract Introduction: Colorectal surgery has evolved with the advent of laparoscopic techniques and now robotic-assisted surgery. There is significant literature supporting the use of laparoscopic techniques over open surgery with evidence of enhanced post-operative recovery, reduced use of opioids, smaller incisions and equivalent oncological outcomes. Robotic minimally invasive surgery addresses some of the limitations of laparoscopic surgery, providing surgical precision and improvements in perception and dexterity with a resulting decrease in tissue damage.
    Methods: We retrospectively reviewed the medical records of patients who underwent robotic-assisted anterior resection for cancer of the rectum or rectosigmoid junction in our institution since our robotic programme began in 2017. Patient demographics were identified via electronic databases and patient charts. A matched cohort of laparoscopic cases was identified.
    Results: A total of 51 consecutive robotic-assisted anterior resections were identified and case matched with laparoscopic resections for comparison. Robotic-assisted surgery was associated with a shorter length of stay (p = 0.04), reduced initial post-operative analgesia requirements (p < 0.01) and no significant difference in time to bowel movement or stoma functioning (p = 0.84). All patients had an R0 resection, and there was no statistical difference in lymph node yield between the groups (p = 0.14). Robotic surgery was associated with a longer operative duration (p < 0.001).
    Conclusion: In this early experience, robotic surgery has proven feasible and safe and is comparable to laparoscopic surgery in terms of completeness of resection and recovery. As costs and operating times decline and as technology progresses, robotic surgery may one day replace traditional laparoscopic techniques.
    MeSH term(s) Humans ; Laparoscopy/methods ; Rectal Neoplasms/surgery ; Rectum/surgery ; Retrospective Studies ; Robotic Surgical Procedures/methods ; Treatment Outcome
    Language English
    Publishing date 2021-04-13
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 390895-1
    ISSN 1863-4362 ; 0021-1265
    ISSN (online) 1863-4362
    ISSN 0021-1265
    DOI 10.1007/s11845-021-02625-z
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  7. Article: Distant melanoma causing small bowel obstruction.

    Hintze, Justin M / O'Connor, Donal B / Molony, Peter / Neary, Paul C

    Journal of surgical case reports

    2017  Volume 2017, Issue 2, Page(s) rjx020

    Abstract: Small bowel obstructions (SBOs) are common. Adhesions make up the majority of cases at 84.9%, followed by abdominal herniae and malignancies. A 71-year-old female presented with total constipation, abdominal distension, on a background of resected ... ...

    Abstract Small bowel obstructions (SBOs) are common. Adhesions make up the majority of cases at 84.9%, followed by abdominal herniae and malignancies. A 71-year-old female presented with total constipation, abdominal distension, on a background of resected cutaneous melanoma nine years prior. A CT-scan showed small bowel intussusception and disseminated mucosal-enhancing lesions consistent with metastases. She was brought to the operating theatre where six areas of intussusception were identified and manually reduced. Biopsies confirmed the diagnosis of melanoma. Melanoma of the gastrointestinal tract (GIT) is rare, with most cases occurring as metastasis from cutaneous lesions. Melanomas of the GIT are usually asymptomatic in their early stages, and are often diagnosed when complications, such as obstruction or perforation occur. Management of such cases consists mainly of surgical intervention to resolve the complication. In people who present with SBO without previous surgeries or herniae, a malignant cause must be considered.
    Language English
    Publishing date 2017-02-10
    Publishing country England
    Document type Case Reports
    ISSN 2042-8812
    ISSN 2042-8812
    DOI 10.1093/jscr/rjx020
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  8. Article ; Online: Is the skillset obtained in surgical simulation transferable to the operating theatre?

    Buckley, Christina E / Kavanagh, Dara O / Traynor, Oscar / Neary, Paul C

    American journal of surgery

    2014  Volume 207, Issue 1, Page(s) 146–157

    Abstract: Background: Simulated surgical training offers a safe and accessible way of learning surgical procedures outside the operating room. Training programs have been developed using simulated laboratories to train surgical trainees to proficiency outside the ...

    Abstract Background: Simulated surgical training offers a safe and accessible way of learning surgical procedures outside the operating room. Training programs have been developed using simulated laboratories to train surgical trainees to proficiency outside the operating room. Despite the global enthusiasm among educators to enhance training through simulation-based learning, it remains to be elucidated whether the skill set obtained is transferrable to the operating room.
    Methods: Using standardized search methods, the authors searched the Cochrane Central Register of Controlled Trials, PubMed, Embase, and Web-Based Knowledge, as well as the reference lists of relevant articles, and retrieved all published randomized controlled trials.
    Results: Sixteen randomized controlled trials involving 309 participants were identified to be suitable for qualitative analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The mean Consolidated Standards of Reporting Trials score was 16 (range, 12-22). The studies showed considerable clinical and methodologic diversity. Operative time improved consistently in all trials after training and was the only objective parameter measurable in the live setting. Studies that used the Objective Structured Assessment of Technical Skills as their primary outcome showed improved scores in 80% of trials, and studies that used performance indicators to assess participants all showed improved scores after simulation training in all of the trials, with 88% showing statistical significance.
    Conclusions: The current literature consistently demonstrates the positive impact of simulation on operative time and predefined performance scores. However, these reproducible measures alone are insufficient to demonstrate transferability of skills from the laboratory to the operating room. The authors advocate a multimodal assessment, including metrics, the Objective Structured Assessment of Technical Skills, and critical step completion. This may provide a more complete assessment of operative performance. Only then can it be concluded that simulation skills are transferable to the live operative setting.
    MeSH term(s) Clinical Competence ; Computer Simulation ; General Surgery/education ; Humans ; Internship and Residency/methods ; Internship and Residency/organization & administration ; Internship and Residency/trends ; Operating Rooms ; Specialties, Surgical/education ; Surveys and Questionnaires
    Keywords covid19
    Language English
    Publishing date 2014-01
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 2953-1
    ISSN 1879-1883 ; 0002-9610
    ISSN (online) 1879-1883
    ISSN 0002-9610
    DOI 10.1016/j.amjsurg.2013.06.017
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  9. Article ; Online: Visual spatial ability for surgical trainees: implications for learning endoscopic, laparoscopic surgery and other image-guided procedures.

    Henn, Patrick / Gallagher, Anthony G / Nugent, Emmeline / Seymour, Neal E / Haluck, Randy S / Hseino, Hazem / Traynor, Oscar / Neary, Paul C

    Surgical endoscopy

    2018  Volume 32, Issue 8, Page(s) 3634–3639

    Abstract: Background: In image-guided procedures, a high level of visual spatial ability may be an advantage for surgical trainees. We assessed the visual spatial ability of surgical trainees.: Methods: Two hundred and thirty-nine surgical trainees and 61 ... ...

    Abstract Background: In image-guided procedures, a high level of visual spatial ability may be an advantage for surgical trainees. We assessed the visual spatial ability of surgical trainees.
    Methods: Two hundred and thirty-nine surgical trainees and 61 controls were tested on visual spatial ability using 3 standardised tests, the Card Rotation, Cube Comparison and Map-Planning Tests.
    Results: Two hundred and twenty-one, 236 and 236 surgical trainees and 61 controls completed the Card Rotation test, Cube Comparison test and Map-Planning test, respectively. Two percent of surgical trainees performed statistically significantly worse than their peers on card rotation and map-planning test, > 1% on Cube Comparison test. Surgical trainees performed statistically significantly better than controls on all tests.
    Conclusions: Two percent of surgical trainees performed statistically significantly worse than their peers on visual spatial ability. The implication of this finding is unclear, further research is required that can look at the learning and educational portfolios of these trainees who perform poorly on visual spatial ability, and ascertain if they are struggling to learn skills for image-guided procedures.
    MeSH term(s) Adult ; Clinical Competence ; Education, Medical, Graduate/methods ; Female ; General Surgery/education ; Humans ; Internship and Residency/methods ; Ireland ; Laparoscopy/education ; Learning/physiology ; Male ; Spatial Navigation ; Surgery, Computer-Assisted/education
    Language English
    Publishing date 2018-02-12
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-018-6094-3
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  10. Article ; Online: Outlier experienced surgeon's performances impact on benchmark for technical surgical skills training.

    Gallagher, Anthony G / Henn, Patrick J / Neary, Paul C / Senagore, Anthony J / Marcello, Peter W / Bunting, Brendan P / Seymour, Neal E / Satava, Richard M

    ANZ journal of surgery

    2018  Volume 88, Issue 5, Page(s) E412–E417

    Abstract: Background: Training in medicine must move to an outcome-based approach. A proficiency-based progression outcome approach to training relies on a quantitative estimation of experienced operator performance. We aimed to develop a method for dealing with ... ...

    Abstract Background: Training in medicine must move to an outcome-based approach. A proficiency-based progression outcome approach to training relies on a quantitative estimation of experienced operator performance. We aimed to develop a method for dealing with atypical expert performances in the quantitative definition of surgical proficiency.
    Methods: In study one, 100 experienced laparoscopic surgeons' performances on virtual reality and box-trainer simulators were assessed for two similar laparoscopic tasks. In study two, 15 experienced surgeons and 16 trainee colorectal surgeons performed one simulated hand-assisted laparoscopic colorectal procedure. Performance scores of experienced surgeons in both studies were standardized (i.e. Z-scores) using the mean and standard deviations (SDs). Performances >1.96 SDs from the mean were excluded in proficiency definitions.
    Results: In study one, 1-5% of surgeons' performances were excluded having performed significantly below their colleagues. Excluded surgeons made significantly fewer correct incisions (mean = 7 (SD = 2) versus 19.42 (SD = 4.6), P < 0.0001) and a greater proportion of incorrect incisions (mean = 45.71 (SD = 10.48) versus 5.25 (SD = 6.6), P < 0.0001). In study two, one experienced colorectal surgeon performance was >4 SDs for time to complete the procedure and >6 SDs for path length. After their exclusions, experienced surgeons' performances were significantly better than trainees for path length: P = 0.031 and for time: P = 0.002.
    Conclusion: Objectively assessed atypical expert performances were few. Z-score standardization identified them and produced a more robust quantitative definition of proficiency.
    MeSH term(s) Benchmarking ; Clinical Competence ; Colorectal Surgery/education ; Humans ; Laparoscopy/education ; Simulation Training
    Language English
    Publishing date 2018-03-23
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 2050749-5
    ISSN 1445-2197 ; 1445-1433 ; 0004-8682
    ISSN (online) 1445-2197
    ISSN 1445-1433 ; 0004-8682
    DOI 10.1111/ans.14474
    Database MEDical Literature Analysis and Retrieval System OnLINE

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