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Article ; Online: A novel ergonomic simulator for laparoscopic surgery.

Sathe, Tejas S / Sorrentino, Thomas A / Drapeau, Scott / Soriano, Ian S / Lee, Hanmin

2024

Abstract: Despite the importance of laparoscopic skill development to General Surgery trainees, current laparoscopic simulators are either too expensive or suffer from poor portability or low video quality. Moreover, several trainers without height adjustable ... ...

Abstract	Despite the importance of laparoscopic skill development to General Surgery trainees, current laparoscopic simulators are either too expensive or suffer from poor portability or low video quality. Moreover, several trainers without height adjustable platforms and screens do not promote optimal ergonomics. In this paper, we present the design process and initial prototype of a novel ergonomic laparoscopic simulator that addresses these limitations.
Language	English
Publishing date	2024-04-07
Publishing country	United States
Document type	Editorial
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2024.04.004
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Article ; Online: Robotic repair of moderate-sized midline ventral hernias reduced complications, readmissions, and length of hospitalization compared to open techniques.

Carter, Jonathan / Ahamed, Fayyaz / Juprasert, Jackly / Anderson, Mark / Lin, Matthew / Lebares, Carter / Soriano, Ian

Journal of robotic surgery

2024 Volume 18, Issue 1, Page(s) 142

Abstract: Purpose: To compare outcomes of robotic and open repair for uncomplicated, moderate-sized, midline ventral hernias.: Methods: From 2017 to 2021, patient characteristics and 30 day outcomes for all ventral hernias at our center were prospectively ... ...

Abstract	Purpose: To compare outcomes of robotic and open repair for uncomplicated, moderate-sized, midline ventral hernias. Methods: From 2017 to 2021, patient characteristics and 30 day outcomes for all ventral hernias at our center were prospectively collected. We studied hernias potentially suitable for robotic repair: elective, midline, 3-10 cm rectus separation, no prior mesh, and no need for concomitant procedure. Robotic or open repair was performed by surgeon or patient preference. The primary outcome was any complication using Clavien-Dindo scoring. Secondary outcomes were operative time, length-of-stay, and readmissions. Regression identified predictors of complications. Results: Of 648 hernias repaired, 70 robotic and 52 open repairs met inclusion criteria. The groups had similar patient demographics, co-morbidities, and hernia size, except that there were more immunosuppressed patients in the open group (11 versus 5 patients, p = 0.031). Complications occurred after 7 (13%) open repairs versus 2 (3%) robotic repairs, p = 0.036. Surgical site infection occurred after four open repairs but no robotic repair, p = 0.004. Length-of-stay averaged almost 3 days longer after open repair (4.3 ± 2.7 days versus 1.5 ± 1.4 days, p = 0.031). Readmission occurred after 6 (12%) oppen repairs but only 1 (1%) robotic repair. A long-term survey (61% response rate after mean follow-up of 2.8 years) showed that the HerQLes QOL score was better after robotic repair (46 ± 15 versus 40 ± 17, = 0.049). In regression models, only open technique predicted complications. Conclusions: Robotic techniques were associated with fewer complications, shorter hospitalization, fewer infections, and fewer readmissions compared to open techniques. Open surgical technique was the only predictor of complications.
MeSH term(s)	Humans ; Patient Readmission ; Robotic Surgical Procedures/methods ; Quality of Life ; Hernia, Ventral/surgery ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/etiology ; Herniorrhaphy/adverse effects ; Herniorrhaphy/methods ; Surgical Mesh ; Laparoscopy ; Retrospective Studies
Language	English
Publishing date	2024-03-30
Publishing country	England
Document type	Journal Article
ZDB-ID	2268283-1
ISSN	1863-2491 ; 1863-2483
ISSN (online)	1863-2491
ISSN	1863-2483
DOI	10.1007/s11701-024-01909-7
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Article ; Online: Ergonomic Assessment of Septorhinoplasty Maneuvers During Simulated Pregnancy.

Bhethanabotla, Rohith M / Ledgister, Kaye / Soriano, Ian S / O'Sullivan, Patricia / Bigelow, Elaine / Knott, Philip Daniel / Park, Andrea M

OTO open

2024 Volume 8, Issue 2, Page(s) e126

Abstract: Objective: Women represent an increasing proportion of the otolaryngology workforce. Work-related musculoskeletal disorders (WRMSD) are a little-studied yet important impediment to career completion. Scant attention has been directed to study the impact ...

Abstract	Objective: Women represent an increasing proportion of the otolaryngology workforce. Work-related musculoskeletal disorders (WRMSD) are a little-studied yet important impediment to career completion. Scant attention has been directed to study the impact of pregnancy on surgeon posture and ergonomics. We piloted the use of a pregnancy simulation suit (Empathy Belly) to assess the risk of ergonomic compromise when performing open septorhinoplasty. Study design: Surgical simulation. Setting: Single session, training simulation lab at academic medical center. Methods: Medical students and surgical residents performed the initial steps of a rhinoplasty procedure without and with a pregnancy simulation suit and were filmed with an artificial intelligence-based video analysis app from Kinetica Labs that calculates joint angles and categorizes the ergonomic risk factors. Still images from videos were taken and analyzed using validated posture-based analysis rubrics. Participants were asked to complete a qualitative questionnaire after the session. Results: Twelve medical students and surgical residents participated in the study. Posture-based analysis indicated increased ergonomics risk factors among trainees when performing a rhinoplasty while wearing the pregnancy suit. Video analysis indicated trends of worsening back angle and shoulder postures. Trainees reported experiencing pain in the neck, suprapubic area, and lower back. They acknowledged the importance of ergonomics in otolaryngology and desired further education about workplace injury risk mitigation. Conclusion: Pregnancy impacts the ergonomics of performing septorhinoplasty and further investigation is required into interventions to reduce risk of WRMSDs.
Language	English
Publishing date	2024-04-03
Publishing country	United States
Document type	Journal Article
ISSN	2473-974X
ISSN (online)	2473-974X
DOI	10.1002/oto2.126
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Article ; Online: The Aerosolization of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Phase I.

Ayuso, Sullivan A / Soriano, Ian S / Augenstein, Vedra A / Shao, Jenny M

The Journal of surgical research

2022 Volume 274, Page(s) 108–115

Abstract: Introduction: The degree to which Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is aerosolized has yet to be determined. The aim of this study is to prove methods of detection of aerosolization of SARS-CoV-2 in hospitalized patients in ... ...

Abstract	Introduction: The degree to which Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is aerosolized has yet to be determined. The aim of this study is to prove methods of detection of aerosolization of SARS-CoV-2 in hospitalized patients in anticipation of testing for aerosolization in procedural and operative settings. Methods: In this prospective study, inpatients with SARS-CoV-2 were identified. Demographic information was obtained, and a symptom questionnaire was completed. Polytetrafluoroethylene (PTFE) filters, which were attached to an air pump, were used to detect viral aerosolization and placed in four locations in each patient's room. The filters were left in the rooms for a three-hour period. Results: There were 10 patients who enrolled in the study, none of whom were vaccinated. Only two patients were more than a week from the onset of symptoms, and half of the patients received treatment for COVID with antivirals and steroids. Among ten RT-PCR positive and hospitalized patients, and four filters per patient, there was only one positive SARS-CoV-2 aerosol sample, and it was directly attached to one of the patients. Overall, there was no correlation between symptoms or symptom onset and aerosolized test result. Conclusions: The results of this suggest that there is limited aerosolization of SARS-CoV-2 and provided proof of concept for this filter sampling technique. Further studies with increased sample size should be performed in a procedural and operative setting to provide more information about SARS-CoV-2 aerosolization.
MeSH term(s)	COVID-19/diagnosis ; Humans ; Prospective Studies ; SARS-CoV-2
Language	English
Publishing date	2022-01-13
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2022.01.003
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Article: Robot-assisted ventral sacral Tarlov cystectomy; A case report.

Albayar, Ahmed / Shao, Jenny M / Soriano, Ian S / Welch, William C

International journal of surgery case reports

2021 Volume 90, Page(s) 106732

Abstract: Introduction and importance: Although asymptomatic Tarlov cysts (TCs) are reported in up to 13% of the population, symptomatic TCs are rare (less than 1%), making the management of the symptomatic cysts controversial. The most common location of ... ...

Abstract	Introduction and importance: Although asymptomatic Tarlov cysts (TCs) are reported in up to 13% of the population, symptomatic TCs are rare (less than 1%), making the management of the symptomatic cysts controversial. The most common location of symptomatic TCs is sacral nerve roots where they can cause pelvic, perineal chronic discomfort and pain, and lower extremity sensory and motor changes. Ventral (intrapelvic retroperitoneal) sacral TCs are extremely rare with no management recommendations. Available surgical options include cyst resection, and inlet-obliteration, however, these methods are often considered invasive and not definitive. Case presentation: A 39-year-old woman presented with debilitating low back pain (LBP) radiating to her pelvis and the right lower extremity for 4 years. Magnetic Resonance Imaging (MRI) showed multiple sacral nerve root TCs including a large retroperitoneal right S3 TC. Surgical resection of the right S3 cyst was achieved utilizing a robot-assisted anterior approach which provided excellent visualization and maneuverability in the targeted retroperitoneal space. Postoperatively, the patient experienced significant pain relief, and she was able to perform activities of daily life and return to work. Clinical discussion: Robotic-assisted pelvic surgery has gained widespread popularity in the last two decades due to its many potential benefits. Utilizing robotic systems in sacral nerve sheath lesions shows a promise to deliver effective minimally invasive surgical management without sacrificing good visualization or instrument maneuverability. Conclusion: Robot-assisted resection of sacral nerve roots TCs represents a minimally invasive and safe surgical option to manage cysts located anterior to the sacrum in the pelvic retroperitoneal space.
Language	English
Publishing date	2021-12-28
Publishing country	Netherlands
Document type	Journal Article
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2021.106732
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Article ; Online: Promoting a Culture of Safety in Cholecystectomy (COSIC) over a decade at a Philippine public regional hospital after the SAGES International Proctoring Course in Laparoscopic Cholecystectomy Course.

Yi, William / Perez, Juan / Rosen, Claire / Akalal, Ferdauzi / Hassan, Ibrahim / Soriano, Ian

Surgical endoscopy

2022 Volume 37, Issue 1, Page(s) 613–616

Abstract: Background: The SAGES International Proctoring Course for Laparoscopic Cholecystecomy accepts applications from low to middle-income countries for SAGES faculty to train local surgeons. A regional public hospital in the 10th most populous city in the ... ...

Abstract	Background: The SAGES International Proctoring Course for Laparoscopic Cholecystecomy accepts applications from low to middle-income countries for SAGES faculty to train local surgeons. A regional public hospital in the 10th most populous city in the Philippines was one of the chosen sites for the 1-week course in 2010. Two SAGES surgeons and one nurse trained two local surgeons and four nurses identified by the hospital director. Methods: All patients seen in the out-patient clinic at the Zamboanga City Medical Center in the Philippines and scheduled for elective laparoscopic cholecystectomy from the first day of the course in August 2010 until December 2018 were entered into a prospectively collected database including demographics, pre-op diagnosis, operative findings, histopathologic diagnosis, conversion rates and 30-day complications including re-operations. Results: 521 patients underwent laparoscopic cholecystectomy. Majority were female (63.7%) with a mean age of 45.9 years. Most procedures were completed laparoscopically with an open conversion rate of 3.3%. Three patients underwent laparoscopic subtotal cholecystectomy. Reported complications requiring reoperation included one stump necrosis, two incisional hernias and one retained stone. One serosal injury and one surgical site infection were also reported for an overall morbidity rate of 4.6%. Pathology showed chronic calculous cholecystitis in 92.8% of specimens. No 30-day mortality was recorded. Conclusion: The SAGES International Proctoring Course for Laparoscopic Cholecystectomy has been shown to be a successful method for global surgery training. A focused 1-week direct proctoring model in the Philippines showed a sustained culture of safety in cholecystectomy with low 30-day morbidity, complication and conversion rates over a decade following participation in this program.
MeSH term(s)	Humans ; Female ; Male ; Middle Aged ; Cholecystectomy, Laparoscopic/methods ; Philippines ; Cholecystectomy/methods ; Cholecystitis/surgery ; Hospitals, Public
Language	English
Publishing date	2022-06-13
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/s00464-022-09355-y
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Article ; Online: Delayed Sigmoid Colon Erosion by Artificial Urinary Sphincter Tubing.

Shieh, Christine / Shaw, Nathan M / Decker, Hannah / Soriano, Ian / Breyer, Benjamin N

Urology

2022 Volume 166, Page(s) e5–e6

MeSH term(s)	Colon, Sigmoid/surgery ; Humans ; Prosthesis Failure ; Reoperation ; Urinary Incontinence, Stress/surgery ; Urinary Sphincter, Artificial/adverse effects
Language	English
Publishing date	2022-05-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	192062-5
ISSN	1527-9995 ; 0090-4295
ISSN (online)	1527-9995
ISSN	0090-4295
DOI	10.1016/j.urology.2022.04.035
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Article ; Online: Conversion to Roux-En-Y Gastric Bypass: a successful means of mitigating reflux after laparoscopic sleeve gastrectomy.

Strauss, Alexandra L / Triggs, Joseph R / Tewksbury, Colleen M / Soriano, Ian / Wernsing, David S / Dumon, Kristoffel R / Williams, Noel N / Shao, Jenny M

Surgical endoscopy

2023 Volume 37, Issue 7, Page(s) 5374–5379

Abstract: Introduction: Laparoscopic sleeve gastrectomy (LSG) has become the most common bariatric procedure due to the technical ease and weight loss success of the operation. However, there has been concern that LSG contributes to gastroesophageal reflux ... ...

Abstract	Introduction: Laparoscopic sleeve gastrectomy (LSG) has become the most common bariatric procedure due to the technical ease and weight loss success of the operation. However, there has been concern that LSG contributes to gastroesophageal reflux disease (GERD) postoperatively with a proportion of patients requiring conversion to a Roux-En-Y Gastric Bypass (RYGB). The objective of this study was to characterize the patients who underwent revision in our hospital system and to better understand pre-operative predictors of GERD and revision. Methods: After IRB approval, a retrospective review was conducted assessing for patients who had conversion of LSG to RYGB at three hospitals within the University of Pennsylvania Health System from January 2015 to December 2021. The patients' charts were then reviewed to evaluate for demographics, BMI, operative findings, imaging and endoscopic reports, and post-operative outcomes. Results: 97 patients were identified who underwent conversion of LSG to RYGB between January 2015 and December 2021. The cohort was predominantly female (n = 89, 91.7%) with an average age of 42.7 ± 10.6 years at the time of conversion. The most common indications for revision were GERD (72.2%) and obesity/insufficient weight loss (24.7%). Patients lost an average of 11.1 ± 12.9 kg after revision to RYGB. Of the patients who underwent revision for GERD, 80.2% noted global symptomatic improvement after revision and 19.4% were able to stop their proton pump inhibitor (PPI) postoperatively, with most patients decreasing the frequency of the PPI use postoperatively. Conclusion: The majority of patients who underwent conversion from LSG to RYGB due to GERD and saw marked improvements in GERD symptoms and outcomes. These findings illuminate the real-world practices and outcomes of bariatric revisional procedures for reflux and the need for more research on standardized practice.
MeSH term(s)	Humans ; Female ; Adult ; Middle Aged ; Male ; Gastric Bypass/methods ; Obesity, Morbid/surgery ; Laparoscopy/methods ; Gastroesophageal Reflux/etiology ; Gastroesophageal Reflux/prevention & control ; Gastroesophageal Reflux/surgery ; Gastrectomy/methods ; Reoperation ; Retrospective Studies ; Weight Loss ; Proton Pump Inhibitors ; Treatment Outcome
Chemical Substances	Proton Pump Inhibitors
Language	English
Publishing date	2023-03-30
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/s00464-023-10024-x
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Article ; Online: Artificial intelligence based real-time video ergonomic assessment and training improves resident ergonomics.

Hamilton, Barbara Cs / Dairywala, Mohammed I / Highet, Alexandra / Nguyen, Tom C / O'Sullivan, Patricia / Chern, Hueylan / Soriano, Ian S

American journal of surgery

2023 Volume 226, Issue 5, Page(s) 741–746

Abstract: Background: Surgery demands long hours and intense exertion raising ergonomic concerns. We piloted a sensorless artificial intelligence (AI)-assisted ergonomics analysis app to determine its feasibility for use with residents.: Methods: Surgery ... ...

Abstract	Background: Surgery demands long hours and intense exertion raising ergonomic concerns. We piloted a sensorless artificial intelligence (AI)-assisted ergonomics analysis app to determine its feasibility for use with residents. Methods: Surgery residents performed simulated laparoscopic tasks before and after a review of the SCORE ergonomics curriculum while filmed with a sensorless app from Kinetica Labs that calculates joint angles as a metric of ergonomics. A survey was completed before the session and a focus group was conducted after. Results: Thirteen surgical residents participated in the study. The brief intervention took little time and residents improved their ergonomic scores in neck and right shoulder angles. Residents expressed increased awareness of ergonomics based on the session content and AI information. All trainees desired more training in ergonomics. Conclusions: Ergonomic assessment AI software can provide immediate feedback to surgical trainees to improve ergonomics. Additional studies using sensorless AI technology are needed.
MeSH term(s)	Humans ; Artificial Intelligence ; Curriculum ; Ergonomics ; Musculoskeletal Diseases ; Software
Language	English
Publishing date	2023-07-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2023.07.028
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Article ; Online: Laparoscopy allows the harvest of the DIEP flap with shorter fascial incisions as compared to endoscopic harvest: A single surgeon retrospective cohort study.

Shakir, Sameer / Spencer, Amy B / Piper, Merisa / Kozak, Geoffrey M / Soriano, Ian S / Kanchwala, Suhail K

Journal of plastic, reconstructive & aesthetic surgery : JPRAS

2020 Volume 74, Issue 6, Page(s) 1203–1212

Abstract: Background: We present a comparative series to utilize minimally invasive endoscopic, total extraperitoneal laparoscopic (TEP-lap), and transabdominal preperitoneal robotic perforator (TAP-RAP) harvest of the deep inferior epigastric (DIE) vessels for ... ...

Abstract	Background: We present a comparative series to utilize minimally invasive endoscopic, total extraperitoneal laparoscopic (TEP-lap), and transabdominal preperitoneal robotic perforator (TAP-RAP) harvest of the deep inferior epigastric (DIE) vessels for autologous breast reconstruction (ABR) to mitigate donor site morbidity. We hypothesized that TEP-lap and TAP-RAP harvests of abdominal-based free flaps are safe techniques associated with decreased fascial incision when compared with the endoscopic harvest. Methods: We designed a retrospective cohort series of subjects with newly diagnosed breast cancer who presented for ABR using endoscopic (control), laparoscopic, or robotic assistance between September 2017 and April 2019. The primary outcome variables were flap success (i.e., absence of perioperative flap loss), fascial incision length, and intraoperative complications. Secondary variables included operating time, costs, and postoperative complications within 90 days (arterial thrombosis, venous congestion, bulge/hernia, and operative revision). Exclusion criteria included < 90 days follow-up. Results: In total 94, 38, and 3 subjects underwent endoscopic, TEP-lap, and TAP-RAP flap harvests. Mean lengths of fascial incisions for the endoscopic and laparoscopic cohorts were 4.5 ± 0.5 cm and 2.0 ± 0.6 cm (p < 0.0001), while incision length depended on the concurrent procedure in the robotic cohort. No subjects required conversion to an open harvest. There were no bleeding complications, intra-abdominal injuries, flap losses, or abdominal bulges/hernias noted in the TEP-lap and TAP-RAP cohorts. Conclusion: Minimally invasive DIEP flap harvest may decrease fascial injury when compared with conventional open harvest. There are significant trade-offs among harvest methods. TEP-lap harvest may better balance the trade-off related to abdominal wall morbidity.
MeSH term(s)	Abdominal Muscles/blood supply ; Abdominal Muscles/transplantation ; Autografts ; Breast Neoplasms/surgery ; Epigastric Arteries/surgery ; Fascia/injuries ; Female ; Humans ; Intraoperative Complications/prevention & control ; Laparoscopy/adverse effects ; Laparoscopy/methods ; Mammaplasty/adverse effects ; Mammaplasty/methods ; Middle Aged ; Perforator Flap/transplantation ; Postoperative Complications/diagnosis ; Postoperative Complications/etiology ; Retrospective Studies ; Robotic Surgical Procedures/adverse effects ; Robotic Surgical Procedures/methods ; Tissue and Organ Harvesting/adverse effects ; Tissue and Organ Harvesting/methods
Language	English
Publishing date	2020-11-09
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2217750-4
ISSN	1878-0539 ; 1748-6815 ; 0007-1226
ISSN (online)	1878-0539
ISSN	1748-6815 ; 0007-1226
DOI	10.1016/j.bjps.2020.10.098
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