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Surgical Overview

Thermal Effect of J-Plasma® Energy in a Porcine Tissue Model: Implications for Minimally Invasive Surgery
Jasmine D. Pedroso, MD, Assistant FMIGS Program Director, Minimally Invasive Gynecologic Surgery, Las Vegas Minimally Invasive Surgery/Women’s Pelvic Health Center, Las Vegas, Nevada, Melissa M. Gutierrez, MD, Assistant FMIGS Program Director, Minimally Invasive Gynecologic Surgery, Las Vegas Minimally Invasive Surgery/Women’s Pelvic Health Center, Las Vegas, Nevada, K. Warren Volker MD, PhD, FMIGS Program Director, Minimally Invasive Gynecologic Surgery, Las Vegas Minimally Invasive Surgery/Women’s Pelvic Health Center, Las Vegas, Nevada, David L Howard MD, PhD, Research Director, Minimally Invasive Gynecologic Surgery, Las Vegas Minimally Invasive Surgery/Women’s Pelvic Health Center, Las Vegas, Nevada

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Abstract

Objective: To evaluate tissue effect of J-Plasma® (Bovie Medical Corporation, Clearwater, Florida) in porcine liver, kidney, muscle, ovarian, and uterine tissue blocks.
Design: Prospective study utilizing porcine tissue blocks to evaluate the thermal spread of J-Plasma® device on liver, kidney, muscle, ovarian, and uterine tissue at various power settings, gas flow, and exposure times.
Materials and Methods: J-Plasma® helium was used in porcine liver, kidney, and muscle tissue at 20%, 50%, and 100% power, and 1 L/min, 3 L/min, and 5 L/min gas flow at one, five, and 10-second intervals. J-Plasma® was then used in ovarian and uterine tissue at maximum power and gas flow settings in intervals of one, five, 10, and 30 seconds. Histologic evaluation of each tissue was then performed to measure thermal spread.
Results: Regardless of tissue type, increased power setting, gas flow rate, and exposure time correlated with greater depth of thermal spread in liver, kidney, and muscle tissue. J-Plasma® did not exceed 2 mm thermal spread on liver, kidney, muscle, ovarian, and uterine tissue, even at a maximum setting of 100% power and 5 L/min gas flow after five seconds. Prolonged exposure to J-Plasma® of up to 30 seconds resulted in increased length and width of thermal spread of up to 12 mm, but did not result in significantly increased depth at 2.84 mm.
Conclusions: The J-Plasma® helium device has minimal lateral and depth of thermal spread in a variety of tissue types and can likely be used for a multitude of gynecologic surgical procedures. However, further studies are needed to demonstrate device safety in a clinical setting.

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Web-Based Video Assessments of Operative Performance for Remote Telementoring
Alexandra M. Moore, MD, Resident, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, Nicholas H. Carter, MD, Resident, Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, Justin P. Wagner, MD, Resident, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, Charles J. Filipi, MD, Professor, Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, David C. Chen, MD, Associate Professor, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California

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Abstract

Introduction: Performance-based feedback is critical to surgical skills acquisition. Barriers of geography and time limit trainees’ access to expert mentorship. In this study, we hypothesized that telementoring using an asynchronous, web-based video interface would allow trainees to receive systematic feedback from expert mentors despite these barriers.
Materials and Methods: Between October 2014 and October 2016, 18 surgeons in Brazil, Dominican Republic, Haiti, and Paraguay underwent in-person training in Lichtenstein for hernioplasty or laparoscopic total extraperitoneal inguinal hernia repair. After initial training, surgeons submitted 6- to 12-month interval operative videos for expert review. Expert surgeons reviewed each video using the Surgus web platform with performance metrics adapted from the Operative Performance Rating Scale (OPRS). The time required to perform video review, number of freeform comments, mean OPRS scores, and variance of OPRS scores among telementors was assessed.
Results: A total of 18 surgeons submitted 20 operative videos, and three expert surgeons reviewed each video using the Surgus platform. The median time to perform video review was 20 minutes. Median number of freeform verbal comments was eight. Mean OPRS overall performance scores were 3.9 ± 0.9 (scale of five). Mean variance in scoring among telementors for overall performance was 0.25 (maximum 5.29), suggesting a high degree of concordance.
Conclusions: Video-based assessments had a high degree of concordance among expert raters. Asynchronous performance reviews by telementors offer opportunities for longitudinal feedback that overcome geographical, material, and temporal disparities. This platform offers a means of sharing expertise in surgical training, continuing education, credentialing, and global health.

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A Web-Based Application to Communicate Benefits and Risks of Surgical Treatments

Fabienne E. Stubenrouch, MSc, PhD Candidate, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands, Marwin Baumann, MSc, System and Network Engineer, Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands, Dink A. Legemate, MD, PhD, Professor of Surgery, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands, Dirk T. Ubbink, MD, PhD, Principal Investigator, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands

 

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Abstract


Background: In general, communication is an important aspect during surgeon-patient consultations. However, clear communication of the benefits and risks of the possible treatment options can be challenging. Visual presentation of information may increase patient comprehension. We developed and piloted a web-based application that provides graphical representations of the numerical benefits and risks of surgical treatment options.
Materials and Methods: The app was developed by assessing functional requirements, developing a prototype, pilot-testing and adjusting the prototype, and evaluating the final app. In the app, the surgeon enters the benefits and risks of the surgical treatment options as percentages. The app shows the possible outcomes ad libitum as bar charts, icon arrays, or natural frequency trees. Subsequently, we investigated clinicians’ and patients’ satisfaction with the prototype by means of questionnaires, semi-structured interviews, and by observing their conversations.
Results: The MAPPING app (“Mapping All Patient Probabilities In Numerical Graphs�?) was pilot-tested among five surgeons and 12 patients with various surgical disorders. Nine patients welcomed the app and were eager to understand the risks and benefits involved when presented as graphs. The surgeons judged the app as simple to use and valuable. The prototype was improved based on their suggestions.
Conclusion: The MAPPING app was developed successfully and has the potential to facilitate surgical risk communication in a more structured and uniform manner. Future research will focus on its validation and promotion of SDM in different types of patients and disorders.

 

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Robotic-Assisted Radical Prostatectomy with the Use of Barbed Sutures
Angelo Porreca, MD, Urologist/Chief, Department of Urologic Robotic Surgery, Policlinico di Abano Terme, Abano Terme, Italy, Antonio Salvaggio, MD, Urologist, Department of Urologic Robotic Surgery, Policlinico di Abano Terme, Abano Terme, Italy, Matteo Dandrea, MD, Urologist, Department of Urologic Robotic Surgery, Policlinico di Abano Terme, Abano Terme, Italy, Emanuele Cappa, MD, Urologist, Department of Urologic Robotic Surgery, Policlinico di Abano Terme, Abano Terme, Italy, Alessio Zuccala, MD, Urologist, Department of Urologic Robotic Surgery, Policlinico di Abano Terme, Abano Terme, Italy, Alessandro Del Rosso, Urologist, Department of Urologic Robotic Surgery, Policlinico di Abano Terme, Abano Terme, Italy, Daniele D’Agostino, Urologist, Department of Urologic Robotic Surgery, Policlinico di Abano Terme, Abano Terme, Italy

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Abstract

Objectives: The aim of this study is to analyze the principal advantages of posterior muscolo-fascial reconstruction using knotless barbed sutures (BS) during robot-assisted radical prostatectomy (RARP).
Materials and Methods: We analyzed the available evidence regarding the efficacy and safety of principal BS (Quill™ SRS Angiotech Pharmaceuticals Inc., Vancouver, Canada; V-Loc™ Medtronic, Dublin, Ireland; STRATAFIX™ Ethicon Inc., Somerville, New Jersey; Filbloc® Assut Europe S.p.A., Rome, Italy).
Results: We analysed the principal outcomes (operative time and suturing time of urethra-vesical anastomosis, length of catheterization, hospital stay, and postoperative complications rate) reported in literature.
Conclusions: In light of our experience, we believe that the utilization of BS during RARP is safe as the development of a new surgical technique of urethrovesical anastomosis offers advantages in terms of continence rate, length of catheterization, and other surgical outcomes. Other studies (prospective trials) are necessary to investigate the real benefits of BS in comparison to conventional sutures (CS).

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The Incidence of Postoperative Pneumonia in Various Surgical Subspecialties: A Dual Database Analysis
Morad Chughtai, MD, Research Fellow, Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, Chukwuweike U. Gwam, MD, Research Fellow, Department of Orthopaedic Surgery, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, Anton Khlopas, MD, Research Fellow, Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, Jared M. Newman, MD, Research Fellow, Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, Gannon L. Curtis, MD, Research Fellow, Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, Pedro A. Torres, MD, Emergency Medicine Resident, Hospital Episcopal San Lucas, Ponce School of Medicine, Ponce, Puerto Rico, Rafay Khan, MD, Internal Medicine Resident, Raritan Bay Medical Center, Perth Amboy, New Jersey 08861, Michael A. Mont, MD, Chairman, Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio

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Abstract

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Bovie Medical

Assut Europe

Karl Storz