Upper gastrointestinal and hepatopancreaticobiliary surgery in New Zealand: Balancing the volume-outcome relationship with accessibility in a surgically low volume country.

INTRODUCTION: New Zealand has a population of only 5.5 million meaning that for many surgical procedures the country qualifies as a "low-volume center." However, the health system is well developed and required to provide complex surgical procedures that benchmark internationally against comparable countries. This investigation was undertaken to review regional variation and volumes of complex resection and palliative upper gastrointestinal (UGI) surgical procedures within New Zealand. METHODS: Data pertaining to patients undergoing complex resectional UGI procedures (esophagectomy, gastrectomy, pancreatectomy, and hepatectomies) and palliative UGI procedures (esophageal stenting, enteroenterostomy, biliary enteric anastomosis, and liver ablation) in a New Zealand hospital between January 1, 2000 and December 31, 2019 were obtained from the National Minimum Dataset. RESULTS: New Zealand is a low-volume center for UGI surgery (229 hepatectomies, 250 gastrectomies, 126 pancreatectomies, and 74 esophagectomies annually). Over 80% of patients undergoing hepatic resection/ablation, gastrectomy, esophagectomy, and pancreatectomy are treated in one of the six national cancer centers (Auckland, Waikato, Mid-Central, Capital Coast, Canterbury, or Southern). There is evidence of the decreasing frequency of these procedures in small centers with increasing frequency in large centers suggesting that some regionalization is occurring. Palliative procedures were more widely performed. Indigenous Maori were less likely to be treated in a nationally designated cancer center than non-Maori. CONCLUSIONS: The challenge for New Zealand and similarly sized countries is to develop and implement a system that optimizes the skills and pathways that come from a frequent performance of complex surgery while maintaining system resilience and ensuring equitable access for all patients.

Educational quality of Robotic Whipple videos on YouTube.

BACKGROUND: Videos on Robotic pancreaticoduodenectomy (RPD) may be watched by surgeons learning RPD. This study sought to appraise the educational quality of RPD videos on YouTube. METHODS: One-hundred videos showing RPD or 'Robotic Whipple' were assessed using validated scales (LAP-VEGaS & Consensus Statement Score (CSS)). The association between the scores and the video characteristics (e.g. order of appearance, provider type etc) was assessed. The minimum number of videos required to cumulatively cover the entire LAP-VEGaS and CSS was also noted. RESULTS: The videos were of variable quality; median LAP-VEGaS = 0.67 (0.17-0.94), median CSS = 0.45 (0.29-0.53). There was no association between the educational quality of the videos and their order of appearance, view counts, provider type, length or country of origin. Videos lacked information such as patient consent (100%), potential pitfalls (97%) or surgeon credentials (84%). The first 29 videos cumulatively met all the criteria of CSS and LAP-VEGaS scores except for reporting consent. CONCLUSION: YouTube videos on RPD are of variable quality, without any recognised predictors of quality, and miss important safety information. An impractical number of videos need to be watched to cumulatively fulfil educational criteria. There is a need for high-quality, peer-reviewed videos that adhere to educational principles.

Robot-assisted general surgery in Aotearoa New Zealand.

Robot-assisted surgery refers to a surgeon controlling a robotic device that performs an operation. This viewpoint explores the current state of robot-assisted surgery in Aotearoa New Zealand using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, California, United States), the only currently available robotic surgical system for general surgery in the country. We describe the contemporary progress in Aotearoa New Zealand compared to Australia and globally, and present emerging high-level evidence from randomised controlled trials regarding the utility of the robot-assisted approach for general surgery procedures. From the available evidence, we suggest that the value of robot-assisted general surgery in the public healthcare system arises from its emerging clinical benefits for complex procedures and its potential to engender equitable access and outcomes, particularly for Maori and Pacific peoples, improve education and training and contribute towards quality assurance and workforce development. Therefore, its implementation aligns with the New Zealand Health Strategy's long-term goals and priority areas to achieve pae ora, healthy futures for all.

Systematic review of the efficacy and purpose of student surgical interest groups.

BACKGROUND: There is concern around projected unmet need in the surgical workforce internationally. Current barriers to medical students pursuing surgical careers include lack of early exposure, low confidence in surgical skills, and perceived lifestyle barriers. This review aimed to examine both the purpose of student surgical interest groups (SIGs) globally, and their effect on metrics representing student surgical career interest. barriers. METHODS: MEDLINE, EMBASE, PubMed, and Google Scholar were searched for papers analysing surgical interest group purpose and efficacy. Risk of bias was assessed for survey-based papers using a 20-point checklist. Descriptive analysis was performed based on qualitative data. RESULTS: Twenty-eight papers were included in the analysis including 13 surveys. These were of moderate quality. The analysed SIGs had 100-1000 student members and a diverse range of funding sources. Purpose of SIGs was described by 26 of 28 papers with common themes including promotion of surgical career choice and developing theoretical/practical surgical skills. Common initiatives of SIGs included surgical lectures/teaching and practical skills workshops. Data from 15 papers analysing efficacy of SIGs suggested they positively influenced self-reported student interest in surgical careers (78.6%) and confidence in surgical knowledge (80%), as well as confidence in practical skills, knowledge about surgical careers/lifestyle, mentorship opportunity, and research involvement. CONCLUSION: Student SIGs make a unique contribution to early medical student experience through positive effect on promoting surgical careers. They target relevant metrics such as surgical knowledge and confidence that are known to influence surgical career choice in the modern surgical landscape.

Hepatectomy and pancreatectomy: how we could do it.

Visible patient software provides surgeons and trainees with the opportunity to construct accurate three dimensional models of patients liver and pancreas which reflect tumour location and unique anatomical features. These can be used for operative planning, patient discussions, operative rehearsal and teaching as well as pre and postoperative briefings.

Are they ready? A survey of postgraduate year 1 and 2 surgical house officers.

AIM: An online survey was undertaken to analyse the perception of medical school graduates, in postgraduate years 1 and 2, of being ready to work (preparedness) and of managing the demands of practice as a junior doctor on a general surgical attachment. METHODS: An email-based survey was designed to assess medical school graduates' sense of preparedness, and was sent electronically to all house officers at the beginning of their 3-month attachment in general surgery between December 2020 and December 2021. One email reminder was sent 2 weeks after the initial email with the embedded survey hyperlink. RESULTS: The overall response rate was 50%. Of those, over 90% had accompanied surgical teams on acute calls and over extended hours as a medical student. However, only 50% had ever attended a trauma call or a resuscitation call with clinical teams. Half of the respondents indicated that they would have liked specific teaching on mental and physical self-care, preparation for night shifts and extended periods of duty as well as in prioritisation, delegation and management of workloads. CONCLUSION: This survey showed that new doctors lacked dedicated teaching in professional behaviours and felt it to be an important part of medical training and preparation for medical practice.

Epidemiology and survival of Merkel cell carcinoma in New Zealand: A population-based study between 2000 and 2015 with international comparison.

BACKGROUND/OBJECTIVES: Merkel cell carcinoma is an aggressive neuroendocrine skin cancer. Australian studies report high incidence and poor survival rates compared internationally. While New Zealand has a comparable UV index and racial composition to Australia, survival outcomes are currently unknown. The role of Merkel cell polyoma virus in oncogenesis of Merkel cell carcinoma is an active area of research. We describe the incidence and survival of Merkel cell carcinoma in New Zealand with correlation to demographic and clinical factors including regional polyoma virus prevalence. METHODS: Retrospective study of population-based data from the New Zealand Cancer Registry. Incidence rates were directly standardised to the US standard 2000 population. Survival was investigated using Kaplan-Meier and multivariable Cox regression models. RESULTS: Six hundred and one cases were diagnosed in New Zealand between 2000 and 2015. The overall incidence rate was 0.96/100 000 population. Merkel cell carcinoma is more common in males, elderly and on sun-exposed areas. Eighteen percent of patients were diagnosed with distant metastasis at time of presentation. The overall 5-year survival rate and relative 5-year survival rate were 31% and 45%, respectively. Mortality was 1.9 and 2.5 times higher for stage III and IV disease, respectively, relative to stage I/II disease. Patients over age 80 had twice the mortality compared to those aged 60-69. CONCLUSIONS: New Zealand has a high incidence of Merkel cell carcinoma and poor survival outcomes when compared internationally. We have the highest proportion of distant metastatic disease at time of diagnosis. Further research into the role of nonpolyoma-related Merkel cell carcinoma is warranted to improve Merkel cell carcinoma outcomes in New Zealand and abroad.