Perception from students regarding online synchronous interactive teaching in the clinical year during COVID-19 pandemic.

AIM: The global pandemic of COVID-19 has led to extensive practice of online learning. Our main objective is to compare different online synchronous interactive learning activities to evaluate students' perceptions. Moreover, we also aim to identify factors influencing their perceptions in these classes. METHODS: A cross-sectional, questionnaire-based study focusing on clinical year medical students' perceptions and feedback was conducted between February 2021 -June 2021 at the University of Hong Kong. Online learning activities were divided into bedside teaching, practical skill session, problem-based learning (PBL) or tutorial, and lecture. A questionnaire based on the Dundee Ready Education Environment Measure (DREEM) was distributed to 716 clinical year students to document their perceptions. RESULTS: One hundred responses were received with a response rate of 15.4% (110/716, including 96 from bedside teaching, 67 from practical skill session, 104 from PBL/tutorial, and 101 from lecture). For the mean score of the DREEM-extracted questionnaire, online PBL/tutorial scored the highest (2.72 ± 0.54), while bedside scored the lowest (2.38 ± 0.68, p = 0.001). Meanwhile, there was no significant difference when we compared different school years (p = 0.39), age (p = 0.37), gender (p = 1.00), year of internet experience (<17 vs ≥17 years p = 0.59), or prior online class experience (p = 0.62). When asked about students' preference for online vs face-to-face classes. Students showed higher preferences for online PBL/tutorial (2.06 ± 0.75) and lectures (2.27 ± 0.81). Distraction remains a significant problem across all four learning activities. A multivariate analysis was performed regarding students' reported behavior in comparison with their perception through the DREEM-extracted questionnaire. The results showed that good audio and video quality had a significant and positive correlation with their perception of online bedside teaching, practical skill sessions, and PBL/tutorial. It also showed that the use of the video camera correlated with an increase in perception scores for lectures. CONCLUSION: The present analysis has demonstrated that students' perception of different online synchronous interactive learning activities varies. Further investigations are required on minimizing distraction during online classes.

New insights on missed colonic lesions during colonoscopy through artificial intelligence-assisted real-time detection (with video).

BACKGROUND AND AIMS: Meta-analysis shows that up to 26% of adenomas could be missed during colonoscopy. We investigated whether the use of artificial intelligence (AI)-assisted real-time detection could provide new insights into mechanisms underlying missed lesions during colonoscopy. METHODS: A validated real-time deep-learning AI model for the detection of colonic polyps was first tested in videos of tandem colonoscopy of the proximal colon for missed lesions. The real-time AI model was then prospectively validated in a total colonoscopy in which the endoscopist was blinded to real-time AI findings. Segmental unblinding of the AI findings were provided, and the colonic segment was then re-examined when missed lesions were detected by AI but not the endoscopist. All polyps were removed for histologic examination as the criterion standard. RESULTS: Sixty-five videos of tandem examination of the proximal colon were reviewed by AI. AI detected 79.1% (19/24) of missed proximal adenomas in the video of the first-pass examination. In 52 prospective colonoscopies, real-time AI detection detected at least 1 missed adenoma in 14 patients (26.9%) and increased the total number of adenomas detected by 23.6%. Multivariable analysis showed that a missed adenoma(s) was more likely when there were multiple polyps (adjusted odds ratio, 1.05; 95% confidence interval, 1.02-1.09; P < .0001) or colonoscopy was performed by less-experienced endoscopists (adjusted odds ratio, 1.30; 95% confidence interval, 1.05-1.62; P = .02). CONCLUSIONS: Our findings provide new insights on the prominent role of human factors, including inexperience and distraction, on missed colonic lesions. With the use of real-time AI assistance, up to 80% of missed adenomas could be prevented. (Clinical trial registration number: NCT04227795.).

Comparison of early experience of robotic and transanal total mesorectal excision using propensity score matching.

BACKGROUND: Robotic surgery and transanal minimally invasive surgery are the two recently developed techniques, which can overcome the difficult pelvic dissection in conventional laparoscopy. This study aimed to compare the early cases of robotic and transanal total mesorectal excision (taTME) using propensity score matching. METHODS: The first 40 cases of taTME and the first 80 sphincter-saving robotic total mesorectal resection for rectal cancer were selected from the prospectively collected database. Using propensity score matching, the outcomes of 40 matched cases of robotic TME were compared with the 40 cases of taTME. RESULTS: Before matching, patients in the taTME group were significantly younger. The tumors were smaller but more distally located. Significantly more patients in the taTME group received preoperative chemoradiation. After matching, the two groups did not show any differences in gender, age, comorbidity, the level of tumors, and incidences of preoperative chemoradiation. The operating time was significantly shorter (254 vs. 170 min, p < 0.05) and the blood loss was less (50 vs. 150 ml, p = 0.002) in the taTME group. Conversion rate was 5% in both groups. There was no difference in the hospital stay, overall morbidity, the anastomotic leakage rate, and the urinary complication rate between the two groups. More patients in the taTME group did not require a separate abdominal incision. The distal margin, the number of lymph nodes examined, and the rate positive circumferential margin (0 vs. 5%, p = 0.494) were also similar between the two groups. CONCLUSIONS: Both taTME and robotic surgery can achieve favorable outcomes in the rectal cancer resection. Comparison of the early experience of the two procedures with propensity score matching showed the taTME was associated with a shorter operating time, less blood loss, and a higher rate of transanal extraction of the specimen. Further evaluation by randomized trials is warranted.

Comparison of short-term and oncologic outcomes of robotic and laparoscopic resection for mid- and distal rectal cancer.

PURPOSE: Laparoscopic rectal resection with total mesorectal excision is a technically challenging procedure, and there are limitations in conventional laparoscopy. A surgical robotic system may help to overcome some of the limitations. This study aimed to compare the short-term operative as well as oncologic outcomes of laparoscopic and robotic rectal resection. METHODS: This study was based on a prospectively collected database of patients with mid- to distal rectal cancer (up to 12 cm from the anal verge) undergoing either laparoscopic or robotic low anterior resection from January 2008 to June 2015. Data on patient demographics, intraoperative parameters and short-term outcomes were analyzed. Patient survival and recurrence were also compared. RESULTS: During the study period, 171 and 220 consecutive patients underwent laparoscopic and robotic rectal resection, respectively. The median age was 65 years (range 23-96). The median tumor distance was 8 and 7 cm from the anal verge in the laparoscopic and robotic groups, respectively (p = 0.06). Significantly more male patients and more patients with comorbidities and preoperative radiation underwent robotic surgery. The median operating time for robotic resection was significantly longer, 260 versus 225 min (p < 0.001). Conversion rates of laparoscopic and robotic resection were 3.5 and 0.8 %, respectively (p = 0.308). The median hospital stay was 6 days in both groups (p = 0.29). There was no difference in the overall complication rate, but the incidence of urinary retention was significantly less in the robotic group (4.1 vs. 10.5 %, p = 0.024). With a median follow-up of 31 months, there was no difference in local recurrence, overall survival and disease-specific survival between the two groups. CONCLUSIONS: In the treatment of mid- to low rectal cancer, robotic resection can achieve operative results and oncologic outcomes comparable to laparoscopic resection. The postoperative urinary retention rate is lower following robotic surgery.

Alternatives to colonoscopy for population-wide colorectal cancer screening.

Colorectal cancer is one of the top three cancers in the world in terms of incidence. Colonoscopy, which many regard as the gold standard in diagnosis of colonic polyps and neoplasm, is costly, invasive and labour-intensive, and deemed an unsuitable population-wide index screening tool. Alternative modalities, including guaiac and immunohistochemical faecal occult blood tests, computed tomographic colonography, colon capsule endoscopy, flexible sigmoidoscopy, and double-contrast barium enema are available. The procedures, test characteristics, and their implications are reviewed. Immunohistochemical faecal occult blood testing appears to be the most suitable population-wide screening test for an average-risk population, with flexible sigmoidoscopy as an alternative. More evidence is needed to determine the role of computed tomographic colonography and colon capsule endoscopy in colorectal cancer screening.

Surgical Results and Oncologic Outcomes for Rectal Cancer with Tailored Mesorectal Excision over Two Decades.

OBJECTIVE: This study aimed to compare the characteristics of the tumors, the management strategy, and oncologic outcomes of patients with rectal cancer surgery in these two periods: period 1 (1993-2001) and period 2 (2002-2011). METHODS: All patients who underwent radical resection of rectal cancer from 1993 to 2011 were included. Comparisons of the patients' demographics, characteristics, operating results, and oncologic outcome between the two periods were undertaken. RESULTS: Radical resection for rectal cancer was performed in 1611 patients (993 men). Patients were significantly older and more had comorbid medical diseases in period 2. More laparoscopic resections were performed and more patients had preoperative chemoradiation in period 2. The postoperative mortality was significantly lower and the hospital stay was significantly shorter in period 2. In those with non-metastatic cancer, the 5-year local recurrences of patients in period 1 and period 2 were 11.9 and 5.9 %, respectively. (p = 0.002) The patients in period 2 had significantly better 5-year overall (68.1 vs. 60.2 %, p = 0.003) and 5-year cancer-specific survival (76.1 vs. 69.4 %, p < 0.001) when compared with those treated in period 1. The improvement occurred mainly in patients with abdominoperineal resection and those with stage III diseases. In the multivariate analysis, among the other histological factors, operations performed in period 2 and laparoscopic surgery were independent factors associated with better overall survival. CONCLUSIONS: Significant improvement in the surgical outcomes in terms of a lower recurrence rate and better survival was achieved in the recent years with the increase in neoadjuvant therapy and the application of laparoscopic surgery.

Impact of prenatal diagnosis on choledochal cysts and the benefits of early excision.

AIM: To evaluate the clinical outcomes of patients with prenatally diagnosed choledochal cysts compared with those diagnosed after birth and the optimal timing of definitive treatment. METHODS: Retrospective review of all patients who underwent primary choledochal cyst excision and Roux-en-Y hepaticojejunostomy from 1996 to 2006 at a single institution. RESULTS: A total of 45 patients were included. Ten (22.2%) of the patients had prior prenatal diagnosis. The mean age at operation for this group was 4.4 months and mean follow up was 55.9 months. There was no operative complication or late morbidity. For the post-natal diagnosis group, the mean age at operation was 5.7 years (P < 0.000) and mean follow up period was 69 months. The most common presentation in this group was abdominal pain (31.4%), followed by pancreatitis (28.6%) and symptoms of cholestasis (25.7%). Early post-operative morbidities occurred in two (5.7%) patients. On long-term follow up, two (5.7%) further patients in the post-natal group developed complications. CONCLUSION: Prenatal diagnosis of choledochal cysts results in earlier definitive surgery. More adverse complications were seen in those who had surgery at an older age. We therefore recommend early excision of choledochal cysts.