Can MRI pelvimetry predict the technical difficulty of laparoscopic rectal cancer surgery?

PURPOSE: Selection of an open or minimally invasive approach to total mesorectal excision (TME) is generally based on surgeon preference and an intuitive assessment of patient characteristics but there consensus on criteria to predict surgical difficulty. Pelvimetry has been used to predict the difficult surgical pelvis, typically using only bony landmarks. This study aimed to assess the relationship between pelvic soft tissue measurements on preoperative MRI and surgical difficulty. METHODS: Preoperative MRIs for patients undergoing laparoscopic rectal resection in the Australasian Laparoscopic Cancer of the Rectum Trial (ALaCaRT) were retrospectively reviewed by two blinded surgeons and pelvimetric variables measured. Pelvimetric variables were analyzed for predictors of successful resection of the rectal cancer, defined by clear circumferential and distal resection margins and completeness of TME. RESULTS: There was no association between successful surgery and any measurement of distance, area, or ratio. However, the was a strong association between the primary outcome and the estimated total pelvic volume on adjusted logistic regression analysis (OR = 0.99, P = 0.01). For each cubic centimeter increase in the pelvic volume, there was a 1% decrease in the odds of successful laparoscopic rectal cancer surgery. Intuitive prediction of unsuccessful surgery was correct in 43% of cases, and correlation between surgeons was poor (ICC = 0.18). CONCLUSIONS: A surgeon's intuitive assessment of the difficult pelvis, based on visible MRI assessment, is not a reliable predictor of successful laparoscopic surgery. Further assessment of pelvic volume may provide an objective method of defining the difficult surgical pelvis.

Utility of digitally supported surgical competency assessments in a work-based setting: a systematic review of the literature.

BACKGROUND: Adequate training and assessment of competency in surgical trainees are important in minimizing adverse events and achieving good patient outcomes. The purpose was to investigate the current literature on digitally supported methods of facilitating work-based competency assessment of surgical trainees. METHODS: Two concurrent literature searches were performed by two independent researchers using three databases: MEDLINE, Embase and Education Resources Information Center. Eligible studies reported on digitally supported tools for assessing surgical competency in a work-based setting for interns, residents or trainees of a post-graduate surgical programme. Studies focusing primarily on training courses, simulations or other tools for assessing surgical skills in a setting outside of work were excluded. Articles published as abstracts only, articles not published in English and review articles that did not contain original data were excluded. RESULTS: A total of 11 eligible studies were included, with six of these implementing smartphone application-based programmes, and five utilizing web-based programmes. Five studies implemented the 'System for Improving and Measuring Procedural Learning' smartphone application. Studies were based predominantly on general surgery residents, and were limited to the North American context. There was significant variability between studies regarding methodology, including the scoring system used to assess competency. CONCLUSION: This review confirms that digitally supported competency assessment of surgical trainees in a work-based setting is both feasible and effective. Digital platforms allow evaluations to be performed in a timely fashion without significant disturbance to workflow.

Patterns of internet and social media use in colorectal surgery.

BACKGROUND: Surgeons use the Internet and social media to provide health information, promote their clinical practice, network with clinicians and researchers, and engage with journal clubs and online campaigns. While surgical patients are increasingly Internet-literate, the prevalence and purpose of searching for online health information vary among patient populations. We aimed to characterise patient and colorectal surgeon (CRS) use of the Internet and social media to seek health information. METHODS: Members of the Colorectal Society of Australia and New Zealand and patients under the care of CRS at the Royal Prince Alfred Hospital, Sydney, were surveyed. Questions pertained to the types of information sought from the Internet, the platforms used to seek it, and the perceived utility of this information. RESULTS: Most CRS spent 2-6 h per week using the Internet for clinical purposes and an additional 2-6 h per week for research. 79% preferred literature databases as an information source. CRS most commonly directed patients to professional healthcare body websites. 59% of CRS use social media, mainly for socialising or networking. Nine percent of surgeons spent > 1 h per week on social media for clinical or research purposes. 72% of surgeons have a surgical practice website. 43% of patients searched the Internet for information on their doctor, and 75% of patients sought information on their symptoms or condition. However, 25% used health-specific websites, and 14% used professional healthcare body websites. Around 84% of patients found the information helpful, and 8% found it difficult to find information on the Internet. 12% of patients used social media to seek health information. CONCLUSIONS: Colorectal surgery patients commonly find health information on the Internet but social media is not a prominent source of health information for patients or CRS.

A Rare Pathological Couplet of Colocolic Intussusception Plus Cecal Bascule in a Young Adult: A Case Report.

This report is of a rare case involving a 27-year-old female who presented to the hospital with the pathological couplet of colocolic intussusception and cecal bascule causing bowel obstruction. Up to the time of presentation to the hospital, this patient had not undergone a full investigation for a known iron deficiency, anemia. Subsequently, during the emergency admission and after having an operative surgical procedure, the patient was found to have both a congenitally malpositioned cecum and a benign colonic polyp-forming condition. The pertinent issues about this unusual case to be highlighted are its ambiguous clinical presentation; uncommon gender and age group for either condition; the simultaneous occurrence of dual anatomical anomalies; and the uncommon benign etiology of causes of bowel obstruction in adults.

Spontaneous idiopathic omental haemorrhage: a rare cause of right iliac fossa pain.

BACKGROUND: Isolated omental haemorrhage is a rare entity of which only case reports exist. This is usually in the setting of trauma, neoplasms or anticoagulation. CASE PRESENTATION: We report a case of spontaneous idiopathic omental haemorrhage with no evidence of trauma, neoplasm or presence of anticoagulation. This was identified on the imaging studies performed for the purpose of diagnosis of the cause of the patient's right iliac fossa pain. The patient required urgent laparotomy and omentectomy to achieve haemostasis. DISCUSSION: Spontaneous omental haemorrhage is a rare entity that is usually preceeded by trauma or occurs in the context of adhesions, neoplasms or anticoagulation. If there are delays in diagnosis, it could lead to significant morbidity for the patient. Therefore, it requires prompt recognition and definitive management. CONCLUSION: Spontaneous omental haemorrhage is a rare entity characterised only in case reports. It is usually a secondary event and requires prompt management.

Observational study of decision making concerning radiotherapy in rectal cancer.

AIM: To understand how surgeons arrive at a decision in the complex and controversial field of radiotherapy in rectal cancer by identifying which variables are important in this decision and to assess the influence of age, training, area of practice and access to radiotherapy on decisions in this field. METHODS: A self-administered survey was distributed to 150 members of the CSSANZ. They were asked to rank the importance of 33 variables considered when making decisions to use radiotherapy in the treatment of rectal cancer. The responses were assessed for association of surgeon age, area of practise or access to radiotherapy with decisions in this field. RESULTS: A hierarchy of variables was produced which showed tumour characteristics had the highest average importance, higher than that attained by patient characteristics and side effects. There were subtle but statistically significant differences in the ranking of importance when surgeons were grouped by age, site of subspeciality training, site of practise and availability of radiotherapy service. CONCLUSION: This study identifies a hierarchy of variables used in decision making concerning radiotherapy in rectal cancer treatment, which may be used in heuristic decision making. Decisions on using radiotherapy are influenced by age, site of practise, site of training, and the presence of radiotherapy on site.