Does the advanced training in laparoscopic suturing enhance laparoscopic suturing skill beyond fundamentals of laparoscopic surgery?

BACKGROUND: Laparoscopic suturing is associated with a steep learning curve. Hence, many general surgery graduate residents entering fellowship have reportedly not been able to proficiently suture laparoscopically despite achieving Fundamentals of Laparoscopic Surgery certification. To address this deficiency, the Advanced Training in Laparoscopic Suturing curriculum was developed. This study aimed to compare the effectiveness of the Advanced Training in Laparoscopic Suturing curriculum in improving laparoscopic suturing skills compared with Fundamentals of Laparoscopic Surgery training. METHODS: Novices were enrolled in a prospective randomized controlled study. All novices followed proficiency-based training on Fundamentals of Laparoscopic Surgery peg-transfer and intracorporeal suturing. Students were then stratified based on their peg-transfer performance and randomized into an Advanced Training in Laparoscopic Suturing or Fundamentals of Laparoscopic Surgery group. The Advanced Training in Laparoscopic Suturing group trained on 3 of the 6 Advanced Training in Laparoscopic Suturing tasks (needle handling, offset forehand suturing, confined space suturing), while the Fundamentals of Laparoscopic Surgery group was assigned more stringent suturing performance goals. Each group trained for an additional 6 hours, after which the laparoscopic suturing performance of the 2 groups was compared on a Nissen fundoplication porcine model. RESULTS: Thirty-nine medical students were enrolled in the study; 17 (11 males and 6 females) completed the study protocol (44%). Controlling for confounders including the student suturing performance at the end of stage-1 training, the Advanced Training in Laparoscopic Suturing group at the porcine model was significantly faster/safer (coefficient = 102.7, P = .037), and more skilled (coefficient = 19.1, P = .048) compared with the Fundamentals of Laparoscopic Surgery group. CONCLUSION: Compared with Fundamentals of Laparoscopic Surgery training alone the Advanced Training in Laparoscopic Suturing curriculum further enhances the laparoscopic suturing skill of novices. These findings support incorporating Advanced Training in Laparoscopic Suturing into existing skills curricula.

Surgeon stress negatively affects their non-technical skills in the operating room.

BACKGROUND: Poor surgeons' non-technical skills (NTS) and excessive stress and workload are known contributors to surgical errors. Our aim was to examine the relationship between surgeons' stress and workload, and their observed NTS intraoperatively. METHODS: Surgeon's NTS were rated in the operating room (OR) by trained observers. Surgeon stress, workload, familiarity with the OR team, prior experience, and case difficulty were captured. Relationships between variables were assessed. RESULTS: Fifteen surgeons participated in our study. Agreement among raters was high for NTS observations (ICC range = 0.56-0.96). Stress was negatively correlated with situation awareness, and workload was negatively correlated with decision making. Less familiarity among the team was correlated with higher stress. CONCLUSIONS: Surgeons' stress and workload negatively affected their NTS in the OR. Further, unfamiliarity with the surgical team contributed to surgeon's stress. Methods to reduce surgeons' stress and workload such as mental skills training should be considered.

Bariatric surgery outcomes: is age just a number?

INTRODUCTION: Obesity and its associated comorbidities represent a pervasive problem in the United States across all age groups. There are conflicting data regarding the effectiveness and postoperative recovery of bariatric surgery in elderly patients. The aim of this study was to compare outcomes of bariatric surgery across age groups. MATERIALS AND METHODS: After obtaining institutional review board approval, patients with morbid obesity who underwent non-revisional laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG) at our institution between 2011 and 2015 were included in this retrospective study. Patients were subdivided into five age groups: < 30, 30-39, 40-49, 50-59, and ≥ 60 years. Patient baseline demographics and comorbidities were collected. Postoperative outcomes including reinterventions/reoperations, 30-day-readmissions, 90-day-mortality, comorbidities' resolution, and change in BMI (ΔBMI) up to 4 years were recorded and compared. The groups were compared with ANOVA and chi-square tests and multivariable analyses. RESULTS: LRYGB was performed in 74.7% of the 1026 study patients. Patients ≥ 60 years old demonstrated lower preoperative BMI than patients < 50 years (p < 0.001). Patients 50-59 years old had increased length of stay compared to 30-39 (p = 0.003) and a higher prevalence of all comorbidities was found in older patients (p < 0.001). There was no significant difference in 30-day-readmissions; 90-day-mortality; reoperations; and reinterventions among the study groups. The ΔBMI was higher in younger patients and comorbidity resolution was more likely in younger patients with the exception of obstructive sleep apnea. CONCLUSION: Bariatric surgery can be accomplished safely across all age groups with satisfiable postoperative weight loss. However, older age had higher hospital stay and convalescence and lower comorbidity resolution compared to younger patients. Thus, bariatric surgery should be offered earlier in life to allow the patients to reap its benefits.