Impact of COVID-19 on operating assignments in residency training of endocrine surgery: A retrospective cohort study.

PURPOSE: Airborne pandemics illustrate a significant problem in training grounds. From the endocrine surgery point of view, we scrutinized the impact of Covid-19 on general surgery residency training in our university hospital. METHODS: The number of endocrine procedure curves was forecasted using the expert modeler in a time series model from March to September 2020 based on data from previous years. We then compared the estimation curves to actual numbers. RESULTS: There were 1340 resident participants in thyroid procedures, 405 in parathyroid procedures, 65 in other neck procedures, and 304 in adrenal procedures. In 884 of the endocrine procedures, the operating surgeon was a resident. The median experience of operating residents in endocrine procedures was 3.2 years (interquartile range 2.7-3.6) before the impact and 3.8 years (interquartile range 3.1-4.1) after it (p = 0.023). The monthly number of actual procedures with at least one resident participation in the Covid-19 period was significantly lower (8.7 ± 7.5 vs. 19.9 ± 3.7, p = 0.012) than the forecasted numbers. There were no semi-autonomous operating chief residents, although we expected a moderate level (0 actual vs. 0.5 ± 0.2 predicted, p = 0.002). CONCLUSION: This study clearly represents sustainability in surgical training and includes usual trends. Essential endocrine surgical procedures the pandemic disrupted the most were the treatment of thyroid and parathyroid diseases. Covid-19 reduced our surgical volume and resulted in delays in training. A full-scale disaster plan is necessary for possible crises threatening surgical education.

Rare Relationship Between the Right Hepatic Artery and Common Hepatic Duct in Living Donor Right Hepatectomy.

In living donor liver transplant, it is vital to perceive the hepatic artery anatomy and its variants. In the normal hepatic artery pattern, the common hepatic artery originates from the celiac artery to form the proper hepatic artery and gastroduodenal artery. The proper hepatic artery divides into right and left branches that supply the right and left lobes of the liver, respectively. Here, we report a rare variation of the right hepatic artery that was detected during a living liver right lobe hepatectomy. A 59-year-old man with alcoholic liver cirrhosis underwent living donor liver transplant. The patient's niece (a 47-year-old woman) volunteered to be a living donor. During the hilar dissection, we noticed that the anterior and posterior branches of the right hepatic artery passed through points anterior and posterior to the common hepatic duct, respectively. The right anterior hepatic artery and the right hepatic artery were divided separately. Although previously defined classifications have described anatomical variations of origin, branching, and course of hepatic artery, the topographical relationship of the anterior right hepatic artery and the posterior right hepatic artery versus the common hepatic duct has not been a matter of concern. Awareness must be maintained of this rare anatomical course of the right hepatic artery, especially in living liver right lobe donors. In the event of donors with rare variations, living donor liver transplant should be performed by an experienced team.

Learning-by-teaching coming into play as a reliable trick for lower GI procedures: a learning curve analysis in 13,210 operative logs including the COVID-19 era.

After suspecting a plunge in the operative case logs in our clinic, we wanted to explore the COVID-19 impact on surgical training side of the lower gastrointestinal procedures to raise awareness of the possible cracks in the pillars of general surgery residency. Comparing the coronavirus impact to previous years starting from 2014, we examined the procedures of our residents for their roles in the operating room. We performed interrupted time-series analyses to get a sense of the magnitude and then used a new index to identify the trend of change in operator-to-first assistant rate of experience and searched for signs of learning-by-teaching motives. In total, 13,210 operative logs of residents were included; of procedures, 3483 (41%) were emergency. Both overall resident participations and learning-by-teaching dropped during first 3 months, followed by a rebound. The overall operator-to-first assistant rate of experience was 1.06 before and 0.86 after. Emergency procedures, obstruction, perforation, enterostomy closure, appendix, colon, anus and minimally invasive procedures, and COVID-19 were associated with learning-by-teaching (OR and 95% Cl were; 2.20, 1.76-2.75; 0.56, 0.36-0.85; 0.50, 0.38-0.67; 2.29, 1.44-3.63; 11.09, 8.33-14.75; 1.75, 1.32-2.32; 2.56, 2.03-3.22; 0.80, 0.65-0.99 and 1.93, 1.54-2.42, respectively) (p < 0.05). The study provided insights into a vastly underrated surgical education subject: learning-by-teaching. The training index introduced here was a valuable learning curve instrument that has the capacity of comparing different training parameters or different residency programs. The surge in learning-by-teaching after the pandemic was interpreted as a reflex, processing the teaching as a training tool.