"How to" Course for Resident Reviewers: from the Resident and Fellow Education Committee of the Society for Surgery of the Alimentary Tract (SSAT).

The Resident and Fellow Education Committee of the Society for Surgery of the Alimentary Tract (SSAT) hosted a "How to" course for resident reviewers at the 2021 Annual Meeting at Digestive Disease Week. This panel drew from their extensive experience to help neophyte reviewers perform high quality, comprehensive peer reviews. Dr. Snyder kicked off the session with "Why Should I be a Resident Reviewer?" Dr. Talamini followed by "Defining the Review Process," while Dr. Keller presented "OK, You Are Ready to Review, Where to Start?" Dr. Pawlik ended the session with "How to Be an Excellent Reviewer." Residents are encouraged to apply the content from these sessions to volunteer as reviewers and develop critical skills to help further their academic surgery career.

Emergent robotic versus laparoscopic surgery for perforated gastrojejunal ulcers: a retrospective cohort study of 44 patients.

BACKGROUND: Perforated gastrojejunal ulcers are a known complication following Roux-en-Y gastric bypass (RYGB) surgery requiring emergent surgical repair. The robotic approach has not been evaluated for emergency general surgery. METHODS: A retrospective cohort study from 2015 to 2019 was performed identifying all patients who underwent repair of perforated gastrojejunal ulcers after RYGB at a single institution. Patient characteristics and outcomes were compared by robotic or laparoscopic approach. RESULTS: Of the 44 patients analyzed, there were 24 robotic and 20 laparoscopic repairs of perforated gastrojejunal ulcers. No patients were initially approached with open surgery. In-room-to-surgery-start time was significantly faster in the robotic group than the laparoscopic group (25 versus 31 min, p = 0.01). Complication rate, complication severity, operating time, hospital length of stay, postoperative vasopressor requirement, discharge to home, hospital length of stay and 30-day readmission were all improved in the robotic group, although these were not statistically significant. Both total inpatient and procedural costs were more in the robotic group than the laparoscopic group. CONCLUSION: Perforated hollow viscus is not a contraindication for the use of the surgical robot, which may improve outcomes.

Surgical Society Podcasts: A Novel Way to Engage and Educate the Community.

BACKGROUND: Podcasts are increasingly being utilized in the surgical field as an asynchronous educational resource. This article discusses podcasts devoted to the field of surgery and their growing contribution to surgical education. METHODS: We provide examples of current podcasts and their varied structures, including those that distribute clinical and educational content, discuss recent literature and advancements, interview leaders in the field, and/or showcase unique perspectives on topics such as career development, diversity, and wellness. RESULTS AND CONCLUSIONS: Podcasts generated from surgical societies stand on unique ground to educate and engage the surgical community.

The emerging role for robotics in cholecystectomy: the dawn of a new era?

Though laparoscopic cholecystectomy (LC) was highly criticized in its early stages, it quickly grew to become a new standard of care and has revolutionized the field of general surgery. Now emerging robotic technology is making its way into the minimally invasive arena. Robotic cholecystectomy (RC) is often disparaged as a costly technology that can lead to increased operative times with outcomes that are quite similar to LC. However, this perspective is skewed as many existing studies were performed in the early phase of learning for this procedure. RC can be performed in a cost-effective manner as the volume of robotic procedures increases. In addition, improved visualization and capability to perform fluorescence cholangiography can improve the safety profile of cholecystectomy to a level that has not yet been achieved with conventional laparoscopy. Advanced simulation technology for robotic surgery, and newer single-site robotic platforms have the potential to further revolutionize this technology and lead to improved patient satisfaction. In this review, we will present current data, trends, and controversies in robotic-assisted cholecystectomy.

The effects of optimal perioperative glucose control on morbidly obese patients undergoing bariatric surgery.

BACKGROUND: Bariatric surgery is the most effective treatment for morbidly obese type II diabetics. However, guidelines for perioperative glucose control are not well established. We examined management of perioperative glucose levels in diabetic patients undergoing bariatric surgery and determined the impact of optimal glucose control as defined by the American Society for Metabolic and Bariatric Surgery (ASMBS) on patient outcomes, including long-term diabetes resolution. METHODS: A single-institution, retrospective analysis of 155 morbidly obese diabetic patients who underwent laparoscopic gastric bypass (RYGB) or sleeve gastrectomy (LSG) from 2010 to 2014 was performed. Inpatient finger-stick glucose levels were extracted from the electronic health record and defined as optimal if all values were <180 mg/dl. Ninety-day and one-year outcomes, including diabetes resolution, medication management, mortality and total costs were compared for patients with and without optimal control. RESULTS: 80 % (n = 124) of patients with type II diabetes underwent RYGB, while the remaining patients underwent LSG. Diabetes resolution at 1 year was 70.1 % (73.4 % for RYGB and 53.9 % for LSG, p = 0.191). Preoperatively, 72 % (n = 112) of patients were taking one or more oral antihyperglycemic agents, while only 50.3 % (n = 78) took an oral medication on discharge. 93 % of RYGB and 82 % of LSG patients, respectively, reduced their long-acting insulin dosage by greater than 50 % upon discharge (p = 0.251). Ninety-day and one-year outcomes including total costs were not improved by optimal perioperative glucose control. In total, 96.7 % of optimally controlled patients experienced diabetes resolution at 1 year compared to 53.2 % in the non-optimally controlled group (p < 0.001). CONCLUSION: Bariatric surgery leads to significant resolution of type II diabetes and a prompt improvement in glucose tolerance in the perioperative period. Optimal glucose control as defined by the ASMBS was not associated with improved postoperative outcomes in our patient population but was highly predictive of long-term diabetes resolution.

The Optimal Approach to Symptomatic Paraesophageal Hernia Repair: Important Technical Considerations.

While the asymptomatic paraesophageal hernia (PEH) can be observed safely, surgery is indicated for symptomatic hernias. Laparoscopic repair is associated with decreased morbidity and mortality; however, it is associated with a higher rate of radiologic recurrence when compared with the open approach. Though a majority of patients experience good symptomatic relief from laparoscopic repair, strict adherence to good technique is critical to minimize recurrence. The fundamental steps of laparoscopic PEH repair include adequate mediastinal mobilization of the esophagus, tension-free approximation of the diaphragmatic crura, and gastric fundoplication. Collis gastroplasty, mesh reinforcement, use of relaxing incisions, and anterior gastropexy are just a few adjuncts to basic principles that can be utilized and have been widely studied in recent years. In this article, we present a comprehensive review of literature addressing key aspects and controversies regarding the optimal approach to repairing paraesophageal hernias laparoscopically.

The utility of lymph node mapping sonogram and thyroglobulin surveillance in post thyroidectomy papillary thyroid cancer patients.

BACKGROUND: The American Thyroid Association recommends lymph node mapping (LNM) ultrasonography 6-12 months after thyroidectomy for patients with papillary thyroid cancer (PTC). The yield of LNM over thyroglobulin (TG) screening is not well defined. We sought to investigate this relationship. METHODS: Post thyroidectomy LNM was performed on 163 patients with PTC. LNM was considered positive based on these criteria: Loss of fatty hilum (LOFH), microcalcifications, hypervascularity, architectural distortion, or short axis (>8 mm). Serum TG levels were compared to LNM and fine needle aspiration (FNA). RESULTS: Sixty-nine patients had suspicious LNM (42%) and 17 had PTC on FNA (25%). There were 135 suspicious lymph nodes described with malignant nodes found in 6 of 65 patients (9%) with LOFH, 13 of 18 patients (76%) with microcalcifications, 11 of 12 patients (92%) with hypervascularity, 16 of 28 patients (52%) with architectural distortion, and 4 of 7 patients (52%) with enlarged size on FNA. The positive predictive value of LNM was 0.34, increasing to 0.66 when LOFH was excluded. Among 152 patients with documented TG data, LNM identified cervical nodal metastasis in 4 patients with TG < 0.5 pg/mL (anti-TG antibody negative, thyroid-stimulating hormone suppressed). Of the 15 patients with positive anti-TG antibody, 3 with recurrence were found on LNM. CONCLUSION: LNM can detect recurrent PTC when TG level is undetectable, and LOFH is a low-yield sonographic characteristic.