bluuebunny/crossref_metadata_2025_split huggingface dataset:
WP8.11 - Perception of Patients, Physicians, and Chaperones Regarding the Use of Chaperones During Patient Examinations for Plastic Surgery: A Systemic Review
Authors: Wong Zhen Yu , Ou Kai Qi , Wong Zhen Ning 
Published: September 2024

Abstract

Aim
There is a scarcity of information related to the use of chaperones during patient examinations of body areas where plastic and reconstructive surgery is performed.

Methods
In this systematic review, we searched electronic databases for literature addressing physician use of chaperones during examinations of patients undergoing plastic surgery from the perspective of the patient, physician, and chaperone from inception of the database until April 2023. We conducted an inductive thematic analysis of four domains (physician perspective, patient perspective, chaperone perspective, and chaperone documentation.

Result
The results of the analysis showed that surgeons who are experienced, are men, or have received education related to using chaperones are more likely to provide chaperones during patient examinations for medico-legal protection and patient comfort. A small percentage of surgeons have faced accusations from patients of inappropriate behavior. Most of these incidents have occurred without a chaperone present. Patients who have long associations with a particular plastic surgery practice are less likely to want a chaperone. When physicians examine nonsensitive areas, most patients prefer having no chaperone. However, young patients and patients undergoing reconstructive procedures are more likely to request chaperones. Patients prefer having family members or friends serve as chaperones. Notably, despite the presence of a chaperone, we found that documentation of the presence of a chaperone was inadequate.

Conclusion
Further research, including qualitative studies and multinational approaches, is warranted to gain deeper insights and develop comprehensive guidelines for chaperone use that empowers both patients and healthcare providers.
WP8.13 - Validating Remote Basic Surgical Skills Certification: A Randomised Controlled Trial
Authors: Khalil Miriam , Pazvakavambwa Hannah , Kader Nayaab Abdul , Komperla Siddharth , Aloul Zaina , Rawaf David 
Published: September 2024

Abstract

Aims
Simulation based training comprises a fundamental component of modern surgical education, necessitating the development and advancement of affordable, functional, and validated simulators. This study explored the effectiveness of using the Inovus Basic Surgical Skills (BSS) simulator in improving core surgical skills amongst junior trainees.

Methods
This was a multicentre, RCT between August 2022 – November 2022 involving junior trainees yet to complete a validated basic surgical skills course. All participants completed an initial series of basic surgical tasks, including a range of suturing and knot-tying techniques. Three parameters (objective scoring tool, time taken for task completion, self-assessment questionnaire) were used to evaluate each surgical skill. Subsequently, participants were randomly allocated to the intervention group (BSS simulator) for at home training, or the control group receiving no further training.

Results
5 domains were assessed for suturing tasks through respect for tissue, motion and efficiency, visuo-spatial, suture quality and time taken. Knot-tying was assessed by quality and time taken. Independent samples t-test revealed no significant difference between control and intervention groups (p&gt;0.05) despite improvement in task quality and reduced completion time. Self-assessment questionnaires revealed a significant (p&lt;0.05) improvement in confidence performing more complex tasks in intervention groups.

Conclusions
Study results demonstrate an improvement in both the quality of basic surgical skills and reduced completion time with use of the BSS simulator. Participants report increased confidence post-intervention following use of the BSS simulator. Despite the limitation of a small sample size, these findings underpin the potential benefits of BSS simulator use for surgical education amongst trainees, increasing accessibility to surgical training through an exceptionally realistic remote training environment.
ThP1.2 - Management of breast cancer sentinel lymph node macrometastasis in the axilla; audit of current unit practice and evaluation of factors that influence patient management
Authors: Farthing Charlotte , Hussain Zahra , Jones Sian , Tahir Wasif , MacInnes Emma , Kim Baek 
Published: September 2024

Abstract

Aims
Detection of sentinel lymph node (SLN) macrometastasis for breast cancer no longer mandates further axillary surgery. Association of Breast Surgery (ABS) guideline provides recommendation to optimise patient management. It also acknowledges management uncertainties in specific patient groups. We aimed to examine our unit practice against national guideline and evaluate potential factors that influence axillary management.

Methods
Retrospective analysis of prospectively maintained electronic database determined clinico-pathological characteristics on patients diagnosed with SLN macrometastasis (n=127) at the Leeds Breast Unit (2020-2022). Axillary management was compared against ABS guideline.

Results
56 (44.1%) received completion axillary node clearance (cANC), 37 (29.1%) axillary radiotherapy (aRT), and 34 (26.8%) no further axillary treatment. 80.3% had one macrometastasis. As per guideline, all patients who had &gt;3 macrometastasis (n=10) underwent cANC. Type of breast surgery (mastectomy vs. breast conserving surgery; BCS) did not affect further axillary treatment rate (76.7% vs. 70.1%). Type of further axillary treatment varied with cANC commonest for mastectomy patients (78.3%) and aRT commonest for BCS patients (57.4%). In contrast to the guideline, 58% of post-menopausal BCS patients with ER+HER2- T1 tumours (n=12) received further axillary treatment. Where guideline stated management uncertainty, further axillary treatment was frequent; pre-menopausal patients (82%), T2 tumours (73%), lymphovascular invasion (74%), and extranodal spread (77%).

Conclusion
Our unit’s SLN macrometastasis management is mostly in line with national guideline but further work is required to avoid overtreatment. Where management uncertainty exists, patients commonly received further axillary treatment. Further research is required in these patient groups to optimise axillary management.
ThP2.5 - Number of lymph nodes removed in SLNB: comparison between standard technique versus Magtrace from a single-centre study
Authors: Castelhano Rute , Gavisiddappa Chandana , McManus Penny 
Published: September 2024

Abstract

Introduction
Sentinel lymph node biopsy (SLNB) is a precise method for axillary staging in early breast cancer. Historically, the standard approach used radioisotope, often combined with blue dye, for localising the sentinel lymph node (SLN). Recently, the introduction of the superparamagnetic iron oxide mapping agent, Magtrace, offers an alternative. Following the adoption of Magtrace, there was a perception that more nodes were being removed during SLNB. This study aims to compare the number of lymph nodes removed, during SLNB, between both techniques.

Methods
A retrospective single-centre study (2022-2023) included 316 patients undergoing SLNB at Royal Lancaster Infirmary. Before the late 2022 adoption of Magtrace, the standard technique involved radioisotope+/-blue dye. Subsequently, based on consultant preference, patients received Magtrace alone or with blue dye. The comparison focused on the number of identified SLN between the magnetic and standard techniques.

Results
Data from 316 patients was analysed across two periods: March to October 2022 (standard technique n=160), and March to October 2023 (Magtrace n=120; Magtrace+blue dye n=30; blue dye only n=5). Comparative analysis of the number of nodes removed produced the following results: standard technique 2.425, magnetic technique alone 2.403, magnetic technique with blue dye 2.133, and blue dye only 1.6.

Conclusion
Despite initial concerns regarding the perceived increase in the number of nodes removed during SLNB with the implementation of the Magtrace technique, our study reveals that the use of this technique results in a reduction in the number SLNs removed in comparison to the standard dual technique.
ThP3.1 - Dysphagia: Should we be going straight to scope? A retrospective analysis within a single Scottish District General Hospital
Authors: McDowall Neil , Agiotakis Stefanos , Khan Khurram S 
Published: September 2024

Abstract

Aim
Dysphagia is the main symptom in patients with oesophageal cancer. British Society of Gastroenterology guidelines state that all patients with an Edinburgh Dysphagia score (EDS) of &gt;3.5 should be investigated with an urgent oesophagogastroduodenoscopy (OGD) for suspicion of cancer. We aim to investigate the outpatient clinic outcome for patients referred with dysphagia.

Methods
A retrospective cohort study of all urgent suspicion of cancer (USOC) referrals with dysphagia between April to September 2022. Patients demographics, clinic outcome and waiting time for OGD were analysed. This study was registered with Clinical Quality Project (LanQIP 14747).

Results
138 (37.5%) of 361 USOC referrals had dysphagia. Median age was 63 years (IQR 51-72) and 78 (56.5%) were female. Median Scottish Index of Multiple Deprivation was 4 (IQR 2-6). 3 (2.2%) patients were referred straight to scope. 125 (90.6%) patients attended clinic, of these 106 (84.8%) patients had an OGD requested. 84 (67.2%) were requested urgently, 16 (12.8%) routinely and 25 (20%) did not receive a scope.
The median waiting time to clinic was 42 days (IQR 62-31) and median time from clinic to OGD was 36 days (IQR 24-59). Total waiting time from the referral to OGD was 81 days (IQR 62-111).

Conclusions
The majority of patients presenting with dysphagia will necessitate urgent OGD following clinic consultations. Therefore, to expedite the diagnostic process, implementing a direct referral pathway to endoscopy, bypassing clinic wait times, is recommended.
ThP3.4 - Suture Endoclips coding, a novel technique to improve efficiency and reduce errors In laparoscopic repair of peptic ulcer perforation
Authors: Zino Samer , Alaeq Ali , Djoudi Assia , Hanna Michael , Costello Amy 
Published: September 2024

Abstract

The presentation describes our a novel technique of using Endo clips to tag the sutures during laparoscopic repair of perforated peptic ulcer utilizing Graham omental patch,

Methods
Four patients presented with perforated peptic ulcer. All treated with Laparoscopically. Supine position with split leg was standard. 5 and10mm thirty-degree scopes were used to facilitate efficient and comprehensive washing, through 11 mm umbilical port and two 5 mm ports. An extra 5mm port was needed on the lateral right Upper Quadrant for drain or liver retractor. We used 5mm endoclips to tag the end of sutures and create a tunnel to pass the patch through it. Each suture end was tagged with either one, two or three clips, in order. The suture ends were held together to create a tunnel, where the omental patch was passed through that tunnel.
Corresponding sutures end where identified easily by holding endoclips in order, then removed to allow the two ends to be tied without mixing the sutures. Furthermore, the endoclip tagging prevents suture looping around each other, minimizing wasted time, error and dislodging the stitches during identifying, correcting the looping and picking the corresponding ends.
All patients had uneventful recovery, with assuring follow up.

Conclusions
Our novel technique of suture Coding with endolcips eliminated the confusion between the different suture threads and prevents looping and consequently improved the technique efficiency and prevent mistakes and loose ties
ThP3.6 - Long Term Surgical Outcome of Complete Intrathoracic Stomach (CIS)
Authors: Pal Shreya , Divekar Omkaar , Fernandes Roland , Basu Sanjoy 
Published: September 2024

Abstract

Background & Aims
Surgery is required for medically fit symptomatic CIS patients to avoid complications (volvulus, obstruction & strangulation) that have high morbidity & mortality. To assess the long term outcome including QOL (quality of life) for patients who underwent laparoscopic biological hiatal mesh reconstruction for CIS (100%).

Methods
Retrospective analysis of a prospectively collected of 34 CIS of 154 consecutive GPEH(Giant Para-Esophageal Hernia) patients intervened between March 2008- December 2023 in a large DGH.
Data collected included demographics, BMI, ASA, Preoperative investigations (OGD & Computerised Tomography), operative details including complications, & standardised GERD-Health Related Quality of Life Questionnaire(GERD-QOL) scores of 0-5, 6-10, 11-15 & more than 15 as excellent, good, fair & poor respectively (pre-operatively, 6-month post-operative & long-term), postoperative diet, SOB (shortness of breath) & patient satisfaction.

Results
34 included M:F 11: 23, age 72*(45-83) years, BMI 29 *(20-43), ASA III *(II-III). 20(59%), 20(59%), 18(53%), 14(41%), 14(41%) & 12(35%) had heartburn, dysphagia, retrosternal discomfort, vomiting, weight loss and SOB respectively. 6 (18%) emergencies, 22 (65%) incomplete OGDs, operative time 210* (150-510) mins, 1(3%) conversion, 3*(9%) surgical mortality & PO stay 3*(2-27) days. Pre and 6-month post surgery GERD-QOL poor (≥15) & excellent (&lt;5) in 21(62%) & 32(94%) respectively with 32(94%) excellent satisfaction.
Follow up at 102*(16-190) months had 2 more unrelated deaths, 21(72%) contacted with GERD-QOL excellent (&lt;5) in 14(67%), poor 1(5%), 19(90%) solid diet, 2(10%) SOB with 19(90%) excellent satisfaction.

Conclusion
Favourable long term outcome achieved here supports complex surgery for this debilitating condition in the medically fit symptomatic elderly patients.
* Median
ThP4.3 - How accurate is the clinical diagnosis of acute cholecystitis? A plea for specialisation in biliary emergencies!
Authors: Omran Asmaa , Al Shaye Ahmad A , Hayyawi Israa , Nassar Ahmad H M 
Published: September 2024

Abstract

Aim
To evaluate the accuracy of preoperative diagnosis of acute cholecystitis (AC).

Methods
A prospective database of cholecystectomies and bile duct explorations spanning 30 years was analysed.

Results
593/6140 patients (9.6%) had a preoperative diagnosis of AC (Group 1) 12.3% had no AC at surgery. 300/5547 patients (5.4%) had AC without preoperative criteria (Group 2).Group 1Group 2Emergency admission588 (99.1)203 (67.6)Presentation with Jaundice96 (16.2)110 (36.6)Previous acute cholecystitis76 (12.8)3 (1)USS:GB Thick wall or contraction389 (65.6)112 (37.3))Bile duct dilatation66 (11.1)179 (36.6)Preoperative imaging:MRCP23 (3.8)21 (7)CT76 (12.8)15 (5)ERCP8 (1.35)11 (3.6)Operative GB findingsAcute193 (32.5)140 (46.7)Empyema313 (52.8)160 (53.3)Difficulty Grading I&II20 (3.4)--III177 (29.8)117 (39.1)IV344 (58)168 (56.2)V52 (8.8)15 (4.7)Adhesions GB to:Duodenum503 (84.8)241 (80.3))Hepatic flexure410 (69.1)169 (56.3)Difficult cystic pedicle524 (88.3)273 (91)Fundus first dissection39 (6.6)19 (6.3)Bile Duct Exploration:106 (17.8)98 (32.6)Transcystic93 (15.6)72 (24)Choledochotomy13 (2.2)26 (8.7)Operative time (median, range)80 min (32-280)85 (35-350)Open conversion3 (0.5)3 (1)Morbidity40 (6.7)30 (10)Hospital stay (median, range)9.9 (1-62)13 (1-100)Mortality4 (0.67)1 (0.3)Resolved in one episode427 (72)189 (63)

Conclusions
300/806 (37.2%) of AC or empyema encountered at operation do not have preoperative criteria. 25% of all AC require bile duct exploration. Emergency biliary admissions should be dealt with by specialist surgeons.
ThP4.10 - Outcomes of Transcystic Laparoscopic Common Bile Duct Exploration at the time of Laparoscopic Cholecystectomy in patients with small common bile duct diameter
Authors: Winter Jonny , Gudyma Jaroslaw , Eltayeb Omer 
Published: September 2024

Abstract

Aim
Laparoscopic Cholecystectomy with Laparoscopic Common Bile Duct Exploration (LC+LCBDE) is a single stage therapeutic option for management of choledocholithiasis. There have been limited publications regarding the feasibility of transcystic LCBDE in patients with small (≤8mm) common bile ducts (CBD). This study seeks to examine the outcomes for patients with small ducts who underwent LC+LCBDE via a transcystic approach in a district general hospital over a two-year period.

Methods
Prospectively collected data regarding all patients who underwent LC+LCBDE over a period from January 2022 to December 2023 was retrospectively reviewed. Data concerning indication for surgery, CBD diameter, length of stay, complication rate, and readmission rate were determined from Electronic Care Records. Data were analysed using Microsoft Excel.

Results
50 patients were identified. CBD diameter (as measured at pre-operative Magnetic Resonance Cholangiopancreatography [MRCP]) ranged from 3.5mm to 8mm (average 6.25mm). One patient required conversion to open surgery due to difficulties with the LC element of the operation. Median postoperative length of stay was 1 day (range 0-8 days) and readmission rate was 6%. One patient experienced a complication beyond Clavien-Dindo Grade 2, this caused by a superficial wound infection requiring washout under general anaesthetic. One patient required subsequent Endoscopic Retrograde Cholangiopancreatography (ERCP) for management of retained CBD stones.

Conclusions
LC+LCBDE is a safe and effective management option for patients in the setting of choledocholithiasis with small common bile duct diameter. Small CBD should not necessarily be a deterrent to consideration of LCBDE as a therapeutic option in appropriately selected patients.
ThP4.11 - Preoperative respiratory disease and outcomes of pancreatoduodenectomy performed for malignancy
Authors: Jordan Caitlin , Rees Jonathan , Russell Tom , Aroori Somaiah ,   RAW Study Collaborators, Mavroeidis Vasileios K 
Published: September 2024

Abstract

Background
Despite improvements to morbidity and mortality rates in recent decades, pancreatoduodenectomy for malignancy (PD) remains a high-risk operation. Patients with pre-existing respiratory disease are likely to be at increased risk of developing postoperative complications but few prior studies have investigated this. This may be as few patients with significant respiratory pathology are considered appropriate surgical candidates. This study aimed to compare PD outcomes in patients with a prior respiratory condition to those without. The outcomes of interest were median length of stay (LoS), 30-day readmission, 90-day mortality, unplanned return to theatre rate and five-year survival.

Methods
Data was extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for pancreatic head malignancy (29 centres in 8 countries, n=1484). Pre-existing respiratory disease included a prior diagnosis of: asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, pulmonary embolism, asbestosis, obstructive sleep apnoea, pleural effusion, tuberculosis, pulmonary sarcoidosis, pneumoconiosis or hypersensitivity pneumonitis. The Mann-Whitney U test and Fisher exact test were used to compare the two groups.

Results
Out of a total of 1484 cases, 142 patients (9.6%) had a pre existing respiratory comorbidity. Asthma and COPD both affected 4.2% of patients. All other included pathologies affected less than one percent of patients. 30-day readmission (8.5% vs 9.1%, p=0.1), 90-day mortality (1.4% vs 3.7%, p=0.2), and unplanned return to theatre rate (3.5% vs 5.1%, p=0.5) were similar between the two groups, however, median LoS was significantly longer in those with a prior respiratory disease (14 vs 13 days, p&lt;0.0001). Five-year survival was also higher in those without respiratory disease but this was not statistically significant (24.6% vs 32.5%, p=0.06).

Conclusion
In our multicentre study of patients with confirmed malignancy, PD patients with a preoperative respiratory disease had significantly longer length of stay. There was a trend towards lower 5-year survival.
ThP5.2 - Comparison of perioperative outcomes of open (CUSA) versus laparoscopic (LOTUS) major hepatectomy – revisited. First evaluation of efficacy and safety of AEON stapler
Authors: Iqbal Affan , Baltatzis Minas , Stathakis Panos , Siriwardena Ajith , Jamdar Saurabh , Sheen Aali Jan 
Published: September 2024

Abstract

Introduction
In 2019, preliminary data matching 40 cases demonstrated improved outcomes of laparoscopic major liver resections using the BOWA-LOTUS liver blade (Devon, UK). An updated and expanded comparison between open and laparoscopic major hepatectomies is presented as well as evaluating of an endovascular stapler AEON™ (Lexington Medical, Massachusetts, USA).

Methods
January 2020 to June 2023 patients were identified from a prospectively maintained database. Propensity score matching analysis used R statistical tool in SPSS (IBM, New York, USA) to isolate matched open and laparoscopic cases. LOTUS ultrasonic energy device was used for parenchymal transection in laparoscopic cases and CUSA (Valleylab, Colorado, USA) in open procedures. AEON endovascular stapler was used from early 2021.

Results
86 patients constitute the study population after applying propensity score matching analysis in a 1:1 ratio. The median (range) age in the matched sample was 63 (27-83) yrs. Hospital stay (mean 7.8 v 14.7 days; p=0.025) and blood transfusion requirement (0 v 4 units; p=0.035) were all significantly improved when comparing laparoscopic to open. Comparison of the AEON stapler with Endo-GIA (Medtronic, MN, USA) showed no significant difference in any outcome measure, although AEON demonstrated (non-significantly) a reduced trend in operating time comparing all cases (56 v 69 mins; p=0.300) and laparoscopic (56 v 71 min; p=0.295).

Conclusion
The LOTUS liver blade continues to be associated with acceptable outcomes in laparoscopic liver resections. The AEON endovascular stapler was equivalent to other staplers with a trend towards a shorter operating time in liver transectional surgery.
ThP5.9 - Evaluation of cholecystectomy service in a general NHS hospital
Authors: Albendary Mohamed , Abbasova Aisel , Jacob Preethi , Sakr Mohamed , Elarian Mohamed , Ihedioha Ugo 
Published: September 2024

Abstract

Background
Cholecystectomy is commonly performed for biliary pathologies, as elective, emergency, or at prioritised basis (Hot Gall bladder service).

Aim
Evaluating local performance of cholecystectomy, outcomes and areas for improvement.

Results
Over a 4-week period, 38 cholecystectomies were performed, all laparoscopically. Almost half had cholecystitis or cholangitis requiring at least 1 admission with 5 patients required more than 1 admission in 12 months prior to surgery. 50% of cholecystectomies were done in 6 months, while the longest waiting time was 13 months. 50% of procedures were done electively, whereas the rest in emergency and hot gall bladder lists. Indications included acute cholecystitis (13), biliary colic (11), chronic cholecystitis (6), biliary pancreatitis (4), GB polyps (3) and CBD stones (1).
Only 2 had subtotal cholecystectomy, and Nassar operative difficulty was graded as one in 18, two in 15, three in 4 and four in 1 of the cases. Critical view of safety was obtained in 85% and biliary anatomy was unusual in 12 cases. Operative cholangiogram and CBD exploration were performed in 5 and 8 cases respectively. Complications included bile spillage (12/38), and bleeding (7/38).
30-day follow up showed 16 patients were discharged in 24 hours and only 3 readmitted. The incidence of complications was 37%, 11 cases had SSI and 3 had pulmonary complications). No bile leak or CBD injury. All specimens were sent for examination showing benign histology.

Recommendation
Emergency and hot cholecystectomy services not only cut down waiting lists but also reduce costs of reoccurring admissions, with no significant added complications. Selective gall bladder histological examination may reduce costs with no recognised risks.