bluuebunny/crossref_metadata_2025_split huggingface dataset:
442 Prophylactic Peri-Nephric Drain Placement in Renal Transplant Surgery: A Systematic Review and Meta-Analysis
Authors: Lakha A S , Ahmed S , Hunter J , O’Callaghan J 
Published: July 2024

Abstract

Aim
Usage of prophylactic perinephric drains is variable in renal transplantation, drains are associated with risks, and there is a lack of consensus as to the relative benefit of placing a drain intraoperatively in this patient cohort. This meta-analysis assessed whether prophylactic perinephric drainage reduced the need for postoperative intervention to manage collections.

Method
This systematic review and meta-analysis was performed using the Preferred Reporting Items in Systematic Reviews and Meta-Analysis and was prospectively registered on PROSPERO (CRD42021255795). A literature search was carried out in June 2023, and titles and s was screened against our pre-defined criteria. Quality assessment was performed using the Newcastle Ottawa Scale. Summary statistics for outcomes of interest underwent meta-analyses to a confidence interval (CI) of 95% and are presented as Forest Plots for Odds Ratio (OR).

Results
Literature search revealed 1540 unique titles and s across all four databases. Of these, 4 retrospective cohort studies were selected. Meta-analysis of 3 studies showed no evidence of a significant reduction in reintervention rate with drain placement, OR=0.59 (95%CI: 0.16-2.23, p=0.44). Meta-analysis did not show a significant reduction in perinephric collections with drainage OR=0.55 (95%CI: 0.13-2.37, p=0.42). Finally, there is not good evidence that drain placement reduces superficial wound complications or improves 12-month graft survival.

Conclusions
Given the lack of current evidence basis supporting the practice of prophylactic perinephric drain placement in renal transplantation, we advocate for a drain-free strategy in this patient cohort. Well-designed, prospective studies to assess the risks and benefits of intraoperative drain placement in these patients is needed.
152 Three-Dimensional Printing Bespoke Polycaprolactone Tracheal Splint for Treatment of Tracheomalacia
Authors: Gnanalingham S , Wu L , Song W 
Published: July 2024

Abstract

Aim
Tracheomalacia can be a fatal airway disease with limited treatment options. Three-dimensional (3D) printing has led to various patient-specific tracheal stents and splints. However, these are limited by mismatched stiffness and resulting granulation tissue formation and fibrosis. We aimed to develop a non-toxic and biodegradable polycaprolactone expandable tracheal splint by 3D printing. By fine-tuning mechanical properties, we hypothesised that the splint would match the native trachea and accommodate tracheal growth in tracheomalacia patients.

Method
We designed splints consisting of concave topological patterns with varying angles and aspect ratios. Fabrication occurred using polycaprolactone filaments in a 3D fuse deposition modelling printer. Uniaxial tensile studies were performed on splints to assess Young’s Modulus, Toughness, Ultimate strain, Strength, and Poisson ratio. Splints displaying optimal mechanical properties were tested for human lung fibroblast cell viability, proliferation, and morphology.

Results
On a mechanical testing rig, uniaxial tensile studies confirmed that splint designs with smaller angles and negative Poisson ratios of up to strains of 25%, better mimicked mechanical properties of native human trachea, accommodating tracheal growth. In vitro studies using these tracheal splints demonstrated successful human lung cell proliferation with low cell toxicity.

Conclusions
This study characterised 3D printed bespoke tracheal splints with various 2D structures, showing mechanical properties that match the native trachea. However, in vivo studies investigating cellular interactions on our splint must be performed to further evaluate the ability for endogenous tissue formation.
542 Reducing the Burden to Deliver Remote Postoperative Surveillance Using Machine Learning for Surgical-Site Infection (SSI)
Authors: McLean K , Sgrò A , Brown L , Buijs L , Potter M , Bouamrane M M , Harrison E 
Published: July 2024

Abstract

Aim
To develop novel methods for automated assessment of patient-generated data from remote postoperative wound (RPW) surveillance to reduce the burden of clinical triage for in-person assessment.

Method
This was a secondary analysis of an interventional study on RPW surveillance: “ImplementatioN of Remote Surgical wOund Assessment During the coviD-19 pandEmic” (INROADE). INROADE included adult patients undergoing gastrointestinal surgery, who could submit images of their surgical wound(s), and patient-reported symptoms of SSI for 30-days postoperatively. Separate models were developed to predict a clinical diagnosis of SSI within 48h based on patient-reported symptoms (logistic regression) and wound images (convolutional neural networks [CNN]). Model performance was evaluated using area under the curve (AUC), with 95% confidence intervals. The impact of implementation of automated assessment was simulated within the RPW surveillance pathway to “rule-out” responses needing clinician triage.

Results
Of 200 patients enrolled, there were 1529 responses with 3.3% (n=51) submitted within 48h of an SSI. There was excellent discrimination using logistic regression with patient-reported symptoms (AUC: 0.830, 0.765-0.894). 2,125 images were used to develop the CNN, which showed moderate discrimination to identify 48h SSI (AUC: 0.615, 0.556-0.674). Usage to screen out “low-risk” responses prior to clinical triage was estimated to half the staff-time to deliver (12.2h vs 25.5h), while maintaining diagnostic accuracy (AUC: 0.760 [0.685-0.834] vs 0.789 [0.717-0.861]).

Conclusions
Automated assessment can be successfully deployed within RPW surveillance pathways to reduce the burden on staff to deliver without compromising care and allow resources to be appropriately directed to those at greatest risk of SSI.
895 Innovating Automated Progress Tracking System (APS) for Laparoscopic Simulation Training in Low-Middle-Income-Countries Using LaApSi Models: Low-Cost High-Fidelity Performance Assessment System with Microcontroller Connectivity
Authors: Karki B B , Sharma S , Neupane P , Phuyal S , Shrestha S , Katuwal S , Loubani M , Satyal S 
Published: July 2024

Abstract

Aim
To develop a Low-Cost Automated Progress tracking system (APS) embedded in the silicon based Laparoscopic Appendicectomy Simulation (LaApSi) Model which enables real-time assessment of Laparoscopic Appendicectomy (LA). To assess its application and validity in the low-resource setting via Laparoscopic Surgery courses.

Method
APS architecture includes thin insulated wires embedded in the LaApSi Models at the mesoappendix, appendicular artery, and the base of the appendix which acts as an indicator when cut during the appendicectomy. These wires are further connected to the Printed Circuit Board (PCB) located at the base of the model which connects with the microcontroller and establishes communication with the computer giving real-time data.

Results
The prototyped APS model was able to establish key features: 1. Total duration of the procedure 2. Identify potential surgical hazard: blood vessel injury 3. Length at which the appendicectomy is performed 4. Injury to surrounding structures. These performance data were recorded in the database for further review, analysis, and comparison for progression in the simulation training. The system is set up on a points basis hence when a user makes a surgical error e.g., blood vessel injury during the surgical simulation in the APS LaApSi Model, -20 points (Blood Vessels Cut) appear on the computer screen (images available). Further assessment and validity of the APS models are planned to be carried out in low-resource settings in the next 8 weeks.

Conclusions
The availability of a model blueprint of this cost-effective APS system (&lt;20£) to LMICs will address the key barrier of surgical simulation in low-resource settings.
356 The Role of Cancer Cachexia in Influencing Outcomes in Pancreatic & Biliary Malignancy
Authors: Jackson S , Dreyer S , Bryce A , Holroyd D , Jamieson N l , Chang D 
Published: July 2024

Abstract

Aim
To investigate the influence of cancer cachexia on outcomes and clinicopathological variables in pancreatico-biliary malignancies.

Method
Patients who underwent pancreaticoduodenectomy for malignancy from 2007-2020 at the Glasgow Royal Infirmary were included in this study. Pre-operative single-slice CT scan images were collected for cross sectional analysis of body composition using the semi-automated segmentation programme, SliceOmatic. Body composition measurements were represented as z-scores to account for age and sex.

Results
Subcutaneous fat radiodensity (SFD) was significantly lower in ampullary adenocarcinoma (-0.17+/-0.95), duodenal adenocarcinoma (-0.03+/-1.08), and cholangiocarcinoma (-0.18+/-1.00) groups compared to the pancreatic cancer group (0.12+/-1.00) (P=0.09). Skeletal muscle index (SMI) was significantly higher in those diagnosed with cholangiocarcinoma compared to all other indications (0.20+/-0.91 vs -0.04+/-1.02, P=0.05). Disease-specific and recurrence-free median survival was lower in those with low SMI compared to those with high SMI for all indications (35 months vs 41 months, 13 months vs 18 months).When comparing those who underwent up-front resection to those who received neoadjuvant therapy, visceral fat index (VFI) was found to be higher (0.06+/-1.00 vs -0.21+/-0.99, P=0.03) and skeletal muscle density was found to be lower (-0.05+/-1.01 vs 0.18+/-0.96, P=0.04). SFD was also found to be significantly lower in those with AJCC stage 1 compared to all other stages (-0.21+/-0.86 vs 0.07+/-1.01, P=0.03).

Conclusions
Adverse body composition may influence outcomes in pancreatic and biliary malignancy; however, this influence appears to be modest at best. Clinical applications of body composition analysis may be limited to serial monitoring of patients within the context of their treatment pathway.
617 Patient Harm Is Underreported Due to an Inadequate Reporting System for Serious Incidents
Authors: Marla A , Borra P , Lau J , Parthiban S , Butler P , Ponniah A 
Published: July 2024

Abstract

Aim
The Royal Free London Skin Cancer Service (RFL-SCS) is the largest referral centre in London, having received 26,114 two-week-wait referrals since January 2022. Patients are filtered through a complex Skin Cancer Pathway (SCP) involving multiple disciplines (dermatology, plastic surgery, oncology). This root cause analysis of Serious Incidents (SIs) attempts to pinpoint their underlying causes and identify key themes for the re-design of the SCP to ensure patient safety.

Method
A retrospective analysis of SIs recorded by the RFL-SCS between January 2022 and September 2023 was conducted. Incidents were attributed to various stages in the SCP, which was mapped out in detail. Related information was gathered by interviewing staff at significant points in the pathway and reviewing relevant procedures. A survey of practitioners was conducted to understand if SI reporting through the Datix system was accurate.

Results
From 26,114 referrals, 1326 needed treatment. 657 of these patients breached the two-week-referral target, with 10 SIs identified. 83% of practitioners surveyed felt that this was an underestimation. Major event types involved no follow-up appointments being booked after: MDT (3); surgery (2); scans (5); patient lost to follow up (1); and poor communication with patients (2).

Conclusions
System-wide changes must be implemented to prevent SIs from reoccurring. The Datix reporting system was described as convoluted and inadequate, leading to under-reporting of patient harm. More research needs to be conducted in designing an automated tracking system to flag-up and action MDT outcomes for patients with completed excisions, histology, and scans. This will prospectively avoid delays in onward referrals.
565 Robot-Assisted Surgery for Thoracic Endometriosis Syndrome – a Single-Centre, Retrospective Review of the First Fifty Cases
Authors: Kawka M , Barton-Smith P , Routledge T , So C , Dhond G , Jiao L R 
Published: July 2024

Abstract

Aim
Thoracic endometriosis syndrome (TES) is underdiagnosed, due to cyclical thoracic symptoms being underreported. Management of TES also remains controversial, with abdominal and thoracic approaches proposed, both laparoscopically and robotically, and no guidelines available. We aimed to characterise our experience with a multidisciplinary, robot-assisted approach, with a focus on symptom prevalence and surgical outcomes.

Method
A retrospective review of all consecutive procedures for TES between July 2020 and March 2023 surgery was performed. Robot-assisted removal of endometriosis from the underside of the diaphragm, from the pleura or superior diaphragm, or wedge resection of the lung through videoscope-assisted thoracic surgery, in any combination with or without pelvic endometriosis removal, were included. Presenting symptoms, intra-operative, and histological outcomes were analysed.

Results
Fifty robotic TES procedures, on forty-six patients were undertaken; median age was 32 (IQR 26–36). Cyclical shoulder tip pain (n = 29, 63%), costal margin pain (n=18, 39.1%), and scapular pain (n=11, 23.9%). There were no major Clavien-Dindo complications. Median blood loss was 10ml (IQR 6.25–27.25), and median length of stay was 1 day (IQR 1–2 ). The majority of the underside of the diaphragm specimen (n=35, 77.8%), and the pleural, and lung specimens (n=17, 85%) were either histologically positive for endometriosis or showed inflammation consistent with endometriosis.

Conclusions
Robotic-assisted surgery can be safely used for TES. Management of TES should involve an MDT including gynaecologic, hepato-pancreatico-billary, and thoracic surgeons, with minimally invasive experience. Going forward, long-term, patient-reported outcomes need to be analysed to ensure the effectiveness of robot-assisted surgery in TES.
619 Training the Trainees in Robotic Surgery – a UK Pilot Scheme
Authors: Al Ani M , Jayawardena P , Hashmi K , Assaf N , Lo T , Sudlow A , Patel V 
Published: July 2024

Abstract

Aim
Training the trainees in robotic surgery is a specialised and crucial process, given the precision and complexity involved in performing operations using robotic systems. Robotic training for trainees is challenging due to limited access to robotic systems and the lack of training opportunities. We describe how we implemented a training programme for trainees at West Hertfordshire Teaching Hospitals (WHTH) NHS Trust within a year of the consultants starting their robotics programme.

Method
Specialist trainees at WHTH who would have been offered training in laparoscopic surgery in colorectal, upper gastrointestinal and general surgery were selected to train as console surgeons on the CMR Surgical Versius system. All trainees had been on a first assist course and had experience in assisting in robotic surgery. Training included online modules, metrics-based virtual training, and technical skills assessment. Live operating was supervised by consultant trainers who sat beside the trainee.

Results
Six trainees ranging from ST4 to ST8 level were selected to partake in the training programme over a period of six months. Operations were broken down into modular parts and included segmental colectomies, anterior resections, cholecystectomy, and inguinal hernia repair. The trainees have participated in over thirty operations. Feedback from consultant trainers was given verbally and through work-based assessments. No adverse events were reported in training cases.

Conclusions
Robotic surgical training for specialist trainees can be implemented safely and in a timely manner. Objective metrics such as docking time, console time and volumetric hand motion may help with trainee assessment in the future.
772 Assessing the Impact of Gaming Skills on Robotic Surgical Skill Acquisition and Learning Curves
Authors: Ike D I , Asemota N , Jacob A , Okorocha C , Stamenkovic S 
Published: July 2024

Abstract
Robotic surgery has rapidly advanced across various medical specialties over the past decade. Extensive research has confirmed the benefits of robotic surgery, leading to improved surgical outcomes and patient satisfaction. Historically, only highly experienced consultants in laparoscopic and open surgery received training in robotic surgery to the detriment of junior surgical trainees.
Virtual reality simulators have introduced gamification to enhance surgical skills. Studies have shown that individuals with gaming experience, musical aptitude, and sports backgrounds exhibit improved psychomotor skills relevant to surgery, including hand-eye coordination, reaction time, and visuospatial awareness. Despite this, there is a lack of research on how gaming and musical abilities impact robotic surgical skill acquisition and learning curves.
This prospective, observational, and comparative study involved 15 novice surgeons with no prior robotic experience recruited from various UK medical institutions. Participants were divided into two groups based on their video game experience.
While statistical significance was not reached (p 0.26), an observed trend favoured the gaming cohort's performance (M 56.29, SD 57.85) on the robotic surgical simulator compared to the non-gamer group (M 38.41, SD 46.77) possibly due to the limited sample size. Gamers exhibited notably superior reaction time scores (p 0.037) Additionally, gamers demonstrated enhanced overall performance in spatial reasoning and the Beat Saber game, assessing hand-eye coordination, though these differences did not reach statistical significance.
This study suggests that video gaming experience may provide novice surgeons with certain advantages when beginning training on the high-fidelity dVSS robotic surgical simulator. Further research with larger participant groups may confirm these findings.
1170 Bridging the Gap in Surgical Robotics Education
Authors: San N T , Rahman K R , Wongsikhee J R , Brahmbhatt K , George J , Mahmood A , Bowrey D 
Published: July 2024

Abstract

Aim
Despite rapid evolution of surgical robotics systems, training opportunities are very limited especially for medical students and junior doctors. We organised a free-of-charge regional robotics workshop in collaboration with CMR Surgical with the goal of increasing exposure to surgical robotics technology. We also evaluated the delegates’ perception on current surgical robotics training and the workshop.

Method
CMR Surgical was invited to exhibit their Versius® robot and Virtual-Reality trainer for a one-day workshop at Glenfield Hospital, Leicester. The workshop was advertised across universities and hospital trusts in East Midlands. Registration form included pre-workshop questionnaire which assessed the motivation and barriers to attending surgical robotics courses, and their familiarity with robotics surgery. After 1-hour hands-on exercise supervised by consultants and CMR Surgical trainers, delegates were asked to complete post-workshop questionnaire to evaluate shift in familiarity, interest, and confidence in basic robotic skills.

Results
75 delegates registered with 93% having never attended similar workshop before and the barriers were perceiving that robotics surgery skills are for advanced surgeons only (37%), cost (26%), no accessible courses (24%), time constraints (9%) and others (4%). The primary motivation to attend this workshop were learning basic robotic skills (49%), exploring innovative technology (44%) and networking (7%). 30 delegates were shortlisted for 1-hour hands-on experience into six groups consisting of 18 students and 12 junior doctors. Post-workshop feedback showed a positive shift in familiarity, interest, and confidence in basic robotic skills. Delegates also expressed increased interest in surgical specialties after this workshop. They also found VR station was enjoyable and believed it has potential in training future robotic surgeons.

Conclusions
These findings highlight the feasibility and importance of creating accessible training opportunities to bridge the gap in surgical robotics education.
363 Development and Validation of a Virtual Teaching Method for Minimally Invasive Surgery Skills
Authors: Ali I , Das B , Ledesma F , Law S , Pai M , Ashrafian H , Spalding D , Fehervari M 
Published: July 2024

Abstract

Aim
Remote teaching of surgical skills has rapidly emerged as a promising alternative to the traditional face-to-face (F2F) format. This study sought to evaluate whether minimally invasive surgery (MIS) skills could be taught remotely using available technology with objective assessments of proficiency.

Method
In a pilot study, we compared face-to-face (F2F) and virtual training for novice MIS learners, evaluating proficiency through objective parameters. The pilot refined methods, and the subsequent course was the evaluation basis. Virtual training shifted from conventional to personalised teaching in the second round, introducing headphones for enhanced guidance. Optimisation achieved comparable online teaching quality to F2F. Evaluation tasks included peg transfer (MISTELS) and suturing (SUTT) on box trainers.

Results
Technical challenges in delivering a virtual MIS skills course were successfully addressed, particularly through the personalised approach in an isolated fashion in the second pilot course. Participants (n = 20) in the final course had similar baseline characteristics and were randomly allocated to F2F (n = 8) and virtual (n = 12) teaching groups. Participants in the virtual group demonstrated faster completion of the peg transfer task compared to the F2F group (11.25 minutes vs. 16.88 minutes; p = 0.015). However, no significant differences were observed in other MISTELS and SUTT performance measures or cognitive workload. parameters.

Conclusions
This study demonstrates that virtual teaching of MIS skills using a web-based streaming platform is feasible and effective, providing the foundation for scalable future programs. Online surgical skills teaching offers simultaneous access for learners in different regions and reduces costs and travel time.