bluuebunny/crossref_metadata_2025_split huggingface dataset:
WTP5.8 An International Multispecialty Survey of Work-Related Musculoskeletal Pain in Laparoscopic Surgeons
Authors: Dixon Frances , Vitish-Sharma Parveen , Khanna Achal , Keeler Barrie 
Published: August 2023

Abstract

Aims
Maintenance of uncomfortable body positions during laparoscopic surgery may lead to work-related musculoskeletal disorders in surgeons. Increasing laparoscopic surgical adoption worldwide necessitates understanding of the nature & extent of the impact on surgeons’ physical health.

Methods
An international open online survey of multispecialty laparoscopic surgeons was undertaken in 2022, with support from ASGBI. This was designed and reported in accordance with the CHERRIES checklist for internet e-survey research. There were no incentives offered or paid advertising. Questions included assessment of surgical experience, incidence, nature, and sequelae of pain.

Results
There were 259 respondents from 9 specialties across 32 different countries, with 90% reporting pain attributable to performing laparoscopic surgery. All training grades were represented. Longer average operative duration (&gt;4hrs vs &lt;1hr) and a greater number of years in practice (&gt;15yrs vs &lt;5yrs) were both associated with a significantly higher pain prevalence (p&lt;0.01 & p=0.041 respectively). Surgeons with a pre-existing injury were significantly more likely to report pain than those without (p=0.029). Early retirement due to pain was being considered by 20%, particularly those performing longer operations. Thirty-five percent of surgeons sought treatment for laparoscopic induced pain, ranging from analgesia to surgery.

Conclusions
The physical impact of performing laparoscopic surgery is significant and consistent across specialties and countries. Particular at-risk groups are those with prior injuries and longer operation times. Innovations such as robotic surgery and improved ergonomic education need further evaluation as to whether they may mitigate against these issues.
WTP6.14 The Effectiveness of Mental Practice in Surgical Skills Practice and Acquisition: A Review
Authors: Walshaw Josephine , Huo Bright , Banks Philippa , McClean Adam , Kwan Jing Yi , Yiasemidou Marina 
Published: August 2023

Abstract

Aims
Mental practice (MP) is an established method to enhance performance in other disciplines. The aim of this review is to assess whether the principles of MP are transferable to surgery and describe how it has been applied in our field so far.

Methods
A narrative review was conducted according to the four steps described by Demiris et. al.

Results
This review describes the different types of MP and their role on motor skill acquisition. The process of preparation, delivery and assessment of a MP session is described here in a reproducible manner; providing a ‘user guide’ to surgeons. MP has been shown in several reports to be an effective means in learning surgical skills, from basic surgical technique to the steps of a procedure. It has also been described as a technique applicable to both surgical trainees and established surgeons. Ten RCTs demonstrated a favourable effect of MP on technical skills and one trial showed that MP with MI is equivalent to additional physical practice. On the contrary two RCTs showed MP to be inferior or have no impact compared to other types of preparation. Reduced MP duration was identified as one of the possible reasons for a lack of positive results.

Conclusion
Mental practice is a feasible method for rehearsing surgical skills and procedures that has been demonstrated to enhance skills acquisition and surgical performance. Larger scale, randomised controlled trials are needed to standardise the duration, number of repetitions, and practical considerations for mental practice in surgery.
WTP8.7 Patient Reported Outcome Measures- Assessment of Breast Day Case Surgery treatment pathway
Authors: Jenkins Stephanie 
Published: August 2023

Abstract

Day Case Surgery is an advancement in patient care and efficiency for hospitals.
The success of day surgery is dependent on the patient’s experience of the pathway.
The usefulness of PROMS is dependant on the questions asked and the “comments box” that encourages any other patient related incidences to be conveyed.

Method
All patients undergoing day case breast surgery were assessed using PROMs to validate the surgical pathway with respect to pain control since patients were requested in advance to purchase simple over the counter analgesia to take according to their own requirements and hospital prescribed discharge analgesia was discontinued.

Results
All patients felt that their pain control immediately after surgery was good, no patients recorded that the pain kept them awake, all felt the pain was well controlled having left hospital and none felt they needed stronger pain relief. Importantly none sought medical help for pain from another source and all rated the service as good.
One patient stayed overnight for medical reasons and stated that this was a necessary and acceptable outcome in the circumstances.
Three patients experienced sore throats and two had post -operative nausea / vomiting and dizziness.
Despite these experiences all stated they liked having day case surgery.

Discussion
PROMS allows patient feedback of the treatment pathway and enables reflection and further improvement to be achieved.
The results support discontinuation of medication on discharge and patient self-medication with over the counter analgesia is acceptable and does not result in seeking pain relief from other sources.
ThTP1.1 Follow-Up of Young Patients Undergoing ERCP for Common Bile Duct Stones: Moving Algorithm Towards Surgery
Authors: Loo Shi Pei , Cooper Duncan , Ciscar Andrea Gonzalez , Katbeh Tarek , Glen Paul 
Published: August 2023

Abstract

Background
Historically, the default treatment for common bile duct (CBD) stones in our institution has been endoscopic retrograde cholangiopancreatography (ERCP). We aimed to assess the clinical outcomes following ERCP performed for CBD stones in patients aged 35 years old and younger, who may have been suitable for single-stage cholecystectomy with CBD exploration instead.

Methods
A database of all patients undergoing ERCP from May 2015 to May 2022 in a tertiary institution was prospectively maintained. We identified patients aged 35 and under who received ERCP for CBD stones, and reviewed data on their demographics and clinical outcomes from electronic clinical records.

Results
A total of 4079 ERCPs were carried out with a post-ERCP pancreatitis rate of 4.3%. 124 patients aged 35 and under (mean age 29±4 years, 84.7% female) were selected for further analysis. They had a post-ERCP pancreatitis rate of 12.1%. 100 patients (80.6%) proceeded to definitive surgery, with a median waiting time of 76 days. Of these, 38.0% experienced an unplanned admission resulting in emergency laparoscopic cholecystectomy; a proportion required repeat ERCP and imaging. Consequently, these patients accumulated a total hospital stay of 13±8 days.

Conclusions
A higher rate of pancreatitis was seen in younger patients and a delay to definitive treatment is described, resulting in unplanned admissions, re-interventions and extra imaging with the associated increased cost. Single-stage cholecystectomy with CBD exploration would reduce complications, unplanned readmissions and cost. It is now our choice of treatment for CBD stones in this group of patients.
ThTP1.3 Does radiological staging accurately predict histological stage in Whipple patients with pancreatic cancer? Results from an international multicentre study
Authors: Russell Thomas , Labib Peter ,   RAW Study Collaborators, Aroori Somaiah 
Published: August 2023

Abstract

Aims
Patients with a suspected malignancy of the pancreatic head should undergo preoperative radiological staging to ensure they are appropriate candidates for pancreatoduodenectomy (PD). Postoperatively, histological staging is performed as this guides adjuvant treatment and is useful for estimating prognoses. This study aimed to investigate the concordance of radiological and histological staging in patients with pancreatic ductal adenocarcinoma (PDAC).

Methods
Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective study of PD outcomes (29 centres from eight countries, n=1484). Patients were excluded if: they had staging data missing, they underwent neoadjuvant chemo-/radiotherapy, or if radiological staging was performed for another malignancy. Pre- and postoperative stages were then compared.

Results
Of the 595 included cases, 20%, 40%, 26%, 4% and 12% of patients were radiological stage T1, T2, T3, T4, and TX, respectively, and 7% (OR: 3.4, 95% CI: 2.3-5.0), 11% (5.4, 4.0-7.4), 80% (0.1, 0.1-0.1), 3% (0.8, 0.4-1.8) and 1% (27.0, 8.4-86.3) were T1, T2, T3, T4 and TX, respectively. Tumour size was significantly larger on histology (median difference: 3mm, p&lt;0.00001). 66%, 27% and 7% of patients were radiological stage N0, N1 and NX, respectively, and 23% (OR: 6.5, 95% CI: 5.0-8.4), 77% (0.1, 0.1-0.1) and 0.3% (22.5, 5.4-93.5) were histological stage N0, N1 and NX, respectively.

Conclusions
In patients who underwent PD for PDAC, preoperative imaging appeared to underestimate disease stage. Histologically, patients had larger, more advanced tumours and were significantly more likely to have involved lymph nodes.
ThTP1.8 Comparison of clinic outcomes between face-to-face and virtual appointments in patients with gallstone pathology: a single-centre retrospective observational study
Authors: Park Eunsoo , Trung Le Ha Bao , John Jomcy , Couper Jasper , Raja Asdaq , Malik Momin 
Published: August 2023

Abstract

Aims
Precautions relating to the COVID-19 pandemic increased the use of virtual telephone and video consultations in the outpatient setting. This study aims to see whether the increased adoption of remote, virtual appointments affected clinic outcomes in patients presenting with gallstone pathology at a district general hospital.

Methods
Data on mode of consultation and clinic outcome was collected retrospectively for all patients reviewed at our department’s outpatient clinics between 01/04/2019 – 01/07/2019 and 01/04/2022 – 01/07/2022 (n=1243). Only patients with a primary diagnosis of gallstones, choledocholithiasis and cholecystitis were included in this study (n=179). Additional details on demographics and co-morbidities (age, ASA, BMI, previous abdominal surgery, abnormal LFTs) were collected for analysis of confounding factors.

Results
60 patients had face-to-face (F2F) appointments and 119 patients had virtual (Virt) appointments (video (VV) n=52, telephone (VT) n=67). Patients who had virtual appointments had a higher rate of discharge (Virt=18.5%, F2F=11.7%) and a lower proportion was offered an operation (Virt=68.1%, F2F=80.0%), although these differences were not statistically significant. When compared to F2F, VT appointments had a significantly higher rate of discharge (26.9%, p-value=0.0540) and a significantly lower proportion were offered operations (58.2%, p-value=0.0144). There were no significant differences in demographics or co-morbidities between the patient groups.

Conclusions
The use of virtual telephone consultations was associated with significantly lower operation offers and higher rates of discharge when compared to face-to-face appointments. Further continuous auditing across multiple centres is required to uphold the standard of care for patients requiring intervention for gallstone pathology following the widespread introduction of virtual outpatient appointments.
ThTP1.12 Stitch Closure of Gall Bladder Remnant during Laparoscopic Retrograde Subtotal Cholecystectomy for Difficult Gall Bladders
Authors: Shrestha Anuj , Basu Sanjoy 
Published: August 2023

Abstract

Background and Aim
Laparoscopic Retrograde Subtotal cholecystectomy (LRSC) recommended for difficult gall bladders (Grade 3&4, Nassar et al) reduces CBD injury (.08%), however, increases subhepatic collections (2.9%), reoperations (1.8%) and bile leaks (18%). Assess whether intracorporeal stitch closure of gall bladder remnant reduces complications and improves outcome.

Patients and Method
Prospective study of 1722 consecutive patients undergoing LC in a large DGH (2007-2022) with data of age, sex, BMI, ASA, grade of operation with postoperative stay and complications were collected and analysed. Group A: Conventional laparoscopic total cholecystectomy (LTC). Group B: LRSC includes a ‘fundus first approach’, piecemeal anterior & posterior wall transection with &lt;1cm gall bladder remnant that is closed with a figure of 8 absorbable sutures.

Results
Group A: 1584(92%) with Male: Female 1:4 (363:1221), Age 51* (16-89) years, BMI 27* (17-65), ASA 2* (1-3), Grade 1* (1-4), Operating time 45* (15-200) minutes, PO stay 0* (0-15) day. 11(.7%) conversions, 3(.18%) CBD injury, 4 (.25%) bile leaks, 3(.18%) ERCPs, 13 (.82%) collections requiring 9 surgical wash outs and 4 radiological drainages.
Group B: 138(8%) with Male: Female 1:1 (64:74), Age 61* (21-88) years, BMI 29 * (19-60), ASA 2* (1-3), Grade 4* (3-4), Operating time 100 *(40-240) minutes, PO stay 1 *(0-13) day. One (.72%) conversion, 6(4.3%) bile leaks, 3(2.17%) ERCPs and 3(2.17%) collections requiring 1 surgical wash out and 2 radiological drainages.

Conclusion
We recommend routine stitch closure of the gall bladder remnant during LRSC that significantly reduces post operative morbidity (bile leak and collection) for a better outcome.
* Median
ThTP2.3 Value of staging laparoscopy in patients with oesophageal and junctional cancers – Single centre retrospective observational study
Authors: Liyanage Nanayakkara Kushan Dhanuja , Khateeb Basim , Ng James , Sengupta Paulomi , Savadia Krishna , El-Sharkawy Ahmed 
Published: August 2023

Abstract

Introduction
The role of staging laparoscopy in oesophageal and junctional cancer remains controversial due to lack of robust evidence leading to heterogenous practice nationally and globally. The purpose of this study was to identify the value of staging laparoscopy in patients with oesophageal and junctional cancer.

Methods
A retrospective review of all consecutive patients who underwent staging laparoscopy for oesophageal and junctional cancer over 7-year period at Royal Derby Hospital, Derby was conducted using hospital database. Patient demographics, histology, staging, location, and findings of staging laparoscopy were analysed.

Results
A total of 278 of patients underwent staging laparoscopy from July 2015 to September 2022 were included. All patients with gastric cancer histology were excluded. Majority of the patients were having adenocarcinoma histology (N=248, 89.2%) and 236 (84.8%) cancers were involving lower oesophagus/ GOJ. Additionally, nearly three-quarters of patients (N=203, 73%) were having T3 staging before the procedure. Overall, staging laparoscopy had changed the management in 22 patients (7.9%) due to positive cytology (N=12, 4.3%) and other findings (N=10, 3.5%) such as cirrhosis liver, large bulky tumour, and peritoneal deposits. Out of patients who were having positive cytology, all had adenocarcinoma histology, located in the lower oesophagus, and had T3 or above pre-operative staging.

Conclusion
This study identified the value of staging laparoscopy in patients with certain risk factors who are at risk of having peritoneal disease. Therefore, selective approach would be more appropriate when selecting patients for staging laparoscopy in oesophageal and junctional cancer.
ThTP3.2 Introducing a ward round template to improve the quality of documentation on the general surgery ward round
Authors: Davenport Matthew , Chan Chetying , Suhail Shameel , Davies Emma 
Published: August 2023

Abstract

Aims
We aimed to improve documentation on general surgical ward rounds, through the introduction of a ward round template at a single UK surgical unit.

Methods
The structure of the template was adapted from the ‘Surgical Assessment for Emergencies Ward Round Tool’ produced by the RCSEd, with modifications based on local requirements. A retrospective audit was performed of 4 weeks of electronic ward round notes prior to, and 4 weeks after the introduction of the template. Ward round notes on 2 chosen days (Wednesdays and Saturdays) during the 4 week study periods were included for analysis. We observed how frequently specific important clinical information was documented.

Results
378 electronic ward round notes were analysed (176 before, and 202 after the introduction of the template). The ward round template was used, either in part or in full, in 72% of ward round notes following it’s introduction. An pre-existing structured electronic ward round note had previously been used in only 1% of cases. How frequently each of the following components was documented when using the template was: important admission events (86%), VTE prophylaxis (93%), nutritional status (76%), review of prescribed antibiotics (91%) and ceiling of care (65%). We demonstrated statistically significant improvements for each of these components (p&lt;0.05) from pre-template rates (73%, 16%, 63%, 51% and 2% respectively).

Conclusion
The introduction of a ward round template vastly improved the frequency with which a structured approach to ward round was taken. In doing so, significantly improving the documentation of important clinical information.
ThTP3.6 Patient-Reported Experience Measures: the impact of In-Person Surveys
Authors: Gouaalla Hafsah , Riyazati Mahta , Nyantakyi Maame , Ali Fizza , Gambhir Raghvinder Pal Singh 
Published: August 2023

Abstract

Aims
This study aimed to identify the impact of actively administering a survey to aid patients in completing patient-reported experience measure (PREM) surveys. We aimed to compare key domains' results to the national UK kidney PREM 2021 report and determine whether there is a difference between surveys administered by an in-person volunteer and self-administered surveys.

Methods
Our volunteers visited hospital renal and satellite dialysis units weekly from Aug to Oct 2022. All haemodialysis patients were offered to complete a 38-item survey covering 14 domains on their renal care experience using a 1-7 rating scale, 1 being the lowest rating and 7 the highest. We then compiled and compared our results to the 2021 report.

Results
49 out of 82 patients completed the PREM survey. The completion rate increased from the previous year in hospital dialysis and satellite units. The patients’ experience domain score was lower than the 2021 report, with an average score of 5.66 compared to 6.24. A higher percentage of patients in our study (36.7%) reported never being asked about their emotions compared to 14.4% in 2021. This has led to a new referral pathway for seeking emotional counselling.

Conclusions
This year’s survey identified a felt need for emotional support and creation of a new referral pathway for the same. Administering surveys in person through volunteers increases patient engagement and receptiveness to engage, especially for patient groups that may have barriers such as language, disabilities and lack of access to technology.
ThTP3.9 Perceptions and priorities of perioperative staff and the public for sustainable surgery: a validated questionnaire study
Authors: Gadi Nishita , Lam Kyle , Beatty Jasmine Winter , Acharya Amish , Purkayastha Sanjay 
Published: August 2023

Abstract

Aims
To determine the attitudes and beliefs of perioperative staff and the public to sustainability initiatives in surgery, and whether differences exist between the two groups. Despite a drive to improve surgical sustainability, few interventions have been adopted. Stakeholder engagement is considered a key barrier to implementation.

Methods
Validated healthcare questionnaires were developed using a stepwise process. A systematic review was undertaken to identify key domains pertaining to sustainability, and ensure content validity. Initial questionnaires were refined using an iterative process of feedback from focus groups. Psychometric validation was conducted to remove question ambiguity. The final validated questionnaire was distributed to perioperative staff and the public using a multi-modal approach.

Results
Only 37.1% of perioperative staff reported implementation of sustainability initiatives in their departments. Yet, staff (45.7%) and the public (48.2%) somewhat agreed that sustainability should influence a surgeon’s procedural decision-making. Insufficient staff education regarding sustainability was a potential cause for lack of adoption, with 71.4% reporting they had no formal training. Staff and the public agreed outcomes (38.6% v. 42.7% p=0.767) and surgeon experience with a technique (28.6% v. 40.0%, p=0.082) were more important than sustainability. However, 40.9% of the public did not consider operative time an important factor compared to sustainability, whilst 45.7% staff would only tolerate procedures 25% longer.

Conclusions
Engaging stakeholders is central to implementing long-term environmentally sustainable initiatives in surgery, without compromising patient outcomes. More work is needed to understand the relative trade-offs considered by perioperative staff and the public, as well as providing both groups with more education on ecological outcomes.
ThTP4.3 Single Incision Laparoscopy (SIL) Versus Conventional Multi-port laparoscopy (CL) for Colorectal Surgery: A Systematic Review and Meta-analysis
Authors: Sherbiney Mohammed El , Khawaja Amir Hassan , Noureldin Khaled , Issa Mohamed , Varma Aarti 
Published: August 2023

Abstract

Background
There is an increase in colorectal cancer resections worldwide and in the UK. The surgical resections were conducted open initially and replaced later with the conventional multiport technique. Laparoscopic colectomy became the standard surgical technique in 1991. With the innovation in surgical technology, single-incision laparoscopy is stated to attract more attention to the possible next step in colorectal resection. This project aimed to compare the outcome between the two techniques and detect if one technique is superior to the other.

Methods
According to the PRISMA guidelines, A detailed literature survey using PubMed, MEDLINE, and EMBASE databases was carried out to extract Randomised Controlled Trials published between January 2000 and May 2021 and using Revman for statistical analysis.

Results
Eleven RCTs were extracted with a total of 1370 with 686patients (50.07%) underwent SIL and 684pateints (49.92%) underwent CL.There was no significant difference between SIL and CL in terms of operative time (SMD=0.01; 95% CI=-0.19 to 0.22; Z= 0.11; P=0.91), length of hospital stays, (SMD= -0.10; 95% CI=-0.22 to 0.02; Z= 1.61; P=0.11), overall complication (OR=0.99; 95% CI= 0.75 to 1.30; Z=0.09; P=0.93). SIL showed shorter length incision (SMD= -0.99; 95% CI=-1.35 to -0.62; Z= 5.25; P&lt;0.00001). SIL showed more intra operative complication (OR=1.80; 95% CI= 0.92 to 3.51; Z=1.72; P=0.09) and conversion to other technique or open (OR=3.10; 95% CI= 0.95 to 10.14; Z=1.87; P=0.06) but was not statistically significant.

Conclusion
SIL can be considered a safe alternative to CL if performed by experienced surgeons.