bluuebunny/crossref_metadata_2025_split huggingface dataset:
1128 Outcomes of Early and Late Decompressive Craniectomies in Contrast to Standard Medical Management in Patients with Traumatic Brain Injury with Refractory Intracranial Hypertension: Systematic Review and Meta-Analysis Study
Authors: Minta K , Kaliaperumal C , Shaker T 
Published: August 2023

Abstract

Aim
The meta-analysis explored the effectiveness of early and late decompressive craniectomies versus medical management in patients with refractory intracranial hypertension after sustaining traumatic brain injury. The clinical outcomes analysed were grouped into 2 categories: favourable (good recovery and moderate disability) and unfavourable outcomes (death, vegetative state, and severe disability). Intracranial pressure has been measured post-randomisation in the studies included.

Method
Google Scholar, Cochrane and Medline search engines were utilised for data collection ranging from 1999 until present. The searched keywords encompassed: decompressive craniectomy, refractory intracranial hypertension, medical management, and traumatic brain injury. Thereafter, the data was uploaded to Review Manager for statistical analysis.

Results
Of the 122 articles, 10 randomized controlled trials were included in the meta-analysis. The analysis yielded that relative risk (RR) of overall mortality in decompressive craniectomy group vs medical management is 0.58 95% CI [0.41, 0.81] (P = 0.001). The standardised mean difference (SMD) for intracranial pressure is -2.59 95% CI [-3.72, -1.46] (P &lt; 0.00001) between the two groups. The odds ratio considering favourable outcomes (Glasgow Outcome Scale) for patients undergoing surgery vs medical care is 1.02 95% [0.57, 1.82] (P = 0.95).

Conclusions
This meta-analysis demonstrates that decompressive craniectomy significantly reduces the overall mortality and intracranial pressure in patients with TBI and refractory intracranial hypertension versus medical management. Decompressive craniectomy has a greater potential to treat TBI patients with refractory intracranial hypertension than medical care alone however more randomised clinical trials are needed to ascertain the effectiveness of the superiority of these treatments in the future research.
633 Are Laparoscopic Skills Transferable to Robotic Assisted Surgery? A Systematic Review
Authors: Behera K , Smith L , McKnight G , Coxon A , Horwood J , Cornish J , Davies M , Torkington J , Ansell J 
Published: August 2023

Abstract

Aim
Surgical education programs are being developed to incorporate robotic technical skills training into pre-existing curricula. With limited availability of robotic training platforms, the aim of this paper was to determine if laparoscopic training can facilitate the acquisition of robotic surgical skills.

Method
A search was conducted using PubMed, MEDLINE, Embase and Cochrane databases according to PRISMA guidelines. Original articles evaluating the transferability of laparoscopic skills into robotic surgery were included across multiple surgical specialities. Non-peer reviewed papers, conference s, and single surgeon’s experience were excluded. The primary outcome was skills transfer, secondary outcomes included; the level of participant experience, tasks performed and assessment tools used.

Results
17 papers were included. 9 (53%) showed good evidence for skill transfer from laparoscopic to robotic surgery, 7 (41%) reported no significant difference. 1 (6%) paper demonstrated prior laparoscopic training had a positive impact on robotic skill but this was diminished for senior trainees. The majority of studies compared residents at different stages of training. All papers assessed simulator surgical specific tasks. There was limited standardisation of assessment processes. No papers assessed tasks in real-life surgical practice.

Conclusions
Evidence exists to suggest that laparoscopic skills are transferable to robotic surgery in a simulation environment. This is particularly evident for surgical novices and less so for experienced laparoscopists. This could potentially enable the use of established laparoscopic training as a means of reducing the robotic learning curve. Further work is needed to assess laparoscopic to robotic skills transfer in a real-world setting.
911 How to Design a Low-Cost 3D Printed Laparoscopic Appendicectomy Simulation Model (LaApSi)?
Authors: Karki B B , Katuwal S , Walshaw J , Atkinson C , Satyal S , Loubani M 
Published: August 2023

Abstract

Aim
To develop a Low-cost Laparoscopic Appendicectomy Simulation (LaApSi) Model and to assess its application for surgical simulation in UK & Lower Middle-Income Countries (LMICs).
To ensure a realistic and accurate representation of the anatomy of the appendix and the laparoscopic appendicectomy procedure.

Method
Autodesk Fusion 360 software was used to design the appendix mould which was 3D printed using Ultimaker Tough PLA material. LaTeX material, Reschimica Shore 20 silicon was used & Validity Testing following simulation by HST using Face Validity & Likert 5-Point scale. LaApSi model has been recently used for the Laparoscopic workshop endorsed by RCSEd organised in LMICs and multiple times within the UK (Hull Suture Centre Laparoscopic Courses & East of England Laparoscopic course for Core Surgery).

Results
Successful Development of a local low-cost Appendix model (under £5) vs expensive market models. Prototype testing results & feedback from the users within and outside the UK are very positive and inspiring. The continuous evolvement of the LaApSi models based on the efficacy testing via face validity and Likert 5 Point Testing results has proved to be effective as evidenced by quantitative assessment where the users scored on Model specification shape, size and Texture: 90%, 96%, 92 % resemblance respectively.

Conclusions
The notion of creating low-cost LA simulation models provides a variety of potential benefits for surgical simulation in LMICs and the UK, and it warrants support from the industry and charity. These simulations aid in offering a standardised, affordable, and safe method for surgical training.
778 New Intervention: Transanal Local Excision of Rectal Lesions with CMR Versius Robotic Surgical System
Authors: Behera K , Khoo E , Reddy C , Speake D 
Published: August 2023

Abstract

Introduction
The Versius robotic surgical system (CMR) is a modular robotic platform. Since its launch in clinical practice in 2019 for General Surgical and Gynaecological procedures it has rapidly expanded into other clinical specialties. We describe its implementation and the world's first series of its use for trans-anal resection of significant rectal lesions.

Method
The optimum bedside unit set-up and port placement was determined in an exploratory study using dry and wet-lab models prior to clinical implementation. The early intervention panel at NHS Lothian were consulted prior to introducing the technique into clinical practice. The case series of patients undergoing robotic Trans-Anal Minimally Invasive Surgery (rTAMIS) were prospectively identified and data collected retrospectively.

Results
A total of 12 patients were included in this case series. Data was collected from cases over a 6-month period from December 2021 to June 2022. 8 patients underwent robotic TAMIS using the Versius platform. 2 cases were converted to laparoscopic TAMIS due to external arm clashes. The average length of stay in hospital was 1 day (range 0-3). There was only one Clavien-Dindo grade II morbidity.

Conclusions
The Versius surgical system is a safe and feasible alternative to TEMS and TAMIS. The technique allows access to the rectum with the advantages of enhanced optics and wristed instruments. We have produced a blueprint for optimised bedside unit positioning and port placement enabling resection of anterior, lateral, and posterior rectal lesions without further patient position changes. Further studies are needed for accurate outcome and cost comparisons to TEMS and TAMIS.
840 Digital Consent: Does It Have a Role in the Perioperative Workflow?
Authors: Moore C , Hart P , Loughran D , St John E 
Published: August 2023

Abstract

Aim
Paper consent processes often contain errors of omission, illegibility, and unwarranted variation. Missing paper-consent forms can cause delays, cancellations, and poor theatre efficiency. Digital consent reduces errors, empowers patients in clinical decision discussions and improves patient perception of Shared Decision Making (SDM). This study evaluates the roll-out of the Concentric Health digital consent application in 2022.

Method
Consent episode data was assessed from a one-year period (1st January 2022 - 18th December 2022) using Concentric analytics. Qualitative data was obtained via optional patient satisfaction surveys.

Results
63,024 consent episodes were created during the period, amounting to 51,424 completed consent episodes for 4,021 unique procedures by 1,427 clinicians across 28 specialties from 38 healthcare providers. Of the completed episodes, 36.8% were completed in advance of the day-of-surgery. 22.9% of episodes were remote. Patients were aged 0-103 years, (median 56, IQR 31). Treatment information was shared digitally with 77.7% of patients. The average patient satisfaction rating was 4.6 out of 5 (1 very poor - 5 very good, n = 8359).

Conclusions
Concentric has been introduced into practice across multiple hospitals and clinical environments, with patients reporting high satisfaction scores. Remote consent is feasible, being used by nearly a quarter of patients. Digital consent facilitates consent in advance of the day-of-surgery, giving patients adequate time for consideration and possibly optimising theatre efficiency. Digital consent applications can be considered for adoption across all units to capitalise on these benefits. Further work will investigate demographic effects on satisfaction scores.
570 Utility of Gaze-Control for Real-Time Surgical Training During Minimally Invasive Surgery - a Feasilibility Study of Eye-Tracking Technology
Authors: Le H B T 
Published: August 2023

Abstract

Aim
Training in laparoscopic surgery is limited to observing what the trainee is doing on the screen and reliant on verbal coaching. The idea of a physical pointer onto the screen in real-time to allow for more focused supervision and to improve communication was conceptualised. The study aims to demonstrate the feasibility and identify the challenges of using eye-tracking glasses in producing this digital pointer onto a screen.

Method
Pupil Core (Pupil Labs GmbH) eye-tracking glasses were used to calibrate the edges of a computer monitor to the pupil tracking cameras (200Hz) and the point-of-view (POV) cameras. Utilising the accompanying open-source Pupil Core software, a red-dot cursor was programmed to display in real-time on an accompanying screen. A video of a simulated laparoscopic cholecystectomy and geometric shapes were displayed onto the screen to demonstrate the technology.

Results
A red dot pointer was successfully displayed on a screen as an overlay controlled entirely by gaze. It was able to track the edges of shapes and used to point out anatomical structures in a video in real-time. Despite the tester looking away from the screen and leaving the seated position, the glasses were able to recallibrate automatically and work seamlessly after. The saccadic nature of eye movements meant that the tracing lines were not always smooth.

Conclusions
This study demonstrates that the technology exists to make this feasible. Further optimisation in software design is required to mitigate the effects of saccadic eye movements. Further studies collecting objective data is required to demonstrate a minimum viable product.
1232 Case Study "Forging a Better Future": A Ground-Breaking Student-Led EDI Curriculum at the University of Oxford
Authors: de Luca e Tuma R , Ali S 
Published: August 2023

Abstract
This case-study will critically analyse the novel EDI curriculum at the Oxford Medical School, including feedback from participating students and facilitators. The curriculum launched in 2020, designed and delivered with the help of students, who advocated for its creation.
The curriculum includes lectures on medical history, ally-ship, ontology, and needs of different minority groups. One of its cornerstones is group-based case discussions, where students discuss how to approach clinical scenarios of discrimination and injustice. Surveys were circulated between all participants (Years 1, 2, Graduate-Entry 1, 4(GE2) and 6(GE4)) from 2020 to 2023; as well as the doctors and students who mediated discussions in 2022-3. These were analysed in conjunction with testimonials from the curriculum's creators.
199 surveys were analysed, and responses were overwhelmingly positive. Average agreement with the statement “Overall, this session was beneficial to my training as a medical student and a future doctor” was 4.48/5; and 4.06/5 with “I feel empowered to challenge acts of harassment or discrimination in clinical settings.” Feedback from facilitators suggest that they also benefit from these discussions. Areas indicated for improvement included length of sessions, and better weaving with wider curriculum.
The experience of a stand-alone EDI curriculum at the University of Oxford yielded positive results. This case-study shows there is great appetite from students to create space to learn more about and discuss these topics. As EDI becomes an increasingly recognised need, universities can share their successes and challenges, working together to create doctors better prepared to handle these issues.
849 Quality Improvement in the Service Delivery of Early Laparoscopic Cholecystectomy (LC) for Acute Cholecystitis (AC)
Authors: Ibrahim M A H , Tsai A Y C , Campbell M , Patel S , Sunny R , Frith D , Tsironis C 
Published: August 2023

Abstract

Aim
Acute gallstone disease comprises 30-40% of emergency general surgery workload. Delayed cholecystectomy is related to increased readmissions, biliary complications, and costs. BSG, AUGIS and NICE guideline advocate early Laparoscopic Cholecystectomy (LC).
The aim of this Quality Improvement (QI) project is to establish an early LC service in a tertiary hospital in central London, based on national QI Collaborative led by Royal College of Surgeons (RCS). The objectives are assessing existing management, developing strategies, and measuring outcome.

Method
The management was evaluated including surgeons’ preferences and operating barriers. Strategies were developed through process mapping and stakeholder engagements. Following the implementation, admissions including time to surgery, and reasons for non-compliance, were recorded. The intervention period was set in 4 phases between September 2019 and November 2020: Plan, Improve, Pause and Restart. The sustainability of change was monitored between January 2021 and October 2022.

Results
282 AC cases were admitted during intervention period and 68% (194) were fit and consented for surgery. The rate of early LC within 8 days increased from 11% to 61%. During the “pause” phase, the intervention was stopped, and early LC rate dropped to zero, demonstrating the importance of continuous application of strategy. The sustainability was shown during the monitoring period; 343 cases were admitted, 140 (41%) fit for surgery, 62 had surgery within 8 days (43%), and 77 within 14 days (54%).

Conclusions
The QI study significantly improved the urgent LC rate and received the RCS prize. Sustainability was demonstrated with continual reviews and adaptations.
113 Does Robotic Anterior Resection Improve the Outcomes for Patients with Rectal Cancer Over Standard Laparoscopic Surgery?
Authors: Nwabueze M , McPherson S 
Published: August 2023

Abstract

Background
Currently, laparoscopic anterior resection (L-AR) is the standard approach for rectal cancer (RC) treatment. Increasingly, AR procedures have been conducted robotically using the Da Vinci Surgical System (DVSS).
Its design has the potential to improve upon the operative outcomes of L-AR. However, the DVSS’s controversial price of $2,000,000 has slowed its clinical adoption. There has been speculation as to whether the clinical outcomes conferred by robotic-assisted AR (R-AR) merits the cost of the DVSS.

Aim
To review the literature on R-AR and L-AR surgery for RC, primarily comparing the clinical outcomes of each approach, with an auxiliary evaluation of cost-effectiveness.

Method
A literature search was performed using the databases OVID Embase, MedLine, and Web of Science. The keywords ‘anterior resection’, ‘rectal neoplasm’, ‘robotics’, ‘robotic surgical procedures’, and ‘laparoscopy’ were entered into each database.
141 records were initially retrieved and screened for relevance. The remaining texts that were fully available and adhered to the eligibility criteria were included in this review.

Results
Ten studies were identified. R-AR resulted in higher quality TME specimens in three studies, (p = 0.02, 0.03, 0.033). and in shorter hospital stays and longer operative times in four studies: (p = 0.03, 0.0001&lt;, 0.001&lt;, 0.001). Overall, R-AR had lower rates of intraoperative complications.

Conclusions
Generally, R-AR seemed to deliver better outcomes, but there is insufficient evidence to establish its superiority over L-AR. Longitudinal studies with extended research periods are required to evaluate the long-term oncological benefits of R-AR.
992 Pioneering Robot-Assisted Spine Surgery in the United Kingdom
Authors: Saha P , Lui D 
Published: August 2023

Abstract

Aim
The placement of a large interbody implant allows for a larger fusion area. Retroperitoneal approaches, like anterior, antero-lateral, and lateral fusion, facilitate the placement of these implants. At the same time, robot-navigation facilitate complex, minimally invasive spine surgery for posterior screw fixation. This is a single-surgeon, single-centre report on the experience of the first procedures ever performed for navigated robot-assisted spine surgery in the United Kingdom.

Method
Between October 2019 and May 2021, we identified 34 consecutive patients who underwent robot-assisted spine surgery. The demographic, intra-operative, and peri-operative data were reviewed.

Results
Of the 34 patients, 65 levels were treated in total (204 screws). 21 patients (60%) underwent single-level fixation, 14 of them (67%) were treated at the L5/S1 level, 3 at L3/L4, 3 at L4/L5 and 1 at L2/L3 level, 13 patients (40%) underwent multi-level fixation, with 4 of them treated for adult scoliosis. Eight patients underwent a supine ALALIF approach and one a lateral decubitus AL-ALIF, 7 had a pure ALIF approach, 8 patients underwent combined XLIF and AL-ALIF approach in a lateral decubitus, 6 underwent pure XLIF approach, 1 patient had previous TLIF surgery, and 3 patients underwent single position lateral surgery (lateral decubitus fusion and posterior screw fixation).

Conclusions
Minimally invasive spine surgery using robot-assisted navigation yields an improved level of accuracy, decreased radiation exposure, minimal muscle disruption, decreased blood loss, shorter operating theatre time, length of stay, and lower complication rates. Further follow-up of the patients treated will help compare the clinical outcomes with other techniques.
1170 An Experience of Arranging the UK’s First Free Robotic Surgery Workshop for Medical Students and Doctors Early in Their Careers
Authors: Ullah F , Seabrook M , Brahmbhatt K , Tyson N , Knifton H , Guy J , Melemenis A , Khan S , Sangal S 
Published: August 2023

Abstract

Aim
Training opportunities for Robotic Surgery training are very competitive and expensive in the era of parallel training with consultants also in a learning phase. We share our experience of providing a free Robotic Surgery workshop to medical students and junior doctors under the umbrella of Association of Surgeons in training (ASiT).

Method
The course was organised as a collaboration between ASiT and Intuitive Surgical at Leicester General Hospital Educational centre. Dedicated opportunities were designed for device training, theory, and DaVinci XI console and simulator stations. Training was provided by a Robotic Surgery Fellow and Technical team from Intuitive on voluntary basis. No fees were charged for the course.

Results
48 Delegates applied for registration. 23 were shortlisted into four groups. 13 medical students and 10 doctors were in attendance. Each Delegate was provided a dedicated time of at least 20 minutes on each station. Delegates had an opportunity to use the Console and Simulator for training exercises. Feedback from the course was resoundingly positive. To our knowledge this was the 1st free Robotic Surgery course in UK providing hands on experience to medical students and junior doctors.

Conclusions
Our experience of organizing a “Free Robotic Surgery Workshop” may be utilised nationally to increase training opportunities for medical students and junior doctors.
745 The Effect of 3D Versus 2D Training Models in Laparoscopic Skills Acquisition: A Randomised Controlled Trial of Novice Medical Students
Authors: Alampritis G , Rossou C , Patel B 
Published: August 2023

Abstract

Aim
Determining whether the effect of laparoscopic technical skills acquisition will be superior with the use of low-fidelity 3D training models with contours compared to flat, 2D LapPass training models in novice medical students.

Method
This was a prospective, single-centre, two-arm, randomised controlled trial. Participants were randomised equally into either 3D or 2D group and performed two standardised laparoscopic tasks: (1) grasping and manipulation and (2) intracorporeal suturing on separate days. Performance was based on the GOALS tool, completion time and number of errors via 3 assessments (baseline, interim and post-training) each session. A post-study survey was used to measure participant-perceived confidence and performance.

Results
Sixty-two participants completed the study from April to June 2022. The two groups were homogenous regarding demographic data (p&gt;0.05). Both groups had significantly superior performance post-training compared to baseline in the two tasks via the intra-group comparison (p&lt;0.017). In the inter-group comparison, the 3D group had statistically significantly greater improvements in GOALS score parameter and depth perception domain in all comparisons in the two tasks (p&lt;0.05). The time improvement and error reduction also favoured the 3D group. In the post-study survey, the 3D group reported significantly greater perceived post-training confidence and performance in the suturing task only (p&lt;0.05).

Conclusions
The 3D training models resulted in a superior laparoscopic skills acquisition for novices in two tasks compared to 2D LapPass training models and should be incorporated into laparoscopic training curricula. Further work should focus on their long-term efficacy on a competency-based endpoint.