IMPORTANCE Increasing use of robotic surgery for common surgical procedures with limited evidence and unclear clinical benefit is raising concern. Analyses of population-based trends in practice and how hospitals' acquisition of robotic surgical technologies is associated with their use are limited. OBJECTIVE To characterize trends in the use of robotic surgery for common surgical procedures.

IMPORTANCE While telehealth use in surgery has shown to be feasible, telehealth became a major modality of health care delivery during the COVID-19 pandemic.OBJECTIVE To assess patterns of telehealth use across surgical specialties before and during the COVID-19 pandemic.

Many prepubertal girls and young women suffer from premature ovarian insufficiency induced by chemotherapy given for treatment of cancer and autoimmune diseases. Autotransplantation of cryopreserved ovarian tissue could restore the lost ovarian endocrine function and fertility. Unfortunately, tissue ischemia, inconsistent graft quality and the risk of reintroducing malignant cells may stand in the way of the clinical translation of this approach. To address these risks and limitations, we engineered an artificial ovarian tissue from immature follicles using a synthetic hydrogel, poly(ethylene glycol) vinyl sulfone (PEG-VS), as a supportive matrix. Enzymatically isolated follicles from 6–7-day-old mice ovaries were encapsulated in 7% PEG-VS hydrogels modified with 0.5 mmol/l RGD and crosslinked with a trifunctional matrix metalloproteinase-sensitive peptide. PEG hydrogels with the encapsulated follicles were orthotopically implanted into ovariectomised mice to investigate whether PEG hydrogel supports folliculogenesis and steroidogenesis in vivo. After 30 days, grafts revealed multiple fully developed antral follicles and corpora lutea, which corresponded with regular ovulation cycles and follicle-stimulating hormone (FSH) levels. The elevated levels of FSH, caused by bilateral ovariectomy, were reversed by the implanted follicles and maintained at physiological levels for 60 days. Importantly, primordial and primary follicles still represented 60% of the follicular pool, demonstrating selective recruitment of primordial follicles into the growing pool. Functioning blood vessels in the grafts 30 and 60 days after implantation proved the capability of PEG hydrogels to undergo graft remodelling and revascularisation. Our results demonstrate that PEG hydrogels with encapsulated immature ovarian follicles successfully functioned as an artificial ovarian tissue for 60 days in vivo.

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Given the US health care system mandates to minimize patient and clinician exposure to COVID-19, telehealth use across all specialties increased dramatically in the COVID-19 pandemic. Telehealth for preoperative and postoperative surgical follow-up patient visits had started to occur at low levels before the pandemic. The extent to which different surgical specialties were able to adjust to telehealth as the major modality of health care delivery remains unclear.This statewide cohort study aimed to determine how telehealth use patterns changed across surgical specialties before and during the COVID-19 pandemic. For the primary analysis, new adult outpatient visits with a surgeon (including colorectal surgery, general surgery, neurosurgery, obstetrics and gynecology, ophthalmology/ear, nose, and throat, orthopedics, plastic surgery, thoracic surgery, and urology) between January 5 and September 5, 2020, were identified from a large commercial insurance payer in Michigan. Patient visits were categorized as in-person office visits or telehealth visits using appropriate telehealth modifier codes. The pandemic was stratified into 3 periods based on national and state regulations, as well as trends in raw data: period 1 (pre-COVID-19 pandemic, January 5 to March 7), period 2 (early pandemic, March 8 to June 6), and period 3 (late pandemic, June 7 to September 5). The primary study outcome was telehealth conversion in 2020. This outcome was defined as the rate of new patient telehealth visits per week divided by the mean weekly new patient visit volume in 2019

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Objective The development of operative skill during general surgery residency depends largely on the resident surgeons’ ability to accurately self-assess and identify areas for improvement. We compared evaluations of laparoscopic skill and comfort level of resident surgeons from both the resident surgeon’s and attending surgeon’s perspectives. Design We prospectively observed 111 elective cholecystectomies at the University of Michigan as part of a larger quality improvement initiative. Immediately after the operation, both resident and attending surgeons completed a survey in which they rated the resident’s operative proficiency, comfort level, and the difficulty of the case using a previously validated instrument. Resident’s and attending’s evaluations of resident performance were compared using two-sided t-tests. Setting The University of Michigan Health System in Ann Arbor, MI. Large academic, tertiary care institution. Participants All general surgery residents and faculty at the University of Michigan performing laparoscopic cholecystectomy between June 1st and August 31st 2013. Data was collected for 28 of the institution’s 54 trainees. Results Attendings rated residents higher than residents rated themselves on a five-point Likerttype scale with regards to depth perception (3.86 vs. 3.38, p<0.005), bimanual dexterity (3.75 vs. 3.36, p=0.005), efficiency (3.58 vs. 3.18, p<0.005), tissue handling (3.69 vs. 3.23, p<0.005), and comfort performing case (3.86 vs. 3.38, p<0.005). Attendings and residents were in agreement on the level of autonomy displayed by the resident during the case (3.31 vs. 3.34, p=0.85), the level of difficulty of the case (2.98 vs. 2.85, p=0.443), and the degree of teaching done by the attending surgeon during the case (3.61 vs. 3.54, p=0.701). Conclusions A gap exists between resident and attending surgeons’ perception of residents’ laparoscopic skills and comfort level in performing laparoscopic cholecystectomy. These findings call for improved communication between residents and attendings in order to ensure that graduates are adequately prepared to operate independently. In the context of changing methods of resident evaluations that call for explicitly defined competencies in surgery, it is essential that residents are able to accurately self-assess, and be in general agreement with attending surgeons on their level of laparoscopic skill and comfort level performing a case.

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