Do not break up the surgical team! Familiarity and expertise affect operative time in complex surgery

Finnesgard, Eric J.; Pandian, T.K.; Kendrick, Michael L.; Farley, David R.

doi:10.1016/j.amjsurg.2017.11.013

Cited by 24 publications

(39 citation statements)

References 12 publications

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“…It is reported that the replacement of a familiar, experienced surgical assistant was associated with a longer operative time. [35] In our experience, we initiate laparoscopic pancreatoduodenectomy since 2010. After a period of learning curve, we performed over 60 laparoscopic pancreatoduodenectomy yearly since 2015, and the figure was increased significantly to 116 cases in 2017, and some challenging cases such as venous resection were performed in the recent two years.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic pancreatoduodenectomy combined with portal-superior mesenteric vein resection and reconstruction with interposition graft

Wang

Cai²,

Zhao

et al. 2019

Medicine

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Rationale:With the development of laparoscopic techniques, laparoscopic pancreatoduodenectomy was applied in various indications including pancreatic cancer. Here, we share our experience of venous resection and reconstruction with interposition graft in laparoscopic pancreatoduodenectomy in these patients.Patient concerns:We reviewed data of laparoscopic pancreatoduodenectomy with venous resection and reconstruction in patients with pancreatic cancer between the dates of October 2010 and November 2017.Outcomes:Ten patients underwent laparoscopic pancreatoduodenectomy with portal-superior mesenteric vein resection and reconstruction with interposition graft. The mean operative time was 547 min. The mean blood loss was 435 ml. The mean length of venous defect after resection was 5.4 cm. R0 resection was achieved in nine patients (90%). There was one patient who suffered from severe postoperative complication. There was no 30-day mortality in this study. The long-term patency was achieved in all patients.Conclusion:In this study, we demonstrate the initial experience of laparoscopic pancreaticoduodenectomy with long venous resection and reconstruction. Although applied in small number of patients, it could be another option for well-selected patients with reasonable morbidity and mortality as well as long-term outcomes in experienced minimally invasive surgical team.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic pancreatoduodenectomy combined with portal-superior mesenteric vein resection and reconstruction with interposition graft

Wang

Cai²,

Zhao

et al. 2019

Medicine

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“…A minimum number of surgical assistants and nurses is recruited into the surgical team. This recruitment will have to be carefully balanced with their experience levels because unfamiliarity will prolong the surgery and increase the risks for the patient and the surgical team [ 18 ]. Although not ideal, if circumstances require a prolonged surgery, a standby relieving team may be needed to avoid adverse events that result from fatigue.…”

Section: Surgical Team Preoperative Considerationsmentioning

confidence: 99%

In the Extraordinary Times of Coronavirus Disease 2019: Clinical Strategies for Performing Spinal Surgery

et al. 2020

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<p>The coronavirus disease 2019 (COVID-19) pandemic has caused pronounced strain on global healthcare systems, forcing the streamlining of clinical activities and conservation of health resources. There is a pressing need for institutions to present discipline-specific strategies for the management of COVID-19 patients. We present the comprehensive considerations at the National University Hospital, Singapore from the surgeon’s and anesthetist’s perspectives in the performance of spinal surgery in COVID-19 patients. These are based on national guidelines and overarching principles of protection for the healthcare workers (HCWs) and efficiency in surgical planning. The workflow begins with the emergency department screening that has been adapted to the local epidemiology of COVID-19 in order to identify suspected/confirmed cases. If patient history cannot be obtained, demographic, clinical, and imaging data are used. Designated orthopedic “contaminated teams” are available 24/7 with an activation time of <30 minutes for review. In cases where sub-specialty spine surgeons were required, these professionals were inducted into the “contaminated team” and quarantined until cleared to return to work. Indications for emergency spine surgery were determined pre-emptively. Preoperative surgical considerations included the minimization of manpower, limited dissection, reduced operative time, and judicious use of equipment, leading to reduced aerosolization. Anesthesia considerations include preoperative screening for COVID-19–related concerns that influence surgery, operating room process planning and induction, intraoperative, reversal, recovery, and resuscitation considerations. Focused multi-disciplinary preoperative briefing facilitates familiarization. Surgical, anesthetic, and postoperative workflows were designed to reduce the risk of transmission and protect HCWs while effectively performing spinal surgery. The COVID-19 pandemic has necessitated paradigm shifts in healthcare planning, hospital workflows, and operative protocols. The viral burden does not discriminate between surgeons and physicians, and it is crucial that we, as medical professionals, adapt practices to be malleable and fluid to address the ever-changing developments.</p>

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“…Finnesgard et al conducted a similar study, which found that having a more experienced, certified surgical assistant (CSA) led to significantly shorter operative times for laparoscopic pancreatoduodenectomies. 9 Kim et al also found that having a novice assistant resulted in longer operative times for laparoscopic sigmoidectomies, but this difference was negated after an initial learning curve of 10 cases. 11 The first assistant surgeon in this study, however, was at least a fellow and had different responsibilities of modulating the actions of the second assistant who was in charge of operating the laparoscope, establishing pneumoperitoneum, placing initial trocars, minor hemostasis, drain placement, and wound closure.…”

Section: Impact Of Assistant Experience On Laparoscopic Hepatectomiesmentioning

confidence: 99%

“…Team familiarity has been associated with better surgical performance, improved safety, reduced operative time, and fewer complications in open abdominal surgeries, inguinal hernia repairs, laparoscopic bariatric surgeries, total knee replacements, reduction mammoplasties, and breast reconstruction procedures. [1][2][3][4][5][6][7][8][9] Likewise, how experienced the surgical assistant(s) and the collective operative team are has also been found to influence operative efficiency and time, which may have a bearing on outcomes in higher risk patient profiles and procedures. 4,6,7,[9][10][11][12] In particular, concerns have been raised about performing complex laparoscopic surgeries with assistance from less experienced team members, such as residents, and whether this would negatively impact outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Impact of First Assistant Surgeon Experience on the Perioperative Outcomes of Laparoscopic Hepatectomies

Cai

Syn

Koh

et al. 2020

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Introduction: This study aims to evaluate the impact of first assistant surgeon experience on the outcomes of laparoscopic hepatectomies in a university-affiliated teaching hospital. Methods: This is a retrospective study comparing outcomes of laparoscopic hepatectomies with first assistant surgeons of varying experience levels. Three hundred and eighty-five consecutive laparoscopic hepatectomies performed in a tertiary university-affiliated teaching hospital from 2012 to 2018 were included and stratified into three cohorts-Group 1 in which assistants were residents, Group 2 for fellows, and Group 3 for attendings. Baseline clinicopathologic variables and outcome measures were analyzed using the augmented inverse probability of treatment weighting approach, which is a propensity score-based method that combines aspects of covariate adjustment and inverse probability weighting. Results: Group 3 comprised a greater proportion of advanced-and expert-level surgeries based on the Iwate criteria; 33.8%, 32.2%, and 46.0% of patients underwent advanced-and expert-level surgeries in Groups 1, 2, and 3, respectively. Group 3 had consistently higher operative times as well as more frequent use and longer duration of Pringle's maneuver (P < .05). The median operative times for Groups 1, 2, and 3 were 195, 195, and 290 minutes, respectively. Pringle's maneuver was applied in 26.9%, 33.9%, and 60.2% of patients with a corresponding median duration of 35, 36, and 45 minutes, respectively. None of the other perioperative and postoperative outcomes demonstrated statistically significant differences. Conclusion: With an appropriate selection of cases, participation of residents as first assistants in laparoscopic hepatectomies can be encouraged without compromise in perioperative outcomes.

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Do not break up the surgical team! Familiarity and expertise affect operative time in complex surgery

Cited by 24 publications

References 12 publications

Laparoscopic pancreatoduodenectomy combined with portal-superior mesenteric vein resection and reconstruction with interposition graft

Laparoscopic pancreatoduodenectomy combined with portal-superior mesenteric vein resection and reconstruction with interposition graft

In the Extraordinary Times of Coronavirus Disease 2019: Clinical Strategies for Performing Spinal Surgery

Impact of First Assistant Surgeon Experience on the Perioperative Outcomes of Laparoscopic Hepatectomies

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