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BackgroundSurgical education was limited during the COVID-19 pandemic due to redeployment, limited clinical activity, and cancelation of elective procedures and educational conferences. Closed Facebook groups became a tool for surgical education while upholding social distancing guidelines. We aim to evaluate the use of Online Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) closed Facebook groups, during and prior to the COVID-19 pandemic.MethodsInstitutional Review Board evaluation and written consent was not indicated as the data does not pertain to any human subjects. Data files pertaining to new membership activity, posts, comments and reactions of eight closed Facebook groups. The pandemic group was defined as March 19th to April 30, 2020. The pre-pandemic group was defined as February 6th, to March 18th, 2020. The percentage increase of new memberships, posts, comments and reactions were calculated for each period. A two-tailed t-test, using a significance level of 0.05 was used to evaluate significance.ResultsA statistically significant increase in membership during the pandemic period was noted for each group. In regards to posts, the Flex Endo, Acute Care, Colorectal, Foregut, and Bariatric groups were noted to have a statistically significant increase in the pandemic period. Colorectal and Bariatric groups were the only two groups that were noted to have a significant increase in comments in the pandemic period. For reactions, Flex Endo, Colorectal, Foregut, and Bariatric groups were noted to have experienced a significant increase during the pandemic.ConclusionsThe COVID-19 pandemic halted surgical education at all levels. The membership and utilization of closed Facebook groups increased significantly in many instances, demonstrating the importance of internet-based surgical education now and into the future. Further development of internet-based curriculums is warranted.

IntroductionCommunication is fundamental to effective surgical coaching. This can be challenging for training during image-guided procedures where coaches and trainees need to articulate technical details on a monitor. Telestration devices that annotate on monitors remotely could potentially overcome these limitations and enhance the coaching experience. This study aims to evaluate the value of a novel telestration device in surgical coaching.MethodsA randomized-controlled trial was designed. All participants watched a video demonstrating the task followed by a baseline performance assessment and randomization into either control group (conventional verbal coaching without telestration) or telestration group (verbal coaching with telestration). Coaching for a simulated laparoscopic small bowel anastomosis on a dry lab model was done by a faculty surgeon. Following the coaching session, participants underwent a post-coaching performance assessment of the same task. Assessments were recorded and rated by blinded reviewers using a modified Global Rating Scale of the Objective Structured Assessment of Technical Skills (OSATS). Coaching sessions were also recorded and compared in terms of mentoring moments; guidance misinterpretations, questions/clarifications by trainees, and task completion time. A 5-point Likert scale was administered to obtain feedback.ResultsTwenty-four residents participated (control group 13, telestration group 11). Improvements in some elements of the OSATS scale were noted in the Telestration arm but there was no statistical significance in the overall score between the two groups. Mentoring moments were more in the telestration Group. Amongst the telestration Group, 55% felt comfortable that they could perform this task independently, compared to only 8% amongst the control group and 82% would recommend the use of telestration tools here.ConclusionThere is demonstrated educational value of this novel telestration device mainly in the non-technical aspects of the interaction by enhancing the coaching experience with improvement in communication and greater mentoring moments between coach and trainee.

BackgroundRobotic surgery is a valid option for minimally invasive surgery in most surgical specialties. However, the need to master laparoscopy is questionable before starting specific training in robotic surgery. We compared the development of basic robotic surgery skills between individuals randomized to train in conventional, laparoscopic, or robotic skills.MethodsWe conducted a single-centered, single-blinded randomized trial. Medical students were randomly assigned to 20 h of conventional, laparoscopic, or robotic surgical training. Students with previous surgical experience were excluded. Participants were evaluated pre- and post-training on the dV-Trainer robotic surgical simulator with the following exercises: Camera Targeting 1, Peg Board 1, Ring and Rail 1, and Ring and Rail 2.ResultsSixty-six students were randomly assigned to each training group. Eight individuals did not complete the study (2 in the conventional group, 3 in the laparoscopic group, and 3 in the robotic group). All groups demonstrated significant improvement in the composite score and in each task following the training period (p < 0.001). No differences were seen between the conventional and laparoscopic groups in the composite score or individual tasks. The robotic group showed greater improvement in number of errors, economy of motion, workspace utilization, and time for completion compared to the other groups. The laparoscopic group showed improved camera manipulation skills compared to the conventional group, while the conventional group showed improved errors and economy of motion compared to the laparoscopic group.ConclusionThere was no difference in the acquisition of basic robotic surgical skills between individuals trained in basic conventional or laparoscopic surgical skills. We believe surgeons mastery in laparoscopy is not needed before initiating robotic surgical training. However, basic principles of laparoscopy remain applicable to robotic surgery. Future studies should compare transferability of conventional and laparoscopic training to robotic skills in the operating room.

BackgroundThe adoption of robotic techniques in liver surgery introduces significant challenges for their safe integration within hepatobiliary surgery units. This study is designed to investigate the complexities associated with establishing a robotic surgery program.MethodsData on robotic hepatobiliary surgeries were prospectively collected from October 2021 to October 2023. Historical cohorts from the institutional experiences for comparison were hand-assisted (HALS) and purely laparoscopic procedures (PLS). Inverse probability of treatment weighting and propensity score matching were employed to compare outcomes between PLS and robotic resections. The learning curve for robotic surgeries was evaluated by the cumulative sum method.ResultsIn this study, 454 patients were enrolled (113 robotic surgeries, 157 HALS, and 184 PLS). The posterosuperior segments resections were significantly higher in the robotic group (47.8%) compared to PLS (31.5%) and HALS (35.7%). There were no conversions in the robotic group, in PLS 2.7% and HALS 3.8%. The degree of difficulty according to the median of the IWATE score and IMM score was significantly higher in the robot group (p < 0.001 and p = 0.008, respectively). No significant differences in short-term outcomes were observed between robotic procedures and PLS in a matched subset of patients. Operative efficiency and blood loss improved significantly after the 75th robotic surgery patient, with high-difficulty cases (IWATE ≥ 10) incorporated from the beginning.ConclusionThis study suggests that robotic liver surgery in units with prior experience in minimally invasive liver surgery offers benefits, such as a lower conversion rate and a higher rate of successful difficult resections.

Female trainees continue to be underrepresented in surgical specialties. Studies have shown lower enrollment and higher attrition of female trainees in surgery. However, there is no comprehensive data examining trends to determine if positive strides have been made towards greater equity. Retrospective cohort study examining Canadian surgical residents who began training between 2000 and 2010. Enrollment data was compared to how many of those individuals registered for their final surgical certifying examinations by 2018, which indicated completion of residency. In the 10-year period, overall attrition rates of surgical trainees was 8%. Female residents were twice as likely to leave training compared to their male counterparts (12.4 vs 6.1% p < 0.001). Attrition rates for female residents appeared to trend downwards. Enrollment of female surgical trainees across all surgical specialties increased from 27.3% to 39.2% during this time. Equity in Canadian surgical training enrollment and retention improved for those who began training from 2000 to 2010, but there continued to be differences in female trainee recruitment and attrition rates compared to their male counterparts. •New female surgical trainees from 2000 to 2010 left training at twice the rate of male counterparts.•Female enrollment in Canadian surgical training has increased from 2000 to 2016.•Attrition rates of female trainees has been decreasing while male attrition rates remain steady.

Background HPB surgery is being increasingly performed robotically worldwide. However, there is no consensus on what constitutes adequate training or an established curriculum. We evaluate the existing literature on formal education in robotic hepatopancreaticobiliary (HPB) surgery and propose a curriculum using Kern’s six-step curriculum development model. Methods A systematic search was performed across major databases and the methodology of the Joanna Briggs Institute was followed. The PRISMA-ScR was conformed in reporting. Evidence pertaining to cholecystectomy alone was excluded and studies that described formal training pathways were included. Results Fifteen curricula were included with predilection towards the pancreas ( n  = 7, liver: n  = 5, combination: n  = 3). Almost all studies proposed initial robot system training through online modules, observership and console simulation exercises. Following this, six curricula described procedure-specific anastomosis training. Almost all studies described mentorship and proctorship. The assessment for implementation commonly described includes objective structured assessment of technical skill (OSATS) and cumulative sum technique (CUSUM) for operation time, conversion-to-open rate and postoperative complications. Discussion This study has summarised the formal curricula for learning robotic HPB surgery. The majority share similar implementation tools. A comprehensive curriculum based on validated educational principles has been proposed which incorporates these elements.

Background The benefits of the totally laparoscopic right hemicolectomy have been established, but its adoption has been limited by the challenges of intracorporeal suturing. While simulation is effective for training advanced surgical skills, no dedicated simulation-based course exists for intracorporeal ileo-transverse anastomosis (ICA). This study aimed to develop and validate a simulation module for training in ICA. Methods This study employed a proof-of-concept design for an educational tool. Key aspects of the anastomosis were identified using the team’s surgical experience, surgical videos, and existing evidence. Surgeons were recruited to test and refine successive simulation models through an iterative process until a functional prototype was achieved and assessed. Subsequently, surgeons with varying experience levels were invited to perform an ICA in the model. Performance was evaluated by two blinded surgeons through video recordings, utilizing a modified Objective Structured Assessment of Technical Skills (OSATS), a Specific Rating Score (SRS), and operative time measurements. Non-parametric descriptive and analytical methods were applied, with results presented as median [IQR]. Results An ex vivo based model was developed. Seventeen participants evaluated the model. Eighty-three percent declared acceptable or maximum fidelity regarding the colon. Resemblance to the surgical scenario in terms of ergonomic and anatomical similarity was highlighted. All participants found the model useful to train intracorporeal suturing. Thirteen subjects performed the ICA. Experts achieved significantly higher OSATS scores (22.3 [22–22.5] vs 18 [16–19.5]; p  =  .013 ), exhibited a trend toward higher SRS, and obtained shorter operative times (21.5 vs 36 min; p  = .039). Conclusion An ex vivo simulation module for ICA was developed, demonstrating acceptable fidelity in replicating the surgical environment. The simulated scenario could successfully distinguish between levels of surgical experience, as evidenced by significant differences in OSATS scores and operative times, thereby confirming its construct validity.

Purpose The Japanese Association for Surgical Education (JASE) was established in 2014 to improve the quality of surgical education in Japan. This study aimed to identify the needs of the participants in the annual meetings of the JASE and determine the future direction of the association. Methods An online survey was sent to all the participants at the annual meetings of the JASE between 2014 and 2022. The survey included questions about demographics, challenges in their educational roles and research, degree of satisfaction with the meetings, and expectations of the JASE. Results The response rate was 34.5% ( n  = 107/310), and the respondents represented 12 surgical specialties, with gastroenterological surgery being the most common. Lack of teaching time (66.7%) and insufficient incentives (57.1%) were the most frequent challenges for surgical educators. A total of 92.0% of the respondents rated the annual meetings as satisfactory as it provided up-to-date information practical teaching skills, and valuable networking opportunities that they could use as surgical educators. The respondents expected JASE to continue providing the latest information and topics in surgical education, offering collaborative opportunities and guidance on surgical education research. Suggestions for future included formalizing the association and conducting meetings in various locations across the country. Conclusions The survey identified key challenges faced by the participants as a surgical educator or a surgical education researcher in Japan. The annual meetings proved effective in supporting participants’ ongoing efforts in surgical education. In addition, suggestions regarding the association’s future directions are currently being implemented.

Background Synoptic operative reports (SORs) are checklists or templates that contain standardized elements of an operation. These elements are associated with standardized inclusion of critical elements of the operative report that translate into numerous potential benefits. Whereas SORs for melanoma, breast, and colorectal cancer surgery have already been widely implemented, similar templates for hepato-pancreato-biliary (HPB) cancer surgery are currently lacking. Methods An anonymous voluntary online survey was distributed to HPB attendings and fellows at HPB and complex general surgical oncology (CGSO) fellowship programs. Results The 54 participants in this study comprised 31 (57%) HPB surgery attendings, 15 (28%) HPB surgery fellows, and 8 (15%) CGSO fellows. Notably, only six (11%) participants reported consistent use of an HPB SOR. The most commonly reported barriers to SOR uptake were the “lack of a readily available template” (55%) and the “lack of consensus/guidelines” (49%). Despite these limiting factors, a majority of respondents indicated a strong willingness to use a standardized and readily available HPB SOR (mean, 4.13/5 ± 1.23). This interest did not differ between attendings and fellows ( p = 0.52) or between the participants stratified by surgical experience ( p = 0.58). Finally, the participants were provided a comprehensive list of possible elements to incorporate into a standardized pancreatic and hepatobiliary SOR. After the exclusion of elements with less than 75% agreement, the pancreatic SORs included 17 (57%) of 30 possible elements, and the hepatobiliary SORs included 19 (76%) of 25 possible elements. Conclusion Broad consensus on several elements of the HPB SOR suggests that uptake should be accelerated in HPB surgery.

With the rapid growth of robotic-assisted surgery, surgical educators recognize the need to develop appropriate curriculum for trainees. However, the unique robotic learning environment challenges educators to determine the most appropriate ways to instruct surgical residents. The purpose of this study was to characterize the instructional techniques used in the robotic teaching environment by observing attending surgeon's language and behaviors during resident robotic dissection. Attending robotic surgeons guided senior residents through robotic dissection of live porcine tissue. Three observers documented the language, gestures and behaviors occurring at three different stations, and at a fourth station, they obtained video and audio recordings of the instructional interaction. Afterwards, instructors and residents met in separate focus groups. The authors used qualitative content analysis to summarize the type and frequency of teaching behaviors and focus group information to clarify the analysis. We compared the frequency of the behaviors to an existing taxonomy of 16 operative teaching behaviors in open and laparoscopic surgery. Robotic instructors used 11 of the 16 behaviors previously described for surgical instruction. Frequency of use differed in the robotic environment due to relevance and application of new techniques. New, unique robotic teaching behaviors involved disengaging the resident from the operative console for either onscreen direction or for gesturing with verbal instruction. Focus group participants highlighted these behaviors as essential. Robotic instruction uses a different set of instructional approaches compared to open and laparoscopic surgery. New teaching behaviors emerged driven by physical separation within the robotic environment. Robotic faculty development should emphasize these unique features. •Surgical educators are unclear how best to teach in the new robotic environment.•We observed attending surgeons as they guided residents through robotic dissections.•Qualitative analysis was used to summarize frequency and type of instructional behaviors.•Results were compared to prior studies that observed instructional behaviors in laparoscopic and open operative environments.•Instructional behaviors differed in the robotic environment and unique behaviors emerged. The unique robotic learning environment challenges educators to determine the most appropriate ways to instruct surgical residents. This study aims to characterize the instructional techniques used in the robotic teaching environment by observing attending surgeon’s as they guide residents through robotic dissection. Attending surgeons guided residents through robotic dissection of live porcine tissue. Observers documented language, gestures and behaviors occurring at each station. Focus groups met after the session. Using qualitative content analysis, we summarized the type and frequency of teaching behaviors and compared this to an existing taxonomy of 16 instructional behaviors in open and laparoscopic surgery. Robotic instructors used 11 of the 16 behaviors previously described, but frequency of use differed in the robotic environment, and unique behaviors emerged. These behaviors involved disengaging the resident from the operative console for either onscreen direction or for gesturing with verbal instruction. Focus groups highlighted these behaviors as essential. Robotic teaching requires different instructional approaches than open and laparoscopic surgery. New behaviors emerged due to physical separation within the robotic environment illustrating opportunities for faculty development.