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The modern management of rectal cancers continues to evolve. With the release of data from new landmark randomized controlled trials (RAPIDO, PRODIGE-23), total neoadjuvant therapy (TNT) has moved to the forefront of locally advanced rectal cancer treatment and is considered a standard option in selected patients. Total neoadjuvant therapy promises enhanced systemic disease control, better treatment adherence and less time with an ostomy. However, TNT as currently described encompasses a number of different potential treatment options that differ significantly in terms of their radiation dosage, chemotherapy regimen and order of treatments administered. Being familiar with TNT regimens will be important for rectal cancer surgeons to appropriately advocate for their patients and optimize their outcomes. This article serves as a primer for the general surgeon and offers a pragmatic overview of the indications, realistic expected benefits and potential downsides of each TNT regimen., For 15 years, the standard of care for locally advanced (clinical T3-4 or N-positive) rectal cancer in North America has consisted of neoadjuvant therapy (radiation or chemoradiotherapy) followed by total [...]

Identifying characteristics of disciplined surgeons is important for public safety. A database of all physicians disciplined by a Canadian provincial medical regulatory authority (College of Physicians and Surgeons) between 2000 and 2017 was constructed, and comparisons between surgeons and other physicians were undertaken. Of 1100 disciplined physicians, 174 (15.8 %) were surgeons. Obstetrics and gynecology was the specialty with the most disciplined surgeons (57 of 174 [32.8%]), followed by general surgery (48 of 174 [27.6%]). The overall disciplinary rate for surgeons was higher than for other physicians (12.59, 95 % confidence interval [CI] 10.69-14.83 v. 9.85, 95 % CI 8.88-10.94 cases per 10 000 physician-years, p = 0.013). Even after adjusting for surgeon age, sex, international medical graduation and years in practice, surgeons remained more likely than other physicians to be disciplined for standard of care issues (55.6%, 95% CI 46.6-64.2 v. 38.7%, 95% CI 32.6-45.2, p < 0.001)., Physician discipline through self-regulation is important for the medical profession to ensure patient safety and improve quality of care. Estimated rates of disciplinary action against licensed physicians ranges from 0.3% [...]

Background: For academic hiring committees and surgical trainees, the benefits of a graduate degree are unclear. We sought to identify if graduate degrees or professorship status were associated with increased research productivity among Canadian academic surgeons. Methods: We included general surgeons from the largest hospitals associated with accredited residency programs. We classified staff surgeons active between 2013 and 2018 by degree (MD only, master's degree, PhD) and professorship (assistant, associate, professor) status. We identified their publications from January 2013 to December 2018. Variables of interest included publications per year, citations per article, journal of publication, CiteScore, author's Hirsch (h) index and the revised b-index (r-index). We used Kruskal--Wallis tests and the Dunn multiple comparison test to assess statistical significance. Results: We identified 3262 publications from 187 surgeons, including 78 (41.7%) with no graduate degree, 84 (44.9%) with master's degrees and 25 (13.4%) with PhDs. Surgeons with graduate degrees had more publications per year, higher CiteScores, more citations per article, and higher h- and r-indices than those without graduate degrees. Surgeons with doctorates had the highest median values in all domains, but differences were not significant compared with surgeons with master's degrees. Seventy-seven (41.8%) surgeons were assistant professors, 63 (34.2%) were associate professors and 44 (23.9%) were full professors. Statistically, full professors had a greater number of publications per year and higher h- and r-indices than their counterparts. Conclusion: Surgeons with graduate degrees or more advanced professorships had the greatest research productivity. Surgeons with doctorates trended toward greater research productivity than those holding master's degrees. Contexte : Pour les comités d'embauche universitaires et les chirurgiens en formation, les avantages d'un diplôme d'études supérieures sont flous. Nous avons voulu vérifier si les diplômes d'études supérieures ou le statut au sein du corps professoral étaient associés à une plus grande productivité en recherche chez les professeurs de chirurgie canadiens. Méthodes : Nous avons inclus les chirurgiens généraux des plus grands hôpitaux offrant des programmes de résidence agréés. Nous avons classé les chirurgiens attachés aux établissements qui étaient actifs entre 2013 et 2018 selon leurs types de diplômes (MD seulement, maîtrise, PhD) et leur statut de professeur (adjoint, agrégé, titulaire). Nous avons recensé leurs publications de janvier 2013 à décembre 2018. Les variables d'intérêt incluaient le nombre de publications annuelles, le nombre de citations par article, les revues/journaux les ayant publiés, l'indicateur CiteScore et leurs indices Hirsch (h) et h révisé (r). Nous avons utilisé des tests de Kruskal-Wallis et le test de comparaisons multiples de Dunn pour en mesurer la portée statistique. Résultats : Nous avons recensé 3262 publications de 187 chirurgiens, dont 78 (41,7%) ne détenaient pas de diplôme d'études supérieures, 84 (44,9%) avaient un diplôme de maîtrise et 25 (13,4%) détenaient un PhD. Les chirurgiens qui avaient des diplômes d'études supérieures avaient publié davantage, présentaient un indicateur CiteScore plus élevé, avaient plus de citations par article et des indices h et r plus élevés par rapport à ceux qui n'avaient pas de diplômes d'études supérieures. Les chirurgiens détenteurs d'un PhD avaient la valeur médiane la plus élevée dans tous les domaines, mais les différences n'étaient pas statistiquement significatives par rapport aux chirurgiens détenteurs d'une maîtrise. Soixante-dix-sept (41,8%) chirurgiens étaient professeurs adjoints, 63 (34,2%) étaient professeurs agrégés et 44 (23,9%) étaient professeurs titulaires. Au plan statistique, ces derniers avaient un plus grand nombre de publications par année et des indices h et r plus élevés comparativement à leurs collègues. Conclusion : Les chirurgiens détenteurs d'un diplôme d'études supérieures ou de statut professoral plus élevé avaient la plus grande productivité en termes de recherche. Les chirurgiens détenteurs d'un PhD tendaient à avoir une plus grande productivité en recherche, comparativement aux détenteurs de maîtrises., Academic general surgery in Canada continues to transform, with additional fellowship or research training becoming increasingly common for surgeons holding academic positions. (1,2) More than 60% of surgeons hired in [...]

* Context.--Pancreatic adenocarcinoma is the third leading cause of cancer death in the United States. Surgery remains the mainstay of treatment, and frozen section analysis is used to confirm diagnosis and determine resectability and margin status. Objective.--To evaluate use and accuracy of frozen section and how diagnosis impacts surgical procedure. Design.--We reviewed patients with planned pancreatic resections between January 2014 and March 2019 with at least 1 frozen section. Pathology reports including frozen sections, preoperative cytology, and operative notes were reviewed. Frozen sections were categorized by margin, primary pancreatic diagnosis, metastasis, or vascular resectability. The deferral and error rates and surgeons' response were noted. Results.--We identified 898 planned pancreatic resections and 221 frozen sections that were performed on 152 cases for 102 margins, 94 metastatic lesions, 20 primary diagnoses, and 5 to confirm vascular resectability. The diagnosis was deferred to permanent sections in 13 of 152 cases (8.6%) on 16 of 221 frozen sections (7.2%): 6 for metastasis, 8 for margins, and 2 for primary diagnosis. Discrepancies/errors were identified in 4 of 152 cases (2.6%) and 4 of 221 frozen sections (1.8%). Surgeons' responses were different than expected in 8 of 221 frozen sections (3.6%), but their actions were explained by other intraoperative findings in 6 of 8. Conclusions.--Frozen section remains an important diagnostic tool used primarily for evaluation of margins and metastasis during pancreatectomy. In most cases, a definitive diagnosis is rendered, with occasional deferrals and few errors. Intraoperative findings explain most cases where surgeons act differently than expected based on frozen section diagnosis., Pancreatic cancer is the third leading cause of cancer-related death in the United States, with poor survival (9% 5-year relative survival rate). (1,2) Pancreatic ductal adenocarcinoma and its variants account [...]

Preoperative optimization has not been explored comprehensively in the sur gic al literature, as this responsibility has often been divided among surgery, anesthesia and medicine. We developed an evidence-based clinical practice guideline to summarize existing evidence and present diagnostic and treatment algorithms for use by surgeons caring for patients scheduled to undergo major elective surgery. We focus on 3 common comorbid conditions seen across surgical specialties--anemia, hyperglycemia and smoking--as these conditions increase complication rates in patients undergoing major surgery and can be optimized successfully as soon as 6-8 weeks before surgery. With the ability to address these conditions earlier in the patient journey, surgeons can positively affect patient outcomes. The aim of this guideline is to bring optimization in the preoperative period under the existing umbrella of evidence-based surgical care. L'optimisation preoperatoire n'a pas ete exploree de maniere exhaustive dans la litterature chirurgicale, car cette responsabilite a souvent ete divisee entre la chirurgie, l'anesthesie et la medecine. Cette ligne directrice de pratique clinique fondee sur des donnees probantes a ete concue pour resumer les donnees existantes et presenter des algorithmes diagnostics et therapeutiques relatifs a des comorbidites frequentes chez les patients vus dans toutes les specialites chirurgicales. L'accent a ete place sur l'optimisation preoperatoire de l'anemie, de l'hyperglycemie et du tabagisme, etant donne que ces problemes de sante accroissent le risque de complications chez les patients qui doivent subir une chirurgie majeure et qu'il est possible de les corriger en bonne partie dans les 6-8 semaines precedant la chirurgie. Or, si les chirurgiens arrivent a corriger ces problemes de sante plus tot dans le parcours des patients, ils pourraient ameliorer leurs resultats. Le but de cette ligne directrice est que l'optimisation preoperatoire soit integree a l'ensemble actuel des soins chirurgicaux fondes sur des donnees probantes., For most of the 20th century, the focus of research in surgery was improvements in intraoperative technique, which led to major technical paradigm shifts exemplified by the evolution of transurethral [...]

Background: Academic productivity, as measured by number and impact of publications, is central to the career advancement and promotion of academic surgeons. We compared research productivity metrics among specialties and sought factors associated with increased productivity. Methods: Academic surgeons were identified through departmental webpages and their scholarly metrics were collected through Scopus in a standardized fashion. We collected total number of documents, h-index, and average number of publications per year in the preceding 5 years. We explored whether presence of a training program, graduate degree, academic rank and size of the clinical group affected productivity metrics. Linear regression was used for multivariable analysis. Results: We collected data on 2172 surgeons from 15 separate academic centres across Canada. Wide variability existed in metrics among specialties, with cardiac and neurosurgery being the most productive, and vascular surgery and plastic surgery being the least productive. The average number of publications was 71, and the average h-index was 18.7. The average h-index for cardiac surgery was 25.7 compared with 8.3 for vascular surgery (p < 0.001). Our multivariable model identified academic rank, surgical specialty, graduate degree, presence of a training program, and larger clinical group as being associated with increased academic productivity. Conclusion: There is variability in research productivity among Canadian surgical specialties. Cardiac surgery and neurosurgery are productive, whereas vascular surgery and plastic surgery are less productive than other surgical disciplines. Obtaining a research-oriented graduate degree, being part of a larger clinical group, and presence of a training program were all associated with higher productivity, even after adjusting for academic rank and specialty. Contexte : La productivité universitaire, évaluée selon le nombre de publications et leurs retombées, est déterminante pour la carrière et l'avancement des professeurs de chirurgie. Nous avons comparé des indicateurs de la productivité en recherche de diverses spécialités et cherché les facteurs liés à une productivité accrue. Méthodes : Nous avons identifié les professeurs de chirurgie dans les pages Web de départements, et recueilli dans Scopus, de manière normalisée, les données : nombre total de documents, indice h et nombre moyen de publications par année dans les 5 dernières années. Nous avons cherché à savoir si l'existence d'un programme de formation, le diplôme d'études supérieures, le rang professoral et la taille du groupe clinique avaient une incidence sur les indicateurs de productivité. L'analyse multivariable a été faite au moyen d'une régression linéaire. Résultats : Nous avons recueilli des données sur 2172 chirurgiens de 15 différents centres universitaires du Canada. Les indicateurs variaient grandement selon la spécialité. La productivité la plus élevée était associée à la chirurgie cardiaque et à la neurochirurgie, et la productivité la moins élevée, à la chirurgie vasculaire et à la chirurgie plastique. Le nombre moyen de publications était de 71 et l'indice h moyen, de 18,7. L'indice h moyen pour la chirurgie cardiaque était de 25,7, comparativement à 8,3 pour la chirurgie vasculaire (p < 0,001). Notre modèle multivariable a montré que le rang professoral, la spécialité chirurgicale, le diplôme d'études supérieures, l'existence d'un programme de formation et un grand groupe clinique sont liés à une productivité universitaire accrue. Conclusion : La productivité en recherche varie en fonction de la spécialité chirurgicale au Canada. La chirurgie cardiaque et la neurochirurgie sont productives, tandis que la chirurgie vasculaire et la chirurgie plastique le sont moins que d'autres spécialités. L'obtention d'un diplôme d'études supérieures axées sur la recherche, l'appartenance à un grand groupe clinique et l'existence d'un programme de formation étaient toutes associées à une productivité supérieure, même après correction pour tenir compte du rang professoral et de la spécialité., Academic surgeons must fulfill numerous professional obligations. In addition to the care of complex surgical patients, they are expected to mentor and train surgical residents and conduct research. Research output, [...]

Background: Mannitol and furosemide have been used as diuretics intraoperatively to facilitate early renal allograft function and reduce delayed graft function. As the evidence of any efficacy of these agents is limited, we sought to characterize the use of diuretics among transplant surgeons. Methods: An anonymous online survey was sent to all Canadian transplant programs where kidney transplants are routinely performed. Questions were related to the use and indications for mannitol and furosemide. Responses were collected and analyzed as counts and percentages of respondents. We used [chi square] analysis to assess the relationship between demographic factors and survey responses. Results: Thirty-five surgeons completed the survey (response rate 50%). Seventy per cent of respondents reported performing 26 or more transplants per year, 88% had formal transplant fellowship training and 67% indicated that they currently train fellows. Only 24% and 12% reported believing that delayed graft function is reduced by mannitol and furosemide use, respectively. However, 73% routinely gave mannitol to patients and 53% routinely gave furosemide. The most common justification given for mannitol use was to induce diuresis (54%); 37% of respondents reported using mannitol because of training dogma. Likewise, 57% used furosemide for diuresis, with 23% reporting that their use of this agent was based on dogma. No relationship emerged between fellowship training, case volume or training program status and the use of any agent. Interestingly, 71% of respondents indicated that a randomized controlled trial evaluating the utility of intraoperative diuretics is needed and that they were interested in participating in such a trial. Conclusion: Use of intraoperative diuretics and the rationale for their use vary among surgeons. A substantial proportion of surgeons use these medications on the basis of dogma alone. A randomized controlled trial is needed to clarify the role of intraoperative diuretics in kidney transplant surgery. Contexte : On a utilise le mannitol et le furosemide comme diuretiques peroperatoires pour stimuler le fonctionnement precoce de l'allogreffe renale et reduire le retard de fonctionnement du greffon. Comme les donnees probantes quant a l'efucacite de ces agents sont limitees, nous avons voulu caracteriser l'utilisation des diuretiques chez les chirurgiens qui effectuent ces transplantations. Methodes : Un sondage anonyme en ligne a ete envoye a tous les programmes de greffe canadiens ou des greffes renales sont couramment effectuees. Les questions avaient trait a l'utilisation et aux indications du mannitol et du furosemide. Les reponses ont ete recueillies et analysees sous forme de nombres et de pourcentages des repondants. Le test du [chi square]a ete utilise pour evaluer le lien entre les facteurs demographiques et les reponses au sondage. Resultats : Trente-cinq chirurgiens ont repondu au sondage (taux de reponse 50%). Soixante-dix pour cent des repondants ont indique effectuer annuellement 26 greffes ou plus, 88 % avaient suivi une specialisation formelle pour l'execution des greffes et 67% ont dit etre en cours de specialisation. Seulement 24% et 12 % respectivement ont dit croire que le mannitol et le furosemide permettent de reduire le retard de fonctionnement du greffon. Toutefois, 73 % et 53 % respectivement administraient de routine du mannitol et du furosemide aux patients. La justification la plus frequente de l'utilisation du mannitol etait d'induire la diurese (54%); 37% des repondants ont dit utiliser le mannitol parce que c'est ce qu'on leur a ens eigne durant leur formation. De meme, 57% utilisaient le furosemide pour la diurese, dont 23 % disaient que c'est ce qu'on leur avait ens eigne durant leur formation. Aucun lien n'est ressorti entre la specialisation, le volume de cas ou le statut a l'egard du programme de formation et l'utilisation d'un agent quelconque. Fait a noter, 71 % des repondants ont indique qu'un essai randomise et controle sur l'utilite des diuretiques peroperatoires serait necessaire et qu'ils y participeraient volontiers. Conclusion : L'utilisation de diuretiques peroperatoires et la justification de leur utilisation varient d'un chirurgien a 1'autre. En majeure partie, les chirurgiens utilisent ces medicaments sur la base des notions theoriques seulement. Un essai randomise et controle s'impose pour clarifier le role des diuretiques peroperatoires dans la greffe renale., Renal transplantation remains the preferred treatment for the management of end-stage renal disease. (1) Despite high technical success rates for the procedure, transplanted kidneys can experience slow or delayed graft [...]

Background: The scope of practice of general surgeons in Canada is highly variable. The objective of this study was to examine the demographic characteristics of general surgeons in Canada and compare surgical procedures performed across community sizes and specialties. Methods: Data from the Canadian Institute for Health Information's National Physician Database were used to analyze fee-for-service (FFS) care provided by general surgeons and other providers across Canada in 2015/16. Results: Across 8 Canadian provinces, 1669 general surgeons provided FFS care. The majority of the surgeons worked in communities with more than 100 000 residents (71%), were male (78%), were aged 35-54 years (56%) and were Canadian medical graduates (76%). Only 7% of general surgeons practised in rural areas and 14% in communities with between 10 000 and 50 000 residents. Rural communities were significantly more likely to have surgeons who were international medical graduates or who were older than 65 years. The surgical procedures most commonly performed by general surgeons were hernia repairs, gallbladder and biliary tree surgery, excision of skin tumours, colon and intestine resections and breast surgery. Many general surgeons performed procedures not listed in their Royal College of Physicians and Surgeons of Canada training objectives. Conclusion: Canadian general surgeons provide a wide array of surgical services, and practice patterns vary by community size. Surgeons practising in rural and small communities require proficiency in skills not routinely taught in general surgery residency. Opportunities to acquire these skills should be available in training to prepare surgeons to meet the care needs of Canadians. Contexte : La pratique des chirurgiens generalistes au Canada varie grandement. Cette etude vis ait a examiner les caracteristiques demographiques des chirurgiens generalistes au Canada et a comparer les interventions realisees selon la specialite et la taille des collectivites. Methodes : Des donnees de la Base de donnees nationale sur les medecins de l'Institut canadien d'information sur la sante ont ete utilisees pour analyser les soins remuneres a Facte dispenses par des chirurgiens generalistes et d'autres fournisseurs de soins au Canada en 2015-2016. Resultats : Dans 8 provinces canadiennes, 1669 chirurgiens generalistes ont fourni des soins remuneres a Facte. La majorite d'entre eux travaillaient dans des collectivites de plus de 100 000 residents (71 %), etaient des hommes (78%), avaient entre 35 et 54 ans (56 %) et avaient obtenu leur diplome de medecine au Canada (76 %). Seuls 7 % des chirurgiens generalistes travaillaient en region rurale et 14 %, dans des collectivites comptant entre 10 000 et 50 000 residents. En region rurale, la probabilite que les chirurgiens soient des diplomes internationaux en medecine ou aient plus de 65 ans etait significativement plus elevee. Les interventions les plus frequent es etaient la reparation d'une hernie, la chirurgie de la vesicule biliaire et des voies biliaires, le re trait de tumeurs de la peau, la resection du colon ou de Fintestin et la chirurgie mammaire. De nombreux chirurgiens generalistes ont realise des procedures ne faisant pas partie des objectifs de formation du College royal des medecins et chirurgiens du Canada. Conclusion : Les chirurgiens generalistes canadiens realisent une large gamme d'interventions chirurgie ales et leur pratique varie selon la taille de la collectivite dans laquelle ils travaillent. Les chirurgiens exercant en milieu rural et dans les petites collectivities doivent avoir des competences qui ne sont habituellement pas enseignees durant la residence en chirurgie generale. La formation devrait integrer des occasions d'acquerir ces competences pour preparer les chirurgiens a repondre aux besoins en matiere de soins des Canadiens., The scope of practice of general surgeons in Canada is highly variable. (1) Despite having vastly different practice profiles, all graduates must meet the training objectives set forth by the [...]

Comparisons with other high-income countries suggest that Canada has been slower to adopt laparoscopic colectomy (LC). The Canadian Association of General Surgeons sought to evaluate the barriers to adoption of laparoscopic colon surgery and to propose potential intervention strategies to enhance the use of the procedure. Given the clinical benefits of laparoscopic surgery for patients, the increasing needs for surgical care and the desire of Canadian general surgeons to advance their specialty and enhance the care of their patients, it is an important priority to improve the utilization of LC., The first study of laparoscopic colectomy (LC) was published in 1991. (1) Throughout the 1990s, adoption of the technique was hampered by concerns regarding oncologic safety and effectiveness. (2,3) This [...]

Byline: Sanjay. Sharma, Sarosh. Katrak The mining of manganese ore in India started in the year 1899, in Nagpur district of the Central Provinces. Almost six decades later, in 1957, [...]

SUMMARY Phase 3 randomized controlled trials are the widely accepted gold standard through which treatment decisions are made, as they assess the efficacy of a novel treatment against the control [...]

Background: Pheochromocytomas are rare tumours that require complex perioperative management. Despite recent consensus guidelines, there is substantial variability in the management of pheochromocytomas. Our study characterizes the current state of [...]

Exposure-prone procedures (EPPs) are those in which the surgeon is exposed to the tissues in a patient's body cavity and there is a possibility of blood contamination via sharp objects/instruments [...]

Byline: Varun. Madaan, G. Adithya, Satya. Jindal, Rigved. Gupta, Vivek. Tandon, Deepak. Govil Laparoscopic cholecystectomy has many known complications which can be ascertained to a particular cause. We report a [...]

Background: Recognition of tissue planes during surgery appears to be a skill acquired with experience. We conducted a pilot study to test this hypothesis using a novel method for evaluating [...]

Background: Our objective was to examine the knowledge and treatment decision practice patterns of Canadian surgeons who treat patients with rectal cancer. Methods: A mail survey with 6 questions on staging investigations, management of low rectal cancer, lymph node harvest, surgical margins and use of adjuvant therapies was sent to all general surgeons in Canada. Appropriate responses to survey questions were defined a priori. We compared survey responses according to surgeon training (colorectal/surgical oncology v. others) and geographic region (Atlantic, Central, West). Results: The survey was sent to 2143 general surgeons; of the 1312 respondents, 703 treat patients with rectal cancer. Most surgeons responded appropriately to the questions regarding staging investigations (88%) and management of low rectal cancer (88%). Only 55% of surgeons correctly identified the recommended lymph node harvest as 12 or more nodes, 45% identified 5 cm as the recommended distal margin for upper rectal cancer, and 70% appropriately identified which patients should be referred for adjuvant therapy. Surgeons with subspecialty training were significantly more likely to provide correct responses to all of the survey questions than other surgeons. There was limited variation in responses according to geographic region. Subspecialty-trained surgeons and recent graduates were more likely to answer all of the survey questions correctly than other surgeons. Conclusion: Initiatives are needed to ensure that all surgeons who treat patients with rectal cancer, regardless of training, maintain a thorough and accurate knowledge of rectal cancer treatment issues. Contexte : Notre objectif etait d'evaluer les connaissances et les processus decisionnels therapeutiques des chirurgiens canadiens qui traitent des patients atteints de cancer rectal. Methodes : Un sondage envoye par la poste comportant 6 questions sur les epreuves de stadification, la prise en charge du cancer du bas rectum, le prelevement des ganglions lymphatiques, les marges chirurgicales et l'utilisation de traitements adjuvants a ete envoye a tous les chirurgiens generaux au Canada. Les reponses appropriees aux questions du sondage avaient ete definies au prealable. Nous avons compare les reponses au sondage selon la formation des chirurgiens (oncologie colorectale/chirurgicale c. autres) et selon la region (Atlantique, Centre, Ouest). Resultats : Le sondage a ete envoye a 2143 chirurgiens generaux; parmi les 1312 repondants, 703 traitent des patients atteints de cancer rectal. La plupart des chirurgiens ont repondu de facon appropriee aux questions concernant les epreuves de stadification (88 %) et la prise en charge du cancer du bas rectum (88 %). Seulement 55 % des chirurgiens ont correctement repondu a la question sur le nombre optimal de ganglions lymphatiques a prelever, soit 12 ganglions ou plus, 45 % ont donne 5 cm comme marge distale recommandee pour le cancer du haut rectum et 70 % ont determine de maniere appropriee quels patients il faut orienter vers un traitement adjuvant. Les chirurgiens qui avaient recu une formation specialisee etaient significativement plus susceptibles de fournir des reponses exactes a toutes les questions du sondage comparativement aux autres chirurgiens. On a note une variation limitee entre les reponses selon les regions. Les chirurgiens specialises et les nouveaux diplomes etaient plus susceptibles de repondre correctement a toutes les questions du sondage comparativement aux autres chirurgiens. Conclusion : Des initiatives s'imposent pour s'assurer qu'independamment de leur formation tous les chirurgiens qui traitent des patients atteints d'un cancer rectal maintiennent des connaissances completes et exactes sur les enjeux therapeutiques entourant le cancer rectal., The management of rectal cancer has evolved considerably over the past 2 decades with significant advances in many areas, such as preoperative staging investigations, use of and timing of adjuvant [...]

The ability to tie surgical knots efficiently and effectively is an essential surgical skill for medical procedures, especially pacemaker implantation. Device generators and their leads need to be safely anchored with sutures during implantation to prevent dislodgement and inadequate packaging in the pacemaker pocket. With most knot tying techniques, a generous amount of suture slack is required. We introduce a new technique that is a variation of the 2-handed surgical square knot and the 1-handed surgeon's knot that allows one to finish or tie a knot when left with little slack., There are many ways to tie a suture during a surgical procedure. (1-3) Depending on the surgeon's experience and familiarity with a technique, most knots can be completed fairly rapidly. [...]

CLINICAL SCENARIO You are a young general surgeon in a community practice. A new consultation is scheduled in your clinic: a 60-year-old woman presenting with chronic venous ulcers on both [...]

Background: Theory suggests the uptake of a medical innovation is influenced by how potential adopters perceive innovation characteristics and by characteristics of potential adopters. Innovation adoption is slow among the first 20% of individuals in a target group and then accelerates. The Quality Initiative in Rectal Cancer (QIRC) trial assessed if rectal cancer surgery outcomes could be improved through surgeon participation in the QIRC strategy. We tested if traditional uptake of innovation concepts applied to surgeons in the experimental arm of the trial. Methods: The QIRC strategy included workshops, access to opinion leaders, intraoperative demonstrations, postoperative questionnaires, and audit and feedback. For intraoperative demonstrations, a participating surgeon invited an outside surgeon to demonstrate optimal rectal surgery techniques. We used surgeon timing in a demonstration to differentiate early and late adopters of the QIRC strategy. Surgeons completed surveys on perceptions of the strategy and personal characteristics. Results: Nineteen of 56 surgeons (34%) requested an operative demonstration on their first case of rectal surgery. Early and late adopters had similar perceptions of the QIRC strategy and similar characteristics. Late adopters were less likely than early adopters to perceive an advantage for the surgical techniques promoted by the trial (p = 0.023). Conclusion: Most traditional diffusion of innovation concepts did not apply to surgeons in the QIRC trial, with the exception of the importance of perceptions of comparative advantage. Contexte: Selon une theorie, 2 facteurs influencent l'adoption de nouvelles pratiques en medecine, soit la facon dont les adeptes potentiels percoivent les caracteristiques novatrices et les caracteristiques propres aux adeptes potentiels eux-memes. L'adoption des nouvelles pratiques se fait lentement chez les premiers 20 % des individus d'un groupe cible, puis va en s'accelerant. L'etude QIRC (Quality Initiative in Rectal Cancer) a voulu verifier si la participation des chirurgiens a la strategie QIRC pouvait ameliorer l'issue de la chirurgie pour cancer du rectum. Nous avons verifie si les modes habituels d'adoption des nouvelles pratiques s'appliquaient aux chirurgiens dans le groupe experimental de l'etude. Methodes: La strategie QIRC incluait des ateliers, l'acces a des meneurs d'opinion, des demonstrations peroperatoires et des questionnaires postoperatoires, suivis de verifications et de commentaires. Pour les demonstrations peroperatoires, un chirurgien participant invitait un chirurgien de l'exterieur a faire une demonstration de techniques chirurgicales rectales optimales. Nous avons utilise les delais d'adoption des nouvelles pratiques par les chirurgiens pour faire ressortir la distinction entre les adeptes precoces et tardifs de la strategie QIRC. Les chirurgiens ont repondu a des questionnaires sur leurs perceptions a l'endroit de la strategie et sur leurs caracteristiques personnelles. Resultats: Dix-neuf chirurgiens sur 56 (34 %) ont demande une demonstration operatoire lors de leur premier cas de chirurgie rectale. Les adeptes precoces et tardifs avaient des perceptions similaires de la strategie QIRC et des caracteristiques personnelles similaires. Les adeptes tardifs etaient moins susceptibles que les adeptes precoces de percevoir l'avantage des techniques chirurgicales preconisees dans le cadre de l'etude (p= 0,023). Conclusion: La plupart des modes habituels de diffusion des nouvelles pratiques ne s'appliquaient pas aux chirurgiens de l'essai QIRC, a l'exception de l'importance des perceptions a l'endroit des avantages comparatifs., Researchers suggest that the uptake of a medical innovation depends on how potential adopters perceive the characteristics of the innovation, the characteristics of the potential adopters and contextual factors that [...]

Background: Operative reports (ORs) serve as the official documentation of surgical procedures. They are essential for optimal patient care, physician accountability and billing, and direction for clinical research and auditing. Nonstandardized narrative reports are often of poor quality and lacking in detail. We sought to audit the completeness of narrative inguinal hernia ORs. Methods: A standardized checklist for inguinal hernia repair (IHR) comprising 33 variables was developed by consensus of 4 surgeons. Five high-volume IHR surgeons categorized items as essential, preferable or nonessential. We audited ORs for open IHR at 6 academic hospitals. Results: We audited 213 ORs, and we excluded 7 femoral hernia ORs. Tension-free repairs were the most common (82.5%), and the plug-and-patch technique was the most frequent (52.9%). Residents dictated 59% of ORs. Of 33 variables, 15 were considered essential and, on average, 10.8 ± 1.3 were included. Poorly reported elements included first occurrence versus recurrent repair (8.3 %), small bowel viability in incarcerated hernias (10.7%) and occurrence of intraoperative complications (32.5%). Of 18 nonessential elements, deep vein thrombosis prophylaxis, preoperative antibiotics and urgency were reported in 1.9%, 11.7% and 24.3% of ORs, respectively. Repairspecific details were reported in 0 to 97.1% of ORs, including patch sutured to tubercle (55.1%) and location of plug (67.0%). Conclusion: Completeness of IHR ORs varied with regards to essential and nonessential items but were generally incomplete, suggesting there is opportunity for improvement, including implementation of a standardized synoptic OR. Contexte: Les notes operatoires (NO) servent a documenter officiellement les interventions chirurgicales. Elles sont indispensables a des soins optimaux aux patients, a l'imputabilite des medecins, a la facturation de leurs actes, a l'orientation de la recherche clinique et aux verifications. Les notes narratives non standardisees sont souvent de pietre qualite et incompletes. Nous avons voulu verifier l'exhaustivite des notes operatoires narratives concernant les reparations d'hernies inguinales (RHI). Methodes: Une equipe de 4 chirurgiens a cree une liste de verification standardisee consensuelle comprenant 33 variables applicables a la RHI. Cinq chirurgiens experts des RHI ont classe ces elements selon qu'ils leurs semblaient essentiels, preferables ou non essentiels. Nous avons passe en revue les NO des RHI ouvertes effectuees dans 6 hopitaux universitaires. Resultats: Nous avons passe en revue 213 NO et nous avons exclus les NO concernant 7 hernies femorales. Les reparations sans tension se sont revelees les plus communes (82,5 %) et la technique plug-and-patch a ete la plus frequente (52,9 %). Les residents ont dicte 59 % des NO. Sur les 33 variables, 15 etaient considerees essentielles et en moyenne, 10,8 ± 1,3 ont ete incluses dans les NO. Parmi les elements qui laissaient a desirer, mentionnons : premiere reparation c. reparation recurrente (8,3 %), viabilite du grele dans les hernies incarcerees (10,7 %) et complications peroperatoires (32,5 %). Parmi les 18 elements juges non essentiels, la prophylaxie contre la thrombose veineuse profonde, l'antibioprophylaxie et le degre d'urgence ont ete mentionnes dans 1,9 %, 11,7 % et 24,3 % des NO, respectivement. Les details specifiques a la reparation ont ete notes dans 0 a 97,1 % des NO, y compris la fixation de la prothese au tubercule par des sutures (55,1 %) et la localisation du bouchon (67,0 %). Conclusion: L'exhaustivite des NO consignees dans les cas de RHI a varie en ce qui a trait aux elements juges essentiels et non essentiels et les NO se sont generalement revelees incompletes. On en conclut qu'il y a place a amelioration, entre autre par l'adoption d'un modele synoptique standardise de NO., The operative report (OR) has traditionally been in the form of a narrative, which is dictated after the surgical procedure by either a surgeon or resident. Its role is multifaceted: [...]

Clostridium difficile is emerging as a major infectious disease threat worldwide. The incidence of C. difficile infection (CDI) has exponentially increased globally, and the profile of patients at risk has [...]

Byline: Yongmin. Lee, Younghoon. Roh, Minchan. Kim, Younghoon. Kim, Kwanwoo. Kim, Sunghwa. Kang, Eunjeong. Jang Background: Single-port laparoscopic cholecystectomy (SPLC) is a new advanced technique in laparoscopic surgery which has [...]

Byline: J. C Parthiban A ventral approach to the cervico-thoracic junction is always technically challenging and needs special expertise to perform. Over the years, many modifications have been carried out [...]

Byline: Edoardo. Raposio Introduction: Repairing large scalp defects has always been a difficult task for plastic surgeons. This is because the requirements of such procedures are two-fold: sufficient soft-tissue coverage [...]

Byline: Suryanarayanan. Bhaskar, Mayank. Garg Sir, We read with interest the article by Abraham AP et al ., entitled 'Subgaleoatrial shunt: Further progress in the management of iatrogenic cranial pseudomeningoceles'.[1] [...]