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Far from Standardized: Using Surgical Videos to Identify Variation in Technique for Laparoscopic Sleeve Gastrectomy

Published on Aug 1, 2017in Journal of Laparoendoscopic & Advanced Surgical Techniques1.322
· DOI :10.1089/lap.2017.0184
A VarbanOliver1
Estimated H-index: 1
,
NiemannAdam1
Estimated H-index: 1
(UM: University of Michigan)
+ 4 AuthorsB DimickJustin1
Estimated H-index: 1
Abstract
Abstract Background: Video assessment is an emerging tool for understanding variation in surgical technique. Methods: Representative videos of laparoscopic sleeve gastrectomy (LSG) were voluntarily submitted by 20 surgeons who participated in a statewide quality improvement collaborative. The amount of time required to complete the salient steps of the operation was measured and variations in the tasks performed during each step were captured. Results: Twenty-two videos of LSG were submitted and 11 videos included concurrent hiatal hernia repair. Data obtained from video analysis identified variation in time to complete each step of the procedure: prestapling dissection of stomach (5–25 minutes), gastric stapling (8–20 minutes), and management of the staple line (1–25 minutes). Time required to perform a hiatal hernia repair also varied (1–26 minutes), as did the type of repair: 55% were performed with a posterior cruropexy, 27% were performed with an anterior cruropexy, and 18% were performed with both. ...
  • References (29)
  • Citations (7)
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References29
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#1Ninh T. Nguyen (UCI: University of California, Irvine)H-Index: 63
#2Stephen Vu (UCI: University of California, Irvine)H-Index: 5
Last. Michael J. Phelan (UCI: University of California, Irvine)H-Index: 15
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Background Utilization of bariatric surgery has changed dramatically over the past two decades. The aim of this study was to update the trends in volume and procedural type of bariatric surgery in the USA. Data were derived from the National Inpatient Sample from 2009 through 2012.
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#1Ricard Corcelles (University of Barcelona)H-Index: 16
#2Mena Boules (Cleveland Clinic)H-Index: 8
Last. Tomasz Rogula (Case Western Reserve University)H-Index: 16
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Abstract Background: Further minimization of abdominal wall trauma during laparoscopic bariatric surgery is a topic of great interest. Reducing the number of trocars may provide superior cosmetic results with less pain and shorter length of stay (LOS). However, it remains unclear if this approach compromises safety or effectiveness of weight loss. The aim of this study is to report initial safety and feasibility results using a three-port minimally invasive sleeve gastrectomy technique. Material...
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Abstract Surgeons are under enormous pressure to continually improve and learn new surgical skills. Novel uses of surgical video in the preoperative, intraoperative, and postoperative setting are emerging to accelerate the learning curve of surgical skill and minimize harm to patients. In the preoperative setting, social media outlets provide a valuable platform for surgeons to collaborate and plan for difficult operative cases. Live streaming of video has allowed for intraoperative telementorin...
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#2Sujata Saha (NU: Northwestern University)H-Index: 7
Last. Magdy P. Milad (NU: Northwestern University)H-Index: 31
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Abstract Study Objective The relationship between operative time and perioperative morbidity has not been fully characterized in gynecology. We aimed to determine the impact of operative time on 30-day perioperative complications after laparoscopic and robotic hysterectomy. Design Patients undergoing laparoscopic and robotic hysterectomy for benign disease from 2006 to 2011 within the National Surgical Quality Improvement Program (NSQIP) database were identified by Current Procedural Terminology...
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#1J. Esteban Varela (UCI: University of California, Irvine)H-Index: 31
#2Ninh T. Nguyen (UCI: University of California, Irvine)H-Index: 63
Abstract Background Analysis of a recent single state bariatric surgery registry revealed that laparoscopic sleeve gastrectomy was the most common bariatric procedure starting in 2012. The objective of this study was to examine the trend in utilization of laparoscopic sleeve gastrectomy performed at academic medical centers in the United States. Methods Using ICD-9 diagnosis and procedure codes, clinical data obtained from the University HealthSystem Consortium database for all bariatric procedu...
67 CitationsSource
Background Leaks after sleeve gastrectomy (SG) may be due to a mismatch between staple height and tissue thickness. The aim of this study was to determine the range of gastric thicknesses in three areas of stapling.
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#1Brian J. Daley (UTMC: University of Tennessee Medical Center)H-Index: 15
#2William CecilH-Index: 2
Last. Oscar D. Guillamondegui (Vandy: Vanderbilt University)H-Index: 27
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Background The Tennessee Surgical Quality Collaborative analyzes NSQIP data from 21 participating hospitals. The Tennessee Surgical Quality Collaborative has reduced surgical complications, but causative factors are unclear. We sought to correlate surgical duration with complications to reveal mitigating strategies. Study Design Risk-adjusted Tennessee Surgical Quality Collaborative data on 104,632 general and vascular cases had a standard duration for 35 procedures (eg, breast, colectomy) calcu...
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#1Bradley N. Reames (UM: University of Michigan)H-Index: 15
#2Daniel BacalH-Index: 4
Last. Jonathan F. Finks (UM: University of Michigan)H-Index: 18
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#2KanayamaHiroomiH-Index: 1
Last. TerachiToshiroH-Index: 1
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Abstract Background and Purpose: The Japanese Urological Association and Japanese Society of Endourology established a urologic laparoscopic skills qualification system called the Endoscopic Surgical Skill Qualification (ESSQ) System in Urological Laparoscopy in 2004. The reliability of video assessments by referees was evaluated. Materials and Methods: Videos of nephrectomies or adrenalectomies performed by the applicants were assessed by two referees selected among a pool of 42 referees. From ...
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#1Bradley N. Reames (UM: University of Michigan)H-Index: 15
#2Jonathan F. Finks (UM: University of Michigan)H-Index: 18
Last. Justin B. Dimick (UM: University of Michigan)H-Index: 67
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Bariatric surgery is the most effective therapy available for significant and sustainable weight loss in morbidly obese patients.1,2 As a result of the rising prevalence of obesity, improvements in perioperative safety, and expanded insurance coverage, bariatric surgery utilization has increased in the last decade.3,4 Changes in procedure use over time reflect emerging evidence regarding the comparative safety and effectiveness of available procedures.1,2,5 An understanding of current trends in ...
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Introduction Autonomy is of foremost concern in the current era of surgical residency, and it is especially important to trainees when considering their surgical education. Factors impacting trainee independence include the restriction of clinical work hours and the development of advanced minimally invasive techniques such as robotics, which requires separate technical education outside of conventional surgical education. Moreover, when residents are left to learn fundamental exposures via thei...
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#1Wu Rc (UM: University of Michigan)
#2Zack Prebay (MCW: Medical College of Wisconsin)
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Purpose Video assessment is an emerging tool for understanding surgical technique. Patient outcomes after robot-assisted radical prostatectomy (RARP) may be linked to technical aspects of the procedure. In an effort to refine surgical approaches and improve outcomes, we sought to understand technical variation for the key steps of RARP in a surgical collaborative.
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#1Amr I. Al Abbas (University of Pittsburgh)H-Index: 1
#2Jae P. Jung (University of Pittsburgh)H-Index: 1
Last. Melissa E. Hogg (NorthShore University HealthSystem)H-Index: 17
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#1Oliver A. VarbanH-Index: 12
#2Jyothi R. Thumma (UM: University of Michigan)H-Index: 12
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Background Considerable technical variation exists when performing laparoscopic sleeve gastrectomy (LSG). However, little is known about which techniques are associated with optimal outcomes.
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#1Jonathan F. Finks (UM: University of Michigan)H-Index: 18
With evidence for wide variation in the quality and cost of inpatient surgery in the United States, payers and policy makers have increasingly pursued strategies to improve the cost-effectiveness of surgical care. Payer-funded collaborative quality improvement (CQI) efforts represent an innovative and effective means of enhancing surgical care across a large population. Unlike more top-down approaches, such as pay-for- performance measures, CQI programs engage multiple stakeholders, foster knowl...
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Importance Technical proficiency at robotic pancreaticoduodenectomy (RPD) and video assessment are promising tools for understanding postoperative outcomes. Delayed gastric emptying (DGE) remains a major driver of cost and morbidity after pancreaticoduodenectomy. Objective To determine if technical variables during RPD are associated with postoperative DGE. Design, Setting, and Participants A retrospective study was conducted of technical assessment performed in all available videos (n = 192) of...
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