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Use of Video Review to Investigate Technical Factors That May Be Associated With Delayed Gastric Emptying After Pancreaticoduodenectomy

Published on Oct 1, 2018in JAMA Surgery10.67
· DOI :10.1001/jamasurg.2018.2089
Jae Pil Jung1
Estimated H-index: 1
(University of Pittsburgh),
Mazen S. Zenati27
Estimated H-index: 27
(University of Pittsburgh)
+ 4 AuthorsMelissa E. Hogg15
Estimated H-index: 15
(University of Pittsburgh)
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Abstract
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 consecutive RPDs performed at a single academic institution from October 3, 2008, through September 27, 2016. Exposures Video review of gastrojejunal anastomosis during RPD. Main Outcomes and Measures Delayed gastric emptying was classified according to International Study Group of Pancreatic Surgery criteria. Video analysis reviewed technical variables specific in the construction of the gastrojejunal anastomosis. Using multivariate analysis, DGE was correlated with known patient variables and technical variables, individually and combined. Results Of 410 RPDs performed, video was available for 192 RPDs (80 women and 112 men; mean [SD] age, 65.7 [11.1] years). Delayed gastric emptying occurred in 41 patients (21.4%; grade A, 15; grade B, 14; and grade C, 12). Patient variables contributing to DGE on multivariate analysis were advanced age (odds ratio [OR] 1.11; 95% CI, 1.05-1.16; P P  = .03), and postoperative pseudoaneurysm (OR, 17.29; 95% CI, 2.34-127.78; P  = .005). However, technical variables contributing to decreased DGE on multivariate analysis included the flow angle (within 30° of vertical) between the stomach and efferent jejunal limb (OR, 0.25; 95% CI, 0.08-0.79; P  = .02), greater length of the gastrojejunal anastomosis (OR, 0.40; 95% CI, 0.20-0.77; P  = .006), and a robotic-sewn anastomosis (robotic suture vs stapler: OR, 0.30; 95% CI, 0.09-0.95; P  = .04). Conclusions and Relevance This study examines modifiable technical factors through the use of review of video obtained at the time of operation and suggests ways by which the surgical construction of the gastrojejunal anastomosis during RPD may reduce the incidence of DGE as a framework for prospective quality improvement.
  • References (62)
  • Citations (2)
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References62
Newest
Published on Nov 1, 2017in Journal of Gastrointestinal Surgery2.69
Ibrahim Nassour7
Estimated H-index: 7
(UTSW: University of Texas Southwestern Medical Center),
Sam C. Wang13
Estimated H-index: 13
(UTSW: University of Texas Southwestern Medical Center)
+ 6 AuthorsRebecca M. Minter21
Estimated H-index: 21
(UTSW: University of Texas Southwestern Medical Center)
Background An increasing body of literature is supporting the safety of minimally invasive pancreaticoduodenectomy compared to open pancreaticoduodenectomy, but there are limited comparative studies between laparoscopic and robotic pancreaticoduodenectomy. The aim of this study was to compare the rate of postoperative 30-day overall complications between laparoscopic and robotic pancreaticoduodenectomy.
Published on Nov 1, 2017in Journal of Surgical Education2.21
Vernissia Tam5
Estimated H-index: 5
(University of Pittsburgh),
Mazen S. Zenati27
Estimated H-index: 27
(University of Pittsburgh)
+ 4 AuthorsMelissa E. Hogg15
Estimated H-index: 15
(University of Pittsburgh)
Objective Obtaining the proficiency on the robotic platform necessary to safely perform a robotic pancreatoduodenectomy is particularly challenging. We hypothesize that by instituting a proficiency-based robotic training curriculum we can enhance novice surgeons’ skills outside of the operating room, leading to a shorter learning curve. Design A biotissue curriculum was designed consisting of sewing artificial organs to simulate a hepaticojejunostomy (HJ), gastrojejunostomy (GJ), and pancreatico...
Published on Oct 1, 2017in Journal of Gastrointestinal Surgery2.69
Akio Tsutaho1
Estimated H-index: 1
(Hokkaido University),
Toru Nakamura13
Estimated H-index: 13
(Hokkaido University)
+ 11 AuthorsYo Kurashima9
Estimated H-index: 9
(Hokkaido University)
Background Delayed gastric emptying (DGE) is one of the most common morbidities of pancreaticoduodenectomy (PD). The aim of this study was to clarify whether the incidence of DGE can be reduced by side-to-side gastric greater curvature-to-jejunal anastomosis in subtotal stomach-preserving pancreaticoduodenectomy (SSPPD).
Published on Oct 1, 2017in Journal of The American College of Surgeons4.45
Adeel S. Khan7
Estimated H-index: 7
(WashU: Washington University in St. Louis),
Greg Williams1
Estimated H-index: 1
(WashU: Washington University in St. Louis)
+ 5 AuthorsSteven M. Strasberg66
Estimated H-index: 66
(WashU: Washington University in St. Louis)
Background Delayed gastric emptying (DGE) is a common serious problem after pancreaticoduodenectomy (PD). Flange gastrojejunostomy (FL-GE) is a previously described technique that creates an internal flange in a hand-sewn gastroenterostomy. Results of FL-GE on incidence and severity of DGE after PD are presented. Study Design Data were extracted from a prospective database of PD. Standard PD with antrectomy were performed with flange gastroenterostomy (FL-GE) or other techniques (NonFL-GE) at a ...
Rajesh Panwar4
Estimated H-index: 4
(AIIMS: All India Institute of Medical Sciences),
Sujoy Pal17
Estimated H-index: 17
(AIIMS: All India Institute of Medical Sciences)
Background A number of definitions have been used for delayed gastric emptying (DGE) after pancreatoduodenectomy and the reported rates varied widely. The International Study Group of Pancreatic Surgery (ISGPS) definition is the current standard but it is not used universally. In this comprehensive review, we aimed to determine the acceptance rate of ISGPS definition of DGE, the incidence of DGE after pancreatoduodenectomy and the effect of various technical modifications on its incidence. Data ...
A VarbanOliver1
Estimated H-index: 1
,
NiemannAdam1
Estimated H-index: 1
(UM: University of Michigan)
+ 4 AuthorsB DimickJustin1
Estimated H-index: 1
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...
Published on Apr 1, 2017in JAMA Surgery10.67
Matthew T. McMillan15
Estimated H-index: 15
(UPenn: University of Pennsylvania),
Amer H. Zureikat28
Estimated H-index: 28
(University of Pittsburgh)
+ 4 AuthorsCharles M. Vollmer38
Estimated H-index: 38
(UPenn: University of Pennsylvania)
Importance The adoption of robotic pancreatoduodenectomy (RPD) is gaining momentum; however, its impact on major outcomes, including pancreatic fistula, has yet to be adequately compared with open pancreatoduodenectomy (OPD). Objective To demonstrate that use of RPD does not increase the incidence of clinically relevant pancreatic fistula (CR-POPF) compared with OPD. Design, Setting, and Participants Data were accrued from 2846 patients who underwent pancreatoduodenectomies (OPDs, n = 2661; RPDs...
Published on Feb 1, 2017in Hpb3.05
Mark D. Girgis7
Estimated H-index: 7
(UCLA: University of California, Los Angeles),
Mazen S. Zenati27
Estimated H-index: 27
+ 4 AuthorsMelissa E. Hogg15
Estimated H-index: 15
Abstract Introduction The aim was to evaluate the impact of obesity on perioperative outcomes in patients undergoing robotic pancreaticoduodenectomy (RPD) compared to open pancreaticoduodenectomy (OPD). Methods A retrospective review of all pancreaticoduodenectomies from 9/2011 to 4/2015 was performed. Obesity was defined as body mass index (BMI) > 30 kg/m 2 . Results Of 474 pancreaticoduodenectomies performed: RPD = 213 (45%) and OPD = 261 (55%). A total of 145 (31%) patients were obese (70 RPD...
Published on Feb 1, 2017in Digestive Diseases and Sciences2.94
Savio George Barreto15
Estimated H-index: 15
(Flinders Medical Centre),
John A. Windsor50
Estimated H-index: 50
(University of Auckland)
Delayed gastric emptying (DGE) represents a significant cause for morbidity following pancreatoduodenectomy (PD). At a time when no specific and universally effective therapy exists to treat these patients, elucidating other potential (preventable or treatable) mechanisms for DGE is important. The aim of the manuscript was to test the hypothesis that ileal brake contributes to DGE in PD patients receiving jejunal tube feeding by systematically reviewing experimental and clinical literature. A se...
Published on Nov 1, 2016in Surgery3.48
Oliver A. Varban10
Estimated H-index: 10
(UM: University of Michigan),
Caprice C. Greenberg29
Estimated H-index: 29
(UW: University of Wisconsin-Madison)
+ 4 AuthorsJustin B. Dimick62
Estimated H-index: 62
(UM: University of Michigan)
Background Recent data establish a strong link between peer video ratings of surgical skill and clinical outcomes with laparoscopic gastric bypass. Whether skill for one bariatric procedure can predict outcomes for another related procedure is unknown. Methods Twenty surgeons voluntarily submitted videos of a standard laparoscopic gastric bypass procedure, which was blindly rated by 10 or more peers using a modified version of the Objective Structured Assessment of Technical Skills. Surgeons wer...
Cited By2
Newest
Published on May 1, 2019in Journal of Surgical Education2.21
Amr I. Al Abbas1
Estimated H-index: 1
(University of Pittsburgh),
Jae P. Jung (University of Pittsburgh)+ 3 AuthorsMelissa E. Hogg1
Estimated H-index: 1
(NorthShore University HealthSystem)
Objective Explore the methods used and costs necessary for the creation and maintenance of a surgical video library with an emphasis on its applications in surgical education and scholarship. Design A methodology paper highlighting how to develop and utilize a surgical video library for trainee operative preparation, development of research projects, and surgeon credentialing. Setting The study was conducted at the University of Pittsburgh Medical Center, a tertiary care medical center. Particip...