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Kuboki D, Unoki T, Kaneda Y, Maeda Y, Oiwa K, Yamaguchi H, Sata N, Kawahira H. Feedback differences between upper gastrointestinal and colorectal specialists observing laparoscopic trainee surgeon suturing videos. Surg Open Sci 2025; 24:31-37. [PMID: 40027544 PMCID: PMC11869984 DOI: 10.1016/j.sopen.2025.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 01/30/2025] [Accepted: 02/03/2025] [Indexed: 03/05/2025] Open
Abstract
Background Performing laparoscopic suturing requires quality education. Differences in instruction according to trainer surgeon specialty could affect trainee skill acquisition. This study compares the focus of feedback between Upper gastrointestinal (UGI) specialists and Colorectal (CR) specialists. Methods A 13-year postgraduate trainee received online feedback for two laparoscopic suturing procedures videos of "low" and "high" difficulty from 16 surgeons (UGI = 8, CR = 8) who are specialists in laparoscopic surgery and qualified by the Endoscopic Surgical Skill Qualification System of the Japan Society for Endoscopic Surgery. The number of feedback comments was compared between specialist groups for grasping the needle, needle driving, knot tying preparation, and knot tying. Both groups were also surveyed regarding suturing procedures. Results The UGI group had significantly more feedback comment varieties for knot tying preparation during the "high" difficulty video (UGI 4.0 ± 2.1 (mean ± SD), CR 1.9 ± 1.4, p < 0.05). According to questionnaire results, the UGI group performed suturing more routinely than the CR group, was more confident, and less stressed about the procedure. Conclusion In feedback for laparoscopic suturing videos, the UGI group focused more on the preparatory stage for knot tying than the CR group. This indicates that comment focus differs according to specialty, suggesting that instruction from trainers of multiple specialties is optimal. Key message In this study, it was shown that the focus of feedback on laparoscopic suturing procedures differs according to the surgeon's subspecialty. These insights could have important implications for optimizing laparoscopic training programs.
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Affiliation(s)
- Daigo Kuboki
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, Japan
| | - Teruhiko Unoki
- College of Foreign Studies, Kansai Gaidai University, 16-1, Nakamiyahigashino-cho, Hirakata-shi, Osaka, Japan
| | - Yuji Kaneda
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, Japan
- Medical Simulation Center, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, Japan
| | - Yoshitaka Maeda
- Medical Simulation Center, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, Japan
| | - Kosuke Oiwa
- Department of Information and Management Systems Engineering, Nagaoka University of Technology, 1603-1, Kamitomioka-cho, Nagaoka-shi, Niigata, Japan
| | - Hironori Yamaguchi
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, Japan
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, Japan
| | - Hiroshi Kawahira
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, Japan
- Medical Simulation Center, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, Japan
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Ono R, Nonaka T, Tominaga T, Ishii M, Hisanaga M, Araki M, Sumida Y, Shiraishi T, Hashimoto S, Noda K, Takeshita H, Fukuoka H, To K, Tanaka K, Sawai T, Matsumoto K. Effect of endoscopic surgical skill qualification system for laparoscopic rectal surgery: Japanese multicenter analysis. Surg Endosc 2025; 39:394-400. [PMID: 39562345 DOI: 10.1007/s00464-024-11407-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Accepted: 11/03/2024] [Indexed: 11/21/2024]
Abstract
BACKGROUND Laparoscopic rectal surgery is often technically difficult. The Endoscopic Surgical Skill Qualification System (ESSQS) was established in Japan as an objective measure of skill for laparoscopic surgeons. However, the advantages of the ESSQS qualification for laparoscopic rectal surgery have been limited. The aim of this multicenter study was to assess the effects of the ESSQS on short- and long-term outcomes for laparoscopic rectal cancer surgery. METHODS We retrospectively reviewed 933 rectal cancer patients who underwent laparoscopic surgery between 2016 and 2023. Patients were divided into two groups: those for whom surgery was performed by an ESSQS-qualified surgeon (Expert group, n = 568); and those for whom surgery was performed by an ESSQS-unqualified surgeon (Non-expert group, n = 365). After propensity score matching, 299 patients from each group were matched. Short- and long-term outcomes were compared between groups. RESULTS Before matching, the Expert group showed greater frequencies of poor performance status (PS) (PS ≥ 3, 10.6% vs 4.1%, p < 0.001), lower rectum cancer (32.0% vs 18.4%, p < 0.001), preoperative treatment (17.3% vs 8.2%, p < 0.001), and pelvic lymph node dissection (30.8% vs 21.4%, p = 0.001). After matching, the Expert group showed lower frequencies of open conversion (0.3% vs 2.3%, p = 0.034) and postoperative complications (18.1% vs 26.1%, p = 0.037). Relapse-free survival (p = 0.811) and overall survival (p = 0.374) were similar between groups. CONCLUSION Superior results such as lower conversion rates and postoperative complication rates were obtained for laparoscopic rectal surgery performed by ESSQS-qualified surgeons.
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Affiliation(s)
- Rika Ono
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirasemachi, Nagasaki, 857-8511, Japan
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
- Department of Surgical Oncology, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Mitsutoshi Ishii
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirasemachi, Nagasaki, 857-8511, Japan
| | - Makoto Hisanaga
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirasemachi, Nagasaki, 857-8511, Japan
| | - Masato Araki
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirasemachi, Nagasaki, 857-8511, Japan
| | - Yorihisa Sumida
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirasemachi, Nagasaki, 857-8511, Japan
| | - Toshio Shiraishi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Shintaro Hashimoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Keisuke Noda
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Hiroaki Takeshita
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, 1-1001-1, Omura, Nagasaki, 856-8562, Japan
| | - Hidetoshi Fukuoka
- Department of Surgery, Isahaya General Hospital, 24-1, Isahaya, Nagasaki, 854-8501, Japan
| | - Kazuo To
- Department of Surgery, Ureshino Medical Center, 4279-3, Ureshino, Saga, 843-0393, Japan
| | - Kenji Tanaka
- Department of Surgery, Saiseikai Nagasaki Hospital, 2-5-1 Katafuchi, Nagasaki, 850-0003, Japan
| | - Terumitsu Sawai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Chatha HN, Pawar O, Boutros C, Khan SZ, Wieland P, Levine I, Alvarado C, Benson J, Katz G, Lyons J, Marks JM. Does practice make perfect? Studying the relationship between surgeon experience and patient outcomes for paraesophageal hernia repairs. Surg Endosc 2024; 38:6017-6025. [PMID: 39107480 DOI: 10.1007/s00464-024-11122-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/25/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND It has been reported that higher surgeon experience leads to better patient outcomes. In this study, we look at surgeon experience and its association with postoperative outcomes and variation among the practice of surgeons performing paraesophageal hernia repairs (PEH). METHOD This was a retrospective study of 1155 patients who underwent PEH repair at a single institution (2010-2023). Surgeon experience was defined as the number of surgeries performed per surgeon and was split using the median surgeries (n = 100), with surgeons performing at or above the median categorized as high-experience and below the median as low-experience surgeons. A multivariable logistic regression model was used to test correlation between surgeon experience and variables, including demographics and intra- and post-operative outcomes. RESULTS High-experience surgeons performed more elective cases (93.4% vs 85.5%), but low-experience surgeons operated more on emergent (2.7% vs 0.9%), semi-elective (2.3% vs 1.4%), and urgent cases (9.5% vs 4.3%). Low-experience surgeons operated more on patients who were older (67.5 vs 63.2 years, p < 0.001) and had an increased risk of CVD (72.9% vs 61.5%, p < 0.001). Intraoperative OR time was considerably less for high-experience surgeons (115.8 vs 172.9 min, p < 0.001). Low-experience surgeons had increased risk of intra-operative complications (4.5% vs 1.8%, p = 0.021) and post-op pneumonia within 30 days (1.8% vs 0.3%). However, long-term outcomes such as hernia recurrence (OR: 1.10, CI: 0.78-1.54) and redo-operations for hiatal hernia (OR: 1.10, CI: 0.65-1.75) were similar for both groups. CONCLUSION High-experience surgeons perform more complex revisional surgeries in less time with fewer complications. Low-experience surgeons operated more on patients with higher comorbidities but had significantly higher OR times. Long-term results of recurrence and redo-operations were comparable. These variations suggest that high-experience surgeons are more efficient while operating on more complex cases. These findings have pivotal implications to facilitate mentorship and education among less-experienced surgeons.
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Affiliation(s)
- Hamza Nasir Chatha
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH, 44106, USA
| | - Omkar Pawar
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH, 44106, USA
| | - Christina Boutros
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH, 44106, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Saher-Zahra Khan
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH, 44106, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Patrick Wieland
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH, 44106, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Iris Levine
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH, 44106, USA
| | - Christine Alvarado
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH, 44106, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Jamie Benson
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH, 44106, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Guy Katz
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH, 44106, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Joshua Lyons
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH, 44106, USA.
- Case Western Reserve University, Cleveland, OH, USA.
| | - Jeffrey M Marks
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH, 44106, USA
- Case Western Reserve University, Cleveland, OH, USA
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Sawada N, Akagi T, Shimomura M, Todate Y, Nagakari K, Takeshita H, Maruyama S, Takata M, Ichikawa N, Hida K, Iijima H, Yamaguchi S, Taketomi A, Naitoh T. Evaluation of the advantage of surgeons certified by the endoscopic surgical skill qualification system participating in laparoscopic low anterior rectal resection. Ann Gastroenterol Surg 2024; 8:464-470. [PMID: 38707236 PMCID: PMC11066495 DOI: 10.1002/ags3.12763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/11/2023] [Accepted: 11/29/2023] [Indexed: 05/07/2024] Open
Abstract
Background A technical qualification system was developed in 2004 by the Japan Society for Endoscopic Surgery. An analysis of the EnSSURE study on 3188 stage II-III rectal cancer patients, which was performed by including the participation of qualified surgeons as assistants and advisers without restricting their participation as operators, revealed that the participation of technically qualified surgeons in surgery improved the technical and oncological safety of laparoscopic rectal resection. Aim This secondary retrospective analysis of the EnSSURE study examined the advantage of qualified surgeons participating in laparoscopic low anterior resection (LAR). Methods The outcomes of low anterior resection were compared between groups with and without the participation of surgeons qualified by the Endoscopic Surgical Skill Qualification System (Q and non-Q groups, respectively). We used propensity score matching to generate paired cohorts at a one-to-one ratio. The postoperative complication rate, short-term results (hemorrhage volume, operative time, number of dissected lymph nodes, open conversion rate, intraoperative complication rate, and R0 resection rate), and long-term results (disease-free survival rate, local recurrence rate, and overall survival rate) were evaluated. Results The frequencies of postoperative complications, anastomotic bleeding, and intraperitoneal abscess were significantly lower, the operative time was significantly shorter, the postoperative hospital stay was significantly shorter, and the number of dissected lymph nodes was higher in the Q group. No significant differences were observed in disease-free survival, local recurrence, or overall survival rate rates between the groups. Conclusion The participation of qualified surgeons in LAR is technically advantageous.
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Affiliation(s)
- Naruhiko Sawada
- Digestive Disease CenterShowa University Northern Yokohama HospitalYokohamaJapan
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric SurgeryOita UniversityOitaJapan
| | - Manabu Shimomura
- Hiroshima City North Medical Center Asa Citizens HospitalHiroshimaJapan
| | - Yukitoshi Todate
- Department of SurgerySouthern Tohoku General HospitalKoriyamaJapan
| | - Kunihiko Nagakari
- Department of Digestive and General SurgeryJuntendo University Urayasu HospitalUrayasuJapan
| | - Hiroaki Takeshita
- Department of SurgeryNational Hospital Organization Nagasaki Medical CenterNagasakiJapan
| | - Satoshi Maruyama
- Department of Gastroenterological SurgeryNiigata Cancer Center HospitalNiigataJapan
| | - Manabu Takata
- Department of SurgeryNagano Municipal HospitalNaganoJapan
| | - Nobuki Ichikawa
- Department of Gastroenterological Surgery I, Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Koya Hida
- Department of SurgeryKyoto University HospitalKyotoJapan
| | - Hiroaki Iijima
- Department of Gastroenterological Surgery I, Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Shigeki Yamaguchi
- Division of Colorectal Surgery, Department of SurgeryTokyo Women's Medical UniversityTokyoJapan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
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Goto K, Watanabe J, Nagasaki T, Uemura M, Ozawa H, Kurose Y, Akagi T, Ichikawa N, Iijima H, Inomata M, Taketomi A, Naitoh T. Impact of the endoscopic surgical skill qualification system on conversion to laparotomy after low anterior resection for rectal cancer in Japan (a secondary analysis of the EnSSURE study). Surg Endosc 2024; 38:2454-2464. [PMID: 38459211 PMCID: PMC11078784 DOI: 10.1007/s00464-024-10740-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 01/28/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND AND AIMS Conversion to laparotomy is among the serious intraoperative complications and carries an increased risk of postoperative complications. In this cohort study, we investigated whether or not the Endoscopic Surgical Skill Qualification System (ESSQS) affects the conversion rate among patients undergoing laparoscopic surgery for rectal cancer. METHODS We performed a retrospective secondary analysis of data collected from patients undergoing laparoscopic surgery for cStage II and III rectal cancer from 2014 to 2016 across 56 institutions affiliated with the Japan Society of Laparoscopic Colorectal Surgery. Data from the original EnSSURE study were analyzed to investigate risk factors for conversion to laparotomy by performing univariate and multivariate analyses based on the reason for conversion. RESULTS Data were collected for 3,168 cases, including 65 (2.1%) involving conversion to laparotomy. Indicated conversion accounted for 27 cases (0.9%), while technical conversion accounted for 35 cases (1.1%). The multivariate analysis identified the following independent risk factors for indicated conversion to laparotomy: tumor diameter [mm] (odds ratio [OR] 1.01, 95% confidence interval [CI] 1.01-1.05, p = 0.0002), combined resection of adjacent organs [+/-] (OR 7.92, 95% CI 3.14-19.97, p < 0.0001), and surgical participation of an ESSQS-certified physician [-/+] (OR 4.46, 95% CI 2.01-9.90, p = 0.0002). The multivariate analysis identified the following risk factors for technical conversion to laparotomy: registered case number of institution (OR 0.99, 95% CI 0.99-1.00, p = 0.0029), institution type [non-university/university hospital] (OR 3.52, 95% CI 1.54-8.04, p = 0.0028), combined resection of adjacent organs [+/-] (OR 5.96, 95% CI 2.15-16.53, p = 0.0006), and surgical participation of an ESSQS-certified physician [-/+] (OR 6.26, 95% CI 3.01-13.05, p < 0.0001). CONCLUSIONS Participation of ESSQS-certified physicians may reduce the risk of both indicated and technical conversion. Referral to specialized institutions, such as high-volume centers and university hospitals, especially for patients exhibiting relevant background risk factors, may reduce the risk of conversion to laparotomy and lead to better outcomes for patients. TRIAL REGISTRATION This study was registered with the Japanese Clinical Trials Registry as UMIN000040645.
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Affiliation(s)
- Koki Goto
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Jun Watanabe
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshiya Nagasaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mamoru Uemura
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Heita Ozawa
- Department of Colorectal Surgery, Tochigi Cancer Center, Utsunomiya, Japan
| | - Yohei Kurose
- Department of Surgery, Fukuyama City Hospital, Fukuyama, Japan
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric Surgery, Oita University, Oita, Japan.
| | - Nobuki Ichikawa
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroaki Iijima
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University, Oita, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Kiyozumi Y, Yamaguchi T, Ichikawa N, Homma S, Ikeda K, Inada R, Otsuka K, Furutani A, Iijima H, Watanabe M, Taketomi A, Naitoh T. Endoscopic Surgical Skill Qualification System: propensity-score matched cohort analysis of accredited supervisors in laparoscopic rectal cancer surgery. Br J Surg 2023; 110:1834-1839. [PMID: 37695301 DOI: 10.1093/bjs/znad282] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/23/2023] [Accepted: 08/06/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND The Endoscopic Surgical Skill Qualification System (ESSQS) in Japan evaluates the surgical skills required for laparoscopic surgery as an operator as well as a supervisor. This study aimed to demonstrate the benefits of an ESSQS-certified surgeon's participation in laparoscopic rectal resections as a supervisor (assistant or advisor). METHODS We retrospectively reviewed laparoscopic resection results for cStage II and III rectal cancer performed at 56 Japanese hospitals between 2014 and 2016. We used propensity score matching to generate paired cohorts with or without an ESSQS-certified supervisor at a one-to-one ratio. The impact of ESSQS-certified supervisors' participation on short-term outcomes was assessed. In the matched cohort, multivariable logistic regression analysis and multivariable regression analysis of postoperative complication rate and intraoperative blood loss were performed to further mitigate the impact of pathological factors. RESULTS Two groups (n = 399 each) with or without an ESSQS-certified supervisor were well matched by clinical factors. The group with an ESSQS-certified supervisor had lower blood loss (68 mL vs. 98 mL, P = 0.036) and a lower incidence of severe morbidities of Clavien-Dindo grade ≥IIIa (8.0% vs. 13.3%, P = 0.016). Multivariable logistic regression analysis and multivariable regression analysis confirmed that the attendance of ESSQS-certified supervisors reduced postoperative complication occurrence (adjusted odds ratio: 2.28, 95% confidence interval: 1.38 - 3.80, P = 0.001) and intraoperative blood loss (estimated difference: -15.7 mL, P = 0.016). CONCLUSION This study demonstrated the educational benefits of ESSQS-certified supervisors, including assistants and advisors, evidenced by their superior short-term outcomes.
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Affiliation(s)
- Yuki Kiyozumi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Nobuki Ichikawa
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigenori Homma
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Koji Ikeda
- Department of Colorectal Surgery, National Cancer Centre Hospital East, Kashiwa, Japan
| | - Ryo Inada
- Department of Gastroenterological Surgery, Kochi Health Sciences Centre, Kochi, Japan
| | - Koki Otsuka
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Akinobu Furutani
- Department of Gastroenterological Surgery, Hyogo Cancer Centre, Akashi, Japan
| | - Hiroaki Iijima
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | | | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Kuboki D, Kawahira H, Maeda Y, Oiwa K, Unoki T, Lefor AK, Sata N. An online feedback system for laparoscopic training during the COVID-19 pandemic: evaluation from the trainer perspective. Heliyon 2022; 8:e10303. [PMID: 35999836 PMCID: PMC9388291 DOI: 10.1016/j.heliyon.2022.e10303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/23/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022] Open
Abstract
Objective A system to provide feedback for laparoscopic training using an online conferencing system during the COVID-19 pandemic was developed. The purpose of this study is to evaluate this system from the trainer perspective. Design A procedural feedback system using an online conferencing system was devised. Setting Surgical training was observed using an online conferencing system (Zoom). Feedback was provided while viewing suture videos which are, as a feature of this system, pre-recorded. Feedback was then recorded. Trainer comments were then converted into text, summarized as feedback items, and sorted by suture phase which facilitates reflection. Trainers completed a questionnaire concerning the usability of the online feedback session. Results Eleven trainers were selected. Physicians had an average experience of 21.9 ± 5.9 years (mean ± standard deviation). The total number of feedback items obtained by classifying each phase was 32. Based on questionnaire results, 91% of trainers were accustomed to the use of Zoom, and 100% felt that online procedural education was useful. In questions regarding system effectiveness, more than 70% of trainers answered positively to all questions, and in questions about efficiency, more than 70% of trainers answered positively. Only 55% of the trainers felt that this system was easy to use, but 91% were satisfied as trainers. Conclusions The results of the questionnaire suggest that this system has high usability for training. This online system could be a useful tool for providing feedback in situations where face-to-face education is difficult.
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Affiliation(s)
- Daigo Kuboki
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, Japan.,Department of Surgery, Kitaibaraki City Hospital, 1050, Sekimotoshimo, Sekinami-cho, Kitaibaraki-shi, Ibaraki, Japan
| | - Hiroshi Kawahira
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, Japan.,Medical Simulation Center, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, Japan
| | - Yoshitaka Maeda
- Medical Simulation Center, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, Japan
| | - Kosuke Oiwa
- Department of Electrical Engineering and Electronics, Aoyama Gakuin University, 5-10-1, Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, Japan
| | - Teruhiko Unoki
- College of Foreign Studies, Kansai Gaidai University, 16-1, Nakamiyahigashino-cho, Hirakata-shi, Osaka, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, Japan
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, Japan
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Ichikawa N, Homma S, Hida K, Akagi T, Kamada Y, Yamaguchi T, Ito M, Ishida F, Watanabe J, Yamamoto D, Iijima H, Yamaguchi S, Inomata M, Sakai Y, Naitoh T, Taketomi A. Impact of Endoscopic Surgical Skill Qualification on Laparoscopic Resections for Rectal Cancer in Japan: The EnSSURE Study. ANNALS OF SURGERY OPEN 2022; 3:e160. [PMID: 37601611 PMCID: PMC10431478 DOI: 10.1097/as9.0000000000000160] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/04/2022] [Indexed: 12/15/2022] Open
Abstract
Objective This cohort study investigated short- and long-term postoperative outcomes of laparoscopic procedures for rectal cancer performed with versus without certified surgeons. Background In Japan, the Endoscopic Surgical Skill Qualification System (ESSQS) evaluates surgical skills deemed essential for laparoscopic surgery; however, it is unknown whether this certification contributes to procedural safety. Methods Outcomes of laparoscopic rectal resections for cStage II and III rectal cancer performed from 2014 to 2016 at 56 Japanese hospitals were retrospectively reviewed. The impact of having versus not having certified surgeons on postoperative complications and other short- and long-term outcomes were assessed. In cases with ESSQS-certified surgeons, surgeons attended surgery in the capacity of an operator, assistant, scope operator, or advisor. Results Overall, 3188 procedures were analyzed, with 2644 procedures performed with and 544 without ESSQS-certified surgeons. A multivariate logistic regression model showed that the adjusted odds ratio of postoperative complications after procedures performed with ESSQS-certified surgeons was 0.68 (95% confidence interval, 0.51-0.91; P = 0.009). The adjusted odds ratios for conversion and pathological R0 resection rates with ESSQS-certified surgeons were 0.20 (P < 0.001) and 2.10 (P = 0.04), respectively. Multiple linear regression analyses showed significantly shorter surgical duration and more harvested lymph nodes for operations performed with ESSQS-certified surgeons. Multivariate Cox regression showed that the adjusted hazard ratios for poor overall and recurrence-free survival after operations performed with ESSQS-certified surgeons were 0.88 (P = 0.35) and 1.04 (P = 0.71), respectively. Conclusions This study showed the superiority of the short-term postoperative results for laparoscopic rectal procedures performed with ESSQS-certified surgeons.
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Affiliation(s)
- Nobuki Ichikawa
- From the Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigenori Homma
- From the Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Koya Hida
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric Surgery, Oita University, Oita, Japan
| | - Yasuyuki Kamada
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Tomohiro Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Jun Watanabe
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Daisuke Yamamoto
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hiroaki Iijima
- From the Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University, Oita, Japan
| | - Yoshiharu Sakai
- Department of Gastroenterological Surgery, Japan Red Cross Osaka Hospital, Osaka, Japan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Akinobu Taketomi
- From the Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Saeki T, Otowa Y, Yamazaki Y, Arai K, Shimizu T, Mii Y, Kakinoki K, Oka S, Nakamura T, Kuroda D. Distance of Peritoneum to Inferior Mesenteric Artery Predicts the Operation Time During Laparoscopic Colectomy for Sigmoid or Rectosigmoid Colon Cancer. CANCER DIAGNOSIS & PROGNOSIS 2022; 2:240-246. [PMID: 35399172 PMCID: PMC8962805 DOI: 10.21873/cdp.10100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIM Obesity is a major technical limiting factor for laparoscopic surgery because abundant visceral fat is known to extend the operation time. However, special hardware is needed to assess it. We hypothesized that the depth from the peritoneum to the bifurcation of the inferior mesenteric artery (IMA) defined as 'peritoneum to IMA distance (PID)' might be a simple predictive factor for extended operation time during laparoscopic colectomy. PATIENTS AND METHODS One hundred twenty-four patients who were diagnosed with sigmoid or rectosigmoid colon cancer and underwent laparoscopic colectomy were included. The patients were divided into two groups based on the operation time (210 min). The vertical distance from the peritoneum to the bifurcation of the inferior mesenteric artery was defined as PID. The factors eliciting an operation time longer than 210 min were investigated. RESULTS There was significant difference in sex, BMI, cT, cN, and PID between the Early group (<210 min) and Late group (≥210 min). Less blood loss was observed in the Early group than in the Late group. Multivariate analysis showed that PID was the only independent factor that affected operation time (p<0.001). CONCLUSION PID predicts the operation time during laparoscopic colectomy for sigmoid or rectosigmoid colon cancer.
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Affiliation(s)
- Takafumi Saeki
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
| | - Yasunori Otowa
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
| | - Yuta Yamazaki
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
| | - Keisuke Arai
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
| | - Takashi Shimizu
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
| | - Yasuhiko Mii
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
| | | | - Shigeteru Oka
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
| | - Tetsu Nakamura
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
| | - Daisuke Kuroda
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
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Virtual Procedural Supervision During the COVID-19 Pandemic: A Novel Pilot for Supervising Invasive Bedside Procedures in the ICU. Mayo Clin Proc Innov Qual Outcomes 2021; 5:992-996. [PMID: 34568767 PMCID: PMC8452522 DOI: 10.1016/j.mayocpiqo.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The ability to perform invasive bedside procedures (IBPs) safely and efficiently is a core skill set within critical care medicine. Fellowship training provides a pivotal time for learners to attain baseline proficiency in such procedures to decrease patient complications. The coronavirus disease 2019 pandemic has posed distinct challenges to the traditional model of teaching and supervising IBPs in the intensive care unit, including stewardship of personal protective equipment and limiting health care worker exposure to persons with coronavirus disease 2019. To address these challenges, we piloted a novel method of IBP supervision and teaching using a virtual monitoring system. In this virtual procedural supervision model, the supervising teacher is located outside the patient room, limiting personal protective equipment use and health care worker exposure. An audiovisual monitoring system allowed communication between the teacher and the learner as well as supervisor visualization of the procedural encounter. Virtual supervision was used for central line placement and bronchoscopy in the medical intensive care unit with no complications or instances of the supervisor needing to enter the patient room. Success was felt to depend on camera positioning and preprocedure planning and to be best for advanced learners who would not require tactile feedback. Upper level learners appreciated autonomy granted by this process. Virtual IBP supervision is felt to be a useful tool in specific situations. As with any tool, there are notable strengths and limitations. Success is felt to be optimized when attention is paid to procedural teaching best practices, learner selection, and technological logistics.
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11
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Effect of endoscopic surgical skill qualification system for laparoscopic multivisceral resection: Japanese multicenter analysis. Surg Endosc 2021; 36:3068-3075. [PMID: 34142238 DOI: 10.1007/s00464-021-08605-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The efficacy of laparoscopic multivisceral resection (Lap-MVR) has been reported by several experienced high-volume centers. The Endoscopic Surgical Skill Qualification System (ESSQS) was established in Japan to improve the skill of laparoscopic surgeons and further develop surgical teams. We examined the safety and feasibility of Lap-MVR in general hospitals, and evaluated the effects of the Japanese ESSQS for this approach. METHODS We retrospectively reviewed 131 patients who underwent MVR between April 2016 and December 2019. Patients were divided into the laparoscopic surgery group (LAC group, n = 98) and the open surgery group (OPEN group, n = 33). The clinicopathological and surgical features were compared between the groups. RESULTS Compared with the OPEN group, BMI was significantly higher (21.9 vs 19.3 kg/m2, p = 0.012) and blood loss was lower (55 vs 380 ml, p < 0.001) in the LAC group. Operation time, postoperative complications, and postoperative hospital stay were similar between the groups. ESSQS-qualified surgeons tended to select the laparoscopic approach for MVR (p < 0.001). In the LAC group, ESSQS-qualified surgeons had superior results to those without ESSQS qualifications in terms of blood loss (63 vs 137 ml, p = 0.042) and higher R0 resection rate (0% vs 2.0%, p = 0.040), despite having more cases of locally advanced tumor. In addition, there were no conversions to open surgery among ESSQS-qualified surgeons, and three conversions among surgeons without ESSQS qualifications (0% vs 15.0%, p = 0.007). Multivariate analysis revealed blood loss (odds ratio 1.821; 95% CI 1.324-7.654; p = 0.010) as an independent predictor of postoperative complications. Laparoscopic approach was not a predictive factor. CONCLUSIONS The present multicenter study confirmed the feasibility and safety of Lap-MVR even in general hospitals, and revealed superior results for ESSQS-qualified surgeons.
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Does the Endoscopic Surgical Skill Qualification System improve patients' outcome following laparoscopic surgery for colon cancer? A multicentre, retrospective analysis with propensity score matching. World J Surg Oncol 2021; 19:53. [PMID: 33608034 PMCID: PMC7893747 DOI: 10.1186/s12957-021-02155-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/31/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND This study aimed to investigate the short-term and oncological impact of the Endoscopic Surgical Skill Qualification System (ESSQS) by the Japan Society for Endoscopic Surgery on the operator performing laparoscopic surgery for colon cancer. METHODS This retrospective cohort study was based on medical records from a multicentre database. A total of 417 patients diagnosed with stage II/III colon and rectosigmoid cancer treated with curative resection were divided into two groups according to whether they were operated on by qualified surgeons (Q group, n=352) or not (NQ group, n=65). Through strict propensity score matching, 98 cases (49 in each group) were assessed. RESULTS Operative time was significantly longer in the NQ group than in the Q group (199 vs. 168 min, p=0.029). The amount of blood loss, post-operative complications, and duration of hospitalisation were similar between both groups. No mortality was observed. One conversion case was seen in the NQ group. The 3-year recurrence-free survival rate was 86.6% in the NQ group and 88.2% in the Q group, which was not statistically significant (log-rank p=0.966). CONCLUSION Direct operation by ESSQS-qualified surgeons contributed to a shortened operation time. Under an organised educational environment, almost equivalent safety and oncological outcomes are expected regardless of the surgeon's qualifications.
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Amin-Tai H, Elnaim ALK, Wong MPK, Sagap I. Acquiring Advanced Laparoscopic Colectomy Skills - The Issues. Malays J Med Sci 2020; 27:24-35. [PMID: 33154699 PMCID: PMC7605826 DOI: 10.21315/mjms2020.27.5.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/14/2020] [Indexed: 10/28/2022] Open
Abstract
Colorectal surgery has been revolutionised towards minimally invasive surgery with the emergence of enhanced recovery protocol after surgery initiatives. However, laparoscopic colectomy has yet to be widely adopted, due mainly to the steep learning curve. We aim to review and discuss the methods of overcoming these learning curves by accelerating the competency level of the trainees without compromising patient safety. To provide this mini review, we assessed 70 articles in PubMed that were found through a search comprised the keywords laparoscopic colectomy, minimal invasive colectomy, learning curve and surgical education. We found England's Laparoscopic Colorectal National Training Programme (LAPCO-NTP) England to be by far the most structured programme established for colorectal surgeons, which involves pre-clinical and clinical phases that end with an assessment. For budding colorectal trainees, learning may be accelerated by simulator-based training to achieve laparoscopic dexterity coupled with an in-theatre proctorship by field experts. Task-specific checklists and video recordings are essential adjuncts to gauge progress and performance. As competency is established, careful case selections with the proctor are essential to maintain motivation and ensure safe performances. A structured programme to establish competency is vital to help both the proctor and trainee gauge real-time progress and performance. However, training systems both inside and outside the operating theatre (OT) are equally useful to achieve the desired performance.
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Affiliation(s)
- Hizami Amin-Tai
- Department of Surgery, Universiti Putra Malaysia, Kuala Lumpur, Malaysia
| | | | - Michael Pak Kai Wong
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ismail Sagap
- Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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14
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Kim W, Son J, Lee S, Seo JM. The learning curve for thoracoscopic repair of esophageal atresia with distal tracheoesophageal fistula: A cumulative sum analysis. J Pediatr Surg 2020; 55:2527-2530. [PMID: 32646663 DOI: 10.1016/j.jpedsurg.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/26/2020] [Accepted: 06/05/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA/TEF) remains technically challenging due to the rarity of these procedures. The aim of this study is to report our experience with thoracoscopic repair of type C EA/TEF and to evaluate the learning curve based upon the surgeon's skill level. METHODS We retrospectively reviewed data of thoracoscopic EA/TEF repair performed in our center between October 2008 and May 2019. The learning curve was evaluated using the cumulative sum (CUSUM) method based on operative time. RESULTS Of the 50 consecutive cases evaluated, the mean birth weight was 2634 ± 608 g and the median age at operation was 3 days (range, 1-29 days). The mean operation time was 144 ± 65 min. Anastomosis leakage occurred in 3 cases (6%) and strictures requiring balloon dilatations occurred in 16 cases (32%). The CUSUM analysis evaluated a learning curve of approximately 10 cases of thoracoscopic type C EA/TEF repair. A lower gestational age was associated with longer operation time. CONCLUSIONS Thoracoscopic repair of type C EA/TEF is a feasible and safe procedure. The number of procedures required to achieve a stable learning curve was 10. The learning phase may be shortened by adequate set-up under the supervision of an expert endoscopic surgeon. TYPE OF STUDY Retrospective Comparative Treatment Study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Wontae Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joonhyuk Son
- Department of Pediatric Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sanghoon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jeong-Meen Seo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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15
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Akagi T, Endo H, Inomata M, Yamamoto H, Mori T, Kojima K, Kuroyanagi H, Sakai Y, Nakajima K, Shiroshita H, Etoh T, Saida Y, Yamamoto S, Hasegawa H, Ueno H, Kakeji Y, Miyata H, Kitagawa Y, Watanabe M. Clinical impact of Endoscopic Surgical Skill Qualification System (ESSQS) by Japan Society for Endoscopic Surgery (JSES) for laparoscopic distal gastrectomy and low anterior resection based on the National Clinical Database (NCD) registry. Ann Gastroenterol Surg 2020; 4:721-734. [PMID: 33319163 PMCID: PMC7726689 DOI: 10.1002/ags3.12384] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 01/11/2023] Open
Abstract
AIM This study aimed to evaluate the association between surgeons certified via the Endoscopic Surgical Skill Qualification System (ESSQS) of the Japan Society for Endoscopic Surgery (JSES) and surgical outcomes of laparoscopic distal gastrectomy (LDG) and laparoscopic low anterior resection (LLAR). METHODS Japanese National Clinical Database data on the patients undergoing LDG and LLAR between 2014-2016 were analyzed retrospectively. The proportion of cases performed by ESSQS-certified surgeons was calculated for each procedure, and clinicopathological factors with or without participation of ESSQS-certified surgeons as an operator were assessed. Then, effects of operations performed by ESSQS-certified surgeons on short-term patient outcomes were analyzed using generalized estimating equations logistic regression analysis. RESULTS There were 110 610 and 65 717 patients who underwent LDG and LLAR, respectively. The operations performed by ESSQS-certified surgeons in each procedure totaled 28 467 (35.3%) and 12 866 (31.2%), respectively. A multivariable logistic regression model showed that odds ratios of mortality for LDG and LLAR performed by ESSQS-certified surgeons were 0.774 (95% CI, 0.566-1.060, P = 0.108) and 0.977 (0.591-1.301, P = 0.514), respectively. Odds ratios for secondary endpoints of anastomotic leakage in LDG and LLAR performed by ESSQS-certified surgeons were 0.835 (95% CI, 0.723-0.964, P = 0.014) and 0.929 (0.860-1.003, P = 0.059), respectively, whereas that of ileus/bowel obstruction for LLAR performed by ESSQS-certified surgeons was 1.265 (1.132-1.415, P < 0.001). There were no significant associations between the two operations performed by ESSQS-certified surgeons and other factors such as mortality and overall complications. CONCLUSIONS ESSQS certification did not affect postoperative mortality following LDG and LLAR, but annual experience of laparoscopic surgery was associated with it. ESSQS certification may contribute to favorable outcomes regarding anastomotic leakage following LDG and LLAR.
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Affiliation(s)
- Tomonori Akagi
- Gastroenterological and Pediatric SurgeryOita University of Faculty of MedicineYufuOitaJapan
| | - Hideki Endo
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Masafumi Inomata
- Gastroenterological and Pediatric SurgeryOita University of Faculty of MedicineYufuOitaJapan
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Toshiyuki Mori
- Department of SurgeryKyorin University School of MedicineTokyoJapan
| | - Kazuyuki Kojima
- First Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Hiroya Kuroyanagi
- Department of Gastroenterological SurgeryToranomon HospitalTokyoJapan
| | - Yoshiharu Sakai
- Department of SurgeryGraduate School of MedicineKyoto UniversityKyotoJapan
| | | | - Hidefumi Shiroshita
- Gastroenterological and Pediatric SurgeryOita University of Faculty of MedicineYufuOitaJapan
| | - Tsuyoshi Etoh
- Gastroenterological and Pediatric SurgeryOita University of Faculty of MedicineYufuOitaJapan
| | - Yoshihisa Saida
- Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
| | | | - Hirotoshi Hasegawa
- Department of SurgeryTokyo Dental College Ichikawa General HospitalChibaJapan
| | - Hideki Ueno
- Department of SurgeryNational Defense Medical CollegeSaitamaJapan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Hiroaki Miyata
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Yuko Kitagawa
- Department of SurgeryKeio University School of MedicineTokyoJapan
| | - Masahiko Watanabe
- Department of SurgeryKitasato University Kitasato Institute HospitalTokyoJapan
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Nakanishi R, Fukunaga Y, Mukai T, Nagasaki T, Yamaguchi T, Akiyoshi T, Konishi T, Nagayama S, Ueno M. Educational system for acquiring appropriate laparoscopic colorectal surgical skills: analysis in a Japanese high-volume cancer center. Surg Endosc 2020; 35:2660-2666. [PMID: 32556761 DOI: 10.1007/s00464-020-07686-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Acquiring appropriate laparoscopic technique is necessary to safely perform laparoscopic surgery. The Endoscopic Surgical Skill Qualification System of the Japanese Society of Endoscopic Surgery, which was established to improve the quality of laparoscopic surgery in Japan, provides training to become an expert laparoscopic surgeon. In this study, we describe our educational system, in a Japanese highest volume cancer center, and evaluate the system according to the pass rate for the Endoscopic Surgical Skill Qualification System examination. METHODS We assessed 14 residents who trained for more than 2 years from 2012 to 2018 in our department. All teaching surgeons, qualified by the Endoscopic Surgical Skill Qualification System, participated in all surgeries as supervisors. For the first 3 months, trainees learned as the scopist, then as the first assistant for 3 months, and then by performing laparoscopic surgery as an operator during ileocecal resection or sigmoidectomy. Trainees apply for this training in their second year of residency or later. All laparoscopic procedures in our department are standardized in detail. RESULTS The cumulative pass rate was 75% (12/16), and 87% (12/14) of the trainees eventually passed, while the general pass rate was approximately 30%. On average, those who passed in their second or third year had experienced 94 procedures as the surgeon, 177 as the first assistant, and 199 as the scopist. The number of laparoscopic procedures and the learning curves did not differ between successful and failed applicants. CONCLUSIONS Through our educational system, residents successfully acquired laparoscopic skills with a much higher pass rate in the Endoscopic Surgical Skill Qualification System examination than the general standard. Laparoscopic practice under supervision by experienced surgeons with standardized procedures and accurate understanding of the relevant anatomy is very helpful to achieving appropriate laparoscopic technique.
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Affiliation(s)
- Ryota Nakanishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Toshiki Mukai
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Toshiya Nagasaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tomohiro Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tsuyoshi Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Nagayama
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masashi Ueno
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Feasibility and Utility of an Eye-Tracking Device for Assessing Teachers of Invasive Bedside Procedures. Mayo Clin Proc Innov Qual Outcomes 2020; 4:339-344. [PMID: 32542224 PMCID: PMC7283964 DOI: 10.1016/j.mayocpiqo.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/21/2020] [Indexed: 01/22/2023] Open
Abstract
Patient-related complications from invasive bedside procedures (IBPs) are attributed to the experience and proficiency of the operator. Furthermore, IBP complications by trainees may be due to practice variability and competency among IBP teachers. The use of gaze metrics technology to better understand the behaviors of IBP teachers may aid in the creation of faculty development checklists and, ultimately, reduce procedural complications. Prior research on gaze patterns has focused on the individual performing the procedure, but the goal of this pilot study was to assess gaze behaviors of supervising teachers of IBPs, which is a paradigm shift within procedural education. In this study, pulmonary and critical care medicine fellows placed a central venous catheter on a simulated task trainer as pulmonary and critical care medicine faculty supervised while wearing an eye-tracking device. Both quantitative and qualitative data were obtained. Gaze analysis was divided into 2 areas of interest (ultrasonography and procedure site) and 3 procedural tasks (venous puncture, dilation, and flushing the line). Study findings included the following: (1) calibration was easy and took seconds to complete, (2) the device is relatively comfortable and did not interfere with tasks, (3) a trend toward a higher fixation frequency and dwell time on the ultrasound images during the puncture segment, and (4) variations in fixation frequency on the ultrasound images among supervising IBP teachers. This study documents the feasibility of the eye-tracking device for assessing behaviors of supervisory IBP teachers. There may be a signal suggesting differences in gaze patterns among supervisory teachers, which warrants further study.
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Gajewski J, Monzer N, Pittalis C, Bijlmakers L, Cheelo M, Kachimba J, Brugha R. Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia. HUMAN RESOURCES FOR HEALTH 2020; 18:25. [PMID: 32216789 PMCID: PMC7098155 DOI: 10.1186/s12960-020-00467-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/11/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Many countries in sub-Saharan Africa have adopted task shifting of surgical responsibilities to non-physician clinicians (NPCs) as a solution to address workforce shortages. There is resistance to delegating surgical procedures to NPCs due to concerns about their surgical skills and lack of supervision systems to ensure safety and quality of care provided. This study aimed to explore the effects of a new supervision model implemented in Zambia to improve the delivery of health services by surgical NPCs working at district hospitals. METHODS Twenty-eight semi-structured interviews were conducted with NPCs and medical doctors at nine district hospitals and with the surgical specialists who provided in-person and remote supervision over an average period of 15 months. Data were analysed using 'top-down' and 'bottom-up' thematic coding. RESULTS Interviewees reported an improvement in the surgical skills and confidence of NPCs, as well as better teamwork. At the facility level, supervision led to an increase in the volume and range of surgical procedures done and helped to reduce unnecessary surgical referrals. The supervision also improved communication links by facilitating the establishment of a remote consultation network, which enabled specialists to provide real-time support to district NPCs in how to undertake particular surgical procedures and expert guidance on referral decisions. Despite these benefits, shortages of operating theatre support staff, lack of equipment and unreliable power supply impeded maximum utilisation of supervision. CONCLUSION This supervision model demonstrated the additional role that specialist surgeons can play, bringing their expertise to rural populations, where such surgical competence would otherwise be unobtainable. Further research is needed to establish the cost-effectiveness of the supervision model; the opportunity costs from surgical specialists being away from referral hospitals, providing supervision in districts; and the steps needed for regular district surgical supervision to become part of sustainable national programmes.
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Affiliation(s)
- Jakub Gajewski
- Institute of Global Surgery, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Nasser Monzer
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Chiara Pittalis
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Leon Bijlmakers
- Radboud University Medical Centre Netherlands, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, Netherlands
| | - Mweene Cheelo
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, P.O. Box 50110, Lusaka, Zambia
| | - John Kachimba
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, P.O. Box 50110, Lusaka, Zambia
| | - Ruairi Brugha
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
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Ichikawa N, Homma S, Funakoshi T, Ohshima T, Hirose K, Yamada K, Nakamoto H, Kazui K, Yokota R, Honma T, Maeda Y, Yoshida T, Ishikawa T, Iijima H, Aiyama T, Taketomi A. Impact of technically qualified surgeons on laparoscopic colorectal resection outcomes: results of a propensity score-matching analysis. BJS Open 2020; 4:486-498. [PMID: 32207580 PMCID: PMC7260420 DOI: 10.1002/bjs5.50263] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/21/2019] [Indexed: 02/06/2023] Open
Abstract
Background The Endoscopic Surgical Skill Qualification System (ESSQS) was introduced in Japan to improve the quality of laparoscopic surgery. This cohort study investigated the short‐ and long‐term postoperative outcomes of colorectal cancer laparoscopic procedures performed by or with qualified surgeons compared with outcomes for unqualified surgeons. Methods All laparoscopic colorectal resections performed from 2010 to 2013 in 11 Japanese hospitals were reviewed retrospectively. The procedures were categorized as performed by surgeons with or without the ESSQS qualification and patients' clinical, pathological and surgical features were used to match subgroups using propensity scoring. Outcome measures included postoperative and long‐term results. Results Overall, 1428 procedures were analysed; 586 procedures were performed with ESSQS‐qualified surgeons and 842 were done by ESSQS‐unqualified surgeons. Upon matching, two cohorts of 426 patients were selected for comparison of short‐term results. A prevalence of rectal resection (50·3 versus 40·5 per cent; P < 0·001) and shorter duration of surgery (230 versus 238 min; P = 0·045) was reported for the ESSQS group. Intraoperative and postoperative complication and reoperation rates were significantly lower in the ESSQS group than in the non‐ESSQS group (1·2 versus 3·6 per cent, P = 0·014; 4·6 versus 7·5 per cent, P = 0·025; 1·9 versus 3·9 per cent, P = 0·023, respectively). These findings were confirmed after propensity score matching. Cox regression analysis found that non‐attendance of ESSQS‐qualified surgeons (hazard ratio 12·30, 95 per cent c.i. 1·28 to 119·10; P = 0·038) was independently associated with local recurrence in patients with stage II disease. Conclusion Laparoscopic colorectal procedures performed with ESSQS‐qualified surgeons showed improved postoperative results. Further studies are needed to investigate the impact of the qualification on long‐term oncological outcomes.
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Affiliation(s)
- N Ichikawa
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo
| | - S Homma
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo
| | - T Funakoshi
- Department of Surgery, Sapporo-Kosei General Hospital, Sapporo
| | - T Ohshima
- Department of Surgery, Sapporo City General Hospital, Sapporo
| | - K Hirose
- Department of Surgery, Tomakomai City Hospital, Tomakomai
| | - K Yamada
- Department of Surgery, Asahikawa-Kosei General Hospital, Asahikawa
| | - H Nakamoto
- Department of Surgery, KKR Sapporo Medical Centre, Sapporo
| | - K Kazui
- Department of Surgery, Hokkaido Hospital, Japan Community Healthcare Organization, Sapporo
| | - R Yokota
- Department of Surgery, Sunagawa City Medical Centre, Sunagawa
| | - T Honma
- Department of Surgery, Obihiro Kyokai Hospital, Obihiro
| | - Y Maeda
- Department of Gastroenterological Surgery, Hokkaido Cancer Centre, Sapporo
| | - T Yoshida
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo
| | - T Ishikawa
- Department of Surgery, Kushiro Rosai Hospital, Japan Labour Health and Welfare Organization, Kushiro
| | - H Iijima
- Clinical Research and Medical Innovation Centre, Hokkaido University Hospital, Sapporo
| | - T Aiyama
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo
| | - A Taketomi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo
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20
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Ohtsuka T, Nagakawa Y, Toyama H, Takeda Y, Maeda A, Kumamoto Y, Nakamura Y, Hashida K, Honda G, Fukuzawa K, Toyoda E, Tanabe M, Gotohda N, Matsumoto I, Ryu T, Uyama I, Kojima T, Unno M, Ichikawa D, Inoue Y, Matsukawa H, Sudo T, Takaori K, Yamaue H, Eguchi S, Tahara M, Shinzeki M, Eguchi H, Kurata M, Morimoto M, Hayashi H, Marubashi S, Inomata M, Kimura K, Amaya K, Sho M, Yoshida R, Murata A, Yoshitomi H, Hakamada K, Yasunaga M, Abe N, Hioki M, Tsuchiya M, Misawa T, Seyama Y, Noshiro H, Sakamoto E, Hasegawa K, Kawabata Y, Uchida Y, Kameyama S, Ko S, Takao T, Kitahara K, Nakahira S, Baba H, Watanabe M, Yamamoto M, Nakamura M. A multicenter prospective registration study on laparoscopic pancreatectomy in Japan: report on the assessment of 1,429 patients. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2019; 27:47-55. [PMID: 31665567 DOI: 10.1002/jhbp.695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Prospective studies are needed to understand the safety and feasibility of laparoscopic pancreatectomy. The aim of the present study was to describe laparoscopic pancreatectomy currently undertaken in Japan, using a prospective registration system. METHODS Patient characteristics and planned operations were registered preoperatively, and then the performed operation and outcomes were reported using an online system. Collected data were also compared between institutions based on their level of experience. This study was registered with UMIN000022836. RESULTS Available data were obtained from 1,429 patients at 100 Japanese institutions, including 1,197 laparoscopic distal pancreatectomies (LDPs) and 232 laparoscopic pancreatoduodenectomies (LPDs). The rates of completion for planned operations were 92% for LDP and 91% for LPD. Postoperative complication rates after LDP and LPD were 17% and 30%, and 90-day mortality rates were 0.3% and 0.4%, respectively. Shorter operation time, less blood loss, and lower incidence of pancreatic fistula were observed in institutions experienced in LDP. A higher rate of pure laparoscopic procedure and shorter operation time were noted in institutions experienced with LPD. CONCLUSION LDPs and LPDs are performed safely in Japan, especially in experienced institutions. Our data could support the next challenges in the field of laparoscopic pancreatectomy.
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Affiliation(s)
- Takao Ohtsuka
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hirochika Toyama
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yutaka Takeda
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Atsuyuki Maeda
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Yusuke Kumamoto
- Department of General, Pediatric and Hepato-Biliary-Pancreatic Surgery, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Yoshiharu Nakamura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Kazuki Hashida
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Goro Honda
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Eiji Toyoda
- Department of Surgery, Otsu Red Cross Hospital, Otsu, Shiga, Japan
| | - Minoru Tanabe
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoto Gotohda
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Ippei Matsumoto
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tomoki Ryu
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Toru Kojima
- Department of Surgery, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Daisuke Ichikawa
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Kofu, Yamanashi, Japan
| | - Yosuke Inoue
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroyoshi Matsukawa
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Takeshi Sudo
- Department of Surgery National Hospital Organization Kure Medical Center Chugoku Cancer Center, Kure, Hiroshima, Japan
| | - Kyoichi Takaori
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Munenori Tahara
- Department of Surgery, Hokkaido P.W.F.A.C Sapporo Kosei General Hospital, Sapporo, Hokkaido, Japan
| | - Makoto Shinzeki
- Department of Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Masanao Kurata
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Mamoru Morimoto
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | | | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Kenjiro Kimura
- Department of Surgical Oncology, Osaka City University School of Medicine, Osaka, Japan
| | - Koji Amaya
- Department of Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Ryuichi Yoshida
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Akihiro Murata
- Department of Hepatobiliary Pancreatic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hideyuki Yoshitomi
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Masafumi Yasunaga
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Nobutsugu Abe
- Department of Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Masayoshi Hioki
- Department of Gastroenterological Surgery, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
| | - Masaru Tsuchiya
- Division of General and Gastroenterological Surgery, Department of Surgery, Toho University School of Medicine, Omori, Tokyo, Japan
| | - Takeyuki Misawa
- Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Yasuji Seyama
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Hirokazu Noshiro
- Department of Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Eiji Sakamoto
- Department of Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Aichi, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasunari Kawabata
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yoichiro Uchida
- Department of Gastroenterological Surgery and Oncology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Shinichiro Kameyama
- Department of Surgery, Center for Gastroenterology, Urasoe General Hospital, Urasoe, Okinawa, Japan
| | - Saiho Ko
- Department of Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Takashi Takao
- Department of Surgery, Shin Koga Hospital, Kurume, Fukuoka, Japan
| | - Kenji Kitahara
- Department of Surgery, Saga Medical Center Koseikan, Saga, Japan
| | - Shin Nakahira
- Department of Surgery, Sakai City Medical Center, Sakai, Osaka, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masahiko Watanabe
- Kitasato University Kitasato Institutional Hospital, Sagamihara, Kanagawa, Japan.,Japan Society for Endoscopic Surgery, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.,Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Japanese Society for Endoscopic and Robotic Pancreatic Surgery, Tokyo, Japan
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Proficiency Level of Novice Technically Qualified Surgeons in Laparoscopic Rectal Resection. Surg Laparosc Endosc Percutan Tech 2019; 30:49-54. [DOI: 10.1097/sle.0000000000000740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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22
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Podda M, Pisanu A, Birindelli A, Gori A, Wheeler J, Di Saverio S. Response to: 'Back-handed, left-to-right' intracorporeal anastomosis technique during laparoscopic right hemicolectomy: a safe and reproducible approach by Zizzo M et al. Colorectal Dis 2019; 21:968-970. [PMID: 31161696 DOI: 10.1111/codi.14723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 05/01/2019] [Indexed: 02/08/2023]
Affiliation(s)
- M Podda
- Department of General, Emergency and Minimally Invasive Surgery, Cagliari University Hospital "Policlinico Universitario D. Casula", Cagliari, Italy
| | - A Pisanu
- Department of General, Emergency and Minimally Invasive Surgery, Cagliari University Hospital "Policlinico Universitario D. Casula", Cagliari, Italy
| | - A Birindelli
- Department of General and Emergency Surgery, Bologna University Hospital "Policlinico Universitario S. Orsola", Bologna, Italy
| | - A Gori
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Wheeler
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S Di Saverio
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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23
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Aoyama S, Inoue Y, Ohki T, Itabashi M, Yamamoto M. Usefulness of the endoscopic surgical skill qualification system in laparoscopic colorectal surgery: short-term outcomes: a single-center and retrospective analysis. BMC Surg 2019; 19:90. [PMID: 31296194 PMCID: PMC6625019 DOI: 10.1186/s12893-019-0528-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 06/04/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The use of laparoscopic surgery has become widespread, and many surgeons are striving to acquire the necessary techniques for it. The Endoscopic Surgical Skill Qualification System (ESSQS), established by the Japan Society for Endoscopic Surgery, serves to maintain and improve the quality of laparoscopic surgery in Japan. In this study, we aimed to determine whether ESSQS certification is useful in maintaining and improving the quality of surgical techniques and in standardization of laparoscopic surgery in Japan. METHODS This retrospective study used data from the Institute for Integrated Medical Sciences, Tokyo Women's Medical University, Japan. From January 2016 to October 2017, 241 patients with colorectal cancer underwent laparoscopic surgery. Of them, 220 patients were selected and divided into two groups on the basis of surgery performed by an ESSQS-qualified surgeon (QS group) (n = 170) and a non-ESSQS-QS (NQS) (n = 50). We compared the short-term results in the two groups and examined those before and after propensity score matching (PSM). RESULTS Mean operation time was longer in the NQS group than in the QS group. Furthermore, mean blood loss was significantly less in the QS group. These were similar before and after PSM. The rate of conversion to open surgery was significantly higher in the NQS group before PSM. However, the rate of postoperative complications was not different between the two groups. CONCLUSIONS A laparoscopic procedure performed by ESSQS-QS often leads to good short-term outcomes. Thus, the ESSQS system works and is potentially useful in maintaining and improving the quality of surgical techniques and in standardization of laparoscopic surgery in Japan.
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Affiliation(s)
- Shota Aoyama
- Department of Gastroenterological Surgery, Tokyo Women’s Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Yuji Inoue
- Department of Gastroenterological Surgery, Tokyo Women’s Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Takeshi Ohki
- Department of Gastroenterological Surgery, Tokyo Women’s Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Michio Itabashi
- Department of Gastroenterological Surgery, Tokyo Women’s Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Masakazu Yamamoto
- Department of Gastroenterological Surgery, Tokyo Women’s Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
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Miki H, Fukunaga Y, Nagasaki T, Akiyoshi T, Konishi T, Fujimoto Y, Nagayama S, Ueno M. Feasibility of needlescopic surgery for colorectal cancer: safety and learning curve for Japanese Endoscopic Surgical Skill Qualification System-unqualified young surgeons. Surg Endosc 2019; 34:752-757. [PMID: 31087171 DOI: 10.1007/s00464-019-06824-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 05/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Needlescopic surgery (NS) is a minimally invasive technique for colorectal cancer. NS may be easier to perform than other minimally invasive surgery such as single-incision laparoscopic surgery and natural orifice transluminal endoscopic surgery because the port setting is the same while the shafts are thinner than in conventional laparoscopic surgery. We evaluated the capability of introducing this surgery for sigmoid and rectosigmoid colon cancer by assessing the learning curve in Japanese Endoscopic Surgical Skill Qualification System (JESSQS)-unqualified surgeons. METHODS In this retrospective study, 112 cases of sigmoidectomy and anterior resection were performed by NS from October 2011 to December 2015 in our institution. Surgical outcomes including operation time, blood loss, postoperative hospital stay, perioperative complications, and overall survival were compared between JESSQS-qualified surgeons (Group A) and JESSQS-unqualified surgeons (Group B). The learning curve for NS was established using the average operation times in JESSQS-unqualified surgeons. RESULTS Groups A and B comprised of 41 and 71 patients, respectively. Ninety patients underwent sigmoidectomy and 22 patients underwent anterior resection. No conversion to open surgery occurred. The operation time was significantly shorter in Group A than B (P = 0.0080). There were no significant differences in blood loss, the postoperative hospital stay, perioperative complications, or overall survival between the two groups. These variables were similar even when NS was considered relatively difficult, as in patients with obesity (body mass index of ≥ 25 kg/m2), bulky tumors (tumor size of ≥ 50 mm), and stage III/IV cancer. The average operation time in JESSQS-unqualified young surgeons was significantly shorter in the ninth and tenth cases than in the first and second cases of NS (P = 0.0282). CONCLUSIONS NS for sigmoid and rectosigmoid colon cancer was performed safely by both JESSQS-qualified surgeons and JESSQS-unqualified surgeons. Even JESSQS-unqualified young surgeons might be able to quickly learn NS techniques.
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Affiliation(s)
- Hisanori Miki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, 135-8550, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, 135-8550, Japan.
| | - Toshiya Nagasaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, 135-8550, Japan
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, 135-8550, Japan
| | - Tsuyoshi Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, 135-8550, Japan
| | - Yoshiya Fujimoto
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Nagayama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, 135-8550, Japan
| | - Masashi Ueno
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, 135-8550, Japan
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25
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Fujii S, Akagi T, Inomata M, Katayama H, Mizusawa J, Ota M, Saito S, Kinugasa Y, Yamaguchi S, Sato T, Kitano S, The Japan Clinical Oncology Group. Transitional impact of short- and long-term outcomes of a randomized controlled trial to evaluate laparoscopic versus open surgery for colorectal cancer from Japan Clinical Oncology Group Study JCOG0404. Ann Gastroenterol Surg 2019; 3:301-309. [PMID: 31131359 PMCID: PMC6524094 DOI: 10.1002/ags3.12245] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/04/2019] [Accepted: 02/17/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The JCOG0404 randomized controlled trial conducted to compare laparoscopic surgery (LAP) with open surgery (OP) for stage II/III colon cancer showed better short-term outcomes and equal long-term outcomes of LAP versus OP. Technical instrumentation of surgery and anticancer agents given during the registration period might have affected the outcomes. AIM To evaluate outcomes according to the registration periods. METHODS The overall registration period was divided into three periods (first: 2004-2005, second: 2006-2007 and third: 2008-2009). Short-term and long-term outcomes were compared between registration periods. RESULTS In total, 1057 patients were registered. Numbers of patients undergoing each approach for each of the three periods (1st/2nd/3rd) were 528 for OP (106/244/178) and 529 for LAP (106/246/177). Operation time (minutes) did not change between the periods for OP (160/156/161) or LAP (205/211/219). Blood loss (mL) gradually decreased in the latter two periods: (119/80/75) for OP and (35/28/25) for LAP. Incidence of complications (%) decreased in the latter periods for OP (27.6/20.3/21.3), whereas that for LAP remained consistently low (14.3/14.8/13.6). There was no particular trend in 5-year overall survival and recurrence-free survival depending on the period regardless of treatment. D3 dissection rates were 95% or more for all periods in both groups. CONCLUSIONS Operation time and survival rates did not change over time, whereas blood loss in OP improved in the latter periods. Quality control applied in this trial might have been effective in producing such safe endpoints. (ClinicalTrials.gov, number NCT00147134, UMIN Clinical Trials Registry, number C000000105.).
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Affiliation(s)
- Shoichi Fujii
- Department of Gastroenterological SurgeryYokohama City University Medical CenterYokohamaJapan
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric SurgeryOita UniversityOitaJapan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric SurgeryOita UniversityOitaJapan
| | - Hiroshi Katayama
- Japan Clinical Oncology Group Data Center/Operations OfficeNational Cancer CenterTokyoJapan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations OfficeNational Cancer CenterTokyoJapan
| | - Mitsuyoshi Ota
- Department of Gastroenterological SurgeryYokohama City University Medical CenterYokohamaJapan
| | - Shuji Saito
- Division of Colon and Rectal SurgeryShizuoka Cancer CenterShizuokaJapan
| | - Yusuke Kinugasa
- Division of Colon and Rectal SurgeryShizuoka Cancer CenterShizuokaJapan
| | - Shigeki Yamaguchi
- Division of Colon and Rectal SurgeryShizuoka Cancer CenterShizuokaJapan
| | - Takeo Sato
- Department of SurgeryKitasato University HospitalSagamiharaJapan
| | - Seigo Kitano
- Department of Gastroenterological and Pediatric SurgeryOita UniversityOitaJapan
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Wang Y, Zhang Y, Wang H, Wang T, Xia S, Chen W, Li B. Learning Curve Analysis of Open Kasai Portoenterostomy for Biliary Atresia. J Surg Res 2019; 239:38-43. [PMID: 30798170 DOI: 10.1016/j.jss.2019.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/10/2018] [Accepted: 01/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Open Kasai portoenterostomy (KPE) remains the mainstay of treatment for biliary atresia (BA) even in the era of minimally invasive surgery and is generally considered to be technically challenging. This study describes the learning curve (LC) of open KPE and its effect on outcomes. MATERIALS AND METHODS In our center, the caseload of BA was relatively low with average annual caseload below five in the past, and open KPE was started in the early 2000s. This study retrospectively enrolled the first 35 consecutive children undergoing open KPE for BA by the same surgeon in our center between June 2003 and April 2014. The LC was evaluated using the cumulative sum (CUSUM) method for operative time (OT). RESULTS The CUSUM LC of OT, which peaked at the 23rd case, was best modeled as a second-order polynomial with equation CUSUM (min) = -0.8851 × case number2 + 33.54 × case number -45.978 (R2 = 0.7287). The LC consisted of two distinct phases: phase 1 (the initial 23 cases), representing the initial learning phase and phase 2 (the remaining 12 cases), representing acquisition of technical competency. Preoperative parameters were comparable between the two phases (each P > 0.05). Of note, OT and estimated blood loss significantly decreased in phase 2 compared with phase 1 (P < 0.001; P < 0.001, respectively). Furthermore, the rates of early jaundice clearance and 2-y native liver survival significantly increased in phase 2 (P = 0.032; P = 0.034, respectively). CONCLUSIONS The two phases identified by CUSUM analysis of OT represents characteristic stages of LC for open KPE of the surgeon in our center. It is possible for surgeons to achieve competency of this demanding technique in centers with relatively low caseload of BA and late start of KPE.
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Affiliation(s)
- Yujiao Wang
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, Jiang Su, China.
| | - Yuanyuan Zhang
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, Jiang Su, China
| | - Hui Wang
- Department of Public Health, Huai'an Women and Children's Hospital, Huai'an, Jiang Su, China
| | - Ting Wang
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, Jiang Su, China
| | - Shunlin Xia
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, Jiang Su, China
| | - Weibing Chen
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, Jiang Su, China
| | - Bing Li
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, Jiang Su, China.
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Ohtsuka T, Ban D, Nakamura Y, Nagakawa Y, Tanabe M, Gotoh Y, Velasquez VVDM, Nakata K, Sahara Y, Takaori K, Honda G, Misawa T, Kawai M, Yamaue H, Morikawa T, Kuroki T, Mou Y, Lee WJ, Shrikhande SV, Tang CN, Conrad C, Han HS, Palanivelu C, Asbun HJ, Kooby DA, Wakabayashi G, Takada T, Yamamoto M, Nakamura M. Difficulty scoring system in laparoscopic distal pancreatectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2018; 25:489-497. [PMID: 30118575 DOI: 10.1002/jhbp.578] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several factors affect the level of difficulty of laparoscopic distal pancreatectomy (LDP). The purpose of this study was to develop a difficulty scoring (DS) system to quantify the degree of difficulty in LDP. METHODS We collected clinical data for 80 patients who underwent LDP. A 10-level difficulty index was developed and subcategorized into a three-level difficulty index; 1-3 as low, 4-6 as intermediate, and 7-10 as high index. The automatic linear modeling (LINEAR) statistical tool was used to identify factors that significantly increase level of difficulty in LDP. RESULTS The operator's 10-level DS concordance between the 10-level DS by the reviewers, LINEAR index DS, and clinical index DS systems were analyzed, and the weighted Cohen's kappa statistic were at 0.869, 0.729, and 0.648, respectively, showing good to excellent inter-rater agreement. We identified five factors significantly affecting level of difficulty in LDP; type of operation, resection line, proximity of tumor to major vessel, tumor extension to peripancreatic tissue, and left-sided portal hypertension/splenomegaly. CONCLUSIONS This novel DS for LDP adequately quantified the degree of difficulty, and can be useful for selecting patients for LDP, in conjunction with fitness for surgery and prognosis.
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Affiliation(s)
- Takao Ohtsuka
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Ban
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiharu Nakamura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Minoru Tanabe
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshitaka Gotoh
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Kohei Nakata
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yatsuka Sahara
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kyoichi Takaori
- Division of Hepatobiliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Goro Honda
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Takeyuki Misawa
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Manabu Kawai
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | | | - Tamotsu Kuroki
- Department of Surgery, National Hospital Nagasaki Medical Center, Nagasaki, Japan
| | - Yiping Mou
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Woo-Jung Lee
- Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Shailesh V Shrikhande
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Chung Ngai Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Claudius Conrad
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ho-Seong Han
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Chinnusamy Palanivelu
- Division of Gastrointestinal Surgery and Minimal Access Surgery, GEM Hospital and Research Centre, Coimbatore, India
| | | | - David A Kooby
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Go Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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