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Humm GL, Peckham-Cooper A, Chang J, Fernandes R, Gomez NF, Mohan H, Nally D, Thaventhiran AJ, Zakeri R, Gupte A, Crosbie J, Wood C, Dawas K, Stoyanov D, Lovat LB. Surgical experience and identification of errors in laparoscopic cholecystectomy. Br J Surg 2023; 110:1535-1542. [PMID: 37611141 PMCID: PMC10564403 DOI: 10.1093/bjs/znad256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/29/2023] [Accepted: 07/25/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Surgical errors are acts or omissions resulting in negative consequences and/or increased operating time. This study describes surgeon-reported errors in laparoscopic cholecystectomy. METHODS Intraoperative videos were uploaded and annotated on Touch SurgeryTM Enterprise. Participants evaluated videos for severity using a 10-point intraoperative cholecystitis grading score, and errors using Observational Clinical Human Reliability Assessment, which includes skill, consequence, and mechanism classifications. RESULTS Nine videos were assessed by 8 participants (3 junior (specialist trainee (ST) 3-5), 2 senior trainees (ST6-8), and 3 consultants). Participants identified 550 errors. Positive relationships were seen between total operating time and error count (r2 = 0.284, P < 0.001), intraoperative grade score and error count (r2 = 0.578, P = 0.001), and intraoperative grade score and total operating time (r2 = 0.157, P < 0.001). Error counts differed significantly across intraoperative phases (H(6) = 47.06, P < 0.001), most frequently at dissection of the hepatocystic triangle (total 282; median 33.5 (i.q.r. 23.5-47.8, range 15-63)), ligation/division of cystic structures (total 124; median 13.5 (i.q.r. 12-19.3, range 10-26)), and gallbladder dissection (total 117; median 14.5 (i.q.r. 10.3-18.8, range 6-26)). There were no significant differences in error counts between juniors, seniors, and consultants (H(2) = 0.03, P = 0.987). Errors were classified differently. For dissection of the hepatocystic triangle, thermal injuries (50 in total) were frequently classified as executional, consequential errors; trainees classified thermal injuries as step done with excessive force, speed, depth, distance, time or rotation (29 out of 50), whereas consultants classified them as incorrect orientation (6 out of 50). For ligation/division of cystic structures, inappropriate clipping (60 errors in total), procedural errors were reported by junior trainees (6 out of 60), but not consultants. For gallbladder dissection, inappropriate dissection (20 errors in total) was reported in incorrect planes by consultants and seniors (6 out of 20), but not by juniors. Poor economy of movement (11 errors in total) was reported more by consultants (8 out of 11) than trainees (3 out of 11). CONCLUSION This study suggests that surgical experience influences error interpretation, but the benefits for surgical training are currently unclear.
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Affiliation(s)
- Gemma L Humm
- Wellcome/Engineering and Physical Sciences Research Council Centre for Interventional and Surgical Sciences, University College London, London, UK
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Adam Peckham-Cooper
- Leeds Institute of Emergency General Surgery, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Jessica Chang
- Department of General Surgery, Shrewsbury and Telford Hospital NHS Trust, Royal Shrewsbury Hospital, Shrewsbury, UK
| | - Roland Fernandes
- Department of General Surgery, East Kent Hospitals University Foundation Trust, William Harvey Hospital, Ashford, UK
| | - Naim Fakih Gomez
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Helen Mohan
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Deirdre Nally
- Department of General Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Roxanna Zakeri
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Anaya Gupte
- Department of General Surgery, University College London Hospital NHS Foundation Trust, University College Hospital, London, UK
| | - James Crosbie
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Christopher Wood
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Khaled Dawas
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Danail Stoyanov
- Wellcome/Engineering and Physical Sciences Research Council Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Laurence B Lovat
- Wellcome/Engineering and Physical Sciences Research Council Centre for Interventional and Surgical Sciences, University College London, London, UK
- UCL Division of Surgery and Interventional Science, University College London, London, UK
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DeBenedittis P, Karpurapu A, Henry A, Thomas MC, McCord TJ, Brezitski K, Prasad A, Baker CE, Kobayashi Y, Shah SH, Kontos CD, Tata PR, Lumbers RT, Karra R. Coupled myovascular expansion directs cardiac growth and regeneration. Development 2022; 149:dev200654. [PMID: 36134690 PMCID: PMC10692274 DOI: 10.1242/dev.200654] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/15/2022] [Indexed: 12/04/2023]
Abstract
Heart regeneration requires multiple cell types to enable cardiomyocyte (CM) proliferation. How these cells interact to create growth niches is unclear. Here, we profile proliferation kinetics of cardiac endothelial cells (CECs) and CMs in the neonatal mouse heart and find that they are spatiotemporally coupled. We show that coupled myovascular expansion during cardiac growth or regeneration is dependent upon VEGF-VEGFR2 signaling, as genetic deletion of Vegfr2 from CECs or inhibition of VEGFA abrogates both CEC and CM proliferation. Repair of cryoinjury displays poor spatial coupling of CEC and CM proliferation. Boosting CEC density after cryoinjury with virus encoding Vegfa enhances regeneration. Using Mendelian randomization, we demonstrate that circulating VEGFA levels are positively linked with human myocardial mass, suggesting that Vegfa can stimulate human cardiac growth. Our work demonstrates the importance of coupled CEC and CM expansion and reveals a myovascular niche that may be therapeutically targeted for heart regeneration.
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Affiliation(s)
- Paige DeBenedittis
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Anish Karpurapu
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Albert Henry
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
- Institute of Health Informatics, University College London, London WC1E 6BT, UK
| | - Michael C. Thomas
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Timothy J. McCord
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Kyla Brezitski
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Anil Prasad
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Caroline E. Baker
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | | | - Svati H. Shah
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Christopher D. Kontos
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
- Department of Pharmacology & Cancer Biology, Duke University, Durham, NC 27710, USA
| | - Purushothama Rao Tata
- Department of Cell Biology, Duke University, Durham, NC 27710, USA
- Regeneration Next, Duke University, Durham, NC 27710, USA
- Center for Aging, Duke University Medical Center, Durham, NC 27710, USA
| | - R. Thomas Lumbers
- Institute of Health Informatics, University College London, London WC1E 6BT, UK
- Health Data Research UK London, University College London, London, WC1E 6BT, UK
- British Heart Foundation Research Accelerator, University College London, London WC1E 6BT, UK
| | - Ravi Karra
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
- Regeneration Next, Duke University, Durham, NC 27710, USA
- Center for Aging, Duke University Medical Center, Durham, NC 27710, USA
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
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