Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Endoscopic Cervical Lymph Node Dissection Using the Extra-cervical Anterior Chest Wall Approach: A New Technique

Introduction This study aims to demonstrate the safety, surgical feasibility, and esthetic features of total endoscopic neck dissection (END) through anterior chest wall approach (ACWA) without creation of any neck incisions. Resection of their primary tumors followed by selective total END through ACWA using 3 ports (one 10-mm port for the camera and two 5-mm ports for the working instruments). Methods From January 2020 to August 2020, 6 patients with a biopsy proven head and neck carcinoma underwent resection of their primary tumors followed by selective total END through ACWA using 3 ports (one 10-mm port for the camera and two 5-mm ports for the working instruments). Results The selective neck dissection was successfully performed endoscopically in all cases with no conversion to open approach and with good visualization of the major neurovascular structures. The operative time for the END ranged from 120 to 170 minutes, with 10–50 mL estimated blood loss. No significant perioperative complications were encountered. The mean total number of cervical LN retrieved was 13.67 + 2.42, and the mean LNR was .01 + .13. All patients were discharged in the third postoperative day, and they were satisfied with the cosmetic outcome. Conclusion Selective total END through ACWA is technically feasible and safe with satisfactory cosmetic results. The absence of neck scars and magnification of the important neurovascular structures are the most obvious advantages of this innovative technique. It may be a valid alternative to conventional surgery when performed in selected patients. However, further research with longer follow up is needed to clarify the oncological safety and the real benefits of END in head and neck cancer patients. </jats:sec

Laparoscopic Partial Gastrectomy for Large Gastric GISTs

Abstract Background: Gastrointestinal stromal tumors (GISTs) are considered the most common mesenchymal tumors in the gastrointestinal tract and the stomach is the most frequently site affected (50–60%). The safety and feasibility of laparoscopic surgery for gastric GISTs of sizes larger than 5 cm remains unclear. It depends on the surgical skills, tumor location and the learning curve of the surgeons. Methods: Between December 2013 and January 2021, thirty patients diagnosed with gastric GISTs underwent laparoscopic partial gastrectomy. This is a retrospective study done in surgical oncology unit, Oncology Center, Mansoura University, Egypt. Results: The most common tumor location was in the greater curvature in (46.7%). The mean tumor size was 7.2 cm (the largest was 13 cm). All of the patients underwent laparoscopic partial gastrectomy. Splenectomy was done for one patient only. The mean operative time was 152.67 minutes and the estimated blood loss (EBL) was 139.33 ml. The mean hospital stay was 3.53 days. The mean follows up period was 32.4 months. Conclusion: Laparoscopic resection for gastric GISTs has become a feasible method. Patients with large tumors have the same favorable outcomes as small tumors. Large-sized GISTs may receive neoadjuvant therapy to downstage the disease and make it amenable for laparoscopic resection.</jats:p

Scalpel Morcellation During Laparoscopic Hysterectomy for Large Uterine Fibroids. Is It a Safe Alternative to Power-Morcellation?

Abstract Background Laparoscopic hysterectomy has many surgical advantages. Specimen retrieval options after a laparoscopic hysterectomy include laparotomy or “mini-laparotomy,” vaginal delivery, and removal through a laparoscopic port using intracorporeal power morcellation. Patients and Methods Fifty-two lady patients underwent (manual) scalpel morcellation of the uterus through the anterior abdominal wall after laparoscopic hysterectomy for large uterine fibroids, to facilitate specimen delivery through the vagina without employing any abdominal incisions; this study was done in the Department of Surgical Oncology, Oncology Center, Mansoura University, Egypt. Results The mean operative time was 140 min; the mean scalping time was 17.21 min. The estimated blood loss was 105.29 ml. Extensive intraoperative adhesions were noted in 67.3% of the patients. The postoperative uterine weight had a median of 450 g (range 320–740 g). The median uterine length was 14 cm (range 9–23 cm), while its width was 9 cm (range 6–18 cm). Leiomyoma was the common postoperative pathology in most of the cases (96.15%) with a median size of 8 cm (range 5–12 cm). Conclusion Scalpel morcellation of large uterine leiomyomas after laparoscopic hysterectomy is a safe and cheap method. Its merits include no intraperitoneal dissemination, spillage, and intact specimens’ delivery for proper postoperative pathological examination. </jats:sec

Abdominal Wall Reconstruction Using Omental Flap with Mesh Repair following Resection of Aggressive Abdominal Wall Neoplasms

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Resection of large anterior abdominal wall tumors causes large full-thickness abdominal wall defects, and the repair of these defects remains a challenging point. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Between July 2016 and February 2021, we retrospectively reviewed the internal database registry of the Oncology Center, Mansoura University (OCMU), Egypt, for patients with large abdominal wall defects after abdominal wall tumors resection and repair with omental flaps and synthetic polypropylene (PP) mesh. Thirty-two patients met the inclusion criteria. They were analyzed for demographics and operative data including defect size, mesh size, intra-abdominal tumor extension, and postoperative outcomes and complications. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Thirty-Two patients with abdominal wall neoplasm underwent local resection in our center and the defect was closed with an omental flap and PP mesh. The mean operative time was 143.75 ± 30.77 min. The mean size of the abdominal wall defect was 50.8 cm&lt;sup&gt;2&lt;/sup&gt; (range: 25–90 cm&lt;sup&gt;2&lt;/sup&gt;). The meshes used in reconstruction had a mean size of 89.5 cm&lt;sup&gt;2&lt;/sup&gt; (range: 55–130 cm&lt;sup&gt;2&lt;/sup&gt;). The median follow-up period of the patients was 13.5 months (range: 5–54 months). Postoperative complications included infection (&lt;i&gt;n&lt;/i&gt; = 4 cases), seroma (&lt;i&gt;n&lt;/i&gt; = 2 cases), hematoma (&lt;i&gt;n&lt;/i&gt; = 1 case), and abnormal sensation (&lt;i&gt;n&lt;/i&gt; = 5 cases). Tumor recurrence was reported in 2 cases, and no cases developed incisional hernia during the follow-up period. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Immediate use of omental flap with synthetic PP mesh for reconstruction of abdominal wall defects is a feasible technique and has avoided the complications associated with the use of synthetic mesh alone. </jats:p