Laparoscopic cholecystectomy : first, do no harm ; second take care of bile duct stones

Editorial. The introduction of laparoscopic cholecystectomy (LC) in the USA in 1989 marked the beginning of what has become know as the ‘‘laparoscopic revolution’’ [1–4]. It was quickly adopted among surgeons in private practice. The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) was the first organization to take the lead in ensuring patient safety by insisting on quality training through certified training courses, establishing guidelines, and introducing credentialing criteria for laparoscopic surgery. More than two decades later, it is time for SAGES to assume a leadership role in addressing two major and troublesome issues that remain in laparoscopic biliary surgery relating to patient safety and high-quality outcomes

General Surgery Residency Inadequately Prepares Trainees for Fellowship

To assess readiness of general surgery graduate trainees entering accredited surgical subspecialty fellowships in North America.A multidomain, global assessment survey designed by the Fellowship Council research committee was electronically sent to all subspecialty program directors. Respondents spanned minimally invasive surgery, bariatric, colorectal, hepatobiliary, and thoracic specialties. There were 46 quantitative questions distributed across 5 domains and 1 or more reflective qualitative questions/domains.There was a 63% response rate (n = 91/145). Of respondent program directors, 21% felt that new fellows arrived unprepared for the operating room, 38% demonstrated lack of patient ownership, 30% could not independently perform a laparoscopic cholecystectomy, and 66% were deemed unable to operate for 30 unsupervised minutes of a major procedure. With regard to laparoscopic skills, 30% could not atraumatically manipulate tissue, 26% could not recognize anatomical planes, and 56% could not suture. Furthermore, 28% of fellows were not familiar with therapeutic options and 24% were unable to recognize early signs of complications. Finally, it was felt that the majority of new fellows were unable to conceive, design, and conduct research/academic projects. Thematic clustering of qualitative data revealed deficits in domains of operative autonomy, progressive responsibility, longitudinal follow-up, and scholarly focus after general surgery education

Neoadjuvant gemcitabine and nab-paclitaxel followed by concurrent capecitabine and radiation efficacy in borderline resectable (BR) pancreatic cancer

Published abstract from the 2016 ASCO Annual Meeting