Surgical Management of Ovarian Cancer

Advanced ovarian cancer remains a disease with a poor prognosis. Surgical therapy remains the cornerstone of treatment with essential contribution from chemotherapy. The combination therapy continues to offer the best treatment strategy. Complete cytoreductive surgery is still the most important prognostic marker. The role of primary debulking surgery in advanced ovarian cancer remains under investigation through high quality rigorous clinical trials. The current evidence regarding primary versus interval debulking surgery has drawn much criticism regarding patient recruitment and quality of surgery, both of which are key pillars in achieving complete cytoreduction. It is expected that greater centralisation and development of ‘ovarian cancer surgery teams’ will further enhance clinical outcomes

Interesting case of ovarian sarcoidosis: The value of multi disciplinary team working

BACKGROUND: Sarcoidosis of the genital tract is a rare condition. Ovarian manifestation of this disease is rarer still. CASE PRESENTATION: The case presented here represents ovarian manifestation of sarcoidosis. At the point of referral to our hospital, based on computerised tomography (CT) ovarian carcinoma was a differential diagnosis. Further magnetic resonance imaging along with CT guided biopsy aided by laboratory study supported a diagnosis of sarcoidosis. Patient responded to medical management by a multidisciplinary team. CONCLUSION: The case shows the importance of FNAC and biopsy in case or ovarian masses and multi disciplinary team approach to management

Subspecialty training in Europe:a report by the European Network of Young Gynaecological Oncologists

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Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Obstetrics and gynaecology trainees' perceptions of the CanMEDS expertise model: implications for training from a regional questionnaire study in the United Kingdom

The CanMEDS expertise model is a multi-domain competency framework for doctors. The aims of this study were to assess the perceived importance of the CanMEDS roles and achievement among obstetrics and gynaecology trainees of all grades with a view to identifying opportunities to enhance training. This study was exempt from formal ethical or institutional registration. The data collection was completed in 2017. Following a video introduction, the trainees completed a questionnaire. For each of the CanMEDS domains, trainees of different tiers perceived them to be equally important. Indeed, the junior and senior cohorts of trainees perceived all domains to be equally important, as signified by the significant degree of score correlation. Age was a significant variable for achievement of competency in the roles of a Medical Expert (p = .01), a Communicator (p = .04), a Collaborator (p = .002), a Scholar (p = .01) and a Professional (p = .03). Grade was significant for the Medical Expert (p = .001) and Leader (p = .001) role. Better alignment of clinical activities with CanMEDS competencies and faculty development will complement the training in leadership skills. Impact statement What is already known on this subject? The CanMEDS medical expertise model is a multi-domain framework of seven components. This framework has been utilised to assess the training efficacy of curricula and unlock opportunities for improvement. The research application of the CanMEDS framework within Obstetrics and Gynaecology is limited. What does this study add? Results indicate that all trainees recognise the importance of CanMEDS roles: age and grade are significant variables in the perceived achievement of CanMEDS roles. The study identifies areas for improvement in the current training strategy. What are the implications for clinical practice/future research? Research should formalise the assessment of competencies in non-technical skills. Efforts should focus on identifying the activities which will develop leadership skills

Mental practice for laparoscopic salpingectomy

Mental practice (MP) is a method of enhancing surgical training by rehearsal of a task without physical action. The primary objective of the study was to develop and validate a MP tool for laparoscopic salpingectomy (LS). An imagery script for LS was developed and used to facilitate a structured MP session for trainees in Obstetrics and Gynaecology and expert gynaecologists across three teaching hospitals in the UK. A virtual platform was used for one trainee group to assess its feasibility compared to a face-to-face approach. Pre- and post-session assessments were conducted to evaluate the impact of the script on motivation, confidence, preparedness and quality of imagery and demonstrated a significant improvement in global imagery scores for both novice groups. The expert group scored significantly higher than the face-to-face novice group on all items both before and after MP, indicating construct validity. There were no significant differences demonstrated between the two novice groups, thus demonstrating the virtual platform to be a non-inferior approach – an important consideration in the current COVID era

Effect of blue dye guided lymph channel ligation on the surgical morbidity of groin lymphadenectomy for vulval cancer: a feasibility study

Inguinal lymphadenectomy has significant morbidity. Blue dye-guided lymph channel ligation is an effective technique for resolving lymphocele. This was a feasibility study in a preventative setting. Patients with vulval cancer requiring bilateral inguinal lymphadenectomy were recruited. After lymphadenectomy, patent blue V dye was injected and the severed lymph channels leaking blue dye, on the randomly-designated side were ligated. The median age was 72.5 years and the median body mass index was 25. The median lymph node harvest was 18.5. There were no significant surgical procedural differences between the right and the left sides. There was no significant difference between the two arms in terms of the duration or the volume of drainage and post-operative complications. All patients were alive at the follow-up period of 40.5 months. In this feasibility study, blue dye-guided lymph channel ligation did not significantly impact on post-operative outcomes.Impact statement What is already known on this subject? Lymph channel ligation with blue dye-guidance is an effective strategy for managing recalcitrant inguinal lymphocyst. This strategy was prospectively-studied in a small series of patients with non-gynaecological cancers. This particular study by Nakamura et al. () revealed that such a strategy might be efficacious in reducing wound drain output. What do the results of this study add? Our study is the first study to assess this technique exclusively in vulval cancer. Blue dye-guided lymph channel ligation at the time of inguinal lymphadenectomy does not appear to reduce wound drainage. However, this study suggests that primary lymphocyst predominantly results from inflammatory exudates, whereas persistent secondary lymphocysts are likely to result from lymphorrhoea. What are the implications of these findings for clinical practice and/or further research? Future studies, which aim to reduce the morbidity of open inguinal lymphadenectomy, should employ a composite strategy to reduce inflammatory secretions. In addition, a biochemical and cytological analysis on lymphocysts at various time points should be performed to characterise the natural history of groin lymphocysts

An immersive "simulation week" enhances clinical performance of incoming surgical interns improved performance persists at 6 months follow-up

BACKGROUND: The transition from student to intern can be challenging. The "August" or "July effect" describes increased errors and reduced patient safety during this transition. The study objectives were to develop, pilot, and evaluate clinical performance after an immersive simulation course for incoming interns. METHODS: Graduating students were recruited for a 1-week immersive simulation course. Controls received no simulation training. Primary outcome (at baseline, and 1 and 6 months) was clinical performance on Objective Structured Clinical Examinations (OSCE) of clinical procedures and surgical technical skills. Secondary outcomes were self-reported confidence and clinical procedure logbook data. RESULTS: Nineteen students were recruited. Sixteen completed the 6-month follow-up, 10 in the intervention group and 6 in the control group. No differences were demonstrated between interventions and controls at baseline (OSCE [median, 66 vs. 78; P = .181], technical skills [48 vs. 52.5; P = .381], and confidence [101 vs 96; P = .368]). Interventions outperformed controls at 1 month (OSCE [111 vs 82; P = .001], technical skills [78.5 vs 63; P = .030], and confidence [142 vs. 119; P < .001]), and 6 months (OSCE [107 vs. 93; P = .007], technical skills [92.5 vs. 69; P = .044], and confidence [148 vs. 129; P = .022]). No differences were observed in numbers of clinical procedures performed at 1 (P = .958), 4 (P = .093), or 6 months (P = .713). CONCLUSION: The immersive simulation course objectively improved subjects' clinical skills, technical skills, and confidence. Despite similar clinical experience as controls, the intervention group's improved performance persisted at 6 months follow-up. This feasible and effective intervention to ease transition from student to intern could reduce errors and enhance patient safety