The impact of EAES Fellowship Programme:a five-year review and evaluation

Background: The European Association of Endoscopic Surgery (EAES) fellowship programme was established in 2014, allowing nine surgeons annually to obtain experience and skills in minimally invasive surgery (MIS) from specialist centres across the Europe and United States. It aligns with the strategic focus of EAES Education and Training Committee on enabling Learning Mobility opportunities. To assess the impact of the programme, a survey was conducted aiming to evaluate the experience and impact of the programme and receive feedback for improvements.Methods: A survey using a 5-point Likert scale was used to evaluate clinical, education and research experience. The impact on acquisition of new technical skills, change in clinical practice and ongoing collaboration with the host institute was assessed. The fellows selected between 2014 and 2018 were included. Ratings were analysed in percentage; thematic analysis was applied to the free-text feedbacks using qualitative analysis.Results: All the fellows had good access to observing in operating theatres and 70.6% were able to assist. 91.2% participated in educational activities and 23.5% were able to contribute through teaching. 44.1% participated in research activities and 41.2% became an author/co-author of a publication from the host. 97.1% of fellows stated that their operative competency had increased, 94.3% gained new surgical skills and 85.7% was able to introduce new techniques in their hospitals. 74.29% agreed that the clinical experience led to a change in their practices. The most commonly suggested improvements were setting realistic target in clinical and research areas, increasing fellowship duration, and maximising theatre assisting opportunities. Nevertheless, 100% of fellows would recommend the fellowship to their peers.Conclusion: EAES fellowship programme has shown a positive impact on acquiring and adopting new MIS techniques. To further refine the programme, an individualised approach should be adopted to set achievable learning objectives in clinical skills, education and research.</p

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p &lt; 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

System of day surgery in Slovakia: analysis of pediatric day surgery discrepancies in the regions and their importance in strategy of its development

In the recent years in Slovakia occurred some negative changes in settings of the health system which deflected steady relationships in the system and significantly changed the motivation of their participants. It deepened the inefficiency use of healthcare resources. In the foreground of urgent problems is the unresolved issue of ensuring health policy objectives, the availability and quality of health care and the financial sustainability of the system. The indebtedness of Slovak hospitals disproportionately increases and in international comparison of results of healthcare is Slovakia gradually moving away from developed countries. One form of increasing the efficiency of the health system is to support the development of day surgery, which in Slovakia in during its 15 years of existence stagnating and reached only a level of 7%. The aim of the study is to analyze the level of implementation of pediatric day surgery in Slovakia, with special focus on possible regional discrepancies, based on the data available from the National Health Information Centre. This topic was chosen due to specificity of pediatric population compared to the adult one. Analysis revealed uneven trends in the number of completed pediatric day surgery procedures and specified regional disparities. Extreme fluctuations in the proportions of day surgery and traditional in-hospital surgical care suggest deliberate misuse of reporting methodology by some healthcare providers (reporting day surgery procedures as in-hospital care) in various regions during the analyzed period. This observation may be caused by the instability of reimbursement system. With respect to the financial issues, the importance of health insurance companies is obvious, as they have the right to set their own payment strategies and are responsible for the contractual relations with the health care providers. To achieve positive progress in the pediatric day surgery in Slovakia, it is necessary to adjust the active health policy in the country in a way that the balance among the quality of health care, costs, efficiency and equality is achieved

Laparoscopic left and right adrenalectomy from an anterior approach – is there any difference? Outcomes in 176 consecutive patients

Introduction : Traditionally, in open surgery, right adrenalectomy is considered technically more demanding than its left-sided counterpart. This belief is supposed to be attributable mainly to different anatomic characteristics of the adrenal veins. Whether this opinion is also correct for laparoscopic adrenalectomy remains elusive. Aim : To compare the outcomes of left versus right laparoscopic adrenalectomy from an anterior approach. Material and methods: Retrospective statistical analysis of a prospectively compiled database of consecutive patients undergoing laparoscopic adrenalectomy in a single center with focus on potential differences in the left- versus right-sided procedure in terms of demographic parameters, tumor size, operating time, occurrence of serious intraoperative complications, conversion, length of hospital stay and re-operation rate. Results: One hundred seventy-six patients underwent elective laparoscopic adrenalectomy – 80 left-sided (45.45%) and 96 right-sided (54.55%). No significant difference was found between the groups in terms of age (54.09 ±11.2 vs. 56.27 ±11.6; p = 0.2), tumor size (3.39 ±1.86 vs. 3.26 ±1.66; p = 0.64), operating time (71.84 ±22.33 vs. 72.06 ±30.99; p = 0.95), occurrence of serious intraoperative complications (7.5% vs. 10.4%; p = 0.5), conversion (1.25% vs. 1.04%; p = 0.9), length of hospital stay (4.52 ±1.30 vs. 4.37 ±1.91; p = 0.55) or reoperation rate (5% vs. 1%; p = 0.11). There was no mortality. Conclusions : No significant difference was found between the left and right laparoscopic adrenalectomy in terms of operating time, occurrence of serious intraoperative complications, conversion rate or postoperative outcome. Therefore, the opinion that the right-sided procedure is more difficult does not seem to be justified for laparoscopic adrenalectomy from the anterior approach

Managing Complicated Diverticular Disease in 2014

Complicated diverticular disease refers to patients who present with abscess, peritonitis, bleeding, fistula, or bowel obstruction. Management paradigms for these complications have changed enormously in the last 20 years. Surgical options include primary resection with or without anastomosis, exteriorisation of the perforation as the site of diversion, and more and more in recent years, simple lavage and drainage. The different classifications, the indications and techniques of interventional radiology, and endoscopy, as well as other minimally invasive or traditional surgical treatment of these complications are covered in this review

Laparoscopic Surgical Skills programme: preliminary evaluation of Grade I Level 1 courses by trainees

Introduction: New training models are needed to maintain safety and quality of surgical performance. A simulated setting using virtual reality, synthetic, and/or organic models should precede traditional supervised training in the operating room. Aim: The aim of the paper is to describe the Laparoscopic Surgical Skills (LSS) programme and to provide information about preliminary evaluation of Grade! Level 1 courses, including overall quality, applicability of the course content in practice and the balance between theory and hands-on training modules, by participating trainees. Material and methods: During 5 accredited LSS Grade I Level I courses held in Eindhoven (the Netherlands), Kosice (Slovak Republic), and Lisbon (Portugal) between April 2011 and January 2012, demographic data and pre-course surgical experience in laparoscopic surgery of the participants were recorded. The final course evaluation form was completed by each participant after the course (anonymous) to evaluate course progress, course materials, assessment, staff location and overall impression of the course on a 1-10 scale to obtain feedback information. Results: Forty-seven surgeons of 5 different nationalities were enrolled in an LSS Grade I Level I programme. Most participants were first or second year residents (n = 25), but also already established surgeons took part (n = 6). The mean age of the participants was 31.2 years (SD = 2.86), the male/female ratio was 32/15, and previous experience with laparoscopic surgery was limited. Overall impression of the course was rated with 8.7 points (SD = 0.78). The applicability of the course content in practice and the balance between theory and hands-on training were also rated very well mean 8.8 (SD = 1.01) and 8.1 points (SD = 0.80) respectively Conclusions: Laparoscopic Surgical Skills Grade I Level 1 courses are evaluated as well balanced, with content applicable in clinical practice, meeting the expectations of individual participants. International interest in the programme suggests that LSS might become the future European standard in surgical education in laparoscopic surgery. Further conclusions concerning success of the programme may be drawn after the completion of clinical assessment of enrolled participants