Journal of the American College of Surgeons
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Multicenter Study
Training High-Volume Melanoma Surgeons to Perform a Novel Minimally Invasive Inguinal Lymphadenectomy: Report of a Prospective Multi-Institutional Trial.
Minimally invasive inguinal lymphadenectomy (MILND) is a novel procedure with the potential to decrease surgical morbidity compared with the traditional open approach. The current study examined the feasibility of a combined didactic and hands-on training program to prepare high-volume melanoma surgeons to perform this procedure safely and proficiently. ⋯ After a structured training program, experienced melanoma surgeons adopted a novel surgical technique with acceptable operative times, conversions, and lymph node yield. Eighty-four percent of the surgeons who completed at least 6 MILND procedures were considered proficient based on our predetermined definition.
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As the cost of health care is subjected to increasingly greater scrutiny, the assessment of new technologies must include the surgical value (SV) of the procedure. Surgical value is defined as outcome divided by cost. ⋯ Nontraditional, minimally invasive gallbladder removal (SILS and ROBOSILS) offers significantly less surgical value for elective, outpatient gallbladder removal.
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We sought to examine our institutional experience (1998 to 2014) with minimally invasive repairs of pectus excavatum (MIRPE). ⋯ Although excellent outcomes after MIRPE can be achieved, our results highlight identified strategies that are associated with decreased risk of reoperation (eg, use of bilateral pericostal suture fixation, surgeon experience, and thoracoscopic guidance). Our results also suggest that elective bar removal should be delayed until the patient is at least 18 years old and has had the bar in for at least 4 years.