Annals of surgery
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The objective of this study was to determine the outcomes of robotic peritoneal flap vaginoplasty. ⋯ Clinician-observed and patient-reported outcomes for robotic gender-affirming peritoneal flap vaginoplasty were superior to those reported in the literature for penile inversion vaginoplasty. Patients who do not achieve orgasm prior to surgery are less likely to achieve orgasm and maintain vaginal depth afterwards, however the majority of these patients have improved sexual health after surgery.
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To investigate the clinicopathological features and long-term outcomes of cystic and solid pancreatic neuroendocrine tumors (PanNETs). ⋯ Cystic PanNETs have a more benign course than their solid counterparts and conservative management can be considered for EUS-FNA-proven cystic PanNETs ≤3 cm. Parenchyma and lymph-node sparing resections are warranted in patients with cystic PanNETs>3 cm. Patients with poor baseline performance status may forego cystic PanNET resection and not affect their overall survival.
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To explore the association of socioeconomic status (SES) and race/ethnicity with perioperative metrics within the Enhanced Recovery After Surgery (ERAS) framework to identify gaps for equity-informed improvements. ⋯ Low SES was linked to lower compliance with important process measures, higher infectious and all in-hospital complication rates, and longer LOS. Despite high rates of protocol compliance, Black race/ethnicity showed an association with increased odds of respiratory complications and extended LOS. Adjustments to perioperative protocols could address such disparities, helping to improve postoperative outcomes of colorectal surgeries.
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The magnitude of advances in surgical care inspires awe consistent with the impact of these developments on patients' lives. With this comes greater knowledge, new practices, and novel technologies for integration into residency training, making the skillset required of today's residents quite different from those in the past. Competency-based medical education and learner-centered approaches offer innovative and studied methodologies for teaching, learning, and assessment to meet the demands of today's educational environment. ⋯ The research agenda includes five domains of inquiry: entrustment and practice readiness; bias and environment; distinguishing features and certification; qualitative feedback; and patient outcomes, and builds upon prior work by ten Cate et al. by expanding upon their organizing framework to also include the element of time. Additionally, the authors provide questions and suggest data integration strategies that might foster a breadth of studies investigating the utility of Entrustable Professional Activities in surgical training. Collectively engaging in such a process of evaluation early in the process of competency-based reform will serve to optimize education, assessment, and ultimately patient care.
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To explore the perspectives and experiences of patients and carers living with the long-term consequences of pelvic exenteration. ⋯ Although survivors of pelvic exenteration accept the long-term consequences of surgery as the price of survival, these are significant, and improved access to support services in the community may better equip survivors to manage these challenges.