Annals of surgery
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To identify the most prevalent patterns of technical errors in surgery, and evaluate commonly recommended interventions in light of these patterns. ⋯ Most technical errors occur in routine operations with experienced surgeons, under conditions of increased patient complexity or systems failure. Commonly recommended interventions, including restricting high-complexity operations to experienced surgeons, additional training for inexperienced surgeons, and stricter supervision of trainees, are likely to address only a minority of technical errors. Surgical safety research should instead focus on improving decision-making and performance in routine operations for complex patients and circumstances.
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Controlled Clinical Trial
Proving the effectiveness of virtual reality simulation for training in laparoscopic surgery.
The aim of this study was to compare learning curves for laparoscopic cholecystectomy (LC) after training on a proficiency based virtual reality (VR) curriculum with that of a traditionally trained group. ⋯ A proficiency based VR training curriculum shortens the learning curve on real laparoscopic procedures when compared with traditional training methods. This may be a more cost- and time-effective approach, and supports the need for simulator-based practice to be integrated into surgical training programs.
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To determine whether nonemergent major surgery leads to higher mortality when performed on Friday versus early weekdays. ⋯ For patients admitted to regular hospital floors after nonemergent major surgery, mortality is increased if surgery is performed on Friday versus Monday through Wednesday.
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To describe the results and complications of in situ preservation (ISP) of kidneys from donors after cardiac death (DCD). ⋯ A minority of initiated ISP procedures led to transplantation, resulting in a high workload compared with donation after brain death. The association between increasing catheter insertion time and inferior graft outcome emphasizes the need for fast and effective surgery. Therefore, rapid laparotomy with direct aortic cannulation is preferred over ISP in controlled DCD donation. Despite these limitations, we have expanded our donor pool 3- to 4-fold by procuring DCD kidneys that were preserved in situ.
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The aim of this study was to describe the technique of colopharyngoplasty for the reconstruction of concomitant esophageal and pharyngeal caustic injuries and to evaluate the postoperative course and late functional outcomes. ⋯ Colopharyngoplasty is a simple and reliable procedure that can be successfully employed to restore the digestive continuity in patients with concomitant esophageal and pharyngeal caustic injuries. Control of the underlying psychiatric disease before reconstruction is a key factor for success.