Browsing by Subject "surgery"
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Item 3D printing in surgical simulation: emphasized importance in the COVID-19 pandemic era(Future Medicine, 2021-03-01) Michaels, Ross; Witsberger, Chelsey A; Powell, Allison R; Koka, Krishna; Cohen, Katheryn; Nourmohammadi, Zahra; Green, Glen E; Zopf, David A; Otolaryngology -- Head and Neck Surgery, School of MedicineHistorically, surgical training was an apprenticeship model of see one, do one, teach one. However, a proficiency-based training approach has become increasingly implemented for assessing surgical skills with performance scores used as benchmarks to track trainee proficiency [1]. Surgical simulators are starting to be utilized more to assess proficiency in trainees on certain procedures with many residency programs having simulation as a piece of their training curriculum. Today, simulation in surgical training takes many forms. Live animals and cadavers are often implemented since these simulators can simulate operating on realistic tissue and on human anatomy respectively. There are also basic simulators that are models that simulate a component of an operation such as suturing or knot-tying. These help trainees practice certain surgical skills necessary for completing a procedure. Some of these simulators have become more complex and simulate several steps or even an entire procedure such as joint replacements and fixating fractures [1]. With the increased availability in 3D printing technology and a push toward personalized medicine, 3D printing research has exponentially increased in recent years and has been an area of investigation for the development of surgical simulators [2]. Using a 3D printer to construct models for simulation leads to vast opportunity to customize the simulator while significantly reducing cost. Prior to the advent of 3D printing and additive manufacturing, computed tomography (CT) data were used to construct anatomic models using subtractive manufacturing with the first model made in 1979 [3]. Commercial 3D printers became available in the 1980s and were introduced into the medical field in 1994 [4]. Currently, 3D printing has several surgical applications including anatomic models for surgical planning, simulation and education; implants and prostheses; and surgical guides [3].Item Aerosol and droplet generation from orbital repair: Surgical risk in the pandemic era(Elsevier, 2021) Ye, Michael J.; Vadhul, Raghav B.; Sharma, Dhruv; Campiti, Vincent J.; Burgin, Sarah J.; Illing, Elisa A.; Ting, Jonathan Y.; Hong Park, Jae; Koehler, Karl R.; Lee, Hui Bae; Vernon, Dominic J.; Johnson, Jeffrey D.; Nesemeier, B. Ryan; Shipchandler, Taha Z.; Otolaryngology -- Head and Neck Surgery, School of MedicineIntroduction The highly contagious COVID-19 has resulted in millions of deaths worldwide. Physicians performing orbital procedures may be at increased risk of occupational exposure to the virus due to exposure to secretions. The goal of this study is to measure the droplet and aerosol production during repair of the inferior orbital rim and trial a smoke-evacuating electrocautery handpiece as a mitigation device. Material and methods The inferior rim of 6 cadaveric orbits was approached transconjunctivally using either standard or smoke-evacuator electrocautery and plated using a high-speed drill. Following fluorescein inoculation, droplet generation was measured by counting under ultraviolet-A (UV-A) light against a blue background. Aerosol generation from 0.300–10.000 μm was measured using an optical particle sizer. Droplet and aerosol generation was compared against retraction of the orbital soft tissue as a negative control. Results No droplets were observed following the orbital approach using electrocautery. Visible droplets were observed after plating with a high-speed drill for 3 of 6 orbits. Total aerosol generation was significantly higher than negative control following the use of standard electrocautery. Use of smoke-evacuator electrocautery was associated with significantly lower aerosol generation in 2 of 3 size groups and in total. There was no significant increase in total aerosols associated with high-speed drilling. Discussion and conclusions Droplet generation for orbital repair was present only following plating with high-speed drill. Aerosol generation during standard electrocautery was significantly reduced using a smoke-evacuating electrocautery handpiece. Aerosols were not significantly increased by high-speed drilling.Item Application of Mental Skills Training in Surgery: A Review of Its Effectiveness and Proposed Next Steps(Liebert, 2017-05) Anton, Nicholas E.; Bean, Eric A.; Hammonds, Samuel C.; Stefanidis, Dimitrios; Surgery, School of MedicineIntroduction: Mental skills training, which refers to the teaching of performance enhancement and stress management psychological strategies, may benefit surgeons. Our objective was to review the application of mental skills training in surgery and contrast it to other domains, examine the effectiveness of this approach in enhancing surgical performance and reducing stress, and provide future directions for mental skills training in surgery. Materials and Methods: A systematic literature search of MEDLINE, PubMed, PsycINFO, and ClinicalKey was performed between 1996 and 2016. Keywords included were mental readiness, mental competency, mental skill, mental practice, imagery, mental imagery, mental rehearsal, stress management training, stress coping, mental training, performance enhancement, and surgery. Reviews of mental skills interventions in sport and well-regarded sport psychology textbooks were also reviewed. Primary outcome of interest was the effect of mental skills on surgical performance in the simulated or clinical environment. Results: Of 490 identified abstracts, 28 articles met inclusion criteria and were reviewed. The majority of the literature provides evidence that mental imagery and stress management training programs are effective at enhancing surgical performance and reducing stress. Studies from other disciplines suggest that comprehensive mental skills programs may be more effective than imagery and stress management techniques alone. Conclusions: Given the demonstrated efficacy of mental imagery and stress management training in surgery and the incremental value of comprehensive mental skills curricula used in other domains, a concerted effort should be made to apply comprehensive mental skills curricula during surgical training.Item Are Antibiotics a Feasible Alternative to Surgery for Acute Appendicitis?(Elsevier, 2016-05) Gottlieb, Michael; Hunter, Benton; Department of Emergency Medicine, IU School of MedicineItem Assessment of postoperative outcomes in spinal epidural abscess following surgical decompression(Elsevier, 2019) Keller, Leonard J.; Alentado, Vincent J.; Tanenbaum, Joseph E.; Lee, Bryan S.; Nowacki, Amy S.; Benzel, Edward C.; Mroz, Thomas E.; Steinmetz, Michael P.; Neurological Surgery, School of MedicineBackground context A spinal epidural abscess (SEA) is a serious condition that may be managed with antibiotics alone or with decompressive surgery combined with antibiotics. Purpose The objectives of this study were to assess the clinical outcomes of SEA after surgical management and to identify the patient-level factors that are associated with outcomes following surgical decompression and removal of SEA. Study design/setting Retrospective chart review analysis. Patient sample An analysis of 154 consecutive patients who initially presented to a tertiary-care, academic medical center with SEA, and were subsequently treated with surgery between 2010 and 2015 was performed. Outcome measures Postoperative predischarge American Spinal Injury Association Impairment Scale (AIS) scores, 6-month follow-up encounter AIS scores, need for revision surgery, and mortality during SEA surgery were the primary outcomes.Physiological Measures: AIS scores. Method Fisher's exact and Wilcoxon rank-sum tests were used to assess the associations between patient-level factors and surgical outcomes. Moreover, an interactive, predictive model for postoperative predischarge AIS score was developed using a proportional odds regression model. There was no funding secured for this study and there is no conflict of interest-associated biases. Results One hundred fifty-four patients (mean age of 58 years) were treated using surgical decompression in addition to antibiotics. The majority of patients were Caucasian (81%) and male (61%). No intraoperative mortality was reported. A second SEA surgery was performed in 8% of patients. A comparison of the preoperative and postoperative predischarge AIS scores showed that 49% of patients maintained a score of E or improved, while 45% remained at their preoperative status and 6% worsened. Among a subset of patients (n=36; 23%) for whom a 6-month follow-up encounter occurred, 75% maintained an AIS score of E or improved, 19% remained at their preoperative status, and 6% worsened. Both the presence and longer duration of preoperative paresis was associated with an increased risk of remaining at the same AIS score or worsening at the predischarge encounter (both p< .001). A predictive model for predischarge AIS scores was developed based on several patient characteristics. Conclusions Surgical decompression can contribute to improving or maintaining AIS scores in a high percentage of SEA patients. The presence and duration of preoperative paresis are prognostic for poorer outcomes and suggest that rapid surgical intervention before paresis develops may lead to improved postoperative outcomes. Our modeling tool enables an estimation of probabilities of patients’ predischarge condition.Item Attentional selectivity, automaticity, and self-efficacy predict simulator-acquired skill transfer to the clinical environment(Elsevier, 2019-02) Anton, Nicholas E.; Mizota, Tomoko; Timsina, Lava R.; Whiteside, Jake A.; Myers, Erinn M.; Stefanidis, Dimitrios; Surgery, School of MedicineIntroduction Several studies demonstrated that simulator-acquired skill transfer to the operating room is incomplete. Our objective was to identify trainee characteristics that predict the transfer of simulator-acquired skill to the operating room. Methods Trainees completed baseline assessments including intracorporeal suturing (IS) performance, attentional selectivity, self-reported use of mental skills, and self-reported prior clinical and simulated laparoscopic experience and confidence. Residents then followed proficiency-based laparoscopic skills training, and their skill transfer was assessed on a live-anesthetized porcine model. Predictive characteristics for transfer test performance were assessed using multiple linear regression. Results Thirty-eight residents completed the study. Automaticity, attentional selectivity, resident perceived ability with laparoscopy and simulators, and post-training IS performance were predictive of IS performance during the transfer test. Conclusions Promoting automaticity, self-efficacy, and attention selectivity may help improve the transfer of simulator-acquired skill. Mental skills training and training to automaticity may therefore be valuable interventions to achieve this goal.Item Casual observation(Elsevier, 2023-09) Zborek, Kirsten; Denlinger, Chadrick E.; Surgery, School of MedicinePulmonary carcinoid tumors are a rare form of lung cancer subdivided into typical and atypical variants. Long-term outcomes after surgical resection are excellent, with 5-year survival rates approaching 85% even among patients with N2 lymph node involvement. Surgical resection of carcinoids remains the standard of care. However, in patients with diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH), a condition characterized by the presence of innumerable small pulmonary carcinoids, observing small carcinoids may be acceptable.Item Commercial Insurance Coverage Decline Associated with Affordable Care Act: What's Next?(Ohio Valley Society of Plastic Surgeons, 2017-02-15) Fielding, Stephen M.; Jerkins, David; Johnson, R. MichaelBACKGROUND: A key feature of the Affordable Care Act was the establishment of insurance exchanges and subsidies to assist Americans in obtaining affordable commercial insurance. This study was undertaken to determine whether this effort has met its goal. METHODS: A review of all patients requiring surgery for maxillofacial trauma at a level 1 trauma center was undertaken for time periods before the Affordable Care Act was passed (2008 and 2009), while partially in effect (2012), and after the establishment exchanges and subsidies (2014). Insurance statuses were recorded and rates of commercial insurance coverage during each period were compared. RESULTS: A total of 1,123 patients were included. Of these, 511 were treated before passage of the Affordable Care Act, 288 were treated in 2012, and 324 were treated in 2014. Before passage, 50.5% of patients had commercial insurance. This number was virtually unchanged in 2012. However, after the insurance exchanges and subsidies were established, the percentage of patients with commercial insurance fell to 36.73% (p = 0.004). CONCLUSIONS: Surprisingly, the establishment of insurance exchanges and subsidies through the Affordable Care Act was associated with a decline in rates of commercial insurance coverage. Trends in reimbursement patterns will need to be followed if the law is repealed and replaced.Item Comparison of Artificial Intelligence and Eyeball Method in the Detection of Fatty Liver Disease(2023-07-26) Catron, Evan J.; Passarelli, Robert P.; Danielle, Wilmes; Wei, Barry; Le, Thi M.U.; Li, Ping; Zhang, Wenjun; Lin, Jingmei; Melcher, Mark L.; Mihaylov, Plamen V.; Kubal, Chandrashekhar A.; Mangus, Robert S.; Ekser, BurcinBackground: Quantification of liver fat content relies on visual microscopic inspection of liver biopsies by pathologists. Their percent macrosteatosis (%MaS) estimation is vital in determining donor liver transplantability; however, the eyeball method may vary between observers. Overestimations of %MaS can potentially lead to the discard of viable donor livers. We hypothesize that artificial intelligence (AI) could be helpful in providing a more objective and accurate measurement of %MaS. Methods: Literature review identified HALO (image analysis) and U-Net (deep-learning) as high-accuracy AI programs capable of calculating %MaS in liver biopsies. We compared (i) an experienced pathologist’s and (ii) a transplant surgeon’s eyeball %MaS estimations from de-novo liver transplant (LT) biopsy samples taken 2h post-reperfusion to (iii) the HALO-calculated %MaS (Fig.1). 250 patients had undergone LT at Indiana University between 2020-2021, and 211 had sufficient data for inclusion. Each biopsy was digitized into 5 random non-overlapping tiles at 20x magnification (a total of 1,055 images). We used HALO software for analysis and set the minimum vacuole area to 10μm² to avoid the inclusion of microsteatosis. Microsteatosis was excluded by the pathologist and the surgeon by the eyeball method using the same 1,055 images. Each %MaS estimation was compared with early allograft dysfunction (EAD). EAD is defined by the presence of at least one of the following: INR >1.6 on postoperative day (POD) 7, total bilirubin >10mg/dL on POD7, or AST/ALT >2000IU/L within the first 7 days following LT. Results: Of 211 LTs, 42 (19.9%) had EAD. The mean %MaS estimation of pathologist and transplant surgeon were 6.3% (SD: 11.9%) and 3.2% (SD: 6.4%), respectively. HALO yielded a significantly lower mean %MaS of 2.6% (SD: 2.6%) than the pathologist’s eyeball method (p<0.001). The mean %MaS calculated by HALO was higher in EAD patients than in non-EAD (p=0.032), but this difference did not reach statistical significance in the pathologist’s estimation (p=0.069). Conclusions: Although mean %MaS measurements from all parties were mild (<10%), human eyeball estimations of %MaS were significantly higher than HALO’s %MaS. The HALO-calculated %MaS differed significantly between the EAD and non-EAD LTs which might suggest a possible correlation between the AI’s steatosis analysis and EAD outcomes. However, pathologic variables other than %MaS (necrosis or cholestasis) should be included in future analyses to determine whether %MaS is the dominant parameter predicting EAD. AI is a promising tool to quantify liver steatosis and will help pathologists and transplant surgeons predict liver transplant viability.Item Distinctive and pervasive alterations in aqueous humor protein composition following different types of glaucoma surgery(Molecular Vision, 2015) Rosenfeld, Cyril; Price, Marianne O.; Lai, Xianyin; Witzmann, Frank A.; Price, Francis W.; Department of Biochemistry and Molecular Biology, IU School of MedicinePURPOSE: To investigate whether specific glaucoma surgeries are associated with differences in aqueous humor protein concentrations compared to eyes without filters. METHODS: In this cross-sectional study, aqueous humor samples were prospectively collected from control subjects who underwent routine cataract surgery (n=14) and from patients who had different glaucoma filters: Baerveldt aqueous shunt (n=6), Ahmed aqueous shunt (n=6), trabeculectomy (n=5), and Ex-Press trabeculectomy (n=3). Total protein concentrations were determined with Bradford assay. Tryptic digests were analyzed with liquid chromatography-tandem mass spectrometry (LC-MS/MS). Proteins were identified with high confidence using stringent criteria and were quantitatively compared with a label-free platform. Relative protein quantities were compared across groups with ANOVA. Post hoc pair-wise comparisons were adjusted for multiple comparisons. RESULTS: Compared to the control eyes, the aqueous humor protein concentration was increased approximately tenfold in the Ahmed and Baerveldt eyes and fivefold in the trabeculectomy and Ex-Press eyes. Overall, 718 unique proteins, splice variants, or isoforms were identified. No differences in the protein concentrations were detected between the Baerveldt and Ahmed groups. Likewise, the trabeculectomy and Ex-Press groups were remarkably similar. Therefore, the aqueous shunt groups were pooled, and the trabeculectomy groups were pooled for a three-way comparison with the controls. More than 500 proteins differed significantly in relative abundance (ANOVA p<0.01) among the control, aqueous shunt, and trabeculectomy groups. Functional analyses suggested these alterations in relative protein abundance affected dozens of signaling pathways. CONCLUSIONS: Different glaucoma surgical procedures were associated with marked increases in the aqueous humor protein concentration and distinctive changes in the relative abundance of numerous proteins involved in multiple signaling pathways.