Our technique modification simplifies previously described approaches to intercostal nerve cryoablation. Patients undergoing this adjunct benefit with less PNR and a faster discharge time.

A small but important proportion of healthcare workers are susceptible to measles. Whenever feasible, measles immunity programs for healthcare workers should include workers born before 1957. Of workers born after 1956, those from outside the United States are more likely to be immune than workers from inside the United States. Using the currently available vaccine, revaccination of initial non- or hyporesponders appears to be effective.

ObjectiveTo examine trends in fireworks-related injuries (FRI) before and after enactment of an ordinance to limit access in the City and County of Honolulu (the island of Oahu).MethodsSurveillance of FRI treated in all emergency departments in the state, for 18 new year’s periods (31 December through 1 January) from 2004 to 2021. Prelaw (2004 to 2011) and postlaw (2012 to 2021) number of FRI were compared, by patient age and county.ResultsThe average annual number of FRI for all ages decreased significantly in Oahu, from 74 during the prelaw period to 27 during the postlaw period (p<0.01), but not in the remaining neighbour islands (p=0.07). Decreases were particularly evident for Oahu paediatric patients (under 18 years), among whom FRI declined from 42 to 10 per year (p<0.01). FRI were approximately halved for older Oahu patients and neighbour island paediatric patients.ConclusionsLegislation requiring permits for a specified number and type of fireworks, and limiting access to persons 18 years and older was associated with significant decreases in FRI in the City and County of Honolulu.

A small but important proportion of healthcare workers are susceptible to measles. Whenever feasible, measles immunity programs for healthcare workers should include workers born before 1957. Of workers born after 1956, those from outside the United States are more likely to be immune than workers from inside the United States. Using the currently available vaccine, revaccination of initial non- or hyporesponders appears to be effective.

INTRODUCTION AND OBJECTIVE:The deconstruction of surgery into a semantic vocabulary yields an effective tool for surgical education. Herein, we disassemble tissue dissection into basic maneuvers, then utilize them to compare dissection between experts (E) and novices (N) during robotic renal hilum preparation.METHODS: Videos of robotic renal hilum dissection were manually reviewed. Only cases where the dominant hand uses monopolar scissors were included. Experts were defined by > 100 prior robotic cases, while novices 100 cases. 6 expert surgeons at our center arrived at a consensus for a dissection gestures classification system: blunt dissection (spread, peel/push, hook), sharp dissection (cold cut, energy cut and burn), and combination gestures (pediclize [ multiple peels, hand over hand [ both hands push) (Fig 1a). Continuous variables were compared by Mann-Whitney U test, and categorical variables by Chi-square test. RESULTS: 19 hilar dissections with 3,179 dissection maneuvers were analyzed, representing 11 cases from 6 expert surgeons (median 1750, range [150-3500] cases) and 8 cases from 6 novices (median 80 [5-100] cases). Patient baseline variables were comparable (p > 0.05). Compared to novices, experts were more efficient completing the artery preparation (E 32 vs N 83 gestures, p [ 0.004) (Fig 1b). Experts needed less retraction adjustments (E 26 vs N 55 gestures, p [ 0.047) and utilized more hand over hand gestures (5 vs 1 counts, p [ 0.005). During artery preparation, they used more proportion of hook (E 15.7% vs N 6.4%, p<0.001) and burn (E 24.1% vs N 10.7%, p<0.001) (Fig 1c). Experts were more efficient with spread (E 2.71 vs N 2.96 s/gesture, p [ 0.028) and hook (E 2.20 s vs N 2.50 s/gesture, p [ 0.05), but spent more time with peel/push (E 1.73 vs N 1.44 s/gesture, p<0.001), energy cut (E 2.28 vs 1.50 s/gesture, p<0.001) and pediclize (E 4.05 vs 2.92 s/ gesture, p<0.001). Overall, surgeons spent more time with peel/push (1.58 vs 1.41 s/gesture, p<0.001) and hook (2.79 vs 1.23 s/gesture, p<0.001) around the vein vs artery.CONCLUSIONS: This dissection gesture classification system can disassemble the renal hilum preparation. We found differences in dissection patterns of experts vs novices. This novel comprehensive classification may help streamline surgery education.