Comparative study of the operative experience of surgical residents before and after 80-hour work week restrictions

Kim, Dong Jin; Kim, Sung Geun

doi:10.4174/astr.2018.95.5.233

Cited by 8 publications

(6 citation statements)

References 12 publications

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“…Second, legal issues are also associated with the lack of manpower. Korea limited the working hours of residents to no more than 80 hours per week in December 2017 (22). Moreover, The Korean Surgical Society announced that the duration of resident training was shortened from four to three years, which was implemented for the first-year residents in 2019.…”

Section: Minimally Invasive Surgical Approaches In Abdominalmentioning

confidence: 99%

Duet laparoscopic repair with knotless barbed sutures for treatment of perforated peptic ulcer: reality in general surgery with lacking of manpower

2021

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Background: Perforated peptic ulcer (PPU) is a fatal complication of peptic ulcer disease, which requires emergency surgery. Laparoscopic repair is the widely accepted and effective method for the treatment of PPU. The aim of this study was to evaluate the safety and efficacy of duet laparoscopic repair of PPU with knotless barbed sutures.Methods: From January 2013 to May 2019, 40 patients with PPU underwent laparoscopic primary repair and omentopexy at the Dankook University Hospital. The operative outcomes and complications of patients undergoing surgery using continuous suturing with absorbable knotless barbed sutures (group A, n=15) were compared with those undergoing surgery with conventional interrupted sutures (group B, n=25). Results:The mean operative time was significantly shorter in group A than group B (84.4±39.8 vs.104.2±49.4 min, P<0.001). There were no differences in other operative outcomes or postoperative complications (group A vs. group B, 20.0% vs. 24.0%, respectively; P=0.249) between the two groups. The mean operation time spent for laparoscopic sutures and omentopexy was 22.7 minutes. Conclusions:The findings of the current study, albeit performed retrospectively at a single institution, suggested that duet laparoscopic repair of PPU with knotless barbed sutures might be considered as an alternative option, especially in hospitals lacking manpower.

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Section: Minimally Invasive Surgical Approaches In Abdominalmentioning

confidence: 99%

Duet laparoscopic repair with knotless barbed sutures for treatment of perforated peptic ulcer: reality in general surgery with lacking of manpower

2021

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“…Furthermore, most of the responders valued the skillfulness of surgical assistants who manipulate the laparoscopic camera and instrument assistants, because the extent of assistant experience may be closely related to the operation time and complication rate [ 17 ]. Recently, in the Republic of Korea, owing to the implementation of the special act regarding an 80-hour workweek for residents, their working time has reduced, and thereby, the number of cases of surgical training has reduced [ 18 ]. In contrast, physician assistants are still useful for coordination in the operating room because of their high level of proficiency based on repetitive work [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…The majority of responders anticipated that the introduction of the AI-based surgical assistant system would replace the existing workforce by 41%-60%. Therefore, an AI-based surgical assistant system for AISS could be a great solution in university hospitals where resident working hours are regulated (eg, 80-hour resident special act in Korea and The European Working Time Directive in Europe) [ 18 , 20 ]. Of course, there may be some opinions concerning undertraining of residents, but the introduction of educational tools, such as simulation training systems, is a possible alternative [ 17 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Desire for an Artificial Intelligence–Based Surgical Assistant System: Electronic Survey–Based Study

et al. 2020

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Background Techniques utilizing artificial intelligence (AI) are rapidly growing in medical research and development, especially in the operating room. However, the application of AI in the operating room has been limited to small tasks or software, such as clinical decision systems. It still largely depends on human resources and technology involving the surgeons’ hands. Therefore, we conceptualized AI-based solo surgery (AISS) defined as laparoscopic surgery conducted by only one surgeon with support from an AI-based surgical assistant system, and we performed an electronic survey on the clinical desire for such a system. Objective This study aimed to evaluate the experiences of surgeons who have performed laparoscopic surgery, the limitations of conventional laparoscopic surgical systems, and the desire for an AI-based surgical assistant system for AISS. Methods We performed an online survey for gynecologists, urologists, and general surgeons from June to August 2017. The questionnaire consisted of six items about experience, two about limitations, and five about the clinical desire for an AI-based surgical assistant system for AISS. Results A total of 508 surgeons who have performed laparoscopic surgery responded to the survey. Most of the surgeons needed two or more assistants during laparoscopic surgery, and the rate was higher among gynecologists (251/278, 90.3%) than among general surgeons (123/173, 71.1%) and urologists (35/57, 61.4%). The majority of responders answered that the skillfulness of surgical assistants was “very important” or “important.” The most uncomfortable aspect of laparoscopic surgery was unskilled movement of the camera (431/508, 84.8%) and instruments (303/508, 59.6%). About 40% (199/508, 39.1%) of responders answered that the AI-based surgical assistant system could substitute 41%-60% of the current workforce, and 83.3% (423/508) showed willingness to buy the system. Furthermore, the most reasonable price was US $30,000-50,000. Conclusions Surgeons who perform laparoscopic surgery may feel discomfort with the conventional laparoscopic surgical system in terms of assistant skillfulness, and they may think that the skillfulness of surgical assistants is essential. They desire to alleviate present inconveniences with the conventional laparoscopic surgical system and to perform a safe and comfortable operation by using an AI-based surgical assistant system for AISS.

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“…However, research after the implementation of AITR is limited. 5 7 8 9 In addition, studies on post-AITR data focusing on surgery are extremely rare. In this study, we hypothesized that the implementation of the AITR would have affected clinical outcomes in patients undergoing emergency abdominal surgery and that there would be an observable change in the time from emergency room (ER) arrival to emergency operation after AITR implementation.…”

Section: Introductionmentioning

confidence: 99%

Impact of Enforcement of the Act to Improve Training Conditions and the Status of Medical Residents in Emergency Abdominal Surgery

et al. 2022

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Purpose In 2018, the Act to Improve Training Conditions and the Status of Medical Residents (AITR) was fully implemented in South Korea. This study aimed to investigate the effects of AITR implementation on the clinical outcomes of patients who underwent emergency abdominal surgery. Materials and Methods A total of 2571 patients who underwent emergency abdominal surgery after visiting the emergency room (ER) between 2015 and 2019 was included. Electronic medical records were retrospectively reviewed. In addition, a comparative analysis was performed for patient groups treated before and after AITR implementation. Results The median patient age was 48.0 years, and 49.2% of them were male. Appendicitis was the most common diagnosis (82.6%), followed by major abdominal emergencies (9.9%) and cholecystitis (7.5%). The median time from arrival to surgery was 439 min, and 52 (2.0%) patients died. A comparison of patients who underwent surgery before (pre-AITR; 1453, 56.5%) and after (post-AITR; 1118, 43.5%) AITR implementation revealed a significant difference in age, number of residents on a 24-h shift, and diagnosis. The time from ER arrival to surgery was not significantly longer after AITR implementation than before AITR implementation (434 min vs. 443 min, p =0.230). AITR was not a significant risk factor for mortality ( p =0.225). Conclusion The time from ER arrival to emergency surgery did not increase significantly after AITR implementation, and there was no difference in the patients’ clinical outcomes.

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Comparative study of the operative experience of surgical residents before and after 80-hour work week restrictions

Cited by 8 publications

References 12 publications

Duet laparoscopic repair with knotless barbed sutures for treatment of perforated peptic ulcer: reality in general surgery with lacking of manpower

Duet laparoscopic repair with knotless barbed sutures for treatment of perforated peptic ulcer: reality in general surgery with lacking of manpower

Clinical Desire for an Artificial Intelligence–Based Surgical Assistant System: Electronic Survey–Based Study

Impact of Enforcement of the Act to Improve Training Conditions and the Status of Medical Residents in Emergency Abdominal Surgery

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