Research & Publications

Summary: This retrospective study evaluated 33 patients undergoing robotic duodenal derotation with duodenoduodenostomy for superior mesenteric artery syndrome. Results showed high rates of pain relief, weight regain, and reduced nutritional support needs, with low complication rates and no mortality. Findings suggest the robotic approach is safe and may provide better outcomes than duodenojejunostomy.

Summary: This review examines human factors in robotic-assisted surgery, highlighting how teamwork, communication, workflow, training, and systems engineering can improve the safety, efficiency, and integration of surgical technology.

Summary: This systematic review found that the most effective strategies for reducing operating room turnover time used process redesign informed by prospective analysis of clinical workflows.

Summary: This observational study identified frequent workflow disruptions during robotic-assisted bariatric surgery, averaging one disruption every 2.4 minutes. The greatest challenges occurred during robot docking and patient transfer, with coordination issues, unavailable staff or instruments, and equipment adjustments accounting for most delays. The findings highlight opportunities to improve surgical team efficiency and workflow.

Summary: This study found that higher-volume centers achieved better surgical margins for adrenocortical carcinoma, while laparoscopic surgery was associated with greater odds of positive margins than open surgery.

Summary: This article provides guidelines for training non-clinical healthcare observers to improve the reliability of direct observations used to identify safety risks, workflow challenges, and system complexities.

Summary: This study found that human factors-based interventions significantly improved robotic surgery efficiency, reducing operating room turnover time by 26 minutes and major delays by more than 50%.

Summary: This study analyzed Stage I-III adrenocortical carcinoma patients undergoing adrenalectomy to assess the lymphadenectomy’s prognostic value. Among 386 cases, increasing positive lymph node burden strongly predicted worse survival. Patients with four or more positive nodes had the poorest outcomes. Lymphadenectomy was also associated with improved survival, supporting its role in ACC staging and management.

Summary: This study evaluated routine versus selective liver biopsy during bariatric surgery in 2,393 patients. Routine biopsies detected significantly more steatosis, fibrosis, and NASH without increasing postoperative complications. Higher BMI and insulin-dependent diabetes predicted NASH risk, while Black race was associated with lower odds. Routine biopsy safely improved identification of advanced NAFLD.

Summary: This study examined factors associated with non-operative management of resectable adrenocortical carcinoma using National Cancer Database data from 2004-2016. Older patients, those with advanced disease, and individuals treated at community centers were less likely to undergo surgery. Non-operative patients had significantly poorer survival, supporting referral to experienced, high-volume academic centers for optimal care.

Summary: This review examines complications following cholecystectomy, including bile duct injury, strictures, bleeding, infection, retained gallstones, hernias, and postcholecystectomy syndrome. The authors emphasize prevention through adherence to Safe Cholecystectomy Task Force principles, particularly achieving the critical view of safety, to reduce morbidity and improve surgical outcomes after this commonly performed procedure.

Summary: This study examined outcomes after converting laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass for persistent GERD symptoms. Among 54 patients, conversion significantly improved reflux-related quality of life, reduced antisecretory medication use, and promoted modest weight loss. However, patients with GERD symptoms developing more than three months after surgery were more likely to experience persistent symptoms.

Summary: This study evaluated how operating room size affects flow disruptions during robotic-assisted surgery across 56 procedures at two academic hospitals. Larger rooms increased disruptions during pre-docking, while smaller rooms increased disruptions during docking. Findings highlight previously underrecognized spatial challenges associated with integrating robotic technology and emphasize considering infrastructure needs to optimize workflow and patient safety.

Summary: This review described clinico-pathologic findings in four women with median arcuate ligament syndrome (MALS), characterized by chronic postprandial abdominal pain and symptoms. Surgical exploration revealed fibrotic tissue compressing the celiac artery and surrounding nerves. Histopathology supported neurogenic compression as a contributor to symptoms, reinforcing the use of the term MALS rather than celiac artery compression syndrome.

Summary: This systematic review examined work-system barriers and interventions in robotic-assisted surgery (RAS). Among 30 studies, most identified problems such as communication failures, ergonomic issues, and workflow disruptions, but few evaluated practical solutions. Proposed interventions included team training, checklists, and workspace redesign, highlighting the need for tested strategies to improve safety, efficiency, and operating room dynamics.

Summary: This protocol outlines a 5-year, multicenter study examining safety and efficiency in robotic-assisted surgery using flow disruptions as indicators of systemic risk. Across four hospitals and 680 procedures, researchers will evaluate interventions targeting teamwork, task design, and workplace design to improve patient safety, workflow, and organizational culture through observational and analytical methods.

Abstract: This article explores the role of human factors engineering in patient safety in surgery. The authors discuss the history and evolution of human factors and the role of human factors in patient safety and provide a description of human factors methods used to study and improve patient safety.

Summary: This study examined barriers to efficient robotic operating room turnover time using direct observation and staff surveys. Researchers found cleaning consumed the most turnover time, contrary to staff perceptions that blamed operating room setup or instrument availability. The findings revealed discrepancies between perceptions and reality, identifying opportunities for targeted interventions to improve robotic surgery efficiency.

Summary: This case series evaluated outcomes after Collis gastroplasty with fundoplication and hiatal hernia repair in 183 patients. The procedure produced durable reductions in heartburn, regurgitation, dysphagia, and antacid use, with improved quality-of-life scores and high patient satisfaction. Complications and reoperation rates were low, supporting Collis gastroplasty as a safe, effective treatment option.

Summary: This review examines the relationship between obesity and GERD, evaluating surgical management options, including fundoplication, gastric bypass, and bariatric surgery, while providing expert recommendations for treating obese patients.

Summary: This study found MALS may be associated with delayed gastric emptying, visceral vascular abnormalities, Ehlers-Danlos syndrome, and postural orthostatic tachycardia syndrome, suggesting potential underlying pathophysiologic relationships.

Summary: This study found that HAS2-driven hyaluronan production promotes liver fibrosis through Notch1 activation, suggesting that targeted inhibition of hyaluronan synthesis may offer a potential treatment for liver fibrosis.