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Comment on "The Limit for Artificial Intelligence's Potentiality in Surgery Doesn't Have to Be the Surgeon"
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Robotic Training in General Surgery Residency: How Early Can We Begin?
No full textBackground: The increasing demand for robotics in general surgery has prompted academic institutions to train general surgery residents toward the acquisition of basic robotic skills. Our current robotic training curriculum begins in the PGY-3 year and is based on the use of surgical simulators in a risk-free environment, in which each resident must show proficiency prior to advancing to training on an animate model as PGY-4. Our unpublished data on the curriculum indicates that PGY-3s required additional remediation training on the robotic simulator, suggesting room for improvement in our teaching paradigm [8]. Because of resident duty hour restrictions, we could not provide remediation by simply increasing the number of training sessions. We therefore decided to investigate an alternative strategy of shifting the training to an earlier time point in general surgical residency during PGY-1 and PGY-2 years. To explore the feasibility of a new curriculum, we undertook a pilot study to investigate the willingness of residents in their PGY-1 and PGY-2 years to begin robotic training on the robotic simulator, the dV-Trainer (dV-T). We also wanted to see if even minimal early exposure to the dV-T would help overcome residents’ initial diffidence in using the daVinci Surgical System (DaVss).
Methods: Ten general surgery residents (seven PGY-1s and three PGY-2s) with no prior exposure to robotic training were randomly distributed into MIMIC (MIM G) and daVinci (DaV G) groups. The MIM G subjects answered a post-exposure questionnaire about their overall experience with the robotic training. The five MIM G subjects performed five basic skills exercises on the dV-T simulator prior to executing the same exercises on the DaVss, while the five DaV G subjects performed the same exercises only on the DaVss. Two blinded robotic proctors scored each subject’s performance on the DaVss.
Results: All MIM G subjects found their overall experience constructive and viewed the dV-T as useful in preparing them to complete subsequent tasks on the DaVss. The MIM G subjects also performed better than the DaV G (p= 0.32) subjects in operation of the da-Vss, although statistical significance could not be achieved. Given the small sample size, statistical significant was unlikely.
Conclusions: The subjective perception of the dV-T experience was strongly positive, as the residents enjoyed the experience and seemed to be open to the possibility of introducing some robotic training with the robotic simulator earlier in their career. We attribute the fact that MIM G residents performed better with the DaVss than the DaV G residents to the value of minimal exposure to dV-T as a way to overcome the discomfort of using the DaVss for the first time
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Analysis of Clinical Relevance and Predictive Factors for Postoperative Ascites after Liver Resection for Hepatocellular Carcinoma with Actual Long-Term Survival Analysis
No full textBackground: Ascites is one of the most common complications after liver resection. Although it is not generally considered to be an expression of postoperative liver failure, it is commonly associated with an increased rate of postoperative mortality. Objective: We evaluated the predictive factors and the clinical relevance of postoperative ascites, both for early and long-term results, using actuarial and actual long-term survival analysis. Materials and methods: A retrospective evaluation of 325 unselected and consecutive patients who received liver resection with hepatocellular carcinoma (HCC) was carried out. Overall survival and disease free survival according to the occurrence of postoperative ascites were computed. Results: No features linked to the technical aspect of the resection had a predictive value. The only feature related to the tumor was the posterior location of HCC. In the subgroup of cirrhotic patients with a posterior-side HCC, the rate of ascites was 34.9%; 51 out of 57 patients with ascites (89.5%) presented a posteriorly located HCC in cirrhosis. Roughly one-fifth of patients with postoperative ascites presented signs of liver failure, but in-hospital mortality was almost four-fold that of patients without ascites. Conclusion: A posterior location of HCC significantly increased the risk of ascites
Continuous Infusion of Local Anesthesia After Living Donor Nephrectomy: A Comparative Analysis
No full textIntroduction. Today local anesthetic wound infiltration is widely recognized as a useful adjunct in a multimodality approach to postoperative pain management. The effectiveness of continuous wound infusion of ropivacaine for postoperative pain relief after laparoscopic living donor nephrectomy was analyzed in this retrospective, comparative analysis. Methods. Twenty patients undergoing living donor nephrectomy were divided into two groups: standard analgesic therapy (n = 10) and ropivacaine continuous infusion group (n = 10). Results. We observed a significant difference in term of visual analogue scale scores, use of morphine, hospital stay, and bowel recovery in favor of the ropivacaine group. The cost analysis demonstrated an overall savings of 985 Euros/patient. Discussion. Surgical wound infusion with ropivacaine was safe and seemed to improve pain relief and accelerate recovery and discharge, reducing the overall costs of care. Postoperative pain control in the donor is of primary importance for better patient compliance and greater perceived quality of health care service
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