D Nepomnayshy

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The Fundamentals of Laparoscopic Surgery certification is a milestone in surgical training, but residents often complete it too late to benefit from it during early operative experience. This paper recommends completing FLS by the end of the second postgraduate year so residents can build on those skills while still under close supervision. Earlier certification would give trainees a stronger laparoscopic foundation during the years when supervised practice matters most.

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In the ATLAS laparoscopic suturing curriculum, evaluating performance currently requires manual observation or video review, which is time-consuming. This study tested AI models to automatically predict completion time and errors in the needle-handling task, and found accurate predictions without human raters. Automated AI assessment could make proficiency-based surgical education more scalable and consistent.

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Personality traits shape how people prefer to learn, but their role in surgical education preferences is poorly understood. This study surveyed general surgery residents on personality dimensions and matched them to preferred teaching styles, finding meaningful correlations between introversion/extraversion and learning environment preferences. Understanding residents' personalities could help programs tailor teaching methods to improve learning and satisfaction.

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Surgical training has expanded far beyond basic laparoscopy to include robotic, endoscopic, and complex minimally invasive procedures. This review traces the evolution of simulation-based education for advanced laparoscopic skills, summarizing the evidence base and identifying gaps that remain. Simulation must continue to evolve alongside surgical practice to prepare trainees for the full breadth of modern operating.

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Communication in the operating room directly affects patient safety, but whether a surgeon's gender influences how nurses and anesthesia providers communicate with them is unknown. This study used a novel scoring tool to evaluate intraoperative communication patterns and found meaningful differences in the type and quality of interactions based on surgeon gender. Addressing communication disparities in the OR is a patient safety priority, not just an equity one.

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Surgeons performing bariatric operations frequently encounter livers that look abnormal, but how accurately they can identify true liver disease is unclear. This study presented surgeons with liver images in a simulated environment and found that visual assessment alone was unreliable for detecting non-cirrhotic liver disease. These findings argue against relying on intraoperative inspection and support standardized liver biopsy protocols during bariatric surgery.

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Resuscitative thoracotomy is a life-saving but rare procedure that most general surgery residents have minimal experience with. A regional survey found wide gaps in resident exposure and confidence, with most residents feeling unprepared to perform the procedure independently. A structured simulation-based curriculum for resuscitative thoracotomy is needed and feasible to implement.

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The Fundamentals of Laparoscopic Surgery program was designed over two decades ago, and the field has since changed significantly. This national survey of fellowship directors and fellows identified which laparoscopic skills are now considered truly fundamental and which have become obsolete or insufficient. The results will inform a revision of the FLS curriculum to reflect modern operative expectations.

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Surgical residents face significant financial stress from educational debt and low salaries during long training periods. This follow-up survey of New England general surgery residents found ongoing financial strain, with debt levels and financial literacy gaps persisting over time. Residency programs should incorporate financial wellness support to reduce a known driver of burnout.

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Whether injecting local anesthetic into the surgical space during laparoscopic inguinal hernia repair reduces post-operative pain is debated. This randomized double-blind placebo-controlled trial found no significant difference in pain scores between groups receiving local anesthetic and those receiving placebo. Routine local anesthetic instillation does not appear to improve pain control after laparoscopic TEP hernia repair.

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Surgical culture has begun prioritizing resident well-being, but longitudinal data tracking how well-being changes over training are scarce. This five-year multi-institutional survey of New England surgery residents found persistent rates of burnout and poor health maintenance, with limited improvement over the study period. Structural changes—not just wellness programs—are needed to durably improve surgical resident health.

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The COVID-19 pandemic accelerated adoption of virtual surgical education, but the evidence base for it was poorly organized. This systematic review evaluated virtual education literature across cognitive, psychomotor, and mentorship domains and produced evidence-based guidelines. These guidelines give programs a rigorous framework for deciding when and how to use virtual tools in surgical training.

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Laparoscopic procedures require a camera holder, which often creates crowding at the table and miscommunication. This study evaluated AutoLap, a robotic camera-holding system, and found it provided more stable and consistent imaging than human holders while improving ergonomics. Robotic camera systems offer a practical quality improvement for laparoscopic surgery without adding significant complexity.

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General surgery residency programs increasingly use social media to recruit trainees and build community, but usage patterns are uncharacterized. This study audited Facebook, Instagram, and Twitter accounts of surgery programs and found rapid growth in adoption, particularly Instagram, with wide variability in content quality and posting frequency. Programs that invest in social media strategy may gain a meaningful recruitment and engagement advantage.

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Surgical errors are inevitable, but training on how to recover from them is almost entirely absent from surgical education. This qualitative study of surgical trainees found that residents value error recovery skills, recognize their own gaps, and want more formal preparation. Incorporating error recovery training into surgical curricula would better prepare residents for the realities of independent practice.

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Weight loss after bariatric surgery varies widely between patients, and predicting who will benefit most remains difficult. This exploratory study examined whether microRNA profiles in blood before surgery could predict weight loss outcomes. While preliminary, the results identify specific miRNAs associated with weight loss response and support further investigation of genetic predictors of bariatric surgery success.

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Surgical training requires residents to develop not just technical skills but also the ability to manage mistakes in real time. A broad survey of North American surgical residents and fellows found that the majority had made intraoperative errors but felt inadequately prepared to recover from them. Formal error recovery training should be a core component of surgical education.

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Bariatric surgery is the most effective long-term treatment for severe obesity and its related conditions like diabetes and sleep apnea. This review covers the evidence base for bariatric procedures, patient selection criteria, and the emerging role of endoscopic and device-based interventions. It serves as a practical guide for clinicians managing patients with obesity who may benefit from surgical treatment.

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Parotid surgery risks damaging the facial nerve, and training for this procedure is limited by the rarity of cadaveric specimens. This study developed and validated a low-cost simulator using 3D-printed bone and copper-wire nerve replicas, with electrical feedback when the nerve is touched. Face and content validity were confirmed, offering a practical training tool for a high-stakes operation.

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Mastery learning theory holds that most trainees can reach expert performance with sufficient practice. This study tested whether surgical residents could achieve expert-level benchmarks on the six ATLAS laparoscopic suturing tasks and found that with deliberate practice, most reached the proficiency thresholds. Mastery learning is achievable in residency for laparoscopic suturing, supporting its integration into training programs.

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Defining what expert laparoscopic suturing looks like is a prerequisite for any valid training or assessment program. This Delphi study convened expert laparoscopic surgeons to reach consensus on the specific skills and behaviors that distinguish expert-level performance in laparoscopic suturing. The expert-derived competency framework underpins objective proficiency benchmarks for the ATLAS curriculum.

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The ATLAS laparoscopic suturing curriculum was developed to address gaps in advanced technical training, but whether simulation practice translates to better clinical performance is unknown. This study found that residents who practiced on ATLAS tasks improved their laparoscopic suturing in the operating room compared to controls. The result validates ATLAS as a training tool with real clinical impact.

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Paraesophageal hernia repair is a common operation, but long-term patient-reported outcomes are rarely captured. This retrospective study found that many patients report persistent symptoms years after open or laparoscopic repair, though most were satisfied with their decision to operate. These findings improve surgical consent conversations by giving patients realistic expectations for long-term outcomes.

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Incentive spirometry—breathing exercises with a small device—is routinely prescribed after bariatric surgery to prevent lung complications, but evidence for its benefit is lacking. This randomized trial found no difference in post-operative oxygen levels or pulmonary complications between patients who used incentive spirometry and those who did not. Routine incentive spirometry after bariatric surgery may not be necessary and could be safely omitted.

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The traditional residency application process relies heavily on grades and test scores, which may not predict clinical competence. This feasibility study incorporated a simulation workshop and teamwork activity into the surgery residency selection process and found that both applicants and evaluators responded positively. Simulation-based components are feasible to add to residency selection and capture skills the current process misses.

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The ATLAS advanced laparoscopic suturing curriculum required proficiency benchmarks grounded in expert performance data. This multicenter study involving expert surgeons across institutions established time and error thresholds for each of the six tasks. Multicenter-derived benchmarks carry broader validity than single-center standards and strengthen ATLAS as a national training tool.

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Simulation-based training in surgery requires institutional investment, and that investment must be justified with outcomes data. This paper argues that simulation's value proposition lies in its ability to improve patient safety, reduce errors, and accelerate trainee competency development. A clear framework for measuring and communicating simulation's value can help programs secure resources for expansion.

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Fellowship directors reported that graduating general surgery residents often lack sufficient laparoscopic suturing skills for fellowship-level work. A national survey identified both the need for and the preferred content of an advanced laparoscopic simulation curriculum. This needs assessment directly shaped the development of the ATLAS curriculum.

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Hospitals are increasingly evaluated on surgical outcomes, raising concerns about resident involvement in complex operations. Using national NSQIP data for laparoscopic gastric bypass, this study found no significant increase in 30-day complications or mortality when residents participated in the case. Resident involvement in bariatric surgery is safe and should be preserved for training purposes.

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Tracking whether surgical residents actually improve their technical skills over time is challenging but essential. This multi-institutional longitudinal study measured resident performance on standardized tasks annually over two years and found consistent, measurable progression across training levels. Longitudinal multi-institutional assessment is feasible and provides evidence that training programs are developing technical competence.

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After FLS established a minimum standard for laparoscopic competency, more advanced benchmarks were needed for senior trainees. This study evaluated six novel laparoscopic tasks designed to test higher-level skills and found they successfully differentiated novices from experts. The tasks have strong validity evidence and formed the foundation of the ATLAS advanced laparoscopic curriculum.

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Renal cell carcinoma that spreads to the stomach at the time of initial diagnosis is exceedingly rare, and such cases typically present with GI symptoms. This case report describes a patient with no GI symptoms who was found to have gastric metastasis from RCC simultaneously with the primary kidney tumor. The case alerts clinicians to include gastric metastasis in the workup of RCC even without typical symptoms.

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Surgery training programs need level-specific performance benchmarks to assess whether residents are progressing appropriately. This prospective multi-institutional study established normative performance data for each training year on standardized simulation tasks. These norms give programs objective milestones to use in competency-based residency evaluations.

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Obstructive sleep apnea is common in bariatric surgery patients, but whether all obese patients undergoing non-bariatric surgery need preoperative screening is unclear. This study of morbidly obese bariatric candidates found very high rates of undiagnosed OSA on formal testing. The results support routine preoperative sleep apnea screening in all morbidly obese surgical patients, not just those seeking bariatric procedures.

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A removable intestinal liner inserted through an endoscope creates a bypass that causes weight loss and improves diabetes without surgery. This randomized sham-controlled trial tested the duodenojejunal bypass liner as a pre-bariatric weight-loss tool and found meaningful weight loss with acceptable safety. The device offers a reversible, non-surgical option for patients who need to lose weight before bariatric surgery.

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Laparoscopic lumbar spine fusion has declined in use despite theoretical advantages, prompting questions about whether technique or training explains the trend. This prospective study used established risk-reduction methods—including careful patient selection and planned vessel management—to minimize complications during laparoscopic anterior lumbar interbody fusion. The results suggest the procedure remains viable when performed with appropriate technique and that the decline in use may be avoidable.