AMPATH Surgical App: Open Appendectomy

Background/Objective: Due to a geographic shortage of surgical providers within Kenya, doctors without surgical training are expected to complete emergency surgical procedures. The Academic Model Providing Access to Healthcare (AMPATH) surgical team is developing an education module, delivered via mobile phone app and self-made simulators, dedicated to the skills necessary to complete open appendectomy. We hypothesize that our model and curriculum will provide a low-cost method of effectively simulating the open appendectomy. Methods: After developing a step-based curriculum, an initial prototype of a model for the appendectomy was constructed. Expert academic surgeons from Indiana University were identified to test the prototype by performing an open appendectomy on the model. Feedback on both the model and the procedure was obtained via recorded video and REDCap. Results: A total of 8 expert surgeons were consulted on the model, each presented with an updated version of the appendectomy model and procedure based on feedback. Experts provided feedback on the model and each substep of the curriculum. Overall, the curriculum was clear with each substep receiving a median score of at least 82 out of 100 for clarity. While the model received lower scores in utility and “realism, expert feedback was incorporated in an iterative process such that latter models demonstrated net improvement in the realism and utility of several substeps, including “the appendectomy”. Conclusion: A low-cost appendectomy model with corresponding curriculum was developed, and refined with expert feedback, to facilitate this project’s transition to its next stage – testing on medical trainees. Additionally, the model and curriculum will enable the development of an AI algorithm to give the learner real-time feedback as they perform the simulation. Implications: Ultimately, this study may create a platform that increases access to best possible practice and improves outcomes in settings where surgical education is limited.

Controversial Areas in Axillary Staging: Are We Following the Guidelines?

Background Sentinel lymph node biopsy (SLNB) has been the standard of care for clinically node-negative women with invasive breast cancer (IBC); however, there is less agreement on whether to perform SLNB when the risk of metastasis is low or when it does not affect survival or locoregional control. Methods An Institutional Review Board-approved survey was sent to members of the American Society of Breast Surgeons asking in which scenarios surgeons would recommend SLNB. Descriptive statistics and multivariable analysis were performed using SPSS software. Results There was a 23% response rate; 68% identified as breast surgical oncologists, 6% as surgical oncologists, 24% as general surgeons, and 2% as other. The majority practiced in a community setting (71%) versus an academic setting (29%). In a healthy female with clinical T1N0 hormone receptor-positive (HR+) IBC, 83% favored SLNB if the patient was 75 years of age, versus 35% if the patient was 85 years of age. Academic surgeons were less likely to perform axillary staging in a healthy 75-year-old (odds ratio [OR] 0.51 [0.32–0.80], p = 0.004) or a healthy 85-year-old (OR 0.48 [0.31–0.74], p = 0.001). For DCIS, 32% endorsed SLNB in women undergoing lumpectomy, with breast surgical oncologists and academic surgeons being less likely to endorse this procedure (OR 0.54 [0.36–0.82], p = 0.028; and OR 0.53 [0.34–0.83], p = 0.005, respectively). Conclusions Despite studies showing that omitting SLNB in older patients with HR+ IBC does not impact regional control or survival, most surgeons are still opting for axillary staging. In addition, one in three are performing SLNB for lumpectomies for DCIS. Breast surgical oncologists and academic surgeons were more likely to be practicing based on recent data and guidelines. Practice patterns are changing but there is still room for improvement.

Demystifying the potential of Global surgery for Public health

Remarkable gains have been made in global health in the last 25 years, and surgical care is anintegral component of healthcare systems for countries at all levels of development. Globalsurgery, which global surgery, which comprises clinical, educational, and researchcollaborations to improve surgical care between academic surgeons in high-income countriesand low- and middle-income countries (LMICs) and their affiliated academic institutions, hasgrown significantly. Global surgery may resonate most with those in low-or-middle-incomecountries (LCMICs), where basic surgery needs are rarely met, and even the most trivialresource may be hard to obtain on a permanent or reliable basis. Therefore, considering this,this article provides an overview on various factors defining the interface between surgery andpublic health at a global level and discuss future directions.