Erica Sutton

Use of the falciform ligament flap for closure of the esophageal hiatus in giant paraesophageal hernia.

ObjectivesLaparoscopic repair of a giant paraesophageal hiatal hernia remains a challenging procedure. Several techniques have been developed in efforts to achieve tension-free reconstruction of the esophageal hiatus. In this report, we describe a technique whereby the falciform ligament is used as an autologous onlay flap to achieve tension-free closure of the crural defect of a giant paraesophageal hernia (GPEH).DiscussionUse of the falciform ligament as a vascularized autologous onlay flap is a safe and effective procedure to obtain closure of the crural defect of a GPEH. The falciform ligament should be adequately mobilized from the anterior abdominal wall to prevent lateral tension on the flap, but care must be taken to avoid devascularization. Interrupted vertical mattress sutures are used to fix the falciform ligament to the left and right hiatal crurae.

Training techniques in laparoscopic donor nephrectomy: a systematic review

The learning curve to achieve competency in laparoscopic donor nephrectomy (LDN) is poorly outlined. Online databases were searched for training in LDN. Abstracts and manuscripts were excluded if they did not address introduction of a laparoscopic technique for donor nephrectomy. Relevant manuscripts were reviewed for surgical technique, use of animal models, co‐surgeons, surgeon specialty and training, institution type/volume, and assessment of training method. Forty‐four met inclusion criteria, with 75% describing the evolution from open to LDN. Eighty‐two percent were from academic centers, and 36% were from centers performing <25 donor nephrectomies each year. The learner was an attending surgeon 80% of the time, mostly urologists with prior laparoscopy or open nephrectomy experience. The learning curve, defined by decreased operating time, averaged 35 cases. Improved intra‐operative, patient, and recipient outcomes were observed for centers performing ≥50 LDNs annually. The United Network of Organ Sharing requires 15 cases as surgeon or assistant to be certified as the primary LDN surgeon. This falls below the described learning curve for LDN. The assessment of training and competency for LDN is heterogeneous, and objective learner‐based metrics could help surgeons and institutions reach a quality standard for performing this operation.

4. Ergonomics in Operating Room Design

This chapter reviews mechanical and cognitive ergonomics as human factors concepts, discusses the background work in other fields that has guided the development of surgical ergonomics, and presents the research on surgical workflow. Principles that should be used in undertaking mechanical and cognitive ergonomic research in the surgical arena and those that should be used to inform the design of ergonomically safe operating rooms in the future are elaborated.

Development of a human cadaver model for training in laparoscopic donor nephrectomy

The organ procurement network recommends a surgeon record 15 cases as surgeon or assistant for laparoscopic donor nephrectomies (LDN) prior to independent practice. The literature suggests that the learning curve for improved perioperative and patient outcomes is closer to 35 cases. In this article, we describe our development of a model utilizing fresh tissue and objective, quantifiable endpoints to document surgical progress, and efficiency in each of the major steps involved in LDN.