Implementation of an educational program for pancreaticoduodenectomy in a university hospital: a retrospective observational study

Objective:No ideal training system exists for pancreaticoduodenectomy(PD).We developed an educational system that uses an objective structured assessment of technical skills.Methods:This retrospective observational study was conducted using the data of consecutive trainees and patients who underwent PD from 2007 to 2013 in Kansai Medical University Hospital.The total score on the task checklist(21 parameters)for measuring technical performance during PD by self assessment and instructor assessment was compared between junior(JN)and hepatobiliary pancreatic(HBP)trainees at a university hospital.Surgical outcomes of 303 PDs(2007-2013)were also compared among JN trainees,HBP trainees,and instructors,and the present position of the trainees was investigated.This study was approved by the institutional review board of Kansai Medical University on May 26,2020.Results:The self-assessment score on the task checklist was significantly higher for the HBP trainees than for the JN trainees on all parts of PD(P<.001).The discrepancy between self-assessment and instructor assessment improved in 3 JN trainees after experience with the first 5 PDs.Although total score curves rose to the right in the JN group,scores in the HBP group were stable,at 70 or higher,which correlated with the instructor assessment.The 90-day and 30-day mortality rates were 1.6%and 0.3%,respectively.Mortality and morbidity after PD did not differ between the JN and HBP trainees or between the instructors and the trainees.Four of 10 trainees became board-certified expert surgeons of the Japanese Society of Hepatobiliary Pancreatic Surgery.Conclusion:These results indicated good construct validity of the task checklist system.This program was safely and effectively implemented in terms of surgical outcomes and final outcomes of trainees becoming board-certified expert surgeons.

Postoperative complications of umbilical loop colostomy for anorectal malformations in neonates compared with the conventional abdominal stoma: a non-randomized study

background We previously reported a pilot study of temporary umbilical loop colostomy for neonates with intermediate-type anorectal malformations(ARM)and recommended this technique because of its cosmetic excellence.We herein report the postoperative complications of umbilical stomas(US)compared with traditional abdominal stomas(AS).Methods From our institutional prospective database,we analyzed the patients with ARMs who underwent stoma creation at Kansai Medical University Hospital from January 1995 to November 2016.The surgical technique used to create the US had been performed since 2004.results US and AS were made for 12 and 27 patients with ARMs,respectively.The postoperative complication rates in patients who underwent US and AS had no significant difference(17%and 11%,p=0.6).The complications comprised a wound infection(one case of US),ileus(one case each of US and AS),mucosal prolapse(one case of AS),and depression(one case of AS).No emergency surgery was required for these complications.Conclusion For patients with ARMs,the umbilicus appears to be a safe alternative site for temporary loop colostomy.