This study describes the educational experiences of left-handed (LH) surgeons and provides recommendations for educating LH trainees, who face challenges due to their handedness.A mixed methods analysis was performed. Semi-structured interviews were conducted with LH trainees, LH attendings, and right-handed (RH) attendings representing 4 hospitals within a large academic hospital system. Questions were curated from current literature to explore the educational experiences of LH trainees. Inductive and iterative coding techniques were employed to manually generate themes. Laterality questionnaires for skills in daily life and surgery were collected and analyzed.Laterality questionnaires demonstrate that LH trainees and surgeons are more mixed-handed and use their nondominant hand to a greater extent in surgery compared to daily life than RH attendings. Key themes were identified in the dimension of learning, including that initial decisions for which hand to use remain fixed throughout career, LH learning is largely self-directed, forced conformation to RH norms and microaggressions are common, LH instruments are rarely practical, and LH surgeons are advantaged with situational ambidexterity. Key themes related to teaching include that communication regarding handedness is lacking, RH surgeons are often unaware of/resistant to a LH approach, the onus is on the trainee to suggest accommodations to use their left hand, and attendings rarely effectively mentor LH learners in using their left hand.Left-handed surgeons face challenges in an environment designed for RH individuals, represented by themes regarding learning and teaching experiences of LH surgeons told by themselves and their teachers. Recommendations were created for LH trainees in learning, all attendings in teaching, LH attendings in their opportunity to mentor, and surgical societies in supporting LH trainees. Development of resources for LH trainees could fill a substantial gap. Exploration of how LH surgeons evolve situational ambidexterity could benefit all surgeons. 

The Right Way to Teach Lefties - Exploring the Experiences of Left-Handed Trainees and Surgeons.

Background Short-term outcomes of pancreatic surgery have improved globally during the last two decades. Long-term survival of resectable pancreatic ductal adenocarcinoma (PDAC) has also shown slight improvement. We describe a cohort of 566 consecutive pancreatectomies performed at a Northern Finnish tertiary center. We analyze the trends in short-term outcomes of all-cause pancreatic surgery and long-term survival of PDAC patients. Methods All pancreatic resections performed at the Oulu University Hospital during years 2000–2020 were included. Patient data was analyzed in four time periods (2000–2005, 2006–2010, 2011–2015 and 2016–2020). Clinicopathological parameters of patients and tumors, complication data and short-term mortality were recorded for all patients and compared between time quartiles. Long-term survival and administration rates of neo-, and/or adjuvant therapy of PDAC patients were analyzed. Results A total of 566 pancreatectomies were performed during the study period: 359 (63%) pancreatoduodenectomies (PDs), 130 (23.0%) open left pancreatectomies (LPs), 45 (8.0%) laparoscopic LPs, 26 (5.1%) total pancreatectomies (TPs), and 6 (1.1%) enucleations. Median age of patients was 63 [57–71] years, and 49% [267] of patients were men. Number of pancreatectomies per time period increased from 67 in 2000–2005 to 266 in 2016–2020. American Society of Anesthesiologists (ASA) Physical Classification III patients and T3 tumors were more frequently operated on in later time periods. Complication rates remained at constant low levels throughout the study period, but reoperation rate increased from 9.4% in 2000–2010 to 16.2% in 2011–2020. Short-term (90-day) mortality after pancreatectomy decreased from 3.1% to 0.74%, while 5-year survival improved from 14.3% in 2006–2011 to 21.4% in 2011–2015. Resection rate of diagnosed PDAC cases, as reported by the Finnish Cancer Registry (FCR) for the catchment area, increased from 3.2% to 14.9% over the study period. Conclusions The hospital volume of pancreatectomies has increased substantially, while complications and postoperative mortality have remained at acceptable levels. Long-term survival and resection rate of PDAC patients showed notable improvement over two decades.

Evolution of pancreatic surgery over time and effects of centralization—a single-center retrospective cohort study

Chloe Milton describes the challenges of being left handed in clinical environments that are designed for righthanded use

Medicine is designed for righthanded people.

pdf/umbilical-pilonidal-sinus-9e37vjwck2.pdf

Umbilical Pilonidal Sinus.

Abstract OBJECTIVES There is a lack of guidance and scant learning resources for left-handed (LH) cardiac surgery residents and surgeons. No objective data exists to evaluate the reality of the training experience of LH cardiac surgeons and residents. METHODS A 32-question survey was designed for left-handed cardiac surgeons and residents. The survey questions were aimed towards understanding the experiences of left-handed cardiac surgeons and residents in order to identify and determine where the challenges of LH in cardiac surgery lie. The survey was disseminated by the European Association for Cardio-thoracic Surgery (EACTS) through online platforms, social media and the EACTS website. RESULTS 74 total responses were gathered from the survey. 73% were true Left-handed operators. During residency, 78.1% of LH cardiac surgery residents had no excess to LH faculty. Of those with LH mentors, only 53.3% were supportive and helped teach LH techniques. As trainees, 49.3% considered coronary artery bypass (CABG) anastomosis to be the most difficult portion of LH technique. Upon initiating independent practice, LH cardiac surgeons consider being LH an advantage in comparison to residency. CONCLUSIONS In Left-handed cardiac surgery there is a lack of tailored surgical exposure, training guidance, standardization, learning tools and teaching resources. Training resources for LH cardiac surgeons and residents should be developed. 

Left-handed cardiac surgery and training: a survey-based assessment

Left‐handers make up 10%–12% of all surgeons. Surgical education and practice by nature has significant technical demands but there is a paucity of data on left‐handers and training in surgery. The surgical curriculum has no specific salutation or recognition of left‐handers and the contributions and challenges they represent.

Age of the leftie: the lived experience of left‐handed surgeons

Benchmarking Performance in Pancreatic Surgery: a Systematic Review of Published Quality Metrics

A 79 year old patient presented to hospital with nausea and an episode of haematemesis. She was receiving chemotherapy for low volume metastatic transitional cell carcinoma of the bladder. In the subsequent days she developed multiple episodes of both dark and bright red per rectal (PR) bleeding, with a haemoglobin drop to 75 g/L and thrombocytopenia. She was not on any anticoagulation. She was resuscitated with blood products and had two Computed Tomography (CT) angiograms that failed to demonstrate any active bleeding. She proceeded to a Technetium 99 m red cell scan and at the 10 minute mark there was a small focus of increased red cell activity within the left upper quadrant which progressed over the next 15 min. Corresponding single-photon emission computerized tomography (SPECT) images were highly suggestive of a proximal small bowel haemorrhage, possibly in the proximal jejunum (Fig. 1). She proceeded to a gastroscopy and colonoscopy. There was severe reflux oesophagitis and multiple superficial gastric ulcers, with normal proximal jejunum seen. No old or fresh blood was seen in the upper gastrointestinal tract. The colonoscope was only able to be advanced to the splenic flexure due to the presence of blood and clots. She was placed on intravenous proton pump inhibitor and began to improve. A few days later she developed recurrent melaena that was associated with a further haemoglobin drop to 65 g/L. She underwent a repeat gastroscopy which showed improved gastritis thus suggestive of an alternate source of bleeding, and a PillCam was deployed into the duodenum. Review of the images confirmed multiple angioectasia in the proximal third of the small bowel. Active bleeding from an arteriovenous malformation (AVM) was seen at 34% of transit time, and again at 46% (Fig. 2a, b). She underwent double balloon endoscopy and four AVMs in the proximal jejunum were treated with Argon Plasma Coagulation (APC). A resolution clip and tattoo were placed at this site for future localisation if her bleeding did not settle (Fig. 2c, d). Two days later she had further melaena and a haemoglobin drop to 43 g/L, with a repeat CT angiogram demonstrating active bleeding from the proximal small bowel and angiographic embolisation was organized (Fig. 3a). Right common femoral artery puncture was performed with preliminary images demonstrating a small irregular vessel in the region of the clip. A Prograte microcatheter was positioned into the relevant jejunal branch which was successfully coiled with two 4 mm 8 cm Concerto coils (Fig. 3b, c). Despite the above interventions, as well as multiple transfusions of blood and blood products, she had persistent melaena with an ongoing haemoglobin drop and subsequently altered vital signs. She proceeded to theatre and underwent a midline laparotomy. The affected jejunal segment was identified by the tattoo and a palpable clip. An enterotomy was made in this segment and

Resistive small bowel bleeding secondary to an arteriovenous malformation

Colonic lipoma (CL) is a rare cause of mechanical large bowel obstruction. The first case of CL was reported by Bauer in 1757. CL has a peak incidence in patients between 50 and 60 years of age, and more commonly in women than men. They most commonly arise in the ascending colon followed by the sigmoid colon. CL are rarely symptomatic and tend to be incidental findings although lipomas larger than 2 cm are more likely to cause symptoms such as abdominal pain, constipation, diarrhoea and haemorrhage. Lipomas larger than 4 cm possess a risk of bowel obstruction and intussusception, and become symptomatic greater than 75% of the time. A 59-year-old male presented to the emergency department (ED) with 2 months of intermittent right sided abdominal pain and change in bowel habit. External investigations including an abdominal ultrasound and stool cultures were unremarkable. The patient had multiple presentations to the ED with similar symptoms over the preceding months. A computed tomography (CT) abdomen with oral and IV contrast was performed which demonstrated a 5.1 cm fat density lesion in the right colon acting as the lead point for colonic intussusception (Fig. 1). The patient proceeded to an emergency laparoscopic right hemicolectomy. Upon insertion of the laparoscope, the colonic intussusception was confirmed and was able to be reduced with atraumatic bowel graspers (Fig. 2). The patient recovered well from the procedure. Histopathology demonstrated a benign submucosal lipoma measuring 60 mm in main dimension and changes associated with intussusception with crypt distortion, oedema and focal transmural ischaemic change. There was no evidence of dysplasia or

Colonic lipoma: a rare cause of intussusception

ABSTRACT Metastatic spread of invasive lobular breast cancer is rare. It can have a delayed and varied presentation that can mimic other bowel pathologies, such as colorectal cancer and inflammatory bowel disease, making its diagnosis difficult. In this study, we present two patients who required colonic resection due to malignant obstruction caused by metastatic invasive lobular carcinoma of the breast.

An unwelcome guest: two cases of colonic metastatic lobular breast cancer

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