From Moral Injury Vulnerability to Protective Equity: The Voyage Every Surgeon Must Take.

Objective: To examine the relationship between moral injury and surgical practice, further explore the concept of protective equity, and understand its role in mitigating the impact of morally injurious events throughout a surgical career.

Background: Moral injury in health care settings has evolved from Jonathan Shay's original definition, modified by Brett Litz and others, to encompass the psychological impact of adverse patient outcomes on medical practitioners. Early career surgeons may be particularly susceptible to moral injury, yet the factors influencing this vulnerability remain poorly understood.

Moral injury: An unspoken burden of transplant surgery.

Moral injury in health care is characterized as the lasting psychological, biological, and social impact on providers that occurs following an adverse patient outcome. Moral injury can contribute to second victim syndrome and lasting psychological harm. Although many surgeons face moral injury due to patient acuity and the potential for intraoperative or postoperative complications, the transplant ecosystem compounds the impact of moral injury.

Medical and Surgical Weight Loss as a Pathway to Renal Transplant Listing.

Purpose: Severe obesity is a barrier to listing for kidney transplantation due to concern for poor outcomes. This study aims to compare bariatric surgery with medical weight loss as a means of achieving weight loss and subsequent listing for renal transplant. We hypothesize that bariatric surgery will induce greater frequency of listing for transplant within 18 months of study initiation.

Simulation of Image-Guided Microwave Ablation Therapy Using a Digital Twin Computational Model.

Emerging computational tools such as healthcare digital twin modeling are enabling the creation of patient-specific surgical planning, including microwave ablation to treat primary and secondary liver cancers. Healthcare digital twins (DTs) are anatomically one-to-one biophysical models constructed from structural, functional, and biomarker-based imaging data to simulate patient-specific therapies and guide clinical decision-making. In microwave ablation (MWA), tissue-specific factors including tissue perfusion, hepatic steatosis, and fibrosis affect therapeutic extent, but current thermal dosing guidelines do not account for these parameters.

Comparison study of intraoperative surface acquisition methods on registration accuracy for soft-tissue surgical navigation.

Purpose: To study the difference between rigid registration and nonrigid registration using two forms of digitization (contact and noncontact) in human liver surgery.

Approach: A Conoprobe device attachment and sterilization process was developed to enable prospective noncontact intraoperative acquisition of organ surface data in the operating room (OR). The noncontact Conoprobe digitization method was compared against stylus-based acquisition in the context of image-to-physical registration for image-guided surgical navigation.

The use of an educational time-out in thyroid and parathyroid surgery to move the needle in periprocedural education.

Background: As surgical training shifts toward a competency-based paradigm, deliberate practice for procedures must be a point of focus. The purpose of this study was to assess the impact of an educational time-out intervention on educational experience and operative performance in endocrine surgery.

Methods: For 12 months, third-year general surgery residents used the educational time-out to establish an operative step of focus for thyroidectomy and parathyroidectomy procedures.

Fat Quantification Imaging and Biophysical Modeling for Patient-Specific Forecasting of Microwave Ablation Therapy.

Computational tools are beginning to enable patient-specific surgical planning to localize and prescribe thermal dosing for liver cancer ablation therapy. Tissue-specific factors (e.g.

Fireside Chats: A Novel Wellness Initiative for Medical Students in the COVID-19 Era.

To supplement preexisting wellness programming for the surgery clerkship, a faculty surgeon at Vanderbilt initiated Fireside Chats (FC) in 2015. Inspired by Franklin Roosevelt's Depression-era radio broadcasts, FC features small group sizes, off-campus excursions, and a reimagining of the mentor-mentee relationship that eschews hierarchy in favor of deep, mutualistic connections in both personal and professional domains. Here we describe the rationale and implementation of FC and present survey data that demonstrate the warm reception of FC and its efficacy in stewarding the mental health of medical students.

Effect of Donor Transaminase Levels on Graft Survival Following Liver Transplant: An Analysis of the Organ Procurement and Transplantation Network Database.

Objectives: Despite data showing equivalent outcomes between grafts from marginal versus standard criteria deceased liver donors, elevated donor transaminases constitute a frequent reason to decline potential livers. We assessed the effect of donor transaminase levels and other characteristics on graft survival.

Materials And Methods: We performed a retrospective cohort analysis of adult first deceased donor liver transplant recipients with available transaminase levels registered in the Organ Procurement and Transplantation Network database (2008-2018).

Living vs deceased donor liver transplantation in cholestatic liver disease: An analysis of the OPTN database.

Background: Living donor liver transplantation (LDLT) and donation after circulatory death (DCD) can expand the donor pool for cholestatic liver disease (CLD) patients. We sought to compare the outcomes of deceased donor liver transplant (DDLT) vs LDLT in CLD patients.

Methods: Retrospective cohort analysis of adult CLD recipients registered in the OPTN database who received primary LT between 2002 and 2018.

Primary Heptaic Melanoma or Melanoma of Unknown Primary?

Melanoma is the deadliest malignancy of the skin with an estimated 91 000 new annual cases with 9300 deaths in 2018. Metastatic disease generally presents with identification of known primary lesion; however, in 3.2% of patients, metastatic disease is discovered with unknown primary lesion/site.

Obesity in Liver Transplantation: A Risk Factor for Unplanned Reoperation and Prolonged Operative Time.

Selection of orthotopic liver transplantation (OLT) candidates is increasingly inclusive of patients with high BMI. We aim to characterize the influence of obesity on the surgical outcome measures of prolonged operative time and unplanned reoperation. We reviewed the records of obese and normal weight OLT recipients over a 10-year period from a single institution.

A Preoperative Educational Time-Out is Associated with Improved Resident Goal Setting and Strengthens Educational Experiences.

Objective: The purpose of this study was to assess the impact of a preoperative Educational Time-Out (ETO) with structured postoperative feedback on resident preoperative goal-setting and the educational experience of a clinical rotation.

Design: A preoperative ETO was developed during which trainees and faculty jointly identified an operative goal and discussed the trainee's operative autonomy. Postoperative feedback with a smartphone application was encouraged.

The Abdominal Transplant Surgery Workforce: Current state and future trends.

Transplant surgical workforce concerns have arisen in the last 5 years as reflected in challenges securing job opportunities for new fellows. The present survey was designed by the ASTS Membership and Workforce Committee to describe the current practice characteristics of transplant centers in order to estimate changes in the workforce. The survey questionnaire requested information about the transplant programs, the transplant surgeons involved in the program, and the estimated changes in the staffing of the program over the next 3 years.

Preoperative goal setting and perioperative communication in an academic training institution: Where do we stand?

Background: We collected data regarding specific aspects of perioperative surgical education within our institution's Section of Surgical Sciences as a needs assessment.

Methods: Categorical general surgery residents and attending surgeons were queried regarding their perceptions of resident preoperative planning and perioperative communication.

Results: The overall response rate was 81%, with 35 resident and 54 faculty respondents.

Characterization and correction of intraoperative soft tissue deformation in image-guided laparoscopic liver surgery.

Laparoscopic liver surgery is challenging to perform due to a compromised ability of the surgeon to localize subsurface anatomy in the constrained environment. While image guidance has the potential to address this barrier, intraoperative factors, such as insufflation and variable degrees of organ mobilization from supporting ligaments, may generate substantial deformation. The severity of laparoscopic deformation in humans has not been characterized, and current laparoscopic correction methods do not account for the mechanics of how intraoperative deformation is applied to the liver.

Utility of [F]FSPG PET to Image Hepatocellular Carcinoma: First Clinical Evaluation in a US Population.

Purpose: Non-invasive imaging is central to hepatocellular carcinoma (HCC) diagnosis; however, conventional modalities are limited by smaller tumors and other chronic diseases that are often present in patients with HCC, such as cirrhosis. This pilot study evaluated the feasibility of (4S)-4-(3-[F]fluoropropyl)-L-glutamic acid ([F]FSPG) positron emission tomography (PET)/X-ray computed tomography (CT) to image HCC. [F]FSPG PET/CT was compared to standard-of-care (SOC) magnetic resonance imaging (MRI) and CT, and [C]acetate PET/CT, commonly used in this setting.

Refractory anastomotic bile leaks after orthotopic liver transplantation are associated with hepatic artery disease.

Background And Aims: Anastomotic bile leaks are common after orthotopic liver transplant (OLT), and standard treatment consists of placement of a biliary endoprosthesis. The objectives of this study were to identify risk factors for refractory anastomotic bile leaks and to determine the morbidity associated with refractory bile leaks after OLT.

Methods: Consecutive adult patients who underwent ERCP for treatment of post-OLT biliary adverse events between 2009 and 2014 at a high-volume transplant center were retrospectively identified.