Publications by authors named "Salvador Morales-Conde"

97 Publications

Analysis of the broadcasting and perceived utility through the implementation of a virtual training platform during the pandemic.

Cir Esp (Engl Ed) 2022 Jul 7. Epub 2022 Jul 7.

Servicio de Cirugía General y Digestiva, Hospital Morales Meseguer, Murcia, Spain.

Introduction: The SARS-CoV-2 pandemic has affected training opportunities for healthcare professionals partly because face to face courses were cancelled. This study analyzes the results of participation and satisfaction of the AEC Virtual Classroom sessions during the first year.

Methods: The AEC Virtual Classroom includes a combined format of weekly Webinar broadcast live that can be viewed on a delayed basis in a virtual platform. In this study, the results in its first year are evaluated considering the number of live participants, the delayed views and the global reach; as well as the results of the satisfaction survey in each of the sessions (0-10).

Results: From 16/04/2020 to 15/04/2021, 50 sessions of the Virtual Classroom AEC were held. The average scope of the sessions was 509 ± 288 views with a range between 196 and 149. At the times of highest incidence of cases during the pandemic, a decrease in live participants was observed 275 ± 135 vs. 391 ± 233 (P = 0.032). The mean score on the format was 8.46 ± 0.31/10. The best-scored sessions were those of the subject related to coloproctology with a statistically significant difference in the mean score 8.79 ± 0.42 vs. 8.39 ± 0.27 (P = 0.035). 90% of users considered the sessions useful. 97.2% of respondents believe that the sessions should be maintained after the pandemic.

Conclusions: The AEC Virtual Classroom has had very good results in the first year, proving to be a useful surgical teaching tool that will foreseeably survive once the pandemic is over.
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http://dx.doi.org/10.1016/j.cireng.2021.10.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9259185PMC
July 2022

Primary closure of the midline abdominal wall defect during laparoscopic ventral hernia repair: analysis of risk factors for failure and outcomes at 5 years follow-up.

Surg Endosc 2022 Jun 21. Epub 2022 Jun 21.

Unit of General and Digestive Surgery, Hospital Quirónsalud Sagrado Corazón, Seville, Spain.

Background: The primary aim of this prospective study is to report bulging and recurrence rates and to analyze the risk factors responsible for failure, after laparoscopic ventral hernia repair (LVHR) with primary closure of defect (PCD) using a running suture and intraperitoneal mesh placement, at 5-year follow-up. The secondary endpoint is to evaluate 30-day postoperative complications, seroma, and pain.

Methods: PCD failure was defined as the presence of postoperative bulging and/or recurrence. Pain was evaluated using a visual analogue scale (VAS). After surgery, fifty-eight patients underwent clinical examination and computed tomography scan to diagnose bulging, recurrence, and seroma (classified according to the Morales-Conde classification).

Results: At 60 months follow-up, recurrence was observed in five patients (8.6%), while bulging, not needing a surgical treatment, occurred in fifteen patients (25.9%). Chronic obstructive pulmonary disease (COPD) is the only risk factor responsible for both outcomes together, bulging and recurrences (p = 0.029), while other considered risk factors as gender, age, body mass index, diabetes, smoke habits, primary or incisional hernia and the ratio defect width/transverse abdominal axis did not achieve the statistically significance. Clinical seroma was diagnosed at one month in eight patients (13.8%). Seromas were observed at one year of follow-up. During the follow-up, pain reduction occurred.

Conclusion: LVHR has evolved toward more anatomical concepts, with the current trend being the abdominal wall anatomical reconstruction to improve its functionality, reducing seroma rates. Based on results obtained, PCD is a reliable technique with excellent recurrence rate at 5 years follow-up, even when the defect closure may generate tension at the midline. On the other hand, this tension could be related with high bulging rate at long-term, particular in case of patients with COPD.
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http://dx.doi.org/10.1007/s00464-022-09374-9DOI Listing
June 2022

Trends of social networks in the American College of Surgeons Clinical Congress and the Congreso Nacional de Cirugía. Analysis of the #ACSCC20 and #CNCirugia2020.

Cir Esp (Engl Ed) 2022 Sep 15;100(9):562-568. Epub 2022 Jun 15.

Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain.

Aim: The objective of this study is to analyze the impact of the congresses of the American College of Surgeons (ACSCC2020) and the National Surgery Congress of the Spanish Association of Surgeons (CNC2020) in virtual format due to the SARS-CoV2 pandemic according to the fingerprint.

Material And Methods: The Twitter hashtags # ACSCC20 and # CNCirugia2020 were studied to determine tweets, retweets, users and impressions. The data on the accounts with the greatest influence and the historical evolution of the congresses between 2015 and 2020 were analyzed. We used the symplur software to collect and analyze the data.

Results: Between 2015 and 2017 there was a consistent increase in the number of tweets, participants and impressions. Between 2018 and 2020, the ACS maintains the number of impressions with the fewest number of tweets. However, the CNC continues to grow and achieves its best metrics in 2020. We found statistically significant differences between the most prolific accounts of the ACSCC versus the CNC (P < .002) but there are no differences between the 10 most influential accounts (P = ,19) or the accounts with the highest number of impressions (P = .450) CONCLUSIONS: Virtual congresses generate a global impact through the use of Twitter for the dissemination of knowledge. In the present 2020, the growth of the impact on social networks has been proportionally greater in the CNC than in the ACSCC. However, the ACS virtual congress generated the greatest impact on social networks measured by the number of users, tweets and impressions between 2015 and 2020.
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http://dx.doi.org/10.1016/j.cireng.2022.06.017DOI Listing
September 2022

Indocyanine green (ICG) fluorescence guide for the use and indications in general surgery: recommendations based on the descriptive review of the literature and the analysis of experience.

Cir Esp (Engl Ed) 2022 Sep 11;100(9):534-554. Epub 2022 Jun 11.

Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain; UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Civitavecchia, Rome, Italy. Electronic address:

Indocyanine Green is a fluorescent substance visible in near-infrared light. It is useful for the identification of anatomical structures (biliary tract, ureters, parathyroid, thoracic duct), the tissues vascularization (anastomosis in colorectal, esophageal, gastric, bariatric surgery, for plasties and flaps in abdominal wall surgery, liver resection, in strangulated hernias and in intestinal ischemia), for tumor identification (liver, pancreas, adrenal glands, implants of peritoneal carcinomatosis, retroperitoneal tumors and lymphomas) and sentinel node identification and lymphatic mapping in malignant tumors (stomach, breast, colon, rectum, esophagus and skin cancer). The evidence is very encouraging, although standardization of its use and randomized studies with higher number of patients are required to obtain definitive conclusions on its use in general surgery. The aim of this literature review is to provide a guide for the use of ICG fluorescence in general surgery procedures.
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http://dx.doi.org/10.1016/j.cireng.2022.06.023DOI Listing
September 2022

Thoracoscopic resection of esophageal diverticulum assisted by white light under ICG mode.

Cir Esp (Engl Ed) 2022 08 18;100(8):511. Epub 2022 May 18.

Unidad de Innovación en Cirugía Mínimamente Invasiva, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain.

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http://dx.doi.org/10.1016/j.cireng.2022.05.014DOI Listing
August 2022

Is the single-incision laparoscopic duodenojejunostomy factible, safe and effective for patients with Wilkie's syndrome?

Cir Esp (Engl Ed) 2022 07 6;100(7):450-452. Epub 2022 May 6.

Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain.

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http://dx.doi.org/10.1016/j.cireng.2021.04.026DOI Listing
July 2022

Editorial: Mesh Complications in Hernia Surgery.

Front Surg 2022 7;9:841672. Epub 2022 Mar 7.

Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.

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http://dx.doi.org/10.3389/fsurg.2022.841672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8974239PMC
March 2022

The Influence of an Online Platform (Hernia U) in Surgical Education and Patient Management.

JSLS 2022 Jan-Mar;26(1)

Division of General Surgery, NYU Langone Health, New York, NY, USA.

Introduction: Hernia U was created with the objective to expand the educational landscape of abdominal wall surgery. It is an online platform where surgeons can register with no cost and subscribe for different courses. The aim of this study is to evaluate the impact of the platform on patient management and surgical education.

Methods: A questionnaire regarding the influence of Hernia U in surgical education and patient management was emailed to professionals who had previously participated in any course of the Hernia U. Variables were shown with absolute and relative frequencies. Pearson's χ and Fisher's exact test were performed to analyze relationships between variables as appropriate.

Results: Nine hundred three participants responded to the questionnaire. Seven hundred fifty-two (83.3%) were men; 248 (27.4%) participants were older than 50 years old; 240 (26.6%) were between 41 and 50 years old. Two hundred seventy-four (30.4%) participants had been in practice for more than 20 years, 242 (26.8%) between 11 and 20 years, and 161(17.8%) between 5 and 10 years. When analyzing the impact of time spent on the platform, spending over an hour per week was significantly associated with self-reported change in practice patterns compared to spending less than an hour per week (p < 0.0003). More experienced surgeons (10 or more years of practice) were less likely to change their practice patterns when compared to less experienced surgeons.

Conclusion: Hernia U has allowed surgeons to change their daily practice and to boost their education. Surgeons spending more than one hour weekly in the platform are more likely to adopt changes.
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http://dx.doi.org/10.4293/JSLS.2021.00085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8896819PMC
March 2022

Individualised splenic hilum lymphadenectomy in gastric cancer: ICG-guided mapping.

Cir Esp (Engl Ed) 2022 03 23;100(3):173. Epub 2022 Feb 23.

Hospital Universitario Virgen del Rocío, Sevilla, Spain.

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http://dx.doi.org/10.1016/j.cireng.2022.02.007DOI Listing
March 2022

EAES rapid guideline: systematic review, network meta-analysis, CINeMA and GRADE assessment, and European consensus on bariatric surgery-extension 2022.

Surg Endosc 2022 03 20;36(3):1709-1725. Epub 2022 Jan 20.

Surgical Department, Mediterranean Hospital of Cyprus, Limassol, Cyprus.

Background: The European Association for Endoscopic Surgery Bariatric Guidelines Group identified a gap in bariatric surgery recommendations with a structured, contextualized consideration of multiple bariatric interventions.

Objective: To provide evidence-informed, transparent and trustworthy recommendations on the use of sleeve gastrectomy, Roux-en-Y gastric bypass, adjustable gastric banding, gastric plication, biliopancreatic diversion with duodenal switch, one anastomosis gastric bypass, and single anastomosis duodeno-ileal bypass with sleeve gastrectomy in patients with severe obesity and metabolic diseases. Only laparoscopic procedures in adults were considered.

Methods: A European interdisciplinary panel including general surgeons, obesity physicians, anesthetists, a psychologist and a patient representative informed outcome importance and minimal important differences. We conducted a systematic review and frequentist fixed and random-effects network meta-analysis of randomized-controlled trials (RCTs) using the graph theory approach for each outcome. We calculated the odds ratio or the (standardized) mean differences with 95% confidence intervals for binary and continuous outcomes, respectively. We assessed the certainty of evidence using the CINeMA and GRADE methodologies. We considered the risk/benefit outcomes within a GRADE evidence to decision framework to arrive at recommendations, which were validated through an anonymous Delphi process of the panel.

Results: We identified 43 records reporting on 24 RCTs. Most network information surrounded sleeve gastrectomy and Roux-en-Y gastric bypass. Under consideration of the certainty of the evidence and evidence to decision parameters, we suggest sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass over adjustable gastric banding, biliopancreatic diversion with duodenal switch and gastric plication for the management of severe obesity and associated metabolic diseases. One anastomosis gastric bypass and single anastomosis duodeno-ileal bypass with sleeve gastrectomy are suggested as alternatives, although evidence on benefits and harms, and specific selection criteria is limited compared to sleeve gastrectomy and Roux-en-Y gastric bypass. The guideline, with recommendations, evidence summaries and decision aids in user friendly formats can also be accessed in MAGICapp:  https://app.magicapp.org/#/guideline/Lpv2kE CONCLUSIONS: This rapid guideline provides evidence-informed, pertinent recommendations on the use of bariatric and metabolic surgery for the management of severe obesity and metabolic diseases. The guideline replaces relevant recommendations published in the EAES Bariatric Guidelines 2020.
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http://dx.doi.org/10.1007/s00464-022-09008-0DOI Listing
March 2022

Use of the indocyanine green mode to visualize the white light in esophagogastric surgery.

Cir Esp (Engl Ed) 2022 Feb 13;100(2):102. Epub 2022 Jan 13.

Hospital Virgen del Rocío, Sevilla, Spain.

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http://dx.doi.org/10.1016/j.cireng.2021.04.024DOI Listing
February 2022

[Analysis Of The Broadcasting And Perceived Utility Through The Implementation Of A Virtual Training Platform During The Pandemic].

Cir Esp 2021 Oct 25. Epub 2021 Oct 25.

Servicio de Cirugia General y Digestiva. Hospital Morales Meseguer, Murcia, Spain.

Introduction: The SARS-COV-2 pandemic has affected training opportunities for healthcare professionals partly because face to face courses were cancelled. This study analiyzes the results of participation and satisfaction of the AEC Virtual Classroom sessions during the first yearMethods: The AEC Virtual Classroom includes a combined format of weekly webinar broadcast live that can be viewed on a delayed basis in a virtual platform. In this study, the results in its first year are evaluated considering the number of live participants, the delayed views and the global reach; as well as the results of the satisfaction survey in each of the sessions (0-10)Results: From 16/04/2020 to 15/04/2021, 50 sessions of the Virtual Classroom AEC were held. The average scope of the sessions was 509±288 views with a range between 196 and 149. At the times of highest incidence of cases during the pandemic, a decrease in live participants was observed 275±135 vs 391±233 (p=0,032) The mean score on the format was 8,46± 0,31/10. The best-scored sessions were those of the subject related to coloproctology with a statistically significant difference in the mean score 8,79±0,42 vs 8,39±0,27 (p=0,035). 90% of users considered the sessions useful. 97,2% of respondents believe that the sessions should be maintained after the pandemic.

Conclusion: The AEC virtual Classroom has had a very good results in the first year, proving to be a useful surgical teaching tool that will foreseeably survive once the pandemic is over.
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http://dx.doi.org/10.1016/j.ciresp.2021.10.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8542455PMC
October 2021

Complete mesocolon excision guided by indocyanine green for right colonic cancer.

Colorectal Dis 2021 10 24;23(10):2779-2780. Epub 2021 Jul 24.

Innovation and Minimal Invasive Surgery Unit, Virgen del Rocio University Hospital, Seville, Spain.

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http://dx.doi.org/10.1111/codi.15797DOI Listing
October 2021

Teaching in times of crisis: Virtual classroom AEC. Influence of COVID-19 on surgeons of the future.

Cir Esp (Engl Ed) 2021 Aug-Sep;99(7):479-481. Epub 2021 Jun 21.

Servicio de Cirugía General y Digestiva, Hospital Universitario de Getafe, Madrid, Spain.

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http://dx.doi.org/10.1016/j.cireng.2021.06.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8214937PMC
August 2021

Guideline Assessment Project II: statistical calibration informed the development of an AGREE II extension for surgical guidelines.

Surg Endosc 2021 08 22;35(8):4061-4068. Epub 2021 Jun 22.

Department of Primary Education, School of Education, University of Ioannina, 451 10, Ioannina, Greece.

Objective: To inform the development of an AGREE II extension specifically tailored for surgical guidelines. AGREE II was designed to inform the development, reporting, and appraisal of clinical practice guidelines. Previous research has suggested substantial room for improvement of the quality of surgical guidelines.

Methods: A previously published search in MEDLINE for clinical practice guidelines published by surgical scientific organizations with an international scope between 2008 and 2017, resulted in a total of 67 guidelines. The quality of these guidelines was assessed using AGREE II. We performed a series of statistical analyses (reliability, correlation and Factor Analysis, Item Response Theory) with the objective to calibrate AGREE II for use specifically in surgical guidelines.

Results: Reliability/correlation/factor analysis and Item Response Theory produced similar results and suggested that a structure of 5 domains, instead of 6 domains of the original instrument, might be more appropriate. Furthermore, exclusion and re-arrangement of items to other domains was found to increase the reliability of AGREE II when applied in surgical guidelines.

Conclusions: The findings of this study suggest that statistical calibration of AGREE II might improve the development, reporting, and appraisal of surgical guidelines.
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http://dx.doi.org/10.1007/s00464-021-08604-wDOI Listing
August 2021

Trends of social networks in the American College of Surgeons Clinical Congress and the Congreso Nacional de Cirugía. Analysis of the #ACSCC20 and #CNCirugia2020.

Cir Esp (Engl Ed) 2021 May 5. Epub 2021 May 5.

Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, España.

Aim: The objective of this study is to analyze the impact of the American College of Surgeons Clinical Congress (ACSCC2020) and the National Surgery Congress of the Spanish Association of Surgeons (CNC2020) in virtual format due to the SARS-CoV-2 pandemic according to the fingerprint.

Material And Methods: The Twitter hashtags # ACSCC20 and # CNCirugia2020 were studied to determine tweets, retweets, users and impressions. The data on the accounts with the greatest influence and the historical evolution of the congresses between 2015 and 2020 were analyzed. We used the symplur software to collect and analyze the data.

Results: Between 2015 and 2017 there was a consistent increase in the number of tweets, participants and impressions. Between 2018 and 2020, the ACS maintains the number of impressions with the fewest number of tweets. However, the CNC continues to grow and achieves its best metrics in 2020. We found statistically significant differences between the most prolific accounts of the ACSCC versus the CNC (P<.002) but there are no differences between the 10 most influential accounts (P=.19) or the accounts with the highest number of impressions (P=.450).

Conclusions: Virtual congresses generate a global impact through the use of Twitter for the dissemination of knowledge. In the present 2020, the growth of the impact on social networks has been proportionally greater in the CNC than in the ACSCC. However, the ACS virtual congress generated the greatest impact on social networks measured by the number of users, tweets and impressions between 2015 and 2020.
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http://dx.doi.org/10.1016/j.ciresp.2021.04.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165562PMC
May 2021

Is the single-incision laparoscopic duodenojejunostomy factible, safe and effective for patients with Wilkiés syndrome?

Cir Esp (Engl Ed) 2021 May 28. Epub 2021 May 28.

Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen del RocíoSevilla, España.

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http://dx.doi.org/10.1016/j.ciresp.2021.04.024DOI Listing
May 2021

Use of the indocyanine green mode to visualize the white light in esophagogastric surgery.

Cir Esp (Engl Ed) 2021 May 27. Epub 2021 May 27.

Hospital Virgen del Rocío, Sevilla, España.

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http://dx.doi.org/10.1016/j.ciresp.2021.04.023DOI Listing
May 2021

Hernia U: challenges and opportunities of an online platform for surgical education.

Rev Col Bras Cir 2021 31;48:e20202873. Epub 2021 Mar 31.

- Montefiore Medical Center, Director Abdominal Wall Program, Department of Surgery - The Bronx - NY - Estados Unidos.

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http://dx.doi.org/10.1590/0100-6991e-20202873DOI Listing
June 2021

Management of postoperative complications after laparoscopic left hemicolectomy: an approach in modern times after incorporation of indocyanine green and full mobilization of the splenic flexure.

Minerva Surg 2021 Aug 14;76(4):303-309. Epub 2021 Apr 14.

Unit of General and Digestive Surgery, Quironsalud Sagrado Corazón Hospital, Sevilla, Spain.

Background: The aim of this study was to report our experience in the management of complications after laparoscopic left hemicolectomy (LLH) after the incorporation in our clinical practice of intraoperative indocyanine green (ICG) fluorescence angiography (FA).

Methods: In our last period after incorporation of ICG-FA, 277 unselected consecutive patients underwent laparoscopic colorectal surgery with this technology. Ninety-seven (35%) right hemicolectomy, 19 segmental resection of the splenic flexure (6.9%), 54 anterior resection of the rectum (19.5%) and 107 LLH (38.6%) were performed. Complications were graded according to Clavien-Dindo classification, and anastomotic leakages (AL) were graded according to Clavien-Dindo classification and to International Study Group of Rectal Cancer (ISGRC) classification.

Results: Eight surgical and one medical complications (8.4%) were observed. Two AL occurred (1.9%). One drained spontaneously by drainage placed intraoperatively (Clavien-Dindo I, ISGRC A) and one treated by laparoscopic peritoneal lavage, leakage suture and ileostomy (Clavien-Dindo III-b, ISGRC C). Other complications were: wound infection (Clavien-Dindo II) (2); postoperative anemia caused by rectorrhagia (Clavien-Dindo II) (2); pelvic abscess between bladder and uterus (Clavien-Dindo III-a) (1); hemoperitoneum secondary to inferior mesenteric artery bleeding treated with peritoneal lavage and hemostasis (Clavien-Dindo III-b) (1); atrial fibrillation (Clavien-Dindo II) (1). All complications have been resolved.

Conclusions: The complication rate after LLH after the incorporation of ICG-FA is low, since the number of AL have dramatically decreased in comparison to our previous experience. The management of these patients proved to be safe and effective due to in all cases the complication has been resolved. Further studies are required to standardize the management of these patients.
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http://dx.doi.org/10.23736/S2724-5691.21.08642-9DOI Listing
August 2021

International Delphi Expert Consensus on Safe Return to Surgical and Endoscopic Practice: From the Coronavirus Global Surgical Collaborative.

Ann Surg 2021 07;274(1):50-56

Southern Illinois University School of Medicine, Departments of Surgery and Medical Education, Springfield, Illinois.

Objective: The aim of this work is to formulate recommendations based on global expert consensus to guide the surgical community on the safe resumption of surgical and endoscopic activities.

Background: The COVID-19 pandemic has caused marked disruptions in the delivery of surgical care worldwide. A thoughtful, structured approach to resuming surgical services is necessary as the impact of COVID-19 becomes better controlled. The Coronavirus Global Surgical Collaborative sought to formulate, through rigorous scientific methodology, consensus-based recommendations in collaboration with a multidisciplinary group of international experts and policymakers.

Methods: Recommendations were developed following a Delphi process. Domain topics were formulated and subsequently subdivided into questions pertinent to different aspects of surgical care in the COVID-19 crisis. Forty-four experts from 15 countries across 4 continents drafted statements based on the specific questions. Anonymous Delphi voting on the statements was performed in 2 rounds, as well as in a telepresence meeting.

Results: One hundred statements were formulated across 10 domains. The statements addressed terminology, impact on procedural services, patient/staff safety, managing a backlog of surgeries, methods to restart and sustain surgical services, education, and research. Eighty-three of the statements were approved during the first round of Delphi voting, and 11 during the second round. A final telepresence meeting and discussion yielded acceptance of 5 other statements.

Conclusions: The Delphi process resulted in 99 recommendations. These consensus statements provide expert guidance, based on scientific methodology, for the safe resumption of surgical activities during the COVID-19 pandemic.
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http://dx.doi.org/10.1097/SLA.0000000000004674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189258PMC
July 2021

Single/reduced port surgery vs. conventional laparoscopic gastrectomy: systematic review and meta-analysis.

Minim Invasive Ther Allied Technol 2022 Apr 18;31(4):515-524. Epub 2021 Feb 18.

Department of General and Digestive Surgery, Unit of Innovation in Minimally Invasive Surgery, University Hospital "Virgen del Rocio", University of Seville, Seville, Spain.

Introduction: The aim is to compare single port surgery (SPS)/reduced port surgery (RPS) versus conventional laparoscopy (CL) for gastrectomy for gastric cancer in terms of intra- and postoperative outcomes.

Material And Methods: After a search in Pubmed and Embase, six articles were included. Pooled analysis was used to evaluate the statistically significance for each variable.

Results: Two hundred and thirty-three and 230 patients underwent SPS/RPS and CL, respectively. One hundred and eighty-eight patients and 45 patients underwent subtotal and total gastrectomy, respectively, using the SPS/RPS approach. One hundred and eighty-five patients and 45 patients underwent subtotal and total gastrectomy, respectively, by CL. In 85 patients, an extra trocar was systematically placed at the end of surgery. Statistically significant differences were not observed about preoperative staging. The pooled analysis regarding operative time, blood loss, postoperative complications, number of harvested lymph nodes and postoperative hospital stay showed that the only statistically significant difference between the two approaches is the shorter hospital stay in case of SPS/RPS.

Conclusions: SPS/RPS total or subtotal gastrectomy shows a lower postoperative hospital stay, with comparable operative time, blood loss, early postoperative complication rate and number of harvested lymph nodes in comparison to CL, provided extensive experience in minimally invasive gastrectomy is present. AGC: advanced gastric cancer; BMI: body mass index; CI: confidence interval; CL: conventional laparoscopy; LESS: laparoendoscopic single site; MD: mean difference; NOS: Newcastle-Ottawa Scale; OR: odds ratio; PRISMA: Preferred Reporting Items for Systematic Review and Meta-Analysis; ROBIN-I: Risk Of Bias In Non-randomised Studies - of Interventions; RPS: reduced port surgery; RR: risk ratio; SILS: single incision laparoscopic surgery; SPS: single port surgery; WMD: weighted mean differences.
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http://dx.doi.org/10.1080/13645706.2021.1884571DOI Listing
April 2022

Individualised splenic hilum lymphadenectomy in gastric cancer: ICG-guided mapping.

Cir Esp (Engl Ed) 2021 Feb 10. Epub 2021 Feb 10.

Hospital Universitario Virgen del Rocío, Sevilla, España.

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http://dx.doi.org/10.1016/j.ciresp.2021.01.003DOI Listing
February 2021

Fluorescence-based bowel anastomosis perfusion evaluation: results from the IHU-IRCAD-EAES EURO-FIGS registry.

Surg Endosc 2021 12 25;35(12):7142-7153. Epub 2021 Jan 25.

Ospedale di Vaio, Fidenza, Italy.

Background: Anastomotic leakage (AL) is one of the dreaded complications following surgery in the digestive tract. Near-infrared fluorescence (NIRF) imaging is a means to intraoperatively visualize anastomotic perfusion, facilitating fluorescence image-guided surgery (FIGS) with the purpose to reduce the incidence of AL. The aim of this study was to analyze the current practices and results of NIRF imaging of the anastomosis in digestive tract surgery through the EURO-FIGS registry.

Methods: Analysis of data prospectively collected by the registry members provided patient and procedural data along with the ICG dose, timing, and consequences of NIRF imaging. Among the included upper-GI, colorectal, and bariatric surgeries, subgroup analysis was performed to identify risk factors associated with complications.

Results: A total of 1240 patients were included in the study. The included patients, 74.8% of whom were operated on for cancer, originated from 8 European countries and 30 hospitals. A total of 54 surgeons performed the procedures. In 83.8% of cases, a pre-anastomotic ICG dose was administered, and in 60.1% of cases, a post-anastomotic ICG dose was administered. A significant difference (p < 0.001) was found in the ICG dose given in the four pathology groups registered (range: 0.013-0.89 mg/kg) and a significant (p < 0.001) negative correlation was found between the ICG dose and BMI. In 27.3% of the procedures, the choice of the anastomotic level was guided by means of NIRF imaging which means that in these cases NIRF imaging changed the level of anastomosis which was first decided based on visual findings in conventional white light imaging. In 98.7% of the procedures, the use of ICG partly or strongly provided a sense of confidence about the anastomosis. A total of 133 complications occurred, without any statistical significance in the incidence of complications in the anastomoses, whether they were ICG-guided or not.

Conclusion: The EURO-FIGS registry provides an insight into the current clinical practice across Europe with respect to NIRF imaging of anastomotic perfusion during digestive tract surgery.
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http://dx.doi.org/10.1007/s00464-020-08234-8DOI Listing
December 2021

Surgical education during pandemic times: How the virtual world can help us in real life? The Hernia U experience.

Cir Esp (Engl Ed) 2021 Apr 16;99(4):315-316. Epub 2021 Jan 16.

Chief of Innovation in Minimally Invasive Surgery of the University Hospital Virgen del Rocio and Head of the General and Digestive Surgery Unit of Hospital Quironsalud Sagrado Corazon, Sevilla, Spain.

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http://dx.doi.org/10.1016/j.ciresp.2020.12.007DOI Listing
April 2021

Recommendations on intervention for hepatobiliary oncological surgery during the COVID-19 pandemic.

Cir Esp (Engl Ed) 2021 Mar 16;99(3):174-182. Epub 2020 Dec 16.

Cirugía general y del aparato digestivo, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España.

The SARS-CoV-2 (COVID-19) pandemic requires an analysis in the field of oncological surgery, both on the risk of infection, with very relevant clinical consequences, and on the need to generate plans to minimize the impact on possible restrictions on health resources. The AEC is making a proposal for the management of patients with hepatopancreatobiliary (HPB) malignancies in the different pandemic scenarios in order to offer the maximum benefit to patients, minimising the risks of COVID-19 infection, and optimising the healthcare resources available at any time. This requires the coordination of the different treatment options between the departments involved in the management of these patients: medical oncology, radiotherapy oncology, surgery, anaesthesia, radiology, endoscopy department and intensive care. The goal is offer effective treatments, adapted to the available resources, without compromising patients and healthcare professionals safety.
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http://dx.doi.org/10.1016/j.ciresp.2020.10.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744030PMC
March 2021

Minimally invasive repair of ventral hernia with one third of tackers and fibrin glue: less pain and same recurrence rate.

Minerva Chir 2020 Oct;75(5):292-297

Unit of General and Digestive Surgery, Quironsalud Sagrado Corazón Hospital, Sevilla, Spain.

Background: Aim of this study was to assess whether the reduction in the number of tackers maintains a similar recurrence rate and to subsequently evaluate whether this reduction associated with fibrin adhesive (FA) influences postsurgical pain after laparoscopic ventral hernia repair (LVHR) at 5 years follow-up.

Methods: Fifty patients with ventral hernia (intervention group) underwent to LVHR with the double crown (DC) technique with a decrease in the number of tackers, each tacker being separated by about 3 cm associated with FA to seal the spaces between them. Data obtained from intervention group were compared to data obtained from a historical series of 50 patients (control group) undergoing LVHR using DC technique with tackers at 1 cm each other.

Results: No statistically significant differences were found between groups about patients' characteristics. Mean hospital stay was 2 days. Statistically significant differences were observed about hospital stay between both groups U-Mann-Whitney ([UMW] =345, P=0) being higher in the control group. Statistically significant difference was observed in the postoperative pain evaluated by the visual analogical scale (VAS) score, having 95% of patients in the control group with VAS less than or equal to 7 compared to 4.55 in the intervention group. Recurrence rate was 4.1% for the control group versus 4.2% in the intervention group.

Conclusions: The reduction of metallic tackers associated with FA does not present statistically significant differences in the recurrence rate in comparison to conventional DC technique. In the intervention group a reduction in postoperative pain and hospital stay were observed.
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http://dx.doi.org/10.23736/S0026-4733.20.08468-0DOI Listing
October 2020

EAES Recommendations for Recovery Plan in Minimally Invasive Surgery Amid COVID-19 Pandemic.

Surg Endosc 2021 01 10;35(1):1-17. Epub 2020 Nov 10.

Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Background: COVID-19 pandemic presented an unexpected challenge for the surgical community in general and Minimally Invasive Surgery (MIS) specialists in particular. This document aims to summarize recent evidence and experts' opinion and formulate recommendations to guide the surgical community on how to best organize the recovery plan for surgical activity across different sub-specialities after the COVID-19 pandemic.

Methods: Recommendations were developed through a Delphi process for establishment of expert consensus. Domain topics were formulated and subsequently subdivided into questions pertinent to different surgical specialities following the COVID-19 crisis. Sixty-five experts from 24 countries, representing the entire EAES board, were invited. Fifty clinicians and six engineers accepted the invitation and drafted statements based on specific key questions. Anonymous voting on the statements was performed until consensus was achieved, defined by at least 70% agreement.

Results: A total of 92 consensus statements were formulated with regard to safe resumption of surgery across eight domains, addressing general surgery, upper GI, lower GI, bariatrics, endocrine, HPB, abdominal wall and technology/research. The statements addressed elective and emergency services across all subspecialties with specific attention to the role of MIS during the recovery plan. Eighty-four of the statements were approved during the first round of Delphi voting (91.3%) and another 8 during the following round after substantial modification, resulting in a 100% consensus.

Conclusion: The recommendations formulated by the EAES board establish a framework for resumption of surgery following COVID-19 pandemic with particular focus on the role of MIS across surgical specialities. The statements have the potential for wide application in the clinical setting, education activities and research work across different healthcare systems.
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http://dx.doi.org/10.1007/s00464-020-08131-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7653984PMC
January 2021
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