February 28 - March 3, 2017 Encore at Wynn Las Vegas
MISS eNEWS

Improving Patient Outcomes with Minimally Invasive Surgery

Each month, MISS eNews brings you the latest on novel minimally invasive techniques and findings from around the world.

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Volume: #8, No. #4
TOP NEWS
The New MISS eNews!
Welcome to MISS eNews. I am excited to take on the editorial management of this publication, with this issue being my first! As you will see in this issue and those to come, we have some changes in store for you that I think you will find beneficial. First, we’ve added an Endoscopy section to the existing 4 MISS focus areas of colon, foregut, hernia, and bariatric minimally invasive surgery, and we’ve enlisted the help of 2016 MISS faculty member Matthew Kroh, MD, of Cleveland Clinic to help develop this new endoscopic focus. In this first issue, Matt gives his thoughts on endoscopy’s role in minimally invasive surgery.

We also have invited some new faces to be contributors, and have made some adjustments to the format of Suggested Readings. From now on, you will see new contributors share not only their own recommendations of suggested articles for you to read, but also the critical article takeaways as well. It’s one thing to read a list of what we should be reading, but it’s totally another to know what the experts think are the best new publications and why they think so.

We are also adding some new quarterly segments to this newsletter that will include focuses on residents and fellows, social media, an industry spotlight, and more. Get ready to be engaged and entertained, as well as educated, in the coming months. We have great things in store for you.

Here’s to a new and improved MISS eNews, to the new names and faces you will see in these issues, and to developing a lasting rapport with you, the readership! We want to be your go–to source of information in all things minimally invasive surgery. Please contact us at MISS@globalacademycme.com with any comments and/or suggestions.

—Colleen Hutchinson

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Colon Suggested Readings
Medicine and Robotics
John Marks, MD: Operating in the pelvis for rectal cancer remains a challenge facing surgeons today that is most apparent when treating disease in the distal rectum. A transanal approach to total mesorectal excision (taTME) has become popular to address these challenges. This is the largest study published to date examining pathologic and early oncologic outcomes using taTME in rectal cancer. The study results confirm that taTME is a safe operation with good quality pathologic outcomes, while not promising that the oncologic outcomes are meaningful—as follow–up is only 15 months.
 
Article: Bravo R, Lacy AM. Medicine and robotics. Med Clin (Barc). 2015 Dec 7;145(11):493-5. [Article in Spanish].
 
Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial
John Marks, MD: This trial highlights the challenges facing surgeons operating in the pelvis for rectal cancer. The study compares open versus laparoscopic total mesorectal excision approaches to total mesorectal excision, and while the paper fails to establish the non-inferiority of laparoscopy based on pathologic outcomes, it is unclear how these findings will ultimately translate into long-term oncologic and survival outcomes. What the study does bring to the fore is the need to explore other surgical techniques, such as robotics and transanal total mesorectal excision, for rectal cancer surgery.
 
Article: Fleshman J, Branda M, Sargent DJ, et al. Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial. JAMA. 2015 Oct 6;314(13):1346-55.
 
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Endoscopy Suggested Readings
Early human experience with per-oral endoscopic pyloromyotomy (POP)
Matthew Kroh, MD, FACS: Gastroparesis is an increasingly common disease, with multiple etiologies and treatments that span from medical to surgical therapies. Often, existing therapy may be unsuccessful and evolving strategies are needed to improve patient symptoms. Shlomovitz et al describe their initial human experience with endoluminal therapy by means of per oral endoscopic pyloromyotomy. Based on techniques derived from ESD (endoscopic submucosal dissection) and POEM (per oral endoscopic myotomy), the Oregon group has demonstrated feasibility and safety in a small cohort of patients.
 
Article: Shlomovitz E1, Pescarus R, Cassera MA, et al. Early human experience with per-oral endoscopic pyloromyotomy (POP). Surg Endosc. 2015 Mar;29(3):543-51.
 
The REDUCE pivotal trial: a prospective, randomized controlled pivotal trial of a dual intragastric balloon for the treatment of obesity
Matthew Kroh, MD, FACS: The increasing obesity epidemic has prompted development of new endoscopic therapies for treating obese patients and improving weight-related comorbid disease. Two intragastric balloon therapy devices have recently been approved for use in patients with BMI 30-40. The REDUCE pivotal trial is a multi-institutional study that showed endoscopically placed dual balloon therapy plus exercise and diet modification was more effective than diet and exercise alone.
 
Article: Ponce J, Woodman G, Swain J, et al. The REDUCE pivotal trial: a prospective, randomized controlled pivotal trial of a dual intragastric balloon for the treatment of obesity. Surg Obes Relat Dis. 2015 Jul-Aug;11(4):874-81.
http://www.ncbi.nlm.nih.gov/pubmed/25868829
 
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Foregut Suggested Readings
Laparoscopic magnetic sphincter augmentation vs laparoscopic Nissen fundoplication: a matched-pair analysis of 100 patients
Marina Kurian, MD: While I may not agree with the conclusions, there is symptomatic improvement with both techniques. We see less gas bloating and belching issues with LINX®, which is what we expected compared to Nissen. It would be great to see studies one year out in a case-matched analysis—but it’s challenging to get patients do that testing.
 
Article: Reynolds JL, Zehetner J, Wu P, Shah S, Bildzukewicz N, Lipham JC. Laparoscopic magnetic sphincter augmentation vs laparoscopic nissen fundoplication: a matched-pair analysis of 100 patients. J Am Coll Surg. 2015 Jul;221(1):123-8.
 
Revisional paraesophageal hernia repair outcomes compare favorably to initial operations
Dana Telem, MD: This article studies outcomes of revisional versus primary paraesophageal hernia repair. Given the rate of recurrence following this procedure, this is important data to help counsel patients who are undergoing revisional operations.
 
Article: Wennergren J, Levy S, Bower C, Miller M, Borman D, Davenport D, Plymale M, Scott Roth J. Revisional paraesophageal hernia repair outcomes compare favorably to initial operations. Surg Endosc. 2015 Dec 10.
 
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Hernia Suggested Readings
Novel Uses of Video to Accelerate the Surgical Learning Curve
Aurora Pryor, MD/Andrew Bates, MD: Social media is increasingly used to disseminate ideas and surgical techniques, for better or for worse. The most prominent example is the International Hernia Collaboration, which is hosted by Facebook. Social media's role as an educational tool remains hotly debated.
 
Article: Ibrahim AM, Varban OA, Dimick JB. Novel Uses of Video to Accelerate the Surgical Learning Curve. J Laparoendosc Adv Surg Tech A. 2016 Mar 31. [Epub ahead of print]
 
Benefits of Multimodal Enhanced Recovery Pathway in Patients Undergoing Open Ventral Hernia Repair
Guy Voeller, MD: The effectiveness of enhanced recovery after surgery (ERAS) pathways is well established in the field of colorectal surgery. The evaluation of the ERAS pathways relative to hernia surgery is in its infancy. These investigators evaluated the ERAS pathways to see if they would accelerate functional recovery and shorten hospital stay in patients undergoing open ventral hernia repair. They evaluated consecutive patients undergoing open major ventral hernia repair with the use of their ERAS pathway and compared them to a historical cohort before implementation of the ERAS.
 
They compared 100 patients undergoing ventral hernia repair with the ERAS implementation to a similar historical cohort. The ERAS group demonstrated significantly shorter times to diet (1.1 vs. 2.7 days) and significantly shorter times to bowel function. Average length of stay was reduced from 6 to 4 days and the ERAS Group had significantly fewer 90-day readmissions. The ERAS pathways are well established in the colorectal surgical arena, and this study supports their use in major abdominal wall reconstruction and the notion that practitioners should consider ERAS protocols.
 
Article: Majumder A, Fayezizadeh M, Neupane R, Elliot HL, Novitsky YW. Benefits of Multimodal Enhanced Recovery Pathway in Patients Undergoing Open Ventral Hernia Repair. J Am Coll Surg. 2016 Mar 3. (ePub).
 
Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial
Todd Heniford, MD: An incisional hernia is the most frequent long-term complication following abdominal surgery. This results in more than 600,000 ventral, incisional hernia repairs per year in the US and Europe. The STITCH trial, a randomized, prospective, multi-center trial hosted by the outstanding Rotterdam group, compared small bite-small walk suture closure (5mm bite and 5mm walk) of the abdominal midline fascia with standard 1cm walk-1cm bite closure in primary laparotomies. With a 97% one-year followup, the small bite-small walk closure reduced the incidence of ventral hernia formation by more than a third. The adjusted odds ratio was 0.52. Small bite-small walk laparotomy closure should be considered a means to reduce ventral hernia formation.
 
Article: Eva B Deerenberg, MD, Dr Joris J Harlaar, MD, Prof Ewout W Steyerberg, PhD, et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet. 2015 Sep 26;386(10000):1254-60.
 
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Bariatric/Metabolic Suggested Readings
Effectiveness of intragastric balloon for obesity: A systematic review and meta-analysis based on randomized control trials
Jaime Ponce, MD, FACS, FASMBS: It has been proven in several randomized clinical trials that a diet becomes more effective with an intragastric balloon. The balloon is not intended to compete or replace surgery. It does enable mild to moderate obese patients to have access to more management options and keeps them engaged. Based on this meta-analysis, we should consider offering diet management associated with the balloon to some of our growing obese population.
 
Article: Moura D, Oliveira J, De Moura EG, Bernardo W, Manoel Galvao Neto M, Campos J, Popov VB, Thompson C. Effectiveness of intragastric balloon for obesity: A systematic review and meta-analysis based on randomized control trials. Surg Obes Relat Dis. 2016 Feb;12(2):420-9.
 
Mental Health Conditions Among Patients Seeking and Undergoing Bariatric Surgery: A Meta-analysis
Aurora Pryor, MD/Andrew Bates, MD: There has been a newfound academic interest in the psychiatric confounders within the bariatric surgery population. Bariatric surgeons have previously noted anecdotal evidence of increased incidence of psychiatric comorbidities within the population, but only now are we establishing the prevalence and impact on surgical outcome.
 
Article: Dawes, A. J., Maggard-Gibbons, M., Maher, A. R., Booth, M. J., Miake-Lye, I., Beroes, J. M., & Shekelle, P. G. (2016). Mental Health Conditions Among Patients Seeking and Undergoing Bariatric Surgery: A Meta-analysis. JAMA,315(2), 150-163.