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Study Finds Grading System For Surgeons May Help Increase Safety For Complex Surgeries

Medical Society Presents Florida Hospital Research at MIS Week 2017

Tampa, FL – July 10, 2017/Press Release/ – A Florida Hospital Tampa study is attempting to show surgeons how to grade what they see during surgery in order to increase patient safety and create a systematic standard for how surgeon’s outcomes should be studied.   The research will be presented at the Society of Laparoendoscopic Surgery (SLS) annual meeting on September 6-9, 2017, in San Francisco. The study could have broad implications for how our surgeons are trained.

This study, conducted by Dr. Sharona Ross, director of minimally invasive surgery at Florida Hospital Tampa, was undertaken to provide a systematic grading system and determine factors that affect visualization during complex but patient-convenient laparoscopic surgery.   The results showed that visualization during specific surgeries can be qualified and codified.

“We need to look at patient outcomes and safety in a standardized fashion. The grading system provides a mechanism to minimize risk by ensuring adequate exposure and optimal visualization, thereby, increasing patient safety,” says Dr. Ross. “What we’re saying is let’s study and grade common surgical procedures by sight in a way that measures them consistently.”

The study measured whether the visualization during surgery, which is essential with laparoscopic (minimally invasive) procedures was adequate for the surgeon.  Currently, there is no grading system to assess the degree or quality of visualization during laparoscopy. The systematic grading system determines the factors that affect visualization during a minimally invasive procedure.

“Dr. Ross’ study shows that we can and should objectively measure what we visualize for critical portions of surgical procedures,” says Dr. Steven Schwaitzberg, professor and chairman of the department of surgery, professor, bioinformatics, University at Buffalo’s Jacob School of Medicine and Biomedical Science.  “Since the quality of our work is dependent on what we can see, I believe this will be a measurement worth looking at.”


30 patients underwent a cholecystectomy at Florida Hospital Tampa. Three different insufflation pressures (15, 12, and 8mmHg) were used during four critical landmarks of the operation (initial view of gallbladder, grasping/retracting the infundibulum of the gallbladder, just before clipping the cystic duct, before disengaging the gallbladder from the liver). Utilizing a Likert scale (1=poor to 5=excellent), independent reviewers were given an edited surgical video and were asked to document a score at different insufflation pressures during the four critical landmarks of the operation. Median data are reported.  The 30 patients underwent LESS cholecystectomy after informed consent. Patients were 45 years old with BMI of 28 kg/m2 and 83% were women.  There were no intraoperative complications; operative duration was 70 minutes.

The study specifically found that there was no difference in blind assessor scores between 15 and 12mmHg insufflation pressures at all critical landmarks (p>0.05). However, scores were significantly lower for 8mmHg when compared to 12 and 15mmHg at three of the four critical landmarks (p<0.05 for both).

“We will be pleased to hear the results of this study at MIS Week,” says Dr. Paul Wetter, founder and chairman of the society.  “Once we understand surgeons’ perception of optimal exposure and visualization, we can then better standardize operations and therefore outcomes.”

About Dr. Sharona Ross

Sharona Ross is the director of minimally invasive surgery, director of surgical endoscopy, director of the Advanced GI & HPB Fellowship Program.  She is also the founder & director of the Florida Hospital Tampa Women in Surgery Initiative and the Program Director.  She is the founder and chair of the 2009-2017 Annual International Women in Surgery Career Symposium.

About the Society of Laparoendoscopic Surgeons

The Society of Laparoendoscopic Surgeons was established as an educational, non-profit organization to help ensure the highest standards for the practice of laparoscopic, endoscopic, and minimally invasive surgery. The Society serves surgeons from various specialties and other health professionals who are interested in advancing their expertise in the diagnostic and therapeutic uses of Laparoendoscopic and minimally invasive surgical techniques. With an international membership of over 6,000 surgeons, the organization offers a unique approach to the study and education of minimally invasive surgery by bringing together different medical specialties that use the techniques and tools of minimally invasive surgery.

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