Journal of the American College of Surgeons
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Because of its known malignant potential, precise histologic diagnosis of intraductal papillary mucinous neoplasm of the pancreas (IPMN) during intraoperative pancreatoscopy (IOP) is essential for complete surgical resection. The impact of IOP on perioperative IPMN patient management was reviewed over 20 years of practice at Cliniques universitaires Saint-Luc, Brussels, Belgium. ⋯ Intraoperative pancreatoscopy of the main pancreatic duct combined with intraductal biopsies plays a significant role in the surgical management of IPMN patients and should be used in all patients presenting a sufficiently dilated main pancreatic duct.
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Bile duct injuries from laparoscopic cholecystectomy remain a significant source of morbidity and are often the result of intraoperative errors in perception, judgment, and decision-making. This qualitative study aimed to define and characterize higher-order cognitive competencies required to safely perform a laparoscopic cholecystectomy. ⋯ This study defines the competencies that are essential to establishing a critical view of safety and avoiding bile duct injuries during laparoscopic cholecystectomy. This framework may serve as the basis for instructional design, assessment tools, and quality-control metrics to prevent injuries and promote a culture of patient safety.
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In 2006, the Centers for Medicare and Medicaid Services restricted coverage for bariatric procedures to designated high-volume Centers of Excellence. The effect of centralization of elective surgical procedures on the ability of patients to access surgery has not been studied previously. ⋯ Despite the longer travel distance required for Medicare patients, centralization of bariatric surgery to Centers of Excellence did not result in impaired access to care. In fact, in this study, an improvement in access to bariatric surgery was seen and persisted among some underserved populations.