Front Matter| Volume 54, Pxvii-xxiii, September 2020


        Editorial Board ix
        Contributors xi

        Controversies in the Management of Diverticulitis

        Thomas Curran and Mary R. Kwaan
         Introduction 1
         Indications for urgent or emergent operative procedures in patients with acute diverticulitis 2
         Assessing the intraoperative environment to determine an operative plan 3
         Role of damage-control surgery/second-look laparotomy 4
         Postoperative morbidity and mortality 5
         Anastomotic leak 6
         Laparoscopic approach 7
         Hartmann procedure versus primary anastomosis: observational data 8
         Hartmann procedure versus primary anastomosis: randomized trial data 9
         Hartmann procedure versus primary anastomosis: patient selection for inclusion in randomized controlled trials and crossover 11
         Hartmann procedure versus primary anastomosis: primary anastomosis with or without diverting ostomy 12
         Colostomy takedown 12
         Summary 13
        Disclosure 14

        Venous Thromboembolism Prevention and Treatment in Cancer Surgery

        Lawrence B. Brown, Michael B. Streiff, and Elliott R. Haut
         Introduction 18
         Epidemiology 18
         Risk stratification 19
         Prevention 21
        Perioperative venous thromboembolism prophylaxis for cancer surgery patients 21
        Preoperative thromboprophylaxis 21
        Postoperative thromboprophylaxis 21
        Extended (outpatient) prophylaxis 22
        Mechanical prevention 22
         Diagnosis 23
        Imaging 23
        The role of D dimer 23
         Treatment 24
        Acute treatment of venous thromboembolism 24
        Extended therapy 25
        Role of inferior vena cava filters 26
         Summary 26
        Disclosure 27

        The Value of Surgical Coaching Beyond Training

        Jason C. Pradarelli, Yue-Yung Hu, Justin B. Dimick, and Caprice C. Greenberg
         Overview of surgical coaching 32
         Motivation for surgical coaching 32
         Established surgical coaching programs 33
        Wisconsin Surgical Coaching Program 33
        Surgical coaching initiative in the Michigan Bariatric Surgery Collaborative 35
        Illinois Surgical Quality Improvement Collaborative video-based coaching project 36
        Harvard Surgical Coaching for Operative Performance Enhancement 38
        Other notable surgical coaching interventions 41
         Benefits of surgical coaching for practicing surgeons 41
         Addressing barriers to implementing surgical coaching 42
        Time and money 42
        Value-based health care 43
        Logistics 43
        Culture 44
         Future directions for surgical coaching 44
        Disclosure 45

        Neoadjuvant Therapy: When Should It Be Used for Pancreatic Cancer?

        Kristin N. Kelly, Francisco I. Macedo, and Nipun B. Merchant
         Introduction 49
         Classification 50
         Resection margins 53
         Role of neoadjuvant chemotherapy with or without radiation therapy 56
        Neoadjuvant chemotherapy alone 56
        Neoadjuvant chemoradiation therapy 58
        Pathologic complete response 59
        Upcoming studies 59
         Surgical considerations after neoadjuvant chemotherapy 61
         Summary 63
        Disclosure 64

        Islet Tumors: Resect or Follow?

        Tiffany J. Sinclair and George A. Poultsides
         Introduction 69
         Treatment guidelines 71
         Potential for metastasis 72
         Accuracy of preoperative biopsy in defining grade 74
         Can tumor morphology on preoperative imaging predict grade and metastatic potential? 74
         Survival after resection versus observation for islet cell tumors 76
         Natural history of small islet cell tumors 82
         Morbidity and mortality after resection of small islet tumors 84
         Summary 85

        The Role of Artificial Intelligence in Surgery

        Daniel A. Hashimoto, Thomas M. Ward, and Ozanan R. Meireles
         Introduction 89
         Techniques in artificial intelligence 90
        Machine Learning 91
        Neural networks 92
        Deep neural networks 93
         Applicative fields of artificial intelligence 93
        Computer vision 93
        Natural language processing 94
         Specific applications of artificial intelligence in surgery 95
        Preoperative risk prediction 95
        Intraoperative video analysis 96
        Electronic Health Records 98
         Regulatory and legal considerations 98
         Surgeon’s role 98
         Summary 99
        Disclosures 99

        What Is the Current Status of Lung Transplantation?

        Daniel A. Walker, Fatima G. Wilder, and Errol L. Bush
         History of lung transplantation 103
        Early experimental activity 103
        Clinical experience 104
         Evolution in techniques 105
         Current lung transplant volume and outcomes 106
         Trends in changing diagnosis 108
         Significant lung allocation changes in 2005 108
         Indications 110
         Contraindications 112
         Surgical technique 112
        Donor organ recovery 112
         Complications 116
        Primary graft dysfunction 116
        Readmission 116
        Outcomes 116
         Extracorporeal membrane oxygenation as a bridge to transplant 118
         Venovenous and venoarterial extracorporeal membrane oxygenation 118
         Extracorporeal membrane oxygenation outcomes 119
         Intraoperative use 120
         Combined heart-lung transplant 121
         Expanding the donor pool 122
        Hepatitis C mismatch 122
        Ex vivo lung perfusion 122
         Summary 124
        Disclosure 124

        Contemporary Management of Mitral Valve Disease

        Brian D. Cohen, Michael A. Napolitano, J. James Edelman, Keegan V. Thourani, and Vinod H. Thourani
         Introduction 129
        Evaluation 131
        Classification 132
        Primary mitral regurgitation 134
        Secondary mitral regurgitation 137
        Median sternotomy and minithoracotomy 138
         Summary 142
        Disclosure 143

        Surgery Resident Wellness Programs: The Current State of the Field and Recommendations for Creation and Implementation

        Rebecca L. Williams-Karnesky, Alissa Greenbaum, and Jasmeet S. Paul
         Introduction 149
         Burnout in medical training 150
         Initiatives to address resident wellness 151
         Current state of the field 151
         Best practice recommendations for designing a resident wellness program 156
         Conceptual models used to develop trainee wellness programs 157
         Maslow’s hierarchy of needs 157
         Domains of wellness model 159
         Ensuring the success of a surgery resident wellness program 163
         Future advances in resident wellness 166
         Summary 166
        Disclosure 166

        Evidence-Based Management of Gallstone Pancreatitis

        Lillian S. Kao and Jayne S. McCauley
         Introduction 173
         Stratification and prediction of severity of acute gallstone pancreatitis 174
         Medical management 177
        Fluid resuscitation 177
        Nutritional support 178
        Analgesia 179
         Endoscopic and surgical management of acute gallstone pancreatitis 179
        Routine endoscopic retrograde cholangiopancreatography in gallstone pancreatitis 179
        Management of common bile duct stones in acute gallstone pancreatitis 179
        The role of endoscopic sphincterotomy in the management of acute gallstone pancreatitis 180
        Timing of cholecystectomy after mild acute gallstone pancreatitis 181
        Management of necrotizing gallstone pancreatitis 184
        Future advances 185
        Disclosure 186

        Management of Melanoma Patients with Positive Nodes

        Rachel M. Lee, Keith A. Delman, and Michael C. Lowe
         Introduction 192
         Background 192
         The clinically node-positive patient 193
         The patient with nodal recurrence 195
         The evolving role of neoadjuvant therapy 195
         The patient with a positive sentinel lymph node biopsy 197
         Summary 201
        Disclosure 202

        Video Assessment of Surgeons and Surgery

        Elif Bilgic, Sofia Valanci-Aroesty, and Gerald M. Fried
         Why is video-based assessment important? 206
         What are the limitations of video-based assessment? 206
         What is the impact of technology on video-based assessment? 207
         Metrics 208
        Video-based assessment 208
        Peer review 208
        Crowd sourcing 208
        Artificial intelligence 209
         Applications of video review 210
        Quality improvement and education 210
        Privileges and credentials 210
         Future applications 211
         Summary 211
        Disclosure 211

        Fascial Closure: New Surgery Paradigms

        Gregory A. Dumanian and Simon Moradian
         Introduction 215
         Wound healing, inflammatory response to biomaterials, and the foreign body reaction 216
         Strength of tissues repaired with sutures 219
         Suture composition 219
         Suture tension 220
         Suture size 220
         New options for fascial closure to decrease hernia recurrence 221
         Prophylactic mesh augmentation 223
         Mesh sutured repairs 225
         Mesh suture 225
         Summary 226
        Disclosure 227

        Enteral Feeding: Percutaneous Endoscopic Gastrostomies, Tubes, and Formulas

        Colin G. DeLong and Eric M. Pauli
         Introduction 231
         Updates on the indications for percutaneous endoscopic gastrostomy 232
         Perioperative considerations 234
         Adjuncts to standard percutaneous endoscopic gastrostomy techniques 236
        Gastrointestinal T-anchors placement 236
        Overtube placement 237
         Difficult percutaneous endoscopic gastrostomy: strategies and options 238
        Laparoscopic-assisted percutaneous endoscopic gastrostomy 239
        Image-guided percutaneous endoscopic gastrostomy 239
        Colonoscopy-assisted percutaneous endoscopic gastrostomy 239
         Minimally invasive jejunal access 240
        Percutaneous endoscopic gastrostomy with jejunal extension 240
        Direct percutaneous endoscopic jejunostomy 241
         Alternative methods for enteral access 242
        Sabnis, Liu, and Chand technique 242
        Percutaneous transesophageal gastrostomy 242
        Fistuloclysis 243
         Endoscopic management of percutaneous endoscopic gastrostomy complications 244
         Enteral feeding decisions in surgical patients 245
         Summary 246
        Disclosure 246

        Increasing Importance of Ethics in Surgical Decision Making

        Anghela Z. Paredes, Christopher T. Aquina, Luke V. Selby, Stephanie DiFilippo, and Timothy M. Pawlik
         Introduction 251
         Principles of biomedical ethics 252
        Autonomy 252
        Nonmaleficence 253
        Beneficence 253
        Justice 253
         Integration of ethics in surgery 254
        Informed consent 254
        Goals of care and futility 256
        Surgical palliation 258
         Decisional regret 260
         Summary 261
        Disclosure 261

        Per Oral Pyloromyotomy for Gastroparesis

        John H. Rodriguez and Jeffrey Ponsky
         Introduction 265
         History 267
         Evaluation 267
         Patient selection 268
         Equipment 269
         Technique 269
         Postoperative management 271

        What Is the Role of Neoadjuvant Radiation Therapy for Retroperitoneal Sarcoma?

        Sophia K. McKinley, Thomas F. DeLaney, and John T. Mullen
         Introduction 273
        Incidence of retroperitoneal sarcoma 273
        Current treatment challenges 274
         Neoadjuvant radiotherapy for retroperitoneal sarcoma 275
        Current use of radiotherapy for retroperitoneal sarcoma 275
        Rationale for neoadjuvant radiation therapy for retroperitoneal sarcoma 276
        Summary of current evidence 278
        Safety of neoadjuvant radiation therapy 280
        Future directions 280
         Summary 281
        Disclosure 281

        New Models of Surgical Training

        Christopher C. Stahl and Rebecca M. Minter
         Introduction 285
         Concerns regarding the ability of graduating general surgery residents 285
         The spectrum of surgical training and participating organizations 286
         Defining competency-based education 288
         The transition to competency-based medical and surgical education 289
         Fundamentals of laparoscopic and endoscopic surgery 289
         Milestones 290
         Operative Performance Rating System 291
         End of rotation evaluations 292
         Microassessments 292
         Entrustable professional activities 293
         Summary 296
        Disclosure 297