Dimitrios Stefanidis

• MD, PhD
• Vice Chair of Education at Indiana University – Purdue University Indianapolis

Background Peroral Endoscopic Myotomy (POEM) is a safe treatment for esophageal achalasia with comparable safety to Heller myotomy plus fundoplication and pneumatic dilatation (PD). More data comparing POEM to Heller Myotomy plus fundoplication and pneumatic dilation are available since the previous Society of American Gastrointestinal and Endoscop...

Objectives/Goals: Glucagon-like peptide-1 (GLP1) use prior to bariatric surgery may represent a novel approach to treating obesity. The objectives of this study were to describe trends in pre-bariatric GLP1 use, investigate social and clinical factors associated with their use, and evaluate differences in clinical outcomes based on preoperative GLP...

Background Smoking, obesity, diabetes mellitus, and COPD are known risk factors for surgical site occurrences (SSO) following open ventral hernia repair. However, little evidence exists on whether these factors also significantly impact SSO after robotic hernia repair. This is a particularly important distinction because robotic approaches have bee...

Purpose Surgeons often experience stress that may negatively impact performance. Mental skills are designed to prevent skill deterioration under stress and enhance performance. Mental skills curricula have proved effective in other disciplines but are rarely used in surgery. Additionally, research on mental skill use by surgeons has been very limit...

In a recent study of surgical education leaders, a foundational understanding of educational needs in surgery was established. However, the challenges faced by and needs of the broader surgical education community remain elusive. The aim of this study was to determine the challenges and prioritize the needs of a variety of stakeholders in surgical...

Due to the evolving educational needs and limited literature in educational needs, the Association for Surgical Education (ASE) leadership established a needs assessment task force to assess the education needs of surgeons and trainees to inform its efforts and offerings. Following Witkin and Altschuld’s Three Phase Needs Assessment Model, the task...

Background The efficacy of Glucagon-Like Peptide-1 Receptor Agonists (GLP1RA) for the treatment of obesity has led to considerably increased demand for these medications. GLP1RA use prior to bariatric surgery may represent a novel approach to treating obesity. The objectives of this study were to (1) describe trends in pre-bariatric GLP1RA use, (2)...

This study aims to conduct a comprehensive global needs assessment to identify the prevailing conditions, specific needs, and challenges faced by surgical trainees and educators across diverse healthcare contexts. An international survey was developed and disseminated to surgical trainees and educators in 50 countries. The survey included sections...

The Advanced Training in Laparoscopic Suturing (ATLAS) curriculum was created to address gaps in advanced laparoscopic suturing training and has been previously studied using in-person assessment (IPA). This study aimed to evaluate the reliability of a remote, asynchronous video-based assessment (VBA) protocol by comparing to IPA to build validity...

Non-technical skills (NTS) challenges experienced by surgeons may degrade performance, ultimately impacting the safety and quality of care delivered to patients. The objectives of this work were to develop a framework for NTS coaching for surgeons and implement a coaching program utilizing the developed NTS coaching framework. Leveraging adult lear...

Introduction Weight recurrence (WR) affects > 20% of patients following Roux-en-Y gastric bypass (RYGB). Shortening of the common channel (CC) after RYGB (distal bypass) has been proposed for additional weight loss in patients with WR, but results vary, and concerns for vitamin deficiencies/malnutrition exist. Our aim was to determine whether the p...

Background Improvements in bariatric surgery outcomes have prompted policy initiatives that explore shifting bariatric surgery toward outpatient procedures. While the safety of early discharge after primary laparoscopic Roux-en-Y gastric bypass (LRYGB) has been reported, its safety for revisional LRYGB remains uncertain. Our study aimed to investig...

Background In a recent study of surgical education leaders, a foundational understanding of educational needs in surgery was established. However, the challenges faced by and needs of the broader surgical education community remain elusive. The aim of this study was to determine the challenges and prioritize the needs of a variety of stakeholders i...

Introduction The condition of trauma patients and the urgent need for timely resuscitation present unique challenges to trauma teams. These difficulties are exacerbated for military trauma teams in combat environments. Consequently, there is a need for continued improvement of nontechnical skills (NTS) training for trauma teams. However, current ap...

Background Patients with acute cholecystitis (AC) presenting with unfavorable systemic or local conditions are often managed with percutaneous cholecystostomy (PC) as a temporary measure. The clinical outcomes of interval cholecystectomy following PC remain unclear. The aim of the study was to identify the association between the timing of cholecys...

Background: Retraumatization is the conscious or unconscious reminder of past trauma that results in a re-experiencing of the initial traumatic event. This phenomenon has been well-studied in primary and secondary education and has been shown to negatively impact the learning environment. Retraumatization in the context of undergraduate medical edu...

Importance: Work-related musculoskeletal disorders (WMSDs) among surgeons are markedly increasing. Several proposed interventions to reduce WMSDs among surgeons have been studied, but few follow an occupational therapy–oriented approach addressing biomechanical, psychophysical, and psychosocial risk factors. Objective: To design, implement, and ass...

The National Board of Medical Examiners (NBME) surgery subject exam (SSE) is a high-stakes exam with few predictors of success. We hypothesized that performance on a mid-clerkship NBME surgery self-assessment (SSA) practice test would predict performance on the SSE and could be used to selectively intervene with struggling students. Participating s...

Purpose The AAMC has expanded its focus on healthcare disparities training during undergraduate medical education (UME). Currently, no standardized published curriculum dedicated to surgical disparity training exists. Therefore, our purpose was to develop, implement, and evaluate a novel Surgical Disparities Curriculum to equip medical students to...

Weight recurrence (WR) affects nearly 20% of patients after bariatric surgery and may decrease its benefits, affecting patients’ quality of life negatively. Patient perspectives on WR are not well known. Assess patient needs, goals, and preferences regarding WR treatment. Single MBSAQIP-accredited academic center, and online recruitment. An 18-item...

Background/Objective: Cognitive load (CL) is the amount of mental effort and resources required to complete a task and process information in the working memory. In a surgical setting, high CL decreases attention to critical details, and slows down decision-making, increasing errors which can compromise patient safety. Our aim was to determine if C...

This Guide to Statistics and Methods provides an overview of common flaws with surgical education research, including how to recognize and avoid them.

Background Simulation has become a staple in the training of healthcare professionals with accumulating evidence on its effectiveness. However, guidelines for optimal methods of simulation training do not currently exist. Methods Systematic reviews of the literature on 16 identified key questions were conducted and expert panel consensus recommend...

Background Minimally invasive surgery has been used for both de novo insertion and salvage of peritoneal dialysis (PD) catheters. Advanced laparoscopic, basic laparoscopic, open, and image-guided techniques have evolved as the most popular techniques. The aim of this guideline was to develop evidence-based guidelines that support surgeons, patients...

Nontechnical skills (NTS) of healthcare teams are fundamental to successful and safe surgeries. This study aims to identify the communication measures associated with overall NTS and leadership skills. Ten medical students assuming the roles of attending physicians completed two simulated critical care scenarios containing five disruptive integrate...

Background Acute cholecystitis (AC) is one of the most prevalent diseases in clinical practice. Poor surgical candidates may benefit from early percutaneous cholecystostomy (PC) drainage followed by interval cholecystectomy (IC), which is the definitive treatment. The optimal timing between the PC drainage and the IC has not been identified. This s...

Objective: The purpose of this study was to assess how neuropsychological factors differ between general surgery interns and normative data from age-matched adults in the general population. Design: Participants completed a comprehensive neuropsychological assessment battery. Neuropsychological factors assessed included: executive function (Beha...

Background Iron deficiency anemia is a common paraesophageal hernia (PEH) symptom and may improve after repair. When present, anemia has also been proposed to be associated with an increase in length of hospital stay, morbidity, and mortality after PEH repair. This study aimed to determine anemia-related factors in patients with PEH, the rate of an...

Background: Non-technical skills, such as communication and situation awareness, are vital for patient care and effective surgical team performance. Previous research has found that residents' perceived stress is associated with poorer non-technical skills; however, few studies have investigated the relationship between objectively assessed stress...

In many low- and middle-income countries (LMICs), non-surgeon physicians are responsible for urgent and emergent surgical procedures due to the paucity of formally trained surgeons. The insufficiency of practicing surgeons also limits the mentorship and educational opportunities for these physicians. To assist with the limited formal surgical educa...

Background Mental imagery (MI) can enhance surgical skills. Research has shown that through brain–computer interface (BCI), it is possible to provide feedback on MI strength. We hypothesized that adding BCI to MI training would enhance robotic skill acquisition compared with controls.Methods Surgical novices were recruited. At baseline, participant...

Purpose: Since 2002, the Japan Surgical Society has established a board certification system for surgeons to be certified for a specialty. Surgery remains a male-dominated field in Japan. This study aimed to clarify if the Japanese surgical residency training system is equally suitable for female and male residents. Methods: The Japan Surgical S...

Background Non-technical skills (NTS) are essential for safe surgical patient management. However, assessing NTS involves observer-based ratings, which can introduce bias. Eye tracking (ET) has been proposed as an effective method to capture NTS. The purpose of the current study was to determine if ET metrics are associated with NTS performance.Met...

Background: Weight recurrence (WR) after bariatric surgery occurs in nearly 20% of patients. Revisional bariatric surgery (RBS) may benefit this population but remains controversial among surgeons. Objectives: Explore surgeon perspectives and practices for patients with WR after primary bariatric surgery (PBS). Setting: Web-based survey of bar...

Percutaneous cholecystostomy (PC) tube insertion has been shown to be an effective treatment of acute cholecystitis (AC) as a temporary step to subsequent laparoscopic cholecystectomy (LC). However, the optimal time gap between PC implantation and LC has not been identified. Adult patients who underwent PC followed by LC for the treatment of AC bet...

Background: It is yet unknown what contributes to the variable degrees of post-operative dysphagia following a laparoscopic Nissen fundoplication (LNF). Previous studies have not found a contributing factor to post-operative dysphagia. This study reviews the effect of procedure practices, especially Bougie device use, that could be possible contrib...

Introduction: Due to paucity of surgical personnel and lack of resources in low- and middle-income countries (LMICs), general practitioners with little surgical education are often relied upon to complete emergent appendectomies. To address this concern, a smart phone app-based curriculum called AMPATH Surgical App: Open Appendectomy Model (ASAP) w...

Background: Venous thromboembolism (VTE) is the most common cause of death following metabolic/bariatric surgery (MBS), with most events occurring after discharge. The available evidence on ideal prophylaxis type, dosage, and duration after discharge is limited. Objectives: Assess metabolic/bariatric surgeon VTE prophylaxis practices and define...

Purpose: Intraoperative teaching is a critical component of surgery residents' education. Although prior studies have investigated best practices from the viewpoint of the expert educator, the perspective of the learner has been less explored. This study examined the ideal faculty teaching behaviors that optimize intraoperative teaching from the s...

Background: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Bariatric Surgical Risk/Benefit Calculator uses procedure-specific prediction models to generate individualized surgical risk/outcome estimates. This tool helps guide informed consent and operative selection. We hypothesized that calculator use...

This article was updated to correct Alessandro Montedori’s name. Collaborative authorship: The GAP Consortium: Yasser Sami Abdel Dayem, Luca Bertolaccini, Pablo Alonso-Coello, Elie Akl, Manish Chand, John J. Como, Gert J. de Borst, Salomone Di Saverio, Sameh Emile, Bang Wool Eom, Ramon Gorter, George Hanna, Kaisa Immonen, Quirino Lai, Nicolaas Lum...

Purpose Intraoperative teaching is a critical component of surgery residents’ education. Prior efforts to guide faculty on best intraoperative teaching practices have failed to address potential differences in the needs of the junior versus senior resident in the operating room (OR). The objective of this study was to determine the qualities of eff...

PurposeOpen appendectomy is one of the most common procedures performed globally, especially in low- and middle-income countries (LMICs). In many LMICs, surgical education is limited by personnel shortages. Developing effective teaching methods for resource-limited environments may enhance the availability of a trained workforce. Cognitive task ana...

PurposeThe goal of surgical residency is to produce technically competent surgeons who can safely operate autonomously. This study aimed to explore residents’ perception of intraoperative autonomy across post-graduate years (PGY).Methods General surgery residents at a single academic institution were invited to participate in focus groups divided b...

Background Considerable weight recurrence (WR) after Roux-en-Y gastric bypass (RYGB) may occur in nearly 20% of patients. While several nonoperative, endoscopic, and surgical interventions exist for this population, the optimal approach is unknown. This study reports our initial experience with distal bypass revision (DGB) and provides a comparison...

Background Proton pump inhibitors (PPI) are frequently used after Roux-en-Y gastric bypass (RYGB) to prevent marginal ulceration. The optimal duration of PPI treatment after surgery to minimize ulcer development is unclear. Objectives Assess bariatric surgeon practice variability regarding postoperative PPI prophylaxis. Setting Survey of medical...

Background Since 2004 the ASMBS Foundation has funded competitive proposals by ASMBS members that are administered through the ASMBS Research Committee. These grants are intended to further the knowledge in the field of metabolic and bariatric surgery and support the scholarly growth of its members. Objectives The aim of this project was to evalua...

Background Weight regain (WR) post bariatric surgery affects almost 20% of patients. It has been theorized that a complex interplay between physiologic adaptations and epigenetic mechanisms promotes WR in obesity, however, reliable predictors have not been identified. Our study examines the relationship between early postoperative weight loss (WL),...

Background The American Board of Surgery (ABS) has required Fundamentals of Endoscopic Surgery (FES) certification for general surgery applicants since 2018. Flexible Endoscopy Curriculum (FEC) completion is recommended prior to taking the FES exam. The objective of the study was to determine if FEC completion prepares individuals to pass the FES m...

Background Due to a shortage and maldistribution of surgeons within Kenya, doctors with limited formal surgical training often perform emergency surgical procedures such as appendectomy. This lack of training can compromise patient outcomes and complicate care delivery. Our aim was to develop a low-cost simulator and skills curriculum to effectivel...

Background Despite the advantages of laparoscopic cholecystectomy, major bile duct injury (BDI) rates during this operation remain unacceptably high. In October 2018, SAGES released the Safe Cholecystectomy modules, which define specific strategies to minimize the risk of BDI. This study aims to investigate whether this curriculum can change the kn...

BACKGROUND: Artificial intelligence (AI) methods and AI-enabled metrics hold tremendous potential to advance surgical education. Our objective was to generate consensus guidance on specific needs for AI methods and AI-enabled metrics for surgical education. STUDY DESIGN: The study included a systematic literature search, a virtual conference, an...

Objective The purpose of this study was to identify objective measures that predict surgeon nontechnical skills (NTS) during surgery. Background NTS are cognitive and social skills that impact operative performance and patient outcomes. Current methods for NTS assessment in surgery rely on observation-based tools to rate intraoperative behavior. T...

Internal hernia formation is a feared complication following bariatric surgery. Protrusion of the small bowel through mesenteric defects can result in volvulus presenting with symptoms of bowel obstruction. If left untreated, patients may go on to develop bowel ischemia with possible perforation or necrosis necessitating emergent surgical explorati...

Gastrointestinal bleeding following bariatric surgery is a relatively rare adverse event but constitutes a significant cause of morbidity. It requires a high index of suspicion, early diagnosis, and prompt management, as it can lead to rapid deterioration and potential mortality. In most cases, GI bleeding is self-limited and does not necessitate e...

Emotional regulation is increasingly gaining acceptance as a means to improve well-being, performance, and leadership across high-stakes professions, representing innovation in thinking within the field of surgical education. As one part of a broader cognitive skill set that can be trained and honed, emotional regulation has a strong evidence base...

Introduction Work related injuries in minimally invasive surgery (MIS) are common because of the strains placed on the surgeon’s or assistant’s body. The objective of this study was to compare specific ergonomic risks among surgeons and surgical trainees performing robotic and laparoscopic procedures. Materials and methods Ergonomic data and disco...

Background Patients’ social support has been shown to impact outcomes after bariatric surgery. We have previously shown that a Facebook group administered by bariatric providers offers an effective alternative social support mechanism to in-person support groups, with higher patient participation. Our aim was to determine whether participation in t...

Introduction We assessed students' perception of the impact of the pandemic on their well-being, education, academic achievement, and whether grit and resilience alter students’ ability to mitigate the stress associated with disruptions in education. We hypothesized that students would report a negative impact, and those with higher grit and resili...

Operating rooms consist of high-stress, complex environments, which creates a propensity for serious errors. In order to improve patient safety, several strategies can be implemented. By executing a timeout before and after the planned procedure, one can significantly decrease the number of wrong site surgeries and retained foreign bodies. In addit...

Background Bariatric surgery is the most effective treatment for obesity; however, its utilization in older patients remains low. There is a dearth of literature on long-term effectiveness and safety of bariatric surgery in septuagenarian patients. The aim of this study was to compare the short- and long-term outcomes of bariatric surgery in this p...

Objective General surgery training prepares residents for the autonomous practice of surgery; however, assessment for readiness for independent practice presents several challenges. The simulation lab offers a safe and standardized environment for assessing the technical skills of a resident in the absence of numerous confounders of the real operat...

This cohort study uses sensor-based communication and proximity metrics to assess surgeon nontechnical skills during robotic-assisted surgery.

Background Minimally invasive splenectomy (MIS) is increasingly favored for the treatment of benign and malignant diseases of the spleen over open access approaches. While many studies cite the superiority of MIS in terms of decreased morbidity and length of stay over a traditional open approach, the comparative effectiveness of specific technical...

Study Objective To describe the key principles of successful extra pelvic endometriosis excision, highlighting diaphragmatic endometriosis, and the potential role of indocyanine green and near infrared imaging. Design Case Report. Setting Multidisciplinary surgical case at an academic institution using robotic and near infrared technology. Patie...

Background Gastroesophageal Reflux Disease (GERD) is an extremely common condition with several medical and surgical treatment options. A multidisciplinary expert panel was convened to develop evidence-based recommendations to support clinicians, patients, and others in decisions regarding the treatment of GERD with an emphasis on evaluating differ...

Background Social support after bariatric surgery is considered essential. Unfortunately, patient participation in such groups tends to be limited threatening their effectiveness. Facebook groups may provide a social support option that attracts more participation. The aim of this study was to describe our experience with the administration of a Fa...

Introduction To systematically review the literature to assess the incidence and risk factors of weight regain (WR) after bariatric surgery. Bariatric surgery is the most effective intervention for sustained weight loss of morbidly obese patients, but WR remains a concern. Materials and methods A PRISMA compliant systematic literature review was p...

Objective To inform the development of an AGREE II extension specifically tailored for surgical guidelines.Summary background dataAGREE 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.MethodsA p...

Background: Laparoscopic suturing is associated with a steep learning curve. Hence, many general surgery graduate residents entering fellowship have reportedly not been able to proficiently suture laparoscopically despite achieving Fundamentals of Laparoscopic Surgery certification. To address this deficiency, the Advanced Training in Laparoscopic...

IntroductionImproving operating room (OR) inefficiencies benefits the OR team, hospital, and patients alike but the available literature is limited. Our goal was, using a novel surgical application, to identify any OR incidents that cause delays from the time the patient enters the OR till procedure start (preparatory phase).Materials and methodsWe...

IntroductionObesity and its associated comorbidities represent a pervasive problem in the United States across all age groups. There are conflicting data regarding the effectiveness and postoperative recovery of bariatric surgery in elderly patients. The aim of this study was to compare outcomes of bariatric surgery across age groups.Materials and...

IntroductionThe mission of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) is to innovate, educate, and collaborate to improve patient care. A critical element in meeting this mission is the publishing of trustworthy and current guidelines for the practicing surgeon.Methods In this manuscript, we outline the steps of develo...

In diesem Kapitel werden ausführlich die technischen Besonderheiten von drei Adipositasoperationen – Schlauchmagen, Magenbypass und Duodenalswitch sowie unterschiedlichen Varianten der Redo-Chirurgie unter Verwendung minimal invasiver oder roboterassistierter Technik dargestellt. BMI über 60, Thoraxmagen, Z. n. großen viszeralchirurgischen Operatio...

Background Chylous ascites is often reported in cases with lymphatic obstruction or after lymphatic injuries such as intraabdominal malignancies or lymphadenectomies. However, chylous ascites is also frequently encountered in operations for internal hernias. We sought to characterize the frequency and conditions when chylous ascites is encountered...

Surface electromyography (sEMG) can monitor muscle activity and potentially predict fatigue in the workplace. However, objectively measuring fatigue is challenging in complex work with unpredictable work cycles where sEMG may be influenced by the dynamically changing posture demands. This study proposes a multi-modal approach integrating sEMG with...