L Michael Brunt

• Washington University in St. Louis

Background With the advent of advanced imaging and endoscopy, we hypothesized that IOC resident training has declined and is currently insufficient. To this end, we evaluated the national general surgery resident experience with laparoscopic cholecystectomy both with and without intraoperative cholangiography. Methods The National Accreditation Co...

Liver senescence involves the gradual deterioration of hepatic cell function and reduction of regenerative capacity due to aging, chronic liver disease, and cancer. To elucidate the role of liver senescence in aging and cancer, we employed single-cell sequencing, spatial omics, and imaging approaches, collectively over 100 assays, to characterize 4...

Introduction Many surgical fellowship programs incorporate robotic surgery, yet not all residency programs offer robotic training for residents. Given the variability of pre-fellowship robotic exposure, the goal of this study was to explore whether standardized robotic skills assessment would be useful to fellows at the start of their training. Me...

We describe our institution’s development and implementation of our Capstone course from a small elective course to the only required fourth-year course. The course’s structure evolved from mostly didactic to one including various workshops and simulation sessions. Course content has become increasingly specialty-specific. Implementation requires h...

The COVID-19 pandemic led the Fellowship Council (FC) to transition rapidly from in-person to virtual interviews. We investigated the impact of this transition on the FC application and main match process. Five years (2018–2022) of deidentified FC applicant, program, and match rank data were used to assess differences between in-person (2018–2019)...

Background The interview process represents a necessary but potentially resource intensive process from applicant and program perspectives. This study aimed to identify opinions of the 2020 Fellowship Council (FC) application and match process and in-cycle transition to virtual interviews due to the COVID-19 pandemic.Methods Surveys were developed...

Intraoperative cholangiography (IOC) is an essential skill that surgeons need for the safe performance of cholecystectomy and intraoperative diagnosis and management of bile duct stones. Whether it should be performed routinely or selectively is an ongoing debate that goes back to the early days of laparoscopic cholecystectomy (LC). Benefits of IOC...

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...

Objective The Fellowship Council (FC) is transitioning to a competency-based medical education (CBME) model, including the introduction of Entrustable Professional Activities (EPAs) for training and assessment of Fellows. This study describes the implementation process employed by the FC during a ten-month pilot project and presents data regarding...

Background Many surgical adverse events, such as bile duct injuries during laparoscopic cholecystectomy (LC), occur due to errors in visual perception and judgment. Artificial intelligence (AI) can potentially improve the quality and safety of surgery, such as through real-time intraoperative decision support. GoNoGoNet is a novel AI model capable...

Laparoscopic cholecystectomy is one of the most common procedures performed by general surgeons worldwide. Although complications occur infrequently, serious adverse events such as bile duct injury still occur at a frequency somewhat higher than reported prior to the development of laparoscopic cholecystectomy. Optimization of safe performance of t...

Background The COVID-19 pandemic forced surgical fellowship programs to transition from in-person to remote applicant interviews; the virtual interviewing format presented new and unique challenges. We sought to understand applicants’ perceived challenges to virtual interviewing for a surgical fellowship program. Method A grounded theory-based qua...

Objective: To develop and evaluate the performance of artificial intelligence (AI) models that can identify safe and dangerous zones of dissection, and anatomical landmarks during laparoscopic cholecystectomy (LC). Summary background data: Many adverse events during surgery occur due to errors in visual perception and judgment leading to misinte...

Background: The COVID-19 pandemic travel restrictions triggered a rapid alteration in the interview process for fellowships this spring. We describe our initial experience with virtual interviews for Advanced GI Minimally Invasive Surgery Fellowships and assess the value and limitations via a post-interview applicant survey. Study design: Twenty...

Background: Practices of opioid prescribing vary widely across general surgery providers. The goal of this study was to use a text-based platform to assess postdischarge opioid utilization. Methods: A prospective, cohort study enrolled adult patients undergoing operations across the following 3 general surgery sections: minimally invasive surger...

Background Paraesophageal hernias (PEH) can be associated with obstructive symptoms, but high‐resolution manometry (HRM) characteristics have not been described in detail. Methods HRM studies of confirmed PEH patients (n = 60, 66.3 ± 1.5 years, 76.7% F), axial hernias (n = 125, 56.1 ± 1.1 years, 58.4% F), and healthy controls (n = 20, 27.9 ± 0.7 y...

Background Bile duct injury (BDI) is the most common serious complication of laparoscopic cholecystectomy. To address this problem, a multi-society consensus conference was held to develop evidenced-based recommendations for safe cholecystectomy and prevention of BDI.Methods Literature reviews were conducted for 18 key questions across six broad to...

Background: BDI is the most common serious complication of laparoscopic cholecystectomy. To address this problem, a multi-society consensus conference was held to develop evidenced-based recommendations for safe cholecystectomy and prevention of BDI. Methods: Literature reviews were conducted for 18 key questions across 6 broad topics around cho...

Importance To our knowledge, there has been little research conducted on the attitudes of residents toward their pregnant peers and parental leave. Objective To examine the perceptions of current surgery residents regarding parental leave. Design, Setting, and Participants A 36-item survey was distributed to current US general surgery residents a...

Abdominal wall hernia repair is one of the most common operations done by general surgeons today. Patients with incisional hernias can be extremely challenging to manage due to a number of factors that include obesity, prior hernia repairs, previous mesh placement, loss of domain, and other variables. The approach to patients with incisional hernia...

Background & aims: Dysphagia is a consequence of antireflux surgery (ARS) for gastroesophageal reflux disease (GERD). We studied patient management and symptomatic outcomes. Methods: We performed a retrospective study of 157 consecutive adult patients with GERD (mean age, 65.1 ± 1.0 y; 72% female) who underwent ARS at a tertiary care center from...

Groin injuries are common in sports, most of which are muscular/tendon strain-type injuries that resolve with conservative treatment. The term sports hernia or athletic pubalgia refers to a subset of athletic groin injuries that present with exertional inguinal/rectus abdominal insertional pain that limits athletic performance. These injuries not i...

Background: In 2014, hydrocodone was moved from Schedule III to II, thus it could no longer be "called in" to a pharmacy. We analyzed current postoperative opioid prescribing patterns and the impact of the schedule change on the type and amount prescribed. Methods: Opioid prescriptions for common surgeries at 1 medical center from 2013 to 2016 w...

Background: With the epidemic of prescription opioid abuse in the United States, rates of opioid-related unintentional deaths have risen dramatically. However, little data exists comparing postoperative opioid prescriptions with patient use. We sought to better elucidate this relationship in surgical patients. Study design: A prospective cohort...

Background: Robotic platforms have the potential advantage of providing additional dexterity and precision to surgeons while performing complex laparoscopic tasks, especially for those in training. Few quantitative evaluations of surgical task performance comparing laparoscopic and robotic platforms among surgeons of varying experience levels have...

Groin injuries are common in sports, and the condition known as a “sports hernia” is being increasingly recognized as a cause of chronic exertional groin pain. Surgery is indicated for athletes who have the appropriate exam and imaging findings and who have failed a period of conservative management. A variety of surgical approaches to this problem...

� Groin injuries are common in sports because of the forces exerted around the pelvis in high-level athletes. � The approach to athletic groin pain requires a multidisciplinary approach involving sports orthopedists, athletic trainers, and surgeons. � Surgeons who evaluate athletes with groin pain should be well versed in the differential diagnosis...

We hypothesized that a proficiency-based curriculum administered early in the fourth year to senior medical students (MS4) would achieve outcomes comparable to a similar program administered during surgical internship. MS4 (n = 18) entering any surgical specialty enrolled in a proficiency-based skills curriculum at the beginning of the fourth year...

Purpose: The objective of this study was to evaluate the performance of acellular human dermis reinforcement during laparoscopic hiatal hernia repair. Methods: A prospective non-randomized, single institution study enrolled patients undergoing laparoscopic hiatal hernia repair. Acellular human dermis, FlexHD (Musculoskeletal Transplant Foundatio...

Background: Adrenal myelolipoma (AM) is a benign lesion for which adrenalectomy is infrequently indicated. We investigated operative indications and outcomes for AM in a large single-institution series. Subjects and methods: A retrospective cohort study of prospectively collected data was conducted. Patients (≥16 years of age) who underwent adre...

We evaluated suturing skills performance and retention in senior medical students (MS4) at the beginning of their fourth year and 7 months later. MS4 students entering a surgery specialty were randomized to a proficiency-based suturing/knot-tying curriculum at the beginning of fourth year (Intervention, n = 11) versus no training (Control, n = 10)....

Background: Intraoperative perforation is a potentially major complication of laparoscopic (lap) foregut surgery. This study analyzed the incidence, mechanism, and outcomes of intraoperative perforations during these procedures in a large institutional experience. Methods: All patients who underwent lap foregut surgery including laparoscopic ant...

Self-assessment is important to learning but few studies have utilized video self-assessment of basic surgical skills. We compared a video self-assessment of suturing and knot tying skills by novice trainees to the assessment by a senior attending surgeon. Sixteen senior medical students and 7 beginner surgical interns were video-recorded while per...

Background: Risk factors for selecting patients for open adrenalectomy (OA) and for conversion are limited in most series. This study aimed to investigate variables that are important in selecting patients for OA, predict risk of conversion from laparoscopic adrenalectomy (LA), and impact 30-day outcomes of OA and LA. Methods: A retrospective co...

Groin injuries are a common occurrence in sport, especially in elite level athletes. Most of these injuries are muscular strains that resolve completely with standard conservative management measures. However, some groin injuries result in a significant loss of playing time and can be a source of persistent pain that limits performance. Over the la...

Introduction: Laparoscopic adrenalectomy (LA) is the standard for removal of adrenal pheochromocytomas (pheos), but laparoscopic (LAP) resection of paragangliomas (PGs) is controversial. This study analyzes our results of resection of PGs in the LAP era. Methods: A retrospective record review of all patients who underwent resection of intra-abdo...

Background: This study compared the performance of validated laparoscopic tasks on four commercially available single-site-access (SSA) devices with the performance of those tasks on an independent-port (IP) SSA setup. Methods: A prospective, randomized comparison of laparoscopic skills performance on four access devices (ADs) (GelPOINT, SILS Po...

Laparoscopic herniorrhaphy is the minimally invasive approach to the preperitoneal space, where all hernias of the myopectineal orifice in the pelvic floor can be identified and repaired. This advantage, coupled with the benefits of decreased postoperative pain and a quicker recovery has made it a valuable skill to be mastered by the general surgeo...

We recently reported in a multi-institutional, randomized study of laparoscopic paraesophageal hernia repair (LPEHR) that the anatomic recurrence rate at a median of approximately 5 years was >50%. This study focuses exclusively on the symptomatic response to LPEHR and its relationship with the development of a recurrent hernia. During 2002 to 2005...

We implemented and evaluated the outcomes of a proficiency-based program to enhance basic suturing and knot-tying skills in surgical interns. A suturing and knot-tying "masters program" was implemented for 9 surgical interns. Assessment consisted of timed and videotaped technical performance (TP) of 6 suturing (simple interrupted, subcuticular, and...

Background: The type of fundoplication that should be performed in conjunction with Heller myotomy for esophageal achalasia is controversial. We prospectively compared anterior fundoplication (Dor) with partial posterior fundoplication (Toupet) in patients undergoing laparoscopic Heller myotomy. Methods: A multicenter, prospective, randomized-co...

While it is well established that antireflux surgery is effective in relieving typical gastroesophageal reflux disease (GERD) symptoms such as heartburn and regurgitation, it is currently unclear whether atypical symptoms (cough, hoarseness, wheeze) foreshadow a less satisfactory outcome following laparoscopic antireflux surgery (LARS). The purpose...

Groin injuries are a common occurrence in elite-level athletes. These injuries can cause significant pain and disability, leading to prolonged periods of inactivity and consternation among athletes, coaches, athletic trainers, and physicians alike. The differential diagnosis for groin pain is vast and spans multiple disciplines, including orthopaed...

Introduction: There are numerous management options for splenic artery aneurysms, including observation, interventional vascular embolization, and surgical intervention.1–5 Management strategies can vary based on size, location, and number of aneurysms present. While aneurysms of the splenic artery that occur in the splenic hilum are easily managed...

Single-site-access (SSA) laparoscopy is more challenging to perform than multiport (MP) laparoscopy. This study examined the effect of MP versus SSA skills training on laparoscopic performance using surgically naive medical students. For the study, 40 medical students at the end of their first year were randomized into two groups. Both groups were...

The purpose of this comparative study is to evaluate the acute fixation strength of mechanical tacking devices and fibrin sealant against polypropylene suture for laparoscopic ventral hernia repair. Three metallic mechanical tacking devices (ProTack, Salute, EndoANCHOR), 4 absorbable tacking devices (AbsorbaTack, PermaSorb, I-Clip, and SorbaFix), a...

The purpose of this study was to compare perioperative outcomes for intracorporeal versus extracorporeal anastomotic techniques for isolated laparoscopic small-intestine resection. A retrospective database was created for all adult patients who underwent a laparoscopic segmental small-intestine resection. Patients with inflammatory bowel disease or...

The purpose of this study was to examine the biological environment of the esophageal hiatus through analysis of the collagen content within the gastrohepatic ligament (GHL), gastrophrenic ligament (GPL), and phrenoesophageal ligament (PEL) in patients with type I hiatal hernias (HH) and type III paraesophageal hernias (PEH). A control group (N=10)...

Dedicated skills courses may help to prepare 4th-year medical students for surgical internships. The purpose of this study was to analyze the factors that influence the preparedness of 4th-year medical students planning a surgical career, and the role that our skills course plays in that preparedness. A comprehensive skills course for senior medica...

Background: Because of uncertainties about the complexity of laparoscopic ventral hernia repair for varying patient populations, surgeons may be reluctant to perform this procedure. This study aimed to delineate the risk factors that can be identified in the preoperative setting predictive of longer operative times and complexity in laparoscopic v...

Ligamentous attachments maintain the normal anatomic position of the gastroesophageal (GE) junction. Failure of these elastic ligaments through an alteration in collagen synthesis, deposition, and metabolism may be a primary etiology of hiatal hernia formation. Differential expression of zinc-dependent matrix metalloproteinases (MMPs) is largely re...

Single-incision laparoscopic cholecystectomy (SILC) is emerging as a potentially less invasive alternative to standard laparoscopic cholecystectomy and natural orifice transluminal endoscopic surgery cholecystectomy. As this technique is more widely used, it is important to maintain well-established practices of the critical view of safety (CVS) di...

Surgical skills laboratories have become an increasingly important component of technical skills training for learners entering surgical fields. This article describes the experiences with intensive skill preparation courses for senior medical students and interns. The advantages, limitations, and challenges of learning in the skills laboratory are...

The purpose of this study was to characterize the adhesion characteristics of absorbable- and nonabsorbable-barrier-coated meshes and to report adhesiolysis-related complications during laparoscopic re-exploration after prior ventral hernia repair. Under an IRB-approved protocol, patients undergoing laparoscopic re-exploration after prior intraperi...

Primary laparoscopic hiatal hernia repair is associated with up to a 42% recurrence rate. This has lead to the use of mesh for crural repair, which has resulted in an improved recurrence rate (0-24%). However, mesh complications have been observed. We compiled two cases, and our senior author contacted other experienced esophageal surgeons who prov...

Background This study aimed to evaluate the clinical utility of routine barium esophagram after laparoscopic anterior esophageal myotomy for achalasia. Methods The records of 260 consecutive patients who underwent laparoscopic anterior esophageal myotomy for achalasia from May 1996 to August 2007 were reviewed from a prospective institutional revie...

Background Internal drainage of pancreatic pseudocysts can be accomplished by traditional open or minimally invasive laparoscopic or endoscopic approaches. This study aimed to evaluate the primary and overall success rates and clinical outcomes after laparoscopic, endoscopic, and open pancreatic cystgastrostomy for pancreatic pseudocysts. Methods R...

Background Serious complications of adrenalectomy are rare but the incidence may be underestimated if they occur outside major referral centers. We report five cases of high-grade complications after adrenalectomy that have not been previously described. Methods The records of five cases of adrenalectomy performed at outside hospitals were reviewed...

Background This study aimed to review clinical outcomes for patients selected to undergo laparoscopic resection for gastrointestinal stromal tumor (GIST) of the stomach. Methods All 112 laparoscopic gastric resections performed from February 1995 to March 2007 were reviewed. Pre- and postoperative variables were analyzed, and data are given as mean...

Introduction The purpose of this study is to determine the incidence of residual common bile duct (CBD) stones after preoperative ERCP for choledocholithiasis and to evaluate the utility of routine intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) in this patient population. Methods All patients who underwent preoperativ...

Skills training plays an increasing role in residency training. Few medical schools have skills courses for senior students entering surgical residency. A skills course for 4(th)-year medical students matched in a surgical specialty was conducted in 2006 and 2007 during 7 weekly 3-hour sessions. Topics included suturing, knot tying, procedural skil...

When a small adrenal mass is found on a computed tomography (CT) scan and biochemical parameters are all normal, the question of observation versus removal arises. When removal required open surgery, a threshold of 6 cm was commonly used to trigger operative removal. As both imaging modalities and laparoscopic techniques have evolved, the question...

Suturing skills and surgical Instruments presentation focusing on surgical instruments, suture material, and suturing techniques.

Sestamibi scanning is commonly used for preoperative localization in patients with hyperparathyroidism. However, 12% to 15% of these studies are equivocal or negative. Ultrasound may also be used to identify patients suitable for a minimally invasive parathyroidectomy. Data from patients treated for hyperparathyroidism between January 2000 and Apri...

The role of fine needle aspiration (FNA) biopsy in patients with incidentally discovered adrenal masses is limited. However, image-guided biopsy continues to be performed in this setting, in some cases before biochemical workup. The purpose of this study was to review the value of FNA biopsy of adrenal masses in patients referred to a large univers...

Background: The purpose of this study was to analyze the published perioperative results and outcomes of laparoscopic (LVHR) and open (OVHR) ventral hernia repair focusing on complications and hernia recurrences. Methods: Data were compiled from all English-language reports of LVHR published from 1996 through January 2006. Series with fewer than...

This study examines the impact of age and comorbidities on complications and outcomes of laparoscopic (Lap) paraesophageal hernia (PEH) repair. Data were collected prospectively on all patients who underwent Lap PEH repair from January 1995 through June 2005. Pre- and postoperative variables including complications were analyzed. Patients were stra...

Minimally invasive parathyroidectomy (MIP) using local/regional anesthesia has become an accepted treatment for selected patients with primary hyperparathyroidism (HPT) and can be performed in the ambulatory setting. From 1999 to 2004, 139 consecutive patients at our institution with HPT caused by a single localized parathyroid adenoma underwent MI...

Laparoscopic techniques are being used increasingly in the repair of ventral hernias and offer the potential benefits of a shorter hospital stay, decreased wound complications, and possibly a lower recurrence rate. Despite good results from high-volume centers, significant complications may occur with this approach and the morbidity of incisional h...

Adrenalectomy is a relatively recent addition to the growing list of surgical procedures that have been successfully performed using laparoscopic or minimally invasive surgical techniques. The adrenal glands are in many respects ideally suited to a laparoscopic approach, since most adrenal tumors are small in size and pathologically benign. However...

Laparoscopic splenectomy should be considered the standard of care for patients who require splenectomy for ITP, hemolytic anemia, and other hematological disorders with primary splenic manifestations. Relative to open splenectomy, laparoscopic splenectomy appears to have equivalent clinical outcomes in terms of cure of the underlying disorder. How...