Jason Park’s research while affiliated with Vancouver General Hospital and other places


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Publications (95)


Reducing unnecessary laboratory investigations in General Surgery: a modified Delphi consensus
  • Article

June 2024

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4 Reads

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1 Citation

Journal of Gastrointestinal Surgery

Karina Spoyalo

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Jason Park

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Applying fit theory: exploratory analysis of an online survey of care coordination and satisfaction with ambulatory cancer care during the COVID-19 pandemic in Manitoba, Canada (Preprint)

March 2024

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6 Reads

BACKGROUND During the COVID19 pandemic in Manitoba, Canada, the cancer experience was explored using two sibling studies. One study consisted of an online survey designed to assess how patient satisfaction and experience with care coordination differed among the population of cancer patients undergoing cancer treatment. The survey facilitated recruitment for a grounded theory study exploring the cancer experience and how the pandemic impacted it. OBJECTIVE This report presents the results of the survey, with discussion informed by the findings of the grounded theory study. METHODS A link to an online survey was made available to patients receiving cancer treatment (intravenous treatments and radiotherapy) in Manitoba, Canada, between July 31, 2020, and February 28, 2022, primarily through invitations printed on patient’s individualized treatment schedules. The survey included validated patient reported experience measures (PREMs) for patient satisfaction and care coordination as well as an option to opt into being contacted for additional research opportunities. Analysis included the generation of descriptive statistics and logistic regression, including univariate and stepwise multivariate model building, exploring predictors of above and below average PREMs scores. RESULTS A total of 203 responses were collected, 154 were complete for at least one PREM measure and were included in the analysis. Average age was 65 years (SD = 11.7). Most respondents were male (n = 79, 52.7%), and being treated with curative intent (n = 81, 53.6%). The most common type of cancer was breast (n = 41, 26.6%). Univariate analysis demonstrated that age 60 – 69 was associated with above average satisfaction with care (OR = 2.205, 95% CI = 1.045 – 4.624, P = .04), while age < 60 (OR = 0.437, 95% CI = 0.204 – 0.934, P = .03) and ECOG ≥ 2 were associated with below average patient satisfaction (OR = 0.327, 95% CI = 0.137 – 0.782, P = .01). Age between 60 – 69, ECOG ≥ 2, and hematological malignancy were selected through stepwise model building, resulting in an explanatory model (R2 = 0.129) of patient satisfaction. ECOG ≥ 2 was associated with below average care coordination (OR = 0.357, 95% CI = 0.145 – 0.880, P = .03), and was the only identified predictor of care coordination, with no explanatory multivariate model generated. CONCLUSIONS This survey identified that those with poor functional status, as well as those outside of the 60 – 69 age range, are likely to have a below average experience with regards to satisfaction and coordination of care. Through the lens of the sibling grounded theory study, it is possible that these findings are due to unmet supportive care needs that need to be further characterized and addressed. The approach to collecting PREMs used in this study was simple to deploy, and yielded meaningful results, however further work is needed to improve response rates.


Fig. 1. Schematic representation of the Paris classification of polyp morphology. 5 M = mucosal layer; SM = submucosal layer.
Fig. 2. Lateral spreading tumour classification. Reused from Kudo S ei, Lambert R, Allen JI, et al. Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc 2008;68(4 Suppl):S3-S47, 25 with permission from Elsevier.
Fig. 4. The Japan NBI Expert Team (JNET) classification subdivision of NICE type 2 polyps. Reused from Kobayashi S, Yamada M, Takamaru H, et al. Diagnostic yield of the Japan NBI Expert Team (JNET) classification for endoscopic diagnosis of superficial colorectal neoplasms in a large-scale clinical practice database. United European Gastroenterol J 2019;7:914-23, 10 with permission from John Wiley & Sons Inc. NBI = narrow-band imaging; NICE = Narrow-Band Imaging International Colorectal Endoscopic Classification.
Fig. 6. Decision aid for when a polyp is discovered at endoscopy. *These lesions should be tattooed just distal, ensuring that tattoo material does not touch the lesion. †If the endoscopist cannot confidently and completely remove the polyp, they should not attempt and refer. As always, treatment should be individualized accounting for patient factors and the skill set of the surgeon endoscopist.
Colorectal polyp classification and management of complex polyps for surgeon endoscopists
  • Literature Review
  • Full-text available

September 2023

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474 Reads

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4 Citations

Canadian Journal of Surgery

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Ramzi Helewa

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Dana C. Moffatt

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[...]

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Eric Hyun

Increasing familiarity with advanced endoscopic excision techniques allows for more colorectal lesions to be removed without major surgery. Endoscopic excision with negative margins is adequate for most polyps and low-risk T1 cancers. The use of modern polyp classification techniques based on size, morphology and pit pattern by an experienced endoscopist allow for an optical diagnosis of these lesions and can predict, with high accuracy, which lesions contain malignant disease and the level of invasion. A surgeon endoscopist must be able to recognize which complex polyps can be resected with advanced polypectomy techniques and which require upfront surgery. We aimed to provide an overview of polyp classification techniques to help surgeons select the correct treatment algorithm for advanced colorectal lesions based on their visual characteristics at index endoscopy.

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Fig. 1. Decision-making matrix for considering neoadjuvant therapy for locally advanced rectal cancer. Radiation first can lead to standard neoadjuvant therapy or total neoadjuvant therapy depending on patient response and risk factors. CAO/ARO/AIO-12 = Chemoradiotherapy Plus Induction or Consolidation Chemotherapy as Total Neoadjuvant Therapy trial; EMVI = extramural vascular invasion; MRF = mesorectal fascia; OPRA = Organ Preservation of Rectal Adenocarcinoma study; PRODIGE-23 = Neoadjuvant Chemotherapy with FOLFIRINOX and Preoperative Chemoradiotherapy for Patients with Locally Advanced Rectal Cancer; RAPIDO = Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation trial; RT = radiation therapy.
Landmark total neoadjuvant therapy randomized controlled trials
Total neoadjuvant therapy for rectal cancer: a guide for surgeons

April 2023

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203 Reads

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20 Citations

Canadian Journal of Surgery

The modern management of rectal cancers continues to evolve. With the release of data from new landmark randomized controlled trials (RAPIDO, PRODIGE-23), total neoadjuvant therapy (TNT) has moved to the forefront of locally advanced rectal cancer treatment and is considered a standard option in selected patients. Total neoadjuvant therapy promises enhanced systemic disease control, better treatment adherence and less time with an ostomy. However, TNT as currently described encompasses a number of different potential treatment options that differ significantly in terms of their radiation dosage, chemotherapy regimen and order of treatments administered. Being familiar with TNT regimens will be important for rectal cancer surgeons to appropriately advocate for their patients and optimize their outcomes. This article serves as a primer for the general surgeon and offers a pragmatic overview of the indications, realistic expected benefits and potential downsides of each TNT regimen.



Recommendations for Optimal Endoscopic Localization of Colorectal Neoplasms: A Consensus Delphi of National Experts

November 2022

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34 Reads

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4 Citations

Diseases of the Colon & Rectum

Background: Colonoscopy is the standard of care for diagnosis and evaluation of colorectal cancers prior to surgery. However, varied practices and heterogenous documentation affects communication between endoscopists and operating surgeons, hampering surgical planning. Objective: This study aimed to develop recommendations for the use of standardized localization and reporting practices for colorectal lesions identified at lower gastrointestinal endoscopy. Design: A systematic review of existing endoscopy guidelines, and thorough narrative review of the overall endoscopy literature were performed to identify existing practices recommended globally. An online Delphi process was used to establish consensus recommendations based on literature review. Setting: Colorectal surgeons and gastroenterologists from across Canada who had previously demonstrated leadership in endoscopy, managed large endoscopy programs, produced high impact publications in the field of endoscopy, or have participated in the development of endoscopy guidelines, were selected to participate. Primary outcome measures: Colorectal lesion localization and documentation practice recommendations important to planning surgical or advanced endoscopic excisions. Results: At total of 129 of 197 statements achieved consensus after three rounds of voting by 23 experts from across Canada. There was >90% participation in each round. Recommendations varied according to lesion location in the cecum, colon, or rectum, and whether referral was planned for surgical or advanced endoscopic resection. Recommendations were provided for appropriate documentation, indications, location and method of tattoo placement, in addition to photograph and real-time 3D scope configuration device use. Limitations: Due to a paucity of evidence, recommendations are based primarily on expert opinion. There may be bias, as representatives were based in Canada. Conclusions: Best practices to optimize endoscopic lesion localization and communication are not addressed in previous guidelines. This consensus involving national experts in colorectal surgery and gastroenterology provides a framework for efficient and effective colorectal lesion localization. See Video Abstract at http://links.lww.com/DCR/C71.


Fig. 1 CONSORT flow diagram showing patient exclusions for retrospective study
Retrospective study patient characteristics
Retrospective study anastomotic ring findings
Routine pathologic evaluation of circular stapler anastomotic rings is not useful after resection for colorectal cancer: retrospective study and systematic review with meta-analysis

October 2022

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609 Reads

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1 Citation

BJS Open

Background: Circular staplers are commonly used for reconstruction after radical resection for colorectal cancer. Pathological analysis of the anastomotic rings is common practice, although the benefits are unclear. The purpose of this study was to evaluate the usefulness of routine histopathological analysis of anastomotic rings in an original series and in a systematic review of the literature. Method: The retrospective study was performed at two university-associated academic hospitals in Winnipeg, Canada, including patients investigated for colorectal cancers (within 30 cm of the anal verge) who underwent resection between 2007 and 2020. The systematic review involved Ovid MEDLINE, Embase, Scopus, and Web of Science databases, selecting for adult human studies involving analysis of anastomotic rings in elective colorectal cancer resections. The main outcome measure was the proportion of patients with cancer in the anastomotic ring specimens. The frequency of benign pathology findings and changes to patient management were also examined. Results: Out of 673 eligible patients, 487 were included in the retrospective analysis. No patients had cancer within the anastomotic ring specimens. Twenty-five patients (5.1 per cent) had benign pathological findings within the anastomotic ring specimens, and patient management was never affected. In the systematic review, 27 articles were included in the final analysis out of 5848 records reviewed. The rate of cancer within anastomotic ring specimens was 0.34 per cent, and the rate of change in patient management was 0.19 per cent. Conclusion: The likelihood of finding cancer within anastomotic rings is rare and their histopathological examination seldom changes patient management.


Study flow diagram
Patients’ perceived importance of possible advantages and disadvantages to EIC
Patients’ responses to a “How difficult did you find living with a stoma between both of your surgeries?” and b would you have agreed to undergo early ileostomy closure had the option been presented to you at the time you consented for surgery?”
Patient and surgeon preferences for early ileostomy closure following restorative proctectomy for rectal cancer: why aren’t we doing it?

October 2022

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109 Reads

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6 Citations

Surgical Endoscopy

Background Early ileostomy closure (EIC), ≤\le 2 weeks from creation, is a relatively new practice. Multiple studies have demonstrated that this approach is safe, feasible, and cost-effective. Despite the demonstrated benefits, this is neither routine practice, nor has it been studied, in North America. This study aimed to assess patient and surgeon perspectives about EIC. Methods A mixed-methods, cross-sectional study of patients and surgeons was performed. Rectal cancer survivors from a single institution who underwent restorative proctectomy with diverting loop ileostomy and subsequent closure within the last 5 years were contacted. North American surgeons with high rectal cancer volumes (> 20 cases/year) were included. Surveys (patients) and semi-structured interviews (surgeons) were conducted. Analysis employed descriptive statistics and thematic analysis, respectively. Results Forty-eight patients were surveyed (mean age 65.1 ± 11.8 years; 54.2% male). Stoma closure occurred after a median of 7.7 months (IQR 4.8–10.9) and 50.0% (24) found it “difficult” or “very difficult” to live with their stoma. Patients considered improvement in quality of life and quicker return to normal function the most important advantages of EIC, whereas the idea of two operations in two weeks being too taxing on the body was deemed the biggest disadvantage. Most patients (35, 72.9%) would have opted for EIC. Surgeon interviews (15) revealed 4 overarching themes: (1) there are many benefits to EIC; (2) specific patient characteristics would make EIC an appropriate option; (3) many barriers to implementing EIC exist; and (4) many logistical hurdles need to be addressed for successful implementation. Most surgeons (12, 80.0%) would “definitely want to participate” in a North American randomized-controlled trial (RCT) on EIC for rectal cancer patients. Conclusions Implementing EIC poses many logistical challenges. Both patients and surgeons are interested in further exploring EIC and believe it warrants a North American RCT to motivate a change in practice. Graphical abstract


Patient-reported satisfaction with care and care coordination: Results from an online survey conducted in Manitoba, Canada during the COVID-19 pandemic.

October 2022

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8 Reads

Journal of Clinical Oncology

258 Background: In Manitoba, Canada, changes to cancer care delivery implemented in response to the COVID19 pandemic included, but were not limited to, restrictions on informal caregiver accompaniment for ambulatory care appointments and implementation of physician care administered over the telephone. These changes were predicted to negatively impact the patient experience, specifically patient satisfaction with care and perceived care coordination. To assess this, a survey of patients on active treatment was conducted. Methods: After ethics approval, a SurveyMonkey survey was conducted of cancer patients receiving radiation and IV treatment at one of the 24 cancer treatment sites across Manitoba. The survey collected demographics, disease characteristics, functional status and responses to validated questionnaires addressing satisfaction with care (PSCC), and care coordination (CCQP, including communication (CCQP comm ) and navigation (CCQP nav ) subscales). Mean differences of PSCC and CCQP scores (including subscales) were compared using t-test for dichotomous patient characteristics and ANOVA followed by post-hoc pairwise t-tests for non-dichotomous categorical patient characteristics with statistically significant ANOVA results. Results: Between July 2020 and February 2022, 203 responses were collected. The 154 respondents with complete responses for either PSCC, CCQP or both were included in this analysis. Median age of respondents was 64.6 (SD = 11.7). Sex was balanced (male = 47%, female = 52.3%, other/prefer not to say = 0.7%). Breast (26.1%), hematological (13.7%), and prostate (13.1%) cancers were the most common. PSCC and CCQP scores did not differ by marital status, treatment site, disease type, or treatment intent (i.e., curative versus non-curative). Individuals with lower functional status (i.e., ECOG > 1) were identified to have lower mean scores for CCQP and CCQP comm . Patients < 59 years had lower mean PSCC scores compared to those 59 – 69, and 70+. See Table for comparison of CCPQ and PSCC scores by age and functional status. Conclusions: Young patients and those with decreased functional status were identified to have statistically significant lower mean scores for PREMs reflecting satisfaction and coordination of care. Further work to identify meaningful strategies to improve the patient experience for these two patient groups is needed.[Table: see text]


Study protocol flow diagram
Cannulation task trainer
Fundamentals of laparoscopic surgery (FLS) task performance curves, stratified by training arm. Final two trials per arm represent a 4–6 week delay. p values indicate logistic regression curve fit to data. See manuscript text for pairwise comparisons
Box and whisker plots of average cannulation task assessment metrics. Bold horizontal lines denote median values, boxes depict interquartile range, and whiskers denote range. Dots indicate outliers more than 1.5 times outside of the IQR and asterisks denote extreme outliers more than 3 times outside of the IQR
Scatter plot showing the relationship between total final fundamentals of laparoscopic (FLS) surgery scores (mean of last two trials) and mean cannulation task scores. A “passing” FLS score in this study was ≥ 270. An “expert” cannulation task score is ≥ 80
Contextual interference for skills development and transfer in laparoscopic surgery: a randomized controlled trial

September 2022

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135 Reads

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6 Citations

Surgical Endoscopy

Introduction Past education literature has shown benefits for random practice schedules (termed contextual interference) for skills retention and transfer to novel tasks. The purpose of fundamentals of laparoscopic surgery (FLS) training is to develop skills in simulation and transfer to new in vivo intraoperative experiences. The study objective was to assess whether individuals trained over a fixed number of trials in the FLS tasks would outperform untrained controls on an unpracticed previously validated bile duct cannulation task and scoring system and to determine whether random training schedules conferred any relative advantage. Methods 44 trainees with no laparoscopic experience were recruited to participate. 35 were randomized to practice the FLS tasks using either a blocked or random training schedule. Nine were randomized to no additional training (controls). Participant performance was measured throughout training to monitor skills acquisition and were then tested on an unpracticed bile duct cannulation simulation task 4 to 6 weeks later. Outcomes included previously validated FLS scores and hand–motion analyses. Results All 44 participants completed the study. Trained individuals in both groups showed significant improvements in all FLS tasks after training. There were no differences between groups in performance on the cannulation task median scores (Blocked: 89.8 [IQR:37.6]; Random: 83.2 [32.3]; Control: 83.6 [19.1]; p = 0.955), number of hand motions (Blocked: 42.5 [IQR:130.3]; Random: 75.3 [111.3]; Control: 63.0 [71.8]; p = 0.912), or distance traveled by participants hands (Blocked: 2.0 m [IQR:5.8]; Random: 3.8 [8.9]; Control: 2.6 [2.5]; p = 0.816). Cannulation task performance had no correlation with total FLS performance, R² linear = 0.014, p = 0.445. Conclusions Skills acquired from conventional FLS tasks did not effectively transfer to a laparoscopic bile duct cannulation task. Neither blocked nor random practice schedules conferred a relative advantage. These findings provide evidence that cannulation is a distinct skill from what is taught and assessed in FLS.


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Citations (79)


... Colorectal cancer is a common malignant tumor of the digestive tract with a complex pathogenesis involving various genetic and environmental factors. Extensive research has confirmed that colorectal adenomas, particularly tubular and villous adenomatous polyps, are important precursors to colorectal cancer [7][8][9]. Although the presence of these polyps increases the risk of developing colorectal cancer, it also provides opportunities for early intervention and prevention. ...

Reference:

Characteristics and risk factor analyses of high-grade intraepithelial neoplasia in older patients with colorectal polyps
Colorectal polyp classification and management of complex polyps for surgeon endoscopists

Canadian Journal of Surgery

... TNT involves administering both oxaliplatin-based chemotherapy and radiochemotherapy preoperatively, with radiosensitizing fluoropyrimidine. Clear indications for this approach include stage T4 or N2 disease, tumors less than 5 cm from the anal verge, invaded mesorectal fascia, or extramural venous invasion [16]. Intensifying preoperative treatment in advanced rectal cancer aims to achieve the best possible pathological response, improving resectability and even organ preservation. ...

Total neoadjuvant therapy for rectal cancer: a guide for surgeons

Canadian Journal of Surgery

... Participants were provided with a copy of the recommendations both prior to and at the beginning of the meeting. A previously published visual infographic tool was used to help participants understand and refer to the recommendations 5 . All interviews were audio-recorded and later transcribed by the primary analyst. ...

Recommendations for Optimal Endoscopic Localization of Colorectal Neoplasms: A Consensus Delphi of National Experts
  • Citing Article
  • November 2022

Diseases of the Colon & Rectum

... Following recommendation development, we performed a qualitative interview study and a needs assessment, using a mainstream implementation science framework called the Consolidated Framework for Implementation Research [12,13]. We interviewed regional endoscopists to identify barriers and facilitators to following the new recommendations. ...

2022 Canadian Surgery Forum Sept. 15-17, 2022: Abstracts presented at the 2022 Canadian Surgery Forum in Toronto, Ontario

Canadian Journal of Surgery

... A similar result was found in other studies in the literature. 4,5,8 This shows the existing controversy regarding the optimal timing for reversing the intestinal stoma. ...

Patient and surgeon preferences for early ileostomy closure following restorative proctectomy for rectal cancer: why aren’t we doing it?

Surgical Endoscopy

... This work builds on existing theory by recognizing everyday material and social resources as key assets in tackling the existential and biographical issues raised by canceran issue which has only recently been acknowledged in the literature. Thiessen et al. (2018Thiessen et al. ( , 2022 have explored the "non-patient domain", pinpointing the significance of roles and relationships after cancer treatment, and the centrality of routine in the construction of meaning. Milzer et al. (2022) demonstrated that the boundary-setting activity of recording patterns of fatigue in a diary helps to shape new daily routines during recovery. ...

Fit theory: A cancer experience grounded theory emerging from semi-structured interviews with cancer patients and informal caregivers in Manitoba Canada during the COVID-19 pandemic
PLOS ONE

... However, their study was not randomized and did not control for the improvement in scores merely due to repeated exposure to the same clinical questions. In another study, a DA was evaluated by 6 endoscopists assessing a total of 58 colonoscopies [12]. As this was a small pilot study primarily focused on assessing the attitudes of potential users to guide the development of a new DA, it is difficult to draw meaningful conclusions about the potential benefit of the tool in improving guideline concordance. ...

Clinician based decision tool to guide recommended interval between colonoscopies: development and evaluation pilot study

BMC Medical Informatics and Decision Making

... Variable practice has since been explored in non-surgical motor learning studies and has demonstrated increased transfer effect and retention of skills [10][11][12]. In contrast, previous studies in surgical skills acquisition on variable practice versus blocked training have found mixed results and failed to demonstrate the superiority of variable practice [13][14][15][16]. A possible explanation for this could be that prior studies only allowed participants to practice for a limited amount of time or a certain number of repetitions which only examines the effect on the initial part of the trainee's learning curve. ...

Contextual interference for skills development and transfer in laparoscopic surgery: a randomized controlled trial

Surgical Endoscopy

... Various groups have created recommendations to standardize lesion localization techniques 9,35-37 , however, there is large variation in these practices 25,27,38,39 . New Canadian Delphi consensus recommendations for optimal endoscopic localization of colorectal neoplasms provides a framework to standardize practices between providers 5 . ...

Variability in Communication and Reporting Practices Between Gastroenterologists and General Surgeons Contributes to Repeat Preoperative Endoscopy for Colorectal Neoplasms: A Qualitative Analysis
  • Citing Article
  • December 2021

Diseases of the Colon & Rectum

... Users of synthetic or artificial parts produced of conventional synthetic materials are subjected to the unpleasant tactile feedback. Natural fibres, on the other hand, stop allergic reactions in the skin that arise from prolonged skin contact with the prosthetic part [6]. Kumar et al. [7] studied thermo-mechanical and degradation properties of naturally derived biocomposites for prosthesis applications: analysis of the interface pressure and stress distribution on the developed socket. ...

P335 Repeat preoperative endoscopy after regional implementation of electronic synoptic endoscopy reporting: a retrospective comparative study
  • Citing Article
  • November 2021

Surgical Endoscopy