@article{WidderBackhausWierlemannetal., author = {Widder, A. and Backhaus, J. and Wierlemann, A. and Hering, I. and Flemming, S. and Hankir, M. and Germer, C.-T. and Wiegering, A. and Lock, J. F. and K{\"o}nig, S. and Seyfried, F.}, title = {Optimizing laparoscopic training efficacy by 'deconstruction into key steps': a randomized controlled trial with novice medical students}, series = {Surgical Endoscopy}, volume = {36}, journal = {Surgical Endoscopy}, number = {12}, doi = {10.1007/s00464-022-09408-2}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-323969}, pages = {8726-8736}, abstract = {Background Simulator training is an effective way of acquiring laparoscopic skills but there remains a need to optimize teaching methods to accelerate learning. We evaluated the effect of the mental exercise 'deconstruction into key steps' (DIKS) on the time required to acquire laparoscopic skills. Methods A randomized controlled trial with undergraduate medical students was implemented into a structured curricular laparoscopic training course. The intervention group (IG) was trained using the DIKS approach, while the control group (CG) underwent the standard course. Laparoscopic performance of all participants was video-recorded at baseline (t0), after the first session (t1) and after the second session (t2) nine days later. Two double-blinded raters assessed the videos. The Impact of potential covariates on performance (gender, age, prior laparoscopic experience, self-assessed motivation and self-assessed dexterity) was evaluated with a self-report questionnaire. Results Both the IG (n = 58) and the CG (n = 68) improved their performance after each training session (p < 0.001) but with notable differences between sessions. Whereas the CG significantly improved their performance from t0 -t1 (p < 0.05), DIKS shortened practical exercise time by 58\% so that the IG outperformed the CG from t1 -t2, (p < 0.05). High self-assessed motivation and dexterity associated with significantly better performance (p < 0.05). Male participants demonstrated significantly higher overall performance (p < 0.05). Conclusion Mental exercises like DIKS can improve laparoscopic performance and shorten practice times. Given the limited exposure of surgical residents to simulator training, implementation of mental exercises like DIKS is highly recommended. Gender, self-assessed dexterity, and motivation all appreciably influence performance in laparoscopic training.}, language = {en} } @article{ReimerLockFlemmingetal.2022, author = {Reimer, Stanislaus and Lock, Johan F. and Flemming, Sven and Weich, Alexander and Widder, Anna and Plaßmeier, Lars and D{\"o}ring, Anna and Hering, Ilona and Hankir, Mohammed K. and Meining, Alexander and Germer, Christoph-Thomas and Groneberg, Kaja and Seyfried, Florian}, title = {Endoscopic management of large leakages after upper gastrointestinal surgery}, series = {Frontiers in Surgery}, volume = {9}, journal = {Frontiers in Surgery}, issn = {2296-875X}, doi = {10.3389/fsurg.2022.885244}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-274044}, year = {2022}, abstract = {Background Endoscopic vacuum therapy (EVT) is an evidence-based option to treat anastomotic leakages of the upper gastrointestinal (GI) tract, but the technical challenges and clinical outcomes of patients with large defects remain poorly described. Methods All patients with leakages of the upper GI tract that were treated with endoscopic negative pressure therapy at our institution from 2012-2021 were analyzed. Patients with large defects (>30 mm) as an indicator of complex treatment were compared to patients with smaller defects (control group). Results Ninety-two patients with postoperative anastomotic or staplerline leakages were identified, of whom 20 (21.7\%) had large defects. Compared to the control group, these patients required prolonged therapy (42 vs. 14 days, p < 0.001) and hospital stay (63 vs. 26 days, p < 0.001) and developed significantly more septic complications (40 vs. 17.6\%, p = 0.027.) which often necessitated additional endoscopic and/or surgical/interventional treatments (45 vs. 17.4\%, p = 0.007.) Nevertheless, a resolution of leakages was achieved in 80\% of patients with large defects, which was similar compared to the control group (p = 0.42). Multiple leakages, especially on the opposite side, along with other local unfavorable conditions, such as foreign material mass, limited access to the defect or extensive necrosis occurred significantly more often in cases with large defects (p < 0.001). Conclusions Overall, our study confirms that EVT for leakages even from large defects of the upper GI tract is feasible in most cases but comes with significant technical challenges.}, language = {en} } @article{KelmSeyfriedReimeretal.2017, author = {Kelm, M. and Seyfried, F. and Reimer, S. and Krajinovic, K. and Miras, A. D. and Jurowich, C. and Germer, C. T. and Brand, M.}, title = {Proximal jejunal stoma as ultima ratio in case of traumatic distal duodenal perforation facilitating successful EndoVAC\(^{®}\) treatment: a case report}, series = {International Journal of Surgery Case Reports}, volume = {41}, journal = {International Journal of Surgery Case Reports}, doi = {10.1016/j.ijscr.2017.11.022}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-159292}, pages = {401-403}, year = {2017}, abstract = {Introduction: During damage control surgery for blunt abdominal traumata simultaneous duodenal perforations can be missed making secondary sufficient surgical treatment challenging. Endoluminal vacuum (EndoVAC™) therapy has been shown to be a revolutionary option but has anatomical and technical limits. Presentation of the case: A 59-year old man with hemorrhagic shock due to rupture of the mesenteric root after blunt abdominal trauma received damage control treatment. Within a scheduled second-look, perforation of the posterior duodenal wall was identified. Due to local and systemic conditions, further surgical treatment was limited. Decision for endoscopic treatment was made but proved to be difficult due to the distal location. Finally, double-barreled jejunal stoma was created for transstomal EndoVAC™ treatment. Complete leakage healing was achieved and jejunostomy reversal followed subsequently. Discussion: During damage control surgery simultaneous bowel injuries can be missed leading to life-threatening complications with limited surgical options. EndoVAC™ treatment is an option for gastrointestinal perforations but has anatomical limitations that can be sufficiently shifted by a transstomal approach for intestinal leakage. Conclusion: In trauma related laparotomy complete mobilization of the duodenum is crucial. As ultima ratio, transstomal EndoVAC™ is a safe and feasible option and can be considered for similar cases.}, language = {en} } @article{FlemmingHankirErnestusetal.2020, author = {Flemming, S. and Hankir, M. and Ernestus, R.-I. and Seyfried, F. and Germer, C.-T. and Meybohm, P. and Wurmb, T. and Vogel, U. and Wiegering, A.}, title = {Surgery in times of COVID-19 — recommendations for hospital and patient management}, series = {Langenbeck's Archives of Surgery}, volume = {405}, journal = {Langenbeck's Archives of Surgery}, issn = {1435-2443}, doi = {10.1007/s00423-020-01888-x}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-231766}, pages = {359-364}, year = {2020}, abstract = {Background The novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), has escalated rapidly to a global pandemic stretching healthcare systems worldwide to their limits. Surgeonshave had to immediately react to this unprecedented clinical challenge by systematically repurposing surgical wards. Purpose To provide a detailed set of guidelines developed in a surgical ward at University Hospital Wuerzburg to safelyaccommodate the exponentially rising cases of SARS-CoV-2 infected patients without compromising the care of emergencysurgery and oncological patients or jeopardizing the well-being of hospital staff. Conclusions The dynamic prioritization of SARS-CoV-2 infected and surgical patient groups is key to preserving life whilemaintaining high surgical standards. Strictly segregating patient groups in emergency rooms, non-intensive care wards andoperating areas prevents viral spread while adequately training and carefully selecting hospital staff allow them to confidentlyand successfully undertake their respective clinical duties.}, language = {en} } @article{CuiSchlesingerSchoenhalsetal.2016, author = {Cui, Huanhuan and Schlesinger, Jenny and Schoenhals, Sophia and Tonjes, Martje and Dunkel, Ilona and Meierhofer, David and Cano, Elena and Schulz, Kerstin and Berger, Michael F. and Haack, Timm and Abdelilah-Seyfried, Salim and Bulyk, Martha L. and Sauer, Sascha and Sperling, Silke R.}, title = {Phosphorylation of the chromatin remodeling factor DPF3a induces cardiac hypertrophy through releasing HEY repressors from DNA}, series = {Nucleic Acids Research}, volume = {44}, journal = {Nucleic Acids Research}, number = {6}, doi = {10.1093/nar/gkv1244}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-166391}, pages = {2538-2553}, year = {2016}, abstract = {DPF3 (BAF45c) is a member of the BAF chromatin remodeling complex. Two isoforms have been described, namely DPF3a and DPF3b. The latter binds to acetylated and methylated lysine residues of histones. Here, we elaborate on the role of DPF3a and describe a novel pathway of cardiac gene transcription leading to pathological cardiac hypertrophy. Upon hypertrophic stimuli, casein kinase 2 phosphorylates DPF3a at serine 348. This initiates the interaction of DPF3a with the transcriptional repressors HEY, followed by the release of HEY from the DNA. Moreover, BRG1 is bound by DPF3a, and is thus recruited to HEY genomic targets upon interaction of the two components. Consequently, the transcription of downstream targets such as NPPA and GATA4 is initiated and pathological cardiac hypertrophy is established. In human, DPF3a is significantly up-regulated in hypertrophic hearts of patients with hypertrophic cardiomyopathy or aortic stenosis. Taken together, we show that activation of DPF3a upon hypertrophic stimuli switches cardiac fetal gene expression from being silenced by HEY to being activated by BRG1. Thus, we present a novel pathway for pathological cardiac hypertrophy, whose inhibition is a long-term therapeutic goal for the treatment of the course of heart failure.}, language = {en} } @article{ReimerSeyfriedFlemmingetal.2022, author = {Reimer, Stanislaus and Seyfried, Florian and Flemming, Sven and Brand, Markus and Weich, Alexander and Widder, Anna and Plaßmeier, Lars and Kraus, Peter and D{\"o}ring, Anna and Hering, Ilona and Hankir, Mohammed K. and Meining, Alexander and Germer, Christoph-Thomas and Lock, Johan F. and Groneberg, Kaja}, title = {Evolution of endoscopic vacuum therapy for upper gastrointestinal leakage over a 10-year period: a quality improvement study}, series = {Surgical Endoscopy}, volume = {36}, journal = {Surgical Endoscopy}, number = {12}, doi = {10.1007/s00464-022-09400-w}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-323953}, pages = {9169-9178}, year = {2022}, abstract = {Background Endoscopic vacuum therapy (EVT) is an effective treatment option for leakage of the upper gastrointestinal (UGI) tract. The aim of this study was to evaluate the clinical impact of quality improvements in EVT management on patients' outcome. Methods All patients treated by EVT at our center during 2012-2021 were divided into two consecutive and equal-sized cohorts (period 1 vs. period 2). Over time several quality improvement strategies were implemented including the earlier diagnosis and EVT treatment and technical optimization of endoscopy. The primary endpoint was defined as the composite score MTL30 (mortality, transfer, length-of-stay > 30 days). Secondary endpoints included EVT efficacy, complications, in-hospital mortality, length-of-stay (LOS) and nutrition status at discharge. Results A total of 156 patients were analyzed. During the latter period the primary endpoint MTL30 decreased from 60.8 to 39.0\% (P = .006). EVT efficacy increased from 80 to 91\% (P = .049). Further, the need for additional procedures for leakage management decreased from 49.9 to 29.9\% (P = .013) and reoperations became less frequent (38.0\% vs.15.6\%; P = .001). The duration of leakage therapy and LOS were shortened from 25 to 14 days (P = .003) and 38 days to 25 days (P = .006), respectively. Morbidity (as determined by the comprehensive complication index) decreased from 54.6 to 46.5 (P = .034). More patients could be discharged on oral nutrition (70.9\% vs. 84.4\%, P = .043). Conclusions Our experience confirms the efficacy of EVT for the successful management of UGI leakage. Our quality improvement analysis demonstrates significant changes in EVT management resulting in accelerated recovery, fewer complications and improved functional outcome.}, language = {en} }