OPINION
GENERAL SURGERY NEWS / DECEMBER 2021
Mental Skills for Training, Performance Excellence in Surgery continued from page 1
gives a subjective impression of related growth in the number of articles on the value of these skills for the training and practice of surgery. More than 20 years ago, surgeons agreed that mental skills are a large component of performance excellence.4 More recently, this perspective has been reinforced in the surgical literature for performance and procedural preparation.5,6 Mental imagery may be the most frequently cited technique, but critical skills such as emotion regulation, negative thought stopping, affirmations, self-talk, breathing techniques and others are also described, as are individual, group and comprehensive curricular approaches.7,8 A perceived increasing emphasis on training mindset and mental skills suggests an important trend, but this is subjective. In an attempt to objectively document the growing surgical focus on the value of training and use of mental skills through the frequency of relevant publications, we surveyed the surgical literature from 1990 to May 2021 for articles published on this topic.
A search of the literature was conducted in the databases PubMed, Web of Science and Google Scholar. Two thousand articles were retrieved and assessed for specific relevance. Articles on non-surgeon populations were discarded. Furthermore, articles on general aspects of resilience and wellness in surgeons (although important and impacting performance) were also excluded to focus on psychological skills and concepts directly related to enhancing surgical performance. Our findings are shown in the Figure, which displays the number of publications on mental skills in surgery on a five-year basis from 1990 to 2019. As can be seen in this figure, there has been steadily increasing growth, with a positively accelerating trend in the past decade, of publications related to mental skills for training and performance in surgery. Our analysis is limited to articles that focused on psychological performance concepts and skills such as mental training, mental practice, mental skills and mental toughness. This approach was adopted to avoid potential contamination
80 70 60 Number of Articles
8
50
50 40
33 30 20 10 0
7 1
2
3
1990-1994
1995-1999
2000-2004
2005-2009
2010-2014
2015-2019
5-Year Period
Figure. Number of publications on mental performance skills in surgery.
by other similar terms in the surgical literature like “cognitive training” and “nontechnical skills,” which often do refer to psychological skills, although not necessarily or exclusively. However, if articles on these terms are included, the same pattern emerges, just with higher absolute numbers.
A systematic review of the impact of mental practice on surgical performance described benefits from the use of this technique.9 Of note, despite using a different search strategy and focus resulting in higher absolute numbers, an incidental finding of a similar pattern of increasing frequency of publications in this area was reported.
Novel Device Uses Mechanotransduction To Treat Small Bowel Syndrome By MONICA J. SMITH
A
pplying the concept of mechanotransduction to the small intestine in animal models, researchers have had success in regenerating tissue. They expect to soon begin human trials to treat patients with short bowel syndrome, a rare but debilitating disease with few, usually less than satisfactory, treatment options. “The basic concept is similar to distraction osteogenesis, which orthopedic surgeons have used for years, applying distraction force to broken bone that will grow up to a millimeter a day,” said Andre Bessette, the CEO and a co-founder of Eclipse Regenesis, Inc., a medical device company in Menlo Park, Calif.
From that point, around 2005, Dr. Dunn devoted himself to documenting his research and proving the science behind it—“the basic science at the cellular level, the stimulation of growth factors, what type of tissue is created: Is it scar tissue? Is it functional? Will it disappear? What he found was that this procedure produces healthy, viable small intestine tissue,” Mr. Bessette said.
How It Works
To regenerate small-bowel tissue, a surgeon inserts the device, which looks like a small, compressed coil, inside the small intestine and secures both ends with plication sutures applied to the outside of the intestine. Over two to three weeks, the device slowly expands to its uncomThis 20-mm diameter device is intended for older and larger pediatric How It Started pressed state, stimulating new Seeing colleagues in orthope- patients; younger patients would tissue growth—ultimately two dic medicine successfully stimulate receive a 10-mm diameter device. to three times the segment’s bone growth, James Dunn, MD, original length, about 4 cm. PhD, wondered if that concept could be applied to the Once this process is complete, the chromic sutures unmet need he saw in his pediatric patients with short dissolve over about a month, allowing the device to pass bowel syndrome (SBS). through the body to be excreted. “He literally started off with a screw-and-nut conPreclinical studies have shown successful lengthencept in a rat model and slowly put some distraction on ing (tissue growth), no perforations and no obstructhis intestinal tissue and—lo and behold—it grew new tions, and the newly formed tissue looks and acts like intestinal tissue,” Mr. Bessette said. normal intestinal tissue with regard to metabolic uptake
and contractile function. (These studies are available on Eclipse’s website at www.eclipseregenesis.com/ publications.) “Patients with SBS have lost more than 50% of their small intestine, so they’ll need more than one device applied or more than one procedure,” Mr. Bessette said. Treatment will vary depending on a patient’s starting point (how much small intestine they have), and their end point (how much new intestine they need) to achieve the clinical benefits of reducing total parenteral nutrition dependence and being able to absorb nutrients from the food they eat. Michael R. Harrison, MD, the director emeritus of the Fetal Treatment Center at the University of California, San Francisco, is not involved in Dr. Dunn’s research, but has been following the company’s progress for the past decade. “I like the people, and I really like the technology— the idea of mechanotransduction, that you can push on something a little bit over a long period of time and change biology. We’ve been using this principle for a long time,” Dr. Harrison said.
Eclipse: On the Horizon One of the newest companies to join the acclaimed Fogarty Innovation Accelerator Program, Eclipse Regenesis recently was awarded a National Institutes of Health Small Business Innovation Fast Track grant of $1.7 million to help promote research on the Eclipse XL1 System. “The Fast Track grant will allow us to fund the final animal studies we need to do for our FDA submission,
