Papers by Steven Schwaitzberg
Current Surgery, Nov 1, 2001
The Journal of Trauma: Injury, Infection, and Critical Care, 2000
To compare the hemostatic capabilities of poly-Nacetylglucosamine (p-GlcNAc) with three currently... more To compare the hemostatic capabilities of poly-Nacetylglucosamine (p-GlcNAc) with three currently available products: Actifoam, Surgicel, and Bolheal fibrin glue. This study was conducted in a controlled animal model, with monitoring of hematologic parameters over the course of the study. Two series were conducted, one in unheparinized animals comparing Bolheal fibrin sealant, Actifoam (absorbable collagen, AC), and Surgicel (ORC) with p-GlcNAc, and the second in systemically heparinized animals comparing p-GlcNAc with AC. This study was performed in immature female Yorkshire White swine. Splenic lacerations controlled for length and depth of wound were used as sources of bleeding, with one material used per wound to assess hemostatic effectiveness. A total of 97 wounds in 12 animals were created for the study, 74 wounds in unheparinized animals, and 23 wounds in the heparinized animals. In the heparinized animals, hemostatic efficacy was judged by number of applications needed to achieve complete hemostasis. In the unheparinized animals, hemostatic efficacy was judged by length of time required to achieve complete hemostasis (p-GlcNAc vs. fibrin sealant) or the number of applications needed to achieve complete hemostasis (p-GlcNAc vs. AC or ORC). In systemically heparinized animals, p-GlcNAc demonstrated greater hemostatic efficacy (72.7 %) in one application than did the control material (0%), p < 0.01. In the unheparinized animals, p-GlcNAc took less time to achieve hemostasis (mean, 22.9 seconds) than fibrin sealant (mean, 172.9 seconds), p < 0.01. p-GlcNAc achieved hemostasis with a greater efficacy (79.2%) in one application than did the AC or ORC (16.7%), p < 0.01, whereas there was no difference in the efficacy of the control materials. The results of the previous series in unheparinized animals demonstrated that p-GlcNAc in the form of a membrane is a more effective topical hemostatic agent than Bolheal fibrin glue, AC or ORC. The results in the anticoagulated animals similarly demonstrate that p-GlcNAc is a more effective topical hemostatic agent than the control material AC. These data indicate that p-GlcNAc is a promising hemostatic agent as evaluated in this model.
Annals of Surgery Open, 2020
Operative video has great potential to enable instant replays of critical surgical decisions for ... more Operative video has great potential to enable instant replays of critical surgical decisions for training and quality review. Recently, artificial intelligence (AI) has shown early promise as a method of enabling efficient video review, analysis, and segmentation. Despite the progress with AI analysis of surgical videos, more work needs to be done to improve the accuracy and efficiency of AI-driven video analysis. At a recent consensus conference held on July 10–11, 2020, 8 research teams shared their work using AI for surgical video analysis. Four of the teams showcased the utility of wearable technology in providing objective surgical metrics. Data from these technologies were shown to pinpoint important cognitive and motor actions during operative tasks and procedures. The results support the utility of wearable technology to facilitate efficient and accurate video analysis and segmentation.
Research Square (Research Square), Jan 4, 2023
Transcranial direct current stimulation (tDCS) has been shown to facilitate surgical training and... more Transcranial direct current stimulation (tDCS) has been shown to facilitate surgical training and performance when compared to sham tDCS; however, the potency may be improved by selecting appropriate brain targets based on neuroimaging and mechanistic insights. Published studies have shown the feasibility of portable brain imaging in conjunction with tDCS during Fundamentals of Laparoscopic Surgery (FLS) tasks for concurrently monitoring the cortical activations via functional near-infrared spectroscopy (fNIRS). Then, fNIRS can be combined with electroencephalogram (EEG) where EEG band power changes have been shown to correspond to the changes in oxyhemoglobin (HbO) concentration, found from the fNIRS. In principal accordance with these prior works, our current study aimed to investigate multi-modal imaging of the brain response to cerebellar (CER) and ventrolateral prefrontal cortex (PFC) tDCS that may facilitate the most complex FLS suturing with intracorporal knot tying task. Our healthy human study on twelve novices (age: 22-28 years, 2 males, 1 female with left-hand dominance) from medical/premedical backgrounds aimed for mechanistic insights from neuroimaging brain areas that are related to error-based learning one of the basic skill acquisition mechanisms. We found that right CER tDCS of the posterior lobe facilitated a statistically significant (q<0.05) brain response at the bilateral prefrontal areas at the start of the FLS task that was higher than sham tDCS. Also, right CER tDCS significantly (p<0.05) improved FLS score when compared to sham tDCS. In contrast, left PFC tDCS failed to facilitate a significant brain response and FLS performance improvement. Moreover, right CER tDCS facilitated activation of the bilateral prefrontal brain areas related to FLS performance improvement provided mechanistic insights into the CER tDCS effects. The mechanistic insights motivated future investigation of CER tDCS effects on the error-related perception action coupling based on directed functional connectivity studies.
Objective: The objective of this study was to evaluate the differences in brain activity between ... more Objective: The objective of this study was to evaluate the differences in brain activity between expert surgeons and novice medical residents based on electroencephalography (EEG). The first sub-goal was to assess the Microstate EEGlab toolbox and BCIlab toolboxes for data analysis and classification of the topographical features for microstate-based Common Spatial Pattern (CSP) analysis. Then, the second sub-goal was to compare microstate-based CSP with the conventional regularized CSP approach.Methods: After IRB approval, ten expert surgeons and 13 novice medical residents were recruited at the University at Buffalo. After informed consent, the subjects performed three trials of laparoscopic suturing and knot tying with rest periods in-between the task trials. 32-channel EEG was performed during the task performance that was used to analyze spatial patterns of brain activity in 8 expert surgeons (2 dropouts due to data quality) and 13 novice medical residents. Microstate analysis ...
The comparison of the effects of physical and virtual reality (VR) simulators on the brain networ... more The comparison of the effects of physical and virtual reality (VR) simulators on the brain network during skill acquisition has not been well addressed. In this study, the brain network and skilled behavior relationship were evaluated using functional near-infrared spectroscopy (fNIRS) data from seven experienced right-handed surgeons and six right-handed medical students during the performance of a well-established Fundamentals of Laparoscopic Surgery (FLS) pattern of cutting tasks. Multiple regression path analysis found that the FLS performance score was statistically significantly related to the interregional directed functional connectivity from the right prefrontal cortex to the supplementary motor area with F(2, 114) = 9, p < 0.001, and R2 = 0.136. The coefficient of variation (CoV) of the FLS performance score was statistically significantly related to the CoV of the interregionally directed functional connectivity from the right primary motor cortex to the left primary m...
The Fundamentals of Laparoscopic Surgery (FLS) training module is designed to provide essential s... more The Fundamentals of Laparoscopic Surgery (FLS) training module is designed to provide essential surgical skills. During skill training of the FLS "suturing and intracorporeal knot-tying" task (FLS complex task) – the most difficult among the five psychomotor FLS tasks, the error-related chain of mental processes is postulated to depend on the skill level leading to a difference in the contextual switching of the brain states on error commission between experts and novices. So, this study investigated changes in the brain states using simultaneously acquired functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG) signals during FLS complex task and following motor errors in thirteen right-handed novice medical students and nine expert surgeons. A brain state analysis of the quasi-stable EEG scalp topography (called microstates) changes was performed using 32-channel EEG data acquired at 250Hz (high temporal resolution). Six microstate prototypes were ...
Fundamentals of Laparoscopic Surgery (FLS) is a training module designed to provide basic surgica... more Fundamentals of Laparoscopic Surgery (FLS) is a training module designed to provide basic surgical skills. During skill training of the FLS "suturing and intracorporeal knot-tying" task – the most difficult among the five psychomotor FLS tasks, learning from errors is one of the basic principles of motor skill acquisition where appropriate contextual switching of the brain state on error is postulated. This study investigated changes in the brain state following an error event based on the fusion of simultaneously acquired functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG) signals. Here, human error processing is postulated to differentiate experts from novices based on the differences in the error-related chain of mental processes. Thirteen right-handed novice medical students and nine expert surgeons participated in this study. Error-related microstate analysis was performed using 32-channel EEG data at a high temporal resolution. Six microsta...
Fundamentals of Laparoscopic Surgery (FLS) is a standard education and training module with a set... more Fundamentals of Laparoscopic Surgery (FLS) is a standard education and training module with a set of basic surgical skills. During surgical skill acquisition, novices need to learn from errors due to perturbations in their performance which is one of the basic principles of motor skill acquisition. This study on thirteen healthy novice medical students and nine expert surgeons aimed to capture the brain state during error epochs using multimodal brain imaging by combining functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG). We performed error-related microstate analysis in the latent space that was found using regularized temporally embedded Canonical Correlation Analysis from fNIRS-EEG recordings during the performance of FLS "suturing and intracorporeal knot-tying" task – the most difficult among the five psychomotor FLS tasks. We found from two-way analysis of variance (ANOVA) with factors, skill level (expert, novice), and microstate type (1-...
Journal of the American College of Surgeons, 2017
Surgeons are expected leaders, and the need for leadership development is acknowledged. However, ... more Surgeons are expected leaders, and the need for leadership development is acknowledged. However, formal didactics on this topic during residency remain uncommon. This study aimed to develop and implement a curriculum to fulfill this need. METHODS: Four 1-hour weekly interactive leadership sessions were developed and taught by a single resident during pre-existing didactic times. The content was derived from leadership texts and the ACS Residents as Teachers and Leaders syllabus. Pre and postcourse surveys of leadership knowledge and interest using a 5-point Likert scale were administered. A similar one-time survey was administered to faculty. Follow-up course evaluations were obtained from residents. Data was analyzed using Mann Whitney U tests with significance attributed to p < 0.05. RESULTS: Twenty-two of 25 residents (88%) responded to the pre-course survey and 16 (64%) responded to the post-course survey. Improvement was noted in relevance of leadership to daily work (p¼0.046) and where to seek additional education (p¼0.01).Of 65 faculty, 45 (69%) completed the survey. Compared to pre-course resident responses, faculty had less exposure to leadership topics during training (p¼0.005), but had more interest (p¼0.005), and more knowledge on where to seek additional education (p¼0.038).Of 17 resident course evaluations, 82% wanted ongoing leadership training and found this a good use of didactic time. Ninety-four percent recommended a leadership curriculum for other residency programs. CONCLUSIONS: Leadership development is relevant to surgical training and practice, and is desired by residents. This study supports the value and feasibility of an integrated leadership curriculum in surgical residency.
Biophotonics Congress: Biomedical Optics 2020 (Translational, Microscopy, OCT, OTS, BRAIN), 2020
We established a neural network model to efficiently remove motion artifacts during fNIRS data pr... more We established a neural network model to efficiently remove motion artifacts during fNIRS data processing.
Annals of Surgery, 2020
Objective: The aim of this work is to formulate recommendations based on global expert consensus ... more Objective: The aim of this work is to formulate recommendations based on global expert consensus to guide the surgical community on the safe resumption of surgical and endoscopic activities. Background: The COVID-19 pandemic has caused marked disruptions in the delivery of surgical care worldwide. A thoughtful, structured approach to resuming surgical services is necessary as the impact of COVID-19 becomes better controlled. The Coronavirus Global Surgical Collaborative sought to formulate, through rigorous scientific methodology, consensus-based recommendations in collaboration with a multidisciplinary group of international experts and policymakers. Methods: Recommendations were developed following a Delphi process. Domain topics were formulated and subsequently subdivided into questions pertinent to different aspects of surgical care in the COVID-19 crisis. Forty-four experts from 15 countries across 4 continents drafted statements based on the specific questions. Anonymous Delph...
Journal of the American College of Surgeons, 2021
METHODS: Acute care surgeons at a tertiary care center prospectively estimated 30-day mortality a... more METHODS: Acute care surgeons at a tertiary care center prospectively estimated 30-day mortality and complications (as defined by the calculators) for adult EGS patients (2019-2021). Surgeon estimates were compared to NSQIP and Predictive OpTimal Trees in Emergency Surgery Risk (POTTER) predictions. Observed-to-expected (O:E) ratios of means were calculated using actual and predicted outcomes. C-statistics for surgeon and calculator estimations were used to quantify predictive accuracy.
Despite substantial progress towards establishing virtual reality (VR) simulators as a replacemen... more Despite substantial progress towards establishing virtual reality (VR) simulators as a replacement for physical ones for skill training, its effect on the brain network during skill acquisition has not been well addressed. In this study, we employed portable optical neuroimaging technology and Granger causality approach to uncover the impact of the two medical simulation technologies on the directed functional brain network of the subjects with two different skill levels. The mobile brain-behavior relantionship was evaluated using functional near-infrared spectroscopy (fNIRS) while right-handed subjects performed well-established fundamentals of laparoscopic surgery (FLS) pattern cutting task. A multiple regression path analysis found that the cognitive-action information flow from the right prefrontal cortex to the supplementary motor area statistically significantly predicted the FLS task performance. Here, the skill level (expert vs novice) affected the cognitive-action informati...
Fundamentals of Laparoscopic Surgery (FLS) is a prerequisite for board certification in general s... more Fundamentals of Laparoscopic Surgery (FLS) is a prerequisite for board certification in general surgery in the USA. In FLS, the suturing task with intracorporeal knot tying is considered the most complex. Transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (PFC) has been shown to facilitate FLS surgical skill acquisition where 2mA tDCS for 15min with the anode over F3 (10/10 EEG montage) and cathode over F4 has improved performance score in an open knot-tying task. Since PFC has a functional organization related to the hierarchy of cognitive control, we performed functional near-infrared spectroscopy (fNIRS) to investigate PFC activation during the more complex FLS suturing task with intracorporeal knot tying. We performed fNIRS-based analysis using AtlasViewer software on two expert surgeons and four novice medical students. We found an average cortical activation mainly at the left medial PFC across the experts, while the average cortical activatio...
Annals of Surgery, 2021
Objective: The aim of this study was to examine real-life patterns of care and patient outcomes a... more Objective: The aim of this study was to examine real-life patterns of care and patient outcomes associated with robot-assisted cholecystectomy (RAC) in New York State (NYS). Background: Although robotic assistance may offer some technological advantages, RACs are associated with higher procedural costs and longer operating times compared to traditional laparoscopic cholecystectomies (LCs). Evidence on long-term patient outcomes after RAC from large population-based datasets remains limited and inconsistent. Methods: Using NYS inpatient and ambulatory surgery data from the Statewide Planning and Research Cooperative System (2009–2017), we conducted bivariate and multivariate analyses to examine patterns of utilization, complications, and secondary procedures following cholecystectomies. Results: Among 299,306 minimally invasive cholecystectomies performed in NYS between 2009 and 2017, one thousand one hundred eighteen (0.4%) were robot-assisted. Compared to those undergoing LC, RAC p...
IEEE Transactions on Biomedical Engineering, 2020
Currently, there is a dearth of objective metrics for assessing bi-manual motor skills, which are... more Currently, there is a dearth of objective metrics for assessing bi-manual motor skills, which are critical for high-stakes professions such as surgery. Recently, functional near-infrared spectroscopy (fNIRS) has been shown to be effective at classifying motor task types, which can be potentially used for assessing motor performance level. In this work, we use fNIRS data for predicting the performance scores in a standardized bi-manual motor task used in surgical certification and propose a deep-learning framework ‘Brain-NET’ to extract features from the fNIRS data. Our results demonstrate that the Brain-NET is able to predict bi-manual surgical motor skills based on neuroimaging data accurately ($R^2=0.73$). Furthermore, the classification ability of the Brain-NET model is demonstrated based on receiver operating characteristic (ROC) curves and area under the curve (AUC) values of 0.91. Hence, these results establish that fNIRS associated with deep learning analysis is a promising method for a bedside, quick and cost-effective assessment of bi-manual skill levels.
Surgical Endoscopy, 2019
Background Despite improvements in safety and effectiveness in surgical management of extreme obe... more Background Despite improvements in safety and effectiveness in surgical management of extreme obesity, men and racial minorities are less likely to receive metabolic and bariatric surgery (MBS) compared to other patient groups. This study examines the racial and gender disparities in access to MBS to understand the mechanism that drives these problems and to propose strategies for closing the disparity gap. Methods Using 2013-2014 National Health and Nutrition Examination Survey data, we estimated the proportion of individuals, by race and gender, who were eligible for MBS based on Body Mass Index (BMI) and comorbidity profile. We analyzed the 2015 MBS Accreditation and Quality Improvement Program Participant Use Data File to examine differences in patient characteristics, comorbidities, and postsurgical outcomes among African-American (AA) and White men. Predictors of poor outcomes were identified using unconditional logistic regression models. Results AA men represented 11% of eligible patients but only 2.4% of actual MBS patients. Compared to White men, AA men were younger, had higher BMI, were more likely to have a history of hypertension, renal insufficiency, required dialysis, and had American Society of Anesthesiologists class 4 or 5 (all P values < 0.01). After surgery, AA men were more likely to suffer from postoperative complications (adjusted odds ratio (aOR) 1.25, 95% confidence interval (CI) 1.02-1.52) and stayed in the hospital for more than 4 days (aOR 1.51, 95% CI 1.26-1.82) compared to White men. Conclusions Despite being eligible for MBS based on both BMI and obesity-related comorbidities, AA men are significantly less likely to undergo MBS. Those AA men who receive surgery are significantly younger than White men but also experience greater comorbidities compared to White men and all women. Further longitudinal studies into patient-, system-, and provider-level barriers are necessary to understand and address these disparities. Keywords Bariatric surgery • Obesity • Disparities • Men • African-American men • Postsurgical outcomes Obesity rates in the United States are on the rise, with more than two-thirds of the adult population considered obese or overweight [1]. Obesity is a major risk factor for many chronic conditions (such as hypertension, diabetes, cancer, renal failure, and joint disease) and long-term disability, and is associated with enormous patient and healthcare costs ($176 billion annually) [2-4]. Technological advances have transformed metabolic and bariatric surgery (MBS) into a highly effective, safe, and cost-effective procedure for longterm weight reduction. Current guidelines recommend MBS for patients who present with a Body Mass Index (BMI) of 40 and higher or between 35 and 40 with coexisting medical conditions related to obesity and resistant to other clinical and Other Interventional Techniques The earlier version of the study was presented at the 2019 SAGES Annual Meeting.
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Papers by Steven Schwaitzberg