SAGES

Reimagining surgical care for a healthier world

A Message from SAGES President Dr. Patricia Sylla – Fall 2023

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As we wrap up an eventful summer of 2023, we take a moment to stand in solidarity with colleagues, patients and the communities devastated by recent fires, earthquakes, and catastrophic floods across the world. The loss of life and unimaginable grief have challenged us to reflect more urgently on the role we must play in curbing the impact of our activities on the global climate crisis.

As a surgical organization, SAGES has acknowledged the direct environmental impact of the healthcare sector and specifically of minimally invasive and endoscopic practices [1]. SAGES has pledged to educate and disseminate best practices and collaborate with other stakeholders including industry partners in global efforts to reduce the surgical footprint on the environment [1]. We have joined forces with EAES to organize a Sustainability in Surgical Practice (SSP) taskforce that includes 36 members passionate about sustainability. SAGES recently joined the Medical Society Consortium on Climate and Health and will continue to build strong partnerships and expertise in this space, as reflected in the 2024 SAGES Annual Meeting featuring inaugural sessions focused on SSP. You will soon be asked to complete a 5-minute survey that will help us focus efforts on empowering surgeons through education, collaborative actions and initiatives in promoting sustainable practices. We urge you to complete it so we better understand your interests, local resources and concerns. We want to hear from students, trainees, and surgeons across all levels of leadership and diversity of practice.

Our SAGES committees have been actively preparing to launch other important initiatives, programing and curricula. Please join me in congratulating the SAGES Global Affairs Committee for kicking off the Global Laparoscopic Advancement Program (GLAP) training in Ondangwa, Namibia just a few weeks ago, which is the first official site of SAGES Go Global in Africa. The virtual GLAP programming will continue in Guadalajara, Mexico and Costa Rica, with plans to expand to El Salvador. The Global and Safe Chole Committees are teaming up to pilot Safe Chole Virtual Modules in Costa Rica. In collaboration with the Fundamentals leadership, the Global Committee is also working to bring FLS certification to LMIC locations via GAC/GLAP programming. Much of the work by the GLAP team is led by volunteers like you, practicing surgeons and trainees who have a passion for educating, and has been supported by the SAGES Research and Education Foundation and a prior generous grant from one of our members, Dr. Pon Satitpunwaycha. Donations from external sponsors and members like you can help scale up GLAP outreach and impact to even more underserved regions of the world – www.sagesfoundation.org.

In keeping with creating meaningful SAGES educational offerings for our members, the QOS Committee just launched a free OpiVoidTM course that meets the new DEA requirement for clinicians seeking a new license or renewing an existing DEA prescriber license. The QOS Committee curated content from past conferences to create a free 8-hour CME activity that provides training on treating and managing patients with opioid or other substance use disorders. Log on to www.sages.org/login and then click “Access Organization Wide Learning System (OWLS)” to take advantage of this free resource that is relevant to your practice.

Our FLS Committee has also been hard at work developing more than 300 new MCQs mapped to a revised blueprint focused on a set of EPAs and OBs selected based on the results of a prior multi-specialty survey. Beta testing will soon begin to select questions to be included in the revised FLS exam. The committee developed the prototype for a new technical skill task that may be included in the revised FLS skills exam. The committee also plans to revamp the curricular content for the FLS program to provide a more comprehensive and up-to-date learning experience to better support competency goals for laparoscopic surgeons in training and in early practice.

In the not so distant future, trainees and practicing surgeons alike will also have the opportunity to submit surgical videos for comprehensive video based assessment (VBA) and feedback through a SAGES online platform! The Education Council and associated committees are developing several VBA initiatives. Following a rigorous process for validating its scoring methodology, the Lap Fundoplication VBA is now complete! The Lap Chole VBA has finalized a scoring rubric and is developing an asynchronous rater training module, and the Colorectal Committee is in the process of adapting the CAT framework for a Lap Right Colectomy VBA. To support the launch of VBA, the Surgical Data Science (SDS) task force led an RFP for developing a secure online platform that can support video upload, storage, review and rating by external raters, with added features such as coaching and data analytics, all intended to enable quality improvement initiatives. Several proposals by commercial vendors are currently under review with the goal of finalizing a formal partnership and launching the SAGES Foregut VBA.

We are proud to announce that in line with our mission to improve patient care, SAGES was recently granted recognition as a Patient Safety Organization (PSO) by the Agency for Healthcare Research and Quality (AHRQ). As a PSO, SAGES can create a legally secure environment (conferring privilege and confidentiality) where clinicians and health care organizations can voluntarily report, aggregate, and analyze clinical data with the goal of improving the safety and quality of patient care. SAGES will leverage its PSO designation as we move towards developing multispecialty video-based repositories and clinical registries.

SAGES remains committed to fostering DEI and improving the quality and equity of surgical care across the diverse populations we serve. Our Diversity, Leadership and Professional Development (DLPD) Committee has developed the Fundamentals of Leadership Development (FLD) course that incorporates DEI training. The course was launched virtually and will be offered for the first time in-person on April 15, 2024, immediately preceding the SAGES meeting. This course that all SAGES Board Members are required to take will be accessible to all. The DLPD Committee is exploring strategies to expand access to the course both in-person and virtually.

Our Guidelines Committee was also tasked with re-evaluating its methodology for developing SAGES Guidelines and ensuring that review of the best published evidence of a clinical topic and subsequent strength of recommendations take into account the diversity, or lack thereof, in the patient groups included in relevant trials. To that effect, SAGES guidelines will incorporate a section at least recommending new areas of research, when diversity is lacking.

In order to address this gap in surgical trials, the Research Committee has developed an initiative to increase diversity in surgical trials, not only among participating trial sites and investigators, but also among patients enrolled. Stay tuned for the launch of the SAGES Research Network Database that will provide the opportunity for surgeons interested in participating in investigator-initiated and/or sponsored clinical trials, to be matched as an eligible trial site, based on site, investigator, clinical and research profile.

SAGES continues to innovate, explore and bring our members the latest and most exciting new technologies and techniques in our specialties through specialty meetings, our Annual Meeting and via social media. The SAGES 5th Annual Next Best Thing (NBT) Innovation weekend will be held February 22-24, 2024. The summit will feature the 17th annual NOSCAR meeting, the Surgical Disruptive Technology Summit (SDTS) meeting and a summit on Governance led by the SAGES AI Committee. Once again, the SAGES Shark Tank semi-finalists will pitch their proposals, with the finalists moving on to present at the SAGES Annual Meeting on April 18, 2024.

The SAGES Critical View of Safety (CVS) Challenge is a biomedical computer vision challenge launched by the SAGES AI Committee, aimed at developing clinically meaningful and effective solutions to assess the CVS during laparoscopic cholecystectomy. The goal of this initiative is to generate a large and diverse and annotated dataset of lap chole videos and encourage researchers to compete in developing innovative AI algorithms for real-time intraoperative CVS detection. This groundbreaking project represents the first effort by a Surgical Society to leverage AI-driven intraoperative assistance for enhancing surgical safety, and has benefited from academic and industry collaborations and sponsorships. To date, nearly 825 videos from 55 countries have been uploaded and expert annotation is well underway. Upon reaching a target of 1,000 videos and finalizing the dataset, the CVS Challenge will be presented at the International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI). If accepted, the challenge will officially launch by March 2024. We invite surgeons worldwide to continue contributing to this landmark project that is poised to serve as a framework for future AI-based clinical challenges. Contribute to the challenge at www.cvschallenge.org.

Calling out new members! With 7,478 members to date, we remain committed to growing a diverse membership and engaging, supporting and providing value to our members. The Membership committee implemented several initiatives to recruit more next generation members and leaders, including facilitating the Candidate Membership application process, reducing the financial burden for trainees transitioning to practice by discounting the 1st year Active membership fee, and launching “Trainee Town Hall” and “Meet a Member” events at our annual meeting for medical students, residents and fellows to mingle with our members.

SAGES listens. Over the past few months, the QOS Committee surveyed our membership about the state of burnout in surgery, while the Reimagining the Practice of Surgery (RPS) task force inquired about factors important to surgeons in their professional well-being. The candid and detailed feedback received from as many as 600 of our members will help inform our Society on action plans and initiatives to better support surgeons in practice and in training. We look forward to strong participation at several wellness sessions and activities at our Annual Meeting.

Fresh off the Press! We are pleased to report a near record high number of abstract submissions for the SAGES 2024 meeting in Cleveland! Please Visit https://www.sages2024.org/ to view the Schedule at a Glance. Registration and housing will open later this Fall. Special thanks to Program Chairs Marylise Boutros, Caitlin Halbert and Eric Pauli for organizing a superb program centered around the theme of educating, innovating and collaborating for a sustainable future.

Lastly, I want to express my deepest thanks to the Executive Committee, Board, Committee Chairs and Co-Chairs, SAGES staff and more than 900 committee members for their efforts advancing SAGES’s mission while maintaining financial sustainability. We are particularly grateful to the SAGES Foundation for its ongoing support.

Sincerely,

Your President,
Pat Sylla

  1. Pietrabissa A, Sylla P. Green surgery: time to make a choice. Surg Endosc 2023;37(9):6609-6610.

A Message From SAGES President Dr. Patricia Sylla – Spring 2023

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We could not have hoped for a more energizing and meaningful reunion in Montreal. With 2,500 participants from around the globe, our auditoria, tech exhibits and hallways once again buzzed with delight as attendees reconnected with mentors, collaborators, colleagues and friends. Scientific abstracts and meeting sessions were masterfully coordinated along specialty tracks by our program chairs Dr. Stefanidis and Dr. Petersen and featured a diverse faculty of current and future leaders in surgery.

This year’s program also highlighted sessions on how to sustain the joy of surgical practice and transitioning (well) through the various phases of our careers. A strong focus on new technologies permeated the meeting with important themes woven into expert panel discussions including how to implement guidelines, achieve equitable care, and advocate against erosion in physician compensation. We celebrated President John Mellinger, who reminded us of the deep meaning of our profession, and how through SAGES, we can support others in leading change in their communities. Our first keynote speaker, Dr. Hachach-Haram, shared her vision of a future of digitally interconnected operating rooms that will expand access to better quality care, and how we should all prepare for change in our own ORs. Our 2nd keynote speaker, Dr. Govindarajan, reminded us of the power of reverse innovation, and the imperative of supporting low-cost high-impact solutions that have the potential to disrupt health care delivery on a global scale.

Looking ahead, I am incredibly excited about the future of our society and deeply honored to serve as your President for the coming year. SAGES is ideally positioned to lead as we enter an era where surgical data science will increasingly inform clinical workflows and best practices, and where rapid influx of new technologies and AI-based solutions will require clinical validation and training of our workforce to ensure safe adoption. SAGES will persevere in its commitment to advancing MIS surgical and endoscopic skill training and access to high-quality educational content through various platforms and collaborative partnerships.

SAGES is also dedicated to developing a framework for assessing and mitigating the environmental impact of our surgical practices, and to outlining strategies to achieve sustainable practices while providing the highest quality of care for all our patients. Many of you have already reached out and expressed strong interest in joining this effort, and I am so excited about what we can accomplish together. There is no greater honor and privilege than serving in this role, and I look forward to working with all of you in shaping the future of the most innovative and forward-thinking society in North America.

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

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The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the world will compete in developing AI models capable of reliable and accurate detection of the CVS.

The SAGES Video Acquisition Portal is now live, offering de-identification features to seamlessly remove Private Health Information data and metadata securely. Consider participating in this global endeavor and its associated research projects by contributing your laparoscopic cholecystectomy videos through the portal and/or signing up as an annotator.

Please go to the CVS Challenge Data donation web page to sign up and donate your videos of laparoscopic cholecystectomy procedures. For more information or any questions on how to donate your videos, please contact [email protected] or go to www.cvschallenge.org.

Additionally, we are asking people and institutions to volunteer or appoint annotators to be part of our annotation team. Annotators will be trained under SAGES consensus recommendations on an annotation framework for surgical video. Please appoint a volunteer to be part of our annotation team.

Thank you for your support of this exciting and promising AI data challenge!

Help us promote the CVS Data Challenge! Use the images below in your social media or email to help us get more submissions.Critical View of Safety (CVS) Challenge QR Code Critical View of Safety (CVS) Challenge QR Code

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

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El estudio NordICC, recientemente publicado en el New England Journal of Medicine, ha generado controversia con respecto al beneficio de la colonoscopia de tamizaje para reducir el riesgo cáncer de colon, así como para reducir la muerte relacionada a cáncer entre hombres y mujeres sanos, asintomáticos, entre 55 y 64 años.

Añadiendo a la controversia se han generado varios notas y titulares, incluyendo una nota de un medio (CNN) describiendo las colonoscopias como el “temido rito de transición o paso para adultos de mediana edad. La premisa ha sido que si sobrellevas la incomodidad e invasión de tener una cámara a lo largo de tu intestino grueso una vez cada década después de los 45 años, tienes la mejor oportunidad de detectar – y quizá prevenir – el cáncer colorrectal”.

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones. El estudio NordICC enroló a 84,585 pacientes en Polonia, Noruega, y Suecia. Los pacientes fueron aleatorizados para recibir una invitación a tamizaje (para someterse a una colonoscopia) o a seguir manejo habitual. A una mediana de seguimiento de 10 años, los autores encontraron que el riesgo de desarrollar cáncer colorrectal era 18% más bajo en el grupo invitado, y el riesgo de muerte por cáncer colorrectal no fue significativamente más bajo que en el grupo de cuidado habitual (0.31% vs. 0.28%). Estos resultados difieren de estudios de tamizaje previos y quedan muy lejos de la esperada reducción de 25% en mortalidad relacionada a cáncer colorrectal.

Sin embargo, estos resultados se deben interpretar con precaución dadas las importantes limitantes de diseño de selección o inclusión de pacientes. Entre los pacientes que recibieron una invitación al tamizaje, solo el 42% cumplieron con el protocolo del estudio y se sometieron a una colonoscopia. A pesar del cumplimiento con el protocolo menor a lo esperado, todos los pacientes en el brazo de tamizaje, incluyendo el 58% que no se sometió a colonoscopia, permanecieron en el grupo “Invitado a tamizaje”, lo cual diluye el impacto de colonoscopia para reducir la incidencia de cáncer colorrectal y las muertes relacionadas a cáncer. Adicionalmente, el estudio no especificó cuando o cómo fue que los pacientes que no se sometieron a una colonoscopia recibieron posteriormente un diagnóstico de cáncer colorrectal. Dado que no hubo diferencias significativas en el estadio del cáncer al momento de diagnóstico entre los grupos, la colonoscopia probablemente jugó un papel en establecer el diagnóstico en ambos grupos e impactó la mortalidad relacionada a cáncer en toda la cohorte de pacientes.

Finalmente, el resultado más importantes del estudio NordICC es que una colonoscopia de tamizaje redujo el riesgo de cáncer colorrectal a los 10 años. El hallazgo de un beneficio en reducción de muerte relacionada a cáncer menor a lo esperado no debe impactar recomendaciones nacionales acerca de tamizaje de cáncer colorrectal. La Sociedad Americana del Cáncer (American Cancer Society) ha establecido guías para el tamizaje a partir de los 45 años para paciente con riesgo promedio. Los pacientes con otros factores de riesgo como historia familiar se podrían beneficiar de tamizaje más temprano. La colonoscopia de tamizaje en pacientes con riesgo medio fue aprobada por CMS para beneficiarios de Medicare en el 2000, y es cubierta casi universalmente por la mayoría de las empresas de seguros médicos privados.

SAGES desea reafirmar el valor de la colonoscopia en la prevención, identificación, y tratamiento del cáncer colorrectal basado en la preponderancia de la evidencia disponible. Le pedimos a las personas a seguir las guías de tamizaje para prevenir el cáncer colorrectal. Asimismo, suplicamos a las empresas de seguros médicos a mantener la cobertura para la colonoscopia de tamizaje a fin de asegurar el acceso equitativo a la salud y mantener el estándar de la salud pública. SAGES representa a más de 6000 cirujanos y endoscopistas que dan servicios de salud a pacientes con enfermedades del tracto digestivo, incluyendo el cáncer de colon. Nuestros miembros están enfocados en el uso de endoscopia flexible y técnicas de cirugía mínimamente invasiva para lograr los mejores resultados de nuestros pacientes.

Gracias a Luis Fernandez, MD y Alejandro Rodriguez, MD por la traducción inicial.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

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The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64.

Provocative headlines and commentaries have added further to the controversy, with one outlet (CNN) describing colonoscopies as the “dreaded rite of passage for many middle-aged adults. The promise has been that if you endure the awkwardness and invasiveness of having a camera travel the length of your large intestine once every decade after age 45, you have the best chance of catching – and perhaps preventing – colorectal cancer.”

SAGES hopes to clarify the results of the NordICC study and frame them in the context of decade-long efforts by several national agencies to reduce the risk of colorectal cancer, the second leading cause of cancer death in the United States, by promoting early detection and treatment of lesions. The NordICC study enrolled 84,585 patients across Poland, Norway, and Sweden where patients were randomized to either receive a screening invitation (to undergo colonoscopy) or to follow usual care. At a median follow-up of 10 years, the authors found that the risk of developing colorectal cancer was 18% lower in the group invited to undergo screening and the risk of death from colorectal cancer was not significantly lower relative to the usual care group (0.31% vs 0.28%). These results deviate from the results of prior screening trials and fell short of the expected 25% reduction in colorectal cancer-related mortality.

However, these results must be interpreted with caution considering the significant design limitations. Among patients who received an invitation to undergo screening, only 42% complied with the study protocol and underwent colonoscopy. Despite the lower-than-expected compliance with the screening protocol, all patients in the screening arm, including the 58% of patients who did not undergo colonoscopy, were still included in the “invited to undergo screening” group, which significantly diluted the impact of screening colonoscopy on reducing colorectal cancer incidence and cancer-related mortality. In addition, the study did not specify when or how the patients who did not undergo screening colonoscopy underwent subsequent diagnosis of colorectal cancer. Given that there were no significant differences in cancer stage at diagnosis between the groups, colonoscopy presumably played a role in establishing a diagnosis in both groups and impacted cancer-related mortality across the entire cohort of patients.

Ultimately, the most important finding of the NordICC study is that a screening colonoscopy did reduce the risk of colorectal cancer at 10 years. The lower-than-expected benefits, especially as it relates to reducing cancer-related mortality, should not impact national recommendations regarding colorectal cancer screening. At this time, colonoscopy remains the most effective screening test to identify and reduce the incidence of colorectal cancer. Guidelines for screening have been established by the American Cancer Society to begin at age 45 for patients with average risk. Patients with other risk factors such as family history may benefit from earlier screening. Colonoscopy for screening in average risk patients was approved by CMS for Medicare beneficiaries in 2000 and is almost universally covered by most private insurance carriers.

SAGES affirms the value of colonoscopy in the prevention, identification, and treatment of colorectal cancer based on the preponderance of evidence. We urge the public to follow the guidelines for screening to prevent colon cancer. We also advocate for the insurance industry to maintain coverage for screening colonoscopy to ensure equitable access to care and maintain the standard for public health. SAGES represents more than 6,000 surgeons and endoscopists who care for patients with GI diseases including colon cancer. Our members are focused on the use of flexible endoscopy and minimally invasive surgery techniques to achieve the best results for our patients.

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