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Estimate or calculate? How surgeons rate volumes and surfaces

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Abstract

Purpose

Surgeons frequently describe the shape of intraoperative findings using visual judgement and their own sense of proportion or describing these findings in comparison to commonly used or metaphoric subjects. The aim of the study was to analyse the reliability of surgeon’s estimations of dimensions.

Methods

The study was performed in two phases. First, physicians had to estimate the metric proportions of four well-known objects. Second, surgeons were asked intraoperatively to estimate the liver resection surface after partial hepatectomy. The exact surface of the resection plane was measured using computed tomography-guided planimetry of the resection specimen. Physician’s estimations and the exact measurements of the well-known objects and the liver resection surface were compared. Systematic error was defined by the natural logarithm of estimated/real size.

Results

We found a large individual discrepancy in estimating the metric proportions of commonly used objects and a tendency to underestimate both commonly used objects and liver resection surface. Experienced liver surgeons were more accurate in estimating liver resection surface compared with younger staff members.

Conclusions

We found a large bias in estimating the dimension of both commonly used objects and the surface area of liver parenchyma transection. Obviously, estimating errors are more influenced by the individual subject who estimates than by the object itself. In clinical routine, surgeons should rely more on simple measuring devices than on their own sense of proportion. Education in how to estimate more correctly human liver resection surfaces can be achieved by ex vivo studies using porcine livers.

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References

  1. Haider MA, Amitai MM, Rappaport DC, O’Malley ME, Hanbidge AE, Redston M, Lockwood GA, Gallinger S (2002) Multi-detector row helical CT in preoperative assessment of small (< or = 1.5 cm) liver metastases: is thinner collimation better? Radiology 225(1):137–142

    Article  PubMed  Google Scholar 

  2. Sica GT, Ji H, Ros PR (2002) Computed tomography and magnetic resonance imaging of hepatic metastases. Clin Liver Dis 6(1):165–179, vii

    Article  PubMed  Google Scholar 

  3. Meiser A, Casagranda O, Skipka G, Laubenthal H (2001) Quantification of blood loss. How precise is visual estimation and what does its accuracy depend on? Anaesthesist 50(1):13–20

    Article  PubMed  CAS  Google Scholar 

  4. Jeong O, Ryu SY, Jeong MR, Sun JW, Park YK (2011) Accuracy of macroscopic intraoperative diagnosis of serosal invasion and risk of over- and underestimation in gastric carcinoma. World J Surg 35(10):2252–2258

    Article  PubMed  Google Scholar 

  5. Brookman-May S, Johannsen M, May M, Hoschke B, Gunschera J, Wieland WF, Burger M (2011) Difference between clinical and pathologic renal tumor size, correlation with survival, and implications for patient counseling regarding nephron-sparing surgery. AJR Am J Roentgenol 197(5):1137–1145

    Article  PubMed  Google Scholar 

  6. Kubota K, Makuuchi M, Kusaka K, Kobayashi T, Miki K, Hasegawa K, Harihara Y, Takayama T (1997) Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology 26(5):1176–1181

    PubMed  CAS  Google Scholar 

  7. Benzoni E, Lorenzin D, Baccarani U, Adani GL, Favero A, Cojutti A, Bresadola F, Uzzau A (2006) Resective surgery for liver tumor: a multivariate analysis of causes and risk factors linked to postoperative complications. Hepatobiliary Pancreat Dis Int 5(4):526–533

    PubMed  Google Scholar 

  8. Bruix J (1997) Treatment of hepatocellular carcinoma. Hepatology 25(2):259–262

    Article  PubMed  CAS  Google Scholar 

  9. Mullen JT, Ribero D, Reddy SK, Donadon M, Zorzi D, Gautam S, Abdalla EK, Curley SA, Capussotti L, Clary BM, Vauthey JN (2007) Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg 204(5):854–862, discussion 862 –854

    Article  PubMed  Google Scholar 

  10. Fisher BL, Atkinson JD, Cottam D (2007) Incidence of gastroenterostomy stenosis in laparoscopic Roux-en-Y gastric bypass using 21- or 25-mm circular stapler: a randomized prospective blinded study. Surg Obes Relat Dis 3(2):176–179

    Article  PubMed  Google Scholar 

  11. Suggs WJ, Kouli W, Lupovici M, Chau WY, Brolin RE (2007) Complications at gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass: comparison between 21- and 25-mm circular staplers. Surg Obes Relat Dis 3(5):508–514

    Article  PubMed  Google Scholar 

  12. Agrawal N, Fowler AL, Thomas MG (2006) The routine use of intra-operative ultrasound in patients with colorectal cancer improves the detection of hepatic metastases. Colorectal Dis 8(3):192–194

    Article  PubMed  CAS  Google Scholar 

  13. Foltys D, Moench C, Burck I, Hoppe-Lotichius M, Schad A, Teufel A, Heise M, Otto G (2008) The solid pseudopapillary tumor (SPT). A rare neoplasm of the pancreas. Z Gastroenterol 46(07):689–694

    Article  PubMed  CAS  Google Scholar 

  14. Frickmann H, Jungblut S, Holzknecht N, Hansmann ML, Hanke P (2007) Post-operative sclerosing mesenteritis. Der Urologe A 46(1):63–65

    Article  CAS  Google Scholar 

  15. Hach W, Hach-Wunderle V (2006) Beherrschung einer dramatischen venösen Blutung bei Bernhard von Langenbeck anno 1857. Gefässchirurgie 11(2):113–116

    Article  Google Scholar 

  16. Paganelli CV, Olszowka A, Ar A (1974) The avian egg: surface area, volume, and density. Condor 76(3):319–325

    Article  Google Scholar 

  17. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476):307–310

    Article  PubMed  CAS  Google Scholar 

  18. Bland JM, Altman DJ (1986) Regression analysis. Lancet 1(8486):908–909

    Article  PubMed  CAS  Google Scholar 

  19. Cohen J (2003) Applied multiple regression/correlation analysis for the behavioral sciences, 3rd edn. Erlbaum, Mahwah, NJ

    Google Scholar 

  20. Bose P, Regan F, Paterson-Brown S (2006) Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. BJOG 113(8):919–924

    Article  PubMed  CAS  Google Scholar 

  21. McConnell JS, Fox TJ, Josson JP, Subramanian A (2007) “About a cupful”—a prospective study into accuracy of volume estimation by medical and nursing staff. Accid Emerg Nurs 15(2):101–105

    Article  PubMed  Google Scholar 

  22. Yoong W, Karavolos S, Damodaram M, Madgwick K, Milestone N, Al-Habib A, Fakokunde A, Okolo S (2010) Observer accuracy and reproducibility of visual estimation of blood loss in obstetrics: how accurate and consistent are health-care professionals? Arch Gynecol Obstet 281(2):207–213

    Article  PubMed  CAS  Google Scholar 

  23. Kahrimanovic M, Bergmann Tiest WM, Kappers AM (2010) Seeing and feeling volumes: the influence of shape on volume perception. Acta Psychol (Amst) 134(3):385–390

    Article  Google Scholar 

  24. Tanaka W, Yamanaka N, Oriyama T, Katoh T, Kuroda N, Okamoto E (1997) Multivariate analysis of liver regenerative capacity after hepatectomy in humans. J Hepatobiliary Pancreat Surg 4(1):78–82

    Article  Google Scholar 

  25. Truant S, Oberlin O, Sergent G, Lebuffe G, Gambiez L, Ernst O, Pruvot FR (2007) Remnant liver volume to body weight ratio > or =0.5 %: a new cut-off to estimate postoperative risks after extended resection in noncirrhotic liver. J Am Coll Surg 204(1):22–33

    Article  PubMed  Google Scholar 

  26. Kahrimanovic M, Tiest WM, Kappers AM (2010) Haptic perception of volume and surface area of 3-D objects. Atten Percept Psychophys 72(2):517–527

    Article  PubMed  Google Scholar 

  27. Bohrer T, Koller M, Schlitt HJ, Bauer H (2011) Workload and quality of life of surgeons. Results and implications of a large-scale survey by the German Society of Surgery. Langenbecks Arch Surg 396(5):669–676

    Article  PubMed  Google Scholar 

  28. von Heesen M, Schuld J, Sperling J, Grünhage F, Lammert F, Richter S, Schilling M, Kollmar O (2011) Parenchyma-preserving hepatic resection for colorectal liver metastases. Langenbecks Arch Surg. doi:10.1007/s00423-011-0872-x

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Authors and Affiliations

  1. Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of the Saarland, Kirrberger Straße, 66421, Homburg/Saar, Germany

    Jochen Schuld, Otto Kollmar, Catherine Black, Martin K. Schilling & Sven Richter

  2. Department of Diagnostic and Interventional Radiology, University of Saarland, 66421, Homburg/Saar, Germany

    Roland Seidel

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  1. Jochen Schuld
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  2. Otto Kollmar
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  3. Roland Seidel
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  4. Catherine Black
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  5. Martin K. Schilling
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  6. Sven Richter
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Corresponding author

Correspondence to Jochen Schuld.

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Authors’ contributions

Jochen Schuld: drafting the article, acquisition of data, statistical analysis and interpretation of the data and review of the literature

Otto Kollmar: drafting the article, analysis and interpretation of the data and review of the literature

Roland Seidel: planimetric CT scans of the liver resection surface, drafting the article and review of radiological literature

Catherine Black: revision of the article concerning English grammar and style and drafting the article

Martin K. Schilling : revision of the article for important intellectual content

Sven Richter: conception and design of the study, analysis and interpretation of the data, review of the literature and acquisition of data

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Schuld, J., Kollmar, O., Seidel, R. et al. Estimate or calculate? How surgeons rate volumes and surfaces. Langenbecks Arch Surg 397, 763–769 (2012). https://doi.org/10.1007/s00423-012-0942-8

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  • DOI: https://doi.org/10.1007/s00423-012-0942-8

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