Surgical innovation
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Surgical innovation · Mar 2008
Randomized Controlled TrialProficiency-based laparoscopic simulator training leads to improved operating room skill that is resistant to decay.
The aim of this study was to assess skill retention in the operating room following completion of a proficiency-based laparoscopic skills curriculum. Novices (n = 15) were randomized to a control and a training group that practiced to proficiency on the Fundamentals of Laparoscopic Surgery suturing model. The performance of both groups was assessed on the simulator and on a live porcine laparoscopic Nissen fundoplication model at training completion (posttest) and 5 months later (retention test). ⋯ Trained participants outperformed controls, and their performance deteriorated slightly between posttests and retention tests on the simulator (505 +/- 22 vs 462 +/- 50, respectively; P < .05) but not in operating room (263 +/- 138 vs 279 +/- 88, respectively; P = .38). Proficiency-based simulator training results in durable improvement in operative skill of trainees even in the absence of practice for up to 5 months. Minute simulator performance changes do not translate to the operating room.
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Surgical innovation · Mar 2008
Clinical TrialUse of laparoscopy in evaluation and treatment of penetrating and blunt abdominal injuries.
Use of laparoscopy in penetrating trauma has been well established; however, its application in blunt trauma is evolving. The authors hypothesized that laparoscopy is safe and feasible as a diagnostic and therapeutic modality in both the patients with penetrating and blunt trauma. Trauma registry data and medical records of consecutive patients who underwent laparoscopy for abdominal trauma were reviewed. ⋯ Sensitivity/specificity of laparoscopy in patients with blunt and penetrating trauma was 92%/100% and 90%/100%, respectively. Overall, laparotomy was avoided in 25 (58%) patients. Use of laparoscopy in selected patients with blunt and penetrating abdominal trauma is safe, minimizes nontherapeutic laparotomies, and allows for minimal invasive management of selected intra-abdominal injuries.