Comparison of training on two laparoscopic simulators and assessment of skills transfer to surgical performance

BACKGROUND: Several studies have investigated the transfer of surgical trainees' skills acquired on surgical simulators to the operating room setting. The purpose of this study was to compare the effectiveness of two laparoscopic surgery simulators by assessing the transfer of skills learned on simulators to closely matched surgical tasks in the animal laboratory. STUDY DESIGN: In this post-test-only Control group study design, 46 surgically naive medical student volunteers were randomly assigned to one of three groups: Tower Trainer group (n = 16), LapSim group (n = 17), and Control group (n = 13). Outcomes measures included both time and accuracy scores on three laparoscopic tasks (Task 1: Grasp and Place; Task 2: Run the Bowel; Task 3: Clip and Cut) performed on live anesthetized pigs, and a global rating of overall performance as judged by four experienced surgeons. RESULTS: The Tower Trainer group performed significantly better than the Control group on 1 of 7 outcomes measures-Task 3: Time (p < 0.032), although the LapSim group performed significantly better than the Control group on 2 of 7 measures-Task 3: Time (p < 0.008) and Global score (p < 0.005). In comparing the two simulators, the LapSim group performed significantly better than the Tower Trainer group on 3 of 7 outcomes measures-Task 2: Time (p < 0.032), Task 2: Accuracy (p < 0.030) and Global score (p < 0.005), although the Tower Trainer group did not perform significantly better than the LapSim group on any measure. CONCLUSIONS: This study demonstrated that naive subjects trained on a virtual-reality part-task trainer performed better on live surgical tasks in a porcine model as compared with those trained with a traditional box trainer. These findings could aid in selection of appropriate training methodologies.     

Biochemical profiles of Indian donkey population located in six different agro-climatic zones

To establish normal values of blood biochemical indices for different indigenous local donkey population available in various agro-climatic zones, blood samples were collected from 233 adult and apparently healthy donkeys. The samples were analysed for metabolites (albumin, total serum protein, direct bilirubin, total bilirubin, cholesterol, HDL cholesterol, urea, uric acid, triglyceride, creatinine) and minerals (calcium, phosphorus) to evaluate significant difference within and between populations. Confidence limit of each biochemical indices showed a close range as compared to their actual range observed under varied geographic areas. All the metabolites and minerals showed significant variations in their levels within and between donkey populations which could possibly be due to the differences in the nutritional status of donkeys, their managemental aspects and biochemical metabolism. In agro-climatic zone 1 (Spiti and Leh areas), having low vegetation cover with poor nutritious grasses for a limited period, levels of most of the biochemical profiles in donkey populations belonging to these areas were significantly lower than those in other zones (VI, IX, XII, XIV). This study indicated that normal biochemical values of different indices for a particular population should not be used as such for disease prognosis, diagnosis and therapeutic monitoring of other donkey population belonging to other agro-climatic zone having different nutritional and managemental practices.     

Renal Imaging in Patients with Renal Impairment

In patients with renal impairment, the incremental benefits from administration of contrast media for imaging studies need to be carefully assessed relative to the potential increased risks of worsening renal dysfunction and systemic adverse effects. This review provides an overview of risk and benefits of iodinated and gadolinium-based contrast agents; examines their relationships to contrast-induced nephropathy (CIN) and nephrogenic systemic fibrosis (NSF), respectively; and discusses various clinical strategies to minimize the risk of CIN and NSF. Specifically, renal imaging strategies aimed to minimize the adverse effects of contrast media as well as alternatives to iodinated and gadolinium-based contrast-enhanced renal imaging are proposed with emphasis on non–contrast-enhanced magnetic resonance imaging.     

Communication between the ureter and an aortic aneurysm sac after an abdominal aortic aneurysm repair

Fistulae between the vasculature and the ureter are rare. We describe a communication between the ureter and the sac of an aortic aneurysm following abdominal aortic aneurysm repair.     

Electrical burn injuries. Some unusual clinical situations and management

A retrospective and prospective management of 665 patients of electrical burn injuries out of 10,000 burn cases admitted between 1996 and 2004 (9 years) was analyzed. The problems encountered and their solutions are presented. One hundred and fifty-five (155) of them had their limbs amputated, i.e. (24%). The pathophysiology of electrical injury is reviewed. Serial and multiple debridement of wounds were performed, preserving the nerves, tendons, joints and bones even if denatured to preserve the continuity as these could regenerate partially if covered with vascularised skin. Functional outcome of an electrical burn wound is inversely proportional to the time lapsed before start of reconstructive procedure/s. Infrastructural limitations like severe shortage of blood, and surgical materials due to a disparity between demand and supply added to the poor general condition of the patient unfavorably delayed the start of reconstruction and precipitated "an unusual clinical situation". The aim of management has been to obtain a healthy wound, which could support an inset of a skin edge. Under these situations, a stable wound was obtained on the 12th day [average]. Split skin grafts and loco-regional flaps, using time-old principles of rotation, advancement, transposition served well in most of our cases. Through this paper, some unusual wounds in unusual clinical situations, which were managed with various methods of reconstruction, following the reconstructive ladder are presented.     

Ureteral pseudodiverticulosis and urothelial cell carcinoma: rethinking the association

Purpose

To compare frequency of new and recurrent urothelial cell carcinoma (UCC) among patients with and without pseudodiverticulosis on imaging.

Methods

This retrospective case–control study compared all 113 sequential patients with ureteral pseudodiverticulosis on radiographic urography between 1/1/2002 and 12/31/2012. Six patients were lost to follow-up. 107 patients without pseudodiverticulosis were matched by imaging modality, clinical indication, and tumor grade. Known UCC and primary outcome of new or recurrent UCC were determined through pathology on cystoscopy or clinical follow-up.

Results

Nearly half of patients with pseudodiverticulosis had known UCC at the time of imaging (49/107, 46%). Mean cystoscopy follow-up was 7.0 and 4.6 years for pseudodiverticulosis cases with and without known UCC, respectively, and 7.5 and 7.3 years for controls, respectively. Mean clinic follow-up was 7.5 and 6.0 years for pseudodiverticulosis cases with and without known UCC, respectively, and 6.4 and 7.6 years for controls, respectively. Among patients with known UCC at the time of imaging, similar rates of recurrent UCC were demonstrated on follow-up among patients with pseudodiverticulosis (6/49, 12%) and without (7/49, 14%). Among patients with no known history of UCC at the time of imaging, no patients with pseudodiverticulosis developed UCC on follow-up and 5% (3/58) of patients without pseudodiverticulosis developed UCC.

Conclusion

Although half of patients with ureteral pseudodiverticulosis have a known diagnosis of UCC, the presence of pseudodiverticulosis did not signify an increased likelihood of developing new or recurrent UCC over the follow-up period.

     

Acute flank pain secondary to urolithiasis: radiologic evaluation and alternate diagnoses

This article discusses the radiologic management of the patient who has acute flank pain. It describes the evolution of radiologic imaging in patients who present with acute symptoms caused by suspected urolithiasis, the advantages of unenhanced helical CT and the limitations of abdominal radiography, intravenous urography, and ultrasonography in this setting, and the alternative diagnoses encountered within the urinary tract, abdomen, and pelvis.