Laparoscopic suturing learning curve in an open versus closed box trainer.

Background: The aim of this study was to examine the influence of training under direct vision prior to training with indirect vision on the learning curve of the laparoscopic suture task.

Methods: Novices were randomized in two groups. Group 1 performed three suturing tasks in a transparent laparoscopic box trainer under direct vision followed by three suturing tasks in a standard non-transparent laparoscopic box trainer equipped with a 0° laparoscope.

Intracorporeal knot tying in a box trainer: how proficient is in vitro evaluation in laparoscopic experts?

Objective: To determine the applicability of motion analysis parameters of intracorporeal knot tying in box trainers in experts as predictors of surgical outcome.

Design: Consecutive series of 1534 advanced laparoscopic hysterectomies (Canadian Task Force classification II-2).

Intervention: Time, path length, and motion in depth of a standardized intracorporeal knot-tying task were compared with mean risk-adjusted primary clinical outcomes for each participant.

Ectopic pregnancy: when is expectant management safe?

This study was conducted to evaluate expectant management in asymptomatic patients with an initial serum beta-hCG titer of <2,500 IU/l and to determine the independent ability of initial serum beta-hCG titers and trend of serum beta-hCG to predict successful expectant management. A cohort of patients (N = 418) with suspected ectopic pregnancy (EP) between January 1991 and July 2008 is described. Three groups were defined: group I (n = 182), immediate surgical intervention (<24 h); group IIa (n = 130), unsuccessful expectant management (surgical intervention during follow-up), and group IIb (n = 99), successful expectant management (spontaneous regression of trophoblast).

Assessment of joystick and wrist control in hand-held articulated laparoscopic prototypes.

Background: Various steerable instruments with flexible distal tip have been developed for laparoscopic surgery. The problem of steering such instruments, however, remains a challenge, because no study investigated which control method is the most suitable. This study was designed to examine whether thumb (joystick) or wrist control method is designated for prototypes of steerable instruments by means of motion analysis.

Intracorporeal suturing: economy of instrument movements using a box trainer model.

Study Objective: To determine whether economy of instrument movement can differentiate between skills levels during intracorporeal suturing using a box trainer model.

Design: Prospective cohort study (Canadian Task Force classification II-2).

Setting: Skills laboratory of a university teaching hospital.

Power Doppler area in the diagnosis of endometrial cancer.

Objective: To evaluate the diagnostic accuracy of power Doppler area (PDA) in the detection of endometrial cancer in women with postmenopausal bleeding.

Design: Prospective diagnostic study.

Setting: University hospital.

Virtual reality in laparoscopic skills training: is haptic feedback replaceable?

With the emphasis on laparoscopic skills training outside of the operating room (OR), simulators are constantly being developed and improved. Virtual reality (VR) trainers have been looking for solutions to compensate their lack of haptic feedback. A possible solution is the addition of kinematic interaction between laparoscopic instruments and objects.

Value of an objective assessment tool in the operating room.

Background: Concerns about the achievement of surgical proficiency during residency are increasing. To objectify surgical skills, the Objective Structured Assessment of Technical Skills (OSATS) was developed and proven valid, feasible and reliable for use in laboratory settings. This study aimed to evaluate the value of this tool for intraoperative use.

Are minimally invasive procedures harder to acquire than conventional surgical procedures?

Background: It is frequently suggested that minimally invasive surgery (MIS) is harder to acquire than conventional surgery. To test this hypothesis, residents' learning curves of both surgical skills are compared.

Methods: Residents had to be assessed using a general global rating scale of the OSATS (Objective Structured Assessment of Technical Skills) for every procedure they performed as primary surgeon during a 3-month clinical rotation in gynecological surgery.

Feedback in laparoscopic skills acquisition: an observational study during a basic skills training course.

This study aimed to obtain insight in the effect of expert feedback during a basic laparoscopic skills training course for residents. A questionnaire was held among participants regarding provided feedback and the self-perceived laparoscopic skills improvement. The participants (n = 24) who completed the questionnaire were in their first to fifth postgraduate year.

Retention of basic laparoscopic skills after a structured training program.

The purpose of this study was to test the retention of basic laparoscopic skills on a box trainer 1 year after a short training program. For a prior study, eight medical students without prior experience (novices) underwent baseline testing, followed by five weekly training sessions and a final test. During each of seven sessions, they performed five tasks on an inanimate box trainer.

Skills training in minimally invasive surgery in Dutch obstetrics and gynecology residency curriculum.

The complexity of acquiring minimally invasive surgical (MIS) skills, combined with smaller case volumes for residents have pushed the development of skills training facilities on simulators outside the operating room (OR). Medico-legal and financial constraints have stimulated this development even more. However, the implementation of simulator training into a residency curriculum is shown to be troublesome.

Management of chronic pelvic pain additional to tubal sterilization.

Objective: A case series is presented to illustrate the dilemma in management of women with Chronic Pelvic Pain (CPP) additional to a tubal sterilization.

Methods: Between January 1999 and June 2007, five women consulted the Department of Gynecology for CPP additional to tubal sterilization with Filshie Clips (FCs). A biopsychosocial approach of the complaint was offered and laparoscopic removal of the clips was performed in all cases.

The role of antibiotic prophylaxis in prevention of wound infection after Lichtenstein open mesh repair of primary inguinal hernia: a multicenter double-blind randomized controlled trial.

Objective: To determine whether the use of prophylactic antibiotics is effective in the prevention of postoperative wound infection after Lichtenstein open mesh inguinal hernia repair.

Summary Background Data: A recent Cochrane meta-analysis (2003) concluded that "antibiotic prophylaxis for elective inguinal hernia repair cannot be firmly recommended or discarded."

Methods: Patients with a primary inguinal hernia scheduled for Lichtenstein repair were randomized to a preoperative single dose of 1.

Use of malaria prevention measures by North American and European travelers to East Africa.

Background: The use of preventive measures, including effective chemoprophylaxis, is essential for protection against malaria among travelers. However, data have shown that travelers and medical advisors are confused by the lack of uniform recommendations and numerous prophylactic regimens of varying effectiveness that are used.

Methods: To assess the use and type of preventive measures against malaria, we conducted a cross-sectional study in 1997 among travelers departing from the Nairobi and Mombasa airports in Kenya with European destinations.