Resident training experience with robotic assisted transabdominal preperitoneal inguinal hernia repair.

Background: General surgery is the fastest growing field in the adoption of robotic assisted laparoscopic surgery. Here, we present the results of one institution's experience in training surgical residents in robotic assisted transabdominal preperitoneal inguinal hernia repairs.

Methods: Data were prospectively collected on patients undergoing robotic assisted laparoscopic inguinal hernia repair with residents.

The Effect of Patient Education on the Perceptions of Resident Participation in Surgical Care.

Objective: To decipher if patient attitudes toward resident participation in their surgical care can be improved with patient education regarding resident roles, education, and responsibilities.

Design: An anonymous questionnaire was created and distributed in outpatient surgery clinics that had residents involved with patient care. In total, 3 groups of patients were surveyed, a control group and 2 intervention groups.

Is current surgery resident and GI fellow training adequate to pass FES?

Background: The purpose of this study was to assess the adequacy of current surgical residency and gastroenterology (GI) fellowship flexible endoscopy training as measured by performance on the FES examination.

Methods: Fifth-year general surgery residents and GI fellows across six institutions were invited to participate. All general surgery residents had met ACGME/ABS case volume requirements as well as additional institution-specific requirements for endoscopy.

What do residents need to be competent laparoscopic and endoscopic surgeons?

Background: Despite numerous efforts to ensure that surgery residents are adequately trained in the areas of laparoscopy and flexible endoscopy, there remain significant concerns that graduates are not comfortable performing many of these procedures.

Methods: Online surveys were sent to surgery residents (98 items, PGY1-5 Categorical) and faculty (78 items, general surgery, and gastrointestinal specialties) at seven institutions. De-identified data were analyzed under an IRB-approved protocol.

Current Status of Simulation-Based Training in Graduate Medical Education.

The use of simulation in Graduate Medical Education has evolved significantly over time, particularly during the past decade. The applications of simulation include introductory and basic technical skills, more advanced technical skills, and nontechnical skills, and simulation is gaining acceptance in high-stakes assessments. Simulation-based training has also brought about paradigm shifts in the medical and surgical education arenas and has borne new and exciting national and local consortia that will ensure that the scope and impact of simulation will continue to broaden.

Validity evidence for a new portable, lower-cost platform for the fundamentals of endoscopic surgery skills test.

Background: The fundamentals of endoscopic surgery (FES) examination measures the knowledge and skills required to perform safe flexible endoscopy. A potential limitation of the FES skills test is the size and cost of the simulator on which it was developed (GI Mentor II virtual reality endoscopy simulator; Simbionix LTD, Israel). A more compact and lower-cost alternative (GI Mentor Express) was developed to address this issue.

Development of a virtual reality robotic surgical curriculum using the da Vinci Si surgical system.

Introduction: This study aimed to develop a training curriculum to evaluate the basic robotic skills necessary to reach an 80 % preset proficiency score and correlate the level of surgical experience with the overall performance obtained using the da Vinci Surgical Skills simulator.

Methods: Twenty-two participants (4 faculty, 4 senior, and 14 junior residents) were enrolled in a 4-week robotic training curriculum developed at our institution. A set of seven robotic skills were selected based on the manufacturer's exercise primary endpoint.

Evaluation of two flexible colonoscopy simulators and transfer of skills into clinical practice.

Introduction: Surgical residents have learned flexible endoscopy by practicing on patients in hospital settings under the strict guidance of experienced surgeons. Simulation is often used to "pretrain" novices on endoscopic skills before real clinical practice; nonetheless, the optimal method of training remains unknown. The purpose of this study was to compare endoscopic virtual reality and physical model simulators and their respective roles in transferring skills to the clinical environment.

Virtual reality simulators: valuable surgical skills trainers or video games?

Background: Virtual reality (VR) and physical model (PM) simulators differ in terms of whether the trainee is manipulating actual 3-dimensional objects (PM) or computer-generated 3-dimensional objects (VR). Much like video games (VG), VR simulators utilize computer-generated graphics. These differences may have profound effects on the utility of VR and PM training platforms.

A retrospective study evaluating the use of Permacol™ surgical implant in incisional and ventral hernia repair.

Background: The outcome of incisional and ventral hernia repair depends on surgical technique, patient, and material. Permacol™ surgical implant (crosslinked porcine collagen) has been used for over a decade; however, there are few data on outcomes. This study is the largest retrospective multinational study to date to evaluate outcomes with Permacol™ surgical implant in the repair of incisional and ventral hernias.

Development of an animal model to investigate optimal laparoscopic trocar site fascial closure.

Background: The rate of hernia formation after closure of 10-12 mm laparoscopic trocar sites is grossly under-reported. Using an animal model, we have developed a method to assess trocar site fascial dehiscence and the strength of different methods of fascial closure.

Materials And Methods: Pigs (n = 9; 17 ± 2.

Ensuring competency: are fundamentals of laparoscopic surgery training and certification necessary for practicing surgeons and operating room personnel?

Background: Certification in fundamentals of laparoscopic surgery (FLS) is required by the American board of surgery for graduating residents. This study aimed to evaluate the feasibility and need for certifying practicing surgeons and to assess proficiency of operating room (OR) personnel.

Methods: Through a patient safety and health care delivery effectiveness grant, investigators at four state medical schools received funding for FLS certification of all attending surgeons and OR personnel credentialed in laparoscopy.

Comparing three pedagogical approaches to psychomotor skills acquisition.

Background: We compared traditional pedagogical approaches such as time- and repetition-based methods with proficiency-based training.

Methods: Laparoscopic novices were assigned randomly to 1 of 3 training conditions. In experiment 1, participants in the time condition practiced for 60 minutes, participants in the repetition condition performed 5 practice trials, and participants in the proficiency condition trained until reaching a predetermined proficiency goal.

A multicenter, simulation-based skills training collaborative using shared GI Mentor II systems: results from the Texas Association of Surgical Skills Laboratories (TASSL) flexible endoscopy curriculum.

Background: The Texas Association of Surgical Skills Laboratories (TASSL) is a nonprofit consortium of surgical skills training centers for the accredited surgery residency programs in Texas. A training and research collaborative was forged between TASSL members and Simbionix (Cleveland, OH, USA) to assess the feasibility and efficacy of a multicenter, simulation- and Web-based flexible endoscopy training curriculum using shared GI Mentor II systems.

Methods: Two GI Mentor II flexible endoscopy simulators were provided for the study, and four institutions, namely, the University of Texas Health Science Center-San Antonio (UTHSCSA), Texas A & M University (TAMU), Methodist Hospital (MHD), and Brooke Army Medical Center (BAMC), agreed to share them.

Randomized study of natural orifice transluminal endoscopic surgery and endoscopy shows similar hemodynamic impact in a porcine model.

Background: A previous porcine study showed a significant difference in heart rate and diastolic blood pressure (DBP) between natural orifice transluminal endoscopic surgery (NOTES) and laparoscopy. This study evaluated the hemodynamics during endoscopy, laparoscopy, and transluminal access.

Methods: For this study, 37 female swine were randomized and invasively monitored in terms of blood and abdominal pressure, heart rate, and arterial blood gas (ABG) during 90-min procedures.

Prospective, randomized, double-blind trial of curriculum-based training for intracorporeal suturing and knot tying.

Background: Advanced surgical skills such as laparoscopic suturing are difficult to learn in an operating room environment. The use of simulation within a defined skills-training curriculum is attractive for instructor, trainee, and patient. This study examined the impact of a curriculum-based approach to laparoscopic suturing and knot tying.

Music experience influences laparoscopic skills performance.

Background: Music education affects the mathematical and visuo-spatial skills of school-age children. Visuo-spatial abilities have a significant effect on laparoscopic suturing performance. We hypothesize that prior music experience influences the performance of laparoscopic suturing tasks.

Can gastric irrigation prevent infection during NOTES mesh placement?

Background: Natural orifice transluminal endoscopic surgery (NOTES) ventral hernia repair could avoid abdominal wall incisions. The infectious risk for mesh placement is of concern. We compared NOTES with laparoscopic mesh placement.

Randomized blinded trial shows relative thrombocytopenia in natural orifice translumenal endoscopic surgery compared with standard laparoscopy in a porcine survival model.

Background: Anecdotal reports of natural orifice translumenal endoscopic surgery (NOTES) procedures in patients are emerging. Whether the new procedure truly is less invasive is not known. Perioperative hematologic parameters during NOTES was compared with those during standard laparoscopy.

Construct validity of an objective assessment method for laparoscopic intracorporeal suturing and knot tying.

Background: The ideal objective assessment method for laparoscopic technical skills is difficult to achieve in the operating room. Recent "VR2OR" studies have used a blinded, 2-reviewer error-based video tape analysis for intraoperative performance assessment. This study examines the validity of this methodology applied to laparoscopic intracorporeal suturing and knot tying.

Randomized blinded trial comparing the cardiopulmonary effects of NOTES with standard laparoscopy in a porcine survival model.

Background: Anecdotal reports of natural orifice translumenal endoscopic surgery (NOTES) procedures in patients are emerging. Whether the new procedure is truly less invasive is not known. We compared perioperative cardiopulmonary parameters during NOTES with standard laparoscopy.

Randomized double-blinded trial investigating the impact of a curriculum focused on error recognition on laparoscopic suturing training.

Background: Error recognition predicts technical skill. A curriculum including error recognition may improve laparoscopic suturing performance.

Methods: Thirty novices were randomized into 2 groups.

Management of the challenging bariatric surgical patient.

Despite the continued increase in surgical procedures for weight loss, the dramatic increase in the prevalence of morbid obesity far outpaces the treatments to correct it. As a result, the primary care physician is increasingly more likely to be evaluating patients who are either candidates for weight loss surgery or who have already undergone a weight loss procedure. Unique medical and social situations must be considered when evaluating these patients, and it is anticipated that all physicians will be seeing a greater number of complex or challenging patients.

Delayed gastric emptying in patients undergoing antireflux surgery: analysis of a treatment algorithm.

Purpose: Controversy remains about the treatment of patients with mild delayed gastric emptying (90 min < emptying half-time [T(1/2)] < 180 min) who undergo antireflux surgery. This retrospective, nonrandomized study reviewed the records of patients treated from January 1996 through October 2003, during which time we applied two treatment algorithms for patients with mild delayed gastric emptying. The goal of this study was to determine whether the most recent treatment algorithm was effective in reducing the need for a concomitant gastric drainage procedure, pyloroplasty.

A comparison between fluoroscopically guided radiofrequency energy delivery and conventional technique in an animal model of fundoplication failure.

Background: The use of radiofrequency energy (RFe) treatment at the gastroesophageal junction (GEJ) has been considered an alternative to surgery after fundoplication disruption. It is unknown whether the recommended delivery technique for primary gastroesophageal reflux disease applies to an anatomically altered GEJ following fundoplication. The aim of this study was to determine whether modifications to the standard technique using fluoroscopic guidance more accurately localizes ablation zones compared with standard technique alone.