Validation of the portable virtual reality training system for robotic surgery (PoLaRS): a randomized controlled trial.

Background: As global use of surgical robotic systems is steadily increasing, surgical simulation can be an excellent way for robotic surgeons to acquire and retain their skills in a safe environment. To address the need for training in less wealthy parts of the world, an affordable surgical robot simulator (PoLaRS) was designed.

Methods: The aim of this pilot study is to compare learning curve data of the PoLaRS prototype with those of Intuitive Surgical's da Vinci Skills Simulator (dVSS) and to establish face- and construct validity.

The effective dose due to scattered radiation at patients during primary osteosynthesis; a multicenter prospective observational study.

Objectives: During osteosynthesis of a fracture patients are exposed to the primary radiation of an X-ray image and scattered (secondary) radiation. The primary objective was to measure the amount of scattered radiation at the thyroid, breast tissue, and gonads of patients undergoing primary osteosynthesis of acute fractures. The secondary objective was to calculate the effective dose caused by scattered radiation.

Electrosurgery: short-circuit between education and practice.

Electrosurgery is used in 80% of surgical procedures. The technique allows surgeons to skilfully dissect tissues and achieve haemostasis. Since improper use of electrosurgery can lead to serious adverse events, training is required to potentially reduce the number and severity of these events.

The Art of Electrosurgery: Trainees and Experts.

The benefits of electrosurgery have been acknowledged since the early 1920s, and nowadays more than 80% of surgical procedures involve devices that apply energy to tissues. Despite its widespread use, it is currently unknown how the operator's choices with regard to instrument selection and application technique are related to complications. As such, the manner in which electrosurgery is applied can have a serious influence on the outcome of the procedure and the well-being of patients.

Where are my instruments? Hazards in delivery of surgical instruments.

Background: Unavailability of instruments is recognised to cause delays and stress in the operating room, which can lead to additional risks for the patients. The aim was to provide an overview of the hazards in the entire delivery process of surgical instruments and to provide insight into how Information Technology (IT) could support this process in terms of information availability and exchange.

Methods: The process of delivery was described according to the Healthcare Failure Mode and Effects Analysis methodology for two hospitals.

[Slipped capital femoral epiphysis in children].

Background: Slipped capital femoral epiphysis (SCFE) is among the most common causes of hip problems in childhood and adolescence. Its incidence is increasing due to rising childhood obesity. There are three different types of SCFE, the rarest of which is the acute traumatic slip.

Impact of the European Working Time Directive (EWTD) on the operative experience of surgery residents.

Background: In Europe and the United States, work hour restrictions are considered to be particularly burdensome for residents in surgery specialties. The aim of this study was to examine whether reduction of the work week to 48 hours resulting from the implementation of the European Working Time Directive has affected the operative experience of surgery residents.

Methods: This study was conducted in a general surgery training region in the Netherlands, consisting of 1 university hospital and 6 district training hospitals.

Tissue adhesives for closure of surgical incisions.

Background: Sutures (stitches), staples and adhesive tapes have been used for many years as methods of wound closure, but tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables the closure to be meticulous, but the sutures may show tissue reactivity and can require removal. Tissue adhesives offer the advantages of an absence of risk of needlestick injury and no requirement to remove sutures later.

Assessment of surgery residents' operative skills in the operating theater using a modified Objective Structured Assessment of Technical Skills (OSATS): a prospective multicenter study.

Background: With the implementation of competency-based curricula, Objective Structured Assessment of Technical Skills (OSATS) increasingly is being used for the assessment of operative skills. Although evidence for its usefulness has been demonstrated in experimental study designs, data supporting OSATS application in the operating room are limited. This study evaluates the validity and reliability of the OSATS instrument to assess the operative skills of surgery residents in the operating theater.

Safety status system for operating room devices.

Background: Since the increase of the number of technological aids in the operating room (OR), equipment-related incidents have come to be a common kind of adverse events. This underlines the importance of adequate equipment management to improve the safety in the OR.

Objective: A system was developed to monitor the safety status (periodic maintenance and registered malfunctions) of OR devices and to facilitate the notification of malfunctions.

Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies.

Falls are the leading cause of injuries among older adults, aged 65 years and older. Furthermore, falls are an increasing public health problem because of ageing populations worldwide due to an increase in the number of older adults, and an increase in life expectancy. Numerous studies have identified risk factors and investigated possible strategies to prevent (recurrent) falls in community-dwelling older people and those living in long-term care facilities.

First quantification of calcium intake from calcium-dense dairy products in Dutch fracture patients (the Delft cohort study).

Recommendations for daily calcium intake from dairy products are variable and based on local consensus. To investigate whether patients with a recent fracture complied with these recommendations, we quantified the daily dairy calcium intake including milk, milk drinks, pudding, yoghurt, and cheese in a Dutch cohort of fracture patients and compared outcomes with recent data of a healthy U.S.

HUMeral shaft fractures: measuring recovery after operative versus non-operative treatment (HUMMER): a multicenter comparative observational study.

Background: Fractures of the humeral shaft are associated with a profound temporary (and in the elderly sometimes even permanent) impairment of independence and quality of life. These fractures can be treated operatively or non-operatively, but the optimal tailored treatment is an unresolved problem. As no high-quality comparative randomized or observational studies are available, a recent Cochrane review concluded there is no evidence of sufficient scientific quality available to inform the decision to operate or not.

Increasing rates of pelvic fractures among older adults: The Netherlands, 1986-2011.

Background: age-related issues are expected to rise in the coming decades. Osteoporosis, falls and fractures are major public health issues among elderly. Pelvic fractures are associated with a serious morbidity and hospitalisation rate.

Technical aspects of the syndesmotic screw and their effect on functional outcome following acute distal tibiofibular syndesmosis injury.

Introduction: Much of the currently available data on the technical aspects of syndesmotic screw placement are based upon biomechanical studies, using cadaveric legs with different testing protocols, and on surgeon preference. The primary aim of this study was to investigate the effect of the level of syndesmotic screw insertion on functional outcome. Further, the effects of number of cortices engaged, the diameter of the screw, use of a second syndesmotic screw and the timing of removal on functional outcome were tested.

Surgeons' attitude toward a competency-based training and assessment program: results of a multicenter survey.

Background: Currently, most surgical training programs are focused on the development and evaluation of professional competencies. Also in the Netherlands, competency-based training and assessment programs were introduced to restructure postgraduate medical training. The current surgical residency program is based on the Canadian Medical Education Directives for Specialists (CanMEDS) competencies and uses assessment tools to evaluate residents' competence progression.

[Splenic rupture not always painful: diagnostics after blunt abdominal trauma].

Background: In blunt abdominal traumata the spleen is the most frequently and often the only injured organ. Splenic rupture can result in severe abdominal pain and haemodynamic instability, but may only have mild symptoms. A normal physical exam following abdominal trauma does not exclude splenic rupture.

The timing of ankle fracture surgery and the effect on infectious complications; a case series and systematic review of the literature.

Purpose: Information about the influence of delayed surgery on infectious wound complications is ambiguous. A clinical audit was performed to test the hypothesis that early surgery lowers the rate of infectious wound complications. Secondly we looked at the influence of surgical delay and complications on patient reported functional outcome.

Complications of syndesmotic screw removal.

Background: Currently, the metallic syndesmotic screw is the gold standard in the treatment of syndesmotic disruption. Whether or not this screw needs to be removed remains debatable. The aim of the current study was to determine the complications which occur following routine removal of the syndesmotic screw following operative treatment of unstable ankle fractures.

Discriminating between simple and perforated appendicitis.

Background: Several studies have been performed in order to diagnose an acute appendicitis using history taking and laboratory investigations. The aim of this study was to create a model for the identification of a perforated appendicitis.

Methods: All consecutive patients who have undergone an appendectomy in the Reinier de Graaf hospital between January 1, 2007 and July 31, 2009, were included in a retrospective cohort study.

Demographics and functional outcome of toe fractures.

Toe fractures are common; however, there are few data on demographics and functional outcome. We studied outcomes in 339 consecutive patients with toe fractures treated between January 2006 and September 2008. Two hundred and sixty-four patients, aged 16 to 75, were mailed an outcome questionnaire, and overall subjective satisfaction with the outcome of treatment was measured using a visual analog scale (VAS).

Foot and ankle fractures at the supination line.

Background: The supination line is a fictive line along the foot and ankle, on which over twenty fracture types and approximately ten different ligamentous sprain-injuries have been identified.

Objective: The current study was conducted to evaluate the incidence of different types of supination line injuries visible at the initial radiographs at the Emergency Department and to determine the type and percentage of misdiagnosed injuries.

Method: Retrospective study of consecutive patients who visited the Emergency Department, between January 1 and June 30, 2009, after sustaining an injury of the foot or ankle and had a radiograph taken within 24 h of the incident.

Chopart joint injury: a study of outcome and morbidity.

Injuries involving the Chopart joint complex are relatively rare and frequently missed or misdiagnosed, often leading to a poor functional outcome. This study was performed to determine the outcome and morbidity in patients with Chopart joint injuries, and to increase awareness of this severe injury. Patients with a Chopart dislocation or fracture-dislocation, treated between January 2004 and January 2010, were identified using the appropriate diagnosis code and reviewing all radiographs of patients diagnosed with hindfoot or midfoot injuries treated at our institution.

Tissue adhesives for closure of surgical incisions.

Background: Sutures, staples and adhesive tapes are the traditional methods of wound closure, whilst tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables meticulous closure, but they may show tissue reactivity and can require removal. Tissue adhesives offer the advantages of no risk of needlestick injury and no requirement to remove sutures later.