Assessment of Robotic Console Skills (ARCS): construct validity of a novel global rating scale for technical skills in robotically assisted surgery.

Background: Skill assessment during robotically assisted surgery remains challenging. While the popularity of the Global Evaluative Assessment of Robotics Skills (GEARS) has grown, its lack of discrimination between independent console skills limits its usefulness. The purpose of this study was to evaluate construct validity and interrater reliability of a novel assessment designed to overcome this limitation.

Viewpoint matters: objective performance metrics for surgeon endoscope control during robot-assisted surgery.

Background: Effective visualization of the operative field is vital to surgical safety and education. However, additional metrics for visualization are needed to complement other common measures of surgeon proficiency, such as time or errors. Unlike other surgical modalities, robot-assisted minimally invasive surgery (RAMIS) enables data-driven feedback to trainees through measurement of camera adjustments.

A review of training research and virtual reality simulators for the da Vinci surgical system.

Unlabelled: PHENOMENON: Virtual reality simulators are the subject of several recent studies of skills training for robot-assisted surgery. Yet no consensus exists regarding what a core skill set comprises or how to measure skill performance. Defining a core skill set and relevant metrics would help surgical educators evaluate different simulators.

Face, content, and construct validity of four, inanimate training exercises using the da Vinci ® Si surgical system configured with Single-Site ™ instrumentation.

Background: Validated training exercises are essential tools for surgeons as they develop technical skills to use robot-assisted minimally invasive surgical systems. The purpose of this study was to show face, content, and construct validity of four, inanimate training exercises using the da Vinci (®) Si surgical system configured with Single-Site (™) instrumentation.

Methods: New (N = 21) and experienced (N = 6) surgeons participated in the study.

The evolving application of single-port robotic surgery in general surgery.

Advances in the field of minimally invasive surgery have grown since the original advent of conventional multiport laparoscopic surgery. The recent development of single incision laparoscopic surgery remains a relatively novel technique, and has had mixed reviews as to whether it has been associated with lower pain scores, shorter hospital stays, and higher satisfaction levels among patients undergoing procedures through cosmetically-appeasing single incisions. However, due to technical difficulties that arise from the clustering of laparoscopic instruments through a confined working space, such as loss of instrument triangulation, poor surgical exposure, and instrument clashing, uptake by surgeons without a specific interest and expertise in cutting-edge minimally invasive approaches has been limited.

Construct validity of nine new inanimate exercises for robotic surgeon training using a standardized setup.

Background: As more surgeons choose to complete procedures robotically, validated training tools are needed so that they can acquire and maintain the technical skills required to proficiently use robotic systems. The purpose of this study was to show construct validity of nine new inanimate training exercises for robot-assisted surgery. The inanimate training exercises were designed to span several core technical skills required to use a robotic system.

Single-port robotic cholecystectomy: results from a first human use clinical study of the new da Vinci single-site surgical platform.

Objectives: To report our results from a first human use clinical study with the da Vinci Surgical single-site instrumentation in patients with gallbladder disease and to perform a retrospective comparison with traditional multiport laparoscopic cholecystectomy.

Design: Ten patients underwent robotic single-port cholecystectomy performed with the da Vinci Si robot and novel da Vinci single-site instrumentation. Outcomes and operative times were compared with patients undergoing traditional multiport laparoscopic cholecystectomy during the same period.

Bariatric surgery.

Bariatric surgery is a growing segment of minimally invasive surgery. Laparoscopic bariatric procedures are considered some of the most technically challenging surgeries, requiring advanced surgical skills. Successful care of the morbidly obese patient requires a multidisciplinary team approach.

Early, intermediate, and late effects of a surgical skills "boot camp" on an objective structured assessment of technical skills: a randomized controlled study.

Background: Surgical interns enter residency with variable technical abilities and many feel unprepared to perform necessary procedures. We hypothesized that interns exposed to a preinternship intensive surgical skills curriculum would demonstrate improved competency over unexposed colleagues on a test of surgical skills and that this effect would persist throughout internship.

Study Design: We designed a 3-day intensive skills "boot camp" with simulation-based training on 10 topics.

Minimally invasive surgery.

Minimally invasive surgery (MIS), or laparoscopic surgery, plays a vital role in residency training in a number of surgical disciplines including general surgery, surgical oncology, colorectal surgery, pediatric surgery, and thoracic surgery. The tremendous patient demand for MIS over the past 2 decades has resulted in surgeons rapidly embracing this technique. Many general surgery residencies cover basic laparoscopy within their residency program; however, the experience with more advanced cases is more variable.

Video self-assessment augments development of videoscopic suturing skill.

Background: Development of surgical skills on inanimate models has been popularized by efforts to improve patient safety and efficiency of resident training. We evaluated whether surgical residents' acquisition of videoscopic suturing skill is accelerated by reviewing video of their own previous practice session.

Study Design: Fourteen residents from two general surgery training programs received didactic instruction on laparoscopy.

Comparison of hospital charges between robotic, laparoscopic stapled, and laparoscopic handsewn Roux-en-Y gastric bypass.

The feasibility and safety of laparoscopic and robotic Roux-en-Y gastric bypass (RRYGB) have been established. To evaluate the cost-effectiveness of robotic surgery we compared the hospital charges for robotic, laparoscopic stapled (SRYGB), and laparoscopic handsewn Roux-en-Y gastric bypass (HRYGB) at our institution. One hundred thirty-five consecutive patients undergoing Roux-en-Y gastric bypass at Stanford University Medical Center by handsewn, stapled or robotic techniques from 1 July 2005 to 31 December 2005 were evaluated.

Endoscopy is accurate, safe, and effective in the assessment and management of complications following gastric bypass surgery.

Objectives: Roux-en-Y gastric bypass (RYGB) is a common intervention for morbid obesity. Upper gastrointestinal (UGI) symptoms are frequent and difficult to interpret following RYGB. The aim of our study was to examine the role of endoscopy in evaluating UGI symptoms after RYGB and to assess the safety and efficacy of endoscopic therapy.

Benefits to patients choosing preoperative weight loss in gastric bypass surgery: new results of a randomized trial.

Background: Historically, preoperative weight loss has been encouraged for patients undergoing gastric bypass surgery to decrease liver mass, technically facilitating the procedure. In an earlier prospective randomized trial investigating effects of preoperative weight loss on patients' clinical outcomes, we reported no differences in postoperative complications or weight-loss profiles at 6-month followup. This article demonstrates results of the same study, with 1-year followup.

Preoperative endoscopic screening for laparoscopic Roux-en-Y gastric bypass has a low yield for anatomic findings.

Background: Patients undergoing laparoscopic Roux-en-Y bariatric surgery undergo screening esophagoduodenoscopy (EGD) during preoperative evaluation. The hypothesis is to examine the utility of this examination. The purpose of this study was to evaluate the prevalence of clinically significant upper gastrointestinal (UGI) tract findings at screening EGD in patients undergoing laparoscopic Roux-en-Y bariatric surgery.

Use of flexible endoscopic scissors to cut obstructing suture material in gastric bypass patients.

With the epidemic increase in obesity in the USA and consequent increased demand for bariatric surgery, new complications of the surgery are being described. The most common surgery practiced is the Roux-en-Y gastric bypass (RYGBP). Unraveling of suture material at the gastrojejunal anastomosis may occur, which may be troublesome if nonabsorbable suture is employed.

Innovative introduction to surgery in the preclinical years.

Background: Lack of exposure to surgery in the preclinical years of medical school contributes to students' negative opinions of the field and to low application rates to categorical surgical programs.

Methods: Forty preclinical medical students attended a series of 16 seminars and practice sessions covering the gamut of surgical specialties and basic technical skills. Students were given a Likert format survey before and after taking the course.

Abnormal findings on routine upper GI series following laparoscopic Roux-en-Y gastric bypass.

Background: The use of postoperative upper GI series (UGIS) after laparoscopic Roux-en-Y gastric bypass (LRYGBP) varies among bariatric surgeons. The authors describe the findings and impact of UGIS after LRYGBP.

Methods: From July 2003 to January 2006, 487 patients undergoing primary LRYGBP at a single academic institution had a single-contrast Gastrografin UGIS performed on the first postoperative day, without complication.

Retrievable inferior vena cava filters may be safely applied in gastric bypass surgery.

Introduction: Pulmonary embolus (PE) is a potentially devastating and fatal postoperative complication in morbidly obese patients. This study was undertaken to review the safety and efficacy of retrievable prophylactic inferior vena cava (IVC) filters in high-risk morbidly obese patients undergoing gastric bypass.

Methods: Patients who underwent gastric bypass surgery and preoperative insertion of retrievable IVC filters had their records reviewed.