A comparison of the incidence of midline catheter-associated bloodstream infections to that of central line-associated bloodstream infections in 5 acute care hospitals.

In a retrospective study conducted over 12 months in a multi-hospital system, the incidence of bloodstream infections associated with midline catheters was not significantly lower than that associated with central venous catheters (0.88 vs 1.10 infections per 1,000 catheter-days).

Incidence and risk factors for and the effect of a program to reduce the incidence of surgical site infection after cardiac surgery.

Background: Surgical site infection (SSI) after cardiac surgery (CS) is a serious complication that increases hospital length of stay (LOS), has a substantial financial impact, and increases mortality. The study described here was done to evaluate the effect of a program to reduce SSI after CS.

Methods: In January 2007, a multi-disciplinary CS infection-prevention team developed guidelines and implemented bundled tactics for reducing SSI.

Evaluation of surgical fellows' laparoscopic performance using Global Operative Assessment of Laparoscopic Skills (GOALS).

Background: The acquisition of technical skills is one of the fundamental goals of postgraduate surgical training; however, validation and utilization of objective tools to assess the technical skills of trainees remains elusive. The objectives of this project are to develop models to identify predictive factors for fellow performance, validate the Global Operative Assessment of Laparoscopic Skills (GOALS) as an assessment tool for laparoscopic skills, and to define the learning curve for complex laparoscopic gastrointestinal surgery.

Methods: Using previously recorded data from a centralized database of the Fellowship Council, we analyzed the voluntarily submitted performance scores of surgical fellows for three complex laparoscopic gastrointestinal operations: Roux-en-Y gastric bypass, LapBand placement, and Nissen fundoplication.

The Fellowship Council: a decade of impact on surgical training.

Background: The objective of this project is to document the history of the Fellowship Council (FC) and report its current impact on surgical training. The need for advanced training in laparoscopic surgery resulted in the rapid development of fellowships for which there was no oversight. Fellowship program directors began meeting in the 1990s and formally created the FC in 2004 to provide that oversight.

Assessing the value of the SimPraxis laparoscopic cholecystectomy trainer.

Background And Objectives: Our aim was to determine whether the SimPraxis Laparoscopic Cholecystectomy Trainer is an effective adjunct for training both junior and senior surgical residents.

Methods: During the 2009-2010 academic year, 20 of 27 surgical residents at our institution completed training with the SimPraxis Laparoscopic Cholecystectomy Trainer. These 20 residents took an identical 25-question pre- and posttest prepared in-house by a senior laparoscopic surgeon, based on the SimPraxis Laparoscopic Cholecystectomy program content.

Limiting PGY 1 residents to 16 hours of duty: review and report of a workshop.

Background: In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted limits on duty hours. Residents were restricted to working 80 hours/week and limited to 24 hours of continuous patient care. Effective July 2011, an additional restriction will be instituted for PGY 1 residents limiting continuous duty to 16 hours maximum.

Completion of a novel, virtual-reality-based, advanced laparoscopic curriculum improves advanced laparoscopic skills in senior residents.

Introduction: Virtual reality simulators contribute to basic laparoscopic skill acquisition. These trainers have not yet been shown to contribute to the acquisition of more advanced laparoscopic skills as measured by the Fundamentals of Laparoscopic Surgery (FLS). We have customized novel basic and advanced curricula for the LapSim trainer (Surgical Science, Göteborg, Sweden).

Does training novices to criteria and does rapid acquisition of skills on laparoscopic simulators have predictive validity or are we just playing video games?

Purpose: To determine whether LapSim training (version 3.0; Surgical Science Ltd, Göteborg, Sweden) to criteria for novice PGY1 surgical residents had predictive validity for improvement in the performance of laparoscopic cholecystectomy.

Methods: In all, 21 PGY1 residents performed laparoscopic cholecystectomies in pigs after minimal training; their performance was evaluated by skilled laparoscopic surgeons using the validated tool GOALS (global operative assessment of laparoscopic operative skills: depth perception, bimanual dexterity, efficiency, tissue handling, and overall competence).

Comparison of monoscopic insertable, remotely controlled imaging device with a standard laparoscope in a porcine model.

Laparoscopic imaging has remained relatively unchanged since the introduction of the rod-lens system. The intent here is to improve imaging by designing and building sensors and effectors placed directly into the body and controlled remotely. An 11-mm monoscopic insertable pan/tilt endoscopic imaging device with an integrated light source was studied.

High definition in minimally invasive surgery: a review of methods for recording, editing, and distributing video.

The use of high-definition cameras and monitors during minimally invasive procedures can provide the surgeon and operating team with more than twice the resolution of standard definition systems. Although this dramatic improvement in visualization offers numerous advantages, the adoption of high definition cameras in the operating room can be challenging because new recording equipment must be purchased, and several new technologies are required to edit and distribute video. The purpose of this review article is to provide an overview of the popular methods for recording, editing, and distributing high-definition video.

Do the laparoscopic skills of trainees deteriorate over time?

Introduction: Without ongoing practice, acquired motor skills may deteriorate over time. The purpose of this study is to document the level of retention of laparoscopic skills over time.

Methods: Thirty-three general-surgery PGY 1, 2, and 3 residents trained to established criteria and passed an exam for each of seven technical skills (camera navigation, instrument navigation, camera/instrument coordination, grasping, lifting and grasping, cutting, and clip applying) on a virtual simulator (LapSim Surgical Science Ltd.

In vivo pan/tilt endoscope with integrated light source, zoom and auto-focusing.

We describe a surgical imaging device with pan, tilt, zoom and integrated LED light source. It can be fully inserted into the abdomen, leaving the insertion port free for tooling. Using a porcine model we have tested the device and performed surgical procedures including cholecystectomy, appendectomy, running (measuring) the bowel, suturing, and nephrectomy.

Multimedia article: Transvaginal laparoscopic cholecystectomy: laparoscopically assisted.

Natural orifice transluminal endoscopic surgery (NOTES) is considered the new frontier for minimally invasive surgery. NOTES procedures such as peritoneoscopy, splenectomy, and cholecystectomy in animal models have been described. The aim of our experiment was to determine the feasibility and technical aspects of a new endoluminal surgical procedure.

Documenting a learning curve and test-retest reliability of two tasks on a virtual reality training simulator in laparoscopic surgery.

Background: Virtual reality simulators are a component of the armamentarium for training surgical residents. No one knows exactly how to incorporate virtual reality simulators into a curriculum. The purpose of this study was to document and show the learning curve and test-retest reliability of 2 tasks on a virtual reality-training simulator (LapSim; Surgical Science, Göteborg, Sweden) in laparoscopic surgery.

Reliable assessment of laparoscopic performance in the operating room using videotape analysis.

The Global Operative Assessment of Laparoscopic Skills (GOALS) is a valid assessment tool for objectively evaluating the technical performance of laparoscopic skills in surgery residents. We hypothesized that GOALS would reliably differentiate between an experienced (expert) and an inexperienced (novice) laparoscopic surgeon (construct validity) based on a blinded videotape review of a laparoscopic cholecystectomy procedure. Ten board-certified surgeons actively engaged in the practice and teaching of laparoscopy reviewed and evaluated the videotaped operative performance of one novice and one expert laparoscopic surgeon using GOALS.

Evaluation of resident laparoscopic performance using global operative assessment of laparoscopic skills.

Background: The Global Operative Assessment of Laparoscopic Skills (GOALS), developed by Vassiliou and colleagues, has construct validity in the assessment of surgical residents' laparoscopic skills in dissection of the gallbladder from the liver bed. We hypothesized that GOALS would have construct validity for the entire laparoscopic cholecystectomy procedure and also for laparoscopic appendectomy.

Methods: Using GOALS, attending surgeons evaluated PGY1 through PGY5 surgical resident performance during laparoscopic cholecystectomy (LC, n = 51) and laparoscopic appendectomy (LA, n = 43).

Efficacy of novel robotic camera vs a standard laparoscopic camera.

To improve visualization during minimal access surgery, a novel robotic camera has been developed. The prototype camera is totally insertable, has 5 degrees of freedom, and is remotely controlled. This study compared the performance of laparoscopic surgeons using both a laparoscope and the robotic camera.

Therapeutic efficacy of laparoscopic cholecystectomy in the treatment of biliary dyskinesia.

Background: The outcome of laparoscopic cholecystectomy for patients who present with "classic" biliary colic without evidence of cholelithiasis or acute inflammation (biliary dyskinesia) is not well documented. This study evaluates whether a cholecystokinin dimethyl iminodiacetic acid (CCK-HIDA) scan can predict relief of symptoms in this group of patients.

Methods: Patients who underwent laparoscopic cholecystectomy after a normal ultrasound and with an abnormal dimethyl iminodiacetic acid scan were retrospectively reviewed.

Bedside diagnostic minilaparoscopy in the intensive care patient.

Background: The diagnosis of acute abdominal conditions in the critically ill patient remains difficult. The goal of this study is to demonstrate the use of bedside minilaparoscopy as a diagnostic aid in the intensive care unit (ICU) in patients with possible intra-abdominal catastrophic condition.

Methods: Between February 1998 and May 1999, intensive care patients with abdominal pain, unexplained acidosis or sepsis, or suspected mesenteric ischemia were eligible for bedside diagnostic minilaparoscopy (3.