Legal & ethical dilemmas in incidental findings during surgery: Review article.

Background: Discovering IF (incidental findings) during surgery results in ethical and legal dilemmas for the surgeon, especially those in training or recently qualified. The situation is further compounded as these can occur in an emergency. The immediacy of making the correct decision can be paramount for both the surgeon and the patient.

Validation of open inguinal hernia repair simulation model: a randomized controlled educational trial.

Background: A hernia repair open surgical simulation computer software was developed at Imperial College London. A randomized controlled educational trial was conducted to investigate the benefit of the simulation on the development of procedural knowledge.

Methods: Medical students in their clinical years were invited to participate in the trial.

Simulation in surgery: a review.

The ability to acquire surgical skills requires consistent practice, and evidence suggests that many of these technical skills can be learnt away from the operating theatre. The aim of this review article is to discuss the importance of surgical simulation today and its various types, exploring the effectiveness of simulation in the clinical setting and its challenges for the future. Surgical simulation offers the opportunity for trainees to practise their surgical skills prior to entering the operating theatre, allowing detailed feedback and objective assessment of their performance.

Open surgery simulation of inguinal hernia repair.

Inguinal hernia repair procedures are often one of the first surgical procedures faced by junior surgeons. The biggest challenge in this procedure for novice trainees is understanding the 3D spatial relations of the complex anatomy of the inguinal region, which is crucial for the effective and careful handling of the present anatomical structures in order to perform a successful and lasting repair. Such relationships are difficult to illustrate and comprehend through standard learning material.

Operative performance in laparoscopic cholecystectomy using the Procedural-Based Assessment tool.

Aims: The Intercollegiate Surgical Curriculum Project (ISCP) has devised assessment tools for index operations to assess trainee technical skills. In this study we used the Procedural-Based Assessment (PBA) tool to evaluate operations performed by trainees.

Methods: Live and simulated laparoscopic cholecystectomies were performed by trainees.

Procedural performance in gastrointestinal endoscopy: live and simulated.

Background: The purpose of the present study was to compare the use of a human and a computer-based technical skills assessment tool in live and simulated gastrointestinal endoscopies performed by consultants and trainees.

Methods: Validated human-based Likert scales were used individually for generic and specific technical skills for two procedures. Two observers assessed each procedure independently and blindly.

Feasibility of self-appraisal in assessing operative performance in advanced laparoscopic colorectal surgery.

Aim: To date there has been no attempt to assess comprehensively generic and specific technical skills in live advanced laparoscopic colorectal surgery. In this study, we aim to develop and validate a new tool which can assess these skills.

Method: Weighted Likert scales were constructed individually for generic and specific technical skills on three key laparoscopic colorectal operations: right hemicolectomy, sigmoid colectomy and anterior resection, after expert discussions.

Assessing operative performance in advanced laparoscopic colorectal surgery.

Background: Competent technical skills performance in complex operations is vital for satisfactory patient outcome. Assessing these skills is therefore of paramount importance. In this study we aim to develop and validate a new tool that can assess both generic and specific technical skills in advanced complex laparoscopic colorectal surgery in the operating room.

Procedural performance in gastrointestinal endoscopy: an assessment and self-appraisal tool.

Aims: Assessing endoscopic technical skills competency in a structured manner is a topical issue, in light of several workforce factors that may affect the training of future endoscopists. To date there has been little attempt to comprehensively assess both generic and specific technical skills in lower gastrointestinal endoscopies; the current study aimed to develop and validate a tool that can assess these varied skills.

Methods: Hierarchical task analyses of generic and specific technical skills were constructed on flexible sigmoidoscopy and colonoscopy after expert panel discussions.

A decision-making learning and assessment tool in laparoscopic cholecystectomy.

Aims: Making correct decisions is an integral part of surgical competency and excellence. The learning of this expert skill takes years to accumulate during training. To date there has not been an attempt to accelerate this learning process by developing a tool.

Decision making in laparoscopic surgery: a prospective, independent and blinded analysis.

Aims: Correct decision making is pivotal and an integral part of surgical competency. To date there has not been an attempt to assess surgeons making decisions whilst operating. In our present study we aim to assess operative decision making by trainee and expert surgeons by using hierarchical task analysis (HTA) as a method to map out decision making in surgery.

Laparoscopic extraperitoneal repair of Amyand's inguinal hernia.

Amyand's hernia (appendix in the sac of an inguinal hernia) although rare is a fairly well-recognized clinical entity. It is associated with an increased risk of developing appendicitis. Amyand's hernia can be repaired by open or laparoscopic methods.

Constructing hierarchical task analysis in surgery.

Background: Generic technical skills are required by a surgeon to perform a complete operation or procedure. They alone do not form a task or subtask but allow the surgeon to perform so. Specific technical skills are required to complete a task or subtask, which can be depicted by hierarchical task analysis (HTA).

Errors in surgery.

Making errors is part of normal human behaviour. However when errors have significant consequences or occur in high risk industries they become of paramount importance. There has been little research in why and how errors occur in the healthcare industry.

Technical and technological skills assessment in laparoscopic surgery.

Objectives: Surgical appraisal and revalidation are key components of good surgical practice and training. Assessing technical skills in a structured manner is still not widely used. Laparoscopic surgery also requires the surgeon to be competent in technological aspects of the operation.

Development of assessing generic and specific technical skills in laparoscopic surgery.

Background: Assessing live laparoscopic surgery using structured methodology is still in its infancy; however, it removes bias and subjectivity. We critique a new assessment tool for technical skills in laparoscopic surgery.

Methods: A hierarchical task analysis was done for laparoscopic cholecystectomy (LC), and a global assessment for generic and specific technical skills for LC was developed.

Assessing the teaching of technical skills.

Background: There is a lack of structured instruments to assess how technical skills are taught. We aimed to develop a practical assessment tool that is easy to use and will assess the teaching of technical skills.

Methods: A 5-point Likert global rating scale was constructed.

Systems approaches to surgical quality and safety: from concept to measurement.

Objective: This approach provides the basis of our research program, which aims to expand operative assessment beyond patient factors and the technical skills of the surgeon; to extend assessment of surgical skills beyond bench models to the operating theater; to provide a basis for assessing interventions; and to provide a deeper understanding of surgical outcomes.

Summary Background Data: Research into surgical outcomes has primarily focused on the role of patient pathophysiological risk factors and on the skills of the individual surgeon. However, this approach neglects a wide range of factors that have been found to be of important in achieving safe, high-quality performance in other high-risk environments.

Objective assessment of technical skills in surgery.

In the past few years, considerable developments have been made in the objective assessment of technical proficiency of surgeons. Technical skills should be assessed during training, and various methods have been developed for this purpose

Diagnostic use of mean nuclear area and nuclear DNA content in preoperative breast cancer cytology.

Objective: Fine needle aspiration (FNA) cytology of breast lumps is a routine procedure, and the diagnostic accuracy can be 95%. Occasional discrepancies arise, and it would be valuable to have additional parameters for accurate diagnosis. We evaluated nuclear DNA content and mean nuclear area (MNA) using image cytometry in the diagnosis of preoperative breast cancers by FNA in those with a discrepancy between clinical, radiologic and cytologic diagnoses.

Mean nuclear area of fine needle aspirates of primary preoperative palpable breast carcinoma using image cytometry.

Objective: Early, operable breast cancers in appropriate patients are increasingly being treated preoperatively using neoadjuvant chemotherapy. A good response rate is seen with high grade tumors. Nuclear size, which may reflect the grade of the tumor, is also of possible prognostic value in breast cancer.