A. Ganpule

Task completion time: Objective tool for assessment of technical skills in laparoscopic simulator for urology trainees.

Context: Laparoscopic surgical simulation is a valuable training tool for urology trainees. Aims: We assessed the validity of task completion time (TCT) as an objective tool for practicing and acquiring technical skills in a simulated laparoscopy environment. Materials and Methods: Fifteen participants comprising postgraduate urology trainees from first to third year (n = 12), urology fellow (n = 1) and consultants (n = 2) underwent basic laparoscopic training on the “Beetle Universal” endotrainer. Training included 10 attempts each comprising four tasks; placing a ball in a cup (Task 1), threading five rings (Task 2), threading five balls (Task 3) and tying a suture (Task 4). Individual task (IT) time was measured. The TCT was defined as sum of IT time for a single attempt. Statistical Analysis Used: Statistical analysis was done by Pearsons correlation coefficient and students t test using SPSS software 10. Results: The average TCT for the first attempt to complete the four tasks by the participants was 76.5 ± 13.0 min (range 38 to 92.5, skew −1.8), compared to the 10th attempt 33 ± 4.23 min (range 25 to 38.5, skew −0.5). There was statistically significant correlation (r = mean −0.91, range −0.97 to −.83, skew −0.5), (P = < 0.001) between the number of attempts and decreasing TCT for all participants. Correlation decreased when TCT between the sixth to 10th attempt was compared (r = mean −0.67, range −0.99 to 0.76). Conclusions: The TCT is practical, easy and a valid objective tool for assessing acquired technical skills of urology trainees in a laparoscopic simulated environment.

Surgical management of pediatric urolithiasis

Pediatric urolithiasis poses a technical challenge to the urologist. A review of the recent literature on the subject was performed to highlight the various treatment modalities in the management of pediatric stones. A Medline search was used to identify manuscripts dealing with management options such as percutaneous nephrolithotomy, shock wave lithotripsy, ureteroscopy and cystolithotripsy in pediatric stone diseases. We also share our experience on the subject. Shock wave lithotripsy should be the treatment modality for renal stone less than 1cm or < 150 mm2 and proximal non-impacted ureteric stone less than 1 cm with normal renal function, no infection and favorable anatomy. Indications for PCNL in children are large burden stone more than 2cm or more than 150mm2 with or without hydronephrosis, urosepsis and renal insufficiency, more than 1cm impacted upper ureteric stone, failure of SWL and significant volume of residual stones after open surgery. Shock wave lithotripsy can be offered for more soft (< 900 HU on CT scan) renal stones between 1-2cm. Primary vesical stone more than 1cm can be tackled with percutaneous cystolithomy or open cystolithotomy. Open renal stone surgery can be done for renal stones with associated structural abnormalities, large burden infective and staghorn stones, large impacted proximal ureteric stone. The role of laparoscopic surgery for stone disease in children still needs to be explored.

A novel prototype 3/5 laparoscopic needle driver: A validation study with conventional laparoscopic needle driver

Introduction: The challenges in laparoscopic suturing include need to expertise to suture. Laparoscopic needle holder is a” key” instrument to accomplish this arduous task. Instrument: The objective of this new invention was to develop a laparoscopic needle holder which would be adapted to avoid any wobble (with a shaft diameter same as a 5mm port), ensure accurate and dexterous suturing not just in adult patients but pediatric patients alike (with a short shaft diameter) and finally ensure seamless throw of knots with a narrow tip configuration. Validation: We did an initial evaluation to evaluate the validity of the prototype needle holder and its impact on laparoscopic suturing skills by experienced laparoscopic surgeons and novice laparoscopic Surgeons. Both the groups of surgeons performed two tasks. The first task was to grasp the needle and position it in an angle deemed ideal for suturing. The second task was to pass suture through two fixed points and make a single square knot. At the end of the tasks each participant was asked to complete a 5- point Likerts scale questionnaire (8 items; 4 items of handling and 4 items of suturing) rating each needle holder. In expert group, the mean time to complete task 1 was shorter with prototype 3/5 laparoscopic needle holder (11.8 sec Vs 20.8 sec). The mean time to complete task 2 was also shorter with prototype 3/5 laparoscopic needle holder (103.2 sec Vs 153.2 sec). In novice group, mean time to complete both the task was shorter with prototype 3/5 laparoscopic needle holder. Conclusion: The expert laparoscopic surgeons as well as novice laparoscopic surgeons performed laparoscopic suturing faster and with more ease while using the prototype 3/5 laparoscopic needle holder.