Barnard Palmer

Bringing the Skills Laboratory Home: An Affordable Webcam-Based Personal Trainer for Developing Laparoscopic Skills

OBJECTIVE The purpose of this work was to develop a more flexible system of laparoscopic surgery training with demonstrated effectiveness and construct validity. HYPOTHESES A personal, portable, durable laparoscopic trainer can be designed at low cost. The evaluation of expert surgeons on this device will reveal technical superiority over novices. With practice, novice surgeons can improve their performance significantly as measured by scores derived from performing skills with this training device. DESIGN Prospective trial with observation and intervention components. The first aspect was observational comparison of novice and expert performance. The second was a prospective static-group comparison with pretest/posttest single-sample design. SETTING Tertiary-care academic medical center with affiliated general surgery residency. PARTICIPANTS A total of 21 junior surgical residents and 5 experienced operators. MAIN OUTCOME MEASURES Performance was assessed by the 5 tasks in the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS): pegboard transfer, pattern cutting, placement of ligating loop, extracorporeal knotting, and intracorporeal knotting. Each task was assessed for accuracy and speed. RESULTS Expert surgeons scored significantly higher than novices on total score and 4 of the 5 MISTELS tasks (peg transfer, pattern cut, extracorporeal knot, and intracorporeal knot). After 4 months of home-based training, the novices improved in total score and 3 of the 5 tasks (peg transfer, pattern cut, and extracorporeal knot). CONCLUSIONS A low-cost personal laparoscopic training device can be built by individual residents. With their use, residents can significantly improve performance in important surgical skills. Evaluation of the system supports its validity.

Pan computed tomography versus selective computed tomography in stable, young adults after blunt trauma with moderate mechanism: a cost-utility analysis.

BACKGROUND Pan computed tomography (PCT) of the head, cervical spine, chest, abdomen, and pelvis is a valuable approach for rapid evaluation of severely injured blunt trauma patients. A PCT strategy has also been applied for the evaluation of patients with lower injury severity; however, the cost-utility of this approach is undetermined. The advantage of rapidly identifying all injuries via PCT must be weighed against the risk of radiation-induced cancer (RIC). Our objective was to compare the cost-utility of PCT with selective computed tomography (SCT) in the management of blunt trauma patients with low injury severity. METHODS A Markov model–based, cost-utility analysis of a hypothetical cohort of hemodynamically stable, 30-year-old males evaluated in a trauma center after motor vehicle crash was used. CT scans are performed based on the mechanism of injury. The analysis compared PCT with SCT over a 1-year time frame with an analytic horizon over the lifespan of the patients. The possible outcomes, utilities of health states, and health care costs including RIC were derived from the published medical literature and public data. Costs were measured in US 2010 dollars, and incremental effectiveness was measured in quality-adjusted life-years (QALYs) with 3% annual discounted rates. Multiway sensitivity analyses were performed on all variables. RESULTS The total cost for blunt trauma patients undergoing PCT was

Peer assisted learning in surgical skills laboratory training: A pilot study

15,682 versus

Anterior Chest Wall Elevation Using a T-Fastener Suture Technique During a Nuss Procedure

17,673 for SCT. There was no difference in QALYs between the two populations (26.42 vs. 26.40). However, there was a cost savings of

Routine prophylactic central neck dissection for low-risk papillary thyroid cancer is not cost-effective

75 per QALY for patients receiving PCT versus SCT (

Use of transthoracic cryoanalgesia during the Nuss procedure

594 per QALY vs.

Modification of U-Stitch Laparoscopic Gastrostomy Technique to Minimize Suture Knot Abscess Formation.

669 per QALY). CONCLUSION PCT enables surgeons to identify and rule out injuries promptly, thereby reducing the need for inpatient observation. The risk of RIC is low following a single PCT. This cost-utility analysis finds PCT based on mechanism to be a cost-effective use of resources. LEVEL OF EVIDENCE Economic and value-based evaluations, level II.

A better way to teach knot tying: a randomized controlled trial comparing the kinesthetic and traditional methods

Background: Peer assisted learning (PAL) has been rarely investigated in surgical skills training. Aims: Describe feedback residents give peers on surgical skills with and without guidelines, determine the association between feedback and actual performance, evaluate resident satisfaction with PAL. Method: Participants evaluated peers using a validated knot-tying checklist and provided feedback on suturing without a guideline. Feedback comments were coded by type and an expert scored performance of each participant. Residents completed a satisfaction questionnaire. Results: Comments were generally specific. Feedback was twice as likely with the use of a guideline. Specific feedback correlated significantly with expert knot-tying score but not suturing score. Most participants felt peer feedback was helpful and were motivated to practice surgical skills after PAL sessions. Conclusions: Surgical residents can provide high quality specific feedback to peers on surgical skills using performance guidelines. Further exploration of effective PAL methodology in surgical skills laboratory training is needed.

Peer video review and feedback improve performance in basic surgical skills.

The most critical part of the Nuss procedure is the passage of the introducer across the anterior mediastinum without cardiac injury. For patients with severe pectus excavatum, passing the introducer can be difficult and hazardous. We describe a technique that resembles a use of T-fastenerlike suture material to elevate the anterior chest. The elevation of the chest allows safe, blunt anterior mediastinal dissection before the passage of the introducer. The risk of intraoperative cardiac perforation is minimized.

BRAF mutation in papillary thyroid cancer: A cost-utility analysis of preoperative testing.

The role of routine prophylactic central neck dissection (CND) in papillary thyroid cancer (PTC) remains controversial. The aim of this study was to evaluate the cost utility of the addition of routine CND in patients with low‐risk PTC compared with total thyroidectomy (TT) alone.