Davendra Sharma

Learning basic laparoscopic skills: a randomized controlled study comparing box trainer, virtual reality simulator, and mental training.

OBJECTIVES The objectives of this study were (1) to compare different methods of learning basic laparoscopic skills using box trainer (BT), virtual reality simulator (VRS) and mental training (MT); and (2) to determine the most effective method of learning laparoscopic skills. DESIGN Randomized controlled trial. SETTING Kings College, London. METHODS 41 medical students were included in the study. After randomization, they were divided into 5 groups. Group 1 was the control group without training; group 2 was box trained; group 3 was also box trained with an additional practice session; group 4 was VRS trained; and group 5 was solely mentally trained. The task was to cut out a circle marked on a stretchable material. All groups were assessed after 1 week on both BT and VRS. Four main parameters were assessed, namely time, precision, accuracy, and performance. RESULTS Time: On BT assessment, the box-trained group with additional practice group 3 was the fastest, and the mental-trained group 5 was the slowest. On VRS assessment, the time difference between group 3 and the control group 1 was statistically significant. Precision: On BT assessment, the box-trained groups 2 and 3 scored high, and mental trained were low on precision. On VRS assessment, the VRS-trained group ranked at the top, and the MT group was at the bottom on precision. Accuracy: On BT assessment, the box-trained group 3 was best and the mental-trained group was last. On VRS assessment, the VRS-trained group 4 scored high closely followed by box-trained groups 2 and 3. Performance: On BT assessment, the box-trained group 3 ranked above all the other groups, and the mental-trained group ranked last. On VRS assessment, the VRS group 4 scored best, followed closely by box-trained groups 2 and 3. CONCLUSIONS The skills learned on box training were reproducible on both VRS and BT. However, not all the skills learned on VRS were transferable to BT. Furthermore, VRS was found to be a reliable and the most convenient method of assessment. MT alone cannot replace conventional training.

Using the Mind as a Simulator: A Randomized Controlled Trial of Mental Training

OBJECTIVES Laparoscopic simulators have been introduced as safe and effective methods of developing basic skills. Mental training is a novel training method likened to using the mind as a simulator to mentally rehearse the movements of a task or operation. It is widely used by professional athletes and musicians and has been suggested as a technique that could be used by surgical trainees. The purpose of this study was to assess the use of mental training in developing basic laparoscopic skills in novices. METHODS Sixty-four medical students without laparoscopic experience were randomized into 4 groups. The first 3 groups were trained to cut a circle on a box trainer. Group 1 received no additional training (BT), Group 2 received additional virtual reality training (BT + VRS), and Group 3 received additional mental training (BT + MT). The fourth group was trained on a virtual reality simulator with additional mental training (box-free). The following 4 assessment criterias: time, accuracy, precision and overall performance were measured on both the box-trainer and virtual simulator. RESULTS The mental training group (BT + MT) demonstrated improved laparoscopic skills over both assessments. The improvement in skills in the VRS group (BT + VRS) was limited to VRS assessment and not observed in the box assessment. The fourth group (box-free) had the worst performance on both methods of assessment. CONCLUSION The addition of mental training led to improved laparoscopic skills development. It is a flexible technique and has the potential to challenge VRS as a more cost-effective training method associated with lower capital investment. Given the benefits of mental training with further research, it could be considered for inclusion in training curricula.

Scarless Single-Port Laparoscopic Pelvic Kidney Nephrectomy

INTRODUCTION We report the first pelvic kidney removal through the umbilicus using a scarless pure single-port technique in a young woman. PATIENTS AND METHODS A 27-year-old woman presented with uro-sepsis and acute renal failure secondary to a dilated, chronically infected, nonfunctioning left-sided pelvic kidney with ureteropelvic obstruction causing an obstruction to the right kidney. The acute episode was managed with bilateral ureteric stents and antibiotics. Definitive treatment involved removal of the diseased pelvic kidney through the umbilicus via a single-port access device (TriPor™; Olympus). A curved tissue grasper and extralong bariatric suction device were used along with standard straight laparoscopic instruments. In addition, a 10-mm flexible-tip video laparoendoscope (HD EndoEYE LTF-VH™; Olympus) and a robotic camera holder (FreeHand™; Prosurgics) were used to reduce external instrument clash. RESULTS The procedure was technically successful leaving the patient with a scarless abdomen. The operative time was 185 minutes, blood loss 100 mL, and length of stay 48 hours. There were no complications. CONCLUSION Scarless transumbilical pelvic nephrectomy is technically feasible. The first reported clinical experience is discussed.

INTRALUMINAL ROBOTICS: A NEW DAWN IN MINIMALLY INVASIVE SURGERY?

Whilst laparoscopy is clearly established as the standard-bearer of minimally invasive techniques, it does have limitations. Surgical dexterity, as measured by degrees of freedom, is limited by the fulcrum effect of the entry ports. Visual feedback is limited by a twodimensional image and constrained by the entry ports. Robotic assistance allows for unprecedented control and precision of surgical instruments. It has been shown to enhance dexterity by nearly 50% as compared with laparoscopic surgery [1]. There are two types of surgical robotics that are well established, telemanipulators and robotic camera holders. Despite the obvious progress, there are limitations to both of these methods. Telemanipulaton requires large external machines that are still constrained technically by the use of long tools, and limited financially by high cost. The robotic camera holder is much more affordable and eliminates the problems of the camera assistant, but there still exist the limitations of standard laparoscopic surgery. ‘Internalization’ of instrumentation by miniaturization is one fascinating way of addressing the problems of present day minimally invasive surgery and is possibly the most exciting development in robotics. This allows the robot to work within the region of interest. Surgeons from Nebraska working with the Department of Mechanical Engineering, University of Nebraska-Lincoln have reported their early experiences with intraluminal robots in experimental models [2]. The mini-robots are introduced into the body cavity either through a standard laparoscopic port site or via the gastrointestinal tract. External control of the mini-robot then greatly aids dexterity and produces superior visualization. The robots are presently categorized into two groups, either fixed or mobile, depending on their mobility.

A study into the association between local recurrence rates and surgical resection margins in organ-sparing surgery for penile squamous cell cancer

To evaluate the significance of close surgical margins in organ‐sparing surgery (OSS) in the treatment of penile squamous cell carcinoma (pSCC) and clinicopathological factors that may influence local recurrence.

Hyperammonaemic encephalopathy 60 years after ureterosigmoidostomy: Case report and clinicopathological correlations

1875-9742/

Natural orifice transluminal endoscopic surgery: a new dimension in minimally invasive surgery

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