Keith N. Apelgren

Surgical simulation: a current review

BackgroundSimulation tools offer the opportunity for the acquisition of surgical skill in the preclinical setting. Potential educational, safety, cost, and outcome benefits have brought increasing attention to this area in recent years. Utility in ongoing assessment and documentation of surgical skill, and in documenting proficiency and competency by standardized metrics, is another potential application of this technology. Significant work is yet to be done in validating simulation tools in the teaching of endoscopic, laparoscopic, and other surgical skills. Early data suggest face and construct validity, and the potential for clinical benefit, from simulation-based preclinical skills development. The purpose of this review is to highlight the status of simulation in surgical education, including available simulator options, and to briefly discuss the future impact of these modalities on surgical training.

SAGES guidelines for the clinical application of laparoscopic biliary tract surgery

Laparoscopic cholecystectomy (LC) has become the standard of care for patients requiring removal of the gallbladder. In 1992, a National Institutes of Health (NIH) consensus development conference concluded that ‘‘laparoscopic cholecystectomy provides a safe and effective treatment for most patients with symptomatic gallstones, laparoscopic cholecystectomy appears to have become the procedure of choice for many of these patients’’ [1]. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) first offered guidelines for the clinical application of laparoscopic cholecystectomy in May 1990. These guidelines have peri- odically been updated, and the last guideline in November 2002 expanded the guidelines to include all laparoscopic biliary tract surgery. This document updates and replaces the previous guideline. The current recommendations are graded and linked to the evidence utilizing the definitions in Appendices 1 and 2.

Reusable instruments are more cost-effective than disposable instruments for laparoscopic cholecystectomy

Health care costs are rising rapidly, and surgeons can play a role in limiting costs of operations. Of the 600,000 cholecystectomies performed each year in the United States, approximately 80% are performed with laparoscopic technique. The purpose of this study was to compare the costs of reusable vs disposable instruments used during laparoscopic cholecystectomy.The costs to the hospital of reusable and disposable instruments were obtained. Instruments studied were the Veress needle, trocars and sleeves (two 10 mm and two 5 mm), reducers, clip appliers, and clips. In addition, the costs of sterilization and sharpening for reusable instruments were calculated. The cost of reusable instruments was based on an assumed instrument life of 100 cases.Data from three private hospitals and a Canadian university hospital were collected and examined.Data from the four hospitals revealed that the costs of reusable instruments per case were

Guidelines for deep venous thrombosis prophlaxis during laparoscopic surgery

46.92–

Scrotal incarceration of the ureter with crossed renal ectopia: case report and literature review.

50.67. The comparable costs for disposable instruments were

Is laparoscopic better than open appendectomy

385.28–

Portal vein thrombosis

515.48. The advantage was thus

LAPAROSCOPIC APPENDECTOMY AND THE MANAGEMENT OF GYNECOLOGIC PATHOLOGIC CONDITIONS FOUND AT LAPAROSCOPY FOR PRESUMED APPENDICITIS

330.00–

Supermedia Interface for Internet-based Telediagnostics of Breast Pathology

460.00 per case. Theoretical advantages of disposable instruments such as safety, sterility, and better efficiency are not borne out in literature review. In addition, the environmental impact of increased refuse from disposable instruments could not be exactly defined.With the consideration of significant cost savings and the absence of data demonstrating disadvantages of their use, reusable instruments for laparoscopic cholecystectomy are strongly recommended.

Supermedia Interface for Internet Based Tele-diagnostics of Breast Pathology

There is still some controversy over the best practice for the prevention of deep vein thrombosis (DVT) during laparoscopic surgery. This guideline is intended to assist surgeons in making decisions regarding DVT prophylaxis when performing laparoscopic procedures. Although there are examples of specific procedures, the basic philosophy is that the prophylactic therapy should be tailored to the individual patients needs based on an estimated risk of venous thromboembolic (VTE) disease. Therefore there may be a specific procedure that has a variety of treatment strategies for varying clinical scenarios. Recommendations are based on the current medical evidence and have been graded according to the available evidence. Data existing only for open surgical procedures will be adapted, and a lower evidence and/or recommendation rating noted.