Sajida Ahad

Does resident involvement effect surgical times and complication rates during laparoscopic appendectomy for uncomplicated appendicitis? An analysis of 16,849 cases from the ACS-NSQIP

BACKGROUND Controversy exists regarding whether resident involvement during surgery impacts patient outcomes. We compared surgical times and perioperative complications of patients undergoing laparoscopic appendectomy with and without residents. METHODS Patients undergoing laparoscopic appendectomy for uncomplicated acute appendicitis during 2005 to 2008 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. RESULTS During the study period, 16,849 patients underwent laparoscopic appendectomy for uncomplicated appendicitis (residents participated in 68% of procedures). There were no statistical and/or clinically meaningful differences between median age, sex, body mass index, American Society of Anesthesiology score, and morbidity probability between the 2 groups, suggesting that case mix was not a significant confounder. Patients undergoing laparoscopic appendectomy with residents compared with patients undergoing laparoscopic appendectomy without residents had a higher incidence of serious and overall morbidity and longer surgical times. However, surgical times and complications were similar between residents in postgraduate years 1 to 5. CONCLUSIONS Regardless of the postgraduate year level, resident involvement resulted in a clinically appreciable increase in surgical times and a statistically significant increase in certain complications.

Laparoscopic removal of a copper intrauterine device from the sigmoid colon.

Removal of a migrated intrauterine device by using minimally invasive procedures is indicated even in select asymptomatic patients.

Laparoscopic splenopexy for wandering spleen: case report and review of the literature.

Wandering spleen is a rare condition in which the spleen lacks retroperitoneal fixation, thus its vascular pedicle can twist resulting in ischemia. Although splenectomy has traditionally been used for this condition, splenopexy is increasingly used in the pediatric population to anchor the spleen and preserve splenic function. We report an unusual case of wandering spleen in an adult with chronic torsion managed with laparoscopic splenopexy, suggesting splenic preservation is possible in adults with this presentation as well.

The effect of model fidelity on colonoscopic skills acquisition. A randomized controlled study.

INTRODUCTION Colonoscopic simulators offer the opportunity for skill acquisition in the preclinical setting. Currently available simulators vary widely with respect to level of fidelity and technological sophistication. Despite the belief that more realistic is better, there is a paucity of evidence regarding the relative effectiveness of simulator fidelity (high vs low) on the acquisition of basic colonoscopic skills. We hypothesized that novice learners can acquire basic colonoscopic skills using simulators, however fidelity of the simulator does not make a difference. METHODS We randomly assigned novice third-year and fourth-year medical students to practice on either a low-fidelity or high-fidelity colonoscopy model. The low-fidelity model used is described in the module 16 of the American College of Surgeons/Association of Program Directors in Surgery surgical skills curriculum for residents, Phase 1: basic or core skills and tasks < http://elearning.facs.org/mod/resource/view.php?1d=450 >. The high-fidelity model was the AccuTouch colonoscopy simulator, Immersion Medical (AccuTouch CS) that has 6 different simulated scenarios for diagnostic colonoscopy (level 1-6). Both groups had 16 students and were given standard instruction by an expert with respect to the procedure and instrument handling on both models. Both groups were pretested and posttested on level 1 of the AccuTouch CS. The high-fidelity group practiced on level 2 and 4 of the AccuTouch CS, whereas the low-fidelity group practiced on the low-fidelity model for 2 sessions of 1 hour each. The computer-based evaluation parameters available on the AccuTouch CS were used to compare performances. RESULTS Both groups had similar demographics. There were no significant differences in the baseline performances of either group. Each group demonstrated significant improvement for insertion time and percentage of mucosa visualized. However, there were no significant differences between the groups on posttesting on any of the measured parameters. CONCLUSIONS Colonoscopic skill training on a low-fidelity model appears to be as effective as high-fidelity model training for basic endoscopic skill acquisition for novice learners.

Single Incision Laparoscopic Right Hemicolectomy for Colon Cancer Less Is More

Single incision laparoscopic colectomy has been reported to be safe and feasible using several techniques and devices. The authors’ report their experience with a single incision laparoscopic colectomy performed in a lateral to medical fashion using a commercially developed access device with standard laparoscopic instruments.

Tools and Techniques for Gastrointestinal Hemostasis

Acute gastrointestinal (GI) bleeding can be amongst the most challenging GI conditions for care givers and is optimally managed in a multidisciplinary fashion. Team members can be highly variable and may include an emergency room physician, interventional radiologist or vascular surgeon, gastroenterologist, intensivist, and surgeon or surgical endoscopist. It is vital to have clear, concise, and current communication among team members to optimize outcome for the patient. Each member has a critical role from initiating resuscitation promptly in the emergency room, to endoscopic diagnostic and therapeutic management, to endovascular or interventional radiologic strategies if endoscopic therapies fail, and finally to post-procedure support and monitoring of the patient. This chapter provides an in-depth look at the tools used to gain endoscopic hemostasis in the GI tract. Basic elements of the proper evaluation and preparation of a patient for endoscopic therapy of GI bleeding are also covered.

26. Laparoscopic Gastrostomy

Feeding gastrostomy is a time-honored method of nutritional support in patients with a functioning gastrointestinal tract. Laparoscopic gastrostomy is an alternative method to percutaneous placement that offers the advantage of minimally invasive technique over that of traditional open gastrostomy.