Tiffany C. Cox

Moving the Needle: Simulation's Impact on Patient Outcomes

This review investigates the available literature that addresses the impact simulator training has on patient outcomes. The authors conducted a comprehensive literature search of studies reporting outcomes of simulation training and categorized studies based on the Kirkpatrick model of training evaluation. Kirkpatrick level 4 studies reporting patient outcomes were identified and included in this review. Existing evidence is promising, demonstrating patient benefits as a result of simulation training for central line placement, obstetric emergencies, cataract surgery, laparoscopic inguinal hernia repair, and team training.

Minimally Invasive Approaches to Gastrointestinal Stromal Tumors (GISTs)

The concept and proof of concept of minimally invasive surgical techniques began with the introduction of laparoscopic cholecystectomy in 1987. Since then, laparoscopy has improved patient outcomes and transitioned through all surgical specialties, including general surgery thoracic, vascular, gynecology, and urology. Minimally invasive surgery has evolved since its creation due to improvements in instruments, visualization, hemostatsis, robotics, the ability to combine laparoscopy with intraoperative endoscopy, and the wide availability of these technologies to maximize favorable outcomes. The application of minimally invasive surgical techniques to the treatment of gastrointestinal stromal tumors (GISTs) has been extensively studied, and the general conclusion is that laparoscopic removal of GIST in most patients is associated with a shorter hospital stay and comparable long-term oncologic outcomes compared to open resection [1–8]. However, as with any operation for GIST, the adherence to oncologic surgical practices, including prevention of tumor spillage and appropriate resection, must be considered before deciding on a minimally invasive resection [1].

Long-Term Quality of Life Outcomes in Laparoscopic and Open Repair of the Flank Hernia: A Prospective, International Study

RESULTS: Sixty-seven flank hernia repairs, 25 laparoscopic and 42 open, were examined. Patients undergoing laparoscopic vs open repair were similar in age (58.9 vs 61.8 years, p1⁄40.42), BMI (30.2 vs 30.5 kg/m, p1⁄40.78), operative time (97.7 vs 118.1 minutes, p<0.21), and percentage of primary hernias (72.0% vs 76.2%, p<0.70). Open repairs had larger defects (136.0 vs 41.7cm, p<0.068) and longer length of stay (LOS, 5.6 vs 3.0 days, p<0.0012). There were no mesh or wound infections reported in the study population. There was 1 recurrence in each group (3.0% overall). One-year follow-up rates were 84% for laparoscopic and 74% for open; overall mean follow-up was 22.1 months. At 1 year, mesh sensation, pain, and movement limitation were persistent in nearly 30% of patients regardless of operative approach (Table). Overall, of patients endorsing preoperative pain, 56.5% improved, 39.1% stayed the same, and 4.3% worsened by 1 year.