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Watch great Videos of First International Conference on Recent Advances in Minimal Access Surgery Laparoscopic training on bench models: better and more cost effective than operating room experience? STUDY DESIGN: Second- and third-year residents (n= 27) were prospectively randomized to receive formal laparoscopic skills training or to a control group. At baseline, residents had a validated global assessment of their ability to perform a laparoscopic cholecystectomy based on direct observation by three evaluators who were blinded to the residents' randomization status. Residents were also tested on five standardized video-trainer tasks. The training group practiced the video-trainer tasks as a group for 30 minutes daily for 10 days. The control group received no formal training. All residents repeated the video-trainer test and underwent a second global assessment by the same three blinded evaluators at the end of the 1-month rotation. Within-person improvement was determined; improvement was adjusted for differences in baseline performance. RESULTS: Five residents were unable to participate because of scheduling problems; 9 residents in the training group and 13 residents in the control group completed the study. Baseline laparoscopic experience, video-trainer scores, and global assessments were not significantly different between the two groups. The training group on average practiced the video-trainer tasks 138 times (range 94 to 171 times); the control group did not practice any task. The trained group achieved significantly greater adjusted improvement in video-trainer scores (five of five tasks) and global assessments (four of eight criteria) over the course of the four-week curriculum, compared with controls. CONCLUSIONS: Intense training improves video-eye-hand skills and translates into improved operative performance for junior surgery residents. Surgical curricula should contain laparoscopic skills training. Laparoscopic Colectomy for Curable Cancer Position Statement of the American Society of Colon and Rectal Surgeons (ASCRS)Endorsed by the Society of American Gastrointestinal Endoscopic Surgeons (SAGES)Laparoscopic colectomy for curable cancer results in equivalent cancer related survival to open colectomy when performed by experienced surgeons. Adherence to standard cancer resection techniques including but not limited to complete exploration of the abdomen, adequate proximal and distal margins, ligation of the major vessels at their respective origins, containment and careful tissue handling, and en bloc resection with negative tumor margins using the laparoscopic approach will result in acceptable outcomes. Based upon the COST* trial, pre-requisite experience should include at least 20 laparoscopic colorectal resections with anastomosis for benign disease or metastatic colon cancer before using the technique to treat curable cancer. Hospitals may base credentialing for laparoscopic colectomy for cancer on experience gained by formal graduate medical educational training or advanced laparoscopic experience, participation in hands on training courses and outcomes. *The Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004;350:2050-2059.
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Connection Stopped at the time of Telesurgery Doctors can control surgery from thousands of miles away Surgeons in the US have successfully used computers and robots to take part in operations in a different continent. Researchers from the influential Johns Hopkins University in Baltimore have revealed that they now have the technology to carry out "Telesurgery" on patients anywhere in the world. Already 17 patients undergoing surgery at Rome's Policlinico Casilino University have benefited from the technological advances. US doctors used a combination of computers, telecommunications, videoconferencing and advanced surgical robots to guide surgery that was actually being carried out thousands of miles away. None of the patients suffered any adverse effects. Surgical robots augment a surgeon's ability by scaling down range of motion, providing three-dimensional vision and eliminating hand tremor. The robotic systems consist of a surgeon's viewing and control console and a cart with robotic arms that sits next to the patient. Fourteen of the patients underwent a laparoscopy. This involves inserting a thin fibre optic scope into the body. Of these, eight underwent a procedure correct a fault with the blood supply to the testicles, and the six others underwent work on their kidneys. The three other operations also involved surgery on the kidneys. Fourteen of the patients had surgery to treat problems with the blood supply to the testicles. Laparoscopic surgery is performed with only a minimal incision so the patient experiences less pain and blood loss and has a shorter recovery time. However, surgeons need extensive training to use the technology. The Johns Hopkins technology allows experienced surgeons at a remote site to guide others through the procedure. Connection stopped In seven of the 17 procedures, the telesurgical connection was stopped and the operations were continued only from the primary site. Two of the 17 were converted to open surgery and during one of the kidney-related procedures problems developed with a manual control for a robotic device. Dr Dan Stoianovici, director of the robot laboratory at Johns Hopkins, said: "This is still an experimental project. "If robots improve and we are really able to do all kinds of surgery, you could see a single surgeon sitting at a console switching from one surgery to another around the world." The Johns Hopkins team revealed details of their work at a meeting of the American Urological Association in Anaheim, California.
Courtesy -BBC NEWS Benefits of Hand-Assisted Colectomy Debated New York—The debate over the benefits of hand-assisted colectomy has reached the point where even a surgeon whose study found the procedure to be faster and easier than a total laparoscopic procedure now says the total is "the way to go." David Naar, MD, chief resident and instructor in surgery at New England Medical Center, Boston, reported on his research at the meeting of the Society of Laparoendoscopic Surgeons. In the prospective, nonrandomized study, 50 consecutive patients were assigned to undergo either a hand-assisted or a total laparoscopic colectomy. Dr. Naar found that the hand-assisted colectomy took significantly less operative time than the total (P <0.002). The average time for the total procedure was about 3.5 hours, while the hand-assisted averaged 40 minutes less. Differences in conversion rate, length of stay, convalescence and complications were not significant. His printed abstract concluded: "The results support the routine use of hand-assisted laparoscopic colectomy over total laparoscopic colectomy." However, in a subsequent interview with General Surgery News, Dr. Naar said he would now favor the total laparoscopic procedure over the hand-assisted. Laparoscopic Colectomy Safe, Speedy With TrainingOvercoming learning curve will benefit patients in the long run, experts suggestLaparoscopic colectomy can be safely performed–as fast as, or faster than, the open technique, with quicker patient recovery time–by surgeons experienced with the procedure, researchers in Georgia have found. "Once the surgeon has gotten through the learning curve, the operating time can definitely be less than with an open," said Bruce Ramshaw, MD, associate clinical professor of surgery at the Medical College of Georgia, in Augusta. He presented his findings recently at the annual meeting of the Society of Laparoscopic Surgeons in New York City. The study was described as "well done" and "timely" by C. Daniel Smith, MD, chief of general and gastrointestinal surgery at Emory University School of Medicine, in Atlanta. Pyloromyotomy: Lap As Effective as Open Less post-op vomiting and improved cosmesisNew York—Pyloromyotomy can be performed laparoscopically with efficiency similar to open procedures for infants with hypertrophic pyloric stenosis. In fact, there is no increase in length of hospital stay associated with the laparoscopic approach, in addition to the potential added advantage of less postoperative emesis, according to a recent retrospective report. "A trend to less postoperative emesis, with no impact on hospital stay, is a possible benefit of the laparoscopic approach," said Manuel Caceres, MD, senior resident in the Department of Surgery, Louisiana State University School of Medicine in New Orleans. Favorable cosmetic outcome and absence of wound complications may be other important advantages of laparoscopic pyloromyotomy.
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