Surgical endoscopy
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Randomized Controlled Trial
Tailored instructor feedback leads to more effective virtual-reality laparoscopic training.
Laparoscopic novices begin at different performance levels, and studies on tailored training concepts are warranted. The effect of verbal instructor feedback has been investigated with varying results, and its effectiveness in virtual-reality laparoscopic (VRL) simulations still is unclear. This study aimed to determine whether laparoscopic novices with lower initial performance statuses may profit from training with intensive instructor feedback. ⋯ This is the first study to use a tailored training concept with instructor feedback limited to the LPG. The tailored training was effective and economic for the laparoscopic novices and their teachers.
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The aim of this prospective controlled trial was the definition of the optimal timepoint for delayed closure after negative pressure wound therapy (NPWT) in the treatment of the open abdomen (OA) in septic patients after abdominal surgery. The delayed closure of the abdominal wall after abdominal NPWT treatment is often problematic due to the lateralization of the fascial edge leading to unfavorably high tensile forces of the adapting sutures in the midline. We present the results of an innovative combination of NPWT with a new fascial-approximation technique using dynamic fascial sutures (DFS) and delayed closure of the abdominal wall. ⋯ Using a new technique combining NPWT and DFS in the treatment of the OA, the delayed closure of the fascial edges by running suture can be achieved and the number of re-operations can be kept low. The technique was safe and led to a low incidence of incisional hernias. Extensive abdominal wall reconstruction was seldom required.
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The ideal method for managing concomitant gallbladder stones and common bile duct (CBD) stones is debatable. The currently preferred method is two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy (LC). This prospective randomized trial compared the success and cost effectiveness of single- and two-stage management of patients with concomitant gallbladder and CBD stones. ⋯ Single- and two-stage management for uncomplicated concomitant gallbladder and CBD stones had similar success and complication rates, but the single-stage strategy was better in terms of shorter hospital stay, need for fewer procedures, and cost effectiveness.
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Randomized Controlled Trial Comparative Study
Totally extraperitoneal repair under general anesthesia versus Lichtenstein repair under local anesthesia for unilateral inguinal hernia: a prospective randomized controlled trial.
Lichtenstein repair (preferably under local anesthesia) or totally extraperitoneal repair (TEP) are both good options for treating uncomplicated unilateral inguinal hernia. We performed a prospective randomized trial to compare the outcome of TEP repair under general anesthesia versus open Lichtenstein inguinal hernioplasty under local anesthesia. ⋯ Lichtenstein repair under local anesthesia is as good as TEP under general anesthesia. The shorter operating room time, smaller mesh size, and lower cost of local anesthetic drugs all contribute to make Lichtenstein repair the better choice for repair of uncomplicated unilateral inguinal hernia, especially in developing nations with scarce resources.
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Approximately 175,000 umbilical hernia repairs are performed annually in the US. Controversy exists regarding the optimal approach for the elective repair of primary umbilical hernias. ⋯ This study identified potential decreased total and wound morbidity associated with LHR for elective primary umbilical hernia repairs at the expense of increased operative time, LOS, and respiratory and cardiac complications. These results should be considered within the context of a retrospective study with its inherent risks of bias and limitations.