Surgical endoscopy
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Randomized Controlled Trial Comparative Study
Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload.
Intracorporeal suturing is one of the most difficult laparoscopic tasks. The purpose of this study was to assess the impact of robotic assistance on novice suturing performance, safety, and workload in the operating room. ⋯ Compared with standard laparoscopy, robotic assistance significantly improved intracorporeal suturing performance and safety of novices in the operating room while decreasing their workload. Moreover, the robot significantly shortened the learning curve of this difficult task. Further study is needed to assess the value of robotic assistance for experienced surgeons, and validated robotic training curricula need to be developed.
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Multicenter Study
Telesimulation: an effective method for teaching the fundamentals of laparoscopic surgery in resource-restricted countries.
Several challenges exist with laparoscopic skills training in resource-restricted countries, including long travel distances required by mentors for onsite teaching. Telesimulation (TS) is a novel concept that uses the internet to link simulators between an instructor and a trainee in different locations. The purpose of this study was to determine the effectiveness of telesimulation for teaching the Fundamentals of Laparoscopic Surgery (FLS) to surgeons in Botswana, Africa. ⋯ Remote telesimulation is an effective method for teaching the Fundamentals of Laparoscopic Surgery in Africa, achieving a 100% FLS skills pass rate. This training platform provides a cost-effective method of teaching in resource-restricted countries and could be used to teach laparoscopic skills anywhere in the world with internet access.
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The aim of this study was to evaluate laparoscopic versus open surgery for suspected appendicitis during pregnancy. ⋯ This article is the largest hospital-based series evaluating the laparoscopic versus open approach for pregnant patients with presumed acute appendicitis. While methodological limitations preclude a definitive recommendation, laparoscopy appears to be a safe, feasible, and efficacious approach for pregnant patients with presumed acute appendicitis. We conclude that it is likely not the surgical approach but the underlying diagnosis combined with maternal factors that determine the risk for pregnancy complications. A benefit of laparoscopy is the diagnostic ability to identify other intra-abdominal pathology which may mimic appendicitis and harbor pregnancy risks.
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Self-expandable metallic stent (SEMS) for malignant colorectal obstruction is widely used in palliative treatment and as an alternative to surgery. The aims of this study are to evaluate the effectiveness of stent placement for palliative treatment and to identify the predictive factors associated with stent occlusion. ⋯ Uncovered SEMS placement is an effective palliative treatment for malignant colorectal obstruction. The degree of stent expansion 48 h after stent placement is significantly associated with the maintenance of stent patency and is a predictive factor for stent occlusion.
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Surgical-site infections (SSIs) are nosocomial infectious complications causing significant morbidity, mortality, and hospital costs. Recently, the US Department of Human Health Services and the Centers for Medicare and Medicare Services outlined measures intended to decrease and prevent hospital-acquired infections such as SSI. This study aimed to compare the incidence of SSI after laparoscopic and open surgery. ⋯ In US academic medical centers, laparoscopy significantly reduces SSI. Patients treated with laparoscopic procedures are less likely to experience SSI. After stratification by severity of illness, admission status, and wound classification, laparoscopic techniques showed a protective effect against SSI.