Journal of the American College of Surgeons
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Randomized Controlled Trial
Proficiency maintenance: impact of ongoing simulator training on laparoscopic skill retention.
Proficiency-based training in laparoscopic suturing and knot tying translates to the operating room, but little is known about the durability of acquired skill. The purpose of this study was to determine the effect of maintenance training on skill retention after demonstration of proficiency. ⋯ Although proficiency-based training results in excellent skill retention, ongoing training substantially enhances performance and minimizes skill loss. Curricula should incorporate training that fosters maintenance of proficiency.
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Percutaneous dilational tracheostomy (PDT) is becoming a widely accepted technique that has replaced open tracheostomy (OT) in many hospitals. One of the remaining relative contraindications is morbid obesity. There are no published case series of its use in this patient population. We reviewed our experience with PDT in the morbidly obese and compared it to OT in this patient population. Our hypothesis is that PDT and OT have a similar frequency of adverse events. ⋯ PDT is a safe procedure to perform on morbidly obese patients.
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A two- or three-step procedure is mandatory for restorative proctocolectomy in patients presenting with severe or acute colitis complicating inflammatory bowel disease (IBD). The aim of this study was to analyze the feasibility of a total laparoscopic approach for consecutive subtotal colectomy (STC) and secondary ileal pouch-anal anastomosis (IPAA). ⋯ Our study suggests that a total laparoscopic approach is feasible and safe in inflammatory bowel disease patients with acute or severe colitis, not only for STC but also for IPAA after STC, with no mortality and an acceptable morbidity rate.
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Comparative Study
Association of no epidural analgesia with postoperative morbidity and mortality after transthoracic esophageal cancer resection.
The aim of this study was to compare morbidity and mortality of patients who had epidural analgesia for at least 2 days after transthoracic esophagectomy for cancer with those who did not have epidural analgesia at all or who had it for less than 2 days. ⋯ No epidural analgesia for more than 2 days after a transthoracic esophageal cancer resection is associated with increased postoperative morbidity. To optimize postoperative recovery, it is of vital importance to ensure adequate epidural analgesia in these patients.