The Journal of surgical research
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Comparative Study
Laparoscopic ventral hernia repair is safer than open repair: analysis of the NSQIP data.
Previous single institutional studies have demonstrated fewer complications in laparoscopic ventral hernia repair (LVHR) compared to open ventral hernia repair (OVHR). We questioned whether or not these data were supported in large cross-sectional studies. ⋯ Despite no differences in ASA class or wound classification, there were more total and infectious complications in the OVHR group. This large cross-sectional study supports single institutional studies that demonstrate fewer complications and infections in patients with laparoscopic versus open ventral hernia repair.
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Technological advancements, along with economic and political issues, have resulted in major changes in surgical education. The development of high fidelity simulators and the widespread availability of the Internet have allowed learning to be shifted away from the operating room. Furthermore, the Internet provides an opportunity for surgical educators to standardize general surgery training and assessment and to develop collaborations nationally and globally. This paper highlights presentations about the challenges as well as the rewards of surgical education in the age of the Internet from the 2009 Academic Surgical Congress.
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Laparoscopic virtual reality simulators are becoming a ubiquitous tool in resident training and assessment. These devices provide the operator with various levels of realism, including haptic (or force) feedback. However, this feature adds significantly to the cost of the devices, and limited data exist assessing the value of haptics in skill acquisition and development. Utilizing the Laparoscopy VR (Immersion Medical, Gaithersburg, MD), we hypothesized that the incorporation of force feedback in the simulated operative environment would allow superior trainee performance compared with performance of the same basic skills tasks in a non-haptic model. ⋯ In the more advanced tasks, haptics allowed superior precision, resulting in faster completion of tasks and a trend toward fewer technical errors. In the more basic tasks, haptic-enhanced simulation did not demonstrate an appreciable performance improvement among our trainees. These data suggest that the additional expense of haptic-enhanced laparoscopic simulators may be justified for advanced skill development in surgical trainees as simulator technology continues to improve.
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The Accreditation Council for Graduate Medical Education (ACGME) has placed great emphasis on residents learning to identify their training needs and to develop learning strategies to address these needs. In surgery, residents can play an active role in identifying training needs through self-assessment of their procedural skills. Our study contributes to the growing body of literature regarding practice-based learning and improvement by attempting to determine if surgery resident experience is associated with comfort level and perceived training needs. ⋯ Our study demonstrates that residents are able to assess their comfort level and training needs based on both actual and perceived experience. The procedural survey has been a useful tool for resident self-assessment in that residents are able to play a more active role in their education by developing appropriate learning plans.
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Very few quality indicators of care exist for surgical procedures. These may be used to both score the quality of care received, and as a method of improving the quality of care delivered (quality improvement initiatives). ⋯ This Delphi process has used the best available evidence, along with a consensus methodology employing the opinion of experts in the field, to identify 18 quality indicators for patients undergoing hepatic resection for metastatic colorectal cancer. These indicators will provide a means for benchmarking quality of care among surgeons, institutions, and health regions.