Use of box simulators for improving intraoperative laparoscopic skills: an essential tool for the surgeon in training

To compare the improvement of intraoperative laparoscopic skills by measuring GOALS score between residents who have undergone simulator training with those who have not received any simulator training. A randomized controlled trial. Department of Surgery, Services Hospital, Lahore, from August 2013 to February 2014. Thirty residents belonging to year 1, 2 and 3 were included in the study. They were randomly divided into 2 groups. Both groups had a baseline evaluation with GOALS score while performing dissection of gallbladder from liver bed during laparoscopic cholecystectomy. Group-A underwent formal training on simulators whereas group-B did not receive any formal training on simulators. After 6 months, a repeat evaluation was done again by measuring GOALS score while performing gallbladder dissection. Baseline GOALS scores of both the groups were similar. Group-A baseline score was 7.66 +/- 0.93 and group-B score was 7.46 +/- 1.04 [p = 0.585]. However repeat scores for group-A showed a significant improvement [an increase of 7.16 +/- 1.48 to 14.76 +/- 1.67, p < 0.001] from baseline scores. Residents in group-B improved their scores by 2.30 +/- 0.99 to 9.76 +/- 0.79 [p < 0.001]. When inter group comparison was done the second score of group-A was significantly higher than that of group-B [14.76 +/- 1.67 vs. 9.76 +/- 0.79, p < 0.001]. Inter-rater reliability was moderately significant [Kappa 0.540]. Training on laparoscopic simulators results in significant improvement of intraoperative laparoscopic skills

Communication skills training of undergraduates

To assess the adequacy or deficiency of relevant communication skills needed in clinical practice among students of King Edward Medical University and identify the need of developing curriculum for communication skills. Sequential mixed method design using survey questionnaire and in-depth interviews. King Edward Medical University, Lahore, from March - September 2010. Final year students consented to participate in the survey questionnaire regarding communication skills needed in clinical practice selected on the basis of random stratified sampling technique. The questioned aspects include communication skills, supervised training, breaking bad news, counselling and written communication skills. In the second qualitative phase, volunteers who had passed final year were selected on the basis of non-probability purposive sampling technique for recording in-depth interviews. Qualitative data was analyzed with content analysis after identifying themes and trends from the data. Only 20% students had clarity of communication skills training, 28% believed that their learning was supervised, 20% believed training was structured, 28% were confident about handling difficult situations, 15% could effectively break bad news, and 22% were confident in written communication skills. In the interviews 70% felt that their peers had average skills in handling difficult situations like breaking bad news and counselling, 60% believed that communication skills program was non-existent and 100% agreed that patient turnover is a strength for the institute and structured training would improve their communication skills performance. The communication skills of the studied group were inadequate to address special situations. This presses need for developing a communication skills training program

Surgical management of malignant gastric tumours

The aim of our study was to highlight the importance of better surgical outcome if presentation is earlier. Gastric cancer is second most common malignancy of gastrointestinal tract after colorectal carcinoma. The common presentation is pain epigastrium, weight loss, vomiting and anorexia. Patients usually present in advanced disease and only palliative surgery is possible. Commonest type is adenocarcinoma. We conducted a case series of 60 patients who were treated for gastric carcinoma at Mayo Hospital, Lahore from March 2003 to March 2008. The objective of study was to assess the morbidity, mortality and outcome of surgical management. Out of 60 patients included in this study, 27 patients were male and 23 female. Commonest presentation was vomiting 69.9%. Most of the patients presented in advance disease. Operative procedures include Billroth-I and D1 resection, 20% Billroth II + L.N. dissection [16.6%], total gastrectomy along with reconstruction [6.7%]. Most of the patients [23.3%] had palliative procedure in the form of bypass or feeding jejunostomy [56.7%]. Only 30.1% presented in early stage of disease and its mortality rate was low. Postop complications recorded were diarrhea 30 patients, bilious vomiting in 24 patients, 2 patients underwent revisional surgery. Surgical outcome is directly related to stage of disease at presentation. Early presentation leads to better outcome

Complications of uterine instrumentation : a preventable misery on rise

Objective: to determine the intra peritoneal injuries after the illegal uterine instrumentation for illegal abortion

Design: Retrospective study

Place and duration of study: The study was conducted over a period of 3 years in North surgical ward Mayo Hospital, Lahore

Material and methods: 21 patients were included in the study when they present after the illegal instrumentation of uterus for the abortion. Patients were resuscitated and operated in the emergency theatre. Carefully intraperitoneal injuries were recorded and dealt accordingly. Postoperative complications and mortality were recorded

Results: Half of the patients were in the thirties while 4 patients were teenagers. Six patients were unmarried which is approximately 29%. Most of these abortions were done by Dais while 6 were conducted by doctors. Only 35% of the cases present within 24 hours while 28% came to emergency after 10 days of injury. Uterus was injured in more than 76% of cases while fundus is the most common in uterus. Small intestine was damaged in 52%of the patients in which Ileum was injured in 7 patients and jejunum in 4 patients. In 4 patients large intestine was damaged. Ovary and urinary bladder were damaged in one patient each. Resection and exteriorization was done in 14 patients as most of the patients present late and had bad peritonitis. Mortality rate is 5% in our study

Conclusion: Peritonitis is the most common sequel after uterine instrumentation as the unauthorized or untrained personnel mostly do it

Abdominal wound closure: a prospective randomized trial of polypropylene and polydioxanone

Results of a prospective study on 164 patients, comparing the polydioxanone [PDS[R]] and polypropylene [Prolene [R]] in laparotomy wound closure; over a 30 month period are presented. All types of laparotomy wounds were considered for evaluation. Patients were analyzed for early and late wound related complications. Overall wound infection was 11%. Whereas no significant difference between two sutures was noticed for the early postoperative complications, persistent wound pain, palpable knots, and suture sinuses were significantly less with less with PDS in continued follow up [mean 24.5 months]. With the comparable safety in early postoperative period and significantly lower incidence of delayed complications, PDS can be regarded as near-to-ideal suture material for closing all types of laparotomy wounds