A systematic review and meta-analyis on the effect of training with Nintendo® WiiTM in the improvement of basic laparoscopic skills among laparoscopic novices

@#<p style="text-align: justify;">Videogames offer the usual skills needed for laparoscopy namely, eye-hand coordination, depth perception, and bimanual operation. The impact of playing videogames on basic laparoscopic skills is still ambiguous with some studies showing correlation and with other studies demonstrating little or no effect.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the impact of training with Nintendo® WiiTM in the improvement of basic laparoscopic skill among laparoscopic novices by measuring the time to completion of eye-hand coordination task, two-hand manipulation task, grasping and cutting task or grasping and clipping tasks.</p><p style="text-align: justify;"><strong>METHODS:</strong> An electronic systematic search was done in online databases and search engines. This review included randomized prospective studies, written in English language, and published within the last 5 years. Participants included adults 19-29 years old, medical students and surgical residents, with a low video game experience, without or minimal experience in laparoscopic surgery and laparoscopic simulator. The studies compared the performance of participants in a laparoscopic simulator (SimbionixTM LapMentorTM or ProMIS) after training with Nintendo® WiiTM and measured their completion time of several tasks.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Training with Nintendo® WiiTM showed improvement in time to completion of eye-hand coordination task, two-hand manipulation task, and grasping and clipping task. The study however showed equivocal results in the grasping and cutting tasks.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Training with Nintendo® WiiTM can be used as a training tool for the improvement of basic laparoscopic skills of laparoscopic novices.</p>

Efficacy of intraperitoneal bupivacaine on postoperative analgesia in laparoscopic cholecystectomy: A meta-analysis

@#<p style="text-align: justify;">The analgesic effect of intraperitoneal bupivacaine has been widely studied, but with controversial results.<br /><strong>OBJECTIVE:</strong> To determine the efficacy of intraperitoneal bupivacaine on  producing  postoperative  analgesia  in  patients  who  underwent laparoscopic  cholecystectomy.<br /><strong>METHODS:</strong> A systematic literature search on the use of intraperitoneal bupivacaine in reducing postoperative pain was done using Medline and Cochrane. The search yielded 6 randomized controlled trials,involving a total of 440 patients. Mean differences in visual analog pain score at 0, 2, 4, 6, 8, 12, and 24 hours post-surgery were pooled using random effects model.<br /><strong>RESULTS:</strong> Overall, there was a significant reduction of pain score in the bupivacaine group with VAS score of -0.55 cm (95% CI, -0.80 to -0.31). Subgroup analysis at 0, 2, 4, 6, 8, and 12 hours post-surgery showed statistically significant mean differences in the VAS score of  -1.59 cm (95% CI, -2.31 to -0.86), -0.60 cm (95% CI, -1.02 to -0.17), -0.80 cm  (95% CI, -1.34 to -0.26),  -0.85 cm  (95% CI, -1.46 to -0.24), -0.64 cm  (95% CI, -1.12 to -0.16), and -0.38 cm  (95% CI,-0.68  to  -0.08),  respectively,  in  favor  of  the  bupivacaine  group.However,  at  24  hours  post-surgery,  there  was  no  statistically significant mean difference in the VAS score of -0.09 cm (95% CI,-0.49 to 0.31).<br /><strong>CONCLUSION:</strong> Intraperitoneal bupivacaine instillation among patients undergoing laparoscopic cholecystectomy is effective in providing postoperative analgesia specifically in the first 12 hours post-op.</p>