Validation of a novel laparoscopic adjustable gastric band simulator.

BACKGROUND: Morbid obesity accounts for more than 90,000 deaths per year in the United States. Laparoscopic adjustable gastric banding (LAGB) is the second most common weight loss procedure performed in the US and the most common in Europe and Australia. Simulation in surgical training is a rapidly advancing field that has been adopted by many to prepare surgeons for surgical techniques and procedures. The aim of our study was to determine face, construct, and content validity for a novel virtual reality laparoscopic adjustable gastric band simulator. METHODS: Twenty-eight subjects were categorized into two groups (expert and novice), determined by their skill level in laparoscopic surgery. Experts consisted of subjects who had at least 4 years of laparoscopic training and operative experience. Novices consisted of subjects with medical training but with less than 4 years of laparoscopic training. The subjects used the virtual reality laparoscopic adjustable band surgery simulator. They were automatically scored according to various tasks. The subjects then completed a questionnaire to evaluate face and content validity. RESULTS: On a 5-point Likert scale (1 = lowest score, 5 = highest score), the mean score for visual realism was 4.00 ± 0.67 and the mean score for realism of the interface and tool movements was 4.07 ± 0.77 (face validity). There were significant differences in the performances of the two subject groups (expert and novice) based on total scores (p < 0.001) (construct validity). Mean score for utility of the simulator, as addressed by the expert group, was 4.50 ± 0.71 (content validity). CONCLUSION: We created a virtual reality laparoscopic adjustable gastric band simulator. Our initial results demonstrate excellent face, construct, and content validity findings. To our knowledge, this is the first virtual reality simulator with haptic feedback for training residents and surgeons in the laparoscopic adjustable gastric banding procedure.

Can intravenous lidocaine decrease postsurgical ileus and shorten hospital stay in elective bowel surgery? A pilot study and literature review.

BACKGROUND: This study examined whether systemic infusion of lidocaine, a local anesthetic with anti-inflammatory properties, can decrease surgical pain, length of postsurgical ileus, and hospital stay. METHODS: Twenty-two patients at a community hospital were randomized into 2 groups. Subjects were allocated to receive either lidocaine or a placebo infusion for the first 24 hours after surgery. RESULTS: Patients in the lidocaine group appeared to report less pain as reflected by a decrease in overall visual analogue scale pain scores 24 hours after surgery. The return of flatus after surgery was not considered significant (lidocaine 68.2 +/- 9.7 hours vs placebo 86.9 +/- 13.6 hours; P = .2802). The return of bowel movement after surgery was considered significant (lidocaine 88.3 +/- 6.08 hours vs placebo group 116 +/- 10.1 hours; P = .0286). The lidocaine group was discharged by mean day 3.76 +/- .24 versus placebo at mean day 4.93 +/- .42; P = .0277. CONCLUSIONS: Patients in the lidocaine group had bowel movements >24 hours earlier than those in the placebo group and were discharged earlier.

Seat belt trauma: pectoralis muscle rupture and delayed mesh repair.

To our knowledge, this is the first reported case of a seat belt-related rupture of the pectoralis major muscle and its successful delayed repair using mesh. We report a case of a 34-year-old white man who sustained a right pectoralis major muscle rupture from a seat belt during a motor vehicle crash. The patient presented to us 2 years after the injury. We introduce a technique using mesh that results in a successful repair of a cosmetically disfiguring chest wall defect.