Sequential psychomotor skills development in laparoscopic colon surgery.

OBJECTIVES: To quantify the complexity of each of three skills used in laparoscopic colon surgery and to quantify the relative complexity of seven laparoscopic colon procedures on a graduated complexity scale. DESIGN: Five surgeons used a scale of 1 through 6 to measure the relative complexity of three laparoscopic skills (intracorporeal mobilization, intracorporeal devascularization, and intracorporeal anastomosis) to assess the relative difficulty of seven laparoscopic procedures (right colon resection, sigmoid colon resection, low anterior resection, Hartmann's procedure, left colon resection, abdominoperineal resection, and transverse colon resection) using detailed evaluation of their first 100 laparoscopic colon resections. SETTING: Three private community hospitals. MAIN OUTCOME MEASURES: The complexities of intracorporeal mobilization, intracorporeal devascularization, and intracoporeal anastomosis were recorded for seven laparoscopic colon procedures. RESULTS: The least complex procedure was right colon resection, followed in increasing complexity by sigmoid colon, Hartmann's procedure, low anterior resection, abdominoperineal resection, left colon resection, and transverse colon resection. The addition of each laparoscopic skill increased the complexity during each procedure. All three skills were not required for every procedure. CONCLUSIONS: Since all procedures do not require all three skills, skills can be learned sequentially if patients are chosen judiciously. A sequence of laparoscopic procedures performed by surgeons is recommended. The relative complexities for each procedure suggest an outline (map) for surgeons to use during laparoscopic colon surgery.

The value of postoperative ultrasound examination after laparoscopic laser cholecystectomy surgery.

Laparoscopic cholecystectomy surgery is rapidly becoming the procedure of choice for patients undergoing gallbladder removal. For the patient, this new minimally invasive surgery allows shorter hospitalization and faster recuperation than traditional open cholecystectomy surgery. Examinations were performed to determine the value of ultrasound in predicting morbidity of patients undergoing the laparoscopic cholecystectomy procedure. Examinations were performed immediately and 6-8 weeks postlaparoscopic surgery on 24 patients with acute or chronic gallbladder disease. All patients had ultrasound examinations prior to surgery. Of the 24 patients studied, 6 patients (25%) developed small fluid accumulations immediately postsurgery. All patients were asymptomatic clinically and remained asymptomatic 6-8 weeks after surgery. The fluid accumulation was thought to be insignificant on the immediate postsurgical studies. This percentage equals that found in open cholecystectomy surgeries. On the delayed ultrasound studies, no fluid deposits or other abnormalities were seen. Ultrasound examination of the asymptomatic patient postlaparoscopic cholecystectomy surgery is not of value for predicting complications in patients undergoing this procedure. Furthermore, immediately postlaparoscopic cholecystectomy surgery, 25% of patients will have small fluid collections, but will not develop complications.

Laparoscopic renal exploration and biopsy.

A new and novel technique to obtain renal biopsy specimens using laparoscopy is presented. In some patients there are contraindications to obtaining biopsy material through standard percutaneous techniques. Open renal biopsy has been the procedure of choice in these patients. The laparoscopic approach can accomplish the same surgical objectives as open renal biopsy without the associated morbidity. This report discusses the indications, contraindications, materials, methods, and techniques associated with this new procedure.