Skills improvement after observation or direct practice of a simulated laparoscopic intervention.

BACKGROUND: Laparoscopic skills are more and more often being learned on simulators. PURPOSE: To assess the respective roles of observation and direct practice in the retention of laparoscopic procedural skills. BASIC PROCEDURES: Twelve surgical residents were included in a two-session laparoscopic training course. During the first session (S1), one participant completed a cholecystectomy on the Simbionix LAPMentor™ and then observed his colleague carrying out a total hysterectomy and vice versa. During the second session (S2), each participant completed both interventions. Skills evaluation was assessed using the Objective Structured Assessment of Technical Skills (OSATS) global rating scale and LAPMentor™ metrics. MAIN FINDINGS: Mean OSATS score during the first session was 19.3±5.1, and increased by 37% in the group of former observer students (S2O, P=0.003), and by 54% in the group of former practising students (S2A, P=0.001). Self- and peer-grading results were concordant with the supervisor's evaluation. Detailed analysis of LAPMentor™ metrics showed a trend toward more parameters being improved in group S2A as compared to group S2O on both interventions. The most significant improvements concerned the time of completion for the hysterectomy and the efficiency of cautery for the cholecystectomy. CONCLUSIONS: Observation of laparoscopic skills still allows for surgical improvement, but direct practice on a virtual reality trainer provides better results. Self- and peer-grading were concordant with the supervisor's evaluation. This work may advocate the integration of both personal training on simulators and surgical observation into residents' surgical curricula.

Characteristics of endobronchial primitive tumors in children.

Primary endobronchial tumors are rare in children and they include a broad spectrum of lesions. The aim of this study was to determine the characteristic features, treatments and outcomes of these tumors. We report a retrospective analysis of all patients treated for endobronchial tumor in nine French hospitals between 1990 and 2010 and a comparison of the results with those reported in the medical literature. Twelve tumors were reported: five low grade muco epidermoid carcinomas, two inflammatory myofibroblastic tumors, two hemangiomas, one anaplastic large cell lymphoma, one carcinoid tumor, and one juvenile xanthogranuloma. The mean age of the patients was 7.5 ± 3.5 years. The most common sign revealing the disease was persistent atelectasis or recurrent pneumonia (eight cases). The other revealing signs were a persistent bronchospasm (three cases) and hemoptysis (one case). The clinical presentation, biology, serum tumor markers, and chest X-ray abnormalities were not specific to a particular histological diagnosis. Chest CT scan revealed the presence of an endobronchial tumor in 11 cases. Nine tumors could be diagnosed from a biopsy obtained by video endoscopy. Complete surgical resection was performed in seven patients. Bronchoscopic removal was performed in five cases and was successful in three. There were no deaths. Endobronchial tumors are rare in childhood and their histology is diverse. Chest CT scan and per-endoscopic endobronchial biopsies are required for diagnosis, when possible. Surgical or endoscopic treatment should be discussed by a multidisciplinary team. Despite the multiple etiologies, the prognosis of these tumors is good if diagnosis is early and if resection is complete. Long-term recurrences have been described, so long-term follow-up of these children is recommended.

Intrascrotal lipoblastoma: a report of two cases and a review of the literature.

Lipoblastomas are rare benign mesenchymal tumors of fetal white fat tissue appearing most commonly in children under 3 years of age, and usually affecting the extremities. Only nine cases of intrascrotal lipoblastoma have been reported to our knowledge, and although they are benign, in one case an orchidectomy was performed. We describe two new cases of intrascrotal lipoblastoma, and review the literature.

[Chronic limping due to calcification in a subureteric Macroplastique(®) implant]. / Boiterie chronique secondaire à la calcification d'un implant de Macroplastique(®) para-urétéral.

Endoscopic subureteric implantation of polydimethylsiloxane (Macroplastique(®)) to treat vesico-ureteric reflux is known to be safe and efficient, but long-term complications of this technique are often unknown. A 15-year-old patient was admitted to several hospital services with abdominal pain in the right lower quadrant and chronic limping. After multiple examinations, the diagnosis of renal colic due to the calcification of a Macroplastique(®) implant was made. Calcification of an implant after endoscopic subureteral injection has already been described in the literature, but the clinical presentation of this complication is poorly reported, which can delay the diagnosis. The treatment can consist in an exeresis of the implanted material or even in ureteral reimplantation.

The use of the Alvarado score in the management of right lower quadrant abdominal pain in the adult.

AIM OF THE STUDY: The Alvarado score is a validated test in clinical adult surgery practice which can be helpful in the diagnosis of acute appendicitis. This study aimed to assess the reliability and the reproducibility of this score for patients presenting in the emergency room with acute right lower quadrant abdominal pain. MATERIAL AND METHODS: A prospective monocenter study included all adults who presented in the emergency room with right lower quadrant abdominal pain. The score was calculated by assessing six symptoms and two laboratory values weighted by coefficients. The diagnosis of acute appendicitis was confirmed by the histological examination of the resected appendix. Three groups of patients with high, low, and intermediate scores were defined as described in the literature. RESULTS: Of the 233 patients studied, 174 underwent surgery: three had a normal appendix on histological exam. The statistical analysis of the results showed that a score lower than 4 was significantly associated with the absence of acute appendicitis while a score higher than 6 was significantly associated with acute appendicitis which required surgical care. But a score between 4 and 6 was not discriminant. CONCLUSION: The Alvarado score is a reliable, cheap and reproducible tool for the diagnosis of acute appendicitis in the emergency room; if the score is higher than 6 or lower than 4, there is no need for complementary exams. Patients with a score between 4 and 6, require serial reassessment of physical findings and score over 24 hours and/or complementary diagnostic exam such as ultrasound or CT scan.