A comparative study of skills in virtual laparoscopy and endoscopy.

BACKGROUND: The present study was designed to investigate whether there is a correlation between manual skills in laparoscopic procedures and manual skills in flexible endoscopy. METHODS: In a prospective study using laparoscopy and endoscopy simulators (MIST-VR, and GI-Mentor II), 24 consecutive subjects (gastrointestinal surgeons, novice and experienced gastroenterologists, and untrained subjects) were asked to perform laparoscopic and endoscopic tasks. Their performance was assessed by the simulators' software and by observers blinded to the levels of subjects' experience. Performance in experienced vs inexperienced subjects was compared. Score pairs of three parameters--time, errors, and economy of movement--were also compared. RESULTS: Experienced subjects performed significantly better than inexperienced subjects on both tasks in terms of time, errors, and economy of movement (p < 0.05). All three performance parameters in laparoscopy and endoscopy correlated significantly (p < 0.02). CONCLUSION: Both simulators can distinguish between experienced and inexperienced subjects. Observed skills in simulated laparoscopy correlate with skills in simulated flexible endoscopy. This finding may have an impact on the design of training programs involving both procedures.

[Gastroesophageal reflux surgery in Denmark 1997-1999]. / Operation for gastroøsofageal refluks i Danmark 1997-1999.

INTRODUCTION: The incidence and length of postoperative stay in hospital in Denmark after oesophageal reflux surgery has not been described previously. MATERIAL AND METHODS: We examined the national patient hospital register and discharge information from the hospitals for the number of reflux operations carried out, the length of postoperative hospital stay, readmissions, and postoperative complications occurring within 30 days in the period, 1997-1999. RESULTS: Twenty-four departments performed 4.9 operations/100,000 inhabitants per year, corresponding to 788 operations. The postoperative 30-day mortality was 0.4% and 6.6% of the operations were followed by serious surgical complications. The combined primary + readmission hospital stay was 3.7 days in the first postoperative month. DISCUSSION: The small number of oesophageal reflux operations performed in many departments in Denmark is not in agreement with the Danish National Board of Health recommendations from 1996, which say that the operations should be done in only five departments. The spreading of surgery means that only few surgeons can reach sufficient training of surgery and that statistical comparison between the departments of the early results of treatment is not meaningful. Overall, national results are comparable to international results. The incidence of oesophageal reflux surgery is about three times lower than in other Scandinavian countries. On these results, it is recommended that the operation is performed in fewer departments and by fewer surgeons.

[National surveillance of Helicobacter pylori eradication in Denmark. Results based on registration of 34.582 drug prescriptions]. / National overvågning af Helicobacter pylori-eradikationsterapi i Danmark. Resultater fra registreringen af 34.582 receptudskrivninger.

We wanted to characterize the use of H. pylori eradication therapy in Denmark (inhabitants 5,227,862). All H. pylori eradication treatments from a nation wide database covering all drug prescriptions in the period January 1994-June 1996 were identified. We found 28,784 out-patients having a prescription with drugs for H. pylori eradication, accounting for 34,582 prescriptions in total. The incidence of new consumers was 220 per 10(5) inhabitants per year, with a maximum at 70-79 years of age. Eighty-six percent of the patients had only one treatment course. Forty-five percent had an anti-ulcer drug prescribed 1-12 months after the H. pylori eradication therapy. Consumption of antibiotics used for H. pylori eradication accounted for 1.4% of the total consumption of antibiotics. In conclusion, the incidence of H. pylori eradication therapy was fairly stable but with changes in the pattern of drug regimens used. Anti-ulcer drugs were often given after H. pylori eradication therapy, suggesting an inappropriate use of eradication treatment.

[Laparoscopic excision of the rectum. An advanced technique or true clinical progress?]. / Laparoskopisk rectumeksstirpation. En avanceret teknisk øvelse eller et reelt klinisk fremskridt?

A very high postoperative morbidity is seen after conventional open abdominoperineal excision of the rectum. The use of laparoscopic technique for this operation implies theoretical benefits, but only sparse clinical data have been published and advantages have not yet been convincingly documented. In the light of our experiences with laparoscopic colonic resections in high-risk patients and in two patients with abdominoperineal excision we propose the following perioperative regime for elderly patients undergoing rectal excision: Laparoscopic operation followed by continuous epidural analgesia, opioid-free pain treatment, restricted administration of fluids perioperatively, early enteral nutrition and enforced mobilisation as well as intensified training in colostomy care-that should already be started preoperatively. Preliminary results suggest that morbidity and the need for hospital stay can be considerably reduced by such an approach. A prospective evaluation of this strategy on the immediate postoperative results will be followed by long-term results concerning survival, local recurrence rates, distant metastases and the risk of port-site metastases.

[Two days' hospital stay after laparoscopic colon resection]. / To døgns indlaeggelse efter laparoskopisk colonresektion.

In order to reduce surgical stress-induced dysfunction and morbidity in the postoperative period after colon cancer surgery in old people, we performed the operations laparoscopically and optimized the postoperative regime especially as regards to treatment of pain, early oral intake and mobilisation. The patients were treated with continuous epidural infusion of local anaesthetic for 48 hours postoperatively. Morphine was avoided. Normal oral intake was allowed immediately after operation and active mobilisation was ensured. Twenty patients with a median age of 81 years (71-92 years), who preoperatively were able to take care of themselves at home, entered the study. In four the operation was converted to open surgery due mainly to growth of the cancer into neighbouring organs. One patient had to have an open reoperation due to small bowel strangulation. Fifteen followed the scheduled programme. They all had normal bowel function on day one or two and were mobilised for eight hours on day two and 12 hours on day three. Accordingly postoperative hospital stay was only two days (median), and the high level of activity continued at home after discharge. The combination of laparoscopic mini-invasive surgical technique and a postoperative regime that optimized pain treatment, early oral intake and active mobilisation considerably reduced postoperative convalescence after colon cancer surgery in old patients.

[Esophagoscopy in patients with angina pectoris and normal coronary arteriography]. / Ovre endoskopi hos patienter med angina pectoris og normal koronararteriografi.

The clinical value of oesophago-gastro-duodenoscopy and distal oesophageal biopsies was investigated in 49 patients with angina pectoris and normal coronary angiograms. The results were compared to 24 hour oesophageal pH-monitoring of the patients and of a control group of 22 healthy sons. Macroscopic esophagitis--mainly grade I was found in 31% of the patients and microscopic oesophagitis in 25%. The only major abnormalities were the identification of three peptic ulcers (6%). Median (range) reflux index was 1.3 (0.0-13.4) in the patient group and 2.1 (0.0-9.9) in the controls (p = 0.49). There were no differences with respect to endoscopical findings or reflux index between patients with a positive and patients with a normal exercise electrocardiogram. At a median 36 months post study 38% of the patients had undergone acid secretion inhibitor treatment with an effect on symptoms in only 4%. The study provides evidence that routine oesophago-gastro-duodenoscopy is of limited value in this patient group.