Providing a specialty trainee teaching programme over long distances.

BACKGROUND: Today's teaching programmes must be interesting, relevant to the surgical curriculum, as defined in the UK by the Intercollegiate Surgical Curriculum Programme (ISCP), and attractive enough to the trainee so that they encourage attendance without compromising operative experience. METHODS: Our aim was to achieve the objectives of the ISCP and to provide high-quality teaching to the trainees. We devised a 2-year rolling programme of events to cover the knowledge and skills required for general surgical training for both the Membership of the Royal College of Surgeons (MRCS) and Fellowship of the Royal College of Surgeons (FRCS) examinations. For the trainees unable to attend because of on-call commitments, we developed online course material, creating our own virtual learning environment (VLE). Attendance at training days, website use and exam pass rates were monitored. We surveyed trainees annually to identify whether the teaching was meeting their needs. RESULTS: There were 100 per cent pass rates for FRCS clinical and viva examinations, with 16 out of the 16 candidates passing on their first attempt and one gold medal awarded. DISCUSSION: Our attendance rates show that it is possible to provide well-attended sessions despite modern working patterns. The production of a yearly teaching plan with identified topics and dates allowed trainees to maximise their attendance.

Patient preferences for surgical techniques: should we invest in new approaches?

BACKGROUND: The face of surgery has changed over the past two decades with the introduction of laparoscopic techniques. The majority of surgical specialties now perform minimally invasive procedures hence decreasing the scarring, pain, and infection historically associated with open surgery. To further reduce the invasiveness of surgery, new surgical techniques like Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Single-Port Surgery (SPS) are under development. Despite investment from the medical device industry and enthusiasm from medical professionals, we must analyse patient preferences and expectations of these novel techniques. This analysis will help us establish the demand for such techniques and guide future resource allocation. METHODS: A questionnaire-based study was derived to identify whether the concepts of innovative techniques are acceptable to the general population. Their preferences between different available surgical options were recorded along with their choices for new innovative techniques. This study was carried out face-to-face and by using an online survey. It comprised four questions based upon a hypothetical scenario of an acute appendicitis. All the data were captured in a prospective database and analysed using statistical software. RESULTS: A total of 750 participants from variable backgrounds took part in the study. NOTES or SPS without an established safety profile was accepted by 34.3% of patients. SPS was the most popular method followed by conventional laparoscopy. Open surgery and NOTES were the least preferred (ranked 1.78, 1.98, 2.94, and 3.27, respectively). Choosing between SPS and NOTES only, 80.6% opted for SPS, 11.8% NOTES, and 5.6% declined surgery. The most popular route of access for NOTES is oral (37.7%). CONCLUSION: Single-port surgery was the most preferred method and NOTES was the least preferred technique. This shows general acceptance of the concept of virtually scarless surgery but without using the natural orifices.

"Single-port" laparoscopic cholecystectomy--the Aberdeen technique.

INTRODUCTION: Laparoscopic cholecystectomy remains the most frequently performed minimally invasive operation for general surgeons. The next step toward "scar-less" surgery uses a modified single multichannel port inserted through the umbilicus. METHODS: The use of a single port requires modification of the currently established technique for laparoscopic cholecystectomy with a single-port protocol. This new method presents a few technical difficulties and challenges compared with the conventional 3-port or 4-port laparoscopic cholecystectomy. We discuss maneuvers to help overcome these difficulties based on our initial experiences. All the data for the procedures that were performed were prospectively collected and analyzed. RESULTS: Single port cholecystectomy was attempted in 30 patients (all females) with no intraoperative/postoperative complications from September 2008 to March 2008. In all, 20 of 30 patients had their operation completed with the use of a single port. An extra 5-mm epigastric port was required in 8 of the 20 patients. Another 2 of 20 patients required conversion of the operation into a standard laparoscopic technique (1x3-port and 1x4-port procedure). All the patients were discharged within 24 hours. There were no intraoperative or postoperative complications or mortalities. CONCLUSIONS: The single-port technique is feasible for performing routine laparoscopic procedures. With further advances in surgical technique, technology, and instrumentation, this technique can be reproduced to perform more complex biliary and other procedures in future.

Are automated blood pressure monitors accurate enough to calculate the ankle brachial pressure index?

OBJECTIVE: Conventional sphygmomanometers are being replaced by automated devices; can they be used to accurately calculate ABPI? METHOD: Thirty-six volunteers (72 legs) attending a vascular clinic had their ankle, brachial blood pressure and ABPIs calculated using each of these 3 methods. (1) Conventional aneuroid BP cuff with hand held doppler. (2) OMRON HEM 705CP portable automated BP monitor. (3) The hand held doppler to determine systolic BP measured by the OMRON. RESULTS: Conventional doppler readings for brachial and ankle pressures were generally higher than those obtained digitally by less than 3 mmHg but this was not statistically significant. This did not translate into a significant difference in ABPIs obtained using all 3 techniques; the correlation coefficient of conventional ABPI with automated ABPI (method 2) was 0.746, this was improved to 0.899 using method 3. The OMRON failed to detect a signal in 16 of the 72 legs, 11 of these legs had ABPIs <0.66. CONCLUSION: Conventional doppler measurements give higher readings for systolic blood pressure but there is no significant difference when calculating ABPI. A normal digital ABPI excludes significant vascular disease and a low digital ABPI indicates disease. If no blood pressure is recordable a doppler should be used to confirm the true result. Automated oscillometric BP monitors may be used to accurately measure ABPI in non-diabetics in the community without teaching clinicians to use a doppler, thus removing observer error. This may be of particular use in the community to exclude significant arterial disease in venous ulcer patients and assess general cardiovascular risk.