Laparoscopic pancreatic resections in two medium-sized medical centres.

To analyze the clinical outcomes of patients undergoing minimally invasive surgery for pancreatic neoplasms, in two medium-volume centers in Northern Italy, a retrospective chart review was performed in the operative registries, searching for patients who had undergone pancreatic surgery via laparoscopy, irrespective of the final pathological nature of the resected neoplasm. For each case, a standard data extraction form was completed and the following data was extracted: age and sex, type of resection, estimated blood loss, length of the operation, number of harvested nodes, post-operative pancreatic fistula, major post-operative complications, mortality and final pathological diagnosis. The systematic literature research was also undertaken and the reported results were analyzed. A total of 55 cases were recorded, including 39 distal pancreatectomies and 16 pancreaticoduodenectomies. The most frequent indications leading to surgery were ductal adenocarcinoma (26 pts) and cystic neoplasm (22 pts). No post-operative death occurred in this series; pancreatic fistula occurred in 64% of distal pancreatectomies and 22% of pancreaticoduodenectomies. The mean operating times were 178' and 572', respectively. Both distal pancreatectomy and pancreaticoduodenectomy proved to be feasible and were safely performed by laparoscopy, in two centers with medium-volume pancreatic caseload.

Are gynecologists sufficiently trained and educated on electro surgery and basic laparoscopic setting?

BACKGROUND: Basic knowledge of electrosurgery and patient's safety during laparoscopic setup are fundamental, as laparoscopic surgical skills do. The aim of this prospective case-control study was to assess the improvement of such knowledge and skills among gynecologists. METHODS: Gynecologists attending a training course on laparoscopy at the Centre International de Chirurgie Endoscopique (CICE), Clermont Ferrand (France) (December 2013-March 2014) were asked to answer a questionnaire about their own clinical activity and basic surgical knowledge and skills at the beginning and end of the course. The questionnaire included multiple choice questions about technical (four questions) and safety (five questions) aspects of laparoscopic set up and electrosurgery (five questions). RESULTS: Sixty-two residents and 68 graduated gynecologists completed pre- and post-course questionnaires (PrQ and PoQ, respectively). Considering 9 as an arbitrary cut-off score indicating an adequate theoretical knowledge, a total of 70 (51.8 %) and 128 (94.8 %) participants had a sufficient score at the PrQ and PoQ, respectively. Only 9.6 % of participants were able to complete PoQ without making any mistakes, with a mean PrQ score of 9.5. At the beginning, the most difficult steps in laparoscopy in participants' opinion were intra-corporeal suture and insufflation of pneumoperitoneum (both 36.1 %). After the course and the practical training, only 20 % of participants still indicated intra-corporeal suture as the most difficult. CONCLUSION: Education on electro surgery and basic laparoscopic setting and laparoscopic practical training are necessary to improve and maintain laparoscopic surgical skills. The assessment of that knowledge is mandatory to define surgical competence.