Empowering future surgeons: a workshop bridging the gap between graduation and the operating room.

AIMS/BACKGROUND: Feedback from foundation trainees in Blackpool highlighted low levels of confidence with the prospect of surgical on-call shifts. Key areas of concern were assessing and managing the acute surgical patient, identifying which patients need an operation and having the technical skills to proficiently assist in theatre. This lack of confidence prevents trainees engaging in what should be an educational and rewarding rotation. METHODS: The authors designed and facilitated a day of workshops, addressing these key educational needs. Bespoke to the trust's services, lectures were delivered by core surgical trainees on the assessment and management of acute surgical patients in general surgery, urology and trauma and orthopaedics. For the development of technical skills, an afternoon of surgical skills workshops covered suturing, knot tying, laparoscopic principles and theatre etiquette. Small groups of foundation trainees rotated through each workshop, delivered by surgical registrars (ST3+), to ensure high fidelity training. RESULTS: Pre- and post-course questionnaires assessed the efficacy of teaching. Out of a total of 72 foundation trainees, 55 attended the teaching day, of which 45 (81.8%) completed pre- and post-course surveys using a six-point modified Likert scale. Rates for satisfactory confidence levels while on-call improved from 66 to 100% of participants after the course. Suturing skills satisfaction rose from 37.5 to 100%, among other impact markers. DISCUSSION: All trainees that attended the course displayed a marked improvement. This course is now being incorporated into foundation teaching programmes at a regional level and has scope to be expanded nationally.

Gastric perforation secondary to metastasis from breast cancer.

Gastric perforation secondary to metastasis from breast cancer occurs infrequently. We present the case of a 72-year-old postmenopausal female patient with a known history of lobular carcinoma of the breast who presented to a district general hospital with a clinical diagnosis of an acute abdomen. Further contrast-enhanced CT scan demonstrated free gas and fluid in the abdomen. She underwent emergency exploratory laparotomy and onlay Graham's omentopexy patch due to 1×1 cm prepyloric gastric perforation. Final histopathology proved the presence of metastatic malignant cells in the breast origin. We discuss the issues involved in postoperative investigation and management.

Evolution of laparoscopy in colorectal surgery: an evidence-based review.

Open surgery for colorectal disease has progressed significantly over the past century from humble beginnings to form the mainstay of treatment for colorectal cancer and a number of benign conditions. Following the introduction of laparoscopic abdominal surgery, the next stage in the evolution of the specialty began in the 1990s with the first laparoscopic colonic resection. Following some early concerns regarding its safety and oncological efficacy during the latter part of that decade, laparoscopic colorectal surgery rapidly came into mainstream use in the early part of the current century with evidence supporting its use being made available from large scale randomised controlled trials. This article provides an evidence-based summary of this evolutionary process as it relates to both benign and malignant colorectal disease, as well as discussion of the next phase of new technologies such as robotic surgery.

Prone cylindrical abdominoperineal resection with subsequent rectus abdominis myocutaneous flap reconstruction performed by a colorectal surgeon.

PURPOSE: Prone cylindrical abdominoperineal resection (APR) leads to reduced circumferential resection margin (CRM) involvement but is associated with a large perineal deficit. A rectus abdominis myocutaneous (RAM) flap can reduce the morbidity associated with the perineal wound. This is often performed in coordination with a plastic surgeon. We reviewed the outcome of prone APR carried out by a single colorectal surgeon using RAM flap without the involvement of plastic surgeons in a district general hospital. METHODS: Data were reviewed retrospectively for consecutive patients who have undergone prone cylindrical APR and RAM flap reconstruction between 2008 and 2011. Additional data were reviewed for all patients who have undergone supine APR between 2004 and 2008 for comparison. RESULTS: Twelve patients (seven females, five males) of median age of 69 years (range 50-84 years) underwent prone APR and RAM flap reconstruction. The CRM was negative in all cases. One patient had complete flap necrosis and subsequent flap removal, and three (25 %) patients experienced delayed flap healing. One patient died from bronchopneumonia following a cerebrovascular accident at day 14. In the preceding 4 years, nine patients (three females, six males) of median age of 70 years (range 32-83 years) underwent supine APR alone. The CRM was negative in all cases. Three patients suffered breakdown of the perineal wound requiring prolonged packing, and one developed a methicillin-resistant Staphylococcus aureus wound infection. CONCLUSIONS: Prone APR and RAM flap reconstruction can be performed by colorectal surgeons in a district general setting with good outcomes, without the need for a plastic surgeon, thus increasing the feasibility of this treatment modality.