Optimizing laparoscopic training efficacy by 'deconstruction into key steps': a randomized controlled trial with novice medical students.

BACKGROUND: Simulator training is an effective way of acquiring laparoscopic skills but there remains a need to optimize teaching methods to accelerate learning. We evaluated the effect of the mental exercise 'deconstruction into key steps' (DIKS) on the time required to acquire laparoscopic skills. METHODS: A randomized controlled trial with undergraduate medical students was implemented into a structured curricular laparoscopic training course. The intervention group (IG) was trained using the DIKS approach, while the control group (CG) underwent the standard course. Laparoscopic performance of all participants was video-recorded at baseline (t0), after the first session (t1) and after the second session (t2) nine days later. Two double-blinded raters assessed the videos. The Impact of potential covariates on performance (gender, age, prior laparoscopic experience, self-assessed motivation and self-assessed dexterity) was evaluated with a self-report questionnaire. RESULTS: Both the IG (n = 58) and the CG (n = 68) improved their performance after each training session (p < 0.001) but with notable differences between sessions. Whereas the CG significantly improved their performance from t0 -t1 (p < 0.05), DIKS shortened practical exercise time by 58% so that the IG outperformed the CG from t1 -t2, (p < 0.05). High self-assessed motivation and dexterity associated with significantly better performance (p < 0.05). Male participants demonstrated significantly higher overall performance (p < 0.05). CONCLUSION: Mental exercises like DIKS can improve laparoscopic performance and shorten practice times. Given the limited exposure of surgical residents to simulator training, implementation of mental exercises like DIKS is highly recommended. Gender, self-assessed dexterity, and motivation all appreciably influence performance in laparoscopic training.

[Bariatric surgery: Expectations and therapeutic goals-a contradiction?] / Bariatrische Chirurgie: Erwartungshaltung und Therapieziele ­ ein Gegensatz?

In the majority of patients with morbid obesity, metabolic/bariatric surgery leads to relevant and sustained weight loss and improves obesity-related comorbidities, quality of life and functionality. Moreover, the associated reduction of risk factors for cardiovascular events and cancerous diseases has been shown to improve life expectations. Due to its excellent antidiabetic effect, the currently valid national S3 guidelines now recommend metabolic/bariatric surgery in patients who have a body mass index (BMI) ≥30 kg/m2 with poorly controlled diabetes. The Edmonton staging system enables a multidimensional consideration of the severity grade of obesity for each individual patient independent of the BMI. Patients with relevant obesity-related metabolic comorbidities should be prioritized for treatment and if possible before the occurrence of end-organ damage that is at least in some cases irreversible and which also increases the perioperative risk. Therapeutic goals for each individual patient should be carefully defined preoperatively in order to mediate realistic expectations. Unrealistic expectations, such as "surgery solves my problems", "surgery makes me more beautiful", "surgery eliminates stigma", and "surgery guarantees success", are common in bariatric surgery patients. These unrealistic expectations can lead to frustration and to severe psychological decompensation and need to be addressed as early as possible by an interdisciplinary team. Redundancies, conclusive and empathic communication in the team improve therapy adherence, the expectations and therefore the overall outcome.