MINIMALLY INVASIVE SURGICAL REPAIR FOR ABDOMINAL WALL HERNIAS IN NONHUMAN PRIMATES, TWO CASES IN WESTERN LOWLAND GORILLAS (GORILLA GORILLA GORILLA).

A 33-yr-old female Western lowland gorilla (Gorilla gorilla gorilla) was diagnosed with a congenital umbilical hernia that was reducible and asymptomatic; change in the hernia was noted after parturition and concerns regarding increased risk of bowel incarceration developed. The hernia was successfully repaired with robot-assisted laparoscopic surgery. A 5-mon-old male Western lowland gorilla presented with bilateral inguinal hernias that were repaired via elective laparoscopic repair. In both cases, the gorillas did well without complications and never appeared to acknowledge wounds or exhibit signs of pain postoperatively. A literature review and interinstitutional survey was conducted to determine success rate of minimally invasive versus open repair of hernias in nonhuman primates (NHP). Of the cases identified, recurrence and/or wound morbidity was seen in 0% of laparoscopic repairs and 50% of open repairs. NHP may benefit from elective, minimally invasive surgical techniques that may reduce hernia recurrences and wound morbidity.

Utilizing Simulation to Evaluate Robotic Skill Acquisition and Learning Decay.

BACKGROUND: We aim to evaluate how new robotic skills are acquired and retained by having participants train and retest using exercises on the robotic platform. We hypothesized that participants with a 3-month break from the robotic platform will have less learning decay and increased retention compared with those with a 6-month break. METHODS: This was a prospective randomized trial in which participants voluntarily enrolled and completed an initial training phase to reach proficiency in 9 robot simulator exercises. They were then instructed to refrain from practicing until they retested either 3 or 6 months later. This study was completed at an academic medical center within the general surgery department. Participants were medical students, and junior-level residents with minimal experience in robotic surgery were enrolled. A total of 27 enrolled, and 13 participants completed the study due to attrition. RESULTS: Overall, intragroup analysis revealed that participants performed better in their retest phase compared with their initial training in terms of attempts to reach proficiency, time for completion, penalty score, and overall score. Specifically, during the first attempt in the retesting phase, the 3-month group did not deviate far from their final attempt in the training phase, whereas the 6-month group experienced significantly worse time to complete and overall score in interrupted suturing {[-4 (-18 to 20) seconds vs. 109 (55 to 118) seconds, P =0.02] [-1.3 (-8 to 1.9) vs. -18.9 (-19.5 to (-15.0)], P =0.04} and 3-arm relay {[3 (-4 to 23) seconds vs. 43 (30 to 50) seconds, P =0.02] [0.4 (-4.6 to 3.1) vs. -24.8 (-30.6 to (-20.3)], P =0.01] exercises. In addition, the 6-month group had a significant increase in penalty score in retesting compared with the 3-month group, which performed similarly to their training phase [3.3 (2.7 to 3.3) vs. 0 (-0.8 to 1.7), P =0.03]. CONCLUSIONS: This study identified statistically significant differences in learning decay, skills retention, and proficiency between 3-month and 6-month retesting intervals on a robotic simulation platform.

Characteristics and Distribution of Graduate Medical Education Training Sites: Are We Missing Opportunities to Meet U.S. Health Workforce Needs?

PURPOSE: Shortages of generalist physicians in primary care and surgery have been projected. Residency programs that expose trainees to community-based health clinics and rural settings have a greater likelihood of producing physicians who later practice in these environments. The objective of this study was to characterize the distribution of residency training sites in different settings for three high-need specialties-family medicine, internal medicine, and general surgery. METHOD: The authors merged 2012 data from the Accreditation Council for Graduate Medical Education Accreditation Data System and 2010 data from the Centers for Medicare and Medicaid Services hospital cost report to match training sites with descriptive data about those locations. They used chi-square tests to compare the characteristics and distribution of residency programs and training sites in family medicine, internal medicine, and general surgery. RESULTS: The authors identified 1,095 residency programs and 3,373 training sites. The majority of training occurred in private, not-for-profit hospitals. Only 48 (of 1,390; 4%) family medicine training sites and 43 (of 936; 5%) internal medicine training sites were community-based health clinics. Seventy-eight (6%) family medicine sites, 8 (1%) internal medicine sites, and 16 (2%) general surgery sites were located in rural settings. One hundred thirty (14%) internal medicine sites were Department of Veterans Affairs medical facilities compared with 78 (6%) family medicine sites and 94 (9%) general surgery sites (P < .001). CONCLUSIONS: Relatively little training occurs in rural or community-based settings. Expanding training opportunities in these low-access areas could improve physician supply there.