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Fischer RL, Schenker D, Gosschalk J. Cesarean section prior to 28 weeks' gestation: which type of uterine incision is optimal? J Matern Fetal Neonatal Med 2024; 37:2358385. [PMID: 38887786 DOI: 10.1080/14767058.2024.2358385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/17/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE The purpose of this study was to determine the factors that influence physician preference for type of hysterotomy incisions in gravidas with a singleton or twin pregnancy undergoing cesarean section under 28 weeks, and to assess factors that result in delivery complications, defined as either intraoperative dystocia or hysterotomy extension. We hypothesized that compared to those with non-cephalic presentations, gravidas with a presenting fetus in cephalic presentation would have higher rates of low-transverse cesarean section, and reduced rates of delivery complications with low-transverse hysterotomy. METHODS This was a retrospective cohort chart analysis of 128 gravidas between 23 0/7 and 27 6/7 weeks undergoing cesarean section at a single academic institution between August 2010 and December 2022. Data was abstracted for factors that might influence the decision for hysterotomy incision type, as well as for documentation of difficulty with delivery of the fetus or need for hysterotomy extension to affect delivery. RESULTS There was a total of 128 subjects, 113 with a singleton gestation and 15 with twins. The presenting fetus was in cephalic presentation in 43 (33.6%), breech presentation in 71 (55.5%), transverse/oblique lie in 13 (10.2%), and not documented in 1 (0.8%). Sixty-eight (53.1%) had a low-transverse cesarean section (LTCS), 53 (41.4%) had a Classical, 5 (3.9%) had a low-vertical hysterotomy and 2 (1.6%) had a mid-transverse incision. There was a significantly higher rate of LTCS among gravidas with the presenting fetus in cephalic presentation (30/43, 69.8%) compared to those with breech (31/71, 43.7%) or transverse/oblique presentations (7/13, 53.8%), p = .03. No other significant associations were related to hysterotomy incision, including nulliparity, racially or ethnically minoritized status, plurality, indication for cesarean delivery, or pre-cesarean labor. Twenty (15.6%) subjects experienced either an intraoperative dystocia or hysterotomy extension. For the entire cohort, there was a greater median cervical dilatation in those with delivery complications (4.0 cm, IQR .5 - 10 cm) compared to those without complications (1.5, IQR 0 - 4.0), p = .03, but no significant association between delivery complications and fetal presentation, hysterotomy type, plurality, or other demographic/obstetrical factors. However, among gravidas undergoing low-transverse cesarean section, only 2/30 (6.7%) with cephalic presentations had a delivery complication, compared to 9/31 (29.0%) with breech presentations and 3/7 (42.9%) with a transverse/oblique lie, p = .03. CONCLUSION In pregnancies under 28 weeks, the performance of a low-transverse cesarean section was significantly associated only with presentation of the presenting fetus. Among those with cephalic presentations, the rate of intrapartum dystocia or hysterotomy extension was low after a low-transverse hysterotomy, suggesting that in this subgroup, a low-transverse cesarean section should be considered.
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Affiliation(s)
- Richard L Fischer
- Cooper Medical School of Rowan University, Camden, NJ, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cooper University Hospital, Camden, NJ, USA
| | - Danielle Schenker
- Department of Obstetrics and Gynecology, Cooper University Hospital, Camden, NJ, USA
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Jayasena W, Bormann S, Thomas R. A rare acute complication of caesarean section: Preperitoneal incisional hernia. ANZ J Surg 2021; 92:552-554. [PMID: 34191393 DOI: 10.1111/ans.17050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/20/2021] [Accepted: 06/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Warunika Jayasena
- Department of General Surgery, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Sarah Bormann
- Department of General Surgery, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Rebecca Thomas
- Department of General Surgery, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
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3
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Lam WL, Ruettermann M. Challenging surgical dogmas in hand surgery. J Hand Surg Eur Vol 2021; 46:3-4. [PMID: 33325319 DOI: 10.1177/1753193420975674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Nayak G B, Saha PK, Bagga R, Joshi B, Rohilla M, Gainder S, Sikka P. Wound complication among different skin closure techniques in the emergency cesarean section: a randomized control trial. Obstet Gynecol Sci 2020; 63:27-34. [PMID: 31970125 PMCID: PMC6962586 DOI: 10.5468/ogs.2020.63.1.27] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/02/2019] [Accepted: 07/15/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Cesarean section is the most commonly performed obstetrical surgical procedure; however, there are no standard guidelines on appropriate skin closure techniques and materials. Only few comparative studies have been conducted on different skin closure techniques, and they have shown conflicting results. Therefore, we compared different skin closure techniques during emergency cesarean section to identify the best technique with minimal wound complication rates. METHODS Patients were randomized into 3 groups (group A, n=100; group B, n=102; and group C, n=98). In group A, the skin was closed using staples; in group B, via the subcuticular technique using monocryl 3-0; and in group C, using mattress suture nylon (2-0). The primary outcome was a composite of wound complications, including infection, seroma, gaping, and need for resuturing and antibiotic administration. The secondary outcome included closure time, pain perception, patient satisfaction, and cost. Analyses were performed in accordance with the intention-to-treat principle. RESULTS The composite wound complication rate in the entire cohort was 16.6% (n=50); the complication rate was significantly higher in group A than in the other groups. Infection was the most common wound complication observed in the entire study group (86%) and was significantly higher in group A than in groups B and C (P≤0.001). CONCLUSION The use of staples for cesarean section skin closure is associated with an increased risk of wound complications and prolonged hospital stay postoperative visits.
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Affiliation(s)
- Bhimeswar Nayak G
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pradip Kumar Saha
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rashmi Bagga
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bharti Joshi
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Minakshi Rohilla
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shalini Gainder
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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The current status of clinical trials in emergency gastrointestinal surgery: A systematic analysis of contemporary clinical trials. J Trauma Acute Care Surg 2019; 86:524-531. [DOI: 10.1097/ta.0000000000002123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Madsen AM, Dow ML, Lohse CM, Tessmer‐Tuck JA. Absorbable subcuticular staples versus suture for caesarean section closure: a randomised clinical trial. BJOG 2018; 126:502-510. [DOI: 10.1111/1471-0528.15532] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 11/28/2022]
Affiliation(s)
- AM Madsen
- Department of Obstetrics and Gynecology Mayo Clinic Rochester MN USA
| | - ML Dow
- Department of Obstetrics and Gynecology Mayo Clinic Rochester MN USA
| | - CM Lohse
- Department of Health Science Research Mayo Clinic Rochester MN USA
| | - JA Tessmer‐Tuck
- Department of Obstetrics and Gynecology Mayo Clinic Rochester MN USA
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Dojode CMR, Krishna M, Shepherd AJ, Dojode CMR, Kattimani R, Reddy GS, Bhattacharjee D. No differences in healing among different closure methods of arthroscopic portals: a systematic review. J ISAKOS 2017. [DOI: 10.1136/jisakos-2017-000132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sinkey RG, Pavelka JC, Guenther JM, Schuler KM, Basil JB. Combination Risk-Reducing Breast, Gynecologic and Reconstructive Surgery Among High-Risk Women: Does Surgical Order Impact Outcome? J Gynecol Surg 2016. [DOI: 10.1089/gyn.2015.0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rachel G. Sinkey
- Department of Obstetrics and Gynecology, St. Elizabeth Hospital, Edgewood, KY
- Department of Obstetrics and Gynecology, TriHealth Hospital, Cincinnati, OH
| | - James C. Pavelka
- Department of Obstetrics and Gynecology, St. Elizabeth Hospital, Edgewood, KY
- Department of Obstetrics and Gynecology, TriHealth Hospital, Cincinnati, OH
| | - Joseph M. Guenther
- Department of General Surgery, St. Elizabeth Hospital, Edgewood, KY
- Department of General Surgery, TriHealth Hospital, Cincinnati, OH
| | - Kevin M. Schuler
- Department of Obstetrics and Gynecology, St. Elizabeth Hospital, Edgewood, KY
- Department of Obstetrics and Gynecology, TriHealth Hospital, Cincinnati, OH
| | - Jack B. Basil
- Department of Obstetrics and Gynecology, St. Elizabeth Hospital, Edgewood, KY
- Department of Obstetrics and Gynecology, TriHealth Hospital, Cincinnati, OH
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Bouvier A, Rat P, Drissi-Chbihi F, Bonnetain F, Lacaine F, Mariette C, Ortega-Deballon P. Abdominal binders after laparotomy: review of the literature and French survey of policies. Hernia 2014; 18:501-6. [DOI: 10.1007/s10029-014-1264-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 04/28/2014] [Indexed: 11/29/2022]
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Sharp compared with blunt fascial incision at cesarean delivery: a randomized controlled trial with each case as her own control. Eur J Obstet Gynecol Reprod Biol 2014; 172:40-5. [DOI: 10.1016/j.ejogrb.2013.10.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 10/04/2013] [Accepted: 10/25/2013] [Indexed: 11/22/2022]
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Subcuticular Suture Compared With Staples for Skin Closure After Cesarean Delivery. Obstet Gynecol 2013; 122:878-884. [DOI: 10.1097/aog.0b013e3182a5f0c3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dittmar Y, Rauchfuss F, Ardelt M, Settmacher U. [Approaches to the abdominal cavity and closure of the abdominal wall]. Chirurg 2011; 82:1067-74. [PMID: 22113429 DOI: 10.1007/s00104-011-2114-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although minimally invasive approaches to the abdominal cavity are becoming increasingly more important, open surgical techniques are still of essential interest and must be mastered by general and visceral surgeons. The choice of the particular approach depends on the specificity and location of the scheduled procedure. The following article is intended to give an overview on the current literature as well as experiences in the field of open surgical approaches to the abdominal cavity.
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Affiliation(s)
- Y Dittmar
- Klinik für Allgemein-, Viszeral- und Gefässchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, Jena, Germany.
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Gkegkes ID, Mavros MN, Alexiou VG, Peppas G, Athanasiou S, Falagas ME. Adhesive strips for the closure of surgical incisional sites: a systematic review and meta-analysis. Surg Innov 2011; 19:145-55. [PMID: 21926099 DOI: 10.1177/1553350611418989] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The authors evaluated the available evidence regarding the use of adhesive strips for the management of surgical incisions and compared them with sutures and other closure materials. Study design. Systematic review and meta-analysis of randomized controlled trials (RCTs). RESULTS Twelve RCTs studying 1317 incisions in 1023 patients were included. No difference was found regarding the development of infection (odds ratio [OR] = 0.47; 95% Confidence interval [CI] = 0.12-1.85), dehiscence (OR = 1.22; 95% CI = 0.32-4.64), and overall cosmetic result (standardized mean difference = 0.01; 95% CI = -0.19 to 0.20). Closure with strips resulted in significantly lower incidence of redness (OR = 0.57; 95% CI = 0.37-0.89). The available data on pain, need for resuturing, swelling, patient satisfaction, and closure time with the use of strips could not be synthesized; however, regarding the latter 2 outcomes, application of strips seemed favorable. There was significant heterogeneity among the studies. CONCLUSIONS The findings suggest that adhesive strips may be an efficient closure material for certain small-length incisions. Further research is warranted on outcomes such as dehiscence and the need for resuturing.
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Atabekoğlu CS, Türkçüoğlu I, Duru B, Sönmezer M, Süer G, Uysalel A, Koç A, Söylemez F. Closure vs non-closure of peritoneum at caesarean section: evaluation of pain. J OBSTET GYNAECOL 2011; 31:307-10. [PMID: 21534751 DOI: 10.3109/01443615.2011.560302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We evaluated the effect of closure or non-closure of parietal and visceral peritoneum during caesarean section (CS) on post-caesarean pain and analgesic requirement. A total of 94 primigravidas planned for elective CS were prospectively enrolled into closure (n = 46) and non-closure (n = 48) groups. Analgesia was provided by a patient-controlled analgesia pump (PCA) postoperatively. Pain was evaluated using a visual analogue scale (VAS) and verbal rating scale (VRS). Total dose of analgesics administered through PCA and times of analgesia demand and additional analgesics were also assessed. VAS and VRS scores were similar between the groups. The total dose of analgesics administered were similar (p = 0.095) between groups, however the mean number of analgesic demand (p = 0.020) and the additional analgesics (p < 0.001) were higher in the closure group. As a conclusion, the closure or non-closure of the peritoneum does not have any impact on postoperative pain intensity, however the analgesia demand and additional analgesia requirement decreases with non-closure.
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Affiliation(s)
- C S Atabekoğlu
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, University School of Medicine, Turkey
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Altman AD, Allen VM, McNeil SA, Dempster J. Pfannenstiel Incision Closure: A Review of Current Skin Closure Techniques. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:514-520. [DOI: 10.1016/s1701-2163(16)34213-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Six Sigma tympanostomy tube insertion: Achieving the highest safety levels during residency training. Otolaryngol Head Neck Surg 2008; 139:353-7. [DOI: 10.1016/j.otohns.2008.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 06/03/2008] [Accepted: 06/10/2008] [Indexed: 12/19/2022]
Abstract
Objective To evaluate a protocol designed to avoid complications during tympanostomy tube insertion by residents. Design Ten-year consecutive cases series by a single surgeon supervising residents. Setting Tertiary children's hospital. Patients Children 6 weeks to 21 years. Intervention Residents followed a defined protocol for tube insertion. A resident operated until the tube was placed or he/she committed one major or two minor errors. Main Outcome Measures Incidence of 1) major complications: profound sensorineural hearing loss (SNHL), injury to major vascular structures, or disruption of the ossicular chain; and 2) minor complications: tube loss into the middle ear, tympanic membrane tears, or tube occlusion by blood clot. Results There were no major complications in 10,000 tube insertions. Two children had unilateral profound SNHL; both were found to have Mondini malformations. Five tubes were recovered from the middle ear. Eight tympanic membrane tears healed with gelatin patches. Three tubes were occluded by blood clots. Conclusion By following a defined protocol, major complications of a common operation can be reduced to the five-sigma level and minor complications minimized.
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Kadir RA, Khan A, Wilcock F, Chapman L. Is inferior dissection of the rectus sheath necessary during Pfannenstiel incision for lower segment Caesarean section? A randomised controlled trial. Eur J Obstet Gynecol Reprod Biol 2006; 128:262-6. [PMID: 16621227 DOI: 10.1016/j.ejogrb.2006.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 11/30/2005] [Accepted: 02/08/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective was to determine the benefit of non-dissection of the rectus sheath inferiorly in a Pfannenstiel incision during an elective Caesarean section with regard to operative blood loss and post-operative pain. DESIGN A randomised controlled trial. SETTING The Royal Free Teaching Hospital in London. POPULATION One hundred and twenty women who underwent elective Caesarean section delivery. METHOD Women were randomised to have dissection or non-dissection of the rectus sheath inferiorly during an elective Caesarean section. MAIN OUTCOME MEASURES Estimated blood loss during the operation, as well as the difference between pre- and post-operative haemoglobin levels. Post-operative pain was assessed by the visual analogue scale, a verbal rating scale and the use of post-operative analgesia. Patient satisfaction was assessed by a verbal rating scale. RESULTS There was no significant difference in the estimated blood loss during the procedure between the two groups; however, the mean difference between the pre-operative and post-operative haemoglobin was significantly smaller in the study group (p=0.05). There was a statistically significant difference in both the visual analogue scale (p-value=0.03) and the verbal rating scale scores (p-value=0.02) for pain between the two groups, with lower scores for the study group. There was no overall difference in the verbal rating scale scores for patient satisfaction. CONCLUSION Non-dissection of the rectus sheath inferiorly in Pfannenstiel incisions during Caesarean section procedures is associated with a significant reduction in the post-operative pain as well as a smaller drop in post-operative haemoglobin.
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Affiliation(s)
- Rezan A Kadir
- Department of Obstetrics and Gynaecology, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, United Kingdom.
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Lentz GM, Mandel LS, Goff BA. A six-year study of surgical teaching and skills evaluation for obstetric/gynecologic residents in porcine and inanimate surgical models. Am J Obstet Gynecol 2005; 193:2056-61. [PMID: 16325615 DOI: 10.1016/j.ajog.2005.07.064] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2005] [Revised: 06/22/2005] [Accepted: 07/18/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study was undertaken to evaluate an ongoing teaching and objective surgical skills testing program for obstetric/gynecologic residents in a laboratory setting, and assess the impact on residents of having 4 years of a surgical laboratory curriculum. STUDY DESIGN From 1997 through 2002, we conducted surgical skills training sessions for all obstetric/gynecologic residents, using both inanimate and animal (porcine) models. Once a year we tested each resident on 12 structured surgical bench tasks. At the end of each year, we conducted formal objective structured assessment of technical skills (OSATS) with all residents attempting multiple surgical procedures. We compared residents who had 4 years of laboratory training with those who started residency earlier and had only 1 or 2 years of the new curriculum. We also compared residents' own performance from year to year and cohort performance by resident year. RESULTS PGY3 and PGY4s who had 4 years of surgical laboratory training did significantly better on bench laboratory skills than PGY3 and PGY4s with fewer years of training sessions (total scores of 48.8 vs 30.3, P < .001). However, no significant improvement in surgical procedures as measured by global OSATS was found. When comparing residents' own performance between the beginning and the end of 1 year, global OSATS scores improved significantly on laparoscopic salpingotomy (P < .001) and open oophorectomy (P < .001). For the cohort of PGY4s completing 4 years of laboratory training, average global OSATS scores showed statistically significant improvement (PGY1, PGY2 < PGY3 < PGY4, P < .001). CONCLUSION Residents who completed the 4-year curriculum showed significantly better technical skills on bench tasks but not on OSATS compared with those with less training. Resident surgical skills evaluated by OSATS significantly improve over time both individually and as a cohort by resident year.
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Affiliation(s)
- Gretchen M Lentz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
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Interrupted or continuous slowly absorbable sutures - design of a multi-centre randomised trial to evaluate abdominal closure techniques INSECT-trial [ISRCTN24023541]. BMC Surg 2005; 5:3. [PMID: 15755324 PMCID: PMC554977 DOI: 10.1186/1471-2482-5-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2005] [Accepted: 03/08/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The closure of the abdomen after median laparotomy is still a matter of debate among surgeons. Further well designed and performed randomised controlled trials determining the optimal method of abdominal fascial closure are needed. DESIGN This is a three armed, multi-centre, intra-operatively randomised, controlled, patient blinded trial. Over 20 surgical departments will enrol 600 patients who are planned for an elective primary abdominal operation. The objective of this study is to compare the frequency of abdominal incisional hernias between two continuous suture techniques with different, slowly absorbable monofilament materials and an interrupted suture using an absorbable braided suture material at one year postoperatively. CONCLUSION This trial will answer the question whether the continuous abdominal wall closure with a slowly absorbable material with longitudinal elasticity is superior to the continuous suture with a material lacking elasticity and to interrupted sutures with braided thread.
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Abstract
Abstract
Patient Safety Leading Article Series, 2004 Continuing the Journal's ‘Patient Safety’ series, Ubblink and Legemate remind readers that only 24 per cent of surgery is based on evidence from randomized clinical trials. Expert opinion, intuition and the tradition of experience are fallible.
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Affiliation(s)
- D T Ubbink
- Department of Surgery, G4-109.2, Academic Medical Centre, PO Box 22700, 1100 DE Amsterdam, The Netherlands.
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Jenkins TR. Reply. Am J Obstet Gynecol 2004. [DOI: 10.1016/j.ajog.2003.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Grossman RA. Evidence-based medicine. Am J Obstet Gynecol 2004; 190:1173-4; author reply 1174. [PMID: 15118657 DOI: 10.1016/j.ajog.2003.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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