Comparing proficiency of obstetrics and gynaecology trainees with general surgery trainees using simulated laparoscopic tasks in Health Education England, North-West: a prospective observational study

BACKGROUND

Training programmes for obstetrics and gynaecology (O&G) and general surgery (GS) vary significantly, but both require proficiency in laparoscopic skills. We sought to determine performance in each specialty.

DESIGN

Prospective, observational study.

SETTING

Health Education England North-West, UK.

PARTICIPANTS

47 surgical trainees (24 O&G and 23 GS) were subdivided into four groups: 11 junior O&G, 13 senior O&G, 11 junior GS and 12 senior GS trainees.

OBJECTIVES

Trainees were tested on four simulated laparoscopic tasks: laparoscopic camera navigation (LCN), hand-eye coordination (HEC), bimanual coordination (BMC) and suturing with intracorporeal knot tying (suturing).

RESULTS

O&G trainees completed LCN (p<0.001), HEC (p<0.001) and BMC (p<0.001) significantly slower than GS trainees. Furthermore, O&G found fewer number of targets in LCN (p=0.001) and dropped a greater number of pins than the GS trainees in BMC (p=0.04). In all three tasks, there were significant differences between O&G and GS trainees but no difference between the junior and senior groups within each specialty. Performance in suturing also varied by specialty; senior O&G trainees scored significantly lower than senior GS trainees (O&G 11.4±4.4 vs GS 16.8±2.1, p=0.03). Whilst suturing scores improved with seniority among O&G trainees, there was no difference between the junior and senior GS trainees (senior O&G 11.4±4.4 vs junior O&G 3.6±2.1, p=0.004).

DISCUSSION

GS trainees performed better than O&G trainees in core laparoscopic skills, and the structure of O&G training may require modification.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT05116332).

The effect of the enhanced recovery programme on long-term survival following liver resection for colorectal liver metastases

BACKGROUND

Enhanced recovery programmes are associated with improved short-term outcomes following liver surgery. The impact of enhanced recovery programmes on medium- and long-term outcomes is incompletely understood. This study aimed to assess the impact of an enhanced recovery programme on long-term survival in patients undergoing surgery for colorectal liver metastases.

METHODS

At a tertiary hepatobiliary centre, we analysed short-, medium- and long-term outcomes in consecutive patients undergoing liver resection for colorectal liver metastases. A five-year retrospective review was carried out comparing the enhanced recovery programme to standard care.

RESULTS

A total of 172 patients were included in the analysis: 87 on standard care and 85 on an enhanced recovery programme. Open surgery was performed in 122 patients: 74 (85.1%) and 48 (56.5%) patients in the standard care and enhanced recovery programme, respectively (p < 0.001). There was a significant reduction in the median (IQR) length of hospital stay in the enhanced recovery programme compared with standard care (7 (5) days vs. 8 (3) days, p = 0.0009). There was no significant difference in survival between standard care and the Enhanced Recovery Programme at one (p = 0.818), three (p = 0.203), and five years (p = 0.247).

CONCLUSION

An enhanced recovery programme was associated with a reduced length of hospital stay. There was no effect on the one-, three- and five-year survival.

SP6.1.11 The Effect of the Enhanced Recovery Programme for Liver Surgery on Long Term Survival

Aims

The Enhanced Recovery Programme for Liver Surgery (ERPLS) has been shown to promote functional recovery and reduce hospital stay. However, its effect on long term survival has yet to be established. The aim of this study was to determine the effect of the ERPLS on 5-year patient survival.

Methods

This was a retrospective study of patients who underwent liver resection for colorectal liver metastasis (CRLM) between January 2011 and December 2016 at a regional hepatobiliary centre. The cohort comprised of 60 pre-ERPLS and 60 post-ERPLS patients. The primary outcome was 5-year patient survival. The secondary outcomes were length of stay (LOS), postoperative complications and 90-day readmission rates. Multivariate analysis was performed to identify independent predictors of overall survival.

Results

There was no significant difference in the age (p = 0.960), gender (p = 0.332) and type of resection (p = 0.198) between both groups. ERPLS was not an independent predictor for overall survival (Gehan Wilcoxon Test, p = 0.828). There was no significant difference in the LOS (p = 0.874) and 90-day readmission rates (p = 0.349). Major postoperative complications (&gt;3a Clavien-Dindo classification) were significantly less in the ERPLS group (p = 0.02). On multivariate analysis, positive resection margins and major postoperative complications were independent predictors for overall survival.

Conclusions

ERPLS does not seem to have an effect on long term patient survival. However, it appears to reduce the rate of major postoperative complications. LOS and 90-day readmission rates were not influenced by ERPLS.

Effects of acute bovine trypanosomosis (Trypanosoma vivax) on plasma kinetics of intravenously administered lactose

Four calves infected with Trypanosoma vivax and four uninfected control calves were each injected intravenously with repeated doses of 0.5 g lactose kg-1 body weight, thrice daily at intervals of 4 h. Plasma samples were collected at specified time intervals and analysed for lactose. Pharmacokinetic parameters were calculated from the data. T. vivax infection delayed excretion of lactose from the body, thus leading to significantly (P < 0.001) increased biological half life (t1/2) and a significantly (P < 0.001) reduced elimination rate constant for lactose in the body. The apparent volume of distribution and total clearance of lactose were not affected by the infection. T. vivax infection also appeared to cause accumulation of lactose in the plasma after repeated intravenous administration.

Fasting hyperglycaemia and impaired oral glucose tolerance in acute Trypanosoma brucei infection of rats

Trypanosoma brucei (Federe strain) produced all acute infection in rats given 10(6) parasites intraperitoneally. Parasitaemia, which first appeared at 2 days post-infection (pi), was heavy from day 5 until death at 8 to 12 days pi. The fasting tail-blood glucose (FBG) concentrations in the infected rats increased significantly (P<0.05) from 2.73+/-0.14 mmol/l on day 0 pi to 6.21+/-0.16 mmol/l and 5.93+/-0.33 mmol/l on days 5 and 8, respectively. However, the values had decreased in most of the rats on day 11 pi, at which time 4 out of 12 had less than 0.5 mmol/l. The mean FBG showed a quadratic relationship with the duration of infection and the fitted curve had a high goodness of fit (r2=0.98). Oral glucose tolerance was impaired in the infected rats on days 5, 8 and 11 pi. Tail-blood glucose concentration was determined 2 h after the intake of glucose (1.0 g/kg). The mean percentage increases in blood glucose from the FBG concentrations were significantly (P<0.05) higher in the infected than in uninfected rats. There was a positive correlation (r=1.0) between the mean percentage increases and the duration of infection. It seems probable, therefore, that the delivery of glucose into the tissues was reduced, with other metabolic implications likely to affect the pathogenesis of the disease.

Biochemical differences (O-acetyl and glycolyl groups) in erythrocyte surface sialic acids of trypanotolerant N'dama and trypanosusceptible Zebu cattle

Differences in the distribution and concentration of O-acetyl and glycolyl groups in erythrocyte sialic acids of trypanotolerant N'dama and trypanosusceptible Zebu cattle were investigated. Erythrocyte surface sialic acid concentrations were 25.4 +/- 5.5 mg per dl and 5.9 +/- 0.97 mg per dl in N'dama and Zebu animals, respectively. In N'damas, O-acetyl and glycolyl groups were present in concentrations of 16.4 +/- 4.3 mg per dl and 12.8 +/- 2.9 mg per dl, respectively, whereas the corresponding values in Zebus were 2.8 +/- 5.0 mg per dl and 7.6 +/- 1.7 mg per dl, respectively. The differences between N'dama and Zebu cattle in surface sialic acids and in O-acetyl and glycolyl groups were significant (P < 0.01 to < 0.001). N'dama erythrocyte sialic acids had more O-acetyl than glycolyl groups while those of Zebus had less O-acetyl than glycolyl groups. These findings may be relevant to the trypanotolerance of N'dama cattle.