Endoscopic surgery: talent or training?

PURPOSE

There are two groups of undergraduate students involved in endoscopic surgery with different degrees of experience: average and more experience. This study proves whether the subjective impression of the laparoscopic trainer is verifiable and which factors influence extreme talent.

METHODS

21 medical students of the eighth term of the University of Witten-Herdecke participated in the study. On their first course day, students got instructed in suturing and knot technique. They were then required to tie a maximum of five knots within 2 h. After a week, students repeated this procedure. Time used for tying knots was stopped.

RESULTS

Regarding the time students used for their first knots, great differences were provable (7-8 min, average 23 min). However, an adaption of the knotting time was noticed at the end of the first course day. This was confirmed during the second course day. Neither acquired factors (music, sport, etc.) nor individual factors (visual acuity, handedness, etc.) had any impact on the time used for knotting. Merely, one advantage was seen with the first knots with the factors of playing the guitar and having a more than 10-h surgical previous experience. Knotting times leveled off at 95% to less than 10 min, though.

DISCUSSION

Neither normally talented nor extremely talented junior surgeons could be noticed, and so could not the co-factors providing an advantage or disadvantage for surgery, respectively. All prospective surgeons can learn defined tasks (knots) by short interval training, and thus show similarly good results after a few repetitions.

Laparoscopic pectopexy: a randomised comparative clinical trial of standard laparoscopic sacral colpo-cervicopexy to the new laparoscopic pectopexy. Short-term postoperative results

PURPOSE

Sacral colpopexy is a well established method of vaginal prolapse correction. Although it is capable of restoring the physiologic axis of the vagina, this method also bears some serious operative risks [1]. The aim of the study was to compare the laparoscopic sacral colpopexy with a laparoscopic bilateral fixation of the vagina/cervix to the iliopectineal ligaments via a PVDF-mesh (pectopexy).

METHODS

This part of a single-center randomized prospective clinical trial (Canadian Task Force Classification) compared the short-term operative outcome of laparoscopic sacropexy and pectopexy. We evaluated the operating time, blood loss, hospital stay duration, occurrence of major complications, episodes of constipation, urinary retention, de novo urinary incontinence, urinary tract infections, body mass index and postoperative Creactive protein values. The 1-year follow up examination will be carried out to evaluate the occurrence of relapse as well as late complications. Local symptoms and sexual activity will be evaluated using a German version of the ICIQ Vaginal Symptoms Questionnaire.

RESULTS

We carried out 43 pectopexies and 40 sacropexies in conjunction with other laparoscopic and/or vaginal procedures, as indicated. No major complications occurred in both groups during the hospital stay. There were no significant differences in the body mass index, average age, hospital stay duration and occurrence of constipation. The average operating time (43.1 vs. 52.1 min) and blood loss (4.6 vs. 15.3 ml) were significantly lower in the pectopexy group (p < 0.001).

CONCLUSION

Although laparoscopic pectopexy cannot yet be generally recommended as an alternative to sacropexy until the follow-up data is obtained, the new method can be considered in patients where the presacral preparation bears a higher risk of injury.