Background: Surgery for hand trauma accounts for a significant proportion of the plastic surgery training curriculum. The aim of this study was to create a standardized simulation training module for hand fracture fixation with Kirschner wire (K-wire) techniques for residents to create a standardized hand training framework that universally hones their skill and prepares them for their first encounter in a clinical setting. Methods: A step-ladder approach training with 6 levels of difficulty on 3-dimensional (3D) printed ex vivo hand biomimetics was employed on a cohort of 20 plastic surgery residents (n = 20). Assessment of skills using a score system (global rating scale) was performed in the beginning and at the end of the module by hand experts of our unit. Results: The overall average scores of the cohort before and after assessment were 23.75/40 (59.4%) and 34.7/40 (86.8%), respectively. Significant ( P < 0.01) difference of improvement of skills was noted on all trainees. All trainees confirmed that the simulated models provided in this module were akin to the patient scenario and noted that it helped them improve their skills with regard to K-wire fixation techniques, including improvement of their understanding of the 3D bone topography. Conclusions: We demonstrate a standardized simulation training framework that employs 3D printed ex vivo hand biomimetics proved to improve the skills of residents and that paves the way to more universal, standardized and validated training across hand surgery. This is, to our knowledge, the first standardized method of simulated training on such hand surgical cases.

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Background: In the recent years, with the advancement of laparoscopic surgery, management of ovarian dermoid cysts is possible with laparoscopic approach. Concerns regarding safety of the procedure has been raised. Objective: To analyze the safety of laparoscopic surgery done for ovarian dermoid cyst at Kathmandu Medical College Teaching Hospital. Methods: This is a descriptive study done from July 2012 to June 2015. All the cases with the diagnosis of ovarian dermoid cyst managed laparoscopically during the study period were enrolled in the study. Thorough history, clinical examination fi nding and diagnostic modalities were noted. Three port laparoscopy was done for the management of dermoid cyst. Thorough peritoneal lavage with warm saline was done at the end of the procedure in the cases with spillage.Variables like preoperative diagnosis, postoperative diagnosis, and type of surgery performed, rate of spillage, features of chemical peritonitis if any and duration of hospital stay were noted and analyzed. Results: Total 52 cases with the preoperative diagnosis of dermoid cyst were managed with laparoscopy during the study period. Of these, only 46 cases (88.46%) were dermoid cyst on laparoscopy. In majority of the cases (45.65%) diagnosis was incidental by Ultrasound scan done for other indications. Cystectomy was performed in 42 cases (91.30%) and in 4 cases (8.69%) oophorectomy was done. Spillage occurred in approximately 89% of the cases but there were no cases of chemical peritonitis. Duration of hospital stay ranged between 2 to 5 days. Conclusion: Laparoscopic management of ovarian dermoid cyst is a safe procedure.

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