Objective To evaluate the role of mental imagery (MI) in resident training for a complex surgical procedure.Design Randomised controlled trial.Setting Eight centres across Canada and the USA.Population Junior gynaecology residents who had performed fewer than five vaginal hysterectomies (VH).Methods After performing a pretest VH, junior gynaecology residents were randomised to standard MI versus textbook reading (No MI) and then performed a test VH. Surgeons blinded to group evaluated resident performance on the pretest and test VH via global rating scales (GRS), procedure-specific scales and intraoperative parameters. Residents evaluated their own performance.Main outcome measure Change in surgeon GRS score from pretest to test VH. The study was powered to detect a 20% difference in score change. Conclusions No difference was observed in the surgical performance of residents after MI. Improved resident selfconfidence may be attributable to MI or the effect of unblinding on trial participants.
OBJECTIVES: To evaluate the effectiveness of routine intraoperative x-ray to identify unanticipated retained foreign objects in obese patients undergoing abdominal gynecologic surgery. MATERIALS AND METHODS: This was a retrospective cohort study of obese women who underwent abdominal gynecologic surgery at a tertiary care academic institution from 2010 to 2015. Women with a BMI greater than or equal to 35 kg/m 2 who underwent gynecologic surgery and had an intraoperative abdominal x-ray per our institution's protocol were included. Per this protocol, all patients had a series of abdominal x-rays taken in the operating room immediately postoperatively prior to waking from anesthesia. Subjects who underwent a routine intraoperative x-ray were compared to similar subjects from our sister community hospital who did not have an intraoperative xray. The primary outcome was identification of an unanticipated retained foreign object. Additional information including patient demographics, indication for surgery and post-operative course was extracted from the electronic medical record. Baseline information and results were assessed with univariable generalized linear mixed effect model and an exact logistic regression model. RESULTS: Two hundred fifty-nine of 308 women met inclusion criteria. Of these, 243 (93.8%) received a routine intraoperative x-ray and 16 (6.2%) did not. There was no statistical difference between the two groups of patients in terms of age, race, BMI, type of surgical procedure, length of surgery, whether or not the surgery was converted to open after minimally invasive approach, or whether or not unplanned procedures or surgeons were involved. There were no retained foreign objects identified by routine x-ray in this cohort of patients. There was also no significant difference in other postoperative outcomes including odds of developing a post-operative infection (OR 2.86, CI 0.39-22.32, p¼0.31) or odds of reoperation (OR 2.00, CI 0.34-11.61, p¼0.44). There was a significant difference in the time spent in the operating room after surgery was completed (31.8 v. 10.9 minutes, p¼0.046), with the x-ray group spending on average 20.7 minutes more in the operating room after surgery was completed. The median number of x-rays performed was 3 (range 2-10).
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