Background Unsteady camera movement and poor visualization contribute to a difficult learning curve for laparoscopic surgery. Remote-controlled camera holders (RCHs) aim to mitigate these factors and may be used to overcome barriers to learning. Our aim was to evaluate performance benefits to laparoscopic skill acquisition in novices using a RCH. Methods Novices were randomized into groups using a human camera assistant (HCA) or the FreeHand v1.0 RCH and trained in the (E-BLUS) curriculum. After completing training, a surgical workload questionnaire (SURG-TLX) was issued to participants. Results Forty volunteers naïve in laparoscopic skill were randomized into control and intervention groups (n = 20) with intention-to-treat analysis. Each participant received up to 10 training sessions using the E-BLUS curriculum. Competency was reached in the peg transfer task in 5.5 and 7.6 sessions for the ACH and HCA groups, respectively (P = 0.015), and 3.6 and 6.8 sessions for the laparoscopic suturing task (P = 0.0004). No significance differences were achieved in the circle cutting (P = 0.18) or needle guidance tasks (P = 0.32). The RCH group experienced significantly lower workload (P = 0.014) due to lower levels of distraction (P = 0.047). Conclusions Remote-controlled camera holders have demonstrated the potential to significantly benefit intra-operative performance and surgical experience where camera movement is minimal. Future high-quality studies are needed to evaluate RCHs in clinical practice. Trial registration ISRCTN 83733979
Aim
Ruptured Abdominal Aortic aneurysms (rAAA) are a fatal vascular condition. In 2018, The Get It Right First Time Programme (GRIFT) recommended the restructuring of vascular services in England to a Hub and Spoke model where AAA repairs should be performed in higher volume centres, the hub sites. This study aims to assess the mortality rates in patients presenting at hub versus spoke sites in the Merseyside region.
Method
We conducted a retrospective review, 1st January 2017 to 31st December 2020, recognising 110 patients with a rAAA presenting to hub and spoke sites in the Merseyside Region. We determined if there was any association in mortality and the presenting site. We also assessed the mean time to theatre for both Hub and Spoke patients.
Results
41 patients presented to Hub site and 69 patients to the spoke sites. 81% underwent operative intervention and 19% died in A+E or were palliated. 57% of those who underwent an intervention survived. Overall mortality rate in hospital was 53% (58 patients). There was no association between mortality and transfer from a spoke site (p = 0.58). The median time to theatre for Hub patients was 160 minutes from presentation and 315 minutes from Spoke sites. Time to theatre had no overall effect on mortality (p = 0.1)
Conclusions
This study indicates that the GRIFT programme does not have a negative effect on mortality irrespective of time taken to theatre. Therefore, transferring patients to a specialist hub site will positively influence patient outcomes.
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