Background: Laparoscopic surgery is based on 2D imaging, with limited depth perception. The aim of this study was to analyse the impact of 3D training on the performance of surgical trainees in 2D laparoscopic simulation. Methods: Thirty medical students were randomised into group A, completing five training attempts of three modified Fundamentals of Laparoscopic Surgery tasks (peg transfer, pattern cutting, and intra-corporeal suturing) using a 3D simulator, or group B, who were only exposed to the 2D platform. Time to completion, error rate, and efficiency improvement were measured. Results: The overall performance time was lower for group A than for group B, and this was statistically significant in task 2 (P = 0.02) and task 3 (P 5 0.01). The mean error rate was lower for group A versus group B, which was statistically significant for all three tasks (task 1, 0 vs 0.2; task 2, 0.4 vs 1.8; task 3, 0.24 vs 1.1). When efficiency improvement was evaluated, group B displayed a faster rate of improvement during task 1 (132.1% vs 248.8%; P 5 0.01) and task 2 (123.9% vs 139%; P = 0.15). For task 3, group A demonstrated a superior rate of improvement (190% vs 173.1%; P = 0.2). Conclusions: Introducing 3D training is beneficial for novices to execute 2D laparoscopic skills, particularly for complex tasks where depth perception is critical. 3D-based laparoscopic training, in conjunction with standard 2D platforms, should be introduced into surgical training to facilitate quicker and better preparation before translation of these skills into clinical practice.
Introduction Many authors have written about the need to treat patients closer to their beds, in order to observe them more as distinct people. The FAST HUG mnemonic, which consists of a checklist, was suggested as an idea to be employed everyday, by professionals dealing with patients who are critically ill. Minding these questions and motivated by an idea of follow patients' treatment closer, we have put into practice the instrument developed by Jean-Louis Vincent, evaluating the seven most important procedures in critically ill patients, and performed the FAST HUG. This checklist consists of seven items to be evaluated: Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glucose control. Knowing that the pressure ulcer is one of the challenges faced by ICU nurses, related to patients' need to stay at rest, to be under rigorous control or more complex therapy, it was decided to create the eighth item on the checklist: S, for skin. It stands for skin treatment, with the techniques used in the unit (Braden Scale), monitoring and evaluating closer skin integrity, and allowing nurses to calculate the scoring average of the Braden Scale, and greater incidence of ulcer in interned patients. Objective To expose the shortcomings found during the FAST HUG application, and to show results obtained with the eighth item of the FAST HUG mnemonic: S-Skin. Methods A descriptive study, based on institutional data, was carried out in the adult ICU of a private hospital. It was performed from 2 to 27 June 2008, except on weekends. Three hundred and twenty-three patients were involved. The checklist was carried out during the afternoons by the head nurse, or the assistant nurse of the unit. In order to do this job, a spreadsheet was elaborated to control data, updated every week. This spreadsheet provided graphics for a more objective control of the results obtained. The idea was exposed to the team, during a training program, and so we started the activities. Results and discussion For 20 days of the checklist, 323 patients were evaluated for the eight items. The real shortcomings most frequently found were related to thromboembolic prophylaxis (85%) and glucose control (90%). These shortcomings were immediately evaluated and, depending on this analysis, this item would go on or not, according to the patient's clinical situation. The shortcomings found were tracked just as they were detected, and their cause would be discussed in a multidisciplinary group, and a solution was found. If the item was not observed, it would be 1. Vincent JL: Give your patient a fast hug (at least) once a day.
Purpose: The aim of this paper is to propose a modified surgical technique for immediate intravaginal prosthesis implantation in patients undergoing orchiectomy due to testicular torsion, and to evaluate the wound healing process and patient’s satisfaction. Material and methods: We prospectively analyzed 137 patients with testicular torsion admitted to our facility between April 2018 and May 2020. Twenty-five patients who underwent orchiectomy were included in this study. Fifteen had a testicular prosthesis implanted at the same time as orchiectomy using a modified intravaginal technique (summary figure) and 10 received implants 6 to 12 months after orchiectomy. Wound healing was evaluated at a minimum of four checkpoints (on days 15, 45, 90 and 180 after surgery). At the end of the study, a questionnaire was administered to measure patients’ satisfaction rate. Student’s t test was used for comparison of quantitative data between negative vs. positive cultures (p <0.05). The chi-square test was used to verify associations between categorical variables and immediate vs. late prosthesis implantation (p <0.05). Results: Patient’s ages ranged from 13 to 23 years (mean 16.44 years). Overall time lapse from symptoms to orchiectomy ranged from 10 hours to 25 days (mean 7.92 days). Only one extrusion occurred and it happened in the late implant group. All wounds were healed in 72%, 88%, 95.8% and 100% of the cases on the 15th, 45th, 90th and 180th days after implant, respectively. At the end of the study, all patients stated they would recommend it to a friend or relative. The only patient that had prothesis extrusion asked to have it implanted again. Conclusion: There was no prosthesis extrusion using the modified intravaginal surgical technique for immediate testicular prosthesis implantation, which proved to be an easily performed and safe procedure that can avoid further reconstructive surgery in patients whose testicle was removed due to testicular torsion.
Pelvic trauma is responsible for high complexity and morbidity lesions; especially bleeding and infection. 38% of all trauma involves scenarios tippically associated with pelvic trauma. This study aimed to correlate the admission data of the patients, the mechanism of injury, the traumatic lesions and outcomes.
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