Urolithiasis is the most common cause of nonobstetric abdominal pain, resulting in 1.7 admissions per 1000 deliveries. Urolithiasis most commonly occurs in the second and third trimesters, with an incidence between 1:125 and 1:2000. Acute urinary system obstructions are challenging to manage in obstetric patients because they contribute to physiological and anatomical changes that result in pathological outcomes. The restricted use of computed tomography in diagnosing and managing urolithiasis is particularly challenging. In addition, a prompt diagnosis is required because the presence of renal calculi during pregnancy increases the risk of fulminating sepsis and preterm delivery. Affected pregnancies are conservatively managed; however, 1 in 4 requires surgical intervention. Indications for surgical interventions are complex and range from nephrostomy insertion to empirical stent placement or ureteroscopy. Therefore, a multidisciplinary approach is required to optimize patient care.The diagnosis and management of urolithiasis in pregnancy are complex. We reviewed the role, safety, advantages and disadvantages of diagnostic tests and treatment used to manage acute urinary obstructions in pregnancy.
Introduction Effective port site closure is a major mediator of patient-reported outcome measures. Traditionally, subcuticular sutures are used to close laparoscopic trocar sites. However, this can be challenging and time-consuming to achieve an effective cosmetic outcome. Skin re-approximation using tissue adhesives, such as octylcyanoacrylate, has benefits associated with aftercare, cosmesis, time-efficiency, and wound complication rates attributed to favourable bacteriostatic properties. Despite this, there remains poor uptake of its use in clinical practice. Our aim was to gain insight into port-site closure techniques favoured by a sample of laparoscopic surgeons. Method A standardised questionnaire was developed and distributed electronically to surgeons in the United Kingdom. Questions were pertaining to closure material and technique. Data was collected prospectively and analysed using Prism GraphPad. Results 63 surgeons; including 32 consultants, 22 senior trainees, 8 junior trainees and 1 allied healthcare professional participated in the study. Regarding port sites <5mm we found; 50.79% (n=32) used subcuticular sutures, 14.28% (n=9) used glue alone, and 23.80% (n=15) used glue in combination with sutures or steri-strips. For larger port sites >5mm we found 61.90% (n=39) used subcuticular sutures, 6.34% (n=4) used glue alone and 22.22% (n=14) used subcuticular sutures and glue in combination. 9.52% (n=6) used other methods of closure such as staples and sutures in combination with steri-strips. Conclusion Despite the many benefits of skin adhesive assisted closure, its uptake remains low in clinical practice. We suggest an approach targeting improvements in awareness and education to positively impact decision making regarding methods of trocar site closure.
Background Applications to surgical training are declining. Whilst early introduction to surgical specialities may develop interest, medical schools do not place enough emphasis on the growing trend towards performing laparoscopic procedures. We hypothesised that exposing medical students to laparoscopy would stimulate an interest in pursuing a surgical career. Methods Clinical medical students were randomised into two groups: Laparoscopic skills with box trainer and open surgical skills. Each session lasted one hour and was organised and conducted by the same tutors. Prior to participation in the teaching session, each student completed a pre and post event questionnaires regarding their speciality interest. Results A total of 45 students participated. 18 (33%) expressed an interest in a surgical career prior to the event. After the session, 15/23 (65%) of students who participated in the laparoscopic skills session expressed an interest in a career in surgery. The open surgical skills group had a positive response from 9/22 (41%) with respect to a career in surgery. Conclusions Participation in our surgical skills course increased interest in pursuing a surgical career amongst clinical medical students. Of note, our laparoscopic skills session increased interest more in comparison to an open surgical skills session. Our study highlights the importance of introducing laparoscopy simulation to the medical school curriculum in order to maintain interest towards the surgical specialities.
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