Although direct exposure to procedures in the operating theater environment, together with practice on laboratory animals, is still seen as the gold standard of teaching in microsurgery, practice on nonliving simulators is currently being validated as an important educational tool. We reviewed the widely used nonliving training models, together with currently accepted innovations, which are parts of curricula of training courses in microsurgery. Using the experience accumulated in training programs at the Centre for Simulation and Training in Surgery, we identified which particular skills can be reliably targeted by each nonliving tissue exercise. We were able to find five groups of nonliving training models: basic manipulation, knot-tying principles, completing the anastomosis, the real tissue experience, and training in virtual reality. The more abstract models might seem quite far from the real life experience, but they each closely address specific skills. It thus becomes convenient for the instructor to train these skills separately. This generates series of consistently favorable results once the skills are integrated into a more complex procedure. Focused exercises, once assembled in continuity, reconstruct the real life scenario. The training program can comprise a series of increasingly difficult exercises, which mirror the real life situations. Performance on nonliving models in each progressively more challenging exercise can be assessed via direct observation, assisted by clear and objective criteria. Finally, focused training will help both the transition to human surgery and replication of the favorable results to large series of subjects.

The aim of this study is to evaluate the amount of training needed by a trainee, with no background in microsurgery, in order to achieve proper skills for microvascular anastomosis. A protocol based on the rat femoral artery was established to provide a quantitative representation. Five inexperienced subjects started performing microvascular anastomosis. Patency was assessed at 30 min. The final assessment was performed at 2 weeks when rats were reoperated and the patency below the anastomosis was checked. The experiment was discontinued for one subject when he/she succeeded to have two series of four anastomosis with 100% patency at 2 weeks. The results were: 47.5% patency rate at 30 min and 7.5% at 2 weeks (series 1-2); 67.5 and 32.5% (3-4); 82.5 and 35% (5-6); 100 and 70% (7-8); 100 and 87.5% (9-10). Two trainees obtained 100% patency at 2 weeks after series 9-10. Other three needed two more series. There is a significant statistic difference (P < 0.01) between the results at 30 min and 2 weeks for the series (1-2, 3-4, 5-6, 7-8). The patency rate at 2 weeks reflects in a better way the microsurgical skills of a trainee. For long term functioning anastomosis, the training period needs an extension beyond that necessary for 100% patency at 30 min.

Pedunculated lipomas arising from the peritoneal wall are a rare finding during abdominal surgery. These benign tumours of mesenchymal origin can arise anywhere in the body and are usually asymptomatic. We present a case of a torted, pedunculated parietal wall lipoma in the right iliac fossa that gave rise to a clinical diagnosis of appendicitis. To our knowledge, such a case has never been reported in the literature previously. We suggest that torsion of a pedunculated parietal lipoma is a rare differential of acute abdominal pain.

Background: The aim of the study is to comprehensively report on a single tertiary referral center experience with the use of ureteric stents, assess complication burden and determine risk factors to further inform institutional practice. Materials and Methods: The retrospectively analyzed cohorts includes 529 patients treated over a 12 months period. Data regarding details of the index pathology, stent characteristics and complications were collected retrospectively. Results: Most stents (58.9%) were used in the context of stone surgery. Stent encrustation occurred in 14.5% of patients and sepsis in 4.3%. There was a statistically significant difference between the complications of the stents removed after 90 days and the rest of the cohort. Infectious complications were more frequent in diabetic patients and in patients with chronic renal impairment. At our institution, we managed to avoid forgotten stents and catastrophic complications. Conclusion: Stent complications are the complex outcome of interplay between the foreign body and the collecting system environment, influenced by the nature and timing of surgery. Longer stent dwelling times are associated with increased complications rates, especially in patients with significant comorbidities.

Loupes are commonly used when high demands of visual performance are needed. This article will review the available information on who should use loupes, and provide a guide on when and how to use them. Purchasing this piece of equipment should not yield to a pressure to be 'equipped' for certain procedures, nor should it copy other surgeon's choices blindly. 1 Magnification has revolutionized the operating theatre. Even for macroscopic procedures, it allows appreciation of subtle tissue differences, permits a sharper navigation within the anatomical borders and a more precise instrument positioning.According to Professor WA Morrison, 'using the microscope is not essentially different from turning on the theatre lights; if you can see what you are doing, you have a better chance of doing it well'. 2 The use of magnification dramatically improves wound care, allowing precise debridement and clear identification of anatomical structures and foreign bodies. 3 This is equally relevant to surgeons and emergency medicine trainees performing primary or secondary PERSPECTIVES ANZJSurg.com

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Epithelioid angiomyolipoma is a rare mesenchymal derived neoplasm of the kidney. Thought to be a variant of classical angiomyolipoma, a benign tumour, its malignant potential has been highlighted by case reports of loco-regional and distant metastasis. Given the potentially adverse clinical course associated with epithelioid angiomyolipoma compared to classical angiomyolipoma, the distinction and comprehensive histological characterisation of this rare entity is essential.