Self-regulated Learning: why is it important compared to traditional learning in medical education?

Self-regulated learning has played an increasingly significant role in medical education over the last one to two decades. Medical educators have endeavored to ensure that the students are equipped to face the challenges of continued growth of medical knowledge. Here we enquire and reflect on various aspects of self-regulated learning including its strengths and weaknesses. We investigate how it could be incorporated with traditional teaching to bring the best out of the students and what students think about it

Laparascopic repair of paraesophegeal hiatus hernia: Suture cruroplasty or prosthetic repair

Since the introduction of laparoscopic antireflux surgery in 1991, the repair of very large paraesophageal hiatal hernias (PHH), encountered in approximately 50% of laparoscopic antireflux surgical practice, seem to pose a challenging predicament for surgeons. In the chronic setting there is debate about indications for surgery and what is the best operative approach. The issue of which technique i.e. laparoscopic, robotic, transthoracic or transabdominal produces better surgical outcomes for these large hiatal hernia remains contentious. Furthermore, there also remains a debate regarding the best way to close the crural pillars of these large hiatal hernias i.e. either using sutures (tension producing) or mesh (tensionless). This is because the dehiscence of crural repair may lead to intrathoracic migration of the wrap, recurrence of reflux and/or dysphagia requiring difficult revisional surgery. The current chapter will address an area of controversy i.e. the use of prosthetic material (mesh) at the esophageal hiatus and whenever possible will compare it to suture cruroplasty based on up-to-date clinical literature. The objective of the following discussion is to discuss the clinical outcomes, safety and effectiveness and complications of the two commonly used methods for elective surgical repair of large hiatal hernias

Laparoscopic surgery for achalasia and other primary esophageal motility disorders (PEMD)-indications, preoperative investigations and patient's selection

Primary esophageal motility disorders (PEMD) including achalasia cardia are relatively rare disorders and diagnosed with relative accuracy using high-resolution manometry applying the new Chicago Classification v3.0. The role of additional investigations such endoscopy and barium swallow play a vital role in the diagnosis of achalasia, however their inclusion in diagnosing other PEMD is of no value as the esophagus is anatomically normal. Surgical treatment in the form of Heller myotomy and partial fundoplication is considered the gold standard for achalasia but there is uncertainty regarding the surgical treatment of other PEMD even when the patient experiences obstructive symptoms of dysphagia due to unpredictable outcome. It is therefore imperative that the patient selection and preoperative counseling should take the lead role in these patients before embarking on the surgical treatment. In recent days Heller myotomy has been challenged by a newer endoscopic technique of peroral endoscopic myotomy for achalasia treatment. However, the long-term results are still not available and caution is required. This review scrutinizes both the new and old literature regarding the diagnostic features, preoperative investigations, indications and patient's selection for the laparoscopic treatment of achalasia and other PEMD. It also aims to provide argument for and against various aspects of Heller myotomy in combination with antireflux procedures. It is hoped that further refinement of Chicago Classification may subgroup some of these PEMD and therefore provide clarity regarding the ones requiring definite surgical treatment for the improvement of their symptoms in long term

Technical problems during laparoscopy: a systematic method of troubleshooting for surgeons

Laparoscopic surgery has progressed rapidly since the early 1990s. For some surgical operations, it has become the standard of care to the extent where open surgery is sometimes looked down upon by some surgical colleagues as well as by patients

Complications, implications and prevention of electrosurgical injuries: corner stone of diathermy use for junior surgical trainees

Diathermy is commonly used in modern-day surgery. The incidence of electrosurgical injuries related to diathermy is under reported, as it is difficult to ascertain the true impact on both patient and healthcare professionals. As junior surgical trainees, understanding of the mechanism and biophysics of the electrosurgical tools enables safer usage and contributes to improved outcome. Careful use of electrosurgical tools during operation and appropriate communication amongst staff members are pivotal to a safe surgical outcome. Here, we discuss the causes and risk factors regarding electrosurgical complications along with suggestions to ensure safe practice, focusing on commonly neglected areas

A New Era of Minimally Invasive Surgery: Progress and Development of Major Technical Innovations in General Surgery Over the Last Decade

Minimally invasive surgery (MIS) continues to play an important role in general surgery as an alternative to traditional open surgery as well as traditional laparoscopic techniques. Since the 1980s, technological advancement and innovation have seen surgical techniques in MIS rapidly grow as it is viewed as more desirable. MIS, which includes natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS), is less invasive and has better cosmetic results. The technological growth and adoption of NOTES and SILS by clinicians in the last decade has however not been uniform. We look at the differences in new developments and advancement in the different techniques in the last 10 years. We also aim to explain these differences as well as the implications in general surgery for the future

Technical problems during laparoscopy: a systematic method of troubleshooting for surgeons

Background: Laparoscopic surgery has progressed rapidly since the early 1990s. For some surgical operations, it has become the standard of care to the extent where open surgery is sometimes looked down upon by some surgical colleagues as well as by patients.Current status: Despite this widespread adoption and acceptance, many surgeons struggle to understand how the laparoscopy stacks work despite having the skills to perform the operation. Most hospitals rely on operating theatre assistants to troubleshoot in the event of problems. This could be potentially unsafe for patients if laparoscopic vision or pneumoperitoneum is lost at a critical point of the operation.Discussion: There are a number of approaches that have been published for troubleshooting laparoscopy stack. We explore and discuss some of them along with their advantages and disadvantages and how they relate to our methodology and approach. As a product of the discussion, we suggest a systematic way forward to troubleshooting laparoscopic tower equipment problems.Conclusion: The technical knowledge of surgeons and trainees varies widely in the area of laparoscopy-related troubleshooting. This systematic, practical algorithm would help and guide all surgeons to adopt a uniform approach, thereby improving patient safety

Causes of recurrence in laparoscopic inguinal hernia repair

Recurrence after laparoscopic inguinal herniorrhaphy is poorly understood. Reports suggest that up to 13% of all inguinal herniorrhaphies worldwide, irrespective of the approach, are repaired for recurrence. We aim to review the risk factors responsible for these recurrences in laparoscopic mesh techniques.A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified English language, peer reviewed articles on the causes of recurrence following laparoscopic mesh inguinal herniorrhaphy published between 1990 and 2018. The search terms included 'Laparoscopic methods', 'Inguinal hernia; Mesh repair', 'Recurrence', 'Causes', 'Humans'.The literature revealed several contributing risk factors that were responsible for recurrence following laparoscopic mesh inguinal herniorrhaphy. These included modifiable and non-modifiable risk factors related to patient and surgical techniques.Recurrence can occur at any stage following inguinal hernia surgery. Patients' risk factors such as higher BMI, smoking, diabetes and postoperative surgical site infections increase the risk of recurrence and can be modified. Amongst the surgical factors, surgeon's experience, larger mesh with better tissue overlap and careful surgical techniques to reduce the incidence of seroma or hematoma help reduce the recurrence rate. Other factors including type of mesh and fixation of mesh have not shown any difference in the incidence of recurrence. It is hoped that future randomized controlled trials will address some of these issues and initiate preoperative management strategies to modify some of these risk factors to lower the risk of recurrence following laparoscopic inguinal herniorrhaphy

Causes of recurrence in laparoscopic inguinal hernia repair (vol 22, pg 975, 2018)

In the original publication, affiliation 3 was incorrectly published for the author 'Darius Ashrafi'. The correct affiliation should read as 'Department of Surgery, Sunshine Coast University Hospital, Birtinya, QLD, Australia