A novel method for assessing visual perception of surgical planes

Background: Recognition of tissue planes during surgery appears to be a skill acquired with experience. We conducted a pilot study to test this hypothesis using a novel method for evaluating this skill in a simulated environment. Methods: Twelve surgeons of varying levels of experience were shown 16 captured images from a mesorectal excision. For each image, they were asked to draw the ideal dissection plane with a stylus on a tablet computer. We used a novel metric for comparing agreement between lines to determine the level of precision observed between junior and senior trainees and consultant surgeons and measure the accuracy of junior and senior trainees compared with consultant surgeons. Results: We observed significant differences in precision for 9 of 16 images; 7 of these followed the predicted stepwise pattern associated with level of experience. Using consultant surgeons as the reference standard, we observed significant differences in accuracy between senior and junior trainees for 11 images, with senior trainees being more accurate in 10 of them. Only 2 images failed to contribute significant findings to our analysis. Conclusion: The findings of this pilot evaluation of a novel method for measuring a surgeon\u27s ability to recognize tissue planes in a simulated model show that skill improves with experience. Further evaluation of this method will reveal its utility as an assessment tool and possibly as a training instrument

Testemunhos em perspectiva: uma análise das narrativas de vítimas da ditadura e a atuação da Comissão Estadual da Verdade no Oeste do Paraná

Esta pesquisa tem como objetivo realizar uma análise dos trabalhos da Comissão Nacional da Verdade no Brasil, instituída em maio de 2012 pela Presidenta Dilma Rousseff. Pautamo-nos em uma análise documental do relatório final publicado pelos membros desta Comissão em dezembro de 2014, seu cotejamento dos depoimentos prestados em audiências públicas promovidas pela CNV na cidade de Cascavel – PR, bem como com entrevistas posteriormente realizadas com depoentes destas audiências, tendo por objetivo compreender como se dá a construção das memórias desses sujeitos em relação ao passado e ao presente, atentando também para o modo como estas memórias são trabalhadas pela Comissão. Esta etapa consiste numa fase inicial de um projeto mais amplo, que se baseia em revisitar os depoentes das audiências da CNV realizadas em Cascavel, produzindo novas entrevistas e adentrando em percepções mais amplas e ligadas às suas trajetórias de vida cotejando as mesmas às experiências testemunhadas com relação à ditadura civil-militar brasileira. Nesta perspectiva levantamos algumas perguntas: como a CNV percebe essas relações entre passado e presente na construção dos depoimentos prestados? De que maneira a construção das entrevistas e do próprio ambiente das audiências influencia nos depoimentos? De que modo as narrativas coletadas são transportadas para os relatórios finais? Entre outras questões. Palavras-chave: Memória. Vitimização. Comissão Nacional da Verdade

To rule and to prepare: Claudia de’ Medici and her European “fellow widows”

n his book Familien = Stats=Recht Derer Teutschen Reichsstände from 1745 Johann Jacob Moser, a legal scholar from Wuertemberg, wrote the following on early modern widows, ruling as guardians for their sons: “Some may, when asked, not give a penny for a form of government whereby female guardians may rule nations, but 1. this is a quaestio consilii and not juris, 2. one cannot deny that royal houses and their country have fared as well– if not better – during the rule of a female guardian than during the reign of males. In this question one cannot state firm rules.”In his book Familien = Stats=Recht Derer Teutschen Reichsstände from 1745 Johann Jacob Moser, a legal scholar from Wuertemberg, wrote the following on early modern widows, ruling as guardians for their sons: “Some may, when asked, not give a penny for a form of government whereby female guardians may rule nations, but 1. this is a quaestio consilii and not juris, 2. one cannot deny that royal houses and their country have fared as well– if not better – during the rule of a female guardian than during the reign of males. In this question one cannot state firm rules.

Harmonic long shears further reduce operation time in transanal endoscopic microsurgery

Background: Previous research indicates that application of 5-mm harmonic shears rather than diathermia significantly reduces operation time in transanal endoscopic microsurgery (TEM). Frequently, however, additional instruments were required to complete resection. We investigated whether the new 5-mm harmonic long shears (H-LS) are better equipped for TEM compared with regular harmonic shears (HS). Methods: Between 2001 and 2006, 162 tumors (117 adenomas, 42 carcinomas, and 3 other tumors; mean distance 6.6 cm, mean area 40 cm2) were excised in 161 patients (82 men, 79 women; mean age 66 years). Results: Eighty-eight resections were performed with HS and 74 with H-LS. Tumor and patient characteristics were similar except for specimen area. Tumors resected by H-LS were on average smaller than those resected by HS (34.4 versus 44.1 cm2; Mann-Whitney U-test: p = 0.027). Mean operation time was 48 min and proportional to area in both groups (univariate analysis of variance p<0.001). Mean operation time was 54 min using HS and 41 min using H-LS (t-test: p<0.001). After correction for area, operation time for H-LS was reduced by 14% compared with HS (t-test: p<0.001). H-LS is singly capable of completing resection in 88% compared with 26% for HS (Mann- Whitney U-test: p<0.001). Mean blood loss was 16 cc for HS and 3 cc for H-LS (p<0.001). Morbidity (11%) and mortality (0.6%) were not different between the two groups (Fisher's exact test). Conclusion: Performing transanal endoscopic microsurgery with 5-mm harmonic long shears reduces operation time compared with regular shears, and completing resection seldom requires other instruments

The influence of obesity and body mass index on the outcome of laparoscopic colorectal surgery: a systematic literature review

AIM: The relationship between obesity, body-mass index (BMI) and laparoscopic colorectal resection is unclear. Our object was to assess systematically the available evidence to establish the influence of obesity and BMI on the outcome of laparoscopic colorectal resection. METHOD: A search of PubMed/Medline databases was performed in May 2015 to identify all studies investigating the impact of BMI and obesity on elective laparoscopic colorectal resection performed for benign or malignant bowel disease. Clinical end points examined included operation time, conversion rate to open surgery, post-operative complications including anastomotic leakage, length of hospital stay, readmission rate, reoperation rate and mortality. For patients who underwent an operation for cancer, the harvested number of lymph nodes and long-term oncological data were also examined. RESULTS: 45 studies were analysed, the majority of which were Level IV with only four level III case-controlled studies. Thirty comparative studies containing 23649 patients including 17895 non-obese and 5754 obese showed no significant differences between the two groups with respect to intraoperative blood loss, overall postoperative morbidity, anastomotic leakage, reoperation rate, mortality and the number of retrieved lymph nodes in patients operated on for malignancy. Most studies, including 15 non-comparative studies, reported a longer operation time in patients who underwent a laparoscopic procedure with the BMI being an independent predictor in multivariate analyses for the operation time. CONCLUSION: Laparoscopic colorectal resection is safe and technically and oncologically feasible in obese patients. These results, however, may be different outside high volume centres of expertise. This article is protected by copyright. All rights reserved