Laparoscopic surgery in gynecology : studies about implementaion and training

The development of gynecological laparoscopy in The Netherlands is slow. Laparoscopic training needs more emphasis during residency training. The laparoscopic simulator needs to be officially implemented into residency curriculum guidelines and incorporated into practice. Simulator training should be structured and mandatory, as a training tool, as well as a skills assessment tool. In order for residents to obtain a sufficient and uniform level of skills, their surgical skills need to be measured individually and objectively by means of the simulator. In addition, experts' level on the simulator can be set as performance standards for residents and should be reached by residents before performing live laparoscopic surgery. Assisting during laparoscopic hysterectomy should be added to the requirements for graduation in the curriculum guidelines. To accomplish these recommendations, skilled laparoscopic gynecologists are required in every teaching hospital. Besides the beneficial aspects for residency training, a skilled laparoscopic gynecologist is needed to establish an internal referral system for procedures such as laparoscopic hysterectomy. For the other advanced laparoscopic procedures a regional or national referral system can be created.LEI Universiteit LeidenCervixcarcinoo

Retention of basic laparoscopic skills after a structured training program

The purpose of this study was to test the retention of basic laparoscopic skills on a box trainer 1 year after a short training program. For a prior study, eight medical students without prior experience (novices) underwent baseline testing, followed by five weekly training sessions and a final test. During each of seven sessions, they performed five tasks on an inanimate box trainer. Scores were calculated by adding up the time to completion of the task with penalty points, consequently rewarding speed and precision. The sum score was the sum of the five scores. One year later, seven of them underwent retention testing for the current study. The final test results were compared with retention test results as a measure of durability of acquired skills. Novices’ scores did not worsen significantly for four out of five tasks (i.e., placing a pipe cleaner p = 0.46, placing beads p = 0.24, cutting a circle p = 0.31, and knot tying p = 0.13). However, deterioration was observed in the performance on stretching a rubber band (p < 0.05), as well as in the sum score (p < 0.05). Nevertheless, all retention scores remained better than the baseline results. In conclusion, basic laparoscopic skills acquired during a short training program merely sustain over time. However, ongoing practice is advisable, especially to preserve tissue-handling skills, since these may be the first to deteriorate

Vermarkten van natuur; Perspectieven voor ketenarrangementen?

http://www.lei.dlo.nl/publicaties/PDF/1999/4_xxx/4_99_22.pd

Skills training in minimally invasive surgery in Dutch obstetrics and gynecology residency curriculum

The complexity of acquiring minimally invasive surgical (MIS) skills, combined with smaller case volumes for residents have pushed the development of skills training facilities on simulators outside the operating room (OR). Medico-legal and financial constraints have stimulated this development even more. However, the implementation of simulator training into a residency curriculum is shown to be troublesome. MIS skills training is organized in a uniform and easily applicable way in the Dutch obstetrics and gynecology residency curriculum. Every resident is obliged to attend the same basic surgical skills course, named Cobra-alpha course, intentionally during postgraduate year (PGY) 1 or 2. Furthermore, surgical skills are trained, evaluated and expanded on simulators in teaching hospitals. Additional to the Cobra-alpha course, residents may attend advanced training courses and congresses focusing on laparoscopy and hysteroscopy. This organization guarantees a uniform introduction to MIS skills training for every resident. However, preconditions for continuous training and evaluation after this introduction have to be optimized

Serial nonivasive photoacoustic imaging of neovascularization in tumor angiogenesis

We present photoacoustic images of tumor neovascularization obtained over a 10-day period after subcutaneous inoculation of pancreatic tumor cells in a rat. The images were obtained from ultrasound generated by absorption in hemoglobin of short laser pulses at a wavelength of 1064 nm. The ultrasound signals were measured in reflection mode using a single scanning piezodetector, and images were reconstructed with a weighted delay-and-sum algorithm. Three-dimensional data visualize the development and quantify the extent of individual blood vessels around the growing tumor, blood concentration changes inside the tumor and growth in depth of the neovascularized region