scholarly journals A Comparative Study in Learning Curves of Two Different Intracorporeal Knot Tying Techniques

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Manuneethimaran Thiyagarajan ◽  
Chandru Ravindrakumar
Keyword(s):  
Learning Curves ◽  
Difficulty Level ◽  
Knot Tying ◽  
Standard Methods ◽  
Loop Method ◽  
Surgical Trainees ◽  
Group A ◽  
Frustration Level ◽  
Group B ◽  
Intracorporeal Knot Tying

Objectives. In our study we are aiming to analyse the learning curves in our surgical trainees by using two standard methods of intracorporeal knot tying.Material and Method. Two randomized groups of trainees are trained with two different intracorporeal knot tying techniques (loop and winding) by single surgeon for eight sessions. In each session participants were allowed to make as many numbers of knots in thirty minutes. The duration for each set of knots and the number of knots for each session were calculated. At the end each session, participants were asked about their frustration level, difficulty in making knot, and dexterity.Results. In winding method the number of knots tied was increasing significantly in each session with less frustration and less difficulty level.Discussion. The suturing and knotting skill improved in every session in both groups. But group B (winding method) trainees made significantly higher number of knots and they took less time for each set of knots than group A (loop method). Although both knotting methods are standard methods, the learning curve is better in loop method.Conclusion. The winding method of knotting is simpler and easier to perform, especially for the surgeons who have limited laparoscopic experience.

Arthroscopic Rotator Cuff Repair Using Modified Mason-Allen Medial Row Stitch

2012 ◽  
Vol 40 (11) ◽  
pp. 2440-2447 ◽  
Author(s):  
Yong Girl Rhee ◽  
Nam Su Cho ◽  
Chong Suck Parke
Keyword(s):  
Rotator Cuff ◽  
Clinical Results ◽  
Rotator Cuff Tears ◽  
Knot Tying ◽  
Suture Bridge ◽  
Group A ◽  
Group B ◽  
Arthroscopic Rotator Cuff ◽  
Suture Bridge Technique

Background: When using a method of suture bridge technique, there may be a possibility of strangulation of the rotator cuff tendon at the medial row. The style of knots chosen to secure the medial row might conceivably be a factor to reduce this possibility. Purpose: To compare the clinical results and repair integrity of arthroscopic rotator cuff repair between a knotless and a conventional knot-tying suture bridge technique for patients with full-thickness rotator cuff tears and to evaluate retear patterns in the cases with structural failure after arthroscopic repair by magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence, 2. Methods: After arthroscopic repair for medium-sized rotator cuff tears, 110 patients available for postoperative MRI evaluation at least 6 months were enrolled in this study. According to the repair technique, 51 shoulders were enrolled in a knotless suture bridge technique group (group A) and 59 shoulders in a conventional knot-tying suture bridge technique group (group B). The mean age at the time of the operation was 61.0 years (range, 44-68 years) in group A and 57.6 years (range, 45-70 years) in group B. The mean follow-up period was 21.2 months (range, 12-34 months) and 22.1 months (range, 13-32 months), respectively. Results: The Constant score of group A increased from the preoperative mean of 65.2 points to 79.1 points at the last follow-up ( P < .001). The corresponding figures for group B improved from 66.6 points to 76.3 points ( P < .001). The preoperative Shoulder Rating Scale of the University of California at Los Angeles (UCLA) score was 21.1 points in group A and 18.3 points in group B. The UCLA score at the last follow-up was 31.0 points in group A and 27.9 points in group B ( P < .001, P < .001). Retear rate was significantly lower in group A (5.9%) than group B (18.6%) ( P < .001). In group B, retear occurred at the musculotendinous junction in 72.7%, but group A had no medial cuff failure. Conclusion: In arthroscopic suture bridge repair of full-thickness rotator cuff tears, clinical results of both a knotless and a conventional knot-tying group showed improvement without significant difference between the 2 groups. However, the knotless group had a significantly lower retear rate compared with the conventional knot-tying group. A knotless suture bridge technique could be a new supplementary repair technique to conventional technique.

scholarly journals The Effect on Performance Time and Quality of the Knots after Mono or Bimanual Training of Laparoscopic Intracorporeal Knot Tying according to the Gladiator Rule Technique

2018 ◽  
Vol 40 (05) ◽  
pp. 266-274
Author(s):  
Fernanda Asencio ◽  
Helizabet Ribeiro ◽  
Armando Romeo ◽  
Arnauld Wattiez ◽  
Paulo Ribeiro
Keyword(s):  
Dominant Hand ◽  
Resident Students ◽  
Performance Time ◽  
Laparoscopic Suture ◽  
Significant Difference ◽  
Bimanual Training ◽  
Group A ◽  
Group B ◽  
Intracorporeal Knot Tying

Objective To assess whether the monomanual or bimanual training of laparoscopic suture following the same technique may interfere with the knots' performance time and/or quality. Methods A prospective observational study involving 41 resident students of gynecology/obstetrics and general surgery who attended a laparoscopic suture training for 2 days. The participants were divided into two groups. Group A performed the training using exclusively their dominant hand, and group B performed the training using both hands to tie the intracorporeal knot. All participants followed the same technique, called Romeo Gladiator Rule. At the end of the course, the participants were asked to perform three exercises to assess the time it took them to tie the knots, as well as the quality of the knots. Results A comparative analysis of the groups showed that there was no statistically significant difference (p = 0.334) between them regarding the length of time to tie one knot. However, when the time to tie 10 consecutive knots was compared, group A was faster than group B (p = 0.020). A comparison of the knot loosening average, in millimeters, revealed that the knots made by group B loosened less than those made by group A, but there was no statistically significant difference regarding the number of knots that became untied. Conclusion This study demonstrated that the knots from group B showed better quality than those from group A, with lower loosening measures and more strength necessary to untie the knots. The study also demonstrated that group A was faster than B when the time to tie ten consecutive knots was compared.

scholarly journals TP8.2.19 Virtual versus In-Person Education Research (VIPER) in Surgical Skills Teaching: A crossover randomised controlled trial

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jih Dar Yau ◽  
Radheswari Measuria ◽  
Professor Mahmoud Loubani
Keyword(s):  
Controlled Trial ◽  
Training Needs ◽  
Surgical Skills ◽  
Student Feedback ◽  
Written Feedback ◽  
Initial Experience ◽  
Knot Tying ◽  
Group A ◽  
Group B ◽  
Randomised Controlled

Abstract Aims To compare effectiveness of virtual versus in-person teaching of one-handed reef knot to medical students. Methodology 20 students were randomised into 2 groups of 10, to learn to tie one-handed reef knot. Group A attended a 15-minute virtual session followed by a 15-minute in-person session; vice versa for Group B simultaneously. For the virtual session, trainer and students used online platform, Zoom, on an overhead webcam-laptop workstation in separate rooms. For the in-person session, trainer and students were in one room. Anonymous written feedback was collected from all students. Results 50% of the students had previous experience in knot-tying. On average, the instruction clarity and support received during the virtual session were reported to be less by Group A than Group B. 30% reported non-inferiority in the virtual method to in-person in fulfilling their training needs to learn this skill. 80% said they could have benefited from more time during the virtual session when compared to learning the same skill in-person. During the virtual sessions, 60% encountered technical difficulties relating to internet (20%), Zoom (25%), trainer availability (10%), and hardware (5%). 35% felt that a fully virtual session is suitable for learning one-handed reef knot. 30% stated they would attend a fully virtual basic surgical skills course whilst 40% would attend a partially virtual one. Conclusion Initial experience with virtual surgical skills teaching revealed promising potential based on student feedback. Further focused studies with targeted optimisation are warranted for it to be a viable alternative to traditional in-person teaching.

scholarly journals Is the learning curve for arthroscopic Latarjet procedure facilitated by a specific step-by-step guiding system for the surgical technique?

2021 ◽  
Vol 9 (2_suppl) ◽  
pp. 2325967121S0000
Author(s):  
Maxime Belas ◽  
Nicolas Gaujac ◽  
Pierre Alban Bouche ◽  
Christophe Charousset,MD
Keyword(s):  
Learning Curve ◽  
Shoulder Instability ◽  
Operating Time ◽  
Difficulty Level ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Arthroscopic Latarjet ◽  
Arthroscopic Latarjet Procedure ◽  
Group A ◽  
Group B

Objectives: Treating anterior shoulder instability with the arthroscopic Latarjet procedure is a complex, operator-dependent technique that requires a learning curve. The objective of the study is to compare a guided technique with cortical button fixation and a non-guided technique with screw fixation. Methods: This is a retrospective study including 72 consecutive patients who underwent surgery for recurrent anterior shoulder instability by the arthroscopic Latarjet procedure, with a mean age of 26 years and minimum clinical follow-up of 6 months. The same surgeon performed all the surgeries. The procedure was performed either with an instrument set and dedicated instrumentation that guides the different surgical steps and fixed by two cortical buttons connected by loops of a continuous thread (Group A) or with a specific instrument set and fixed by two cortical screws (Group B). We compared the difficulty of the different surgical steps, each rated from 1 to 5 (1 being the simplest and 5 the most difficult), the number of procedures required to attain a level of difficulty, the operating time and the intraoperative or postoperative complications. Results: Coracoid preparation had a score of 1.3 in group A versus 2.9 in group B (p<0.001) with a difficulty level of 1 as of 19 procedures. The Subscapularis split had a score of 1.9 in group A versus 3.2 in group B (p<0.001) with a level as of 15 procedures. Horizontal positioning of the bone block scored 1.4 in group A versus 1.8 in group B (p=0.019) with a level as of 15 procedures. The mean operating time was 95 minutes in group A and 123 minutes in group B (p<0.0001). There was one coracoid fracture in group A, one case of sepsis and 2 repeat procedures for screw removal in group B, and 2 reversible neurological complications in each group. Conclusion: The Latarjet procedure performed under arthroscopy remains a difficult procedure. An instrument set and dedicated instrumentation with reciprocating rasp and saw, posterior glenoid drill guide and subscapularis retractors allow faster and more reproducible learning.

scholarly journals Assessment of the Learning Curve of Supercapsular Percutaneously Assisted Total Hip Arthroplasty in an Asian Population

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Pengfei Lei ◽  
Zhan Liao ◽  
Jiang Peng ◽  
Guang Li ◽  
Qian Zhou ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Hip Arthroplasty ◽  
Learning Curves ◽  
Harris Hip Score ◽  
Intraoperative Blood Loss ◽  
Total Hip ◽  
Significant Difference ◽  
Group A ◽  
Group B

The supercapsular percutaneously assisted total hip (SuperPATH) approach is a microinvasive approach that was developed to minimize surgical disruption of soft tissue during routine total hip arthroplasty (THA). This study was aimed at assessing early outcomes and learning curves of the SuperPATH approach in one Chinese hospital’s experience. Early outcomes of the first consecutive 78 SuperPATH cases (80 hips) performed by the same surgeon were evaluated. The patients were divided into 4 groups according to the surgical order. The incision, intraoperative blood loss, hospital stay, Harris hip score, and complication occurrence in each group were evaluated. Learning curves were assessed using operative time and intraoperative blood loss as surrogates. The operation time and intraoperative blood loss of groups A and B were more than those of groups C and D, and the difference was statistically significant (P<0.05); however, there was no statistically significant difference between the two groups (group A vs. group B, P=0.426; group A vs. group B, P=0.426). There was no statistically significant difference in terms of incision length and hospital stay, and Harris hip score at the last follow-up was increased with statistically significant difference when compared with that preoperatively among the 4 groups. One case of periprosthetic fracture occurred in group A. No other complication, such as joint dislocation, sciatic nerve injury, prosthesis loosening, periprosthetic infection, and deep vein thromboembolism, occurred in the 4 groups. In summary, for surgeons who are familiar with the standard posterolateral approach, they could achieve more familiarity with SuperPATH after 40 cases of surgery.

scholarly journals Early Laparoscopic Cholecystectomy Service Provision is Feasible and Safe in the Current UK National Health Service

2009 ◽  
Vol 91 (8) ◽  
pp. 660-664 ◽  
Author(s):  
S Agrawal ◽  
N Battula ◽  
L Barraclough ◽  
D Durkin ◽  
CVN Cheruvu
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Care ◽  
Early Laparoscopic Cholecystectomy ◽  
Emergency Procedures ◽  
Surgical Trainees ◽  
Group A ◽  
Group B ◽  
The Impact ◽  
Theatre List ◽  
Surgical Operations

INTRODUCTION Despite increasing evidence of the benefits and safety of early laparoscopic cholecystectomy (LC) in acute gallstone disease, it is not widely practised in England. The Royal College of Surgeons of England support the separation of emergency and elective surgical care. The aim of this prospective study was to examine the impact of the implementation of ‘Surgeon of the Week (SoW)’ model on the number of early LCs performed and the efficiency of the emergency theatre activity in our hospital. This study also looked into its implications on specialist registrar training for early LC, and the financial impact to the hospital. PATIENTS AND METHODS Between January 2007 and May 2008, demographic data, admission and discharge dates, complications, conversions to an open operation and deaths were collected for all patients who underwent early laparoscopic cholecystectomies. For ease of comparison, patients were divided into Group A representing before introduction of SoW (1 January 2007 to 30 August 2007) and Group B representing after introduction of SoW (1 October 2007 to 31 May 2008). The total numbers of operations performed in the emergency theatre list in the two groups were also calculated. RESULTS A total of 1361 emergency operations were performed on the emergency theatre list in Group A, of which 951 were general surgical procedures. In Group B, the numbers of emergency procedures were 1537, of which 1138 were general surgical operations. There was a significant increase in the number of general surgical operations after introduction of SoW (P = 0.013). Before introduction of the SoW rota, 45 early LCs were performed. This increased to 118 after SoW which was significant (P < 0.001). In Group A, the number of early LCs performed by surgical trainees was 10 (22%). In Group B, the number of LCs performed by surgical trainees was 35 (30%; not significant). CONCLUSIONS This study has demonstrated an increase in the efficiency of the emergency theatre with an increase in the number of early LCs on their index admission without extra morbidity following implementation of the SOW model in our hospital. We recommend the introduction of a suitable emergency surgical consultant on-call model separating emergency and elective surgical care depending on local circumstances. This can lead to significant cost savings and reduce re-admissions with gallstone-related complications.

scholarly journals ‘Four-position method’ makes beginner endoscopists aware of spatial positioning of the left hand to master upper gastrointestinal endoscopy

2020 ◽  
Vol 08 (10) ◽  
pp. E1225-E1230 ◽  
Author(s):  
Ken Sugimoto ◽  
Satoshi Osawa
Keyword(s):  
Transit Time ◽  
Early Stage ◽  
Difficulty Level ◽  
Upper Gastrointestinal Endoscopy ◽  
Left Hand ◽  
Before And After ◽  
Group A ◽  
Group B ◽  
Spatial Positioning ◽  
Upper Gastrointestinal

Abstract Background and study aims We developed a novel “four-position method” for facilitating endoscopy of the upper gastrointestinal tract, and this study aimed to verify its usefulness for beginner endoscopists. Methods Medical students (n = 121) were divided into three groups. A simulator subsequently was used to perform endoscopy. Group A was taught how to hold the endoscope and move the dial; Group B was taught the “four-position method”; and Group C, in addition to being taught the “four-position method,” was permitted to use an endoscope before introduction to the simulator. In each group, the transit time to various parts of the upper digestive tract was recorded in addition to the time to grasp a clip in the stomach with the forceps. We also surveyed the groups with respect to their impression of the difficulty level of endoscopic operation before and after instructions. Results Transit time to the cardia was no different among the groups; however, with regard to other targets, Group C reached the sites significantly more quickly than did Groups A and B. Time to clip grasping was significantly shorter in Groups B and C than in Group A. Regarding the impression of the difficulty level, significantly more students in Groups B and C compared to Group A felt that endoscopy was easier after instructions. Conclusion Learning the “four-position method” made it possible to achieve stable endoscopic manipulation at an early stage and improve subsequent endoscopic procedures.

scholarly journals Blended Learning in Healthcare Education

2021 ◽  
Vol 9 (8) ◽  
Author(s):  
S. J. Leinster ◽  
J. H. Pereira ◽  
S. Down ◽  
A.D. Simpson
Keyword(s):  
Blended Learning ◽  
Clinical Training ◽  
Discussion Forum ◽  
Instructional Materials ◽  
Oncoplastic Breast Surgery ◽  
Surgical Trainees ◽  
Group A ◽  
On Line ◽  
Group B ◽  
The Uk

Blended learning is an approach to learning that combines face-to-face instruction with e-learning experiences. It draws on the advantages of each approach while seeking to mitigate their recognised disadvantages. The Master in Oncoplastic Breast Surgery programme at UEA is aimed at advanced surgical trainees working in approved training units in the UK and internationally. It comprises a series of complex cases discussed by the students in an on-line, asynchronous discussion forum moderated by a member of faculty. Students can participate at their convenience despite varied clinical rotas and different time zones. A case-based, flipped learning course for surgical trainees was piloted. Instructional materials for each case were provided. Students joined in an asynchronous, moderated discussion forum. 64 trainees randomised into 2 groups participated. They sat a pre-test Script Concordance Test (SCT). Group A then commenced the on-line course while Group B continued with their usual hospital-based teaching. After 8 weeks, they sat the same SCT. Group B then joined the on-line course along with Group A. After week 16, they sat another SCT. Pre-test scores for both groups were the same (A 6.45; B 6.59 p=0.78). At 8 weeks Group A’s scores had improved significantly (7.96 p<0.001) while Group B’s remained unchanged (6.54). At 16 weeks the scores had equalised (A 7.13; B 7.18). The trainees self-rating of confidence in managing 8 common surgical emergencies followed a similar pattern. Our experience suggests that on-line learning that is highly interactive can add value to the usual postgraduate clinical training. We are exploring its utility in other settings such as training nurse associates, and in breast care nursing in the UK and developing countries. We have introduced 3600 filming and virtual reality in teaching practical skills and providing induction training for complex clinical environments.

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