Merged virtual reality teaching of the fundamentals of laparoscopic surgery: a randomized controlled trial.

BACKGROUND: The COVID-19 pandemic challenges our ability to provide surgical education, as our ability to gather and train together has been restricted due to safety concerns. However, the importance of quality surgical education has remained. High-fidelity simulation platforms have been developed that merge virtual reality video streams to allow for remote instruction and collaboration. This study sought to validate the use of a merged virtual reality (MVR) platform for the instruction and assessment of the fundamentals of laparoscopic surgery (FLS) skills. METHODS: This was a prospective randomized controlled non-inferiority study. Thirty participants were randomized between three groups: The standard group received in-person instruction and expert feedback, the experimental group received identical training via the MVR platform, and the control group practiced on their own, but received no feedback. All participants were pre-tested for baseline performance at the beginning of the study. Change in performance was evaluated immediately after training and one month later for retention. Ordinary one-way analysis of variance was used to evaluate the effects of time, group, and time-on-group. RESULTS: The pre-test confirmed baseline homogeneity between the groups. MVR was non-inferior to standard in-person training for total FLS times on either the post-test (p = 0.632) or the retention test (p = 0.829). Performance was also identical between MVR and standard training groups for each of the individual FLS tasks. Each group improved significantly in nearly all tasks after practice; however, the standard and MVR training groups both improved significantly more than controls for the ligating loop, extracorporeal suturing, intracorporeal suturing, and total FLS task training but did not reach statistical significance for peg transfer and pattern cut tasks. CONCLUSION: This randomized, controlled trial has demonstrated the use of an MVR platform as non-inferior to in-person instruction for the FLS program, forming the foundation for future work on remote instruction and collaboration.

Iron deficiency in bariatric surgery patients: a single-centre experience over 5 years.

Background: As the prevalence of obesity has increased, so too has the demand for bariatric surgery. This study aimed to determine the incidence of postoperative iron deficiency and anemia and the impact of an increased preoperative ferritin target on postoperative outcomes. Methods: Patients undergoing bariatric surgery in Winnipeg from 2010 to 2014 were included in the analysis. Data capture included age, sex and date of surgery and iron, ferritin and hemoglobin levels before surgery and 12 months postoperatively. Before 2014, there was no protocol for preoperative iron supplementation at our centre; in 2014, a more aggressive preoperative iron supplementation program was introduced to target a minimum preoperative ferritin level of 50 mg/L. Data were analyzed using unpaired t tests, paired t tests and χ2 tests. Results: A total of 399 patients were considered; 288 were included in the analysis. The incidence of iron and ferritin deficiency and anemia at 12 months postoperatively was 14.6%, 9.3% and 15.0%, respectively. In patients who underwent surgery before 2014, the 12-month postoperative levels of iron and ferritin were 12.9 mmol/L and 64.0 mg/L, respectively; patients who underwent surgery in 2014 had levels of 18.3 mmol/L and 124.0 mg/L, respectively (all p = 0.001). The 12-month postoperative hemoglobin levels did not significantly differ between the 2 groups. Conclusion: Bariatric surgery performed with more aggressive preoperative iron supplementation is associated with increased iron and ferritin levels at 1 year postoperatively. As this improves overall clinical outcomes by avoiding iron deficiency and anemia, a minimum preoperative ferritin target should be implemented in metabolic and bariatric surgery programs.

Contexte: L'augmentation de la prévalence de l'obésité s'est accompagnée d'un accroissement de la demande de chirurgie bariatrique. La présente étude visait à déterminer l'incidence de la carence en fer et de l'anémie postopératoires ainsi que les conséquences de la hausse du taux cible de ferritine avant l'intervention sur les issues postopératoires. Méthodes: L'analyse a porté sur des patients ayant subi une chirurgie bariatrique à Winnipeg entre 2010 et 2014. Les données recueillies faisaient état de l'âge, du sexe et de la date d'opération des patients, ainsi que de leurs taux de fer, de ferritine et d'hémoglobine avant la chirurgie et 12 mois après celle-ci. Avant 2014, notre centre n'avait pas de protocole de supplémentation préopératoire en fer; en 2014, il a instauré un programme de supplémentation rigoureux visant un taux préopératoire de ferritine d'au moins 50 mg/L. L'analyse des données a été faite au moyen de tests t non appariés, de tests t appariés et de tests χ2. Résultats: Au total, les cas de 399 patients ont été envisagés pour l'analyse, et 288 ont été retenus. L'incidence de la carence en fer, celle de la carence en ferritine et celle de l'anémie 12 mois après la chirurgie étaient de 14,6 %, de 9,3 % et de 15,0 %, respectivement. Chez les patients ayant été opérés avant 2014, les taux de fer et de ferritine à 12 mois étaient de 12,9 mmol/L et de 64,0 mg/L, respectivement, et chez ceux ayant été opérés en 2014, ils étaient de 18,3 mmol/L et de 124,0 mg/L, respectivement (p = 0,001 pour toutes les valeurs). En ce qui concerne le taux d'hémoglobine à 12 mois, aucune différence significative n'a été observée entre les 2 groupes. Conclusion: Les chirurgies bariatriques effectuées après une supplémentation rigoureuse en fer sont associées à des taux accrus de fer et de ferritine 1 an après l'intervention. Sachant que la prévention de la carence en fer et de l'anémie améliore les issues cliniques en général, les programmes de chirurgie métabolique et bariatrique devraient se fixer une cible quant au taux préopératoire minimal de ferritine.