Why and how to implement an electronic resident's surgical logbook to improve operating-room training? First 5-year feedback from a French center.

INTRODUCTION: The evaluation of general surgery residents' operating room (OR)-training and technical skills progression may be difficult in the absence of a standardized evaluation tool. The aim of this study was to evaluate the impact of the implementation of an electronic "surgical logbook" for general surgery residents. METHODS: A prospective single center study was conducted between May 2015 and October 2020. An electronic logbook was filled by all residents immediately after each surgical procedure and data were prospectively collected and analyzed. RESULTS: Fifty-five students (34 men/21 women) reported their participation to 6917 surgical procedures, which corresponded to 55.5% of all procedures performed in our department. Residents performed the entire procedure as the operating surgeon in 28.5% of cases (n=1963), parts of the procedure as operating surgeon in 32.5% of cases (n=2230) and as operating-assistant in 38.5% (n=2672). Residents were more likely an operating surgeon for the entire procedure when they were assisted by a fellow or a practicing physician than an associate professor or a clinical professor (P<0.001). There was no significant difference in the major morbidity rate between different resident's contribution to the procedure (P=0.14). CONCLUSION: We present here a simple, useful and cost efficient tool which offers easy data collection and reporting that could help improve OR-training, OR-supervision and certification at a local or national level.

Gait phenotype from mild cognitive impairment to moderate dementia: results from the GOOD initiative.

BACKGROUND AND PURPOSE: The differences in gait abnormalities from the earliest to the later stages of dementia and in the different subtypes of dementia have not been fully examined. This study aims to compare spatiotemporal gait parameters in cognitively healthy individuals, patients with amnestic mild cognitive impairment (MCI) and non-amnestic MCI, and patients with mild and moderate stages of Alzheimer's disease (AD) and non-Alzheimer's disease (non-AD). METHODS: Based on a cross-sectional design, 1719 participants (77.4 ± 7.3 years, 53.9% female) were recruited from cohorts from seven countries participating in the Gait, Cognition and Decline (GOOD) initiative. Mean values and coefficients of variation of spatiotemporal gait parameters were measured during normal pace walking with the GAITRite system at all sites. RESULTS: Performance of spatiotemporal gait parameters declined in parallel with the stage of cognitive decline from MCI status to moderate dementia. Gait parameters of patients with non-amnestic MCI were more disturbed compared to patients with amnestic MCI, and MCI subgroups performed better than demented patients. Patients with non-AD dementia had worse gait performance than those with AD dementia. This degradation of gait parameters was similar between mean values and coefficients of variation of spatiotemporal gait parameters in the earliest stages of cognitive decline, but different in the most advanced stages, especially in the non-AD subtypes. CONCLUSIONS: Spatiotemporal gait parameters were more disturbed in the advanced stages of dementia, and more affected in the non-AD dementias than in AD. These findings suggest that quantitative gait parameters could be used as a surrogate marker for improving the diagnosis of dementia.

Value of a preoperative checklist for laparoscopic appendectomy and cholecystectomy.

UNLABELLED: Laparoscopy is a complex technique where incidents related to equipment failure/malfunction commonly occur. The purpose of the WHO preoperative safety checklist is to significantly reduce surgically associated complications and mortality. GOAL: The goal of this study was to show that a preoperative checklist for laparoscopy could improve procedure efficiency by reducing lost time due to these incidents. MATERIAL AND METHODS: This prospective study compared the occurrence of incidents related to equipment, patient installation and the time loss attributed to these incidents, before and after the initiation of a preoperative checklist. Two hundred consecutive laparoscopic procedures (appendectomies and cholecystectomies) were studied; the first hundred without the preoperative checklist and the second hundred after the initiation of this laparoscopic checklist. RESULTS: The risk of at least one incident to occur during the procedure was increased 3-fold ([1.36 vs. 6.64], P=0.007) when the checklist was not used compared to when the preoperative checklist was used. Likewise, the number of incidents increased 2.4-fold ([1.15; 5.01], P=0.02), compared to when the preoperative checklist was used. The checklist significantly reduced the proportion of incidences during which time was lost from 22% to 10% (P=0.03). CONCLUSION: A preoperative checklist for laparoscopic procedures is feasible and seems useful to prevent adverse events in the operating room.

Prognostic factors of postoperative morbidity and mortality in strangulated groin hernia.

OBJECTIVE: Strangulated groin hernia is a serious surgical emergency, as it is associated with high morbidity and mortality (2.6-9 %). This retrospective study aimed to find significant prognostic factors of postoperative morbidity and mortality. METHODS: From January 2000 to August 2011, we analyzed all patients who had undergone surgery in emergency for strangulated groin hernia. Forty-nine patients out of 2,917 were operated on strangulated groin hernia in an emergency. RESULTS: The occurrence of strangulated hernia during this period was 1.7 %. Thirty patients out of 49 had inguinal (61.2 %) and 19 femoral (38.8 %) strangulated hernias. The median age was 68.9 years ± 15.3. Patients with strangulated femoral hernia were significantly older than those with inguinal hernia (P = 0.03). There was a significant predominance of men in the inguinal hernia group and a female predominance in the femoral hernia group (P = 0.001). An additional exploration was performed on 12 patients (24.5 %). This exploration was done through a midline laparotomy in 8 patients, a laparoscopy in a single patient and the hernioscopy technique was beneficial in exploring the peritoneal cavity in 3 patients. Intestinal resection was necessary in 10.2 %. In our experience, 50 % of midline laparotomies were performed without any intestinal resection. Fisher's test identified midline laparotomy as the only prognostic factor of postoperative morbidity. CONCLUSION: First intention exploratory laparotomy in strangulated hernia surgery was, in our study, a major cause of postoperative complication.

[The usefulness of scores in the diagnosis of appendicitis]. / De l'intérêt des scores en matière de diagnostic d'appendicite.

The diagnosis of acute appendicitis relies largely on clinical experience; the performance of complementary tests is oftentimes unnecessary. We have created a score based on clinical and laboratory findings which can reliably categorize three zones of diagnostic probability : probable, doubtful, or improbable. Only the intermediate category requires complementary imaging. Alvarado first developed a scoring system based on operative findings and this has been modified and improved by others. In our experience, the scoring system of François has been most useful. This score is based on simple clinical data and findings such as age, sex, duration of symptoms, leucocytosis, palpable mass on rectal exam, and urinary symptoms. We have validated this score in a cohort of 202 patients presenting with right lower quadrant abdominal pain and found a sensitivity of 94.7% and a negative predictive value of 97.4% for patients falling into the probable and improbable categories. Management of patients with either very high or very low scores can proceed more expeditiously and with less expense. Diagnostic imaging can be reserved for those patients with intermediate scores where the diagnosis is in doubt. We have established a clinical pathway in our emergency department based on this scoring system.

Lateral approach to laparoscopic repair of left diaphragmatic ruptures.

Video-assisted repairs of traumatic diaphragmatic ruptures have been described where thoracoscopy or laparoscopy in the supine position were used. This study aims to validate a new lateral laparoscopic approach for left diaphragmatic repairs. Six consecutive patients were operated on for left diaphragmatic rupture using a lateral approach (Gagner's position). A series of 362 consecutive patients presenting with abdominal or thoracic trauma with or without diaphragmatic rupture over a 2-year period were reviewed retrospectively. Contraindications for immediate or delayed lateral laparoscopic approach were studied. The lateral approach provided complete visibility of the subdiaphragmatic space, easy reduction of herniated organs, easy thoracic inspection and cleaning, the use of low peritoneal pressure, full range of instrumental motion, and rapid diaphragmatic repair. No operative mortality or morbidity was noted. Altogether, 14% to 50% of the patients with diaphragmatic ruptures were candidates for immediate lateral laparoscopic repair. Associated spleen injury in 50% of the cases was the main contraindication. The lateral laparoscopic approach provides better exposure of the diaphragm on the left side and facilitates the diaphragmatic repair especially with a large herniation. Immediate repair is possible in selected cases (14-50%). There is no contraindication in case of delayed diagnosis.

Ultrasonography as an aid to diagnosis and treatment in a rural African hospital: a prospective study of 1,119 cases.

The aim of this study was to assess the utility of ultrasonography in a rural African hospital in Cameroon with scarce resources. A prospective questionnaire was administered and completed for each of the 1,119 consecutive cases included in the study. Among these 1,119 cases, the diagnosis made by clinicians and by echography could be verified by another means for 323 patients. Ultrasonography showed abnormal findings in 78% of the cases. In the group of 323 patients in which the diagnosis made by echography could be verified, it was correct in 95.4% of the cases, erroneous in 4.6% of the cases, judged useful for diagnosis in 67.8% of the cases, and not contributive in 27.6% of the cases. Ultrasonography was judged useful when treatment was decided upon in 62% of the cases. This study demonstrated the value of ultrasonography in the context of a developing country and the conditions by which its use could be delineated.

[5 new cases of entomophthoromycosis observed in Cameroon. Role of immunofluorescence in thr diagnosis]. / Cinq nouveaux cas d'entomophthoromycose observés au Cameroun. Place de l'immunofluorescence dans le diagnostic.

The authors present five new cases of entomophthoromycosis observed during three years of histopathology in Cameroon. Three classic cases of rhinoentomophthoromycosis. In one case, Conidiobolus coronatus was isolated. Two cases of subcutaneous entomophthoromycosis, without isolation of the germ. In one observation, the clinical and histological aspect suggested mucormycosis post entomophthoromycosis. An immunofluorescence technique showed the Basidiobolus haptosporus to be the real cause.