Structured assessment of laparoscopic camera navigation skills: the SALAS score.

BACKGROUND: Tools are needed to assess laparoscopic camera navigation (LCN) in the operating room. Here, we aimed to develop an objective rating scale for LCN. STUDY DESIGN: We defined the following key aspects of LCN: operational field centering, correct angle of the horizon, correct instrument visualization, verbal commands from the operating surgeon, and manual corrections from the operating surgeon. We then developed a score based on intraoperative error evaluation from intraoperative recordings of 80 procedures. Finally, the newly developed score was validated by four different raters using video-based analysis of 20 elective laparoscopic cholecystectomies. RESULTS: We developed and validated a tool for the structured assessment of laparoscopic assistant skills (SALAS). This score showed good internal consistency, with a Cronbach's alpha of > 0.7. Intraclass correlation revealed a low interrater variability (ICC 0.866) for the total score. Comparison of experienced and inexperienced camera assistants revealed significantly better SALAS scores for experienced assistants (p < 0.05). CONCLUSION: Our present results show that SALAS score is valid, reliable, and practicable. This score can be used for future investigations of camera navigation efficiency and training.

[Scrotal ultrasound in children and adolecents with duplex Doppler analysis of intratesticular arteries]. / Hodensonografie bei Kindern und Jugendlichen mit Bestimmung Doppler-sonografischer Referenzwerte der intratestikulären Arterien.

PURPOSE: Scrotal ultrasound, color Doppler and spectral Doppler analysis of intratesticular arteries are the most common and important examinations in boys with scrotal pain. In the existing literature information concerning feasibility and reference values of color Doppler and spectral Doppler in small testes is inconsistent. MATERIALS AND METHODS: In the present study 102 boys from 2 days to 16 years old without present or anamnestic scrotal disease were examined in a standardized manner. Using linear scanners (9 - 14 mHz), testicular volumetry and spectral Doppler analysis of typical intratesticular arteries were performed and the paratesticular structures were examined. For analysis we grouped the testes by volume and compared the measured values V. max syst., V. max enddiast., and RI. RESULTS: In all test subjects a complete examination with spectral Doppler analysis of intratesticular arteries could be performed. With increasing testicular volume, there is a linear increase in blood flow velocities V. max syst. and V. enddiast. Irrespective of age and testicular volume, the RI of the intratesticular arteries is 0.54 ± 0.08. CONCLUSION: In contrast to published data, this study shows that color Doppler and spectral Doppler of testicular arteries can be regularly performed even in small testes of less than 1 ml. Reference values for blood flow velocities and RI were found and should improve the diagnostic value of testicular ultrasound examinations in children.

[Imaging studies in infants and children with dilatation of the upper urinary tract]. / Bildgebung bei Hohlsystemdilationen des oberen Harntraktes im Neugeborenen- und Kindesalter.

Prenatally or postnatally diagnosed dilatation of the upper urinary tract initiates postnatal investigations, including sonography, dynamic renography (MAG 3) and optional voiding cystourethrography. The first ultrasound examination should be performed 3-5 days after birth and in urgent cases 10-12 h after delivery of the baby. Dynamic renography (MAG 3) is the standard diagnostic investigation and permits simultaneous assessment of renal perfusion and drainage. MRI combines excellent anatomical detail with functional information, without exposure to radiation but needs general anaesthesia in infants and younger children. Intravenous urography is no longer performed routinely in children with a dilated upper urinary tract. The combination of ultrasound and MAG 3 produces the necessary anatomical and functional information to follow the degree of obstruction and to decide between surgical intervention or a conservative follow-up.

The conus medullaris: time of ascendence to normal level.

This study was intended to determine the level of the conus medullaris in normal babies. We examined 114 healthy infants using high resolution ultrasound which identified the spinal cord and the tip of the conus medullaris. This method provided a good analysis of the level of the conus medullaris so that we could assess the rate of ascent to L1/2. The range of the conus level for all children was at TH12/L1 interspace to L4.78% of babies aged between the 30th and 39th postmenstrual week had the tip of the conus medullaris between L2 and L4.84% of babies aged between the 40th and 63rd postmenstrual week had their conus level between TH12/L1 and L1/2 interspace. In one girl aged 53 weeks the tip was found at L4. Ultrasound is a reliable method to observe the development of the conus level in young infants and to identify a tethered cord.

[Identification of wood splinters in soft tissues with ultrasound]. / Nachweis von Holzsplittern in Weichteilen mit Ultraschall.

Two cases of wooden foreign bodies in soft tissue found by ultrasound are described. Furthermore we proved the existence of a typical sonographic pattern of wood in muscle tissue.

Acquired cystic kidney disease before and after renal transplantation.

To determine the prevalence of acquired cystic kidney disease (ACKD), as reported in adults receiving long-term hemodialysis treatment, we studied 48 pediatric patients (aged 17 +/- 5.1 years) with end-stage renal disease by high-resolution ultrasonography or magnetic resonance imaging or both. Forty patients (83%) had a functioning renal transplant, with a mean transplant survival time of 3.4 years (range, 0.3 to 14.8 years); four patients were treated by hemodialysis and four by peritoneal dialysis. The mean duration of end-stage renal disease was 5.7 +/- 3.8 years. Ultrasonography detected ACKD in 12 (29%) of 42 patients, solitary cysts in 14 patients (33%), and no cysts in 16 patients (38%). In contrast, ACKD was diagnosed in only 3 of 37 patients studied by magnetic resonance imaging. In 31 patients studied by both imaging techniques. ACKD was diagnosed in three patients by magnetic resonance imaging but in 11 by ultrasonography. In patients with ACKD, the duration of end-stage renal disease was significantly longer, but renal (transplant) function was not different from that in patients with solitary cysts or no cysts. One patient with a history of 12 1/2 years of hemodialysis had multiple renal tumors that were diagnosed as renal cell carcinomas after bilateral nephrectomy. These results indicate that young patients with end-stage renal disease should be monitored regularly for the presence of ACKD, preferably by ultrasonography, even after successful renal transplantation.

Peritoneal morphology in children treated by continuous ambulatory peritoneal dialysis.

Fifty peritoneal biopsies (PB) from 35 patients with end-stage renal disease, treated by continuous ambulatory peritoneal dialysis (CAPD) and aged 2 months to 18 years, were examined by light microscopy (n = 50) and/or scanning electron microscopy. PB were performed during surgical procedures immediately before the start of, during, or after the cessation of CAPD treatment. PB from 15 children without renal disease undergoing laparatomy were examined similarly. Before the start of CAPD, a scarcity and shortening of the mesothelial microvilli was observed by scanning electron microscopy. During and after CAPD, variable alterations of mesothelium, interstitium and capillaries were found. The mesothelial layer was absent in all 5 PB obtained during episodes of active peritonitis. In patients treated by CAPD for longer than 6 months, mesothelial denudation was observed more frequently (6/11) than in children treated for shorter periods (1/7) (P < 0.08). Fibrosis of the peritoneal membrane was present in about 50% of patients during or after the cessation of CAPD without impairment of peritoneal function. No correlation was found between the presence of fibrosis and the frequency of peritonitis or the duration of CAPD treatment.