A comparison of shoulder pressure among different patient stabilization techniques.

OBJECTIVE: The purpose of this study was to evaluate the pressure placed on the shoulders as a function of varying degrees of head-down tilt (the Trendelenburg position) and to compare these pressures among 3 different patient-positioning systems. STUDY DESIGN: Participants were placed in the dorsal-lithotomy position with arms tucked and tilted at 5, 10, 15, 20, 25, and 30 degrees of head-down tilt. Using a manometer, we measured the pressure (centimeters of water) on the shoulders at each angle for 3 support devices: the Skytron shoulder support (Skytron, Grand Rapids, MI), the Allen shoulder support (Allen Medical Systems, Acton, MA), and the Allen Hug-u-Vac. RESULTS: Among 23 participants, body mass index (mean ± SD) was 24.5 ± 4.3 kg/m(2). As the tilt angle increased, so did the shoulder pressure for all support systems. At a 30-degree Trendelenburg position, the Allen Hug-u-Vac transmitted less pressure to the shoulders than the Skytron (right and left, P < .001) and the Allen shoulder supports system (right, P < .001; left, P = .434). Each participant was asked, "Which system was most comfortable?" Seventy-four percent of the participants reported that they preferred the Hug-u-Vac (P < .001). CONCLUSION: Shoulder pressure increases as tilt angle increases. Of the 3 support systems that were tested, the Allen Hug-u-Vac transmitted less pressure to the shoulders at a 30-degree Trendelenburg position than the Skytron and the Allen shoulder support systems.

Advanced pelvic organ prolapse and routine health screening.

OBJECTIVE: To evaluate whether patients with advanced pelvic-organ prolapse (POP) were less likely than controls to obtain screening Papanicolaou (Pap) test, mammography, and colonoscopy. STUDY DESIGN: Records were reviewed from 7/2/2010 through 4/22/2011. We identified patients with advanced POP, defined as prolapse > or = 4 cm beyond the hymenal ring, and made age- and parity-matched controls from patients whose prolapse was <4 cm. Compliance for screening of cervical, breast and colon cancers was compared between the two groups. RESULTS: Of 933 records, we identified 51 patients with advanced POP and 51 controls. Neither Pap test nor colonoscopy screening differed between the groups (McNemar chi2, P=1.00; McNemar chi2, P=1.00). Mammogram screening did not differ statistically; however, there was a trend towards neglecting screening in the advanced POP group (McNemar chi2, P=0.057). CONCLUSION: Patients with POP > or = 4 cm beyond the hymenal ring were equally as likely to obtain routine health screening as age- and parity-matched controls whose POP measured <4 cm.

Can visuospatial ability predict performance and learning curves on a robotic surgery simulator?

OBJECTIVE: This study aimed to examine the correlation between visuospatial ability, measured with the Perceptual Ability Test (PAT), and da Vinci robot simulator performance on the da Vinci Skills Simulator. METHODS: Twenty-five consenting medical students naive to both the PAT and the da Vinci robot completed the PAT and then performed a single simulation (Ring-walk 2) 10 consecutive times. Raw PAT scores were compared with composite simulator scores for all subjects. Participants were divided into those with high and low visuospatial ability based on whether they scored above or below (or equal) to the median on the PAT. We compared the mean composite simulator scores and the time to complete each exercise between the high and the low PAT performers. RESULTS: The mean (SD) raw PAT score (out of 90) was 45.5 (18.3) (median, 43.0). The mean composite simulator score was 65.5 (24.1) (median, 72.2). The high (n = 12) and low (n = 13) PAT performers had a mean (SD) (median) simulator score of 79.1 (9.8) (80.3) and 53.0 (26.7) (65.9), respectively. On average, the high PAT performers scored 26.1 points (95% confidence interval, 9.2-43.0, P = 0.005), or 49.2%, higher on the simulation than the low PAT performers. The high PAT performers completed the exercise in 96.5 seconds (95% confidence interval, 26.0-167.0; P = 0.009), or 36.2%, faster than the low PAT performers. CONCLUSIONS: Better visuospatial ability relates to improved performance on a robotic surgery simulator.

A comparison of laparoscopic and abdominal sacral colpopexy: objective outcome and perioperative differences.

The purpose of this study was to compare anatomic and perioperative outcomes following laparoscopic sacral colpopexy (LSC) and abdominal sacral colpopexy (ASC). The hypothesis is that the laparoscopic technique has similar anatomic outcomes as compared with the open technique. A retrospective comparative chart review was conducted consisting of 43 patients who underwent laparoscopic sacral colpopexy and 41 patients who underwent abdominal sacral colpopexy. Demographics were comparable between groups except mean follow-up time (LSC = 7.4 months, ASC = 10.6 months). Mean improvement at the apex was similar between the two groups. Hospital stay in hours was shorter for the LSC group (mean/median = 35.4/30.9) than the ASC group (mean/median = 63.3/54.1, p < 0.001). Mean operative time was similar (LSC = 183, ASC = 168 min, p = NS) and complication rates were comparable between the groups. Patients undergoing laparoscopic and abdominal sacral colpopexy have comparable anatomical outcomes and operative times. Laparoscopy affords a shorter hospital stay.