Management of non-parasitic splenic cysts: does size really matter?

BACKGROUND: Splenic cysts are relatively rare clinical entities and are often diagnosed incidentally upon imaging conducted for a variety of clinical complaints. They can be categorized as primary or secondary based on the presence or absence of an epithelial lining. Primary cysts are further subdivided into those that are and are not secondary to parasitic infection. The treatment of non-parasitic splenic cysts (NPSC) has historically been dictated by two primary factors: the presence of symptoms attributable to the cyst and cyst size greater or less than 5 cm. While it is appropriate to resect a symptomatic lesion, the premise of recommending operative intervention based on size is not firmly supported by the literature. METHODS: In the current study, we identified 115 patients with splenic cysts and retrospectively reviewed their management that included aspiration, resection, or observation. RESULTS: Our data reveal a negative overall growth rate of asymptomatic cysts, a high recurrence rate after percutaneous drainage, as well as demonstrate the safety of observing asymptomatic lesions over time. CONCLUSION: We conclude that observation of asymptomatic splenic cysts is safe regardless of size and that aspiration should be reserved for those who are not surgical candidates or in cases of diagnostic uncertainty.

Housestaff performance is improved by participation in a laparoscopic skills curriculum.

BACKGROUND: After the implementation of a laparoscopic skills curriculum, we studied two questions: (1) can skills curriculum participation improve performance and (2) can we identify housestaff who may benefit from early instruction in laparoscopic technical skills? METHODS: We administered a six-task laparoscopic skills curriculum to postgraduate year (PGY) 2 and PGY3 surgical housestaff. Six laparoscopic tasks were divided into two groups: generalized skills and task specific skills. All participants were evaluated during a pretest and were placed in the novice group (total score less than 600) or in the intermediate skill (IS) group (total score 600 or more). Each participant had two 1-hour practice/instruction sessions and 2 weeks for independent practice. After these sessions, a posttest was administered. RESULTS: Novices and intermediate skill participants demonstrated significant improvement in general skills and task specific skills. However, comparison of novice and IS group learners revealed that IS group learners were significantly more proficient in the performance of general skills, but the performance of task specific skills failed to demonstrate a difference between the two groups. On posttest, there was no significant difference in overall score between novices and IS participants. CONCLUSIONS: Overall ability and performance of generalized skills by all housestaff are improved with a laparoscopic skills curriculum; however, the performance of novices improved the greatest. Task specific skills did not discriminate novices from more advanced learners. Early testing of housestaff may identify those individuals who could benefit from intervention and instruction prior to performing the laparoscopic skills in the operating room.