Validity of a Novel Chicken and Porcine Model for Laparoscopic Neobladder Reconstruction.

Introduction: Simulation-based training in laparoscopic urology is essential, as these surgeries require a skill set different from routine urologic procedures. We aim to describe and validate the chicken and porcine intestine model for laparoscopic neobladder reconstruction. Materials and Methods: Prospective observational study was conducted at our institute. Twenty novice and 20 trained laparoscopic surgeons were included in the study. The relevant chicken anatomy and surgical steps were described to all the surgeons. The surgeons were asked to fill a nine-point questionnaire after completing the exercise comprising bowel organization, ability to do urethroneovesical anastomosis, suturing time, suturing similarity, quality of suturing, tissue feel, integrity of anastomosis, realism, and usefulness of model after finishing the procedure, and score it on a scale of 1-5. Time taken to perform the entire exercise was noted in addition. An independent expert observer retrospectively rated the urethroneovesical anastomosis on a scale of 1-5. Results: All the participants in the study gave a mean score of 3.5 or more to all the questions asked in the questionnaire. Both the groups rated the usefulness of the model highly with a mean score of 4.6 and 4.45, respectively. The mean score of the questionnaire was 35.9 and 36, respectively, for both the groups. The quality of urethroneovesical anastomosis as observed by an expert was better in the expert group (p = 0.001). Conclusion: The chicken and porcine model for laparoscopic neobladder reconstruction is a useful and effective training tool. This model has face, content, and construct validity to be used as a teaching and training tool in laparoscopic urology.

Fast-track Protocol versus Conventional Protocol on Patient Outcome: A Randomized Clinical Trial.

BACKGROUND: The aim of this study is to compare fast-track methodology with traditional methods of surgical care in achieving better patient outcome, and ensuring a timely discharge from the hospital, and also note the factors that are responsible for a delayed discharge from the hospital. MATERIALS AND METHODS: One hundred patients undergoing elective surgeries were randomly allocated into fast-track and traditional protocol of perioperative care. Patients who underwent fast-track protocol (FTP) were started on early oral feeding and were encouraged for early discharge, while the others were made to follow the traditional method of recovery. The gastrointestinal functions, postoperative complications and hospital stay time were recorded. The results were tabulated and analyzed. RESULTS: Early feeding was well tolerated by all the patients in the "fast track" group, while the patients in the control group had increased number of "nil by mouth" days, and this result was statistically significant. Ambulation was started earlier in the case group as compared to the controls, and the mean period of starting of ambulation was statistically significant, in the cases as compared to the controls. The patients in the case group had an earlier discharge from the hospital, as compared to the control group. The most common reason for a delay in discharge from the hospital, in either group, was seen to be inadequate pain relief postoperatively. CONCLUSION: The FTP can significantly shorten the postoperative hospital stay after elective surgery, as compared to the traditional protocol.

Pseudoangiomatous Stromal Hyperplasia: A Rare Cause of Breast Lump in a Premenopausal Female.

Pseudoangiomatous Stromal Hyperplasia (PASH) of the breast is a rare benign proliferating breast condition. We report a case of a 26-year-old female who was being worked up for infertility and was incidentally noted to have a well defined lump in the left breast. Fine Needle Aspiration Cytology (FNAC) and core needle biopsy of the lump were suggestive of benign breast disease. Patient underwent excision of the lump. Histopathology report of which was suggestive of PASH of the breast.