The Effect of an Interval Training on Skill Retention of High-Complex Low-Volume Minimal Invasive Pediatric Surgery Skills: A Pilot Study.

Background: Current training programs for complex pediatric minimal invasive surgery (MIS) are usually bulk training, consisting of 1- or 2-day courses. The aim of this study was to examine the effects of bulk training versus interval training on the preservation of high-complex, low-volume MIS skills. Materials and Methods: Medical students, without prior surgical experience, were randomly assigned to either a bulk or interval training program for complex MIS (congenital diaphragmatic hernia [CDH] and esophageal atresia [EA] repair). Both groups trained for 5 hours; the bulk group twice within 3 days and the interval groups five times in 3 weeks. Skills retention was assessed at 2 weeks, 6 weeks, and 6 months posttraining, using a composite score (0%-100%) based on the objective parameters tracked by SurgTrac. Results: Seventeen students completed the training sessions (bulk n = 9, interval n = 8) and were assessed accordingly. Retention of the skills for EA repair was significantly better for the interval training group than for the bulk group at 6 weeks (P = .004). However, at 6 months, both groups scored significantly worse than after the training sessions for EA repair (bulk 60 versus 67, P = .176; interval 63 versus 74, P = .028) and CDH repair (bulk 32 versus 67, P = .018; interval 47 versus 62, P = .176). Conclusion: This pilot study suggests superior retention of complex pediatric MIS skills after interval training, during a longer period of time, than bulk training. However, after 6 months, both groups scored significantly worse than after their training, indicating the need for continuous training.

[Artificial esophagus in children]. / Iskusstvennyi pishchevid u detei.

The aims of the study were: 1) to formulate up-to-date principles of coloesophagoplasty (CEP) and to compare methods of CEP; 2) to determine the optimal age for esophagoplasty in children with esophageal atresia; 3) to evaluate quality of life and long term results after esophagoplasty performed in childhood; 4) to present results of surgical treatment of pharynx stenosis in children. Over the last 50 years more than 2 thousand surgeries on the esophagus in children were performed including more than 600 operations of artificial esophagus creation. From 1995 in some patients we carried out extirpation of the esophagus with one-stage plastic operation coloesophagoplasty taken the transplant in the posterior mediastinum. From 1992 on the pharynx with free revascularized intestinal segment was performed in isolated stenosis of the pharynx. Case histories of 54 children aged from 3 months to 15 years were analyzed to compare methods of esophagoplasty when the esophagus was taken behind the sternum and in posterior mediastinum. Case histories of 27 children with atresia of the esophagus were analyzed for determination of optimal age for coloesophagoplasty. Responses to questionnaires were analyzed to evaluate quality of life. From 1980 ive hase operated 28 patients with scarry stenosis of the pharynx (isolated or in combination with esophageal stenosis). Current policy of surgical treatment of pharyngeal stenosis which is considered as surgery of choice-pharyngoplasty with a free intestinal transplant--is described. Development and clinical appliance of up-to-date principles of CEP permitted to reduce the number of complications and to decrease lethality from 3 to 0.5%. After introduction of antireflux cologastroanastomosis the number of complications due to reflux reduced. Extirpation of the esophagus may be valid in peptic stenosis, Barrett's metaplasia, tumors, portal hypertension or angiodisplasia, and in the majority of cases of scarry stenosis of the esophagus.