ABSTRACT
PURPOSE: Assessing construct, face and content validity of the camera handling trainer (CHT), a novel low-fidelity training device for 30° laparoscope navigation skills. METHODS: We developed a custom-designed box trainer with clinically based graphic targets. A total of 117 participants, stratified according to their previous experience (novice, competent, expert), took part to a CHT session and subsequently were asked to fill out a survey to assess the impact of the CHT on their 30° laparoscope navigation skills. Sixty of them were also studied for task performance during a 1-h session, with multiple time measurements. RESULTS: All participants, regardless of the previous experience, significantly improved their performance after the CHT session. Regarding construct validity, the mean task performance on the last measurement for novice group was found to be comparable to the mean first attempt of both competent (p = 0.12) and expert (p = 0.24) participants. All participants agreed that "the CHT is a valid training tool" and that "the CHT should be part of the regular dry laboratory training sessions", assessing both face and content validity. Limitations include the need for assessment of predictive validity. CONCLUSIONS: The CHT is a valid training tool for 30° laparoscope navigation and thus should be considered as one of the fundamental exercises during basic laparoscopic hands-on training sessions for urologists.
Subject(s)
Clinical Competence , Computer Simulation , Education, Medical, Graduate/methods , Laparoscopes , Laparoscopy/education , User-Computer Interface , Video Recording/instrumentation , Equipment Design , Female , Humans , Male , Reproducibility of ResultsABSTRACT
BACKGROUND: Infrared thermography (IRT) imaging technology is able to measure surface temperatures in real-time. The aim of our study is to understand whether IRT imaging is a reliable technology for the assessment of kidney-parenchyma perfusion with warm fluids. METHODS: We used three porcine kidneys as a sample. IRT was compared to Near-infrared fluorescence (NIRF) technology with Indocyanine Green (ICG), X-rays with Contrast medium was used as a benchmark. Each kidney, placed inside an incubator, was perfused with contrast medium by a vascular 6-Fr catheter, to preview the perfusable parenchymal area. 100 mL of saline solution at 45 °C was then administered along a five-minutes time, followed by a second administration of 2/10 diluted ICG solution. A FLIR© C2 IR camera was used to acquire thermal data. During ICG administration, image acquisition was obtained with FireFly technology, with a 0° endoscopic camera. Quantitative variables are described using median and quartiles. RESULTS: Real-time evaluation by IRT showed that, after five minutes of perfusion, it was possible to highlight the same parenchymal areas as visualized by X-ray. The IR images showed that surface temperature rise was directly reflecting local perfusion with heated saline solution. Analysis of NIRF technology and ICG showed an overlap between the two technologies. In addition to the compared technology, IR provided separate temperature measurement for each pixel in real time. Our findings were replicable on all the three kidneys examined. Higher resolution IR-cameras could provide even more detailed information. CONCLUSIONS: Although NIRF technology with ICG is providing more image detail, we demonstrated that IRT is capable of detecting kidney parenchyma perfusion with warm fluids. Further studies will show its feasibility in graft re-perfusion assessment during kidney transplant or similar applications.
Subject(s)
Fluorescent Dyes , Indocyanine Green , Kidney/diagnostic imaging , Renal Circulation , Thermography/methods , Animals , Computer Systems , Fluorescence , Humans , In Vitro Techniques , Infrared Rays , Kidney Transplantation/methods , Perfusion , SwineABSTRACT
BACKGROUND: A reduction in salivary and lacrimal secretion has been described in several diseases. However, such alterations have not been investigated fully in patients with chronic renal failure. The aim of the present study is to estimate the frequency of alterations in salivary and lacrimal secretion in long-term hemodialysis patients. METHODS: Sixty-three hemodialysis patients and 23 healthy control subjects were studied. In all of them, we tested salivary secretion (Saxon's test), lacrimal secretion (Shirmer's test), and the presence of xerostomia and xerophthalmia symptoms. In a subgroup of patients, we performed other tests to evaluate evidence of ocular lesions and tissue damage to salivary glands. We also tested the relationship between salivary and lacrimal secretion and autonomic nervous system function. RESULTS: On average, salivary and lacrimal secretion were markedly reduced in uremic patients compared with healthy controls, and alterations in salivary gland function were related strongly to salivary gland fibrosis and atrophy. Xerophthalmia often was asymptomatic, but frequently was associated with corneal lesions. Xerostomia and xerophthalmia were unrelated to autonomic dysfunction and hepatitis C virus infection. CONCLUSION: A reduction in lacrimal and salivary secretion is frequent in long-term dialysis patients. Such alterations often are asymptomatic and could be the expression of acceleration of an age-dependent decline in glandular function and attendant fibrosis and atrophy.