Virtual reality simulation training in laparoscopic surgery - does it really matter, what simulator to use? Results of a cross-sectional study.

BACKGROUND: Virtual reality simulation training plays a crucial role in modern surgical training, as it facilitates trainees to carry out surgical procedures or parts of it without the need for training "on the patient". However, there are no data comparing different commercially available high-end virtual reality simulators. METHODS: Trainees of an international gastrointestinal surgery workshop practiced in different sequences on LaparoS® (VirtaMed), LapSim® (Surgical Science) and LapMentor III® (Simbionix) eight comparable exercises, training the same basic laparoscopic skills. Simulator based metrics were compared between an entrance and exit examination. RESULTS: All trainees significantly improved their basic laparoscopic skills performance, regardless of the sequence in which they used the three simulators. Median path length was initially 830 cm and 463 cm on the exit examination (p < 0.001), median time taken improved from 305 to 167 s (p < 0.001). CONCLUSIONS: All Simulators trained efficiently the same basic surgery skills, regardless of the sequence or simulator used. Virtual reality simulation training, regardless of the simulator used, should be incorporated in all surgical training programs. To enhance comparability across different types of simulators, standardized outcome metrics should be implemented.

Risk factors and outcomes of postoperative aspiration pneumonia in abdominal surgery patients: An exact matching and weighting analysis.

BACKGROUND: Postoperative aspiration pneumonia is a feared complication contributing significantly to postoperative morbidity and mortality. Over decades, there has been little progress in reducing incidence and mortality of postoperative aspiration pneumonia. Here, we assessed risk factors for postoperative aspiration pneumonia in general and abdominal surgery patients. METHODS: Patients undergoing surgery between January 2012 and December 2018 were included in this exact matched and weighted case-control study. Data from a prospectively acquired clinical database were retrospectively analyzed. RESULTS: Among 23,647 patients undergoing 32,901 operations, 144 (0.44%, 95% Confidence Interval: 0.37%-0.52%) cases of postoperative aspiration pneumonia were identified. Ninety-day mortality was 27.8% (n = 40). Major risk factors for postoperative aspiration pneumonia were emergency surgery in patients with prolonged preoperative fasting (>6 hours; odds ratio: 3.25, 95% confidence interval: 1.46-7.26; P < .001), older age with increasing risk in octogenarians compared to seniors (65-80 years: n = 69; odds ratio 5.23, 95% confidence interval: 2.18-12.51; >80 years: n = 50; odds ratio 13.72, 95% confidence interval: 4.94-38.09; P < .001), American Society of Anesthesiologists scores >II (American Society of Anesthesiologists III: n = 90; odds ratio 3.38, 95% confidence interval: 1.08-16.01; American Society of Anesthesiologists IV/V: n = 18; odds ratio 5.20, 95% confidence interval: 1.48-27.61; P < .001), and body mass index <18 kg/m2 (n = 9; odds ratio: 2.53; 95% confidence interval: 1.04-6.11; P = .029). Laparoscopies (odds ratio 0.45, 95% confidence interval: 0.23-0.88; <0.001) and female sex were associated with a decreased risk for postoperative aspiration pneumonia (odds ratio 0.40, 95% confidence interval: 0.23-0.69; P < .001). CONCLUSION: Preventive measures to reduce postoperative aspiration pneumonia should focus on older patients with American Society of Anesthesiologists scores ≥III undergoing open surgery. Cachectic patients and patients undergoing emergency surgery with prolonged preoperative fasting require increased attention. Laparoscopy was associated with a lower risk for postoperative aspiration pneumonia and should be preferred whenever appropriate.