Construction and validation of a low-cost laparoscopic simulator for surgical education.

INTRODUCTION: To construct a trainer that would achieve the equivalent goals of the Fundamentals of Laparoscopic Surgery (FLS) trainer at an economical cost. A validation study comparing our homemade (HM) trainer vs the FLS trainer was performed. A literature search as well as a price comparison with other commercially available laparoscopic trainers is presented. METHODS: The HM laparoscopic trainer was constructed using a prefabricated hard plastic frame with a vinyl plastic sheet affixed as the roof. A row of light-emitting diode lights and a charge-coupled device camera were mounted on the inside roof of the frame. Electrical wires were spliced to supply power to both the light-emitting diode lights and the camera. The charge-coupled device camera was connected to a liquid crystal display screen which was affixed directly across from the user. Subjects were prospectively randomized to perform the 5 tasks put forth by the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills on both the HM trainer and the FLS trainer (pegboard transfer, pattern cut, placement of ligating loop, extracorporeal knot suture, and intracorporeal knot suture). Simple paired t test was performed to compare times between the trainers. SETTING: The construction of the trainer and the validation study were performed at the Central Michigan University College of Medicine Department of Simulation. PARTICIPANTS: Subjects consisted of third- and fourth-year medical students (n = 30). RESULTS: A laparoscopic trainer box was constructed and assembled in 2 hours. The HM trainer cost $309 representing a cost savings of $1371. Results of the validation study demonstrated no statistical difference in times to complete 3 out of the 5 tasks as well as no difference in total time to complete all 5 tasks (p value< 0.05). CONCLUSION: Valid laparoscopic simulators can be constructed at an economical cost.

Colonic volvulus in an adult after childhood Ladd's procedure for malrotation.

Malrotation and volvulus are encountered early in infancy and sometimes later in childhood, but rarely in adulthood. This ailment is treated through Ladd's adhesiolysis, detorsion, and possibly bowel resection. Literature is scarce on the long-term outcomes of this procedure, especially into adulthood. We present a case report of an adult female with a history of a laparotomy as a child for a bowel obstruction secondary to malrotation, presenting with an obstruction and colonic volvulus, secondary to an adhesive band, requiring emergent surgery. The patient did well postoperatively without complications. In adult patients presenting with a bowel obstruction and a consistent history in childhood, recurrence of volvulus should be considered as part of the differential diagnosis through a detailed history and assessment.

Bariatric surgery for morbid obesity: why, who, when, how, where, and then what?

Bariatric surgery is not a cure, but it can take weight off and keep it off, improve most obesity-related conditions, reduce the risk of premature death, and improve quality of life. Given the interest in the procedure, primary care physicians need to understand the risks and benefits to help patients determine if this therapy is a good option, and they need to know the health changes that may occur after surgery when following these patients.