Serum biochemical changes after laparoscopy may be indicators of bladder injury.

We evaluated the serum renal biochemical profile as an indicator of unrecognized laparoscopic bladder injury in four women. The patients were seen 24 to 56 hours postoperatively with elevated serum creatinine and urea levels, and electrolyte changes compatible with acute renal dysfunction. The mechanism responsible for these biochemical changes appears to be extravasation and reabsorption of urine. Biochemical values returned to normal within 24 hours after bladder repair.

Development of a computerized telecommunication system for in-training evaluation of residents in a laparoscopic educational program.

OBJECTIVE: To describe our initial experience with a computerized telecommunication system, termed the interactive voice-response system, to record resident performance of laparoscopic surgery. METHODS: After completing a laparoscopic procedure, the surgeon and resident telephone a toll-free number independently and respond to three prerecorded statements using a Likert scale of 1 to 5. The caller then is asked to describe the resident's response to critical incidents or elements of surprise that arose during the surgery. The ratings and verbal comments are compiled, transcribed, and forwarded to the respective resident. The resident (and program director) can hear the verbal comments by entering a four-digit code. RESULTS: Between May 1, 1995, and May 31, 1996, 430 cases were reported by 11 surgeons and 16 residents using the interactive voice-response system. One hundred ninety-five (45%) procedures were entered by both the resident and surgeon. A survey undertaken during the introductory phase of the project revealed that five of the seven residents exposed to the system found that it provided useful feedback and preferred the system to traditional in-service reporting methods. In addition, five residents thought that the system complemented the personal feedback they received in the operating room. CONCLUSION: The system has been accepted by both residents and surgeons and has addressed the important components of resident in-training evaluation, namely, evaluation on a case-by-case basis, timely feedback, and self-assessment of resident performance.