Does training in a virtual reality simulator improve surgical performance?

BACKGROUND: The development of computerized surgical simulators in a virtual reality environment demands models for proper validation. Recent investigations have shown that a virtual reality simulator (MIST-VR) is a reliable tool for the assessment of laparoscopic psychomotor skills and that it improves the automation of the so-called fulcrum effect. Therefore, we set out to determine whether training with the MIST-VR would improve the surgical performance of surgically inexperienced medical students and to see if results obtained in the simulator would correlate with surgical performance. METHODS: A total of 29 medical students were randomized into two groups. One group received preoperative MIST-VR training. Both groups then performed a simulated laparoscopic appendectomy in a pig. The operations were videotaped and examined by three independent observers. RESULTS: There was no significant difference in performance between the two groups. The performance with the MIST-VR correlated with the results in surgery. CONCLUSION: A method that can measure surgical skill, based on the scoring of independent observers who view videotaped performances, seems to be reliable. MIST-VR did not improve the surgical skills of the subjects, but the results with MIST-VR did predict surgical outcome.

Prophylactic antibiotics in uncomplicated appendicitis during childhood--a prospective randomised study.

544 children operated upon for uncomplicated appendicitis were randomised into three groups. Group I received no antibiotics, patients in Group II were administered one single pre-operative dose of metronidazole (10 mg/kg) and patients in Group III received both both metronidazole (20 mg/kg) and cefuroxime (50 mg/kg) in a single preoperative dose. The rate of infectious complications in Group I was 6.3% but only 2.1 and 2.3 in Groups II and III, respectively. Among patients with a normal appendix or patients with simple appendicitis there was no difference in the rate of post-operative infections between the three different groups. However, in patients with gangrenous appendicitis the rate of postoperative infections was significantly lower in the two groups who received preoperative antibiotics (1.8% and 3.0% respectively) than in the group receiving no prophylactic antibiotics (infection rate 14%). It is concluded that a single preoperative dose of metronidazole significantly decreases the rate of postoperative infectious complications in children with appendicitis. No further improvement could be demonstrated if cefuroxime against aerobic organisms was added.

Mechanical small-bowel obstruction after conventional appendectomy in children.

During the period May 1988 to August 1990, 871 children aged between 0 and 15 years were appendectomized by laparotomy because of suspected appendicitis at the department of pediatric surgery, St. Göran's Children's Hospital. The children were followed 4-6 years after appendectomy. 1.3 % (10/791) developed clinical symptoms consistent with mechanical small bowel obstruction (SBO) resulting in relaparotomy and confirmation of the diagnosis. The patients were divided into subgroups according to the degree of appendicitis. In the group with normal appendix 1.8% (3/170) developed mechanical SBO, simple appendicitis 0% (0/209), gangrenous appendicitis 0.4 % (1/236) and perforated appendicitis 3.4% (6/176). There was no mortality due to postoperative complications. Two patients died due to unrelated causes during the follow-up period.