2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
P149–Education/Outcomes
EXPERIENCE WITH THE OPTICAL ACCESS TROCAR FOR SAFE
AND RAPID ENTRY IN PERFORMING THE LAPAROSCOPIC
GASTRIC BYPASS, Barry R Berch MD, Rami Lutfi MD,Alfonso
Torquati MD,William O Richards MD, Vanderbilt University
Medical Center
BACKGROUND: In laparoscopic surgery, serious complications
caused by the blind insertion of trocars and the Veress needle
are well known. The open technique is compromised by the
leakage of carbon dioxide and can also be time consuming,
especially in the obese population. Our aim is to determine
whether the optical access trocar can be used to establish a
safe and rapid entry during laparoscopic gastric bypass.
METHODS: The data on a single Surgeons experience with
over 350 laparoscopic gastric bypass procedures during a 4
year period was reviewed. The Optiview (Ethicon
Endosurgery) trocar was used on all but the initial 21 patients.
The entry time for the optical trocar was measured in 10
patients. RESULTS: Of the 350 patients undergoing laparoscopic
gastric bypass from 11/2000 to 9/2004, the initial 21
were performed using the standard Veress needle to create the
pneumoperitoneum. The next 22 were performed using the
Veress needle to create the pneumoperitoneum followed by
the optical access trocar in the left upper quadrant as the initial
trocar inserted. From this point to present, the optical
access trocar has been inserted without the use of a Veress
needle. There have been no trocar related bowel or vascular
injuries in the entire series. Mean optical trocar insertion times
were 28 ± 1.26 seconds. CONCLUSIONS: This is the first
laparoscopic gastric bypass series to report the results of its
experience with the optical access trocar. This device provides
a safe and rapid technique for the initial trocar placement in
the laparoscopic gastric bypass. Insertion of the optical trocar
with a 10mm laparoscope into the left upper quadrant is our
procedure of choice for obtaining the pneumoperitoneum in
this patient population.
P150–Education/Outcomes
TELEMENTORING VERSUS ON-SITE MENTORING IN SIMULA-
TION TRAINING, Lucian Panait MD, Alfredo M Carbonell DO,
Victor Tomulescu MD,Azhar Rafiq MD,Cosmin Boanca BS,Irinel
Popescu MD,Ronald C Merrell MD, Virginia Commonwealth
University Medical Center, Richmond, VA & Fundeni Clinical
Institute, Bucharest, Romania
Telementoring could be an adjunct tool to surgical training
using virtual reality (VR) surgical simulation. The hypothesis of
this study was that telementoring is just as effective as proximal
mentoring for acquisition of surgical skills in simulation.
Twenty Romanian medical students, with no previous
laparoscopy experience, were randomly assigned to two
groups that trained with a VR surgical simulator (LapSim,
Surgical Science) under supervision of a telementor or a proximal
mentor, respectively. The telementor, located in the US,
interacted with the students by videoconferencing, coaching
both vocally and demonstrating on another VR simulator. The
simulator screen and two other room cameras were integrated
into a videoconferencing unit with audio for Internet broadband
transmission. All students watched an instructional module
at the beginning of the exercise. Skill assessment before
and after the training sessions involved measurement of path
length and time for completing four basic laparoscopic tasks:
grasping, cutting, clip applying, and suturing. Student t-test
statistical analysis was used to compare the results within
each group at the beginning and end of study.
The combined use of instructional media and practice session
with mentoring prior to testing resulted in similar a level of
performance between proximal and telementored groups.
After adjusting for other covariates, right and left hand path
length and time decreased significantly within each group
from the initial to the final evaluation (p