2005 SAGES Abstracts

POSTER ABSTRACTS
to avoid dissemination of the cystic contents or a anaphylactic
shock.
Cystectomy and pericystic resection, (by open surgery) as
extensive as possible, is the adequate treatment that gives
successful results in most cases.
note: I wish to present this clinical case in the form of poster.
P153–Education/Outcomes
A PRIMARY HYDATID CYST OF THE GLUTEAL MUSCLE : A
CASE REPORT, Adel Chokki MD, Youssef Harrath MD,Soufiene
Nouira MD,Jalel Kdous MD,Chedly Dziri MD,Mohamed Tahar
Khalfallah MD, Service de chirurgie Hopital de Siliana. Siliana.
Tunisie
hydatidosis remains an endemic surgical problem in many
Mediterranean countries like Tunisia. the hydatid cyst can
touch all the organs of the human body.
The muscular localization of the hydatid cyst is uncommon
(0.5 to 5.4%) and it is usually secondary to hepatic or pulmonary
disease.
A 59 year old woman presented with a mass of the left buttock
witch appeared two years before and increased size gradually.
Clinical examination, noted the presence of two masses of the
left buttock
Ultrasonography revealed that the masses were a hydatid cystic
classified stage III (Garbi’s classification).
Serology was positive.
Thoracic radiography and abdominal Ultrasonography were
normal and did not revealed another localisation of the
hydatid cyst.
At surgical exploration, three hydatid cyst were found.
Two cyst were totally removed and the third cyst was treated
by pericystic resection.
Follow up : four years later, there was no recurrence.
An isolated hydatid cyst can be the unique manifestation of
hydatid disease. Preoperative diagnosis is desirable for the
selection of a surgical approach and prevention of allergic
reactions and operative spillage.
The purpose of this work is to call attention to this atypical
localization of the disease, which should be taken into account
in the practice of surgery.
In the light of this case, we discuss the epidemiological, diagnostic
and therapeutic aspects of muscle hydatidosis.
P154–Education/Outcomes
CHARACTERIZING THE LEARNING CURVE FOR A BASIC
LAPAROSCOPIC DRILL., Shannon A Fraser MD, Liane S
Feldman MD,Donna Stanbridge RN,Gerald M Fried, Steinberg-
Bernstein Center for Minimally Invasive Surgery, McGill
University
CHARACTERIZING THE LEARNING CURVE FOR A BASIC
LAPAROSCOPIC DRILL
Shannon A. Fraser MD, Liane S. Feldman MD, Donna
Stanbridge RN, Gerald M. Fried MD Steinberg-Bernstein
Centre for Minimally Invasive Surgery, McGill University,
Montreal, Canada.
Background: Psychomotor challenges inherent in laparoscopic
surgery are evident by the steep procedural ?learning curves?
documented throughout the literature. Few methods have
been described to evaluate learning curves. The cumulative
summation (CUSUM) method is a criterion-based evaluation
of the learning process. The purpose of this study is to
describe the CUSUM learning curves for a simple task for individuals
and for a group of novice laparoscopists. Methods: 16
medical students did 40 repetitions of MISTELS laparoscopic
peg transfers. Performance was recorded for each trial.
CUSUM learning curves were constructed based on the goal
of achieving mean scores for senior, intermediate or junior
laparoscopists >95% time. Results: Based on senior criteria, 1
student achieved the goal by the 40th trial; based on intermediate
criteria, 3 achieved the goal by the 40th trial (trials 21,
36), and for junior criteria, 10 achieved the acceptable success
rate by the 40th trial (range = 26-40).
Conclusion: CUSUM analysis suggests criterion-based practice
is useful for novice laparoscopists. It allows educators to track
an individual’s progress toward specific performance
goals for each MISTELS task, to more logically allocate the
required time for training and set attainable goals, to objectively
evaluate trainee acquisition of basic laparoscopic skills,
and to identify trainees who need remediation.
P155–Education/Outcomes
OBJECTIVE ASSESSMENT OF LAPAROSCOPIC SKILLS USING
A VIRTUAL REALITY SIMULATOR ? CORREALTION WITH PER-
FORMANCE IN THE OPERATING ROOM, Teodor P Grantcharov
PhD, J Ravn Eriksen MD,PF Caushaj MD,P Funch Jensen MD,
Department of Surgery, Copenhagen University, Glostrup
Hospital, Denmark, Department of Surgery, Aarhus University,
Kommunehospitalet, Denmark, The Western Pennsylvania
Hospital, Pittsburgh, USA
BACKGROUND
The study was carried out to validate the role of virtual reality
computer simulation as a method for assessment of psychomotor
skills in laparoscopic surgery. We aimed to investigate
whether performance in the OR, assessed using a modified
OSATS correlated with the performance parameters, registered
by LapSim during simulated laparoscopic tasks.
MATERIALS AND METHODS
Ten surgical residents with similar, limited experience in
laparoscopic surgery (median 5 (range 1-16) laparoscopic
cholecystectomies) were included in the study. All participants
performed 3 repetitions of all 7 tasks on the LapSim trainer
and one laparoscopic cholecystectomy in the OR. The OR procedure
was video recorded and blindly assessed by 2 independent
observers using a modified OSATS rating scale.
Assessment in the OR was based on 3 parameters: time used,
error score and economy of motion score. During the tasks on
LapSim, time, error- (tissue damage, mm tissue damage (tasks
2-6) and error score (task 7)) and economy of movement
parameters (path length, angular path) were registered. Data
was analysed using Spearman?s test.
RESULTS
Significant correlations were demonstrated between time used
to complete the OR procedure and task 7 (p=0.015). Error score
demonstrated during the laparoscopic cholecystectomy correlated
well with tissue damage (task 4 (p=0.04), task 5 (p=0.05)
and task 6 (p=0.01)); mm tissue damage (task 3 (p=0.001), task
6 (p=0.028)); and error score in task 7 (p=0.034). Furthermore,
statistically significant correlations were observed between
economy of motion score from the operative procedure and
LapSim?s economy parameters ? path length (task 1 (p=0.028),
task 2 (p=0.006), task 3 (p=0.004), task 4 (p=0.001), task 5
(p