2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
BSP used or perceptions of the relative safety of LS.
Conclusion: Occupational exposures among surgical residents
are less common in LS as compared with open surgery.
Operating laparoscopically did not influence the BSP used by
surgical trainees during surgery, even though the majority of
surgical residents feel LS is safer.
P163–Education/Outcomes
EARLY VERSUS DELAYED INTERVAL LAPAROSCOPIC CHOLE-
CYSTECTOMY FOR ACUTE CHOLECYSTITIS: A META-ANALY-
SIS, Hung Lau MD, University of Hong Kong Medical Center,
Tung Wah Hospital, Sheung Wan, Hong Kong
Background: Early laparoscopic cholecystectomy has been
advocated for the management of acute cholecystitis but little
data exists to support the superiority of this approach over
delayed interval operation. The present systematic review was
undertaken to compare the outcomes and efficacy of early and
delayed interval laparoscopic cholecystectomy for acute cholecystitis
in an evidence-based approach using meta-analytical
techniques.
Methods: A search of electronic databases, including MEDLINE
and EMBASE, was conducted to identify relevant articles published
between January 1988 and June 2004. Only randomized
or quasi-randomized prospective clinical trials in English language
comparing the outcomes of early and delayed interval
laparoscopic cholecystectomy for acute cholecystitis were
recruited. All papers were critically appraised with respect to
their methodology and outcome. Both qualitative and quantitative
statistical analyses were carried out. The effect size of
outcome parameters was estimated by odds ratio and weight
mean difference where feasible and appropriate.
Results: A total of 4 clinical trials comprising 504 patients met
the inclusion criteria. Failure of conservative treatment requiring
emergency cholecystectomy occurred in 42 patients in the
delayed group. Meta-analyses demonstrated a significant
shortening in the total length of hospital stay in the early
group (weighted mean difference = - 1.12, 95% CI = -1.42 to
¡V0.99, P < 0.001). Pooled estimates of operative time, conversion
rate, overall complication rate, bile leakage and intraabdominal
collection showed no significant differences between
two approaches.
Conclusions: The safety and efficacy of early and delayed
interval laparoscopic cholecystectomy for acute cholecystitis
were comparable. Evidence suggested that early laparoscopic
cholecystectomy conferred a significant shortening in the total
length of hospital stay. Early cholecystectomy is therefore a
cost-effective approach and reduces the risk of recurrent acute
cholecystitis or development of other biliary complications.
P164–Education/Outcomes
TELESURGERY ENHANCES EDUCATION OF MEDICAL STU-
DENTS, Thomas P McIntyre MD, Leonardo Villegas
MD,Jennifer Doyle BA,Daniel B Jones, Beth Israel Deaconess
Medical Center, Harvard University
INTRODUCTION: Telesurgery (TS) may improve the learning
environment for third year medical students. Our aim was to
evaluate the TS environment vs. the traditional Operating
Room (OR) in two aspects: student satisfaction and studentfaculty
interaction. METHODS: Typical OR learning during the
third year medical student surgery clerkship was supplemented
with two TS sessions to which all students (n=11) were
invited. Faculty-student interaction was evaluated by an independent
observer in both settings. Surgeons and students
were blinded to the study. Students also completed a questionnaire
evaluating each setting. (scale: 1=not at all; 5=completely).
Analysis was performed using a T-Test. RESULTS: The
average time allotted to sessions were; TS=77.5 min; OR=76
min. A total of 12 observations were conducted (TS=2; OR=10),
and 29 evaluations were returned (TS=19; OR=10).
Observations revealed that nearly 4 times as many teaching
points were made in TS sessions: students asked 5 times more
questions; and faculty asked 3 times more questions of students.
In addition teaching points made in TS sessions were
broader than anatomy and surgical technique. [See Table]
Student evaluations of the TS sessions were more positive:
they felt freer to ask questions, reported leaving TS sessions
168 http://www.sages.org/
with fewer unanswered questions and more felt TS sessions
were a good use of their time.
CONCLUSIONS: This study suggests that TS sessions provide
a positive learning environment for third year students,
enabling greater student-faculty interaction. TS sessions allow
the scope of clerkship teaching to expand beyond anatomy
and surgical technique.
P165–Education/Outcomes
VIRTUAL REALITY TESTING ON THE EFFECTS OF SLEEP
DEPRIVATION, Benjamin E Schneider MD, Louis C Rivera BS,
Leonardo Villegas MD,Daniel B Jones MD, Beth Israel
Deaconess Hospital, Harvard Medical School
Background: Sleep deprivation has been shown to increase
technical errors in a virtual reality simulated environment
among surgical residents averaging 2 hours of sleep on call.
Recent adoption of resident work hour restrictions may obviate
the impact of sleep deprivation.
Aim: The purpose of this study was to objectively mesure the
performance of residents when rested and when sleep
deprived.
Methods: Volunteer surgical residents (N=18) were enrolled
prospectively. Residents underwent pre-test instruction, randomization,
and served as their own controls. Questionnaires
assessed sleep, caffeine intake, and subjective measure of
?tiredness.? Testing was directly observed, although actual
assessment was computer-generated using the Minimally
Invasive Surgery Trainer, Virtual Reality (MIST-VR) with a
series of six tasks designed to simulate simple laparoscopic
procedures. Outcomes included speed, error, economy of
motion, and economy of diathermy.
Results: Rested residents reported an average of 6.45 hours
(range 1-13) since last period of sleep compared to an average
of 18.76 hours (range 5.8-33.5) for sleep-deprived residents.
Rested residents reported the length of their last sleep period
to be an average of 5.89 hours (range 4.5-8) while sleepdeprived
residents reported their last sleep as an average of
4.83 hours (range 1.75-7).
Conclusion: In the era of shortened workweek, while residents
report fatigue, resident performance in a simulated learning
environment does not seem to be adversely affected due to
sleep deprivation.
P166–Education/Outcomes
THE IMPACT OF HAPTIC EXPECTATIONS ON INITIAL LAPSIM®
PERFORMANCE: PRIOR LAPAROSCOPIC EXPERIENCE DOES
NOT PREDICT PERFORMANCE, Charles Y Ro MD, Joseph J
DeRose MD,Robert C Ashton MD,Tony Jebara PhD,Avinash
Burra MS,Seung H Shin MD,Haroon L Chughtai MD,George J
Todd MD,James J McGinty MD, St. Luke’s-Roosevelt Hospital
Center, Columbia University
Experts and novices may have different expectations when
confronted with a novel simulated environment. The LapSim®
is a computer-based virtual reality laparoscopic trainer. We
sought to analyze the performance of experienced basic
laparoscopists and novices during their first exposure to the
LapSim® Basic Skill set and Dissection module.
Experienced basic laparoscopists (n=16) were defined as
attending surgeons and chief residents who performed > 30
laparoscopic cholecystectomies. Novices (n=13) were surgical
residents with minimal laparoscopic experience. None of the