Videogames offer the usual skills needed for laparoscopy namely, eye-hand coordination, depth perception, and bimanual operation. The impact of playing videogames on basic laparoscopic skills is still ambiguous with some studies showing correlation and with other studies demonstrating little or no effect.

OBJECTIVE: To determine the impact of training with Nintendo® WiiTM in the improvement of basic laparoscopic skill among laparoscopic novices by measuring the time to completion of eye-hand coordination task, two-hand manipulation task, grasping and cutting task or grasping and clipping tasks.

METHODS: An electronic systematic search was done in online databases and search engines. This review included randomized prospective studies, written in English language, and published within the last 5 years. Participants included adults 19-29 years old, medical students and surgical residents, with a low video game experience, without or minimal experience in laparoscopic surgery and laparoscopic simulator. The studies compared the performance of participants in a laparoscopic simulator (SimbionixTM LapMentorTM or ProMIS) after training with Nintendo® WiiTM and measured their completion time of several tasks.

RESULTS: Training with Nintendo® WiiTM showed improvement in time to completion of eye-hand coordination task, two-hand manipulation task, and grasping and clipping task. The study however showed equivocal results in the grasping and cutting tasks.

CONCLUSION: Training with Nintendo® WiiTM can be used as a training tool for the improvement of basic laparoscopic skills of laparoscopic novices.

Human ; Adult ; Video Games ; Students, Medical ; Search Engine ; Laparoscopy ; Depth Perception

Background: Postoperative urinary retention is a commonly encountered problem after anal surgery particularly under spinal anesthesia. Bethanchol chloride, a muscarinic cholinergic receptor agonist was used to determine whether it could prevent this problem. Methods: One hundred six patients with mean age of 37+ 9 who underwent anal surgery under spinal anesthesia from January to August 2007 were included in this nonblinded randomized prospective experimental study. Forty- six patients were given bethanechol chloride 25mg/tab 1 hour post- op then another dose after 4-6 hours. Those with the urge to void but unable to do so within the hour or had hypogastric pain (VAS > 8) were immediately catheterized and the amount drain recorded. Conclusion: Although bethanechol chloride did not completely prevent the development of postoperative urinary retention, it use was associated with reduced need for the catheterization.
Human ; Adult ; BETHANECHOL ; URINARY RETENTION ; ANESTHESIA, SPINAL

Objective: This study sought to validate Surgical APGAR Score in predicting major postoperative complications 30 days after surgery in our hospital setting. Methods: All patients undergoing major general surgery in Chinese General Hospital and Medical Center from March to October 2009 were enrolled. Three intraoperative variables were measured: estimated blood loss (EBL), lowest mean arterial pressure (LMAP) and lowest heart rate (LHR). Base on these three variables, Surgical APGAR Scores were obtained. Resulting data were analyzed and the relationship between the scores and the incidence of major complications evaluated. Results: Eighty patients were enrolled in this study. There was a significant association of incidence of major complications decreased monotonically. The optimum cutoff point was <= 6. At this cutoff point, sensitivity was 80%, specificity was 78.57%, positive predictive value was low at 34.8%, while negative predictive value was high at 96.5%. Conclusion: Results showed that a simple surgical score can be derived from intraoperative data alone that are readily available. It validated that this 10-point scoring system based on estimated blood loss (EBL), lowest mean arterial pressure (LAMP) and lowest heart rate (LHR) can predict group of patients at higher risk of major complications within 30 days of surgery. This system can be a significant tool for prognostification and clinical guide for early intervention of postoperative care in surgery. Key words: estimated blood loss, lowest mean arterial pressure
BLOOD LOSS, SURGICAL

The analgesic effect of intraperitoneal bupivacaine has been widely studied, but with controversial results.
OBJECTIVE: To determine the efficacy of intraperitoneal bupivacaine on  producing  postoperative  analgesia  in  patients  who  underwent laparoscopic  cholecystectomy.
METHODS: A systematic literature search on the use of intraperitoneal bupivacaine in reducing postoperative pain was done using Medline and Cochrane. The search yielded 6 randomized controlled trials,involving a total of 440 patients. Mean differences in visual analog pain score at 0, 2, 4, 6, 8, 12, and 24 hours post-surgery were pooled using random effects model.
RESULTS: Overall, there was a significant reduction of pain score in the bupivacaine group with VAS score of -0.55 cm (95% CI, -0.80 to -0.31). Subgroup analysis at 0, 2, 4, 6, 8, and 12 hours post-surgery showed statistically significant mean differences in the VAS score of  -1.59 cm (95% CI, -2.31 to -0.86), -0.60 cm (95% CI, -1.02 to -0.17), -0.80 cm  (95% CI, -1.34 to -0.26),  -0.85 cm  (95% CI, -1.46 to -0.24), -0.64 cm  (95% CI, -1.12 to -0.16), and -0.38 cm  (95% CI,-0.68  to  -0.08),  respectively,  in  favor  of  the  bupivacaine  group.However,  at  24  hours  post-surgery,  there  was  no  statistically significant mean difference in the VAS score of -0.09 cm (95% CI,-0.49 to 0.31).
CONCLUSION: Intraperitoneal bupivacaine instillation among patients undergoing laparoscopic cholecystectomy is effective in providing postoperative analgesia specifically in the first 12 hours post-op.

Human ; Bupivacaine ; Cholecystectomy, Laparoscopic ; Pain, Postoperative ; Cholecystectomy ; Laparoscopy ; Analgesia ; Analgesics