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Papers by Daniel Jones

Essential Practice of Surgery, 2003

The SAGES Manual of Quality, Outcomes and Patient Safety, 2011

Surgical Research, 2001

During the last 10 years, minimally invasive surgery has influenced the techniques used in every ... more During the last 10 years, minimally invasive surgery has influenced the techniques used in every specialty of surgical medicine. This development has not only led to the replacement of conventional procedures with minimally invasive ones, but has also stimulated ...

American Journal of Surgery, 2001

Background: The purpose of this study was to quantify the learning curve of a previously validate... more Background: The purpose of this study was to quantify the learning curve of a previously validated laparoscopic skills curriculum.Methods: Second-year medical students (MS2, n = 11) and second (PGY2, n = 11) and third (PGY3, n = 6) year surgery residents were enrolled into a curriculum using five video-trainer tasks. All subjects underwent baseline testing, training (30 minutes per day for 10 days), and final testing. Scores were based on completion time. The relationship between task completion time and the number of practice repetitions was examined. Improvement (the difference in baseline and final performance) amongst groups was compared by one-way analysis of variance using the baseline score as a covariate; P <0.05 indicated significance.Results: Baseline scores were not significantly different. Final scores were significantly better for MS2s versus PGY3s. Adjusted-improvement was significantly larger for the MS2s compared with PGY2s and PGY3s, and for PGY2s compared with PGY3s. The mean number of repetitions corresponding to a predicted 90th percentile score was 32.Conclusions: Inexperienced subjects benefit the most from skills training. For maximal benefit, we recommend that each task be practiced for at least 30 to 35 repetitions.

Ground Water, 1986

Microbial biomass, community structure and activity were determined in the subsurface horizons of... more Microbial biomass, community structure and activity were determined in the subsurface horizons of four contrasting soil types common to Alabama. Biomass and community structure were determined by analyzing the fatty acids of the extractable phospholipids. Activity was estimated by measuring the rate of enzymatic hydrolysis of fluorescein diacetate (FDA). In all four soils, biomass and activity declined with increasing depth; however, the magnitude and pattern of this decline varied as a function of soil type. Biomass concentrations in the lower Ap horizon ranged from 8.2 to 18.0 nmoles phospholipid/g dry wt soil. In the deepest subsoil horizons, the range was 0.0085 to 0.059 nmoles phospholipid/g dry wt soil. The rate of FDA hydrolysis was highly correlated with biomass (r=0.90). Polyenoic fatty acids, which are present only in cukaryotic microorganisms, were found in all horizons; however, their relative abundance differed as a function of soil type. Stepwise regression analysis revealed that soil characteristics could explain 89 and 82% of the variation in biomass and activity, respectively. The results indicated that the vertical distribution of microorganisms in a soil profile differs greatly as a function of soil type. Hence, soil type may be an important determinant as to whether potential ground-water pollutants are biodegraded as they pass through the unsaturated zone of a soil profile.

American Journal of Surgery, 2001

Background: Traditionally, the acquisition of surgical skill has occurred entirely in the operati... more Background: Traditionally, the acquisition of surgical skill has occurred entirely in the operating room. To meet the expanding challenges of cost containment and patient safety, novel methods of surgical training utilizing ex-vivo workstations are being developed. The purpose of our study was to evaluate the impact of a laparoscopic training curriculum on surgical residents' operative performance. Methods: Twenty-one surgery residents completed baseline laparoscopic total extraperitoneal (TEP) hernia repairs. Operative performance was evaluated using a validated global assessment tool. Each resident was then randomized to a control group or a trained group. A CD ROM, video, and simulator were used for training. At the end of the study, each resident's operative performance was again evaluated. Results: Improvement was significantly greater in the trained group in five of the eight individual global assessment areas as well as the composite score (P Ͻ0.05). Questionnaire data suggested that training resulted in improved understanding of the TEP hernia repair (P ϭ 0.01) and an increased willingness to offer the operation to patients with nonrecurrent unilateral hernias (P ϭ 0.02). Conclusions: A multimodality laparoscopic TEP hernia curriculum improves residents' knowledge of the TEP hernia repair and comfort in performing the procedure, and may also improve actual operative performance.

Current Microbiology, 1998

Multiplex PCR amplification of uidA, cth, invA, ctx, and tl genes was developed enabling simultan... more Multiplex PCR amplification of uidA, cth, invA, ctx, and tl genes was developed enabling simultaneous detection in shellfish of Escherichia coli, an indicator of fecal contamination and microbial pathogens, Salmonella typhimurium, Vibrio vulnificus, V. cholerae, and V. parahaemolyticus, respectively. Each of the five pairs of oligonucleotide primers was found to support PCR amplifications of only its targeted gene. The optimized multiplex PCR reaction utilized a PCR reaction buffer containing 2.5 mM MgCl2 and primer annealing temperature of 55°C. Oyster tissue homogenate seeded with these microbial pathogens was subjected to DNA purification by the Chelex™ 100 (BioRad) method. The sensitivity of detection for each of the microbial pathogens was ≤101–102 cells following a “double” multiplex PCR amplification approach. Amplified target genes in a multiplex PCR reaction were subjected to a colorimetric GeneComb™ (BioRad) DNA-DNA hybridization assay. This assay was rapid and showed sensitivity of detection comparable to the agarose gel electrophoresis method. The colorimetric GeneComb™ assay avoids use of hazardous materials inherent in conventional gel electrophoresis and radioactive-based hybridization methods. Multiplex PCR amplification, followed by colorimetric GeneComb™ DNA-DNA hybridization, has been shown to be an effective, sensitive, and rapid method to detect microbial pathogens in shellfish.

Surgery, 1997

Background. Recent advances in minimally invasive surgical technology have the potential to lead ... more Background. Recent advances in minimally invasive surgical technology have the potential to lead to new applications outside body cavities. The purpose of the present study was to develop techniques for obtaining endoscopic exposure and access to the pretracheal space in the neck with the goal of performing neck exploration and parathyroidectomy and to evaluate the safety and efficacy of such an approach experimentally.Methods. The technique for endoscopic neck exploration was developed in eight adult mongrel dogs and was further evaluated in a survival dog model and in human cadavers. The pretracheal space was accessed by a 2.5 cm midline incision in the lower neck. This space was expanded with a balloon dissector, and exposure was maintained with an external lift device. A 5 or mm midline port and two to four lateral 5 mm cervical ports were placed, and dissection was carried out with pediatric endoscopic instruments and an ultrasonic coagulator. Excised parathyroid tissue was verified histologically.Results. Two-gland parathyroidectomy was successfully completed in five of six dogs; inadequate exposure led to a failed procedure in one animal. Mean operative time was 130 ± 6 minutes, and there were no operative complications. Serum calcium levels did not change significantly after operation (p = not significant). At autopsy, approximately 20 ml of clear sterile fluid was present in the pretracheal space of every dog. In five human cadavers mean dissection time for attempted four-gland parathyroidectomy was 69 ± 38 minutes (range, 45 to 135 minutes). Four of four parathyroids were identified and removed in two patients, three of three parathyroids in one patient, three of four parathyroids in one patient, and two of four parathyroids in one patient.Conclusions. Parathyroidectomy may be performed safely and reliably in an animal model with minimally invasive techniques that can be applied to parathyroid dissection in human cadavers. These results suggest that an endoscopic approach to neck exploration and parathyroidectomy is potentially feasible and may warrant further study in clinical trials.

Journal of Microbiological Methods, 1999

Vibrio parahaemolyticus is an important human pathogen which can cause gastroenteritis when consu... more Vibrio parahaemolyticus is an important human pathogen which can cause gastroenteritis when consumed in raw or partially-cooked seafood. A multiplex PCR amplification-based detection of total and virulent strains of V. parahaemolyticus was developed by targeting thermolabile hemolysin encoded by tl, thermostable direct hemolysin encoded by tdh, and thermostable direct hemolysin-related trh genes. Following optimization using oligonucleotide primers targeting tl, tdh and trh genes, the multiplex PCR was applied to V. parahaemolyticus from 27 clinical, 43 seafood, 15 environmental, 7 strains obtained from various laboratories and 19 from oyster plants. All 111 V. parahaemolyticus isolates showed PCR amplification of the tl gene; however, only 60 isolates showed amplification of tdh, and 43 isolates showed amplification of the trh gene. Also, 18 strains showed amplification of the tdh gene, but these strains did not show amplification of the trh gene. However, one strain exhibited amplification for the trh but not the tdh gene, suggesting both genes need to be targeted in a PCR amplification reaction to detect all hemolysin-producing strains of this pathogen. The multiplex PCR approach was successfully used to detect various strains of V. parahaemolyticus in seeded oyster tissue homogenate. Sensitivity of detection for all three target gene segments was at least between 101–102 cfu per 10 g of alkaline peptone water enriched seeded oyster tissue homogenate. This high level of sensitivity of detection of this pathogen within 8 h of pre-enrichment is well within the action level (104 cfu per 1 g of shell stock) suggested by the National Seafood Sanitation Program guideline. Compared to conventional microbiological culture methods, this multiplex PCR approach is rapid and reliable for accomplishing a comprehensive detection of V. parahaemolyticus in shellfish.

Journal of The American College of Surgeons, 2000

Background: Developing technical skill is essential to surgical training, but using the operating... more Background: Developing technical skill is essential to surgical training, but using the operating room for basic skill acquisition may be inefficient and expensive, especially for laparoscopic operations. This study determines if laparoscopic skills training using simulated tasks on a video-trainer improves the operative performance of surgery residents.Study Design: Second- and third-year residents (n = 27) were prospectively randomized to receive formal laparoscopic skills training or to a control group. At baseline, residents had a validated global assessment of their ability to perform a laparoscopic cholecystectomy based on direct observation by three evaluators who were blinded to the residents’ randomization status. Residents were also tested on five standardized video-trainer tasks. The training group practiced the video-trainer tasks as a group for 30 minutes daily for 10 days. The control group received no formal training. All residents repeated the video-trainer test and underwent a second global assessment by the same three blinded evaluators at the end of the 1-month rotation. Within-person improvement was determined; improvement was adjusted for differences in baseline performance.Results: Five residents were unable to participate because of scheduling problems; 9 residents in the training group and 13 residents in the control group completed the study. Baseline laparoscopic experience, video-trainer scores, and global assessments were not significantly different between the two groups. The training group on average practiced the video-trainer tasks 138 times (range 94 to 171 times); the control group did not practice any task. The trained group achieved significantly greater adjusted improvement in video-trainer scores (five of five tasks) and global assessments (four of eight criteria) over the course of the four-week curriculum, compared with controls.Conclusions: Intense training improves video-eye-hand skills and translates into improved operative performance for junior surgery residents. Surgical curricula should contain laparoscopic skills training.

Journal of Urology, 2001

As laparoscopy has become more commonplace in urology, increased emphasis has been placed on lapa... more As laparoscopy has become more commonplace in urology, increased emphasis has been placed on laparoscopic education. We assessed the impact of laparoscopic skills training on the operative performance of urological surgeons inexperienced with laparoscopy. Urology residents were prospectively randomized to undergo laparoscopic skills training (6) or no training (6). Baseline assessment of operative performance (scale 0 to 35) during porcine laparoscopic nephrectomy was completed by all subjects. Cumulative time to complete laparoscopic tasks using an inanimate trainer was also recorded. The skills training group then practiced inanimate trainer tasks for 30 minutes daily for 10 days. The 2 groups then repeated the timed inanimate trainer tasks and underwent repeat assessment of the ability to perform porcine laparoscopic nephrectomy. At baseline no statistical difference was noted in laparoscopic experience, inanimate trainer time or overall operative assessment in the 2 groups. In the skills training group mean cumulative time to complete inanimate trainer tasks decreased from 341 to 176 seconds (p = 0.003), while in the control group it decreased from 365 to 301 (p = 0.15). Operative assessment improved from initial to repeat porcine laparoscopic nephrectomy regardless of the trained versus control randomization grouping (22.0 to 27.8, p = 0.0008 and 20.8 to 26.5, p = 0.00007, respectively). In vivo experience enables urological surgeons inexperienced with laparoscopy to improve significantly in all aspects of complex laparoscopic procedures. In this pilot study the magnitude of improvement was independent of additional training in laparoscopic skills. Educational curriculum should include in vivo practice in addition to skills training.

Diseases of The Colon & Rectum, 1995

BACKGROUND: Numerous anecdotal reports have documented the spread of colon cancer to trocar sites... more BACKGROUND: Numerous anecdotal reports have documented the spread of colon cancer to trocar sites after laparoscopic-assisted colectomy. We hypothesized that the pneumoperitoneum of laparoscopy potentiated tumor adherence to trocar sites. PURPOSE: This study was designed to determine the affect of CO 2 pneumoperitoneum on the rate of tumor implantation at trocar sites. METHODS: Viable GW-39 human colon cancer cells were injected into the abdominal cavity of hamsters (2 × 10 6 cells/hamster). A midline laparotomy, insertion of four 5-mm trocars, injection of viable cells into the mesentery of the cecum, and free peritoneal cavity was performed in two groups: one control group (41) who did not receive a pneumoperitoneum and a comparison group (50) who underwent pneumoperitoneum for ten minutes at an insufflation pressure of 10 mmHg. Animals were killed at six weeks, and hematoxylin and eosin-stained sections of trocar wounds, midline wound, small intestine, cecum, liver, and lung were examined by a veterinary pathologist, who was blinded to operation. RESULTS: Pneumoperitoneum increased tumor implantation in the cecal mesentery and the midline incision (P vs.75 percent) (P Pneumoperitoneum increased implantation of free intra-abdominal cancer cells at wound sites on the abdominal wall or within the abdominal cavity in this animal model. The use of pneumoperitoneum during laparoscopy in patients with colon cancer should only be performed in a protocol setting to evaluate the effect of pneumoperitoneum on the treatment of cancer.

Essential Practice of Surgery, 2003

The SAGES Manual of Quality, Outcomes and Patient Safety, 2011

Surgical Research, 2001

During the last 10 years, minimally invasive surgery has influenced the techniques used in every ... more During the last 10 years, minimally invasive surgery has influenced the techniques used in every specialty of surgical medicine. This development has not only led to the replacement of conventional procedures with minimally invasive ones, but has also stimulated ...

American Journal of Surgery, 2001

Background: The purpose of this study was to quantify the learning curve of a previously validate... more Background: The purpose of this study was to quantify the learning curve of a previously validated laparoscopic skills curriculum.Methods: Second-year medical students (MS2, n = 11) and second (PGY2, n = 11) and third (PGY3, n = 6) year surgery residents were enrolled into a curriculum using five video-trainer tasks. All subjects underwent baseline testing, training (30 minutes per day for 10 days), and final testing. Scores were based on completion time. The relationship between task completion time and the number of practice repetitions was examined. Improvement (the difference in baseline and final performance) amongst groups was compared by one-way analysis of variance using the baseline score as a covariate; P <0.05 indicated significance.Results: Baseline scores were not significantly different. Final scores were significantly better for MS2s versus PGY3s. Adjusted-improvement was significantly larger for the MS2s compared with PGY2s and PGY3s, and for PGY2s compared with PGY3s. The mean number of repetitions corresponding to a predicted 90th percentile score was 32.Conclusions: Inexperienced subjects benefit the most from skills training. For maximal benefit, we recommend that each task be practiced for at least 30 to 35 repetitions.

Ground Water, 1986

Microbial biomass, community structure and activity were determined in the subsurface horizons of... more Microbial biomass, community structure and activity were determined in the subsurface horizons of four contrasting soil types common to Alabama. Biomass and community structure were determined by analyzing the fatty acids of the extractable phospholipids. Activity was estimated by measuring the rate of enzymatic hydrolysis of fluorescein diacetate (FDA). In all four soils, biomass and activity declined with increasing depth; however, the magnitude and pattern of this decline varied as a function of soil type. Biomass concentrations in the lower Ap horizon ranged from 8.2 to 18.0 nmoles phospholipid/g dry wt soil. In the deepest subsoil horizons, the range was 0.0085 to 0.059 nmoles phospholipid/g dry wt soil. The rate of FDA hydrolysis was highly correlated with biomass (r=0.90). Polyenoic fatty acids, which are present only in cukaryotic microorganisms, were found in all horizons; however, their relative abundance differed as a function of soil type. Stepwise regression analysis revealed that soil characteristics could explain 89 and 82% of the variation in biomass and activity, respectively. The results indicated that the vertical distribution of microorganisms in a soil profile differs greatly as a function of soil type. Hence, soil type may be an important determinant as to whether potential ground-water pollutants are biodegraded as they pass through the unsaturated zone of a soil profile.

American Journal of Surgery, 2001

Background: Traditionally, the acquisition of surgical skill has occurred entirely in the operati... more Background: Traditionally, the acquisition of surgical skill has occurred entirely in the operating room. To meet the expanding challenges of cost containment and patient safety, novel methods of surgical training utilizing ex-vivo workstations are being developed. The purpose of our study was to evaluate the impact of a laparoscopic training curriculum on surgical residents' operative performance. Methods: Twenty-one surgery residents completed baseline laparoscopic total extraperitoneal (TEP) hernia repairs. Operative performance was evaluated using a validated global assessment tool. Each resident was then randomized to a control group or a trained group. A CD ROM, video, and simulator were used for training. At the end of the study, each resident's operative performance was again evaluated. Results: Improvement was significantly greater in the trained group in five of the eight individual global assessment areas as well as the composite score (P Ͻ0.05). Questionnaire data suggested that training resulted in improved understanding of the TEP hernia repair (P ϭ 0.01) and an increased willingness to offer the operation to patients with nonrecurrent unilateral hernias (P ϭ 0.02). Conclusions: A multimodality laparoscopic TEP hernia curriculum improves residents' knowledge of the TEP hernia repair and comfort in performing the procedure, and may also improve actual operative performance.

Current Microbiology, 1998

Multiplex PCR amplification of uidA, cth, invA, ctx, and tl genes was developed enabling simultan... more Multiplex PCR amplification of uidA, cth, invA, ctx, and tl genes was developed enabling simultaneous detection in shellfish of Escherichia coli, an indicator of fecal contamination and microbial pathogens, Salmonella typhimurium, Vibrio vulnificus, V. cholerae, and V. parahaemolyticus, respectively. Each of the five pairs of oligonucleotide primers was found to support PCR amplifications of only its targeted gene. The optimized multiplex PCR reaction utilized a PCR reaction buffer containing 2.5 mM MgCl2 and primer annealing temperature of 55°C. Oyster tissue homogenate seeded with these microbial pathogens was subjected to DNA purification by the Chelex™ 100 (BioRad) method. The sensitivity of detection for each of the microbial pathogens was ≤101–102 cells following a “double” multiplex PCR amplification approach. Amplified target genes in a multiplex PCR reaction were subjected to a colorimetric GeneComb™ (BioRad) DNA-DNA hybridization assay. This assay was rapid and showed sensitivity of detection comparable to the agarose gel electrophoresis method. The colorimetric GeneComb™ assay avoids use of hazardous materials inherent in conventional gel electrophoresis and radioactive-based hybridization methods. Multiplex PCR amplification, followed by colorimetric GeneComb™ DNA-DNA hybridization, has been shown to be an effective, sensitive, and rapid method to detect microbial pathogens in shellfish.

Surgery, 1997

Background. Recent advances in minimally invasive surgical technology have the potential to lead ... more Background. Recent advances in minimally invasive surgical technology have the potential to lead to new applications outside body cavities. The purpose of the present study was to develop techniques for obtaining endoscopic exposure and access to the pretracheal space in the neck with the goal of performing neck exploration and parathyroidectomy and to evaluate the safety and efficacy of such an approach experimentally.Methods. The technique for endoscopic neck exploration was developed in eight adult mongrel dogs and was further evaluated in a survival dog model and in human cadavers. The pretracheal space was accessed by a 2.5 cm midline incision in the lower neck. This space was expanded with a balloon dissector, and exposure was maintained with an external lift device. A 5 or mm midline port and two to four lateral 5 mm cervical ports were placed, and dissection was carried out with pediatric endoscopic instruments and an ultrasonic coagulator. Excised parathyroid tissue was verified histologically.Results. Two-gland parathyroidectomy was successfully completed in five of six dogs; inadequate exposure led to a failed procedure in one animal. Mean operative time was 130 ± 6 minutes, and there were no operative complications. Serum calcium levels did not change significantly after operation (p = not significant). At autopsy, approximately 20 ml of clear sterile fluid was present in the pretracheal space of every dog. In five human cadavers mean dissection time for attempted four-gland parathyroidectomy was 69 ± 38 minutes (range, 45 to 135 minutes). Four of four parathyroids were identified and removed in two patients, three of three parathyroids in one patient, three of four parathyroids in one patient, and two of four parathyroids in one patient.Conclusions. Parathyroidectomy may be performed safely and reliably in an animal model with minimally invasive techniques that can be applied to parathyroid dissection in human cadavers. These results suggest that an endoscopic approach to neck exploration and parathyroidectomy is potentially feasible and may warrant further study in clinical trials.

Journal of Microbiological Methods, 1999

Vibrio parahaemolyticus is an important human pathogen which can cause gastroenteritis when consu... more Vibrio parahaemolyticus is an important human pathogen which can cause gastroenteritis when consumed in raw or partially-cooked seafood. A multiplex PCR amplification-based detection of total and virulent strains of V. parahaemolyticus was developed by targeting thermolabile hemolysin encoded by tl, thermostable direct hemolysin encoded by tdh, and thermostable direct hemolysin-related trh genes. Following optimization using oligonucleotide primers targeting tl, tdh and trh genes, the multiplex PCR was applied to V. parahaemolyticus from 27 clinical, 43 seafood, 15 environmental, 7 strains obtained from various laboratories and 19 from oyster plants. All 111 V. parahaemolyticus isolates showed PCR amplification of the tl gene; however, only 60 isolates showed amplification of tdh, and 43 isolates showed amplification of the trh gene. Also, 18 strains showed amplification of the tdh gene, but these strains did not show amplification of the trh gene. However, one strain exhibited amplification for the trh but not the tdh gene, suggesting both genes need to be targeted in a PCR amplification reaction to detect all hemolysin-producing strains of this pathogen. The multiplex PCR approach was successfully used to detect various strains of V. parahaemolyticus in seeded oyster tissue homogenate. Sensitivity of detection for all three target gene segments was at least between 101–102 cfu per 10 g of alkaline peptone water enriched seeded oyster tissue homogenate. This high level of sensitivity of detection of this pathogen within 8 h of pre-enrichment is well within the action level (104 cfu per 1 g of shell stock) suggested by the National Seafood Sanitation Program guideline. Compared to conventional microbiological culture methods, this multiplex PCR approach is rapid and reliable for accomplishing a comprehensive detection of V. parahaemolyticus in shellfish.

Journal of The American College of Surgeons, 2000

Background: Developing technical skill is essential to surgical training, but using the operating... more Background: Developing technical skill is essential to surgical training, but using the operating room for basic skill acquisition may be inefficient and expensive, especially for laparoscopic operations. This study determines if laparoscopic skills training using simulated tasks on a video-trainer improves the operative performance of surgery residents.Study Design: Second- and third-year residents (n = 27) were prospectively randomized to receive formal laparoscopic skills training or to a control group. At baseline, residents had a validated global assessment of their ability to perform a laparoscopic cholecystectomy based on direct observation by three evaluators who were blinded to the residents’ randomization status. Residents were also tested on five standardized video-trainer tasks. The training group practiced the video-trainer tasks as a group for 30 minutes daily for 10 days. The control group received no formal training. All residents repeated the video-trainer test and underwent a second global assessment by the same three blinded evaluators at the end of the 1-month rotation. Within-person improvement was determined; improvement was adjusted for differences in baseline performance.Results: Five residents were unable to participate because of scheduling problems; 9 residents in the training group and 13 residents in the control group completed the study. Baseline laparoscopic experience, video-trainer scores, and global assessments were not significantly different between the two groups. The training group on average practiced the video-trainer tasks 138 times (range 94 to 171 times); the control group did not practice any task. The trained group achieved significantly greater adjusted improvement in video-trainer scores (five of five tasks) and global assessments (four of eight criteria) over the course of the four-week curriculum, compared with controls.Conclusions: Intense training improves video-eye-hand skills and translates into improved operative performance for junior surgery residents. Surgical curricula should contain laparoscopic skills training.

Journal of Urology, 2001

As laparoscopy has become more commonplace in urology, increased emphasis has been placed on lapa... more As laparoscopy has become more commonplace in urology, increased emphasis has been placed on laparoscopic education. We assessed the impact of laparoscopic skills training on the operative performance of urological surgeons inexperienced with laparoscopy. Urology residents were prospectively randomized to undergo laparoscopic skills training (6) or no training (6). Baseline assessment of operative performance (scale 0 to 35) during porcine laparoscopic nephrectomy was completed by all subjects. Cumulative time to complete laparoscopic tasks using an inanimate trainer was also recorded. The skills training group then practiced inanimate trainer tasks for 30 minutes daily for 10 days. The 2 groups then repeated the timed inanimate trainer tasks and underwent repeat assessment of the ability to perform porcine laparoscopic nephrectomy. At baseline no statistical difference was noted in laparoscopic experience, inanimate trainer time or overall operative assessment in the 2 groups. In the skills training group mean cumulative time to complete inanimate trainer tasks decreased from 341 to 176 seconds (p = 0.003), while in the control group it decreased from 365 to 301 (p = 0.15). Operative assessment improved from initial to repeat porcine laparoscopic nephrectomy regardless of the trained versus control randomization grouping (22.0 to 27.8, p = 0.0008 and 20.8 to 26.5, p = 0.00007, respectively). In vivo experience enables urological surgeons inexperienced with laparoscopy to improve significantly in all aspects of complex laparoscopic procedures. In this pilot study the magnitude of improvement was independent of additional training in laparoscopic skills. Educational curriculum should include in vivo practice in addition to skills training.

Diseases of The Colon & Rectum, 1995

BACKGROUND: Numerous anecdotal reports have documented the spread of colon cancer to trocar sites... more BACKGROUND: Numerous anecdotal reports have documented the spread of colon cancer to trocar sites after laparoscopic-assisted colectomy. We hypothesized that the pneumoperitoneum of laparoscopy potentiated tumor adherence to trocar sites. PURPOSE: This study was designed to determine the affect of CO 2 pneumoperitoneum on the rate of tumor implantation at trocar sites. METHODS: Viable GW-39 human colon cancer cells were injected into the abdominal cavity of hamsters (2 × 10 6 cells/hamster). A midline laparotomy, insertion of four 5-mm trocars, injection of viable cells into the mesentery of the cecum, and free peritoneal cavity was performed in two groups: one control group (41) who did not receive a pneumoperitoneum and a comparison group (50) who underwent pneumoperitoneum for ten minutes at an insufflation pressure of 10 mmHg. Animals were killed at six weeks, and hematoxylin and eosin-stained sections of trocar wounds, midline wound, small intestine, cecum, liver, and lung were examined by a veterinary pathologist, who was blinded to operation. RESULTS: Pneumoperitoneum increased tumor implantation in the cecal mesentery and the midline incision (P vs.75 percent) (P Pneumoperitoneum increased implantation of free intra-abdominal cancer cells at wound sites on the abdominal wall or within the abdominal cavity in this animal model. The use of pneumoperitoneum during laparoscopy in patients with colon cancer should only be performed in a protocol setting to evaluate the effect of pneumoperitoneum on the treatment of cancer.