Urolithiasis, Endourology and Laparoscopy

Urological Survey UROLITHIASIS, ENDOUROLOGY AND LAPAROSCOPY A Laparoscopic Simulator Tool for Objective Measurement of Residents’ Laparoscopic Ability R. Bell, P. Maseelall, J. Fanning, B. Fenton and R. Flora, Department of Obstetrics and Gynecology, Summa Health System, Northeastern Ohio Universities College of Medicine, Akron, Ohio JSLS 2007; 11: 470 – 473. Objective: We sought to develop an objective measurement of residents’ laparoscopic ability by using a laparoscopic simulator assessment tool. Methods: An inexpensive laparoscopic simulator was developed. Three laparoscopic assessment procedures were created: 1) bead/pom-pom drop, 2) checkerboard drill, and 3) bead manipulation. Two minimally invasive surgeons and 8 PGY 3/4 and 15 PGY 1 residents were timed performing the 3 procedures. Ten of the PGY 1 residents were retested at the end of their PGY 1 year. Results: The minimally invasive surgeons completed the laparoscopic drills in approximately half the time of the PGY 3/4 (P⫽0.02), and PGY 3/4 were 60% faster than PGY 1 (P⫽0.01). PGY 1 completed the drills in half the time at the end of the PGY 1 year (P⫽0.005). As an objective measurement of residents’ laparoscopic surgery competency, by the completion of the academic year, all PGY 1 residents must be able to complete the drills as fast as or faster than the original PGY 3/4 times. Conclusion: We developed an inexpensive, objective, simple laparoscopic simulator assessment tool for measurement of residents’ laparoscopic ability. Editorial Comment: Using 3 simple low-level exercises (bead drop, checkerboard drill of putting tiles onto their respective letters and bead manipulation onto a curved hook) in a homemade $300 pelvic trainer, the authors noted statistically significant differences in time to completion among postgraduate year (PGY) 1 residents, PGY 3/4 residents and postgraduate surgeons. They then REQUIRED all PGY 1 residents to be able to complete the drills as fast as the original PGY 3/4 times. Herein lie the seeds of an ongoing psychomotor curriculum with definite benchmarks. While these types of developments will stimulate residents to practice their skills outside the operating room, they cannot be used as tests to determine suitability for promotion to the next year. Indeed, until such time that these “drills” are shown to be predictive of actual operating room performance via observed structured assessments of technical skills, they will not achieve the scientific proof necessary for them to become standards for testing practical skills at certification or recertification. Ralph Clayman, M.D.

ADRENAL AND RENAL PHYSIOLOGY, AND MEDICAL RENAL DISEASE The Elderly Patient and Postoperative Pain Treatment F. Aubrun and F. Marmion, Department of Anesthesiology and Critical Care, Groupe Hospitalier Pitie-Salpetriere, Assistance Publique-Hopitaux de Paris, Universite Pierre et Marie Curie, Paris, France Best Pract Res Clin Anaesthesiol 2007; 21: 109 –127. The management of postoperative pain in elderly patients can be a difficult task. Older patients have co-existing diseases and concurrent medications, diminished functional status and physiological reserve and age-related pharmacodynamic and pharmacokinetic changes. Pain assessment presents numerous problems arising from differences in reporting cognitive impairment and difficulties in measurement. The elderly are also at higher risk of adverse consequences from surgery and unrelieved or undertreated pain. Selection of analgesic therapy needs to balance the potential efficacy with the incidence of interactions, complications or side effects in the post-operative period. Drug titration in the post-anaesthesia care unit should be encouraged together with analgesia on request in the wards. Multimodal analgesia, using acetaminophen, non-steroidal anti-inflammatory drugs or other non opioid drugs, is the best way to 0022-5347/08/1802-0673/0 THE JOURNAL OF UROLOGY® Copyright © 2008 by AMERICAN UROLOGICAL ASSOCIATION

673

Vol. 180, 673-674, August 2008 Printed in U.S.A. DOI:10.1016/j.juro.2008.04.092