Royal Australasian College of Surgeons

About: Royal Australasian College of Surgeons is a education organization based out in Melbourne, Victoria, Australia. It is known for research contribution in the topics: Poison control & Audit. The organization has 436 authors who have published 512 publications receiving 13280 citations. The organization is also known as: RACS.

A systematic review of skills transfer after surgical simulation training.

Abstract: Objective: To determine whether skills acquired by simulationbased training transfer to the operative setting. Summary Background Data: The fundamental assumption of simulation-based training is that skills acquired in simulated settings are directly transferable to the operating room, yet little evidence has focused on correlating simulated performance with actual surgical performance. Methods: A systematic search strategy was used to retrieve relevant studies. Inclusion of articles was determined using a predetermined protocol, independent assessment by 2 reviewers, and a final consensus decision. Only studies that reported on the use of simulationbased training for surgical skills training, and the transferability of these skills to the operative setting, were included. Results: Ten randomized controlled trials and 1 nonrandomized comparative study were included in this review. In most cases, simulation-based training was in addition to normal training programs. Only 1 study compared simulation-based training with patient-based training. For laparoscopic cholecystectomy and colonoscopy/sigmoidoscopy, participants who received simulation-based training before undergoing patient-based assessment performed better than their counterparts who did not receive previous simulation training, but improvement was not demonstrated for all measured parameters. Conclusions: Skills acquired by simulation-based training seem to be transferable to the operative setting. The studies included in this review were of variable quality and did not use comparable simulation-based training methodologies, which limited the strength of the conclusions. More studies are required to strengthen the evidence base and to provide the evidence needed to determine the extent to which simulation should become a part of surgical training programs. (Ann Surg 2008;248: 166‐179)

Surgical simulation: a systematic review.

Abstract: Objective: To evaluate the effectiveness of surgical simulation compared with other methods of surgical training.

Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review.

Abstract: Colorectal cancer can result in malignant obstruction of the colon or rectum, through the presence of either intrinsic or extrinsic tumors. Acute or subacute bowel obstruction can lead to abdominal pain, nausea, vomiting, bowel rupture, and eventual death if left untreated. Conventional therapies for relieving malignant colorectal obstruction include surgical resection (potentially curative) or palliative colostomy. Resection is more frequently an option in patients with less advanced cancer, and is ideally carried out as a single-stage procedure, with anastomosis to restore bowel continuity. Multistage procedures may also be undertaken, with resection and stoma formation in one procedure, followed by restoration of continuity in another procedure.1 However, a significant proportion of patients receiving a staged procedure never undergo reversal of the colostomy.2 Permanent stoma creation is the standard treatment of bowel obstruction caused by nonresectable tumors, relieving the symptoms of bowel obstruction. Although it is the standard treatment modality, stoma creation is associated with high morbidity and mortality rates, particularly when undertaken under emergency conditions.1 Furthermore, stoma creation is recognized as having a highly negative impact on patients' psychosocial well-being3 and can be a burden to caregivers as well as the patient during the final months of their life. Endoscopic treatments to palliate rectal obstruction have also been developed in recent years but are not yet a standard treatment option. Medical management, including the use of opioids, anticholinergics, and antiemetics, is most commonly used in hospices and palliative care settings to assist in maintaining an acceptable quality of life in patients with terminal illness. Self-expanding metallic stents (SEMS) are expandable metallic tubes that are advanced to the site of the obstruction along a guidewire in a collapsed state, under fluoroscopic and/or endoscopic guidance. Once deployed, the stents slowly expand radially to their maximum diameter under their own force, thereby achieving patency of the obstructed anatomy. Almost all stenting procedures are carried out transanally, and are generally well tolerated by patients with only conscious sedation, or no anesthesia. The value of stent placement is as a minimally invasive alternative to open surgical techniques, such as resection or stoma creation. SEMS may be used as a definitive palliative measure or can be used as a “bridge to surgery” to allow stabilization of the patient's condition before surgery is carried out as an elective procedure at a later date. A number of stents have been designed specifically for use in the lower gastrointestinal tract and are available in a variety of lengths and diameters, so that the appropriate stent can be selected based on factors such as the length of the obstructed section of bowel and anatomic location of the obstruction. While stenting procedures are becoming a more frequent treatment modality, it is currently unclear whether stenting represents a safe and effective alternative to surgical procedures for the treatment of malignant colorectal obstructions. The aim of this review is to assess the safety and efficacy of SEMS placement for the relief of malignant colorectal obstruction in comparison to surgical procedures through a systematic review of the literature.