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J Torkington

Publications and source records attributed to J Torkington.

18 recordsLinked to original sources
PubMed2003

Hypothermia and acute pancreatitis: myth or reality?

Among the rarer causes of acute pancreatitis listed in surgical texts is hypothermia. To assess the evidence for cause and effect, we questioned selected consultants about their experience and examined the case-notes of patients admitted with hypothermia. The 31 consultants who returned our questionnaire (69% response rate; 317 consultant-years' experience) could recall only 5 cases of pancreatitis associated with hypothermia, in 2 of which other aetiological factors were judged primary. In case-notes for 100 months of emergency admissions at a single hospital we identified 310 patients with hypothermia and 1153 with acute pancreatitis; none had the dual diagnosis. Of the hypothermic patients, none had abdominal pain typical of acute pancreatitis. In 43 serum amylase was measured because the patient was unable to give a full history and in 2 of these the enzyme was slightly raised; both had experienced a cerebrovascular accident, which is a known cause of hyperamylasaemia. Considered alongside the weak evidence from previous studies, these findings offer negligible support for the idea that hypothermia is a clinically relevant risk factor for acute pancreatitis.

Acute Disease↗
PubMed2001

Motion analysis.

BACKGROUND: The ability to make an objective evaluation of a surgeon's operative ability remains an elusive goal. In this study, we used motion analysis as a measure of dexterity in the performance of a simulated operation. METHODS: Fifteen surgeons performed a total of 45 laboratory-based laparoscopic cholecystectomies on a cadaveric porcine liver model. Subjects were assigned to one of three groups according to their level of experience in human laparoscopic cholecystectomy. Electromagnetic tracking devices were used to analyze the surgeon's hand movements as they performed the procedure. Movement data (time, distance, number of movements, and speed of movement) were then compared. RESULTS: Analysis of variance (ANOVA) movement scores across the three groups showed significantly better performance among the experienced laparoscopic surgeons than the novices. Learning curves across repetitions of procedures were plotted. Novices made more improvement than experts. CONCLUSIONS: Motion analysis provides useful data for the assessment of laparoscopic dexterity, and the porcine liver model is a valid simulation of the real procedure.

Animals↗
PubMed2001

The role of the basic surgical skills course in the acquisition and retention of laparoscopic skill.

BACKGROUND: This study assesses the transfer of laparoscopic skills to a group of Basic Surgical Trainees (BST) attending the Basic Surgical Skills (BSS) course. METHODS: The virtual reality simulator MIST-VR was used to assess 13 trainees before and after the course and again 3 weeks and 3 months later. Analysis of kinematic data using the Imperial College Surgical Assessment Device gave measures of distance traveled, distance efficiency ratio, time taken, number of errors made, and number of movements made in completing a virtual laparoscopic task. The performance of the group was compared to a control group who underwent no training. RESULTS: All parameters improved significantly after the course, with the exception of distance traveled by the instruments. All outcome measures were significantly improved at 3 weeks. The control group showed a nonsignificant trend toward improvement in all parameters. CONCLUSIONS: The Basic Surgical Skills course produces quantifiable improvements in laparoscopic skill that are measurable by MIST-VR. There is a learning effect associated with using MIST-VR alone.

Case-Control Studies↗
PubMed2001

Skill transfer from virtual reality to a real laparoscopic task.

BACKGROUND: To validate the usefulness of virtual reality surgical simulators, we investigated the transfer of skills achieved by their use to real tasks. METHODS: Thirty medical students underwent a pretest using a real laparoscopic trainer. They were then randomized to the following three groups: group I received no training; group II received training using the Minimal Invasive Surgical Trainer in Virtual Reality (MIST-VR); and group III received training using conventional training exercises. Each group then underwent a posttest. Using the Imperial College Surgical Assessment Device (ICSAD), scores were generated for time taken, distance traveled, number of movements made, and speed of instrument movement. RESULTS: Significant changes between the MIST-VR group (group II) and the conventionally trained group (group III), were observed in the speed of movement of the left hand and the numbers of movements taken by each hand, when compared to the untrained group (group I). CONCLUSION: The training of novices using MIST-VR yields quantifiable changes in skill that are transferable to a simple real task and are similar to the results achieved with conventional training.

Clinical Competence↗
PubMed2000

The role of simulation in surgical training.

Surgical training has undergone many changes in the last decade. One outcome of these changes is the interest that has been generated in the possibility of training surgical skills outside the operating theatre. Simulation of surgical procedures and human tissue, if perfect, would allow complete transfer of techniques learnt in a skills laboratory directly to the operating theatre. Several techniques of simulation are available including artificial tissues, animal models and virtual reality computer simulation. Each is discussed in this article and their advantages and disadvantages considered.

Computer Simulation↗
PubMed1999

Objective assessment of surgical dexterity using simulators.

Surgical skill, like training for any craft, has traditionally been learnt as an apprenticeship. However, whereas carpenters learn on wood that is never displayed, operative training is done on real clinical cases. Over recent years surgical skills training laboratories have in part, replaced the apprenticeship. This article discusses some of the tools used within such laboratories to ensure optimal surgical performance.

Clinical Competence↗
PubMed1999

Endometriosis: presentation to general surgeons.

We present nine cases of endometriosis presenting to general surgeons over a period of 4.5 years at Gwynedd Hospital, Bangor. A total of 83 cases of endometriosis was found on analysis of pathology records. Of these, 73 presented to gynaecologists, one to a dermatologist and nine to general surgeons. The presentation to general surgeons includes swelling related to Pfannanstiel scar (two), swelling in inguinal canal (two), umbilical nodule (one), rectal bleeding (one), recurrent abdominal pain (one), mimicking ovarian tumour (one) and presenting as pelvic peritonitis (one). Six were elective admissions and three were admitted as an emergency. All were premenopausal (range 19-49 years) women. None had any previous history of endometriosis or subfertility. Two patients with cyclical symptoms were correctly diagnosed clinically, and the others were postoperative diagnosis. Six patients required gynaecological referral and four of these required further medical treatment. None of them has required further surgical intervention in follow-up (range 4 weeks to 3 years). Endometriosis usually presents to general surgeons with deposits at extragonadal sites. Some patients may present as an emergency with abdominal pain. Endometriosis should be included in the differential diagnosis of women presenting with swellings related to umbilicus, surgical scars, inguinal canal and pelvis, especially if symptoms are cyclical. Usually, surgical excision is adequate. Selected cases require gynaecological referral and further medical therapy.

Adult↗
PubMed1998

Laparoscopic cholecystectomy, bile duct injury and the British and Irish surgeon.

Laparoscopic cholecystectomy continues to attract controversy with regard to a perceived higher incidence of bile duct injury than in the open procedure. One possible cause for this is the trend away from intraoperative cholangiography previously considered an essential part of the open procedure. Under the auspices of The Association of Surgeons of Great Britain and Ireland, a questionnaire was sent to all its consultant fellows asking for details about their individual experience of the most serious injury, bile duct resection. In all, 1100 questionnaires were sent; 362 (33%) replies were returned. Of those who replied, 300 performed laparoscopic cholecystectomy as part of their practice. The experience of the respondents was divided into three groups; 19 surgeons had performed < 50 laparoscopic cholecystectomies, 53 between 50 and 100 and 228 had performed over 100. Ninety-five (32%) never performed intraoperative cholangiography, 167 (56%) on a selective basis and 38 (12%) routinely. In all, 58 bile duct resection injuries were reported by 48 surgeons. Of the bile duct resection injuries reported, 49 of 58 (85%) occurred when an intraoperative cholangiogram was not performed. These figures suggest that if the incidence of bile duct resection injury is to be decreased in laparoscopic cholecystectomy, the use of intraoperative cholangiography has an integral role to play.

Bile Ducts↗