Suturing Skills Research Articles

Effects of a retention interval and refresher session on intracorporeal suturing and knot tying skill and mental workload

The effects of refraining from practice for different intervals on laparoscopic suturing and mental workload was assessed with a secondary task developed by the authors. We expected the inability to practice to produce a decrease in performance on the suturing, knot tying, and secondary task and skills to rebound after a single refresher session. In total, 22 surgical assistant and premedical students trained to Fundamentals of Laparoscopic Surgery proficiency in intracorporeal suturing and knot tying were assessed on that task using a secondary task. Participants refrained from practicing any Fundamentals of Laparoscopic Surgery tasks for 1 or 5months. At the time of their return, they were assessed immediately on suturing and knot tying with the secondary task, practiced suturing and knot tying for 40minutes, and then were reassessed. The mean suture times from the initial reassessment were greater than the proficiency times but returned to proficiency levels after one practice session, F(2, 40)=14.5, P<.001, partial η2=.420. Secondary task scores mirrored the results of suturing time, F(2, 40)=6.128, P<.005, partial η2=.235, and were moderated by retention interval. When participants who reached proficiency in suturing and knot tying were reassessed after either 1or 5months without practice, their performance times increased by 35% and secondary task scores decreased by 30%. These deficits, however, were nearly reversed after a single refresher session.

How to suture a wound.

Rationale and key points This article explores how to suture a wound using several common techniques. The use of different suture techniques depends on various factors, including the type of wound, its location, skin thickness, wound tension and cosmetic considerations. » Nurses should have a comprehensive understanding of the relevant anatomy and underlying structures, and the expertise to determine that suturing, rather than other methods of wound closure, is appropriate in each case. » Nurses should work within their scope of practice and to agreed departmental protocols. » Nurses should audit and reflect on their practice to ensure that their suturing skills are maintained and improved. » Nurses should be aware of local procedures in the event of needle-stick injury. Reflective activity 'How to' articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. What factors would affect your decision to use sutures to close a wound rather than another method. 2. How you think this article will change your practice.

Quick and Easy Acquisition of Laparoscopic Suturing Skills

To investigate the learning curve for surgeons acquiring laparoscopic suturing skills.

Impact of seductive details on the acquisition and transfer of laparoscopic suturing skills: Emotionally interesting or cognitively taxing?

A common strategy to increase learner engagement is to interweave educational material with interesting but slightly tangential tidbits of information (eg, "war stories" and funny anecdotes), known as seductive details. Our objective was to examine the impact of seductive details on initial acquisition and transfer of basic laparoscopic surgical skills. Novices (first- to fourth-year medical students) were randomized into control (N=47) or seductive details (N=42) groups. Curricula consisted of a baseline skills assessment (Fundamentals of Laparoscopic Surgery Task 1), instructional video on intracorporeal laparoscopic suturing (Fundamentals of Laparoscopic Surgery Task 5), multiple choice quiz, practice, and assessment on both primary and transfer tasks. Two separate instructional videos were used for Task 5; 20% of the seductive details group's instructional video consisted of seductive details, whereas the control group's video included no seductive details. Participants completed questionnaires of mental workload and task engagement after training. We also conducted a mediation analysis, which is a statistical approach to identify causal paths among a group of variables. Baseline skill scores (control: 112±52; standard deviation: 118±56; 0=lowest possible score; 600=highest possible score) and knowledge scores (control: 76±19; standard deviation: 74±16; 0=lowest possible score; 100=highest possible score) were similar for both groups. The control group demonstrated better (higher) performance on both the primary (434±193 vs 399±133, P<.05) and transfer (184±74 vs 149±91, P<.05) suturing tasks. Mental workload, as measured by the National Aeronautics and Space Administration-Task Load Index, was more demanding (higher) for the seductive details group (3.8±0.5 vs 3.4±0.7, P<.01; 1=low workload; 5=high workload) and was investigated as the possible mechanism by which group assignment impacted performance. Mediational paths using hierarchical regression were significant (P<.05), suggesting that trainees in the seductive details group performed worse because of their increased workload. Our findings suggest that the inclusion of seductive details may be detrimental to the acquisition and transfer of laparoscopic surgical skills due to increased mental workload for trainees.

Laparoscopic suturing: A simple technique of rapid and precise needle diving in ergonomically difficult operative situations - An innate puzzle solved

Nowadays, the acquisition of safe, effective yet rapid and minimally invasive suturing skills has become not only desirable but also an essential part of any laparoscopic intervention. Although there remains a substantial body of literature focusing mainly on varied minimal access knotting techniques, there seem to be scarcely any contributions devoted specifically to the crux of its successful execution—the precise intracorporeal needle loading methodology that eventually translates into easy and secure tissue approximation. In that context, traditional and generally accepted teaching endorses grasping of the needle at a right angle to its holder-shaft. However, after accumulating over 15 years of experience in this field, we have consistently observed this angle to be barely user-friendly; on the contrary, it is ergonomically much rate-limiting and annoying particularly in areas with limited accessibility for laparoscopic instruments. To counter these limitations, we have devised a simple technique that ensures gripping the needle in a peculiar way by the needle driver to procure an obtuse needle-to-shaft angle; this tends to make endoscopic suturing rather effortless, faster and easy to learn.

How to repair an episiotomy.

Rationale and key points Skilful repair of an episiotomy is an important aspect of maternal health care. It is essential that midwives and doctors have the knowledge and skills to undertake this procedure in a safe and effective manner. ▶ An episiotomy should be repaired promptly to reduce blood loss and prevent infection. ▶ Repair of an episiotomy is undertaken in three stages: repair of the vaginal mucosa, repair of the muscle layer and repair of the skin layer. ▶ Adequate pain relief should be provided before suturing. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. Why a rectal examination is recommended before and following repair of an episiotomy. 2. What you would do to improve your suturing skills. 3. The factors that may prevent or delay an episiotomy from healing. Subscribers can upload their reflective accounts at rcni.com/portfolio .

An ex vivo liver training model continuously perfused to simulate bleeding for suture skills involved in laparoscopic liver resection: development and validity.

Suture skills are essential to laparoscopic liver resection. The current suture training models are not ideal enough. The aim of this study is to develop and verify a highly simulated-bleeding continuously perfused training model (CPTM) and to evaluate its training efficacy. CPTM was constructed using fresh lamb liver whose portal veins were perfused with red-dyed liquid gelatin. Construct validity of CPTMs was tested in 33 participants with three levels of laparoscopic experience (experts, intermediates, and novices) who were demanded to finish one superficial stitch and one deep stitch for suture hemostasis on CPTMs. The CPTMs were also evaluated by the experts. CPTMs were compared with dry box training models (DBTMs) regarding training efficacy among the novices who were assigned to DBTM and CPTM groups to, respectively, complete a 10-day training on CPTMs or DBTMs. Before and after their assignments, their superficial stitches were assessed by completion time, suture accuracy, and suture knot performance while their deep stitches by completion time and bleeding control. CPTM proved to be construct valid by both superficial and deep stitches. Significant differences were found regarding completion time (763, 271, 174s), suture accuracy (4.4, 1.8, 0.2mm), and suturing knot performance (12.1, 21.5, 22.0) for superficial stitches (p<0.001), as well as regarding completion time (807, 423, 277s) for deep stitches (p<0.001). Positive comments were given by all experts. CPTMs helped novices to acquire laparoscopic suture skills. Their training efficacy was significantly better than that of DBTMs (p<0.05). Learning curves of CPTM group plateaued at the sixth round for superficial stitches and at the seventh round for deep stitches. CPTM offers trainees a highly simulated-bleeding means to acquire advanced laparoscopic suture skills. The suture skills learned on CPTMs may improve significantly at the seventh round.

A National Survey of Undergraduate Suture and Local Anesthetic Training in the United Kingdom

Suturing is a skill expected to be attained by all medical students on graduation, according to the General Medical Council's (GMC) Tomorrow's Doctors. There are no GMC recommendations for the amount of suture training required at medical school nor the level of competence to be achieved. This study examines the state of undergraduate suture training by surveying a sample of medical students across the United Kingdom. We distributed a survey to 17 medical schools to be completed by undergraduates who have undergone curricular suture training. The survey included questions relating to career intention, hours of curricular suture training, hours of additional paid training, confidence in performing various suture techniques and knowledge of their indications. We also asked about the students' perceived proficiency at injecting local anesthetic and their overall opinion of medical school suture training. We received responses from 705 medical students at 16 UK medical schools. A total of 607 (86.1%) medical students had completed their scheduled curricular suture training. Among them, 526 (86.5%) students reported inadequate suture training in medical school and 133 (21.9%) students had paid for additional training. Results for all competence markers were significantly lower than the required GMC standards (p < 0.001). Students who had paid for additional training were significantly more confident across all areas examined (p < 0.001). Our study identified a deficiency in the curricular suture training provided to the medical students surveyed. These findings suggest that medical schools should provide more opportunities for students to develop their suturing skills to achieve the GMC standard.

Developing intra-oral suturing skills in OMFS junior trainees

Developing intra-oral suturing skills in OMFS junior trainees

Developing an Objective Structured Assessment of Technical Skills for Laparoscopic Suturing and Intracorporeal Knot Tying

To develop a teaching and assessment tool for laparoscopic suturing and intracorporeal knot tying. We designed an Objective Structured Assessment of Technical Skills (OSATS) tool that includes a procedure-specific checklist (PSC) and global rating scale (GRS) to assess laparoscopic suturing and intracorporeal knot-tying performance. Obstetrics and Gynecology residents at our institution were videotaped while performing a laparoscopic suturing and intracorporeal knot-tying task at a surgical simulation workshop. A total of 2 expert reviewers assessed resident performance using the OSATS tool during live performance and 1 month later using the videotaped recordings. OSATS scores were analyzed using the Wilcoxon rank-sum test. Data are presented as median scores (interquartile range [IQR]). Intrarater and interrater reliabilities were assessed using a Spearman correlation and are presented as an r correlation coefficient and p value. An r ≥ 0.8 was considered as a high correlation. After testing, we received feedback from residents and faculty to improve the OSATS tool as part of an iterative design process. In all, 14 of 21 residents (66.7%) completed the study, with 9 junior residents and 5 senior residents. Junior residents had a lower score on the PSC than senior residents did; however, this was not statistically significant (median = 6.0 [IQR: 4.0-10.0] and median = 13.0 [IQR: 10.0-13.0]; p = 0.09). There was excellent intrarater reliability with our OSATS tool (for PSC component, r = 0.88 for Rater 1 and 0.93 for Rater 2, both p < 0.0001; for GRS component, r = 0.85 for Rater 1 and 0.88 for Rater 2, both p ≤ 0.0002). The PSC also has high interrater reliability during live evaluation (r = 0.92; p < 0.0001), and during the videotape scoring with r = 0.77 (p = 0.001). Our OSATS tool may be a useful assessment and teaching tool for laparoscopic suturing and intracorporeal knot-tying skills. Overall, good intrarater reliability was demonstrated, suggesting that this tool may be useful for longitudinal assessment of surgical skills.

Validation of the AUA BLUS Tasks

Standardized assessment of laparoscopic skill in urology is lacking. Weinvestigated whether the AUA (American Urological Association) BLUS (Basic Laparoscopic Urologic Skills) skill tasks are valid to address thisneed. This institutional review board approved study included 27 medical students, 42 urology residents, 18 fellows and 37 faculty urologists across 8 sites. Using the EDGE (Electronic Data Generation and Evaluation) device (Simulab, Seattle, Washington) 454 recordings were collected on peg transfer, pattern cutting, suturing and clip applying tasks, which together comprise the expert determined BLUS tasks. We collected synchronized video and tool motion data for each trial. For each task errors, time, path length, economy of motion, peak grasp force and EDGE score were collected. An expert panel of 5 faculty members performed GOALS (Global Objective Assessment of Laparoscopic Skills) evaluations on a representative subset of peg transfer and suturing skill tasks performed by 24 participants (IRR = 0.95). Demographically derived skill levels proved unsuitable to evaluate construct validity. Separation of mean scores by grouped skill levels was strongest for the suturing task. Objective motion metrics and errors supported construct validity vis-à-vis correlation with blinded expert video ratings (motion metrics R(2) = 0.95, p <0.01). Expert scores appeared to reward errors in suturing but not in block transfer. BLUS skill task performance scoring can discriminate among basic laparoscopic technical skill levels. Self-reported demographics are an unreliable source of determining laparoscopic technical skill.

Letter of Welcome

Congratulations. As a future dentist, you will soon embark on an exciting career that offers unlimited opportunities for personal growth and improving the oral health and lives of your patients. As you advance through your dental school curriculum, you will learn more about the nine ADA–recognized dental specialties and the skills and unique training that set them apart from general dentistry and each other. Whether you decide to practice general dentistry or pursue a dental specialty, you will from time to time be required to suture a wound or surgical incision in the oral cavity. Successful suturing techniques require careful attention to both function and esthetic concerns. The American Association of Oral and Maxillofacial Surgeons (AAOMS) believes it is vital that the dentist placing a suture is trained in the proper technique, the use of appropriate materials, and the potential consequences of an improperly placed suture. We are pleased to present you with this Guide to Suturing to assist you in perfecting your suturing skills. We have also included information on biopsy techniques and prescription medication ordering that we trust you will find useful as you provide care for your patients in dental school and in the future. The AAOMS is the professional association that represents the more than 9,000 oral and maxillofacial surgeons practicing in the United States. As the surgical specialists of the dental profession, oral and maxillofacial surgeons are the experts in face, mouth, and jaw surgery. Oral and maxillofacial surgeons enjoy a far-reaching scope of practice that includes dentoalveolar and implant surgery, anesthesiology, management of facial injuries and deformities, treatment of oral, head, and neck cancer, and reconstructive and cosmetic surgery. It is an exciting surgical specialty that is both challenging and rewarding. As you consider your future in dentistry, I invite you to learn more about the specialty of oral and maxillofacial surgery by visiting our Web site at AAOMS.org and our new patient site at MyOMS.org. Sincerely,

Intracorporeal suturing: Transfer from Fundamentals of Laparoscopic Surgery to cadavers results in substantial increase in mental workload

A spatial secondary task developed by the authors was used to measure the mental workload of the participant when transferring suturing skills from a box simulator to more realistic surgical conditions using a fresh cadaver. We hypothesized that laparoscopic suturing on genuine bowel would be more challenging than on the Fundamentals of Laparoscopic Surgery (FLS)-simulated bowel as reflected in differences on both suturing and secondary task scores. We trained 14 surgical assistant students to FLS proficiency in intracorporeal suturing. Participants practiced suturing on the FLS box for 30 minutes and then were tested on both the FLS box and the bowel of a fresh cadaver using the spatial, secondary dual-task conditions developed by the authors. Suturing times increased by >333% when moving from the FLS platform to the cadaver F(1,13) = 44.04, P < .001. The increased completion times were accompanied by a 70% decrease in secondary task scores, F(1,13) = 21.21, P < .001. The mental workload associated with intracorporeal suturing increases dramatically when trainees transfer from the FLS platform to human tissue under more realistic conditions of suturing. The increase in mental workload is indexed by both an increase in suturing times and a decrease in the ability to attend to the secondary task.

Virtual reality robotic surgery simulation curriculum to teach robotic suturing: a randomized controlled trial.

The objective of this randomized, controlled trial was to assess whether voluntary participation in a proctored, proficiency-based, virtual reality robotic suturing curriculum using the da Vinci(®) Skills Simulator™ improves robotic suturing performance. Residents and attending surgeons were randomized to participation or non-participation during a 5week training curriculum. Robotic suturing skills were evaluated before and after training using an inanimate vaginal cuff model, which participants sutured for 10min using the da Vinci(®) Surgical System. Performances were videotaped, anonymized, and subsequently graded independently by three robotic surgeons. 27 participants were randomized. 23 of the 27 completed both the pre- and post-test, 13 in the training group and 10 in the control group. Mean training time in the intervention group was 238±136min (SD) over the 5weeks. The primary outcome (improvement in GOALS+ score) and the secondary outcomes (improvement in GEARS, total knots, satisfactory knots, and the virtual reality suture sponge 1 task) were significantly greater in the training group than the control group in unadjusted analysis. After adjusting for lower baseline scores in the training group, improvement in the suture sponge 1 task remained significantly greater in the training group and a trend was demonstrated to greater improvement in the training group for the GOALS+ score, GEARS score, total knots, and satisfactory knots.

PD19-04 VALIDATION OF LAPAROSCOPIC TRAINING CURRICULUM: THE BASIC LAPAROSCOPIC UROLOGIC SKILLS (BLUS) INITIATIVE

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment III1 Apr 2015PD19-04 VALIDATION OF LAPAROSCOPIC TRAINING CURRICULUM: THE BASIC LAPAROSCOPIC UROLOGIC SKILLS (BLUS) INITIATIVE Timothy Kowalewski, Robert Sweet, Ashleigh Menhadji, Timothy Averch, Geoffrey Box, Timothy Brand, Michael Fearrandino, Jihad Kaouk, Bodo Knudsen, Jamie Landman, Benjamin Lee, Bradley Schwartz, Elspeth McDougall, and Thomas Lendvay Timothy KowalewskiTimothy Kowalewski More articles by this author , Robert SweetRobert Sweet More articles by this author , Ashleigh MenhadjiAshleigh Menhadji More articles by this author , Timothy AverchTimothy Averch More articles by this author , Geoffrey BoxGeoffrey Box More articles by this author , Timothy BrandTimothy Brand More articles by this author , Michael FearrandinoMichael Fearrandino More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Bodo KnudsenBodo Knudsen More articles by this author , Jamie LandmanJamie Landman More articles by this author , Benjamin LeeBenjamin Lee More articles by this author , Bradley SchwartzBradley Schwartz More articles by this author , Elspeth McDougallElspeth McDougall More articles by this author , and Thomas LendvayThomas Lendvay More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.703AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Standard basic laparoscopic training is required for urologic trainees to ensure proficiency prior to graduation from residency. The American Urological Association created the Basic Laparoscopic Urologic Skills (BLUS) skills tasks as an objective assessment tool to determine laparoscopic skills proficiency. We sought to establish construct validity of the psychomotor skills portion of this curriculum using objective performance metrics and structured assessment by video review. METHODS After IRB approval, eight US medical teaching institutions contributed 117 subjects of varying skill from medical student to full-time faculty urologist. All subjects performed four dry-lab laparoscopic tasks: Peg Transfer, Cutting, Intracorporeal Suturing, and Clip Applying. The Electronic Data Generation and Evaluation (EDGE) laparoscopic platform (Simulab Corp, Seattle WA) recorded synchronized video and tool motion metrics for all tasks along with proctor-entered task errors. Skill levels were assigned by both demographically-derived status (training level) and blinded video review by five faculty urologists employing the Global Objective Assessment of Laparoscopic Skills (GOALS) instrument for a representative subset of the database (12 Suturing, 12 Peg Transfer; maximum, median, and minimum task times). We employed Pearson's correlation to evaluate agreement between metrics and ground truth. RESULTS Using the structured assessment tool – GOALS – provided skill discrimination. Demographically-derived assignments were less correlated with skill. Task time, path length, and motion smoothness (jerk cost) correlated with ground truth structured video assessment (-0.69, -0.69 -0.79 respectively) for Peg Transfer and (-0.86, -0.91 -0.84 respectively) for Suturing (p<0.01). Inter-rater reliability of the five experienced faculty GOALS reviewers was >0.9. CONCLUSIONS The BLUS Peg Transfer and Intracorporeal Suturing skill tasks showed good construct validity based on a consensus of established objective performance metrics and blinded video review by experienced faculty. Training level or case experience alone may be inadequate to assign proficiency levels, thus more objective quantification of skill is required for advancement strategies in training centers. Table 1. Correlation of GOALS scores provided by five expert laparoscopists and EDGE objective performance metrics. Expert GOALS Assessments vs. Tool Metrics Peg Transfer Task Suturing Task N=24, Pearsons R n=12 n=12 R (p-value) R (p-value) EDGE Overall Score 0.95 (0.00) 0.95 (0.00) Task Time -0.91 (0.00) -0.95 (0.00) Tool Path Length -0.95 (0.00) -0.81 (0.00) Jerk Cost -0.63 (0.03) -0.82 (0.00) Movement Count -0.94 (0.00) -0.72 (0.01) Grasp Force NS NS Max Grasp Force NS NS Economy of Motion 0.62 (0.03) NS Errors -0.68 (0.02) 0.62 (0.03) © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e392-e393 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Timothy Kowalewski More articles by this author Robert Sweet More articles by this author Ashleigh Menhadji More articles by this author Timothy Averch More articles by this author Geoffrey Box More articles by this author Timothy Brand More articles by this author Michael Fearrandino More articles by this author Jihad Kaouk More articles by this author Bodo Knudsen More articles by this author Jamie Landman More articles by this author Benjamin Lee More articles by this author Bradley Schwartz More articles by this author Elspeth McDougall More articles by this author Thomas Lendvay More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The efficacy of robotic driven handheld instruments for the acquisition of basic laparoscopic suturing skills

ObjectiveTo evaluate the efficacy of robotic-driven handheld laparoscopic instruments for the acquisition and improvement of basic laparoscopic suturing skills.Study design: A prospective study was carried out on 15 physicians grouped by previous experience. They were evaluated on the completion of basic surgical laparoscopic skills. First, they used traditional non-articulating laparoscopic instruments, and later they used robotic-driven articulating instruments. ResultsSignificant time reduction was observed in the group of inexperienced physicians when they used robotic-driven instruments for needle loading and placing stitches. An 8.3% time reduction was observed in the same group when considering total times for the completion of all exercises. No significant differences for the experienced groups were found. ConclusionsRobotic-driven handheld instruments could help inexperienced physicians acquire basic skills in laparoscopic techniques. No benefit has been observed when previous laparoscopic experience is present.

Analysis of the learning process for laparoscopic sacrocolpopexy: identification of challenging steps.

We earlier demonstrated that the operation time of laparoscopic sacrocolpopexy (LSCP) by an experienced surgeon drops significantly after 30 cases to reach a steady state after 90. We now aimed to define the learning curve and to identify the most challenging steps for a trainee learning LSCP. Prospective consecutive series of 60 patients undergoing LSCP performed by a trainee experienced in operative laparoscopy but not LSCP. Prior to the first case, the trainee primed his endoscopic suturing skills on an endotrainer for 15h. His operation time and performance score were analysed using moving average analysis (MOA). The former and the occurrence of complications or short-term failures were compared with those of a concurrent control group consisting of patients operated on by a surgeon experienced in LSCP (teacher). The procedure was empirically divided into five consecutive steps (dissection of the promontory, the paracolic gutter and vagina, suturing of the mesh to the vault, stapling to the promontory, and peritonealisation). The MOA of the operation time demonstrated a learning curve for all steps, except for the dissection of and fixation to the promontory. The most time-consuming step is the dissection of the vault, for which it took the trainee 31 procedures to achieve an operation time comparable to that of the teacher. Also, the quality of the dissection improved over time. Suturing of the implant to the vault and peritonealisation took only 10 and 6 procedures respectively. There was no difference in the occurrence of major complications and in one case the trainee asked for assistance. Quality of LSCP improves with experience. Operation time falls as well, and the most time-consuming step is the dissection of the paracolic and perivaginal spaces. Prior training in laparoscopic suturing coincided with a short learning process for the phases requiring suturing.

Influence of medical students' past experiences and innate dexterity on suturing performance

BackgroundMedical students often site their ability to excel at technical tasks as justification for choosing surgery as a career path. We sought to investigate how medical students' dexterity skills and past experiences correlated with suturing performance. MethodsSixty-four 3rd-year medical students were surveyed about previous experiences that involved manual dexterity. Technical skills were then measured using a validated test of manual dexterity and subcuticular closure of a pig's foot incision. Spearman's rank correlation coefficients determined correlation between variables. ResultsPrevious experiences, self-assessment of dexterity, prior suturing, and current interest in surgery did not significantly correlate with manual dexterity or suturing skill scores. Innate manual dexterity score was the only significant correlating factor to suture skill score (Spearman's rank correlation coefficient = .336; P = .007). ConclusionsInnate manual dexterity skills are predictive of initial surgical suturing performance regardless of past student experiences. Interventions aimed at improving early surgical technique should be optimally focused on dexterity training.

クリニカルクラークシップ中の学生に対するドライボックスによる縫合実習：Suture to Ligation Timeに関連する因子の解析

クリニカルクラークシップ中の学生に対するドライボックスによる縫合実習：Suture to Ligation Timeに関連する因子の解析

Laparoscopic mesh procedures for the treatment of pelvic lorgan prolapse--review of the literature.

The main aim of the article was to describe laparoscopic mesh procedures for the treatment of pelvic organ prolapse, as well as evaluate their role, outcomes and limitations. In February 2014, online search of English-language literature in PubMed was performed. This paper presents the analysis of reports published over the last decade that included at least 50 patients with a minimum of 12 months of follow-up. Numerous laparoscopic techniques to restore proper anatomy in patients with pelvic organ prolapse have been described. Laparoscopy provides a number of important advantages, including enhanced visualization of the pelvic anatomy reduction of adhesion formation, lower morbidity and blood loss, decreased postoperative pain, smaller incision and quicker recovery Nonetheless, this access is technically more difficult than an open or vaginal surgery due to two-dimensional vision and decreased degrees of freedom. It requires high level of laparoscopic suturing skills and longer operative time, especially at the beginning of the learning curve. Laparoscopic sacrocolpopexy hysteropexy and lateral suspension are interesting and effective options for the treatment of pelvic organ prolapse, providing a number of important advantages characteristic for endoscopic techniques.