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S111Vol. 209, No. 3S, September 2009 Surgical Forum Abstracts

ubset of subjects (n � 20) were also evaluated live by a real-timeeviewer to assess correlation with video-based scoring.

ESULTS: Level of training significantly predicted OSATS GRScore for each task (p�0.001 for regression line). Significant differ-nces were seen between students, junior residents, and senior resi-ents for both tasks (p�0.05 for each, Table). Interrater reliability forideo review was moderate for both tasks (alpha�0.8, kappa�0.5).ideo-based scores correlated significantly with real-time reviewer

cores (p�0.001; r�0.8).

SATS Global Rating Scale Scores by Level of Training

ean (SD) N Skin ClosureBowel

Anastomosis

ovice (medical student) 10 13.3 (3.3) 13.7 (4.5)unior resident (R1-R2) 20 21.6 (5.1) 19.0 (4.8)enior resident (R3-R5) 13 25.0 (4.6) 25.9 (5.0)

ONCLUSIONS: The application of OSATS to previously re-orded surgical task performance is a valid and reliable measure ofechnical skill. Benefits include ease of scheduling and ensuringlinded review. One major limitation is the inherent delay in scoringnd lack of immediate formative feedback.

ntensive laparoscopic training: The impact of aimplified pelvitrainer curriculum on long-termearning in surgical novicessther M Bonrath MD, Sören T Mees MD, Barbara Weber,einer H Wolters MD, Norbert Senninger FACS,mile M Rijcken MDniversity Hospital Muenster, Muenster, North Rhine-Westphalia,ermany

NTRODUCTION: With the evolvement of laparoscopic proceduresn general surgery, new strategies in surgical training have been tri-led. We examined whether basic laparoscopic skills can be taught tourgical novices solely in an intensified skills lab environment andhether the achieved skills can be retained permanently.

ETHODS: 12 surgical novices underwent a laparoscopic curricu-um including 9 exercises representing standard skills required inaparoscopic surgery with increasing complexity (eg, navigation, cut-ing, knot tying).The tasks were performed in a ”box-trainer” usingegular laparoscopic instruments. Each subject underwent baselinevaluation [I] and reevaluation after two 4-hour coaching sessions inweek [II]. 6 weeks thereafter, a third reevaluation was performed

III]. During this interval, the subjects tested had no access to theraining facility. Task completion was measured in time (s) withenalties distributed for inaccurate performance. Statistics: Student test (SPSS 16.0).

ESULTS: Comparison of the individual baseline measurementsI] with reevaluation after coaching [II] showed a significant learningutcome (P � 0.001) for each single student in all exercises. In termsf maintenance of the learning outcome, there were no significantifferences comparing results after coaching [II] vs retest [III] ses-ions neither for simple exercises nor for the complex tasks.The mean

alues and standard deviations are shown in table. d

ONCLUSIONS: We have demonstrated that a sound foundationor future laparoscopic procedures can be successfully established inurgical novices with sustained effects using simple and low-costquipment. This is desirable for all surgical trainees prior to firstmployment in the operating room.

askBaseline

[I]Coaching

1Coaching

1Coaching

2Coaching

2Reevaluation

[II]

6-wkEvaluation

[III]

ameranavigation

296.34 � 17.96 286.25 � 29.22 256.33 � 41.86 271.33 � 33.69 249.58 � 43.39 214.21 � 49.21 237.67 � 52.14

rasping 128.5 � 71.26 84.42 � 42.29 68.58 � 22.36 63.75 � 27.68 46.83 � 15.24 39.5 � 15.56 46.92 � 13.79

ransfer(L/R)

289.56 � 37.56 276.17 � 57.63 239.92 � 75.04 244.83 � 54.81 196.08 � 77.35 185.67 � 62.4 201.82 � 75.36

ositioning/placement

223 � 63.62 194.33 � 68.65 171.08 � 89.13 150.33 � 60.97 124.83 � 55.97 109.13 � 43.69 113.58 � 40.09

atterncutting

286.62 � 32.81 256.58 � 49.65 228.4 � 45.38 221.33 � 45.98 189.265 � 60.31 181.08 � 50.16 16..08 � 45.9

oop tie 157.08 � 75.95 89.58 � 34.49 78.33 � 29.05 79.42 � 27.26 47.83 � 20.55 50.42 � 26.44 49.83 � 22.27

xtracorporealknot

231.63 � 55.07 175.33 � 33.08 151.08 � 46.18 134.75 � 30.09 133.58 � 34.41 110.96 � 22.24 122.33 � 21.08

ntracorporealknot

291.67 � 15.9 268.67 � 32.83 248.58 � 43.85 272 � 51.66 221.08 � 48.42 203.67 � 48.88 215.08 � 54.77

lipping 78.21 � 26.72 83.83 � 32.86 77.33 � 27.25 67.17 � 20.28 62.17 � 14.74 41.17 � 16.04 33.58 � 9.97

affeine and taurine reverse the deterioration inaparoscopic and cognitive skill following sleepeprivationatrice Crochet MD, Rajesh Aggarwal MD, Amit Mishra,ramudith Sirimanna BA, Ara Darzi MD, FACSmperial College London, London, England

NTRODUCTION: Sleep deprivation of surgeons leads to concomi-ant effects on surgical performance and the potential to endangeratient safety. Pharmacological stimulants may counter this conse-uence of long work hours. This study aims to investigate whetherommonly available stimulants can counter the effects of fatigue onechnical and neurocognitive skill.

ETHODS: Eighteen surgical novices trained to proficiency on aaparoscopic simulator. In a single-blinded cross-over study, subjectsere acutely sleep-deprived 3 times each, followed by administrationf placebo, caffeine, or caffeine/taurine. Outcome measures wereaparoscopic skill, cognitive performance (reaction time and Stroopest), and subjective sleepiness scores. Rested baselines were gatheredollowing completion of testing sessions.

ESULTS: Subjects made more errors (65.5 vs 58.5; p�0.021) andook longer (40.7 vs 35.4 secs; p�0.016) on the laparoscopic taskhen sleep deprived with placebo than when rested. Similarly, theyad poorer reaction times (360 vs 294 msecs; p�0.002), Strooperformance (24043 vs 18498; p�0.033), and subjective sleepiness6 vs 1; p�0.001). Caffeine improved reaction times (299 vs 360secs; p�0.010) and sleepiness (3 vs 6; p�0.003) compared with

lacebo. Caffeine plus taurine led to improved performance on theomplex laparoscopic task with total errors (74 vs 58.5; p�0.075)nd time (34.8 vs 35.4 secs; p�0.89) similar to rested scores.

ONCLUSIONS: Sleep deprivation affects laparoscopic psychomo-or skills, neurocognitive function, and subjective measures of sleep-ness. This can be countered by commonly available stimulants suchs caffeine and taurine. Further work is required in the field of stim-lant use to counter the deterioration in performance of sleep-

eprived surgeons.