Minimal Invasive Surgery Murielle Brohez, MD

Digital Century

Video Games: an Advantage for Young MIS Surgeons

Positive Effects from Previous Studies Early Studies evaluated psychomotor skills Video gamers showed: superior eye-hand coordination faster reaction times superior spatial visualization skills increased capacity for visual attention and spatial distribution Griffith, Voloschin, Gibb, Bailey; Perceptual and Motor Skills,19832. Yuji H; Perceptual and Motor Skills, 1996 3. Dorval, Pepin; Perceptual and Motor

The Impact of Video Games on Training SURGEONS in the 21st Century Rosser Jr, MD; et al. Arch Surg. 2007;142(2):181-186. Video games are extensively integrated into popular culture Anecdotal observations of young surgeons suggest that video game play contributes to performance excellence in laparoscopic surgery Hypothesis  There is a potential link between video game play and laparoscopic surgical skill and suturing

Design  Cross-sectional analysis of the performance of surgical residents and attending physicians participating in the Rosser Top Gun Laparoscopic Skills and Suturing Program (Top Gun) Participants  Thirty-three residents and attending physicians participating in Top Gun from May 10 to August 24, 2002.

Main Outcome Measures  The primary outcome measures were compared between participants' laparoscopic skills and suturing capability, video game scores, and video game experience. Results  Video Game players 33% better (P<.005) More than 3 h/wk >42 % better (P<.01) Current video game players 32% fewer errors (P=.04), performed 24% faster (P<.04), and scored 26% better overall (time and errors) (P<.005)

Conclusions Video game skill correlates with laparoscopic surgical skills Training curricula that include video games may help thin the technical interface between surgeons and screen-mediated applications, such as laparoscopic surgery Video games may be a practical teaching tool to help train surgeons

Benefits of Laparoscopy Benefits of laparoscopy are mostly derived postoperatively  pain attenuated stress response earlier return to ambulation after lap procedures   postoperative complications + quicker return to full activity

Historical Background 1929 - Heinz Kalk, a german gastroenterologist Up to 1970 – Jurgen Nord, USF 1987 – Phillipe Mouret, Lyons France technique first limited to dx of intraperitoneal TB + disseminated cancer extent of operation limited by need for surgeon to view abd through eyepiece

Hernia More than 600,000 hernias are repaired annually in the United States

Hernia Surgery - History Edwin Smith Papyrus

Medieval Times

Beuk repair

Techniques of Traditional Open Repair -Lucas-Championnière 1881 -Bassini 1889 -Lotheissen 1898 -McVay 1942 -Shouldice 1945 -Lichtenstein 1987

Laparoscopic Repair ? Less pain ? Can it be done

Anterior Abdominal Wall

Totally Extra Peritoneal

TEP anatomy

Mesh layout

Body Contour

TEP Video

TEP Indications: Recurrent Bilateral Active lifestyle Contraindications: Strangulated Hypotensive/sepsis

TEP post-op SDS Minimal narcotic intake Return to work 3-5 days Return to golf / running 3-5 days Return to full activity within 10-15 days

MIS at SOMC Hernias Appendectomy Cholecysctetomy Colectomy Anti-reflux Surgery – Nissen Fudoplication Diagnostic Laparoscopy Lysis of Adhesions Biopsies

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