scholarly journals Bladder injuries in emergency/expedited laparoscopic surgery in the absence of previous surgery: a case series

2012 ◽  
Vol 94 (3) ◽  
pp. e118-e120 ◽  
Author(s):  
BF Levy ◽  
J De Guara ◽  
PD Willson ◽  
Y Soon ◽  
A Kent ◽  
...  
Keyword(s):  
Case Series ◽  
Lower Abdominal Pain ◽  
Bladder Injury ◽  
Emergency Setting ◽  
Surgical Trainees ◽  
Bladder Injuries ◽  
Site Planning ◽  
Supervision And Training ◽  
Alternative Sites ◽  
And Training

INTRODUCTION The use of laparoscopy as a diagnostic and therapeutic tool is being used increasingly in the emergency setting with many of these procedures being performed by trainees. While the incidence of iatrogenic injuries is reported to be low, we present six emergency or expedited cases in which the bladder was perforated by the suprapubic trocar. CASES Three cases were related to the management of appendicitis, two to negative diagnostic laparoscopies for lower abdominal pain and one to an ectopic pregnancy. Management of the bladder injuries varied from a urinary catheter alone to laparotomy with debridement of the abdominal wall due to sepsis and later reconstruction. Four of the six cases were performed by registrars. CONCLUSIONS Although the incidence of bladder injury is low, its importance is highlighted by the large number of laparoscopies being performed. In addition to catheterisation of the patient, care must be taken with the insertion of low suprapubic ports and consideration should be made regarding alternative sites. Adequate laparoscopic supervision and training in port site planning is required for surgical trainees.

scholarly journals Iatrogenic bladder injury: A single institution’s ten-year experience in treatment and outcome 1999-2009, Kuala Lumpur, Malaysia

2011 ◽  
pp. 215-218
Author(s):  
Christopher CK Ho ◽  
Hans Alexander ◽  
Praveen Singam ◽  
Lee Boon Cheok ◽  
Zulkifli MD Zainuddin
Keyword(s):  
Caesarean Section ◽  
Retrospective Review ◽  
Enterocutaneous Fistula ◽  
Case Series ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Caesarian Section ◽  
Bladder Injury ◽  
Absorbable Sutures ◽  
Bladder Injuries

Introduction: This case series is a retrospective review of iatrogenic bladder injuries treated at our institution Universiti Kebangsaan Malaysia, Medical Centre, over a ten-year period, from 1999 to 2009. Materials and methods: A retrospective review of the operating theater database yielded the names and registration numbers of patients who underwent operative repair of bladder injuries. Patients who sustained bladder injuries due to non-surgical reasons (such as traumatic bladder injuries due to pelvic fractures, blunt trauma or penetrating injuries to the pelvis) were excluded. Results: There were 12 cases of iatrogenic bladder injury treated during this time. A total of eight injuries occurred during gynaecological surgery. Five injuries occurred during lower segment caesarean section, two injuries during total abdominal hysterectomy and bilateral salpingo-oopherectomy, and a single injury during Burch colposuspension. Four out of the five injuries during caesarian section had a history of previous caesarian section. Of the four remaining non-gynaecological related injuries, two injuries occurred during hernioplasty, one during exploration of an enterocutaneous fistula and the other was during laparoscopic appendicectomy. Conclusion: Iatrogenic bladder injury should be anticipated in patients undergoing caesarean section who have had multiple previous caesarean sections. Iatrogenic injuries should be identified intra-operatively to enable early repair and the best outcome. These injuries were adequately assessed by ascending cystography. Continuous repair with absorbable sutures together with perivesicle drainage and bladder catheterization produces good outcome.

scholarly journals A Critical Appraisal of the Evidence of Current Methods of Assessment for Surgical Trainees

2013 ◽  
Vol 95 (6) ◽  
pp. 7-11
Author(s):  
AJ Batchelder ◽  
MJ McCarthy
Keyword(s):  
Surgical Training ◽  
Critical Appraisal ◽  
Junior Doctors ◽  
The Past ◽  
Medical Careers ◽  
Surgical Trainees ◽  
The Uk ◽  
Supervision And Training ◽  
And Training

Over the past decade training pathways in the UK have been subject to extensive changes. Concerns regarding the supervision and training of junior doctors led to a number of reforms that were implemented through the Modernising Medical Careers programme and these mandated formalisation of curricula for all specialties. Consequently, the surgical royal colleges of the UK and Ireland designed the Intercollegiate Surgical Curriculum Programme (ISCP), which delineates the framework for surgical training from core trainee level through to the award of a Certificate of Completion of training.

A prospective observational study of the utility of early diagnostic laparoscopy for right lower abdominal pain: a safe and effective diagnostic and therapeutic tool

2019 ◽  
Vol 64 (2) ◽  
pp. 49-55
Author(s):  
Graeme JK Guthrie ◽  
Thomas Johnston ◽  
Anne Ewing ◽  
Russell Mullen ◽  
Stuart A Suttie ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Diagnostic Laparoscopy ◽  
Negative Impact ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Emergency Setting ◽  
Positive Finding ◽  
Therapeutic Tool ◽  
Surgical Trainees ◽  
Early Diagnostic

Background and aims Diagnostic laparoscopy is commonly performed for diagnosis of right lower abdominal pain and its use is increasing in the emergency setting. Some studies have reported that diagnostic laparoscopy and laparoscopic appendicectomy have advantages over conventional surgery. Many emergency surgeons now perform diagnostic laparoscopy for both clinically diagnosed appendicitis and when the diagnosis is in doubt. The aim of the present study was to assess whether the use of diagnostic laparoscopy is justified and safe for those admitted with right lower abdominal pain. Methods and results Data were collected prospectively on consecutive patients attending the acute surgical receiving unit with right iliac fossa pain or a suspected diagnosis of acute appendicitis. A total of 284 patients underwent diagnostic laparoscopy. Of them 233 (82%) had a positive finding at laparoscopy, 207 (88%) underwent appendicectomy, the majority of which were carried out laparoscopically. Surgical trainees performed the majority of operations and this did not have a negative impact on operative findings (p 0.856), operation performed (0.642), or operative duration (0.831). No intra-operative complications were sustained. Ultrasound examination was carried out in 49 patients, while CT was carried out in 24. Conclusion The results of the present study highlight the utility of early diagnostic laparoscopy as both a diagnostic and therapeutic tool in the acute setting.

scholarly journals P38 COVID-19 impact on Surgical Training And Recovery Planning (COVID-STAR) Survey

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
◽  
Joshua Clements
Keyword(s):  
Surgical Training ◽  
Negative Impact ◽  
Healthcare Delivery ◽  
Cross Sectional Study ◽  
Surgical Trainee ◽  
Surgical Specialty ◽  
Cross Sectional ◽  
Training Time ◽  
Surgical Trainees ◽  
And Training

Abstract Background The COVID-19 pandemic has resulted in dynamic changes to healthcare delivery. Surgery as a specialty has been significantly affected and with that the delivery of surgical training. Method This national, collaborative, cross sectional study comprising 13 surgical trainee associations distributed a pan surgical specialty survey on the COVID-19 impact on surgical training over a 4-week period (11th May - 8th June 2020). The survey was voluntary and open to medical students and surgical trainees of all specialties and training grades. All aspects of training were qualitatively assessed. This study was reported according to STROBE guidelines. Results 810 completed responses were analysed. (M401: F 390) with representation from all deaneries and training grades. 41% of respondents (n = 301) were redeployed with 74% (n = 223) redeployed > 4 weeks. Complete loss of training was reported in elective operating (69.5% n = 474), outpatient activity (67.3%, n = 457), Elective endoscopy (69.5% n = 246) with > 50% reduction in training time reported in emergency operating (48%, n = 326) and completion of work-based assessments (WBA) (46%, n = 309). 81% (n = 551) reported course cancellations and departmental and regional teaching programmes were cancelled without rescheduling in 58% and 60% of cases respectively. A perceived lack of Elective operative exposure and completions of WBA’s were the primary reported factor affecting potential training progression. Overall, > 50% of trainees (n = 377) felt they would not meet the competencies required for that training period. Conclusion This study has demonstrated a perceived negative impact on numerous aspects of surgical training affecting all training specialties and grades.

scholarly journals Cultivating the Ethical Repertoires of Behavior Analysts: Prevention of Common Violations

2021 ◽  
Author(s):  
Lisa N. Britton ◽  
Amy A. Crye ◽  
Linda K. Haymes
Keyword(s):  
Behavior Analyst ◽  
Ethical Culture ◽  
Behavior Analyst Certification Board ◽  
Ethical Violations ◽  
Supervision Process ◽  
Organizational Perspective ◽  
Behavior Analysts ◽  
And Performance ◽  
Supervision And Training ◽  
And Training

AbstractViolations of the Professional and Ethical Compliance Code for Behavior Analysts occur despite coursework, supervision, and training. In this discussion, we highlight the most common violation categories identified: (a) improper or inadequate supervision/delegation, (b) failure to report/respond to the Behavior Analyst Certification Board (BACB) as required, and (c) professionalism/integrity. The specific areas addressed under supervision/delegation involve behavior analysts’ standards and performance as supervisors, as well as compliance with coursework. For failure to report, the focus is on responding, reporting, and providing updated information to the BACB in a timely manner. Finally, the section on professionalism and integrity addresses multiple code elements, including integrity, professionalism, and scientific relationships, as well as methods for promoting an ethical culture and decisions involving ethical violations by others. Importantly, we provide guidance on the structure and organization of supervision, methods and guidelines regarding reporting, and rubrics to shape and evaluate professionalism and integrity. We provide recommendations for the supervision process and for practitioners from the organizational perspective so that the organization supports and promotes an ethical culture.

scholarly journals The Incidence, Management, and Outcome of Penetrating Bladder Injuries in Civilians Resultant from Armed Conflict in Baghdad 2005-2006

2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
Firas G. Petros ◽  
Richard A. Santucci ◽  
Naimet K. Al-Saigh
Keyword(s):  
Primary Repair ◽  
Bladder Injury ◽  
Associated Injuries ◽  
Bladder Drainage ◽  
Young Males ◽  
Iraqi War ◽  
Missed Injury ◽  
War Zone ◽  
Civilian Trauma ◽  
Bladder Injuries

The purpose of this paper is to review the diagnosis, treatment, and outcomes of penetrating bladder injuries suffered by civilians in the Iraqi war zone.Materials and Methods.All civilian trauma cases received alive at Al-Yarmouk Teaching Hospital from January 2005 to August 2006 were reviewed for the presence of bladder injury.Results.533 cases of penetrating abdominal trauma were identified, of which 177 (33%) involved the genitourinary (GU) system and 64 (12%) involved the bladder. Most (70%) were young males, and most (55%) had grade IV injuries. Associated injuries occurred in 63/64 (98%) of patients. 3 patients had missed bladder injuries, and all of these had complications related to their missed injury. Bladder-related complications occurred in 11% of cases, and mortality in 13%, all due to extravesical injuries.Conclusions.Penetrating bladder injury among civilians in Baghdad war zone resulted in 64 cases in 18 months. The initial detection rate is very high (98%), and after primary repair, lasting complications are rare. Morbidities from missed injuries were severe hematuria and vesicorectal fistula. However, (3%) of vesicorectal fistulae healed spontaneously with prolonged bladder drainage. Associated injuries are the rule in penetrating bladder injury patients, and must be diligently investigated and treated.

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