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Michael L Tuggy - One of the best experts on this subject based on the ideXlab platform.
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virtual reality Flexible sigmoidoscopy simulator training impact on resident performance
Journal of The American Board of Family Practice, 1998Co-Authors: Michael L TuggyAbstract:BACKGROUND Flexible sigmoidoscopy, a core skill for the primary care physician, requires learned hand-eye skills that can be difficult to master during residency training. With recent advances in virtual reality simulation technology, simulated Flexible Sigmoidoscopes are available to family medicine residents for training before their initial and subsequent live patient examinations. The purpose of the study was to determine whether a virtual reality Flexible Sigmoidoscope simulator would improve the hand-eye skills and various performance parameters in a live patient. METHODS Residents were assigned to a control (n = 5) or experimental group (n = 5) in which the experimental group trained on a virtual reality sigmoidoscopy simulator before their first sigmoidoscopies on live patient volunteers. After the initial live patient sigmoidoscopies, both control and experimental groups trained on the simulator so that it was possible to evaluate presimulator and postsimulator training effects on live patient performance and to compare speed and skill between the groups at different levels of training. RESULTS Training on the virtual reality simulator produced substantial improvements in examination times and hand-eye skill measures. After 6 to 10 hours of training on the simulator, the experimental group achieved significantly faster insertion times to 30 cm (119 versus 357 sec, P = 0.03), 40 cm (211 versus 518 sec, P = 0.03), and a shorter mean length of examination (323 versus 654 sec, P = 0.01). There was also significant improvement of hand-eye skill measures of the experimental group in directional errors (1.6 versus. 8.6, P < 0.01), percentage of colon visualized (79 versus 45 percent, P = 0.02), and viewing quality of examination when compared with the control group's initial performance on live patients. Resident survey findings after the study confirmed the trainee's perception of the benefit of the simulator training. CONCLUSIONS This study shows the value of virtual reality simulator training for accelerating the development of the hand-eye skills to perform adequate sigmoidoscopy.
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Virtual reality Flexible sigmoidoscopy simulator training: Impact on resident performance
1998Co-Authors: Michael L TuggyAbstract:Background: Flexible sigmoidoscopy, a core skill for the primary care physician, requires learned hand-eye skills that can be difficult to master during residency training. With recent advances in virtual reality simulation technology, simulated Flexible Sigmoidoscopes are available to family medicine residents for training before their initial and subsequent live patient examinations. The purpose of the study was to determine whether a virtual reality Flexible Sigmoidoscope simulator would improve the hand-eye skills and various performance parameters in a live patient. llethods: Residents were assigned to a control (n = 5) or experimental group (n = 5) in which the experimental group trained on a virtual reality sigmoidoscopy simulator before their first sigmoidoscopies on live patient volunteers. After the initial live patient sigmoidoscopies, both control and experimental groups trained on the simulator so that it was possible to evaluate presimulator and postsimulator training effects on live patient performance and to compare speed and skill between the groups at different levels of training. Results: Training on the virtual reality simulator produced substantial improvements in examination times and hand-eye skill measures. After 6 to 10 hours of training on the simulator, the experimental group achieved significantly faster insertion times to 30 em (119 versus 357 sec, P = 0.03), 40 em (211 versus 518 sec, P = 0.03), and a shorter mean length of examination (323 versus 654 sec, P = 0.01). There was also sig
J. G. Guillem - One of the best experts on this subject based on the ideXlab platform.
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Anastomotic occlusive web following double-stapled anterior resection and fecal diversion
Surgical Endoscopy, 1998Co-Authors: A. I. Picon, J. G. GuillemAbstract:The incidence of occlusive web following stapled anastomosis for curative resection of rectal cancer is unknown and the management of this entity not well defined. A 73-year-old patient underwent a double-stapled anterior resection with a temporary loop ileostomy for a T3,N1 rectal cancer. He received postoperative chemoradiation adjuvant therapy. Prior to ileostomy closure, sigmoidoscopy revealed an anastomotic occlusive web at 10–12 cm from the anal verge. Under monitored sedation, a Flexible Sigmoidoscope was inserted per anus and advanced to the level of the occlusive web. Utilizing hydrostatic balloon dilatation, the occlusive web was broken and the bowel lumen was restored. The procedure was performed expeditiously and without complications. Subsequently the patient underwent ileostomy closure and experienced normal bowel movements. Although occlusive webs are uncommon after colorectal anastomosis, this case report describes a safe, effective, and uncomplicated endoscopic procedure that can be performed in patients with anastomotic occlusive web developing after prolonged fecal diversion.
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Anastomotic occlusive web following double-stapled anterior resection and fecal diversion. Presentation and endoscopic management.
Surgical endoscopy, 1998Co-Authors: A. I. Picon, J. G. GuillemAbstract:The incidence of occlusive web following stapled anastomosis for curative resection of rectal cancer is unknown and the management of this entity not well defined. A 73-year-old patient underwent a double-stapled anterior resection with a temporary loop ileostomy for a T3,N1 rectal cancer. He received postoperative chemoradiation adjuvant therapy. Prior to ileostomy closure, sigmoidoscopy revealed an anastomotic occlusive web at 10–12 cm from the anal verge. Under monitored sedation, a Flexible Sigmoidoscope was inserted per anus and advanced to the level of the occlusive web. Utilizing hydrostatic balloon dilatation, the occlusive web was broken and the bowel lumen was restored. The procedure was performed expeditiously and without complications. Subsequently the patient underwent ileostomy closure and experienced normal bowel movements. Although occlusive webs are uncommon after colorectal anastomosis, this case report describes a safe, effective, and uncomplicated endoscopic procedure that can be performed in patients with anastomotic occlusive web developing after prolonged fecal diversion.
A. I. Picon - One of the best experts on this subject based on the ideXlab platform.
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Anastomotic occlusive web following double-stapled anterior resection and fecal diversion
Surgical Endoscopy, 1998Co-Authors: A. I. Picon, J. G. GuillemAbstract:The incidence of occlusive web following stapled anastomosis for curative resection of rectal cancer is unknown and the management of this entity not well defined. A 73-year-old patient underwent a double-stapled anterior resection with a temporary loop ileostomy for a T3,N1 rectal cancer. He received postoperative chemoradiation adjuvant therapy. Prior to ileostomy closure, sigmoidoscopy revealed an anastomotic occlusive web at 10–12 cm from the anal verge. Under monitored sedation, a Flexible Sigmoidoscope was inserted per anus and advanced to the level of the occlusive web. Utilizing hydrostatic balloon dilatation, the occlusive web was broken and the bowel lumen was restored. The procedure was performed expeditiously and without complications. Subsequently the patient underwent ileostomy closure and experienced normal bowel movements. Although occlusive webs are uncommon after colorectal anastomosis, this case report describes a safe, effective, and uncomplicated endoscopic procedure that can be performed in patients with anastomotic occlusive web developing after prolonged fecal diversion.
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Anastomotic occlusive web following double-stapled anterior resection and fecal diversion. Presentation and endoscopic management.
Surgical endoscopy, 1998Co-Authors: A. I. Picon, J. G. GuillemAbstract:The incidence of occlusive web following stapled anastomosis for curative resection of rectal cancer is unknown and the management of this entity not well defined. A 73-year-old patient underwent a double-stapled anterior resection with a temporary loop ileostomy for a T3,N1 rectal cancer. He received postoperative chemoradiation adjuvant therapy. Prior to ileostomy closure, sigmoidoscopy revealed an anastomotic occlusive web at 10–12 cm from the anal verge. Under monitored sedation, a Flexible Sigmoidoscope was inserted per anus and advanced to the level of the occlusive web. Utilizing hydrostatic balloon dilatation, the occlusive web was broken and the bowel lumen was restored. The procedure was performed expeditiously and without complications. Subsequently the patient underwent ileostomy closure and experienced normal bowel movements. Although occlusive webs are uncommon after colorectal anastomosis, this case report describes a safe, effective, and uncomplicated endoscopic procedure that can be performed in patients with anastomotic occlusive web developing after prolonged fecal diversion.
Benjamin Littenberg - One of the best experts on this subject based on the ideXlab platform.
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Disposable, sheathed, Flexible sigmoidoscopy: A prospective, multicenter, randomized trial☆☆☆★★★♢♢♢♦
Gastrointestinal endoscopy, 1995Co-Authors: Richard I. Rothstein, Benjamin LittenbergAbstract:Abstract A new fiberoptic sigmoidoscopic system has been developed that utilizes a disposable sheath to cover and protect all working surfaces of the endoscope from contamination. The reusable part of the endoscope has no air, water, or suction/biopsy channels. These are incorporated in the disposable sheath, which is easily removed after use to provide each patient with a contamination-free endoscope. A prospective, randomized, controlled trial was performed to compare the disposable, sheathed, Flexible Sigmoidoscope with standard Sigmoidoscopes. Clinical evaluations of the new Sigmoidoscope system were performed at 15 facilities. Visual analog rating scales were used to record evaluations of endoscope performance and reprocessing by endoscopists and reprocessing personnel. The time to perform procedures, depth of insertion, and total instrument downtime were also recorded. One hundred forty-three procedures (70 standard, 73 sheathed) were performed. No significant difference was found for overall depth of insertion (50 versus 48 cm), although fewer sheathed endoscopes reached to 60 cm than did standard endoscopes (51% versus 30%). The sheathed system had a slightly longer mean procedure time than the standard (5.6 versus 6.7 minutes), but a significantly shortened overall downtime (32.8 vs 8.1 minutes). The standard system was preferred by the endoscopists. Reprocessing personnel preferred the disposable system. The disposable Sigmoidoscope system has important advantages of decreased instrument turn-around time and potentially increased staff and patient safety, and future models should be improved to meet physicians' concerns. (Gastrointest Endosc 1995;41:566-72.)
G D Bell - One of the best experts on this subject based on the ideXlab platform.
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depth of insertion at Flexible sigmoidoscopy implications for colorectal cancer screening and instrument design
Endoscopy, 1999Co-Authors: J Painter, D B Saunders, G D Bell, C B Williams, R Pitt, J S BladenAbstract:Background and Study Aims: The depth of insertion at Flexible sigmoidoscopy is variable, depending upon bowel preparation, patient tolerance and distal colonic anatomy. Many endoscopists routinely aim to insert the 60cm Flexible Sigmoidoscope to the splenic flexure; however internal endoscopic markers are unreliable, making the true anatomical extent of the examination difficult to assess. The aim of this study was to assess the depth of insertion at Flexible sigmoidoscopy. Patients and Methods: Two separate studies were done. In the first (study 1), magnetic endoscopic imaging was used to determine the final depth of insertion at non-sedated, screening Flexible sigmoidoscopy. In the second (study 2), real-time imaging was utilized to determine sigmoid looping and the anatomical location of the endoscope tip after 60 cm of instrument had been inserted during total or limited colonoscopy. A total of 117 consecutive average-risk patients, aged 55-65 years participated in study 1, and 136 patients underwent either limited, (33) or attempted total colonoscopy (103) in study 2. Results: In study 1 the median insertion distance was 52 cm, range 20-58. In 61 % of patients the imaging sytem showed that the descending colon had not been visualized by the end of the procedure. Failure to reach the sigmoid/descending junction occurred in 29 (24%) patients. Reasons for failure included poor tolerance of the procedure due to pain (23 patients) inadequate preparation (3 patients) and, excessive looping (3 patients). In study 2, after 60 cm of instrument had been inserted, the splenic flexure or beyond was reached in 29% and the descending colon in 9%, whilst in 62% the endoscope tip had not passed beyond the sigmoid/descending colon junction. A sigmoid loop formed in 70% of patients, and unusual loops such as the alpha, reverse alpha and reverse sigmoid spiral loop occurred more frequently in women compared to men (P=0.0249). In those 104 patients where the splenic flexure was reached the mean maximum length of instrument inserted prior to reaching the flexure was 75.4cm, (SD = 21.9). Conclusions: Examination of the entire sigmoid was not achieved in approximately one-quarter of patients undergoing screening Flexible sigmoidoscopy, mainly because of discomfort. The descending colon is intubated in a minority of cases (using standard instruments), even after 60 cm has been inserted. Alternative instruments with different shaft characteristics (floppy, narrow calibre, 80-100 cm in length) may be necessary to ensure deeper routine intubation in nonsedated patients.
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Preliminary experience comparing two thinner prototype Olympus endoscopes with a standard 60cm Flexible Sigmoidoscope
1999Co-Authors: G D Bell, John E. Painter, Wendy Atkin, S Dogramadzi, C AllenAbstract:Abstract T86 presented at the British Society of Gastroenterology Annual Meeting 1999, 23-25 th March, Glasgow rmr Introduction We previously used magnetic endoscope imaging todetermine the anatomical location of the instrumenttip and depth of insertion at non-sedated, screeningFlexible sigmoidoscopy (FS) using a 60cm OlympusFlexible Sigmoidoscope (Painter et al., 1999).Examination of the entire sigmoid was not achievedin approximately one-quarter of subjects, mainly dueto discomfort. We postulated that instruments withdifferent shaft characteristics (floppy, narrow calibreand over 100cm in length) might be necessary toensure deeper routine intubation in non-sedatedpatients (Bell et al., 1996). Methods We used two prototype Olympus thin (10mm) diam-eter endoscopes (models XCFSEV and MS230I)measuring 100cm and 130cm respectively in 50 non-sedated symptomatic patients undergoing diagnosticFS (see Figures 1a and 1b).We used the magnetic imaging system (Bladen etal., 1993) in combination with our improved RMR3D graphics system (Rowland and Bell 1998,Rowland et al., 1999) (see Figure 2) to assess boththe total depth of insertion in cms and the location ofthe instrument tip when the endoscope had been ei-ther fully inserted or the patient experienced signifi-cant discomfort.We compared the results with those we had previ-ously obtained with the standard 12.5mm diameter60cm Olympus Flexible Sigmoidoscope using thesame magnetic imaging system (Painter et al., 1999)in 117 subjects attending for screening Flexible sig-moidoscopy as part of the MRC trial (Painter et al.,1999).