Background: Social media has changed the way surgeons communicate worldwide, particularly in dissemination of trial results. However, it is unclear if social media could be used in recruitment to surgical trials. This study aimed to investigate the influence of Twitter in promoting surgical recruitment in The Emergency Laparotomy and Frailty (ELF) Study. Methods: The ELF Study was a UK-based, prospective, observational cohort that aimed to assess the influence of frailty on 90-day mortality in older adults undergoing emergency surgery. A power calculation required 500 patients to be recruited to detect a 10% change in mortality associated with frailty. A 12-week recruitment period was selected, calculated from information submitted by participating hospitals and the numbers of emergency surgeries performed in adults aged > 65 years. A Twitter handle was designed (@ELFStudy) with eye-catching logos to encourage enrolment and inform the public and clinicians involved in the study. Twitter Analytics and Twitonomy (Digonomy Pty Ltd) were used to analyse user engagement in relation to patient recruitment. Results: After 90 days of data collection, 49 sites from Scotland, England and Wales recruited 952 consecutive patients undergoing emergency laparotomy, with data logged into a database created on REDCap. Target recruitment (n = 500) was achieved by week 11. A total of 591 tweets were published by @ELFStudy since its conception, making 218,136 impressions at time of writing. The number of impressions (number of times users see a particular tweet) prior to March 20th 2017 (study commencement date) was 23,335 (343.2 per tweet), compared to the recruitment period with 114,314 impressions (256.3 per tweet), ending June 20th 2017. Each additional tweet was associated with an increase in recruitment of 1.66 (95%CI 1.36 to 1.97; p < 0.001). Conclusion: The ELF Study over-recruited by nearly 100%, reaching over 200,000 people across the U.K. Branding enhanced tweet aesthetics and helped increase tweet engagement to stimulate discussion and healthy competition amongst clinicians to aid trial recruitment. Other studies may draw from the social media experiences of the ELF Study to optimise collaboration amongst researchers.

Background: Laparoscopic surgery is based on 2D imaging, with limited depth perception. The aim of this study was to analyse the impact of 3D training on the performance of surgical trainees in 2D laparoscopic simulation. Methods: Thirty medical students were randomised into group A, completing five training attempts of three modified Fundamentals of Laparoscopic Surgery tasks (peg transfer, pattern cutting, and intra-corporeal suturing) using a 3D simulator, or group B, who were only exposed to the 2D platform. Time to completion, error rate, and efficiency improvement were measured. Results: The overall performance time was lower for group A than for group B, and this was statistically significant in task 2 (P = 0.02) and task 3 (P 5 0.01). The mean error rate was lower for group A versus group B, which was statistically significant for all three tasks (task 1, 0 vs 0.2; task 2, 0.4 vs 1.8; task 3, 0.24 vs 1.1). When efficiency improvement was evaluated, group B displayed a faster rate of improvement during task 1 (132.1% vs 248.8%; P 5 0.01) and task 2 (123.9% vs 139%; P = 0.15). For task 3, group A demonstrated a superior rate of improvement (190% vs 173.1%; P = 0.2). Conclusions: Introducing 3D training is beneficial for novices to execute 2D laparoscopic skills, particularly for complex tasks where depth perception is critical. 3D-based laparoscopic training, in conjunction with standard 2D platforms, should be introduced into surgical training to facilitate quicker and better preparation before translation of these skills into clinical practice.

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Background: Fundamentals in Laparoscopic Surgery (FLS) is widely used in practice for skill acquisition and objective assessments. The peg transfer model enables trainees to acquire basic laparoscopic skills. We structured three different three-dimensional (3D) peg transfer models with various heights and depths to replicate 3D laparoscopic anatomy. Before implementing any simulation model in a laparoscopy curriculum, it is important to determine its validity. Aim: To establish face and construct validity of novel 3D peg transfer models in two-dimensional (2D) and 3D visual systems for training and evaluation of laparoscopic skills in novices using the McGill inanimate system. Methods: Three peg transfer 3D models were designed with different peg heights and depths using wooden blocks from the popular game "Jenga". Ten novices, ten intermediates and ten experts were recruited. They performed three repetitions of peg transfer on each model using 3D and 2D visual modalities. Performance time, error and total score were measured. Multiple comparison (post hoc Bonferroni) tests were used to compare the data (mean value of total time, total errors and total score) for each group. All participants completed a six-question post-test questionnaire (face validity) for 2D and 3D viewing modalities. Results: When novices were compared with intermediates and experts using 2D and 3D visual systems, there were statistically significant differences (P50.001) in the total score and performance time for all models with the exception of model 2 in 2D. We were unable to show any significant difference in total score and performance time when intermediates were compared with experts with any of the three models, in either the 2D or the 3D visual modality. All models were highly rated in both visual modalities. Conclusion: Three models were developed for improving laparoscopic surgical skills. Face validity and construct validity were demonstrated by measuring significant differences in improvement of performance time and lower total score when novices were compared with intermediates and experts in both 2D and 3D visual modalities. We recommend using models 1 and 3 for simulation training in both visual modalities, and this could replace the current relatively "flat" 2D models of the FLS training course to shorten the learning curve for acquiring surgical skills.

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