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This case report presents the management of a 69-year-old man with an extensive history of peripheral vascular disease including 2 previous failed right femoral to distal bypasses and a left above-the-knee amputation who presented with right lower extremity rest pain and non-healing shin ulcers. A redo bypass was performed for limb salvage via the obturator foramen to avoid his extensively scarred femoral region. The postoperative course was uneventful and the bypass remained patent in the early period. This case demonstrates the usefulness of the obturator bypass to provide revascularization and avoid amputation in a patient with chronic limb-threatening ischemia and multiple failed bypasses.

INTRODUCTION:There is lack of clarity on the impact of using simulation as a teaching strategy in novice learners. This study aims to determine whether the number and duration of training sessions influence the acquisition and retention of laparoscopic skills in naı ¨ve learners.METHODS: One hundred medical students were assigned in a 1:1 ratio to 1 of 2 groups. Group A underwent a single orientation and supervised practice session of 3 hours duration. Group B underwent distributed teaching with 3 learning sessions of 1 hour each spread over 3 consecutive weeks. Each participant received visual and manual demonstration of 3 basic laparoscopic tasks. Participant performance were evaluated before (pretest) and after the intervention (immediate post-test), and at 3-and 6-month intervals.RESULTS: Pretest and immediate post-test scores were comparable between the 2 groups. The 3-month interval test showed a significant difference between the 2 groups, with higher scores in group B (difference ¼ e2.90; p ¼ 0.000). The 6-month interval test showed no significant differences in performance between the 2 groups (p ¼ 0.178).In both groups, there were significant improvements in performance between the pretest and the immediate post-test (p ¼ 0.000). However, at 3-and 6-month tests there was a significant decline in the performance of both groups compared with the immediate post-test (p ¼ 0.000). CONCLUSION:In learners naı ¨ve to laparoscopy, distributed teaching resulted in better acquisition of psychomotor skills at 3 months post-test assessment (p ¼ 0.000). However, both teaching strategies yielded similar retention of skills at the 6-month assessment, suggesting the need for repeated intervention.