BACKGROUND Post-operative drains in thyroid surgery are commonly used to avoid haematomas. This study was undertaken to find out the routine placement of drains necessary in thyroid surgeries. This study was conducted in two groups of 50 patients each with and without drains and results compared. Both groups were homogeneous in all aspects. Aim-This prospective clinical trial was conducted to evaluate the routine use of drains after thyroidectomy (total and hemi) for benign thyroid disorders. MATERIALS AND METHODS A total of 50 patients of thyroidectomy were randomly chosen not to be drained from June 2014 to August 2015 in our institution, the Government Chengalpattu Medical College and Hospital. Outcomes including operating time, post-operative pain, hospital stay, complications, necessity for re-operation and satisfaction of patients were all assessed and compared with 50 randomly chosen patients to be drained. RESULTS There was no significant reduction in the operating time. The post-operative pain/ discomfort was found to be significantly low assessed by visual analogue scale. Four cases of seroma were seen, which were treated conservatively. No patient needed reoperation for any complication. The mean hospital stay was shorter, and the satisfaction of patients was significant. CONCLUSION The findings suggest that post-operative complications cannot be significantly prevented by routine use of drains. Furthermore, the use of drains may increase post-operative pain subsequently requiring analgesic, surgical site infection and prolong the hospital stay. In the light of these findings, the routine use of drains may be deemed not routinely necessary following thyroid surgeries.

OBJECTIVEThis prospective clinical trial was conducted to evaluate the incidence of intraperitoneal injuries with the use of closed Veress needle technique in primary port placement, the incidence of Port Site Hernias (PSH) and the efficacy of fascial closure in the prevention of PSH. METHODSA total of 100 patients undergoing various laparoscopic procedures were enrolled in the study, which included Cholecystectomy, Appendectomy, Adhesiolysis and diagnostic procedures. All surgeries were done on selective basis. Fascial closure was not done in any of the cases and no Endobag was used to retrieve the specimens. In the event of difficulty in retrieving the specimen, port site was extended by 2 or 3 mm to facilitate easy removal. The period of study was from October 2013 to March 2015 at The Government Chengalpattu Medical College and Hospital. The incidence of injuries to the intraperitoneal structures during the primary port insertion by the closed Veress needle technique and the incidence of PSH were observed. RESULTSThere was no incidence of bowel or vascular injuries with the use of the closed Veress needle technique or PSH in all the 100 patients (0%). The advantages of fascial closure in preventing PSH is questionable. CONCLUSIONClosed method of primary port insertion using the Veress needle is a very safe method with the appropriate technique. The efficacy of closure of fascial layer in preventing trocar site hernias is a subject of debate and needs further evaluation since our study was restricted to basic laparoscopic procedures done on elective basis and no comparative analysis was made with the open method.

Background: Simulation is a way of learning skills in life like situations that are not real. Simulation based training according to many studies turned out to be effective method in skill development. In this study we have used bench top models available in our institute with simulated patients, which are accessible, and cost effective. The use of simulation in Graduate Medical Education has evolved significantly over time, particularly during the past decade. The applications of simulation include training budding surgeons in technical and non-technical skills and better prepared to face clinical situations.Methods: After 5 days of focused group discussion, 60 interns were asked to perform the two basic tasks in bench models attached to simulated patents. Skills assessed by pre-test, post-test and feedback module created for the 2 tasks. Scores was compared and analyzed, at the end of the module by summative assessment. Tasks were graded to100 point system, using rubrics and difference calculated using pair t test.Results: Mean of the skill score in pre-test 78.26±5.58, range found to be 86-73. There was significant improvement in post test score in which 86.54±4.41, range 97-66. t was found to be 5.5256, a significant improvement, and p value found in post-test 0.0002.Conclusions: Skill development with Mannequins and Standardized patients is found effective in training the interns. In addition to developing technical and non-technical skills, interns also get to communicate with simulated patients, which will make them more competent.

Background: An exam wrapper is a structured debrief­ing questionnaire tailored to help the students understand their performance in the examination and help them to plan and develop improvement strat­egies. Exam wrappers give students a structured reflection about how they performed in a particular exam and act as a useful tool to perform better in the next exam. This mixed-method study was conducted to assess the impact of exam wrapper on metacognitive skills of surgery students and to assess the perception of students on its application in exam preparation.Methods: Metacognition was assessed using the metacognitive inventory questionnaire for students learning surgery. Nonparametric Friedman test was used to analyze quantitative data and qualitative data which were collected from four identified focus groups students who completed the exam wrapper sessions.Results: Students who used the exam wrapper throughout the se­mester demonstrated appreciable improvement in metacog­nition (p=0.013). Focus group data showed that students found the exam wrapper useful and effective. The analysis revealed the students' trust that, the faculties can make a change, complementary to conventional teaching-learning methods and reflecting the exam paper helps them to perform better.Conclu­sions: Medical students in surgery perceive this tool as use­ful and their application of exam wrapper as an effective tool in metacognition. This type of metacognitive intervention needs to be adopted across different departments for exam wrapper to be more engaging and direct students towards self-directed learning.

Huge Cyst of the liver not frequently found. This case of massive liver cyst (left lobe) in a female patient is reported for its rarity. In this case, the patient presented with no other complaints except distention of abdomen and vague pain abdomen. To highlight diagnostic challenges and treatment options available to rural population, that is affordable and accessible.  A 57 years old female patient from nearby village, presented with distention of abdomen for 5years, which was small to start with and gradually increasing in size to attain the present size. Preoperatively, it was a huge tensely cystic swelling arising from left lobe of liver occupying whole upper abdomen. Swelling appeared to be arising from segment II and III (Couinaud system), right lobe compressed to a rim. The cyst was opened anteriorly and drained 4.8l of clear fluid. Marsupialization of the cyst was done. Though huge cystic swellings are comparatively rare, they should be considered in the pre-operative differential diagnosis of abdominal masses. They can be easily diagnosed and managed in hospitals with limited resources and are affordable to the patients also.