Aim The aim of this study was to evaluate the novice performance of advanced bimanual laparoscopic skills using the articulating FlexDex™ laparoscopic needle holder in two-dimensional (2D) and three-dimensional (3D) visual systems. Method In this prospective randomised trial, novices (n=40) without laparoscopic experience were recruited from a university cohort and randomised into two groups, which used the FlexDex™ and 2D or the FlexDex™ and 3D. Both groups performed 10 repetitions of a validated assessment task. Times taken and error rates were measured, and assessments were made based on completion times, error rates and learning curves. Results The intervention group that used FlexDex™ and 3D visual output completed 10 attempts of the standardised laparoscopic task quicker than the control group that used FlexDex™ with standard 2D visual output (268 seconds vs 415 seconds taken for the first three attempts and 176 seconds vs 283 seconds taken for the last three attempts, respectively). Moreover, each attempt was completed faster by the intervention group compared to the control group. The difference in average time for the first three and last three attempts reached statistical significance (P < 0.001). Conclusion Combination of 3D visual systems and the FlexDex™ laparoscopic needle holder resulted in superior task performance speed, leading to shorter completion times and quicker learning effect. Although the 3D group demonstrated lower mean error rates, it did not reach statistical significance.

Aim This study aims to compare novice performance of advanced bimanual laparoscopic skills using an articulating laparoscopic device (FlexDex™) compared to a standard rigid needle holder amongst surgical novices in 2-dimension (2D) visualisation. Method In this prospective randomised trial, novices (n=40) without laparoscopic experience were recruited and randomised into two groups, which used either traditional rigid needle holders or the FlexDex™. Both groups performed 10 repetitions of a validated assessment task. Times taken and error rates were recorded, and results were evaluated based on completion times, error rates, and learning curves. Results The intervention group that used the FlexDex™ completed 10 attempts of the standardised laparoscopic task slower than the control group that used traditional rigid needle holder (415 seconds vs 267 seconds taken for the first three attempts and 283 seconds vs 187 seconds taken for the last three attempts, respectively). The difference in average time for the first three and last three attempts reached statistical significance (P < 0.001). Furthermore, the intervention group demonstrated a higher error rate when compared to the control group (9.2 vs 6.3 errors per individual). Conclusions When compared to the FlexDex™, the traditional rigid needle holder was observed to be superior in task performance speed, leading to shorter completion times and quicker learning effect, as well as fewer errors.

Background Historically, abdominal X-rays (AXRs) have played an essential role in diagnosis of the acute abdomen. With the advent of other imaging modalities and the increasing need for efficiency in time, the utility of AXRs has been clarified by the RCR iRefer guidelines. Aim To assess the congruence between indications of AXR requests and the recommendations provided by the RCR iRefer guidelines. Method All AXRs performed over a 6-week period in the trust were identified retrospectively from our electronic database. Initial indications were subsequently compared with the current guidance and consultant radiologist reports. Results Out of 575 AXRs performed, 36 (6%) had no indication documented on the request. Of the remaining 539, 364 (68%) of AXRs performed met the RCR iRefer guidance. Furthermore, 496 (86%) of AXRs performed were reported as normal. 35% of AXRs that met the guidance underwent further imaging, of which 60% showed abnormality. Of those that did not meet the current criteria, abdominal pain and toxic megacolon were the most frequently documented indications. Conclusions One third of AXRs did not meet the RCR iRefer guidelines and were therefore requested inappropriately. Despite the remaining two thirds of requests being appropriate, over one third required further imaging in the form of CT/US. Moreover, less than one fifth of the total scans were interpreted as abnormal. This questions whether the current guidance requires revision and whether this imaging modality is over utilised with little effect on clinical outcomes.