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The article focuses on a study which explores the outcomes from a prospective randomized trial comparing laparascopic and open surgery for colorectal cancer. In this study, patients undergo laparascopy in order to examine the feasibility of laparascopic resection. It concludes that there is an association between laparascopic resection of colorectal cancer and increased operating time, but does not lessen morbidity.

Summary: Background: Although visual analogue scales in conventional mechanical form (mVAS) and electronical VAS (eVAS) on PDA devices are used to evaluate pain in surgical patients, it is not clear whether results of both instruments are comparable. Therefore, the level of agreement between both VAS instruments was evaluated in patients undergoing general surgery. Methods: After general surgery, 53 patients assessed their pain at rest and while coughing by mVAS and eVAS at the same time. mVAS and eVAS data were correlated and the level of agreement between both was calculated according to the method of Bland and Altman. Thirty-three female and 20 male patients in the median age of 51 (18–78) years participated in this study and a total of 185 data sets (112 at rest, 73 while coughing) were evaluated. Results: When data at rest and while coughing were analysed together, correlation between mVAS and eVAS was very good (r =0.902, p <0.001). While the mean VAS score was 4.5cm, mVAS and eVAS differed from each other by only 0.22cm (4.4% of mean VAS score). However, standard deviation of the difference (“repeatability coefficient”) was 1cm (22% of the mean VAS) and the lower and upper level of agreement ranged from −0.21 to 0.17cm (−47 to 38%). Separate analysis for mVAS and eVAS during rest and while coughing revealed similar results. Conclusion: After elective general surgery, correlation between mVAS and eVAS was high. While measurements with both instruments differ in average only by less than 5%, those differences may vary considerably in individual measurements. The type of VAS (mVAS or eVAS) should not be changed within one trial. Results obtained with different forms of VAS should be compared only with caution. [Copyright &y& Elsevier]

Evidence should define and guide modern clinical care, yet many relevant questions in surgical practice remain unconfirmed by substantial data. Evidence-based medicine requires both the implementation of its principles in day-to-day work and the acquisition of new evidence preferably by randomized controlled trials and systematic reviews. Meaningful clinical research, however, is challenging to conduct, and its overall infrastructure in Germany was, until recently, considered poor compared to other leading countries. Although this has been significantly improved after the establishment of the Study Center of the German Surgical Society (SDGC) and the surgical clinical trial network CHIR-Net, limited focus has been put on the training, teaching, and recruitment of medical students to become competent clinical researchers and clinician scientists. To ensure continuing comprehensive clinical research in surgery, CHIR-Net aims to establish a student-driven multicenter research network in Germany, which is embedded in both the national CHIR-Net and the pan-European and international frameworks. Student-Initiated German Medical Audits (SIGMA) is a product of the strong collaboration between clinical scientists and medical trainees, enabling students to contribute to high-quality clinical trials. Additionally, participants are offered extensive training to support the next generation of research-active clinicians. Starting on 2018, SIGMA will perform its first multicenter observational study in Germany.

Background and aims: Reduced fibrinolytic activity of the peritoneum seems to be the main cause of postoperative adhesions. This prospective randomized trial compared the peritoneal fibrinolytic activity between laparoscopic and conventional colorectal resection. Methods: Parietal peritoneal biopsy specimens were taken in standardized elective laparoscopic (n=14) and conventional (n=16) colorectal resections at the beginning and at the end of surgery. Activities and concentrations of tissue-plasminogen activator (tPA), plasminogen activator (PAI) type 1, and tPA/PAI complex were determined by ELISA kits. Results: There was no difference in age, sex, or body mass index between the two groups. Perioperative tPA activity decreased in both groups without differences between the groups. Concentrations and activities of tPA, PAI-1, and tPA/PAI complex did not differ between the groups at any time. Conclusion: Peritoneal concentrations and activities of tPA, PAI-1, and tPA/PAI complex are similar during laparoscopic and conventional colorectal resections. A capnoperitoneum of 12 mmHg over 3 h did not affect the peritoneal fibrinolytic activity [ABSTRACT FROM AUTHOR]