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Introduction: The popularity of robotic surgery highlights the need for strategies to integrate this technique into surgical education. We present 5 year data for robotic cholecystectomy (RC) as a model for training residents., Methods: Data were collected on all RC over 66 months. Duration for docking the robot (S2) and performing RC (S3), and surgical outcomes, were recorded. We used a linear mixed effects model to investigate learning curves., Results: Thirty-eight trainees performed 160 RCs, with most performing more than four. One case was aborted due to haemodynamic instability, and two were converted to open surgery due to adhesions. There were no technical complications. The duration of S2 (mean = 6.2 ± 3.6 min) decreased considerably (p = 0.027). Trainees also demonstrated decrease in duration of S3 (mean = 38.4 ± 15.4 min), indicating improvement in technique (p = 0.008)., Conclusions: RC is an effective model for teaching residents. Significant and reproducible improvement can be realized with low risk of adverse outcomes., (Copyright © 2013 John Wiley & Sons, Ltd.)

Background: The overall incidence of pseudotumor cerebri (PTC) has been estimated at 1 per 100,000 in the general population, with an increase to 19 per 100,000 among overweight patients. About 25% of affected patients are asymptomatic until they present with vision loss. We hypothesized that PTC would be highly prevalent among obese patients seeking bariatric surgery. The setting of our study was a university hospital., Methods: During a 2-year period, clinical data were collected from candidates for bariatric surgery. A group of the study population was concurrently screened for papilledema using fundus imaging. All images were reviewed by a single neuro-ophthalmologist. All patients with abnormal images were referred for neuro-ophthalmic evaluation., Results: The imaging group (78% women) had a mean age of 45.4 ± 10.7 years, and the mean body mass index of 47.8 ± 8.7 kg/m(2). High definition nonmydriatic fundus imaging was normal in 489 patients (91.9%) and abnormal in 43 patients (8.9%). The subsequent evaluation by the neuro-ophthalmologist revealed ocular abnormalities other than optic disc edema in 27 patients (5.1%) and normal findings in 7 patients (1.3%). Five patients (.9%) declined additional evaluation. Four patients (.8%) had confirmed optic disc edema and normal brain magnetic resonance imaging findings. Of these patients, 3 underwent lumbar puncture, which confirmed the diagnosis of PTC., Conclusion: We identified a greater prevalence of PTC overall (.65%) and in the imaging group (.9%) than previously reported or would have been predicted from the current data. Although routine funduscopic examination is of limited utility, these findings warrant additional investigation into the utility of, and optimal method for, screening morbidly obese patients for this co-morbidity., (Copyright © 2012 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Idiopathic intracranial hypertension (IIH) is a rare condition that can lead to significant morbidity from visual loss. The cause of IIH is unknown, but IIH is known to be associated with obesity. Obese patients may be at particularly high risk for suffering vision loss from IIH. The purpose of the present study is to determine the prevalence of undiagnosed or asymptomatic papilledema in a population of morbidly obese individuals and to determine if these patients should undergo routine screening for papilledema., Methods: Patients presenting to the UC Davis Bariatric Surgery Clinic between February 2008 and January 2011 who met the National Institutes of Health criteria for bariatric surgery were invited to participate in the study. Those patients who met the inclusion criteria and consented to the study were included. Participants were screened for IIH by nonmydriatic fundus photographs and by concerning symptoms prompting direct referral for neuro-ophthalmologic evaluation. Images were reviewed by a neuro-ophthalmologist, and patients with suspicious optic discs underwent neuro-ophthalmologic evaluation. Patients with findings consistent with IIH were sent for neurological evaluation., Results: A total of 606 patients with an average body mass index of 47 kg/m2 were included in the study. Seventeen of these patients had photographic optic disc findings or symptoms suspicious for IIH. Seven of these patients did not have disc edema on clinical examination. Six patients were not evaluated in the clinic. Four of the 17 patients had subtle optic disc edema confirmed by clinical evaluation and were referred for full neurological workup. These 4 patients had normal neuroimaging, 3 of whom underwent lumbar punctures with borderline high opening pressures. All 4 patients had unremarkable visual field examinations. Fundus abnormalities other than optic disc edema were discovered in 33 patients., Conclusion: Our study suggests that in a morbidly obese patient population, papilledema with significant visual loss is rare. Routine screening with fundus photography of morbidly obese patients likely is not warranted.