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Background: Haglund’s syndrome involves a prominent posterior superior prominence of the calcaneus. If nonoperative management fails, operative management with calcaneoplasty is often needed. No study has assessed Achilles tendon pullout strength after an open calcaneoplasty for Haglund’s syndrome. The purpose of this study was to investigate those changes in a cadaveric model and provide objective data upon which to base postoperative recovery. Methods: Seven matched pairs of cadaveric specimens (mid-tibia to toes) were divided into 2 cohorts: (1) intact/untreated and (2) open resection. The open resection group was treated with an open calcaneoplasty through a posterior approach using a microsagittal saw. We compared Achilles pullout strength between the 2 groups through the use of a mechanical testing system. Specimens were then loaded to failure. Lateral radiographs were obtained before and after surgery to quantify bone removal. Outcome measures included height of bony resection, angle of bone resection, and load to failure. Results: The mean maximum pullout strength was significantly higher in the intact specimens (1300 ± 500 N) compared to the open resection group (740 ± 180 N) (P < .01), representing a 45% reduction in pullout force in the open resection group. Pullout force was significantly correlated to bone mineral density (BMD) (P < .05). Pullout force was negatively correlated to both radiographic measures of resection level, angle, and height, but neither of these were significant. Conclusion: Open calcaneoplasty demonstrated a significant weakness of the Achilles tendon insertion. Pullout strength of the Achilles was also positively correlated with BMD. Clinical Relevance: Biomechanical evidence presented above supports the practice of protected weightbearing and cautious return to activity after open calcaneoplasty for Haglund’s syndrome. [ABSTRACT FROM AUTHOR]

Introduction: With the increasing adoption of peroral endoscopic myotomy (POEM) as a first-line therapy for achalasia as well as a growing list of other indications, it is apparent that there is a need for effective training methods for both endoscopists in training and those already in practice. We present a hands-on-focused with pre- and post-testing methodology to teach these skills.Methods: Six POEM courses were taught by 11 experienced POEM endoscopists at two independent simulation laboratories. The training curriculum included a pre-training test, lectures and discussion, mentored hands-on instruction using live porcine and ex-plant models, and a post-training test. The scoring sheet for the pre- and post-tests assessed the POEM performance with a Likert-like scale measuring equipment setup, mucosotomy creation, endoscope navigation, visualization, myotomy, and closure. Participants were stratified by their experience with upper-GI endoscopy (Novices <100 cases vs. Experts ≥100 cases), and their data were analyzed and compared.Results: Sixty-five participants with varying degrees of experience in upper-GI endoscopy and laparoscopic achalasia cases completed the training curriculum. Participants improved knowledge scores from 69.7 ± 17.1 (pre-test) to 87.7 ± 10.8 (post-test) (p < 0.01). POEM performance increased from 15.1 ± 5.1 to 25.0 ± 5.5 (out of 30) (p < 0.01) with the greatest gains in mucosotomy [1.7-4.4 (out of 5), p < 0.01] and equipment (3.4-4.7, p < 0.01). Novices had significantly lower pre-test scores compared with Experts in upper-GI endoscopy (overall pre-score: 11.9 ± 5.6 vs. 16.3 ± 4.6, p < 0.01). Both groups improved significantly after the course, and there were no differences in post-test scores (overall post-score: 23.9 ± 6.6 vs. 25.4 ± 5.1, p = 0.34) between Novices and Experts.Conclusions: A multimodal curriculum with procedural practice was an effective curricular design for teaching POEM to practitioners. The curriculum was specifically helpful for training surgeons with less upper-GI endoscopy experience. [ABSTRACT FROM AUTHOR]

Introduction. Box trainers have been shown to be an effective tool for teaching laparoscopic skills; however, residents are challenged to find practice time. Portable trainers theoretically allow for extended hands on practice out of the hospital. We aimed to report resident experience with laparoscopic home box trainers. Methods. Over 2 years, all residents rotating through a minimally invasive service were given a portable trainer and access to a surgical simulation lab for practice. Each trainer contained a collapsible frame, a webcam with USB port, trocars, and laparoscopic instruments (needle driver, shears, Maryland and straight dissecting graspers) as well as Fundamentals of Laparoscopic Surgery skills testing materials. Residents were asked to log hours, usages, and their experience anonymously. Results. Twenty-three residents received a portable trainer. Fifty percent of the participants found the trainer useful or very useful, 25% said it was not useful, and 25% did not access the trainer. Those that used the trainer during their rotation did so 3.1 ± 3.0 times for 2.9 ± 3.0 hours/week. After completing their rotation, 5 of 12 residents used their trainer for an average of 10.2 ± 9.4 hours. Forty-two percent of the responders liked the accessibility of the home box trainers, while 25% criticized the camera–computer interface. Conclusions. Portable box trainers are useful and can effectively supplement a laboratory-based surgical simulation curriculum; however, personal possession of a portable simulator does not result in voluntarily long-term practice. [ABSTRACT FROM PUBLISHER]