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To assess the effects of practice and dynamic instruction on changes in speed and accuracy during acquisition of simulated laparoscopic surgical skills.Fourteen PGY-1 general surgery residents were randomly assigned to 1 of 2 experimental conditions (n = 7 per group), either practice only or practice with instruction, and required to perform 10 trials of each of 2 laparoscopic surgical skills-cannulation and object passing. Practice only subjects were given verbal instructions for each task, and corrective feedback only after trial 1. Practice with instruction subjects were treated the same, but also saw a videotaped demonstration and received dynamic feedback during and between each trial. Performance speed was recorded for each trial and number of errors was recorded for trials 8 to 10 by videotape review.Mean speed for subjects in both groups increased significantly for both tasks (p0.01). Practice with instruction subjects committed significantly fewer errors on object passing (p0.04) and were less variable in the number of errors committed during the cannulation task (p0.01).Practice, with or without dynamic instruction, results in significant improvement in the speed of performance of simulated laparoscopic surgical skills. The addition of dynamic instruction to simulator-based practice improves the quality and consistency of resident acquisition of laparoscopic surgical skills.

Background: Laparoscopic surgery has proven to be safe and effective. However, the value of laparoscopic resection for malignancy in terms of cancer outcome can only be assessed by large prospective randomized clinical trials with sufficient follow-up. Methods: COLOR (COlon carcinoma Laparoscopic or Open Resection) is a European multicenter randomized trial which has started in September 1997. In 24 hospitals in Sweden, The Netherlands, Germany, France, Italy and Spain, 1,200 patients will be included. The primary end point of the study is cancer-free survival after 3 years. Results: Within Conclusions: Although laparoscopic surgery appears of value in colorectal malignancy, results of randomized trials have to be awaited to determine the definitive place of laparoscopy in colorectal cancer. Considering the current accrual rate, the COLOR study will be completed in 2002.

Granular cell tumors are rare, invariably benign, and often solitary tumors, which infrequently involve the gastrointestinal tract. We report the unique presentation of a granular cell tumor of the internal anal sphincter in a 75 year-old female. The tumor was detected during investigation of new rectal bleeding and was excised using a transanal approach and sphincter repair. At five-year follow-up the patient reported normal continence to stool and flatus and demonstrated no evidence of tumor recurrence. Immunohistochemical studies cite the Schwann neural cell as the origin of the granular cell tumor. Cytoplasmic features include acidophilic, p-aminosalicylic acid-positive, diastaseresistant granules. Granular cell tumors may be located anywhere in the body, but anorectal involvement is rare. In our own search of the world literature, no other cases were reported specifically to involve the anal sphincter. Granular cell tumors are usually detected incidentally but may be symptomatic, especially when the anorectal region is involved. Symptoms include perianal discomfort and bleeding. Adequate local excision is effective for both diagnosis and treatment of anorectal granular cell tumors. Careful follow-up should be performed after excision because of the risk of recurrence.