Introduction
Laparoscopic colorectal surgery (LCRS) offers similar oncologic outcomes to the open approach along with early postoperative recovery but is not without complications, with bleeding being uncommon but with variable impact and technical resource demand.
Methods
A descriptive and retrospective study of bleeding in patients undergoing elective LCRS in our center between 01/012018 and 31/12/2021. The data analysis was performed using the SPSS statistical software.
Results
Out of 945 LCRS, 45 patients (4.8%) presented some hemorrhagic event. The main diagnosis was colorectal cancer (35), followed by diverticular disease (6). The procedures most frequently associated with bleeding were sigmoidectomy (13), TATME (7) and right hemicolectomy (7). Five patients presented moderate (4) or severe (1) intraoperative bleeding, controlled during surgery. The most commonly used hemostatic devices were biopolar energy (29.5%) and combined (34.1%). The diagnosis of postoperative bleeding was clinical in 20 cases (45.5%), 17 by CT angiography (38.6%) and 7 by endoscopy (15.9%). In 36.4% the origin of hemorrhage was in the anastomosis, demonstrated by endoscopy or radiological study. Eleven patients (25%) required reintervention: seven by open approach and four by laparoscopy (two conversions). Therapeutic endoscopy was performed in 7 patients (15.9%), in 1 patient interventional radiology-surgery was combined, and in another patient endoscopy-surgery. There was no mortality due to this cause. The mean length of stay after surgery was 19.52 days.
Conclusions
Hemorrhage in LCRS is a rare but potentially serious complication that requires early diagnosis and staged multidisciplinary approaches, including advanced therapeutic endoscopy and interventional radiology procedures.
INTRODUCTION
Simulation training has become a widely accepted educational tool for the development of technical skills in endoscopic surgery. The objective of this work was to evaluate bachelors who hold a Degree in Medicine in the execution of exercises carried out in both physical and virtual simulations.
MATERIAL AND METHODS
The descriptive study was carried out among 400 students (266 women and 134 men) in their third year of medicine studies between 2016 and 2019. The practises consisted of 11 hours of teaching, made of theory introduction, and exercise work in groups of 15-20 students on 4 workstations: LapSim, Pelvitrainer, Transanal Endoscopic Surgery (singleport) and Flexible Endoscopy. The execution time per individual exercise and in pairs is collected.
RESULTS
Individual exercises: the average execution time was: 277.0±117.8 sg, LapSim: 158.8± 66.44 sg and Pelvitrainer: 123.6±82.7sg. Couple exercises: the average execution time in Transanal Endoscopic Surgery was: 79.4±51.9 sg and Flexible Endoscopy: 53.56±34.4 sg. The analysis by gender showed that men performed better in LapSim with an average of 141.4 sg ± 52.2 in respect to women, 167.8 sg ± 71.1 (p < 0.05). In the rest of the exercises, no significant differences were shown.
CONCLUSIONS
Conducting simulated practises or studies for further development in the Degree is feasible, with objective evaluations of the skills acquired. The possibility of interacting in a controlled environment and with immediate feedback has made it possible to identify baseline differences by gender only in virtual simulation.
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