Purpose: To develop a model of gastroenterostomy and to analyze the acquisition of skills after training by simulation. Methods: Experimental longitudinal study and of a quantitative character. The sample consisted of twelve general surgery residents from four hospitals. The training consisted of making ten anastomoses divided equally into five sessions and it took place over a period of six weeks. The evaluation of the anastomoses considered the time and the analysis of the operative technique through the global evaluation scale Objective Structured Assessment of Technical Skills (OSATS). Results: Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The correlation index of 0.545 and 0.497 showed a high linear correlation between time variables and OSATS. Conclusion: The preparation of ten gastroenterostomies is an exercise capable of transferring basic and advanced skills in laparoscopy through a standardized training using synthetic organs and a simulator.
Purpose To create a checklist to evaluate the performance and systematize the gastroenterostomy simulated training. Methods Experimental longitudinal study of a quantitative character. The sample consisted of twelve general surgery residents. The training was divided into 5 sessions and consisted of participation in 20 gastroenterostomys in synthetic organs. The training was accompanied by an experienced surgeon who was responsible for the feedback and the anastomoses evaluation. The anastomoses evaluated were the first, fourth, sixth, eighth and tenth. A 10 item checklist and the time to evaluate performance were used. Results Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The correlation index of 0.545 and 0,295 showed a high linear correlation between time variables and Checklist. The average Checklist score went from 6.8 to 9 points. Conclusion The proposed checklist can be used to evaluate the performance and systematization of a simulated training aimed at configuring a gastroenterostomy.
-Background -Obesity has adverse health effects. Dietary reeducation does not seem to offer sustained weight loss. For appropriately selected patients, surgery may be beneficial. Aim -To evaluate early postoperative metabolic response to surgery in patients submitted to Capella's gastroplasty using two different surgical approaches to the abdominal cavity. Patients/Method -Twenty patients (9 males and 11 females, aged 21 to 53 years) were randomized prior to submission to either one of the surgical access incisions (bilateral arciform or supra-umbilical midline incisions). Blood samples were collected at the beginning and end of the operation, 12 (T-12 h) and 24 hours (T-24 h) postoperatively. Dieresis and synthesis time, blood loss, planimetry of operative field, operative time, hospital stay, hemoglobin, hematocrit, lymphocytes, potassium, albumin, erythrocyte sedimentation rate, C-reactive protein, glucose, pyruvate, lactate and ketone bodies were analyzed. Results -Dieresis time was significantly decreased when median approach was used. Total operating time, hospital stay, hematocrit, hemoglobin, lymphocyte count, potassium and albumin concentrations were similar in both groups. C-reactive protein (T-12 h), glucose and pyruvate concentrations (T-24 h) increased significantly after completion of surgical procedure. Ketone bodies concentrations were significantly decreased 24 hour following completion of surgical procedure. Conclusion -Capella's gastroplasty induces metabolic and inflammatory changes in blood parameters. There is no evidence of technical superiority of arciform over midline incisions in this study.
The proposed training model was well accepted and proved to be effective in reducing operative time and improving laparoscopic skills. The training should be fractionated (4 sessions in 3 weeks), repetitive (12 anastomoses) and have positive feedback.
RESUMO - RACIONAL: Os afastadores clássicos de cirurgia laparoscópica são geralmente rígidos, necessitando de uma incisão adicional para sua instalação ou de um auxiliar para manuseio durante o ato cirúrgico e ainda, podem envolvem risco de injúria hepática. OBJETIVOS: Avaliar e validar uma técnica de exposição da junção esofagogástrica obtida pelo afastador flexível de fígado em cirurgia bariátrica comparando sua eficácia com a de afastador classicamente utilizado para este fim. MÉTODOS: Tratou-se de um estudo prospectivo, aberto, controlado e comparativo em pacientes com indicação de cirurgia, distribuídos de forma randomizada em dois grupos: clássico (controle) e afastador flexível (teste). RESULTADOS: Foram incluídos 100 pacientes (n=50 grupo controle, n=50 grupo teste), sem diferença estatística na distribuição por idade e por morbidades, havendo diferença estatística somente no gênero (grupo controle obteve proporção maior de homens, p=0,020). Em relação ao tempo médio de realização das operações, não foi constatada diferença estatística. No quesito visibilidade, verificou-se que 100% dos pacientes do grupo afastador flexível obteve nível de visibilidade ótima, porém sem significância estatística com relação ao grupo clássico (94%). Invariavelmente, foi necessário um portal a mais de trocarte quando do uso do afastador clássico. CONCLUSÃO: O afastador flexível de fígado demonstrou-se seguro, eficaz, ergonômico, de baixo custo, de perfil estético satisfatório, não requerendo instrumental específico para uso ou nova curva de adaptação e aprendizado para manuseio.
Introduction: To evaluate the progression of competence, learning curve and degree of satisfaction with the training model of medical students undergoing training to perform laparoscopic knots in a simulator. Methods: This was a prospective, longitudinal, interventional study, carried out from April 2016 to July 2017, with the participation of 52 students from the Centro Universitário Christus, Fortaleza, Brazil, from the first to the third year of medical school, undergoing theoretical practical, systematic, and methodized training, with progression of skills to perform laparoscopic knots in a simulation environment in four stages, with a total duration of 16 hours. It was established the task of performing laparoscopic stitches, with five simple knots, in the beginning and in the end, in a suture mold, in an abdominal cavity simulator, in 18 minutes. The main outcomes were time and quality of performance. The students were evaluated before the first and after all stages of the training regarding the quantity and quality of the knots or the subject of the stage and satisfaction with the training model. ANOVA and Student’s t tests were performed for the independent samples and the chi-square test for the categorical variables. For variables with serial measurements, general linear models were used. Univariate binomial models were used in the evaluation variables of the training model. P values <0.05 were considered significant. Results: The values of the medians were analyzed between the first and last stages of the training; of the number of simple knots (0.0 and 15.0) and laparoscopic knots (0.0 and 3.0), the adequacy of the sizes of the suture tail ends (0.0 and 11.0), the number of adjusted initial simple knots ( 0.0 and 3.0) and adjusted sequential ones (0.0 and 24.0). There was statistical significance in all evaluated parameters (p< 0.001). The learning curve showed that 99.1% of the students attained competence. The degree of satisfactory evaluation of the training model was considered good or great in 97% or more, with statistical relevance in 8 of the 10 evaluated statements. Conclusions: The study demonstrated that the students showed competence progression and learning curve evolution. The degree of student satisfaction in relation to the training model stages was very significant.
Purpose: To discuss the use of models of hepatic retraction by laparoscopy, to present a new Hepatic Retractor (HR) and to evaluate its practicality, efficacy and safety in Esophageal Hiatus Exposure (EHE). Methods: Experimental cross-sectional study with a quantitative character. It was carried out in the Laboratory of Health Training of Christus University Center. The sample consisted of 12 livers of adult pigs weighing between 30 and 45 kg. A circular-shaped HR, 5 cm diameter and deformable materials was developed with a polypropylene cloth, metallic guide wire, epidural needle plastic guide and nylon string. The practicality of HR management was measured by the time required to use the instrument, efficacy by exposure to the operative field and safety by macroscopic assessment of liver damage. Results: The average time to complete the procedure was 3.24 minutes and reached less than 2 minutes after 12 repetitions. In eight experiments the maximum degree of EHE was obtained. No macroscopic lesions were observed. Conclusion: The use of HR described can broaden the operative field, without causing macroscopic liver lesions and prolonging the surgical time.
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