Curva de aprendizado em cirurgia aórtica videolaparoscópica: estudo experimental em porcos

Abstract

ResumoContexto: A cirurgia videolaparoscópica (CVL) vem evoluindo como alternativa cirúrgica menos invasiva para o tratamento da doença aterosclerótica oclusiva aorto-ilíaca e do aneurisma da aorta abdominal. Poucos estudos avaliaram objetivamente a curva de aprendizado com essa técnica em cirurgia vascular.Objetivo: Avaliar objetivamente os tempos e a evolução de cada passo cirúrgico e demonstrar a exeqüibilidade dessa técnica. Métodos:Entre outubro 2007 e janeiro de 2008, dois cirurgiões vasculares iniciantes na CVL operaram, após cursos e treinamentos, seis porcos consecutivos, com dissecção aórtica e interposição de um enxerto de dácron em um segmento da aorta infra-renal abdominal, com técnica totalmente laparoscópica.Resultados: Todos os tempos cirúrgicos foram decrescentes ao longo do estudo, apresentando redução de 45,9% no tempo total de cirurgia, 85,8% no tempo de dissecção da aorta, 81,2% na exposição da aorta, 55,1% no clampeamento total, 71% na confecção da anastomose proximal e 64,9% na anastomose distal. Conclusão:O presente estudo mostrou que os resultados técnicos satisfatórios da CVL vascular ocorreram somente após longa curva de aprendizado, que foi decrescente ao longo do tempo, à medida que aumentou a experiência e vivência com os materiais e com a visão não-estereoscópica. Essa técnica pode ser realizada com perfeição por cirurgiões vasculares desde que façam cursos especializados, com treinamento em simuladores e animais, e desde que busquem constante aprimoramento a fim de conseguir resultados similares aos obtidos com a cirurgia convencional.Palavras-chave: Cirurgia videoassistida, aorta, doenças vasculares, aprendizagem, modelos animais. AbstractBackground: Laparoscopic aortic surgery (LAS) is evolving as a minimal invasive alternative technique for the treatment of abdominal aortic aneurysms and peripheral aortoiliac arterial disease. Few articles have objectively evaluated the technique learning curve in vascular surgery.

Curva de aprendizado de anastomose arteriovenosa com uso de simulador de baixo custo

“…28 Yoshida et al also described reductions in time taken in a study conducted with vascular surgeons. 11 It is important to emphasize that reduction in the time taken to perform a procedure is not in itself enough to conclude that a given skill is being improved. It is also necessary to observe improvement in technical parameters that predict the quality of the procedure, in order to reduce perioperative complications.…”

“…However, training with animal models and simulators results in improved speed and technical refinement, which is reflected in improvements when surgical procedures are conducted. [10][11][12] This being so, a number of alternative models have been developed for teaching and development of vascular anastomosis skills, employing a variety of materials ranging from the synthetic, such as rubber and silicone gloves, to vegetable produce. 13,14 One such model, which was used in this study, was created using latex balloons 15 and offers the advantages of low cost, simple construction, the possibility of reuse, and similar diameter and consistency to vascular structures typically involved in procedures in vivo, such as brachiocephalic fistulas and femoropopliteal bypass.…”

Estudo de anatomia comparada suína por angiotomografia: contribuições para modelos de pesquisa e treinamento em cirurgia vascular e endovascular

“…[1][2][3][4][5][6][7][9][10][11][12][13][14][15]24 Although pigs have been used extensively in many areas, such as genomics, organ transplantation, oncology, trauma, and neurological and cardiovascular diseases, 2-4,10,18 many important physiological and anatomic factors remain unknown or have only been described superficially. 1,5,25 The literature contains several conflicting anatomic descriptions, such as the "bifurcation" of the aorta, 3,6,26 which is actually a "trifurcation" in pigs. Additionally, the subclavian arteries, 3,6,11,15,27 which emerge from the brachiocephalic artery on the right side and from the aortic arch on the left side, supplying the animal's front limbs, are occasionally referred to as brachial arteries.…”

“…29 Landrace pigs weighing 20 to 30 kg were also used successfully for training aortic surgery via videolaparoscopy. 26 In 1998, a radiological anatomy study was conducted with Landrace pigs weighing from 20 to 25 kg, describing angiographic aspects of the brain, head, neck, thorax, abdomen, and pelvis. 6 In addition to the fact that this breed has already been used for training and research into several open and endovascular surgical techniques, the choice to study Landrace pigs was made because they are widely available and are appropriate for a variety of procedures, depending on the age, size and weight of the animal.…”