Training design and improvement of technical skills in the transvaginal cholecystectomy (NOTES)

Sánchez‐Margallo, Francisco M.; Pascual, J M; Álvarez, María del Carmen Tejonero; Hurtado, Miguel; Duarte, Francisco Julián Pérez; Gargallo, J. Usón; Sánchez-Gijón, Salvador Pascual

doi:10.1016/s2173-5077(09)70148-6

Cited by 7 publications

(11 citation statements)

References 51 publications

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“…However, the main obstacles include the limitations of technology for transgastric access [32,33], the complexity of establishing models for pure NOTES [24], control of intraoperative hemorrhage and complications, efficient specimen extraction, and the need for a previous education period [34]. Although the technical feasibility of different NOTES procedures has been widely described, some experimental studies reveal complications and limitations that should be avoided in these practices [35].…”

Section: Discussionmentioning

confidence: 99%

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Transvaginal NOTES-assisted laparoscopic nephrectomy: a survival study in a sheep model

et al. 2011

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Section: Discussionmentioning

confidence: 99%

“…After our first experimental experiences with NOTES in pigs [24,34], in this study we analyzed the utility of an ovine experimental model to assess the viability of NOTESassisted laparoscopic nephrectomy, in order to translate these investigations into clinical practice in a safe way.…”

Section: Discussionmentioning

confidence: 99%

Transvaginal NOTES-assisted laparoscopic nephrectomy: a survival study in a sheep model

et al. 2011

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“…Principalmente, estos sistemas se clasifican en 2 grandes grupos: sistemas virtuales y físicos 6 . En este trabajo nos centraremos en los sistemas físicos de formación y evaluación quirúrgica por su mayor realismo en el uso del instrumental, así como en la interacción con el entorno de trabajo 7,8 . Actualmente, se dispone de sistemas con diversas características y aplicaciones tanto comerciales como académicos.…”

Section: Introductionunclassified

Utilidad de un sistema de seguimiento óptico de instrumental en cirugía laparoscópica para evaluación de destrezas motoras

Sánchez‐Margallo

Pagador

et al. 2014

Cirugía Española

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RESUMENIntroducción: En este trabajo se estudia la utilidad de un sistema de evaluación de destrezas quirúrgicas basado en el análisis de los movimientos del instrumental laparoscópico. Método: El sistema consta de un simulador físico laparoscópico y un sistema de seguimiento y evaluación de habilidades técnicas quirúrgicas. En el estudio han participado 6 cirujanos con experiencia intermedia (entre 1 y 50 intervenciones laparoscópicas) y 5 cirujanos expertos (más de 50 intervenciones laparoscópicas), todos ellos con la mano derecha como dominante. Cada sujeto realizó 3 repeticiones de una tarea de corte con la mano derecha en tejido sintético, una disección de la serosa gástrica y una sutura en la disección realizada. Para cada ejercicio se analizaron los parámetros de tiempo, distancia recorrida, velocidad, aceleración y suavidad de movimientos para los instrumentos de ambas manos.Resultados: En la tarea de corte, los cirujanos expertos muestran menor aceleración (p = 0,014) y mayor suavidad en los movimientos (p = 0,023) en el uso de la tijera. Respecto a la actividad de disección, los cirujanos expertos requieren menos tiempo (p = 0,006) y recorren menos distancia con ambos instrumentos (p = 0,006 para disector y p = 0,01 para tijera). En la tarea de sutura, los cirujanos expertos presentan menor tiempo de ejecución que los cirujanos de nivel intermedio (p = 0,037) y recorren menos distancia con el disector (p = 0,041). Conclusiones: El sistema de evaluación se mostró útil en las tareas de corte, disección y sutura, y constituye un progreso en el desarrollo de sistemas avanzados de entrenamiento y evaluación de destrezas quirúrgicas laparoscópicas. Usefulness of an optical tracking system in laparoscopic surgery for motor skills assessmentABSTRACT Introduction: The objective of this study is to assess the usefulness of an evaluation system of surgical skills based on motion analysis of laparoscopic instruments. Method: This system consists of a physical laparoscopic simulator and a tracking and assessment system of technical skills in laparoscopy. Six surgeons with intermediate experience (between 1 and 50 laparoscopic surgeries) and 5 experienced surgeons (more than 50 laparoscopic surgeries) took part in this study. All participants were right-handed. The subjects performed 3 repetitions of a cutting task on synthetic tissue with the right hand, dissection of a gastric serous layer, and a suturing task in the dissection previously done. Objective metrics such as time, path length, speed of movements, acceleration and motion smoothness were analyzed for the instruments of each hand. Results: In the cutting task, experienced surgeons show less acceleration (P=.014) and a smoother motion (P=.023) using the scissors. Regarding the dissection activity, experienced surgeons need less time (P=.006) and less length with both instruments (P=.006 for dissector and P=.01 for scissors). In the suturing task, experienced surgeons require less time (P=.037) and distance travelled (P=.041) by the dissector. Conclusions: ...

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“…C holecystectomy performed through natural orifice translumenal endoscopic surgery (NOTES) has been widely described with different combinations of hybrid techniques in both animal models [1][2][3][4][5] and human patients. 3,[6][7][8][9][10][11][12][13] Some studies recognized the limitations of technology for transgastric access, [14][15][16][17] especially related to the safe closure of the gastric wall, poor ergonomy, and leakage.…”

mentioning

confidence: 99%

“…9,10,13,14,18 With the special ethical and scientific considerations, regarding the use of experimental models and through the design of novel minimally invasive training programs, the introduction of latest minimally invasive techniques in the clinical routine is achievable. 5,[19][20][21][22][23] Traditionally, experimental studies in NOTES cholecystectomy have used normal pigs, [1][2][3][4][5] but an important limitation was encountered for translating the surgical skills acquired in normal animals to humans with symptomatic cholelithiasis. At this moment, a training model, which includes experimental physiopathology, could be needed.…”

mentioning

confidence: 99%

Hybrid Notes Cholecystectomy in an Experimental Model of Laparoscopic Acute Cholecystitis

Sánchez-Margallo

Pérez²,

Sanchez³

et al. 2011

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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The purpose of this study was to evaluate the feasibility of hybrid natural orifice translumenal endoscopic surgery (NOTES) transvaginal cholecystectomy in a porcine model of acute cholecystitis. We have developed an experimental model of acute cholecystitis in 8 female pigs (33.37±3.11 kg) through the surgical occlusion of the common bile duct. After 4 days, hybrid NOTES cholecystectomy was performed in all animals with the assistance of only one 5 mm trocar. The transvaginal approach and the abdomen exploration were performed without any complication. The hybrid NOTES cholecystectomy was successfully completed in all animals. The mean operative time was 76.50±10 minutes. Gallbladder rupture appeared in 2 cases, and there was no bleeding or laceration of adjacent organs. Our experiments showed the feasibility of hybrid NOTES cholecystectomy in an experimental model of acute cholecystitis. Additional research and training on experimental models of pathology will be necessary to validate NOTES surgery.

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Training design and improvement of technical skills in the transvaginal cholecystectomy (NOTES)

Cited by 7 publications

References 51 publications

Transvaginal NOTES-assisted laparoscopic nephrectomy: a survival study in a sheep model

Transvaginal NOTES-assisted laparoscopic nephrectomy: a survival study in a sheep model

Utilidad de un sistema de seguimiento óptico de instrumental en cirugía laparoscópica para evaluación de destrezas motoras

Hybrid Notes Cholecystectomy in an Experimental Model of Laparoscopic Acute Cholecystitis

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