Treinamento de anastomoses vasculares de baixo custo: o cirurgião vai à feira

Abstract

Vascular anastomoses are common procedures and are performed by most surgeons. Training is primarily conducted in human beings, which violates current ethical principles. This is because current training models are expensive and in short supply. This study was designed to investigate the feasibility of three vegetable models of vascular anastomosis. Five units each of scallions, green beans, and yardlong beans were used. An end-to-end anastomosis was attempted with each specimen. Anastomoses were only successful in green beans and yardlong beans. Since they are narrower, the yardlong beans are the most similar to human vessels.Keywords: surgery; medical education; training; training by simulation. ResumoAnastomoses vasculares são procedimentos comuns realizados por grande parte dos cirurgiões e cujo treinamento ocorre principalmente em seres humanos, contrariando os princípios éticos vigentes. Esse fato se deve, sobretudo, à carência e ao alto custo relacionados aos atuais modelos de treinamento. Assim, este estudo visa avaliar a viabilidade de três vegetais para a realização de anastomoses vasculares. Foram utilizadas cinco unidades de cebolinha, vagem e feijão-verde. Em cada uma tentou-se realizar uma anastomose término-terminal. Conseguiu-se a realização da anastomose apenas na vagem e no

Aperfeiçoando um modelo de treinamento para técnicas cirúrgicas vasculares

“…In the majority of low-cost models of vascular anastomosis, one limitation is related to evaluating the quality of the distance between stitches, since in these synthetic models there are no coagulation factors to reduce leakage between stitches. 1,15 Even though spacing of approximately 1 mm between stitches was maintained, discrete leakage of gelatin was observed, which was expected because of the physical characteristics of the material. However, the peculiar expansivity of the gelatin also made it possible to attest to the patency of anastomoses, since once the clamps had been removed, the gelatin moves to fill the space; other models depend on intraluminal injection of liquid to test the patency of anastomoses.…”

“…A model described by Grahem et al 1 employed vegetables with tubular structures, such as green beans and yardlong beans, describing it as a low-cost model for training end-to-end anastomosis. The consistency and malleability of those vegetables probably would not be suitable for more refined techniques, such as the end-to-side anastomoses, patches, and others described in the present study.…”

“…However, the peculiar expansivity of the gelatin also made it possible to attest to the patency of anastomoses, since once the clamps had been removed, the gelatin moves to fill the space; other models depend on intraluminal injection of liquid to test the patency of anastomoses. 1,5,7,15 During the pilot phase, a model was tested using 6-0 polypropylene sutures. Although it was possible to complete all of the procedures, the suture must be tractioned more carefully, because the friction between the thread and the latex of the balloon can cause the suture to break more easily when pulled.…”

“…This is because its primary objective is reestablishment of blood flow to organs and tissues, which is a procedure that is necessary in many different specialties in addition to vascular surgery itself, including trauma surgery, organ transplantation, and construction of patches and reimplantation in plastic surgery. [1][2][3][4] Currently, the majority of general surgery residents' training is conducted on human beings, with demonstrations by more experienced surgeons. 1,5 However, construction of vascular anastomoses requires significant exposure, dissection, and temporary occlusion of the vessel, increasing the risk of complications, particularly when performed by an inexperienced surgeon.…”

“…[1][2][3][4] Currently, the majority of general surgery residents' training is conducted on human beings, with demonstrations by more experienced surgeons. 1,5 However, construction of vascular anastomoses requires significant exposure, dissection, and temporary occlusion of the vessel, increasing the risk of complications, particularly when performed by an inexperienced surgeon. 6 The best way to acquire and develop this skill is through training with experimental models.…”