Surgical performance during laparoscopic radical nephrectomy is improved with training in a porcine model.

BACKGROUND AND PURPOSE: Becoming proficient in laparoscopic surgery is dependent on the acquisition of specialized skills that can only be obtained from specific training. This training could be achieved in various ways using inanimate models, animal models, or live patient surgery--each with its own pros and cons. Currently, there are substantial data that support the benefits of animal model training in the initial learning of laparoscopy. Nevertheless, whether these benefits extent themselves to moderately experienced surgeons is uncertain. The purpose of this study was to determine if training using a porcine model results in a quantifiable gain in laparoscopic skills for moderately experienced laparoscopic surgeons. MATERIALS AND METHODS: Six urologists with some laparoscopic experience were asked to perform a radical nephrectomy weekly for 10 weeks in a porcine model. The procedures were recorded, and surgical performance was assessed by two experienced laparoscopic surgeons using a previously published surgical performance assessment tool. The obtained data were then submitted to statistical analysis. RESULTS: With training, blood loss was reduced approximately 45% when comparing the averages of the first and last surgical procedures (P=0.006). Depth perception showed an improvement close to 35% (P=0.041), and dexterity showed an improvement close to 25% (P=0.011). Total operative time showed trends of improvement, although it was not significant (P=0.158). Autonomy, efficiency, and tissue handling were the only aspects that did not show any noteworthy change (P=0.202, P=0.677, and P=0.456, respectively). CONCLUSIONS: These findings suggest that there are quantifiable gains in laparoscopic skills obtained from training in an animal model. Our results suggest that these benefits also extend to more advanced stages of the learning curve, but it is unclear how far along the learning curve training with animal models provides a clear benefit for the performance of laparoscopic procedures. Future studies are necessary to confirm these findings and better understand the impact of this learning tool on surgical practice.

Análise do perfil de expressão de fatores de crescimento e sua relação com marcadores de inflamação e angiogênese na etiopatogenia da hiperplasia prostática benigna / Analysis of the expression profile of growth factors and their relationship with markers of inflammation and angiogenesis in the pathogenesis of benign prostatic hyperplasia

INTRODUÇÃO: A HPB é a neoplasia benigna mais comum no homem. Embora amplamente estudada, a patogênese da HPB não foi totalmente elucidada. Fatores de crescimento são proteínas que regulam o crescimento, a diferenciação e morte celular programada. Estudos têm demonstrado que eles interagem com marcadores de inflamação e angiogênese na próstata e simulam a resposta que ocorre no processo de cicatrização de tecidos. Avaliamos o perfil de expressão de FC e marcadores de inflamação e angiogênese no tecido prostático de pacientes com próstata aumentada em relação ao grupo controle com próstata de tamanho normal. MÉTODO: Foram analisados tecidos prostáticos congelados de 62 pacientes submetidos à ressecção transuretral da próstata ou cirurgia aberta para tratamento da HPB. O grupo controle foi composto por amostras de tecido de 8 pacientes com próstata de pequeno volume (menor do que 40 gramas) obtidas por ressecção transuretral. Os níveis de expressão dos FC (EGF, FGF2, PDF, TGFbeta1, IGF1), de angiogênese (VEGF, CD105) e de inflamação (IL-2, IL-6, IL-8 e IL-17) foram avaliados por reação de cadeia da polimerase em tempo real quantitativo (qRT-PCR). A análise de subgrupo de pacientes com e sem uso de sonda vesical de demora antes da cirurgia bem como a correlação da expressão com variáveis clínico-demográficas (volume prostático, PSA, presença de prostatite, idade e tempo de sintoma) foram realizadas. RESULTADOS: Encontramos superexpressão de todos os fatores de crescimento, marcadores de inflamação e angiogênese nos 62 pacientes com HPB em relação ao grupo controle. Verificamos na análise de subgrupo que a presença da sonda vesical parece induzir o aumento da expressão de FGF2, IGF1, TGFbeta1, IL-8 e VEGF. Estes dois últimos apresentaram-se ainda mais superexpressos em pacientes com prostatite associada a HPB. Pacientes com expressão de IGF1 acima da média também apresentaram expressão aumentada de outros fatores de crescimento (FGF2, TGFbeta1,...

INTRODUCTION: BPH is the most common benign tumor in men. Although widely studied, the pathogenesis of BPH has not been fully elucidated. Growth factors (GF) are proteins that regulate growth, differentiation, and programmed cell death. Studies have shown that they interact with markers of inflammation and angiogenesis in prostate and simulate the response that occurs in the tissue healing process. We evaluate the FC expression profile and inflammation and angiogenesis markers in prostate tissue from patients with enlarged prostate compared to the control group with normal sized prostate. METHOD: Frozen prostate tissues were analyzed from 62 patients who underwent transurethral resection of the prostate or open surgery for treating BPH. The control group was composed of tissue samples from 8 patients with small prostate volume (less than 40 grams) obtained by transurethral resection. The expression levels of GF (EGF, FGF2, PDF, TGFbeta1, IGF1), angiogenesis (VEGF, CD105) and inflammatory (IL-2, IL-6, IL-8 and IL-17) were evaluated by reaction Polymerase chain quantitative real-time (qRT-PCR). The subgroup analysis of patients with and without use of indwelling urinary catheter before surgery as well as the correlation of expression with clinical and demographic variables (prostate volume, PSA, presence of prostatitis, age and symptom of time) were performed. RESULTSs: We found overexpression of all growth factors, inflammation and angiogenesis markers in the 62 patients with BPH compared to the control group. We found in subgroup analysis that the presence of urinary catheter seems to induce increased FGF2, IGF1, TGF?1, IL-8 and VEGF expression. These latter had become even more overexpressed in patients with BPH associated with prostatitis. Patients with IGF1 expression above the average also showed increased expression of other GF (FGF2, TGFbeta1, IL-2 and CD105). And also, the level of IGF1 expression was higher in patients older than 65 years...