Distribution, treatment outcome and genetic diversity of Leishmania species in military personnel from Colombia with cutaneous leishmaniasis.

BACKGROUND: Leishmaniasis is one of the most important infectious diseases affecting the Colombian National Army due to the high number of reported cases and exposure throughout military operations in endemic areas. The main aim of this study was to estimate the geographical distribution along with the genetic diversity and treatment outcome of Leishmania species in Colombian military personnel. METHODS: Skin lesion samples by smear and aspirate were collected in 136 patients having parasitological cutaneous leishmaniasis (CL) diagnosis. DNA was extracted, the nuclear marker heat shock protein 70 (HSP70) was amplified by PCR and sequenced. Leishmania species were identified by BLASTn. The geo-spatial distribution of the identified parasites was determined according to the possible site of infection. Gene tree was constructed by maximum likelihood (ML), diversity indices (π, h) were estimated and haplotype network was constructed under the Templeton-Crandall-Sing algorithm in order to determine the geographic relationships of the genetic variants of Leishmania species circulating in Colombian military population. RESULTS: The species were identified in 77.94% of the samples, with a predominance of L. braziliensis (65.09%), followed by L. panamensis (31.13%), L. naiffi by the first time reported in Colombia in two patients (1.89%) as well as L. lindenbergi in a single patient (0.945%) with possible infection in the municipality of Miraflores, Guaviare and L. infantum in a single patient (0.945%) notified with CL in the municipality of Tumaco, Nariño. The phylogenetic analysis was consistent according to bootstrap, showing four strongly differentiated clades. CONCLUSIONS: The geo-spatial distribution suggested that L. braziliensis has a greater abundance, while L. panamensis has a greater dispersion. The phylogenetic relationships of Leishmania species in Colombian military personnel was estimated with the confirmation of two new species circulating without prior report in the country and a species with no background for CL in the Colombian army. A substantial genetic diversity of Leishmania braziliensis was defined. This study contributes through the understanding of the molecular epidemiology to the CL transmission in Colombia.

Laparoscopic subtotal cholecystectomy: a surgical alternative to reduce complications in complex cases. / Colecistectomía laparoscópica subtotal como alternativa quirúrgica segura en casos complejos.

INTRODUCTION: Laparoscopic cholecystectomy is a common procedure in general surgery, and in complex cases it is important for the surgeon to know all the alternatives with low associated morbidity. Laparoscopic subtotal cholecystectomy should be considered as an option when a critical view of safety cannot be obtained, because it has a low complication rate and gives the advantages of minimally invasive surgery. METHODS: Retrospective study of laparoscopic subtotal cholecystectomies in an eight years period. RESULTS: A total of 1,059 laparoscopic cholecystectomies were performed; 22 were subtotal cholecystectomies, without conversion. Biliary fistula (9%) and intraabdominal collections (4.5%) were the most common complications described. No iatrogenic bile duct injuries or deaths were reported. Our follow-up period was 32months, no recurrences were reported. CONCLUSIONS: Laparoscopic subtotal cholecystectomy is a safe and effective procedure. It should be considered as an option in complex cases.

Is YouTube a reliable tool for approaching robotic assisted transabdominal preperitoneal surgery? A critical review of the available resources.

INTRODUCTION: The robotic transabdominal preperitoneal approach (rTAPP) is a relatively recent technique for the treatment of inguinal hernia. To achieve optimal results, the 10 golden rules described must be followed. Surgeons in training often review videos to familiarize themselves with new techniques, YouTube being one of the most used platforms. The objective of this study is to carry out an evaluation of the 10 most viewed videos on YouTube of inguinal hernia repair by transabdominal preperitoneal approach (rTAPP) to determine if the 10 golden rules are met. METHODS: Identify and evaluate the 10 videos with the highest number of views related to rTAPP. Three experienced Surgeons evaluated compliance with the 10 golden rules using a Likert scale. Data were analyzed in Excel (Microsoft) and plotted with Tableau (Tableau Inc). The consistency between evaluators was determined using Cronbach's alpha, considering a value >0.7 acceptable. RESULTS: The average overall evaluation was 3.63 with a range of 2.6 to 4.9. The scores related to compliance with the rules 1, 2, 9, 10 were satisfactory; on the other hand, rules 3, 4, 5, 7 and 8 were weak, particularly rule number 7. Internal consistency was observed between raters with a Cronbach's alpha of 0.98. CONCLUSIONS: The lack of compliance with the 10 golden rules in most of the videos demonstrates that the use of videos (YouTube) is not an adequate resource for learning robot-assisted inguinal hernia cure.

Laparoscopic common bile duct exploration four-task training model: construct validity.

BACKGROUND: Training models in laparoscopic surgery allow the surgical team to practice procedures in a safe environment. We have proposed the use of a 4-task, low-cost inert model to practice critical steps of laparoscopic common bile duct exploration. METHODS: The performance of 3 groups with different levels of expertise in laparoscopic surgery, novices (A), intermediates (B), and experts (C), was evaluated using a low-cost inert model in the following tasks: (1) intraoperative cholangiography catheter insertion, (2) transcystic exploration, (3) T-tube placement, and (4) choledochoscope management. Kruskal-Wallis and Mann-Whitney tests were used to identify differences among the groups. RESULTS: A total of 14 individuals were evaluated: 5 novices (A), 5 intermediates (B), and 4 experts (C). The results involving intraoperative cholangiography catheter insertion were similar among the 3 groups. As for the other tasks, the expert had better results than the other 2, in which no significant differences occurred. The proposed model is able to discriminate among individuals with different levels of expertise, indicating that the abilities that the model evaluates are relevant in the surgeon's performance in CBD exploration. CONCLUSIONS: Construct validity for tasks 2 and 3 was demonstrated. However, task 1 was no capable of distinguishing between groups, and task 4 was not statistically validated.

Development and Implementation of an Objective Structured Clinical Examination (OSCE) of the Subject of Surgery for Undergraduate Students in an Institution with Limited Resources.

This article was migrated. The article was marked as recommended. Aim: To develop and to test the feasibility of conducting an objective structured clinical examination (OSCE) of the subject of surgery for third-year medical students in a limited-resources institution. Methods: To planning the OSCE following the Kane Validity framework. A blueprint based on curriculum was developed to design stations. A specific checklist/rubric (using google forms) was elaborated for each station. The pass/score was determined using the Modified Angoff Approach. Cronbach's alpha was used to determine the reliability. The whole process was evaluated by assessing students' and professors' satisfaction using a survey. Results: It was feasible to develop and implement an OSCE in an institution with limited resources. 28 students and 10 examiners participated. Both considered that the OSCE allows evaluation of the clinical competencies of the subject. They consider that this kind of assessment changed their way of studying, placing more emphasis on clinical skills. In the same way, they consider that it is, more objective, and less stressful when compared to other traditional methods. Similarly, the implementation of this strategy encourages teachers to improve teaching strategies. Conclusion: It's possible to implement un OSCE in an institution with limited resources. The incorporation of this tool has a positive impact on learning.

The potential risk of enzootic Trypanosoma cruzi transmission inside four training and re-training military battalions (BITER) in Colombia.

BACKGROUND: Colombia's National Army is one of the largest military institutions in the country based on the number of serving members and its presence throughout the country. There have been reports of cases of acute or chronic cases of Chagas disease among active military personnel. These may be the result of military-associated activities performed in jungles and other endemic areas or the consequence of exposure to Trypanosoma cruzi inside military establishments/facilities located in endemic areas. The aim of the present study was to describe the circulation of T. cruzi inside facilities housing four training and re-training battalions [Battalions of Instruction, Training en Re-training (BITERs)] located in municipalities with historical reports of triatomine bugs and Chagas disease cases. An entomological and faunal survey of domestic and sylvatic environments was conducted inside each of these military facilities. METHODS: Infection in working and stray dogs present in each BITER location was determined using serological and molecular tools, and T. cruzi in mammal and triatomine bug samples was determined by PCR assay. The PCR products of the vertebrate 12S rRNA gene were also obtained and subjected to Sanger sequencing to identify blood-feeding sources. Finally, we performed a geospatial analysis to evaluate the coexistence of infected triatomines and mammals with the military personal inside of each BITER installation. RESULTS: In total, 86 specimens were collected: 82 Rhodnius pallescens, two Rhodnius prolixus, one Triatoma dimidiata and one Triatoma maculata. The overall T. cruzi infection rate for R. pallescens and R. prolixus was 56.1 and 100% respectively, while T. dimidiata and T. maculata were not infected. Eight feeding sources were found for the infected triatomines, with opossum and humans being the most frequent sources of feeding (85.7%). Infection was most common in the common opossum Didelphis marsupialis, with infection levels of 77.7%. Sylvatic TcI was the most frequent genotype, found in 80% of triatomines and 75% of D. marsupialis. Of the samples collected from dogs (n = 52), five (9.6%; 95% confidence interval: 3.20-21.03) were seropositive based on two independent tests. Four of these dogs were creole and one was a working dog. The spatial analysis revealed a sympatry between infected vectors and mammals with the military population. CONCLUSIONS: We have shown a potential risk of spillover of sylvatic T. cruzi transmission to humans by oral and vectorial transmission in two BITER installations in Colombia. The results indicate that installations where 100,000 active military personnel carry out training activities should be prioritized for epidemiological surveillance of Chagas disease.

Laparoscopic common bile duct exploration in patients with gallstones and choledocholithiasis.

OBJECTIVES: To compare the effectiveness of laparoscopic common bile duct exploration in patients with failed endoscopic retrograde cholangiopancreatography (ERCP). METHODS: This is a descriptive, comparative study. Patients with an indication of common bile duct exploration between February 2005 and October 2008 were included. We studied 2 groups: Group A: patients with failed ERCP who underwent LCBDE plus LC. Group B: patients with common bile duct stones managed with the 1-step approach (LCBDE + LC) with no prior ERCP. RESULTS: Twenty-five patients were included. Group A: 9 patients, group B: 16 patients. Success rate, operative time, and hospital stay were as follows: group A 66% vs group B 87.5%; group A 187 minutes vs 106 minutes; group A 4.5 days vs 2.3 days; respectively. CONCLUSION: Patients with failed ERCP should be considered as high-complex cases in which the laparoscopic procedure success rate decreases, and the conversion rate increases considerably.

Development of a training model for laparoscopic common bile duct exploration.

BACKGROUND: Training and experience of the surgical team are fundamental for the safety and success of complex surgical procedures, such as laparoscopic common bile duct exploration. METHODS: We describe an inert, simple, very low-cost, and readily available training model. Created using a "black box" and basic medical and surgical material, it allows training in the fundamental steps necessary for laparoscopic biliary tract surgery, namely, (1) intraoperative cholangiography, (2) transcystic exploration, and (3) laparoscopic choledochotomy, and t-tube insertion. RESULTS: The proposed model has allowed for the development of the skills necessary for partaking in said procedures, contributing to its development and diminishing surgery time as the trainee advances down the learning curve. Further studies are directed towards objectively determining the impact of the model on skill acquisition. CONCLUSION: The described model is simple and readily available allowing for accurate reproduction of the main steps and maneuvers that take place during laparoscopic common bile duct exploration, with the purpose of reducing failure and complications.

[Laparoscopic management of symptomatic urachal anomalies]. / Manejo laparoscópico de las anomalías sintomáticas del uraco.

INTRODUCTION: Acquired urachal anomalies are a rare pathology. Gold-standard treatment for this clinical situation remains the resection of the urachus in its entire tract with or without partial resection of the bladder. Our aim is to up-date authors's experience in the minimally invasive surgical treatment of acquired urachal disease. METHODS: From 2001 to 2007, 14 patients were operated for acquired urachal disease at our institution. A three portal technique previously described by the authors was employed. The diagnosis of acquired uracal disease was confirmed in all cases and the resection of the urachus in its entire tract performed in cephalocaudal direction onto the bladder. Operative and demographic data was prospectively collected and analysis retrospectively performed. RESULTS: Mean operative time was 63 minutes (45,110), minimal blood loss, and no conversions to open surgery or perioperative complications were verified. The majority of the patients were discharged in the first 24 hours. At a follow-up of 22 months no recurrences of urachal pathology recurrences have been verified. CONCLUSIONS: Laparoscopy plays a significant role in the management of symptomatic urachus anomalies. It allows objective confirmation of clinical diagnosis and adequate resection of the urachus in a safe and efficient fashion, while providing the well-known advantages of minimally acces surgery. Preoperative evaluation work-up has minimal impact of therapeutical decision.

Prevalence of Trypanosoma cruzi infection in active military population of The Colombian National Army gathered in five departments.

BACKGROUND: The National Army of Colombia is present in all of the national territory, focused in sylvatic zones where they are exposed continually to potential risk of transmission of Trypanosoma cruzi, the etiological agent of the Chagas disease. People of this study were active personal that were born and lived during their first years in endemic areas of transmission through domiciled vectors as Rhodnius prolixus. AIM: The main aim of this study was to estimate the prevalence of Chagas disease in the active military population of the National Army, gathered in five departments. METHODS: An observational and descriptive study with cross-sectional analysis was carried out. Blood sample each patient in order to apply serological diagnosis by two different Enzyme Linked ImmunoSorbent Assay tests, following the algorithm of National Institute of Health, Colombia. In cases of serum results with inconsistencies, a Hemagglutination Inhibition test and Indirect Immunofluorescence assay test were performed to solve inconclusiveness. Positive samples by two different tests were considered seropositive. Additionally, to each positive sample by at least one serological test, we did extraction of DNA for molecular diagnosis. RESULTS: 295 serums were analyzed and two of them were positive in order to get a prevalence of 0.68%. Two samples analyzed by molecular diagnosis were negative. CONCLUSION: The prevalence was < 1% It is probable the infection in the seropositive individuals occurred before enlisting in the military service due to origin locations with transmission such as Casanare and Boyacá. These findings allow defining the prevention and control programs of chronic cases and reduction in the disease burden.

Robot-assisted surgery and incisional hernia: a comparative study of ergonomics in a training model.

Over the years, incisional hernia repair has evolved. Currently, primary closure of the defect before placing the mesh is a critical step in incisional hernia repair and minimally invasive surgery incorporation has an important role due to great advantages. Despite its benefits, laparoscopic closure with suture intracorporeal knotting is physically demanding and technically complex. Robotic technology provides an optimal three-dimensional view, maneuverability of the instruments but no study has assessed the impact of the DaVinci system in the ergonomics which is the objective in this study. Fourteen surgeons were able to achieve surgical repair of a defect in an incisional hernia inanimate model. The task was performed with conventional laparoscopy and robotic assistance. The mental effort was registered and physical disturbances were measured with the Local Experienced Discomfort scale. The subjects expressed discomfort mainly in the dominant side (p = 0.006). In the comparative analysis between the two approaches, upper limb less disturbance (p = 0.04) and lower mental effort (p = 0.001) were reported with robotic approach. Robotic assistance decreases mental and physical effort during the primary closure of a defect in an incisional hernia inanimate model.

Rol de la simulación en el entrenamiento de cirugía mínimamente invasiva. Artículo de revisión / Role of simulation in minimally invasive surgery training

La cirugía laparoscópica ha sido uno de los grandes adelantos de la medicina moderna, sin embargo, la incorporación de esta tecnología a la práctica quirúrgica trajo consigo implicaciones en la enseñanza de la cirugía. La cirugía laparoscópica es una técnica más difícil de dominar que la cirugía abierta, en la cual se realizan procedimientos y maniobras particulares que requieren de laadquisición de habilidades específicas. La tendencia en la enseñanza de nuevas técnicas o procedimientos se ha enfocado en el uso de la simulación como una herramienta que permite adquirir las destrezas necesarias en un ambiente seguro, sin comprometer la seguridad y eficacia de los procedimientos. Por otro lado, decidir el momento en el cual el cirujano en entrenamiento ha alcanzado las destrezas necesarias para incorporarse a cirugíasin vivo, requiere de objetivos métodos de evaluación . En la búsqueda de alternativas de mayor objetividad, la tendencia mundial durante los últimos años ha sido dirigir la atención hacia el estudio depatrones de movimientos al momento de realizar determinada tarea o procedimiento(AU)

Laparoscopic surgery has been one of the great advances in modern medicine, however the incorporation of this technology into surgical practice brought with it implications in the teaching of surgery, laparoscopic surgery is a more difficult technique than open surgery, in which particular procedures and maneuvers are performed that require the acquisition of specific skills. The trend in the teaching of new techniques or procedures has focused on the use of simulation as a tool that allows acquiring the necessary skills in a safe environment, without compromising the safety and effectiveness of the procedures. On the other hand, deciding the moment in which the surgeon in training has reached the necessary skills to join in vivo surgeries requires objective evaluation methods. In the search for more objective alternatives, the global trend in recent years has been to direct attention towards the study of movement patterns when performing a certain task or procedure(AU)

Spatial distribution, Leishmania species and clinical traits of Cutaneous Leishmaniasis cases in the Colombian army.

In Colombia, the cutaneous leishmaniasis (CL) is the most common manifestation across the army personnel. Hence, it is mandatory to determine the species associated with the disease as well as the association with the clinical traits. A total of 273 samples of male patients with CL were included in the study and clinical data of the patients was studied. PCR and sequencing analyses (Cytb and HSP70 genes) were performed to identify the species and the intra-specific genetic variability. A georeferenced database was constructed to identify the spatial distribution of Leishmania species isolated. The identification of five species of Leishmania that circulate in the areas where army personnel are deployed is described. Predominant infecting Leishmania species corresponds to L. braziliensis (61.1%), followed by Leishmania panamensis (33.5%), with a high distribution of both species at geographical and municipal level. The species L. guyanensis, L. mexicana and L. lainsoni were also detected at lower frequency. We also showed the identification of different genotypes within L. braziliensis and L. panamensis. In conclusion, we identified the Leishmania species circulating in the areas where Colombian army personnel are deployed, as well as the high intra-specific genetic variability of L. braziliensis and L. panamensis and how these genotypes are distributed at the geographic level.

Robotic surgery training: construct validity of Global Evaluative Assessment of Robotic Skills (GEARS).

The objective of this study is to determine the ability of the GEARS scale (Global Evaluative Assessment of Robotic Skills) to differentiate individuals with different levels of experience in robotic surgery, as a fundamental validation. This is a cross-sectional study that included three groups of individuals with different levels of experience in robotic surgery (expert, intermediate, novice) their performance were assessed by GEARS applied by two reviewers. The difference between groups was determined by Mann-Whitney test and the consistency between the reviewers was studied by Kendall W coefficient. The agreement between the reviewers of the scale GEARS was 0.96. The score was 29.8 ± 0.4 to experts, 24 ± 2.8 to intermediates and 16 ± 3 to novices, with a statistically significant difference between all of them (p < 0.05). All parameters from the scale allow discriminating between different levels of experience, with exception of the depth perception item. We conclude that the scale GEARS was able to differentiate between individuals with different levels of experience in robotic surgery and, therefore, is a validated and useful tool to evaluate surgeons in training.

Robot-assisted video endoscopic inguinal lymphadenectomy for melanoma.

Inguinal lymphadenectomy is the indicated procedure in the regional lymph node management for patients with lower limb melanoma and positive nodes. This procedure is commonly associated with surgical site complications. Video endoscopic inguinal lymphadenectomy is a minimally invasive alternative with oncological principles and lower wound-related morbidity. Incorporation of robotic surgery with optimal vision and great maneuverability would offer great advantages. A 42-year-old male patient was diagnosed with acral lentiginous melanoma and palpable inguinal nodes T2 N1 M0. The patient was scheduled for robot-assisted left inguinal video endoscopic lymphadenectomy. The working space is created using blunt-finger dissection and then extended with the endoscope by sweeping with the lens. Two 8-mm robotic trocars and a 10-mm trocar for assistant are placed. The lymphadenectomy is carried out with Maryland and scissors. The operative time was 130 min, estimated blood loss 70 ml and hospital stay 2 days. The robot-assisted inguinal video endoscopic lymphadenectomy is a safe and feasible procedure for lower limb melanoma treatment. The incorporation of the robotic system to this approach where there is a limited working space would offer advantages to the technique.

Laparoscopic surgery skills evaluation: analysis based on accelerometers.

BACKGROUND AND OBJECTIVE: Technical skills assessment is considered an important part of surgical training. Subjective assessment is not appropriate for training feedback, and there is now increased demand for objective assessment of surgical performance. Economy of movement has been proposed as an excellent alternative for this purpose. The investigators describe a readily available method to evaluate surgical skills through motion analysis using accelerometers in Apple's iPod Touch device. METHODS: Two groups of individuals with different minimally invasive surgery skill levels (experts and novices) were evaluated. Each group was asked to perform a given task with an iPod Touch placed on the dominant-hand wrist. The Accelerometer Data Pro application makes it possible to obtain movement-related data detected by the accelerometers. Average acceleration and maximum acceleration for each axis (x, y, and z) were determined and compared. RESULTS: The analysis of average acceleration and maximum acceleration showed statistically significant differences between groups on both the y (P = .04, P = .03) and z (P = .04, P = .04) axes. This demonstrates the ability to distinguish between experts and novices. The analysis of the x axis showed no significant differences between groups, which could be explained by the fact that the task involves few movements on this axis. CONCLUSION: Accelerometer-based motion analysis is a useful tool to evaluate laparoscopic skill development of surgeons and should be used in training programs. Validation of this device in an in vivo setting is a research goal of the investigators' team.

[Detection of Leishmania spp. based on the gene encoding HSP20]. / Detección de Leishmania spp. en base al gen que codifica la proteína HSP20.

OBJECTIVES: Explore a new target for molecular diagnosis of Leishmania. MATERIALS AND METHODS: We evaluated the utility of the gene that encodes the heat shock protein 20-kDa (Hsp20) for detecting Leishmania by polymerase chain reaction (PCR). PCR was normalized and analytical parameters were determined, as well as the validity and diagnostic accuracy, and concordance with the PCR - 18S. PCR-Hsp20 with DNA was obtained from a group of clinical samples from different sources. RESULTS: The analytical parameters were adequate. The sensitivity obtained was 86% and the specificity was 100%. The concordance with the reference method was good (κ = 0.731), which supports its potential use for diagnosis. The possibility of subsequent identification of the species by sequencing the amplified product gives an additional advantage. CONCLUSIONS: The usefulness of this gene as a new target for the detection of Leishmania was demonstrated. Because of its potential, it is recommended to improve the sensitivity of the method and to evaluate it in different endemic regions.

Construct validity of an inanimate training model for laparoscopic appendectomy.

BACKGROUND AND OBJECTIVE: The use of training models in laparoscopic surgery allows the surgical team to practice procedures in a safe environment. The aim of this study was to determine the capability of an inanimate laparoscopic appendectomy model to discriminate between different levels of surgical experience (construct validity). METHODS: The performance of 3 groups with different levels of expertise in laparoscopic surgery--experts (Group A), intermediates (Group B), and novices (Group C)--was evaluated. The groups were instructed of the task to perform in the model using a video tutorial. Procedures were recorded in a digital format for later analysis using the Global Operative Assessment of Laparoscopic Skills (GOALS) score; procedure time was registered. The data were analyzed using the analysis of variance test. RESULTS: Twelve subjects were evaluated, 4 in each group, using the GOALS score and time required to finish the task. Higher scores were observed in the expert group, followed by the intermediate and novice groups, with statistically significant difference. Regarding procedure time, a significant difference was also found between the groups, with the experts having the shorter time. The proposed model is able to discriminate among individuals with different levels of expertise, indicating that the abilities that the model evaluates are relevant in the surgeon's performance. CONCLUSIONS: Construct validity for the inanimate full-task laparoscopic appendectomy training model was demonstrated. Therefore, it is a useful tool in the development and evaluation of the resident in training.

Colecistectomía laparoscópica: impacto de la implementación de una lista de chequeo en la adecuada preparación del quirófano / Laparoscopic cholecystectomy: impact of the implementation of a checklist in the adequate preparation of the operating room

Evaluar el impacto de la implementación de una lista de chequeo en la adecuada preparación del quirófano para realización de colecistectomía laparoscópica. Métodos: Se trata de un estudio prospectivo, controlado, no aleatorio, donde se estudió el impacto del uso de una lista de chequeo en la incidencia de eventos adversos relacionados con la preparación del quirófano para realización de colecistectomía laparoscópica. Se compararon dos grupos, grupo A, en el cual se utilizó lista de chequeo y grupo B (control) donde la preparación del quirófano se llevó a cabo sin el uso de la lista. Para el estudio, los eventos adversos se clasificaron según su naturaleza en "ausencia y/o posición" y "defecto y/o configuración". El análisis estadístico se llevó a cabo utilizando el test exacto de Fisher considerando diferencia significativa p<0,05. Resultados: Se estudiaron un total de 40 procedimientos, (grupo A: 20, grupo B: 20). La incidencia de eventos adversos relacionados con la preparación del quirófano fue de 45 %, en contraste con el grupo control, en el cual en el 100 % de los procedimientos se documentaron eventos (p<0,001). La mayoría de los eventos documentados estuvo en relación con equipo o instrumental de hemostasia. La lista de chequeo fue útil en reducir significativamente los eventos adversos relacionados con "ausencia y/o posición" (70 % vs 5 %, p<0,001) pero no los relacionados "defecto y/o configuración" (70 % vs 40 %; p=0,057). Conclusiones: La lista de chequeo es una herramienta útil para la reducción de eventos adversos relacionados con la preparación de quirófano para colecistectomía laparoscópica, pero no elimina completamente el riesgo de su aparición(AU)

to evaluate the impact of the implementation of a checklist to obtain an optimal setting of the operating room for laparoscopic cholecystectomy surgeries. Methods: it's a prospective, controlled, non-randomized study. The usefulness of checklist implementation was studied to know the incidence of adverse events related to operating room preparation for laparoscopic cholecystectomy. Two groups, group A (checklist group), and group B (control, without the implementation of a checklist) were compared. For statistical purposes, adverse events were classified according to their nature in "Absence and/or position" and "defect and/or configuration". Statistical analysis was carried out using Fisher's exact test considering significant difference a p value<0.05. Results: A total of 40 procedures were studied (group A: 20, group B: 20). The incidence of adverse events related to operating room preparation was 45 %, in contrast to the control group, in which events were documented in 100 % of the procedures (p<0.001). Most of the documented events were related to hemostasis equipment or instruments. The checklist was useful in reducing adverse events related to "absence and/or position" (70 % vs. 5 %, p<0.001) but not related to "defect and/or configuration" (70 % vs. 40 %; p=0.057). Conclusions: The checklist is a useful tool in order to reduce adverse events related to the preparation of an operating room for laparoscopic cholecystectomy, but does not completely eliminate the risk of its occurrence(AU)

Robotic-assisted Heller myotomy versus laparoscopic Heller myotomy for the treatment of esophageal achalasia: a case-control study.

Minimally invasive surgery has become the gold standard for the treatment of achalasia. The incorporation of robotic technology can improve many limitations of laparoscopic surgery, through, for example, the availability of three-dimensional vision, increasing the degrees of movement, avoiding the fulcrum effect and optimizing ergonomics. The aim of this study was to compare robotic-assisted laparoscopic Heller myotomy (RAHM) with laparoscopic Heller myotomy (LHM) in terms of efficacy and safety. Thirty-one patients with diagnosis of achalasia confirmed by esophagogram and manometry were included. Dysphagia and weight loss were the main complaints in both groups. 18 patients were treated with LHM and 13 patients with RAHM. There was no difference in mean operative time (76 ± 13 vs. 79 ± 20 min; P = 0.73). Intraoperative complications were less frequent in the robotic-assisted procedures (5.5% vs. 0%); however, this was a non-significant difference. 94.5-100% of patients had relief of their symptoms. We conclude that RAHM is a safe and effective procedure. The operative time is no longer than in LHM, but it is necessary to evaluate the technique in randomized clinical trials to determine its advantages in terms of intraoperative complications.