Impacto de la Maestría de Cirugía de Mínimo Acceso en los Objetivos de Desarrollo Sostenible / Impact of the Master's Degree Course in Minimal Access Surgery on Sustainable Development Goals

Introducción: El Programa de Maestría en Cirugía de Mínimo Acceso responde a necesidades sociales y perspectivas del Sistema Nacional de Salud. Los resultados de sus investigaciones impactan en los Objetivos de Desarrollo Sostenible No. 3 Salud y bienestar y No. 4 Educación de calidad. Objetivo: Exponer cómo la Maestría en Cirugía de Mínimo Acceso impacta en el desarrollo sostenible, a partir de las investigaciones realizadas. Métodos: Se realizó una investigación cualitativa y retrospectiva en el Centro Nacional de Cirugía de Mínimo Acceso. La técnica de investigación empleada fue el análisis documental y bibliográfico, con la revisión de los informes de las tesis finales de maestría y de la autoevaluación del programa, en sus dos primeras ediciones (2015 y 2018), según el Sistema de Evaluación y Acreditación de Maestrías. Resultados: El Programa contó con 30 egresados, cuyas investigaciones abordaron el tratamiento laparoscópico del cáncer entre otros temas. Asimismo, la producción científica en la Edición 02 resultó de 100 publicaciones, 159 reconocimientos sociales relevantes y la edición de 3 libros. Conclusiones: La investigación y la creación de conocimiento e innovación en el Programa de Maestría en Cirugía de Mínimo Acceso han permitido fomentar soluciones de desarrollo sostenible en esta área del conocimiento. La producción científica y la socialización de los resultados obtenidos en eventos nacionales e internacionales propician su implementación en el Sistema Nacional de Salud. De esta forma, los resultados de investigación del programa contribuyen al logro de los Objetivos de Desarrollo Sostenible(AU)

Introduction:The program of the Master's degree in Minimal Access Surgery responds to social needs and perspectives of the national health system. The results of its research have an impact on Sustainable Development Goals 3, "Good health and well-being, and 4, Quality education. Objective: To present how the Master's Degree Course in Minimal Access Surgery impacts on sustainable development, upon the base of the researches conducted. Methods: A qualitative and retrospective research was carried out at the National Center for Minimal Access Surgery. The research technique used was the document and bibliographic analysis, with the review of the reports of the final master's theses and the self-evaluation of the program, in its first two editions (2015 and 2018), according to the Evaluation and Accreditation System for Master's Degree Programs. Results: The program had 30 graduates, whose researches addressed, among other topics, the laparoscopic treatment of cancer. Also, the scientific production in the Edition 02 turned out to be one hundred publications, 159 relevant social recognitions, and the edition of three books. Conclusions: Research and the creation of knowledge and innovation in the Master's Degree Program in Minimal Access Surgery have allowed fostering sustainable development solutions in this area of knowledge. The scientific production and the socialization of the results obtained in national and international events favor their implementation in the national health system. Thus, the research results of the program contribute to the achievement of the Sustainable Development Goals(AU)

Ten years of IRCAD, Barretos, SP, Brazil

Minimally invasive surgery represented a significant milestone in modern surgery; however, continuous innovation and the emergence of new technologies pose new challenges in terms of surgical learning curves since new interventions are associated with increased surgical complexity and a higher risk of complications. For this reason, surgeons are aware of the beneficial effects of "learning before doing" and the importance of safely implementing new surgical procedures in order to obtain better patient outcomes. Considered the largest Latin American training center in minimally invasive surgery, IRCAD Barretos, São Paulo, Brazil, makes it possible to acquire surgical skills through training in different and the most complex areas of medicine, providing the experience of real and simulated situations, with focus on innovation. The center possesses state-of-the-art infrastructure and technology, with a very high-level teaching staff and an affectionate and hospitable reception. Since its inauguration, in 2011, the center has already qualified numerous professionals and has placed the country in a privileged position in terms of surgical knowledge. The present article describes the activities developed over these ten years of the institute in Brazil as the largest training center for surgeons of the continent in order to address the importance of surgical skills training.

Residency training for minimally invasive surgery / Treinamento de cirurgia minimamente invasiva em programas de residência médica

ABSTRACT Objective: to develop a training program in minimally invasive surgery, based on simulation and with an emphasis on the acquisition of laparoscopic competences. Methods: this was a prospective, observational study carried out at a university hospital in Belo Horizonte, Brazil, between April 2020 and January 2021. We recruited residents of surgical specialties for structured, progressive training according to instructional principles to promote learning, such as motivation, activation, demonstration, application, and integration. We filmed the skill tests at the program's beginning, middle, and end, which were then anonymously evaluated by a surgical education expert. Individual performances were scored using the global assessment tools "GOALS" and "specific checklist for suture". At the end, all participants received individual feedback and completed a questionnaire to assess the impact of training on the Kirkpatrick model. Results: 43 residents completed the program. The evolution of performances was evident and grew between tests. The average achievements were 29% in the initial test, 43% in the intermediate test, and 88% in the final test, with significant differences between all mean scores, with H=97.59, GL=2, p<0.0001. The program evaluation and learning perceptions were excellent, but only 10.7% of residents felt fully capable of performing unsupervised, low-complexity laparoscopic surgery at the end of training. Conclusions: the training program developed in this study proved to be feasible and promising as a strategy for teaching laparoscopic surgery.

RESUMO Objetivo: desenvolver programa de treinamento em cirurgia minimamente invasiva, baseado em simulação e com ênfase na aquisição de competências laparoscópicas. Métodos: trata-se de estudo prospectivo observacional que foi realizado em hospital universitário de Belo Horizonte, Brasil, entre abril de 2020 e janeiro de 2021. Foram recrutados residentes de clínicas cirúrgicas para treinamento progressivo estruturado de acordo com princípios instrucionais de promoção da aprendizagem, como: motivação, ativação, demonstração, aplicação e integração. Testes de habilidades foram filmados no início, meio e final do programa, e, então, avaliados em anonimato por perito em educação cirúrgica. As performances individuais foram pontuadas por meio das ferramentas de avaliação global "GOALS" e "checklist específico de sutura". Ao final, todos participantes receberam feedbacks individuais e preencheram questionário destinado a avaliar o impacto do treinamento, baseado no modelo de Kirkpatrick. Resultados: 43 residentes concluíram o treinamento. A evolução das performances foi crescente e evidente entre os testes. Os aproveitamentos médios foram: 29% no teste inicial; 43% no teste intermediário; e 88% no teste final, com diferenças significativas entre todas as médias de pontuação, sendo H=97,59; GL=2; p<0,0001. A avaliação do programa e percepções de aprendizagem foram excelentes, mas apenas 10,7% dos residentes sentiram-se totalmente capazes a realizar cirurgia laparoscópica de baixa complexidade sem supervisão ao final do treinamento. Conclusões: o programa de treinamento desenvolvido nesse estudo mostrou-se factível e promissor como estratégia de ensino da cirurgia laparoscópica.

Uso de máquinas 3D e cortadores a laser em simulação aplicada à educação médica / Use of 3D printers and laser cutters for simulation in medical education

Introdução: As impressões tridimensionais (3D) têm obtido relevância em diversas áreas do conhecimento, especialmente na medicina. Com o advento da tecnologia, cada vez mais escolas médicas têm adotado o uso de prototipagem de estruturas humanas para aprimorar o treinamento dos estudantes, uma vez que a simulação produz um ambiente livre de riscos, no qual os alunos podem dominar com sucesso as habilidades relevantes para a prática clínica.Métodos: O projeto foi estruturado a partir da pesquisa dos softwares de impressão; seleção dos segmentos anatômicos a serem impressos; análise de materiais para a confecção; estudo aprofundado das caixas de simulação usadas no treinamento em videocirurgia e, por fim, realização de um treinamento dos estudantes interessados no desenvolvimento das habilidades cirúrgicas.Resultados: Por meio da impressão 3D,foram confeccionadas peças anatômicas para o ensino em anatomia, além de peças de silicone para treinamento de suturas manuais e videolaparoscópicas. O cortador a laser foi utilizado para fabricar caixas pretas, principalmente para simulações de cirurgia laparoscópica.Conclusão: A utilização de materiais 3D no ensino médico tem se mostrado altamente promissora, com aumento da curva de aprendizado dos alunos envolvidos e ótima relação custo-benefício. Contudo, o acesso a essa tecnologia ainda é restrito no Brasil, o que dificulta a expansão do método para todas as escolas médicas nacionais.

Introduction: Three-dimensional (3D) printing has become relevant in several areas of knowledge, especially Medicine. With the advent of technology, medical schools started using prototypes of human structures to improve student training, given that simulation provides a risk-free environment where students can successfully master relevant skills for clinical practice.Methods: The present study consisted of research about printing software, selection of anatomical segments for printing, analysis of printing materials, study of simulation boxes used in video-assisted surgery training, and training of students interested in developing surgical skills.Results: 3D printing was used to fabricate anatomical models for teaching anatomy and silicone models for manual and video-assisted laparoscopic suture training. Laser cutters were used to manufacture black boxes, mainly for laparoscopy simulation. Conclusion: The use of 3D printing in medical education is highly promising, with an improved learning curve among students and an excellent benefit-cost ratio. However, access to this technology is still limited in Brazil, which makes it difficult to expand the method to all national medical schools.

Actividades profesionales confiables en cirugía mínimamente invasiva: iniciando el camino para lograr competencias en el futuro graduado de medicina / Entrustable professional activities in minimally invasive surgery: starting the way to achieve competencies in the future medical graduate

Objetivos: El desarrollo de actividades profesionales confiables (APROC) para el graduado de medicina en Cirugía Mínimamente Invasiva (CMI) es una necesidad en Colombia. La evidencia disponible es limitada. Este estudio describe la experiencia preliminar con una intervención orientada a esta necesidad, en el marco de un modelo de educación basada en competencias (EBC). Materiales y Métodos: Se diseñó una intervención orientada al desarrollo de actitudes, conocimientos y habilidades prácticas en CMI para estudiantes de medicina, mediante un enfoque de aula invertida extendida. Se realizaron evaluaciones pre y posintervención mediante el cuestionario Team-STEPPS (actitudes), exámenes de conocimiento y OSATS (habilidades prácticas). Se realizaron comparaciones pre y posintervención (t-test (p < 0,05) y mediciones del tamaño del efecto de la intervención (prueba d Cohen). Finalmente se evaluó la satisfacción estudiantil. Resultados: Un total de 99 estudiantes participaron en el estudio. Se encontraron diferencias estadísticamente significativas (p < 0,05) entre las mediciones pre y posintervención, y gran efecto en las actitudes, conocimientos y habilidades prácticas (d > 0,80). Se evidenció alta satisfacción estudiantil. Discusión: El diseño instruccional a través de metodologías interactivas permite desarrollar APROC en CMI, desde el pregrado. Estos resultados son similares a los reportados en otras intervenciones en el marco de la EBC. Conclusión: Nuestra intervención demostró efectos positivos sobre competencias estudiantiles orientadas al desarrollo de APROC en CMI para el futuro graduado. Aun es necesario medir estas competencias en la práctica real y al finalizar la carrera, para determinar si estas actividades pueden ser totalmente confiables a los participantes en su futura práctica profesional.

Aims: The development of entrustable professional activities (EPAs) in minimally invasive surgery (MIS) for undergraduates is a need in Colombia. The available evidence is limited. This study aims to describe the preliminary experience with an intervention oriented to this need, embedded in the framework of a competence-based education model (CBE). Materials and Methods: An intervention was designed for the development of EPAs in MIS oriented to the development of attitudes, knowledge and practical skills in medical students. Intervention was delivered through an extended inverted classroom approach. Pre- and postintervention measures were performed by using the Team-STEPPS questionnaire (attitudes), knowledge assessments and OSATS (practical skills). Comparisons were performed by t-test tests (p < 0.05) and the effect size of the intervention was calculated by the Cohen d test. Finally, the student's satisfaction was evaluated. Results: A total of 99 students participated in the study. The intervention showed statistically significant differences (p < 0.05), and great effect on attitudes, knowledge and practical skills (d > 0.80). Likewise, high student satisfaction was evidenced. Discussion: Interactive instructional design fosters development of EPAs in MIS for medical undergraduates. These results are similar to those reported in other interventions under the CBE model. Conclusion: Our intervention showed positive effects on competences oriented to the development of EPAs in MIS for the future graduate. Still is necessary to assess these competencies in real practice and at the end of medical career, in order to evaluate if these activities can be totally reliable to the participants in their future professional practice.

Experiencia del Centro Nacional de Cirugía de Mínimo Acceso en educación de posgrado en cirugía laparoscópica / Experience of the Minimal Access Surgery National Center in the postgraduate education in laparoscopy surgery

La nueva universidad médica cubana exige un estrecho vínculo entre los recursos humanos que en ella se forman y la identificación y solución de los problemas de salud, los cuales a su vez tienen que estar en armonía con el desarrollo tecnológico y la dinámica actual de los servicios en Cuba y la amplia colaboración internacional que brinda el país. El plan de estudios de las especialidades quirúrgicas y la superación profesional de los recursos humanos en estas áreas necesitan perfeccionamiento, entre otros motivos por el surgimiento y desarrollo de la cirugía laparoscópica, que ha conllevado cambios en los médicos, los pacientes, la industria médica, el desarrollo tecnológico y las prestaciones de servicio del sistema de salud. Se realizó una investigación no experimental, transversal y descriptiva de los programas de superación profesional del Centro Nacional de Cirugía de Mínimo Acceso de Cuba, para exponer la experiencia de la institución en la superación profesional de los recursos humanos en cirugía laparoscópica(AU)

The new Cuban medical university demands a close link among its trained human resources and the identification and the meet of health problems, which in turn have to be in harmony with the technological development and the current dynamics of Cuban services, as well as the broad international cooperation offered by our country. The study plan of surgical specialties and the professional overcoming of human resources in these areas need an improvement, among other reasons, due to rise and develop of the laparoscopy surgery allowed us changes in physicians, patients, medical industry, technologic development and health system service provision. A descriptive, cross-sectional and non-experimental research was conducted related to the professional training programs of the Minimal Access Surgery National Center of Cuba to expose the experience of implementation of professional training of human resources in laparoscopy surgery(AU)

Laparoscopic training in India: Need for criterion-based training and objective assessment of surgical skills.

Over the past 2 decades, laparoscopic techniques have evolved from diagnostic laparoscopy to more complex procedures. Minimally invasive techniques are routinely used for bariatric, colonic and advanced gastrointestinal surgical procedures. These new techniques require highly developed psychomotor skills and place an extra demand upon surgeons to acquire, maintain and develop a wide range of operative skills in the middle of their careers. In developed countries, training is imparted in skills centres, which use various models not only to teach a skill, but also as a means of assessment, both of technical competence and of decision-making. In addition, these centres are playing an expanding role in providing credentials to surgeons and maintaining the standards of skills. In India, laparoscopic training for community surgeons is unstructured and opportunistic, while resident’s training is not uniform. There is a need for structured training programmes that include giving residents and community surgeons experience in skills laboratories, along with an objective assessment of acquired skills.

Curso básico de entrenamiento en habilidades para cirugía endoscópica: grado de satisfacción de los profesionales en formación / Basic course in skills training for endoscopic surgey: satisfaction of undergraduate students

Introducción: El Curso Básico de Entrenamiento en Habilidades para Cirugía Endoscópica desarrollado por el Centro Latinoamericano de Investigación y Entrenamiento en Cirugía de Mínima Invasión (CLEMI) suministra al estudiante las herramientas necesarias para el aprendizaje de conceptos básicos en cirugía mínimamente invasiva. El objetivo de este estudio es conocer el grado de satisfacción de los profesionales en formación con el curso. Materiales y métodos: entre los meses de junio y octubre del año 2008, se realizaron 7 cursos básicos con un total de 40 estudiantes. Se elaboraron dos encuestas que los estudiantes diligenciaron antes y después del curso. Las encuestas exploraron el perfil del estudiante, sus expectativas con respecto al curso y su grado de satisfacción. Resultados: de los 40 encuestados, 36 (90%) eran especialistas en ortopedia, ginecología, urología y cirugía general. El 69,6% de los que habían recibido entrenamiento en cirugía de mínima invasión, lo hizo con pacientes. El 100% de los estudiantes le confirieron una importancia máxima a los objetivos esencialmente prácticos del curso que corresponden al desarrollo de habilidades y destrezas en espacios bidimensionales, triangulación y precisión así como disección, corte y sutura en plantillas y modelos anatómicos de animales no vivos. El 97% de los profesionales estuvo satisfecho con el cumplimiento de los objetivos del curso. Discusión: el curso básico es un proyecto innovador en Latinoamérica que busca satisfacer las necesidades de entrenamiento de los cirujanos de las diferentes especialidades. Los resultados muestran el cumplimiento de las expectativas de formación demandadas por los profesionales.

Surgical training in Libya: the way forward

The General Surgical Training Programmes worldwide are designed to ensure that the advanced surgical trainee in surgery achieves competency in knowledge, skill and attitude, both operative and non-operative in a wide range of common surgical conditions, enabling the trainee to practice competently as a surgeon. Therefore, the goal of the surgical training is to train broad-based, highly qualified surgical specialists who can provide excellence in the care of patients with a wide range of surgical diseases. To this end we have to strive to a training programme that emphasizes education over service, training in all major surgical subspecialties, and strong academic affiliations

[Simulation of endoscopic procedures: an innovation to improve laparoscopic technical skills]

Laparoscopic surgery is a technically more demanding procedure compared to open surgery. Safe realistic training and unbiased quantitative assessment of technical skills are required for laparoscopic surgery. Virtual reality [VR simulators may he useful tools for training and assessing basic and advanced surgical skills and procedures to assess the acquisition of laparoscopic skills using virtual reality simulators systematic review of the literature. The simulator can be used to objectively assess the laparoscopic skills of surgeons and distinguish between novices and experienced laparoscopic surgeons. [Evidence level III-B]. 2. The target group as well as the benefit of a three-day poetical course for laparoscopic surgery can be determined by the simulator [Evidence level III-C]. 3. Novices in laparoscopic surgery seem to benefit mostly from simulation training [Evidence level III-B]. 4. Steepness and plateau of a learning curve may be more dependent on the level of performance required by the particular training session rather than the number of repetitions during a training session. [Evidence level III-B]. 5. Clinical background and understanding of the clinical value of a training program lead to faster acquisition and improvement of laparoscopic skills. As performed on the laparoscopy simulator [Evidence level III-B]. 6. Non technical skills such as visual-spatial perception and stress coping positively correlates with virtual laparoscopic skills [Evidence level III-B]. To date, the best method for teaching laparoscopic surgery has not been defined. However. the use of virtual simulators for laparoscopy training is useful when learning basic techniques allow the surgeon to improve hand dexterity and coordination in laparoscopic surgery

Results of the 136 consecutive minimally invasive total knee arthroplasties.

The authors evaluated results of 136 consecutive minimally invasive total knee arthroplasties (MIS TKAs). The first 22 knees, performed with strict patient selection criteria, were determined as a learning experience. According to results of the next 114 knees, the average wound length was 9.2 centimeters and the average blood loss was 470 milliliters. At a mean follow-up of 14 months, the mean Knee Society score improved from 37.5 to 96 points with 96.3% of excellent results. Sixty-five knees, group A, had within 10 degrees of varus and 49 knees, group B, had more deformity. Clinical results of both groups were not statistically different in terms of operative time, blood loss, pain score, postoperative knee flexion at 2 weeks and 6 months and postoperative day of walking. However, the ability to straighten the knee was significantly delayed in knees with more deformity (group B). After gaining learning curve, surgeons could extend performing MIS TKA in patients with more knee deformity.

Minimally invasive surgery training in soft cadaver (MIST-SC).

OBJECTIVES: The purpose of this study was to evaluate the surgical anatomy, tissue plane, organ consistency of soft cadaver and the possibility of minimally invasive surgery training in soft cadaver. SETTING: Surgical Training Center. Department of Anatomy and Department of Surgery Faculty of Medicine, Chulalongkorn University. DESIGN: Prospective descriptive study. MATERIAL AND METHOD: 2 soft cadavers were scheduled for fully laparoscopic surgery in upper gastrointestinal, colorectal, hepatopancreatobiliary and solid organs surgery. All the procedures were performed by the experienced surgical staffs and assisted by surgical staffs and/or surgical residents. The surgical anatomy, tissue plane, organ consistency and the satisfactory in performing the procedures were recorded for evaluation. RESULTS: The surgical anatomy, the tissue consistency the anatomical plane were very well preserved with mean score of 4.72 +/- 0.45. All the surgeons were satisfied with the findings, the mean score was 4.97 +/- 0.18. All the plan procedures were completely performed with great satisfactory results. CONCLUSION: The Minimally Invasive Surgery Training in Soft Cadaver (MIST-SC) was feasible with great satisfactory. This successful integration of basic and advanced laparoscopic procedures into the soft cadaver setting would be the next step in evolution of MIS training.