ABSTRACT
INTRODUCCIÓN: La anastomosis intestinal laterolateral laparoscópica es una práctica habitual en la clínica y entrenada en simulación. El objetivo del estudio es el diseño y posterior validación de una herramienta fiable y reproducible para su evaluación. MÉTODOS: Se utilizó un método Delphi modificado para desarrollar los elementos de evaluación al que finalmente incluyeron 5 apartados (separación entre puntos, eversión, tensión, estanqueidad y iatrogenia). Se incluyeron 21 participantes, 10 residentes quirúrgicos de primer año y 11 expertos. Realizaron anastomosis enteroentéricas laterolateral laparoscópica en víscera ex-vivo porcina de 5 cm. Las evaluaciones fueron ciegas y realizadas por 2 evaluadores de forma independiente. RESULTADOS: Las medias obtenidas por noveles y expertos fueron respectivamente: separación entre puntos 3,2 vs.5,7 (p < 0,001), eversión 3,3 vs.5,9 (p = 0,004), tensión 2,9 vs.5,9 (p = 0,001), estanqueidad 3,2 vs.5,7 (p = 0,005), iatrogenia 6,9 vs.7 (p = 0,47). El parámetro iatrogenia no es discriminatorio, por lo que fue eliminado de la herramienta. Los resultados totales fueron 12,5 los noveles y 23,2 los expertos (p = 0,001). La correlación entre observadores presenta un coeficiente de correlación intraclase de 0,99 para la separación entre puntos, 0,94 la eversión, 0,98 la tensión y 0,99 la estanqueidad. La relación entre la puntuación y la fuga anastomótica sin presión: presenta una R de Rosenthal de -0,71 (p < 0,001); con presión se obtiene una R = 0,55 (p = 0,01). CONCLUSIONES: La herramienta diseñada es válida para discriminar entre participantes noveles y expertos, presenta muy alta concordancia entre observadores y se correlaciona con el riesgo de fuga
INTRODUCTION: Laparoscopic side-to-side intestinal anastomosis is a common in clinic practice and training simulation. The aim of this study is to design and validate a reliable and reproducible tool for its evaluation. METHODS: A modified Delphi method was used to design a tool with elements that determine quality, including 5 items: separation between stiches, eversion, tension, leak and iatrogenesis. The study included 21 participants (10 first-year residents and 11 experts) who performed a 5 cm laparoscopic intestinal side-to-side anastomosis with porcine viscera. The evaluations were blinded and done independently by 2 evaluators. RESULTS: The means obtained by novice and expert participants were, respectively: separation between stiches 3.2 vs.5.7 (P < .001), eversion 3.3 vs.5.9 (P = .004), tension 2.9 vs.5.9 (P = .001), leak tightness 3.2 vs.5.7 (P = .005), iatrogenesis 6.9 vs.7 (P = .47). The iatrogenesis parameter was not discriminatory, so it was removed from the tool. The total results were 12.5 for novices and 23.2 for experts (P = .001). The correlation between observers presented an intraclass correlation coefficient of 0.99 for the separation between stiches, 0.94 for eversion, 0.98 for tension and 0.99 for leak. The correlation between the score and the leak without pressure presented a Rosenthal's R of -0.71 (P < .001); with pressure R = -0.55 (P = .01). CONCLUSIONS: The designed tool is valid to discriminate between novice and expert participants, presents very high concordance between observers and correlates with the risk of leak
Subject(s)
Humans , Animals , Male , Female , Adult , Middle Aged , Anastomosis, Surgical/methods , Intestines/surgery , Laparoscopy/methods , Simulation Training/methods , Anastomosis, Surgical/statistics & numerical data , Anastomotic Leak , Clinical Competence/statistics & numerical data , Delphi Technique , Iatrogenic Disease , Internship and Residency , Surgical Wound Dehiscence , Sutures/statistics & numerical data , Sutures/trends , SwineABSTRACT
INTRODUCTION: Laparoscopic side-to-side intestinal anastomosis is a common in clinic practice and training simulation. The aim of this study is to design and validate a reliable and reproducible tool for its evaluation. METHODS: A modified Delphi method was used to design a tool with elements that determine quality, including 5 items: separation between stiches, eversion, tension, leak and iatrogenesis. The study included 21 participants (10 first-year residents and 11 experts) who performed a 5cm laparoscopic intestinal side-to-side anastomosis with porcine viscera. The evaluations were blinded and done independently by 2 evaluators. RESULTS: The means obtained by novice and expert participants were, respectively: separation between stiches 3.2 vs. 5.7 (P < .001), eversion 3.3 vs. 5.9 (P = .004), tension 2.9 vs. 5.9 (P = .001), leak tightness 3.2 vs. 5.7 (P = .005), iatrogenesis 6.9 vs. 7 (P = .47). The iatrogenesis parameter was not discriminatory, so it was removed from the tool. The total results were 12.5 for novices and 23.2 for experts (P = .001). The correlation between observers presented an intraclass correlation coefficient of 0.99 for the separation between stiches, 0.94 for eversion, 0.98 for tension and 0.99 for leak. The correlation between the score and the leak without pressure presented a Rosenthal's R of -0.71 (P < .001); with pressure R = -0.55 (P = .01). CONCLUSIONS: The designed tool is valid to discriminate between novice and expert participants, presents very high concordance between observers and correlates with the risk of leak.
