Esófago porcino: modelo ex vivo de entrenamiento laparoscópico para la miotomía de Heller y funduplicatura de Dor / Porcine esophagus: ex vivo laparoscopic training model for Heller's myotomy and Dor's funduplication

El dominio de procedimientos avanzados en laparoscopia es fundamental para los cirujanos, por ello el entrenamiento es imprescindible. La miotomía de Heller y funduplicatura de Dor requieren el desarrollo de habilidades y destrezas para realizar la cirugía de forma segura y eficaz, superar la curva de aprendizaje es un reto para el cirujano en formación, por lo que se propone el esófago porcino como modelo ex vivo de entrenamiento laparoscópico, con el fin de permitir desarrollar las habilidades necesarias y así llevar a cabo con éxito el procedimiento quirúrgico.Objetivo : Aplicar el esófago porcino como modelo ex vivo para el entrenamiento laparoscópico de la miotomía de Heller y funduplicatura de Dor.Métodos : Se realizó un estudio prospectivo, experimental y longitudinal, aplicado en un período de 17 semanas, en sesiones de 1 hora cada una, una sesión por semana.Resultados : Se llevaron a cabo 17 prácticas realizadas por el autor, evaluadas por cirujanos expertos, observando un aumento de la puntuación obtenida en la escala GOALS y disminución del tiempo de ejecución a medida que aumentaba el número de prácticas con una correlación altamente significativa, según la tau-B de Kendall (p=0,000).Conclusión : El modelo ex vivo permitió recrear la mayoría de los pasos quirúrgicos y demostró ser una herramienta útil y valiosa, disminuyendo el tiempo de ejecución del procedimiento y aumentando significativamente las habilidades laparoscópicas(AU)

Mastery of advanced procedures in laparoscopy is important for surgeons, therefore training is essential. Heller's myotomy and Dor's fundoplication require the development of abilities and skills to perform the surgery safely and effectively, overcoming the learning curve is a challenge for the surgeon in training, so the porcine esophagus is proposed as an ex vivo model of laparoscopic training in order to develop the necessary skills to successfully carry out the surgical procedure. Objective: To apply the porcine esophagus as an ex vivo model for laparoscopic training of Heller's myotomy and Dor's fundoplication. Methods: A prospective, experimental and longitudinal study was carried out, applied by the authors in a period of 17 weeks, in sessions of 1 hour each, one session per week. Results: 17 practices carried out by the author were carried out, evaluated by expert surgeons, observing an increase in the score obtained on the GOALS scale and a decrease in execution time as the number of practices with a high significant influence increase, according to Kendall's tau-B (p=0.000). Conclusion: The ex vivo model allowed recreating most of the surgical steps and stood out as a useful and valuable tool, decreasing the execution time of the procedure and significantly increasing laparoscopic skills(AU)

Re-Epithelialization Appraisal of Skin Wound in a Porcine Model Using a Salmon-Gelatin Based Biomaterial as Wound Dressing.

The design of new functional materials for skin tissue engineering is an area of constant research. In this work, a novel wound-dressing biomaterial with a porous structure, previously formulated using salmon-gelatin as main component (called salmon-gelatin biomaterial (SGB)), was tested in vivo using pigs as skin wound models. Four weeks after cutaneous excision and implantation in the animals, the healing process did not show apparent symptoms of inflammation or infection. Interestingly, the temporal evolution of wound size from 100% to around 10% would indicate a faster recovery when SGB was compared against a commercial control. Histological analysis established that wounds treated with SGB presented similar healing and epithelialization profiles with respect to the commercial control. Moreover, vascularized granulation tissue and epithelialization stages were clearly identified, indicating a proliferation phase. These results showed that SGB formulation allows cell viability to be maintained. The latter foresees the development of therapeutic alternatives for skin repair based on SGB fabricated using low cost production protocols.

[Endolifter, a new tool for safe and rapid submucosal endoscopic dissection]. / Endolifter, una nueva herramienta para una segura y rápida disección endoscópica submucosa.

BACKGROUND: The effectiveness of endoscopic submucosal dissection (ESD) is similar to that of surgery in the treatment of early lesions. The technique requires a high level of technical skill. Training on biologic models and the mastering of accessories facilitate ESD. AIMS: The aim was to evaluate the usefulness of the Endolifter in facilitating tissue exposure during ESD in an in vivo porcine model performed at the experimental surgery laboratory of the School of Medicine at the Universidad de São Paulo in Brazil. MATERIAL AND METHOD: A study with an experimental design employing an in vivo porcine model was conducted on 5 Yorkshire pigs weighing 20-25kg. ESDs were performed using the Endolifter. Mucosal layer dissection was carried out with a dual knife and IT knife and all the endoscopic procedures were performed by a single expert endoscopist. RESULTS: A total of 25 ESDs were performed, with a technical success rate of 100%. The mean dissection time was 12.34min (range: 10.40-14.50 min) and the mean lesion size was 2.7cm (range: 2.3-3.2cm). There were no episodes of bleeding or perforations during the procedures. CONCLUSIONS: The Endolifter enables rapid and effective ESDs to be carried out. It is an applicable and easy-to-use device that can be manipulated by a single operator.

[Peroral endoscopic full and partial-thickness myotomy. A viability study in an animal model]. / Miotomía endoscópica por vía oral de espesor total y parcial. Estudio de factibilidad en un modelo animal.

BACKGROUND: Peroral endoscopic myotomy has recently been developed and performed on patients with good results. AIMS: To evaluate the technical feasibility of peroral endoscopic full-thickness and partial thickness myotomy in a porcine model. MATERIAL AND METHODS: Eighteen criollo pigs were randomly assigned to 2 groups: group A (partial-thickness myotomy) and group B (full-thickness myotomy). The mucosal defect proximal to the myotomy site was left open. On the seventh postoperative day the pig was euthanized and follow-up surgical exploration was performed. The duration of each procedure, postoperative progression of the animal, complications, and anatomopathologic findings were registered. RESULTS: The procedure was viable in all the pigs. The mean surgery duration was 81±35.3min (group A 51.11±11.12, group B 111±22.61; P<.05). The main complication during myotomy was subcutaneous emphysema (16%). The histopathologic study of the group A surgical specimens reported complete circular myotomy in all cases, and complete circular and longitudinal myotomy was reported in 100% of the group B sample. CONCLUSIONS: The endoscopic myotomy technique is feasible. Endoscopic partial-thickness myotomy was associated with shorter surgery duration and better results during the intraoperative period and the 7-day follow-up.