Low-fidelity simulation models in urology resident's microsurgery training.

PURPOSE: To evaluate the gain of microsurgical skills and competencies by urology residents, using low-fidelity experimental models. METHODS: The study involved the use of training boards, together with a low-fidelity microsurgery simulator, developed using a 3D printer. The model consists in two silicone tubes, coated with a resin, measuring 10 cm in length and with internal and external diameters of 0.5 and 1.5 mm. The support for the ducts is composed by a small box, developed with polylactic acid. The evaluation of the gain of skills and competencies in microsurgery occurred throughout a training course consisting of five training sessions. The first sessions (S1-S4) took place at weekly intervals and the last session (S5) was performed three months after S4. During sessions, were analyzed: the speed of performing microsurgical sutures in the pre and post-training and the performance of each resident through the Objective Structure Assessment of Technical Skill (OSATS) and Student Satisfaction Self-Confidence tools in Learning (SSSCL). RESULTS: There was a decrease in the time needed to perform the anastomosis (p=0.0019), as well as a progressive increase in the score in the OSATS over during sessions S1 to S4. At S5, there was a slightly decrease in performance (p<0.0001), however, remaining within the expected plateau for the gain of skills and competences. The SSSCL satisfaction scale showed an overall approval rating of 96.9%, with a Cronback alpha coefficient of 83%. CONCLUSIONS: The low-fidelity simulation was able to guarantee urology residents a solid gain in skills and competencies in microsurgery.

A realistic model for vasectomy reversal training using swine testicles.

PURPOSE: To evaluate the viability of the porcine vas deferens as a realistic microsurgical training model for vasectomy reversal. METHODS: The model uses swine testicles (vas deferent), which are usually discarded in large street markets since they are not part of Brazilian cuisine. The spermatic cord was carefully dissected, and the vas deferens were isolated, measuring 10 cm in length. A paper quadrilateral with 5 cm2 was built to delimit the surgical training field. The objective of the model is to simulate only the microsurgical step when the vas deferens are already isolated. The parameters analyzed were: feasibility for reproducing the technique, patency before and after performing the vasovasostomy, cost of the model, ease of acquisition, ease of handling, execution time, and model reproducibility. RESULTS: The simulator presented low cost. All models made were viable with a texture similar to human, with positive patency obtained in 100% of the procedures. The internal and external diameters of the vas deferens varied between 0.2-0.4 mm and 2-3 mm, respectively, with a mean length of 9 ± 1.2 cm. The total procedure time was 43.28 ± 3.22 minutes. CONCLUSIONS: The realistic model presented proved to be viable for carrying out vasectomy reversal training, due to its low cost, easy acquisition, and easy handling, and providing similar tissue characteristics to humans.

Low-fidelity simulation models in urology resident's microsurgery training

Purpose: To evaluate the gain of microsurgical skills and competencies by urology residents, using low-fidelity experimental models. Methods: The study involved the use of training boards, together with a low-fidelity microsurgery simulator, developed using a 3D printer. The model consists in two silicone tubes, coated with a resin, measuring 10 cm in length and with internal and external diameters of 0.5 and 1.5 mm. The support for the ducts is composed by a small box, developed with polylactic acid. The evaluation of the gain of skills and competencies in microsurgery occurred throughout a training course consisting of five training sessions. The first sessions (S1-S4) took place at weekly intervals and the last session (S5) was performed three months after S4. During sessions, were analyzed: the speed of performing microsurgical sutures in the pre and post-training and the performance of each resident through the Objective Structure Assessment of Technical Skill (OSATS) and Student Satisfaction Self-Confidence tools in Learning (SSSCL). Results: There was a decrease in the time needed to perform the anastomosis (p=0.0019), as well as a progressive increase in the score in the OSATS over during sessions S1 to S4. At S5, there was a slightly decrease in performance (p<0.0001), however, remaining within the expected plateau for the gain of skills and competences. The SSSCL satisfaction scale showed an overall approval rating of 96.9%, with a Cronback alpha coefficient of 83%. Conclusions: The low-fidelity simulation was able to guarantee urology residents a solid gain in skills and competencies in microsurgery.

Portable model for vasectomy reversal training

ABSTRACT Objectives To validate an experimental non-animal model for training of vasectomy reversal. Materials and Methods The model consisted of two artificial vas deferens, made with silicon tubes, covered by a white resin, measuring 10 cm (length) and internal and external diameters of 0.5 and 1.5 mm, respectively. The holder of the ducts is made by a small box developed with polylactic acid, using a 3D print. The objective of the invention is to simulate the surgical field of vasovasostomy, when the vas deferens are isolated from other cord structures. For validation, it was verified the acquisition of microsurgical skills during its use, in a capacitation course with 5 urology residents from a Hospital of the region. Along the training sessions, it was analyzed the time (speed) of microsurgical sutures, and quantification of the performance using a checklist. Collected data were analyzed using de BioEstat®5.4 software. Results Medium time for the completion of microsurgical sutures improved considerably during the course, and reached a plateau after the third day of training (p=0.0365). In relation to the checklist, it was verified that during capacitation, there was significant improvement of the scores of each participant, that reached a plateau after the fourth day of training with the model (p=0.0035). Conclusion The developed model was able to allow the students that attended the course to gain skills in microsurgery, being considered appropriate for training vasectomy reversal.

Tratamento de hidrocele por escleroterapia com álcool absoluto / Treatament of hydrocele by sclerotherapy using absolute alcohol

Introdução: A hidrocele é uma das doenças urológicas mais comuns. Até hoje o tratamento mais aceito e mais utilizado é cirúrgico, no entanto, o uso de substâncias esclerosantes vem ganhando maior importância no tratamento desta afecção. Objetivo: Apresentar os resultados iniciais obtidos com o uso do ácool absoluto na escleroterapia de hidrocele. Método: Foram estudados aleatoriamente dez pacientes, no período de março 99 a setembro de 2000, com idade variando entre 45 e 72 anos e prole constituída, com diagnóstico clínico de hidrocele da túnica vaginal e tratados por este método. Resultados; Ao final, 100 por cento dos pacientes estavam curados: seis deles (60 por cento) necessitavam apenas de uma sessão; dois (20 por cento) de duas e dois (20 por cento) de três. Considerações Finais: Os procedimentos foram realizados a nível ambulatorial, permitindo que os pacientes retornassem precocemente às suas atividades habituais, demonstrando que além de pouco invasivos, também evitam os custos de um procedimento cirúrgico e seus encargos, confirmando os benefícios desta técnica

Incidência de escabiose emalunos duma escola pública de Belém-Pará / Incidence of scabies in students of public school in Belém-Pará

Introdução: A escabiose é a dermatozoonose mais prevalente. É transmitida por contato pessoal, não tem predileção por raça, sexo ou idade e é fortemente influenciado por fatores sócio-econômicos e culturais. Objetivo: Determinar a incidência de escabiose em alunos da rede pública. Método: Foram realizados exame clínico-dermatológico e aplicado questionário sócio-econômico a 100 alunos do ensino médio da rede pública de Belém. Resultados: Entre os alunos examinados 23 por cento apresentaram escabiose, demonstrando que esta é endêmica em nosso meio, sendo o ambiente escolar propício para sua disseminação. Houve uma nítida predominância sobre o sexo feminino, com 31,1 por cento da mulheres e, apenas, 10,2 por cento dos homens.60,8 por cento dos alunos acometidos coabitam com cinco ou mais pessoas, acentuando a transmissibilidade da doença, e 70 por cento possui renda familiar igual ou inferior a dois salários mínimos, confirmando que fatores sócio-econômicos estão fortemente ligados a escabiose. Considerações Finais: A escabiose apresentou alta incidência nos alunos examinados, alertando a classe médica e vigilância sanitária sobre a importância da prevenção controle e tratamento desta doença