RESUMO
BACKGROUND: The methodology used for recording, evaluating and reporting postoperative complications (PC) is unknown. The aim of the present study was to determine how PC are recorded, evaluated, and reported in General and Digestive Surgery Services (GDSS) in Spain, and to assess their stance on morbidity audits. METHODS: Using a cross-sectional study design, an anonymous survey of 50 questions was sent to all the heads of GDSS at hospitals in Spain. RESULTS: The survey was answered by 67 out of 222 services (30.2%). These services have a reference population (RP) of 15 715 174 inhabitants, representing 33% of the Spanish population. Only 15 services reported being requested to supply data on morbidity by their hospital administrators. Eighteen GDSS, with a RP of 3 241 000 (20.6%) did not record PC. Among these, 7 were accredited for some area of training. Thirty-six GDSS (RP 8 753 174 (55.7%) did not provide details on all PC in patients' discharge reports. Twenty-four (37%) of the 65 GDSS that had started using a new surgical procedure/technique had not recorded PC in any way. Sixty-five GDSS were not concerned by the prospect of their results being audited, and 65 thought that a more comprehensive knowledge of PC would help them improve their results. Out of the 37 GDSS that reported publishing their results, 27 had consulted only one source of information: medical progress records in 11 cases, and discharge reports in 9. CONCLUSIONS: This study reflects serious deficiencies in the recording, evaluation and reporting of PC by GDSS in Spain.
RESUMO
Objective: The objective of this study is to compare the use of three-dimensional (3D) vision systems with traditional two-dimensional systems in laparoscopic urological surgery, analyzing the benefits, limitations, and impact of introducing this medical technology with regard to surgical performance and the surgeon's ergonomics. Methods: A systematic review with a structured bibliographic search was conducted in the electronic libraries (PubMed and EMBASE) until August 2019 and with no language restrictions. Studies on 3D visualization technology in laparoscopic urologic surgery, randomized controlled trials, and observational comparative studies were included. Relevant data were extracted and analyzed. Results: A total of 25 articles were obtained, of which 4 were clinical studies with patients, 2 studies were carried out in experimental animal models, and the remaining 19 were conducted in simulated environments. Regarding the European training program in basic laparoscopic urological skills, the results showed no significant differences in execution time using either imaging system. Three-dimensional vision led to a significant reduction in surgery time in pyeloplasty and radical nephrectomy. In addition, there was a reported decrease in blood loss in adrenalectomy, nephron-sparing nephrectomy, radical nephrectomy, simple nephrectomy, and pyeloplasty using 3D vision. Regarding ergonomics, the studies generally described no differences in side effects (headache, nausea, eye strain) when comparing the two types of visualization systems. Surgeons reported reduced workloads and stress with 3D vision than with traditional laparoscopy. Conclusions: Three-dimensional laparoscopic systems essentially advance surgical performance in less-experienced laparoscopic surgeons. Three-dimensional laparoscopy leads to improvements in surgery time, which is important for specific surgical procedures involving intracorporeal ligatures and sutures. The results achieved on the surgeons' ergonomics showed better depth perception and decreased stress and workloads during 3D vision with no differences in potential side effects.
Assuntos
Laparoscopia , Cirurgiões , Animais , Competência Clínica , Ergonomia , Humanos , Imageamento TridimensionalRESUMO
La aplicación de protocolos de cribado ha determinado que el número de tumores de recto diagnosticados tempranamente haya aumentado de forma significativa. Consecuentemente, el tratamiento local de estos tumores tempranos ha pasado a ocupar un lugar destacado dentro de la terapéutica del cáncer de recto. Este artículo realiza una revisión de las indicaciones del tratamiento local, de las técnicas diagnósticas y terapéuticas disponibles y de sus resultados. La selección de candidatos ha de llevarse a cabo de manera rigurosa mediante la exploración clínica, la biopsia preoperatoria, la ecografía endorrectal y la utilización de otros procedimientos radiológicos. La destrucción tumoral mediante fulguración o radioterapia endocavitaria obtiene resultados similares a la escisión local. Sin embargo, el estudio patológico del tumor resulta imprescindible para identificar a aquellos pacientes que pueden necesitar un tratamiento quirúrgico radical, o que pueden beneficiarse de un protocolo de tratamiento radioquimioterápico adyuvante. La tasa de recidiva local tras estos procedimientos es mayor que la que corresponde a la cirugía radical. Aunque la mayoría de las recidivas son potencialmente resecables, el papel de la cirugía radical de rescate está en discusión. (AU)
