Common surgical training program: standardization of learning quality. / Programa de formación quirúrgica común: uniformidad en la calidad del aprendizaje.

INTRODUCTION: The various surgical specialties in our center have used the simulation and experimental surgery resources available for their training tasks in minimally invasive surgery (MIS) in an individualized manner. With this learning model, a great dispersion of effort and expense was observed, so it was decided to create a unified program based on the following: shared learning, synergy among specialties, moderation of the economic cost, and rational use of the facilities. OBJECTIVE: To describe and assess our consensually designed training program in order to consolidate a shared learning strategy that will enable our residents to acquire and perfect surgical skills in MIS. MATERIALS AND METHODS: The program consists of various increasingly complex phases implemented on a continuous basis throughout the period of specialized training in the virtual laboratory and experimental operating room. The assessment methods were based on quantifiable criteria: percentage of efficiency and completion time of the "McGill Inanimate System for Training and Evaluation of Laparoscopic Skills" (MISTELS) exercises at the beginning and end of the program. An economic study was also conducted. RESULTS: 20 residents have completed the program. Mean times show a significant reduction in each of the exercises. The efficiency percentages at the end of the program were higher than at the beginning (p < 0.001). The cost of the program represented a saving of 67.89%. CONCLUSION: The new MIS training program improved the quality of learning in a safe environment, establishing common criteria among the different specialties and an improved use of resources.

INTRODUCCION: Las diferentes especialidades quirúrgicas de nuestro centro han usado los recursos de simulación y cirugía experimental para sus tareas de formación en cirugía mínimamente invasiva (CMI) de manera individualizada. Con este modelo de aprendizaje se detectó una gran dispersión de esfuerzos y gasto, por lo que se decidió crear un programa unificado basado en: aprendizaje compartido, sinergia entre especialidades, moderación del coste económico y uso racional de las instalaciones. OBJETIVO: Describir y evaluar nuestro programa de entrenamiento diseñado por consenso de cara a la consolidación de una estrategia de aprendizaje compartido que permita a nuestros residentes adquirir y perfeccionar habilidades quirúrgicas en CMI. MATERIAL Y METODOS: El programa consta de diferentes fases con complejidad creciente desarrolladas durante todo el periodo de formación especializada de forma continuada en laboratorio virtual y quirófano experimental. Los criterios de evaluación se basaron en criterios cuantificables: porcentaje de eficiencia y tiempo de realización de los ejercicios de McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) al inicio y final del programa. Se realizó también el estudio económico. RESULTADOS: Han completado el programa 20 residentes. Los tiempos medios demuestran una reducción significativa en cada uno de los ejercicios. Los porcentajes de eficiencia al final fueron mayores que al inicio del programa (p < 0,001). El coste del programa supuso un ahorro del 67,89%. CONCLUSION: El nuevo programa de entrenamiento en CMI mejoró la calidad de aprendizaje en un entorno seguro, estableciendo criterios comunes entre las diferentes especialidades y un mayor aprovechamiento de los recursos.

Programa de formación quirúrgica común: uniformidad en la calidad del aprendizaje / Common surgical training program: standardization of learning quality

Introducción: Las diferentes especialidades quirúrgicas de nuestrocentro han usado los recursos de simulación y cirugía experimentalpara sus tareas de formación en cirugía mínimamente invasiva (CMI)de manera individualizada. Con este modelo de aprendizaje se detectóuna gran dispersión de esfuerzos y gasto, por lo que se decidió crear unprograma unificado basado en: aprendizaje compartido, sinergia entreespecialidades, moderación del coste económico y uso racional de lasinstalaciones. Objetivo: Describir y evaluar nuestro programa de entrenamientodiseñado por consenso de cara a la consolidación de una estrategia deaprendizaje compartido que permita a nuestros residentes adquirir yperfeccionar habilidades quirúrgicas en CMI. Material y métodos: El programa consta de diferentes fases concomplejidad creciente desarrolladas durante todo el periodo de forma-ción especializada de forma continuada en laboratorio virtual y quiró-fano experimental. Los criterios de evaluación se basaron en criterioscuantificables: porcentaje de eficiencia y tiempo de realización de losejercicios de McGill Inanimate System for Training and Evaluation ofLaparoscopic Skills (MISTELS) al inicio y final del programa. Se realizótambién el estudio económico. Resultados: Han completado el programa 20 residentes. Los tiem-pos medios demuestran una reducción significativa en cada uno de losejercicios. Los porcentajes de eficiencia al final fueron mayores queal inicio del programa (p < 0,001). El coste del programa supuso unahorro del 67,89%. Conclusión: El nuevo programa de entrenamiento en CMI mejoróla calidad de aprendizaje en un entorno seguro, estableciendo criterioscomunes entre las diferentes especialidades y un mayor aprovechamientode los recursos.(AU)

Introduction: The various surgical specialties in our center haveused the simulation and experimental surgery resources availablefor their training tasks in minimally invasive surgery (MIS) in anindividualized manner. With this learning model, a great dispersionof effort and expense was observed, so it was decided to create aunified program based on the following: shared learning, synergyamong specialties, moderation of the economic cost, and rationaluse of the facilities. Objective: To describe and assess our consensually designed train-ing program in order to consolidate a shared learning strategy that willenable our residents to acquire and perfect surgical skills in MIS. Materials and methods: The program consists of various increas-ingly complex phases implemented on a continuous basis throughout theperiod of specialized training in the virtual laboratory and experimentaloperating room. The assessment methods were based on quantifiablecriteria: percentage of efficiency and completion time of the “McGillInanimate System for Training and Evaluation of Laparoscopic Skills”(MISTELS) exercises at the beginning and end of the program. Aneconomic study was also conducted. Results: 20 residents have completed the program. Mean timesshow a significant reduction in each of the exercises. The efficiencypercentages at the end of the program were higher than at the begin-ning (p < 0.001). The cost of the program represented a saving of67.89%.(AU)

Características genéticas, poblacionales y fenotípicas de pacientes con enfermedad de Hirschsprung / Genetic, population and phenotypic characterístics of patients with hirschsprung disease

La enfermedad de Hirschsprung (HSCR) está causada por la ausencia de células ganglionares en el intestino, debido a defectos en la migración de las células del sistema nervioso entérico durante el desarrollo embrionario. La incidencia es aproximadamente de uno en cada 5000 nacimientos, más frecuente en hombres que en mujeres. Hay dos fenotipos según la longitud del segmento aganglionar: corto (S-HSCR, 80% de los enfermos) y largo (L-HSCR, el 20%). Se han detectado variaciones en la secuencia codificante del proto-oncogén rEt en enfermos con HCSR, lo que sugiere predisposición genética a padecer la enfermedad. Nuestro trabajo ha consistido en encontrar y analizar polimorfismos (SNPs) asociados a la enfermedad, así como su distribución poblacional (sexo y tipo de segmento). En el estudio genético se han analizado dos polimorfismos presentes en el promotor del gen, así como un polimorfismo en el exón 13 fuertemente asociado con la enfermedad. Como poblaciones en este estudio se establecieron una de enfermos con HSCR esporádico y un grupo de individuos sanos.Los resultados obtenidos corroboran que la enfermedad es más frecuente en hombres que en mujeres. El genotipado de rEt indica que los alelos A y G del promotor (c.-200A>G y c.-196C>A) y G del exón 13 (c.2307T>G) están asociados a la población enferma. Los datos apuntan a que no existe relación entre el fenotipo de la enfermedad y la distribución de los polimorfismos analizados. Concluimos que la presencia de ciertos polimorfismos en la secuencia de rEt indica predisposición genética (combinada con otros factores genéticos o ambientales) a padecer la enfermedad (AU)

Hirschsprung disease (HSCR) is caused by the absence of ganglion cells in the intestine due to defects in the migration of enteric nervous system cells during embryologic development. The incidence is one in every 5000 births, more common in men than women. There are two main phenotypes according to the aganglionic segment length: Short (S-HSCR, (80% of patients) and Long (L-HSCR, 20%). Variations have been detected in the coding sequence of the rEt proto-oncogene in patients with HSCR, suggesting a genetic predisposition to the disease. Our aim is to find and analyze polymorphisms (SNPs) associated with the disease. We are interested also in stablish an association between sex and type of aganglionic segment. We analyzed the rEt promoter as well a polymorphism in exon 13 strongly associated to the disease. The populations for the study were a group of 56 patients with sporadic HSCR and 178 healthy controls.The results obtained show that the disease is more common in men than in women (3:1). The rEt genotype shows that alleles A and G of the promoter (c.-200A> G and c.-196C> A) and G of exon 13 (c.2307T> G) are associated with the affected population. Our data suggest neither association between the disease phenotype and the distribution of the polymorphisms analyzed nor with the sex of the patients. The presence of certain polymorphisms in the rEt sequence indicates a genetic predisposition (combined with other genetic or environmental factors) to the disease (AU)

[Genetic, population and phenotypic characteristics of patients with Hirschsprung disease]. / Características genéticas, poblacionales y fenotípicas de pacientes con enfermedad de Hirschsprung.

Hirschsprung disease (HSCR) is caused by the absence of ganglion cells in the intestine due to defects in the migration of enteric nervous system cells during embryologic development. The incidence is one in every 5000 births, more common in men than women. There are two main phenotypes according to the aganglionic segment length: Short (S-HSCR, (80% of patients) and Long (L-HSCR, 20%). Variations have been detected in the coding sequence of the RET proto-oncogene in patients with HSCR, suggesting a genetic predisposition to the disease. Our aim is to find and analyze polymorphisms (SNPs) associated with the disease. We are interested also in stablish an association between sex and type of aganglionic segment. We analyzed the RET promoter as well a polymorphism in exon 13 strongly associated to the disease. The populations for the study were a group of 56 patients with sporadic HSCR and 178 healthy controls. The results obtained show that the disease is more common in men than in women (3:1). The RET genotype shows that alleles A and G of the promoter (c.-200A > G and c.-196C > A) and G of exon 13 (c.2307T > G) are associated with the affected population. Our data suggest neither association between the disease phenotype and the distribution of the polymorphisms analyzed nor with the sex of the patients. The presence of certain polymorphisms in the RET sequence indicates a genetic predisposition (combined with other genetic or environmental factors) to the disease.

Estudio de polimorfi smos asociadosa la enfermedad de Hirschsprung / Study of polymorphisms associated to hirschsprung’s disease

La enfermedad de Hirschsprung (HSCR) es un desorden congénito caracterizado por la ausencia de células ganglionares a lo largo del tracto gastrointestinal. Está causada por defectos en la migración de las células del sistema nervioso entérico durante el desarrollo embrionario. La mejora de tratamientos quirúrgicos ha disminuido la mortalidad de los pacientes, lo que facilita el estudio genético de enfermos y sus familiares. Aunque se desconoce la causa genética de la enfermedad, se sospecha que el oncogén RET es el principal involucrado. Se han encontrado alteraciones en este gen en enfermos con HSCR, por lo que algunos autores sugieren que ciertos polimorfismos (SNPs) en el gen podrían causar cierta predisposición genética a padecer esta enfermedad. Nuestro trabajo ha consistido en el análisis del gen RET en pacientes con diagnóstico de HSCR mediante secuenciación directa y genotipado con sondas Taqman®.Los resultados obtenidos indican que ciertos alelos de los polimorfismos p.Leu769Leu (c.2307T>G, Exón 13) p.Gly691Ser (c.2071G>A, Exón 11) y p.Ser904Ser (c.2712C>G, Exón 15) están asociados a losenfermos HSCR, ya que existen diferencias significativas respecto ala población sana (AU)

Hirschsprung’s disease (HSCR) is a developmental disorder characterized by the absence of the enteric ganglia along the intestine. Is regarded as the consequence of the premature arrest of the migration of neural crest cells in the hindgut during the embryonic development to form the enteric nervous system (ENS). Is considered, therefore, a neurocristopathy. The development of surgical approaches has importantly decreased mortality and morbility of Hirschsprung’s patients, which has allowed the emergence of genetic studies of patients and their families. Although the genetic cause of the disease is still unknown, the RET oncogene is the main involved. Alterations in this gene have been found in HSCR patients, so many authors suggest that certain polymorphisms(SNPs) in this gene could be responsible of genetic predisposition to have the disease. Our work has consisted in the genetic analysis of the RET gene in HSCR patients using direct sequencing and genotyping with Taq-Man® probes. Our results show that some alleles of the polymorphismsp.Leu769Leu (c.2307T>G, Exon 13) p.Gly691Ser (c.2071G>A, Exon11) and p.Ser904Ser (c.2712C>G, Exon 15) are associated to the disease since there are significant differences from the healthy population (AU)

[Study of polymorphisms associated to Hirschsprung's disease]. / Estudio de polimorfismos asociados a la enfermedad de Hirschsprung.

Hirschsprung's disease (HSCR) is a developmental disorder characterised by the absence of the enteric ganglia along the intestine. Is regarded as the consequence of the premature arrest of the migration of neural crest cells in the hindgut during the embryonic development to form the enteric nervous system (ENS). Is considered, therefore, a neurocristopathy. The development of surgical approaches has importantly decreased mortality and morbility of Hirschsprung's patients, which has allowed the emergence of genetic studies of patients and their families. Although the genetic cause of the disease is still unknown, the RET oncogene is the main involved. Alterations in this gene have been found in HSCR patients, so many authors suggest that certain polymorphisms (SNPs) in this gene could be responsible of genetic predisposition to have the disease. Our work has consisted in the genetic analysis of the RET gene in HSCR patients using direct sequencing and genotyping with TaqMan probes. Our results show that some alleles of the polymorphisms p.Leu769Leu (c.2307T>G, Exon 13) p.Gly691Ser (c.2071G>A, Exon 11) and p.Ser904Ser (c.2712C>G, Exon 15) are associated to the disease since there are significant differences from the healthy population.