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1.
Acta Cir Bras ; 34(7): e201900709, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31531529

RESUMO

PURPOSE: To develop a new low-cost, easy-to-make and available training model using chickens' intestine for infant intestinal anastomosis. METHODS: Segments of chicken intestine were used to create an intestinal anastomosis simulator. We tried to perform an end-to-end, end-to-side and side-to-side anastomosis. Handsewn sutured anastomosis were performed in single layered with interrupted prolene 5-0 suture. The parameters analyzed were cost, intestine's diameter and length, anastomosis patency and flow-through and leakage amount. RESULTS: In all cases it was possible to make the anastomosis in double layered without difficulties, different from the usual ones. There was a positive patency at all anastomoses after the end of the procedure, with no need for reinterventions. CONCLUSION: The new training model using chickens' intestine for infant intestinal anastomosis is low-cost, easy-to-make and easy available.


Assuntos
Anastomose Cirúrgica/educação , Intestinos/cirurgia , Pediatria/educação , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Animais , Galinhas , Criança , Humanos , Modelos Animais , Técnicas de Sutura
2.
Hand Surg Rehabil ; 38(6): 348-352, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31473335

RESUMO

Our hypothesis was that immediate repetition of a microsurgery-suturing task will improve its execution and outcome. This was an experimental animal study. Ten surgeons were divided into two groups of five surgeons. Each performed two end-to-end carotid anastomoses on the same rat, one after the other. The anastomosis was evaluated by the surgeon and an instructor. The primary endpoint was permeability. The outcome was evaluated using an objective and subjective assessment grid yielding 1 to 3 points per item. The total scores for each of the 10 surgeons were used to compare the anastomosis of carotid 1 versus 2, using the ratings given by the surgeon and the instructor. Twenty anastomoses were performed, but 1 rat died intraoperatively, leaving 18 anastomoses for evaluation. No significant differences were found on the main endpoint of permeability, with all anastomoses being permeable. The surgeon's self-assessment was significantly better for the second carotid artery (P=0.05), but this was not confirmed by the proxy assessment (instructor). The analysis by subgroups-morning versus afternoon-found the second carotid anastomosis was significant better in the self-assessment and proxy assessment for the morning group (P<0.001, P=0.024). There was no significant difference in clamping times. The immediate repetition of a microsurgical procedure seems to favor its execution, which leads us to propose that the more difficult or important anastomosis should be done after an easier or less important one during complex surgeries. LEVEL OF EVIDENCE: 2B.


Assuntos
Anastomose Cirúrgica/educação , Competência Clínica , Educação Médica Continuada/métodos , Microcirurgia/educação , Cirurgiões , Suturas , Animais , Artérias Carótidas/cirurgia , Humanos , Ratos Sprague-Dawley , Grau de Desobstrução Vascular
3.
World Neurosurg ; 130: 142-145, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31279115

RESUMO

BACKGROUND: Laboratory training is a very important step on the development of the skills necessary for a neurosurgeon. This can be achieved using animal models and surgical microscopes or stereomicroscopes. Methods, like the use of fluorescein, increase the lifelike situation and allow anyone to assess the patency of an anastomosis and improve the quality of this training. METHODS: We report the use of a stereomicroscope with white light and a fluorescence mode used to perform dissection of small arteries and anastomosis using a chicken wing model. Using an affordable device, we could perform fluorescein videoangiography to asses the patency of those anastomosis and improve the quality of the training skills in microsurgery. RESULTS: The stereomicroscope is a useful tool for laboratory training and can be used as a substitute of a surgical microscope for microsurgery training. The fluorescence mode allowed us to perform fluorescein videoangiography with very a good quality of image. CONCLUSIONS: Microsurgery training is important part in the life of any neurosurgeon. Using a stereomicroscope with a fluorescence mode is an affordable method that can be reproduced in any laboratory in the world.


Assuntos
Anastomose Cirúrgica/educação , Fluorescência , Microcirurgia , Ensino , Animais , Fluoresceína , Microscopia/métodos , Microcirurgia/métodos , Neurocirurgiões
4.
J Reconstr Microsurg ; 35(7): 499-504, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30836413

RESUMO

BACKGROUND: End-to-end, end-to-side, and side-to-side microvascular anastomoses are the main types of vascular bypass grafting used in microsurgery and neurosurgery. Currently, there has been no animal model available for practicing all three anastomoses in one operation. The aim of this study was to develop a novel animal model that utilizes the rat abdominal aorta (AA), common iliac arteries (CIAs), and the median sacral artery (MSA) for practicing these three types of anastomosis. METHODS: Eight adult Sprague-Dawley rats were anesthetized and then laparotomized. The AA, MSA, and bilateral CIAs were exposed and separated from the surrounding tissues. The length and diameter of each artery were measured. The relatively long segment of the AA without major branches was selected to perform end-to-end anastomosis. One side of the CIAs (or AA) and MSA were used for end-to-side anastomosis. The bilateral CIAs were applied to a side-to-side and another end-to-side anastomosis. RESULTS: Anatomical dissection of the AA, CIAs, and MSA was successfully performed on eight Sprague-Dawley rats; four arterial-to-arterial anastomoses were possible for each animal. The AA trunk between the left renal artery and right iliolumbar arteries was 15.60 ± 0.76 mm in length, 1.59 ± 0.15 mm in diameter, for an end-to-end anastomosis. The left CIA was 1.06 ± 0.08 mm in diameter, for an end-to-side anastomosis with the right CIA. The MSA was 0.78 ± 0.07 mm in diameter, for another end-to-side anastomosis with the right CIA or AA. After finishing end-to-side anastomosis in the proximal part of bilateral CIAs, the distal portion was juxtaposed for an average length of 5.6 ± 0.25 mm, for a side-to-side anastomosis. CONCLUSION: This model can comprehensively and effectively simulate anastomosis used in revascularization procedures and can provide more opportunities for surgical education, which may lead to more routine use in microvascular anastomosis training.


Assuntos
Anastomose Cirúrgica/educação , Microcirurgia/educação , Procedimentos Cirúrgicos Vasculares/educação , Animais , Masculino , Modelos Animais , Ratos , Ratos Sprague-Dawley
5.
World J Surg ; 43(5): 1193-1197, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30706107

RESUMO

BACKGROUND: Surgical simulation is an important aspect of competency-based training. Recent trends in paediatric surgical simulations have migrated towards high-fidelity simulation with advanced technology resulting in models which are expensive and largely inaccessible in low- and middle-income countries. METHODS: This article describes four wet simulation models of common surgical procedures in paediatric population created with animal tissue from local abattoir. The models are designed to provide a framework for others to make the models and benefit from the training opportunity they provide especially in low-middle-income countries. RESULTS: The models created in the wet laboratory are neonatal bowel anastomosis, duodenoduodenostomy for discrepancy anastomosis, gastrostomy and pyeloplasty. These models are easily reproducible in resource-challenged healthcare setting as they are low cost, utilise locally available resources and require only a basic set of surgical instruments with which to perform the procedures. CONCLUSION: These models provide locally accessible material for sustainable training programmes which are fundamental in developing safe and affordable surgical care worldwide.


Assuntos
Educação Baseada em Competências/métodos , Educação de Pós-Graduação em Medicina/métodos , Modelos Anatômicos , Pediatria/educação , Anastomose Cirúrgica/educação , Animais , Criança , Países em Desenvolvimento , Procedimentos Cirúrgicos do Sistema Digestório/educação , Recursos em Saúde , Humanos , Recém-Nascido , Treinamento por Simulação/métodos
6.
Cir Esp ; 97(6): 314-319, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30709545

RESUMO

INTRODUCTION: Surgical training based on simulation seeks the acquisition of skills in novice participants and ongoing sill development in experts. The aim of this study is to assess the evolution of students in an intensive laparoscopic anastomosis course and to analyse their results depending on their level and previous experience. METHODS: The students of all the anastomosis courses conducted during 30 months in the Valdecilla virtual hospital (Santander) were analysed. Manual side-to-side intestinal anastomoses with porcine 'ex vivo' viscera were performed in a laparoscopic endotrainer. The technical and quality differences between the first and the last anastomoses were analyzed and the progression between residents and specialists was compared. RESULTS: We analyzed 45 participants, 22 of them residents and 23 specialists. A statistically significant improvement of 80.5% was observed in all procedural parameters (94.8% residents vs. 67.3% specialists). The time was reduced by 48.1% in the residents and 43.2% in the specialists (p<.001). In terms of quality, significant improvements were obtained in the group of residents: an increase of 90% in adequate tension, and a reduction of 75% of everted edges and 60% of leaks. In addition, they obtained results comparable to the specialists (27.3% leak in the last anastomosis vs. 34.8% by the specialists, p=.59), which presented improvement without statistical significance. CONCLUSIONS: The group of residents presented a major and significant improvement in procedural skills and in the quality of the technique, reaching the level of the specialists after completion of the course.


Assuntos
Anastomose Cirúrgica/educação , Internato e Residência , Laparoscopia/educação , Aprendizagem Baseada em Problemas/métodos , Treinamento por Simulação/métodos , Adulto , Animais , Competência Clínica , Escolaridade , Feminino , Humanos , Internato e Residência/métodos , Masculino , Modelos Anatômicos , Suínos
7.
Artigo em Inglês | MEDLINE | ID: mdl-30767439

RESUMO

This Core Skills tutorial shows how a low-fidelity coronary anastomosis simulator can be constructed out of materials available in a normal hospital environment and used to practice various peripheral coronary anastomoses in a realistic-depth environment with limited working space.


Assuntos
Anastomose Cirúrgica/educação , Procedimentos Cirúrgicos Cardíacos/educação , Treinamento por Simulação , Competência Clínica , Humanos
9.
J Reconstr Microsurg ; 35(1): 15-21, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29996154

RESUMO

BACKGROUND: Microsurgery is increasingly relevant, and is difficult to learn. Simulation is relied upon ever more in microvascular training. While living models provide the ultimate physiological feedback, we are ethically obliged to optimize non-living models to replace, refine, and reduce the use of animals in training. There is currently no three-layered synthetic vessel available for microsurgical training. METHODS: A three-layered synthetic vessel was designed with a simulation company. One anastomosis was performed by 14 microsurgical experts at one center. The realism of the vessel was assessed via user questionnaires and the construct validity using objective, validated task scores to assess the anastomosis performance and the final product. Videos were obtained, which were anonymized and marked remotely by a consultant plastic surgeon. RESULTS: The synthetic vessel intima and media displayed reasonable realism, while the adventitia was less realistic. Areas for improvement were identified. Both the task specific assessment score and the final product assessment appropriately identified experts. CONCLUSION: A three-layered synthetic model for microvascular training is a hygienic and useful intermediate-level alternative to commonly used synthetic and ex vivo alternatives.


Assuntos
Anastomose Cirúrgica/educação , Educação Baseada em Competências , Microcirurgia/educação , Técnicas de Sutura/educação , Competência Clínica , Humanos , Modelos Educacionais
10.
J Reconstr Microsurg ; 35(3): 216-220, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30241102

RESUMO

BACKGROUND: The purpose of this study was to evaluate learning curves for an existing microsurgical training model. We compared efficiency and amount of training needed to achieve proficiency between novice microsurgeons without operative experience versus those who had completed a surgical internship. METHODS: Ten novice microsurgeons anastomosed a silastic tube model. Time to perform each anastomosis, luminal diameter, and number of errors were recorded. RESULTS: First year residents improved up to a brief plateau at 10 repetitions, followed by continued improvement. Second year residents improved up to a plateau at 10 repetitions with no further improvement thereafter. There was no significant difference in luminal area or errors between groups. CONCLUSION: Residents with no operative experience can benefit from early exposure to microsurgical training. These interns continue to improve with additional repetitions while second year residents achieve proficiency with fewer repetitions.


Assuntos
Anastomose Cirúrgica/educação , Competência Clínica/normas , Microcirurgia/educação , Treinamento por Simulação , Técnicas de Sutura/normas , Anastomose Cirúrgica/normas , Avaliação Educacional , Humanos , Internato e Residência , Curva de Aprendizado , Microcirurgia/normas
11.
Obes Surg ; 29(2): 414-419, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30291579

RESUMO

INTRODUCTION: This study describes a stepwise training program to teach a laparoscopic Roux-en-Y gastric bypass (LRYGB). Results of a resident are compared to experienced bariatric surgeons (EBS). METHODS: The resident performed a varying amount of surgical steps and the duration of every step was measured using video analysis. In order to compare the resident's results to EBS, the average time per step was calculated for 30 procedures. RESULTS: The total procedure time of LRYGB was 61.15 (± 8.74) min for a novice resident. In comparison, the average of three EBS was 36.22 (± 9.06) min. Creation of the gastric pouch had an average of 12.82 (± 4.08) versus 6.93 (± 2.58) min. Duration of creating the stapled gastrojejunostomy was 7.43 (± 2.11) versus 4.48 (± 2.02) min. Suturing of the gastrojejunostomy was 12.60 (± 3.31) compared to 6.31 (± 2.53) min. Creating the jejunojejunal anastomosis had a duration of 7.12 ( ±2.31) versus 4.22 (± 1.60) min and suturing this anastomosis was 13.93 (± 3.81) compared to 8.51 (± 3.37) min. At the end of the traineeship, the observed progression approximated the skills level of the EBS. CONCLUSION: The stepwise LRYGB-training program, analysed in this study, can result in an efficient and safe way to approach the learning curve to the level of the EBS. Within this training program, the total time of the operation is kept low in order to prevent adverse events for the patient and loss of efficiency in the bariatric program. The results of this study could act as a guideline for the development of such training programs.


Assuntos
Derivação Gástrica/educação , Derivação Gástrica/métodos , Internato e Residência , Curva de Aprendizado , Obesidade Mórbida/cirurgia , Adulto , Anastomose Cirúrgica/educação , Anastomose Cirúrgica/métodos , Competência Clínica , Feminino , Humanos , Laparoscopia/educação , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estômago/cirurgia , Estudantes de Medicina , Cirurgiões/educação , Cirurgiões/normas , Grampeamento Cirúrgico , Fatores de Tempo , Resultado do Tratamento
12.
Minerva Chir ; 74(2): 170-175, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30484601

RESUMO

BACKGROUND: One major issue in general surgery is how to provide novice surgeons with a structured training program (STP). The aim of our study was to assess the efficacy of a STP in robotic colorectal surgery for young surgeons without prior experience in both open and laparoscopic colorectal surgery, who were autonomous in basic minimally-invasive surgical procedures. Right colectomy with intracorporeal anastomosis has been chosen as a model. METHODS: Between May 2015 and December 2017 two junior attending surgeons were trained through a STP. Right colectomy was divided into three main learning modules (colonic mobilization, vascular control, intracorporeal anastomosis) and each one was carried out by the trainees for at least two times under direct supervision of the senior surgeon. After the initial robotic cases completely performed under formal proctoring, they were privileged to perform robotic right colectomy independently without a mentor (20 procedures). Operative time, conversion rate, intra- and postoperative complications, length of stay and pathological outcomes were the variables analyzed to assess the effectiveness of the STP. RESULTS: The mean operative time was 200 minutes and no conversion was required. Neither intraoperative nor major postoperative complications were recorded and the mean length of hospital stay was 6 days. Mean nodal yield was 21. CONCLUSIONS: A STP in robotic colorectal surgery is feasible and effective. Right colectomy represents a good model as first step of the program in order to develop multiple technical skills. Previous experience in open or laparoscopic colorectal surgery may not be necessary.


Assuntos
Colectomia/educação , Neoplasias do Colo/cirurgia , Cirurgia Colorretal/educação , Desenvolvimento de Programas , Procedimentos Cirúrgicos Robóticos/educação , Idoso , Anastomose Cirúrgica/educação , Colectomia/efeitos adversos , Colectomia/métodos , Neoplasias do Colo/patologia , Conversão para Cirurgia Aberta/estatística & dados numéricos , Currículo , Estudos de Viabilidade , Feminino , Humanos , Itália , Tempo de Internação , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos
13.
Am J Surg ; 217(2): 222-227, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30482478

RESUMO

BACKGROUND: This study aimed to identify differences in pattern recognition skill among individuals with varying surgical experience. METHODS: Participants reviewed laparoscopic cholecystectomy videos of various difficulty, and paused them when the cystic duct or artery was identified to outline each structure on the monitor. Time taken to identify each structure, accuracy and work load, which was assessed using the NASA-Task Load Index (TLX), were compared among the three groups. RESULTS: Ten students, ten residents and eight attendings participated in the study. Attendings identified the cystic duct and artery significantly faster and more accurately than students, and identified the cystic artery faster than residents. The NASA-TLX score of attendings was significantly lower than that of students and residents. CONCLUSIONS: Attendings identified anatomical structures faster, more accurately, and with less effort than students or residents. This platform may be valuable for the assessment and teaching of pattern recognition skill to novice surgeons. SHORT SUMMARY: Accurate anatomical recognition is paramount to proceeding safely in surgery. The assessment platform used in this study differentiated recognition skill among individuals with varing surgical experience.


Assuntos
Colecistectomia Laparoscópica/educação , Competência Clínica , Ducto Cístico/anatomia & histologia , Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Internato e Residência/métodos , Cirurgiões/educação , Anastomose Cirúrgica/educação , Ducto Cístico/cirurgia , Humanos
14.
Am J Surg ; 217(2): 281-287, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30420092

RESUMO

INTRODUCTION: "See one, do one, teach one" has represented the model for surgical education for over a century, however recent changes in education have reduced autonomy in training. The goal of this study was to assess the impact of autonomy on learning a procedural skill. METHODS: Senior medical students were randomized and trained to performance a vascular anastomosis utilizing progressive autonomy vs. constant supervision. Performance was tested using videotaped technical grading and anastomotic pressure testing. RESULTS: Mean baseline performance times and technical ratings were similar in both groups. Final completion times was faster in the autonomy group, 14:03min vs. 19:09min (p = 0.02). Final technical ratings were similar, 40.0 vs. 39.2points (max = 50), for each group and both demonstrated similar improvement in leak test against a standardized sample. CONCLUSION: Teaching a procedure, as a final step in graded autonomy, results in superior performance in timing while maintaining equal technical performance compared to trainees with less autonomy.


Assuntos
Competência Clínica , Simulação por Computador , Educação de Pós-Graduação em Medicina/normas , Avaliação Educacional/métodos , Cirurgia Geral/educação , Internato e Residência/métodos , Autonomia Pessoal , Anastomose Cirúrgica/educação , Currículo , Feminino , Humanos , Aprendizagem , Masculino
16.
Asian J Surg ; 42(1): 409-413, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30097397

RESUMO

BACKGROUND: Though microvascular clamps are widely used for anastomosis training, there still have several shortcomings, including the bulging, expensiveness and unavailability due to sterilization. The aim of this study is to introduce a simple and novel microvascular training model without use of microvascular clamps. METHODS: Femoral vessels of Sprague Dawley rats training model were used to evaluate the usefulness of 4-0 silk as a slipknot for performing arterio-arterial and veno-venous microvascular anastomoses. A total of 12 Sprague Dawley rats were randomly assigned to either slipknot group or vascular clamp group. We also assess other endpoints, including ischemic time, patency rate, and clinical features. An additional histological study was performed to compare their immediate traumatic effects on vessel wall. RESULTS: There was no ischemic change or congestive sign in the lower limb after microvascular anastomosis. The total warm ischemic time for the vascular anastomosis was not significantly different. We performed the patency test immediately after microvascular anastomosis and one week after surgery. No intraoperative vascular bleeding was found during these procedures and no thrombosis occurred postoperatively. The histologic damages to occluded area were not significantly different in both groups. CONCLUSION: We demonstrate a microsurgical suture technique performed without any vascular clamp on a rat model. This rat model was designed for training in the technique of microvascular anastomosis. Compared with microvascular clamps, silk slipknot is a cheap, easily available, less space-occupying technique while performing microvascular anastomoses training. This preliminary study provides a simple and effective alternative method for microvascular anastomosis training.


Assuntos
Anastomose Cirúrgica/educação , Educação Médica/métodos , Microcirurgia/educação , Microcirurgia/métodos , Seda , Técnicas de Sutura/educação , Suturas , Procedimentos Cirúrgicos Vasculares/educação , Animais , Perda Sanguínea Cirúrgica , Vasos Sanguíneos/lesões , Vasos Sanguíneos/patologia , Educação Médica/economia , Extremidade Inferior/irrigação sanguínea , Modelos Animais , Ratos Sprague-Dawley , Instrumentos Cirúrgicos , Técnicas de Sutura/economia , Suturas/economia , Grau de Desobstrução Vascular
17.
J Plast Reconstr Aesthet Surg ; 72(2): 203-210, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30501971

RESUMO

INTRODUCTION: Microvascular anastomosis with coupler devices has revolutionized microsurgery practice. Couplers are considered easier to apply and offer improved operating time while maintaining success rates. This study aims to map the learning curve, skill acquisition, and decay of novice microsurgeons in performing coupler anastomosis. METHODS: Novice microsurgeons performed consecutive coupler applications on a three-layer silastic vessel in two phases. Overall time, total movements, and total path-length were objectively measured and the overall surgical performance was calculated using hand motion analyzer (Dextrous MD, Inition, London, UK). RESULTS: Sixty coupler anastomoses were performed using the synthetic, three-layered silicone vessel by 5 novices, 40 for phase 1, 12 for phase 2 and 8 for phase 3. During the phase 1 and phase 2 learning curves deliberate practice, the novices required an average of 8 (6-9) and 4 (2-6) consecutive repetitions, respectively, before reaching the experts' performance. There was an average improvement of 69% (p < 0.001) from their baseline performance during phase I and 37% (p < 0.001) during phase II. End-product assessment revealed that 4 out of 40 coupler applications during phase 1 (10%), 3 out of 20 during phase 2 (15%), and 1 out of 8 during exit performance-phase 3 (12.5%). During phase 3 end-product assessment with f-cMP, 7 out of 8 arterial and venous coupler anastomoses demonstrated an adequate range of flow measures. CONCLUSION: This study demonstrated objectively learning curves and skill decay following a suggested coupler application curriculum and quantified objective thresholds for ethical animal model training and safe supervised clinical sessions in the OR.


Assuntos
Anastomose Cirúrgica/educação , Currículo , Curva de Aprendizado , Microcirurgia/educação , Treinamento por Simulação , Procedimentos Cirúrgicos Vasculares/educação , Procedimentos Cirúrgicos Vasculares/métodos , Anastomose Cirúrgica/métodos , Animais , Galinhas , Modelos Anatômicos , Modelos Animais
18.
Cir Cir ; 86(6): 481-484, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30361717

RESUMO

Introducción: Los programas de entrenamiento simulado permiten optimizar recursos, aumentar la práctica técnica y acortar curvas de aprendizaje, y constituyen un método seguro, estandarizado y validado de aprendizaje para todos los entrenados. Objetivo: Desarrollar un programa de entrenamiento vascular mediante la elaboración de una anastomosis término-terminal de un vaso en un modelo experimental para residentes de cirugía general. Método: Para el desarrollo de este modelo de entrenamiento se utilizó una extremidad amputada a nivel supracondíleo libre de proceso médico-legal. Se realizó la disección de la arteria femoral, se dividió en dos porciones y se realizó una anastomosis término-terminal. Se diseño un sistema que incluye la evaluación de las siguientes variables utlizando la escalas OSATS (Objetive Structured Assesment of Technical Skills) y Likert: 1) nudo manual y punto simple; 2) permeabilidad de la anastomosis; 3) simetría de los puntos; 4) fuga de anastomosis; y 5) tiempo total de anastomosis. Discusión: Al reconocer las ventajas del entrenamiento experimental, se propone un modelo biológico experimental reproducible, estandarizado y de bajo costo. Conclusiones: El desarrollo de modelos biológicos experimentales permite al cirujano general la adquisición de habilidades y destrezas quirúrgicas, mejorando el desempeño durante un procedimiento quirúrgico y reduciendo riesgos. Introduction: Simulated training programs allow to optimize resources, increase technical practice and shorten learning curves, constituting a safe, standardized and validated method of learning for all those trained. Objective: Develop a vascular training program through the elaboration of an end to end anastomosis of a vessel in an experimental model for General Surgery residents. Method: For the development of this training model, an amputated limb was used at the supracondylar level free of medical-legal process. The dissection of the femoral artery was performed, it was divided into two portions and an end to end anastomosis was performed. A system was designed that included the evaluation of the following variables using the OSATS (Objective Structured Assessment of Technical Skills) and Likert scales: 1) manual knot and single stitch; 2) permeability of the anastomosis; 3) symmetry of the stitches; 4) Anastomosis leakage; and 5) total time of the anastomosis. Discussion: Recognizing the advantages of experimental training, a reproducible, standardized, and low cost experimental biological model is proposed. Conclusions: The development of experimental biological models, allows the general surgeon the acquisition of surgical skills and abilities, improving performance during a surgical procedure and reducing risks.


Assuntos
Anastomose Cirúrgica/educação , Cirurgia Geral/educação , Internato e Residência , Modelos Educacionais , Treinamento por Simulação , Humanos
19.
J Surg Oncol ; 118(6): 936-940, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30261100

RESUMO

BACKGROUND AND OBJECTIVES: Lymphedema is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system. Lymphaticovenular anastomoses (LVA) and multiple lymphatic-venous anastomoses (MLVAs) have been recognized as efficient methods to treat chronic lymphedema. Because few models for lymphatics microsurgical training have been described, the aim of this study is to present a new training model for MLVA in a rat. METHODS: Ten norvegicus rats were used for this study. After a longitudinal xifo-pubic incision, lumbar nodes were injected with blue patent violet (BPV) to identify from two to four lymphatic vessels (LVs). MLVAs were carried out inserting lymphatics into the right lumbar vein. RESULTS: The mean weight of the rats was 511.4 g. The average diameter of the abdominal LVs used for MLVA was 0.26 mm, and the mean size of the right lumbar vein was 0.84 mm. The average time to perform MLVA was 49.8 minutes. Anastomosis patency rate was 70% based on the passage of BPV from the lymphatics into the vein. CONCLUSIONS: The rat is still a feasible resource to train microsurgeons, and the MLVA model proposed is simple and reliable and could be very useful for microsurgeon training.


Assuntos
Anastomose Cirúrgica/educação , Anastomose Cirúrgica/métodos , Microcirurgia/educação , Microcirurgia/métodos , Abdome/cirurgia , Animais , Vasos Linfáticos/cirurgia , Linfedema/cirurgia , Modelos Animais , Ratos , Corantes de Rosanilina/administração & dosagem , Veias/cirurgia
20.
World Neurosurg ; 120: e1310-e1318, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30261400

RESUMO

BACKGROUND: Microvascular anastomosis is an essential procedure in neurosurgery, but the opportunity to perform the surgery has gradually decreased for neurosurgeons. Therefore, training is necessary for obtaining and maintaining the skills required for the procedure. We describe the detailed anatomy of cervical and femoral regions in rats and discuss the advantages for practicing microvascular anastomosis. METHODS: Cervical regions of Sprague-Dawley rats were dissected under intraperitoneal anesthesia. The step-by-step anatomic description was documented using a high-resolution charge-coupled device image sensor and recording systems. Using this model, temporal occlusion time and patency were measured, and these measures were compared between the trainee and trainer groups. The number of times the training needs to be completed to attain competency in the bypass procedure was estimated. RESULTS: After exposing the carotid triangle, a half-ring was created by end-to-side anastomosis. Anastomosis was performed at the common carotid artery using the contralateral side of the carotid artery as a graft. The cutoff value for the temporal occlusion time was 79.3 minutes in the receiver operating characteristic curve based on a target temporal occlusion time for beginners determined during the training. CONCLUSIONS: Using a living animal model, a trainee has the opportunity to learn not only anastomotic techniques but also hemostatic control as well as overcoming mental strain during surgery. Living animal models are important in training because the fidelity of a living animal model is superior to nonliving models. Applying training using a half-ring model contributes to safe and efficient surgery.


Assuntos
Anastomose Cirúrgica/educação , Procedimentos Neurocirúrgicos/educação , Ratos Sprague-Dawley/anatomia & histologia , Ratos Sprague-Dawley/cirurgia , Animais , Encéfalo/anatomia & histologia , Encéfalo/irrigação sanguínea , Encéfalo/cirurgia , Competência Clínica , Dissecação , Feminino , Internato e Residência , Neurocirurgia/educação , Estudantes de Medicina
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