RESUMEN

OBJECTIVE: To analyze the applicability and efficiency of a multi-approach laparoscopic training in improving basic laparoscopic skills of obstetrics and gynecology (OBGYN) residents. METHODS: Cross-sectional, observational and descriptive study, developed at the Experimentation and Surgery Training Center (CETEC, in the Portuguese acronym) of the Hospital Israelita Albert Einstein with OBGYN residents. Theoretical and practical tests were applied to 24 OBGYN residents to assess their laparoscopic skills before and after their participation in an 8-week course. The course involved theoretical lectures and practical laparoscopic surgery exercises developed using rubber models, black boxes, virtual simulators and animal models (pigs). RESULTS: There was an overall improvement in the ability of the residents, with an increase in the number of correct answers in the theoretical evaluation and decrease in the time needed to perform practical tests (needle holder assembly and laparoscopic node). The course was evaluated by the students as highly relevant for both improving their surgical skills and motivating them to continue practicing. CONCLUSION: Laparoscopic training using multiple approaches resulted in significant improvement of surgical skills with a high satisfaction level of the participants. Further studies are still needed to measure the long-term retention of these acquired skills.

OBJETIVO: Analisar a aplicabilidade e eficiência de um treinamento em laparoscopia com múltiplas abordagens, em melhorar as habilidades laparoscópicas básicas de residentes de ginecologia e obstetrícia (GO). MéTODOS: Estudo transversal, observacional e descritivo, desenvolvido no Centro de Treinamento em Experimentação e Cirurgia (CETEC) do Instituto de Pesquisa do Hospital Albert Einstein com residentes de GO. Foram aplicadas avaliações teóricas e práticas a 24 residentes de GO com o objetivo de avaliar suas habilidades laparoscópicas antes e após sua participação em um curso de 8 semanas. O curso envolveu palestras teóricas e exercícios práticos de cirurgia laparoscópica através de modelos de borracha, caixas pretas, simuladores virtuais e modelos animais (porcos). RESULTADOS: Houve uma melhora geral na habilidade dos residentes, com aumento do número de respostas corretas na avaliação teórica e diminuição do tempo na execução dos testes práticos (montagem do porta-agulha e realização de nó laparoscópico). O curso foi avaliado pelos alunos como altamente relevante por melhorar suas habilidades cirúrgicas e motivá-los a continuar praticando. CONCLUSãO: O treinamento laparoscópico utilizando múltiplas abordagens resultou em melhora significativa das habilidades cirúrgicas atrelado a alto nível de satisfação dos participantes. Novos estudos ainda são necessários para mensurar a retenção destas habilidades adquiridas a longo prazo.

Asunto(s)

RESUMEN

AIM: Lipschütz ulcers (LU) were first described as rare vulvar ulcerations that affect adolescents without previous history of sexual contact. However, more LU patients have been identified in acute genital ulcers (AGU) services in Europe. PURPOSE: To review cases of AGU and analyze the occurrence of LU in the Ob/Gyn Emergency Department of a Brazilian private hospital, using the currently used diagnostic criteria. METHODS: All female patients who sought our service with AGU complaints from January 2009 to July 2015 were selected and had their medical records reviewed, considering the clinical data and some diagnostic criteria, that included: < 20 years old, first AGU episode, sudden onset, absence of sexual contact 3 months before onset and the absence of immunodeficiency. RESULTS: 273 patients eligible for analysis were identified according to the criteria and 12 (4.39%) of them were identified with the possible diagnosis of LU. By applying less restrictive criteria that allowed the inclusion of patients of any age and sexual status, 98 were identified (35.89%). CONCLUSIONS: Despite being described as a rare pathology, ours and previous results indicate a considerable number of AGU cases, suggesting that LU should be better known and considered for differential diagnosis.

Asunto(s)

RESUMEN

Surgical correction of hypospadias is proposed to improve the aesthetic and functional quality of the penis. Hormone therapy preceding surgical correction is indicated to obtain better surgical conditions. However, there is divergence in the literature regarding the hormone therapy of choice, time of its use before surgery, appropriate dose, and route of application. To try to elucidate this matter, an electronic survey of the databases PubMed and Cochrane Central Library was conducted, limited to articles in English published since 1980. Search strategy identified 14 clinical trials that matched the inclusion criteria. Analysis was made in terms of study design, classification of hypospadias, association with chordee and cryptorchidism, type of hormone, route of application, dose and duration of treatment, penile length before and after hormone therapy, glans circumference before and after hormone therapy, adverse effects, and surgical complications. From the trials evaluated it was not possible to determine the ideal neoadjuvant treatment. A preference for use of testosterone was observed. Intramuscular administration seems to have fewer adverse effects than topical treatment. Side effects were seldom described, and treated patients were not followed on a long-term basis. The scarcity of randomized and controlled clinical trials regarding the topic impairs the establishment of a protocol. In conclusion, although preoperative hormone therapy is currently used before hypospadias surgery, its real benefit in terms of improvement of the penis and surgical results has not been defined.

Asunto(s)