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PURPOSE: To compare laparoscopic gynecological surgery training between a developed country's reference center (host center) and a public reference service in a developing country (home center), and use the technicity index (TI) to compare outcomes and to determine the impact of laparoscopic gynecological surgery fellowship training on the home center's TI. METHODS: The impact of training on the home center was assessed by comparing surgical performance before and after training. TI was assessed in 2017 in the host center, and before and after training in the home center. Epidemiological and clinical data, and information on reason for surgery, preoperative images, estimated intraoperative bleeding, operative time, surgical specimen weight, hospital stay length, complication and reintervention rates were collected from both institutions. Home center pre-training data were retrospectively collected between 2010 and 2013, while post-training data were prospectively collected between 2015 and 2017. A two-tail Z-score was used for TI comparison. RESULTS: The analysis included 366 hysterectomies performed at the host center in 2017, and 663 hysterectomies performed at the home center between 2015 and 2017. TI in the host center was 82.5%, while in the home center it was 6% before training and 22% after training. There were no statistical differences in length of hospital stay, preoperative uterine volume, surgical specimen weight and complication rate between centers. However, significantly shorter mean operative time and lower blood loss during surgery were observed in the host center. CONCLUSIONS: High-quality laparoscopic training in a world-renowned specialized center allowed standardizing laparoscopic hysterectomy procedures and helped to significantly improve TI in the recipient's center with comparable surgical outcomes.

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Purpose: To compare laparoscopic gynecological surgery training between a developed country's reference center (host center) and a public reference service in a developing country (home center), and use the technicity index (TI) to compare outcomes and to determine the impact of laparoscopic gynecological surgery fellowship training on the home center's TI. Methods: The impact of training on the home center was assessed by comparing surgical performance before and after training. TI was assessed in 2017 in the host center, and before and after training in the home center. Epidemiological and clinical data, and information on reason for surgery, preoperative images, estimated intraoperative bleeding, operative time, surgical specimen weight, hospital stay length, complication and reintervention rates were collected from both institutions. Home center pre-training data were retrospectively collected between 2010 and 2013, while post-training data were prospectively collected between 2015 and 2017. A two-tail Z-score was used for TI comparison. Results: The analysis included 366 hysterectomies performed at the host center in 2017, and 663 hysterectomies performed at the home center between 2015 and 2017. TI in the host center was 82.5%, while in the home center it was 6% before training and 22% after training. There were no statistical differences in length of hospital stay, preoperative uterine volume, surgical specimen weight and complication rate between centers. However, significantly shorter mean operative time and lower blood loss during surgery were observed in the host center. Conclusions: High-quality laparoscopic training in a world-renowned specialized center allowed standardizing laparoscopic hysterectomy procedures and helped to significantly improve TI in the recipient's center with comparable surgical outcomes.

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ANTECEDENTES: El tratamiento quirúrgico de la endometriosis profunda es un procedimiento complejo, asociado a un alto riesgo de complicaciones. Recientemente, el uso de la técnica laparoscópica reversa aparece como una variante técnica interesante con el fin de disminuir las complicaciones. OBJETIVO: Describir nuestra experiencia preliminar y demostrar la factibilidad de la técnica laparoscópica reversa en el tratamiento de la endometriosis profunda del tabique rectovaginal. MÉTODO: Reporte de 5 casos a partir de base de datos prospectiva. RESULTADOS: La edad promedio de las pacientes fue 34,2 años (rango: 32-37 años). Todas las pacientes presentaban dismenorrea y dispareunia profunda de larga evolución y en 3 de ellas existía el antecedente de cirugías previas por endometriosis. El tiempo quirúrgico promedio fue 313 minutos (rango: 180-450 minutos). Todas las cirugías se completaron por laparoscopía y no se registraron complicaciones. La anatomía patológica confirmó endometriosis en todos los casos. El seguimiento promedio fue de 4 meses (rango: 2-8 meses). CONCLUSIÓN: La técnica laparoscópica reversa es una alternativa factible en el manejo quirúrgico de la endometriosis profunda, sin embargo es una técnica compleja y debe ser realizada por equipos experimentados en cirugía laparoscópica.

BACKGROUND: Surgical resection of deep infiltrating endometriosis (DIE) is complex and it is associated with a high risk of complications. Recently, the so-called reverse technique seems to be associated with lower a complication rate when compared to standard technique. AIMS: To report our preliminary experience and the feasibility of reverse technique in the management of DIE. METHOD: Report of 5 cases from a prospective database. RESULTS: Mean age was 34.2 years (range: 32-37 years). All patients had chronic pelvic pain and severe dyspareunia and 3 women had previous surgeries for endometriosis. Mean operative time was 313 minutes (range: 180-450 minutes). All surgeries were completed by laparoscopy and no complications were noted. Histological analysis confirmed endometriosis in all cases. Mean follow-up was 4 months (range: 2-8 month). CONCLUSION: Reverse laparoscopic technique is feasible and reproductible, however, it should be reserved to teams experienced in advanced laparoscopic surgery.

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Antecedentes: La esterilización tubárica se realiza en un número importante de pacientes jóvenes que por diferentes motivos desean posteriormente un nuevo embarazo, porcentaje que varía entre el 1,3-15 por ciento. Hasta ahora la cirugía ha sido la primera alternativa de tratamiento y gracias a la evolución de la técnica y el desarrollo de material quirúrgico, es posible de realizar por vía laparoscópica. Objetivos: Hacer una síntesis de la historia y técnicas utilizadas en la reanastomosis tubárica, los criterios de selección, el estudio preoperatorio, los factores pronósticos y comparar los resultados de la laparotomía y la laparoscopia. Métodos: Se realiza búsqueda en base de datos Medline PubMed usando las palabras clave: tubal anastomosis, reversal of esterilization, infertility, microsurgery, tubal esterilization; se seleccionan todas aquellas publicaciones tipo review de reanastomosis tubárica con microcirugía abierta y todas aquellas de reanastomosis por vía laparoscópica. Resultados: La reanastomosis tubárica por laparotomía con técnica microquirúrgica tiene un éxito entre 60 y 90 por ciento de tasas de embarazo. Las primeras publicaciones de la técnica laparoscópica no presentan resultados satisfactorios, sin embargo casuísticas más numerosas y especialmente las que muestran la técnica microlaparoscópica tienen resultados similares con todas las ventajas de la laparoscopia. Conclusión: La recanalización tubaria por vía laparoscopica es una técnica factible, probada y exitosa, alternativa a la laparotomía, sin embargo, para su implementación con resultados satisfactorios es necesario contar con equipamiento apropiado, experiencia previa en cirugía abierta y entrenamiento en cirugía endoscópica.

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