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BACKGROUND: Durotomy during endoscopic spine surgery can cause a patient's neurological or cardiovascular status to deteriorate unexpectedly intra- or postoperatively. There is currently limited literature regarding appropriate fluid management strategies, irrigation-related risk factors, and clinical consequences of incidental durotomy during spinal endoscopy, and no validated irrigation protocol exists for endoscopic spine surgery. Thus, the present article sought to (1) describe 3 cases of durotomy, (2) investigate standard epidural pressure measurements, and (3) survey endoscopic spine surgeons on the incidence of adverse effects believed to result from durotomy. MATERIALS AND METHODS: The authors first reviewed clinical outcomes and analyzed complications in 3 patients with intraoperatively recognized incidental durotomy. Second, the authors conducted a small case series with intraoperative epidural pressure measurements during gravity-assisted irrigated video endoscopy of the lumbar spine. Measurements were conducted on 12 patients with a transducer assembly that was introduced through the endoscopic working channel of the RIWOSpine Panoview Plus and Vertebris endoscope to the decompression site in the spine. Third, the authors conducted a retrospective, multiple-choice survey of endoscopic spine surgeons to better understand the frequency and seriousness of problems they attributed to irrigation fluid escaping from the surgical decompression site into the spinal canal and neural axis. Descriptive and correlative statistical analyses were performed on the surgeons' responses. RESULTS: In the first part of this study, durotomy-related complications during irrigated spinal endoscopy were observed in 3 patients. Postoperative head computed tomographic (CT) images revealed massive blood in the intracranial subarachnoid space, the basal cisterns, the III and IV ventricle, and the lateral ventricles characteristic of an arterial fisher grade IV subarachnoid hemorrhage, and hydrocephalus without evidence of aneurysms or angiomas. Two additional patients developed intraoperative seizures, cardiac arrhythmia, and hypotension. The head CT image in 1 of these 2 patients had intracranial air entrapment.In the second part, epidural pressure measurements in 12 patients who underwent uneventful routine lumbar interlaminar decompression for L4-L5 and L5-S1 disc herniation showed an average epidural pressure of 24.5 mm Hg.In the third part, the online survey was accessed by 766 spine surgeons worldwide and had a response rate of 43.6%. Irrigation-related problems were reported by 38% of responding surgeons. Only 11.8% used irrigation pumps, with 90% running the pump above 40 mm Hg. Headaches (4.5%) and neck pain (4.9%) were observed by nearly a 10th (9.4%) of surgeons. Seizures in combination with headaches, neck and abdominal pain, soft tissue edema, and nerve root injury were reported by another 5 surgeons. One surgeon reported a delirious patient. Another 14 surgeons thought that they had patients with neurological deficits ranging from nerve root injury to cauda equina syndrome related to irrigation fluid. Autonomic dysreflexia associated with hypertension was attributed by 19 of the 244 responding surgeons to the noxious stimulus of escaped irrigation fluid that migrated from the decompression site in the spinal canal. Two of these 19 surgeons reported 1 case associated with a recognized incidental durotomy and another with postoperative paralysis. CONCLUSIONS: Patients should be educated preoperatively about the risk of irrigated spinal endoscopy. Although rare, intracranial blood, hydrocephalus, headaches, neck pain, seizures, and more severe complications, including life-threatening autonomic dysreflexia with hypertension, may arise if irrigation fluid enters the spinal canal or the dural sac and migrates from the endoscopic site along the neural axis rostrally. Experienced endoscopic spine surgeons suspect a correlation between durotomy and irrigation-related extra- and intradural pressure equalization that could be problematic if associated with high volumes of irrigation fluid LEVEL OF EVIDENCE: 3.

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Background: Seizures, neurological deficits, bradycardia, and, in the worst cases, cardiac arrest may occur following incidental durotomy during routine lumbar endoscopy. Therefore, we set out to measure the intraoperative epidural pressure during lumbar endoscopic decompression surgery. Methods: We conducted a retrospective observational cohort study to obtain intraoperative epidural measurements with an epidural catheter-pressure transducer assembly through the spinal endoscope on 15 patients who underwent lumbar endoscopic decompression of symptomatic lumbar herniated discs and spinal stenosis. The endoscopic interlaminar technique was employed. Results: There were six (40.0%) female and nine (60.0%) male patients aged 49.0667 ± 11.31034, ranging from 36 to 72 years, with an average follow-up of 35.15 ± 12.48 months. Three of the fifteen patients had seizures with durotomy and one of these three had intracranial air on their postoperative brain CT. Another patient developed spinal headaches and diplopia on postoperative day one when her deteriorating neurological function was investigated with a brain computed tomography (CT) scan, showing an intraventricular hemorrhage consistent with a Fisher Grade IV subarachnoid hemorrhage. A CT angiogram did not show any abnormalities. Pressure recordings in the epidural space in nine patients ranged from 20 to 29 mm Hg with a mean of 24.33 mm Hg. Conclusion: Most incidental durotomies encountered during lumbar interlaminar endoscopy can be managed without formal repair and supportive care measures. The intradural spread of irrigation fluid and intraoperatively used drugs and air entrapment through an unrecognized durotomy should be suspected if patients deteriorate in the recovery room. Ascending paralysis may cause nausea, vomiting, upper and lower motor neuron symptoms, cranial nerve palsies, hypotension, bradycardia, and respiratory and cardiac arrest. The recovery team should be prepared to manage these complications.

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BACKGROUND: Casually cauterizing the radicular magna during routine thoracic discectomy may have dire consequences. METHODS: We performed a retrospective observational cohort study on patients scheduled for decompression of symptomatic thoracic herniated discs and spinal stenosis who underwent a preoperative computed tomography angiography (CTA) to assess the surgical risks by anatomically defining the foraminal entry level of the magna radicularis artery into the thoracic spinal cord and its relationship to the surgical level. RESULTS: Fifteen patients aged 58.53 ± 19.57, ranging from 31 to 89 years, with an average follow-up of 30.13 ± 13.42 months, were enrolled in this observational cohort study. The mean preoperative VAS for axial back pain was VAS of 8.53 ± 2.06 and reduced to a postoperative VAS of 1.60 ± 0.92 (p < 0.0001) at the final follow-up. The Adamkiewicz was most frequently found at T10/11 (15.4%), T11/12 (23.1%), and T9/10 (30.8%). There were eight patients where the painful pathology was found far from the AKA foraminal entry-level (type 1), three patients with near location (type 2), and another four patients needing decompression at the foraminal (type 3) entry-level. In five of the fifteen patients, the magna radicularis entered the spinal canal on the ventral surface of the exiting nerve root through the neuroforamen at the surgical level requiring a change of surgical strategy to prevent injury to this important contributor to the spinal cord's blood supply. CONCLUSIONS: The authors recommend stratifying patients according to the proximity of the magna radicularis artery to the compressive pathology with CTA to assess the surgical risk with targeted thoracic discectomy methods.

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International collaborations can be the key to overcoming innovation implementation hurdles. The authors report on a joint symposium between the International Society For The Advancement of Spine Surgery (ISASS) and La Sociedad Iberolatinoamerica de Columna (SILACO), and La Sociedad Interamericana de Cirurgia de columna de Minima invasión (SICCMII) aimed at improving joint surgeon education programs. The symposium highlighted that patient-related spine care issues are similar across geographical, cultural, and language barriers. The sustainability of such programs depends on funding and mutually respectful relationships orchestrated by multi-lingual leaders who will bridge gaps created by geographical, cultural, and language barriers to effectively develop clinical research content focused on advancing surgeon education and improving patient outcomes across the Americas.

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Background: Endoscopically visualized spine surgery has become an essential tool that aids in identifying and treating anatomical spine pathologies that are not well demonstrated by traditional advanced imaging, including MRI. These pathologies may be visualized during endoscopic lumbar decompression (ELD) and categorized into primary pain generators (PPG). Identifying these PPGs provides crucial information for a successful outcome with ELD and forms the basis for our proposed personalized spine care protocol (SpineScreen). Methods: a prospective study of 412 patients from 7 endoscopic practices consisting of 207 (50.2%) males and 205 (49.8%) females with an average age of 63.67 years and an average follow-up of 69.27 months was performed to compare the durability of targeted ELD based on validated primary pain generators versus image-based open lumbar laminectomy, and minimally invasive lumbar transforaminal interbody fusion (TLIF) using Kaplan-Meier median survival calculations. The serial time was determined as the interval between index surgery and when patients were censored for additional interventional and surgical treatments for low back-related symptoms. A control group was recruited from patients referred for a surgical consultation but declined interventional and surgical treatment and continued on medical care. Control group patients were censored when they crossed over into any surgical or interventional treatment group. Results: of the 412 study patients, 206 underwent ELD (50.0%), 61 laminectomy (14.8%), and 78 (18.9%) TLIF. There were 67 patients in the control group (16.3% of 412 patients). The most common surgical levels were L4/5 (41.3%), L5/S1 (25.0%), and L4-S1 (16.3%). At two-year f/u, excellent and good Macnab outcomes were reported by 346 of the 412 study patients (84.0%). The VAS leg pain score reduction was 4.250 ± 1.691 (p < 0.001). No other treatment during the available follow-up was required in 60.7% (125/206) of the ELD, 39.9% (31/78) of the TLIF, and 19.7% (12/61 of the laminectomy patients. In control patients, only 15 of the 67 (22.4%) control patients continued with conservative care until final follow-up, all of which had fair and poor functional Macnab outcomes. In patients with Excellent Macnab outcomes, the median durability was 62 months in ELD, 43 in TLIF, and 31 months in laminectomy patients (p < 0.001). The overall survival time in control patients was eight months with a standard error of 0.942, a lower boundary of 6.154, and an upper boundary of 9.846 months. In patients with excellent Macnab outcomes, the median durability was 62 months in ELD, 43 in TLIF, and 31 months in laminectomy patients versus control patients at seven months (p < 0.001). The most common new-onset symptom for censoring was dysesthesia ELD (9.4%; 20/206), axial back pain in TLIF (25.6%;20/78), and recurrent pain in laminectomy (65.6%; 40/61) patients (p < 0.001). Transforaminal epidural steroid injections were tried in 11.7% (24/206) of ELD, 23.1% (18/78) of TLIF, and 36.1% (22/61) of the laminectomy patients. The secondary fusion rate among ELD patients was 8.8% (18/206). Among TLIF patients, the most common additional treatments were revision fusion (19.2%; 15/78) and multilevel rhizotomy (10.3%; 8/78). Common follow-up procedures in laminectomy patients included revision laminectomy (16.4%; 10/61), revision ELD (11.5%; 7/61), and multilevel rhizotomy (11.5%; 7/61). Control patients crossed over into ELD (13.4%), TLIF (13.4%), laminectomy (10.4%) and interventional treatment (40.3%) arms at high rates. Most control patients treated with spinal injections (55.5%) had excellent and good functional outcomes versus 40.7% with fair and poor (3.7%), respectively. The control patients (93.3%) who remained in medical management without surgery or interventional care (14/67) had the worst functional outcomes and were rated as fair and poor. Conclusions: clinical outcomes were more favorable with lumbar surgeries than with non-surgical control groups. Of the control patients, the crossover rate into interventional and surgical care was 40.3% and 37.2%, respectively. There are longer symptom-free intervals after targeted ELD than with TLIF or laminectomy. Additional intervention and surgical treatments are more often needed to manage new-onset postoperative symptoms in TLIF- and laminectomy compared to ELD patients. Few ELD patients will require fusion in the future. Considering the rising cost of surgical spine care, we offer SpineScreen as a simplified and less costly alternative to traditional image-based care models by focusing on primary pain generators rather than image-based criteria derived from the preoperative lumbar MRI scan.

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Las redes sociales han revolucionado el uso de Internet. Según el Informe Digital de Estadísticas Globales de abril de 2022, hay unos 4.650 millones de usuarios de redes sociales en todo el mundo. 1 Este número equivale al 58,7 % de la población mundial, muchos de los cuales utilizan las redes sociales como principal fuente de información. ), youtube (2,2 mil millones), WhatsApp (2 mil millones), Instagram (2 mil millones), TikTok (1 mil millones), Snapchat (538 millones ), Pinterest (444 millones), Reddit (430 millones), Linkedin (250 millones) y Twitter (217 millones). Los cirujanos que están subiendo de rango son usuarios ávidos de las plataformas modernas de redes sociales o, al menos, son conscientes de ellos.

Socialmediahaverevolutionizedtheuseoftheinternet.Accord-ingtotheDigital2022AprilGlobalStatshotReport,therearesome4.65billionsocialmediausersworldwide.1Thisnumberistheequivalentto58.7%oftheglobalpopulation,manyofwhomareusingsocialmediaasaprimarysourceofinformation.Accordingtotheactiveusernumbers,themostpopularsocialmediaplatformsin2022areFacebook(2.9billion),youtube(2.2billion),WhatsApp(2billion),Instagram(2billion),TikTok(1billion),Snapchat(538million),Pinterest(444million),Reddit(430million),Linkedin(250million),andTwitter(217million).1SocialmediaisnotjustaU.S.phenomenonwhere84%ofAmericanshaveatleastoneoftheabove-listedsocialmediaaccounts.Thereareover1billionsocialmediausersinChina,despite415millionofitscitizenshavingnointernetaccess.1Mostyoungergenerationsoforthopedicsur-geonscominguptheranksareeitheravidusersofmodernsocialmediaplatformsorareatleastawareofthem

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Introduction: In clinical studies involving common orthopedic problems and traumatic injuries, randomization methods are difficult to orchestrate. The lack of high-level clinical evidence based on prospective, randomized, double-blind studies is often cited as a major reason for rejecting proposed therapeutic advances in orthopedic surgery. Materials and methods: This opinion document summarizes the limitations of clinical trials in surgical subspecialties. A consensus is presented about how the practicing orthopedic surgeon can produce high-quality clinical evidence and thus make changes to their clinical practice protocols. Results: This literature review revealed that level of evidence classifications vary among surgical subspecialties. Research in orthopedics and traumatology is primarily directed toward diagnosis, preferred treatment, and economic decision analysis, while other prognostic classifications are preferred in other areas, such as plastic surgery. In orthopedics, double-blind controlled studies are rare and often impractical or even unethical. Crossover between randomized surgical trials of study groups is more common. Other difficulties in surgical trials range from: lack of organizational and financial support, institutional approval or ethics committee and registration requirements for clinical trials, and to insufficient time outside of an already busy clinical program to dedicate to this laborious task. uncompensated task. Conclusion: Orthopedic surgery is a subspecialty based on experience and skill. Many innovations begin with enterprising surgeons reporting opinion reports or retrospective cohort studies, many of which are biased. Prospective observational cohort studies with consistent results may offer higher grade clinical evidence than poorly executed randomized trials.

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BACKGROUND: The combination of the percutaneous transforaminal endoscopic decompression (PTED) with an interspinous process distraction system (IPS) may offer additional benefit in the treatment of spinal stenosis in patients who have failed nonsurgical treatment. METHODS: We retrospectively reviewed the medical records of 33 patients diagnosed with lumbar stenosis and radiculopathy and treated them with transforaminal endoscopic lumbar decompression between 2013 and 2017. Primary outcome measures were modified Macnab as well as preoperative and postoperative visual analog scale (VAS) criteria and the Oswestry Disability Index (ODI). Only patients with a minimum follow-up of 2 years were included. RESULTS: A total of 28 patients were treated with a combination of PTED and percutaneous IPS (group A), and 5 patients were treated with PTED and mini-open IPS (group B). In group A patients, there was a 4.48 reduction in the VAS score. The ODI changed from 50.25 preoperatively to 18.2 postoperatively, and excellent and good Macnab outcomes were obtained in 78% of patients. In group B patients, the mean VAS reduction was 5.2 points. The ODI changed from 44.34 preoperatively to 14.62 postoperatively, and 80% of group B patients achieved excellent and good Macnab outcomes. No complications related to PTED or IPS were observed throughout the 2-year follow-up. CONCLUSIONS: The addition of IPS to the PTED procedure in select patients may offer additional benefits to patients being treated for lumbar lateral stenosis and foraminal stenosis with low-grade spondylolisthesis. LEVEL OF EVIDENCE: 3. CLINICAL RELEVANCE: Feasibility study.

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(1) Background: Postoperative nerve root injury with dysesthesia is the most frequent sequela following lumbar endoscopic transforaminal discectomy. At times, it may be accompanied by transient and rarely by permanent motor weakness. The authors hypothesized that direct compression of the exiting nerve root and its dorsal root ganglion (DRG) by manipulating the working cannula or endoscopic instruments may play a role. (2) Objective: To assess whether intraoperative neurophysiological monitoring can help prevent nerve root injury by identifying neurophysiological events during the initial placement of the endoscopic working cannula and the directly visualized video endoscopic procedure. (3) Methods: The authors performed a retrospective chart review of 65 (35 female and 30 male) patients who underwent transforaminal endoscopic decompression for failed non-operative treatment of lumbar disc herniation from 2012 to 2020. The patients' age ranged from 22 to 86 years, with an average of 51.75 years. Patients in the experimental group (32 patients) had intraoperative neurophysiological monitoring recordings using sensory evoked (SSEP), and transcranial motor evoked potentials (TCEP), those in the control group (32 patients) did not. The SSEP and TCMEP data were analyzed and correlated to the postoperative course, including dysesthesia and clinical outcomes using modified Macnab criteria, Oswestry disability index (ODI), visual analog scale (VAS) for leg and back pain. (4) Results: The surgical levels were L4/L5 in 44.6%, L5/S1 in 23.1%, and L3/L4 in 9.2%. Of the 65 patients, 56.9% (37/65) had surgery on the left, 36.9% (24/65) on the right, and the remaining 6.2% (4/65) underwent bilateral decompression. Postoperative dysesthesia occurred in 2 patients in the experimental and six patients in the control group. In the experimental neuromonitoring group, there was electrodiagnostic evidence of compression of the exiting nerve root's DRG in 24 (72.7%) of the 32 patients after initial transforaminal placement of the working cannula. A 5% or more decrease and a 50% or more decrease in amplitude of SSEPs and TCEPs recordings of the exiting nerve root were resolved by repositioning the working cannula or by pausing the root manipulation until recovery to baseline, which typically occurred within an average of 1.15 min. In 15 of the 24 patients with such latency and amplitude changes, a foraminoplasty was performed before advancing the endoscopic working cannula via the transforaminal approach into the neuroforamen to avoid an impeding nerve root injury and postoperative dysesthesia. (5) Conclusion: Neuromonitoring enabled the intraoperative diagnosis of DRG compression during the initial transforaminal placement of the endoscopic working cannula. Future studies with more statistical power will have to investigate whether employing neuromonitoring to avoid intraoperative compression of the exiting nerve root is predictive of lower postoperative dysesthesia rates in patients undergoing videoendoscopic transforaminal discectomy.

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BACKGROUND: Anterior endoscopic cervical decompression with discectomy and foraminotomy is an alternative to open surgical treatment of unrelenting cervical radiculopathy (CR) in patients who have failed non-operative treatment. The purpose of the study is to present the clinical outcomes of patient with CR treated with an anterior endoscopic approach. METHODS: We reviewed the medical records of 293 patients diagnosed with CR and treated with an anterior endoscopic cervical decompression between 1997 and 2018. Primary outcome measures were modified Macnab as well as pre- and postoperative visual analog scale (VAS) criteria. RESULTS: The average surgical time was 65 minutes. At 12 months follow-up, Excellent and Good Macnab outcomes were achieved in 90.1% of patients. The average VAS score reduction was 5.6. Complications occurred in 8 patients and were treated with a second procedure in 10 patients. CONCLUSIONS: The anterior endoscopic cervical decompression is an attractive alternative to open anterior cervical discectomy and fusion (ACDF) with a low complication and reoperations rate.

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We report two cases of a standalone lordotic endoscopic wedge lumbar interbody fusion (LEW-LIF™) with a stress-neutral non-expandable cylindrical threaded polyether ether ketone (PEEK) interbody fusion implant. Patients underwent full-endoscopic transforaminal decompression and fusion for symptomatic lateral recess stenosis due to disc herniation, and hypertrophy of the facet joint complex and ligamentum flavum and no more than grade I spondylolisthesis. Lumbar interbody fusion with cages traditionally calls for posterior supplemental fixation with pedicle screws for added stability. A more simplified version of lumbar decompression and fusion without pedicle screws would allow treating patients suffering from stenosis and instability induced sciatica-type low back and leg pain in an outpatient ambulatory surgery center setting (ASC). This would realize a significant reduction in cost as well as the burden to the patient with decreased postoperative pain and earlier return to function. A 62-year-old female patient had surgery at L4/5 for a 6-year history of worsening right sided sciatica-type leg- and low back pain. Another 79-year-old female had the same surgical management at L4/5 for a 5-year history of unrelenting left-sided spondylolisthesis-related symptoms. Both patients had an uneventful postoperative course until the last available follow-up of 24 weeks with greater than 60% VAS and Oswestry disability index (ODI) reductions. There was no evidence of implant expulsion, subsidence, or postoperative instability. We concluded that standalone outpatient lumbar transforaminal endoscopic interbody fusion with a non-expandable threaded cylindrical cage is feasible, and favorable clinical outcomes provide proof of concept to study long-term clinical outcomes in larger groups of patients.

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Introducción La cirugía endoscópica de columna ha demostrado ser una opción en el tratamiento de hernias discal y estenosis foraminal. El abordaje más empleado es la vía transforaminal, sin embargo, este abordaje es limitado en casos de hernias discales centrales extruidas y migradas. El abordaje interlaminar completamente endoscópico ha permitido el tratamiento sintomático de hernias discales centrales extruidas y migradas en el nivel L5 ­ S1, además es una novedosa alternativa para la resolución de las dificultades técnicas relacionadas con el abordaje posterolateral en éste nivel. El propósito del estudio es reportar los resultados obtenidos con el abordaje endoscópica interlaminar en el tratamiento de hernias discales centrales extruidas y migradas en dos años de seguimiento. Materiales y métodos Se realizó un estudio retrospectivo observacional descriptivo con las historias de pacientes que presentaron sintomatología radicular secundaria a hernia discal central en el nivel L5 ­ S1 y que fueron tratados con cirugía por abordaje interlaminar completamente endoscópico. Se evaluaron los índices de escala visual análoga (EVA) pre y posoperatorio, el criterio Oswestry ODI y el criterio MacNab. Resultados Entre los años 2008 y 2015 se realizaron un total de 99 procedimientos en el mismo número de pacientes. Todos fueron sometidos a una técnica quirúrgica estándar bajo anestesia local y sedación. La EVA tuvo una reducción de 5,81 puntos. El ODI bajó 45,63%. Y el 88% de los pacientes tuvo una completa satisfacción frente al tratamiento. Discusión Los resultados obtenidos en esta muestra permiten considerar la fragmentectomía interlaminar endoscópica bajo anestesia local y sedación como un procedimiento seguro, preciso y efectivo en la resolución del dolor secundario a hernias discales centrales extruidas y migradas en el nivel L5 ­ S1 que cursan con radiculopatía. El uso de anestesia local y sedación como única alternativa analgésica puede no ser la mejor opción en este tipo de técnicas Nivel de evidencia IV

Background Endoscopic spine surgery has shown to be an option for disc hernias and foraminal stenosis. Although the most used approach is transforaminal, this approach is limited in cases of extruded and migrated central hernias. The full-endoscopic interlaminar approach has led to the treatment of the lumbar pain secondary to extruded and migrated central herniated discs at L5 - S1, and is an alternative for resolving technical difficulties related to the transforaminal approach at this level. The aim of this article is to report the results obtained with a full-endoscopic interlaminar approach for the treatment of central extruded and migrated herniated discs, with a two-year follow-up. Methods A descriptive observational retrospective study was conducted using the records of patients who had a radiculopathy secondary to a central herniated disc at level L5 - S1, and who were treated with a full-endoscopic interlaminar approach. An evaluation was made of the pre-operative and post-operative visual analogue scale (VAS) scores, Oswestry ODI criteria, and MacNab criteria. Results A total of 99 procedures were performed in the same number of patients between 2008 and 2015. All were treated with a standard surgical technique and under local anaesthesia and sedation. The visual analogue score showed a reduction of 5.81 points. The ODI was down 45.63%, and 88% of the patients were completely satisfied with the treatment. Discussion The results lead us to consider that full-endoscopic interlaminar fragmentectomy under local anaesthesia and sedation is a safe, accurate, and effective procedure for the treatment of radiculopathy related to L5 - S1 extruded and migrated central hernia. Use of local anaesthesia and sedation as the only analgesic alternative may not be the best option in this type of technique. Evidence Level IV

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La evolución de las técnicas quirúrgicas tradicionales y los modelos de formación de los cirujanos exigen cambios, por esta razón el centro de investigación y entrenamiento en cirugía de mínima invasión (CLEMI) ha desarrollado y aplicado modelos de enseñanza que permiten aprender técnicas quirúrgicas mínimamente invasivas como la artroscopia. CLEMI propone un modelo basado en simulación impartido en un ambiente controlado, estructurado y progresivo que vaya al ritmo individual de cada uno de los estudiantes. Inicialmente el estudiante encontrará conceptos teóricos de instrumental, equipos y ergonomía, posteriormente en la fase práctica usando un modelo de laparoscopia y finalmente usando un modelo de artroscopia con los que se realizan ejercicios para desarrollar destrezas técnicas. El entrenamiento en modelos bajo ambiente controlado disminuye el período de aprendizaje y eleva la competencia del estudiante. El objetivo principal del curso es alcanzar las habilidades mínimas necesarias para realizar con éxito una artroscopia en el paciente.

The evolution of traditional surgical techniques and training models for surgeons demand changes. For this reason, the Latin-American Centre for training in minimally invasive surgery (CLEMI) has developed and applied teaching models that allow surgeons to learn minimally invasive surgical techniques such as arthroscopy. CLEMI proposes a model based on simulation presented in a controlled, structured, and progressive environment that advances with the individual rhythm of each of the students. Initially, the student uses theoretical instrumental, equipment and ergonomics concepts. Later, in the practical phase, they then carry out exercises using a laparoscopy model and finally an arthroscopy model in order to develop their technical skills.

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La evolución de las técnicas quirúrgicas tradicionales y los modelos de formación de los cirujanos exigen cambios, por esta razón el centro de investigación y entrenamiento en cirugía de mínima invasión (CLEMI) ha desarrollado y aplicado modelos de enseñanza que permiten aprender técnicas quirúrgicas mínimamente invasivas como la microcirugía. CLEMI propone un modelo de entrenamiento basado en el uso de un modelo experimental, impartido en un ambiente controlado, estructurado y progresivo que vaya al ritmo individual de cada uno de los estudiantes. Inicialmente el estudiante encontrará conceptos teóricos de instrumental, equipos y ergonomía, posteriormente en la fase práctica usando un modelos sintéticos y finalmente usando un modelo de biológico con los que se desarrollan de una serie de ejercicios para desarrollar destrezas técnicas que permiten alcanzar el nivel necesario para el manejo de las técnicas básicas de microcirugía. El entrenamiento en modelos bajo ambiente controlado disminuye el período de aprendizaje y eleva la competencia del participante. El objetivo principal del entrenamiento es alcanzar las habilidades mínimas necesarias para realizar con éxito una técnica de microcirugía.

The evolution of the traditional surgical techniques and the training models of the surgeons demand changes. For this reason the minimally invasive surgery research and training centre (CLEMI) has developed and applied teaching models as an aid to learn minimally invasive surgical techniques like microsurgery. CLEMI proposes a training model based on the use of an experimental model, presented in a controlled, structured, and progressive environment that is adjusted to the rhythm of the individual student. Initially, the student will encounter theoretical concepts of instrumental, equipment, and ergonomics. Later, in the practical phase, they will use synthetic models and then a biological model with which they perform a series of exercises in order to perfect the technical skills in order to reach the level necessary for the management of basic techniques of microsurgery. Training in controlled environment models reduces the learning period and increases the skills of the participant. The main objective of the training is to achieve the minimum skills necessary to successfully perform a microsurgery technique.

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La evolución de las técnicas quirúrgicas tradicionales y los modelos de formación de los cirujanos exigen cambios, por esta razón el centro de investigación y entrenamiento en cirugía de mínima invasión (CLEMI) ha desarrollado y aplicado modelos de enseñanza que permiten entrenar técnicas quirúrgicas mínimamente invasivas como la endoscopia de columna. CLEMI propone un modelo basado en simulación impartido en un ambiente controlado, estructurado y progresivo que vaya al ritmo individual de cada uno de los participantes. Inicialmente el asistente encontrará conceptos teóricos de instrumental, equipos y la técnica quirúrgica, posteriormente en la fase práctica se aplicarán los conceptos adquiridos usando un modelo sawbone de columna lumbar y finalmente se realizará la practica en un modelo anatómico humano sobre el que se desarrollan de manera completa y guiada los diferentes procedimientos endoscópicos usados a nivel lumbar. El entrenamiento en modelos bajo un ambiente controlado disminuye el período de aprendizaje y eleva la competencia del estudiante.

The evolution of traditional surgical techniques and training models of surgeons require changes. For this reason the centre of research and training in minimally invasive surgery (CLEMI) has developed and applied teaching models that help in the training of minimally invasive surgical techniques such as the endoscopy of the spine. CLEMI proposes a model based on simulation taught in a controlled, structured, and progressive environment that is adjusted to the individual rhythm of each of the participants. The student will initially encounter the theoretical concepts of instruments, equipment, and the surgical technique. This will be followed by a practical phase in which the acquired concepts will be applied using a sawbone model of the lumbar spine. Finally the practice will be carried out on a human anatomical model on which they develop, in a complete and guided manner, the different endoscopic procedures used at the lumbar level. Model training in a controlled environment decreases the learning period and increases student skills.

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La evolución de las técnicas quirúrgicas tradicionales y los modelos de formación de los cirujanos exigen cambios, por esta razón el centro de investigación y entrenamiento en cirugía de mínima invasión (CLEMI) ha desarrollado y aplicado modelos de enseñanza que permiten aprender técnicas quirúrgicas mínimamente invasivas como la artroscopia de hombro. CLEMI propone un modelo basado en simulación impartido en un ambiente controlado, estructurado y progresivo que vaya al ritmo individual de cada uno de los estudiantes. Inicialmente el estudiante encontrará conceptos teóricos de instrumental, equipos y ergonomía, posteriormente en la fase práctica usando un modelo sintético anatómico del hombro y finalmente usando un modelo biológico con el que se realizan ejercicios para desarrollar destrezas exigidas por las técnicas quirúrgicas. El entrenamiento en modelos bajo ambiente controlado disminuye el período de aprendizaje y eleva la competencia del estudiante.

The evolution of traditional surgical techniques and training models for surgeons demand changes. For this reason, the Latin-American centre for training in minimally invasive surgery (CLEMI) has developed and applied teaching models that allow surgeons to learn minimally invasive surgical techniques such as arthroscopy. CLEMI proposes a model based on simulation presented in a controlled, structured, and progressive environment that is adjusted to the individual rhythm of each of the students. The student initially studies the theoretical concepts of the instruments, equipment, and ergonomics. Later, in the practical phase of the instruction, students perform a series of exercises in technical skills. Training and models under controlled environments decrease the learning period and enhance student skills.

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La evolución de las técnicas quirúrgicas tradicionales y los modelos de formación de los cirujanos exigen cambios, por esta razón el centro de investigación y entrenamiento en cirugía de mínima invasión (CLEMI) ha desarrollado y aplicado modelos de enseñanza que permiten entrenar técnicas quirúrgicas mínimamente invasivas como la artroscopia de rodilla. CLEMI propone un modelo basado en simulación impartido en un ambiente controlado, estructurado y progresivo que vaya al ritmo individual de cada uno de los estudiantes. Inicialmente el estudiante encontrará conceptos teóricos de instrumental, equipos y ergonomía, posteriormente en la fase práctica usando un modelo sintético anatómico de la rodilla y finalmente usando un modelo biológico con el que se realizan ejercicios para desarrollar destrezas exigidas por las técnicas quirúrgicas. El entrenamiento en modelos bajo ambiente controlado disminuye el período de aprendizaje y eleva la competencia del estudiante.

Changes are needed due to the evolution of traditional surgical techniques and surgeon training models. For this reason the minimally invasive surgery research and training centre (CLEMI) has developed and applied teaching models to help in the training of minimally invasive surgical techniques, such as knee arthroscopy. CLEMI proposes a model based on simulation taught in a controlled, structured, and progressive environment that is tailored to the individual rhythm of each of the students. Initially, the student will encounter theoretical concepts of instruments, equipment and, ergonomics. Later, in the practical phase, an anatomical synthetic model of the knee will be used in the practical phase, followed by a biological model in order to perform exercises to develop the skills required for the surgical techniques. Training in models under a controlled environment decreases the learning period and increases student skills.

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Introducción: desde hace más de tres décadas la cirugía laparoscópica ha tomado fuerza y, en la actualidad, es uno de los procedimientos más empleados; pero este cambio de la cirugía convencional a la laparoscópica ginecológica hace que también cambien los programas de entrenamiento para ser realmente eficientes y acordes con la nueva curva de aprendizaje. Objetivo: seleccionar un procedimiento quirúrgico aplicable como programa de entrenamiento en cirugía ginecológica laparoscópica mediante simulador. Materiales y métodos: se seleccionaron los procedimientos quirúrgicos laparoscópicos frecuentemente utilizados en ginecología, por medio de un consenso de expertos; después se llevaron a cabo las prácticas en simulador seleccionando el más adecuado mediante la evaluación de los siguientes criterios: grado de dificultad, adquisición de habilidades, adaptabilidad a componente anatómico animal en simulador.Resultados: se seleccionó la ooforectomía laparoscópica como procedimiento experimental ya que este cumple con todos los requisitos previamente establecidos, ofreciendo al cirujano un espacio de formación ideal para adquirir destrezas básicas mediante ejercicios prácticos en simulador.Conclusiones: se propone a la ooforectomía laparoscópica como el procedimiento que mejor se adaptó al modelo de simulación para entrenamiento ajustable a los programas de formación existentes.

Introduction: Laparoscopic surgery has been gaining momentum over more than thirty years, and it is currently one of the most widely used procedures. However, this shift from conventional to laparoscopic surgery in gynecology has also brought about changes in training programs in order to make them truly efficient and consistent with the new learning curve. Objective: To select a surgical procedure applicable to a simulator-based training program in laparoscopic gynecological surgery. Materials and methods: Laparoscopic procedures used frequently in gynecology were selected in accordance with the opinion of an expert panel. Simulator practice sessions were then conducted in order to select the most suitable procedure on the basis of the following criteria: level of difficulty, skills acquisition, and adaptability to an animal anatomic component in the simulator. Results: Laparoscopic oophorectomy was selected as the experimental procedure, considering that it meets the criteria established and provides the surgeon with the ideal training situation for acquiring basic skills by means of practical exercises on the simulator.Conclusions: Laparoscopic oophorectomy is proposed as the procedure that is best suited as a simulation model for use within existing education programs.

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