RESUMO
OBJECTIVE: We undertook this study to determinate the educational impact of training in an inanimate biosimulator in terms of effectiveness, time and complications in performing laparoscopic cholecystectomy. METHODS: We used a comparative, experimental cohort, prospective and longitudinal. Three first-postgraduate-year residents and one pre-grade internship physician were trained and assessed in basic laparoscopic skills using a biosimulator (fiberglass "dummy" where animal organs are introduced ex-vivo). The participants acted as their own control, performing a procedure to determine surgical time, complications and effectiveness. Later they observed a short video demonstrating the suitable development of laparoscopic cholecystectomy. The video defined the specific deviations from the ideal cholecystectomy, which were considered as errors. Every procedure was videotaped, beginning with the careful dissection of cystic structures and clipping them, continuing with the dissection of the gallbladder from the liver with the standardized method. Each participant performed ten procedures. RESULTS: There were no differences in baseline assessment of basic skills. All participants completed all proposed procedures. Surgical time was 61% faster at the end of the study (p<0.001), as well as demonstrating a lower rate of complications of 0.67% (p<0.009). CONCLUSIONS: Skills training in endoscopic surgery by means of an inanimate biosimulator is superior to traditional training because it decreases surgical time and surgical complications without ethical considerations and the effect of a learning curve in the operating room.
Assuntos
Colecistectomia Laparoscópica/educação , Competência Clínica , Simulação por Computador , Humanos , Estudos ProspectivosRESUMO
Objetivo: determinar el impacto educacional del entrenamiento en un biosimulador inanimado en términos de efectividad, tiempo y complicaciones, respecto a la colecistectomía laparoscópica. Material y métodos: estudio comparativo, experimental de una cohorte, prospectivo y longitudinal. Tres médicos residentes de primer año de cirugía y un interno de pregrado, fueron entrenados y evaluados en habilidades laparoscópicas elementales mediante el empleo de un biosimulador (maniquí de fibra de vidrio en el que se introducen órganos de animales ex vivo). Los sujetos fueron su propio control: realizaron un procedimiento inicial en el que se determinó tiempo quirúrgico, complicaciones y efectividad. Posteriormente observaron un corto video que mostraba el desarrollo idóneo de la colecistectomía, y en el que se identificaban las desviaciones específicas del desempeño adecuado. Posteriormente cada sujeto realizó 10 procedimientos. Resultados: no existieron diferencias en la evaluación inicial de habilidades elementales. Los individuos completaron todos los procedimientos propuestos. Las disecciones de las estructuras císticas y de la vesícula biliar fueron 61 % más rápidas al finalizar el estudio (p < 0.001); la tasa de complicación fue de 0.67 % (p <0.009). Conclusión: el entrenamiento de habilidades en cirugía endoscópica por medio de un biosimulador inanimado es mejor que el entrenamiento tradicional, ya que disminuye el tiempo quirúrgico y las complicaciones en la sala de operaciones.
OBJECTIVE: We undertook this study to determinate the educational impact of training in an inanimate biosimulator in terms of effectiveness, time and complications in performing laparoscopic cholecystectomy. METHODS: We used a comparative, experimental cohort, prospective and longitudinal. Three first-postgraduate-year residents and one pre-grade internship physician were trained and assessed in basic laparoscopic skills using a biosimulator (fiberglass [quot ]dummy[quot ] where animal organs are introduced ex-vivo). The participants acted as their own control, performing a procedure to determine surgical time, complications and effectiveness. Later they observed a short video demonstrating the suitable development of laparoscopic cholecystectomy. The video defined the specific deviations from the ideal cholecystectomy, which were considered as errors. Every procedure was videotaped, beginning with the careful dissection of cystic structures and clipping them, continuing with the dissection of the gallbladder from the liver with the standardized method. Each participant performed ten procedures. RESULTS: There were no differences in baseline assessment of basic skills. All participants completed all proposed procedures. Surgical time was 61% faster at the end of the study (p<0.001), as well as demonstrating a lower rate of complications of 0.67% (p<0.009). CONCLUSIONS: Skills training in endoscopic surgery by means of an inanimate biosimulator is superior to traditional training because it decreases surgical time and surgical complications without ethical considerations and the effect of a learning curve in the operating room.
Assuntos
Humanos , Competência Clínica , Simulação por Computador , Colecistectomia Laparoscópica/educação , Estudos ProspectivosRESUMO
Echinococcosis is a frequent hepatic parasitic disease in several countries but it is practically absent in Mexico. A cattle strain of Echinococcus granulosus was identified by RAPD, PCR-RFLP and mitochondrial CO1 gene analysis in an autochthonous case. The parasite was obtained after a laparoscopic excision of a liver cyst from a patient that was symptomatic for 6 years but mis-diagnosed before hospitalization.
Assuntos
Equinococose Hepática/transmissão , Echinococcus granulosus/classificação , Echinococcus granulosus/isolamento & purificação , Adulto , Animais , Bovinos/parasitologia , Equinococose Hepática/parasitologia , Feminino , Humanos , México , Reação em Cadeia da Polimerase/métodos , Polimorfismo de Fragmento de Restrição , Técnica de Amplificação ao Acaso de DNA Polimórfico , Suínos/parasitologia , Zoonoses/transmissãoRESUMO
OBJECTIVE: To describe a case of hydatid disease in Mexico. BACKGROUND: Liver hydatid disease is the most frequent hepatic parasitic disease in developed countries and is considered practically absent in Mexico. METHODS: In this paper we report identification, clinical management, and epidemiologic parasitologic, and molecular biological studies of an autochthonous case of hydatid disease in Mexico. RESULTS: Hepatic cyst was identified by imaging techniques. The patient received cestocidal treatment and the parasite was excised by laparoscopy. It was not possible to identify the origin of the Echinococcus strain neither by epidemiologic studies performed in the patient's household nor by RAPD pattern obtained with DNA of the protoscolices. Infection of a dog with protoscolices was not successful probably because they were damaged by the cestocidal drug. CONCLUSIONS: Care should be taken in the future to identify other possible autochthonous patients harboring liver hydatid cysts to treat them in an adequate and timely fashion, and to identify the strain of Echinococcus granulosus that infects patients in Mexico.