Development and validation a task-specific checklist for a microsurgical varicocelectomy simulation model

ABSTRACT Purpose: To develop and validate a new test of specific technical skills required for microsurgical varicocelectomy. Materials and Methods: An electronic questionnaire was sent to 558 members of the Brazilian Society of Urology for the validation of the task-specific checklist (TSC) for assessment of microsurgical varicocelectomy. Participants who had experience in this procedure were selected as judges. For construct validation, 12 participants including attending urologists and urological residents in training were recruited for voluntary participation. We formed a group of three experts and a group of nine novices, who had to perform the steps of microsurgical varicocelectomy on a simulation model using human placenta. Each participant was filmed and two blinded raters would then evaluate their performance using the TSC of microsurgical varicocelectomy. Results: 14 judges were recruited. The assessment tool was reformulated, according to the judges suggestions and had the content validity achieved. The final version of the TSC was comprised of the task-specific score, a series of 4 items scored in a binary fashion designed for microscopic sub-inguinal varicocelectomy. The differences between the performance of participants with different levels of experience reflected the construct validity. The reliability between the raters was high. The mean time required to complete the training of microsurgical varicocelectomy in simulation model was significantly shorter for experts compared to novices (201 vs. 496 seconds, p=0.01). Conclusions: This preliminary study suggests that the task-specific checklist of microsurgical varicocelectomy is reliable and valid in assessing microsurgical skills.

Validation of the Objective Structured Assessment of Technical Skill in Brasil

SUMMARY BACKGROUND The aim of this study was to perform a cross-cultural adaptation of the Objective Structured Assessment of Technical Skill (OSATS) tool into Brazilian Portuguese and to determine its reproducibility and validity in Brasil. METHODS A Brazilian Portuguese version of OSATS was created through a process of translation, back-translation, expert panel evaluation, pilot testing, and then its validation. For the construct and the concurrent validities, twelve participants were divided into a group of six experts and six novices, who had to perform tasks on a simulation model using human placentas. Each participant was filmed, and two blinded raters would then evaluate their performance using the traditional subjective method and then the Brazilian Portuguese version of OSATS. RESULTS The Brazilian Portuguese version of OSATS had the face, content, construct, and concurrent validities achieved. The average experts' score and standard deviations were 34 and 0.894, respectively, for Judge 1 and 34.33 and 0.816 for Judge 2. In the case of novices, it was 13.33 and 2.388 for Judge 1 and 13.33 and 3.204 for Judge 2. The concordance between the judges was evident, with the Correlation Coefficient (Pearson) of 0.9944 with CI 95% between 0.9797 and 0.9985, with p < 10-10, evidencing the excellent reproducibility of the instrument. CONCLUSION This preliminary study suggests that the Brazilian Portuguese version of OSATS can reliably and validly assess surgical skills in Brasil.

RESUMO OBJETIVOS Objetivou-se com este trabalho adaptar transculturalmente o instrumento Objective Structured Assessment of Technical Skill (Osats) para o português-brasileiro e validá-lo no Brasil. MÉTODOS Uma versão em português-brasileiro do Osats foi criada por meio de um processo de tradução, retrotradução, versão consensual por um comitê de especialistas e pré-teste, seguido da etapa de validação. Para validades de constructo e concorrente, foram recrutados 12 participantes da Universidade Federal de Minas Gerais, divididos em um grupo de seis especialistas e um grupo de seis novatos, que tiveram de realizar tarefas em modelos de simulação utilizando placentas humanas. Cada participante foi filmado em anonimato e dois examinadores avaliaram os seus desempenhos usando o método tradicional subjetivo e depois a versão em português-brasileiro do Osats. RESULTADOS A versão em português-brasileiro do Osats alcançou as validades de face, de conteúdo, de constructo e concorrente. A média e o desvio padrão das pontuações atribuídas aos especialistas foram, respectivamente, 34 e 0,894, para o Juiz 1 e 34,33 e 0,816 para o Juiz 2. No caso dos novatos, foram 13,33 e 2,338 para o Juiz 1 e 13,33 e 3,204 para o Juiz 2. O Coeficiente de Correlação (de Pearson) entre os dois juízes foi de 0,9944 com IC 95% entre 0,9797 e 0,9985, com p<10-10, evidenciando a excelente reprodutibilidade do instrumento. CONCLUSÃO A versão em português-brasileiro do Osats manteve-se equivalente ao instrumento original e foi validada. Assim, pode ser usada para avaliar a performance operatória dos residentes em cirurgia no Brasil.

Tratamento cirúrgico da epilepsia refratária: análise de 34 casos atendidos no Hospital das Clínicas da UFMG / Surgical treatment of refractory epilepsy: analysis of 34 cases from the Hospital das Clínicas, Federal University of Minas Gerais

Objetivo: Apresentar dados estatísticos referentes a uma série de casos submetidos ao tratamento cirúrgico da epilepsia refratária no Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG), no período entre 23/11/2007 e 7/12/2010. Métodos: Estudo retrospectivo com análise de prontuários de 34 pacientes e classificação do controle de crises pós-operatório utilizando a Escala de Engel. Resultados: Dos pacientes, 70,5% apresentaram início das crises antes dos 15 anos, sendo o tipo de crise mais comum as crises parciais complexas com generalização secundária, presente em 55% dos casos. Esclerose mesial temporal foi o diagnóstico de base em 79,4% dos pacientes. Houve complicações cirúrgicas em 23,5% dos casos, sendo as mais frequentes as alterações de campo visual (8,8% dos casos). Conclusão: O controle de crises foi compatível com Engel menor ou igual a III em 64,7% dos casos. O tratamento cirúrgico revelou-se eficiente para melhorar o controle de crises em pacientes portadores de epilepsia refratária ao tratamento medicamentoso.

Objective: Presenting statistical data on a series of cases undergoing surgical treatment of epilepsy at the Hospital das Clínicas, Universidade Federal de Minas Gerais (HC-UFMG) in the period between 11/23/2007 and 12/7/2010. Methods: Retrospective analysis with charts of 34 patients and classification of seizure control postoperatively using the Engel Scale. Results: 70.5% of the patients had the onset of seizures before 15 years old and the most common type of seizure was complex partial seizure with secondary generalization, presented in 55% of cases. Mesial temporal sclerosis was the underlying diagnosis in 79.4% of patients. There were surgical complications in 23.5% of cases, the most frequent visual changes (8.8% of cases). Conclusion: Seizure control was consistent with Engel III or less in 64.7% of cases. Surgical treatment has proved effective in improving seizure control in patients with medically refractory epilepsy.

Avaliação do acesso supratentorial infraoccipital no tratamento das lesões do espaço incisural posterior: estudo anatômico e clínico / Evaluation of the infraoccipital supratentorial approach in the treatment of lesions of the posterior incisural space: an anatomical and clinical study

Realizou-se estudo anatômico e clínico para avaliação da eficácia da operabilidade e ressecabilidade das lesões do espaço incisural posterior (EIP) através do acesso supratentorial infraoccipital (ASI). Este espaço se situa pósterolateralmente ao teto do mesencéfalo e abaixo do esplênio do corpo caloso, englobando o pulvinar do tálamo, a porção póstero-medial do giro parahipocampal e o istmo do giro do cíngulo. O estudo anatômico foi feito em cinco segmentos cefálicos, perfazendo dez acessos, de peças anatômicas preparadas e dissecadas no laboratório de neurocirurgia da Faculdade de Medicina da Universidade Federal de Minas Gerais. Realizou-se análise morfométrica com medição da distância média da tórcula à diferentes estruturas do espaço incisural posterior: esplênio do corpo caloso, glândula pineal, origem da artéria calcarina, istmo do giro do cíngulo, pulvinar do tálamo, lâmina do teto do mesencéfalo e junção falcotentorial. Mediu-se também a distância entre a tórcula e pólo occipital que corresponde ao afastamento do lobo occipital da foice do cérebro. Calculou-se o ângulo de exposição do EIP por meio do ASI usando-se a função tangente, baseado no cálculo de triângulo retângulo criado com a retração do lobo occipital . A análise retrospectiva de vinte e dois pacientes com tumor ou malformação artério-venosa localizado no EIP e tratado pelo ASI foi realizada. Quinze pacientes apresentavam lesão tumoral (astrocitoma, oligodendroglioma, meninigioma e metástase de adenocarcionoma pulmonar), obtendo-se ressecção completa do tumor em seis pacientes, e parcial em nove. Sete pacientes apresentavam lesões vasculares (malformação artério-venosa e aneurisma), que foram tratados de maneira eficaz pelo ASI. Os resultados do estudo anatômico mostraram satisfatória operabilidade do ASI, com ângulo de exposição do EIP de 37,3 graus, e profundidade do campo cirúrgico de aproximadamente 50 mm. O estudo clínico evidenciou que o ASI permite boa ressecabilidade das lesões, com prejuízo funcional mínimo ou nulo

An anatomical and clinical study was performed to evaluate the surgical feasibility of the supratentorial infraoccipital approach (SIA) to treat lesions in the posterior incisural space (PIS). This space is located in the postero-lateral area of the quadrigeminal plate, below the splenium of corpus callosum, envolving the pulvinar of thalamus, postero-medial part of the parahipocampal gyrus and the isthmus of cingulate gyrus. Five cadaveric specimens, ten sides, were used for the anatomical study at the Federal University of Minas Gerais neurosurgery laboratory. A mathematical evaluation was done, measuring the distance from the torcula to the splenium of corpus callosum, pineal gland, calcarine artery, isthmus of cingulate gyrus, quadrigeminal plate, pulvinar of thalamus and the falcotentorial junction. The distance between the occipital pole and the falx cerebri, due to the occipital lobe retraction, was also measured. The exposure angle to reach the PIS was calculated. A retrospective analysis of twenty-two patients harboring tumors or arteriovenous malformations located at the PIS, operated by SIA, was done. There were 15 patients with tumors (astrocytomas, meningiomas and metastatic lesion) and seven with vascular lesions. Total resection was achieved in all five arteriovenous malformations patients as well as in six out of fifteen tumor patients. Nine patients had a partial tumor resection, and two a satisfactory aneurism exclusion. The anatomical and clinical results showed a good surgical feasibility when using the SIA to treat lesion at the PIS, with an exposing angle of 37.3 degrees of the target area, a surgical field deepness of approximately 50 mm, allowing good amount of lesion resection.