Programa de entrenamiento de parotidectomía en modelo cadavérico perfundido

Introducción: La parotidectomía es una cirugía infrecuente y técnicamente compleja determinada por la dificultad de disección del nervio facial, cuya lesión produce alto grado de morbilidad en los pacientes. Los modelos de simulación animales no logran reproducir las características de la anatomía regional, por lo que se hace necesario explorar otras alternativas para el entrenamiento de estas habilidades. Nuestro objetivo es evaluar un programa de entrenamiento de técnicas de parotidectomía en un modelo cadavé-rico perfundido. Métodos: Se diseñó un programa educacional de Kern de entrenamiento de residentes de Cirugía de Cabeza y Cuello para la realización de parotidectomía total en un modelo cadavérico perfundido. La evaluación se realizó mediante el modelo de Kirkpatrick, en los niveles 1 (reacción), 2A (cambio de actitudes) y 2B (adquisición de conocimientos y habilidades). Resultados: Se elaboró un programa teórico-práctico basado en cátedras y simulación de alta fidelidad. En su mayoría los participantes: recomendarían el curso (Nivel 1); tuvieron mayor motivación para el aprendizaje (Nivel 2) y presentaron mejores indicadores sobre conocimientos, habilidades y percepción de mejoría de sus competencias (Nivel 2B). Conclusión: La utilización de un programa de parotidectomía simulado en un modelo de alta fidelidad basado en modelos cadavéricos humanos perfundidos es una alternativa que mejora la calidad de entrenamiento y es útil y factible para el aprendizaje de técnicas de parotidectomía en residentes de Cirugía de Cabeza y Cuello.

Introduction: The parotidectomy is an infrequent and technically complex surgery due to a difficult dissection that may affect the facial nerve, generating high degree of morbidity in patients. Animal simulation models may not reproduce the human characteristics of cervical anatomy. Therefore, it is necessary to explore other alternatives for training dissection skills. Our objective is to evaluate a parotidectomy's techniques training program in a perfused cadaveric model. Methods: A Kern educational program was designed to train Head and Neck Surgery residents to perform total parotidectomy in a perfused cadaveric model. The evaluation was performed using Kirkpatrick model, at levels 1 (reaction), 2A (change of attitudes) and 2B (acquisition of knowledge and skills). Results: A theoretical-practical program based on lectures and high-fidelity simulation was developed. Most of the participants would recommend the course (Level 1); had greater motivation for learning (Level 2) and showed better indicators of knowledge, skills and perception of improvement in their competencies (Level 2B). Conclusion: The use of a simulated parotidectomy program in a high-fidelity model based on perfused human cadaveric models is an alternative that improves the quality of training and is useful and feasible for learning parotidectomy techniques in residents of Head and Head Surgery.

Acquisition of endoscopic nasal surgery skills with a lamb's head model

Abstract Objectives: To evaluate the acquisition of surgical skills by otolaryngology residents and established the minimum number of dissections of a lamb's model to be performed before practicing on human patients. Methods: Nineteen second-year otolaryngology residents performed ten dissections each, five on each nasal cavity, always practicing the same three surgical procedures on the lamb model. Each student's training lasted 2-months, and the entire training intervention lasted 4-years, over four generations of residents. All dissections were recorded and were selected at random for examination by two independent otolaryngology surgeons, who were otherwise not involved in the research. Assessment of the 190 dissections used an instrument validated for surgical training of medical residents. Results: To a 1% significance level, statistical analysis revealed increased performance and satisfactory results were observed after the sixth dissection. Furthermore, after the eighth dissection, skill acquisition was relevant and sustained. Conclusion: Training in endoscopic nasal surgery on a lamb's head model improves surgical skills and handling of surgical instruments. Our results showed the relevance of the lamb model for training in otolaryngology surgery, impacting on patient safety. Level of evidence: 2.

Efectos de la pandemia COVID-19 en la formación de residentes de cirugía general de la Argentina / Efects of the COVID-19 pandemic on the training of residents in general surgery in Argentina

RESUMEN Antecedentes: los sistemas de salud del mundo se han visto afectados en su lucha contra el COVID-19, generando efectos negativos tanto en la actividad asistencial como en la formación de los residentes. Suspender cirugías electivas, disminuir la participación de residentes en quirófano y otros cambios estructurales de los hospitales determinó que los residentes de cirugía experimenten un marcado déficit educacional en su formación. Material y métodos: modalidad observacional y transversal. Se realizó una encuesta anónima online de 20 preguntas a residentes de cirugía de la Argentina. Se confeccionó una base de datos para el análisis estadístico. Se valoraron variables categóricas y numéricas. Resultados: se recibieron 100 respuestas de la encuesta en la que se identificó predominio de residentes de instituciones públicas. Se calculó un descenso del 63% en la cantidad de cirugías en las que participaron los residentes durante la pandemia. El 77% usó plataformas virtuales para remediar el impacto en las instancias de formación académica. El 57% de los encuestados cuentan con programas de simulación quirúrgica en su hospital. La mayoría experimentó consecuencias negativas en sus habilidades quirúrgicas y en su formación durante la pandemia, pero se identificaron diferencias entre el grupo que dispone de simulación quirúrgica y el que no. Conclusión: para resolver el déficit educativo que generó la pandemia por COVID-19, y como medida para potenciar el aprendizaje de habilidades quirúrgicas en situaciones normales, este estudio recomendaría contar con programas de simulación quirúrgica y fomentar el uso de plataformas virtuales como herramienta de formación académica.

ABSTRACT Background: Health systems worldwide have been affected in their fight against COVID-19, generating negative effects on both healthcare activity and training of residents. Cancellation of elective surgeries, less participation of residents in the operating room and other structural changes in the hospitals resulted in an educational gap in the training of residents in surgery. Material and methods: We conducted an observational and cross-sectional study. A 20-question online survey was conducted among residents in surgery from Argentina. A database was created for statistical analysis of categorical and continuous variables. Results: The survey was responded by 100 residents in surgery; most of them belonged to public institutions. There was a 63% decrease in the number of surgeries in which the residents participated during the pandemic. Seventy-seven percent used virtual platforms to mitigate the impact on academic training and 57% count with surgical simulation programs in their hospitals. Most of them experienced negative consequences on their surgical skills and training during the pandemic, but there were differences identified between the group with and without surgical simulation programs. Conclusion: The availability of surgical simulation programs and the use of virtual platforms as an academic training tool could solve the educational gap generated by the COVID-19 pandemic and enhance the learning of surgical skills under normal conditions.

Impacto de COVID-19 en la formación de los alumnos de la Carrera de Posgrado de Cirugía General en un Hospital COVID / Impact of COVID-19 pandemic on trainees' education in the Postgraduate Program in General Surgery in a COVID-19-dedicated hospital

RESUMEN Antecedentes: El Hospital Eva Perón de la ciudad de Granadero Baigorria se destinó a la atención casi exclusiva de pacientes afectados por COVID-19, lo que implicó modificar las actividades que allí se desarrollan. Allí se realizan actividades correspondientes al Posgrado de Cirugía General de la Facultad de Ciencias Médicas de la Universidad Nacional de Rosario. El objetivo es describir los cambios y el funcionamiento del posgrado de Cirugía General en el HEEP durante la pandemia por COVID-19, y el impacto que esta tuvo sobre la formación de los alumnos. Material y métodos: se realizó un trabajo descriptivo, comparativo. Período 20 de marzo de 2020 al 30 de septiembre de 2020 y el mismo período del año 2019. Variables analizadas: número de cirugías, horas en el hospital, número de guardias, actividad en consultorio y pacientes evaluados, seminarios teóricos, cursado de la carrera de posgrado. Resultados: las cirugías totales se redujeron un 74,88%. Las cirugías programadas se redujeron un 85,59%. Las cirugías de guardia se redujeron un 63,19%. Las guardias de R1, R2 y R3 se vieron disminuidas, al contrario de R4. Las horas en el hospital se redujeron en todos los alumnos. Los pacientes ingresados disminuyeron el 74,06%. La atención en todos los consultorios se vio reducida. Las actividades académicas se incrementaron, de forma no presencial. Conclusión: la pandemia por COVID-19 afectó significativamente la formación de los alumnos del posgrado de Cirugía General del HEEP. Se recurrió a métodos no tradicionales de enseñanza para realizar actualizaciones y discutir trabajos científicos.

ABSTRACT Background: Hospital Eva Perón in the city of Granadero Baigorria was almost exclusively dedicated to the care of COVID-19 patients; thereby, it was necessary to modify its activities, as those of the postgraduate program in General Surgery of Facultad de Ciencias Médicas, Universidad Nacional de Rosario, which take place in this hospital. The aim of this study is to describe the changes made and the performance of the postgraduate program in general surgery at HEEP during the COVID-19 pandemic, and its impact on trainees' education. Material and methods: We conducted a descriptive study comparing the period between March 20, 2020, and September 30, 2020, with the same period in 2019. The variables analyzed included number of surgeries, hours spent in hospital, number of in-house call shifts, activities in the outpatient clinic and evaluation of patients, theoretical seminars, attendance to classes of the postgraduate programs and research work. Results: The total number of surgeries decreased by 74.88%, scheduled surgeries by 85.59% and emergency surgeries by 63.19%. The numbers of in-house call shifts of PGY-1, PGY-2 and PGY-3 residents decreased but not those of PGY-4 residents. The hours spent in hospital decreased in all the trainees. The number of patients hospitalized decreased by 74.06% and there was a reduction in all the activities of the outpatient clinics. The academic activities, performed non-face-to-face, increased. Conclusion: The COVID-19 pandemic significantly affected trainees' education in the postgraduate program in General Surgery at HEEP. Non-traditional teaching methods were used for updating and discussing scientific papers.

Sheep as a large animal model for cochlear implantation / Uso de ovelhas como um modelo animal de grande porte para implante coclear

Abstract Introduction In surgical training, large animal models are more suitable as their anatomy is more similar to humans. In otology, there have been relatively few studies about large animal models for surgical training. Objective In this study, we aimed to do a neuroradiologic evaluation and surgical insertion of a cochlear implant electrode array on a sheep head model. Methods Twenty cadaveric sheep heads were studied. A computed tomography scan and neuroradiologic evaluation was performed on each head, obtaining measurements of the inner ear for each sheep. Sheep measurements were compared to those from temporal bone computed tomography scans from 20 female humans. Surgical procedures were first trained with 13 of the sheep temporal bones, after which cochlear implantation was performed on the remaining 7 temporal bones. The position of the inserted electrode array insertion was confirmed by computed tomography scan after the procedure. Results Neuroradiologic evaluation showed that, relative to the 20 female humans, the mean ratio for sheep was 0.60 for volume of cochlea, 0.70 for height of cochlea, 0.73 for length of cochlea; ratios for other metrics were >0.80. For the surgical training, the round window was found in all 20 sheep temporal bones. Computed tomography scans confirmed that electrode insertions were fully complete; the mean value of electrode array insertion was 18.3 mm. Conclusion The neuroradiologic and surgical training data suggest that the sheep is a realistic animal model to train cochlear implant surgery and collection of perilymph samples, but less so for surgical training of mastoidectomy due to pneumatization of the mastoid.

Resumo Introdução No treinamento cirúrgico, os modelos animais de grande porte são mais adequados, pois sua anatomia é mais semelhante à humana. Em otologia, existem relativamente poucos estudos com modelo animal de grande porte para treinamento cirúrgico. Objetivo Fazer a avaliação neurorradiológica e a inserção cirúrgica de um eletrodo de implante coclear em um modelo de ovelha. Método Vinte cabeças de cadáveres de ovelhas foram estudadas. Foram feitas tomografia computadorizada e avaliação neurorradiológica de cada cabeça, obtiveram‐se medidas da orelha interna de cada ovelha. As medidas das ovelhas foram comparadas às de tomografias computadorizadas do osso temporal de 20 mulheres. Os procedimentos cirúrgicos foram inicialmente treinados com 13 dos ossos temporais de ovelhas, após o qual o implante coclear foi feito nos 7 ossos temporais restantes. A posição de inserção do arranjo de eletrodos foi confirmada por tomografia computadorizada após o procedimento. Resultados A avaliação neurorradiológica mostrou que, em comparação às 20 mulheres, a proporção média para as ovelhas foi de 0,60 para o volume da cóclea, 0,70 para a altura da cóclea, 0,73 para o comprimento da cóclea; as proporções para as outras medidas foram > 0,80. Em relação ao treinamento cirúrgico, a janela redonda foi encontrada em todos os 20 ossos temporais de ovelhas. A tomografia computadorizada confirmou que as inserções dos eletrodos foram totalmente completas; o valor médio da inserção do arranjo de eletrodos foi de 18,3 mm. Conclusão Os dados do treinamento neurorradiológico e cirúrgico sugerem que a ovelha é um modelo animal realista para o treinamento da cirurgia de implante coclear e coleta de amostras da perilinfa, mas não tão realista para o treinamento cirúrgico de mastoidectomia devido à pneumatização da mastoide.

Percepciones de los médicos en formación en Cirugía General en la fase inicial de la pandemia por COVID-19 / Perceptions of general surgeons in training in the initial phase of COVID-19 pandemic

RESUMEN Objetivo: describir las percepciones de los cirujanos en formación durante la fase inicial de la pandemia por COVID-19. Material y métodos: se realizó el análisis transversal de una encuesta de 51 preguntas a médicos en formación de un Servicio de Cirugía General en un hospital de la Argentina. Se abarcaron 5 ámbitos: institucional, asistencial, académico, doméstico y emocional. Resultados: en total 55 médicos completaron la encuesta (91,7%): 35 residentes y 20 becarios de perfeccionamiento; 56,4% eran hombres. El 98,1% consideró suficiente la información brindada por el hospital y el servicio sobre las medidas tomadas con respecto al COVID-19. Si bien el 98,1% consideró satisfactorios los instructivos sobre los equipos de protección personal, el 38% informó inconvenientes en su utilización. El 92,5% de los residentes estuvo de acuerdo con el esquema de guardias implementado. El 94,5% incrementó el tiempo dedicado a actividades académicas. El 75% consideró útil el cronograma de clases virtuales implementado. El 72,7% de los encuestados consideró que contaba con espacios donde manifestar sus preocupaciones. El 60% consideró adecuada la supervisión. El 81,81% manifestó preocupación por perder habilidad manual. El 53% dijo sentirse frustrado y el 54% manifestó temor de contagiar a su familia/pareja. Conclusión: conocer las percepciones de los cirujanos en formación en la fase inicial de la pandemia por COVID-19 permitió detectar oportunidades de mejora e incorporar nuevas estrategias educativas para afrontar las fases siguientes, asegurando el aprendizaje y priorizando su bienestar físico y psicosocial.

ABSTRACT Objective: The aim of this study is to describe the perceptions of surgeons in training during the initial phase of the COVID-19 pandemic. Material and methods: A 51-question survey was conducted among physicians in training from a department of surgery in an Argentine hospital. Five domains were explored: institutional, healthcare, academic, domestic and emotional. Results: The survey was completed by 55 physicians (91.7%): 35 residents and 20 fellows. Among the respondents, 98.1% considered the information provided by the hospital and the department about the measures implemented in the COVID-19 stetting was sufficient. 98.1% considered that the instructions about personal protective equipment were satisfactory, but 38% reported difficulties to use them. 92.5% of the residents agreed with the system implemented for on-call shifts, 94.5% increased the time dedicated to academic activities, 75% considered the virtual class schedule implemented as very useful and 72.72% perceived that they had spaces to express their concerns. The supervision was considered adequate by 60%; 81.81% were worried to lose manual dexterity; 53% felt frustrated and 54% were afraid of infecting their family/partner. Conclusion: Understanding the perceptions of surgeons in training in the initial phase of the COVID-19 pandemic made it possible to detect opportunities for improvement and incorporate modifications to address the following phases, ensuring learning and prioritizing their physical and psychosocial well-being.

¿Cómo entrenar una habilidad compleja en cirugía?: Evaluación cualitativa de una estrategia basada en simulación / How to train a complex skill in surgery: Qualitative evaluation of a simulation-based strategy

RESUMEN Antecedentes: el aprendizaje de tareas complejas en cirugía requiere la coordinación e integración de habilidades técnicas y no técnicas que impactan en el rendimiento de los equipos de trabajo. Objetivo: presentar la evaluación de una estrategia educativa basada en simulación para el entrena miento de una habilidad compleja en cirugía, desde la perspectiva de los participantes. Material y métodos: en 2019 se desarrolló un curso de 20 horas (6 horas virtuales y 14 presenciales). Participaron 10 profesionales de la salud. Como estrategia se diseñó la integración de actividades de resolución de casos, role playing, práctica con simuladores sintéticos y virtuales y simulación de alta fidelidad. Al finalizar se realizó un cuestionario sobre percepción de aprendizaje y cambios actitudi nales. Resultados: el 50% tuvo percepción de mejora de sus habilidades y conocimientos al finalizar el cur so. Sin embargo, cuando se preguntó por el impacto del curso sobre su actividad profesional, el 80% respondió niveles superiores al aprendizaje percibido. El 100% se refirió a la necesidad de mejorar habilidades no técnicas. Todos calificaron la experiencia como positiva o muy positiva, y con ganas de repetirla. Conclusión: la perspectiva de quienes participaron de este programa formativo da cuenta de la alta aceptación del método. El hacer conscientes las habilidades no técnicas durante la etapa de reflexión sugiere cambios no solo actitudinales sino sobre la autopercepción de eficacia. Creemos que la meto dología de entrenamiento de equipos basado en simulación tiene potencialidad de mejorar el rendi miento global y futuros estudios deberían estar orientados a ello.

ABSTRACT Background: Learning complex tasks in surgical requires the coordination and integration of technical and non-technical skills have an impact on the performance of work teams. Objective: The aim of this study is to report the results of a simulation-based educational strategy for training in complex surgical skills considering the participants' perceptions. Material and methods: In 2019, 10 healthcare professionals participated in a 20-hour course divided in 6 hours of online training and 14 hours of onsite training. The strategy designed included the inte gration of case resolution activities, role-playing, practice with synthetic and virtual simulators and high-fidelity simulation. At the end of the course, a questionnaire was administered to explore partici pants' perceptions on what they had learned and on their attitude changes. Results: Fifty percent of the participants perceived their skills and knowledge improved at the end of the course compared with their perception at the beginning of the course while 80% perceived the impact of the course on their professional activity was good or excellent. All the participants agreed with the need for improving non-technical skills. The experience was rated as positive or very positive by all participants, who were eager to repeat it. Conclusion: The participants' perceptions of this educational program demonstrates that this method is highly accepted. Raising awareness of non-technical skills during the reflection stage suggests the need for changes in attitude and in self-perception of efficacy. We believe that simulation-based tra ining offers the possibility of improving the overall performance of the surgical team. Future studies should focus on this goal.

Estudio comparativo de laringes humanas y de cerdos: hacia un modelo de entrenamiento quirúrgico / Comparative study of human and pig larynxes: towards a surgical training model

Introducción: La laringe de cerdo doméstico tiene similitudes con la laringe humana. La capacidad elástica de las cuerdas vocales del cerdo demuestran tener la mayor similitud con la humana comparado con otros animales por lo que se ha propuesto usar las laringes de cerdo como modelo de entrenamiento quirúrgico. Objetivo: Determinar las diferencias y similitudes anatómicas e histológicas entre la laringe del cerdo y la humana. Material y método: Se realizaron mediciones por 4 observadores en 5 laringes porcinas cuyos resultados se compararon con los descritos en la literatura para las laringes humanas. Además se realizaron cortes histológicos para visualizar fibras elásticas, mucinas neutras y mucinas ácidas. Resultados: El cartílago tiroides porcino mide entre las astas superiores 37,55 ±7,30 mm, entre astas inferiores 31,33 ±3,27 mm, desde la prominencia laríngea al borde posterior 34,32 ±7,30 mm. En el cartílago cricoides, desde el borde superior-inferior en el arco anterior 7,28 ±2,21 mm, altura borde superior-inferior pared posterior 27,47 ±3,40 mm, ancho máximo pared posterior 30,99 ±4,51 mm, diámetro interior anteroposterior (borde cefálico) 30,90 ±2,12 mm, diámetro interior anteroposterior (borde caudal) 21,78 ±2,55 mm, diámetro interior derecha-izquierda (borde cefálico) 18,11 ±2,13 mm, diámetro interior derecha-izquierda (borde caudal) 21,10 ±2,40 mm. Histológicamente, la laringe de cerdo y humana presentan leves diferencias en cuanto al epitelio de cada porción de la laringe, a pesar de que el tipo de cartílago es el mismo en ambas especies. Conclusión: Si bien existen diferencias anatómicas e histológicas entre la laringe de cerdo y el humano, el modelo porcino es una alternativa útil, accesible y de bajo costo para el entrenamiento en cirugía laringotraqueal y microcirugía laríngea.

Introduction: The domestic pig larynx has similarities with the human larynx. The elastic capacity of the vocal folds of the pig has the greater similarity with the human one compared with other animals. It has been proposed to use the porcine larynx as a model for surgical training. Aim: To determine the anatomical and histological differences and similarities between the pig larynx and the human larynx. Material and method: Measurements were made by 4 observers in 5 porcine larynxes whose results were compared with those described in the literature. In addition, histological sections were performed to visualize elastic fibers, neutral mucins and acid mucins. Results: The porcine thyroid cartilage measured 37.55 ±7.30 mm between the upper horns, 31.33 ±3.27 mm between lower horns and 34.32 ±7.30 mm from the laryngeal prominence to the posterior margin. In the cricoid cartilage, from the upper-lower edge in the anterior arch 7.28 ±2.21mm, height upper-lower edge posterior wall 27.47 ±3.40 mm, maximum posterior wall width 30.99 ±4.51 mm, anteroposterior inner diameter (head margin) 30.90 ±2.12 mm, inner diameter anteroposterior (caudal edge) 21.78 ±2.55 mm, inner diameter right-left (head edge) 18.11 ±2.13 mm, inner diameter right-left (caudal edge) 21.10 ±2.40 mm. Histologically, the pig and human larynxes present slight differences in the epithelium of each portion of the larynx, despite the fact that type of cartilage is the same in both species. Conclusions: Although there are anatomical and histological differences between the pig larynx and the human larynx, the porcine model is a useful, accessible and low cost alternative for training in laryngotracheal surgery and laryngeal microsurgery.

Construction and evaluation of 3D printing simulation model for lumbar surgery / 中国组织工程研究

BACKGROUND: 3D printed bone model was widely used in clinical teaching and simulated surgery training, but it did not pay enough attention to the construction of soft tissue, and the simulation was poor, which cannot reflect the soft tissue exposure process. OBJECTIVE: To explore the feasibility of constructing a simulated lumbar spine surgery model based on 3D printing technology for the training of lumbar pedicle screw placement in junior orthopedic surgeons. METHODS: The solid model of the lumbar spine was printed at the same proportion based on 3D printing technology, and the model of simulated lumbar spine surgery was constructed with plasticine and cloth. Thirty orthopedic residents performed lumbar pedicle screw placement alone on the simulated model, and performed once a day for 10 consecutive days. They recorded the operation time, and evaluated the accuracy of screw placement by postoperative CT scan. By comparing the operation time and screw placement accuracy of the operators in the early stage (the first 5 times) and the later stage (the last 5 times), all above parameters were statistically analyzed. This study was approved by the Ethics Committee of Zigong Fourth People's Hospital. RESULTS AND CONCLUSION: (1) In the early stage (the first 5 times), the average operation time was (100. 00+12. 67) minutes. In the later stage (the last 5 times), the average operation time was (83. 50+10. 14) minutes, and the difference was statistically significant (f=20. 67, P=0. 00). (2) The success rate of former screw placement (including grade I and II screw placement) was 88. 53%, and the failure rate (grade III screw placement) was 11. 47%. The success rate and failure rate of latter screw placement were 97. 47% and 2. 53%, respectively, with statistically significant difference (x2-20. 68, P=0. 00). (3) The simulated model of lumbar spine surgery based on 3D printing technology has high simulation and feasibility, and can be used for the training of lumbar pedicle screw placement in junior orthopedic surgeons.

Buckling surgery on a goat's eye: A simple technique to enhance residents' surgical skill

Buckling surgery is one of the common procedures performed by the retinal surgeons for visual rehabilitation at the earliest in cases of retinal detachment. The optimal surgical skill in this section can only be achieved with repeated practices and clinical experiences. Here, we describe an easy and inexpensive way to perform, practice, and refine surgical skills by demonstrating this complicated surgery in a simple manner on goat's eyes. The advantages of this technique are real-tissue handling experiences and repeatability of the procedure with almost similar practical implications. Thus, whenever feasible, every attempt should be made to refine the residents or budding ophthalmologists surgical skills by undertaking this technique in their routine curriculum.

A study of attributable variables impacting orthopedic trauma surgical training / 中华创伤杂志(英文版)

PURPOSE@#In medical colleges, resident training programs must provide adequate surgical experiences, making them qualified at the end of residency program. It is generally believed that it would take more time for a surgical resident to perform surgical procedures than a board-certified surgeon. There is no current benchmark with regards to operative time and surgical cases involving orthopedic surgery residents. In this study, we focused on two key aspects of surgical training variables, namely, surgical duration & C-arm shoots when the procedure is done by a faculty surgeon in comparison to done by an orthopedic resident under supervision of faculty surgeon.@*METHODS@#It is an observational prospective study, we observed patients undergoing 1 of 5 common orthopedic trauma operations in a community teaching hospital. We recorded two variables, 'skin to skin' surgical duration & number of image intensifier television/C-arm shoots of faculty surgeons and orthopedic resident (postgraduate-3yr) under supervision of faculty surgeon. We calculated mean difference of two variables with or without resident & determined statistical significance, we also compared functional outcome at final follow-up.@*RESULTS@#The total number of procedure observed was 402. On observing summarized results of all surgical procedures, faculty surgeons took on an average 33 min lesser (p  0.05) in functional outcome of cases performed by faulty surgeon and resident.@*CONCLUSION@#Little data has been previously published regarding the impact of teaching orthopedic resident in operating room. We demonstrate that resident participation increases the procedure time for commonly performed orthopedic procedures and also the number of C-arm shoots, hence there is a need for technical training facilities outside the operating room such as in cadaveric labs, saw bone labs & virtual surgery simulation. Also the preoperative plan should be thoroughly discussed by faculty surgeon with residents.

Analysis of the Educational Value of YouTube Laparoscopic Appendectomy Videos

PURPOSE: To evaluate the educational value of laparoscopic appendectomy (LA) videos on YouTube for surgical trainees. METHODS: The search term “Laparoscopic appendectomy” was used on YouTube. The top 100 videos sorted by the number of views were evaluated. Each YouTube account was analyzed, and only videos uploaded by medical physicians were included in this study. Video quality was evaluated using an arbitrary appendectomy scoring system. Video characteristics and Global Operative Assessment of Laparoscopic Skills (GOALS) scores were analyzed regarding video quality and upload source. RESULTS: The video quality of 14 (25.0%) videos was graded as good, 36 (64.3%) moderate, and 6 (10.7%) of poor quality. Video characteristic analysis showed no differences in video quality according to the upload source (p=0.573). Video quality and upload source were not related to video length, total views, days online, number of likes, number of dislikes, number of comments, or GOALS score. Among the factors analyzed, only appendicitis severity was found to be associated with video grade (p=0.049). CONCLUSION: The quality of LA YouTube videos varied. Categories considered as viewer feedback were not associated with video grade or upload source. Responsible video uploading by academic institutions, and appropriate censorship by YouTube seems necessary. Further research with objective data on actual application to surgical trainees is necessary.

Dorsal Track Control (DTC): A Modified Surgical Technique for Atraumatic Handling of the Distal Esophagus in Esophagojejunostomy

Surgical therapy for adenocarcinoma of the esophagogastric junction II requires distal esophagectomy, in which a transhiatal management of the lower esophagus is critical. The ‘dorsal track control’ (DTC) maneuver presented here facilitates the atraumatic handling of the distal esophagus, in preparation for a circular-stapled esophagojejunostomy. It is based on a ventral semicircular incision in the distal esophagus, with an intact dorsal wall for traction control of the esophagus. The maneuver facilitates the proper placement of the purse-string suture, up to its tying (around the anvil), thus minimizing the manipulation of the remaining esophagus. Furthermore, the dorsally-exposed inner wall surface of the ventrally-opened esophagus serves as a guiding chute that eases anvil insertion into the esophageal lumen. We performed this novel technique in 21 cases, enabling a safe anastomosis up to 10 cm proximal to the Z-line. No anastomotic insufficiency was observed. The DTC technique improves high transhiatal esophagojejunostomy.

Técnica de embalsamiento de cadáver según Thiel: un método valioso para entrenar y mejorar las destrezas quirúrgicas en el campo de la otorrinolaringología / Thiel embalming technique for cadáver preservation: an overview of a valuable method for training and improvement of the surgical skills in otolaryngology

RESUMEN Los tiempos modernos nos obligan a que la formación de un médico cirujano no se base sólo en conocimientos teóricos, sino que adquiera las mayores habilidades quirúrgicas para así evitar riesgos innecesarios en una sociedad altamente exigente. La disección y el entrenamiento de los procedimientos quirúrgicos juegan un papel primordial para cumplir este objetivo, por lo que recientemente se ha promovido una forma de preservación cadavérica que permite realizar mediante situaciones bastantes realistas dichos adiestramientos. Se realizó una búsqueda bibliográfica electrónica, restringida al idioma inglés en Pubmed, Scopus y WOS donde se pretende describir y analizar las aplicaciones de esta técnica. La revisión ofreció artículos de relevancia que demuestran la aplicación de esta técnica novedosa en la preservación de cadáveres y sus posibles aplicaciones en el campo de otorrinolaringología.

ABSTRACT Nowadays, it is not possible to train a healthcare professional only based on theoretical knowledge, but acquiring the highest surgical skills to avoid unnecessary risks in a highly demanding society, therefore dissection and training of surgical procedures play a key role in fulfilling this objective, which is why a form of cadaveric preservation has recently been promoted, which allows realizing such training through realistic situations. An electronic literature search was carried out, restricted to the English language in MEDLINE, where it is intended to describe and analyze the applications of this technique. The review offered articles of relevance that demonstrate the application of this novel technique in the preservation of corpses and their possible applications in the field of otorhinolaryngology.

Colorectal Surgery Training in the Hong Kong Special Administrative Region and China

Until 1st July 1997, Hong Kong was under the governance of the British Government; therefore, the British system of education was followed. After internship, 7 years of general surgical training is required to obtain registration and fellowship qualifications of the College of Surgeon of Hong Kong and Edinburg. After having become a specialist in general surgery, the surgeon could choose to specialize in colorectal surgery with an additional 3 to 5 years of specialist training in an accredited centre and 6 months of overseas training with subsidies. On the contrary, China has more than 600 medical schools, and students can enroll in different programs to become a medical practitioner. Despite a great discrepancy exists in the quality of teaching and supervision but there are comprehensive regulations governing the accreditation of hospitals, credentialing of operations, medical records, etc. to ensure medical and patient safety. Vast amounts of resources are being invested to strengthen the quality and to advance the technology used in patient care, not only by supporting basic and clinical research but also by providing extra resources to “import” experts and help develop services with clinical excellence. To accomplish this, the aim of the “three fames project” with a 5-year funding of 3 million United States dollar is to invite overseas experts to help build medical teams in specific areas. Due to its huge population (more than 1.3 billion people), China is a country full of potential for development in clinical research, collaboration, knowledge exchange, and the provision of premier medical services.

Construction and application of 3D printing model of endoscopic endonasal transsphenoidal surgical training / 中国神经精神疾病杂志

Objective The aim of our study was to establish an endoscopic endonasal transsphenoidal surgical training model, and to examine its application value. Methods The endoscopic endonasal transsphenoidal surgical training models were made.After assessments,the models was used for endoscopic operation training for 8 neurosurgeons with no experiences of endoscopic operation. Results The available operating space of this model is similar to the actual operating space in endoscopic endonasal transsphenoidal surgery. The egg fixed on the model has many layers of structure, such as eggshell, shell membrane, egg white and egg yolk, which constituted a good practice object. All students indicated that they could benefit from the training using this model. The skill in grinding the eggshell [(1.07 ± 0.221)cm2/min vs.(1.45±0.27)cm2/min, P<0.001]was significantly improved and the chance for shell membrane rupture (8 vs. 2, P=0.007) was significantly reduced in the last-time practice compared with the first-time practice (P<0.001). Conclusion The endoscopic endonasal transsphenoidal surgical training model is helpful for neurosurgeons to practice the basic operation of endoscopic surgery and to improve their surgical skills,and can be used repeatedly.It can be used in basic operation training before the training using cadaver cranium.

Application and expectation of virtual reality technology in surgical training / 临床外科杂志

Virtual reality technology is a kind of information technology,which can achieve the interaction between the users and the virtual environment by using relevant devices.This article introduces the application and validity of virtual reality technology in surgery of orthopedics,general surgery,neurosurgery and urology surgery and surgical training.It discusses the advantages and disadvantages and development prospects of the virtual reality technology in the field of surgery and surgical training as well.

Walter Thiel's embalming method: review of solutions and applications in different fields of biomedical research / Método de embalsamamiento de Walther Thiel: revisión de las soluciones y sus aplicaciones en diferentes campos de investigación biomédica

Walter Thiel developed the method that enables preservation of the body with natural colors in 1992. It consists in the application of an intravascular injection formula, and maintaining the corps submerged for a determinate period of time in the immersion solution in the pool. After immersion, it is possible to maintain the corps in a hermetically sealed container, thus avoiding dehydration outside the pool. The aim of this work was to review the Thiel method, searching all scientific articles describing this technique from its development point of view, and application in anatomy and morphology teaching, as well as in clinical and surgical practice. Most of these studies were carried out in Europe. We used PubMed, Ebsco and Embase databases with the terms "Thiel cadaver", "Thiel embalming", "Thiel embalming method" and we searched for papers that cited Thiel`s work. In comparison with methods commonly used with high concentrations of formaldehyde, this method lacks the emanation of noxious or irritating gases; gives the corps important passive joint mobility without stiffness; maintaining color, flexibility and tissue plasticity at a level equivalent to that of a living body. Furthermore, it allows vascular repletion at the capillary level. All this makes for great advantage over the formalin-fixed and fresh material. Its multiple uses are applicable in anatomy teaching and research; teaching for undergraduates (prosection and dissection) and for training in surgical techniques for graduates and specialists (laparoscopies, arthroscopies, endoscopies).

En 1992, Walter Thiel desarrolló el método que permite la preservación del cuerpo con colores naturales. Consiste en la aplicación de una fórmula de inyección intravascular y el mantenimiento del cuerpo sumergido en pileta, en una solución de inmersión específica, durante un período determinado de tiempo. Después de la inmersión, es posible mantener el cuerpo en un recipiente herméticamente sellado, evitando así la pérdida del líquido fijador, fuera de la pileta. El objetivo de este trabajo fue revisar el método de Thiel, buscando todos los artículos científicos que describen esta técnica desde el punto de vista de su desarrollo, y su aplicación en la enseñanza de la anatomía y morfología, así como en la práctica clínica y quirúrgica. La mayoría de estos estudios se realizaron en Europa. Utilizamos las bases de datos PubMed, Ebsco y Embase con los términos "Thiel cadaver", "Thiel embalsamamiento", "método de embalsamamiento de Thiel" y se buscaron los documentos que citan el trabajo de Thiel. En comparación con los métodos comúnmente utilizados con altas concentraciones de formaldehído, este método carece de emanación de gases nocivos o irritantes; Da al cuerpo una movilidad articular pasiva importante sin rigidez; Manteniendo el color, la flexibilidad y la plasticidad del tejido a un nivel equivalente al de un cuerpo vivo. Además, permite la repleción vascular a nivel capilar. Todo esto hace una gran ventaja sobre el material fijado con formalina y fresco. Sus usos múltiples son aplicables en la enseñanza y la investigación de la anatomía; (prosección y disección) y para la formación en técnicas quirúrgicas para graduados y especialistas (laparoscopias, artroscopias, endoscopias).

Evaluación del conocimiento anátomo-quirúrgico del sistema de la vena cava inferior por médicos residentes de cirugía general / Evaluation of anatomical and surgical understanding of the inferior vena cava system by general surgery interns

Las lesiones de vena cava inferior (VCI) han sido descritas como la lesión vascular abdominal mas frecuente encontradas en los centros de trauma. Puede lesionarse entre la supra e infrarrenal; y en el caso de lesión retrohepática, se asocia con alta mortalidad. En heridas penetrantes conllevan una elevada mortalidad. Hasta un 50 % de los individuos que experimentan estas lesiones muere antes de llegar al hospital; y la tasa de mortalidad entre los que llegan con vida a un centro de trauma varía entre 20­57 %. Se evaluaron a 12 cirujanos en formación, respecto de los conocimientos anatómicos del sistema de la VCI y sus relaciones, con material cadavérico formalizado mediante listas de verificación (Abril/2014). Luego de un período de entrenamiento mediante la disección anatómica de 10 cadáveres formolizados (Mayo/2014-Agosto/2014); se realizó una nueva evaluación de los médicos residentes de cirugía general en formación mediante listas de verificación, con material cadavérico fresco (Septiembre/2014). Durante la primera evaluación la vena iliaca común derecha e izquierda, fueron identificadas por 8 (66,66 %) residentes. Siete (58,33 %) mencionaron los segmentos de la VCI en intratorácico y abdominal. Seis (85,71 %) mencionaron la porción intrapericárdica y uno (14,29 %) la porción extrapericárdica. La porción o segmento subduodenal fue identificado como subhepático por siete (58,33 %) residentes; y solo dos (16,66 %) mencionaron los segmentos subduodenal, retroduodenopancreático y supraduodenopancreático como parte del segmento subhepático. Tres (25 %) no mencionaron los diferentes segmentos de la VCI (abdominal). El segmento retrohepático fue identificado por ocho (66,66 %). Durante la segunda evaluación la vena iliaca común derecha e izquierda, fueron identificadas por todos los residentes. Once (91,66 %) mencionaron los segmentos de la VCI en intratorácico y abdominal, además de la porción intrapericárdica y la porción extrapericárdica. El segmento subduodenal fue identificado como subhepático por dos (16,66 %) residentes; y nueve (75 %) mencionaron los segmentos subduodenal, retroduodenopancreático y supraduodenopancreático como parte del segmento subhepático. El segmento retrohepático fue identificado por once (91,66 %) residentes. La observación y disección anatómica de la VCI en material cadavérico durante la formación del cirujano general, brinda un importante método de enseñanza, capacitación y entrenamiento hacia el reconocimiento de las diferentes estructuras anatómicas de la región, pudiendo luego ser aplicado en cirugía. La metodología de supervisión y evaluación mediante listas de verificación, por médicos especialistas, es una opción a agregar a los programas de formación para mejorar el proceso de educación.

Injuries in the inferior vena cava (IVC) have been described as the most common vascular abdominal injury found in trauma. The injury may present between the suprarenal and the infrarenal; in the case of retrohepatic injuries, it is associated with a high mortality rate. In a penetrating wound, high mortality rates are reported. Up to 50% of the individuals who experience these injuries die before getting to the hospital, and the mortality rate among those who get to a healthcare facility alive, ranges from 20 to 57 %. The study involved the evaluation of 12 trainee surgeons concerning anatomical understanding of the inferior vena cava system and related areas, using corpses subject to 10 % formol via checklists (April 2014). After a training period with anatomical dissection of 10corpses subject to 10 % formol (May 2014-August 2014), the general surgery interns were reassessed via checklists using fresh corpses fresco (September 2014). During the first evaluation, the right and left common iliac vein were identified by 8 (66.66 %) interns: 7 (58.33 %) mentioned the segments of the IVC in the intrathoracic and abdominal area; 6 (85.71 %) referred to the intrapericardial portion, and 1 (14.29 %) mentioned the extrapericardial portion. The subduodenal portion or segment was identified as subhepatic by 7 (58.33 %) interns, and only 2 (16.66 %) referred to the subduodenal, retroduodenopancreatic and supraduodenopancreatic segments as part of the subhepatic segment. 3 (25 %) failed to mention the various segments of the (abdominal) IVC. The retrohepatic segment was identified by 8 (66.66 %) interns. During the second evaluation, the right and left common iliac vein were identified by 12 (100 %) interns: 11 (91.66 %) mentioned the segments of the inferior vena cava in the intrathoracic and abdominal areas; 11 (91.66 %) interns referred to the intrapericardial and the extrapericardial portions. The subduodenal segment was identified as subhepatic by 2 (16.66 %) interns, and 9 (75 %) of them mentioned the subduodenal, retroduodenopancreatic and supraduodenopancreatic segments as part of the subhepatic segment. The retrohepatic segment was identified by 11 (91.66 %) interns. Observation and anatomical dissection of the IVC in corpses when training a general surgeon provides a major teaching and training method to recognize the different anatomical structures of the area, for subsequent its application to surgery. The supervision and evaluation methodology consisting of the use of checklists by specialist physicians is an option that should be added to training programs in order to improve the educational process.

Learning curves for strabismus surgery in two ophthalmologists.

Purpose: To identify the average turning point by comparing the learning curves of two surgeons learning to perform strabismus surgery. Materials and Methods: Patients who underwent procedures to correct exotropia between January 2010 and December 2014 followed for at least 3 months were retrospectively assessed. The first 70 patients on whom each of two ophthalmologists (A and B) performed surgery to treat strabismus were divided into 7 cohorts comprising 10 patients each based on the chronological order of the surgery. Factors, including patient age, preoperative angle of deviation, operative time, and success or failure of the operation, were compared between the two surgeons. Learning curves were calculated based on changes in operative time and operation success rate. Operation success was determined by measuring the angle of deviation at a distance of 5 m 3 months after the operation. Results: A turning point was observed after 40 cases for Surgeon A and 50 cases for Surgeon B based on the operative time learning curve. No turning point was observed in the operation success rate learning curve based on the absence of a specific trend. Success rate by cohort was not significantly different between the two surgeons (P > 0.05). Surgeon B had a significantly longer mean operative time than Surgeon A (P = 0.045). Conclusions: Approximately 50 cases are required for an ophthalmologist to reach a turning point in strabismus surgery. This outcome can be used as a guideline when training surgeons to perform strabismus surgery.