Experience report on teaching surgical technique without animal use

PURPOSE: To report the experience of the school in implementing the 3 Rs replace, reduce and refine; showing time and assembling cost of the experimental models used in the teaching of Surgical Technique and Experimental Surgery. METHODS: Assembly time and costs of models: grafts and flaps performed in pork belly, model of intestinal anastomosis and jejunostomy done in Bahiana box and black box model for training videosurgery. RESULTS: Average time and cost estimate: ten minutes-pork belly, cost $ 6.00 per kilogram; two minutes-Bahiana box, cost $ 27.2; Black box-3.6 hours for manufacturing, cost $ 100.00. The repetition of each practice the cost is $ 3.20 for Bahiana box and at no cost to the black box. CONCLUSION: The experimental models presented are easily reproducible and of low cost. .

Bench surgical training with lyophilized esophageal segments

PURPOSE: To present lyophilized esophageal segments that can be used to learn surgical skills. METHODS: Four esophagus were harvested from four non-esophagus related research dogs at the moment of euthanasia. Each esophagus was trimmed in 3 cm long segments. They were lyophilized and stored during 30 days. The day programmed for surgical skills practice, they were rehydrated. RESULTS: Sixteen segments have been used. After rehydrating, all the segments kept their normal anatomic shape and structural integrity. One incision was made on every esophageal segment and sutured with running stitches of 3-0 polyglactin 910. There were no complications, such as tissue tears, nor esophageal hardening. CONCLUSIONS: The lyophilized esophagus is a high fidelity, practical, reproducible, portable, low-cost bench model. It allows general surgery apprentices to learn how to handle an esophagus, as well as to perfect their surgical and suture abilities before applying them on real patient's esophagus.

¿Es adecuada la formación del residente en cirugía laparóscopica? / It is appropiated the training of the resident in laparoscopic surgery?

Introducción: A pesar del gran avance que ha experimentado la cirugía laparóscopica en los últimos años, no ha sido hasta hace dos, cuando el Programa Nacional de la Especialidad en Cirugía General y Digestivo se ha hecho eco de esta evolución y en su formato ha especificado el número y el tipo de intervenciones que debería efectuar un residente durante su período de formación para adquirir la destreza quirúrgica necesaria en el dominio de esta nueva técnica quirúrgica. Objetivos: Evaluar la adecuación de la docencia en cirugía laparóscopica en nuestro hospital en relación al Programa Nacional de la Especialidad y al programa específico del Hospital Ramón y Cajal, examinando el número de cirugías laparoscópicas en las que el residente ha participado tanto como cirujano como ayudante durante el período comprendido entre 2000-2005. Resultados: La primera cirugía laparóscopica que realiza el residente de cirugía general es la colecistectomía, y ésta se realiza en general en el 2º año de residencia. Un residente de 5º año, cuando termina su formación, ha realizado una media de 49 colecistecomías laparoscópicas como primer cirujano y ha ayudado a una media de 56,4 cirugías (incluyendo cirugía laparóscopica avanzada). Conclusión: No existe consenso en la literatura acerca de cuál es el número ni el tipo de cirugías laparoscópicas que debe realizar el residente tras acabar su período de formación. En base al Programa Nacional de la Especialidad y al del Hospital Ramón y Cajal, pensamos que nuestros residentes reciben una correcta formación en cirugía laparóscopica.

Introduction: In spite of significant advancements in laparoscopic surgery in the last years, it was two years ago when the Spanish General Surgery Programme showed this evolution, and specified the number and the kind of interventions a resident should realize in his formation period to obtain the necessary ability in this new surgical technique. Purpose: Evaluate the training of residents in laparoscopic surgery in relation to the Spanish General Surgery Programme, and to the Ramón y Cajal specific Programme, investigating the number of laparoscopic surgeries in which the resident took part as surgeon or assistant during the period of 2000-2005. Results: The first laparoscopic surgery realized by the resident is the cholecistectomy, generally in the second year of residence. A resident of fifth year, when finished his formation, has realized approximately 49 laparoscopic cholecistectomies as first surgeon, and has assisted 56,5 surgeries (advanced laparoscopic surgery is included) Conclusion: There is no assent in the literature about the number and the kind of laparoscopic surgeries a resident has to realize in his formation period. In relation to the Spanish General Surgery Programme and the Ramón y Cajal Programme, we think our residents received a correct training in laparoscopic surgery.

Minimally invasive surgery training in soft cadaver (MIST-SC).

OBJECTIVES: The purpose of this study was to evaluate the surgical anatomy, tissue plane, organ consistency of soft cadaver and the possibility of minimally invasive surgery training in soft cadaver. SETTING: Surgical Training Center. Department of Anatomy and Department of Surgery Faculty of Medicine, Chulalongkorn University. DESIGN: Prospective descriptive study. MATERIAL AND METHOD: 2 soft cadavers were scheduled for fully laparoscopic surgery in upper gastrointestinal, colorectal, hepatopancreatobiliary and solid organs surgery. All the procedures were performed by the experienced surgical staffs and assisted by surgical staffs and/or surgical residents. The surgical anatomy, tissue plane, organ consistency and the satisfactory in performing the procedures were recorded for evaluation. RESULTS: The surgical anatomy, the tissue consistency the anatomical plane were very well preserved with mean score of 4.72 +/- 0.45. All the surgeons were satisfied with the findings, the mean score was 4.97 +/- 0.18. All the plan procedures were completely performed with great satisfactory results. CONCLUSION: The Minimally Invasive Surgery Training in Soft Cadaver (MIST-SC) was feasible with great satisfactory. This successful integration of basic and advanced laparoscopic procedures into the soft cadaver setting would be the next step in evolution of MIS training.