Modelo de simulación inanimado para experiencia física de entrenamiento (S. I. M. P. L. E.) En nefrectomia parcial asistida por robot usando tecnología de impresión 3d / Inanimate simulation model for physical training experience (S. I. M. P. L. E.) in robot-assisted partial nephrectomy using 3D printing technology

INTRODUCCIÓN: Pese a que la exposición a pacientes reales sigue estando a la vanguardia de la educación médica, la implementación de simuladores en el entrenamiento y docencia está en uso creciente a nivel global. Muchos de ellos, sin embargo, no entregan una experiencia quirúrgica completa. En este video presentamos un modelo de simulación inanimado de alta fidelidad y bajo costo para el entrenamiento en Nefrectomía parcial asistida por Robot (RAPN). MATERIAL Y MÉTODOS: Utilizando tecnología de impresión 3D se crearon modelos anatómicamente correctos del riñón humano y estructuras relevantes. Estos se consiguieron a través de polimerización gradual de un hidrogel, mediante ciclos de congelación/descongelación, dando distintas características de consistencia y apariencia a los órganos y estructuras, similares a las esperadas durante la cirugía en vivo. Se simularon todas las etapas de RAPN. 3 expertos con >250 casos robóticos fueron asignados al grupo 1; 3 novatos con <50 casos fueron asignados al grupo 2; y 3 estudiantes de medicina que completaron un programa básico de simulación robótica fueron asignados al grupo 3. Se midió validez por expertos, de contenido y de constructo, mediante encuestas y la comparación de las métricas de procedimiento (tiempo de isquemia, la pérdida de sangre, márgenes positivos y la pérdida de sangre estimada) entre los tres grupos. RESULTADOS: El modelo mostró una excelente validación de expertos y de contenido con una puntuación media de 3/5 y 4/5, respectivamente. El tiempo de isquemia medio fue de <15 minutos, entre 20 a 30 minutos y >40 minutos en los grupos 1, 2 y 3, respectivamente. Hubo diferencia estadísticamente significativa en el tiempo operatorio, tiempo de isquemia, márgenes quirúrgicos positivos y la pérdida de sangre estimada (p <0,01), obteniendo una buena validez de constructo. CONCLUSIONES: Este modelo proporciona un modelo realista, de bajo costo y alta fidelidad que ofrece un entrenamiento exhaustivo para RAPN. Esta forma de simulación puede ser una herramienta de enseñanza quirúrgica útil, permitiendo la evaluación objetiva del aprendiz, y entregando a los alumnos una exposición adecuada a un entorno real simulado, para así dominar las habilidades necesarias antes de una experiencia quirúrgica en vivo.(AU)

INTRODUCTION: Although exposure to real patients continues to be at the forefront of medical education, the implementation of simulators in training and teaching is in increasing use, globally. Many of them, however, do not deliver a complete surgical experience. In this video, we present an inanimate simulation model of high fidelity and low cost for training in Robotic-assisted partial nephrectomy (RAPN). MATERIAL AND METHODS: Using 3D printing technology, anatomically correct models of the human kidney and relevant structures were created. These were achieved through the gradual polymerization of a hydrogel, by means of freezing / thawing cycles, giving different characteristics of consistency and appearance to organs and structures, similar to those expected during real surgery. All RAPN stages were simulated. Three experts with> 250 robotic cases were assigned to group 1; three beginners with <50 cases were assigned to group 2; and three medical students who had completed a basic robotic simulation program were assigned to group 3. Validity was measured by experts, content and construct, by means of surveys and comparison of the procedure metrics (ischemia time, blood loss, positive margins and estimated blood loss) among the three groups. RESULTS: The model showed excellent expert and content validation with an average score of 3/5 and 4/5 respectively. The mean ischemia time was <15 minutes, between 20 to 30 minutes and > 40 minutes in groups 1, 2 and 3, respectively. There was statistically significant difference in surgery time, ischemia time, positive surgical margins and estimated blood loss (p <0.01), obtaining good construct validity. CONCLUSIONS: This model provides a realistic, low cost and high fidelity model that offers comprehensive training for RAPN. This type of simulation can be a useful surgical teaching tool, allowing objective evaluation of the apprentice, and giving the students an adequate exposure to a simulated real environment, in order to master the necessary skills before a live surgical experience.(AU)

Clinical analysis on tumorectomy under extracorporeal circulation for 352 patients with primary cardiac tumors / 局解手术学杂志

Objective To summarise the clinical characteristics and surgical treatment experience of primary cardiac tumours treated by tumorectomy under extracorporeal circulation .Methods The clinical data of 352 patients with primary cardiac tumors in our hospital from January 1980 to December 2015,who received surgical treatment of tumorectomy under extracorporeal circulation were retrospectively ana -lyzed.Results Among the 352 cases in all, there were 338 cases (96%) of benign tumor, including 309 cases (87.8%) of myxoma and 14 cases (4.0%) of malignant tumor.There were 4 cases of perioperative death, and all the 4 cases were malignant tumor.Conclusion Myxoma is the most common primary cardiac tumor ,and the best solution for the cardiac benign tumor is surgery .However , the effect of sur-gical operation on malignant cardiac tumors was poor .

Nefrectomias parciales y tumorectomias: experiencia durante los ultimos 10 años en servicio de urología Hospital Clínico de Valdivia / Partial nephrectomy and Tumorectomy specimens: experience duringthe last 10 years in the Urology department of the Hospital the Valdivia

INTRODUCCIÓN Y OBJETIVO: El mayor uso de imágenes diagnósticas, ha implicado un aumento en el diagnóstico de lesionestumorales renales de menor tamaño, llevando al desarrollo de técnicas quirúrgicas conservadoras de parenquimarenal. Series internacionales han demostrado que los resultados oncológicos de este tipo de cirugía son similares a la nefrectomía radical. Nuestro objetivo es mostrar la experiencia y resultados oncológicos de la cirugía conservadora deparenquima renal. MATERIALES Y MÉTODOS: Estudio retrospectivo, de las nefrectomías parciales y tumorectomías realizadas entre Enero del año 2002 y Junio del año 2013, en el Hospital Clínico Regional de Valdivia. RESULTADOS: 50 pacientes fueron sometidos a cirugía renal conservadora, con 51 cirugías realizadas. 26 corresponden a sexo masculino y 24 a sexo femenino; promedio de edad de 58,2 años. De las cirugías realizadas veinte correspondieron a nefrectomías parciales, contamaño tumoral promedio de 4,3 cms. (2-7 cms.) y 31 a tumorectomías, con tamaño tumoral promedio de 2,5 cms. (1-6,1cms.). Del total de los tumores resecados, ocho (26%) fueron informados como tumores benignos y 43 (84%) corresponden a adenocarcinomas; 41 (95%) corresponden a la variante células claras y solo dos a variante de células cromofobas. Lasbiopsias rápidas están todas entre 1-2 mm de tejido sano como margen, y todas fueron negativas para tumor. La biopsiadiferida, informo cuatro márgenes positivos para tumor. De estas, tres fueron a re-cirugía cuyas biopsias fueron negativaspara tumor. El tiempo promedio de seguimiento fue de 51,1 meses, con una sobrevida actuarial a los diez años cercana al70% y una sobrevida específica a los diez años cercana al 95%...

INTRODUCTION AND OBJECTIVE: The increased use of diagnostic imaging, has involved an increase in the diagnosis ofsmaller tumor lesions, taking the development of conservative surgical techniques of renal parenchyma. Internationalseries have shown that cancer results from this type of surgery are similar to radical nephrectomy. Our goal is to show the experience and oncological results of renal parenchymal sparing surgery. MATERIALS AND METHODS: Retrospective studyof tumorectomies and partial nephrectomies performed between January 2002 and June 2013, at the Regional Hospital ofValdivia. RESULTS: 50 patients underwent renal sparing surgery, with 51 surgeries performed. 26 are male and 24 female,average age of 58.2 years old. Of the surgeries performed, twenty were partial nephrectomy, with average tumor size of4.3 cm. (2-7 cms.) and 31 tumorectomies, with average tumor size of 2.5 cm. (1-6.1 cms.). Of all resected tumors, eight (26%)were reported as benign and 43 (84%) were adenocarcinomas, 41 (95%) were clear cell variant and only two chromophobecell variant. Quick biopsies are all 1-2 mm of healthy tissue margin, and all were negative for tumor. The deferred biopsy,reported four positive tumor margins. Of these, three went to re-surgery, whose biopsies were negative for tumor. The average follow-up time was 51.1 months, with an actuarial survival at ten years about 70% and a specific survival at ten years was approximately 95%...

Un análisis de largo plazo del comportamiento de la cirugía conservadora del cáncer de mama / A long-term analysis of the conservative surgery behavior in breast cancer

Introducción: en los últimos años la cirugía conservadora se ha consolidado como un procedimiento válido en el tratamiento de un determinado grupo de pacientes con cáncer de mama, pues permite conseguir un control local satisfactorio con una menor mutilación, sin modificar la supervivencia ni el índice de metástasis a distancia. Objetivo: determinar los resultados de la cirugía conservadora del cáncer de mama según variables seleccionadas en el período 1991-2009. Métodos: se realizó un estudio retropestivo longitudinal a mujeres diagnosticadas y tratadas de cáncer de mama a las que se les realizo cirugía conservadora (n=77), que cumplieron con los criterios de inclusión y exclusión establecidos. El análisis descriptivo de los datos se realizó mediante distribuciones de frecuencias absolutas y relativas. La estimación de las curvas de supervivencia global y libre de recidivas se realizó mediante el método de Kaplan-Meier. Resultados: el grupo de edad 40 a 59 años fue el predominante para 67,6 por ciento. Solo el 10,4 por ciento de las pacientes tuvieron antecedentes de primera línea positivos de cáncer de mama. La etapa clínica IIA predominó con un 54,5 por ciento, y el tipo histológico más frecuente, el carcinoma ductal infiltrante para un 84,4 por ciento. La supervivencia global para nuestras pacientes fue de un 95 por ciento a los 5 años, el intervalo libre de recidiva fue de un 87,5 por ciento. Conclusiones: nuestros resultados no difieren de los encontrados en los estudios a nivel mundial

Introduction: In past years the conservative surgery became consolidated as a valid procedure in treatment of a determined group of breast cancer patients, thus allows to achieve a satisfactory local control with a lesser level of mutilation, neither modifying the survival nor distant metastasis index from a distance. Objective: To determine the results of conservative surgery of breast cancer according to the variables selected during 1991-2009. Methods: a longitudinal and retrospective study was conducted in women diagnosed and treated due to breast cancer who underwent conservative surgery (n=77), fulfilling the established inclusion and exclusion criteria. Data descriptive analysis was performed by absolute and relative frequency distribution. The estimation of global survival curves and free of relapse was performed by Kaplan-Meier method. Results: The 40 to 59 age group was the predominant one for a 67.6 percent. Only the 10.4 percent of patients had first line positive backgrounds of breast cancer. The IIA clinical stage predominates with a 54.5 percent and the more frequent histological type, the infiltrating ductal carcinoma for a 84,4 percent. The 5-years global survival for our patients was of 95 percent and the interval free relapse was of 87.5 percent. Conclusions: Our results not differ from those found in studies at world level

The effect of the preoperative oral carbohydrate treatment on immediate postoperative insulin resistance in patients after colorectal cancer resection / 肠外与肠内营养

Objective: To assess the effect of preoperative carbohydrate fluid intake on immediate postoperative insulin resistance. Methods: 32 patients for elective colorectal cancer resection were recruited to this randomized controlled study. These patients were randomly assigned to control group and test group. Control group were fasted before surgery, while test group were given oral carbohydrate 3 h before surgery. Patient's wellbeing scores on a visual analogue scale(VAS) were recorded at 3 PM the day before operation and 2 h after consuming carbohydrate fluid respectively. Blood sample were collected to measure the level of blood glucose and the serum concentrations of insulin 4 h before surgery and immediately after surgery, respectively. Homeostasis model assessment (HOMA) was applied to assess the status of insulin resistance (HOMA-IR), basic function of pancreatic ? cell (HOMA-? cell) and insulin sensitivity index (ISI). Results: Patients consumed carbohydrate-rich beverage before surgery reduced thirst, hunger and anxiety compared with fasting before surgery. Whole body insulin sensitivity decreased by 33% in the test group vs. 38% in the control group(P

A Case of Granular Cell Tumor of the Ascending Colon / 대한소화기내시경학회지

A 40-year-old woman was admitted with a history of intermittent abdominal pain at the right lower quadrant area. Colonoscopy showed a 1.5 1.5 cm sized polypoid lesion that had yellowish surface, central depression, and normal mucosal covering. The tumor was removed by endoscopic tumorectomy following injection of hypertonic saline solution with epinephrine for lifting the lesion. The tumor consisted of granular tumor cells which were positive for S-100 protein, NSE, and PAS stain. We report a case of granular cell tumor of the ascending colon with a review of the literature.