Metodologia de ensino de anatomia do globo ocular / Methodology of teaching anatomy of the ocular globe

Resumo Objetivo: O objetivo do presente estudo foi desenvolver uma metodologia que aproxime o discente do conteúdo abordado nas aulas de anatomia do globo ocular. Métodos: Foi realizada uma incisão circular na lâmina orbital do osso frontal de um cadáver humano de uma instituição em saúde e, para acessar as estruturas orbitárias, foram dissecadas as estruturas da área criando uma via para a injeção de uma solução de borracha de silicone branca entre o cristalino e a retina com posterior enucleação e dissecação final. Resultados: O emprego da técnica permitiu que os discentes do curso construíssem o conhecimento tátil do órgão em questão e transformando o saber teórico em prático, reconhecendo músculos, funcionalidade, vasos sanguíneos e estruturas oculares durante o procedimento de dissecação. Conclusão: A metodologia empregada no presente estudo é uma opção viável para o ensino da anatomia do olho.

Abstract Objective: The objective of the present study was to develop a methodology that approximates the student of the content addressed in the classes of anatomy of the eyeball. Methods: A circular incision was made in the orbital blade of the frontal bone of a human cadaver of a health institution and, to access the orbital structures, the area structures were dissected creating a pathway for the injection of a solution of white silicone rubber between the lens and the retina with subsequent enucleation and final dissection. Results: The use of the technique allowed the students of the course to construct the tactile knowledge of the organ in question and transform the theoretical knowledge into practice, recognizing muscles, functionality, blood vessels and ocular structures during the dissection procedure. Conclusion: The methodology used in the present study is a viable option for teaching the anatomy of the eye.

Endoscopic sinus surgery dissection courses using a real simulator: the benefits of this training / Cursos de dissecção de cirurgia endoscópica nasossinusal em simulador real - os benefícios deste treinamento

ABSTRACT INTRODUCTION: Endonasal surgeries are among the most common procedures performed in otolaryngology. Due to difficulty in cadaver acquisition and the intrinsic risks of training residents during operations on real patients, nasosinusal endoscopic dissection courses utilizing real simulators, such as the Sinus Model Otorhino Neuro Trainer are being developed as a new technique to facilitate the acquisition of better anatomical knowledge and surgical skill. OBJECTIVE: To evaluate the efficacy of nasosinusal endoscopic dissection courses with the Sinus Model Otorhino Neuro Trainer simulator in the training of otolaryngology surgeons. METHODS: A prospective, longitudinal cohort study was conducted with 111 otolaryngologists who participated in a theoretical and practical course of endoscopic surgery dissection using the Sinus Model Otorhino Neuro Trainer simulator, with application of questionnaires during and after the course. RESULTS: From the ten procedures performed utilizing the simulator, the evaluation revealed mean scores from 3.1 to 4.1 (maximum of 5). Seventy-seven participants answered the questionnaire six months after the end of the course. 93% of them reported that they could perform the procedures more safely following the course, 98% reported an improvement in their anatomical and clinical knowledge, and 85% related an improvement in their surgical ability. After the course, the number of endoscopic surgeries increased in 40% of the respondents. CONCLUSION: Endoscopic sinus dissection courses using the Sinus Model Otorhino Neuro Trainer simulator proved to be useful in the training of otolaryngologists.

RESUMO INTRODUÇÃO: Cirurgias endonasais são as cirurgias mais realizadas na otorrinolaringologia. Devido à dificuldade de adquirir cadáveres e ao risco inerente em realizar treinamento em pacientes reais, cursos de dissecção endoscópica nasossinusal em simuladores reais, como o sinus model otorhino - neuro trainer - S.I.M.O.N.T, são uma nova proposta de aquisição de maior conhecimento anatômico e habilidades cirúrgicas. OBJETIVO: Avaliar a eficácia dos cursos de dissecção de cirurgia endoscópica nasossinusal com simulador S.I.M.O.N.T. no treinamento de cirurgiões otorrinolaringologistas. MÉTODO: Estudo de coorte contemporâneo longitudinal com 111 otorrinolaringologistas que participaram de curso teórico - prático de dissecção endoscópica nasossinusal em simulador real S.I.M.O.N.T., com aplicação de questionários durante e após a realização do curso. RESULTADOS: Dos dez procedimentos realizados no simulador, a avaliação apontou para médias de notas que variaram de 3,1 a 4,1 (máximo de 5). Setenta e sete participantes responderam a avaliação 6 meses após o curso. Declararam que houve aumento da segurança após o curso, 93% dos mesmos; 98% disseram ter aumentado o conhecimento anátomo-clinico e 85% declararam um aumento da habilidade cirúrgica. Quarenta por cento aumentaram o número de cirurgias endonasais após o curso. CONCLUSÃO: Cursos de dissecção de cirurgia endonasais com simulador real S.I.M.O.N.T. mostraram ser úteis para o treinamento de otorrinolaringologistas.

Effectiveness of a reusable low-cost balloon trocar dissection device in the creation of preperitoneal space during endoscopic surgery. An experimental study in swine

PURPOSE: To evaluate a new, low-cost, reusable balloon trocar device for dissection of the preperitoneal space during endoscopic surgery.METHODS:Twenty swine (weight: 15-37 kg) were randomized to two groups, according to whether the preperitoneal space was created with a new balloon device manufactured by Bhio-Supply (group B) or with the commercially available OMSPDB 1000(r) balloon device manufactured by Covidien (group C). Quality and size of the created preperitoneal space, identification of anatomic structures, balloon dissection time, total procedure time, balloon resistance and internal pressure after insufflation with 300 mL of ambient air, balloon-related complications, and procedure cost were assessed.RESULTS:No significant differences in dissection time, total procedure time, or size of the created preperitoneal space were found between the groups. Balloons in group B had a significantly higher internal pressure compared to balloons in group C. None of the balloons ruptured during the experiment. Three animals in group C had balloon-related peritoneal lacerations. Despite a higher individual device cost, group B had a lower procedure cost over the entire experiment.CONCLUSION:The new balloon device is not inferior to the commercially available device in terms of the safety and effectiveness for creating a preperitoneal space in swine.

Analysis of low-energy and high-frequency femtosecond laser for the construction of deep anterior donor corneal lamellae / Laser de femtossegundo de baixa energia e alta frequência na confecção de lamelas corneanas doadoras

Purpose: To evaluate the efficacy and reliability of a low-energy femtosecond laser with a high repetition rate for construction of deep anterior donor corneal lamellae. Methods: This was a prospective laboratory investigation. Twenty-five human corneal buttons were femtosecond laser cut to create thick anterior lamellae (diameter, 10mm; thickness, 500µm). The laser cuts were made using an LDV® femtosecond laser in a Ziemer® anterior chamber. To obtain a better edge, the lamellae were trephined with an 8mm trephine (Katena®). The central corneal thickness and the anterior lamellae were measured using a Mitutoyo® thickness gauge with an accuracy of 0.001mm. Results: The central thickness of the 25 corneas ranged from 500 to 705µm (mean, 584 ± 51µm). The thickness of the anterior lamellae ranged from 420 to 480µm (mean, 455 ± 12.7µm). The anterior lamellae diameters were 7.90 ± 0.1mm, and all laser cuts were round. The lamellar interfaces appeared regular by surgical microscopy. There were no cases of inter-lamellar adhesion. Conclusion: The LDV® femtosecond laser appears to be a safe and reliable instrument for cutting deep anterior lamellae from donor corneoscleral buttons. Minimal variation in donor lamellar depth with the laser will be useful for creating donor corneal tissue for deeper anterior lamellar keratoplasty or endothelial keratoplasty surgery or both from a single donor cornea. .

Objetivo: Avaliar a eficácia e segurança de um laser de femtossegundo de baixa energia e alta taxa de repetição para confecção de lamelas corneanas doadoras anteriores profundas. Métodos: Este é um estudo prospectivo de investigação laboratorial. Vinte e cinco botões corneanos foram cortados com laser de femtossegundo para criar lamelas corneanas doadoras anteriores profundas (diâmetro, 10mm; espessura, 500µm). O corte a laser foi realizado com femtosecond laser LDV® na câmara anterior artificial da Ziemer®. Para obter-se uma melhor borda, as lamelas foram trepanadas com um trépano de 8mm da Katena®. A paquimetria corneana central e as lamelas anteriores foram aferidas utilizando o paquímetro Mitutoyo®, com acurácia de 0.001mm. Resultados: A paquimetria central das 25 córneas variou de 500 a 705µm (média de 584 ± 51µm). A espessura das lamelas anteriores variou de 420 a 480µm (media de 455 ± 12.7µm). O diâmetro das lamelas corneanas doadoras foi 7.90 ± 0,1mm, sendo todos os cortes redondos. As interfaces lamelares apresentaram-se regular ao microscópio cirúrgico. Não houve casos de adesão interlamelar. Conclusão: O laser de femtossegundo LDV® mostrou-se seguro e eficaz para confeccionar lamelas corneanas doadoras a partir de botões córneo-esclerais. Mínima variação na espessura das lamelas doadoras confeccionadas com o laser será útil para criação de tecidos corneanos doadores para ceratoplastia lamelar anterior profunda ou ceratoplastia endoteliais, ou ambas, a partir de uma só córnea. .

Evaluation of intrastromal corneal ring segments for treatment of post-LASIK ectasia patients with a mechanical implantation technique.

Aim: To evaluate the clinical outcomes of Keraring segment implantation in patients with post- laser-assisted in situ keratomileusis (LASIK) ectasia, using a mechanical implantation technique. Materials and Methods: Twelve eyes of 10 patients with post-LASIK ectasia were enrolled. Intracorneal ring segments (ICRS) were implanted after dissection of the tunnel using Tunc's specially designed dissector under suction. A complete ophthalmic examination was performed, including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent, keratometric (K) readings, inferosuperior asymmetry index (ISAI), and ultrasound pachymetry. All 3, 6, and 12-month follow-ups were completed, and statistical analysis was performed. Results: The mean preoperative UDVA for all eyes was 1.28 ± 0.59 logMAR. At 12 months, the mean UDVA was 0.36 ± 0.19 logarithm of the Minimum Angle of Resolution (logMAR) (P=0.002), and the mean preoperative CDVA was 0.58 ± 0.3 logMAR, which improved to 0.15 ± 0.12 (P=0.002) at 1 year. There was a significant reduction in cylindrical refractive and spherical equivalent refractive error from –5.29 ± 2.47 diopters (D) and –5.54 ± 5.04 D preoperatively to –1.47 ± 0.71 D and –0.74 ± 1.07 D (P=0.001, P=0.002), respectively, at 1 year. In the same period, the mean K- readings improved from 47.93 ± 4.84 D to 40.87 ± 2.36 D (P=0.002), and the mean ISAI improved from 5.34 ± 3.05 to 2.37 ± 1.68 (P=0.003). No significant changes in mean central corneal thickness were observed postoperatively. There were no major complications during or after surgery. Conclusion: ICRS implantation using a unique mechanical dissection technique is a safe and effective treatment for post-LASIK ectasia. All parameters showed improvement at 1-year follow-up.

Simulador cirúrgico para treinamento de dissecção do osso temporal / Surgical simulator for temporal bone dissection training

A dissecção em ossos temporais tem papel fundamental na formação de cirurgiões e sua obtenção esbarra em diversas dificuldades. OBJETIVO: Desenvolver uma réplica sintética do osso temporal para treinamento de dissecção. FORMA DE ESTUDO: Experimental. MATERIAIS E MÉTODOS: Foi desenvolvida uma réplica de resina acrílica termopolimerizante através de técnicas de moldagem com silicone. Para a avaliação do método, foram selecionados cinco cirurgiões otológicos para dissecção do modelo em laboratório de cirurgia experimental. Foi preenchido questionário, levando em consideração a aparência externa, a simulação de procedimentos (colocação de tubo de ventilação, mastoidectomia, descompressão do nervo facial e acesso translabiríntico ao meato acústico interno) e a impressão final. RESULTADOS: A avaliação apontou satisfação na utilização do modelo (80 por cento), sendo mais evidente no que se referiu à dissecção do segmento mastoide do nervo facial e ao acesso translabiríntico ao meato acústico interno. A colocação de tubo de ventilação foi razoável para 60 por cento e satisfatória para 40 por cento deles. A mastoidectomia foi totalmente satisfatória para 40 por cento. CONCLUSÃO: A dissecção neste simulador otológico não substitui o treinamento em ossos temporais de cadáveres, porém, dada a crescente dificuldade na obtenção destes, o desenvolvimento de novas ferramentas de ensino deve ser encorajado para o contínuo aprimoramento de cirurgiões.

Temporal bone dissection plays an important role in the training of surgeons; however, they are difficult to obtain. AIM: To develop a synthetic replica of the temporal bone for dissection training. STUDY DESIGN: Experimental. MATERIALS AND METHODS: An acrylic synthetic resin replica was obtained from a human temporal bone. For the evaluation of the method, we selected five ear surgeons to dissect the model in a laboratory of experimental surgery. A questionnaire was filled, assessing external appearance, the simulation of procedures (placement of ventilation tube, mastoidectomy, decompression of the facial nerve and translabyrinthine access to the internal auditory canal) and their final conclusion. RESULTS: The evaluation indicated satisfaction in using the model (80 percent), being more evident concerning the dissection of the mastoid segment of the facial nerve and translabyrinthine access to the internal auditory canal. The placement of a ventilation tube was reasonable for 60 percent and satisfactory for 40 percent of them. Mastoidectomy was satisfactory for 60 percent and fully satisfactory for 40 percent. CONCLUSION: Dissection in this simulator does not replace otologic training in cadaveric temporal bones. However, given the increasing difficulty in obtaining the latter, the development of new teaching tools should be encouraged to continuously improve surgeons.

Dissecção robótica da artéria torácica interna direita por esternotomia mediana / Robotic dissection of the right internal thoracic artery through median sternotomy

A utilização de sistemas robóticos em cirurgia cardíaca visa à diminuição do trauma operatório. A revascularização do miocárdio totalmente endoscópica, assistida por robô DaVinci (Intuitive Surgical, Sunnyvale, Califórnia) é factível e seu aprendizado deve ser realizado em etapas. O primeiro passo é o preparo da artéria torácica interna esquerda, já por via totalmente endoscópica. O caso apresentado propõe a dissecção da artéria torácica interna direita por esternotomia completa. Propõe um novo passo rumo ao procedimento completamente endoscópico, visando à diminuição de lesões decorrentes da curva de aprendizado.

The use of robotic systems in cardiac surgeries aims at decreasing the surgical trauma. The totally endoscopic myocardial revascularization, assisted by the DaVinci robot (Intuitive Surgical, Sunnyvale, California) is feasible and the learning process must be carried out in steps. The first step is the preparation of the left internal thoracic artery, through the totally endoscopic approach. The case presented here proposes the dissection of the right internal thoracic artery through complete sternotomy. It proposes a new step directed at the totally endoscopic procedure, aiming at decreasing the injuries caused by the learning curve.

Comparison of tonsillectomy by standard dissection/snare technique and KTP laser method: a pilot study

A pilot study compared the post-operative morbidity following tonsillectomy by potassium-titanyl Phosphate laser [KTP/532] and standard dissection/snare methods. Twenty one consecutive patients over the age of 12 years had the tonsil on one side removed by standard dissection and that on the other side by KTP/532 laser. The intra-operative blood loss was greater in male and older patients [p=0.01] and significantly less on the KTP laser side [9.8 +/- 5.2 ml] than the dissection side [40.5 +/- 12.2 ml]; p = 0.001. During the first two days following surgery; 71.4% of patients experienced more pain on the laser side. By the first week 76.2% of patients felt both side of the throat were equally painful. At the end of second week 6 1.9% of patients had more persistent pain on the laser side compared to the dissection side. After four weeks all patients had recovered fully. This pilot study showed KTP/laser tonsillectomy had reduced intra-operative blood loss but there was more pain and increased risk of secondary hemorrhage compared to the side of standard dissection. Based on our initial results, we suggest a larger prospective randomized controlled study to compare both methods of tonsillectomy and to determine the potential to perform laser tonsillectomy as a day care procedure

Endoscopic Submucosal Dissection for Early Gastric Cancer and Gastric Adenoma / 대한소화기학회지

BACKGROUND/AIMS: Endoscopic Submucosal Dissection (ESD) is a new endoscopic mucosal resection (EMR) technique which enables en bloc resection even in large and depressed lesions. The aims of this study were to assess the therapeutic efficacy and the safety of ESD in gastric adenoma and in early gastric cancer (EGC). METHODS: We analyzed 101 lesions in 101 patients. ESD with insulated-tipped (IT) knife were performed in 52 adenomas and 49 EGCs from January 2003 to December 2005 in Dong-A University Hospital. RESULTS: The mean size of the lesion was 2.58 cm (0.7-4.5 cm). En bloc resection rate was 90.1% which was influenced by size (p>0.05). Complete resection rate was 83.2% even in large or in malignant tumors (p>0.05). Bleeding after ESD occurred in 41.6%. Tumor recurrence rate was 2.0%. CONCLUSIONS: ESD with IT knife is effective for the treatment of EGC and gastric adenoma even in large or in malignant lesions without definite increased risk of complications.

Disectomía percutánea manual: análisis de 16 casos de patología discal lumbar operados / Manual percutaneous disectomy: analysis of 16 operated cases of lumbar disk patology

Se presenta un análisis de 16 casos operados de patología discal lumbar a nivel L3 L4`L4 L5 y L5 S1. En 15 pacientes, 93,7 por ciento, se objetivó una HNP, en un paciente, 6,3 por ciento, una protrusión discal sintomática. En el 100 por ciento se realizó discografía. El interés de la disectomía percutánea consiste en evitar la vía intraraquídea. Sus ventajas son el uso de anestesia local, gesto poco traumatizante, disminución de riesgos de fibrosis peridural, corto período de hospitalización y menor costo. Los resultados obtenidos son satisfactorios en el 87,5 por ciento de los casos

Preservaçäo de microrganismos: revisäo / Preservation of microrganism: a review

Neste trabalho säo abordados os principais métodos de preservaçäo, como: sub-cultura, secagem ou desidratado, congelamento e liofilizaçäo