Resección laparoscópica de un tumor virilizante suprarrenal derecho / Laparoscopic approach in an adrenal right virilizing tumour

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Duodeno-jejunal tube placement in an experimental model of obesity: effects on food behaviour and basal energy expenditure.

BACKGROUND: Metabolic surgery can modulate weight as well as food intake and basal energy expenditure. In this study, we evaluate the effectiveness of duodenal exclusion by analysing anthropometric results, intake variations, food behaviour and calorimetric parameters. METHODS: This is an experimental study with 8-week-old Sprague-Dawley male rats. The sequences used are as follows: Cafeteria diet for 3 weeks, followed by surgery and sacrifice at 4 weeks. Four experimental groups are as follows: two non-obese groups (n = 15; surgery = 10, sham = 5) and two obese groups by cafeteria diet (n = 15; surgery = 10, sham = 5). Surgery performed was duodenal exclusion with physical barrier. Weight, intake, glycaemia and basal energy expenditure by indirect calorimetry were monitored before and after surgery. RESULTS: Weight changes in groups that underwent intervention were significant. The reduction in calorie consumption after surgery was significant in the obese intervention group despite an increased standard feed consumption (161 ± 11 vs 139 ± 13 Kcal/day, p < 0.05; due to a lower consumption of cafeteria diet). In non-obese animals, changes were transient. Basal energy expenditure decreased in both intervention groups: 6.2 ± 0.5 vs 5.5 ± 0.4 Kcal/kg/h in non-obese animals and 5.6 ± 0.3 vs 4.7 ± 0.3 Kcal/kg/h in obese animals (p < 0.05). CONCLUSIONS: Duodeno-jejunal tube placement stops weight gain in obese and non-obese animals. In obese animals, there is an important qualitative change in appetite towards standard feed with a significant decrease in caloric intake. In non-obese animals, changes in quantitative intake are transient. This surgery decreases basal energy expenditure in obese animals. This may be attributed to an enhanced thermogenic effect of food and a slowing in the animal's weight gain.

Evaluación de las habilidades quirúrgicas durante el pregrado mediante la introducción de un simulador virtual / Evaluation of surgical skills in medical students using a virtual simulator

Introducción Durante el pregrado, la utilización de los simuladores virtuales junto con las prácticas hospitalarias puede mejorar las aptitudes quirúrgicas básicas, e incluso ser un eje motivacional importante. El objetivo del trabajo es determinar el grado de habilidad endoscópica y su curva en 3 etapas dentro del grado de Medicina (segundo, cuarto y sexto curso) mediante un simulador virtual. Material y métodos Se ha utilizado el simulador Lapsim® con 7 ejercicios del módulo básico. Se somete a 24 alumnos (8 de segundo, 8 de cuarto y 8 de sexto curso) a un programa de entrenamiento (prueba basal más 3 sesiones) y a un examen a los 30 días. Un grupo control de cada curso (n=24)ha sido sometido a 2 exámenes con un intervalo de 30 días. Resultados Todos los grupos mejoran significativamente después del entrenamiento y se mantienen después del periodo de lavado de 30 días, y en todos los ejercicios. Los ejercicios «Cutting» y «Lifting and grasping», considerados de nivel intermedio, destacan sobre los demás por el bajo score basal que tienen todos los grupos. Después del proceso de entrenamiento, en cambio, son los únicos ejercicios en los que los alumnos de sexto se muestran claramente superiores respecto a los demás cursos: «Cutting» (94,5%±11 vs 81%±7) (p<0,05), «Lifting and grasping» (88,1%±13 vs 68%±11) (p<0,001).Conclusiones La utilidad del simulador virtual parece mayor para aquellos alumnos de cursos superiores con una mayor experiencia clínica, existiendo un proceso de discriminación ya durante este periodo. Las competencias quirúrgicas durante esta fase deberían reforzarse mediante nuevas apuestas docentes como los programas de simulación en el marco de los laboratorios de habilidades (AU)

Introduction The use of virtual simulators together with hospital practicals during undergraduate training can improve basic surgical skills, and may even be an important motivating focal point. The aim of this work is to determine the endoscopy skill level and its learning curve in three stages within the Medical degree (second, fourth, and sixth year) using a virtual simulator. Material and methods The Lapsim® simulator with 7 basic modular exercises was used. Twenty four students (8 second, 8 fourth, and 8 sixth year) were subjected to a training program (basic test plus 3 sessions), and an examination at 30 days. A control group (n=24) from each year were subjected to 2 examinations with an interval of 30 days. Results All the groups improved significantly after training, and this was maintained in all the exercises after a “wash out” period of 30 days. All the groups achieved lower baseline scores in the “Cutting” and “Lifting and grasping” exercises, considered of intermediate level than any of the others. However, after the training process, they were the only exercises that the sixth year students demonstrated that they were clearly superior to the rest of the years: “Cutting” (94.5%±11 vs 81%±7) (P<.05), “Lifting and grasping” (88.1%±13 vs 68%±11) (P<.001).Conclusions The virtual simulator appears to be of greater use for those students in higher years with more clinical experience, there already being a discrimination process during this period. Surgical skills during this phase should be reinforced by means of new teaching challenges, such as simulation programs in the framework of skills laboratories (AU)

Gastric volvulus after sleeve gastrectomy for morbid obesity.

BACKGROUND: Laparoscopic sleeve gastrectomy in morbid obesity has proved to be a safe and reproducible technique. Sleeve gastrectomy, however, is not free of complications. On the other hand, gastric volvulus is reported in those subjects where, either because of laxity of the gastric anatomical fixations or incorrect position of the stomach, rotation or turning is facilitated. CASE: We report the case of a patient with morbid obesity (Bone mass index / BMI 63 Kg/m2), who in the post-operative period immediately following a sleeve gastrectomy, presented early symptoms of upper gastrointestinal occlusion indicative of gastric volvulus of the gastric sleeve. RESULTS: The patient developed a partial obstruction secondary to a mixed volvulus mechanism (organo-axial and partially mesenteric-axial) after sleeve gastrectomy. We performed a laparoscopic antrectomy of the gastric sleeve and then a gastroileal anastomosis, a form of biliopancreatic diversion, with a common channel of 80 cm and alimentary limb of 160 cm). 18 months after, the patient has a BMI of 28 kg/m2 and enjoys a good quality of life. CONCLUSION: Sleeve gastrectomy leaves the stomach with no fixations along the entire greater curvature, which may predispose to volvulus. This complication is a rare finding and not reported to date following this intervention, but still needs to be considered in this type of patient.

[Evaluation of surgical skills in medical students using a virtual simulator]. / Evaluación de las habilidades quirúrgicas durante el pregrado mediante la introducción de un simulador virtual.

INTRODUCTION: The use of virtual simulators together with hospital practicals during undergraduate training can improve basic surgical skills, and may even be an important motivating focal point. The aim of this work is to determine the endoscopy skill level and its learning curve in three stages within the Medical degree (second, fourth, and sixth year) using a virtual simulator. MATERIAL AND METHODS: The Lapsim simulator with 7 basic modular exercises was used. Twenty four students (8 second, 8 fourth, and 8 sixth year) were subjected to a training program (basic test plus 3 sessions), and an examination at 30 days. A control group (n=24) from each year were subjected to 2 examinations with an interval of 30 days. RESULTS: All the groups improved significantly after training, and this was maintained in all the exercises after a "wash out" period of 30 days. All the groups achieved lower baseline scores in the "Cutting" and "Lifting and grasping" exercises, considered of intermediate level than any of the others. However, after the training process, they were the only exercises that the sixth year students demonstrated that they were clearly superior to the rest of the years: "Cutting" (94.5%±11 vs 81%±7) (P<.05), "Lifting and grasping" (88.1%±13 vs 68%±11) (P<.001). CONCLUSIONS: The virtual simulator appears to be of greater use for those students in higher years with more clinical experience, there already being a discrimination process during this period. Surgical skills during this phase should be reinforced by means of new teaching challenges, such as simulation programs in the framework of skills laboratories.