Eficacia y seguridad de la ablación por radiofrecuencia endoscópica en pacientes con estenosis biliar maligna irresecable / No disponible

INTRODUCCIÓN: se ha observado que la ablación endoscópica por radiofrecuencia en tumores irresecables de vía biliar prolonga la sobrevida. OBJETIVO: evaluar sobrevida, permeabilidad de prótesis y efectos adversos de la ablación contra un grupo control. METODOLOGÍA: estudio observacional en pacientes con estenosis biliar maligna irresecable. RESULTADOS: cuarenta pacientes, 12 radiofrecuencia, no hubo diferencias entre variables basales de ambos grupos. Hubo mayor sobrevida en el grupo de radiofrecuencia sin diferencia estadísticamente significativa (217 vs. 129 días, log-rank 0,31). No hubo diferencia en permeabilidad de prótesis o efectos adversos. CONCLUSIÓN: se encontró ganancia de tres meses en sobrevida a favor de la radiofrecuencia sin alcanzar diferencia estadísticamente significativa

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Efficacy and safety of radiofrequency ablation in patients with unresectable malignant biliary strictures.

INTRODUCTION: previous studies have shown that endoscopic radiofrequency ablation in unresectable biliary duct tumors prolongs survival. METHODS: this was an observational study of patients with an unresectable malignant stricture. The aim was to evaluate survival, stent patency and adverse events of radiofrequency compared with a matched control group. RESULTS: the study included 40 patients, 12 with radiofrequency. There were no differences between baseline parameters in both groups. The survival time was longer in the radiofrequency group with no statistically significant difference (217 vs 129 days, log-rank 0.31). There was no difference in stent permeability or adverse events. CONCLUSION: the radiofrequency group had a three-month increase in survival, which did not reach statistical significance.

[Biosimulator training and its impact on skill in laparoscopic cholecystectomy]. / Entrenamiento en un biosimulador y su impacto sobre la destreza en colecistectomía laparoscópica.

OBJECTIVE: We undertook this study to determinate the educational impact of training in an inanimate biosimulator in terms of effectiveness, time and complications in performing laparoscopic cholecystectomy. METHODS: We used a comparative, experimental cohort, prospective and longitudinal. Three first-postgraduate-year residents and one pre-grade internship physician were trained and assessed in basic laparoscopic skills using a biosimulator (fiberglass "dummy" where animal organs are introduced ex-vivo). The participants acted as their own control, performing a procedure to determine surgical time, complications and effectiveness. Later they observed a short video demonstrating the suitable development of laparoscopic cholecystectomy. The video defined the specific deviations from the ideal cholecystectomy, which were considered as errors. Every procedure was videotaped, beginning with the careful dissection of cystic structures and clipping them, continuing with the dissection of the gallbladder from the liver with the standardized method. Each participant performed ten procedures. RESULTS: There were no differences in baseline assessment of basic skills. All participants completed all proposed procedures. Surgical time was 61% faster at the end of the study (p<0.001), as well as demonstrating a lower rate of complications of 0.67% (p<0.009). CONCLUSIONS: Skills training in endoscopic surgery by means of an inanimate biosimulator is superior to traditional training because it decreases surgical time and surgical complications without ethical considerations and the effect of a learning curve in the operating room.

Entrenamiento en un biosimulador y su impacto sobre la destreza en colecistectomía laparoscópica / Biosimulator training and its impact on skill in laparoscopic cholecystectomy

Objetivo: determinar el impacto educacional del entrenamiento en un biosimulador inanimado en términos de efectividad, tiempo y complicaciones, respecto a la colecistectomía laparoscópica. Material y métodos: estudio comparativo, experimental de una cohorte, prospectivo y longitudinal. Tres médicos residentes de primer año de cirugía y un interno de pregrado, fueron entrenados y evaluados en habilidades laparoscópicas elementales mediante el empleo de un biosimulador (maniquí de fibra de vidrio en el que se introducen órganos de animales ex vivo). Los sujetos fueron su propio control: realizaron un procedimiento inicial en el que se determinó tiempo quirúrgico, complicaciones y efectividad. Posteriormente observaron un corto video que mostraba el desarrollo idóneo de la colecistectomía, y en el que se identificaban las desviaciones específicas del desempeño adecuado. Posteriormente cada sujeto realizó 10 procedimientos. Resultados: no existieron diferencias en la evaluación inicial de habilidades elementales. Los individuos completaron todos los procedimientos propuestos. Las disecciones de las estructuras císticas y de la vesícula biliar fueron 61 % más rápidas al finalizar el estudio (p < 0.001); la tasa de complicación fue de 0.67 % (p <0.009). Conclusión: el entrenamiento de habilidades en cirugía endoscópica por medio de un biosimulador inanimado es mejor que el entrenamiento tradicional, ya que disminuye el tiempo quirúrgico y las complicaciones en la sala de operaciones.

OBJECTIVE: We undertook this study to determinate the educational impact of training in an inanimate biosimulator in terms of effectiveness, time and complications in performing laparoscopic cholecystectomy. METHODS: We used a comparative, experimental cohort, prospective and longitudinal. Three first-postgraduate-year residents and one pre-grade internship physician were trained and assessed in basic laparoscopic skills using a biosimulator (fiberglass [quot ]dummy[quot ] where animal organs are introduced ex-vivo). The participants acted as their own control, performing a procedure to determine surgical time, complications and effectiveness. Later they observed a short video demonstrating the suitable development of laparoscopic cholecystectomy. The video defined the specific deviations from the ideal cholecystectomy, which were considered as errors. Every procedure was videotaped, beginning with the careful dissection of cystic structures and clipping them, continuing with the dissection of the gallbladder from the liver with the standardized method. Each participant performed ten procedures. RESULTS: There were no differences in baseline assessment of basic skills. All participants completed all proposed procedures. Surgical time was 61% faster at the end of the study (p<0.001), as well as demonstrating a lower rate of complications of 0.67% (p<0.009). CONCLUSIONS: Skills training in endoscopic surgery by means of an inanimate biosimulator is superior to traditional training because it decreases surgical time and surgical complications without ethical considerations and the effect of a learning curve in the operating room.

Echinococcus granulosus cattle strain identification in an autochthonous case of cystic echinococcosis in central Mexico.

Echinococcosis is a frequent hepatic parasitic disease in several countries but it is practically absent in Mexico. A cattle strain of Echinococcus granulosus was identified by RAPD, PCR-RFLP and mitochondrial CO1 gene analysis in an autochthonous case. The parasite was obtained after a laparoscopic excision of a liver cyst from a patient that was symptomatic for 6 years but mis-diagnosed before hospitalization.

[Identification and integral management of a case of autochthonous hydatidosis in Mexico]. / Identificación y manejo integral de un caso autóctono de hidatidosis en México.

OBJECTIVE: To describe a case of hydatid disease in Mexico. BACKGROUND: Liver hydatid disease is the most frequent hepatic parasitic disease in developed countries and is considered practically absent in Mexico. METHODS: In this paper we report identification, clinical management, and epidemiologic parasitologic, and molecular biological studies of an autochthonous case of hydatid disease in Mexico. RESULTS: Hepatic cyst was identified by imaging techniques. The patient received cestocidal treatment and the parasite was excised by laparoscopy. It was not possible to identify the origin of the Echinococcus strain neither by epidemiologic studies performed in the patient's household nor by RAPD pattern obtained with DNA of the protoscolices. Infection of a dog with protoscolices was not successful probably because they were damaged by the cestocidal drug. CONCLUSIONS: Care should be taken in the future to identify other possible autochthonous patients harboring liver hydatid cysts to treat them in an adequate and timely fashion, and to identify the strain of Echinococcus granulosus that infects patients in Mexico.