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1.
BMC Gastroenterol ; 23(1): 120, 2023 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-37041464

RESUMO

BACKGROUND: Percutaneous liver biopsy is the gold standard technique for establishing the cause of cirrhosis and liver disease activity assessment. However, some cases of steatohepatitis or other chronic liver diseases show a high number of false negative results in samples obtained via the percutaneous route. This fact justifies performing a liver biopsy via the laparoscopic route. However, this is an expensive technique, with morbidities associated with pneumoperitoneum and anesthetic complications. The main objective of this study is to develop a video-assisted technique that uses only a minimally-invasive device for the liver biopsy and the optical trocar. Without additional trocars, this technique constitutes a less invasive procedure than the existing techniques in clinical practice. METHODS: This is a device development and validation study and patients submitted to abdominal laparoscopic surgery and required liver biopsy for moderate to severe steatosis were recruited. The patients were randomized into two groups: laparoscopic liver biopsy technique (n = 10, control group) and mini-laparoscopic liver biopsy technique (n = 8, experimental group). The times associated with procedure performance in both groups were evaluated using the Mann-Whitney or Kruskal-Wallis tests according to data distribution. RESULTS: At baseline, there was no statistical difference regarding gender and type of surgery. The experimental group had a significantly shorter time compared with the group that underwent the traditional procedure in mean procedure time (p = 0.003), biopsy time (p = 0.002) and hemostasis time (p = 0.003). CONCLUSIONS: The mini-laparoscopic biopsy device and technique showed to be capable of safely obtaining sufficient tissue samples, which was minimally invasive and in a shorter time than the classic technique.


Assuntos
Laparoscopia , Hepatopatias , Humanos , Laparoscopia/métodos , Biópsia , Cirrose Hepática
2.
Acta Cir Bras ; 36(1): e360108, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33605310

RESUMO

PURPOSE: Develop a 3D model for the simulation of laparoscopic inguinal hernioplasty transabdominal preperitoneal (TAPP). METHODS: This is an experimental study, 18 participants were selected, divided into three groups, experimental (GE) surgeons in training, control (GC) experienced surgeons and Shaw (GS) nonexperienced surgeons. The simulation in the 3D model was carried out in 6 sessions fulfilling the 5 stages. Opening the peritoneum with the creation of the preperitoneal space; identification of important structures; hernia identification and reduction; placement and fixation of the mesh in Cooper's ligament and closure of the peritoneum. RESULTS: In the 1st stage, the GE obtained an average of 1.25 ± 0.42 in the 1st session and 3.25 ± 0.62 in the 6th session (p = 0.05) and in the 5th stage 0.91 ± 0.29 in the first session. 1st session and 1.91 ± 0.29 in the 6th session (p = 0.001), with no significant difference between groups. The learning and skill curve in the SG represented 1.08 ± 0.29 1st and 3.50 ± 0.90 6th session (p = 0.001). CONCLUSIONS: The creation of a systematization of training in simulation applied to the three-dimensional model enabled gain in laparoscopic skills and underpinned its theoretical and practical foundations.


Assuntos
Hérnia Inguinal , Laparoscopia , Hérnia Inguinal/cirurgia , Herniorrafia , Humanos , Peritônio/cirurgia , Telas Cirúrgicas
3.
Acta cir. bras ; 36(1): e360108, 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1152693

RESUMO

ABSTRACT Purpose Develop a 3D model for the simulation of laparoscopic inguinal hernioplasty transabdominal preperitoneal (TAPP). Methods This is an experimental study, 18 participants were selected, divided into three groups, experimental (GE) surgeons in training, control (GC) experienced surgeons and Shaw (GS) nonexperienced surgeons. The simulation in the 3D model was carried out in 6 sessions fulfilling the 5 stages. Opening the peritoneum with the creation of the preperitoneal space; identification of important structures; hernia identification and reduction; placement and fixation of the mesh in Cooper's ligament and closure of the peritoneum. Results In the 1st stage, the GE obtained an average of 1.25 ± 0.42 in the 1st session and 3.25 ± 0.62 in the 6th session (p = 0.05) and in the 5th stage 0.91 ± 0.29 in the first session. 1st session and 1.91 ± 0.29 in the 6th session (p = 0.001), with no significant difference between groups. The learning and skill curve in the SG represented 1.08 ± 0.29 1st and 3.50 ± 0.90 6th session (p = 0.001). Conclusions The creation of a systematization of training in simulation applied to the three-dimensional model enabled gain in laparoscopic skills and underpinned its theoretical and practical foundations.


Assuntos
Humanos , Laparoscopia , Hérnia Inguinal/cirurgia , Peritônio/cirurgia , Telas Cirúrgicas , Herniorrafia
4.
Acta Cir Bras ; 35(11): e351108, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33331458

RESUMO

PURPOSE: To develop a model for simulated training of ureteropyelic anastomosis in laparoscopicpyeloplasty. METHODS: Longitudinal and experimental study, with 16 participants. A synthetic instrument was produced to simulate the renal pelvis and the proximal portion of the ureter positioned on a platform within laparoscopic simulators, thereby resulting in the realistic simulation of the ureteropelvic anastomosis. A step-by-step guide was also developed for the accomplishment of the ureteropelvic anastomosis training model. RESULTS: In the evaluation of all participants' suture training, a decrease was found in the time needed to perform the anastomosis, with a median of 17.83 min in the 1st step and 14.21 min in the last one (p = 0.01). Regarding the knots, in the 1st step, 5% of them were considered firm, with an evolution to 30% in the last step (p = 0.011). CONCLUSION: We noticed improvement in the ability to perform the ureteropelvic anastomosis by participants with no experience with it. Therefore, even unexperienced participants can improve their skills with this training. Moreover, we observed the effectiveness of the model use, confirmed by the participants' opinion and its validation by expert surgeons.


Assuntos
Laparoscopia , Procedimentos de Cirurgia Plástica , Ureter , Obstrução Ureteral , Anastomose Cirúrgica , Humanos , Pelve Renal/cirurgia , Ureter/cirurgia , Obstrução Ureteral/cirurgia
5.
Artigo em Português | LILACS | ID: biblio-1087729

RESUMO

Introdução: a pandemia provocada pelo 2019 Novel Coronavírus (COVID-19) provocou um desafio global de saúde pública, com repercussões em diversos setores da sociedade. As práticas médicas necessitaram adaptar-se no atendimento ao doente portador do COVID-19 ou suspeito. Métodos: realizou-se pesquisa bibliográfica de publicações e de diretrizes de sociedades médicas em relação às abordagens cirúrgicas de emergência nesta atual pandemia. Resultados: o material bibliográfico ainda é escasso, indefinido e de baixa evidência, mas são adequados neste momento inicial de enfrentamento do COVID-19 no Brasil. Conclusão: para reduzir o risco de contaminação dos profissionais de saúde, as técnicas e decisões cirúrgicas precisam adaptar-se ao cenário de pandemia do COVID-19.(AU)


Introduction: the pandemic caused by the 2019 Novel Coronavirus (COVID-19) has caused a global public health challenge, with repercussions in several sectors of society. Medical practices needed to adapt in the care of patients with or suspected of having COVID-19. Methods: Bibliographic research of publications and guidelines of medical societies regarding emergency surgical approaches in this current pandemic was carried out. Results: the bibliographic material is still scarce, undefined and of low evidence, but which are adequate in this initial moment of coping with COVID-19 in Brazil. Conclusion: to reduce the risk of contamination of health professionals, surgical techniques and decisions need to adapt to the pandemic scenario of COVID-19.(AU)


Assuntos
Humanos , Centros Cirúrgicos/normas , Pessoal de Saúde/normas , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Contaminação Biológica/prevenção & controle , Pandemias , Brasil
6.
Acta cir. bras ; 35(11): e351108, 2020. graf
Artigo em Inglês | LILACS | ID: biblio-1141939

RESUMO

Abstract Purpose: To develop a model for simulated training of ureteropyelic anastomosis in laparoscopicpyeloplasty. Methods: Longitudinal and experimental study, with 16 participants. A synthetic instrument was produced to simulate the renal pelvis and the proximal portion of the ureter positioned on a platform within laparoscopic simulators, thereby resulting in the realistic simulation of the ureteropelvic anastomosis. A step-by-step guide was also developed for the accomplishment of the ureteropelvic anastomosis training model. Results: In the evaluation of all participants' suture training, a decrease was found in the time needed to perform the anastomosis, with a median of 17.83 min in the 1st step and 14.21 min in the last one (p = 0.01). Regarding the knots, in the 1st step, 5% of them were considered firm, with an evolution to 30% in the last step (p = 0.011). Conclusion: We noticed improvement in the ability to perform the ureteropelvic anastomosis by participants with no experience with it. Therefore, even unexperienced participants can improve their skills with this training. Moreover, we observed the effectiveness of the model use, confirmed by the participants' opinion and its validation by expert surgeons.


Assuntos
Humanos , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Laparoscopia , Procedimentos de Cirurgia Plástica , Anastomose Cirúrgica , Pelve Renal/cirurgia
7.
Acta Cir Bras ; 34(3): e201900308, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30892394

RESUMO

PURPOSE: To create a checklist to evaluate the performance and systematize the gastroenterostomy simulated training. METHODS: Experimental longitudinal study of a quantitative character. The sample consisted of twelve general surgery residents. The training was divided into 5 sessions and consisted of participation in 20 gastroenterostomys in synthetic organs. The training was accompanied by an experienced surgeon who was responsible for the feedback and the anastomoses evaluation. The anastomoses evaluated were the first, fourth, sixth, eighth and tenth. A 10 item checklist and the time to evaluate performance were used. RESULTS: Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The correlation index of 0.545 and 0,295 showed a high linear correlation between time variables and Checklist. The average Checklist score went from 6.8 to 9 points. CONCLUSION: The proposed checklist can be used to evaluate the performance and systematization of a simulated training aimed at configuring a gastroenterostomy.


Assuntos
Lista de Checagem , Gastroenterostomia/educação , Internato e Residência , Treinamento por Simulação/métodos , Competência Clínica , Humanos , Estudos Longitudinais , Modelos Anatômicos
8.
Acta cir. bras ; 34(3): e201900308, 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-989065

RESUMO

Abstract Purpose: To create a checklist to evaluate the performance and systematize the gastroenterostomy simulated training. Methods: Experimental longitudinal study of a quantitative character. The sample consisted of twelve general surgery residents. The training was divided into 5 sessions and consisted of participation in 20 gastroenterostomys in synthetic organs. The training was accompanied by an experienced surgeon who was responsible for the feedback and the anastomoses evaluation. The anastomoses evaluated were the first, fourth, sixth, eighth and tenth. A 10 item checklist and the time to evaluate performance were used. Results: Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The correlation index of 0.545 and 0,295 showed a high linear correlation between time variables and Checklist. The average Checklist score went from 6.8 to 9 points. Conclusion: The proposed checklist can be used to evaluate the performance and systematization of a simulated training aimed at configuring a gastroenterostomy.


Assuntos
Humanos , Gastroenterostomia/educação , Lista de Checagem , Treinamento por Simulação/métodos , Internato e Residência , Estudos Longitudinais , Competência Clínica , Modelos Anatômicos
9.
Acta Cir Bras ; 33(11): 975-982, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30517324

RESUMO

PURPOSE: To discuss the use of models of hepatic retraction by laparoscopy, to present a new Hepatic Retractor (HR) and to evaluate its practicality, efficacy and safety in Esophageal Hiatus Exposure (EHE). METHODS: Experimental cross - sectional study with a quantitative character. It was carried out in the Laboratory of Health Training of Christus University Center. The sample consisted of 12 livers of adult pigs weighing between 30 and 45 kg. A circular-shaped HR, 5 cm diameter and deformable materials was developed with a polypropylene cloth, metallic guide wire, epidural needle plastic guide and nylon string. The practicality of HR management was measured by the time required to use the instrument, efficacy by exposure to the operative field and safety by macroscopic assessment of liver damage. RESULTS: The average time to complete the procedure was 3.24 minutes and reached less than 2 minutes after 12 repetitions. In eight experiments the maximum degree of EHE was obtained. No macroscopic lesions were observed. CONCLUSION: The use of HR described can broaden the operative field, without causing macroscopic liver lesions and prolonging the surgical time.


Assuntos
Laparoscopia/instrumentação , Fígado/cirurgia , Instrumentos Cirúrgicos , Animais , Estudos Transversais , Desenho de Equipamento , Masculino , Modelos Animais , Duração da Cirurgia , Valores de Referência , Reprodutibilidade dos Testes , Suínos
10.
Acta cir. bras ; 33(11): 975-982, Nov. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-973472

RESUMO

Abstract Purpose: To discuss the use of models of hepatic retraction by laparoscopy, to present a new Hepatic Retractor (HR) and to evaluate its practicality, efficacy and safety in Esophageal Hiatus Exposure (EHE). Methods: Experimental cross - sectional study with a quantitative character. It was carried out in the Laboratory of Health Training of Christus University Center. The sample consisted of 12 livers of adult pigs weighing between 30 and 45 kg. A circular-shaped HR, 5 cm diameter and deformable materials was developed with a polypropylene cloth, metallic guide wire, epidural needle plastic guide and nylon string. The practicality of HR management was measured by the time required to use the instrument, efficacy by exposure to the operative field and safety by macroscopic assessment of liver damage. Results: The average time to complete the procedure was 3.24 minutes and reached less than 2 minutes after 12 repetitions. In eight experiments the maximum degree of EHE was obtained. No macroscopic lesions were observed. Conclusion: The use of HR described can broaden the operative field, without causing macroscopic liver lesions and prolonging the surgical time.


Assuntos
Animais , Masculino , Instrumentos Cirúrgicos , Laparoscopia/instrumentação , Fígado/cirurgia , Valores de Referência , Suínos , Estudos Transversais , Reprodutibilidade dos Testes , Modelos Animais , Desenho de Equipamento , Duração da Cirurgia
11.
Acta Cir Bras ; 32(1): 81-89, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28225921

RESUMO

PURPOSE:: To develop a model of gastroenterostomy and to analyze the acquisition of skills after training by simulation. METHODS:: Experimental longitudinal study and of a quantitative character. The sample consisted of twelve general surgery residents from four hospitals. The training consisted of making ten anastomoses divided equally into five sessions and it took place over a period of six weeks. The evaluation of the anastomoses considered the time and the analysis of the operative technique through the global evaluation scale Objective Structured Assessment of Technical Skills (OSATS). RESULTS:: Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The correlation index of 0.545 and 0.497 showed a high linear correlation between time variables and OSATS. CONCLUSION:: The preparation of ten gastroenterostomies is an exercise capable of transferring basic and advanced skills in laparoscopy through a standardized training using synthetic organs and a simulator.


Assuntos
Gastroenterostomia/educação , Cirurgia Geral/educação , Internato e Residência , Laparoscopia/educação , Treinamento por Simulação/métodos , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Modelos Anatômicos
12.
Acta cir. bras ; 32(1): 81-89, Jan. 2017. graf
Artigo em Inglês | LILACS | ID: biblio-837667

RESUMO

Abstract Purpose: To develop a model of gastroenterostomy and to analyze the acquisition of skills after training by simulation. Methods: Experimental longitudinal study and of a quantitative character. The sample consisted of twelve general surgery residents from four hospitals. The training consisted of making ten anastomoses divided equally into five sessions and it took place over a period of six weeks. The evaluation of the anastomoses considered the time and the analysis of the operative technique through the global evaluation scale Objective Structured Assessment of Technical Skills (OSATS). Results: Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The correlation index of 0.545 and 0.497 showed a high linear correlation between time variables and OSATS. Conclusion: The preparation of ten gastroenterostomies is an exercise capable of transferring basic and advanced skills in laparoscopy through a standardized training using synthetic organs and a simulator.


Assuntos
Humanos , Masculino , Feminino , Adulto , Cirurgia Geral/educação , Gastroenterostomia/educação , Laparoscopia/educação , Treinamento por Simulação/métodos , Internato e Residência , Estudos Longitudinais , Modelos Anatômicos
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