Diferencias entre ginecólogos y residentes en habilidades motoras básicas de un módulo de ejercicios de un sistema virtual de simulación / Differences between gynecologists and medical residents in basic motor skills of an exercise module of a virtual simulation system

Resumen OBJETIVO: Evaluar las diferencias en los desenlaces de los ejercicios del módulo de habilidades motoras básicas del simulador Simbionix LAP Mentor entre un grupo de residentes de Ginecología y otro de especialistas en cirugía laparoscópica. MATERIALES Y MÉTODOS: Estudio observacional, prospectivo, longitudinal y comparativo efectuado de diciembre de 2019 a enero de 2020 en el Hospital Español de México. Se seleccionaron médicos residentes de Ginecología y especialistas en la misma rama con experiencia diversa en cirugía laparoscópica. Se evaluaron, con un programa de adiestramiento mediante simulación de alta fidelidad, los ejercicios del módulo de habilidades motoras básicas de un sistema de realidad virtual. Para las variables con distribución normal se aplicó la prueba de t de Student y la de U de Mann-Whitney para las variables que no cumplieron el criterio de normalidad. RESULTADOS: Se incluyeron 31 participantes: el grupo de especialistas (n = 19) y el de residentes (n = 12). Se encontraron diferencias significativas entre residentes y especialistas en el ejercicio 3-coordinación ojo-mano (4.45 seg, IC95%: 0.167-8.73; p < 0.05) y en el ejercicio 5-tracción y engrapado de mangueras con fugas (29.58 seg, IC95%: -42.99 -14.00; p < 0.001), a favor del grupo de especialistas. En los ejercicios 7-corte y ejercicio 8-fulguración no hubo diferencias significativas entre uno y otro grupo. CONCLUSIONES: El simulador de realidad virtual Simbionix LAP Mentor detecta diferencias entre grupos de ginecoobstetras con diferente experiencia en cirugía ginecológica de mínima invasión y residentes de la especialidad.

Abstract OBJECTIVE: To evaluate the differences in the outcomes of the exercises of the basic motor skills module of the Simbionix LAP Mentor simulator between a group of gynecology residents and another group of already graduated specialists. MATERIALS AND METHODS: Observational, prospective, longitudinal and comparative study carried out from December 2019 to January 2020 at the Hospital Español de México. Gynecology residents and specialists in the same branch with diverse experience in laparoscopic surgery were selected. The exercises of the basic motor skills module of a virtual reality system were evaluated with a high-fidelity simulation training program. The Student's t test was applied for variables with normal distribution and the Mann-Whitney U test for variables that did not meet the normality criterion. RESULTS: Thirty-one participants were included: the specialist group (n = 19) and the resident group (n = 12). Significant differences between residents and specialists were found in exercise 3-eye-hand coordination (4.45 sec, 95%CI: 0.167-8.73; p < 0.05) and in exercise 5-pulling and stapling of leaking hoses (29.58 sec, 95%CI: -42.99 -14.00; p < 0.001), in favor of the specialist group. In exercise 7-cutting and exercise 8-fulguration there were no significant differences between one group and the other. CONCLUSIONS: The Simbionix LAP Mentor virtual reality simulator detects differences between groups of obstetrician-gynecologists with different experience in minimally invasive gynecologic surgery and residents of the specialty.

[Laparoscopic cholecystectomy in pregnancy. Five years experience at the Spanish Hospital of Mexico and literature review]. / Colecistectomía laparoscópica en el embarazo. Experiencia de cinco años en el Hospital Español de México y revisión de la bibliografía.

BACKGROUND: Biliary pathology is the second cause of abdominal acute pain during pregnancy. The surgical approach most often used for the treatment of acute cholecystitis during pregnancy is laparoscopy. Some aspects have made this approach during pregnancy controversial. OBJECTIVES: To analyze the maternal-fetal benefits and complications of laparoscopic cholecystectomy during pregnancy and compare these results with the medical literature. MATERIAL AND METHODS: It is a retrospective, transverse study. Laparoscopic cholecystectomy cases and pregnancy from 2005 to 2009 at Hospital Español de Mexico city were reviewed. The following information was obtained: maternal age, gestational age, signs and symptoms, medical department that made the diagnosis, the laparoscopic entry techniques, the monitoring of CO2 for the pressure of pneumoperitoneum, the complications in the peri and postoperatory state, the use of tocolytics medication and other medicines in the hospital stay, maternal and perinatal morbi-morbility, days of hospitable stay, follow-up surgical postintervention in the office. We did a comparation of our results with the medical literature. RESULTS: 10 laparoscopic cholecystectomies were performed. Gestational ages were from 15 to 25 weeks. The incidence was 1:995. All the cases were diagnosed by doctors of the department of general surgery, and also the surgeries. 2/10 patients were in preterm delivery risk at 35 weeks of gestation. There was not any fetal loss or maternal death. CONCLUSIONS: Our results are similar with the literature research, and we confirm that laparoscopic cholecystectomy is a safe therapeutic option for gravid patients, which has minimal fetal-maternal morbidity.

[Hysterectomy through laparoscopy: ten-years experience at Hospital Español de México]. / Histerectomia por laparoscopía: experiencia de 10 años en el Hospital Español de México.

OBJECTIVE: To analyze both clinical and surgical characteristics of patients with no oncologic diseases treated with any variant of laparoscopic hysterectomy during the 1996-2005 period in Hospital Español de Mexico, and compare them with the reported in literature. METHOD AND PATIENTS: Retrospective, longitudinal, descriptive, not experimental. Total 376 patients; group 1, 204 with laparoscopic hysterectomy; group 2, 157 laparoscopic assisted vaginal hysterectomy; group 3, 15 laparoscopic supracervical hysterectomy. RESULTS: Mean age similar for each group (43.9, 44.4 and 44.8), larger numberof patients with at least one previous vaginal delivery compared with cesarean in the first two groups (65.7 vs 55.5%, 77.7 vs. 15.2%); identical in the third group (40 vs. 40%). The 51.5% had at least one previous gynecological-obstetric surgery (52.9, 49.0 and 60%). The mean uterine length was similar in the 3 groups (9.6, 9.8 y 10.9 cm). The most predominant diagnosis was uterine leiomyomata (75, 50.6 and 73.3%). The mean surgical time was shorter in the third group (159.5, 158 and 117.6 min.). Hospital stay was shorter in the third group (2.6, 2.9 and 2.2 days). Group 3 had no minor or major complications. The corresponding major complications was 1.9% (group 1) and 1.8% (group 2); minor complications was 4.9% y 3.1% for groups 1 and two respectively. CONCLUSIONS: There were no significant differences between the clinical and surgical characteristics regarding patients and surgical procedure, therefore they could be offered for the vast majority of patients with no oncologic disease.