RESUMO
Objectives: Most renal tumours can be treated with a partial nephrectomy, with robot-assisted partial nephrectomy becoming the new gold standard. This procedure is challenging to learn in a live setting, especially the enucleation and renorraphy phases. In this study, we attempted to evaluate face, content, and preliminary construct validity of a 3D-printed silicone renal tumour model in robotic training for robot-assisted partial nephrectomy. Materials and Methods: We compared the operative results of three groups of surgeons with different experience levels (>20 partial nephrectomies, 1-20 partial nephrectomies and no experience at all) performing a robotic tumour excision of a newly developed silicone model with four embedded 3D-printed renal tumours. We evaluated the participants' performance using surgical margins, excision time, total preserved parenchyma, tumour injury and GEARS score (as assessed by two blinded experts) for construct validity. Postoperatively, the participants were asked to complete a survey to evaluate the usefulness, realism and difficulty of the model as a training and/or evaluation model. NASA-TLX scores were used to evaluate the operative workload. Results: Thirty-six participants were recruited, each group consisting of 10-14 participants. The operative performance was significantly better in the expert group as compared to the beginner group. NASA-TLX scores proved the model to be of an acceptable difficulty level.Expert group survey results showed an average score of 6.3/10 on realism of the model, 8.2/10 on the usefulness as training model and 6.9/10 score on the usefulness as an evaluation tool. GEARS scores showed a non-significant tendency to improve between trials, emphasizing its potential as a training model. Conclusion: Face and content validity of our 3D renal tumour model were demonstrated. The vast majority of participants found the model realistic and useful for training and for evaluation. To evaluate construct and predictive validity, we require further research, aiming to compare the results of 3D-model trained surgeons with those of untrained surgeons in real-life surgery.
RESUMO
Mosquitoes and the diseases they transmit are a global public health threat that affects most human populations. Mosquito abundances are strongly linked to the number of suitable larval habitats available. However, it is still not well understood how different land uses impact larval habitat quality in different parts of the world. We investigated links between land use practices and abundance of mosquito larvae in temporary ponds located in different land uses in a malaria expansion zone in Tanzania. Temporary ponds are often cited as important sources of mosquitoes but are also of substantial conservation concern being home to a unique fauna and flora. Often, they also have high socio-economic importance. Overall, encountered mosquito larval abundances were very low, both for the collected Anopheles gambiae s.l. and Culex quinquefasciatus. Although temporary ponds are important mosquito larval habitats in other parts of Africa, currently they are unlikely to be an important factor affecting the prevalence of mosquito borne diseases in the Manyara study region. Larval abundances in temporary ponds were higher in agricultural areas where more eutrophic conditions were found and minimal in residential areas. Overall, even though temporary ponds are often modified as rice paddies in the rainy season, they were in a good ecological condition and hosted a diverse assemblage of aquatic predators that likely prevented larval mosquitoes from reaching high densities. Maintaining this good condition by preventing pesticide and nutrient input as much as possible, can be important to prevent pond degradation that is likely to make these habitats more suitable for mosquitoes in the future.
