Introduction: The trachea is a semiflexible tube of 1.5 to 2 cm in width and 10 to 13 cm in length. Its deviation might be caused by not only diverse thoracic but also abdominal pathologies, which may compromise the airway. We present a case of a severe tracheal deviation due to an abdominal pathology causing displacement of mediastinal structures. Clinical Case: A 78-year-old woman presents with difficulty breathing. History of chronic bedridden and frequently constipated, last stool 5 days prior. On physical examination, cachectic complexion, dry mucous membranes, breathing superficially with scarce wheezing, SatO2 82% on room air. Abdomen distended with an absence of bowel sounds. Chest x-rays show severe tracheal deviation and abdominal x-ray with coffee bean sign. A laparotomy evidences a large sigmoid volvulus. A sigmoidectomy and descending colon colostomy is performed. Room air oxygen saturation improved after extubation to 96%. Conclusion: Desaturation and tracheal deviation were caused by a large sigmoid volvulus. Although these pathologies were thoracic, clinicians should suspect different underlying pathologies, in this case, abdominal.

Simulators have been used throughout history to practice complicated procedures before performing them on human beings. The earliest simulation attempts were in cadavers. Donor bodies are still used for teaching and research but involve costly infrastructure, ethical and legal issues, as well as animal models. Training models need to be purposefully designed. These can be physical models, 3-D printed, simulators with virtual reality, augmented reality, or a hybrid simulation. The inert model is an alternative for animal tissue models, based on a trial-and-error method, the learning curve is approximately 65 procedures for a laparoscopist. Simulations models with virtual and augmented reality have shown that can reduce the time of practitioners with experience in laparoscopy, with an approximate reduction of 30 to 58%. Video-based learning method has been adopted in recent years but has shown to be less effective than hand-on learning using a simulator. Simulation can be involved to simulate specific scenarios, recreate simulated trauma patients, help develop a doctor-patient relationship and prepare complex approaches. Patient safety concerns call for the need to train medical personnel in simulated settings to reduce cost and patient morbidity because the ability to acquire surgical skills requires consistent practice. Simulation represents ideal teaching methods to optimize the knowledge and skill of residents before they are entrusted with procedures with real patients.

0002-5538-9397. RESUMENIntroducción: la pancreatitis aguda es una de las enfermedades gastrointestinales más comunes encontradas en la práctica clínica. De estos casos, 10-20% puede estar asociado con necrosis de la glándula pancreática. Existen diferentes procedimientos quirúrgicos donde cobra importancia realizar un correcto abordaje procurando que este sea lo menos invasivo posible como en el caso que presentamos. Reporte de caso: presentamos el caso de un hombre de 59 años con cuadro abdominal y tomografía contrastada que mostró evidencia de pancreatitis necrotizante Balthazar E y fístula duodenal. El paciente fue sometido a necrosectomía pancreática transgástrica por laparoscopía con drenaje y desbridación de material purulento y tejido necrótico. El posoperatorio transcurrió sin incidencias y el paciente fue dado de alta al duodécimo día posoperatorio. Conclusión: la necrosectomía transgástrica a la que fue sometido este paciente fue una excelente opción quirúrgica de primera instancia para el manejo de la necrosis pancreática sintomática. Las técnicas quirúrgicas precisas y el seguimiento ambulatorio a largo plazo son obligatorios para obtener resultados óptimos en pacientes con pancreatitis severa. Determinar el mejor abordaje para nuestros pacientes reduce la morbilidad y mejora la recuperación posoperatoria.