Las estancias de formación con expertos mejoran los resultados en cirugía laparoscópica colorrectal

Balen-Rivera, Enrique; Suárez-Alecha, Javier; Herrera-Cabezón, Javier; Vicente-García, Francisco; Miranda-Murua, Coro; Calvo-Benito, Ana; Zazpe-Ripa, Cruz; Lera-Tricas, José Miguel

doi:10.1016/j.ciresp.2009.05.005

Cited by 8 publications

(4 citation statements)

References 26 publications

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“…6,17 Other variables used by other investigators, such as blood loss or operating time, 12,14 did not change during the study and are, therefore, not good indicators in our experience. This improvement point is defined, in our series, by this learning variable, at patient 70 for the entire surgical team (Figure 4), a far cry from the 180 we should have to operate on to complete the learning curve (30 patients × 6 surgeons) according to other investigators.…”

Section: Discussionmentioning

confidence: 59%

“…There is currently no evidence to support an ideal method for training surgeons in laparoscopic surgery, 11 although there is evidence that in-hospital training stays with experts do improve results 12 and that the progressive introduction of this technique into daily clinical care will encourage formation and shorten the surgeons' learning process. 13,14 …”

Section: Discussionmentioning

confidence: 99%

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How To Reduce the Laparoscopic Colorectal Learning Curve

Trincado¹,

Blanco-Antona²,

Esteban³

et al. 2014

JSLS

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Background:The laparoscopic approach for colorectal pathologies is becoming more widely used, and surgeons have had to learn how to perform this new technique. The purpose of this work is to study the indicators of the learning curve for laparoscopic colectomy in a community hospital and to find when the group begins to improve.Methodology:From January 1 2005 to December 31 2012, 313 consecutive laparoscopic colorectal surgeries were performed (105 rectal and 208 colonic) by at least 60% of the same surgical team (6 members) in each operation. We evaluate the learning curve by moving averages and cumulative sums (CUSUM) for different variables related to the surgery outcomes.Results:Moving average curves for postoperative stay, fasting, and second step analgesia show a stabilizing trend toward improvement as we get more experience. However, intensive care unit stay, number of lymph nodes achieved, and operating time did not show a clear decreasing tendency. CUSUM curves of conversion, specimens <12 lymph nodes, and complications all show a clear turning point marked on all the charts around the procedure 60, accumulating a positive trend toward improvement. The CUSUM curve of the “learning variable” shows this improvement point at procedure 70.Conclusions:The laparoscopic colectomy learning curve accelerates with a collective team involvement in each procedure. The CUSUM and moving average curves are useful for initial and ongoing monitoring of new surgical procedures. The markers of the learning curve evidenced in our study are the conversion rate, postoperative surgical morbidity, and the number of patients with a lymph node count <12.What is new in this paper?The significance of this study is the evaluation of the learning curve, in laparoscopic colorectal surgery, of a surgical team in a community hospital, using moving average and CUSUM curves. This study demonstrated that the number of patients needed to achieve skilful practice decreased when there is collective team involvement in each procedure.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

How To Reduce the Laparoscopic Colorectal Learning Curve

Trincado¹,

Blanco-Antona²,

Esteban³

et al. 2014

JSLS

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“…Las fallas a menudo se pueden tratar con éxito con técnicas percutáneas relativamente simples (es decir, revestimiento con una nueva endoprótesis, manguitos de extensión o embolización). Sin embargo, cuando las reintervenciones endovasculares no tienen éxito o no están indicadas, puede ser necesaria la explantación abierta 5,10,11,12 .…”

Section: Discussionunclassified

“…El estudio se planteó inicialmente con 2 aortas abdominales de cerdos macho, híbridos entre Large White y Landrace, de 8 meses de edad, libres de patógenos específicos, de entre 40 y 70 kg de peso 5,6 .…”

Section: Modelo Animal De Experimentación Cadavéricounclassified

Explantador de Cabrera: un nuevo dispositivo para explantar endoprótesis aórticas después de reparo endovascular de aneurisma de aorta, un estudio experimental ex vivo

Cabrera-Vargas,

Iván,

Forero-Ramírez

et al. 2024

Rev Colomb Cir

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Introducción. Las complicaciones posteriores a la reparación endovascular de aneurisma (EVAR) pueden resolverse con técnicas endovasculares. Sin embargo, cuando está indicada, la explantación de una endoprótesis es un procedimiento complejo, que se asocia a lesiones vasculares o viscerales, con alta morbimortalidad, en pacientes con edad avanzada y múltiples comorbilidades, y por lo tanto, alto riesgo quirúrgico. No existen dispositivos producidos por la industria para explantar las endoprótesis aórticas, por lo que el objetivo de este trabajo fue desarrollar un dispositivo para la explantación de endoprótesis aórticas. Métodos. Se llevó a cabo un estudio experimental, en fase preclínica, para desarrollar un dispositivo para la explantación de endoprótesis aórticas, con pruebas en modelos 3D y en un modelo animal porcino cadavérico. Resultados. Es factible desarrollar un modelo experimental de un nuevo dispositivo para explantar endoprótesis aórticas, denominado explantador de Cabrera, y comprobar su funcionamiento en un modelo animal cadavérico. El uso del explantador de Cabrera limitó el daño de la pared aórtica por parte de la endoprótesis en un 100 % al momento de su explantación en un modelo experimental ex vivo. Conclusión. Usando una jeringa septo, el explantador de Cabrera es superior a la técnica estándar de explantación de una endoprótesis al limitar la lesión de la pared aórtica, al colapsar y liberar los ganchos de fijación suprarrenal de forma controlada y segura al interior de la luz aórtica y, posteriormente, extraerla de forma rápida y efectiva, conservando la mayor cantidad de aorta sana para la posterior reconstrucción aorto-ilíaca.

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