Programa de entrenamiento en reparacion vascular en modelo experimental para residentes de cirugía general

Abstract

Los programas de entrenamiento simulado permiten optimizar recursos, aumentar la práctica técnica y acortar curvas de aprendizaje, y constituyen un método seguro, estandarizado y validado de aprendizaje para todos los entrenados. objetivo: Desarrollar un programa de entrenamiento vascular mediante la elaboración de una anastomosis término-terminal de un vaso en un modelo experimental para residentes de cirugía general. Método: Para el desarrollo de este modelo de entrenamiento se utilizó una extremidad amputada a nivel supracondíleo libre de proceso médico-legal. Se realizó la disección de la arteria femoral, se dividió en dos porciones y se realizó una anastomosis término-terminal. Se diseño un sistema que incluye la evaluación de las siguientes variables utlizando la escalas OSATS (Objetive Structured Assesment of Technical Skills) y Likert: 1) nudo manual y punto simple; 2) permeabilidad de la anastomosis; 3) simetría de los puntos; 4) fuga de anastomosis; y 5) tiempo total de anastomosis. discusión: Al reconocer las ventajas del entrenamiento experimental, se propone un modelo biológico experimental reproducible, estandarizado y de bajo costo. Conclusiones: El desarrollo de modelos biológicos experimentales permite al cirujano general la adquisición de habilidades y destrezas quirúrgicas, mejorando el desempeño durante un procedimiento quirúrgico y reduciendo riesgos.

Aperfeiçoando um modelo de treinamento para técnicas cirúrgicas vasculares

“…13,14 Models using organic materials include chicken trachea and esophagus, simulating the consistency of arteries and veins respectively, 7 vessels from bovine tongue, 4 and recently-amputated human limbs. 5 However, precautions must always be taken when using these materials because of the risk of biological contamination. These precautions include: use of protective devices such as gloves, masks, and goggles, appropriate disposal of the organic material, and care with laboratory hygiene.…”

“…However, the peculiar expansivity of the gelatin also made it possible to attest to the patency of anastomoses, since once the clamps had been removed, the gelatin moves to fill the space; other models depend on intraluminal injection of liquid to test the patency of anastomoses. 1,5,7,15 During the pilot phase, a model was tested using 6-0 polypropylene sutures. Although it was possible to complete all of the procedures, the suture must be tractioned more carefully, because the friction between the thread and the latex of the balloon can cause the suture to break more easily when pulled.…”

“…[1][2][3][4] Currently, the majority of general surgery residents' training is conducted on human beings, with demonstrations by more experienced surgeons. 1,5 However, construction of vascular anastomoses requires significant exposure, dissection, and temporary occlusion of the vessel, increasing the risk of complications, particularly when performed by an inexperienced surgeon. 6 The best way to acquire and develop this skill is through training with experimental models.…”

“…2 Simulations are important in medical education because they enable a range of different skills to be trained, improving patient safety. 5,7 Another objective of simulation is to develop simpler and more functional training methods, using the lowest possible number of animals for experimentation, thereby adhering to the 3 Rs policy (refinement, replacement, and reduction). 4 This is why the American College of Surgeons considers use of skills training models and simulators for accreditation of specialists rather than animal models.…”

“…3,4 There are many different biological models for practicing vascular anastomoses, mostly involving animal viscera. [4][5][6][7] The current initiative within the scientific community is to diversify use of already-existing teaching models to continue the trend to reduce use of animals, in addition to reducing risks and optimize surgery time in humans. 4,5…”