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      Simulador laparoscópico como herramienta de aprendizaje


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          Objetivos: Evaluar el efecto de las prácticas estructuradas de destrezas laparoscópicas básicas en un simulador inanimado al compararse la actuación de estudiantes de medicina con residentes de primer año del posgrado de cirugía general. Métodos: Fueron evaluados diez residentes del primer año del posgrado de Cirugía General y diez estudiantes del tercer año de medicina de la Escuela de Medicina "Luis Razetti", Cátedra de Clínica y Terapéutica Quirúrgica "C" Servicio de Cirugía III, sin experiencia quirúrgica previa. Ambos grupos tuvieron una sesión de evaluación de la destreza laparoscópica de base, asistiendo a una, dos o tres sesiones de prácticas de una hora semanal con un programa de cinco tareas laparoscópicas. El puntaje inicial fue obtenido durante la primera práctica y el puntaje final posterior a su última práctica. Las prácticas fueron realizadas en el Instituto de Cirugía Experimental de la Universidad Central de Venezuela. Resultados: No hubo diferencia significativa en los grupos entre el tiempo inicial y tiempo final. Los sujetos en ambos grupos mostraron marcada mejoría global de sus puntajes en todas las tareas (P<0,0006). En los puntajes de la práctica final, tanto en grupo de estudiantes como en el grupo de residentes hubo mejoría estadísticamente significativa (P=0,0313). Al comparar los puntajes finales obtenidos por cada grupo no hubo diferencia significativa con respecto a la mejoría alcanzada a partir del tiempo inicial, por lo que ambos mejoraron de manera uniforme sin predominio de uno en particular. Conclusiones: El simulador laparoscópico es una herramienta efectiva para el desarrollo de destrezas laparoscópicas en residentes y personas sin experiencia quirúrgica, a través de la realización de prácticas estructuradas en un período de tiempo.

          Translated abstract

          Objectives: To evaluate the effect of the structured practices of basic laparoscopic skills in an inanimate simulator when comparing the performance of medicine students with first year residents of general surgery. Methods: Were evaluated ten first year residents of Surgery Postgraduate of Caracas University Hospital and ten third year medicine students of "Luis Razetti" School, Cathedra of Surgical Therapeutic and Clinic "C" Service of Surgery III, without previous surgical experience. Both groups had a evaluation session of basic laparoscopic skill, attending one, two or three sessions of practices of one hour weekly with a program of five laparoscopic tasks. The initial score was obtained during the first practice and the final score after the last practice. The practices were done in the Experimental Surgery Institute of the Central University of Venezuela. Results: No significant differences between both groups in the initial and final times. The subjects in both groups showed a global improvement of their score in all the tasks (P<0.0006). In the scores of the final practice, as much in the students group as in the residents group there was statistically significant improvement (P=0.0313). When comparing the final score obtained by each group were no significant difference with respect to the improvement reached of the initial time, reason why both improved without predominance. Conclusions: The laparoscopic simulator is an effective tool for the development of laparoscopic skills in residents and people without surgical experience, through the accomplishment of structured practices in a period of time.

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          Most cited references56

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          Virtual Reality Training Improves Operating Room Performance

          To demonstrate that virtual reality (VR) training transfers technical skills to the operating room (OR) environment.
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            Randomized clinical trial of virtual reality simulation for laparoscopic skills training.

            This study examined the impact of virtual reality (VR) surgical simulation on improvement of psychomotor skills relevant to the performance of laparoscopic cholecystectomy. Sixteen surgical trainees performed a laparoscopic cholecystectomy on patients in the operating room (OR). The participants were then randomized to receive VR training (ten repetitions of all six tasks on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR)) or no training. Subsequently, all subjects performed a further laparoscopic cholecystectomy in the OR. Both operative procedures were recorded on videotape, and assessed by two independent and blinded observers using predefined objective criteria. Time to complete the procedure, error score and economy of movement score were assessed during the laparoscopic procedure in the OR. No differences in baseline variables were found between the two groups. Surgeons who received VR training performed laparoscopic cholecystectomy significantly faster than the control group (P=0.021). Furthermore, those who had VR training showed significantly greater improvement in error (P=0.003) and economy of movement (P=0.003) scores. Surgeons who received VR simulator training showed significantly greater improvement in performance in the OR than those in the control group. VR surgical simulation is therefore a valid tool for training of laparoscopic psychomotor skills and could be incorporated into surgical training programmes. Copyright 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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              Laparoscopic skills training and assessment.

              The introduction of laparoscopic techniques to general surgery was associated with many unnecessary complications, which led to the development of skills laboratories to train novice laparoscopic surgeons. This article reviews the tools currently available for training and assessment in laparoscopic surgery. Medline searches were performed to identify articles with combinations of the following key words: laparoscopy, training, curriculum, virtual reality and assessment. Further articles were obtained by manually searching the reference lists of identified papers. Current training involves the use of box trainers with either innate models or animal tissues; it lacks objective assessment of skill acquisition. Virtual reality simulators have the ability to teach laparoscopic psychomotor skills, and objective assessment is now possible using dexterity-based and video analysis systems. The tools are now available for the development of a structured, competency-based, laparoscopic surgical training programme. Copyright 2004 British Journal of Surgery Society Ltd.

                Author and article information

                Revista de la Facultad de Medicina
                Universidad Central de Venezuela. Facultad de Medicina. Comisión de Publicaciones de la Facultad de Medicina (Caracas, Distrito Capital, Venezuela )
                December 2009
                : 32
                : 2
                : 150-157
                [02] orgnameUniversidad Central de Venezuela orgdiv1Facultad de Medicina orgdiv2Escuela Luis Razetti Venezuela
                [03] orgnameUniversidad Central de Venezuela orgdiv1Facultad de Medicina orgdiv2Escuela Luis Razetti Venezuela
                [01] orgnameUniversidad Central de Venezuela orgdiv1Facultad de Medicina orgdiv2Escuela Luis Razetti Venezuela
                S0798-04692009000200011 S0798-0469(09)03200211


                : 28 October 2009
                : 02 November 2009
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 40, Pages: 8

                SciELO Venezuela

                Artículos Originales

                Simulador laparoscópico,Modelo de entrenamiento,Laparoscopic simulator,Training model


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