Treinamento de anastomoses vasculares de baixo custo: o cirurgião vai à feira
Low-cost vascular anastomosis training: the surgeon goes to market
Hícaro Donato Grahem, Renan Kleber Costa Teixeira, Daniel Haber Feijó, Vitor Nagai Yamaki, André Lopes Valente, Denilson José Silva Feitosa Júnior, José Maciel Calda dos Reis, Rui Sérgio Monteiro de Barros
Resumo
Anastomoses vasculares são procedimentos comuns realizados por grande parte dos cirurgiões e cujo treinamento ocorre principalmente em seres humanos, contrariando os princípios éticos vigentes. Esse fato se deve, sobretudo, à carência e ao alto custo relacionados aos atuais modelos de treinamento. Assim, este estudo visa avaliar a viabilidade de três vegetais para a realização de anastomoses vasculares. Foram utilizadas cinco unidades de cebolinha, vagem e feijão-verde. Em cada uma tentou-se realizar uma anastomose término-terminal. Conseguiu-se a realização da anastomose apenas na vagem e no feijão-verde. Contudo, por apresentar uma menor espessura, o feijão-verde assemelhou-se mais aos vasos humanos.
Palavras-chave
Abstract
Vascular anastomoses are common procedures and are performed by most surgeons. Training is primarily conducted in human beings, which violates current ethical principles. This is because current training models are expensive and in short supply. This study was designed to investigate the feasibility of three vegetable models of vascular anastomosis. Five units each of scallions, green beans, and yardlong beans were used. An end-to-end anastomosis was attempted with each specimen. Anastomoses were only successful in green beans and yardlong beans. Since they are narrower, the yardlong beans are the most similar to human vessels.
Keywords
References
1. Sigounas VY, Callas PW, Nicholas C, et al. Evaluation of simulationbased training model on vascular anastomotic skills for surgical residents. Simul Healthc. 2012;7(6):334-8. PMid:22960701. http://dx.doi.org/10.1097/SIH.0b013e318264655e.
2. Kallás IE, Kallás AC, Callas E. Anastomoses arteriais: passado, presente e futuro. Acta Cir Bras. 1999;14(4):221-7. http://dx.doi.org/10.1590/S0102-86501999000400013.
3. Feliciano DV, Moore EE, Biffl WL. Western trauma association critical decisions in trauma: management of abdominal vascular trauma. J Trauma Acute Care Surg. 2015;79(6):1079-88. PMid:26680144. http://dx.doi.org/10.1097/TA.0000000000000869.
4. Eckstein HH, Schmidli J, Schumacher H, et al. Rationale, scope, and 20-year experience of vascular surgical training with lifelike pulsatile flow models. J Vasc Surg. 2013;57(5):1422-8. PMid:23601597. http://dx.doi.org/10.1016/j.jvs.2012.11.113.
5. Okhah Z, Morrissey P, Harrington DT, Cioffi WG, Charpentier KP. Assessment of surgical residents in a vascular anastomosis laboratory. J Surg Res. 2013;185(1):450-4. PMid:23800439. http://dx.doi.org/10.1016/j.jss.2013.04.090.
6. Achar RA, Lozano PA, Achar BN, Pereira Filho GV, Achar E. Experimental model for learning in vascular surgery and microsurgery: esophagus and trachea of chicken. Acta Cir Bras. 2011;26(2):101-6. PMid:21445471. http://dx.doi.org/10.1590/S0102-86502011000200005.
7. Brito CV, Soares RH, Botelho NM. Laboratory animals and analgesia: the responsibility of ethics committees and the obligations of researchers. Rev Bioet. 2016;24(3):528-31.
8. Amato AC, Freitas SL, Veloso PM, Correia TCV, Santos RV, Amato SJTA. Gelatin model for training ultrasound-guided puncture. J Vasc Bras. 2015;14(3):200-4. http://dx.doi.org/10.1590/1677-5449.0088.
9. Wilasrusmee C, Lertsithichai P, Kittur DS. Vascular anastomosis model: relation between competency in a laboratory-based model and surgical competency. Eur J Vasc Endovasc Surg. 2007;34(4):405-10. PMid:17681827. http://dx.doi.org/10.1016/j.ejvs.2007.05.015.
10. Teixeira RK, Yamaki VN, Valente AL, et al. Existem válvulas na veia femoral em ratas Wistar? J Vasc Bras. 2015;14(4):368-71. http://dx.doi.org/10.1590/1677-5449.004515.
11. Price J, Naik V, Boodhwani M, Brandys T, Hendry P, Lam BK. A randomized evaluation of simulation training on performance of vascular anastomosis on a high-fidelity in vivo model: the role of deliberate practice. J Thorac Cardiovasc Surg. 2011;142(3):496-503. PMid:21742349. http://dx.doi.org/10.1016/j.jtcvs.2011.05.015.
12. Lima DA, Galvão MSL, Cardoso MM, Leal PRA. Laboratory training program in microsurgery at the National Cancer Institute. Rev Bras Cir Plast. 2012;27(1):141-9. http://dx.doi.org/10.1590/S1983-51752012000100024.
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email