CARLO CAMARGO PASSEROTTI
Projetos de Pesquisa
Unidades Organizacionais
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina - Líder
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
- Surgical Performance During Laparoscopic Radical Nephrectomy Is Improved With Training in a Porcine Model(2012) CRUZ, Jose Arnaldo Shiomi da; PASSEROTTI, Carlo Camargo; FRATI, Rodrigo Marcus Cunha; REIS, Sabrina Thalita dos; OKANO, Marcelo Takeo Rufato; GOUVEIA, Eder Maxwell; BIOLO, Karlo Domelles; DUARTE, Ricardo Jordao; Hiep Nguyen; SROUGI, MiguelBackground and Purpose: Becoming proficient in laparoscopic surgery is dependent on the acquisition of specialized skills that can only be obtained from specific training. This training could be achieved in various ways using inanimate models, animal models, or live patient surgery-each with its own pros and cons. Currently, there are substantial data that support the benefits of animal model training in the initial learning of laparoscopy. Nevertheless, whether these benefits extent themselves to moderately experienced surgeons is uncertain. The purpose of this study was to determine if training using a porcine model results in a quantifiable gain in laparoscopic skills for moderately experienced laparoscopic surgeons. Materials and Methods: Six urologists with some laparoscopic experience were asked to perform a radical nephrectomy weekly for 10 weeks in a porcine model. The procedures were recorded, and surgical performance was assessed by two experienced laparoscopic surgeons using a previously published surgical performance assessment tool. The obtained data were then submitted to statistical analysis. Results: With training, blood loss was reduced approximately 45% when comparing the averages of the first and last surgical procedures (P = 0.006). Depth perception showed an improvement close to 35% (P = 0.041), and dexterity showed an improvement close to 25% (P = 0.011). Total operative time showed trends of improvement, although it was not significant (P = 0.158). Autonomy, efficiency, and tissue handling were the only aspects that did not show any noteworthy change (P = 0.202, P = 0.677, and P = 0.456, respectively). Conclusions: These findings suggest that there are quantifiable gains in laparoscopic skills obtained from training in an animal model. Our results suggest that these benefits also extend to more advanced stages of the learning curve, but it is unclear how far along the learning curve training with animal models provides a clear benefit for the performance of laparoscopic procedures. Future studies are necessary to confirm these findings and better understand the impact of this learning tool on surgical practice.
- Laparoscopic Insertion of Various Shaped Trocars in a Porcine Model(2019) MORENO, Danilo Galante; PEREIRA, Cesar Augusto Martins; ANNA, Ricardo Kyoiti Sant; AZEVEDO, Rafael Ulysses de; SAVIO, Luiz Felipe; DUARTE, Ricardo Jordao; SROUGI, Miguel; PASSEROTTI, Carlo CamargoBackground and Objective: The number of laparoscopic procedures increases annually with an estimated 3% of complications, one third of them linked to Verres' needle or trocar insertion. The safety and efficacy of ports insertion during laparoscopic surgery may be related the technique but also to trocar design. This study aims to compare physical parameters of abdominal wall penetration for 5 different trocars. Methods: Eleven pigs were studied. Five different commercially available trocars were randomically inserted at the midline. Real-time video recording of the insertions was achieved to measure the excursion of the abdominal wall and the time and distance the cutting surface of the bladed trocars was exposed inside the abdominal cavity. An especially designed hand sensor was developed and placed between the trocar and the hand of the surgeon to record force required for abdominal wall perforation. Results: Greater deformations and forces occurred in non-bladed as compared to bladed trocars, and in conical trocars as compared to pyramidal pointed ones, except for peritoneum perforation. Greater distance and time of blade exposure occurred in pyramidal laminae as compared to conical. Conclusion: The bladed trocars have lower forces and deformations in their introduction, and should be those that cause less injury and are more suitable for first entry. Conical and pyramidal trocars with the same blade size showed similar force, deformation, time, and distance of exposed blade.
conferenceObject Elaborating a learning program on laparoscopy: Assessment of the evolution of the novices' performance according to initial training with simulator or animal model(2012) DUARTE, R. J.; BRITO, A. H.; PASSEROTTI, C.; JR, J. R. Colombo; ARAP, M.; I, A. Mitre; SROUGI, M.INTRODUCTION & OBJECTIVES: This study sought to determinate the most efficient sequence for training new surgeons in laparoscopy: beginning with simulators, followed by surgery on animals, or beginning with surgery on animals and then using manual and virtual simulators. MATERIAL & METHODS: Forty-eight medical students without any experience in laparoscopy were enrolled and split into two groups. Group A consisted of 24 students who started with laparoscopic nephrectomy on pigs, followed by the use of simulators. Group B consisted of 24 students who started with manual and virtual simulators, followed by nephrectomy. In group A, one student performed the surgery, while the other used a camera over a one hour period, after which they switched roles(arterial clipping 30 points; vein clipping 30 points; complete nephrec tomy 20 points; no accidents 20 points). In group B, six pairs of students started with the virtual simulator in cutting and tying activities(50 points). Another six pairs of students began with the manual simulator, evaluated by a board incutting and tying(50 points). After one hour, the students changed roles. Nonparametric test was init ially applied to assess any starting point difference among groups. Then groups A and B were assessed regarding the score index improvement independently of the training sequence, in order to disclose an eventual difference of rhythm of improvement between groups. If a di fference of rhythm of improvement of the score between groups A and b was detected, the data were analyzed in order to disclose the sequence with the most increased score variation. RESULTS: There was no absolute variation of score between groups from the starting until the end of training (p=0.124 and p= 0.053). However, there was a difference in the rhythm of improvement of the novices, when we compare groups from the start to the end of training period (p<0.0001). The analysis of the absolute variation of the score according to the initial sequence of training, showed that the group who started in the animal model presented a skill improvement of 30.5% when after training on the si mulator, although those who started training in simulators presented a performance improvement of 98% after training in animal(p<0.001). CONCLUSIONS: Our data show that nov ice surgeons who start training in animal model have poor improvement with forward training with simulators. These data and the ethical and economic issues will be considered for the refinement of an educational curriculum.- Does Warm-Up Training in a Virtual Reality Simulator Improve Surgical Performance? A Prospective Randomized Analysis(2016) CRUZ, Jose Arnaldo Shiomi da; REIS, Sabrina Thalita dos; FRATI, Rodrigo Marcus Cunha; DUARTE, Ricardo Jordao; Hiep Nguyen; SROUGI, Miguel; PASSEROTTI, Carlo CamargoINTRODUCTION: Virtual reality surgical simulators (VRSS) have been showing themselves as a valuable tool in laparoscopy training and education. Taking in consideration the effectiveness of the VRSS, new uses for this tool have been purposed. In sports, warming up before exercise clearly shows benefit in performance. It is hypothesized that warming up in the VRSS before going to the operating room may show benefit in surgical performance. OBJECTIVE: Verify whether there is benefit in surgical performance with preoperatory warm-up using a VRSS. MATERIALS AND METHODS: A total of 20 medical students with basic knowledge in laparoscopy were divided in 2 groups (I and II). Group I performed a laparoscopic cholecystectomy in a porcine model. Group II performed preoperative warm-up in a VRSS and then performed a laparoscopic cholecystectomy in a porcine model. The performance between both groups was compared regarding quantitative parameters (time for dissection of the gallbladder pedicle, time for clipping the pedicle, time for cutting the pedicle, time for gallbladder removal, total operative time, and aspirated blood loss) and qualitative parameters (depth perception, bimanual dexterity, efficiency, tissue handling, and autonomy) based on a previously validated score system, in which the higher the score, the better the result. Data were analyzed with level of significance of 5%. RESULTS: The group that underwent preoperative warm-up (group II) showed significantly superior results as to the time for dissection of the gallbladder pedicle (11.91 +/- 9.85 vs. 4.52 +/- 2.89 min, p = 0.012), time for clipping the pedicle (5.51 2.36 vs. 2.89 +/- 2.76 min, p = 0.004), time for cutting the pedide (1.84 +/- 0.7 vs. 1.13 +/- 0.51, p = 0.019), aspirated blood loss (171 +/- 112 vs. 57 +/- 27.8 ml, p = 0.006), depth perception (4.5 +/- 0.7 vs. 3.3 +/- 0.67, p = 0.004), bianual dexterity (4.2 +/- 0.78 vs. 3.3 +/- 0.67, p = 0.004), tissue handling (4.2 +/- 0.91 vs. 3.6 +/- 0.66, p = 0.012), and autonomy (4.9 +/- 0.31 vs. 3.6 +/- 0.96, p = 0.028). There was no difference in time for gallbladder removal (11.58 +/- 4.31 vs. 15.08 +/- 4.51 min, p = 0.096), total operative time (30.8 +/- 11.07 vs. 25.60 +/- 5.10 min, p = 0.188), and efficiency (4 0.66 vs. 3.6 +/- 0.69, p = 0.320). CONCLUSION: The practice of preoperative warm-up training seems to benefit surgical performance even in subject with mild laparoscopic experience.
- Can the learning of laparoscopic skills be quantified by the measurements of skill parameters performed in a virtual reality simulator?(2013) SANDY, Natascha Silva; CRUZ, Jose Arnaldo Shiomi da; PASSEROTTI, Carlo Camargo; NGUYEN, Hiep; REIS, Sabrina Thalita dos; GOUVEIA, Eder Maxwell; DUARTE, Ricardo Jordao; BRUSCHINI, Homero; SROUGI, MiguelPurpose: To ensure patient safety and surgical efficiency, much emphasis has been placed on the training of laparoscopic skills using virtual reality simulators. The purpose of this study was to determine whether laparoscopic skills can be objectively quantified by measuring specific skill parameters during training in a virtual reality surgical simulator (VRSS). Materials and Methods: Ten medical students (with no laparoscopic experience) and ten urology residents (PGY3-5 with limited laparoscopic experience) were recruited to participate in a ten-week training course in basic laparoscopic skills (camera, cutting, peg transfer and clipping skills) on a VRSS. Data were collected from the training sessions. The time that individuals took to complete each task and the errors that they made were analyzed independently. Results: The mean time that individuals took to complete tasks was significantly different between the groups (p < 0.05), with the residents being faster than the medical students. The residents' group also completed the tasks with fewer errors. The majority of the subjects in both groups exhibited a significant improvement in their task completion time and error rate. Conclusion: The findings in this study demonstrate that laparoscopic skills can be objectively measured in a VRSS based on quantified skill parameters, including the time spent to complete skill tasks and the associated error rate. We conclude that a VRSS is a feasible tool for training and assessing basic laparoscopic skills.