RESUMO
Introdução: Avaliar os níveis de conhecimento, interesse e treinamento dos cirurgiões inscritos no Colégio Brasileiro dos Cirurgiões (CBC) da cidade de Porto Alegre, Rio Grande do Sul, em relação à cirurgia robótica. Métodos: Estudo transversal, baseado em informações coletadas por meio de questionário enviado via plataforma digital para potenciais participantes. O formulário continha perguntas estruturadas e autoaplicáveis, a fim de caracterizar o perfil profissional, capacitação em cirurgia minimamente invasiva, conhecimento, opinião e treinamento específico em cirurgia robótica. Resultados: Dos 146 membros inscritos no CBC na cidade de Porto Alegre, 99 (67,8%) responderam ao questionário. Houve predomínio do sexo masculino (88%) e a mediana de idade dos participantes foi de 48 anos. Os procedimentos videolaparoscópicos ou vídeo-assistidos foram maioria na rotina dos cirurgiões. Da totalidade da amostra, a maior parte (78%) já assistiu ao menos um procedimento robótico, e um terço (n = 30) já realizou algum tipo de treinamento ou simulação em cirurgia robótica. Entre os que não realizaram, dois terços pretendem se qualificar no futuro. Apenas 10% dos cirurgiões possuem certificação na área. Conclusão: A maioria dos cirurgiões respondentes inscritos no CBC em Porto Alegre tem em sua rotina predominância de procedimentos minimamente invasivos e acredita que a plataforma robótica será o futuro da cirurgia. Embora ainda não disponível na maioria dos serviços gaúchos, espera-se que o desenvolvimento de novas plataformas e a redução dos custos envolvidos na aquisição de equipamento e de capacitação do cirurgião facilitem a disseminação dessa tecnologia.
Introduction: To assess the practical knowledge, interest, and training levels of surgeons enrolled in the Brazilian College of Surgeons (CBC) of the municipality of Porto Alegre, Rio Grande do Sul, regarding robotic surgery. Methods: Cross-sectional study, based on information collected with a questionnaire sent to potential participants via digital platform. The form contained structured and self-administered questions, to characterize their professional profile, skills in minimally invasive surgery, knowledge, opinion, and specific training in robotic surgery. Results: Of the 146 members enrolled in the CBC of the municipality of Porto Alegre, 99 (67.8%) responded to the questionnaire. Most were males (88%) with a mean age of 48 years. Video-laparoscopic or video-assisted procedures were the most frequent in the participants' practice. Of the sample, most (78%) already watched at least one robotic surgery, and one third (n = 30) had already completed some sort of training or simulation course in robotic surgery. Among those who did not, two thirds intend to pursue formal training in the future. Only 10% of participating surgeons are certified in the area. Conclusion: Most responding surgeons enrolled in the CBC in Porto Alegre perform mostly minimally invasive procedures daily and believe that the robotic technology will be the future of surgery. Although not yet available in most services of the state of Rio Grande do Sul, it is expected that the development of new platforms and the reduction of costs involved in equipment acquisition and surgical training will facilitate the dissemination of this technology.
Assuntos
Procedimentos Cirúrgicos Robóticos/educação , Cirurgiões , Estudos Transversais , Competência Clínica , Treinamento por SimulaçãoRESUMO
Introdução: A apendicectomia é o tratamento de escolha da apendicite aguda. Embora a preferência pelas técnicas minimamente invasivas seja tendência mundial, a cirurgia aberta ainda é realidade na maioria dos hospitais públicos. O índice de complicações pós-operatórias varia de acordo com a técnica cirúrgica empregada. O presente estudo objetiva comparar a incidência de complicações pós-operatórias entre a apendicectomia aberta e laparoscópica. Métodos: Coorte retrospectiva incluindo pacientes submetidos à apendicectomia no Hospital de Pronto Socorro de Porto Alegre entre novembro de 2015 a novembro de 2019. Foram avaliados dados demográficos, tempo de evolução dos sintomas, técnica cirúrgica, achados transoperatórios, necessidade de drenos ou ostomias, tempo cirúrgico, tempo de internação, experiência do cirurgião e desfechos. Resultados: Foram incluídos 358 pacientes, com idade de 32 ± 13,8 anos, e predomínio do sexo masculino (58,9%); 58,1% foram submetidos a cirurgia aberta, 41,9% a laparoscopia e 8% necessitaram conversão. As apendicites foram classificadas como complicadas em um terço dos casos. O tempo cirúrgico foi menor na cirurgia aberta (79,3 ± 38,8 vs. 104 ± 35,2 minutos; p < 0,001). O índice de complicações pós-operatórias foi de 21,2%, sendo significativamente maior na técnica aberta (26,4% vs. 13%; p = 0,003). O tempo de internação, a necessidade de reintervenção e mortalidade não apresentaram diferença entre as técnicas. Conclusão: Embora a apendicectomia aberta seja um procedimento seguro, com bons resultados e baixa morbimortalidade, a laparoscopia oferece potenciais vantagens em termos de evolução pós-operatória, inclusive em casos complicados. Deve ser indicada rotineiramente havendo disponibilidade de material e capacitação da equipe cirúrgica. (AU)
Introduction: Appendectomy is the treatment of choice for acute appendicitis. Although the preference for minimally invasive techniques is a worldwide trend, open surgery remains a reality in most public hospitals. The rate of postoperative complications varies according to the surgical technique employed. The present study aimed to compare the incidence of postoperative complications between open and laparoscopic appendectomy. Methods: This retrospective cohort study included patients undergoing appendectomy at the Hospital de Pronto Socorro de Porto Alegre between November 2015 and November 2019. Demographic and clinical data, duration of symptoms, surgical technique, intraoperative findings, use of abdominal drains or stomas, operative time, length of stay, surgeon's experience, and outcomes were assessed. Results: Three hundred and fifty-eight patients were included, predominantly male (58.9%), with a mean age of 32 ± 13.8 years; 58.1% underwent open surgery, 41.9% underwent laparoscopic surgery, and 8% required conversion. One third of the cases were classified as complicated. The mean operative time was shorter for open surgery (79.3 ± 38.8 vs. 104 ± 35.2 minutes; p < 0.001). The rate of postoperative complications was 21.2%, with a significantly higher incidence in the open technique (26.4% vs. 13%; p = 0.003). Length of stay, reoperation rate, and mortality did not differ between the techniques. Conclusions: Although open appendectomy is a safe and efficient procedure, associated with low morbidity and mortality rates, laparoscopy provides potential clinically beneficial advantages in terms of postoperative outcomes, even in complicated cases. Therefore, it should be routinely performed where laparoscopic equipment and skillful staff are available. (AU)
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Apendicectomia/efeitos adversos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Laparoscopia , Complicações Pós-OperatóriasRESUMO
BACKGROUND: The global crisis resulting from the coronavirus pandemic has imposed a large burden on health systems worldwide. Nonetheless, acute abdominal surgical emergencies are major causes for nontrauma-related hospital admissions and their incidences were expected to remain unchanged. Surprisingly, a significant decrease in volume and a higher proportion of complicated cases are being observed worldwide. METHODS: The present study assesses the local impact of the coronavirus pandemic on the emergency presentation of acute appendicitis in a Brazilian hospital. A retrospective analysis was conducted on patients undergoing emergency surgery for the clinically suspected diagnosis of acute appendicitis during the 2-month period of March and April 2020 and the same time interval in the previous year. Data on demographics, timing of symptom onset and hospital presentation, intraoperative details, postoperative complications, hospital length of stay, and histological examination of the specimen were retrieved from individual registries. RESULTS: The number of appendectomies during the pandemic was 36, which represents a 56% reduction compared to the 82 patients operated during the same period in 2019. The average time of symptom onset to hospital arrival was significantly higher in 2020 (40.6 vs. 28.2 hours, P = .02). The classification of appendicitis revealed a significant higher proportion of complicated cases than the previous year (33.3% vs. 15.2%, P = .04). The rate of postoperative complications and the average length of stay were not statistically different between the groups. CONCLUSION: Further assessment of patients' concerns and systematic monitoring of emergency presentations are expected to help us understand and adequately address this issue.
Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , COVID-19/epidemiologia , Emergências , Serviço Hospitalar de Emergência/estatística & dados numéricos , SARS-CoV-2 , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicite/epidemiologia , Brasil/epidemiologia , Criança , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
The evolution of robotic platforms has brought up ethical, economic, educational, and clinical applicability issues that refer to the early 1990s, when laparoscopy began its dissemination as a technology that would revolutionize surgery. Introduced in Brazil since 1990, laparoscopy has received a lot of resistance from different sectors, including the medical academy itself. The technique was considered expensive, complex, poorly available and with limited clinical applications. However, in a short time, it was established as the gold standard for the treatment of most diseases in different organ systems and surgical specialties. At this time, similarly to laparoscopy, robotic surgery is expressed as a disruptive technology, determining an important breakdown of paradigms, and moving the wheel of history forward. The author draws a parallel in relation to the use of both technologies in the surgeon's armamentarium. The fear of the "new technology", seen when laparoscopy appeared, is repeated with the advent of robotic surgery. Laparoscopy and robotic surgery, at the same time, imposed new knowledge challenges for surgeons, anesthetists, nurses, engineers - the need to learn again, to develop new skills. The previous experience of implementing laparoscopy should always be remembered and considered, optimizing the current scenario of the robotic platform, in its introduction and dissemination with the surgical community. The advent of the "robotic era" and its evolutionary potential will continue to assist surgeons in their mission to serve their patients with quality and safety.
Assuntos
Laparoscopia/história , Procedimentos Cirúrgicos Robóticos/história , Robótica/história , Cirurgiões , Brasil , História do Século XX , História do Século XXI , HumanosRESUMO
OBJECTIVE: to appraise the general profile of the Brazilian robotic surgeon and the acknowledgment of the new certification process for robotic surgery upon the Associação Médica Brasileira (AMB - Brazilian Medical Association) statement. According to the AMB statement, medical societies and proctors have to achieve leading roles in training and certification of surgeons, acting in partnership with industry. METHODS: a national web-based survey was promoted by the Colégio Brasileiro de Cirurgiões (CBC - Brazilian College of Surgeons) among their members. RESULTS: the 294 answers were split into two groups: 133 (45.3%) who had robotic console certification, and 161 (54.8%) who did not have it. The overall median age was 46, but the non-robotic group presented more surgeons with at least 30 years of experience than to the robotic group (32.3% versus 23.3%, p=0.033). Surgeons with robotic certification more frequently work in a city with at least one million inhabitants than surgeons who were not certified (85.7 versus 63.4%, p<0.001). The majority of surgeons in both groups have similar positioning for all main points of the statement. However, the agreement proportions for the preceptors responsibility during the procedures were higher among non-robotic surgeons that expected the preceptor to assume co-responsibility for the procedure (85% versus 60.9%, p<0.001), and intervene during the procedure as much as necessary (97.5% versus 91.7%, p=0.033). CONCLUSION: the overall agreement of the answers to the AMB statement seems to be a promising pathway to increase the participation of the medical entities into the robotic certification in Brazil.
Assuntos
Procedimentos Cirúrgicos Robóticos , Brasil , Certificação , Humanos , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
One of the struggles faced by physicians in clinical decisions during the COVID-19 pandemic is how to deal with already available or lacking scientific evidence. The COVID-19 pandemic has a large impact in the routine of the many health services, including surgery, which demanded changes in assist protocols. Questions began to arise about well-established surgery conducts due to situations related to SARS-COV-2 infection, and, according to public health measures that are necessary to fight the pandemic. In situations of scarce available evidence, it is natural for us to have to deal with systematically more fragile, provisory and bias-susceptible information. Considering the principles that guide Evidence Based Medicine and Bioethical, the authors analyze the complexity of the medical decision-making during this time. Medical conducts must be adapted to the context of fighting the pandemic and consider patients and healthcare providers exposure and well-being and, lastly, the conservation of resources. The authors conclude that acceptance and tolerance to divergence is commendable, being a path to achieving unity in the diversity of medicine in times of little safe knowledge.
Assuntos
Infecções por Coronavirus , Medicina Baseada em Evidências , Pandemias , Médicos , Pneumonia Viral , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , SARS-CoV-2Assuntos
Infecções por Coronavirus , Coronavirus , Pandemias , Pneumonia Viral , Cirurgiões , Betacoronavirus , COVID-19 , Humanos , SARS-CoV-2RESUMO
With the expansion of robotic surgical procedures, the acquisition of specific knowledge and skills for surgeons to reach proficiency seems essential before performing surgical procedures on humans. In this sense, the authors present a proposal to establish a certification based on objective and validated criteria for carrying out robotic procedures. A study was carried out by the Committee on Minimally Invasive and Robotic Surgery of the Brazilian College of Surgeons based on a reviewing strategy of the scientific literature. The study serves as a reference for the creation of a standard for the qualification and certification in robotic surgery according to a statement of the Brazilian Medical Association (AMB) announced on December 17, 2019. The standard proposes a minimum curriculum, integrating training and performance evaluation. The initial (pre-clinical) stage aims at knowledge and adaptation to a specific robotic platform and the development of psychomotor skills based on surgical simulation. Afterwards, the surgeon must accompany in person at least five surgeries in the specialty, participate as a bedside assistant in at least 10 cases and perform 10 surgeries under the supervision of a preceptor surgeon. The surgeon who completes all the steps will be considered qualified in robotic surgery in his specialty. The final certification must be issued by the specialty societies affiliated to AMB. The authors conclude that the creation of a norm for habilitation in robotic surgery should encourage Brazilian hospitals to apply objective qualification criteria for this type of procedure to qualify assistance.
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Procedimentos Cirúrgicos Robóticos , Cirurgiões , Brasil , Competência Clínica , Currículo , HumanosRESUMO
ABSTRACT The evolution of robotic platforms has brought up ethical, economic, educational, and clinical applicability issues that refer to the early 1990s, when laparoscopy began its dissemination as a technology that would revolutionize surgery. Introduced in Brazil since 1990, laparoscopy has received a lot of resistance from different sectors, including the medical academy itself. The technique was considered expensive, complex, poorly available and with limited clinical applications. However, in a short time, it was established as the gold standard for the treatment of most diseases in different organ systems and surgical specialties. At this time, similarly to laparoscopy, robotic surgery is expressed as a disruptive technology, determining an important breakdown of paradigms, and moving the wheel of history forward. The author draws a parallel in relation to the use of both technologies in the surgeon's armamentarium. The fear of the "new technology", seen when laparoscopy appeared, is repeated with the advent of robotic surgery. Laparoscopy and robotic surgery, at the same time, imposed new knowledge challenges for surgeons, anesthetists, nurses, engineers - the need to learn again, to develop new skills. The previous experience of implementing laparoscopy should always be remembered and considered, optimizing the current scenario of the robotic platform, in its introduction and dissemination with the surgical community. The advent of the "robotic era" and its evolutionary potential will continue to assist surgeons in their mission to serve their patients with quality and safety.
RESUMO A evolução das plataformas robóticas tem trazido à discussão questões éticas, econômicas, educacionais e de aplicabilidade clínica que remetem ao início dos anos 1990, quando a videolaparoscopia iniciava a sua disseminação como tecnologia que revolucionaria a cirurgia. Introduzida no Brasil a partir de 1990, a videolaparoscopia recebeu muita resistência por parte de diferentes setores, incluindo a própria academia médica. A técnica foi considerada muito cara, complexa, pouco disponível e com aplicações clínicas limitadas. No entanto, em pouco tempo, se estabeleceu como padrão-ouro para o tratamento de grande parte das doenças em diferentes sistemas orgânicos e especialidades cirúrgicas. Neste momento, de forma semelhante à videolaparoscopia, a cirurgia robótica se expressa como tecnologia disruptiva, determinando importante quebra de paradigmas e movendo adiante a roda da história. O autor traça um paralelo em relação a utilização de ambas tecnologias no armamentário dos cirurgiões. O medo da "nova tecnologia", visto quando do aparecimento da videolaparoscopia, se repete com o advento da cirurgia robótica. Videolaparoscopia e cirurgia robótica, ao seu tempo, impuseram novos desafios de conhecimento para cirurgiões, anestesistas, enfermeiros, engenheiros - necessidade de aprender de novo, desenvolver novas habilidades. A experiencia pregressa da implantação da videolaparoscopia deve ser sempre lembrada e considerada, otimizando o cenário atual da plataforma robótica, na sua introdução e disseminação junto à comunidade cirúrgica. O advento da "era robótica" e seu potencial evolutivo continuarão a auxiliar os cirurgiões em sua missão de atender com qualidade e segurança seus pacientes.
Assuntos
História do Século XX , História do Século XXI , Robótica/história , Laparoscopia/história , Procedimentos Cirúrgicos Robóticos/história , Cirurgiões , BrasilRESUMO
ABSTRACT With the expansion of robotic surgical procedures, the acquisition of specific knowledge and skills for surgeons to reach proficiency seems essential before performing surgical procedures on humans. In this sense, the authors present a proposal to establish a certification based on objective and validated criteria for carrying out robotic procedures. A study was carried out by the Committee on Minimally Invasive and Robotic Surgery of the Brazilian College of Surgeons based on a reviewing strategy of the scientific literature. The study serves as a reference for the creation of a standard for the qualification and certification in robotic surgery according to a statement of the Brazilian Medical Association (AMB) announced on December 17, 2019. The standard proposes a minimum curriculum, integrating training and performance evaluation. The initial (pre-clinical) stage aims at knowledge and adaptation to a specific robotic platform and the development of psychomotor skills based on surgical simulation. Afterwards, the surgeon must accompany in person at least five surgeries in the specialty, participate as a bedside assistant in at least 10 cases and perform 10 surgeries under the supervision of a preceptor surgeon. The surgeon who completes all the steps will be considered qualified in robotic surgery in his specialty. The final certification must be issued by the specialty societies affiliated to AMB. The authors conclude that the creation of a norm for habilitation in robotic surgery should encourage Brazilian hospitals to apply objective qualification criteria for this type of procedure to qualify assistance.
RESUMO Com a expansão da realização de procedimentos cirúrgicos robóticos, a aquisição de conhecimentos e habilidades específicas para que o cirurgião alcance proficiência antes de realizar procedimentos cirúrgicos em humanos torna-se fundamental. Neste sentido, os autores apresentam uma proposta de estabelecimento de uma certificação baseada em critérios objetivos e validados para a realização de procedimentos robóticos. Um estudo foi executado pela Comissão de Cirurgia Minimamente Invasiva e Robótica do Colégio Brasileiro de Cirurgiões baseado em uma estratégia de revisão da literatura científica. O estudo serve de referência para a criação de uma normativa para a habilitação e certificação em cirurgia robótica de acordo com comunicado da Associação Médica Brasileira anunciado em 17 de dezembro de 2019. A normativa propõe um currículo mínimo, integrando treinamento e avaliação de desempenho. A etapa inicial (pré-clínica) visa o conhecimento e adaptação a uma plataforma robótica específica e o desenvolvimento de habilidades psicomotoras baseada em simulação cirúrgica. Após, o cirurgião deverá acompanhar presencialmente pelo menos cinco cirurgias na especialidade, participar como cirurgião auxiliar em pelo menos 10 casos e realizar 10 cirurgias sob supervisão de um cirurgião preceptor. O cirurgião que concluir todas as etapas será considerado habilitado em cirurgia robótica em sua especialidade. A certificação de habilitação definitiva deverá ser emitida pelas sociedades de especialidades filiadas à AMB. Os autores concluem que a criação de uma normativa para habilitação em cirurgia robótica deve estimular que os hospitais brasileiros apliquem critérios objetivos de habilitação para este tipo de procedimento, no sentido de qualificar a assistência.