Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492008000300008
Jornal Vascular Brasileiro
Original Article

Curva de aprendizado em cirurgia aórtica videolaparoscópica: estudo experimental em porcos

Laparoscopic aortic surgery learning curve: experimental study in pigs

Ricardo de Alvarenga Yoshida; Winston Bonetti Yoshida; Hamilton de Almeida Rollo; Ralf Kolvenbach; Sílvia Elaine Rodolfo de Sá Lorena

http://dx.doi.org/10.1590/S1677-54492008000300008 J Vasc Bras, vol.7, n3, p.231-238, 2008
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Resumo

CONTEXTO: A cirurgia videolaparoscópica (CVL) vem evoluindo como alternativa cirúrgica menos invasiva para o tratamento da doença aterosclerótica oclusiva aorto-ilíaca e do aneurisma da aorta abdominal. Poucos estudos avaliaram objetivamente a curva de aprendizado com essa técnica em cirurgia vascular. OBJETIVO: Avaliar objetivamente os tempos e a evolução de cada passo cirúrgico e demonstrar a exeqüibilidade dessa técnica. MÉTODOS: Entre outubro 2007 e janeiro de 2008, dois cirurgiões vasculares iniciantes na CVL operaram, após cursos e treinamentos, seis porcos consecutivos, com dissecção aórtica e interposição de um enxerto de dácron em um segmento da aorta infra-renal abdominal, com técnica totalmente laparoscópica. RESULTADOS: Todos os tempos cirúrgicos foram decrescentes ao longo do estudo, apresentando redução de 45,9% no tempo total de cirurgia, 85,8% no tempo de dissecção da aorta, 81,2% na exposição da aorta, 55,1% no clampeamento total, 71% na confecção da anastomose proximal e 64,9% na anastomose distal. CONCLUSÃO: O presente estudo mostrou que os resultados técnicos satisfatórios da CVL vascular ocorreram somente após longa curva de aprendizado, que foi decrescente ao longo do tempo, à medida que aumentou a experiência e vivência com os materiais e com a visão não-estereoscópica. Essa técnica pode ser realizada com perfeição por cirurgiões vasculares desde que façam cursos especializados, com treinamento em simuladores e animais, e desde que busquem constante aprimoramento a fim de conseguir resultados similares aos obtidos com a cirurgia convencional.

Palavras-chave

Cirurgia videoassistida, aorta, doenças vasculares, aprendizagem, modelos animais

Abstract

BACKGROUND: Laparoscopic aortic surgery (LAS) is evolving as a minimal invasive alternative technique for the treatment of abdominal aortic aneurysms and peripheral aortoiliac arterial disease. Few articles have objectively evaluated the technique learning curve in vascular surgery. OBJECTIVE: The aim of the present experimental study was to demonstrate surgical feasibility and evaluate each surgical step of LAS. METHODS: Between October 2007 and January 2008, two beginning surgeons attended laparoscopic courses and operated on six consecutive pigs with a total laparoscopic retroperitoneal aortic dissection and interposition of a Dacron tube graft in the infrarenal aortic segment. Both anastomoses were performed under total laparoscopic technique. RESULTS: All surgical time curves decreased along time: 45.9% in total surgical time, 85.8% in dissection time, 81.2% in aortic exposure, 55.1% in total cross-clamping, 71% in proximal anastomosis and 64.9% in distal anastomosis. CONCLUSION:This experimental study showed that satisfactory results with LAS were only reached after a long learning curve. However, this learning curve decreased along time, as experience with the technique, materials and non-stereoscopic vision improved. Vascular surgeons should attend practical courses and should have training opportunities in simulators and animals to achieve results similar to those of conventional surgery.

Keywords

Video-assisted surgery, aorta, vascular diseases, learning, animal models

References

Kolvenbach R, Yoshida RAY. Cirurgia aórtica videolaparoscópica. Doenças vasculares periféricas. 2008;2.

Lin JC, Kolvenbach R, Schwierz E, Wassiljew S. Total laparoscopic aortofemoral bypass as a routine procedure for the treatment of aortoiliac occlusive disease. Vascular. 2005;13:80-3.

Kolvenbach R. Total laparoscopic aortic aneurysm surgery. Acta Chir Belg. 2006;106:36-9.

Coggia M, Javerliat I, Di Centa I. Total laparoscopic infrarenal aortic aneurysm repair: preliminary results. J Vasc Surg. 2004;40:448-54.

Coggia M, Di Centa I, Javerliat I, Alfonsi P, Kitzis M, Goeau-Brissonniere OA. Total laparoscopic abdominal aortic aneurysms repair. J Cardiovasc Surg (Torino). 2005;46:407-14.

Kolvenbach R, Ceshire N, Pinter L, Da Silva L, Deling O, Kasper AS. Laparoscopy-assisted aneurysm resection as a minimal invasive alternative in patients unsuitable for endovascular surgery. J Vasc Surg. 2001;34:216-21.

Ahn SS, Ro KM. Laparoscopic aortobifemoral bypass. Ann Vasc Surg. 1998;12:625-8.

Kolvenbach R, Da Silva L, Deling O, Schwierz E. J Am Coll Surg. 2000;190:451-7.

Javerliat I, Coggia M, Di Centa I, Kitzis M, Mercier O, Goeau-Brissonniere O. Total laparoscopic abdominal aortic aneurysm repair with reimplantation of the inferior mesenteric artery. J Vasc Surg. 2004;39:1115-7.

Dion YM, Cardon A, Hartung O, Gracia CR. Laparoscopic Aorto-Iliac Surgery: Present Status and Future Perspectives. Surg Technol Int. 2000;VIII:201-207.

Ferrari M, Adami D, Del Corso A. Laparoscopy-assisted abdominal aortic aneurysm repair: early and middle-term results of a consecutive series of 122 cases. J Vasc Surg. 2006;43:695-700.

Mercier O, Coggia M, Javerliat I, Di Centa I, Colacchio G, Goeau-Brissonniere O. Total laparoscopic repeat aortic surgery. J Vasc Surg. 2004;40:822-5.

Kolvenbach R. The role of video-assisted vascular surgery. Eur J Vasc Endovasc Surg. 1998;15:377-9.

Silva L, Kolvenbach R, Pinter L. The feasibility of hand-assisted laparoscopic aortic bypass using a low transverse incision. Surg Endosc. 2002;16:173-6.

Wassiljew S, Kolvenbach R, Puerschel A, Schwierz E. Total laparoscopic iliac artery aneurysm repair using endoscopic techniques and endovascular balloon occlusion. Eur J Vasc Endovasc Surg. 2006;32:270-2.

Dion YM. History and perspectives in laparoscopic vascular surgery. Acta Chir Belg. 2004;104:493-8.

Munro MG. Laparoscopic access: complications, technologies, and techniques. Curr Opin Obstet Gynecol. 2002;14:365-74.

Kolvenbach R, Deling O, Schwierz E, Landers B. Reducing the operative trauma in aortoiliac reconstructions: a prospective study to evaluate the role of video-assisted vascular surgery. Eur J Vasc Endovasc Surg. 1998;15:483-8.

Alfonsi P, Vieillard-Baron A, Coggia M. Cardiac function during intraperitoneal CO2 insufflation for aortic surgery: a transesophageal echocardiographic study. Anesth Analg. 2006;102:1304-10.

Byrne J, Hallett JW Jr., Ilstrup DM. Physiologic responses to laparoscopic aortofemoral bypass grafting in an animal model. Ann Surg. 2000;231:512-8.

Polat C, Yilmaz S, Serteser M, Koken T, Kahraman A, Dilek ON. The effect of different intraabdominal pressures on lipid peroxidation and protein oxidation status during laparoscopic cholecystectomy. Surg Endosc. 2003;17:1719-22.

Coggia M, Javerliat I, Di Centa I. Total laparoscopic versus conventional abdominal aortic aneurysm repair: a case-control study. J Vasc Surg. 2005;42:906-10.

Dion YM, Hartung O, Gracia C, Doillon C. Experimental laparoscopic aortobifemoral bypass with end-to-side aortic anastomosis. Surg Laparosc Endosc. 1999;9:35-8.

Fusco PEB, Marino HLT, Natal SRB. Enxerto aorto-femoral por via laparoscópica: modelo experimental. J Vasc Bras. 2005;4:396-400.

Dion YM, Gracia C. Experimental laparoscopic aortic aneurysm resection and aortobifemoral bypass. Surg Laparosc Endosc. 1996;6:184-90.

Dion YM, Gaillard F, Demalsy JC, Gracia CR. Experimental laparoscopic aortobifemoral bypass for occlusive aortoiliac disease. Can J Surg. 1996;39:451-5.

Dion YM, Chin AK, Thompson TA. Experimental laparoscopic aortobifemoral bypass. Surg Endosc. 1995;9:894-7.

Dion YM, Cardon A, Gracia CR, Doillon C. A model for laparoscopic aortic aneurysm resection. Surg Endosc. 1999;13:654-7.

Dion YM, Thaveau F, Fearn SJ. Current modifications to totally laparoscopic "apron technique". J Vasc Surg. 2003;38:403-6.

Coggia M, Bourriez A, Javerliat I, Goeau-Brissonniere O. Totally laparoscopic aortobifemoral bypass: a new and simplified approach. Eur J Vasc Endovasc Surg. 2002;24:274-5.

Dion YM, Katkhouda N, Rouleau C, Aucoin A. Laparoscopy-assisted aortobifemoral bypass. Surg Laparosc Endosc. 1993;3:425-9.

Dion YM, Griselli F, Douville Y, Langis P. Early and mid-term results of totally laparoscopic surgery for aortoiliac disease: lessons learned. Surg Laparosc Endosc Percutan Tech. 2004;14:328-34.

Kolvenbach R, Schwierz E, Wasilljew S, Miloud A, Puerschel A, Pinter L. Total laparoscopically and robotically assisted aortic aneurysm surgery: a critical evaluation. J Vasc Surg.. 2004;39:771-6.

Memon MA, Fitzgibbons RJ. Jr. Hand-assisted laparoscopic surgery (HALS): a useful technique for complex laparoscopic abdominal procedures. J Laparoendosc Adv Surg Tech A. 1998;8:143-50.

Zucker KA. Perceived future of laparoscopic general surgery. Can J Surg. 1992;35:297-304.

Kolvenbach R, Schwierz E. Combined endovascular/laparoscopic approach to aortic pseudoaneurysm repair. J Endovasc Surg.. 1998;5:191-3.

White GH, Yu W, May J, Chaufour X, Stephen MS. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management. J Endovasc Surg. 1997;4:152-68.

Kolvenbach R, Lin J. Combining laparoscopic and endovascular techniques to improve the outcome of aortic endografts: Hybrid techniques. J Cardiovasc Surg (Torino). 2005;46:415-23.

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