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"apellidos" => "Arango" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480611002865" "doi" => "10.1016/j.acuro.2011.06.020" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480611002865?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578612000388?idApp=UINPBA00004N" "url" => "/21735786/0000003600000001/v1_201304251735/S2173578612000388/v1_201304251735/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173578612000248" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2011.05.001" "estado" => "S300" "fechaPublicacion" => "2012-01-01" "aid" => "314" "copyright" => "AEU" "documento" => "article" "crossmark" => 0 "subdocumento" => "ssu" "cita" => "Actas Urol Esp. 2012;36:48-53" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2315 "formatos" => array:3 [ "EPUB" => 16 "HTML" => 1745 "PDF" => 554 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Urinary tract infections and their prevention" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "48" "paginaFinal" => "53" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La infección urinaria y su prevención" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. 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"apellidos" => "Dámaso" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480611002294" "doi" => "10.1016/j.acuro.2011.05.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480611002294?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578612000248?idApp=UINPBA00004N" "url" => "/21735786/0000003600000001/v1_201304251735/S2173578612000248/v1_201304251735/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Skill and talent</span>" "titulo" => "Animal model for training in laparoscopic pyeloplasty" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "54" "paginaFinal" => "59" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R.J. Valero, J. Moanack, G. Cruz, A. Sánchez-Ismayel, R. Sánchez-Salas, A. García-Seguí" "autores" => array:6 [ 0 => array:4 [ "nombre" => "R.J." "apellidos" => "Valero" "email" => array:1 [ 0 => "rairvalero@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Moanack" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "G." "apellidos" => "Cruz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Sánchez-Ismayel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "R." "apellidos" => "Sánchez-Salas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "A." "apellidos" => "García-Seguí" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamentos de Urología y de Cirugía III, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Urología, L’Institut Mutualiste Montsouris, París, France" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Urología, Hospital General Mateu Orfila, Mahón, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Modelo animal de entrenamiento en pieloplastia laparoscópica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1387 "Ancho" => 963 "Tamanyo" => 146079 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Suture. (A) Benchmarks at the distal end with Vicryl<span class="elsevierStyleSup">®</span> 3-0 between the esophagus and the crop. (B) Continuous sutures with Vicryl<span class="elsevierStyleSup">®</span> 3-0.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Since the 1980s, with the advent of laparoscopy, multiple surgical techniques that have somehow revolutionized the current urological practice have been developed. The extension of laparoscopy into new domains of urology has created the need to change the methodology of training. Whereas previously the practice of urologic laparoscopy was performed directly on the patient, today's practitioners of these techniques must ensure appropriate development of laparoscopic skills before starting their practice on patients, and, thus, provide optimal surgical technique with minimal complications.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Within the training process, some steps must be taken systematically and progressively, from inanimate models to live animal models. Initial practice on inanimate models improves eye-hand coordination; this should be followed by practice on animal models in wet laboratory, initially with dissection and ablative procedures such as nephrectomies, and gradually progressing to advanced techniques involving the laparoscopic suturing.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The rapid advancement of laparoscopic surgery and its insertion in urological practice have led the research and development of new training models that will allow the urologist to develop skills and abilities in each of the levels of complexity of training, which provide the development of a greater number of surgical procedures, with a more refined surgical technique and with better results.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">All this leads to the creation of an economical, simple, and reproducible training model to develop learning skills and abilities in urological laparoscopic techniques, especially for laparoscopic pyeloplasty. Ablative procedures are generally performed in the porcine model, but there are no effective animal models for the development of skills in reconstructive surgery, especially in laparoscopic pyeloplasty, hence the interest in developing a new animal model (<span class="elsevierStyleItalic">Gallus gallus</span>), specifically a segment of the gastrointestinal tract (esophagus and crop), to simulate the steps followed during laparoscopic pyeloplasty and, thus, allow the urologist the possibility to develop the technique and practice their skills in laparoscopic suturing.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Population and sample</span><p id="par0025" class="elsevierStylePara elsevierViewall">We used 8 adult birds (<span class="elsevierStyleItalic">G. gallus</span>), which were freshly killed and plucked, and large in size. We performed the Anderson Hynes type laparoscopic dismembered pyeloplasty technique, using a black box for laparoscopic training. The animal surgery was performed according to the parameters established by the Guide for the Care and Use of Laboratory Animals.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The selection of animals was carried out according to the size and characteristics of the tissues, following the bioethical standards for animal experimentation established by the Declaration of Helsinki.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Model preparation</span><p id="par0030" class="elsevierStylePara elsevierViewall">We proceeded to neck dissection, visualizing the structures of the same and separating the trachea from the esophagus and crop. Careful dissection was performed with emphasis on the connection between both structures. We proceeded to drain and rinse the content of the crop and esophagus. Both structures were filled with physiological solution using a 12 Fr Nelaton catheter (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Subsequently, the proximal esophagus was ligated with 0 silk suture right after removing the probe, making it possible to maintain the liquid in the cavity and, therefore, the proper form of the structures (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). The model was placed inside the black box in a transversal direction to the operator, making a proper fixing of the same to avoid its mobilization.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Surgical technique</span><p id="par0040" class="elsevierStylePara elsevierViewall">Three ports are placed respecting the principles of triangulation: central port for the optics (10–12<span class="elsevierStyleHsp" style=""></span>mm) and left and right ports for the clamps (5<span class="elsevierStyleHsp" style=""></span>mm). The surgeon is perpendicular to the animal model, and the first assistant to the surgeon's left. The instruments, optics, and laparoscopic clamps are introduced. The esophageal-crop junction is identified and dissected. A reference suture with Vicryl<span class="elsevierStyleSup">®</span> 3-0 is placed in the crop near the esophageal–crop junction. We proceed to the section and tissue resection (esophageal–crop junction), which represents the ureteropielic stenosis. Oblique section and spatulate of the esophagus is carried out. After anastomosis area orientation, we proceed to place reference points on the most distal end to the operator with Vicryl<span class="elsevierStyleSup">®</span> 3-0-SH needle between the esophagus and crop (ureteropielic junction) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">First, we perform raffia on the posterior side of the esophageal anastomosis with the crop with Vicryl<span class="elsevierStyleSup">®</span> 3-0-SH needle continuous sutures, and then the anterior side. The remaining defect of the crop is finally closed, simulating the renal pelvis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). We fill the esophagus and the crop through a Nelaton at the proximal end of the esophagus to verify impermeability of the suture (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). We proceed to the opening of the piece and the visual assessment of the anastomosis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B). Minor surgery equipment and basic instruments in laparoscopic surgery, a black box, and disposable laparoscopic material were used.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical method</span><p id="par0050" class="elsevierStylePara elsevierViewall">The statistical analysis of the data was performed using graphs and tables expressing the results of each procedure in a descriptive way. We used the SPSS application for data analysis. We calculated the mean and standard deviation for continuous variables; in the case of nominal variables, we calculated their frequencies and percentages. The comparison of surgical and preparation times between each surgeon was based on the non-parametric Mann–Whitney's <span class="elsevierStyleItalic">U</span> test, and in the case of contrasts, for each surgeon, we used Pearson's Chi-square test. A significant value of contrast was considered if <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05. The data were analyzed using JMP-SAS 9.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">A total of 8 chickens was included, 4 for each surgeon, representing, thus, 50% of the procedures and fairly evaluating each surgeon. We evaluated the model preparation time by each surgeon observing differences that persist until the third attempt, from which similar times can be observed. No statistically significant differences are evident when comparing the times of each individual surgeon, nor when comparing the times between them (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). On the other hand, there is an evident reduction in preparation time of 50% or more between the first and the fourth procedure of each surgeon, with times ranging from 14 to 6<span class="elsevierStyleHsp" style=""></span>min for surgeon 1, and 12 to 6<span class="elsevierStyleHsp" style=""></span>min for surgeon 2, with a final time of 6<span class="elsevierStyleHsp" style=""></span>min as the overall preparation time (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">With regard to the operative time, it ranged from a maximum of 56<span class="elsevierStyleHsp" style=""></span>min to a minimum of 43<span class="elsevierStyleHsp" style=""></span>min for surgeon 1, and from a maximum of 65<span class="elsevierStyleHsp" style=""></span>min to a minimum of 48<span class="elsevierStyleHsp" style=""></span>min for surgeon 2, with differences ranging between 9 and 5<span class="elsevierStyleHsp" style=""></span>min when comparing the results between them. No statistically significant differences are shown between the surgical times when comparing the surgical outcomes between surgeons. But, contrary to this, there is a statistically significant difference when comparing the results between the first and the fourth procedure of each surgeon, reflecting the development of skills in the management of instruments and intracorporeal knotting technique needed to develop this technique of reconstructive surgery (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Another parameter evaluated was the quality of the anastomosis represented by the impermeability of the same once the procedure was finished, with the introduction of fluid into the model. Filtration was proved only in one of the 8 cases performed (12.5% of the procedures), while in the remaining cases it showed an hermetic and impermeable anastomosis.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">The extension of laparoscopy has created the inevitable need to change the methodology of training. Whereas previously the practice of urologic laparoscopy was performed directly on the patient, today's practitioners of these techniques must ensure the appropriate development of laparoscopic skills before starting practice on patients, and, thus, provide an optimal surgical technique with a minimum of complications.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Laparoscopic pyeloplasty has advanced rapidly since its first description, made by Schuessler in 1993,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and it could become the gold standard for the treatment of the ureteropielic junction obstruction.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> Of all laparoscopic procedures, certainly, reconstructive procedures such as pyeloplasty are technically the most demanding, because they require intracorporeal suturing and involve a risk of complications during the learning curve.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–14</span></a> This reality has brought the need to design models to mimic the laparoscopic techniques in the training labs.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">In this process, we must take certain steps systematically and progressively, from inanimate models to live animal models. Initial practice on inanimate models improves hand-eye coordination, which must be followed by wet laboratory animal models, initially with dissection and ablative procedures such as nephrectomies, gradually progressing to advanced techniques involving laparoscopic suturing.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Regular training and standardization of the suture technique can reduce operative time by up to 50% and knotting time up to 75%, improving the efficiency and safety of reconstructive surgery.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> This is evidenced by the reduction of the surgical time of this work by noticing statistically significant differences between individual times of each surgeon.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Training models can range from live animals to simulators and models created with synthetic material or animal tissue, such as the present model. The main limitations for the use of live animals are the ethical considerations and the cost.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The simulators and synthetic models are also costly, which limits their availability. There is, therefore, a need for training models of low cost and easy availability.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,17</span></a> Numerous training models have been described for laparoscopic urethrovesical anastomosis,<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18–20</span></a> but not for laparoscopic pyeloplasty.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In residency training, the initial stage of practice in suturing can be carried out with inanimate models and simple tissue models, but this sequence becomes repetitive and boring for the training staff, in the absence of an aim to achieve. Therefore, the model described here provides an end or aim, to complete the ureteropielic anastomosis, so it might be more useful when using anatomical structures similar to the ureteropielic junction, providing a real tissue and anatomy sensation. This model also provides an important detail, the presence of tissue around work items, which simulates the surgical technique in a more real way. Finally, the postoperative evaluation of the model makes it possible to verify the specific moments of the technique that need improvement.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In summary, we present an animal model for laparoscopic pyeloplasty training that makes it possible to reproduce the conditions required to develop laparoscopic surgical skills and abilities, necessary to perform techniques that deserve intracorporeal suturing.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres100082" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objective" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec87248" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres100083" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivos" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec87247" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Population and sample" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Model preparation" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Surgical technique" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical method" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-06-06" "fechaAceptado" => "2011-06-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec87248" "palabras" => array:4 [ 0 => "Training method" 1 => "Laparoscopy" 2 => "Chicken" 3 => "Pyeloplasty" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec87247" "palabras" => array:4 [ 0 => "Modelo de entrenamiento" 1 => "Laparoscopia" 2 => "Pollo" 3 => "Pieloplastia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">With the coming of the laparoscopy, multiple surgical techniques have been developed that have revolutionized the urological practice. Laparoscopic pyeloplasty has been one of the most developed techniques. However, there are very few training models that permit the surgeon to decrease the learning curve. An animal model of training for the laparoscopic pyeloplasty technique is described.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Eight procedures of laparoscopic pyeloplasty were performed using the animal model (<span class="elsevierStyleItalic">Gallus gallus</span>) in the laparoscopic practice laboratory of the Urology Service of the University Hospital of Caracas. The preparation times of the model and the operation times of each surgeon were compared. The statistical analysis was made calculating the mean operation time, standard deviation, frequencies and percentages. A significant value was considered as <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The laparoscopic pyeloplasty procedure was performed successfully in all of the cases by two surgeons. The preparation time ranged from a maximum of 14<span class="elsevierStyleHsp" style=""></span>min to a minimum of 6<span class="elsevierStyleHsp" style=""></span>min, this being the same for both surgeons in the fourth case. The operation time ranged from a maximum of 65<span class="elsevierStyleHsp" style=""></span>min to a minimum of 43<span class="elsevierStyleHsp" style=""></span>min, observing significant differences when comparing the times individually for each surgeon. Only one case had filtration when comparing the patency of the specimen.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The animal model of training of laparoscopic pyeloplasty that is described is economical, reproducible, of easy availability and it makes it possible to develop laparoscopic surgical skills and competency necessary for reconstructive surgery and techniques that warrant intracorporeal suture.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Con el advenimiento de la laparoscopia se han desarrollado múltiples técnicas quirúrgicas que han revolucionado la práctica urológica. La pieloplastia laparoscópica ha sido una de las técnicas de mayor desarrollo; sin embargo, existen muy pocos modelos de entrenamiento que permitan al cirujano disminuir su curva de aprendizaje. Se describe un modelo animal de entrenamiento para la técnica de pieloplastia laparoscópica.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realizaron 8 procedimientos de pieloplastia laparoscópica utilizando el modelo animal (<span class="elsevierStyleItalic">Gallus gallus</span>) en el laboratorio de prácticas laparoscópicas del Servicio de Urología del Hospital Universitario de Caracas. Se comparó los tiempos de preparacion del modelo y los tiempos operatorios de cada cirujano. Se realizó análisis estadístico calculando el tiempo operatorio medio, la desviación estándar, las frecuencias y los porcentajes. Se consideró un valor significativo <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El procedimiento de pieloplastia laparoscópica se realizó exitosamente en todos los casos por dos cirujanos. El tiempo de preparación osciló entre un máximo de 14 minutos y un mínimo de 6 minutos, siendo igual para ambos cirujanos en el cuarto caso. El tiempo operatorio osciló entre un máximo de 65 minutos y un mínimo de 43 minutos, observándose diferencias significativas al comparar los tiempos de forma individual de cada cirujano. Solo un caso presentó filtración al comprobar la permebilidad de la pieza.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El modelo animal de entrenamiento para pieloplastia laparoscópica que se describe es económico, reproducible, de fácil disponibilidad y permite desarrollar habilidades y destrezas quirúrgicas laparoscópicas, necesarias para cirugía reconstructiva, y técnicas que ameriten sutura intracorpórea.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Valero RJ, et al. Modelo animal de entrenamiento en piloplastia laparoscópica. Actas Urol Esp. 2012;36:54–59.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1402 "Ancho" => 963 "Tamanyo" => 178993 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Model of crop and esophagus of chicken for learning of the laparoscopic pyeloplasty. (A) Cleansing and filling of the structures with physiological solution by means of Nelaton 12 fr catheter. (B) 0 silk suture ligation of the proximal esophagus after removing the probe.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1387 "Ancho" => 963 "Tamanyo" => 146079 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Suture. (A) Benchmarks at the distal end with Vicryl<span class="elsevierStyleSup">®</span> 3-0 between the esophagus and the crop. (B) Continuous sutures with Vicryl<span class="elsevierStyleSup">®</span> 3-0.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1463 "Ancho" => 963 "Tamanyo" => 204625 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Verification of sealing. (A) Filling of the esophagus and crop by means of Nelaton catheter through the proximal end of the esophagus. (B) Opening of the piece and visual assessment of the anastomosis.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Description of preparation times between surgeons: <span class="elsevierStyleItalic">Z</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.735 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.486).</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Comparison of times in surgeon 1: <span class="elsevierStyleItalic">Z</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.005 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.998).</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Comparison of times in surgeon 2: <span class="elsevierStyleItalic">Z</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.012 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.980).</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Hen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Surgeon 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Surgeon 2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hen 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hen 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hen 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hen 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab183927.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Comparison of model preparation times per surgeon (minutes).</p>" ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Description of surgical times between surgeons: <span class="elsevierStyleItalic">Z</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.145 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.886).</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Comparison of times in surgeon 1: <span class="elsevierStyleItalic">Z</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.015 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.950).</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Comparison of times in surgeon 2: <span class="elsevierStyleItalic">Z</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.025 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.922).</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Hen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Surgeon 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Surgeon 2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hen 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hen 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hen 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hen 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab183928.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Comparison of surgical times per surgeon (minutes).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A novel training model for laparoscopic pyeloplasty using chicken crop" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" 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