INTRODUCTION
rupture
SEPARATION, CAVITY, VASCULARIZATION
In surgery and other medical specialties, the transfer of skills was performed through a model where the surgeon-in-training played the role of an apprentice. This model, known in the United States and Europe as the William Halsted model, was introduced at Johns Hopkins University in 1889 and served conventional surgery well for over a centuryWith the advent of laparoscopic cholecystectomy, there was a rupture in this traditional teaching model. A new condition imposed the need to acquire specific skills, in no way similar to practices in conventional surgery until then, in addition to the need to train surgeons who had already completed their training cycle and were in a teaching positionThe methods or strategies commonly used to transfer skills in laparoscopic surgery can be divided into two phases: pre-clinical and clinical. The pre-clinical phase comprises the acquisition of theoretical knowledge, training in inanimate models (black boxes, white boxes and simulators) and training in laboratory animals. The clinical phase, the preceptorships.According to Kopta
Cognitive: This phase involves knowing what to do without necessarily being able to do it. It is about having the theoretical knowledge necessary to take a certain step.Integrative: in this phase the student needs to imagine the task and plan all the necessary motor steps for its accomplishment. Repetition improves the flow of movements, so that the execution of the task does not require a cognitive trigger.Autonomous: At this stage the performance becomes smooth and automatic. Reaching this stage can signify some level of competence.In the eighties, Prof. Zoltan Szabo of the MOET Institute, San Francisco, California, USA developed a suturing technique based on a single stitch with another single inverted knot, plus a third knot just to complement. This knot was called square knot, initially developed for microsurgery and performed with the aid of a microscope. In the nineties, with the advent of laparoscopic surgery, Prof. Szabo together with Prof. Alfred Cuschieri adapted this suture training for laparoscopic surgeryAccurate tissue approximation is essential for the surgical repair of defects and the performance of a safe anastomosis. In addition to a delicate handling of the fabric and careful dissection, tissue approximation must be performed without compromising vascularization, essential for the healing processIn open surgery, with three-dimensional vision and with the surgeon’s hands in the visual field, surgical maneuvers become so ingrained and established that knots and sutures are performed semiautomatically.The advent of laparoscopic surgery has brought with it some challenges that are common to all modalities of laparoscopic surgery and that do not exist in conventional or laparoscopic surgery. The video interface presupposes the need for depth perception using two dimensions instead of three, a limitation corrected with the advent of roboticsThe need to install portals in the abdominal cavity creates the limitation of the fulcrum effect, that is, the need to operate with instruments whose range of motion is limited by a fixed point on the abdominal wall, a limitation that was also attenuated by the instruments used during robotics assistance The consequence of the fulcrum effect causes the surgeon to move his hand in the opposite direction to the tip of the instrument. Tactile feedback is significantly diminished as a result of the separation between the surgeon’s hands and the structures to be operated on. Finally, as a result of the reduced interaction between the surgeon’s hands imposed by the video access route, there is a tendency for surgeons in training to ignore the non-dominant hand, a very common, counterproductive and potentially dangerous occurrenceThis study aims to evaluate the effectiveness of training for doctors, in a suture course, with a workload of 8 hours, in the execution of the laparoscopic knot (square knot) in silicone; analyze whether factors such as sex, age, laterality, knowledge in endosuture, medical specialty and previous experiences interfere in the learning outcomes; assess whether well-executed knots are related to the specialty and evaluate whether well-executed knots depend on the student’s experience with videolaparoscopy; to analyze the correlation of the parameters of execution of knots with the right hand, left hand, needle at 45º and back hand.