Melhoria das habilidades laparoscópicas de residentes de ginecologia e obstetrícia após treinamento em simulador

Abstract

Introduction: laparoscopy is currently consolidated as a minimally invasive surgical technique, presenting, compared to analogous conventional surgeries, gains in postoperative results, being standard procedure for several surgeries. Laparoscopic training has peculiarities that make it difficult to acquire its skills and it has a long learning curve. Objective: to evaluate whether laparoscopic simulator training is effective for the development of laparoscopic skills in gynecology and obstetrics residents. Methodology: prospective, non-randomized, quasi-experimental study in which participants were trained in laparoscopic dominant hand suturing, using the gladiator technique and the laparoscopic E-Knot model with Neoderma® disc. The training consisted of dialogued exposure and two-hour hands-on. The Global Operative Assessment of Laparoscopic Skills (GOALS) was used as an assessment tool. Participants, in addition to performing their self-assessments, were examined by two independent evaluators. The data obtained were analyzed with nonparametric statistical techniques by Wilcoxon and Friedman. Data collection was performed at the Maternidade Escola Januário Cicco / Universidade Federal do Rio Grande do Norte (MEJC/UFRN), from January to February 2019. Results: the sample consisted of 14 residents, but one was excluded for not completing the training. Statistically significant laparoscopic skill gains were demonstrated by the Wilcoxon test, with a mean difference of 2.5 to 5.167 points in the total post-intervention GOALS score compared to the pre-training assessment. All items in the score reached statistical significance, except for tissue handling for one of the evaluators. The inter-rater reliability analyzed by the Friedman test in relation to the pre-intervention GOALS showed no significant differences, but for the post-intervention GOALS, they reached p-value <0.05 for all evaluated items except tissue handling. Conclusion: training in intracorporeal suture simulator by the Armando Romeo technique was effective for laparoscopic skills gains evaluated by GOALS.