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Bibas BJ, Minamoto H, Cardoso PFG, Cremonese MR, Pêgo-Fernandes PM, Terra RM. Brazilian airway surgery survey indicates low overall numbers and need for improved teaching skills. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivad177. [PMID: 37950507 PMCID: PMC10858343 DOI: 10.1093/icvts/ivad177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES The Brazilian Society of Thoracic Surgeons conducted an online survey to determine the number of surgeons that perform adult and paediatric airway surgery and to understand the practice patterns along the country. METHODS Active members were electronically invited to complete the questionnaire through the REDCapR platform. Invitations were sent from January to April 2020. The survey encompassed 40 questions that explored 4 different topics in the assessment of tracheal diseases: (i) surgeon's demography; (ii) institutional profile, (iii) education and training in laryngo-tracheal surgery and (iv) preoperative and postoperative evaluation. RESULTS Eighty-nine percentage of the responders declared to perform tracheal surgery with a median of 5 tracheal resection procedures per year [interquartile range (IQR) 3-12]. Interaction with other specialties occurs in 37.3% of cases. Access to technology and devices is highly variable across the country. Resident training in airway surgery consists in traditional lectures in 97% of the cases. Training in animals (15.2%), cadavers (12.1%) and simulators (6.1%) are rare. Preoperatory evaluation encompasses flexible bronchoscopy (97.8%) and/or computed tomography (CT) scan of the airways (90.6%). Swallowing (20.1%) and voice (14.4%) disorders are rarely evaluated. Eighty-nine percentage of the surgeons consider bronchoscopy to be the preoperatory gold-standard exam, followed by CT scan (38.8%) and CT-3D reconstruction (37.4%). CONCLUSIONS Brazilian surgeons refer that airway resection and reconstruction are part of their current practice, but the total number of procedures per surgeon per year is low. Access to high-end technology and equipment is heterogenous. Training offered to residents in most academic institutions relies on traditional lectures.
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Affiliation(s)
- Benoit Jacques Bibas
- Disciplina de Cirurgia Torácica, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Hospital Municipal Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Helio Minamoto
- Disciplina de Cirurgia Torácica, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paulo Francisco G Cardoso
- Disciplina de Cirurgia Torácica, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mariana Rodrigues Cremonese
- Disciplina de Cirurgia Torácica, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Hospital Municipal Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- Disciplina de Cirurgia Torácica, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ricardo Mingarini Terra
- Disciplina de Cirurgia Torácica, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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Touzé AS, Mudry A, Morinière S. Throat cancer surgery training in France. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:291-298. [DOI: 10.1016/j.anorl.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ex Vivo Porcine Larynx Model for Microlaryngoscopy Laryngeal Surgery: Proposal for a Structured Surgical Training. J Voice 2020; 34:629-635. [DOI: 10.1016/j.jvoice.2019.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/01/2019] [Accepted: 02/13/2019] [Indexed: 11/22/2022]
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Robinson DA, Piekut DT, Hasman L, Knight PA. Cadaveric Simulation Training in Cardiothoracic Surgery: A Systematic Review. ANATOMICAL SCIENCES EDUCATION 2020; 13:413-425. [PMID: 31232510 DOI: 10.1002/ase.1908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 06/19/2019] [Accepted: 06/19/2019] [Indexed: 06/09/2023]
Abstract
Simulation training has become increasingly relevant in the educational curriculum of surgical trainees. The types of simulation models used, goals of simulation training, and an objective assessment of its utility and effectiveness are highly variable. The role and effectiveness of cadaveric simulation in cardiothoracic surgical training has not been well established. The objective of this study was to evaluate the current medical literature available on the utility and the effectiveness of cadaveric simulation in cardiothoracic surgical residency training. A literature search was performed using PubMed, Cochrane Library, Embase, Scopus, and CINAHL from inception to February 2019. Of the 362 citations obtained, 23 articles were identified and retrieved for full review, yielding ten eligible articles that were included for analysis. One additional study was identified and included in the analysis. Extraction of data from the selected articles was performed using predetermined data fields, including study design, study participants, simulation task, performance metrics, and costs. Most of these studies were only descriptive of a cadaveric or perfused cadaveric simulation model that could be used to augment clinical operative training in cardiothoracic surgery. There is a paucity of evidence in the literature that specifically evaluates the utility and the efficacy of cadavers in cardiothoracic surgery training. Of the few studies that have been published in the literature, cadaveric simulation does seem to have a role in cardiothoracic surgery training beyond simply learning basic skills. Additional research in this area is needed.
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Affiliation(s)
- Davida A Robinson
- Division of Cardiac Surgery, Department of Surgery, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Diane T Piekut
- Department of Neuroscience, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Linda Hasman
- Division of Research and Clinical Information Services, University of Rochester, Rochester, New York
| | - Peter A Knight
- Division of Cardiac Surgery, Department of Surgery, School of Medicine and Dentistry, University of Rochester, Rochester, New York
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Aragón-Benedí C, Visiedo-Sánchez S, Pascual-Bellosta A, Ortega-Lucea S, Fernández-Liesa R, Martínez-Ubieto J. Study of Rocuronium-Sugammadex as an Alternative to Succinylcholine-Cisatracurium in Microlaryngeal Surgery. Laryngoscope 2020; 131:E212-E218. [PMID: 32324308 DOI: 10.1002/lary.28649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 12/19/2022]
Abstract
Microlaryngeal surgery (ML) is a short procedure that requires a deep neuromuscular blockade to provide optimum surgical conditions. Succinylcholine is a relaxant widely used but involves numerous complications. One valid alternative is rocuronium, with a specific antagonist, sugammadex. The primary objective was to assess the surgical conditions in ML according to the relaxant. The secondary objectives were to assess intubation conditions and intraoperative and immediate postoperative adverse events. STUDY DESIGN Prospective randomized study. METHODS This was a prospective study of patients scheduled for ML randomized into two groups according to relaxant. Neuromuscular blockade was recorded after administration and during ML surgery. Surgical conditions were assessed using the ML Rating Scale, intubation conditions, remifentanil doses, intraoperative complications, surgery time, emergence time, and complications in the postanesthesia care unit. RESULTS Two hundred five patients were included (rocuronium = 103, succinylcholine = 102). Train-of-four values were higher for rocuronium, though the otorhinolaryngology surgical conditions were significantly better in that group (rocuronium = 5.54 ± 1.39 points; succinylcholine = 9.13 ± 1.99 points). Intubation conditions were similar in both groups. Remifentanil doses were higher for succinylcholine (P < .001) (rocuronium = 0.102 ± 0.05 μg/kg/min; succinylcholine = 0.201 ± 0.05 μg/kg/min). There were no differences in the duration of surgery, but the time to awakening was significantly longer for succinylcholine (rocuronium = 3.82 ± 1.38 minutes, succinylcholine = 9.18 ± 2.04 minutes, P < .001). CONCLUSIONS Rocuronium provides better surgical conditions and allows for the use of lower doses of remifentanil as compared to succinylcholine and cisatracurium in ML. This makes it possible to decrease the time to awakening and the complications associated with high doses of remifentanil. LEVEL OF EVIDENCE 1b Laryngoscope, 131:E212-E218, 2021.
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Affiliation(s)
- Cristian Aragón-Benedí
- Department of Anesthesia, Resuscitation and Pain Therapy, Móstoles General University Hospital, Móstoles, Spain
| | - Sara Visiedo-Sánchez
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, Zaragoza, Spain
| | - Ana Pascual-Bellosta
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, Zaragoza, Spain
| | - Sonia Ortega-Lucea
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, Zaragoza, Spain
| | - Rafael Fernández-Liesa
- Head of Department of Otolaryngology-Head and Neck Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Javier Martínez-Ubieto
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, Zaragoza, Spain
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Kavanagh KR, Murray N. A novel, low fidelity simulator for laryngotracheal reconstruction. Int J Pediatr Otorhinolaryngol 2019; 125:212-215. [PMID: 31442881 DOI: 10.1016/j.ijporl.2019.06.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/15/2019] [Accepted: 06/30/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Open airway reconstruction is a highly specialized skill. Simulation affords the opportunity to practice surgical skills in a low stakes environment which is particularly important for a high acuity, low frequency operation. Although animal models have been described, these present ethical and financial barriers, and therefore are not ideal to expose residents to airway reconstruction techniques. To our knowledge there is not a commercially available simulator for laryngotracheal reconstruction. OBJECTIVES This study describes a novel, low-fidelity simulation technique for laryngotracheal reconstruction using a cartilage graft. METHODS We designed a low-fidelity simulator to represent the trachea, esophagus, and cartilage graft using tubing from a Luken's trap, vinyl backwash hose, and pig's ears from a non-specialty grocery store. The model was evaluated with a Likert scale (1 = strongly disagree to 5 = strongly agree). RESULTS Twelve participants attended simulation sessions. Participants reported a mean score (+/-SD) 4.25 ± 0.75 that the tissue characteristics were adequate and 4.50 ± 0.79 that sutures could be placed. There was universal strong agreement that the tissue could be manipulated appropriately (5 ± 0). The cost per resident was less than 4 dollars. CONCLUSION We present a readily available, easy to construct, and low cost simulation model for open airway reconstruction that can be used as a stand-alone simulator or in preparation for an animal dissection course. Our participants reported that the model had acceptable tissue characteristics to practice performing laryngotracheal reconstruction with a cartilage graft.
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Affiliation(s)
- Katherine R Kavanagh
- Connecticut Children's Medical Center, Pediatric Otolaryngology, 282 Washington St., Hartford, CT, 06106, USA; University of Connecticut Health Sciences Center, Department of Otolaryngology, 263 Farmington Avenue, Farmington, CT, 06032, USA.
| | - Nicole Murray
- Connecticut Children's Medical Center, Pediatric Otolaryngology, 282 Washington St., Hartford, CT, 06106, USA; University of Connecticut Health Sciences Center, Department of Otolaryngology, 263 Farmington Avenue, Farmington, CT, 06032, USA.
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Dhillon VK, Dailey SH, Akst LM. Microlaryngeal Teaching Courses: A National Survey on Prevalence, Value, and Barriers to Implementation. Ann Otol Rhinol Laryngol 2019; 129:101-109. [PMID: 31522512 DOI: 10.1177/0003489419876290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the prevalence of microlaryngeal teaching course in Accreditation Council for Graduate Medical Education (ACGME)-accredited otolaryngology residency programs in an effort to evaluate the nature, perceived value and barriers to implementation of microlaryngeal courses. METHOD A 14-question survey to all ACGME-accredited otolaryngology programs in the United States. RESULT Out of 119 ACGME-accredited otolaryngology programs identified on the ACGME Fellowship and Residency Electronic Interactive Database, responses were received from 67 programs (56%). Although 90% of respondents indicated that instruction courses in one discipline or another existed at their institution for their otolaryngology residents, only 33% indicated that their program offers a hands-on instruction course in microlaryngeal surgery. Of those programs that offered a microlaryngeal surgery course, 100% felt the residents appreciated the course; 95% of those programs that did not have a course felt their residents would appreciate a microlaryngeal course at their institution if they were able to offer one. Among programs without a microlaryngeal teaching course, the largest perceived barriers were cost and availability of appropriate equipment. CONCLUSION Microlaryngeal courses for otolaryngology residency training are limited in availability in the United States, and there is variability in training across the country. All respondents in our survey indicated the value in these courses for microlaryngeal surgical skill training. There is a clear role for increasing availability of low-cost microlaryngeal stations and courses.
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Affiliation(s)
- Vaninder K Dhillon
- Division of Laryngology, Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, Suburban Hospital, Bethesda MD, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Seth H Dailey
- Section of Laryngology, Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Lee M Akst
- Division of Laryngology, Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, Suburban Hospital, Bethesda MD, Johns Hopkins Hospital, Baltimore, MD, USA
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