Browsing by Author "Achurra Tirado, Pablo"

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    A new approach for the acquisition of trauma surgical skills: an OSCE type of simulation training program
    (2022) Ortiz Koh, Catalina Alejandra; Contreras Bertolo, Caterina; Vela Ulloa, Javier Ignacio; Belmar, Francisca; Paul, Ivan; Achurra Tirado, Pablo; Varas Cohen, Julián
    Background Worldwide, trauma-related deaths are one of the main causes of mortality. Appropriate surgical treatment is crucial to prevent mortality, however, in the past decade, general surgery residents’ exposure to trauma cases has decreased, particularly since the COVID-19 pandemic. In this context, accessible simulation-based training scenarios are essential. Methods A low-cost, previously tested OSCE scenario for the evaluation of surgical skills in trauma was implemented as part of a short training boot camp for residents and recently graduated surgeons. The following stations were included bowel anastomosis, vascular anastomosis, penetrating lung injury, penetrating cardiac injury, and gastric perforation (laparoscopic suturing). A total of 75 participants from 15 diferent programs were recruited. Each station was videotaped in high defni tion and assessed in a remote and asynchronous manner. The level of competency was assessed through global and specifc rating scales alongside procedural times. Self-confdence to perform the procedure as the leading surgeon was evaluated before and after training. Results Statistically signifcant diferences were found in pre-training scores between groups for all stations. The lowest scores were obtained in the cardiac and lung injury stations. After training, participants signifcantly increased their level of competence in both grading systems. Procedural times for the pulmonary tractotomy, bowel anastomosis, and vascular anastomosis stations increased after training. A signifcant improvement in self-confdence was shown in all stations. Conclusion An OSCE scenario for training surgical skills in trauma was efective in improving profciency level and self confdence. Low pre-training scores and level of confdence in the cardiac and lung injury stations represent a defcit in resi dency programs that should be addressed. The incorporation of simulation-based teaching tools at early stages in residency would be benefcial when future surgeons face extremely severe trauma scenarios. Keywords Trauma surgery · Simulation training · Surgical training · Surgical education tec
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    Case report: psoriasis relapse following adrenalectomy for cushing syndrome
    (2011) Achurra Tirado, Pablo; Eugenin Soto, María Ignacia; Orlandini Sánchez, Elisa Javiera; Soto, Nestor; García-huidobro Munita, Diego Nicolás
    The relapse of autoimmune diseases following resolution of Cushing syndrome (CS) has been established with frequency, especially for thyroid disease. We present the case of a 39-year-old woman with a history of psoriasis vulgaris, with no other comorbidities. She presented a one-year of weight gain, high blood pressure, hypermenorrhea, pre-diabetes and dyslipidemia. During this period of time, the complete remission of psoriatic lesions was confirmed. The laboratory analysis demonstrated elevated free urinary cortisol in two opportunities, and a confirmatory low-dose dexamethasone test. Low ACTH levels were established (12,3pg/ml), and the abdominal images where compatible with a right adrenal adenoma of 3,0 x 2,3 cm, so the patient underwent a laparoscopic right adrenalectomy with no complications. Her blood pressure, glucose and cholesterol levels improved following surgery. One month after surgery the patient developed new, generalized psoriatic plaques. The excess of glucocorticoids produced by the adrenal tumor could have controlled the immunopathogeny of psoriasis. By removing the tumor, with the consequent reduction of cortisol levels, a more severe relapse of her cutaneous disease occurred.
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    Customized normothermic machine perfusion decreases ischemia–reperfusion injury compared with static cold storage in a porcine model of liver transplantation
    (2023) Riveros González, Sergio; Marino C., Carlo; Ochoa Suazo, Gabriela Susana; Soto Muñoz, Dagoberto Igor; Alegría Vargas, Leyla; Zenteno, María José ; San Martín, Sebastián; Brañes, Alejandro; Achurra Tirado, Pablo; Rebolledo Acevedo, Rolando
    Background: Liver transplantation has been demonstrated to be the best treatment for several liver diseases, while grafts are limited. This has caused an increase in waiting lists, making it necessary to find ways to expand the number of organs available for transplantation. Normothermic perfusion (NMP) of liver grafts has been established as an alternative to static cold storage (SCS), but only a small number of perfusion machines are commercially available. Methods: Using a customized ex situ machine perfusion, we compared the results between ex situ NMP and SCS preservation in a porcine liver transplant model. Results: During NMP, lactate concentrations were 80% lower after the 3-h perfusion period, compared with SCS. Bile production had a 2.5-fold increase during the NMP period. After transplantation, aspartate transaminase (AST) and alanine transaminase (ALT) levels were 35% less in the NMP group, compared to the SCS group. In pathologic analyses of grafts after transplant, tissue oxidation did not change between groups, but the ischemia–reperfusion injury score was lower in the NMP group. Conclusion: NMP reduced hepatocellular damage and ischemia–reperfusion injury when compared to SCS using a customized perfusion machine. This could be an alternative for low-income countries to include machine perfusion in their therapeutic options.
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    Desarrollo y evaluación de modelo ex vivo para entrenamiento de anastomosis intracorpórea en hemicolectomía derecha laparoscópica
    (2020) Jarry T., Cristián; Inzunza A., Martín; Bellolio R., Felipe; Marino C., Carlo; Achurra Tirado, Pablo; Varas Cohen, Julián; Larach Kattan, José Tomás
    Introducción: Si bien la anastomosis intracorpórea (AI) ha demostrado beneficios clínicos sobre la anastomosis extracorpórea (AE) en la hemicolectomía derecha laparoscópica (HDL), su aplicación ha sido limitada por su dificultad técnica y curva de aprendizaje más larga. El presente estudio busca desarrollar y evaluar un modelo simulado para entrenar este procedimiento. Materiales y Método: Se desarrolló un modelo en base a tejido ex vivo, con colon porcino e intestino bovino, montados en un simulador de laparoscopía. Este se modificó sucesivamente en base a entrevistas semiestructuradas a cirujanos hasta lograr el modelo final. Para evaluar apariencia y reacción al modelo, coloproctólogos, cirujanos y residentes previamente expuestos a entrenamiento simulado, realizaron una ileotransverso anastomosis mecánica en el modelo y luego contestaron una encuesta. Resultados: Doce sujetos participaron. Cuatro coloproctólogos, 4 residentes de coloproctología, 2 residentes de cirugía general, 1 cirujano general y 1 cirujano digestivo. El 91,6% valoró positivamente la ergonomía lograda, mientras que el 83,3% y 75% valoraron positivamente el uso del instrumental y la relación anatómica entre estructuras, respectivamente. Todos los participantes consideraron el modelo útil para entrenar sutura manual laparoscópica, el 91,6% para entrenar enterotomías y 83,3% para entrenar el uso de endograpadora. Todos declararon que el módulo permite entender y reflexionar sobre la técnica propuesta. Conclusión: Este modelo desarrollado sería útil para entrenar habilidades críticas para realizar una AI en HDL. Su incorporación a un programa de entrenamiento en laparoscopía avanzada podría contribuir a acortar la curva de aprendizaje de este procedimiento.
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    Implementación de un modelo porcino de trasplante hepático en Chile
    (Sociedad de Cirujanos de Chile, 2020) Ochoa, Gabriela; Marino, Carlo; Riveros, Sergio; Morales, Emilio; Jarry, Cristian; Viñuela, Macarena; Alegría, Leyla; Zenteno, María Josefina; Martínez Castillo, Jorge; Achurra Tirado, Pablo; Rebolledo Acevedo, Rolando Arturo
    Objetivo: Presentar la implementación del primer modelo porcino de trasplante hepático (TH) en Chile y sus resultados. Material y Método: Se implementó un protocolo quirúrgico y anestésico en el contextode una investigación en perfusión normotérmica hepática financiada por un Fondo Nacional de Desarrollo Científico y Tecnológico. Los cerdos fueron seleccionados por peso (35-40 kilos), en cada experimentose utilizó dos, donante y receptor, sometidos a procura y trasplante respectivamente. El análisis se realizó con estadística descriptiva. Resultados: Se realizaron 26 experimentos (marzo de 2018-octubre de 2019). El protocolo consta de 7 etapas: Preparación, Instrumentalización, Procura o Hepatectomía, Tiempo Anhepático, Etapa de Isquemia-Reperfusión, Monitorización y Eutanasia. Las primeras tres son similares en ambos cerdos, y desde la cuarta en adelante corresponde sólo al receptor. La supervivencia a la cirugíafue de 92,3% (24/26) y al seguimiento de 76,9% (20/26). La mortalidad se produjo por inestabilidad cardiovascular postreperfusión portal. El tiempo quirúrgico promedio fue de 170 min, y el tiempo anhepático de 33 min. La PAM cursó una baja postreperfusión con recuperación al final de la monitorización (67,4 mmHg media) y la tendencia en ph fue a acidosis al final del seguimiento (7,21 media). Se requirió drogas vasoactivas en 12 casos. Discusión: Logramos implementar un modelo experimental simplificado y reproducible de TH sin necesidad de circulación extracorpórea ni puente veno-venoso gracias a la estandarización de la técnica quirúrgica y de los cuidados perioperatorios. Conclusiones: La consolidación de un modelo experimental significa el primer paso en investigación preclínica de nuevas tecnologías asociadas al TH en Chile.
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    Self-Confidence on acquired surgical skills to deal with severe trauma patients in recently graduated surgeons
    (2022) Vela Ulloa, Javier; Cárcamo Gruebler, Leonardo; Contreras Bartolo, Caterina; Rebolledo Acevedo, Rolando; Varas Cohen, Julián; Martínez Castillo, Jorge; Jarufe Cassis, Nicolás; Achurra Tirado, Pablo; Pontificia Universidad Católica de Chile. Escuela de Medicina
    Trauma is one of the leading causes of death in the world and proper surgical care is critical to impact mortality. In Chile, trauma associated death ranks first as mortality cause in population between 20 and 59 years old. Appropriate surgical skills are required to deal with these complex patients. Self-confidence to practice trauma procedures after the General Surgery Residency have not been reported in our country. Aim: Describe the level of self-confidence to deal with trauma procedures of surgeons who recently graduated from a General Surgery Residency. Method: Descriptive cross-sectional study. We designed and applied a survey in 2015, 2016 and 2017 to recently graduated surgeons, to inquire about self-confidence of surgical skills to deal with trauma scenarios. Eighteen trauma surgery procedures (including cervical, thoracic, abdominal and vascular procedures) were evaluated using a 5-grade Likert scale. The number of procedures performed during the residency was also queried. Results: Eighty-eight recently graduated surgeons from 11 different training programs in Chile were included. The report of competencies was high in procedures such as intestinal injuries, were 98% felt competent or very competent in their repair. On the other hand, in complex traumas such as major vessel injury, up to 76% reported not being competent. Self-confidence on procedures was directly associated with the number of procedures performed during residency. Conclusions: Recently graduated surgeons from General Surgery Programs report high levels of confidence to deal with low and intermediate complexity traumas, but a lower level of confidence to treat high complexity cases.
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    Simulation-based mastery learning of bronchoscopy-guided percutaneous dilatational tracheostomy competency acquisition and skills transfer to a cadaveric model
    (2021) Kattan Tala, Eduardo José; De la Fuente Sanhueza, René; Putz de la Fuente, Francisca Carolina; Vera Alarcón, María Magdalena; Corvetto Aqueveque, Marcia Antonia; Inzunza, Oscar; Achurra Tirado, Pablo; Inzunza Agüero, Martín Alejandro; Muñoz Gama, Jorge; Sepúlveda Fernández, Marcos Ernesto; Gálvez Yanjarí, Víctor Andrés; Pavez, Nicolás; Retamal Montes, Jaime; Bravo Morales, Sebastián
    Introduction: Although simulation-based training has demonstrated improvement of procedural skills and clinical outcomes in different procedures, there are no published training protocols for bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT). The objective of this study was to assess the acquisition of BG-PDT procedural competency with a simulation-based mastery learning training program, and skills transfer into cadaveric models. Methods: Using a prospective interventional design, 8 trainees naive to the procedure were trained in a simulation-based mastery learning BG-PDT program. Students were assessed using a multimodal approach, including blind global rating scale (GRS) scores of video-recorded executions, total procedural time, and hand-motion tracking–derived parameters. The BG-PDT mastery was defined as proficient tracheostomy (successful procedural performance, with less than 3 puncture attempts, and no complications) with GRS scores higher than 21 points (of 25). After mastery was achieved in the simulator, residents performed 1 BG-PDT execution in a cadaveric model. Results: Compared with baseline, in the final training session, residents presented a higher procedural proficiency (0% vs. 100%, P < 0.001), with higher GRS scores [8 (6–8) vs. 25 (24–25), P = 0.01] performed in less time [563 (408–600) vs. 246 (214–267), P = 0.01] and with higher movement economy. Procedural skills were further transferred to the cadaveric model. Conclusions: Residents successfully acquired BG-PDT procedural skills with a simulation-based mastery learning training program, and skills were effectively transferred to a cadaveric model. This easily replicable program is the first simulation-based BG-PDT training experience reported in the literature, enhancing safe competency acquisition, to further improve patient care.