Os dados da literatura e o presente estudo corroboram a necessidade de se repensar o ensino cirúrgico de nossas instituições.
O uso de simuladores, diante dos novos paradigmas de ensino cirúrgico, parece ser uma ferramenta válida para o ensino cirúrgico. O ensino, em pacientes, poderia ser reservado para residentes que atingiram uma proficiência mínima em simuladores, de modo a haver maior segurança dos procedimentos, como, também, um melhor aproveitamento desta experiência prática por parte dos residentes.
Um currículo, baseado em competências, pode ser mais facilmente criado para o treinamento em simuladores do que para cirurgias reais, uma vez que as demandas dos pacientes da instituição podem não guardar relação com o nível de expertise ou tempo de treinamento dos residentes. Seu emprego, portanto, demandaria menor dificuldade logística para a implementação em relação ao gerenciamento de procedimentos eletivos compatíveis com as necessidades dos residentes.
A relação custo-benefício do treinamento parece ser promissora para utilização de simuladores, em relação a cirurgias reais, uma vez que os procedimentos, realizados por cirurgiões em treinamento, são potencialmente mais longos e com maior possibilidade de complicações cirúrgicas e suas morbidades associadas. Portanto, o ensino tradicional pode ser bastante oneroso em relação a simuladores simples, como o empregado para o presente estudo.
A adoção sistemática de simuladores para o ensino da laparoscopia poderia contribuir para a curto e médio prazo uma maior expertise por parte dos residentes para os procedimentos cirúrgicos. É possível que seu uso gere maior segurança aos pacientes, com potencial redução de custos assistenciais e menor probabilidade de eventos adversos e seus consequentes litígios, promovendo o desenvolvimento de competências médicas de forma ética e segura.
O produto, deste mestrado, é além de um minicurso estruturado de sutura intracorpórea pela técnica do gladiador de Armando Romeo, um conjunto de modelos artesanais para o desenvolvimento da prática da sutura, com ou sem o simulador E- Knot, de fácil confecção e baixo custo.
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