Jesús Usón Gargallo

Centro de Cirugía de Mínima Invasión Jesús Usón, Cárcer, Valencia, Spain

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Publications (28)25.71 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: The use of surgical simulation and objective assessment methods are increasing in microsurgery due to the improvements in the learning phase. Nowadays, European legislation requires a reduction of experimental animals used for training. The aim of this study is to demonstrate the educational ability of the simulator Simulhand®, which is designed for microsurgical anastomoses training. Methodology and Material: Ten veterinary surgeons with no experience in microsurgery were divided randomly into two groups. They received theoretical lectures and performed practices for 90 minutes on a validated training card. Subsequently, the control group continued 4 hours using the training card, while the other group utilized the simulator Simulhand®. Then, both groups performed two end-to-end anastomoses on the carotid arteries of a Wistar rat. These anastomoses were evaluated using a validated rating scale. The patency and the time spent for each anastomosis were observed. These data were then compared. The surgeons who used the simulator, filled a survey to evaluate its quality. Results: The survey mean scores obtained were between 3 to 4’2 on a Likert scale (1-5) where 5 was the highest rating. After comparing the results of both groups, statistically significant differences were not found for any of the studied variables (time, patency and global rating scale). Conclusions: Simulhand® has a great interest for surgeons who used it as the initial training method for microsurgical anastomosis learning. It is necessary to extend the study to obtain statistically significant differences to objectively validate the educational ability of the simulator
    Journal of Reconstructive Microsurgery 04/2014; 30(S01):A041. DOI:10.1055/s-0034-1373943 · 1.01 Impact Factor
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    ABSTRACT: Introduction: The main objective of the Microsurgery Unit of the “Jesús Usón Minimally Invasive Surgery Center” in Cáceres (Spain) is the education and training of professionals in medicine and surgery worldwide and focuses the development of their activities toward the service of society. Methodology and Material: While the past 27 years and from the idea of a pyramid training model with four levels of teaching, we have been imparting training courses. The learning program plans the gradual shift from synthetic materials to biological structures, concluding with working on experimental animals, tele-education and hospital application at the last level. This program is based on an ethical and teaching basis: Before working with living beings the maximum performance must be obtained on simulators, this is the goal of the Microsurgery Unit and of the Centre. Until today 1881 professionals have benefited by this goal. We have designed different simulators with synthetic and organic materials for different specialties that use microsurgery. We also have took good care about the technology in microsurgery training, designing an experimental operating theater with a special system of education: the “multi-station system” for microsurgery teaching: where images of each microscope are collected in a central plasma monitor where the teacher is and from where he can communicate with each student through an audio system. Results: The pyramidal training model and the “multi-station system” provides an ethical and teaching learning method with a teacher-student interaction on an individualized way, it is made in real time without having to move around the room, allowing the monitoring of activities with the same magnifications which are working the students and improving the satisfaction degree of them. Conclusions: The experience of 27 years utilizing this pyramidal model and the “multi-station system” gives us enough data that prove and validate this way of teaching and learning.
    Journal of Reconstructive Microsurgery 04/2014; 30(S 01). DOI:10.1055/s-0034-1373944 · 1.01 Impact Factor
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    ABSTRACT: The latest generation in titanium clip application systems, the AnastoClip Vessel Closure System (VCS; LeMaitre Vascular, Burlington, MA), allows surgeons to perform vascular anastomosis more easily and faster than conventional sutures. This system may become the option of choice for vascular reconstruction in pediatric surgery where, as in the case transplant surgery, decreasing vascular occlusion times may influence outcome. The aim of this study was to determine whether VCS metallic clips would allow shorter anastomosis times than conventional interrupted polypropylene or running polyglycolic acid suturing in end-to-end anastomosis performed in the abdominal cava of young pigs. Thirty-two domestic swine, 45 days old, were used for this study. All animals were subjected to an end-to-end anastomosis in the abdominal cava. VCS clips are easier to use for the surgeon, significantly decreasing cross-clamping time in caval anastomosis (VCS 10.33 ± 1.75 min vs. interrupted polypropylene sutures 46.00 ± 6.16 min vs. continuous polyglycolic acid sutures 18.16 ± 1.47 min). VCS clips significantly decrease the time needed for performing an end-to-end anastomosis in the abdominal cava, decreasing cross-clamping time when compared to interrupted polypropylene or running polyglycolic acid sutures.
    Annals of Vascular Surgery 10/2013; 27(7):947-53. DOI:10.1016/j.avsg.2013.03.005 · 1.03 Impact Factor
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    ABSTRACT: Our aim was to perform a macroscopic and imaging (ultrasonographic and angiographic) evaluation of vascular closure stapler (VCS) metallic clips for renal transplantation in growing piglets to assess their role for transplantation surgery in young children. If these techniques are to be useful, it is necessary to prove that their use avoids one of the main pitfalls of conventional sutures in this setting, namely lack of growth in the suture line. Twenty-four piglets were used for this study. Animals were subjected to a heterotopic renal autotransplantation when they were 45 days old. The right kidney was moved from its normal location to the cranial area of the iliac fossa. The end-to-side anastomoses between the renal artery and vein and the aorta and vena cava, respectively, were performed using VCS metallic clips in 6 animals. Continuous polypropylene suturing was used in another 6 piglets, and continuous polyglycolic acid suture was used in 6 additional piglets. A control group of 6 animals without renal autotransplantation was also included in the study. All animals were allowed to grow for 6 months, during which time serial angiographic and ultrasonographic studies were carried out to assess the existence of vascular flow disturbances or stenosis. Similarly, angiographic measurements were obtained to document growth at the anastomotic site. Longitudinal growth was evaluated postmortem after the 6-month growing period. Angiography showed significant (P < .001) transverse growth in both arteries and veins belonging to the VCS clips, running absorbable suture, or control groups. No significant difference was observed among the 3 groups. Vascular growth in the running nonabsorbable suture (polypropylene) group, however, was significantly less than in the other 3 groups and did not significantly differ from baseline. Baseline luminal diameters at the anastomotic site as measured by angiography in the VCS group were 3.64 ± 0.40 mm in the artery and 5.30 ± 1.43 mm in the vein. After growth, these values increased to 6.87 ± 0.90 mm and 11.27 ± 2.53 mm, respectively. Significant longitudinal growth was evidenced macroscopically after 6 months in both aorta and vena cava in all groups. On the other hand, significant longitudinal growth in the renal artery and vein were only observed in the control, VCS, and absorbable suture groups. In this experimental setting, satisfactory macroscopic and angiographic vascular growth results were obtained using the VCS clips, suggesting that this suture could be the technique of choice in pediatric transplantation surgery.
    Journal of Pediatric Surgery 07/2012; 47(7):1390-8. DOI:10.1016/j.jpedsurg.2011.12.015 · 1.31 Impact Factor
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    ABSTRACT: Despite the many advantages that laparoscopic surgery has for patients, it involves a series of risks for the surgeon. These are related to the reduced freedom of movement and forced postures which lead to greater muscle fatigue than with conventional surgery.In laparoscopic surgery there are few references on the introduction of training programs in ergonomics, despite the numerous advantages demonstrated in other disciplines. The application of ergonomic criteria in the surgical field could have great benefits, both for surgeons and patients.In this work we attempt to review the existing literature and our experience to provide the surgeon with some ergonomic guidelines for body stance and positioning of equipment. We also present a training model based on ergonomics which we have introduced into the training activities carried out in our Centre.
    Cirugía Española 05/2012; DOI:10.1016/j.ciresp.2011.04.021 · 0.89 Impact Factor
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    ABSTRACT: IntroductionOur aim is to assess the face and content validities of the physical simulator Simulap®, as well as the construct validity of its assessment method.
    Cirugía Española 01/2012; DOI:10.1016/j.ciresp.2011.07.013 · 0.89 Impact Factor
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    ABSTRACT: Our aim is to assess the face and content validities of the physical simulator Simulap(®), as well as the construct validity of its assessment method. Five novice surgeons (G1) and five experts (G2) performed seven basic tasks and one suturing exercise on Simulap(®), which were assessed through an exam based on mistakes and performance time. Face and content validations were carried out by novice surgeons and expert surgeons, respectively. Both validations consisted of a questionnaire graded on a five-point scale about the Simulap(®) and its tasks. Construct validity of the assessment system was determined by comparing the scores of both groups. Surgeons rated the Simulap(®) simulator and its training program positively, obtaining an average score of 4±1.1 for G1 and of 4.9±0.6 for G2. G2 considered training on Simulap(®) very useful for the training of residents and surgeons, obtaining a maximum score of 5. G2 outperformed G1 in all task scores, with statistically significant differences in the eye-hand coordination (G1: 52.2±6.7 vs. G2: 39.6±6.5; P=.027), dissection (G1: 301.8±100.2 vs. G2: 150.8±66.7; P=.028) and suturing exercises (G1: 258.5±87.0 vs. G2: 108.4±20.2; P=.009). The assessment method for Simulap(®) is able to distinguish different levels of experience in laparoscopic surgery. Furthermore, this simulator showed a great acceptance by surgeons for the learning of basic skills.
    Cirugía Española 11/2011; 90(1):38-44. · 0.89 Impact Factor
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    ABSTRACT: Despite the many advantages that laparoscopic surgery has for patients, it involves a series of risks for the surgeon. These are related to the reduced freedom of movement and forced postures which lead to greater muscle fatigue than with conventional surgery. In laparoscopic surgery there are few references on the introduction of training programs in ergonomics, despite the numerous advantages demonstrated in other disciplines. The application of ergonomic criteria in the surgical field could have great benefits, both for surgeons and patients. In this work we attempt to review the existing literature and our experience to provide the surgeon with some ergonomic guidelines for body stance and positioning of equipment. We also present a training model based on ergonomics which we have introduced into the training activities carried out in our Centre.
    Cirugía Española 06/2011; 90(5):284-91. · 0.89 Impact Factor
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    ABSTRACT: Despite exhibiting histological differences from the human process, canine hormone-induced benign prostatic hyperplasia (BPH) is still the most widely used animal model for evaluating treatment strategies. The aim of this study is to determine the optimal moment for starting a therapeutic trial in this animal model. Six male beagle dogs over one year of age were used in this study. All animals received a combination of steroid hormones, namely 17beta-estradiol and 5alpha-androstene 3alpha 17beta-diol, every other day during three (Group 1, n=3) or five months (Group 2, n=3). Transrectal ultrasonographic examinations to measure prostate volume were performed monthly. Animals were euthanized after five months for histological study of their prostates. All animals developed BPH, with prostate volume increasing over time as hormones were administered (r=0,910). All ultrasonographic studies performed up to the third month evidenced a significant increase in prostate volume when compared to the prior ultrasound measurement. A significant decrease in prostate volume was seen in Group 1 once hormone administration was interrupted, whereas Group 2 animals showed a continuing increase in prostate size. Histological examination showed almost no evidence of BPH in Group 1 animals, while Group 2 animals clearly exhibited moderate epithelial hyperplasia. The administration of a combination of steroid hormones is effective in inducing benign prostatic hyperplasia in canines, but this hyperplasia disappears when hormone treatment is interrupted. In order to be useful for experimental studies, hormones should be administered for at least three months before commencing any treatment, and they should be continued throughout the length of the study..
    Actas urologicas españolas 09/2009; 33(8):895-901. · 1.15 Impact Factor
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    ABSTRACT: IntroductionThe current surgical scenario of the surgery through natural orifices or «no-scar surgery» requires acquiring new technical skills by the surgeon. We introduce the initial experience of the Minimally Invasive Surgery Centre Jesús Usón (MISCJU) in the design and setting-up of a surgical training programme using the the natural orifices approach for the acquisition of surgical skills and abilities, based on the preliminary trials in simulators and a pig model.
    Cirugía Española 05/2009; 85(5):307-313. DOI:10.1016/j.ciresp.2009.02.004 · 0.89 Impact Factor
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    ABSTRACT: The current surgical scenario of the surgery through natural orifices or requires acquiring new technical skills by the surgeon. We introduce the initial experience of the Minimally Invasive Surgery Centre Jesús Usón (MISCJU) in the design and setting-up of a surgical training programme using the the natural orifices approach for the acquisition of surgical skills and abilities, based on the preliminary trials in simulators and a pig model. After initial training, using a laparoscopic pelvic-trainer, 7 female pigs, with weights between 35-40 kg, were operated on. The transvaginal approach was completed using a one-channel gastroscope in all the animals. After accessing the abdomen, the abdominal cavity was explored, and the surgery was concluded with the endoscopic cholecystectomy. Endoscopic cholecystectomy was successfully completed in 6 cases. In one of the animals, the procedure was stopped because of technical problems regarding the endoscope leaning to one end. The average surgical time was 107.14 min (range, 80-150 min). The transvaginal approach enabled the abdominal to be explored and the dissection, ligature and section of the cystic duct and the cystic artery. After cholecystectomy, the gallbladder was extracted through the vagina. After the procedure necropsy did not reveal intra-abdominal lesions or intraoperative complications. The pure transvaginal cholecystectomy is a feasible and reproducible procedure in the animal model. A systematized training model, which includes physiopathology knowledge as well as technical knowledge, in order to translate these procedures to the clinical practice in a safe way, is needed.
    Cirugía Española 04/2009; 85(5):307-13. DOI:10.1016/S2173-5077(09)70148-6 · 0.89 Impact Factor
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    ABSTRACT: When performing vascular reconstruction in growing elements, specifically in paediatric transplant surgery, where a short vascular occlusion time is mandatory, master and easily handled suturing methods are needed. Thus the present study compares conventional continuous suturing with polypropylene and dexon versus easier and faster to apply titanium clips in heterotopic renal autotransplants. 24 growing pigs were used for this study. Heterotopic renal autotransplant was performed when the animals were 45-days-old using VCS clips, continous Polypropylene or Dexon suturing when anastomosing the renal artery and vein to the aorta and cava in an end-to-side fashion VCS clips were easy to use for the surgeon, significantly (P < or = 0.001) decreasing the time needed for end-to-side anastomosis of the renal artery to the aorta (clips, 5.31 +/- 0.80 min/Polypropylene, 14.25 +/- 2.25 min/Dexon, 14.37 +/- 2.97 min); and also the time needed for end-to-side anastomosis of the renal veins to the cava (clips, 8.25 +/- 1.98 min/Polypropylene, 16.25 +/- 2.96 min/Dexon, 19.00 +/- 4.50 min). The use of VCS clips in heterotopic renal autotransplants significantly decreases the time needed for vascular reconstruction, compared to conventional suturing.
    Actas urologicas españolas 01/2009; 33(1):76-82. · 1.15 Impact Factor
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    ABSTRACT: IntroductionWhen performing vascular reconstruction in growing elements, specifically in paediatric transplant surgery, where a short vascular occlusion time is mandatory, master and easily handled suturing methods are needed. Thus the present study compares conventional continuous suturing with polypropylene and dexon versus easier and faster to apply titanium clips in heterotopic renal autotransplants.Material and methods24 growing pigs were used for this study. Heterotopic renal autotransplant was performed when the animals were 45 days old using VCS clips, continous Polypropylene or Dexon suturing when anastomosing the renal artery and vein to the aorta and cava in an end-to-side fashionResultsVCS clips were easy to use for the surgeon, significantly (P?0.001) decreasing the time needed for end-to-side anastomosis of the renal artery to the aorta (clips, 5.31±0.80 min/ Polypropylene, 14.25±2.25 min/Dexon, 14.37±2.97 min); and also the time needed for end-to-side anastomosis of the renal veins to the cava (clips, 8.25±1.98 min/Polypropylene, 16.25±2.96 min/ Dexon, 19.00±4.50 min).Conclusions The use of VCS clips in heterotopic renal autotransplants significantly decreases the time needed for vascular reconstruction, compared to conventional suturing.
    Actas urologicas españolas 01/2009; 33(1). DOI:10.4321/S0210-48062009000100014 · 1.15 Impact Factor
  • Proceedings of the IADIS International Conference Applied Computing 2009, 19-21 November, Rome, Italy, 2 Volumes; 01/2009
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    ABSTRACT: To present a new simulator designed at the Minimally Invasive Surgery Centre (Cáceres) which offers an integral, effective and viable training system that can be used for learning microsurgical techniques. A square methacrylate block was used. Animal jaws were fixed to the sides by means of butterfly screws. This block also has a drainage tube to facilitate the escape of fluids. Excellent results were obtained using this simulator in microsurgical suturing training in Dental, Oral and Maxillofacial Surgery. We believe that this simulator is an essential component in microsurgical training. It is an ethically and morally valid training method with which various suturing techniques can be practised before using live animals and before applying these to daily clinical practice.
    Medicina oral, patologia oral y cirugia bucal 01/2008; 12(8):E582-4. · 1.10 Impact Factor
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    ABSTRACT: The use of the microscope as a tool for practising Medicine, especially in surgical specialisations, has been established for decades. The microscope was first used in OdontologyDentistry back to the 1970s and 1980s, and was introduced more widely (although it was still far from being in general use) during 1990s. The purpose of this article is to describe the main applications of the microscope in OdontologyDentistry today, as well as providing odontologists and stomatologists, whether specialists or in general practice, with information about microscopic OdontologyDentistry for better patient care. This work also gives particular importance to matters needed to achieve the necessary manual dexterity to work in a magnified operating field using a surgical microscope (SM).
    Medicina oral, patologia oral y cirugia bucal 09/2007; 12(4):E311-6. · 1.10 Impact Factor
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    ABSTRACT: The study was focused on determining the effectiveness and reliability of using the renal resistance index as a method of diagnosing and monitoring the evolution of obstructive uropathy treatment. For this purpose, we conducted an experimental study on a homogenous group of animals that all had the same level of obstruction. 15 healthy female pigs were used. The experiment was divided into three phases: phase I consisted of a study prior to unilateral pyeloureteral junction obstruction, performing retrograde ureteropyelography, renal B-mode ultrasound and duplex-Doppler (of both kidneys) at a level of the arcuate arteries. Then, the obstruction was performed on the animals. Phase II commenced by diagnosing the lesion, 6 weeks after the previous phase, by means of the aforementioned diagnostic methods. Finally, the endourological treatment was completed. Animals were monitored (Phase III) 15 weeks after the endopyelotomy, using the same methods as in the study, by assessing the urinary tract (fluoroscopy) and both kidneys by determining the renal resistance index and ratio. All the animals in the study showed signs of urinary obstruction on radiology and renal ultrasound 6 weeks after ureteral ligature. After treatment and follow-up, all animals showed signs of having recovered from the obstructive uropathy. Values of deltaRI during the 3 phases are detailed below. Fase I deltaIR = 0.01, Fase II deltaIR = 0.11, Fase III deltaIR = 0.02. RI determination using duplex-Doppler is effective for distinguishing obstructive dilatation using non-invasive techniques. However, this parameter provides very slight differences and it can also be influenced by too many direct and indirect factors (observational, patient age, anaesthesia, haemodynamic parameters, etc.), to supplant the classic diagnostic methods.
    Actas urologicas españolas 02/2007; 31(1):38-42. · 1.15 Impact Factor
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    ABSTRACT: We present the experience of the Minimally Invasive Surgery Centre (MISC) in the development of a modular training model in laparoscopic surgery. The experience analysis includes the description of the training objectives, the learning process of simple and advance laparoscopic urologic techniques, as well as some current and future considerations before applying the laparoscopic techniques. This learning program pretends to optimize the knowledge of the surgeon and the clinical practice of these surgical techniques. The phases of the learning process have been classified in four levels, which include different modules and models and whose application will depend on the experience and surgical skills. This pyramidal training system permits the student to advance step by step through each level depending on her surgical skills. We have presented our experience in twelve courses about laparoscopic urology and four courses of laparoscopic radical prostatectomy, in which more than 300 urologists have assisted. Furthermore, some Spanish Urology Units have been developing special experimental training programs on laparoscopic radical prostatectomy, partial nephrectomy or laparoscopic dismembered pyeloplasty with Anderson-Hynes technique. It has been previously described that laparoscopic modular learning constitutes a very useful concept to avoid problems related to an incomplete and incorrect learning process. Also it seems clear that the laparoscopic training reduces the learning curve in laparoscopic urologic techniques.
    Actas urologicas españolas 06/2006; 30(5):443-50. · 1.15 Impact Factor
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    ABSTRACT: El microscopio como herramienta en la práctica de la Medicina, y sobre todo en las especialidades quirúrgicas se ha establecido como un hecho hace ya décadas. Las incorporaciones más tempranas del microscopio a la práctica odontológica debemos buscarlas en los años 70 y 80, si bien la incorporación de una forma más amplia (aún lejos de ser generalizada) ocurre en la década final del siglo pasado. Existen distintos modos de procurar la evolución dentro de las técnicas que se aplican en el gabinete dental. Una primera aproximación podría ser la de aquellos profesionales, con años de experiencia, que aplican directamente el uso del microscopio en sus pacientes, tal como lo hicieron los pioneros del uso del microscopio en Odontología. No obstante, en el trabajo actual presentamos y defendemos un programa de aprendizaje programado que permita introducir esta nueva tecnología de una forma secuencial, siguiendo un método protocolizado de enseñanza, eficiente, ordenado, que reporte al alumno una curva de aprendizaje más rápida y cómoda, dentro de un ambiente de trabajo relajado.
    01/2006;
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    ABSTRACT: This paper describes the histological features of the vagus nerve after its stimulation with an electrostimulation system that is being developed for morbid obesity treatment. An electrostimulation system was implanted laparoscopically around the ventral vagal trunk of five Large White female pigs (49.63+/-1.94 kg.). Vagal nerve stimulation was performed by continuous constant voltage current pulses. Thoracic samples of both ventral and dorsal vagal trunks were obtained thoracoscopically one month after implantation. Animals were sacrificed one month after thoracoscopic vaguectomy. Tissue samples were then harvested from the vagal nerve at the implantation site, 1cm cranial to it, thoracic portion of ventral and dorsal vagal trunks, sub-diaphragmatic dorsal vagal trunk, left and right vagus nerves. Specimens were analysed with light microscope. The severity of the lesions was graded from 0 to 4 (0: no lesion, 1: mild, 2: moderate, 3: severe and 4: extremely severe), taking into account fibrosis, vascularization, necrosis, fiber degeneration and inflammation. Electrode implantation resulted in thickened epineurium and endoneural connective tissue. The greatest lesion score was evidenced at the leads implantation site in the ventral vagal trunk, followed by, in order of decreasing lesion severity, left vagus nerve, thoracic portion of ventral vagal trunk, subdiaphragmatic dorsal vagal trunk, thoracic portion of dorsal vagal trunk and right vagus nerve. The stimulation device used in this study caused connective tissue growth, greatest in the samples located closer to the implantation site. However, there was no sign of altered vascularization in any studied specimen.
    Histology and histopathology 08/2005; 20(3):851-6. · 2.24 Impact Factor