ABSTRACT Purpose: To develop and validate a new test of specific technical skills required for microsurgical varicocelectomy. Materials and Methods: An electronic questionnaire was sent to 558 members of the Brazilian Society of Urology for the validation of the task-specific checklist (TSC) for assessment of microsurgical varicocelectomy. Participants who had experience in this procedure were selected as judges. For construct validation, 12 participants including attending urologists and urological residents in training were recruited for voluntary participation. We formed a group of three experts and a group of nine novices, who had to perform the steps of microsurgical varicocelectomy on a simulation model using human placenta. Each participant was filmed and two blinded raters would then evaluate their performance using the TSC of microsurgical varicocelectomy. Results: 14 judges were recruited. The assessment tool was reformulated, according to the judges suggestions and had the content validity achieved. The final version of the TSC was comprised of the task-specific score, a series of 4 items scored in a binary fashion designed for microscopic sub-inguinal varicocelectomy. The differences between the performance of participants with different levels of experience reflected the construct validity. The reliability between the raters was high. The mean time required to complete the training of microsurgical varicocelectomy in simulation model was significantly shorter for experts compared to novices (201 vs. 496 seconds, p=0.01). Conclusions: This preliminary study suggests that the task-specific checklist of microsurgical varicocelectomy is reliable and valid in assessing microsurgical skills.

RESUMO OBJETIVOS Objetivou-se com este trabalho adaptar transculturalmente o instrumento Objective Structured Assessment of Technical Skill (Osats) para o português-brasileiro e validá-lo no Brasil. MÉTODOS Uma versão em português-brasileiro do Osats foi criada por meio de um processo de tradução, retrotradução, versão consensual por um comitê de especialistas e pré-teste, seguido da etapa de validação. Para validades de constructo e concorrente, foram recrutados 12 participantes da Universidade Federal de Minas Gerais, divididos em um grupo de seis especialistas e um grupo de seis novatos, que tiveram de realizar tarefas em modelos de simulação utilizando placentas humanas. Cada participante foi filmado em anonimato e dois examinadores avaliaram os seus desempenhos usando o método tradicional subjetivo e depois a versão em português-brasileiro do Osats. RESULTADOS A versão em português-brasileiro do Osats alcançou as validades de face, de conteúdo, de constructo e concorrente. A média e o desvio padrão das pontuações atribuídas aos especialistas foram, respectivamente, 34 e 0,894, para o Juiz 1 e 34,33 e 0,816 para o Juiz 2. No caso dos novatos, foram 13,33 e 2,338 para o Juiz 1 e 13,33 e 3,204 para o Juiz 2. O Coeficiente de Correlação (de Pearson) entre os dois juízes foi de 0,9944 com IC 95% entre 0,9797 e 0,9985, com p<10-10, evidenciando a excelente reprodutibilidade do instrumento. CONCLUSÃO A versão em português-brasileiro do Osats manteve-se equivalente ao instrumento original e foi validada. Assim, pode ser usada para avaliar a performance operatória dos residentes em cirurgia no Brasil.

SUMMARY BACKGROUND The aim of this study was to perform a cross-cultural adaptation of the Objective Structured Assessment of Technical Skill (OSATS) tool into Brazilian Portuguese and to determine its reproducibility and validity in Brasil. METHODS A Brazilian Portuguese version of OSATS was created through a process of translation, back-translation, expert panel evaluation, pilot testing, and then its validation. For the construct and the concurrent validities, twelve participants were divided into a group of six experts and six novices, who had to perform tasks on a simulation model using human placentas. Each participant was filmed, and two blinded raters would then evaluate their performance using the traditional subjective method and then the Brazilian Portuguese version of OSATS. RESULTS The Brazilian Portuguese version of OSATS had the face, content, construct, and concurrent validities achieved. The average experts’ score and standard deviations were 34 and 0.894, respectively, for Judge 1 and 34.33 and 0.816 for Judge 2. In the case of novices, it was 13.33 and 2.388 for Judge 1 and 13.33 and 3.204 for Judge 2. The concordance between the judges was evident, with the Correlation Coefficient (Pearson) of 0.9944 with CI 95% between 0.9797 and 0.9985, with p < 10-10, evidencing the excellent reproducibility of the instrument. CONCLUSION This preliminary study suggests that the Brazilian Portuguese version of OSATS can reliably and validly assess surgical skills in Brasil.

INTRODUÇÃO: A craniectomia descompressiva (CD) é técnica utilizada para tratamento da hipertensão intracraniana (HIC) pós-traumática. Sua indicação ainda não está bem definida na população pediátrica. OBJETIVO: Relatar a utilização desta técnica em sete casos pediátricos. MÉTODO: Estudo retrospectivo de sete pacientes (2 a 17 anos) que receberam CD unilateral para tratamento de HIC. Todos tiveram monitorização pós-operatória da pressão intracraniana (PIC) e a CD foi classificada em ultra-precoce (<6h), precoce (6-12h) e tardia (>24h) de acordo com o seu tempo de realização após o trauma. O seguimento mínimo foi seis meses. RESULTADOS: Os pacientes foram seguidos por tomografia e quadro clínico, sendo classificados de acordo com a Escala de Outcome de Glasgow (GOS). Três pacientes faleceram (GOS1), um estava em estado vegetativo (GOS2), dois com déficit neurológico moderado (GOS3 e 4) e um com reabilitação funcional completa (GOS5) à época da alta hospitalar. Após período mínimo de seis meses, o paciente que estava em estado vegetativo e um dos que tinha déficit neurológico moderado melhoraram. Perdeu-se seguimento do paciente com alta em GOS4. Como complicação, ocorreram coleção subdural (2), hidrocefalia (1) e infecção superficial (1). Dos quatro que sobreviveram, dois receberam cranioplastia autóloga e os outros dois, heteróloga. CONCLUSÃO: A CD é método eficaz para redução da PIC, mas não é isenta de complicações. Sua aplicação ainda não está bem definida na população pediátrica, carecendo de estudos multicêntricos.

INTRODUCTION: Decompressive craniectomy (DC) is a surgical technique used to treat patients with elevated intracranial pressure often found in head injury. Its indication remains a controversial issue in the pediatric population. OBJECTIVE: To report seven cases managed with this technique. Method: Retrospective study of seven patients, aged from 2 to 17 years, treated with unilateral DC due to increased intracranial pressure (ICP) as a consequence of head injury. All patients had ICP monitored post operatively and the DC classified as ultra-early (<6h), early (6-12h) or late (>24h) according to the time of its application. The minimum follow-up was six months. RESULTS: Patients were evaluated with CT scans and clinical exams, and graded according the Glasgow Outcome Scale (GOS). Three patients deceased (GOS1), one was in vegetative state (GOS2), two recovered but still requiring nursing care (GOS3 and 4), and one had a full recovery (GOS5) at hospital discharge. After six months the GOS2 and a GOS3 patients achieved full recovery (GOS5). Subdural collection (2), hydrocephalus (1) and superficial infection (1) occurred as complication. Two patients had autologous cranioplasty and the other two heterologous cranioplasty. CONCLUSION: Decompressive craniectomy remains a feasible treatment method to lower the ICP, but is not safe from complications. A multicentric study should be done for appropriate protocol treatment of pediatric patients.

Grandes lesões que ocupam bilateralmente o espaço incisural posterior são de difícil abordagem cirúrgica pelos acessos clássicos. Recentemente, Kawashima et al. descreveram, em peças anatômicas, uma modificação do acesso occipital transtentorial, o acesso occipital bitranstentorial-falcino, para abordagem de grandes lesões que ocupam bilateralmente o espaço incisural posterior. Retata-se um caso de grande meningioma falco-tentorial que ocupava o espaço incisural posterior bilateralmente. O acesso occipital bitranstentorial-falcino permitiu exérese completa da lesão sem déficit no pós-operatório.

Lesions located in the bilateral posterior incisural space are difficult to treat due to limited exposure. The classical approaches to this area are limited for lesions located bilaterally and especially when the lesion extends also below the tentorium as it may occur with meningiomas. Kawashima et al. reported, in anatomic studies, a new occipital transtentorial approach: the occipital bi-transtentorial/falcine approach, to treat such lesions. We present a patient with a large falcotentorial meningioma, located bilaterally in the posterior incisural space. The occipital bi-transtentorial/falcine approach allowed an excellent surgical exposure and complete tumor removal with an excellent patient outcome.

Realizou-se análise de 22 pacientes portadores de tumores e lesões vasculares (malformações arteriovenosas e aneurismas) das regiões posteriores do giro parahipocampal e do pulvinar do tálamo e operados pelo acesso supratentorial-infraoccipital. Em quinze pacientes com tumor, a ressecção foi completa em seis e parcial em nove. Os cinco pacientes com malformação arteriovenosa foram submetidos a exérese total da lesão. Realizou-se também o estudo anatômico deste acesso em cinco segmentos cefálicos (dez lados). Os resultados cirúrgicos e do estudo anatômico sugerem que o acesso supratentorial-infraoccipital representa opção para abordar lesões do pulvinar do tálamo e do lobo temporal posteromedial que afloram na fissura transversa do cérebro.

Twenty-two patients harboring tumors or vascular lesions (AVMs and aneurysms) located at the posterior aspect of the parahipocampal gyrus and the pulvinar of thalamus operated by supratentorial-infraoccipital approach were analysed. Total resection was achieved in all five AVM patients as well as in six out of fifteen tumor patients. This approach was performed in five anatomical specimens (ten approaches); It results, along with the surgical results, allow this approach to be considered a good option for lesions of the pulvinar of thalamus and postero-medial temporal lobe which are evident at the transverse fissure.