Análise da concordância de cirurgiões em pontos-chave técnicos da Gastrectomia Vertical que podem alterar a incidência de Doença do Refluxo Gastroesofágico
Data
2023-09-27
Autores
Katayama, Rafael Cauê 
Orientadores
Herbella, Fernando Augusto Mardiros
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Avaliar a autocrítica e a heterocrítica das variações técnicas nas gastrectomias verticais através da análise de vídeos pré-gravados de operações. Método: Dez cirurgiões experientes (> 30 gastrectomias vertical/ano) (9 homens, idade média de 55 anos) foram convidados a participar do estudo. Os indivíduos foram solicitados a enviar um vídeo não editado com uma gastrectomia vertical laparoscópica típica de sua prática diária (primeira rodada). Os vídeos foram editados em pequenos clipes compreendendo 11 pontos-chave da técnica. Todos os clipes anônimos (incluindo os próprios) foram devolvidos a todos os cirurgiões. Os indivíduos foram solicitados a concordar ou não com a técnica demonstrada. Foi seguido o processo Delphi para avaliação de consenso. Após a rodada em que todos os cirurgiões declararam concordar ou não com a técnica (segunda rodada), a porcentagem de investigadores que concordaram foi apresentada a todo o grupo e foi solicitada uma segunda votação (terceira rodada). A concordância Inter avaliadores – Inter rater Reliability (IRR) foi calculada para avaliar a concordância entre os participantes. Resultados: Durante a segunda rodada, a concordância foi ruim/razoável para todos os pontos, exceto o reparo do hiato, que teve uma concordância muito boa. Para a terceira rodada, houve discreto aumento na concordância para distância junção esofagogástrica/grampeamento proximal e mobilização gástrica para grampeamento; e discreta diminuição da concordância para o formato final do tubo gástrico. Apenas 1 (10%) cirurgião reconheceu que avaliou seu próprio vídeo. Cinco (50%) dos cirurgiões discordaram de si mesmos em 1 ou mais pontos: dissecção do pilar diafragmático (n=2), distância piloro / grampeamento distal (n=2), ângulo de His (n=1), distância esôfago-gástrica junção/grampeamento proximal (n=1) e fixação omental (n=1). Conclusão: A análise de vídeos pré-gravados de operações de GV mostrou auto e hetero concordância fraca / razoável na maioria dos pontos técnicos.
Objective: This study aims to evaluate the auto and heteroagreement for sleeve gastrectomy technical keypoints based on prerecorded videos. Methods: Ten experienced (> 30 sleeve gastrectomy/year) surgeons (9 males, mean age 55 years) were invited to participate in the study. Individuals were asked to send an unedited video with a typical laparoscopic sleeve gastrectomy performed by them (first round). The videos were cropped into small clips comprising 11 keypoints of the technique. All anonymized clips (including their own) were returned to all surgeons. Individuals were asked to agree or not with the technique demonstrated. We followed the Delphi process for consensus evaluation. After the round in which all surgeons declared their agreement or not with the technique (second round), the percentage of investigators that agreed was presented to the entire group and they were asked for a second vote (third round). Interrater Reliability (IRR) was calculated to assess interobserver agreement. Results: During the second round, agreement was poor/fair for all points except hiatal repair that had a very good agreement. For the third round, there was slight increase in agreement for distance esophagogastric junction / proximal stapling and gastric mobilization for stapling; and slight decrease in agreement for gastric tube final shape. Only 1 (10%) surgeon recognized that he evaluated his own video. Five (50%) of the surgeons disagreed with themselves in regard to 1 or more points: diaphragmatic crus dissection (n=2), distance pylorus / distal stapling (n=2), angle of His (n=1), distance esophagogastric junction / proximal stapling (n=1), and omental fixation (n=1). Conclusions: Analysis of prerecorded videos of GV operations showed self and hetero weak/fair agreement on most technical key points.
Objective: This study aims to evaluate the auto and heteroagreement for sleeve gastrectomy technical keypoints based on prerecorded videos. Methods: Ten experienced (> 30 sleeve gastrectomy/year) surgeons (9 males, mean age 55 years) were invited to participate in the study. Individuals were asked to send an unedited video with a typical laparoscopic sleeve gastrectomy performed by them (first round). The videos were cropped into small clips comprising 11 keypoints of the technique. All anonymized clips (including their own) were returned to all surgeons. Individuals were asked to agree or not with the technique demonstrated. We followed the Delphi process for consensus evaluation. After the round in which all surgeons declared their agreement or not with the technique (second round), the percentage of investigators that agreed was presented to the entire group and they were asked for a second vote (third round). Interrater Reliability (IRR) was calculated to assess interobserver agreement. Results: During the second round, agreement was poor/fair for all points except hiatal repair that had a very good agreement. For the third round, there was slight increase in agreement for distance esophagogastric junction / proximal stapling and gastric mobilization for stapling; and slight decrease in agreement for gastric tube final shape. Only 1 (10%) surgeon recognized that he evaluated his own video. Five (50%) of the surgeons disagreed with themselves in regard to 1 or more points: diaphragmatic crus dissection (n=2), distance pylorus / distal stapling (n=2), angle of His (n=1), distance esophagogastric junction / proximal stapling (n=1), and omental fixation (n=1). Conclusions: Analysis of prerecorded videos of GV operations showed self and hetero weak/fair agreement on most technical key points.
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Citação
KATAYAMA, Rafael Cauê. Análise da concordância de cirurgiões em pontos-chave técnicos da Gastrectomia Vertical que podem alterar a incidência de Doença do Refluxo Gastroesofágico. 2023. 52 f. Tese (Doutorado em Ciência Cirúrgica Interdisciplinar) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2023.