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Contexte : en chirurgie, le personnel des blocs opératoires est particulièrement exposé à la transmission directe du SARS-CoV-2.Objectif : décrire dans un premier temps les connaissances des instrumentistes de bloc opératoire sur l’épidémie de Covid-19 ainsi que sur l’état des blocs opératoires où ils exercent au regard des recommandations antiinfectieuses, leurs attitudes et pratiques face au Covid-19 à Lomé, au Togo. Dans un second temps, il s’agissait d’identifier les facteurs associés à une bonne connaissance de ces instrumentistes sur l’épidémie de Covid-19.Méthode : il s’agissait d’une étude transversale menée du 15 juin au 15 septembre 2020 dans dix formations sanitaires de Lomé disposant d’un bloc chirurgical opérationnel. Les données ont été recueillies à l'aide d'un auto questionnaire à remplir immédiatement en présence de l’enquêteur. Un score a été arbitrairement défini pour évaluer la connaissance du Covid-19. Une analyse de régression logistique a été réalisée pour identifier les facteurs associés à une meilleure connaissance du Covid-19. Les analyses statistiques ont été réalisées à l’aide du logiciel R version 4.0.1.Résultats : les femmes avaient un niveau de connaissance significativement plus élevé que les hommes (65,2% vs 34,8%, p=0,026). Il n’y avait pas de différence de connaissance selon les autres caractéristiques socio démographiques des participants. Quatre participants (7,0%) connaissaient l’existence d’un système de régulation de pression à l’intérieur de leur bloc opératoire. En analyse multivariée, les hommes avaient un niveau de connaissance plus faible de 75% par rapport au femmes (OR=0,25 ; p=0,027).Conclusion : cette étude offre des données nécessaires aux autorités sanitaires togolaises sur quelques cibles d’interventions de santé publique en vue de l’amélioration des politiques relatives à l'épidémie de Covid-19. Background : In surgery, operating room personnel are particularly exposed to direct transmission of SARS-CoV-2.Objective : to first describe the knowledge, attitudes and practices of operating room instrumentalists on the Covid-19 epidemic as well as the state of the operating theaters where they work with regard to the anti-infectious recommendations. The second step was to identify the factors associated with a good knowledge of these technicians on the Covid-19 epidemic.Method : this was a cross-sectional study carried out from June 15 to September 15, 2020 in ten health facilities in Lomé with an operational surgical unit. The data was collected using a self-administered questionnaire to be completed immediately in the presence of the interviewer. A logistic regression analysis was performed to identify the factors associated with a better knowledge of Covid-19.Results : Women had a significantly higher level of knowledge than men (65.2% vs. 34.8%, p = 0.026). There was no difference in knowledge according to the other socio-demographic characteristics of the participants. Four participants (7.0%) were aware of the existence of a pressure regulation system inside their operating room. In multivariate analysis, men had a lower level of knowledge of 75% compared to women (OR = 0.25; p = 0.027).Conclusion : this study provides the data necessary for the togolese health authorities on some targets of public health interventions during Covid-19 epidemic.

BACKGROUND Although abdominoplasty is a mainstay of the plastic surgeon, the safety of the Brazilian butt lift (BBL) has been questioned, effectively being prohibited in some countries. The central rationale for the safety concern over the BBL stems from a publication stating a mortality rate of one in 3000. The question remains: What is the real safety of these procedures? METHODS Focusing on mortality, literature searches were performed for BBL and for abdominoplasty. The 2017 Aesthetic Surgery Education and Research Foundation survey data and publication were examined and analyzed. Additional data from the American Association for Accreditation of Ambulatory Surgical Facilities were obtained independently. RESULTS Abdominoplasty and BBL appear to have similar safety based on mortality; however, the nature of their mortalities is different. Although most abdominoplasty deaths are secondary to deep venous thrombosis/pulmonary embolism-inherent circulatory thrombotic abnormality-BBL mortality is associated with iatrogenic pulmonary fat embolism. BBL mortality rates from more recent surveys on BBL safety demonstrate a mortality of one in 15,000. CONCLUSIONS Although deep venous thrombosis/pulmonary embolism will always remain an abdominoplasty risk, intraoperative BBL pulmonary fat embolism has the potential to be reduced dramatically with a better understanding of dynamic anatomy, surgical instrumentation, and technique. The authors are now presented with a better lens with which to view a more accurate safety profile of BBL surgery, including its place among other commonly performed aesthetic procedures.

Titanium aluminum nitride (TiAlN) is proposed as a coating to decrease the reflectivity of surgical instrumentation, thereby improving the field of vision of surgeons during procedures, although the corrosion resistance of the material against repeated sterilization processes must be guaranteed. The influence of aluminum (Al) on the microstructural and electrochemical properties of low-reflectivity titanium aluminum nitride coatings deposited by direct-current unbalanced magnetron sputtering was evaluated. The optical properties, chemical phases and composition were determined using the ultraviolet–visible spectroscopy, energy-dispersive X-ray spectroscopy, X-ray photoelectron spectroscopy and X-ray diffraction techniques. The microstructures were analyzed by atomic force microscopy, scanning electron microscopy and transmission electron microscopy–selected area electron diffraction. The corrosion resistance was evaluated by electrochemical impedance spectroscopy and potentiodynamic polarization. It was found that an increase in the aluminum content reduced the coating reflectivity by 60%, showing a dense columnar crystalline structure with a grain size of 200–100 nm and roughness of 6.7–4.0 nm and the coexistence of titanium nitride (TiN), aluminum nitride (AlN), titanium aluminum nitride and aluminum oxide (Al2O3) phases. In comparison with AISI 420 steel, the TiAlN-1300W aluminum coating showed a more positive corrosion potential, as well as a current density two orders of magnitude lower, thus guaranteeing corrosion resistance.

Digital, La educación en Colombia actualmente se encuentra en un proceso de fortalecimiento progresivo de las Instituciones de Educación Superior (IES), buscando formar profesionales de calidad con competitividades y cualidades que les permitan responder a los desafíos de la sociedad y promover el desarrollo económico y social del país. Por este motivo, y continuando la orientación del Plan Decenal de Educación, se realizó el presente estudio con el fin de brindar un análisis sociodemográfico y ocupacional de los egresados del Programa de Instrumentación Quirúrgica de la Universidad de Santander, sede Bucaramanga en el periodo 2019- 2022A, considerando la pertinencia del programa en el marco de la empleabilidad, así como la articulación entre los lineamientos curriculares del programa, frente al desarrollo de las competencias profesionales, calidad e impacto en el medio. Para el cumplimiento de los objetivos del proyecto se desarrolló una investigación con enfoque cuantitativo de tipo descriptivo con corte transversal, ya que describe las características sociodemográficas, desempeño ocupacional, competencias profesionales y percepción sobre la formación recibida por parte de los egresados del Programa de Instrumentación Quirúrgica de la Universidad de Santander sede Bucaramanga durante el periodo 2019 -2021. Entre los resultados obtenidos se evidencio una participación de 95 egresados de los cuales 25 de ellos no llegaron a completar la encuesta en su totalidad, de los cuales se observó que de los aceptados para dicho análisis el 82,9% pertenecen al sexo femenino y 17,1% al sexo masculino; de los cuales el 78% refiere estar soltero y el 22% responder estar en una relación; así mismo se obtuvo que solo 15% se encuentra laborando en una institución de carácter público, refiriendo así que 74,3% tiene un rango salarial entre 2 a 3 SMMLV, teniendo presente que 64 egresados argumenta que su actual trabajo está directamente relacionado con el programa que estudio., Education in Colombia is currently in a process of progressive strengthening of Higher Education Institutions (HEIs), seeking to train quality professionals with skills and qualities that allow them to respond to the challenges of society and promote the economic and social development of the country. country. For this reason, and continuing the orientation of the Ten Year Education Plan, the present study was carried out in order to provide a sociodemographic and occupational analysis of the graduates of the Surgical Instrumentation Program of the University of Santander, Bucaramanga headquarters in the period 2019- 2021, considering the relevance of the program within the framework of employability, as well as the articulation between the curricular guidelines of the program, regarding the development of professional skills, quality and impact on the environment. For the fulfillment of the objectives of the project, a research was developed with a quantitative approach of a descriptive type with a cross section, since it describes the sociodemographic characteristics, occupational performance, professional skills and perception of the training received by the graduates of the Surgical Instrumentation Program. of the University of Santander Bucaramanga campus during the period 2019 -2021. Among the results obtained, a participation of 95 graduates was evidenced, of which 25 of them did not complete the survey in its entirety, of which it was observed that of those accepted for said analysis, 82.9% belong to the female sex and 17 .1% to the male sex; of which 78% reported being single and 22% answered being in a relationship; Likewise, it was obtained that only 15% are working in a public institution, thus referring that 74.3% have a salary range between 2 to 3 SMMLV, bearing in mind that 64 graduates argue that their current job is directly related to the program I study., Pregrado, Instrumentador Quirúrgico, Introducción ...................................................................................................................................18 Descripción del Problema ..............................................................................................................20 Planteamiento del Problema ......................................................................................................... 20 Formulación del Problema............................................................................................................ 21 Justificación ...................................................................................................................................24 Objetivos........................................................................................................................................26 Objetivo General........................................................................................................................... 26 Objetivos Específicos.................................................................................................................... 26 Marco Referencial..........................................................................................................................27 Marco Teórico............................................................................................................................... 27 Marco Histórico............................................................................................................................ 27 Reseña Histórica de la Universidad de Santander (UDES). ......................................................... 29 Reseña Histórica del Programa Instrumentación Quirúrgica........................................................ 30 Estado del Arte.............................................................................................................................. 33 Estudios de Seguimiento a Egresados........................................................................................... 36 Condiciones Laborales de los Egresados de Ciencias de la Salud en Colombia.. ........................ 38 Impacto Laboral de un Egresado.. ................................................................................................ 40 Marco Conceptual ........................................................................................................................ 41 Calidad de la Educación................................................................................................................ 41 Formación Integral........................................................................................................................ 42 Registro Calificado.. ..................................................................................................................... 42 Renovación del Registro Calificado. ............................................................................................ 43 Verificación de Condiciones......................................................................................................... 44 Condiciones Institucionales de Calidad. ....................................................................................... 44 Condición de Calidad – Programa de Egresados.......................................................................... 45 Marco Legal / Normativo / Jurídico ............................................................................................. 47 Condiciones Laborales de los Egresados en Colombia ............................................................... 49 Importancia del Currículo............................................................................................................. 50 Diseño Metodológico.....................................................................................................................53 Enfoque y Tipo de Estudio ........................................................................................................... 53 Población de Referencia ............................................................................................................... 53 Egresados...................................................................................................................................... 53 Población de Estudio (Muestra).................................................................................................... 53 Egresados...................................................................................................................................... 53 Muestreo ....................................................................................................................................... 54 Criterios de Inclusión y Exclusión................................................................................................ 54 Criterios de Inclusión de Egresados............................................................................................. 54 Criterios de Exclusión................................................................................................................... 54 Variables....................................................................................................................................... 54 Operacionalización de Variables ................................................................................................. 55 Instrumentos.................................................................................................................................. 56 Técnicas de Recolección de Información ..................................................................................... 56 Análisis Estadístico....................................................................................................................... 56 Consideraciones Éticas ..................................................................................................................57 Valoración de Impactos Negativos............................................................................................... 61 Resultados......................................................................................................................................63 Condiciones Laborales.................................................................................................................. 64 Resultados Sobre Opinión de los Egresados Frente al Programa de Instrumentación Quirúrgica69 Resultados Sobre Importancia y Experticia en Competencias Profesionales del Programa de Instrumentación Quirúrgica .......................................................................................................... 70 Resultados Sobre la Importancia en Competencias Genéricas del Programa de Instrumentación Quirúrgica ..................................................................................................................................... 70 Discusión........................................................................................................................................79 Conclusiones..................................................................................................................................82 Referencias Bibliográficas.............................................................................................................84 Apéndices.......................................................................................................................................89

Background: Three-dimensional (3D) technologies have numerous medical applications and have gained a lot of interest in medical world. After the advent of three-dimensional printing technology, and especially in last decade, orthopedic surgeons began to apply this innovative technology in almost all areas of orthopedic traumatic surgery. Objective: The aim of this paper is to give an overview of 3D technologies current usage in orthopedic surgery for patient specific applications. Methods: Two major databases PubMed and Web of Science were explored for content description and applications of 3D technologies in orthopedic surgery. It was considered papers presenting controlled studies and series of cases that include descriptions of 3D technologies compatible with applications to human medical purposes. Results: First it is presented the available three-dimensional technologies that can be used in orthopedic surgery as well as methods of integration in order to achieve the desired medical application for patient specific orthopedics. Technology starts with medical images acquisition, followed by design, numerical simulation, and printing. Then it is described the state of the art clinical applications of 3D technologies in orthopedics, by selecting the latest reported articles in medical literature. It is focused on preoperative visualization and planning, trauma, injuries, elective orthopedic surgery, guides and customized surgical instrumentation, implants, orthopedic fixators, orthoses and prostheses. Conclusion: The new 3D digital technologies are revolutionizing orthopedic clinical practices. The vast potential of 3D technologies is increasingly used in clinical practice. These technologies provide useful tools for clinical environment: accurate preoperative planning for cases of complex trauma and elective cases, personalized surgical instruments and personalized implants. There is a need to further explore the vast potential of 3D technologies in many other areas of orthopedics and to accommodate healthcare professionals with these technologies, as well as to study their effectiveness compared to conventional methods.

Introducción: La promoción de estilos de vida saludables por el profesional de salud depende de sus propios hábitos, los cuales se afianzan durante la formación universitaria. Sin embargo, los hábitos alimentarios, niveles de actividad física y sedentarismo pueden variar entre universitarios de distintos programas del área de la salud. Objetivo: identificar las diferencias de los niveles de actividad física y de hábitos alimentarios entre estudiantes de diferentes programas del área de la salud de una universidad privada en Bogotá. Material y métodos: estudio transversal en estudiantes de I-IV semestre de enfermería, instrumentación quirúrgica, medicina, odontología y optometría durante agosto 2017. Se midió actividad física (IPAQ-SF) y hábitos alimentarios (cuestionario de frecuencia de consumo). Se emplearon las pruebas χ2 y Kruskal-Wallis para las comparaciones entre programas. Resultados: participaron 692 estudiantes y 77,8% fueron mujeres. Instrumentación mostró el más bajo porcentaje de consumo de almuerzo (88%; p0,004); en la población se presentó bajo consumo de todos los grupos de alimentos, específicamente odontología tuvo bajo consumo de cereales (29%; p0,021) y enfermería de frutas (35%; p0,04) y carnes-huevos-leguminosas (35%; p0,01). Por otra parte, medicina presentó la mayor prevalencia de nivel alto de actividad física (41%; p0,002) y enfermería el mayor porcentaje de nivel bajo (60%; p0,01). Conclusiones: Se encontraron diferencias en los niveles de actividad física y hábitos alimentarios entre los distintos programas evaluados. Se deberían realizar intervenciones a nivel curricular y de promoción de la salud para mejorar los estilos de vida de los universitarios. Introduction: The promotion of healthy lifestyles by the health professional depends on their own habits, which are consolidated during university education. However, the variation in eating habits and physical activity among university students from different health programs is not known. Objective: Identify the differences in the levels of physical activity, sedentary lifestyle, and eating habits among students from different programs in the health area at a private university in Bogotá. Material and methods: cross-sectional study in undergraduate students of nursing, surgical instrumentation, optometry, medicine, and dentistry. Students were in the I to IV semester during August 2017. Physical activity (IPAQ-SF) and eating habits (questionnaire of frequency of consumption) were measured; The χ2 and Kruskal-Wallis tests were used for comparisons between programs. Results: 692 students participated and 77.8% were women. Surgical instrumentation showed the lowest percentage of lunch consumption (88%; p0.004); in the sample there was low consumption of all food groups, specifically dentistry had low consumption of cereals (29%; p0.021) and nursing had low consumption of fruits (35%; p0.04) and meat-eggs-legumes (35%; p0.01). On the other hand, medicine presented the highest prevalence of high level of physical activity (41%; p0.002) and nursing the highest percentage of low level (60%; p0.01). Conclusions: Differences were found in the levels of physical activity and eating habits among the different programs evaluated. Interventions at the curricular level and health promotion are necessary to improve university lifestyles.

Summary. The aim. Comparison of clinical, clinical instrumental and morphological data to establish the most informative signs of extremity foreign bodies, the possibility of choosing surgical tactics and improving treatment results. Materials and methods. Removal of ferromagnetic metallic foreign bodies of various sizes was carried out under visual control using a magnetic search tool. Visual control of the removal of a foreign body allows you to assess the adequacy of its removal. Results and its discussion. Removal of a foreign body was carried out using general surgical instrumentation under tactile control using the surgeon's finger and a Billroth curved hemostatic clamp or a mosquito curved hemostatic clamp. Removal of foreign bodies of extremities under hardware control is possible both in continuous time (on line) and intermittent (step-by-step) mode - detection of foreign bodies, marking (leaving marks on the skin). Removal of a foreign body was also carried out under X-ray control. Most often, a step-by-step technique was used, in which the characteristics of a foreign body were first determined, then it was removed and, finally, a control X-ray study was performed with uncertainty about the completeness of removal. In cases where there were problems with the spatial perception of the location of foreign bodies, the removal of foreign bodies under visual, tactile and hardware control was difficult, we used a combination of these methods. Conclusions. As a result of using the proposed modern diagnostic technologies, the completeness of removal of extremities foreign bodies significantly increased from 6.2±0.1 to 1.4±0.1 (p

We aimed to analyze the impact of two different types of surgical instrumentation (conventional manual instrumentation (CI) and patient-specific instrumentation (PSI)) on length of stay (LOS) and objectify differences in cost. We hypothesized that there are no differences in the LOS and cost due to the instrumentation system used.LOS was registered using inpatient admission data provided by the Institutional Management Control Department. We recorded the costs associated with each procedure that could be influenced by the use of one system or another during the in-hospital stay. We conducted a prospectively single-center cohort study of 305 TKAs. Surgery was performed with conventional CI in 122 cases and with PSI in 183 cases.The mean LOS for the CI group was 4.29 days (SD 1.65) and 4.22 days (SD 1.26), for the PSI group. No significant difference among both instrumentation systems was obtained. When comparing global costs, the mean cost was slightly higher (without a significant difference) for the PSI cases (€3110.24 vs. €2852.7 for the CI cases).LOS and overall cost, in hospitals with a low annual TKA surgery volume, are unrelated to conventional or patient-specific instrumentation.

The severe foot and ankle deformities the authors' organization has encountered in humanitarian programs worldwide are more complicated than those surgeons treat in daily practice in developed countries. Severity of deformity, patients' economic limitations, patients' expectations and realistic needs in life, availability of surgical instrumentation, the local team's understanding of foot and ankle surgery and their ability to do consultation for patients postoperatively, and compliance of patients all account for success of the surgery. Regardless of the effort surgeons make, complications and recurrence occur. Educating and training local surgeons to take over medical care are the most important goals of the programs.

Background Surgeons are at high risk of developing musculoskeletal disorders. Study Design This study was designed to identify risk factors and assess intraoperative physical stressors using subjective and objective measures, including type of procedure and equipment used. Wearable sensors and pre- and postoperation surveys were analyzed. Results Data from 116 cases (34 male and 19 female surgeons) were collected across surgical specialties. Surgeons reported increased pain in the neck, upper, and lower back both during and after operations. High-stress intraoperative postures were also revealed by the real-time measurement in the neck and back. Surgical duration also impacted physical pain and fatigue. Open procedures had more stressful physical postures than laparoscopic procedures. Loupe usage negatively impacted neck postures. Conclusions This study highlights the fact that musculoskeletal disorders are common in surgeons and characterizes surgeons’ intraoperative posture as well as surgeon pain and fatigue across specialties. Defining intraoperative ergonomic risk factors is of paramount importance to protect the well-being of the surgical workforce.

There is presently a lack of organization and standardized reporting schema for arteriovenous graft (AVG) infections. The purpose of this article is to evaluate the various types of treatment modalities for access site infections through an analysis of current publications on AVG. Key proposals are made to support standardization in a data-driven manner to make infection reporting more uniform and thereby facilitate more meaningful comparisons between various dialysis modalities and AVG technologies.

OBJECTIVE: Work-related musculoskeletal disorders (WMSDs) among neurosurgeons can lead to consequences for themselves, the hospital, and society. In the current study, the working conditions of neurosurgeons from an ergonomic point of view is evaluated, together with WMSD.METHODS: Members of the Congress of Neurological Surgeons were surveyed with an online survey covering 1) demographics, 2) working conditions, 3) ergonomic features during 3 neurosurgical procedures, and 4) whether they experienced WMSD. Multivariate logistic regression analysis was performed to identify factors associated with experiencing WMSD.RESULTS: hi total, 417 replies were received. Respondents had a mean tenure of 21.9 years. In total, 33.1% stated that the operating room is furnished ergonomically and 90.7% stated that ergonomics is an underexposed field in neurosurgery. The majority of the respondents (73.6%) had experienced WMSD. Performing long procedures and spine surgery were mentioned most often as cause for WMSD. Due to WMSD, 11.3% of the respondents had to take time off work, and 14.2% considered changing their career. Analgesics were mostly used as treatment for WMSD (42.9%) and 7.4% underwent surgery. Having a tenure

This study analyzes reports of the role of robot assistance in dentistry and the main pathways for its further development. We report a retrospective analysis of the construction of robotic and robot-assisted systems used in dental practice. The development of robot-assisted and robotic systems should be included in improvements to methods of intraoperative imaging, diagnostics, and improvements in surgical instrumentation and the introduction of new robotic developments.

Mohs micrographic surgery, excisional surgery, and electrodessication and curettage (EDC) are common dermatologic procedures that often use electrodessication through hyfrecators to achieve hemostasis. According to in vitro studies, electrodessication is considered safe in patients with implanted cardiac devices. To the authors' knowledge, there are no in vivo data to support this claim.In this study, the authors aim to describe the outcomes of hyfrecation during dermatologic procedures in patients with pacemakers and implantable cardiac devices.Retrospective chart review was completed from March 2014 to April 2018 at a single center. Forty-five patients met criteria of having a cardiac device and having undergone an electrosurgery procedure using the Conmed 2000 Hyfrecator (Utica, NY). Adverse perioperative and postoperative outcomes, as well as device malfunction, were evaluated.No adverse perioperative effects were reported. Device reports were examined for inappropriate firing of the defibrillator, loss of capture, temporary inhibition of pacing, battery drainage, pacing at an elevated or erratic rate, failure to deliver antitachycardia, reversion to asynchronous pacing, induction of arrhythmias, or tissue damage at lead tissue, but no such issues were found.The lack of complications associated with cardiac devices with hyfrecation is reassuring. However, prospective and larger retrospective studies are warranted.

Digital, La urología es la especialidad encargada del diagnóstico, tratamiento, promoción y prevención del sistema urinario en mujeres y genitourinario en hombres. En el caso de los procedimientos quirúrgicos surge la “endourología” que se realiza a través de los orificios naturales, en este caso la uretra con el uso de los dispositivos médicos especializados. Las técnicas de endourología siempre ha tenido cierto grado de dificultad debido a la actualización de las nuevas tecnologías y la falta de conocimiento para su manejo, ensamble y conformación. Por lo tanto, el objetivo es Identificar el conocimiento de los dispositivos médicos de endourología por parte de los Instrumentadores quirúrgicos de una Institución de salud de alta complejidad en la ciudad de Bucaramanga, de una Institución de salud de mediana complejidad en la ciudad de Ocaña y de los estudiantes de 7 y 8 semestre de la Universidad de Santander UDES. Se realizó un estudio observacional descriptivo de corte transversal, con muestreo no probabilístico intencional, incluyendo a los estudiantes de séptimo y octavo semestre de Instrumentación Quirúrgica de la universidad de Santander Campus Bucaramanga e Instrumentadores Quirúrgicos de una IPS de Ocaña y Bucaramanga de mediana y alta complejidad respectivamente. Entre los equipos de endourología que se conocen más está, el cistoscopio rígido y flexible y el de menor manejo y conocimiento está el nefroscopio, ureteroscopio y resectoscopio. El 100% de los encuestados consideran útil una herramienta virtual para identificar los equipos de endourología., Urology is the specialty in charge of the diagnosis, treatment, promotion, and prevention of the urinary system in women and the genitourinary system in men. In the case of surgical procedures, "endourology" is performed through the natural orifices, in this case, the urethra with the use of specialized medical devices. The endourology techniques have always had a certain degree of difficulty due to the updating of new technologies and the lack of knowledge for its handling, assembly, and conformation. Therefore, the objective is to identify the knowledge of endourology medical devices by the surgical instrumentators of a high complexity health institution in the city of Bucaramanga, of a medium complexity health institution in the city of Ocaña, and of the 7th and 8th-semester students of the University of Santander UDES. A cross-sectional descriptive observational study was carried out, with non-probabilistic intentional sampling, including seventh and eighth-semester students of Surgical Instrumentation of the University of Santander Campus Bucaramanga and Surgical Instrumentators of an IPS of Ocaña and Bucaramanga of medium and high complexity respectively. Among the endourology equipment most known is the rigid and flexible cystoscope and the least known and known is the nephroscope, ureteroscope, and resectoscope. A virtual tool to identify endourology equipment is considered useful by 100% of the respondents., Pregrado, Instrumentador Quirúrgico, 1 ed., Introducción ................................................................................................................... 12 1. Planteamiento del Problema ............................................................................. 15 1.1 Descripción del Problema ................................................................................. 15 1.2 Pregunta de Investigación ................................................................................ 17 2. Justificación ...................................................................................................... 18 3. Objetivos........................................................................................................... 20 3.1 Objetivo General ............................................................................................... 20 3.2 Objetivos Específicos ....................................................................................... 20 4. Marco Referencial ............................................................................................ 21 4.1 Marco Histórico ................................................................................................. 21 4.2 Estado del Arte ................................................................................................. 25 4.3 Marco Conceptual ............................................................................................ 31 4.4 Marco Legal ...................................................................................................... 41 4.4.1 La Constitución Política de Colombia de 1991. ................................................ 42 4.4.2 Resolución 02183 de 2004. .............................................................................. 43 4.4.3 El Decreto 4725 del 2005. ................................................................................ 43 4.4.4 Resolución 2434 del 2006. ............................................................................... 44 4.4.5 Resolución 3100 del 2019. ............................................................................... 45 4.5 Marco Teórico ................................................................................................... 45 4.6 Marco Contextual ............................................................................................. 62 5. Metodología ...................................................................................................... 64 5.1 Tipo de Estudio ................................................................................................. 64 5.2 Población y Muestra ......................................................................................... 64 5.2.1 Población o Universo.. ...................................................................................... 64 5.2.2 Muestreo.. ......................................................................................................... 64 5.2.3 Muestra. ........................................................................................................... 64 5.3 Criterios de Inclusión y Exclusión ..................................................................... 64 5.3.1 Criterios de Inclusión.. ...................................................................................... 64 5.3.2 Criterios de Exclusión. ...................................................................................... 64 5.4 Procedimientos ................................................................................................. 65 5.5 Análisis Estadístico ........................................................................................... 67 5.6 Consideraciones Éticas .................................................................................... 67 6. Resultados ........................................................................................................ 68 6.1 Análisis de Resultados Encuesta de la Guía Virtual de Dispositivos Especializados en el Área de Endourología .................................................................. 68 7. Discusión .......................................................................................................... 78 8. Conclusiones .................................................................................................... 81 9. Recomendaciones ............................................................................................ 83 9.1 Limitaciones del Estudio ................................................................................... 83 Referencias Bibliográficas ............................................................................................. 84 Anexos .......................................................................................................................... 91

Digital, La educación superior en la actualidad se ha convertido en uno de los factores para el desarrollo socio-económico y cultural del país más importantes, a pesar de esto, la deserción académica ha afectado demasiado el sistema de educación en el país; llegando a tal punto de ser señalada como medida de rendimiento académico en las instituciones de educación superior. Frente a esta crisis han desarrollado diferentes tipos de estudios desde las facultades de las universidades partiendo desde las cifras que se manejan hasta llegar a factores determinantes. Objetivo: Analizar los principales factores que inciden en la deserción estudiantil del programa de Instrumentación Quirúrgica perteneciente a la Universidad de Santander de Bucaramanga. Métodos Estudio descriptivo de corte transversal en 40 estudiantes de primero, segundo, tercero y cuarto semestre que diligenciaron una encuesta auto aplicada que contenía 22 preguntas sobre información sociodemográfica de interés y conocimientos relacionados con factores asociados a la deserción académica como: factores económicos, familiares, académicos, entre otros. Resultados: Entre los factores de deserción para los estudiantes que más sobresalen se encuentran los problemas personales y psicológicos con un 63%, el 13% para la adaptación a las técnicas de enseñanza impartida por los docentes, 80% el factor económico y esta última como mayor dependencia económica de los estudiantes para sostenimiento, estas son unas de las principales causas que los estudiantes de Instrumentación Quirúrgica de la Universidad de Santander de Bucaramanga abandonen sus estudios. Conclusión: Es importante estudiar las posibles estrategias de acompañamiento psicológico a los estudiantes, mejores canales de comunicación entre las dirección de los programas y los estudiantes, análisis de estrategias enseñanza aprendizaje, fortalecer programas para la planificación familiar, y creación de guarderías universitarias para estudiantes con hijos serian buenas estrategias para combatir los principales factores de deserción que se encontraron durante el desarrollo de esta investigación. Citación: Morales-Mesa S. y Tavera-Ariza WE. Análisis de los Factores Asociados a la Deserción Académica del Programa de Instrumentación Quirúrgica de la Universidad de Santander Entre el año 2016 y 2019. (Tesis de Pregrado). Universidad de Santander. 2021., Higher education today has become one of the most important factors for the socio-economic and cultural development of the country, despite this, academic desertion has affected the education system in the country too much; reaching the point of being designated as the measure of academic performance in higher education institutions. Faced with this crisis, different types of studies have been developed from the faculties of the universities, starting from the figures that are handled until arriving at determining factors. Objective: To analyze the main factors that affect student dropout from the Surgical Instrumentation program belonging to the University of Santander de Bucaramanga. Methods: Descriptive cross-sectional study in 40 first, second, third and fourth semester students who filled out a self-administered survey that contained 22 questions on sociodemographic information of interest and knowledge related to factors associated with academic dropout such as: economic, family factors, academics, among others. Results: Among the dropout factors for the students that stand out the most are personal and psychological problems with 63%, 13% for adaptation to the teaching techniques taught by teachers, 80% the economic factor and highlighting the latter as greater economic dependence on students to sustain their expenses, these are one of the main causes for students of Surgical Instrumentation at the University of Santander de Bucaramanga to abandon their studies. Conclusion: It is important to study the possible strategies of psychological support to students, better communication channels between the directors of the programs and the students, analysis of teaching-learning strategies, strengthening programs for family planning, and creation of university nurseries for students with disabilities. Children would be good strategies to combat the main dropout factors that were found during the development of this research. Citation: Morales-Mesa S. and Tavera-Ariza WE. Analysis of the Factors Associated with the Academic Dropout of the Surgical Instrumentation Program of the University of Santander Between 2016 and 2019. (Undergraduate Thesis). University of Santander. 2021., Pregrado, Instrumentador Quirúrgico, 1 ed., Introducción ................................................................................................................... 21 1. Planteamiento del Problema ........................................................................ 23 1.1 Formulación del Problema ............................................................................ 25 2. Justificación .................................................................................................. 26 3. Objetivos ...................................................................................................... 27 3.1 Objetivo General ........................................................................................... 27 3.2 Objetivos Específicos .................................................................................... 27 4. Marco Referencial ........................................................................................ 28 4.1 Marco Histórico ............................................................................................. 28 4.1.1 Universidad de Santander – UDES. . ........................................................... 28 4.1.1.1 Instrumentación Quirúrgica.. ........................................................................ 29 4.1.1.2 Misión del Programa de Instrumentación Quirúrgica.. .................................. 29 4.1.1.3 Visión del Programa de Instrumentación Quirúrgica.. .................................. 30 4.1.1.4 Perfil del Egresado.. ..................................................................................... 30 4.1.2 Antecedentes Deserción Académica.. .......................................................... 30 4.2 Marco Teórico ............................................................................................... 32 4.2.1 Deserción Académica Universitaria.. ............................................................ 32 4.2.2 Deserción Académica Universidad de Santander.. ...................................... 34 4.3 Marco Legal .................................................................................................. 36 4.3.1 Marco Legal de la Educación. ...................................................................... 37 4.3.2 Marco Legal de la Instrumentación Quirúrgica. ............................................ 38 5. Metodología .................................................................................................. 39 5.1 Tipo de Investigación .................................................................................... 39 5.2 Población y Muestra ..................................................................................... 39 5.3 Criterios de Selección ................................................................................... 40 5.3.1 Criterios de Inclusión.. .................................................................................. 40 5.3.2 Criterios de Exclusión.. ................................................................................. 40 5.4 Técnicas de Revisión Bibliográfica ............................................................... 41 5.5 Técnicas de Recolección de la Información .................................................. 41 5.6 Técnicas de Análisis de la Información ......................................................... 41 5.7 Delimitación .................................................................................................. 42 5.8 Consideraciones Éticas, Bioéticas, y de Integridad Científica ...................... 42 6. Resultados ................................................................................................... 44 6.1 Análisis General ............................................................................................ 56 7. Discusión ...................................................................................................... 58 8. Conclusiones ................................................................................................ 61 9. Recomendaciones ........................................................................................ 63 Referencias Bibliográficas........................................................................................... 64 Anexos......................................................................................................................... 70

INTRODUCTION: Surgical instrumentation in children with adolescent idiopathic scoliosis (AIS) is performed early in life and the implants are left in situ for the rest of the patient's life. Concern has been raised regarding persistent elevated levels of serum metal ions, but only a few studies on the topic have been published. The aim of this study was to compare the levels of serum metal ions in patients with AIS treated with either Harrington rod instrumentation or bracing.MATERIALS AND METHODS: AIS patients treated with Boston brace (BB) or posterior spinal fusion with Harrington rod instrumentation (HR) from 1983 to 1990 were requested to return to clinic. One hundred fifty-nine (73%) of 219 patients were available for follow-up of whom 115 agreed to have a blood draw.RESULTS: The proportion of patients who agreed to have a blood draw were similar in the BB (48 of 100, 48%) and HR (67 of 115, 60%, p = 0.085) groups. None of the surgical patients had their implants removed; mean age at follow-up (BB: 43.2 years vs HR: 43.5 years, p = 0.566) and mean length of follow-up (BB: 26.5 years vs HR: 24.5 years). Mean chromium serum levels were similar between the BB (2.7 nmol/L) and the HR (2.9 nmol/L, p = 0.827). Mean Cobalt serum levels were also similar between the BB (2.6 nmol/L) and the HR (2.8 nmol/L, p = 0.200).CONCLUSION: Serum metal ions were similar in AIS patients treated with bracing or Harrington rod instrumentation 25 years after initiation of treatment.

Introducción: La seguridad del paciente constituye una prioridad en la atención en salud, siendo la lista de verificación para la seguridad quirúrgica una de las estrategias implementadas por la OMS. El objetivo fue determinar el nivel de cumplimiento en la aplicación de la lista de verificación de seguridad de la cirugía en personal de sala quirúrgica de una institución pública. Materiales y Métodos: Estudio de corte transversal en 45 miembros del equipo quirúrgico de un hospital, en los cuales se evaluó el cumplimiento a la lista de chequeo de la OMS durante el mes de julio y agosto del año 2018. Resultados: El cumplimiento global fue del 13.3% (n=6), siendo la fase previa a la anestesia la que alcanzó el mayor nivel (55.6%, n=25). El mayor cumplimiento lo registró el personal de instrumentación quirúrgica (100%, n=8), mientras el más bajo el personal de enfermería (25%, n=3), con diferencias estadísticamente significativas (p=0.005). Adicionalmente, se observó una correlación entre los años de trabajo en el servicio y el cumplimiento en fase de transferencia (rho= -0.30, p=0.048). Discusión: El cumplimiento general fue bajo, lo cual corrobora la hipótesis planteada y resulta similar a otros estudios descritos en la literatura. Conclusiones: El cumplimiento general a la lista de chequeo fue muy bajo, con comportamientos diferenciales al ser las instrumentadoras quirúrgicas las que presentaron mayor cumplimiento y el personal de enfermería el menor. El ítem de profilaxis antibiótica el de menor cumplimiento, mientras que la fase previa a la anestesia la de mayor nivel. Como citar este artículo: Sepúlveda Plata Martha Cecilia. López Romero Luis Alberto. González Sandra Beatriz. Cumplimiento de la lista de verificación de seguridad de la cirugía en un hospital de Santander. Un estudio de corte trasversal. Revista Cuidarte. 2021;12(3):e2122. http://dx.doi.org/10.15649/cuidarte.2122

Digital, Las exposiciones prolongadas a los rayos ultravioleta presentes en la luz solar pueden producir cáncer de piel, conocido como Melanoma; La incidencia del melanoma aumenta significativamente y como el resto de las neoplasias, un diagnóstico a tiempo y efectiva prevención puede impedir la evolución de esta patología. Por este motivo, resulta oportuno, desarrollar una Cartilla educativa que permita la consolidación de conocimientos, actitudes y prácticas en estudiantes de Instrumentación Quirúrgica de la Universidad de Santander UDES para la Promoción y Prevención del Cáncer de Piel (Melanoma). Esta investigación es descriptiva de corte transversal, que busca una aproximación sobre el conocimiento de los estudiantes de Instrumentación Quirúrgica de la Universidad de Santander, UDES, Bucaramanga sobre el melanoma. La investigación se llevó a cabo con una metodología analítica-sintética como estrategia de razonamiento empleada para estudiar los hechos, con el fin de diseñar una Cartilla que facilite la información del Melanoma al tiempo que ayudará a recoger información sobre la población encuestada. Para la toma de muestras, se aplicó un cuestionario a 181 estudiantes de Instrumentación Quirúrgica (67%) quienes diligenciaron los formularios, comprendiendo el soporte para el diseño de un material educativo para la promoción y prevención del cáncer de piel. Los resultados han demostrado que los participantes tienen un conocimiento medio alto del cáncer de piel, reconocen las consecuencias y tiene claros los conceptos generales sobre el Melanoma, pero desconocen los riesgos de la exposición a la radiación solar y las diversas formas de prevenir, lo que evidencia la importancia del desarrollo de esta investigación y producción del material educativo plasmado en la cartilla Melanoma para fomentar el cuidado y la prevención de la aparición del cáncer de piel., Prolonged exposures to ultraviolet rays in sunlight can cause skin cancer, known as Melanoma; the incidence of melanoma significantly increases and like the rest of the neoplasms, a timely diagnosis and effective prevention can prevent the evolution of this pathology. For this reason, it is appropriate to develop an educational card that allows the consolidation of knowledge, attitudes and practices in students of Surgical Instrumentation at the University of Santander UDES for the Promotion and Prevention of Skin Cancer (Melanoma). This research is descriptive, cross-sectional, which seeks an approach to the knowledge of the students of Surgical Instrumentation of the University of Santander, UDES, and Bucaramanga about melanoma. The research was carried out with an analytical-synthetic methodology as a reasoning strategy used to study the facts, in order to design a Primer that facilitates Melanoma information while helping to obtain information about the surveyed population. For sampling, a questionnaire was applied to 181 Surgical Instrumentation students (67%) who filled out the forms, including support for the design of educational material for the promotion and prevention of skin cancer. The results have shown that the participants have a medium-high knowledge of skin cancer, recognize the consequences and have clear general concepts about melanoma, but they are unaware of the risks of exposure to solar radiation and the various ways to prevent, which evidences the importance of the development of this research and production of the educational material embodied in the Melanoma primer to promote the care and prevention of the appearance of skin cancer., Pregrado, Instrumentador Quirúrgico, 1 ed., Introducción ................................................................................................................... 26 1. Planteamiento del Problema ............................................................................. 28 1.1 Descripción del Problema ................................................................................. 28 1.2 Formulación del Problema ................................................................................ 29 2. Justificación ...................................................................................................... 30 3. Objetivos........................................................................................................... 33 3.1 Objetivo General ............................................................................................... 33 3.2 Objetivos Específicos ....................................................................................... 33 4. Marco Referencial ............................................................................................ 34 4.1 Antecedentes .................................................................................................... 34 4.1.1 Conceptualización.. .......................................................................................... 34 4.1.2 Promoción y Prevención.. ................................................................................. 35 4.2 Normatividad .................................................................................................... 36 4.2.1 Internacional ................................................................................................ ..36 4.2.2 Normatividad Nacional.. ................................................................................... 39 4.3 Marco Teórico ................................................................................................... 40 4.3.1 Anatomía y Fisiología.. ..................................................................................... 40 4.3.2 Fisiología.. .................................................................................................. 42 4.3.3 Patología. .................................................................................................. 43 4.3.3.1 Cáncer y melanoma. ....................................................................................... 43 4.3.3.2 Melanoma. ........................................................................................................ 43 4.3.4 Diagnóstico. . ................................................................................................. 49 4.3.4.1 Problemas Primarios.. ...................................................................................... 51 4.3.4.2 Diagnóstico del Melanoma en Función de la Evolución. .................................. 56 4.3.5 Factores de Riesgo. ......................................................................................... 58 4.3.5.1 General. . .......................................................................................................... 58 4.3.5.2 Mayor Influencia. .............................................................................................. 60 4.3.6 Tratamiento. . ................................................................................................. 62 5. Diseño Metodológico Cartilla Digital ................................................................. 73 5.1 Tipo de Investigación ........................................................................................ 73 5.2 Método de la Investigación ............................................................................... 73 5.2.1 Cálculo Muestral ............................................................................................... 74 5.2.1.1 Población.. ........................................................................................................ 74 5.2.1.2 Muestra............................................................................................................. 74 5.2.2 Delimitación Espacial/Geográfica.. ................................................................... 74 5.3 Técnicas de Recolección de la Información para el Diseño de la Cartilla ........ 74 5.4 Consideraciones Éticas .................................................................................... 77 5.5 Plan de Trabajo ................................................................................................ 77 5.5.1 Estructura Cartilla. ............................................................................................ 77 5.6 Análisis de los Resultados ................................................................................ 81 5.6.1 Información Personal ........................................................................................ 81 5.6.2 Información Conceptual .................................................................................... 83 6. Desarrollo de la Propuesta ............................................................................... 94 6.1 Cartilla Melanoma ............................................................................................. 94 7. Conclusiones .................................................................................................. 107 8. Recomendaciones .......................................................................................... 109 Referencias Bibliográficas ........................................................................................... 110 Anexos ........................................................................................................................ 116

Quintana, M. L. (2021). Curso de capacitación teórico-práctico sobre el manejo del paciente con priones dentro del área quirúrgica. Propuesta de utilización de simulacros como estrategia de enseñanza. (Trabajo final integrador). Universidad Nacional de Quilmes, Bernal, Argentina. Este trabajo es el resultado de un proceso de investigación e intervención realizado en el marco de la Especialización en Docencia Universitaria perteneciente a la Universidad Nacional de Quilmes. Basándonos en los datos presentados en este trabajo, se pudo observar la falta de un conocimiento formativo sustentable que acompañe la labor de los instrumentadores quirúrgicos ante la práctica profesional con pacientes portadores de enfermedad priónica, (patología con carácter transmisible y evolución clínica fatal) poniendo en riesgo a todo el equipo quirúrgico y a la población en general. Por tal motivo, surgió la necesidad de abordar esta problemática. En la primera parte, se presenta el proyecto de indagación que organiza la intervención, luego la recolección y análisis de datos obtenidos y en la tercera parte, la propuesta didáctica a través de la creación de un curso teórico práctico utilizando un simulador como estrategia de enseñanza. El mismo, podrá generar formas de aprendizaje significativo (reflexión y autonomía) permitiendo la aplicación de saberes en la práctica de los instrumentadores quirúrgicos ante casos de pacientes con alta carga infectiva.

Transoral robotic surgery (TORS) is an established treatment for many subsites of Head and Neck cancer. With the improved flexibility and access of the single-port (SP) robotic system, tumors within the distal upper aerodigestive tract can now be reached and successfully treated with all the published advantages of transoral endoscopic surgery. Here in we offer the first published surgical technique for SP TORS for resectable hypopharyngeal carcinoma. The video presented demonstrates many important aspects utilizing the enhanced robotic system, including adjustments of the semi-flexible endoscope and use of the third transoral surgical instrumentation. As previously reported, TORS hypopharyngectomy should be considered for resectable tumors to improve upon the deleterious effects of open surgical resection or chemoradiation therapy.

Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database years 2010 to 2015.Investigate which short-term outcomes differ for cervical laminoplasty and laminectomy and fusion surgeries.Conflicting reports exist in spine literature regarding short-term outcomes following cervical laminoplasty and posterior laminectomy and fusion. The objective of this study was to compare the 30-day outcomes for these two treatment groups for multilevel cervical pathology.Patients who underwent cervical laminoplasty or posterior laminectomy and fusion were identified in National Surgical Quality Improvement Program (NSQIP) based on Current Procedural Terminology (CPT) code: laminoplasty 63,050 and 63,051, posterior cervical laminectomy 63,015 and 63,045, and instrumentation 22,842. Propensity-adjusted multivariate regressions assessed differences in postoperative length of stay, adverse events, discharge disposition, and readmission.Three thousand seven hundred ninety-six patients were included: 2397 (63%) underwent cervical laminectomy and fusion and 1399 (37%) underwent cervical laminoplasty. Both groups were similar in age, sex, body mass index (BMI), American Society of Anesthesiologist Classification (ASA), Charleston Comorbidity Index (CCI), and had similar rates of malnutrition, chronic kidney disease, diabetes, chronic obstructive pulmonary disease, and history for steroid use. Age more than 70 and age less than 50 were not associated with one treatment group over the other (P 0.05). Compared with laminoplasty patients, laminectomy and fusion patients had increased lengths of stay (LOS) (4.5 vs. 3.7 d, P 0.01) and increased rates of adverse events (41.7% vs. 35.9%, P 0.01), discharge to rehab (16.4% vs. 8.6%, P 0.01), and skilled nursing facilities (12.2% vs. 9.7%, P = 0.02), and readmission (6.2% vs. 4.5%, P = 0.05). Both groups experienced similar rates of death, pulmonary embolus, deep vein thrombosis, deep and superficial surgical site infection, and reoperation (P 0.05 for all).Posterior cervical laminectomy and fusion patients were found to have increased LOS, readmissions, and complications despite having similar pre-op demographics and comorbidities. Patients and surgeons should consider these risks when considering surgical treatment for cervical pathology.3.

The unilateral laminotomy for bilateral decompression initially was described in the late 1990s and has evolved in conjunction with minimally invasive surgical instrumentation. This technique has been shown to significantly improve bilateral symptoms regardless of the side of approach. It also can be used for multilevel decompressions using the slalom technique with alternating lateralizing sites of access. The over-the-top technique involving a unilateral approach for bilateral decompression helps preserve the posterior tension band and can accomplish the operative goals with better clinical outcomes than traditional open approaches.

Background During dissection of paraspinal muscles in posterior surgical approaches, the spine surgeon usually holds a subperiosteal (Cobb) elevator in 1 hand and a monopolar cautery in the other hand. In such a scenario, both the surgical smoke generated by the monopolar and eventual bleeding constitute a significant hindrance to simultaneous bilateral dissection of the paraspinal muscles by 2 surgeons. Methods To address the identified shortcomings in the currently available instrumentation, we initially analyzed the most common surgical techniques employed by residents and fellows at our institution for paraspinal muscle dissection during posterior spinal approaches. Additionally, we collected trainees’ feedback regarding the efficacy of available strategies for dealing with surgical smoke. Results A new coupled Cobb elevator-suction instrument was designed, manufactured, and tested by residents, fellows, and experienced spine surgeons, and small additional design modifications were performed. Conclusions We present what we believe is the first description of a new coupled Cobb-suction instrument that has been developed to enable simultaneous retraction and suction with 1 hand, while allowing the spine surgeon to use the monopolar cautery with the other hand. In our preliminary institutional experience, this new tool has been proven to be especially useful in long posterior spinal approaches in the thoracolumbar region.

Surgery of the petrous apex lesions is considered a surgical challenge. We report our experience and review the literature highlighting current indications and limits in the management of benign and malignant lesions with special focus on the endoscopic approaches. Over the last years, indications and limits of the extended endonasal approaches range from inflammatory disease of the paranasal sinuses to the management of various diseases involving the skull base such as CSF leak, pituitary tumors, ethmoid tumors, petrous apex lesions, and purely intracranial lesions thanks to the development of dedicated surgical instrumentation, the improvement of skull base reconstruction techniques, and a better knowledge of the anatomy. Extended endonasal approach to petrous apex lesions is a safe and effective procedure for appropriately selected patients in the hands of experienced endoscopic skull base surgeons. Nowadays, referral centers equipped by surgical teams with expertise to both endoscopic and lateral skull base routes represent the most safe and effective way of treatment of those diseases.

Innovations in surgical instrumentation and methods are enabling safe and effective minimally invasive options for treatment of many diseases. Similarly, technologic advances in endoscopy are offering assistive devices and techniques to enable more aggressive, yet safe, endoscopic therapies. Endoscopic mucosal resection and submucosal dissection are quickly becoming adopted to offer appropriate patients the least invasive treatment, that is, treatment without surgical scars or approaches. On the horizon at the time of this writing is endoscopic full-thickness resection, which if proven safe has potential to offer the same advantages to a wider variety of pathology. This chapter will focus on a surgeon's perspective of gastrointestinal disease, traditional surgical treatments, and possibilities for these new endoscopic techniques.

Introduction Total hip arthroplasty (THA) is the most common surgery for lower extremities. Improvement in surgical technique and advancement of surgical instrumentation extended the indications for difficult THA in previously impossible to treat. Methods 81 primary THA procedures were performed in Cipto Mangunkusumo National Hospital during the period from January 2012 to June 2017. Subjects consisted of 29 and 52 patients in the difficult and simple group, respectively. Intraoperative parameters including bleeding volume, operation time, complication rate, radiological outcome and functional outcome (Harris Hip Score) were recorded at the end of follow-up and analysed. Results The difficult group had significantly higher bleeding volume (p Conclusions Those with difficult hips did not have significant difference in terms of radiologic and functional outcome compared with the simple hips. It is necessary to identify each primary THA procedures whether there were any, types and levels of difficulties that would be faced intraoperatively in order to improve preoperative planning so the outcome would be optimal.