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Edgardo Spagnuolo, director of the Neurosurgery Service at the Maciel hospital, and Alejandra Jaume, in charge of the hospital's Microsurgery Laboratory.Photo: Pablo Vignali
The Microsurgery Laboratory of the Maciel Hospital was expanded and will open new facilities next week, when Uruguayan and foreign surgery students and surgeons arrive to participate in a theoretical-practical course with renowned teachers from abroad.The activity will precede the V Uruguayan Congress of Neurosurgery, which will take place from April 20 to 22 in Montevideo.The laboratory will allow better training for surgeons, and this will result in the performance of surgeries that were previously done outside the country, explained surgeons Edgardo Spagnuolo, head of the Neurosurgery Service at the Maciel Hospital, and Alejandra Jaume, head of the Microsurgery Laboratory. of the Neurosurgery Service and the Chair of Anatomy of the Faculty of Medicine of the University of the Republic.
To get an idea of the type of practices they do, Jaume detailed the work of the drill, a type of drill with finer bits than those of a dentist's drill."Fine motor skills are practiced: the eggshell is drilled, and the idea is to leave the egg whole without breaking it, it is drilled under the microscope and when you see the thickness change, you feel and stop, and the same thing happens to you in the brain: when you are drilling a bone structure, there comes a time when you have to stop because there is a brain or arteries,” he explained.
-How did the Microsurgery Laboratory emerge?
ES: -Dr. Álvaro Villar, current director of the Maciel Hospital, when he was a resident at this hospital, back in 2003 or 2004, he took a microsurgery course at the Beneficência Portuguesa hospital in São Paulo and came back with the idea of creating a laboratory.At that time it was almost impossible to do so.He got a small room that was part of this place (but less than half the space), we got a very small microscope, and with that he made the first laboratory;It was a very homemade thing, but there the residents were able to start doing their first practices.Then it was closed, until in 2013 or 2014, Dr. Jaume took the initiative and managed to get us more space, half of what there is now.She had gone to take microsurgery courses in San Pablo and sought to imitate the facilities of that laboratory, which was the best in America and the only one where all the residents of Latin America went to practice.
-Why is it important to have this laboratory?
EN: -We are a healthcare and teaching service, and our obligation is to train neurosurgeons.A neurosurgeon is well trained if he does microsurgery, and for that it is not enough to go to help and see an operating room: what is useful is to practice, to do many hours in the laboratory.If you do not train and do hours in the laboratory, when you have to go to operate you will not perform the same as someone trained.
-How did you continue after the previous impulse?
EN: -We achieved the collaboration of a great neurosurgeon from Brazil who sponsored this laboratory and came to take the first courses.Then we brought other colleagues from abroad.In total, we have taken six courses: three international and three local.That allowed us to improve ourselves, not only in the courses;Outside of these, residents have the option of coming to the hospital to practice.For all of this you need to have the Chair of Anatomy as a partner, because if one does not have cadaveric material, the laboratory is practically useless, which is what has happened now in Brazil and in almost all countries: the use of cadaveric material is prohibited. .Using resin prototypes is not the same as using something that is real, that gives this laboratory a plus.The laboratory was recently extended, and this is what we are going to inaugurate next week.Today it has 12 work benches (the San Pablo laboratory, which was the largest there was, had ten benches).Each bench implies having a microscope, material and being able to do dissection;High-magnification microscopes and magnifying glasses are used to perform different procedures.This allows us to catch up with what is everywhere.Many times people say: “I'm going to have surgery outside the country because this can't be done in Uruguay.”The operating rooms of other countries have exactly the same thing that we have, both here in the hospital and at the mutual level.We lacked practice;Now we are trained to do any surgery, to reach any part of the skull.
Since what year have neurosurgery residents been doing internships here?
ES: -Continuously, since 2014. Given the extension, from now on it will not be only for neurosurgery, the idea is that it will also serve for general surgery, CTI, vascular surgery, and to do microsurgery practices with the Chair of Anatomy.
-How many residents are being trained now?
ES: -We work together with the Neurosurgery Chair of the Hospital de Clínicas [HC] and we have nine residents who rotate every six months;four here at Maciel, four at Clínicas and one at Pereira Rossell.It is a joint effort between the responsible unit, which is the Chair of Neurosurgery of the HC, headed by Humberto Prinzo, and this, which is the Graduate School Associated Unit, which I direct.
-How does it affect the general population?In addition to doctors having better training, does it lower costs so that there are more surgeons, or is it not thought in numerical terms?
ES: -It is thought that training and the ability to work and perform surgeries will be greater.It is not the intention to increase the number of neurosurgeons.Today we have about 35 neurosurgeons;For the population of Uruguay it is more than enough, it is a number in line with international rules.Maybe it will make it cheaper, yes, for the population, because there were surgeries that we couldn't do before and people had to go have them done outside.Now we can do any type of neurosurgery, even the most complex.
-What do the practices consist of?
AJ: -Every three years we do three annual courses: one international and two national.In each course a different topic is worked on.For example, there is an approach to the sellar region, which is the area of the nose and where we reach the sella turcica, which is a sector of the brain, and we work two or three days on that.Then we go to the spine, peripheral nerves, vascular surgery, and in each one we work with the specialists, the professors from each sector.This congress is specific to tumors.
-Are the nine residents going to take these courses?
ES: -The nine residents and neurosurgeons recently trained and received, plus foreigners who are going to come.
-That is to say, it is also training for you.
ES: -Yes, because learning does not end when one receives the degree.Surgery is a practice and continuous learning, one continues learning until the day one retires, and these laboratory practices must always be done.
AJ: -I was in Brazil for three months doing the internship to develop the laboratory here, and once a week the surgeons Jean de Oliveira -one of the most recognized in his country-, Luis Alencar Borba and everyone took time to come to the laboratory and dissect.
-How many neurosurgeries are performed in Uruguay per year?
ES: -Usually, about 3,500 surgeries in the specialty, but of those, a little more than a third are those that require a microscope.But after doing something with a microscope you start using it in surgeries for which you did not use it before, because you feel more comfortable;The microscope magnifies, allowing you to see nervous structures and arteries.Neurosurgical practice is increasing microscope surgeries.
-How do you see this laboratory compared to the one in Brazil?
AJ: -We are at a comparable level in terms of those who train us and the material we have.There is always room for improvement, we need more microscopes and more drills, but with respect to how we started, we are at an optimal level.
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