Cirugía General y del Aparato Digestivo: Pasado, Presente y Pautas para el Futuro: Tecnología, Humanidad y Resultados
DOI:
https://doi.org/10.37536/RIECS.2025.10.1.467Palabras clave:
Cirugía, Atención Dirigida al Paciente, Experiencia del Paciente, Formación quirúrgica, Complicaciones Postoperatorias, Indicadores de Calidad en la Atención de la Salud, Auditoría Clínica, Evaluación del Resultado de la Atención al PacienteResumen
La cirugía ha experimentado una evolución trascendental desde sus orígenes anatómico-técnicos en el Renacimiento hasta convertirse en una disciplina altamente tecnológica en la actualidad. El presente trabajo revisa esta evolución en tres etapas clave: el pasado, enfocado en la técnica quirúrgica y el protagonismo del cirujano; el presente, caracterizado por el uso intensivo de tecnologías como la laparoscopia, la robótica, la radiología intervencionista y los sistemas de monitorización avanzada; y el futuro que desde nuestro punto de vista debería abogar por una cirugía centrada en el paciente, apoyada en habilidades no técnicas, experiencia del paciente, auditoría de resultados y transparencia. Se analiza además la necesidad de actualizar los programas formativos de pregrado y postgrado en cirugía general y del aparato digestivo, e integrar herramientas como los PREMs, PROMs y el Comprehensive Complication Index. Esta visión integradora busca optimizar objetivamente no solo los resultados clínicos, sino también la calidad percibida y la equidad en el acceso a una atención quirúrgica segura y eficiente.
Citas
Vesalius A. De humani corporis fabrica libri septem. Basilea: Johannes Oporinus; 1543
Lister J. On the Antiseptic Principle in the Practice of Surgery. Lancet. 1867;90(2299):353–356.
Morton WT. Letter to the Editor on the Use of Sulfuric Ether in Surgical Operations. Boston Medical and Surgical Journal. 1846;35(16):309–312.
Whipple AO. Pancreaticoduodenectomy for islet carcinoma: a five-year follow-up. Ann Surg. 1945;121(6):847–852.
Keesara S, Jonas A, Schulman K. Covid-19 and Health Care’s Digital Revolution. N Engl J Med. 2020 Jun 4;382(23):e82.
Ruiz JG, Mintzer MJ, Leipzig RM. The impact of e-learning in medical education. Acad Med. 2006 Mar;81(3):207–12.
Banerjee A, Kamal M, Chaudhury N, Jha R, Deka D, Sood R. Role of imaging in preoperative planning of complex gynecologic surgeries. J Obstet Gynaecol India. 2019;69(6):525-533.
Liu Y, Ye Z, Su Z, Zheng W. Clinical applications of PET-CT in surgical oncology. J Cancer Res Clin Oncol. 2018;144(6):1047-1056.
Sahin B, Tutar H, Guler SA, Cakmakci M. Use of 3D printing in surgical planning: A new era. J Med Syst. 2020;44(9):151.
Ellis H. A History of Surgery. Cambridge: Cambridge University Press; 2001.
Rutkow IM. Surgery: An Illustrated History. St. Louis: Mosby-Year Book; 1993.
Reznick RK. The modern surgical armamentarium: Technology and skill. Can J Surg. 2000;43(4):281-285.
Kim FJ, Chammas MF Jr, Gewehr E, Morihisa M, Caldas F, Hayacibara E, et al. Impact of a sealing device on operative time and blood loss during laparoscopic nephrectomy. J Endourol. 2008;22(2):255–9.
Sutton PA, Awad S, Perkins AC, Lobo DN. Comparison of lateral thermal spread using monopolar and bipolar diathermy, the Harmonic Scalpel and the LigaSure. Br J Surg. 2010;97(3):428–33.
Achneck HE, Sileshi B, Jamiolkowski RM, Albala DM, Shapiro ML, Lawson JH. A comprehensive review of topical hemostatic agents: efficacy and recommendations for use. Ann Surg. 2010;251(2):217–28.
Kozek-Langenecker SA, Ahmed AB, Afshari A, Albaladejo P, Aldecoa C, Barauskas G, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2017;34(6):332–95.
Gutt CN, Oniu T, Mehrabi A, Schemmer P, Kraus TW, Büchler MW. Fewer adhesions and faster recovery: benefits of laparoscopic surgery. Surg Endosc. 2004;18(1):6-10.
Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev. 2006;(4):CD006231.
Bristow RE, Montz FJ, Lagasse LD, Leuchter RS. Laparoscopic surgery: a review of its current role in gynecologic cancer management. CA Cancer J Clin. 2000;50(6):360-378.
Scheinin TM, Scheinin NM. Laparoscopic versus open appendectomy: a prospective randomized study. Br J Surg. 1994;81(1):133-135.
Intuitive Surgical. da Vinci Surgical System. [Internet]. [citado 2025 abr 19]. Disponible en: https://www.intuitive.com/en-us/products-and-services/da-vinci
Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol. 2009;55(5):1037-1063.
Lenihan JP Jr, Kovanda C, Cammarano C. Comparison of operative outcomes between robotic and laparoscopic hysterectomy. J Minim Invasive Gynecol. 2008;15(5):545-551.
Zihni AM, Kopar PK, Brunt LM. Financial implications of robotic surgery: a comprehensive review. Surg Clin North Am. 2020;100(2):347-360.
Kneuertz PJ, Abdel-Rasoul M, Tweardy DJ, Moffatt-Bruce SD, Merritt RE. Cost comparison of robotic, video-assisted thoracoscopic, and open lobectomy for lung cancer. Ann Thorac Surg. 2019;107(3):935-943.
Geschwind JF, Bluemke DA. Advances in interventional radiology. N Engl J Med. 2002;346(12):897–902.
Sessler DI. Perioperative thermoregulation and heat balance. Lancet. 2016;387(10038):2655-2664.
Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg. 2005;100(1):4-10.
Cannesson M, Shafer SL. Advances in intraoperative monitoring: what's new and what's coming? Anesth Analg. 2016;123(5):1235-1237.
Sandhu GS, Diaz-Gomez JL, Haileselassie B, Sanko SR, Sessler DI, Singh PM. Use of transesophageal echocardiography in non-cardiac surgery: a review. J Cardiothorac Vasc Anesth. 2020;34(2):487-498.
Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg. 2013;37(2):259-284.
Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: a review. JAMA Surg. 2017;152(3):292-298.
Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010;29(4):434-440.
Thiele RH, Rea KM, Turrentine FE, Friel CM, Hassinger TE, Goudreau BJ, et al. Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg. 2015;220(4):430-443.
Orden SCO/1260/2007, de 13 de abril, por la que se aprueba y publica el programa formativo de la especialidad de Cirugía General y del Aparato Digestivo. Boletín Oficial del Estado, núm. 113, de 11 de mayo de 2007.
Ministerio de Sanidad. Programa formativo de la especialidad de Cirugía General y del Aparato Digestivo. [Internet]. Disponible en: https://www.sanidad.gob.es/areas/profesionesSanitarias/formacionEspecializada/acreditacionUnidadesDocentes/legislacion/programasVigor/docs/c_general_ant.pdf
Garas G, Arora S, Aggarwal R, Darzi A, Paraskeva P. Virtual-reality simulation training in laparoscopic surgery: a systematic review and meta-analysis. Ann Surg. 2012;257(6):1150-1159.
Safe Surgery Saves Lives: Patient Safety. World Health Organization [Internet]. Disponible en: https://www.who.int/initiatives/safe-surgery
Yule S, Flin R, Paterson-Brown S, Maran N, Rowley D. Development of a rating system for surgeons' non-technical skills. Med Educ. 2006;40(11):1098-1104.
Hull L, Arora S, Kassab E, Kneebone R, Sevdalis N. Assessment of stress and teamwork in the operating room: an exploratory study. Am J Surg. 2011;201(1):24-30.
Arora S, Sevdalis N, Nestel D, Woloshynowych M, Darzi A, Kneebone R. The impact of stress on surgical performance: a systematic review of the literature. Surgery. 2010;147(3):318-330.
Flin R, Youngson G, Yule S. How do surgeons make intraoperative decisions? Qual Saf Health Care. 2007;16(3):235-239.
Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013;3(1):e001570.
Coulter A, Parsons S, Askham J. Where are the patients in decision-making about their own care? World Health Organization. 2008.
Black N, Jenkinson C. Measuring patients' experiences and outcomes. BMJ. 2009;339:b2495.
Wolf JA, Niederhauser V, Marshburn D, LaVela SL. Defining patient experience. Patient Exp J. 2014;1(1):7-19.
Manary MP, Boulding W, Staelin R, Glickman SW. The patient experience and health outcomes. N Engl J Med. 2013;368(3):201-203.
Black N. Patient reported outcome measures could help transform healthcare. BMJ. 2013;346:f167.
Kingsley C, Patel S. Patient-reported outcome measures and patient-reported experience measures. BJA Educ. 2017;17(4):137–44.
Dawson J, Doll H, Fitzpatrick R, Jenkinson C, Carr AJ. The routine use of patient reported outcome measures in healthcare settings. BMJ. 2010;340:c186.
Weldring T, Smith SM. Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs). Health Serv Insights. 2013;6:61–8.
de la Plaza Llamas R. Real postoperative complication rates: a key parameter that is not monitored. Br J Surg [Internet]. 2021;108:e125-6. Recuperado a partir de: http://www.ncbi.nlm.nih.gov/pubmed/33793733
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey [Internet]. Ann Surg. 2004. p. 205-13. Recuperado a partir de: http://www.ncbi.nlm.nih.gov/pubmed/15273542
Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA. The comprehensive complication index: A novel continuous scale to measure surgical morbidity. Ann Surg. 2013;258:1-7.
De la Plaza Llamas R, Ramia Ángel JM, Bellón JM, Peralta VA, Amador CG, López Marcano AJ, et al. Clinical validation of the comprehensive complication index as a measure of postoperative morbidity at a surgical department: A prospective study. Ann Surg. 2018;268:838-44.
de la Plaza Llamas R, Vega ÁH, Latorre Fragua RA, López Marcano AJ, Medina Velasco AA, Díaz Candelas DA, et al. The cost of postoperative complications and economic validation of the comprehensive complication index prospective study. Ann Surg. 2021;273:112-20.
De la Plaza Llamas R, Parés D, Soria Aledó V, Cabezali Sánchez R, Ruiz Marín M, Senent Boza A, et al. Assessment of postoperative morbidity in Spanish hospitals: Results from a national survey. Cir Esp. 2024;102:364-72.
De La Plaza Llamas R, Ramia JM. Postoperative complications in gastrointestinal surgery: A «hidden» basic quality indicator. World J Gastroenterol. 2019;25:2833-8.
BOE-A-2013-12887 Ley 19/2013, de 9 de diciembre, de transparencia, acceso a la información pública y buen gobierno [Internet]. [citado 19 de abril de 2025]. Recuperado a partir de: https://www.boe.es/buscar/act.php?id=BOE-A-2013-12887
Escrig Sos J. El análisis de resultados quirúrgicos y el laberinto de la confusión. Cir Esp. 2007;81:1-3.
Tekkis PP, McCulloch P, Steger AC, Benjamin IS, Poloniecki JD. Mortality control charts for comparing performance of surgical units: validation study using hospital mortality data. BMJ. 2003;326:786-8.
Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 7th ed. New York: Oxford University Press; 2013.
Truog RD, Campbell ML, Curtis JR, Haas CE, Luce JM, Rubenfeld GD, et al. Recommendations for end-of-life care in the intensive care unit: A consensus statement by the American College of Critical Care Medicine. Crit Care Med. 2008;36(3):953–63.
Schneiderman LJ, Jecker NS, Jonsen AR. Medical futility: its meaning and ethical implications. Ann Intern Med. 1990;112(12):949–54.
Bosslet GT, Pope TM, Rubenfeld GD, Lo B, Truog RD, White DB. An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units. Am J Respir Crit Care Med. 2015;191(11):1318–30.
