In 1993, Dr. Julián Ruiz Torres created a multidisciplinary group at the General Calixto García University Hospital, made up of gastroenterologists, surgeons, anesthesiologists, radiologists and nurses with the vision and objective of offering patients a center that would allow them to comprehensively address the endoscopic surgery, therapeutic endoscopy and high-quality interventional radiology with the best technology, a group that was developed giving rise to the creation in 1994 of the National Reference Center for Minimally Access Surgery and endoscopic therapies.
For all these reasons, the CNCMA is the national reference center for the development of endoscopic therapy and minimum access surgery (CMA) in Cuba. Through these years the Center has trained many professionals and technicians, specialties of general surgery, urology, gynecology, gastroenterology, anesthesiology, interventional radiology, orthopedics, angiology, rheumatology and cardiovascular surgery, among others, which has allowed create a network that covers 119 services throughout the country.
From the link between the teaching-care and research activity carried out in the institution, it has been possible to raise qualitative and quantitative levels of CMA throughout the country, as well as the introduction of technologies. At present, the CNCMA, Entity of Science and Technological Innovation (ECIT) of the Ministry of Public Health (MINSAP), has the mission of developing scientific-technological research in the field of endoscopic therapeutics and minimal access surgery, which It will allow introducing and commercializing health techniques and services, as well as contributing to the training of professionals and technicians through postgraduate teaching activities.
When studying the history experienced by the CNCMA a periodization can be established. They are:
1980-1992: Germ.
1993-2004: Foundation.
2005-Current: Consolidation.
Germ (1980-1992)
At this stage, the scientific leaders who "thought" the so-called Center of Endoscopic Surgery (CCE) were trained in the least access techniques. The main drivers of this process were the specialists in gastroenterology Dr. Julián Ruiz Torres and Dr. Francisco Roberto León Fernández. Among the fundamental characteristics of this period are the intensive research in basic and advanced techniques, the training of human resources that should carry out this task and the necessary introduction of high technology and with possibilities of application in surgical and clinical practice, with results that were satisfactory, but without having the material and organizational resources for further development of these procedures.
In 1984, Dr. Julián Ruiz performed the first endoscopic sphincterotomy in the country, at the National Hospital "Enrique Cabrera". Two years later he placed the first biliary prosthesis and in 1989 he began the endoscopic treatment of chronic pancreatitis through sphincterotomy, prosthesis and quistoenterostomies. The first laparoscopic cholecystectomy in Cuba was performed by doctors Alfredo Felipe Rodríguez and Jorge García Tamarit, in Sancti Spiritus, in 1990 [4] [5], even without the video technology. In 1991 the first cholecystectomy was performed by videolaparoscopy at the Hermanos Ameijeiras Hospital
At this stage, in the country there was not yet a culture for the surgical approach of the patient by minimum access, which led to an unfavorable climate for the introduction of new technologies within the medical environment - essentially among surgeons. This resistance to change was due to the fact that in the country there was a strong prestige in traditional surgery, which included prominent surgeons, which influenced some of them to manifest a certain lack of confidence in the new techniques. Some critics did not wait and there was no lack of those who diminished the value that this surgery really had.
Many of the scientific results that CNCMA exhibits today arose in those years from the hands of today's leading researchers and scientific leaders of the new generations in these techniques.
Foundation (1993-2004)
In the 1990s, when Cuba was going through very difficult economic times, despite the crisis that was experienced, advances in Public Health continued to be important. Precisely, in these years we witnessed the awakening of a branch of medicine - endoscopic surgery - thanks to the work of a nascent work team and a leader who guided them on the long road, a group that grew to this day, surpassing barriers and difficulties, overcoming the obstacles to form a unit that has represented the capacity for improvement and struggle of the Cuban doctor, which has sustained the collective spirit of work and a high sense of self-improvement within the specialty. Its results have been a social benefit of which the Cuban population has been the main recipient. [7]
In March 1993, the General Calixto García University Hospital was created, with assistance, teaching and research purposes, a multidisciplinary group formed by gastroenterologists, surgeons, anesthesiologists and radiologists, to comprehensively deal with endoscopic surgery, therapeutic endoscopy and interventional radiology. This group formed the innovative nucleus that created the Center for Endoscopic Surgery, the first name that the current CNCMA had, at a time when it was imperative that these techniques were introduced, which were already a reality worldwide, which would significantly favor the quality of life of the population and the scientific development of health professionals.
In 1993, endoscopists and radiologists who had been working on endoluminal therapeutic endoscopy since 1991 were joined by surgeons and anesthesiologists. Among the surgeons was Dr. Miguel Ángel Martínez Alfonso and Lic. Zunilda Díaz Drake as a nurse, both workers of the Surgery Service of the Calixto García Hospital. These were the moments in which the performance of laparoscopic surgery began, first with the practice in live animals and later with its application in humans.
In 1994, a small office was assigned to the General Calixto García University Hospital for the creation of the endoscopic surgery service at the CCE. The foundation of this service had the objective of training and preparing future medical specialists in minimal access surgery throughout Cuba. This fact marked a before and an after, stopped being a dream to become a reality. The mission of the Center had two fundamental directions: Assistance and Learning.
The Management of the Center was in charge of guaranteeing their scholarships abroad for them to be trained and then on their arrival in the country they put their knowledge into practice. The professionals of the Center were trained in high level institutions, such as: the Faculty of Medicine of the Eberhard Karls University of Tübingen in Germany, the Mount Sinai Hospital in New York, the European Institute of Telesurgery in Strasbourg, the International Center of Surgery Endoscopic Clermont Ferrand in France, the Hospital Clinic of Barcelona and the Saint Pierre Hospital in Brussels in Belgium, among others.
In 2003, the Ministry of Public Health granted the Center a new name: "National Center for Minimum Access Surgery" and became a center of national subordination. With only four auxiliary researchers and 15 research candidates, 11 research projects were being carried out at the time and two prototypes of laparoscopic instruments were created that were patented at the OCPI: the Vesicular Retractor and the Knot Slider with Simultaneous Coaxial Drive. , which allowed to perform a new variant of mini-laparoscopic cholecystectomy with high efficiency. The most visible achievement of the Center in the field of research was its approval by the CITMA Entity of Science and Technological Innovation of MINSAP in 2004 and since then the incorporation of scientific research into medical care has been reinforced.
In 2004, ecoendoscopy was introduced in Cuba, as a diagnostic technique and treatment of tumor lesions in the digestive system, and the first endoscopic mucosal resections were performed in malignant digestive lesions.
Consolidation (2005-Current)
The year 2005 marks a leap in the development of Centro and the beginning of a phase of accelerated changes and scientific advances, when the CNCMA had better working conditions in a new location in the Municipality of Diez de Octubre. In this stage the specialties that are attended in the Center, the personnel and their scientific development have increased. Significant advances have been made in teaching, the acquisition of research skills, the research itself and the introduction of new technologies in the country, based on projects of integrators.
The CNCMA was accredited in 2006 as a Center for Postgraduate Studies to conduct the training and certification of specialists in the field of minimally invasive surgical and endoscopic therapeutic techniques, as well as the accreditation of the institutions that teach these procedures.
In that same year the Gastroenterology service performed the first double balloon enteroscopies, which allow the study and endoscopic treatment of diseases in the small intestine. Also in that year, the Otorhinolaryngology and Neurosurgery services are opened, which jointly develop the approach by minimum access of lesions in the base of the skull. In parallel, interventional radiology is developed, still in the consolidation phase of results. And aesthetic surgery is the youngest service on the campus that started to provide services in the year 2012.
During 2007, 10 branch projects and six institutional projects were executed. Research projects were initiated for the development of the so-called non-fingerprint surgery, within which surgery through a single port and surgery through the natural orifices of the human organism are found. Firstly, it was presented as a research project, later it was practiced with pigs (vesicles) with a prototype of the instruments that were created, using tweezers and instruments of the laparoscopic technique itself. [8]
The first Master's Program in the country in Minimally Access Surgery was approved in 2013, more than twenty training sessions are held, annual workshops in all modalities. Regarding the scientific potential, the Center has 27 Masters and 10 PhDs in Science. In addition, 33 professionals have teaching categories and 22 research categories. The teaching categories, research and scientific degree have increased every year, according to the increase in staff and their interest in keeping up with the scientific level required by the Center. Five technological innovation projects and 22 research projects are executed.
The need to improve the quality and increase the efficiency of the services provided are growing concerns of the CNCMA Management, so in 2010 work began on the design of a Quality Management System, according to the NC-ISO 9001: 2008 standard. For this, it is necessary to train all the human resources of the institution and receive external consultancies as sources of knowledge necessary to carry out the planned organizational innovation. In 2015, we are already working intensely on the implementation of all the requirements of the reference standard after having already documented all the assistance activities, the teaching and research management processes and the support activities.
Today, the National Center for Minimally Access Surgery has a team of health professionals who provide national and foreign adult patients, a service where the most advanced technology and a highly qualified human staff for the use of the most diverse procedures converge. minimally invasive that are performed in specialties such as Gastroenterology, General Surgery, Cosmetic Surgery, Gynecology, Urology, Otorhinolaryngology and Neurosurgery, which can face with high resolution guarantee the diseases that are treated
Thanks to the material and financial support of the country's management and the strong will and leadership of the management of CNCMA, as well as the commitment and competence of its medical staff, the country now has a national reference center in CMA in the country. that, from 2006 to 2014, 47 595 patients have been treated, and 18 963 have been operated. In addition, the Center has served as a model to follow to create similar institutions in Latin American countries such as Nicaragua and Chile.
References
Roque González R, Torres Peña RdlC, Barrios Osuna IO, Martínez Alfonso MÁ, Barreras González JE, Hernández Gutiérrez JM. Instrument for the evaluation of skills in basic laparoscopic surgery. Educ Med Super [Internet]. 2012; 26 (3): [411-8 pp.]. Available from: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21412012000300006&nrm=iso.
Nogueira Lavoy J. History of the National Center for Minimum Access Surgery (2005-2014) [Thesis]. Havana: University of Havana; 2014
Ruíz Torres JF, Torres Peña RdlC, Martínez Alfonso MÁ, Fernández Zulueta A, Pascual Villardefrancos H. Endoscopic surgery. Fundamentals and applications: Scientific-Technical Editorial; 2000. 208 p
Millán Sandoval RG. Brief historical review of laparoscopic surgery2005 [accessed 29 Sep 2015]. Available from: http://www.sld.cu/galerias/pdf/uvs/cirured/breve_resena_historica_de_la_cirugia_laparoscopica.pdf.
de Armas González L. An approximation to the labor scientific biography of the doctors of the National Center for Minimum Access Surgery [Thesis]. Havana: Univerisidad de La Habana; 2015
Zamora Santana O, Rodríguez López-Calleja CA, Hernández Gutiérrez JM, Legrá Legrá J, Peña Pupo NE, Silvera García JR. Achievements and challenges of laparoscopic cholecystectomy in Cuba. Rev Cubana Cir [Internet]. 2011; 50 (4): [509-16 pp.]. Available from: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-74932011000400011&nrm=iso.
Ortiz Ginoria C. From conventional to minimally invasive surgery. The Center for Endoscopic Surgery a change in the surgical therapeutic approach [Thesis]. Havana: University of Havana; 2014
National Center for Minimum Access Surgery. Havana: National Center for Minimum Access Surgery; c 2005-2015 [updated 6 Aug 2015; consulted 29 Sep 2015]. Research. Main results. [Available from: http://www.cce.sld.cu/investigaciones/resultados.html.
National Center for Minimum Access Surgery. Havana: National Center for Minimum Access Surgery; c
Sources
National Center for Minimum Access Surgery.
Article The tranquility of being at home published by Yosel M. Castellanos in Granma on November 6, 2015.
Article Professor Julián Francisco Ruiz Torres receives the prize for the best doctoral thesis in the biomedical sciences published in INFOMED on January 20, 2015.
Article Minimum access: maximum development published by Lisandra Fariñas Acosta in Cuba Contemporary on December 14, 2014.
Article XX Anniversary National Center for Minimally Access Surgery.
Article Two decades later ... vision of the present published by Lisandra Fariñas Acosta in Granma on November 23, 2014.
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