ABSTRACT
Desde a primeira colecistectomia, a técnica cirúrgica para este procedimento veio recebendo diversas modificações. Com o avanço dos equipamentos laparoscópicos e com o advento da minilaparoscopia, surge uma nova realidade para a realização dessa cirurgia: colecistectomia minilaparoscópica, o qual traz benefícios ao paciente. A crescente preocupação com o processo de limpeza de artigos médico-hospitalares desperta questionamentos em relação a qualidade da higienização nas instituições hospitalares. A água é um item crítico no processo de sanitização e antissepsia do instrumental cirúrgico em razão da procedência e do tipo de tratamento que a mesma é submetida. A combinação desses fatores pode danificar o aço inoxidável dos equipamentos cirúrgicos podendo manchar, reduzir sua resistência à corrosão, até o favorecimento de formação de fissuras em áreas tensionadas, acarretando rompimento do instrumental. Foi realizada uma revisão na literatura correlacionando a qualidade da água na limpeza do material minilaparoscópico e sua manutenção. Foi observado uma relação direta entre tempo de vida útil do material e, consequentemente, sua qualidade para fins cirúrgicos e a qualidade do sistema de higienização do material, sendo a água um dos fatores chave para a manutenção da qualidade e diminuição do risco de utilizar estes equipamentos. A segurança da colecistectomia minilaparoscópica tem como fator independente o tratamento empregado no material pelo Centro de Materiais de Esterilização, porém é necessário o amplo conhecimento do tipo de material envolvido e métodos de higienização para cada aparelho, individualizando o
Since the first cholecystectomy, the surgical technique for this procedure has received several modifications. With the advancement of laparoscopic equipment and the advent of minilaparoscopy, a new reality emerges for this surgery: minilaparoscopic cholecystectomy, which brings benefits to the patient. The growing concern with the cleaning process of medical-hospital articles raises questions regarding the quality of hygiene in hospital institutions. Water is a critical item in the sanitization and antisepsis process of the surgical instruments due to the origin and the type of treatment that is submitted. The combination of these factors can damage the stainless steel of the surgical equipment, which can stain, reduce its resistance to corrosion, favoring the formation of cracks in stressed areas, leading to rupture of the instruments. A literature review was carried out correlating the water quality in the cleaning of the minilaparoscopic material and its maintenance. A direct relationship between the life time of the material and, consequently, its quality for surgical purposes and the quality of the material hygiene system was observed, with water being one of the key factors for maintaining quality and reducing the risk of using these materials equipments. The safety of minilaparoscopic cholecystectomy has as an independent factor the treatment used in the material by the Center for Sterilization Materials, but it is necessary to have a thorough knowledge of the type of material involved and methods of hygiene for each appliance, individualizing the cleaning process.
ABSTRACT
bjetivo: Comparar las técnicas laparoscópicas emergentes demayor popularidad en el ámbito quirúrgico, aplicando modelosmatemáticosteóricos para el cálculo del daño tisular, de manerade poder identificar y predecir que técnicas causan menor traumaparietal y menor morbilidad en el paciente para un procedimientoquirúrgico en común. Métodos:Estudio comparativo, descriptivoy observacional. Se agrupan 13 técnicas de cirugía de mínima inva-sión aplicadas para un procedimiento en común, "colecistecto-mía", con la finalidad de comparar el daño tisular que ocasionacada una de las mismas, calculado por modelos teóricos-matemá-ticos diseñados para tal fin, bajo normas estandarizadas por ungrupo de expertos en el tema, "Consenso de Mazatlán 2013", conel fin de estandarizar las técnicas de medición de las incisiones einstrumentos, de manera de obtener resultados acordes con la rea-lidad en cada uno de los procedimientos. Resultados:La técnicaNOTES presenta los índices más bajos de daño tisular parietal alno producir trauma alguno en su variedad pura y al no utilizar lapared abdominal para la extracción de la pieza quirúrgica en susvariedades híbridas. Las técnicas abordaje abdominal (no LESS),reducen a menos del 50% el daño tisular que ocasiona la laparos-copia tradicional, sin diferencia significativa entre ellas. Las plata-formas multivalvulares no muestran reducción del daño parietalfrente a la colecistectomía laparoscopia tradicional. Conclusión:Las técnicas laparoscópicas que reducen significativamente el trau-ma parietal frente al estándar de oro para colecistectomía aplicanuno o más de las siguientes consideraciones: Extracción de losórganos o piezas quirúrgicas por orificios naturales, sustitución depuertos por dispositivos magnéticos y/o agujas percutáneas, usode óptica con canal operatorio, y utilización de puertos e instru-mentos de menor calibre(AU)
Objective: To compare the most popular emerging surgical lapa-roscopic techniques, applying models for mathematicians-theore-tical for the calculation of the tissue damage, in order to be ableto identify and predict which techniques cause reduced parietaltrauma and less morbidity in the patient for a surgical procedurein common. Methods: Comparative, descriptive and observationalstudy. There were grouped 13 minimally invasive surgery techni-ques applied to a procedure in common, "cholecystectomy", inorder to compare the tissue damage that causes each of them, cal-culated by theoretical-mathematicians models designed for thispurpose, under standardized rules by a group of experts in thefield, "Mazatlan Consensus 2013", to standardize measurement ofincisions and instruments techniques, in order to get results com-mensurate with the reality in each of the procedures. Results:Thetechnique NOTES presents the lowest rates of parietal tissuedamage by not producing any trauma in its sheer variety and doesnot use the abdominal wall for the extraction of the surgical spe-cimen in its hybrid varieties. The technical approach to abdominal(not LESS), reduced to less than 50% the tissue damage that cau-ses traditional laparoscopy, without significant difference betweenthem. Multivalvulars platforms are not against traditional laparos-copy cholecystectomy parietal harm reduction. Conclusion:Thelaparoscopic techniques that significantly reduce the parietal trau-ma against the gold standard for cholecystectomy apply one ormore of the following considerations: removal of organs or surgicalparts through natural openings, replacement of ports by percuta-neous needle or magnetic devices, use of optics with operativechannel, and use of ports and instruments for the smaller caliber
Subject(s)
Tissues , Laparoscopy , Minimally Invasive Surgical Procedures , Abdominal Wall , Wounds and Injuries , Cholecystectomy , Models, TheoreticalABSTRACT
ANTECEDENTES: En el trauma penetrante de abdomen, existe un número de laparotomías innecesarias, con un porcentaje de complicaciones no despreciable. Cuando se identifica lesión del peritoneo, debe ser evaluada la exploración quirúrgica del abdomen. OBJETIVO: Evaluar la penetración del peritoneo, utilizando un método de diagnostico de visión directa. LUGAR DE APLICACIÓN: Hospital de Urgencias de Córdoba. Hospital de trauma. DISEÑO: Se realizó laparoscopia con anestesia local en pacientes con heridas penetrantes de abdomen, que no presentaran evidencias de injuria de órganos intraabdominales en los estudios de imágenes y los cuales se planteaban dudas en el examen físico, para evidenciar lesión del peritoneo. Estudio retrospectivo. POBLACION: Pacientes con trauma penetrante de abdomen, tratados entre mayo de 2004 y enero de 2005, con diagnostico dudoso de violación peritoneal. METODO: Con sedación y anestesia local a nivel umbilical,se coloco un laparoscopio de visión directa, de 5mm y 90°, con el cual se pudo observar todo el peritoneo anterior, los flancos y el diafragma, buscando la herida peritoneal o líquido libre. RESULTADOS: En cuatro pacientes pudo evitarse la laparotomía. Los cuatro restantes se convirtieron a cirugía abierta o videolaparoscopía, de los cuales dos presentaban lesión de víscera hueca, uno hemoperitoneo y otro lesión hepática mínima. No hubo complicaciones en ambos grupos. La estadía del primer grupo fue 13 horas de promedio. CONCLUSIONES: En pacientes seleccionados, la minilaparoscopía resultó útil en disminuir el porcentaje de laparotomías innecesarias y anestesia general y sus complicaciones.
BACKGROUND: There are a number of unnecessary laparotomies in penetrating trauma, with a non worthless percentage of complications. When the peritoneal injury is identified, surgical exploration of the abdomen should be evaluated. OBJECTIVE: Evaluate the penetration of the peritoneum, using a diagnose method with direct vision. SETTING: Hospital de Urgencias de Córdoba. Trauma Hospital. DESIGN: To evidence peritoneum trespassing, laparoscopy was performed with local anaesthesia in patients with penetrating abdominal trauma without signs of abdominal injury in the imaging methods and doubts in the physical examination, in a prospective setting. POPULATION: Patient with penetrating abdominal trauma, treated between May 2004 to January 2005, with doubtful diagnose of peritoneal violation. METHOD: Under sedation and local anaesthesia, a 5 millimetres laparoscope with 90 degrees vision was placed at umbilicus. The anterior abdominal wall, flanks and diaphragm were exanimate, looking for the peritoneal wound or free fluid. RESULTS: Laparotomy could be avoided in four patients. In the four remaining, laparoscopy or conventional surgery was performed. Two presented hollow viscera injury, one hemoperitoneo and the other, minimum liver damage. There were not complications in both groups. The average hospital stay of the first group was 13 hours. CONCLUSIONS: In selected patients, the minilaparoscopy is useful in decreased the percentage of unnecessary laparotomies and general anaesthesia, and its complications.