A comparison of pre- and post-operative outcomes in living donors undergoing transperitoneal laparoscopic nephrectomy and open nephrectomy: a retrospective single-center study

ABSTRACT BACKGROUND: Kidney transplantation is often regarded as the preferred therapy for end-stage renal disease. Several surgical procedures have been developed to reduce postoperative donor complications, while maintaining kidney quality. OBJECTIVE: This study aimed to compare the preoperative and postoperative outcomes of living kidney donors who underwent either transperitoneal laparoscopic nephrectomy or open nephrectomy. DESIGN AND SETTING: Retrospective study conducted in Istanbul, Turkey. METHODS: Fifty-five living-related kidney donors underwent nephrectomy and were retrospectively divided into two groups: 21 donors who underwent open nephrectomy (Group 1) and 34 donors who underwent transperitoneal laparoscopic nephrectomy (Group 2). RESULTS: In comparison to the donors who underwent open nephrectomy, those who underwent transperitoneal laparoscopic nephrectomy had significantly shorter postoperative hospital stays (2.3 ± 0.2 versus 3.8 ± 0.8 days, P = 0.003), duration of urinary catheterization (1.2 ± 0.8 days versus 2.0 ± 0.7 days, P = 0.0001), operating times (210 ± 27 minutes versus 185 ± 24 minutes, P = 0.02), and less blood loss (86 ml versus 142 ml, P = 0.048). There was no statistically significant difference between the two groups with regard to the estimated blood transfusion and warm ischemia time. The preoperative week, first postoperative week, and 1-month postoperative serum creatinine levels were comparable between the groups. CONCLUSIONS: Laparoscopic donor nephrectomy can be safely performed at centers with expertise in laparoscopic surgery. Laparoscopic donor nephrectomy has better outcomes than open donor nephrectomy in terms of length of hospital stay, duration of urinary catheterization, operating time, and blood loss.

Lidocaína en infusión transoperatoria para control de dolor: un estudio aleatorizado / Intraoperative intravenous lidocaine pain control: a randomized study

Resumen: Introducción: contar con una analgesia efectiva en el postoperatorio es fundamental para evitar complicaciones asociadas a dolor, en pacientes sometidos a colecistectomía laparoscópica. Objetivos: evaluar la efectividad de la lidocaína en infusión transoperatoria para el control de dolor postoperatorio en pacientes sometidos a colecistectomía laparoscópica. Material y métodos: se realizó un estudio experimental, aleatorizado, ciego simple, en pacientes sometidos a colecistectomía laparoscópica en el Hospital General Regional No. 1 en Obregón. Se dividieron en dos grupos de forma aleatoria, al grupo L se le aplicó lidocaína 1.5 mg/k en infusión, al grupo P se le aplicó placebo. Se realizó un análisis estadístico en SPSS v. 22 y se consideró significativa una p < 0.05. Resultados: se observó un adecuado manejo del dolor en los pacientes del grupo L a su ingreso a la Unidad de Recuperación Postanestésica (URPA) (p = 0.002), menor consumo de fentanyl transoperatorio sin diferencia estadística contra placebo (p = 0.086), menor uso de analgesia de rescate postquirúrgica (p = 0.045). Conclusiones: la infusión de lidocaína es efectiva para el manejo del dolor postquirúrgico inmediato, así como disminución de consumo de opioides y dosis de rescate analgésico, con una baja incidencia de náuseas y vómito, pero se asoció a hipotensión transoperatoria.

Abstract: Introduction: having an effective analgesia in the postoperative period is essential to avoid complications associated with pain in patients undergoing laparoscopic cholecystectomy. Objectives: test the effectiveness of intravenous lidocaine for postoperative pain in cholecystectomized patients by laparoscopy. Material and methods: an experimental, randomized, single-blind study was carried out in patients who underwent laparoscopic cholecystectomy at the No. 1 Regional General Hospital in Obregon, Sonora. They were divided into two groups randomly: group L to whom we applied lidocaine 1.5 mg/k in infusion and group P to whom placebo was applied. A statistical analysis was performed in SPSS v. 22 and a p < 0.05 was considered significant. Results: adequate pain management was observed in patients of group L upon admission to PACU (p = 0.002), lower consumption of transoperative fentanyl without statistical difference against placebo (p = 0.086), lower use of post-surgical rescue analgesia (p = 0.045), but higher incidence of adverse effects such as hypotension and bradycardia (p = 0.024). Conclusions: the infusion of lidocaine is effective for the management of immediate postsurgical pain; as well it decreases opioid consumption and analgesic rescue dose, with a low incidence of nausea and vomiting, but associated with hypotension after surgery.

Abdomen agudo por torsión de epiplón mayor simulando una apendicitis aguda / Acute abdomen due to torsion of greather omentun simulating acute appendicitis

La torsión del epiplón mayor es una patología poco frecuente con una clínica inespecífica, por lo que históricamente su diagnóstico es realizado en el quirófano ya que simula patologías como la apendicitis o colecistitis. Los métodos auxiliares de diagnóstico como las ecografías o las tomografías son de mucha utilidad para la sospecha de esta patología, aunque no cuenta con signos patognomónicos de la enfermedad, las imágenes asociadas a la clínica del paciente pueden llevar a un diagnóstico preciso. Presentamos el caso de un paciente joven de sexo masculino, que acudió al servicio de urgencias por cuadro de dolor abdominal tipo cólico de moderada intensidad en fosa iliaca derecha, acompañado de sensación febril, sin alteración de la analítica sanguínea, sin hallazgo de valor en la ecografía abdominal, que ante la persistencia del dolor y la fiebre se realizó una tomografía contrastada en la que se observó un empastamiento del epiplón sometiéndose a una laparoscopía exploradora con el hallazgo de una torsión del epiplón mayor.

Torsion of the greater omentum is a rare pathology with non-specific symptoms, so historically its diagnosis is made in the operating room since it simulates pathologies such as appendicitis or cholecystitis. Auxiliary diagnostic methods such as ultrasound or tomography are of very useful for the suspicion of this pathology, although it does not have pathognomonic signs of the disease, the images associated with the patient's symptoms can lead to a precise diagnosis. We present the case of a young male patient who came to the emergency department due to moderately intense colic-like abdominal pain in the right iliac fossa, accompanied by a feverish sensation, without alterations in blood tests, without any finding of value in the abdominal ultrasound, due to the persistence of pain and fever, a contrast-enhanced tomography was performed in which a filling of the omentum was observed, undergoing an exploratory laparoscopy with the discovery of a torsion of the greater omentum.

The effects of positive end-expiratory pressure (PEEP) application on optic nerve sheath diameter in patients undergoing laparoscopic cholecystectomy: a randomized trial

Abstract Background: Positive end-expiratory pressure (PEEP) can overcome respiratory changes that occur during pneumoperitoneum application in laparoscopic procedures, but it can also increase intracranial pressure. We investigated PEEP vs. no PEEP application on ultrasound measurement of optic nerve sheath diameter (indirect measure of increased intracranial pressure) in laparoscopic cholecystectomy. Methods: Eighty ASA I-II patients aged between 18 and 60 years scheduled for elective laparoscopic cholecystectomy were included. The study was registered in the Australian New Zealand Clinical Trials (ACTRN12618000771257). Patients were randomly divided into either Group C (control, PEEP not applied), or Group P (PEEP applied at 10 cmH20). Optic nerve sheath diameter, hemodynamic, and respiratory parameters were recorded at six different time points. Ocular ultrasonography was used to measure optic nerve sheath diameter. Results: Peak pressure (PPeak) values were significantly higher in Group P after application of PEEP (p = 0.012). Mean respiratory rate was higher in Group C at all time points after application of pneumoperitoneum (p < 0.05). The mean values of optic nerve sheath diameters measured at all time points were similar between the groups (p > 0.05). The pulmonary dynamic compliance value was significantly higher in group P as long as PEEP was applied (p = 0.001). Conclusions: During laparoscopic cholecystectomy, application of 10 cmH2O PEEP did not induce a significant change in optic nerve sheath diameter (indirect indicator of intracranial pressure) compared to no PEEP application. It would appear that PEEP can be used safely to correct

Colecistectomía con exploración de vías biliares laparoscópica en paciente con situs inversus totalis

Se presenta el caso de un paciente varón de 77 años con diagnóstico de colecistitis crónica calculosa y coledocolitiasis, con antecedente de situs inversus totalis. Se le realizó una colecistectomía con exploración de vías biliares laparoscópica, utilizando la "técnica francesa en espejo", con extracción de los cálculos. El paciente evolucionó favorablemente. El objetivo del presente trabajo es dar a conocer el caso clínico que es poco frecuente su reporte en la literatura mundial (solo 9 casos). Su importancia radica en que sería el primer reporte de caso clínico publicado de una colecistectomía y exploración de vías biliares laparoscópica con retiro del cálculo en colédoco en un paciente con situs inversus totalis, realizado en el Perú.

We present the case of a 77-year-old male patient with a diagnosis of chronic calculous cholecystitis and choledocholithiasis, with a history of situs inversus totalis. Therefore, a laparoscopic cholecystectomy with common bile duct exploration were performed, using the "french mirror technique", with stone extraction. Patient evolved favorably. The aim of this study is to present this clinical case that is rarely reported in the world literature (only 9 cases). Its importance lies in the fact that it would be the first published clinical case report of a laparoscopic cholecystectomy and bile duct exploration with removal of the common bile duct stones in a patient with situs inversus totalis, performed in Peru.

Caracterización de las cirugías laparoscópicas en el Servicio de Ginecología del Hospital Materno-Infantil Ángel Arturo Aballí

Introducción: La cirugía laparoscópica ginecológica permite intervenir a la paciente sin tener que abrir el abdomen, pues consiste en realizar pequeñas incisiones. Actualmente se emplea en enfermedades como el cáncer o en la extracción de quistes y miomas, por lo que se puede aplicar en casi cualquier intervención de cirugía ginecológica. Objetivo: Caracterizar los procedimientos laparoscópicos del Servicio de Ginecología en el Hospital Materno-Infantil Ángel Arturo Aballí en el período comprendido entre enero del 2018 y diciembre del 2021. Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo de corte longitudinal con el fin de describir la actividad asistencial laparoscópica. La muestra fue de 180 pacientes, según el criterio de selección no probabilístico de los investigadores. Resultados: La edad promedio fue 41,6 años. Según los antecedentes, predominó el tamaño del útero con 91,1 % (n = 164). Dentro de las indicaciones quirúrgicas, se encontró la paridad satisfecha en un 34,4 %, seguido del tumor de ovario (18,9 %), las neoplasias intraepiteliales cervicales (13,4 %) y el fibroma uterino sintomático. En cuanto a la cirugía mayor, se encontró la histerectomía abdominal laparoscópica en un 49,0 % (n = 78), seguido de la salpingectomía con un 38,9 %, resultados con significación desde el punto de vista estadístico (p = 0,004). En cuanto a la cirugía menor, el 11,6 % de la muestra recibió la ablación de los focos endometriales. Las complicaciones fueron escasas. Conclusiones: Los procederes laparoscópicos del Servicio de Ginecología del Hospital Materno-Infantil Ángel Arturo Aballí se consideraron adecuados de acuerdo a los indicadores quirúrgicos.

Introduction: Laparoscopic gynecological surgery allows for the patient to undergo surgery without having to open their abdomen, since it consists in making small incisions. It is currently used in diseases such as cancer or in the removal of cysts and myomas; therefore, it can be applied in almost any gynecological surgery. Objective: To characterize the laparoscopic procedures of the gynecology service at Hospital Materno-Infantil Ángel Arturo Aballí, in the period from January 2018 to December 2021. Methods: An observational, descriptive, retrospective and longitudinal study was carried out in order to describe the laparoscopic assistance activity. The sample consisted of 180 patients, according to the researchers' nonprobabilistic selection criteria. Results: The mean age was 41.6 years. Concerning antecedents, uterine size predominated, with 91.1% (n = 164). Among surgical indications, satisfied parity was found in 34.4%, followed by ovarian tumor (18.9%), cervical intraepithelial neoplasms (13.4 %) and symptomatic uterine fibroid. With respect to major surgery, laparoscopic abdominal hysterectomy was found in 49.0 % (n = 78), followed by salpingectomy, with 38.9%; such results are statistically significant (p = 0.004). Regarding minor surgery, 11.6% of the sample received ablation of endometrial focuses. Complications were rare. Conclusions: The laparoscopic procedures of the gynecology service at Hospital Materno-Infantil Ángel Arturo Aballí are considered adequate according to the surgical indicators.

Factores asociados con la conversión a técnica abierta en la colecistectomía laparoscópica / Factors associated with conversion to open technique in laparoscopic cholecystectomy

Introducción. La colecistectomía laparoscópica es el estándar de oro para el manejo de la patología de la vesícula biliar con indicación quirúrgica. Durante su ejecución existe un grupo de pacientes que podrían requerir conversión a técnica abierta. Este estudio evaluó factores perioperatorios asociados a la conversión en la Clínica Central OHL en Montería, Colombia. Métodos. Estudio observacional analítico de casos y controles anidado a una cohorte retrospectiva entre 2018 y 2021, en una relación de 1:3 casos/controles, nivel de confianza 95 % y una potencia del 90 %. Se caracterizó la población de estudio y se evaluaron las asociaciones según la naturaleza de las variables, luego por análisis bivariado y multivariado se estimaron los OR, con sus IC95%, considerando significativo un valor de p<0,05, controlando variables de confusión. Resultados. El estudio incluyó 332 pacientes, 83 casos y 249 controles, mostrando en el modelo multivariado que las variables más fuertemente asociadas con la conversión fueron: la experiencia del cirujano (p=0,001), la obesidad (p=0,036), engrosamiento de la pared de la vesícula biliar en la ecografía (p=0,011) y un mayor puntaje en la clasificación de Parkland (p<0,001). Conclusión. La identificación temprana y análisis individual de los factores perioperatorios de riesgo a conversión en la planeación de la colecistectomía laparoscópica podría definir qué pacientes se encuentran expuestos y cuáles podrían beneficiarse de un abordaje mínimamente invasivo, en búsqueda de toma de decisiones adecuadas, seguras y costo-efectivas

Introduction. Laparoscopic cholecystectomy is the gold standard for the management of gallbladder pathology with surgical indication. During its execution, there is a group of patients who may require conversion to the open technique. This study evaluated perioperative factors associated with conversion at the OHL Central Clinic in Montería, Colombia. Methods. Observational analytical case-control study nested in a retrospective cohort between 2018 and 2021, in a 1:3 case/control ratio, 95% confidence level and 90% power. The study population was characterized and the associations were evaluated according to the nature of the variables, then the OR were estimated by bivariate and multivariate analysis, with their 95% CI, considering a value of p<0.05 significant, controlling for confounding variables. Results. The study included 332 patients, 83 cases and 249 controls, showing in the multivariate model that the variables most strongly associated with conversion were: the surgeon's experience (p=0.001), obesity (p=0.036), gallbladder wall thickening on ultrasonography (p=0.011), and a higher score in the Parkland classification (p<0.001). Conclusions. Early identification and individual analysis of the perioperative risk factors for conversion in the planning of laparoscopic cholecystectomy could define which patients are exposed, and which could benefit from a minimally invasive approach, in search of making safe, cost-effective, and appropriate decisions

Resección hepática laparoscópica versus hepatectomía abierta para lesiones benignas: estudio comparativo con propensity score matching / Laparoscopic liver resection versus open liver resection for benign lesions: a comparative study with propensity score matching

RESUMEN Antecedentes : las ventajas de la hepatectomía videolaparoscópica (HVL) hicieron que gane cada vez más campo para el tratamiento de los tumores hepáticos benignos (THB). Objetivo : comparar los resultados perioperatorios de pacientes sometidos a HVL con los de los operados con hepatectomía abierta (HA) por THB, emparejados con propensity score matching (PSM). Material y métodos : estudio descriptivo, retrospectivo y comparativo de HA y HVL por THB entre agosto de 2010 y junio de 2021. Se analizaron variables demográficas, preoperatorias, intraoperatorias y posoperatorias. Para evitar sesgos de las distintas covariables entre los grupos se realizó un PSM 1:1. Resultados : de 403 hepatectomías, se analizaron 82 por THB. De ellas 36 (44%) fueron HA y 46 (56%) HVL. Edad media 45 ±14 años, 65% mujeres. Tras realizar el PSM, quedaron dos grupos de 28 pacientes cada uno. En HA, 5 (18%) pacientes requirieron transfusiones y ninguno en HVL (p = 0,01). Las complicaciones mayores se presentaron en 4 (14%) pacientes en HA, y ninguna en HVL (p = 0,03). Se reoperaron 4 (14%) pacientes con HA y ningún paciente con HVL (p = 0,03). La estadía hospitalaria total fue significativamente mayor en las HA (p = 0,04). No se registraron muertes a los 90 días en ninguno de los dos grupos. Conclusión : la HVL por THB es una técnica segura y eficaz, ya que los pacientes presentaron menor requerimiento transfusional, número de reoperaciones, de complicaciones mayores y de estadía hospitalaria que con HA. Por las ventajas encontradas, la HVL podría ser considerada la técnica de elección en cirugía por THB.

ABSTRACT Background : The advantages of laparoscopic liver resection (LLR) have increased its use for the treatment of benign liver tumors (BLTs). Objective : The aim of this study was to compare the perioperative outcomes of patients undergoing LLR with those operated on with open liver resection (OLR) for BLTs using propensity score matching (PSM). Material and methods : We conducted a descriptive and retrospective study comparing OLRs with LLRs performed between August 2010 and June 2021. The demographic, perioperative, intraoperative and postoperative variables were analyzed. We used PSM with 1:1 matching to avoid biases of the different covariates between the groups. Results : Of 303 liver resections, 82 corresponded to BLTs and were included in the analysis; 36 (44%) were OLRs and 46 (56%) were LLRs. Mean age was 45 ±14 years and 65% were women. After PSM, two groups of 28 patients each were constituted. Five patients (18%) in the OLR group and none in the LLR required transfusions (p = 0.01). Major complications, occurred in 4 (14%) patients in the OLR group and in no cases in the LLR group (p = 0.03). Four (14%) undergoing OLR required reoperation versus no patients with LLR (p = 0.03). Total length of hospital stay was significantly longer in OLR (p = 0.04). There were no deaths in any of the groups within 90 days. Conclusion : LLR for BLTs is a safe and effective technique, with lower requirement for transfusions, fewer reoperations and major complications and shorter length of hospital stay than OLR, Therefore, LLR could be considered the surgical technique of choice for BLTs.

Biopsia ganglionar retroperitoneal por laparoscopia

Introducción: La biopsia ganglionar retroperitoneal es un procedimiento frecuentemente requerido en el estudio de neoplasias; resulta deseable optimizar su rendimiento con baja morbilidad. Este artículo describe la utilidad y complicaciones de biopsias ganglionares retroperitoneales por laparoscopia en una institución oncológica de Latinoamérica. Material y Métodos: Cohorte retrospectiva de pacientes con biopsia ganglionar retroperitoneal o mesentérica laparoscópica entre 2011 y 2021 en el Instituto Nacional de Cancerología, en Bogotá, Colombia. Se recogieron datos demográficos, quirúrgicos, complicaciones y mortalidad a 30 días, resultados histopatológicos y su rol en la clínica. Resultados: Se incluyeron 41 pacientes; 73% con diagnóstico de malignidad, principalmente linfoma. La indicación fue mayormente sospecha de recaída, seguida por sospecha de enfermedad hematológica de novo. Siempre se obtuvo tejido adecuado y suficiente para diagnóstico histológico. Requirieron conversión a laparotomía cinco pacientes (12%). No hubo complicaciones Clavien-Dindo III /IV ni mortalidad a 30 días. Se presentó morbilidad grado I o II en 3 casos (7%) y un incidente intraoperatorio grado III. Conclusión: La naturaleza invasiva y el carácter diagnóstico de la biopsia retroperitoneal laparoscópica, constituyen un desafío frecuente en la práctica del cirujano general. La planeación estratégica e individualizada y la técnica quirúrgica depurada son las claves para lograr el máximo rendimiento, con baja morbimortalidad.

Introduction: Retroperitoneal lymph node biopsy is a frequently required procedure in the study of neoplasms; it is desirable to optimize its performance with low morbidity. This paper describes the usefulness and complications of retroperitoneal lymph node biopsies by laparoscopy in a cancer institution in Latin America. Material and Methods: Retrospective cohort of patients with laparoscopic retroperitoneal or mesenteric lymph node biopsy between 2011 and 2021 at the National Cancer Institute, in Bogotá, Colombia. Demographic and surgical data, complications and 30-day mortality, histopathological results and their clinical role were collected. Results: 41 patients were included; 73% diagnosed with malignancy, mainly lymphoma. The indication was mostly suspected relapse, followed by suspected de novo hematologic disease. Adequate and sufficient tissue was always obtained for histological diagnosis. Five patients (12%) required conversion to laparotomy. There were no Clavien-Dindo III/IV complications or 30-day mortality. Grade I or II morbidity occurred in 3 cases (7%) and a grade III intraoperative incident. Conclusion: The invasive nature and diagnostic character of laparoscopic retroperitoneal biopsy constitute a frequent challenge in the practice of the general surgeon. Strategic and individualized planning and a refined surgical technique are the keys to achieving maximum performance, with low morbidity and mortality.

Quiste hidatídico primario de páncreas: reporte de caso

Introducción. El quiste hidatídico puede localizarse en cualquier órgano del cuerpo. El quiste hidatídico en el páncreas (QHP)se presenta con una prevalencia menor a 1%, la localización más frecuente es la cabeza en 61% a 69%, en el cuerpo y cola en 31% a 39%. No es fácil diferenciar el quiste hidatídico pancreático de otros tumores quísticos del páncreas, por lo que esta patología debe tenerse en cuenta en el diagnóstico diferencial de lesiones quísticas pancreáticas. Caso Clínico. Paciente femenino de 66 años quien desde el año 2016 se encontraba en control por una tumoración quística de la cola pancreática de 1,7 cm, diagnosticada en forma incidental. La paciente cursó asintomática y se controló en forma anual. El año 2021 la lesión alcanzó un tamaño de 4,7 cm. En este contexto se decide la resección quirúrgica por vía laparoscópica. Se resecó una pieza quirúrgica de 8 cm de longitud que incluye la cola del páncreas y el quiste. La histología describe la membrana prolígera y múltiples escólex viables. Conclusión. La localización primaria en la cola del páncreas de un quiste hidatídico confunde el diagnóstico con un tumor quístico mucinoso. El tratamiento quirúrgico actual en los quistes distales debería ser la resección laparoscópica.

Introduction. The hydatid cyst can be located in any organ of the body. The hydatid cyst in the pancreas occurs with a prevalence of less than 1%, the most frequent location is the head in 61% to 69%, the body and tail in 31% to 39%. It is not easy to differentiate the pancreatic hydatid cyst from other cystic tumors of the pancreas, so this pathology must be taken into account in the differential diagnosis of pancreatic cystic lesions. Clinical Case. The present report discusses a 66-year-old female patient who had been in control since 2016 for a 1.7 cm cystic tumor of the pancreatic tail. The patient was asymptomatic and was controlled annually. In 2021, the lesion reached a size of 4.7 cm. In this context, laparoscopic surgical resection was decided. An 8 cm long surgical specimen was resected, including the tail of the pancreas and the cyst. Histology describes prolific membrane and multiple viable scolexes. Conclusion. The primary location in the tail of the pancreas of a hydatid cyst confuses the diagnosis with a mucinous cystic tumor. The current surgical treatment for distal cysts should be laparoscopic resection.

Unusually large number of gall stones removed through laparoscopic cholecystectomy from a single patient- A case report

Gallstone disease is characterized by the formation of calculi in the gall bladder or the biliary tract. It may be asymptomatic or present as biliary colic or with complicated disease. Laparoscopic cholecystectomy is the mainstay of treatment for symptomatic gall stones. We describe a case of Gallstone disease in a 43-year-old female, where over seven thousand stones were removed through a Laparoscopic procedure. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Efectividad de la colecistectomía laparoscópica de puerto único asistida con imanes bajo anestesia espinal

Objetivo: Determinar la efectividad de la colecistectomía laparoscópica de puerto único asistida por imanes bajo anestesia espinal en el tratamiento quirúrgico de la colecistopatía litiásica crónica. Material y Métodos: Estudio prospectivo de cohorte en 51 pacientes entre octubre de 2019 y febrero de 2021. 17 pacientes fueron sometidos a colecistectomía laparoscópica de puerto único asistida por imanes y 34 a colecistectomía laparoscópica convencional por un mismo equipo quirúrgico. Se aplicó la técnica quirúrgica descrita por Dominguez et al y SAGES, bajo anestesia espinal. Se realizó estadística descriptiva e inferencial, analizando el dolor postoperatorio a las 3, 6, 12, 24 y 72 h y la satisfacción de los pacientes. Resultados: Se encontró diferencia significativa en el dolor postoperatorio en el grupo de estudio a las 6 h (p = 0,022), 12 h (p = 0,039), 24 h (p = 0,025) y 72 h (p < 0,001). En la satisfacción se encuentra un RR de 3 (p = 0,001), sin diferencia significativa en el tiempo operatorio y horas de hospitalización postquirúrgicas. Conclusiones: La colecistectomía laparoscópica de puerto único asistida por imanes, bajo anestesia espinal, ha demostrado efectividad en la reducción importante del dolor postoperatorio a partir de las 6 h, y en la superación de las expectativas en los intervenidos, sin aumento significativo de tiempo operatorio ni estancia hospitalaria.

Aim: To determine the effectiveness of magnet-assisted single-port laparoscopic cholecystectomy under spinal anesthesia in surgical treatment of chronic lithiasic cholecystopathy. Materials and Method: Prospective cohort study in 51 patients between October 2019 and February 2021. 17 patients underwent magnet-assisted single-port laparoscopic cholecystectomy and 34 underwent conventional laparoscopic cholecystectomy by the same surgical team. The surgical technique described by Dominguez and SAGES was used, under spinal anesthesia. Descriptive and inferential statistics were performed, analyzing postoperative pain at 3, 6, 12, 24 and 72 hours and patient satisfaction. Results: A significant difference in postoperative pain was found in the study group at 6 h (p = 0.022), 12 h (p = 0.039), 24 h (p = 0.025) and 72 h (p < 0.001). In satisfaction, there is an RR of 3 (p = 0.001), with no significant difference in operative time and postoperative hospitalization hours. Conclusions: Magnet-assisted single-port laparoscopic cholecystectomy under spinal anesthesia has shown effectiveness in significantly reducing postoperative pain after 6h, associated with significantly exceeding expectations in those operated on, without a significant increase in operative time or hospital stay.

Colecistectomía laparoscópica en una paciente con situs inversus totalis. Reporte de un caso y revisión de la literatura

Introducción: El situs inversus totalis es una condición congénita en la cual los órganos torácicos y abdominales se encuentran en posición contraria a la posición habitual. En la literatura quirúrgica internacional se encuentran publicados no más de 55 casos de colecistectomía en pacientes con situs inversus totalis. La resolución laparoscópica de una paciente en nuestra Institución nos permite revisar esta particular condición patológica. Caso Clínico: Paciente femenino de 43 años de edad hospitalizada por una colecistitis aguda la cual es resuelta por vía laparoscópica sin incidentes. Material y Método: Se resume la literatura actual mediante una extensa revisión en PubMed de los reportes más relevantes. Considerando que todos los artículos publicados son casos clínicos o pequeñas series de casos, se presentan los resultados de esta revisión en tablas con estadística descriptiva básica. Discusión: Se discuten las características generales de estos pacientes, la presentación clínica, diagnóstico y técnica quirúrgica. Conclusión: La colecistectomía laparoscópica constituye el estándar de oro en pacientes con situs inversus y patología biliar, la cual debe ser realizada por un cirujano experimentado acomodando los trocares apropiadamente, debido a las dificultades técnicas que se encuentran en estos pacientes por las anomalías anatómicas propias de esta condición. El diagnóstico radiológico actual permite la planificación del abordaje y del procedimiento quirúrgico apropiado para cada paciente.

Introduction: Situs inversus totalis is a congenital condition in which the thoracic and abdominal organs are in the opposite position from normal anatomy. We found no more than 55 cases of cholecystectomy in patients with situs inversus totalis published in the international surgical literature. The laparoscopic resolution of a patient in our Institution allows us to review this particular pathological condition. Clinical Case: A 43-year-old female patient was admitted for acute cholecystitis and was resolved laparoscopically without any incidents. Material and Method: We summarized the current literature through an extensive PubMed review of the most relevant reports. Considering that all published articles are clinical cases or small case series, we present the results of this review in a table with basic descriptive statistics. Discussion: We discuss the general characteristics of these patients, clinical presentation, diagnosis, and surgical technique. Conclusions: Laparoscopic cholecystectomy is the gold standard in patients with situs inversus and biliary pathology, which must be performed by an experienced surgeon, properly accommodating the trocars due to the technical difficulties in these patients secondary to anatomical anomalies typical of this condition. Current radiological diagnosis allows planning the appropriate approach and surgical procedure for each patient.

Pancreatectomía izquierda laparoscópica: ¿la sistematización de la técnica es de utilidad? / Laparoscopic left pancreatectomy: is systematization of the technique useful?

RESUMEN Antecedentes: la pancreatectomía izquierda laparoscópica es un procedimiento de alta complejidad que debe ser sistematizado para reducir complicaciones y tiempos quirúrgicos. Objetivo: Describir los resultados con una técnica sitematizada de esplenopancreatectomía laparoscópica. Material y métodos: se seleccionaron pacientes candidatos a realizar esplenopancreatecomía distal en el período comprendido entre 2007 y 2022. Se excluyeron pacientes con enfermedad sistémica. La técnica quirúrgica laparoscópica consiste en ligar los vasos cortos como primer paso, luego disecar y cortar la arteria esplénica, dejando la sección de la vena como último gesto quirúrgico. Esto evita la congestión venosa del bazo. Se analizaron variables preoperatorias, intraoperatorias y posoperatorias. Resultados: sobre un total de 155 pacientes, 90 fueron intervenidos por vía laparoscópica y 65 por vía convencional. El tiempo quirúrgico promedio fue 168 minutos. Cuando se analizó el tiempo quirúrgico en los abordajes laparoscópicos, se observó una disminución del tiempo a partir del caso número 30. La mortalidad fue del 1,12%. La incidencia de fístula pancreática total fue 41%. La necesitad de transfusión intraoperatoria ocurrió en el 10,7% de los pacientes y la tasa de conversión fue del 13,3%. Conclusión: la sistematización de la técnica de la pancreatectomía laparoscópica permite la reducción de los tiempos quirúrgicos, adquirir mayor seguridad en la disección y realizar procedimientos cada vez más complejos.

ABSTRACT Background: Laparoscopic left pancreatectomy is a high complexity procedure that should be systematized to reduce complications and operative time. Objective: To describe the results achieved with a systematized technique for laparoscopic pancreatectomy and splenectomy. Materials and methods: We selected patients who were candidates for distal pancreatectomy and splenectomy between 2007 and 2022. Patients with systemic diseases were excluded. The laparoscopic technique consists of ligating the short vessels as a first step, then dissecting and cutting the splenic artery, leaving the section of the vein as the last surgical gesture to avoid venous congestion of the spleen. Perioperative, intraoperative and postoperative variables were analyzed. Results: A total of 155 patients were analyzed, 90 underwent laparoscopy and 65 underwent conventional surgery. Mean operative time was 168 minutes The operative time in the laparoscopic approach decreased from case 30 onwards. Mortality rate was 1.12%. The incidence of pancreatic fistula was 41%. Need for intraoperative transfusion occurred in 10.7% of the patients and the conversion rate was 13.3%. Conclusion: The systematization of the technique of pancreatic laparoscopy is essential to reduce surgical times, ensure safe dissections and performe more complex procedures.

Outcome of Laparoscopic Cholecystectomy in a District Level Hospital

Background: Laparoscopic cholecystectomy is a type of surgery that uses smaller incision than open cholecystectomy. LC has been performed as outpatient procedure for many years. Few studies have been conducted with primary focus on patient acceptance and preferences in terms of safety and satisfaction. We tried to explore its feasibility in otherwise healthy individuals undergoing laparoscopic cholecystectomy. The aim of the study of laparoscopic cholecystectomy is significantly affected by acute cholecystitis. Mechanical, biochemical, and bacteriological factors which are believed to participate in this inflammatory process are responsible for the different pathological processes observed in acute cholecystitis and in symptomatic cholelithiasis. Material & Methods: Data from 57 patients between the age group 20 to 70 years with cholelithiasis who underwent laparoscopic cholecystectomy in a private Hospital, Madaripur, Bangladesh from April 2018 to June 2020 as ambulatory surgery (hospital stay 23 Hours) with or without overnight stay were analyzed. Complications, admissions and readmissions, patient satisfaction and treatment expenditure were assessed. Results: There were 48 (84.2%) female and 9 (15.8%) male with a median age of 42 years. Only 2.4% patients required readmission while 9.2% patients had unplanned admission. 76.4% percent patients were highly satisfied with the procedure. Treatment cost was about 15% lower than routine inpatient operation. Conclusion: Laparoscopic cholecystectomy is safe and feasible. LC can be performed as an outpatient procedure with a low rate of complications and admissions/readmissions. Patient acceptance in terms of satisfaction is high.

Colecistectomía laparoscópica ambulatoria, una realidad actual / Ambulatory laparoscopic cholecystectomy, a current reality / Colecistectomia Laparoscópica Ambulatorial, uma realidade atual

La cirugía ambulatoria ha ido evolucionando y abarcando cada día procedimientos quirúrgicos más complejos, incluso la colecistectomía laparoscópica, actualmente considerada como la cirugía de elección para el tratamiento de la patología biliar, se puede realizar de manera ambulatoria gracias a los avances en técnicas quirúrgicas y anestésicas que actuales. Objetivo. Determinar la viabilidad y aceptación del procedimiento dentro de la practica ambulatoria mediante una revisión de la literatura actual sobre los protocolos de colecistectomía laparoscópica ambulatoria existentes. Metodología. Se realizó una revisión sistemática de la literatura, basado en la declaración PRISMA para ajustar la información obtenida en las diferentes bases científicas disponibles utilizando los descriptores relacionados con colecistectomía laparoscópica ambulatoria y cirugía del día enfocándose en aquellos registros sobre el tema, su conceptualización y puesta en marcha. De esta manera se identificaron 118 registros en las diferentes bases de datos consultadas. Tras la aplicación de criterios de inclusión se separaron 56 artículos de los cuales finalmente se utilizaron 11 registros para la revisión. Conclusión. La colecistectomía laparoscópica es segura y eficaz, siempre y cuando se realice la estatificación correcta del paciente a beneficiarse. No hay diferencia significativa entre los diferentes anestésicos utilizados durante el procedimiento, el anestésico subdérmico no mejora el tiempo de recuperación por dolor postoperatorio. La valoración protocolizada del postquirúrgico es vital para el alta hospitalaria.

Ambulatory surgery has been evolving and encompassing more complex surgical procedures every day. Even laparoscopic cholecystectomy, currently considered the surgery of choice for the treatment of biliary pathology, can be performed on an ambulatory basis thanks to advances in surgical and anesthetic techniques. Objective. To determine the feasibility and acceptance of the procedure in outpatient practice by reviewing the current literature on existing outpatient laparoscopic cholecystectomy protocols. Methodology. A systematic review of the literature was carried out, based on the PRISMA statement to adjust the information obtained in the different scientific bases available using the descriptors related to ambulatory laparoscopic cholecystectomy and day surgery focusing on those records on the subject, its conceptualization and implementation. In this way, 118 records were identified in the different databases consulted. After the application of inclusion criteria, 56 articles were separated from which 11 records were finally used for the review. Conclusion. Laparoscopic cholecystectomy is safe and effective, as long as the correct staging of the patient to be benefited is performed. There is no significant difference between the different anesthetics used during the procedure, the subdermal anesthetic does not improve postoperative pain recovery time. Protocolized postoperative assessment is vital for hospital discharge.

A cirurgia ambulatorial tem evoluído e engloba procedimentos cirúrgicos mais complexos a cada dia. Mesmo a colecistectomia laparoscópica, atualmente considerada a cirurgia de escolha para o tratamento da patologia biliar, pode ser realizada em regime ambulatorial graças aos avanços nas técnicas cirúrgicas e anestésicas. Objetivo. Determinar a viabilidade e aceitabilidade do procedimento na prática ambulatorial através de uma revisão da literatura atual sobre os protocolos existentes de coleistectomia laparoscópica ambulatorial. Metodologia. Foi realizada uma revisão sistemática da literatura, baseada na declaração PRISMA para ajustar as informações obtidas nas diferentes bases científicas disponíveis usando os descritores relacionados à coleistectomia laparoscópica ambulatorial e à cirurgia diurna, focalizando aqueles registros sobre o assunto, sua conceitualização e implementação. Desta forma, 118 registros foram identificados nos diferentes bancos de dados consultados. Após a aplicação dos critérios de inclusão, 56 artigos foram separados dos quais 11 registros foram finalmente utilizados para a revisão. Conclusão. A coleistectomia laparoscópica é segura e eficaz, desde que o estadiamento correto do paciente a ser beneficiado seja realizado. Não há diferença significativa entre os diferentes anestésicos utilizados durante o procedimento, a anestesia subdérmica não melhora o tempo de recuperação da dor pós-operatória. A avaliação pós-operatória protocolizada é vital para a alta hospitalar.

Application of laparoscopic ultrasound in retroperitoneal radical nephrectomy for renal cell carcinoma with Type II inferior vena cava tumor thrombectomy

Background: The aim of this study was to investigate the application value of laparoscopic ultrasound (LU) in retroperitoneal radical nephrectomy for renal cell carcinoma with Type II inferior vena cava tumor thrombectomy (RRN-RCC-TII-IVCTT). Methods: The clinical data (operative time, length of tumor thrombus, tumor length, intraoperative bleeding, clinical stage, histological type, residual tumor tissue, and postoperative follow-up) of 6 patients who underwent LU-guided RRN-RCC-TII-IVCTT were retrospectively analyzed, and the intraoperative experience of LU was also summarized. Results: All 6 patients recovered well with liver and kidney functions returning to normal, and no tumor recurrence, metastasis, or vena cava tumor thrombus. Conclusions: LU-guided RRN-RCC-TII-IVCTT is a feasible treatment option, which locates the tumor accurately by retroperitoneal approach and provides the additional benefit of reduced intraoperative bleeding and shortened operative time, also achieving the much sought-after goal of precision.

Incidencia de la disfunción sexual eréctil asociada a la prostatectomía radical abierta y laparoscópica

Introducción: la dificultad o imposibilidad de lograr una actividad sexual satisfactoria a pesar de estar presentes las condiciones adecuadas para su desarrollo exitoso, se conoce como disfunción sexual. Si la dificultad consiste en alcanzar y mantener la erección necesaria para una penetración se produce una disfunción eréctil. Objetivo: describir la disfunción eréctil en los pacientes con cáncer de próstata sometidos a prostatectomía radical por vía abierta vs. laparoscópica, en el Hospital Universitario Comandante Faustino Pérez Hernández, de Matanzas, entre enero de 2010 y enero de 2020. Materiales y métodos: se realizó un estudio longitudinal retrospectivo en los 40 pacientes que acudieron a la Consulta Provincial de Cáncer de Próstata y les fue realizado cirugía radical, entre enero de 2010 y enero de 2020. Resultados: el 52,5 % de los pacientes tienen un promedio de edad entre 65 y 74 años. Un índice de comorbilidad de Charlson de 3 a 5 puntos predominó en un 75 % de la muestra. En la vía laparoscópica, todos los casos presentaron disfunción eréctil, siendo severa en el 50 % de ellos. El 22,5 % del total no la tuvieron, representando un 30 % de los operados por cirugía abierta. Conclusiones: la prostatectomía radical continúa siendo considerada uno de los tratamientos de elección del cáncer de próstata órgano-confinado. La causa principal de la presencia de disfunción eréctil se atribuye al procedimiento quirúrgico; la edad avanzada puede contribuir a empeorar el pronóstico y las enfermedades coadyuvantes. Son heterogéneos los resultados en la esfera sexual de la prostatectomía radical laparoscópica y la prostatectomía radical abierta, comparados con la bibliografía internacional.

Introduction: the difficulty or impossibility of achieving a successful sexual activity despite being present the adequate conditions for its successful development is known as sexual dysfunction. If the difficulty consists in reaching and maintaining the erection necessary for a penetration, erectile dysfunction occurs. Objective: to describe the erectile dysfunction in patients with prostate cancer undergoing open vs. laparoscopic radical prostatectomy, in the Comandante Faustino Perez Hernandez University Hospital, of Matanzas, between January 2010 and January 2020. Materials and methods: a longitudinal retrospective study was carried out in the 40 patients who attended Prostate Cancer Provincial Consultation and underwent radical surgery between January 2010 and January 2020. Results: 52.5% of the patients were aged between 65 and 74 on average. A Charlson comorbidity index of 3 to 5 points prevailed in 75% of the sample. In the laparoscopic pathway all the cases presented erectile dysfunction, being severe in 50% of them. 22.5% of the total did not have it, representing 30% of those operated by open surgery. Conclusions: radical prostatectomy continues to be considered one of the treatments of choice for organ-confined prostate cancer. The main cause of the presence of erectile dysfunction is attributed to the surgical procedure; advanced age can contribute to a worse prognosis and adjuvant diseases. The results in the sexual sphere of laparoscopic radical prostatectomy and open radical prostatectomy are heterogeneous compared with the international bibliography.

Bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled study

Abstract Introduction Laparoscopic cholecystectomy (LC) is the common surgical intervention for benign biliary diseases. Postoperative pain after LC remains as an important problem, with two components: somatic and visceral. Trocar entry incisions lead to somatic pain, while peritoneal distension with diaphragm irritation leads to visceral pain. Following its description by Forero et al., the erector spinae plane (ESP) block acquired considerable popularity among clinicians. This led to the use of ESP block for postoperative pain management for various operations. Materials and methods This study was conducted between January and June 2019. Patients aged between 18 and 65 years with an American Society of Anesthesiologists (ASA) physical status I-II, scheduled for elective laparoscopic cholecystectomy were included in the study. All the patients received bilateral or unilateral ESP block at the T8 level preoperatively according to their groups. Results There was no significant difference between the groups in terms NRS scores either at rest or while coughing at any time interval except for postoperative 6th hour (p = 0.023). Morphine consumption was similar between the groups but was significantly lower in group B at 12 and 24 hours (p = 0.044 and p = 0.022, respectively). Twelve patients in group A and three patients in group B had shoulder pain and this difference was statistically significant (p = 0.011). Discussion In conclusion, bilateral ESP block provided more effective analgesia than unilateral ESP block in patients undergoing elective LC. Bilateral ESP block reduced the amount of opioid consumption and the incidence of postoperative shoulder pain.

Comparison of modified laparoscopic total extraperitoneal hernia repair and laparoscopic transabdominal preperitoneal hernia repair in patients with inguinal hernia / 中国医师进修杂志

Objective:To explore the application effects of modified laparoscopic total extraperitoneal hernia repair (TEP) and laparoscopic transabdominal preperitoneal hernia repair (TAPP) in inguinal hernia.Methods:One hundred and twenty-five patients with inguinal hernia in Yiwu Central Hospital from February 2017 to December 2019 were selected for retrospective study. They were divided into modified TEP group (63 cases) and TAPP group (62 cases). The modified TEP group was treated with modified TEP, and the TAPP group was treated with TAPP. The perioperative operation related indexes, serum oxidative stress indexes, 1-year recurrence rate and semen quality indexes were compared between the two groups.Results:The scores of visual analogue scale after operation for 24 h in the modified TEP group was lower than that in the TAPP group: (1.68 ± 0.39) scores vs. (1.97 ± 0.46) scores, P<0.05. After operation for 3 d, the levels of serum superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) in the modified TEP group were higher than those in the TAPP group: (92.79 ± 8.82) μmol/L vs. (84.40 ± 7.36) μmol/L, (81.52 ± 9.37) U/L vs. (75.75 ± 8.50) U/L; and the level of malondialdehyde (MDA) in the modified TEP group was lower than that in the TAPP group: (23.42 ± 3.3) μmol/L vs. (26.71 ± 3.92) μmol/L; the differences were statistically significant ( P<0.05). There was no significant difference in 1-year recurrence rate between the two groups ( P>0.05). One year after operation, the levels of acid phosphatase (ACP), fructose (FRU) and α- glucosidase (α- Glu) in the modified TEP group were higher than those in the TAPP group: (180.87 ± 20.15) kU/L vs. (159.85 ± 14.50) kU/L, (3.37 ± 0.84) g/L vs.(2.53 ± 0.67) g/L, (62.94 ± 6.25) kU/L vs. (43.96 ± 5.31) kU/L, the differences were statistically significant ( P<0.05). Conclusions:Both modified TEP and TAPP are effective methods for the treatment of inguinal hernia, but the former can reduce surgical trauma, recover quickly, and protect normal reproductive function.