Colectomías totales videolaparoscópicas / Videolaparoscopic total colectomy

Introducción: la resección laparoscópica del colon fue informada por primera vez en 1990 por Moisés Jacobs y Gustavo Plascencia. Las colectomías totales son procedimientos complejos indicados en pacientes con enfermedades como la poliposis múltiple familiar y la colitis ulcerativa idiopática. El abordaje laparoscópico ofrece beneficios importantes al paciente con respecto a la cirugía convencional, incluyendo menor riesgo de recurrencia del tumor en los casos con cáncer. Objetivo: describir los resultados quirúrgicos obtenidos con colectomía total videolaparoscópica. Métodos: se realizó un estudio descriptivo de una serie consecutiva de 14 pacientes a los cuales se les practicó colectomías totales videolaparoscópicas en el Centro Nacional de Cirugía de Mínimo Acceso, en el período comprendido entre enero de 2005 a agosto de 2012. Las variables en estudio fueron: la edad, sexo, indicación quirúrgica, tiempo quirúrgico, necesidad de transfusión intraoperatoria, estadía hospitalaria, complicaciones transoperatorias y postoperatorias. La información se obtuvo de las historias clínicas individuales. Se emplearon porcentajes, promedios y desviación estándar, mediana y rango intercuartílico para muestras asimétricas, como medidas de resumen de las variables empleadas. Resultados: las indicaciones quirúrgicas fueron: poliposis múltiple familiar y colitis ulcerativa idiopática. Predominó el sexo femenino. El rango de edad estuvo comprendido de 16 a 76 años. El tiempo quirúrgico promedio fue de 265 ± 54,7 minutos. No existieron complicaciones transoperatorias. Hubo seis pacientes con complicaciones posoperatorias, cuatro de ellas requirieron reintervención para su corrección, los pacientes evolucionaron favorablemente. Conclusiones: la colectomía total videolaparoscópica constituye un procedimiento factible y seguro para el tratamiento quirúrgico de la poliposis múltiple familiar y colitis ulcerativa idiopática(AU)

Introduction: laparoscopic colon resection was reported for first time in 1990 by Moisés Jacobs and Gustavo Plascencia. Total colectomy is a complex procedure for patients with Familial Multiple Polyposis (FMP) and Idiopathic Ulcerative Colitis(IUC). The laparoscopic approach provides important benefits to the patient as compared to the conventional surgery, including lower risk of tumor recurrence in cancer cases. Objective: to describe the surgical results from the used of the videolaparoscopic total colectomy. Methods: a descriptive study of a consecutive series of 14 patients who underwent videolaparoscopic total colectomy in the National Center of of Minimal Access Surgery in the period of January 2005 through August 2012. The study variables were age, sex, surgical indication, surgical time, transfusional requirements during surgery, stay at hospital, and transoperative and postoperative complications. The information was drawn from the individual medical histories. Percentages, means and standard deviations, medians and interquartile range were taken for asymmetric samples, in terms of summary measures of the used variables. Results: the surgical indications were familial multiple polyposis and idiopathic ulcerative colitis. Females predominated. The age range was 16 to 76 years. The average surgical time was 265.0 ± 54.7 minutes, with no transoperative complications. There were six patients with postoperative complications, four of them were reoperated on to correct the disorders, the patients successfully recovered. Conclusions: videolaparoscopic total colectomy is a feasible and safe procedure for the surgical treatment of familial multiple polyposis and for idiopathic ulcerative colitis(AU)

Videocirurgia na criança: estado da arte. Experiência com 1408 procedimentos no Instituto da Criança "Pedro de Alcântara" / Videosurgery in infancy and childhood: state of the art. Experience with 1408 procedures in the Instituto da Criança "Pedro de Alcântara"

A videocirurgia em Cirurgia Pediátrica encontra um imenso campo de aplicações ainda, infelizmente, pouco explorado. São poucos os serviços que utilizam rotineiramente essa via de acesso e são escassas as referências nacionais publicadas. O Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr) há uma década e meia a utiliza e hoje a videocirurgia é a via de primeira escolha para tratar, entre outras doenças, o refluxo gastresofagiano, a colecistopatia calculosa, o testículo não palpável e o megaesôfago. Neste artigo relataremos a experiência em videocirurgia pediátrica do ICr, adquirida com 1408 pacientes operados, para divulgar e popularizar esta via de acesso, útil e benéfica para um grande número de situações e ainda subutilizada em Cirurgia Pediátrica.

The videosurgery in Pediatric Surgery has a large field of applications unfortunately still underexplored. There are few services that routinely use this techinic , and Brazilian articles published are scarce. The Institute of Children's Hospital of the Faculty of Medicine, University of São Paulo, has been using for fifteen years the videosurgery which is now the first choice of treatment, among other diseases as gastroesophageal reflux, the cholecystolithiasis, the nonpalpable undescended testicles and megaesophagus. In this article we report our experience in laparoscopic pediatric surgery, acquired with 1408 surgical procedures, to present this useful method, and beneficial to a large number of situations and still underused in Pediatric Surgery.