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1.
Rev. chil. obstet. ginecol. (En línea) ; 85(4): 343-350, ago. 2020. tab
Article in Spanish | LILACS | ID: biblio-1138630

ABSTRACT

INTRODUCCIÓN: Actualmente la cirugía laparoscópica es el gold standard de la mayoría de las cirugías ginecológicas benignas. Se estima una tasa de complicaciones en cirugía ginecológica por laparoscopía de 3.2 por 1000 pacientes, donde alrededor del 50% ocurren al momento de la primera entrada. Existen numerosas clasificaciones de las complicaciones quirúrgicas, entre ellas, la clasificación Clavien-Dindo se centra en el tratamiento postquirúrgico y tiene como objetivo unificar criterios y hacerlas comparables entre distintos centros. OBJETIVO: Describir las complicaciones en cirugía laparoscópica ginecológica en el Hospital Padre Hurtado, destacando el subgrupo de primera entrada y su clasificación Clavien-Dindo. METODOLOGÍA: Cohorte retrospectiva que incluyó a todas las pacientes operadas por laparoscopía en el pabellón de ginecología del Hospital Padre Hurtado desde el año 2014 al 2017. Se utilizó el software SPSS statistics v25, con prueba X2 para el análisis de las variables no paramétricas y t de Student para las variables paramétrica, considerando una significación estadística con p<0,05. RESULTADOS: De las 513 cirugías laparoscópicas ginecológicas realizadas en el período evaluado, sólo el 4,3% del total de las pacientes tuvieron complicaciones. De éstas, un 9% fueron de primera entrada, y en todos los casos fueron complicaciones menores o Clavien-Dindo I y II. Hubo 2 complicaciones Clavien-Dindo >III B, lo que correspondió a un 0,39%. CONCLUSIÓN: En nuestro grupo hubo una baja incidencia de complicaciones quirúrgicas y de primera entrada lo que es comparable con otras series publicadas.


INTRODUCTION: Laparoscopic surgery is currently the gold standard of most benign gynecological surgeries. A complication rate in gynecological laparoscopy is 3.2 per 1000 patients, where around 50% occur at the time of the first entry. There are numerous classifications of surgical complications, among them, Clavien-Dindo classification focuses on post-surgical treatment and aims to unify criteria and lets compare between different centers. OBJECTIVE: To describe the complications in gynecological laparoscopic surgery at the Padre Hurtado Hospital, highlighting the first entry subgroup and Clavien-Dindo classification. METHODOLOGY: Retrospective cohort that included all gynecological laparoscopy patients in Padre Hurtado Hospital from 2014 to 2017. The SPSS statistics v25 software was used, with X2 test for the analysis of non-parametric variables and t Student for the parametric variables, considering a statistical significance with p <0.05. RESULTS: 513 gynecological laparoscopic surgeries was performed in the evaluated period, only 4.3% of the total patients had complications. Of these, 9% were first entry, and in all cases were minor complications or Clavien-Dindo I and II. There were 2 patients with Clavien-Dindo complications > III B, which corresponded to 0.39%. CONCLUSION: In our group there was a low incidence of surgical complications and first entry which is comparable with other published series.


Subject(s)
Humans , Female , Gynecologic Surgical Procedures/adverse effects , Laparoscopy/adverse effects , Genital Diseases, Female/surgery , Gynecologic Surgical Procedures/methods , Gynecologic Surgical Procedures/statistics & numerical data , Chile , Epidemiology, Descriptive , Retrospective Studies , Cohort Studies , Laparoscopy/statistics & numerical data , Intraoperative Complications/classification , Intraoperative Complications/etiology , Intraoperative Complications/epidemiology
2.
Rev. cir. (Impr.) ; 72(1): 36-42, feb. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1092888

ABSTRACT

Resumen Introducción El uso del sistema de visión 3D en cirugía laparoscópica puede significar una mejor performance de los procedimientos quirúrgicos de mayor complejidad. Objetivo Reportar las indicaciones, los resultados y la valoración de un grupo de cirujanos de diferentes especialidades en el uso de visión 3D. Materiales y Método: Se analizan las indicaciones quirúrgicas y los resultados subjetivos y objetivos del uso del sistema óptico 3D (n = 155 pacientes) en cirugía laparoscópica compleja. Para evaluación subjetiva se aplicó a una encuesta de percepción cualitativa a los cirujanos participantes tipo Likert. Para la evaluación objetiva, se registran los tiempos quirúrgicos empleados en los diferentes procedimientos efectuados y las complicaciones postoperatorias y se comparan con los pacientes operados con sistema 2D (n = 783 pacientes) en el mismo periodo. Resultados el 70,6% concuerda tener mejor imagen con la técnica 3D, el 64,7% de los cirujanos refieren que se puede reducir el tiempo operatorio, el 58,8% considera que se puede reducir el error quirúrgico, el 92% y 100% respectivamente afirman que el confort del cirujano es mejor con el uso de óptica 3D y que esta técnica es recomendable para los procedimientos complejos. El tiempo operatorio se redujo en algunos procedimientos, especialmente urológicos. No se encontró diferencias sustanciales al comparar los resultados con el uso de sistema 3D versus 2D en cuanto a complicaciones postoperatorias. En la 3D no se encontró mortalidad postoperatoria, probablemente por el menor número de pacientes de ese grupo. Conclusión La laparoscopia 3D posee una buena valoración por los cirujanos que la emplearon, principalmente en calidad de imagen, reducción del tiempo operatorio y confort del cirujano en comparación con la laparoscopía 2D convencional. No se encontró diferencias sustanciales al comparar los resultados con el uso de sistema 3D versus 2D en cuanto a tiempo operatorio ni complicaciones postoperatorias.


Introduction The use of the 3D vision system in laparoscopic surgery can mean better performance in more complex surgical procedures. Aim Report the indications, results and assessment of a group of surgeons of different specialties in the use of 3D vision. Materials and Method Surgical indications and subjective and objective results of the use of 3D optical system in patients (n = 155) submitted to complex laparoscopic surgery are analyzed. Subjective evaluation based on a survey of qualitative perception (Likert) was applied to the participating surgeons. For objective evaluation, the operatory times and postoperative complications were recorded and compared with the results observed with the use of the 2D system (783 patients) in the same period. Results 70.6% agree to have a better image with the 3D technique, 64.7% of surgeons report that the operative time can be reduced, 58.8% consider that it can be reduced the surgical error, 92% and 100% respectively considered that the comfort of the surgeon is better with the use of 3D optics and that this technique is recommended for complex procedures. No substantial differences were found when comparing the results with the use of 3D versus 2D system by the same surgical teams in terms of operative times and postoperative complications. In 3D, postoperative mortality was probably not found due to the lower number of patients in this group. Conclusion 3D laparoscopy has a good evaluation by the surgeons who used it, mainly in image quality, reduction of operative time and comfort of the surgeon compared to conventional 2D laparoscopy. No substantial differences were found when comparing the results with the use of 3D versus 2D system in terms of operative times or postoperative complications.


Subject(s)
Humans , Laparoscopy/methods , Imaging, Three-Dimensional/methods , Chile , Surveys and Questionnaires , Laparoscopy/statistics & numerical data , Imaging, Three-Dimensional/instrumentation , Surgery, Computer-Assisted/methods , Comparative Effectiveness Research , Operative Time
3.
Int. braz. j. urol ; 45(4): 739-746, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019870

ABSTRACT

ABSTRACT This study aimed to share a single institute experience of 4,380 procedures about in-traoperative serious complications of laparoscopic urological surgeries. From January 2005 to December 2013, 4,380 cases of laparoscopic urological surgeries were recruited in our department. The distribution, incidence, and characteristics of intraoperative serious complications were retrospectively sorted out and analyzed. The surgeries were divided into three groups: very difficult (VD), difficult (D), and easy (E). The com¬plication at Satava class II was defined to be serious. One hundred thirty one cases with intraoperative serious complications were found (3.0%). The incidence of these complications was significantly increased along with the difficulty of the surgeries (P<0.05). The highest morbidity of serious complication belonged to total cystectomy with a ratio of about 17% as compared with other surgeries (P<0.05). The types of these complications included small vascular injury demanding blood transfusion (101 cases, 77.1%), large vascular (venous and artery) injury (16 cases), hypercapnia & acidosis (8 cases), and organ injury (6 cases). The cases of conversion to open surgery were 37 (≤1%). There was no significant difference in the rates of conversion to open surgery among the three groups (P>0.05). The overall tendency of the intraoperative serious complications was decreasing with the time from 2005 to 2013. In conclusion, through standardized training including improving the surgical technique, being familiar with the anatomic relationship, and constantly summarizing the experience and lessons, laparoscopic surgery could be safe and effective with not only minimal invasion but also few complications.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Urologic Surgical Procedures/adverse effects , Laparoscopy/adverse effects , Intraoperative Complications/epidemiology , Urologic Surgical Procedures/statistics & numerical data , Time Factors , China/epidemiology , Incidence , Retrospective Studies , Laparoscopy/statistics & numerical data , Conversion to Open Surgery/adverse effects , Conversion to Open Surgery/statistics & numerical data , Length of Stay , Middle Aged
4.
Int. braz. j. urol ; 45(4): 732-738, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019874

ABSTRACT

ABSTRACT Minimally invasive urologic surgery has been developing in Brazil and now is a routine part of care in many regions and patients with different conditions benefit from it. Training in laparoscopic and robotic surgery has evolved and concerns exist both over the quality of surgical training and the practical effect on results of the urological training. This is an unprecedented study which undertook a census to determinate the current state of laparoscopic and robotic urological practice and to know the mains barriers to adequate practice in Brazil. In august 2017, surveys, consisting of an anonymous questionnaire with 15 questions, were sent via internet to the mailing list of the Brazilian Society of Urology (SBU). With these data, activities related to laparoscopy and robotic surgery of our urologists and the mains difficulties and barriers to practice laparoscopy and robotic surgery were evaluated. In our survey, 413 questionnaires were completed. Majority of the responders were currently working in the southeast region of Brazil (52.1%) and 75.5% of the surgeons performed laparoscopic surgery while, only 12.8%, robotic surgery. The lack of experience on the technique and the lack of equipment were the mains barriers and difficulties for not executing laparoscopic and robotic surgeries, respectively. Proper longitudinal training and access to good equipment in minimally invasive surgery are still barriers for urologists in our country.


Subject(s)
Humans , Urologic Surgical Procedures/standards , Practice Patterns, Physicians'/standards , Laparoscopy/standards , Robotic Surgical Procedures/standards , Urologists/standards , Urologic Surgical Procedures/methods , Urologic Surgical Procedures/statistics & numerical data , Urology/standards , Practice Patterns, Physicians'/statistics & numerical data , Brazil , Surveys and Questionnaires , Laparoscopy/methods , Laparoscopy/statistics & numerical data , Robotic Surgical Procedures/methods , Robotic Surgical Procedures/statistics & numerical data , Urologists/statistics & numerical data
5.
An. Facultad Med. (Univ. Repúb. Urug., En línea) ; 6(1): 45-56, jun. 2019. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1088692

ABSTRACT

Introducción: A pesar de que la evidencia actual respalda ampliamente el abordaje laparoscópico para las resecciones de colon y recto en función de su seguridad y resultados oncológicos, el desarrollo y adopción del mismo ha sido lento y aún hoy no es de rutina en la mayoría de los centros. Se presenta la experiencia inicial en la Clínica Quirúrgica 2 del Hospital Maciel. Métodos: Estudio retrospectivo que comprende 41 resecciones laparoscópicas en el período 2016-2018. Resultados: El tiempo operatorio medio fue de 3 h para las colectomías y 4 h para las resecciones de recto. El porcentaje de conversión fue de 10%, la falla de sutura del 12% y la mortalidad a 30 días del 13%. Discusión: El abordaje laparoscópico para la colectomía y resección de recto es seguro y con aceptables resultados oncológicos de acuerdo a nuestros resultados. La curva de aprendizaje se sustenta en el volumen anual de cirugías, la realización de otros procedimientos de laparoscopía avanzada y el entrenamiento en simuladores. Conclusiones: nuestra experiencia muestra resultados inmediatos similares a los reportados en la literatura nacional, aunque el tiempo seguimiento aún es insuficiente para analizar los resultados oncológicos a largo plazo.


Introduction: Although current evidence widely supports the laparoscopic approach for resections of the colon and rectum according to their safety and oncological results, the development and adoption of the same has been slow and even today is not routine in most centers. The initial experience is presented in the Surgical Clinic 2 of the Maciel Hospital. Methods: A retrospective study comprising 41 laparoscopic resections in the period 2016-2018. Results: The mean operative time was 3 hours for colectomies and 4 hours for rectal resections. The conversion rate was 10%, the suture failure was 12% and the 30-day mortality was 13%. Discussion: The laparoscopic approach for colectomy and rectal resection is safe and with acceptable oncological results according to our results. The learning curve is based on the annual volume of surgeries, the performance of other advanced laparoscopy procedures and training in simulators. Conclusions: our experience shows immediate results similar to those reported in the national literature, although the follow-up time is still in sufficient to analyze the long-termoncological results.


Introdução: Embora as evidências atuais apóiem amplamente a abordagem laparoscópica para ressecções do cólon e do reto de acordo com sua segurança e resultados ontológicos, o desenvolvimento e a adoção dos mesmos têm sido lentos e até hoje não é rotineiro na maioria dos casos os centros. A experiência inicial é apresentada na Clínica Cirúrgica 2 do Hospital Maciel. Métodos: Estudo retrospectivo com 41 ressecções laparoscópicas no período 2016-2018. Resultados: O tempo operatório médio foi de 3 horas para colectomias e 4 horas para ressecções retais. A taxa de conversão foi de 10%, a falha na sutura foi de 12% e a mortalidade em 30 dias foi de 13%. Discussão: A abordagem laparoscópica para a colectomia e ressecção retal é segura e com resultados ontológicos aceitáveis de acordo com nossos resultados. A curva de aprendizado é baseada no volume anual de cirurgias, no desempenho de outros procedimentos avançados de laparoscopia e no treinamento em simuladores. Conclusões: nossa experiência mostra resultados imediatos semelhantes aos relatados na literatura nacional, embora o tempo de seguimento ainda seja insuficiente para analisar os resultados ontológicos em longo prazo.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Laparoscopy/adverse effects , Laparoscopy/mortality , Laparoscopy/statistics & numerical data , Colectomy/methods , Proctectomy/methods , Postoperative Period , Surgical Wound Infection , Sutures/adverse effects , Retrospective Studies , Laparoscopy/education , Minimally Invasive Surgical Procedures , Video-Assisted Surgery , Abscess , Intraoperative Period
6.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(2): 161-165, Apr.-June 2019. tab
Article in English | LILACS | ID: biblio-1013280

ABSTRACT

ABSTRACT Objective: To investigate how symptoms vary according to the appendiceal position in pediatric patients and to demonstrate that the laparoscopic approach is safe and effective in any appendiceal location by comparing each location to another. Methods: The medical records of 1,736 children aged 14 or younger who underwent laparoscopic appendectomy over a period of 14 years were analyzed retrospectively. Patients were divided according to the position of the appendiceal tip into four groups: anterior, pelvic, retrocecal and subhepatic. The Kruskal-Wallis and chi-square tests were used with the Bonferroni correction, with a significant p<0.05. Results: The appendiceal location was anterior in 1,366 cases, retrocecal in 248 cases, pelvic in 66 cases and subhepatic in 56 cases. There were no significant differences between the groups in terms of patient age and gender. Abdominal pain was the only symptom with statistically significant differences between the groups. The rate of perforated appendicitis was higher in the subhepatic and pelvic positions. Intraoperative complications and conversions were not statistically significant. Technical difficulties and operative time were higher in subhepatic position. The rate of postoperative complications was similar between the different locations, except for bowel obstruction, which was higher in pelvic appendicitis. Conclusions: The clinical symptoms of appendicitis hardly ever change with the position of the appendix. The laparoscopic approach is safe and effective, regardless the appendiceal location.


RESUMO Objetivo: Investigar como os sintomas variam de acordo com a posição do apêndice em pacientes pediátricos e demonstrar que a laparoscopia é segura e eficaz em qualquer posição do apêndice, comparando-as. Métodos: Os prontuários de 1.736 pacientes pediátricos com idade ≤14 anos submetidos à apendicectomia laparoscópica em um período de 14 anos foram analisados retrospectivamente. Os pacientes foram divididos de acordo com a posição do apêndice: anterior, pélvica, retrocecal e sub-hepático. Os testes de Kruskal-Wallis e do qui-quadrado foram usados com a correção de Bonferroni, sendo significante p<0,05. Resultados: A posição do apêndice era anterior em 1.366 casos, retrocecal em 248 casos, pélvica em 66 casos e sub-hepática em 56 casos. Não houve diferenças significativas entre os grupos quanto às variáveis idade e sexo. A dor abdominal foi a única variável com diferenças estatisticamente significantes entre os grupos. A taxa de apêndice perfurado foi superior nas posições sub-hepática e pélvica. As complicações intraoperatórias e a taxa de conversão não foram estatisticamente significativas. As dificuldades técnicas e o tempo cirúrgico foram superiores em posição sub-hepática. A taxa de complicações pós-operatórias foi semelhante entre as diferentes posições, exceto a obstrução intestinal, que foi superior em posição pélvica. Conclusões: Os sintomas da apendicite dificilmente variam com a posição do apêndice. A laparoscopia é segura e eficaz, independentemente da posição do apêndice.


Subject(s)
Humans , Male , Female , Child , Adolescent , Appendicitis/surgery , Appendix/pathology , Outcome and Process Assessment, Health Care , Appendectomy/adverse effects , Appendectomy/methods , Appendectomy/statistics & numerical data , Appendicitis/diagnosis , Appendicitis/physiopathology , Appendicitis/epidemiology , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Postoperative Complications/epidemiology , Spain/epidemiology , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Laparoscopy/adverse effects , Laparoscopy/methods , Laparoscopy/statistics & numerical data , Operative Time , Intraoperative Complications/epidemiology
7.
Rev. argent. cir ; 110(4): 195-201, dic. 2018. map, tab
Article in Spanish | LILACS | ID: biblio-985189

ABSTRACT

Antecedentes: La cirugía laparoscópica colorrectal continúa en camino de convertirse en el abordaje de elección para el tratamiento de la patología colorrectal benigna y maligna. Sin embargo, su aplicabilidad aún es baja y está mayormente limitada a grandes centros urbanos. Objetivo: analizar la factibilidad de un programa de cirugía laparoscópica colorrectal en un centro de comunidad rural. Como objetivo secundario, comparar los resultados con la cirugía abierta convencional Material y métodos: se analizó una base de datos prospectiva de todos los pacientes operados de forma electiva y consecutiva entre junio de 2012 y diciembre de 2016. Se empleó un criterio de alta estandarizado. Los pacientes fueron divididos en dos grupos según la cirugía fuese laparoscópica (grupo A) o convencional (grupo B). El análisis de variables se realizó con los métodos de Chi cuadrado y T-test según corresponda. Resultados: se realizaron 129 resecciones colorrectales con una proporción de varones del 60% y una mediana de edad de 64 años. El 83% pertenecía a comunidades vecinas. Hubo un 35% de pacientes ASA I, 56% ASA II y 9% ASA III. La distancia promedio del lugar de residencia fue 75 km con una superficie de distribución de 24 000 km2. La mediana de internación fue de 4 días. La aplicabilidad de la laparoscopia fue del 74% con una tasa de conversión del 6%. Ambos grupos fueron similares en términos de sexo, IMC, diagnóstico, ASA, proporción de ASA III-IV, antecedentes clínicos y quirúrgicos, así como también distancia de su lugar de residencia. El grupo A presentó una media de edad menor que el grupo B (61 años vs. 69 años; p < 0,01). No se observaron diferencias en términos de tipo de cirugía y tiempo operatorio. La morbilidad posoperatoria fue 18% y la tasa de readmisión fue del 4%, sin diferencias entre grupos. Conclusiones: la cirugía laparoscópica colorrectal puede ser realizada en un centro rural con bajo índice de readmisión y complicaciones y resultados comparables a los de la cirugía abierta convencional.


Of benign tumors and colorectal cancer. However, its use is low and limited to large urban centers. Objective: The aim of this study was to analyze the feasibility of a laparoscopic colorectal surgery program in a rural community center. The secondary outcome was to compare these results with those of conventional open surgery. Material and methods: We analyzed a prospective data base of all the patients undergoing scheduled and consecutive surgery between June 2012 and December 2016. A standardized discharge criterion was used. The patients were divided into two groups: laparoscopic surgery (group A) and conventional surgery (group B). The variables were analyzed with the chi-square test or Student's t test, as applicable. Results: A total of 129 colorectal resections were performed; median age was 64 years, 60% were men and 83% belonged to neighbor communities. The ASA physical status classification system was grade 1 in 35% of the patients, grade 2 in 56% and grade 3 in 9%. The average distance between patients' place of residence was of 75 km comprising an area of 24,000 km2. Patients were hospitalized for a median of 4 days. The applicability of laparoscopy was 74% with a conversion rate of 6%. There were no significant differences in sex, BMI, diagnosis, ASA grade, proportion of ASA grade 3-4 patients, clinical history, previous surgeries and distance from the place of residency. Compared to group B, patients in group A were younger (61.6 years vs. 69 years; p < 0.01). There were no differences in terms of type of surgery and surgery duration. Postoperative morbidity was 18% and the readmission rate was 4%, with no differences between the groups. Conclusions: Laparoscopic colorectal surgery can be performed in a rural center with low readmission rate and complications; these results are similar to those of conventional open surgery.


Subject(s)
Laparoscopy/methods , Colorectal Surgery/methods , Rural Population , Retrospective Studies , Laparoscopy/statistics & numerical data , Colectomy/methods , Colorectal Surgery/statistics & numerical data
8.
Rev. méd. Urug ; 34(2): 82-88, jun. 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-904998

ABSTRACT

Introducción: el cáncer de cuello uterino es el cuarto más frecuente a nivel mundial en mujeres. En estadios precoces la cirugía es el tratamiento de elección. El tratamiento quirúrgico estándar es la histerectomía radical tipo C1 y linfadenectomía pélvica. La vía de abordaje clásicamente utilizada en Uruguay es la laparotomía. Los resultados oncológicos por las diferentes vías de abordaje se consideran equiparables. Presentamos la primera serie de casos publicada en Uruguay de tratamiento quirúrgico de mínima invasión en cáncer de cuello uterino. Método: estudio descriptivo prospectivo de serie de casos. Se incluyen todas las pacientes operadas por cáncer de cuello uterino invasor como tratamiento primario con vía de abordaje de mínima invasión, desde enero de 2013 hasta diciembre de 2016 en la Clínica Ginecotocológica A del Centro Hospitalario Pereira Rossell. Resultados: se operaron 17 pacientes: 14 histerectomía radical laparoscópica + linfadenectomía pélvica laparoscópica y 3 histerectomía radical vaginal + linfadenectomía pélvica laparoscópica. Edad media: 44 años. Tiempo quirúrgico medio: 261 minutos. Tiempo medio de internación posoperatoria: cinco días. Conversión a laparotomía: dos casos. Se resecaron una media de 14,4 ganglios pélvicos. Ningún caso con márgenes comprometidos. Hubo dos lesiones vesicales. Ningún caso de sangrado severo, transfusión, lesión intestinal, vascular ni ureteral. No hubo ningún caso de infección, dehiscencia, trombosis, reintervención o readmisión. No hubo recurrencias, con media de seguimiento de 29 meses. Conclusiones: la cirugía de mínima invasión es factible para el tratamiento del cáncer de cuello uterino en estadios precoces en nuestro medio, obteniendo un buen resultado anatomopatológico, quirúrgico y oncológico con baja morbilidad.


Introduction: Cervical cancer is the fourth most frequent cancer in women around the world. Surgery is the first choice for treatment in early stages. The standard surgical treatment is Type C1 Radical Hysterectomy and pelvic lymphadenectomy. Laparotomy is the typical surgical approach used in Uruguay. Oncologic results are similar for the different surgical approaches. The study presents the first case series of minimally invasive cervical treatment of cervical cancer published in Uruguay. Method: descriptive, prospective study of a series of cases. All patients operated at the Gynecological Clinic "A", Pereira Rossell Hospital from January 2013 until December 2016 for invasive cervical cancer with minimally invasive approach as the primary treatment were included in the study. Results: 17 patients were operated: 14 Radical Laparoscopic hysterectomy + laparoscopic pelvic lymphadenectomy and 3 radical vaginal hysterectomy + laparoscopic pelvic lymphadenectomy. Average ager: 44 years old. Average surgical time: 261 minutes. Average post-surgery hospital stay: 5 days. 2 cases changed into laparotomy. An average of 14.4 pelvic lymph nodes were resected. In no case were margins compromised. Two bladder lesions, no cases of severe bleeding, transfusion, intestine, vascular or ureteral lesions. No cases of infection, deshicence, thrombosis, reoperation or readmission. NO recurrence, average follow up was 29 months. Conclusions: minimally invasive surgery is a feasible treatment for early stages cervical cancer in our country, obtaining good anatomopathological, surgical and oncological results, morbility being low.


Introdução: O câncer de colo uterino é o quarto tipo de câncer mais frequente entre mulheres em todo o mundo. Em estádios precoces a cirurgia é o tratamento de eleição. O tratamento cirúrgico padrão é a Histerectomia Radical Tipo C1 e a linfadenectomia pélvica. No Uruguai a via de abordagem classicamente utilizada é a laparotomia. Os resultados oncológicos pelas diferentes vias de abordagem são considerados equivalentes. Apresentamos a primeira serie de casos publicados no Uruguai, de tratamento cirúrgico minimamente invasivo no câncer de colo uterino. Métodos: Estudo descritivo prospectivo de serie de casos. Foram incluídas todas as pacientes operadas por câncer de colo uterino invasor como tratamento primário com via de abordagem minimamente invasiva, no período janeiro de 2013 ­ dezembro de 2016 na Clínica Ginecotocológica "A", Hospital Pereira Rossell. Resultados: foram operadas 17 pacientes: 14 Histerectomia Radical Laparoscópica + linfadenectomia pélvica laparoscópica e 3 Histerectomia Radical Vaginal + linfadenectomia pélvica laparoscópica. Idade media: 44 anos. Tempo médio da cirurgia: 261 minutos. Tempo médio de internação pós-operatória: 5 dias. Conversão a laparotomia: 2 casos. Foi ressecada uma média de 14,4 gânglios pélvicos. Nenhum caso apresentou comprometimento das margens. Foram registradas 2 lesões vesicais. Não se observaram casos de sangramento severo, transfusão, lesão intestinal, vascular nem ureteral. Não se registraram casos de infecção, deiscência, tromboses, intervenção ou reinternação. Não foram registradas recorrências, com um seguimento médio de 29 meses. Conclusões: a cirurgia minimamente invasiva é factível para o tratamento do câncer de colo uterino em estádios precoces no nosso meio, mostrando bons resultados anatomopatológicos, cirúrgicos e oncológicos com baixa morbidade.


Subject(s)
Female , Minimally Invasive Surgical Procedures , Uterine Cervical Neoplasms/surgery , Hysterectomy/methods , Laparoscopy/statistics & numerical data
9.
Rev. cuba. cir ; 57(1): 40-48, ene.-mar. 2018. ilus, tab
Article in Spanish | LILACS | ID: biblio-960345

ABSTRACT

Introducción: desde el año 1997 se comenzó a realizar la adrenalectomía laparoscópica en nuestro centro. Objetivo: analizar los resultados de la adrenalectomía laparoscópica desde su implementación en el servicio de cirugía general del Hospital Clínico Quirúrgico Hermanos Ameijeiras. Métodos: Se realizó un estudio descriptivo de los resultados obtenidos en 160 pacientes a los que se les realizó adrenalectomía por vía laparoscópica, en el período comprendido desde noviembre de 1997 hasta septiembre del año 2017 en el servicio de cirugía general del Hospital Clínico Quirúrgico Universitario Hermanos Ameijeiras. Se empleó la técnica laparoscópica con abordaje lateral intraperitoneal en la mayoría de los casos y el abordaje en decúbito supino en 2 casos para la adrenalectomía bilateral. Resultados: se realizaron 162 adrenalectomías laparoscópicas en 160 pacientes, ya que a dos pacientes se les realizó la adrenalectomía bilateral en un tiempo. La edad promedio fue de 44,8 años. La indicación quirúrgica fue el incidentaloma en 68 pacientes (42,5 pr ciento), el síndrome de Cushing en 27 (16,8 por ciento), feocromocitoma en 26 (16,25 por ciento), la Enfermedad de Cushing con fracaso del tratamiento neuroquirúrgico en 12 (7,5 por ciento), mielolipomas en 7 (4,37 por ciento), tumor adrenal en 6 (3,75 por ciento), tumor metastásico en 5 (3,1 por ciento), quistes adrenales en 4 (2,5 por ciento), hiperaldosteronismo primario en 3 (1,87 por ciento), tumor virilizante adrenal en 1 paciente y 1 paciente con un Síndrome de secreción ectópica de ACTH que le provocaba un Síndrome de Cushing complicado. Predominaron las lesiones del lado izquierdo en 86 pacientes, 72 del lado derecho y 2 bilaterales. Fueron convertidos a cirugía convencional 2 pacientes (1,25 por ciento). El tiempo quirúrgico promedio fue de 82 minutos. La estadía posoperatoria promedio fue de 2.5 días. Conclusiones: la adrenalectomía laparoscópica es una técnica reproducible y segura con las ventajas inherentes a la cirugía laparoscópica(AU)


Introduction: As far as 1997, the performing of laparoscopic adrenalectomy started in our center. Objective: To analyze the results of laparoscopic adrenalectomy since its implementation in the general surgery service of Hermanos Ameijeiras Clinical Surgical Hospital. Methods: A descriptive study was carried out with the results obtained from 160 patients who underwent laparoscopic adrenalectomy, in the period from November 1997 to September 2017, in the general surgery service of Hermanos Ameijeiras University Clinical Surgical Hospital. The laparoscopic technique with intraperitoneal lateral approach was used in the majority of cases and the supine approach was used in two cases for bilateral adrenalectomy. Results: 162 laparoscopic adrenalectomies were performed in 160 patients, since two patients underwent bilateral adrenalectomy at one time. The average age was 44.8 years. Surgical indication cases were incidentalomas, in 68 patients (42.5 percent), Cushing's syndrome in 27 (16.8 percent), pheochromocytomas in 26 (16.25 percent), Cushing's disease with neurosurgical treatment failure in 12 (7.5 percent), myelolipomas in 7 (4.37 percent), adrenal tumor in 6 (3.75 percent), metastatic tumor in 5 (3.1 percent), adrenal cysts in 4 (2.5 percent), primary hyperaldosteronism in 3 (1.87 percent), adrenal virilizing tumor in 1 patient, and 1 patient with an ectopic ACTH secretion syndrome that caused a complicated Cushing's syndrome. Lesions on the left side were predominant in 86 patients, 72 on the right side and two bilateral. Two patients (1.25 percent) were converted to conventional surgery. The average surgical time was 82 minutes. The average postoperative stay was 2.5 days. Conclusions: Laparoscopic adrenalectomy is a reproducible and safe technique with the advantages inherent to laparoscopic surgery(AU)


Subject(s)
Humans , Adult , Laparoscopy/statistics & numerical data , Adrenal Medulla/injuries , Adrenalectomy/methods , Epidemiology, Descriptive , Cushing Syndrome/surgery
10.
Pakistan Journal of Medical Sciences. 2017; 33 (4): 788-792
in English | IMEMR | ID: emr-188587

ABSTRACT

Background and Objective: Obstructive ureteral pathologies in adult patients are most commonly due to ureteral strictures and secondary to surgical interventions. In this study, we aimed to compare open and iaparoscopic modified Lich-Gregoir ureteral reimplantation with regards to outcomes in benign ureteral pathologies in adult patients


Methods: Between December 2008 and December 2014, 32 open cases and 29 laparoscopic cases were performed as per the data retrieved from surgical databases. All laparoscopic procedures were performed in Bakirkoy Dr. Sadi Konuk Training and Research Hospital [BEAH] and all open ureteral reimplantation procedures in Kartal Dr Lutfi Kirdar Training and Research Hospital [KEAH] and Okmeydani Training and Research Hospital [OEAH]


Results: The mean operation time was significantly lower in the group of patients operated with open group [142.5 minutes versus 188.9 minutes; P< 0.0001]. The mean duration of follow-up was longer in the laparoscopy group [31 versus 28 months; p< 0.0001]. The mean amount of operation associated blood loss was significantly lower in patients operated laparoscopically [93.7 ml versus 214 ml; P< 0.0001]. The mean VAS score obtained six hours after surgery was 6.6 +/- 0.8 in open group, and 5.8 +/- 0.7 in laparoscopic group [p=0.0004]. The mean VAS scores measured at post-operative day 1 was 4.5 +/- 0.7 in open group and 3.7 +/-0.9 in laparoscopy group. Time required to achieve the pre-operative capability of daily activities was significantly longer in open group [15 +/- 1.4 days vs 11 +/- 1.4 days; p< 0.0001]


Conclusion: Despite open techniques provide shorter operation time and laparoscopic techniques require long learning curve, we think that laparoscopic techniques are superior to open ones since that they provide a better post-operative comfort and are better tolerated in terms of complications


Subject(s)
Humans , Female , Male , Adult , Middle Aged , Replantation/methods , Laparoscopy/statistics & numerical data , Adult , Conversion to Open Surgery , Multicenter Studies as Topic , Operative Time
11.
Clin. biomed. res ; 37(4): 301-307, 2017. ilus, graf, tab
Article in Portuguese | LILACS | ID: biblio-876651

ABSTRACT

Introdução: As operações na glândula adrenal são realizadas para determinados cânceres, todas as massas biologicamente ativas, metástases, massas com mais de 4-5 cm encontradas incidentalmente e hiperplasia adrenal primária. Métodos: Estudo transversal e descritivo. Foram analisados os prontuários dos pacientes submetidos a adrenalectomia videolaparoscópica entre agosto de 1994 e novembro de 2014. Resultados: Foram realizadas 146 adrenalectomias videolaparoscópicas. Em 134 casos, foi realizada com sucesso, mas em 12 casos (8,2%), o procedimento foi convertido. Foram 97 pacientes do sexo feminino e 49 do sexo masculino, com idade variando de 9 a 81 anos (média de 46,7 anos). Foram removidas 56 adrenais direitas, 75 esquerdas e 15 bilaterais. O tamanho médio das adrenais foi de 5,7 cm, variando de 0,9 a 15 cm. A mediana do tempo de internação hospitalar pós-operatória foi de 4,5 dias. A mediana do tempo de cirurgia foi de 144 minutos. Houve complicações em 22,5% dos casos (maiores ­ casos em que houve conversão para cirurgia aberta, necessidade de reinternação hospitalar e óbito­ e menores), sendo 10,9% complicações intraoperatórias e 11,6% pós-operatórias. Apenas sete (4,7%) pacientes foram considerados complicações maiores. Conclusão: A cirurgia realizada em nosso serviço está de acordo com o descrito na literatura, com taxas aceitáveis de complicações, com motivos de conversão compatíveis e com as indicações totalmente aceitáveis e condizentes. A adrenalectomia videolaparoscópica é a cirurgia de escolha para patologias cirúrgicas da glândula adrenal, exceto em casos de carcinoma adrenal localmente invasivo com comprometimento de outras estruturas (AU)


Introduction: Adrenal gland surgery is performed for some types of cancer, all biologically active masses, metastases, masses larger than 4-5 cm found incidentally, and primary adrenal hyperplasia. Methods: A cross-sectional, descriptive study. Medical records of patients who underwent laparoscopic adrenalectomy from August 1994 to November 2014 were analyzed. Results: A total of 146 laparoscopic adrenalectomies were performed. In 134 cases, laparoscopic adrenalectomy was successfully performed, but in 12 cases (8.2%), the procedure was converted. There were 97 female patients and 49 male patients. Fifty-six right adrenal glands and 75 left adrenal glands were removed, and 15 patients had both of them removed. The average size of adrenal glands was 5.7 cm, ranging from 0.9 to 1.5 cm. The median length of postoperative hospital stay was 4.5 days, ranging from 1 to 55 days. The median surgery time was 144 minutes. There were 22.5% of complications (major ones ­ cases that required conversion to open surgery, hospital readmission, and death ­ and minor ones), of which 10.9% were intraoperative and 11.6% were postoperative. Only seven (4.7%) patients were classified as having major complications. Conclusion: The surgery performed in our department is consistent with the literature, showing acceptable rates of complications, compatible reasons for conversion, and completely acceptable and consistent indications. Laparoscopic adrenalectomy is the surgery of choice for diseases of the adrenal gland, except for locally invasive adrenal carcinoma compromising other structures (AU)


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Adrenal Gland Diseases/surgery , Adrenalectomy/statistics & numerical data , Laparoscopy/statistics & numerical data , Adrenal Gland Diseases/epidemiology , Adrenalectomy/adverse effects , Adrenalectomy/methods , Brazil/epidemiology , Cross-Sectional Studies , Laparoscopy/adverse effects , Retrospective Studies , Video-Assisted Surgery
12.
Rev. cuba. endocrinol ; 27(2): 0-0, mayo.-ago. 2016. ilus
Article in Spanish | LILACS | ID: lil-780733

ABSTRACT

Los paragangliomas son tumores neuroendocrinos que surgen de los paraganglios autonómicos extraadrenales, los cuales son pequeños órganos formados por células derivadas de la cresta neural embrionaria con capacidad de secretar catecolaminas. Los paragangliomas están estrechamente relacionados con los feocromocitomas porque son indistinguibles a nivel celular, y a menudo comparten las mismas manifestaciones clínicas, como hipertensión, cefalea episódica, sudoración y taquicardia. El diagnóstico de estos tumores es importante por su riesgo de malignización, por las implicaciones de otras neoplasias asociadas, y para la posibilidad de realizar estudios genéticos para detección de otros casos dentro de una misma familia. El objetivo de este artículo es desarrollar un resumen sobre la epidemiología, manifestaciones clínicas, pruebas diagnósticas y tratamiento de estos tumores. Se presenta el caso de un joven de raza negra diagnosticado de un paraganglioma(AU)


Paragangliomas are neuroendocrine tumors emerging from the extra-adrenal autonomic paraganglia, which are small organs formed by embryonic neural crest-derived cells with catecholamine-secreting capacity. Paragangliomas are closely linked to pheochromocytomas because they cannot be differentiated at cell level and often share the same clinical manifestations such as hypertension, episodic headache, sweating and tachycardia. The diagnosis of these tumors is important because of risk of becoming malignant, the implications of other related neoplasias and the possibility of making genetic studies to detect other cases in the same family. The objective of this article was to make an abstract about epidemiology, clinical manifestations, diagnostic tests and treatment of these tumors. This is the case of a young Black female who was diagnosed with paraganglioma(AU)


Subject(s)
Humans , Male , Adult , Biopsy/adverse effects , Laparoscopy/statistics & numerical data , Neuroendocrine Tumors/surgery , Paraganglioma/diagnostic imaging , Pheochromocytoma/diagnosis
13.
Int. braz. j. urol ; 42(3): 438-448, tab, graf
Article in English | LILACS | ID: lil-785715

ABSTRACT

ABSTRACT Introduction There is a lack of studies in our national scenario regarding the results obtained by laparoscopic radical prostatectomy technique (LRP). Except for a few series, there are no consistent data on oncological, functional, and perioperative results on LRP held in Brazil. As for the LRP technique performed by extraperitoneal access (ELRP), when performed by a single surgeon, the results are even scarcer. Objective To analyze the early perioperative and oncologic results obtained with the ELRP, throughout the technical evolution of a single surgeon. Patients and methods A non-randomized retrospective study was held in a Brazilian hospital of reference. In the 5-year period, 115 patients underwent the ELRP procedure. Patients were divided into two groups, the first 57 cases (Group 1) and the following 58 cases, (Group 2). A comparative analysis between the groups of efficacy results and ELRP safety was carried out. Results The average age of patients was 62.8 year-old and the PSA of 6.9ng/dl. The total surgery time was 135.8 minutes on average, and the urethral-bladder anastomosis was 21.9 min (23.3 min versus 20.7 min). The positive surgical margins (PSM) rate was 17.1%, showing no difference between groups (16.4% versus 17.9%; p=0.835). There was statistical difference between the groups in relation to the anastomosis time, estimated blood loss and the withdrawal time of the urinary catheter. Conclusion The ELRP technique proved to be a safe and effective procedure in the treatment of prostate cancer, with low morbidity.


Subject(s)
Humans , Male , Aged , Prostatectomy/methods , Laparoscopy/methods , Learning Curve , Postoperative Complications , Postoperative Period , Prostatectomy/education , Prostatectomy/statistics & numerical data , Prostatic Neoplasms/surgery , Prostatic Neoplasms/pathology , Time Factors , Brazil , Anastomosis, Surgical , Retrospective Studies , Treatment Outcome , Laparoscopy/education , Laparoscopy/statistics & numerical data , Perioperative Period , Neoplasm Grading , Operative Time , Middle Aged
14.
Reprod. clim ; 31(3): 159-162, 2016. tab
Article in Portuguese | LILACS | ID: biblio-882213

ABSTRACT

Objetivo: Analisar o papel da laparoscopia na investigação da infertilidade nos últimos cinco anos na Universidade Estadual de Campinas. Métodos: Estudo retrospectivo descritivo com todas as videolaparoscopias para o diagnóstico da infertilidade feitas de 2008 a 2012 na Universidade Estadual de Campinas. Foram analisados 353 prontuários de mulheres com infertilidade submetidas à laparoscopia diagnóstica. Foram avaliadas as características clínicas dessas mulheres e os achados intraoperatórios. Foi feita uma análise univariada de frequência, médias e desvio padrão para cada uma das variáveis e para avaliar as associações entre as variáveis foi usado o teste de Kruskal-Wallis. Resultados: A média de idade das mulheres com infertilidade foi de 32 ± 4,4 anos. A laparoscopia encontrou 52,98% de alterac¸ões tubárias, 17,84% de endometriose e 11,33% de aderências. Quase 18% dos exames não apresentaram qualquer tipo de alteração. A histerossalpingografia apresentou sensibilidade de 84,61% e especificidade de 32,58% em relação à laparoscopia. As mulheres com infertilidade apresentaram maior risco de ter alterações tubárias. Conclusão: As alterações tubárias são ainda a principal causa de infertilidade. A laparoscopia se mostra como uma técnica melhor do que a histerossalpingografia para detecção de alterações tubárias, além de permitir detectar alterações em outros órgãos que possam causar infertilidade.(AU)


Objective: To evaluate the role of laparoscopy in the investigation of infertility at the University of Campinas in the last five years. Methods: Retrospective descriptive study with all diagnostic laparoscopy in the last five years made in endoscopic gynecology clinic of the tertiary hospital. 353 medical records of women with infertility undergoing diagnostic laparoscopy between the years 2008 to 2012 were analyzed the clinical characteristics of these women and the indications of laparoscopy and intraoperative findings were evaluated. Descriptive analysis (frequency, mean and standard deviation) was performed for categorical variables. To evaluate the association between the variables, we used the Kruskal Wallis test. Results: The women were on average 32 ± 4.4 years. Laparoscopy found 52.98% of tubal alterations, 17.84% of endometriosis and 11.33% of adhesions. Almost 18% of tests did not show any change. The hysterosalpingography had a sensitivity of 84.61% and specificity of 32.58% compared to laparoscopy. Infertile women have a higher risk for tubal changes. Conclusion: Tubal alterations are still the leading cause of infertility. Laparoscopy appears as a better technique hysterosalpingography for detecting tubal alterations, in addition to be able to detect changes in other organs that can cause infertility.(AU)


Subject(s)
Humans , Female , Adult , Fallopian Tubes/abnormalities , Infertility, Female/diagnosis , Laparoscopy/methods , Laparoscopy/statistics & numerical data , Tissue Adhesions
15.
Rev. cuba. cir ; 54(4): 0-0, oct.-dic. 2015. graf, tab
Article in Spanish | LILACS | ID: lil-769391

ABSTRACT

Introducción: la falta de uniformidad en las competencias de cirugía mínimamente invasiva motivó la utilización de la evaluación diagnóstica para determinar los conocimientos previos que poseen los educandos de posgrado sobre este tema.Objetivo: constatar la validez y fiabilidad de los resultados que se obtuvieron con la prueba diagnóstica del entrenamiento "Intensivo en procedimientos laparoscópicos básicos". Métodos: se exploraron los niveles cognoscitivos de las dimensiones: sutura laparoscópica, disección del Triangulo de Calot en la colecistectomía laparoscópica, tratamiento de la litiasis coledociana y Apendicectomía Laparoscópica. Se aplicó un test de Verdadero o Falso a especialistas en Cirugía General, Pediátrica y Coloproctología. Se utilizó la consulta a expertos como fuente de evidencia de validez de contenido de la prueba y la fórmula de Kuder-Richardson 20 para determinar su coeficiente de fiabilidad. Resultados: se consideró apropiada la validez en la definición precisa del universo de contenido que se deseaba medir. El 75 por ciento de los ítems no se diseñaron apropiadamente por lo que no se acreditó la validez en el grado de suficiencia del ámbito que se deseaba evaluar. Conclusiones: no se constató la validez y fiabilidad de los resultados que se obtuvieron con la prueba diagnóstica del entrenamiento "Intensivo en procedimientos laparoscópicos básicos". Se perfeccionó el instrumento de evaluación diagnóstica de dicho entrenamiento a partir del análisis de la validez y fiabilidad de los resultados obtenidos(AU)


Introduction: the lack of uniformity in basic skills of laparoscopic surgery led to the use of diagnostic assessment to determine prior knowledge level by graduate students. Objective: to prove the validity and reliability of the results obtained with the diagnostic test for students of "Basic laparoscopic procedures intensive training". Methods: there were explored the following cognitive dimensions: Laparoscopic suturing, dissection of Calot triangle in laparoscopic cholecystectomy, Treatment of cholelithiasis and Laparoscopic appendectomy. A True or False Test was applied to specialists in General Surgery, Pediatric and Coloproctology. Consulting experts was considered as a source of evidence for content validity of the test and the Kuder-Richardson formula 20 was used to determine the reliability coefficient. Results: it was considered appropriated the validity in the definition of content, which was intended to measure. 75 percent of items were not appropriated designed, that's why validity in sufficiency's grade was not accredited. Conclusions: the diagnosed test for "Basic laparoscopic procedures intensive training" was improved like consequence of validity and fidelity's analysis from the obtained results(AU)


Subject(s)
Humans , Diagnostic Test Approval , Laparoscopy/statistics & numerical data , Minimally Invasive Surgical Procedures , Clinical Competence
16.
Rev. cuba. cir ; 54(3): 0-0, jul.-set. 2015. tab
Article in Spanish | LILACS | ID: lil-765752

ABSTRACT

Introducción: la histerectomía es una de las intervenciones quirúrgicas que con más frecuencia se realizan en el mundo. Constituye, después de la cesárea, el segundo procedimiento quirúrgico que más se realiza en mujeres en edad reproductiva y la tercera operación intrabdominal más frecuente junto a la apendicectomía y la colecistectomía. Objetivo: describir las indicaciones y los resultados de 1 599 histerectomías laparoscópicas en el Centro Nacional de Cirugía de Mínimo Acceso desde enero de 1994 hasta octubre de 2014. Métodos: se realizó un estudio observacional descriptivo y retrospectivo, de todas las pacientes (n= 1 599) con enfermedades ginecológicas, benignas y malignas que fueron operadas mediante histerectomía laparoscopica, en el período comprendido desde enero de 1994 hasta octubre de 2014, en el servicio de Cirugía General del Centro Nacional de Cirugía de Mínimo Acceso de La Habana, Cuba. Resultados: la media de edad fue de 47 años y el fibroma uterino fue la indicación quirúrgica más frecuente. Las medias de tiempo quirúrgico y pérdidas sanguíneas fueron 100 minutos y 114 mililitros, respectivamente. La media del peso del útero fue de 269 g (60 g-1 100 g). La morbilidad fue de 5,8 por ciento; requirieron conversión a laparotomía 13 pacientes (0,8 por ciento). Conclusiones: la histerectomía laparoscópica es una técnica factible y segura que también puede realizarse en otros servicios de cirugía de mínimo acceso del país(AU)


Introduction: hysterectomy is one of the most common surgical procedures worldwide. After the cesarean section, it is the second most performed surgery in women at reproductive age and the third most frequent intra-abdominal operation together with appendicectomy and cholecystectomy. Objective: to describe the indications and the results of 1 559 laparoscopic hysterectomies performed at the National Center of Minimal Access Surgery from January 1994 to October 2014. Methods: a retrospective, descriptive and observational study conducted in all the patients (n=1 559) with benign and malignant gynecological diseases, who were operated on through the laparoscopic hysterectomy technique in the period of January 1994 through October 2014 at the general surgery service of the National Center of Minimal Access Surgery located in Havana, Cuba. Results: mean age was 47 years and uterine fibroma was the main surgical indication. Surgical time and blood loss means were 100 minutes and 114 milliliters, respectively. Uterus weight mean was 269 g (60 g-1100 g). Morbidity reached 5,8 percent; thirteen patients required conversion to laparotomy (0,8 percent). Conclusions: laparoscopic hysterectomy is a safe feasible procedure that can also be performed in other minimally invasive surgery services of the country(AU)


Subject(s)
Humans , Female , Hysterectomy/methods , Laparoscopy/statistics & numerical data , Minimally Invasive Surgical Procedures/methods , Epidemiology, Descriptive , Observational Study , Retrospective Studies
17.
Int. braz. j. urol ; 41(4): 635-641, July-Aug. 2015. tab, graf
Article in English | LILACS | ID: lil-763068

ABSTRACT

ABSTRACTObjectives:To evaluate the differences of peri-operatory and oncological outcomes between Laparoscopic Radical Cystectomy and Open Radical Cystectomy in our center.Materials and Methods:Overall, 50 patients were included in this non randomized match-pair analysis: 25 patients who had undergone Laparoscopic Radical Cystectomy for invasive bladder cancer (Group-1) and 25 patients with similar characteristics who had undergone Open Radical Cystectomy (Group-2). The patients were operated from January 2005 to December 2012 in a single Institution.Results:Mean operative time for groups 1 and 2 were 350 and 280 minutes (p=0.03) respectively. Mean blood loss was 330 mL for group 1 and 580 mL for group 2 (p=0.04). Intraoperative transfusion rate was 0% and 36% for groups 1 and 2 respectively (p=0.005). Perioperative complication rate was similar between groups. Mean time to oral intake was 2 days for group 1 and 3 days for group 2 (p=0.08). Median hospital stay was 7 days for group 1 and 13 for group 2 (p=0.04). There were no differences in positive surgical margins and overall survival, between groups.Conclusions:In a reference center with pelvic laparoscopic expertise, Laparoscopic Radical Cystectomy may be considered a safe procedure with similar complication rate of Open Radical Cystectomy. Laparoscopic Radical Cystectomy is more time consuming, with reduced bleeding and transfusion rate. Hospital stay seems to be shorter. Oncologically no difference was observed in our mid-term follow-up.


Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cystectomy/methods , Laparoscopy , Urinary Bladder Neoplasms/surgery , Blood Loss, Surgical/statistics & numerical data , Blood Transfusion/statistics & numerical data , Brazil/epidemiology , Cystectomy/economics , Follow-Up Studies , Latin America , Lymph Node Excision , Laparoscopy/adverse effects , Laparoscopy/economics , Laparoscopy/statistics & numerical data , Length of Stay/statistics & numerical data , Matched-Pair Analysis , Neoplasm Invasiveness , Operative Time , Perioperative Period/methods , Urinary Bladder Neoplasms/pathology
18.
Rev. méd. Chile ; 143(3): 281-288, mar. 2015. graf, tab
Article in Spanish | LILACS | ID: lil-745624

ABSTRACT

Background: The laparoscopic approach for the treatment of gastric tumors has many advantages. Aim: To evaluate the results of a laparoscopic gastrectomy program developed in a public hospital. Patients and Methods: Retrospective review of epidemiological, perioperative and follow-up data of patients who were treated with a laparoscopic gastrectomy due to gastric tumors between 2006 and 2013. A totally laparoscopic technique was used for all cases. Complications were evaluated according to the Clavien-Dindo classification. Results: Fifty one patients, aged 65 (36-85) years, underwent a laparoscopic gastrectomy. In 22 patients a total gastrectomy was performed. Conversion rate to open surgery was 8%. Operative time was 330 (90-500) min and bleeding was 200 (20-500) ml. Median hospital stay was 7 (3-37) days. Postoperative morbidity was present in 17 (33%) patients, 3 (6%) patients had complications grade 3 or higher and one patient died (1.9%). Tumor pathology was adenocarcinoma in 39 patients. A complete resection was achieved in 97%. Twenty nine patients (74%) with gastric adenocarcinoma had early gastric cancer and 84% of patients were in stage one. Median lymph node count was 24. Median follow-up was 26 (1-91) months. There was no cancer related mortality among patients subjected to a curative resection. Overall survival for patients with adenocarcinoma was 92% at 3 years. Conclusions: This study supports the feasibility and safety of a laparoscopic gastrectomy program in a public hospital; with low morbidity, adequate lymph node dissection and long-term survival. This approach must be considered an option for selected patients with gastric cancer.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Adenocarcinoma/surgery , Gastric Outlet Obstruction , Gastrectomy/methods , Laparoscopy/methods , Postoperative Complications , Stomach Neoplasms/surgery , Anastomotic Leak , Adenocarcinoma/mortality , Chile , Conversion to Open Surgery/statistics & numerical data , Follow-Up Studies , Gastrectomy/statistics & numerical data , Hospitals, Public , Length of Stay , Laparoscopy/statistics & numerical data , Operative Time , Perioperative Period , Reoperation , Retrospective Studies , Survival Rate , Stomach Neoplasms/mortality , Treatment Outcome
19.
Arq. bras. med. vet. zootec ; 67(1): 55-61, 2/2015. tab, fig
Article in English | LILACS | ID: lil-741112

ABSTRACT

In the current experimental study, two different instruments were compared for prophylactic hemostasis during a 3-port technique of laparoscopic ovariohysterectomy (OVH) in bitches. Moreover, the need for port enlargement for specimen retrieval using 5mm or 10mm trocartes, technical difficulties and complications were assessed. Ultrasonic energy and a vascular sealing system were tested. Duration of surgery, patient weight and diameter of the uterine arteries and veins were compared among the groups. Fifteen dogs randomly divided into three groups (GI, GII, GIII) were submitted to ovariohysterectomy with hemostasis from the use of ultrasonic scalpel or vascular sealing equipment. In GI and GII the LigaSure(tm) impedance-controlled bipolar vessel-sealing device was used, differing in the size of trocartes used between groups, and in GIII Autosonix(tm) was used. Patients' weight, duration of surgery, technical difficulties and complications were compared among the groups. Statistical analysis showed no difference between the data analyzed among the groups. In conclusion, both methods of hemostasis were effective for 3-port total laparoscopic ovariohysterectomy in bitches. However, 5mm trocartes were not adequate for retrieval of the uterus and ovaries without need for enlargement of the port incision.


No presente experimento, foram comparados dois diferentes equipamentos, um com emprego de energia ultrassônica, e outro utilizando sistema de selamento vascular, como única forma de hemostasia em ovário-histerectomias laparoscópicas com três portais em cadelas. Ademais, a necessidade de ampliação da incisão do portal de 5mm ou de 10mm para a remoção dos espécimes ressecados, dificuldades técnicas e complicações foram avaliadas. Quinze cadelas aleatoriamente distribuídas em três grupos (GI, GII, GIII) foram submetidas à ovário-histerectomia com hemostasia a partir da utilização de bisturi ultrassônico ou equipamento de selamento vascular. Nos GI e GII foi utilizado um sistema de selamento vascular eletrotérmico bipolar (LigaSure(r)), diferindo-se no tamanho dos portais utilizados; em GIII foi utilizado bisturi ultrassônico (Autosonix(r)). A análise estatística não demonstrou diferença significativa entre os dados analisados nos três grupos. Conclui-se que ambos os métodos de hemostasia utilizados mostraram-se adequados e viabilizaram a realização de ovário-histerectomia laparoscópica em cadelas. Todavia, o trocarte de 5mm não foi adequado para remoção do útero e ovários sem necessidade de ampliação da incisão de acesso.


Subject(s)
Animals , Female , Dogs , Ovariectomy/veterinary , Laparoscopy/statistics & numerical data , Laparoscopy/veterinary , Hysterectomy
20.
Article in English | WPRIM | ID: wpr-66171

ABSTRACT

The aim of this study was to investigate a single-institution experience with radical perineal prostatectomy (RPP), radical retropubic prostatectomy (RRP) and minimally invasive radical prostatectomy (MIRP) with respect to onco-surgical outcomes in patients with intermediate-risk (IR; PSA 10-20 ng/mL, biopsy Gleason score bGS 7 or cT2b-2c) and high-risk (HR; PSA >20 ng/mL, bGS > or =8, or > or =cT3) prostate cancer (PCa). We retrospectively reviewed data from 2,581 men who underwent radical prostatectomy for IR and HR PCa (RPP, n = 689; RRP, n = 402; MIRP, n = 1,490 [laparoscopic, n = 206; robot-assisted laparoscopic, n = 1,284]). The proportion of HR PCa was 40.3%, 46.8%, and 49.5% in RPP, RRP, and MIRP (P < 0.001), respectively. The positive surgical margin rate was 23.8%, 26.1%, and 18.7% (P = 0.002) overall, 17.5%, 17.8%, and 8.8% (P < 0.001) for pT2 disease and 41.9%, 44.4%, and 40.0% (P = 0.55) for pT3 disease in men undergoing RPP, RRP, and MIRP, respectively. Biochemical recurrence-free survival rates among RPP, RRP, and MIRP were 73.0%, 70.1%, and 76.8%, respectively, at 5 yr (RPP vs. RPP, P = 0.02; RPP vs. MIRP, P = 0.23). Furthermore, comparable 5-yr metastases-free survival rates were demonstrated for specific surgical approaches (RPP vs. RPP, P = 0.26; RPP vs. MIRP, P = 0.06). RPP achieved acceptable oncological control for IR and HR PCa.


Subject(s)
Adult , Aged , Aged, 80 and over , Disease-Free Survival , Humans , Laparoscopy/statistics & numerical data , Male , Middle Aged , Minimally Invasive Surgical Procedures/statistics & numerical data , Perineum/surgery , Prevalence , Prostatectomy/statistics & numerical data , Prostatic Neoplasms/diagnosis , Republic of Korea/epidemiology , Retrospective Studies , Risk Factors , Treatment Outcome
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