ABSTRACT
Purpose: To evaluate the effects on peripheral neural regeneration of the end-to-side embracing repair technique compared to the autograft repair technique in Wistar rats. Methods: Fifteen male Wistar rats were divided into three groups with five animals each: denervated group (GD), autograft group (GA), and embracing group (EG). For the evaluation, the grasping test, electroneuromyography (ENMG), and muscle weight assessment were used. Results: Muscle weight assessment and ENMG did not show significant neural regeneration at the end of 12 weeks in the DG and GE groups, but only in GA. The grasping test showed an increase in strength between the surgery and the fourth week in all groups, and only the GA maintained this trend until the 12th week. Conclusions: The present study indicates that the neural regeneration observed in the end-to-side embracing neurorrhaphy technique, in the repair of segmental neural loss, is inferior to autograft repair in Wistar rats.
Subject(s)
Animals , Rats , Transplantation, Autologous , Rats, Wistar , Median Nerve , Microsurgery , Nerve RegenerationABSTRACT
Purpose: To develop a new 4/6 infarct nephrectomy (INx) model rat mimicking moderate chronic kidney disease (CKD) and to evaluate its application. Methods: We modified the conventional 5/6 INx rat model to create the 4/6 INx model by ligating the renal artery branch to induce infarction of one-third of the left kidney after right kidney removal and compared biochemically and histologically both models. To demonstrate the application of the 4/6 INx model, the effects of a supplementary compound containing calcium carbonate, chitosan, palm shell activated charcoal etc., that is effective for both CKD and its complications, were compared between both models. Results: Impairment of renal function in the 4/6 INx group was significantly more moderate than in the 5/6 INx group (P < 0.05). The 4/6 INx group showed less histological damage in kidney than in the 5/6 INx group. The supplementary compound did not improve CKD in the 5/6 INx group, but ameliorated elevation of blood urea nitrogen in the 4/6 INx group. Conclusions: We developed the 4/6 INx model, which is more moderate than the conventional 5/6 INx model. This model could potentially demonstrate the effectiveness of drugs and supplements intended to prevent CKD and its progression.
Subject(s)
Animals , Rats , Renal Insufficiency, Chronic , Animals, Laboratory , Microsurgery , NephrectomyABSTRACT
Purpose: To evaluate the use of the latest generation smartphone camera in performing arterial microanastomosis in rats. Methods: Ten Wistar rats were divided into 2 groups and underwent anastomosis of the right carotid artery with the aid of magnification from a microscope (group M) and a smartphone camera (group S), to compare patency in 72 hours, as well as to measure the weight of the animals, diameter of the carotid arteries and anastomosis time. Results: There was no statistical difference between the weight of the animals or the diameter of the carotid arteries. There was a statistical difference for the time spent on anastomoses, which was greater in group S, with higher rates of thrombosis (p < 0.05). Conclusions: Although our patency and anastomosis time results were statistically lower in the smartphone group, there was success in some cases. As the segment continues to progress, it is likely that the results will improve in line with the evolution of camera technology.
Subject(s)
Animals , Rats , Anastomosis, Surgical , Smartphone , Animals, Laboratory , MicrosurgeryABSTRACT
Introduction: Even with the advent of microsurgical techniques, the pedicled pectoralis major myocutaneous flap (MMF) still has considerable importance in head and neck reconstructions. However, its utilization is quite challenging especially in women. Case report:Female patient, 38 years-old sought medical attention due to a left cervical mass of progressive growth. After investigation with nuclear magnetic resonance imaging, radical cervical emptying was indicated, requiring immediate reconstruction with MMF. Subsequently, the patient returned complaining of asymmetry on the breasts and the volume of the cervical flap and a new surgical approach was performed by the plastic surgery team, where the left breast was reconstructed with a transverse rectus abdominis myocutaneous (TRAM) flap, and the MMF was thinned. Conclusion: The MMF should be used sparingly in women since resulting dysmorphisms often require surgical re-administration for reconstruction. Therefore, it is preferable to use free flaps as a first option.
Introdução: Mesmo com o advento das técnicas microcirúrgicas, o retalho miocutâneo de peitoral maior (RMPM) ainda tem considerável importância nas reconstruções de cabeça e pescoço. No entanto, existem vários desafios ao empregá-lo, especialmente em mulheres. Relato do caso: Paciente, sexo feminino, 38 anos, procurou atendimento médico por causa de uma massa cervical esquerda de crescimento progressivo. Após investigação com ressonância nuclear magnética, foi indicado esvaziamento cervical radical, sendo necessária a reconstrução imediata com RMPM. Posteriormente, a paciente retornou com queixa de assimetria entre as mamas e do volume do retalho cervical. Assim, foi realizada nova abordagem cirúrgica pela equipe de cirurgia plástica, na qual a mama esquerda foi reconstruída com retalho miocutâneo de reto abdominal (TRAM) e o RMPM teve o seu volume reduzido. Conclusão: O RMPM deve ser usado com moderação em mulheres, pois os dismorfismos causados muitas vezes requerem correção cirúrgica. Dessa forma, é preferível utilizar retalhos microcirúrgicos como primeira opção.
Introducción: Incluso con el advenimiento de las técnicas microquirúrgicas, el colgajo miocutáneo de pectoral mayor (CMPM) todavía tiene una importancia considerable en las reconstrucciones de cabeza y cuello. Sin embargo, existen varios desafíos a la hora de emplearlo, especialmente en mujeres. Informe del caso: Paciente femenina, 38 años, consultó por presentar masa cervical izquierda de crecimiento progresivo. Tras investigación con resonancia magnética nuclear se indicó disección radical de cuello, requiriendo reconstrucción inmediata con CMPM. Posteriormente, la paciente regresó quejándose de asimetría entre las mamas y el volumen del colgajo cervical. Por lo anterior, se realizó un nuevo abordaje quirúrgico por parte del equipo de cirugía plástica, en el cual se reconstruyó la mama izquierda con un colgajo miocutáneo de recto abdominal (TRAM) y se redujo el volumen del CMPM. Conclusión: El CMPM debe usarse con moderación en mujeres, ya que los dismorfismos causados a menudo requieren corrección quirúrgica. Por tanto, es preferible utilizar colgajos microquirúrgicos como primera opción.
Subject(s)
Humans , Female , Myocutaneous Flap/surgery , Head and Neck Neoplasms/surgery , Microsurgery/methodsABSTRACT
Introducción: La cirugía del seno cavernoso se consideró durante mucho tiempo inviable (no accesible para el hombre) (5,31) debido al riesgo de sangrado o lesión de estructuras neurovasculares críticas, como la ACI, el nervio oculomotor, troclear y abducens (5.31). Desde entonces, numerosos estudios han contribuido a comprender la anatomía microquirúrgica del seno cavernoso. En 1965, Parkinson (25) realizó el primer abordaje del seno cavernoso para el tratamiento de la fístula carótida-cavernosa. Fue el comienzo de la era moderna en la cirugía del seno cavernoso y abrió la puerta a muchas publicaciones que detallan los abordajes quirúrgicos de diversas lesiones dentro y alrededor del seno cavernoso. Junto al desarrollo y la mejora de la neuroimagen y la anatomía microquirúrgica, permitieron acceder con éxito al seno cavernoso. Nuestro objetivo es presentar una revisión narrativa de vanguardia de la anatomía microquirúrgica del seno cavernoso y el manejo interdisciplinario. Para lograr este propósito, se realizó la disección cadavérica de 2 cabezas (cuatro senos cavernosos) reflejada en 2 casos quirúrgicos, además de una revisión bibliográfica exhaustiva que orienta el manejo multimodal de los tumores que se encuentran dentro o alrededor del seno cavernoso. Objetivo: Describir la anatomía quirúrgica del seno cavernoso a través de disecciones cadavéricas y su aplicación microquirúrgica. Materiales y métodos: Se estudiaron 4 senos cavernosos cadavéricos humanos fijados en formol. Las arterias y venas fueron inyectadas con silicona coloreada, las imágenes fueron tomadas con una cámara DSLR Nikon 3400 profesional de 24,2 megapíxeles. Resultados: El seno cavernoso es un compartimento dural que contiene estructuras neurovasculares críticas, cuya disección debe ser realizada de forma cuidadosa y prolija por el inminente riesgo de lesión de las mismas. Es así que lesiones confinadas por ejemplo a la pared lateral (caso clínico 2) tienen mayor probabilidad de remoción total, por lo tanto mejor pronóstico, no así las lesiones que invaden el seno cavernoso (caso clínico 1) donde la probabilidad de remoción total disminuye y el riesgo de lesión neurovascular aumenta. Conclusiones: El conocimiento preciso de la anatomía microquirúrgica del seno cavernoso y el manejo multimodal son cruciales en el manejo y pronóstico del paciente(AU)
Background: Cavernous sinus surgery was long considered unfeasible (not accessible to humans) (5.31) due to the risk of bleeding or injury to critical neurovascular structures, such as the ICA, oculomotor, trochlear and abducens nerves (5.31). Since then, numerous studies have contributed to understanding the microsurgical anatomy of the cavernous sinus. In 1965, Parkinson (25) performed the first approach to the cavernous sinus for the treatment of carotid-cavernous fistula. This was the beginning of the modern era in cavernous sinus surgery and opens the door to many publications detailing surgical approaches to various injuries in and around the cavernous sinus. Together with the development and improvement of neuroimaging and microsurgical anatomy, they allowed successful access to the cavernous sinus. Our goal is to present a state-of-the-art narrative review of cavernous sinus microsurgical anatomy and interdisciplinary management. To achieve this purpose, cadaveric dissection of 2 heads (four cavernous sinuses) was performed, reflected in 2 surgical cases, in addition to an exhaustive literature review that guides the multimodal management of tumors found within or around the cavernous sinus. Objective: The aim of this study is to describe the surgical anatomy of the cavernous sinus through cadaveric dissections and its microsurgical application. Methods: 4 human cadaveric cavernous sinuses fixed in formalin were studied, the arteries and veins were injected with colored silicone, the images were taken with a 24.2-megapixel Nikon 3400 professional DSLR camera. Results: The cavernous sinus is a dural compartment that contains critical neurovascular structures, whose dissection must be performed carefully and neatly due to the imminent risk of injury to them, so lesions confined, for example, to the lateral wall (clinical case 2 ) have a higher probability of total removal and therefore a better prognosis, but not lesions that invade the cavernous sinus (clinical case 1) itself, where the probability of total removal decreases and the risk of neurovascular injury increases. Conclusions: Precise knowledge of the microsurgical anatomy of the cavernous sinus and multimodal management are crucial in the management and prognosis of the patient
Subject(s)
Cavernous Sinus , Arteries , Veins , Skull Base , Anatomy , MicrosurgeryABSTRACT
Introducción : Los aneurismas intracraneales representan el 85% de casos de hemorragias subaracnoideas, dentro de las cuales las no traumáticas tienen una alta tasa de mortalidad (40-60%). En el manejo endovascular y microquirúrgico de esta enfermedad, el debate ha sido siempre intenso respecto a si el tratamiento temprano produce un beneficioso resultado funcional y reduce la morbi-mortalidad del paciente. Caso Clínico : Paciente mujer de 54 años, admitida con cefalea súbita y cuadro neurológico que cursó con rápido deterioro. La tomografía mostró hemorragia subaracnoidea por ruptura aneurísmica del complejo comunicante anterior; fue sometida a microcirugía dentro de las primeras 24 horas y transferida luego a UCI, sin complicaciones. Discusión : El tiempo de resolución, sea mediante clipaje microquirúrgico o tratamiento endovascular es tema de intensos debates. Las guías actuales señalan la necesidad del manejo más temprano posible de la patología. Conclusión : En nuestro caso, se obtuvo un buen resultado funcional debido a varios factores uno de ellos el ingreso precoz a cirugía. La actualización de las guías y nuevos estudios ayudarán a mejorar el conocimiento de la enfermedad y protocolos hospitalarios adecuados a la realidad clínica ayudarán a reducir su tiempo de resolución.
SUMMARY Introduction : Intracranial aneurysms account for 85% of all subarachnoid hemorrhages. Non-traumatic SAH has a high mortality rate (40-60%). Regarding the microsurgical and endovascular management for this pathology, there has been intense debate on whether early action is beneficial in terms of functional outcome and reduction of morbi-mortality. Clinical case : A 54-year-old woman admitted with a sudden, severe headache and a rapidly deteriorating neurological state at baseline, and with deterioration at the next hour. Tomography showed a subarachnoid hemorrhage due to ruptured aneurysm of the anterior communicating artery; the patient underwent surgery within the first 24 hours, with subsequent ICU management without complications. Discussion : The resolution time of this condition, either by micosurgery or endovascular management is a matter of intense debate. International guidelines point out the need of an earliest possible treatment. Conclusion : In our case, a good functional result was obtained due to several factors, one of which was early admission to surgery. The updating of guidelines and new studies will help to better understand the pathophysiology of SAH, and the creation of hospital protocols adapted to clinical realities will assist to reduce the resolution time of this pathology.
Subject(s)
Humans , Female , Middle Aged , Subarachnoid Hemorrhage , Case Reports , Intracranial Aneurysm , Aneurysm, Ruptured , Tomography , Mortality , MicrosurgeryABSTRACT
Objective:To investigate the clinical manifestations and the effect of peroral endoscopic-assisted laryngeal microsurgery for children with laryngeal neurofibroma, and to provide clinical reference for the diagnosis and treatment of this disease. Methods:The clinical data of 4 children with laryngeal tumors admitted to the Department of Otorhinolaryngology, Children's Hospital of Chongqing Medical University from January 2021 to June 2023 were retrospectively analyzed. Laryngeal tumors were removed by peroral endoscopic-assisted laryngeal microsurgery. One case underwent tracheotomy at the same time, and one case was simultaneously performed with laryngeal T tube placement and tracheotomy. Results:Surgical resection is the best treatment for laryngeal neurofibroma, and laryngeal microsurgery should be actively used for patients with surgical indications.This surgical method has the advantages of good efficacy, minimal invasion, aesthetics and preservation of laryngeal function, which not only ensures safety, but also improves the quality of life after surgery, and has the value of development and promotion.
Subject(s)
Child , Humans , Laryngeal Neoplasms/pathology , Laryngoscopy/methods , Microsurgery/methods , Retrospective Studies , Quality of Life , Neurofibroma/diagnosisABSTRACT
In this review, we tried to systematize all the evidence (from PubMed [MEDLINE], Scopus, Cochrane Library, EBSCO, Embase, and Google Scholar) from 1993 to 2021 on the predictors of microsurgical varicocelectomy efficacy in male infertility treatment. Regarding the outcomes of varicocele repair, we considered semen improvement and pregnancy and analyzed them separately. Based on the 2011 Oxford CEBM Levels of Evidence, we assigned a score to each trial that studied the role of the predictor. We systematized the studied predictors based on the total points, which were, in turn, calculated based on the number and quality of studies that confirmed or rejected the studied predictor as significant, into three levels of significance: predictors of high, moderate, and low clinical significance. Preoperative total motile sperm count (TMSC) coupled with sperm concentration can be a significant predictor of semen improvement and pregnancy after varicocelectomy. In addition, for semen improvement alone, scrotal Doppler ultrasound (DUS) parameters, sperm DNA fragmentation index (DFI), and bilateral varicocelectomy are reliable predictors of microsurgical varicocelectomy efficacy.
Subject(s)
Female , Humans , Male , Pregnancy , Infertility, Male/surgery , Microsurgery , Semen , Sperm Count , Sperm Motility , Varicocele/surgeryABSTRACT
To design a treatment plan for patients with epididymal obstruction, we explored the potential impact of factors such as body mass index (BMI) and age on the surgical outcomes of vasoepididymostomy (VE). In this retrospective study, 181 patients diagnosed with obstructive azoospermia (OA) due to epididymal obstruction between September 2014 and September 2017 were reviewed. All patients underwent single-armed microsurgical intussusception VEs with longitudinal two-suture placement performed by a single surgeon (KH) in a single hospital (Peking University Third Hospital, Beijing, China). Six factors that could possibly influence the patency rates were analyzed, including BMI, age, mode of anastomosis, site of anastomosis, and sperm motility and quantity in the intraoperative epididymal fluid. Single-factor outcome analysis was performed via Chi-square test and multivariable analysis was performed using logistic regression. A total of 159 (87.8%, 159/181) patients were followed up. The follow-up time (mean ± standard deviation [s.d.]) was 27.7 ± 9.3 months, ranging from 12 months to 48 months. The overall patency rate was 73.0% (116/159). The multivariable analysis revealed that BMI and age significantly influenced the patency rate (P = 0.008 and 0.028, respectively). Younger age (≤28 years; odds ratio [OR] = 3.531, 95% confidence interval [95% CI]: 1.397-8.924) and lower BMI score (<26.0 kg m-2; OR = 2.352, 95% CI: 1.095-5.054) appeared to be associated with a higher patency rate. BMI and age were independent factors affecting the outcomes of microsurgical VEs depending on surgical expertise and the use of advanced technology.
Subject(s)
Humans , Male , Adult , Retrospective Studies , Body Mass Index , Epididymis/surgery , Vas Deferens/surgery , Treatment Outcome , Sperm Motility , Microsurgery , Surgeons , VasovasostomyABSTRACT
The hemodynamic characteristics of venous reflux are associated with infertility in patients with varicocele; however, an effective method for quantifying the structural distribution of the reflux is lacking. This study aimed to predict surgical outcomes using a new software for venous reflux quantification. This was a retrospective cohort study of a consecutive series of 105 patients (age range: 22-44 years) between July 2017 and September 2019. Venous reflux of the varicocele was obtained using the Valsalva maneuver during scrotal Doppler ultrasonography before microsurgical varicocelectomy. Using this software, the colored reflux signals were segmented, and the gray scale of the color pixels representing the reflux velocity was comprehensively quantified into the mean reflux velocity of the green layer (MRVG) and the reflux velocity standard deviation of the green layer (RVSDG). Spontaneous pregnancy and changes from baseline in the semen parameters were assessed during a 12-month follow-up period. Data were analyzed using logistic regression analysis. An association of the high MRVG group with impaired progressive motility (odds ratio [OR] = 2.868, 95% confidence interval [CI]: 1.133-7.265) and impaired sperm concentration (OR = 2.943, 95% CI: 1.196-7.239) was found during multivariate analysis. High MRVG (OR = 2.680, 95% CI: 1.086-6.614) and high RVSDG (OR = 2.508, 95% CI: 1.030-6.111) were found to be independent predictors of failure to achieve pregnancy following microsurgical repair. In summary, intense venous reflux is an independent predictor of impaired progressive motility, sperm concentration, and pregnancy outcomes after microsurgical varicocelectomy.
Subject(s)
Pregnancy , Female , Humans , Male , Young Adult , Adult , Varicocele/surgery , Retrospective Studies , Semen , Veins/surgery , Sperm Count , Infertility, Male/surgery , Microsurgery/methods , Sperm MotilityABSTRACT
RESUMO Objetivo Descrever e validar um modelo oftalmológico para treinamento de transplante e microssutura de córnea utilizando globo ocular bovino. Métodos Para a montagem do modelo de treinamento, o globo ocular foi disposto sob o campo cirúrgico, apoiado sobre um recipiente plástico cilíndrico comum de 3,5cm de diâmetro, para a retirada da córnea. Foi realizada uma incisão circular superficial, e, posteriormente, uma tesoura Castroviejo curva de 9 cm foi utilizada para remoção completa da córnea, que foi recolocada em sua posição original, para que, em seguida, fossem confeccionados nove pontos equidistantes, usando fio de nylon 10-0. Por fim, foram avaliados os seguintes critérios: tempo de realização das suturas; evolução do tempo e da qualidade a cada teste; e destreza e aperfeiçoamento da realização das suturas. Resultados O modelo descrito demonstrou-se viável e adequado para o treinamento de microssuturas na córnea, possibilitando aperfeiçoamento e ganho de habilidades cirúrgicas. Conclusão O modelo de treinamento microcirúrgico apresentado possui alta viabilidade para a simulação de cirurgias oftalmológicas e textura semelhante à do olho humano real, o que o torna próximo à realidade.
ABSTRACT Objective To describe and validate an ophthalmic model for corneal transplantation and micro suture training using a bovine eyeball as a model. Methods For the training model, the eyeball was placed under the sanitary field placed on the ends of a common 3.5cm diameter cylindrical plastic container for corneal removal. A superficial circular incision was made, then 9cm curved Castroviejo scissors were used for complete corneal removal. The cornea was replaced in its original position, and 10-0 nylon thread was used to perform the sutures, with 9 equidistant stitches. Finally, the following criteria were evaluated: suturing time, time and quality progression in each attempt, dexterity and suturing improvement. Results The described model proved to be feasible and suitable for corneal micro suture training, allowing improvement and gain of dexterity in the sport. Conclusion The presented microsurgical training model has a high feasibility for the simulation of ophthalmic surgeries, in addition to a texture similar to the real human eye, which makes it close to reality.
Subject(s)
Animals , Ophthalmology/education , Corneal Transplantation/education , Models, Animal , Simulation Training/methods , Microsurgery/education , Teaching Materials , Cattle , Suture Techniques/education , Education, Medical , Models, AnatomicABSTRACT
Purpose: To evaluate the gain of microsurgical skills and competencies by urology residents, using low-fidelity experimental models. Methods: The study involved the use of training boards, together with a low-fidelity microsurgery simulator, developed using a 3D printer. The model consists in two silicone tubes, coated with a resin, measuring 10 cm in length and with internal and external diameters of 0.5 and 1.5 mm. The support for the ducts is composed by a small box, developed with polylactic acid. The evaluation of the gain of skills and competencies in microsurgery occurred throughout a training course consisting of five training sessions. The first sessions (S1-S4) took place at weekly intervals and the last session (S5) was performed three months after S4. During sessions, were analyzed: the speed of performing microsurgical sutures in the pre and post-training and the performance of each resident through the Objective Structure Assessment of Technical Skill (OSATS) and Student Satisfaction Self-Confidence tools in Learning (SSSCL). Results: There was a decrease in the time needed to perform the anastomosis (p=0.0019), as well as a progressive increase in the score in the OSATS over during sessions S1 to S4. At S5, there was a slightly decrease in performance (p<0.0001), however, remaining within the expected plateau for the gain of skills and competences. The SSSCL satisfaction scale showed an overall approval rating of 96.9%, with a Cronback alpha coefficient of 83%. Conclusions: The low-fidelity simulation was able to guarantee urology residents a solid gain in skills and competencies in microsurgery.
Subject(s)
Urology , Education, Medical , Simulation Training , Medical Staff, Hospital , MicrosurgeryABSTRACT
Introdução: A trombectomia microcirúrgica (TM) é usada há muitos anos em casos de Acidente Vascular Cerebral (AVC) e não há descrição detalhada da técnica sistematizada. Com a difusão de procedimentos de trombectomia endovascular é também esperado aumento de falha nesses procedimentos e a TM como procedimento de resgate tende a ser progressivamente mais demandada. Considerando a potencial demanda é crítico o desenvolvimento de planejamento cirúrgico sistematizado que permita a efetividade e celeridade do precedimento e, para isso, descrevemos a técnica microcirúrgica 2-1-2. Além disso, não existem estudos que demonstram o prognóstico funcional do indivíduo baseado no tipo de oclusão vascular encontrado durante a cirurgia, levando em consideração trombo convencional e placa de aterosclerose, e escala funcional para ser realizada com o indivíduo após o procedimento e avaliando de forma fiel a funcionalidade no dia a dia. Método: Foram avaliados oito indivíduos admitidos em pronto-atendimento com quadro de AVC isquêmico extenso e não foi possível realizar ou teve falha na trombectomia por via endovascular. Eles foram encaminhados a TM 2-1-2 após a imagem mostrar colaterais cerebrais ao vaso acometido na angiotomografia de crânio e Alberta stroke program early CT score (ASPECTS) maiores que 6 pontos. O procedimento consistiu em duas punções com agulha hipodérmica, 4 mm, na artéria alvo, arteriotomia transversa com microtesoura de 1mm, retirada do trombo utilizando manobras de ordenha e 2 micro pontos simples. Os indivíduos foram acompanhados por 60 dias com exames físicos e de imagem. Os materiais oclusivos foram coletados e enviados ao setor de anatomia patológica para análise histopatológica. E, para avaliação funcional real, um novo instrumento chamado FOLLOW Scale foi desenvolvido para avaliar diversos aspectos funcionais de indivíduos pós AVC, permitindo que tanto os próprios pacientes quanto seus familiares e cuidadores monitorem a evolução funcional. Foi feita aplicação da escala para sua validação de face e conteúdo através da opinião de 51 indivíduos pós AVC, familiares/cuidadores e profissionais de diferentes áreas. Resultados: Todos os indivíduos tratados com a técnica TM 2-1-2 tiveram a remoção completa do trombo por meio de técnica precisa com controle dos movimentos manuais e do tempo cirúrgico. A angiotomografia de crânio evidenciou restabelecimento integral da circulação cerebrovascular com melhora clínica em 60 dias de seguimento sem complicações ou reinternações hospitalares. O trombo convencional, é de fácil remoção e não obstrui o vaso após o procedimento. Em relação a aparência externa, quando possui aspecto branco o resultado tendeu a ser pior quando comparado com o vaso que possui aparência externa arroxeada. E, a FOLLOW Scale é útil para mensurar a funcionalidade do indivíduo pós três meses do AVC, apresentando fácil entendimento por leigos e não leigos sem diferença estatisticamente significativa. Conclusões: A técnica TM 2-1-2 pode ser realizada de forma rápida e eficaz de forma sistematizada, oferecendo terapêutica terciária ou de resgate para o tratamento do AVC agudo. Foi observado que o trombo convencional possui fácil remoção, podendo levar a melhor prognóstico funcional. A escala FOLLOW é instrumento proposto para acompanhamento funcional longitudinal desses indivíduos e conta com a vantagem de poder ser aplicada por profissionais sem formação específica e ter sido submetida a validação piloto no presente estudo. Treinamento microcirúrgico específico é crítico para realizar esse tratamento e estudos maiores são necessários para confirmar os achados do presente estudo.
Introduction: Microsurgical thrombectomy (MT) has been used for many years in cases of stroke. There is no detailed description of the systematic technique. With the spread of endovascular thrombectomy procedures, an increase in failure in these procedures is also expected and MT as a rescue procedure tends to be progressively more demanded. Considering the potential demand, it is critical to develop a systematized surgical planning that allows the effectiveness and speed of the procedure, and, to this end, we describe the 2-1-2 microsurgical technique. Furthermore, there are no studies that demonstrate the individual's functional prognosis based on the type of vascular occlusion found during surgery, taking into account conventional thrombus and atherosclerosis plaque, and a functional scale to be carried out with the individual after the procedure and faithfully evaluating functionality on a daily basis. Method: Eight individuals admitted to emergency care with extensive ischemic stroke and not possible to perform or the failure of endovascular thrombectomy were evaluated. They were referred to TM 2-1-2 after the image showed cerebral collaterals to the affected vessel on cranial CT angiography and Alberta stroke program early CT score (ASPECTS) greater than 6 points. The procedure consisted of two punctures with a 4 mm hypodermic needle in the target artery, transverse 1mm arteriotomy with micro scissors, removal of the thrombus using milking maneuvers and 2 simple points. The individuals were followed for 60 days with physical and imaging exams. The occlusive materials were collected and sent to the pathological anatomy department for histopathological analysis. A new instrument called the FOLLOW Scale was developed to evaluate various functional aspects of post-stroke individuals, allowing both the patients themselves and their families and caregivers to monitor functional evolution. The scale was applied for face and content validation through the opinion of 51 post-stroke individuals, family members/caregivers and professionals from different areas. Results: All individuals treated with the TM 2-1-2 technique had complete thrombus removal using a precise technique with control of manual movements and surgical time. Skull tomography angiography showed full re-establishment of cerebrovascular circulation with clinical improvement in 60 days of follow-up without complications or hospital readmissions. The conventional thrombus is easy to remove and does not obstruct the vessel after the procedure. Regarding the external appearance, when it has a white appearance, the result tended to be worse when compared to the vessel that has a purplish external appearance. The FOLLOW Scale has face and content validity for measuring an individual's functionality three months after the stroke and is easy to understand by laypeople and non-laypeople with no statistically significant difference. Conclusions: The TM 2-1-2 technique can be performed quickly and effectively in a systematic way, offering tertiary or rescue therapy for the treatment of acute stroke. It was observed that conventional thrombus is easy to remove, which can lead to a better functional prognosis. The FOLLOW scale is an instrument proposed for longitudinal functional monitoring of these individuals and has the advantage of being able to be applied by professionals without specific training and had the initial validation in the present study. Specific microsurgical training is critical to perform this treatment and larger studies are needed to confirm the findings of the present study.
Subject(s)
Humans , Thrombectomy , Embolectomy , Stroke , Functional Status , Microsurgery , NeurosurgeryABSTRACT
Abstract Objective Advances in reconstructive microsurgery in orthopedic surgery provided better functional and aesthetic results and avoided many indications for amputation. In high-volume trauma and orthopedic hospitals, microsurgical reconstruction is essential to reduce costs and complications for these complex orthopedic defects. We describe a microsurgical approach to traumatic wounds, tumor resection, bone defects, and free muscle transfer, performed by an orthopedic microsurgery unit. The objective of the present study was to evaluate predictor factors for outcomes of microsurgical flaps for limb reconstruction, and to provide a descriptive analysis of microsurgical flaps for orthopedic indications. Methods Cross-sectional prospective study that included all consecutive cases of microsurgical flaps for orthopedic indications from 2014 to 2020. Data were collected from personal medical history, intraoperative microsurgical procedure, and laboratory blood tests. Complications and free-flap outcomes were studied in a descriptive and statistical analysis. Results We evaluated 171 flaps in 168 patients; the indications were traumatic in 66% of the patients. Type III complications of the Clavien-Dindo Classification were observed in 51 flaps. The overall success rate of the microsurgical flaps was 88.3%. In the multivariate analysis, the risk factors for complications were ischemia time ≥ 2 hours (p= 0.032) and obesity (p= 0.007). Partial flap loss was more common in patients with thrombocytosis in the preoperative platelet count (p= 0.001). Conclusion The independent risk factors for complications of microsurgical flaps for limb reconstruction are obesity and flap ischemia time ≥ 2 hours, and presence of thrombocytosis is a risk factor for partial flap loss.
Resumo Objetivo Os avanços da microcirurgia reconstrutiva na cirurgia ortopédica proporcionaram melhores resultados funcionais e estéticos, evitando as muitas indicações de amputação. Nos hospitais de ortopedia e traumatologia com um grande volume de atendimento, a reconstrução microcirúrgica é essencial, a fim de reduzir os custos e as complicações destes complexos defeitos ortopédicos. Descrevemos uma abordagem microcirúrgica para feridas traumáticas, ressecção tumoral, defeitos ósseos e transferência muscular livre realizada por uma unidade ortopédica especializada em microcirurgia. O objetivo do presente estudo é avaliar os fatores preditivos de resultados dos retalhos microcirúrgicos na reconstrução dos membros, fornecendo uma análise descritiva dos retalhos microcirúrgicos para as indicações ortopédicas. Métodos Estudo prospectivo transversal, que incluiu todos os casos consecutivos de retalhos microcirúrgicos com indicação ortopédica de 2014 a 2020. Foram coletados os dados do histórico clínico pessoal, procedimentos microcirúrgicos intraoperatórios e exames laboratoriais. As complicações e os desfechos de retalho livre foram estudados mediante uma análise descritiva e estatística. Resultados Avaliamos 171 retalhos em 168 pacientes. A indicação mais frequente para a realização de um retalho microcirúrgico foi a traumática, em 66% dos pacientes. Foram observadas complicações cirúrgicas em 51 retalhos, conforme a classificação de Clavien-Dindo do tipo III. A taxa de êxito global dos retalhos microcirúrgicos foi de 88,3%. Na análise multivariada, foram identificados como fatores de risco para complicações tempo de isquemia ≥ 2 horas (p= 0,032) e obesidade (p= 0,007). A perda parcial do retalho foi mais comum em pacientes com trombocitose, com contagem de plaquetas pré-operatória (p= 0,001). Conclusão Os fatores de risco independentes para complicações de retalhos microcirúrgicos para a reconstrução de membro são obesidade e tempo de isquemia do retalho ≥ 2 horas, e a presença de trombocitose como fator de risco para perda parcial do retalho.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Prospective Studies , Tissue Transplantation , Orthopedic Procedures , Free Tissue Flaps , MicrosurgeryABSTRACT
Abstract Robotic surgery opened a new era of minimally-invasive procedures, through its improved precision, elimination of tremors, greater degrees of freedom, and other facilitating aspects. The field of robotic microsurgery showed great growth in recent years in particular, since robotics offers a potentially-ideal configuration to perform the sensitive manipulations required in microsurgery. We conducted a systematic review to assess the benefits of robotic surgery and its contributions to microsurgery, comparing it with other surgical techniques used in patients of all age groups. We assessed 25 articles found in the PubMed and Cochrane databases using the terms 'robotic surgery' AND microsurgery, with a filter for studies published in the last five years, and studies conducted in humans and published in English or Portuguese. We concluded that there is plenty of room for robotic surgery in microsurgery, such as in male infertility procedures, neurological microsurgery, ocular and otological surgeries, and transoral, hepatobiliary, microvascular, plastic and reconstructive surgeries.
Resumo A cirurgia robótica abriu uma nova era de procedimentos minimamente invasivos, por meio da sua precisão, da eliminação dos tremores, e dos maiores graus de liberdade e demais aspectos facilitadores. O campo da microcirurgia robótica apresentou grande crescimento nos últimos anos em especial, uma vez que a robótica oferece uma configuração potencialmente ideal para realização das manipulações delicadas exigidas na microcirurgia. Assim, conduzimos uma revisão sistemática com o objetivo de avaliar os benefícios da cirurgia robótica e sua contribuição para a microcirurgia, comparando-a com as demais técnicas cirúrgicas utilizadas em pacientes de todas as faixas etárias. Foram analisados 25 artigos encontrados nas bases de dados PubMed e Cochrane utilizando os descritores robotic surgery AND microsurgery com filtro para os últimos cinco anos, e estudos realizados em humanos e publicados em inglês ou português. Concluímos que existe grande espaço para a cirurgia robótica na microcirurgia, como em procedimentos primários de infertilidade masculina, microcirurgia neurológica, cirurgias oculares e otológicas, cirurgia transoral, hepatobiliar, microvascular, e cirurgia plástica e reconstrutiva.
Subject(s)
Humans , Male , Minimally Invasive Surgical Procedures , Robotic Surgical Procedures , Infertility, Male , MicrosurgeryABSTRACT
Resumen Introducción: El linfedema es una enfermedad inflamatoria crónica que afecta cerca de 250 millones de personas en el mundo. El tratamiento tradicional es la terapia descongestiva. Últimamente, existe la opción de complementar el tratamiento tradicional con procedimientos quirúrgicos fisiológicos como anastomosis linfáticovenosas y transferencia de linfonodos vascularizados. Sin embargo, la evidencia del uso de la terapia descongestiva en los cuidados pre y posoperatorios en estas cirugías es limitada. Objetivo: Evaluar el uso de terapia descongestiva como complemento a la cirugía de linfedema mediante anastomosis linfáticovenosas y transferencia de linfonodos vascularizados. Materiales y Método: Se realizó una revisión de la literatura en las siguientes bases de datos: Cochrane, Pubmed y Google académico, utilizando los siguientes términos mesh: "anastomosis, surgical", "lymphedema", "perioperative care", "microsurgery", "rehabilitation", "therapy", "lymph nodes", "bypass", "lymphedema and microsurgery". Se incluyó aquellos artículos que describían el uso de la terapia descongestiva en los cuidados pre- y posoperatorios. Resultados: Se identificó un total de 201 artículos y 12 fueron incluidos en el análisis. La evidencia reporta que las terapias más usadas en el cuidado pre- y posoperatorio son compresión, drenaje linfático manual y tratamientos personalizados. Sin embargo, la mayoría de los autores hace una descripción vaga de las terapias mencionadas. Discusión y Conclusión: La evidencia respecto al uso de terapia descongestiva como tratamiento complementario es débil. Los expertos recomiendan su uso, sin embargo, se necesitan futuras investigaciones que describan el uso de cada uno de sus componentes como complemento de procedimientos quirúrgicos fisiológicos para el manejo del linfedema.
Background: Lymphedema is a disease that affects about 250 million people around the world. The traditional treatment is decongestive therapy. In the past years, there is the option to complementing the traditional treatment with physiological surgical procedures such as lymphatic-venous anastomosis (LVA) and vascularized lymph node transfer (VLNT). However, the evidence for the use of decongestive therapy in pre- and post-operative care in these surgeries is limited. Aim: To evaluate the use of decongestive therapy as a complement to lymphedema surgery such a lymphatic-venous anastomosis and transfer of vascularized lymph nodes. Materials and Method: A literature review was carried out in the following databases: Cochrane, Pubmed and Academic Google, using the following mesh terms: "anastomosis, surgical", "lymphedema", "perioperative care", "microsurgery", "rehabilitation", "therapy", "lymph nodes","bypass", "lymphedema and microsurgery". "Those articles that described the use of decongestive therapy in pre- and post-operative care were included. Results: 201 articles were identified and 12 were included in the analysis. The evidence reports that the most used therapies in pre- and post-operative care are compression, manual lymphatic drainage and personalized treatments. However, most of the authors give a vague description of the mentioned therapies. Discussion and Conclusion: The evidence regarding the use of decongestive therapy as a complementary treatment is weak. Experts recommend its use; however, future research is needed to describe the use of each of its components as a complement to physiological surgical procedures for the management of lymphedema.
Subject(s)
Humans , Lymphatic Vessels/surgery , Lymphatic Vessels/diagnostic imaging , Lymphangitis/surgery , Lymphedema/surgery , Lymphedema/etiology , Neoplasms/surgery , Neoplasms/complications , Software Design , Anastomosis, Surgical/methods , Treatment Outcome , Lymph Nodes , Microsurgery/methodsABSTRACT
The pituitary adenomas comprise the largest part of pituitary neoplasms, representing between 9 and 12% of primary brain tumors. Currently, the treatment of election is the surgical, the trans-sphenoidal endonasal path has provided a broader panoramic view, being feasible more delicate and safe procedures. The objective of this study was to describe the management of pituitary adenomas by endoscopic surgery trans-sphenoidal endonasal path. This is a study in a series of cases, with a sample of 17 patients who met the selection criteria and were attended at the José Carrasco Hospital Arteaga, Cuenca - Ecuador, period 2018 - 2019. All patients presented informed consent for the performance of the surgery and the subsequent dissemination of the results. The 53% of the population belonged to the male gender, 47% were patients between 40 and 60 years old, 65% were detected with macroadenomas, and 29% presented complications such as nasal obstruction, sphenoiditis and headache, the residual tumor stage was due 24%.Endoscopic surgery trans-sphenoidal endonasal path is a safe, minimally invasive tool, a surgical alternative with a high rate of tumor excision, better control and fewer complications, which reduces the morbidity of patients.
Los adenomas de hipófisis comprenden la mayor parte de neoplasias hipofisiarias, representando entre el 9 y 12% de los tumores cerebrales primarios. En la actualidad el tratamiento de elección es el quirúrgico, la vía endonasal transesfenoidal ha proporcionado una visión panorámica más amplia, siendo factibles procedimientos más delicados y seguros. El objetivo de este estudio fue describir el abordaje de adenomas de hipófisis mediante cirugía endoscópica vía endonasal transesfenoidal. Diseñamos un estudio de corte longitudinal, con una muestra de 17 pacientes que cumplieron con los criterios de selección y fueron atendidos en el Hospital José Carrasco Arteaga de la ciudad de Cuenca - Ecuador, periodo 2018 - 2019. Todos los pacientes presentaron consentimiento informado para la realización de la cirugía y la posterior difusión de los resultados. El 53% de la población pertenecieron al sexo masculino, 47% fueron pacientes entre 40 y 60 años, al 65% se le detectó macroadenomas, el 29% presentaron complicaciones como obstrucción nasal, esfenoiditis y cefalea, la tasa de tumor residual fue del 24%. La cirugía endoscópica vía endonasal transesfenoidal es una herramienta segura, mínimamente invasiva, una alternativa quirúrgica con una elevada tasa de exéresis tumoral, mejor control y menos complicaciones, que reduce la morbilidad de los pacientes.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pituitary Neoplasms/surgery , Adenoma/surgery , Endoscopy/methods , Sphenoid Bone/surgery , Longitudinal Studies , Microsurgery , Nasal Cavity/surgeryABSTRACT
Abstract Objective To evaluate the use of external fixators in the delta-type kickstand configuration as an adjuvant method in the postoperative period of patients submitted to free flaps in the lower limbs. Methods A total of 17 external delta fixators were used in patients submitted to free flaps in the lower limbs. The surgical technique was performed in a standardized manner, with the distal pin located 6 cm proximally to the anastomosis, and the proximal pin, 6 cm distally to the anterior tuberosity of the tibia. Results The mean age of the sample was of 34.76 years (range: 15 to 66 years). In total, 11 men and 6 women were selected. The posterior tibial artery was used in 14 cases, and the anterior tibial artery, in 3 cases. The mean time of use of the external fixators was of 3.88 weeks. The rate of reoperation was of 17.64%; that of retail loss was of 11.76%; that of success rate was of 88.23%; and the rate of infection was of 5.9%. Conclusion The use of delta-type fixators as an adjunct method in the postoperative period is reliable; however, more studies are needed to evaluate its true role in the postoperative period.
Resumo Objetivo Avaliar o uso de fixadores externos, na configuração kickstand do tipo delta, como método adjuvante no período pós-operatório de pacientes submetidos a retalhos livres nos membros inferiores. Métodos Ao todo, 17 fixadores externos do tipo delta foram utilizados em pacientes submetidos a retalhos livres nos membros inferiores. A técnica cirúrgica foi realizada de forma padronizada, com o pino distal localizado 6 cm proximal à anastomose, e o pino proximal, 6cm distal à tuberosidade anterior da tíbia. Resultados A idade média da amostra foi de 34,76 anos (variação: 15 a 66 anos). Foram selecionados 11 homens e 6 mulheres. Utilizou-se a artéria tibial posterior em 14 casos, e a tibial anterior, em 3 casos. O tempo médio de uso dos fixadores externos foi de 3,88 semanas. A taxa de reoperação foi de 17,64%; a de perda do retalho foi de 11,76%; a de sucesso foi de 88,23%; e a taxa de infecção foi de 5,9%. Conclusão O uso de fixadores do tipo delta como método adjuvante no pós-operatório é confiável; porém, mais estudos são necessários para avaliar seu verdadeiro papel no pós-operatório.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Fractures, Bone , Perforator Flap , Myocutaneous Flap , MicrosurgeryABSTRACT
RESUMEN Los aneurismas de la arteria comunicante anterior son complejos y requieren de tratamiento endovascular o microquirúrgico según sus características. El uso de enfoques mínimamente invasivos en microcirugía continúa evolucionando. Presentamos el caso de un paciente de 34 años con un aneurisma cerebral no roto de AcoA de cuello ancho, con escala de Glasgow de 15 puntos. Se realizó un abordaje supraorbitario lateral más "clipaje" total del aneurisma usando angio fluoresceína intraoperatoria. Se logró el objetivo con seguridad y eficacia; al mismo tiempo se optimizó el tiempo quirúrgico y hospitalario, maximizando la comodidad del paciente, estética y reanudación a sus actividades tempranas. (AU)
SUMMARY Anterior communicating artery aneurisms (ACAA) are complex and require endovascular or microsurgery approaches. The use of minimally invasive microsurgery techniques is evolving. We present the case of a 34-yearold patient with a broad neck, non-broken, ACAA with a Glasgow coma scale of 15 points. A lateral supra-orbitary approach with total clipping of the ACAA using intra-operatory fluorescein angiography was performed. The objective was accomplished successfully and safe, optimizing both intra-operative and hospitalization times, thus,maximizing patient comfort, esthetic and prompt return to normal duties. (AU)