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2.
Einstein (Säo Paulo) ; 20: eAO6318, 2022. graf
Article in English | LILACS | ID: biblio-1360397

ABSTRACT

ABSTRACT Objective To describe the technical specificities and feasibility of simulation of minimally invasive spine surgery in live pigs, as well as similarities and differences in comparison to surgery in humans. Methods A total of 22 Large White class swine models, weighing between 60 and 80kg, were submitted to surgical simulations, performed during theoretical-practical courses for training surgical techniques (microsurgical and endoscopic lumbar decompression; percutaneous pedicular instrumentation; lateral access to the thoracic spine, and anterior and retroperitoneal to the lumbar spine, and management of complications) by 86 spine surgeons. For each surgical technique, porcine anatomy (similarities and differences in relation to human anatomy), access route, and dimensions of the instruments and implants used were evaluated. Thus, the authors describe the feasibility of each operative simulation, as well as suggestions to optimize training. Study results are descriptive, with figures and drawings. Results Neural decompression surgeries (microsurgeries and endoscopic) and pedicular instrumentation presented higher similarities to surgery on humans. On the other hand, intradiscal procedures had limitations due to the narrow disc space in swines. We were able to simulate situations of surgical trauma in surgical complication scenarios, such as cerebrospinal fluid fistulas and excessive bleeding, with comparable realism to surgery on humans. Conclusion A porcine model for simulation of minimally invasive spinal surgical techniques had similarities with surgery on humans, and is therefore feasible for surgeon training.


Subject(s)
Animals , Spinal Fusion/methods , Intervertebral Disc Degeneration , Swine , Treatment Outcome , Minimally Invasive Surgical Procedures/methods , Lumbar Vertebrae , Lumbosacral Region
3.
Rev. cuba. oftalmol ; 34(3): e1084, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1352024

ABSTRACT

Objetivo: Determinar los resultados de la cirugía mínimamente invasiva en pacientes con estrabismos horizontales. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo de una serie de 19 pacientes (16 ojos derechos, 17 izquierdos) atendidos en el Servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", en el periodo comprendido entre junio de 2018 y julio de 2019, a quienes se les realizó cirugía mínimamente invasiva de estrabismo y fueron seguidos por 6 meses. Se evaluaron las variables: tipo de desviación, agudeza visual, signos posoperatorios, ángulo de desviación pre- y posquirúrgico, éxito quirúrgico, fusión, estereopsis y complicaciones. Resultados: El 73,7 por ciento de los pacientes presentaba esotropías; la media de agudeza visual pre- y posoperatoria entre los dos ojos fue muy similar; el signo posoperatorio más frecuente fue la hiperemia conjuntival ligera (75 por ciento ojos derechos y 64,5 por ciento ojos izquierdos) a las 24 horas. Se encontraron diferencias estadísticas (p < 0,001) en el ángulo de desviación horizontal en dioptrías prismáticas, pre- y poscirugía, con el 84,2 por ciento de éxito quirúrgico. El 78,6 y el 80 por ciento de los pacientes con esotropía y exotropías alcanzaron fusión, pero solo lograron estereopsis el 28,5 y el 60 por ciento de ellos respectivamente. La frecuencia de complicaciones ocurrió en el 15,8 por ciento de los pacientes. Conclusiones: Se alcanzaron buenos resultados motores, así como aceptables en los sensoriales en pacientes operados de estrabismos horizontales por cirugía mínimamente invasiva(AU)


Objective: Determine the results of minimally invasive surgery in patients with horizontal strabismus. Methods: A prospective longitudinal descriptive study was conducted of a series of 19 patients (16 right eyes, 17 left eyes) attending the Pediatric Ophthalmology Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology from June 2018 to July 2019. These patients underwent minimally invasive strabismus surgery and were followed up for six months. The variables considered were deviation type, visual acuity, postoperative signs, pre- and postoperative angle of deviation, surgical success, fusion, stereopsis and complications. Results: Of the patients studied, 73.7 percent presented esotropias; mean pre- and postoperative visual acuity was very similar in the two eyes; the most common postoperative sign was slight conjunctival hyperemia (75 percent right eyes and 64.5 percent left eyes) at 24 hours. Statistical differences (p < 0.001) were found in the horizontal angle of deviation in pre- and postoperative prism diopters, with 84.2 percent surgical success. 78.6 percent and 80 percent of the patients with esotropia and exotropia achieved fusion, but only 28.5 and 60 percent of them, respectively, achieved stereopsis. Complications occurred in 15.8 percent of the patients. Conclusions: Good motor results were obtained, as well as acceptable sensory results in patients undergoing minimally invasive horizontal strabismus surgery(AU)


Subject(s)
Humans , Child, Preschool , Child , Adolescent , Adult , Esotropia/etiology , Strabismus/etiology , Minimally Invasive Surgical Procedures/methods , Depth Perception , Epidemiology, Descriptive , Prospective Studies , Longitudinal Studies
4.
Rev. cuba. cir ; 60(3): e924, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1347392

ABSTRACT

Introducción: La cirugía laparoscópica tiene como avance importante el abordaje monopuerto, que está en constante perfeccionamiento y donde influye para su éxito el dispositivo de acceso del que se disponga. Estos procederes de cirugía laparoscópica por un puerto único se realizan con el uso de dispositivos monopuerto, a través de un guante quirúrgico, por endoscopia flexible o por múltiples trócares en una incisión, pero la primera opción facilita el trabajo y disminuye complicaciones. Objetivo: Actualizar la información existente sobre dispositivos monopuerto para tenerla en consideración a la hora de realizar el proceder. Métodos: Se realizó una revisión bibliográfica sobre dispositivos monopuerto en la cirugía mínimamente invasiva desde marzo hasta abril del año 2020. Se revisaron artículos, libros especializados y citas bibliográficas de estudios elegidos de los cuales fueron seleccionados 25 para esta revisión. Desarrollo: Después de la revisión de 25 bibliografías citadas se detallaron las características de los principales dispositivos. Conclusiones: Existe una amplia gama de dispositivos monopuerto, cuya eficacia se evidencia en la bibliografía consultada, y que la revisión de este tema debe ser tomada en cuenta por los especialistas a la hora de realizar esta cirugía(AU)


Introduction: Laparoscopic surgery has as an important advance the single-port approach, which is in constant improvement and where the available access device influences its success. These procedures of laparoscopic surgery by a single port are performed with the use of single port devices, through a surgical glove, by flexible endoscopy or by multiple trocars in an incision, but the first option facilitates the work and reduces complications. Objective: Update the existing information on single-port devices to take it into consideration when carrying out the procedure. Methods: A bibliographic review on single port devices in minimally invasive surgery was carried out from March to April 2020. Articles, specialized books and bibliographic citations of selected studies were reviewed, of which 25 were selected for this review. Development: After reviewing 25 cited bibliographies, the characteristics of the main devices were detailed. Conclusions: There is a wide range of single-port devices, whose effectiveness is evidenced in the consulted bibliography, and that the review of this topic should be taken into account by specialists when performing this surgery(AU)


Subject(s)
Humans , Surgical Instruments/adverse effects , Laparoscopy/methods , Minimally Invasive Surgical Procedures/methods , Bibliographies as Topic , Review Literature as Topic
5.
Rev. guatemalteca cir ; 27(1): 3-9, 2021. tab
Article in Spanish | LILACS, LIGCSA | ID: biblio-1359836

ABSTRACT

Introducción: Actualmente se prefieren procedimientos mínimamente invasivos como las técnicas endovasculares para el tratamiento de la insuficiencia de vena safena mayor que pueden ser por ablación térmica, química o mecánica. Éstos tienen la ventaja de ser ambulatorios, presentar menos complicaciones postoperatorias, una rápida incorporación laboral y mejores resultados estéticos. El objetivo de este estudio es evaluar los resultados del tratamiento con radiofrecuencia versus crosectomía safenofemoral más oclusión endovascular distal. Material y Métodos: Estudio descriptivo prospectivo que incluyó a todos los pacientes con diagnóstico de insuficiencia de la vena safena mayor de enero 2017 a octubre 2019. La elección de la técnica a utilizar se hizo al azar. Resultados: El 77% correspondió al género femenino, con edad media 49 años, el estadío C:2 de la clasificación clíica CEAP fue la más frecuente (57%) y el shunt tipo 3 (63%). La ablación por radiofrecuencia se realizó con mayor frecuencia (83%). El dolor y parestesias (fueron las complicaciones más frecuentes en ambos grupos sin diferencias estadísticamente significativas (p = 0.1470). No hubo diferencias estadísticamente significativo entre las dos técnicas quirúrgicas realizadas en resultado estético (p = 0.4456), el retorno de actividades cotidianas (p = 0.992) ni las laborales (p = 0.901). Conclusiones: Tanto la ablación por radiofrecuencia de la vena safena mayor como la crosectomía safenofemoral más oclusión endovascular distal se consideran dos métodos seguros y efectivos para tratar insuficiencia de vena safena mayor; ya que los resultados finales fueron similares para ambas técnicas quirúrgicas.


Introduction: Minimally invasive endovascular procedures like thermal, chemical or mechanical ablation are currently preferred for the treatment of the great saphenous vein insufficiency, because have the advantage of being outpatient, with minimal postoperative complications, a faster incorporation to work and better aesthetic results. This study persuit to evaluate the results of radiofrequency treatment versus sapheno-femoral crosectomy plus distal endovascular occlusion. Methods: The study included all the patients with a diagnosis of great saphenous vein insufficiency from January 2017 to October 2019. The technic was chosen randomly. Results: 77% of patients was female , with a mean age of 49 , the C2 stage of the CEAP classification is present in 57% and the type 3 shunt in 63%. Radiofrequency ablation was performed in 83% of the cases. Pain and paresthesia were the most frequent complications, without statistically signification between both technics (p = 0.1470). The aesthetic result, the return to daily activities (p = 0.992) and to work (p = 0.901) had not statistically significant differences between the two surgical techniques. Conclusions: Both, radiofrequency ablation of the greater saphenous vein and sapheno-femoral crosectomy plus distal endovascular occlusion are considered safe and effective methods to treat great saphenous vein insufficiency because the final results were similar for both surgical techniques.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Saphenous Vein/surgery , Venous Insufficiency/surgery , Ablation Techniques/methods , Radiofrequency Ablation/methods , Pain/etiology , Minimally Invasive Surgical Procedures/methods
6.
Artrosc. (B. Aires) ; 28(1): 13-21, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1252436

ABSTRACT

Introducción: La luxación patelofemoral representa el 3% de las lesiones traumáticas de la rodilla. Dos tercios se producen en menores de veinte años. La recidiva luego del segundo episodio supera el 50%, lo que puede causar gran limitación funcional en pacientes jóvenes, disminuyendo su calidad de vida. El ligamento patelofemoral medial (LPFM) es el principal estabilizador medial de la rótula a 30° de flexión. En la actualidad su reconstrucción anatómica, preservando la fisis, parece ser la mejor opción en los pacientes con esqueleto inmaduro. Materiales y métodos: estudiamos el resultado funcional de dos grupos de pacientes tratados con dos técnicas diferentes de reconstrucción del LPFM, una anatómica con semitendinoso autólogo (ST) y otra no anatómica con hemitendón cuadricipital autólogo (QT). Ambos grupos fueron evaluados mediante el score de Kujala antes de la cirugía y durante el seguimiento. Las medias y los ítems del score se compararon utilizando la prueba de Wilcoxon.Resultados: veintidós rodillas fueron evaluadas, once en cada grupo. La edad de los pacientes varió entre ocho y quince años. La media de seguimiento fue de 19.4 meses. Los resultados muestran una mejora en la media del score de Kujala de 51 a 88 en el grupo QT, y de 52 a 97 en el grupo ST (ambos con valor-p = 0.003). No se encontró una diferencia significativa entre ambas técnicas. Solo se registró un caso de reluxación (grupo QT). Conclusiones: podemos afirmar que la reconstrucción del LPFM es una opción válida para la luxación patelofemoral, y las técnicas propuestas son confiables


Introduction: Patellofemoral dislocation accounts for 3% of traumatic knee injuries, with two-thirds occurring in patients under twenty years of age. Recurrence after the second episode is greater than 50%, which can cause great functional limitation in young patients, reducing their quality of life. Medial patellofemoral ligament (MPFL) is the main medial stabilizer of the patella at 30° flexion, currently its anatomic reconstruction preserving the physis appears to be the best option in patients with immature skeleton. Materials and methods: functional results of two groups of patients treated by two different techniques of MPFL reconstruction were evaluated. One anatomic technique, with autologous Semitendinosus (ST) and the other non-anatomic, with autologous quadricipital hemi tendon (QT). Both groups were evaluated through the Kujala score before surgery and during follow-up. Means and score items were compared using Wilcoxon signed-rank test.Results: twenty-two knees were evaluated, eleven in each group. Patient's age ranged between eight and fifteen years old. The mean follow-up was 19.4 months. An improvement in the average Kujala scores for the ST group from 51 to 88 and in the QT group from 52 to 97 was shown. Kujala score was statistically significantly higher in the postoperative evaluation with both technics (p-value 0.003 for both groups), no differences were found between both technics. Only one case of patella redislocation was registered during the study period (QT group). Conclusions: we can affirm that MPFL reconstruction is a valid therapeutic option for patellofemoral dislocation and the proposed techniques are reliable choices


Subject(s)
Child , Minimally Invasive Surgical Procedures/methods , Joint Dislocations , Patellofemoral Joint/surgery , Patellofemoral Joint/injuries , Knee Joint/surgery
7.
Rev. ADM ; 77(6): 321-328, nov.-dic. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1151475

ABSTRACT

La periimplantitis se define como la patología inflamatoria e irreversible que afecta al hueso periimplantario y le hace perder soporte y función al implante según la definición del European Workshop on Periodontology (EWOP). La prevalencia estimada de la periimplantitis es de 28 a 77%. Los diferentes protocolos de abordaje de la periimplantitis nos ofrecen diversas posibilidades: destoxificación de la superficie y regeneración, limpieza mecánica y resección del tejido inflamado, extracción del implante, entre otros. El principal problema de los tratamientos regenerativos es limpiar y desintoxicar correctamente la superficie del implante expuesto, ya que al tratarse de superficies generalmente muy rugosas, las bacterias del medio bucal las colonizan con mucha facilidad y es prácticamente imposible eliminar por completo el biofilm. El protocolo de tratamiento para la periimplantitis se basa en un algoritmo de tratamiento, en el que se retiran los implantes gravemente afectados por periimplantitis de forma atraumática, lo cual garantiza la conservación del lecho al 100% al no retirarse volumen óseo, y cuándo deben utilizarse las trefinas, pues las que se utilizan en el protocolo únicamente rompen la unión ósea de los primeros milímetros sin retirarlo. En el siguiente caso clínico mostramos el retratamiento de un caso de periimplantitis en el que se ha realizado una nueva rehabilitación implantosoportada (AU)


Periimplantitis is defined as the inflammatory and irreversible pathology that affects the peri-implantary bone and causes it to lose support and function to the implant as defined by the European Workshop on Periodontology (EWOP). The estimated prevalence of periimplantitis figures ranging from 28 to 77%. The different protocols for approaching periimplantitis offer different possibilities: detoxification of the surface and re-generation, mechanical cleaning and resection of inflamed tissue and extraction of the implant mainly. The main problem with regenerative treatments is to correctly clean and detoxify the surface of the exposed implant, since as these are generally highly rough surfaces, bacteria in the oral environment colonise them very easily and it is practically impossible to completely eliminate the biofilm. This treatment algorithm, in which implants severely affected by periimplantitis are removed atraumatically, guarantees the conservation of the bed at 100% since no bone volume is removed and trephines must be used, since those used in the protocol only break the bone union of the first few millimetres, without removing it. In the following clinical case, we show the re-treatment of a case of peri-implantitis where a new implant-supported rehabilitation has been performed (AU)


Subject(s)
Humans , Male , Aged , Osseointegration , Minimally Invasive Surgical Procedures/methods , Dental Implantation, Endosseous , Peri-Implantitis/therapy , Bone Regeneration , Algorithms , Clinical Protocols , Dental Prosthesis, Implant-Supported , Retreatment , Mouth Rehabilitation/methods
8.
Arq. neuropsiquiatr ; 78(10): 651-659, Oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131690

ABSTRACT

ABSTRACT Intracerebral hemorrhage (ICH), defined as bleeding into the brain parenchyma, is a significant public health issue. Although it accounts for only 10 to 15% of strokes, it is associated with the highest morbidity and mortality rates. Despite advances in the field of stroke and neurocritical care, the principles of acute management have fundamentally remained the same over many years. The main treatment strategies include aggressive blood pressure control, early hemostasis, reversal of coagulopathies, clot evacuation through open surgical or minimally invasive surgical techniques, and the management of raised intracranial pressure.


RESUMO A hemorragia cerebral é definida como um sangramento no parênquima cerebral e representa um importante problema de saúde pública. Ela corresponde a 10 a 15% das causas de AVC e está associada a altas taxas de morbimortalidade. Apesar dos avanços no campo do AVC e dos cuidados neurocríticos, os princípios do manejo agudo permaneceram fundamentalmente os mesmos por muitos anos. As principais estratégias de tratamento incluem controle agressivo da pressão arterial, hemostasia precoce, reversão de coagulopatias, evacuação do coágulo por meio de técnicas cirúrgicas abertas ou cirúrgicas minimamente invasivas e gerenciamento da pressão intracraniana elevada.


Subject(s)
Humans , Cerebral Hemorrhage , Stroke , Blood Pressure/physiology , Brain , Minimally Invasive Surgical Procedures/methods
9.
Rev. cuba. cir ; 59(3): e1008, jul.-set. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1144435

ABSTRACT

RESUMEN Introducción: El tratamiento quirúrgico ha evolucionado desde la exploración abierta bilateral del cuello hasta la cirugía de invasión mínima. En este momento, la paratiroidectomía mínimamente invasiva en pacientes con hiperparatiroidismo primario es la técnica de elección. Objetivo: Describir los resultados del tratamiento quirúrgico del hiperparatiroidismo primario con el uso de la sonda gamma transoperatoria. Métodos: Se realizó un estudio descriptivo y longitudinal, de tipo serie de casos. La muestra estuvo constituida por 29 pacientes con tratamiento quirúrgico radioguiada para el hiperparatiroidismo primario en el Hospital Clínico Quirúrgico Hermanos Ameijeiras entre marzo de 2007 a diciembre de 2014. Resultados: De los 29 pacientes, 21 no presentaban enfermedad tiroidea asociada, tenían una mediana de edad de 52 años, con predominio femenino (80,9 por ciento), la enfermedad renal resultó ser el síntoma más frecuente (52,4 por ciento), el adenoma paratiroideo fue el diagnóstico anatomopatológico con mayor por ciento (85,7 por ciento). Presentaron complicaciones posoperatorias el 38,1 por ciento y la hipocalcemia transitoria estuvo en un 28,6 por ciento. La media de la estadía posoperatoria fue de 3,37 días y la curación de 90,5 por ciento. En los ocho pacientes con enfermedad tiroidea asociada tenían una mediana de edad de 58 años y predominio femenino (62,5 por ciento). Prevaleció el dolor articular y la fatiga (50 por ciento) como síntomas previos y como diagnóstico anatomopatológico el adenoma paratiroideo (62,5 por ciento). Las complicaciones presentes en un 37,5 por ciento y la más frecuente la hipocalcemia transitoria (25,0 por ciento). La curación estuvo en 62,5 por ciento y la media de la estadía posoperatoria en 2,47 días. Conclusiones: Los resultados alcanzados evidencian la utilidad de la cirugía radioguiada en el tratamiento del hiperparatiroidismo primario(AU)


ABSTRACT Introduction: Surgical treatment has evolved from bilateral open neck exploration to minimally invasive surgery. Currently, minimally invasive parathyroidectomy in patients with primary hyperparathyroidism is the technique of choice. Objective: To describe the outcomes of surgical treatment of primary hyperparathyroidism with the use of the intraoperative gamma probe. Methods: A descriptive and longitudinal study of case series was carried out. The sample consisted of 29 patients who received radioguided surgical treatment for primary hyperparathyroidism at Hermanos Ameijeiras Clinical-Surgical Hospital between March 2007 and December 2014. Results: Of the 29 patients, 21 did not present associated thyroid disease. Their median age was 52 years. They were predominantly female (80.9%). Kidney disease was the most frequent symptom (52.4 percent). Parathyroid adenoma was the anatomopathological diagnosis with the highest percentage value (85.7 percent). 38.1 percent presented postoperative complications and transient hypocalcemia accounted for 28.6 percent. The mean for postoperative stay was 3.37 days and for healing was 90.5 percent. In the eight patients with associated thyroid disease, the mean age was 58 years, and there was predominance of the female sex (62.5 percent). Joint pain and fatigue, accounting for 50 percent, prevailed as previous symptoms; while parathyroid adenoma, accounting for 62.5 percent, prevailed as anatomopathological diagnosis. Complications were present in 37.5 percent and the most frequent was transient hypocalcemia (25.0 percent). Healing accounted for 62.5 percent and the mean postoperative stay was 2.47 days. Conclusions: The results obtained show the usefulness of radioguided surgery in the treatment of primary hyperparathyroidism(AU)


Subject(s)
Humans , Female , Middle Aged , Parathyroidectomy/methods , Minimally Invasive Surgical Procedures/methods , Hyperparathyroidism, Primary/therapy , Epidemiology, Descriptive , Longitudinal Studies
10.
Arq. bras. med. vet. zootec. (Online) ; 72(3): 695-702, May-June, 2020. ilus, tab
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1128849

ABSTRACT

Com o objetivo de promover, por meio de acesso único e com o uso de endoscópio flexível, ampla exploração da cavidade peritoneal de equinos em estação, foi concebida uma cânula laparoscópica para dar sustentação ao endoscópio e possibilitar o acesso sob visualização. O procedimento foi realizado a partir da fossa paralombar. Após pequena incisão cutânea, o endoscópio foi inserido na cânula e os músculos e o peritônio foram divulsionados mediante rotação da cânula. Logo depois da perfuração do peritônio, foi realizada a exploração da cavidade e a identificação das estruturas. Em seguida à exploração do lado ipsilateral ao acesso, realizou-se a transposição do conjunto cânula/endoscópio ventralmente à porção caudal do cólon descendente, seguida de exploração do lado contralateral. Concluída a técnica, foi executado, para fins de comparação, o mesmo procedimento por meio da fossa paralombar contralateral. Foi possível a transposição do conjunto cânula/endoscópio para o lado contralateral ao acesso em todos os procedimentos. Também foi possível a identificação da maioria das estruturas abdominais tanto pelo acesso esquerdo quanto pelo direito. A abordagem por acesso único mostrou-se viável para a exploração ampla da cavidade peritoneal, demonstrando ser uma alternativa à técnica laparoscópica convencional.(AU)


A laparoscopic cannula was designed to support a single access approach with a flexible endoscope for the wide exploration of the peritoneal cavity of standing horses. It provides support to the endoscope and allows access to the peritoneal cavity with a visual aid. This procedure was performed through the paralumbar fossa. After a small cutaneous incision, the endoscope was inserted into the cannula, and the muscles and peritoneum were divulsed through the rotation of the cannula. After the peritoneal perforation, cavity exploration and identification of structures were performed. After the exploration of the ipsilateral side of the access, the cannula/endoscope was transposed ventrally to the caudal portion of the descending colon; this was followed by the exploration of the contralateral side. Once this process was completed, the same procedure was performed through the contralateral paralumbar fossa for comparison. It was possible to transpose the cannula/endoscope set to the contralateral access side in all procedures. Further, it was possible to identify most of the abdominal structures in both the left and right access. This single access approach proved to be feasible for the extensive exploration of the peritoneal cavity, thereby indicating it can be an alternative to the conventional laparoscopic technique.(AU)


Subject(s)
Animals , Peritoneum/diagnostic imaging , Endoscopes/veterinary , Video-Assisted Surgery/veterinary , Cannula , Horses , Minimally Invasive Surgical Procedures/methods
11.
Rev. argent. coloproctología ; 31(2): 63-69, jun. 2020. ilus, tab
Article in English, Spanish | LILACS | ID: biblio-1117012

ABSTRACT

Introducción: La introducción del sistema Da Vinci, ha revolucionado el campo de la cirugía mínima invasiva en el cual el cirujano tiene control de la cámara 3D y los instrumentos son de gran destreza y confort ergonómico, acortando la curva de aprendizaje quirúrgica. Objetivo: Describir nuestra experiencia inicial de cirugía robótica colorectal en un hospital de comunidad cerrada de la Ciudad Autónoma de Buenos Aires. Materiales y Método: Estudio retrospectivo descriptivo sobre una base prospectiva de cirugías colorectales robóticas realizadas por el mismo equipo quirúrgico desde mayo de 2016 a abril de 2019. Resultados: Se operaron 41 pacientes. Trece de ellos fueron colectomías derechas, 17 colectomías izquierdas y 11 cirugías de recto. El tiempo quirúrgico promedio fue de 170 minutos (90-330), la estadía hospitalaria de 4 días (3-30), la tasa de conversión de 7,31% (3/41 pacientes) y la tasa de dehiscencia anastomótica del 9,75% (4/41 pacientes). Morbilidad global del 19.5% (8/41 pacientes). Conclusión: Hemos repasado los resultados iniciales de nuestra experiencia en cirugía robótica colorectal en un número reducido de casos, pero suficiente para evaluar la seguridad y reproducibilidad del método al comienzo de una curva de aprendizaje.


Introduction: The introduction of the Da Vinci System, has revolved the field of invasive minimal surgery in which the surgeon has control of the 3d camera and the instruments are of great strength and ergonomic comfort by cutting the surgical learning curve. Objective: Of this preliminary presentation is to describe our initial experience of colorectal robotic surgery in a closed community hospital of the Autonomous City of Buenos Aires. Materials and Method: Retrospective descriptive study on a prospective basis of robotic colorectal surgeries performed by the same surgical team from May 2016 to April 2019.Results: 41 patients were operated. 13 of them were right colectomies, 17 left colectomies and 11 rectum surgeries. The average surgical time was 170 minutes (90-330), the average hospital stay of 4 days (3-30), the conversion rate of 7.31% (3/41 patients) and the anastomotic dehiscence rate of 9 , 75% (4/41 patients). Overall morbidity of 19.5% (8/41 patients).Conclusion: We have reviewed the initial results of our experience in colorectal robotic surgery in a reduced number of cases but sufficient to evaluate the security and reproducibility of the methodic learning of a learning curve.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Colorectal Neoplasms/surgery , Colorectal Surgery/methods , Robotic Surgical Procedures/methods , Retrospective Studies , Treatment Outcome , Colectomy/methods , Minimally Invasive Surgical Procedures/methods , Proctectomy/methods , Hospitals, Community
12.
Rev. cir. (Impr.) ; 72(1): 17-21, feb. 2020. tab, ilus
Article in Spanish | LILACS | ID: biblio-1092885

ABSTRACT

Resumen Objetivo Comunicar la experiencia en el tratamiento de pectus excavatum en el Instituto Nacional del Tórax. Material y Método: Estudio descriptivo con seguimiento. Se recolectaron datos de las variables de interés, mediante la revisión de fichas clínicas. Se incluyeron pacientes operados entre marzo de 2007 y abril de 2018. Resultados Se incluyeron 86 pacientes operados con técnica mínimamente invasiva en el período descrito. De ellos, 74 pacientes de sexo masculino. El promedio de edad al momento de la cirugía fue de 17,8 años. El principal motivo de consulta fue por desmedro estético que correspondió al 41,8% de los pacientes. Salvo en 1 paciente, en todo el resto se ocupó una sola barra. En nuestra serie hubo 12 pacientes que presentaron alguna complicación operatoria y 1 paciente fallecido. Hasta el cierre del seguimiento se retiraron 61 barras, 2 de ellas previo al período estipulado de tratamiento, por morbilidad. Hay 20 barras in situ y 4 pacientes de los cuales no se tiene registro por abandono de controles. Discusión El pectus excavatum es la más frecuente de las deformidades de la pared torácica, es 4 a 6 veces más frecuente en hombres que en mujeres. En general los pacientes son asintomáticos, aunque algunos pueden presentar síntomas cardiopulmonares. La reparación con cirugía mínimamente invasiva con técnica de Nuss aparece hoy en día como el gold standard de manejo. Conclusión El manejo de los pacientes con pectus excavatum en nuestra Institución se asemeja a lo reportado en la literatura internacional. Nuestros esfuerzos deben apuntar a disminuir la morbimortalidad asociada.


Aim To communicate the experience in the treatment of pectus excavatum in the National Institute of Thorax. Materials and Method: Descriptive study with follow-up. Data of variables of interest were collected through the review of clinical records. Patients operated between March 2007 and April 2018 were included. Results 86 patients operated with the Nuss technique were included in the period described. Of them, 74 male patients. The average age at the time of surgery was 17.8 years. The main reason for consultation was due to cosmetic detriment that corresponded to 41.8% of the patients. Except in 1 patient, in all the rest a single bar was occupied. In our series, there were 12 patients who presented some operative complication and 1 patient died. Up to the end of the follow-up, 61 bars were removed, 2 of them in non-scheduled surgery. There are 20 bars in situ and 4 patients of which there is no registration due to abandonment of controls. Discussion Pectus excavatum is the most frequent of the deformities of the chest wall, it is 4 to 6 times more frequent in men than in women. In general, patients are asymptomatic, although some may have cardiopulmonary symptoms. The repair with minimally invasive surgery with Nuss technique appears today as the goldstandard of management. Conclusion The management of patients with pectus excavatum in our Institution is similar to that reported in the international literature. Our efforts should aim to reduce the associated morbidity and mortality.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Prostheses and Implants , Prosthesis Implantation/methods , Funnel Chest/surgery , Funnel Chest/therapy , Tomography, X-Ray Computed , Treatment Outcome , Minimally Invasive Surgical Procedures/methods , Orthopedic Procedures/methods , Prosthesis Implantation/adverse effects , Funnel Chest/diagnostic imaging
13.
Rev. Col. Bras. Cir ; 47: e20202501, 2020. tab, graf
Article in English | LILACS | ID: biblio-1136552

ABSTRACT

ABSTRACT Objective: the first robotic pancreatic resection in Brazil was performed by our team in 2008. Since March 2018, a new policy prompted us to systematically employ the robot in all minimally invasive pancreatic surgery. The aim of this paper is to review our experience with robotic pancreatic resection. Methods: all patients who underwent robotic pancreatic resection from March 2018 through December 2019 were identified. Descriptive data were collected. Preoperative variables included age, sex, and indication for surgery. Intraoperative variables included operative time, bleeding, blood transfusion. Results: 105 patients underwent robotic pancreatectomy. Median age was 60.5 years old. Fifty-five patients were female. 51 patients underwent robotic pancreatoduodenectomies, 34 distal pancreatectomy. Morbidity was 23.8%, mainly related to postoperative pancreatic fistula and one death occurred (mortality of 0.9%). Three patients (2.8%) were converted to open surgery. Four patients had delayed gastric emptying and two presented bleeding. Twenty-four patients had pancreatic fistula that was treated conservatively with late removal of the pancreatic drain. No patient required percutaneous drainage, reintervention or hospital readmission. Conclusions: the robotic platform is useful for the reconstruction of the alimentary tract after pancreatoduodenectomy or after central pancreatectomy. It may increase the preservation of the spleen during distal pancreatectomies. Pancreas sparing techniques, such as enucleation, resection of uncinate process and central pancreatectomy, should be used to avoid exocrine and/or endocrine insufficiency. Robotic resection of the pancreas is safe and feasible for selected patients. It should be performed in specialized centers by surgeons with experience in both open and minimally invasive pancreatic surgery.


RESUMO Objetivo: a primeira ressecção pancreática robótica no Brasil foi realizada por nossa equipe em 2008. Desde março de 2018, uma nova política nos levou a empregar sistematicamente o robô em todas cirurgias pancreáticas minimamente invasivas. O objetivo deste artigo é revisar nossa experiência com a ressecção pancreática robótica. Métodos: todos os pacientes submetidos a ressecção pancreática robótica de 2018 a 2019 foram incluídos. Variáveis pré- e intraoperatórias como idade, sexo, indicação, tempo cirúrgico, sangramento, diagnóstico, tamanho do tumor foram analisados. Resultados: 105 pacientes foram submetidos a pancreatectomia robótica. A idade mediana dos pacientes foi de 60,5 anos. 55 pacientes eram do sexo feminino. 51 pacientes foram submetidos a pancreatoduodenectomia, 34 pancreatectomia distal. A morbidade foi de 23,8% e ocorreu um óbito (mortalidade de 0,9%). Três pacientes (2,8%) tiveram a operação convertida para aberta. Quatro pacientes apresentaram retardo no esvaziamento gástrico e dois apresentaram sangramento. Vinte e quatro pacientes apresentaram fístula pancreática tratada de forma conservadora com remoção tardia do dreno pancreático. Nenhum paciente necessitou de drenagem percutânea, reintervenção ou readmissão hospitalar. Conclusões: a plataforma robótica é útil para a reconstrução do trato alimentar após pancreatoduodenectomia ou após pancreatectomia central. Pode aumentar a preservação do baço durante pancreatectomias distais. Técnicas poupadoras de pâncreas, como enucleação, ressecção de processo uncinado e pancreatectomia central, devem ser usadas para evitar insuficiência exócrina e/ou endócrina. A ressecção robótica do pâncreas é segura e viável para pacientes selecionados. Deve ser realizada em centros especializados por cirurgiões com experiência em cirurgia pancreática aberta e minimamente invasiva.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Pancreatectomy/methods , Pancreaticoduodenectomy/methods , Minimally Invasive Surgical Procedures/methods , Robotic Surgical Procedures/methods , Pancreatic Neoplasms/surgery , Brazil , Retrospective Studies , Laparoscopy/methods , Middle Aged
14.
Rev. Col. Bras. Cir ; 47: e20202590, 2020. graf
Article in English | LILACS | ID: biblio-1136535

ABSTRACT

ABSTRACT Introduction: the number of hip fractures is estimated to increase from 1.66 million in 1990 to 6.26 million by 2050. Internal fixation is the most common surgical treatment for intertrochanteric fractures. Objectives: the objective of the present research is to describe a minimally invasive technique with a modified instrument for the treatment of stable proximal femoral trochanteric fractures using the standard DHS, classified as Tronzo types 1 and 2 (AO 31A1.2), and presenting a case series. Methods: a case was selected to present the technique. Patients operated by this technique undergo a clinical evaluation and preoperative preparation as routine. The criteria for inclusion in the study were the presence of stable fracture of the proximal femur verified by two hip specialist orthopedists, and operated by the minimally invasive technique with a modified instrument using a standard DHS. Exclusion criteria were cases of patients operated for unstable fractures, and the use of other surgical techniques. A case series of 98 patients was performed and discussed. Results: minimally invasive technique with a modified instrument using the standard DHS device can reduce bleeding, it decreases soft tissue injuries, surgical time, and hospital stay, as any other MIPO procedures. Ninety-eight patients underwent the operation (Tronzo types I and II), 59 female and 39 male, ages from 50 to 85 years old. Immediate post-operative complications were shortening of the lower limb, loss of fracture reduction, and death by clinical complications. Conclusion: the present study describes a minimally invasive surgical technique using a modified instrument to perform proximal femoral osteosynthesis for stable trochanteric fractures, using the standard DHS.


RESUMO Introdução: estima-se que o número de fraturas de quadril aumente de 1,66 milhão em 1990 para 6,26 milhões em 2050. A fixação interna é o tratamento cirúrgico mais comumente utilizado para as fraturas intertrocantéricas. Objetivos: o objetivo da presente investigação é descrever uma técnica minimamente invasiva com um instrumento modificado para o tratamento de fraturas trocantéricas femorais proximais estáveis, classificadas como tipos I e II de Tronzo (AO 31A1.2), usando o DHS padrão, e apresentar uma série de casos. Métodos: foi selecionado um caso aleatório para apresentar a técnica. Os pacientes operados por essa técnica passam por avaliação clínica e preparo pré-operatório de rotina. Os critérios para inclusão no estudo foram a presença de fratura estável do fêmur proximal, verificada por dois ortopedistas especialistas em quadril, e operada pela técnica minimamente invasiva com um instrumento modificado usando um DHS padrão. Os critérios de exclusão foram os casos de pacientes operados por fraturas instáveis e o uso de outras técnicas cirúrgicas. Uma série de casos de 98 pacientes foi realizada e é discutida. Resultados: a técnica minimamente invasiva com o instrumento modificado usando o dispositivo DHS padrão pode reduzir a hemorragia, as lesões dos tecidos moles, o tempo cirúrgico e a estadia hospitalar, tal como quaisquer outros procedimentos de osteossíntese minimamente invasivos. Noventa e oito pacientes foram operados (tipos I e II de Tronzo), 59 do sexo feminino e 39 do masculino, com idades entre 50 e 85 anos. As complicações pós-operatórias imediatas foram encurtamento do membro inferior, perda da redução da fratura e morte por complicações clínicas. Conclusão: o presente estudo descreve uma técnica cirúrgica minimamente invasiva, utilizando um instrumento modificado para realizar osteossíntese femoral proximal para fraturas trocantéricas estáveis, utilizando o DHS padrão.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Minimally Invasive Surgical Procedures/methods , Femoral Fractures/surgery , Fracture Fixation, Internal/methods , Hip Fractures/surgery , Reference Standards , Bone Screws , Treatment Outcome , Middle Aged
15.
Artrosc. (B. Aires) ; 27(4): 208-212, 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1178154

ABSTRACT

Las rupturas del ligamento cruzado anterior (LCA) son de las lesiones ligamentarias más frecuentes de la rodilla. Hay factores que predisponen y aumentan el riesgo de sufrirlas; estos se dividen en extrínsecos e intrínsecos. Estos últimos están relacionados con la anatomía del paciente y pueden predecir un riesgo de lesión ligamentaria. Dentro de estos incluimos la talla, el peso, la inclinación tibial, el eje del miembro, la laxitud anteroposterior, el tamaño del LCA, el ángulo Q y las dimensiones y formas del espacio intercondíleo femoral. Un espacio estrecho aumenta el riesgo de contacto del ligamento cruzado anterior contra la pared y el techo de la escotadura intercondílea, aumentando el índice de ruptura.Habitualmente no se realiza intercondiloplastia ya que la posición anatómica de las reconstrucciones reproduce la anatomía del ligamento cruzado anterior, el cual no produce fricción con las paredes del intercóndilo. Sin embargo, en pacientes en los cuales se detecta el espacio intercondíleo estrecho, o en forma de A (A shape) según la clasificación de Fu presentada en 2010, se realiza la intercondiloplastia amplia para buscar el punto isométrico femoral y así evitar la fricción del injerto, el déficit de extensión y de esta forma mejorar el resultado funcional.El objetivo de este trabajo es describir cómo identificar un espacio intercondíleo estrecho, en forma de A, y exponer la técnica quirúrgica de la intercondiloplastia en la reconstrucción aguda del ligamento cruzado anterior


ACL tears are the most frequent ligament injuries of the knee. There are factors that predispose and increase the risk of suffering this type of injury. They are divided into extrinsic and intrinsic. The latter are related to the patient's anatomy and can predict a risk of ligament injury. These include height, weight, tibial slope, limb axis, posterior anterior laxity, ACL size, Q angle, and dimensions and shapes of the femoral intercondylar space. A narrow space increases the risk of contact of the anterior cruciate ligament against the anterior wall and the roof of the intercondylar stool increases the rate of rupture.Notchplasty is not usually performed, since the anatomical position of the reconstruction reproduces the anatomy of the anterior cruciate ligament, which does not produce friction with the intercondylar walls. However, in patients in whom the narrow intercondylar space is detected, or in the "A Shape", according to Fu's classification, a wide notchplasty is performed to look for the femoral isometric point, avoiding friction of the injection, the extension deficit and improve the functional result.The objective is to identify "A Shape" notch and to describe a notchplasty technique in acute ACL reconstruction


Subject(s)
Acute Disease , Anterior Cruciate Ligament , Minimally Invasive Surgical Procedures/methods , Femur/surgery , Anterior Cruciate Ligament Reconstruction/methods , Knee Joint/surgery
16.
Int. arch. otorhinolaryngol. (Impr.) ; 23(4): 422-426, Out.-Dez. 2019. ilus, tab
Article in English | LILACS | ID: biblio-1024327

ABSTRACT

Introduction: Chronic rhinosinusitis (CRS) is a highly prevalent pathology in our society. Due to the prevalence of this condition and to the persisting symptoms despite an appropriate medical treatment, surgical techniques are often required. Lately, minimal invasive techniques have been described, such as lacrimal diversion devices (LDDs). This technique offers a fast and convenient choice for delivery of sinus irrigation and topical medication. Objective: We aimed to describe our experience with LDDs and evaluate the safety and effectiveness of the procedure in patients with moderate to severe CRS without nasal polyposis (CRSsNP) and persistent symptomatology despite medical therapy. Methods: A total of 7 patients underwent bilateral lacrimal stents placement in the operating room. A retrospective observational study was conducted. The Sino-Nasal Outcome Test-20 (SNOT-20) survey was performed and the score obtained was compared before and 1 month after the procedure. Results: The LDDs were used for an average of 80 days. During the follow-up, only three patients had a mild complication with the device (granuloma in the punctum, obstruction, and early extrusion). The mean baseline SNOT-20 score dropped significantly ( p = 0.015) from 25.85 to 11.57 (mean: - 14.29) 1 month after the procedure. Conclusion: According to our experience and results, the use of LDD is a novel, feasible, and less invasive technique to treat refractory CRS. It reduces the risk of mucosal stripping, provides short-term outcomes, and the surgical procedure does not require advanced training in endoscopic sinus surgery. Moreover, it can be performed in-office under local anesthesia or sedation (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Sinusitis/surgery , Stents , Rhinitis/surgery , Nasal Surgical Procedures/methods , Retrospective Studies , Minimally Invasive Surgical Procedures/methods , Lacrimal Apparatus/surgery
17.
Rev. cuba. oftalmol ; 32(3): e781, jul.-set. 2019.
Article in Spanish | LILACS, CUMED | ID: biblio-1099087

ABSTRACT

RESUMEN La cirugía con incisiones de pequeño tamaño comienza a ser una norma en la medicina actual, la cual ha ganado popularidad en muchos campos, entre ellos el de la Oftalmología. Una muestra de esto son las pequeñas incisiones para la facoemulsificación, la vitrectomía sin sutura 25 G y los pequeños dispositivos de drenaje de glaucoma. Algo similar ocurre con la cirugía de estrabismo mínimamente invasiva (minimally invasive strabismus surgery) al permitir alcanzar iguales resultados motores y sensoriales que con la técnica de abordaje de los músculos extraoculares a nivel del limbo. Esta revisión bibliográfica ofrece nuevos conocimientos teóricos sobre una técnica mínimamente invasiva para el abordaje del estrabismo, que originará mejores resultados estéticos y la satisfacción de los pacientes con esta afección, así como su rápida reincorporación a las distintas ocupaciones laborales, a las escuelas y a las tareas habituales(AU)


ABSTRACT Surgery based on small size incisions is gradually becoming standard practice in health care, gaining popularity in many specialties, among them ophthalmology. Evidence of this are the small incisions made for phacoemulsification, sutureless 25-G vitrectomy, and the small glaucoma drainage devices. Something similar occurs in minimally invasive strabismus surgery, where the same motor and sensory results are achieved as with limbal approach of the extraocular muscles. The present bibliographic review provides new theoretical information about a minimally invasive strabismus surgery technique leading to better esthetic results and greater satisfaction by patients suffering from this disorder, as well as their quick reincorporation to their work, school and regular daily activities(AU)


Subject(s)
Humans , Strabismus/surgery , Minimally Invasive Surgical Procedures/methods , Reconstructive Surgical Procedures/methods , Review Literature as Topic
18.
Rev. cir. (Impr.) ; 71(4): 352-358, ago. 2019. graf, ilus
Article in Spanish | LILACS | ID: biblio-1058284

ABSTRACT

Resumen La cirugía ha pasado de ser una ciencia rudimentaria caracterizada por el padecimiento de insufribles dolores por falta de anestésicos, de realizarse en lugares poco acondicionados y de utilizarse instrumental poco ortodoxo con consecuencias nefastas para el desenlace de los procedimientos debido principalmente a las infecciones, a ser un campo desarrollado donde la tecnología juega un rol trascendental para el objetivo final que es el bienestar del paciente. En las últimas décadas, la cirugía ha pasado del acceso abierto al laparoscópico, cirugía por orificios naturales (NOTES), cirugía laparoscópica de puerto único, hasta la cirugía robótica. Es un hecho que estamos en un momento de la historia de la humanidad en el cual el desarrollo de las tecnologías a cambiado nuestra vida cotidiana, así como también el de nuestra practica quirúrgica diaria y no podemos ser ajenos a esta. El propósito de esta revisión es mostrar la situación actual de la cirugía robótica gastrointestinal y sus perspectivas a futuro. Para esto se realizó una búsqueda en la base de datos medline con las palabras claves "review robotic surgery, robotic digestive surgery, robotic bariatric surgery, robotic esophagectomy, robotic gastrectomy, robotic hepatectomy, robotic pancreatectomy, robotic hernia repair". Además una búsqueda de datos en la web sobre "intutive investorpresentation, future of robotic surgery, digital surgery, new robotic system in surgery, trends in robotic surgery".


It is a fact that we are at a moment in the history of humanity in which the development of technologies has changed our daily lives, as well as that of our daily surgical practice. The fast evolution in technology has allowed surgery to evolve from a rudimentary science characterized by painful, highly invasive procedures, to a rapidly developing and precise field with ever improving patient outcomes. In recent decades, gastrointestinal surgery has gone from open access to laparoscopy, natural orifice transluminal endoscopic surgery (NOTES), single-port laparoscopic surgery, and more recently, robotic assisted surgery. The purpose of this review is to show the current situation of robotic gastrointestinal surgery and its future prospects. A literature review was conducted in the Medline database with the keywords "revision of robotic surgery, robotic digestive surgery, bariatric robotic surgery, robotic esophagectomy, robotic gastrectomy, robotic hepatectomy, robotic pancreatectomy, robotic hernia repair". In addition, online search engine data was conducted using the following key words "intutive investor presentation, future of robotic surgery, digital surgery, new robotic system in surgery, trends in robotic surgery"


Subject(s)
Humans , Digestive System Surgical Procedures/trends , Robotic Surgical Procedures/trends , Digestive System Surgical Procedures/methods , Robotics/instrumentation , Laparoscopy/methods , Minimally Invasive Surgical Procedures/methods
19.
Braz. j. otorhinolaryngol. (Impr.) ; 85(4): 427-434, July-Aug. 2019. graf
Article in English | LILACS | ID: biblio-1019590

ABSTRACT

Abstract Introduction: One of the main concerns in endoscopic endonasal approaches to the skull base has been the high incidence and morbidity associated with cerebrospinal fluid leaks. The introduction and routine use of vascularized flaps allowed a marked decrease in this complication followed by a great expansion in the indications and techniques used in endoscopic endonasal approaches, extending to defects from huge tumours and previously inaccessible areas of the skull base. Objective: Describe the technique of performing endoscopic double flap multi-layered reconstruction of the anterior skull base without craniotomy. Methods: Step by step description of the endoscopic double flap technique (nasoseptal and pericranial vascularized flaps and fascia lata free graft) as used and illustrated in two patients with an olfactory groove meningioma who underwent an endoscopic approach. Results: Both patients achieved a gross total resection: subsequent reconstruction of the anterior skull base was performed with the nasoseptal and pericranial flaps onlay and a fascia lata free graft inlay. Both patients showed an excellent recovery, no signs of cerebrospinal fluid leak, meningitis, flap necrosis, chronic meningeal or sinonasal inflammation or cerebral herniation having developed. Conclusion: This endoscopic double flap technique we have described is a viable, versatile and safe option for anterior skull base reconstructions, decreasing the incidence of complications in endoscopic endonasal approaches.


Resumo Introdução: Uma das principais preocupações em abordagens endoscópicas endonasais da base do crânio tem sido a alta incidência e morbidade associada a fístulas liquóricas. A introdução e o uso rotineiro de retalhos vascularizados permitiram uma acentuada redução dessa complicação, seguida por uma grande expansão nas indicações e técnicas utilizadas nas abordagens endoscópicas endonasais, incluindo grandes tumores e áreas anteriormente inacessíveis da base do crânio. Objetivo: Descrever a técnica cirúrgica realizando uma reconstrução endoscópica multicamadas da base anterior do crânio com duplo retalho, sem craniotomia. Método: Descrição passo a passo da técnica endoscópica com duplo retalho (retalhos vascularizados nasoseptal e pericraniano e enxerto livre de fascia lata), utilizados e ilustrados em dois pacientes com meningioma do sulco olfatório submetidos à cirurgia por via endoscópica endonasal. Resultados: Em ambos os pacientes procedeu-se ressecção total macroscópica seguido de reconstrução da base anterior do crânio com os retalhos nasoseptal e pericraniano onlay e enxerto livre de fáscia lata inlay. Os pacientes apresentaram uma excelente recuperação, sem sinais de fístula liquórica, meningite, necrose do retalho, inflamação meníngea crônica ou sinonasal ou hérnia cerebral. Conclusão: A técnica endoscópica de duplo retalho, como descrita, trata-se de uma opção viável, versátil e segura para as reconstruções da base anterior do crânio, diminuindo a incidência de complicações em abordagens cirúrgicas endoscópicas endonasais.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Skull Base Neoplasms/surgery , Reconstructive Surgical Procedures/methods , Endoscopy/methods , Nasal Cavity/surgery , Postoperative Complications , Surgical Flaps , Cadaver , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Cerebrospinal Fluid Rhinorrhea/surgery , Minimally Invasive Surgical Procedures/methods , Meningeal Neoplasms/surgery , Meningeal Neoplasms/diagnostic imaging , Meningioma/surgery , Meningioma/diagnostic imaging
20.
Rev. bras. cir. cardiovasc ; 34(4): 428-435, July-Aug. 2019. tab
Article in English | LILACS | ID: biblio-1020490

ABSTRACT

Abstract Objective: To analyze and summarize the clinical safety and feasibility of minimally invasive video-assisted mitral valve replacement via a right thoracic minimal incision in patients aged over 65 years. Methods: The clinical data of 45 patients over 65 years old who had mitral valve disease were analyzed retrospectively from January 2014 to January 2017 at Union Hospital, Fujian Medical University. The patients were divided into two groups; 20 patients in group A, who underwent minimally invasive video-assisted mitral valve replacement via a right thoracic minimal incision, and 25 patients in group B, who underwent conventional mitral valve replacement. We collected and analyzed their relevant clinical data. Results: The operation was completed successfully in both groups. Compared with group B, group A was clearly superior for postoperative analgesia time, postoperative hospital length of stay, thoracic drainage liquid, blood transfusion, and length of incision. There were no differences between the two groups in postoperative severe complications and mortality. More patients in group B had pulmonary infections and poor incision healing, while more patients in group A had postoperative pneumothorax and subcutaneous emphysema. Conclusion: In patients aged over 65 years, minimally invasive video-assisted mitral valve replacement with a small incision in the right chest had the same clinical safety and efficacy as the conventional method.


Subject(s)
Humans , Male , Female , Aged , Minimally Invasive Surgical Procedures/methods , Heart Valve Prosthesis Implantation/methods , Video-Assisted Surgery/methods , Heart Valve Diseases/surgery , Mitral Valve/surgery , Postoperative Complications , Thoracotomy/methods , Echocardiography/methods , Retrospective Studies , Surgical Wound
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