Curva de aprendizado de anastomose arteriovenosa com uso de simulador de baixo custo / Arteriovenous anastomosis learning curve using low cost simulator

Resumo Contexto A redução das dificuldades no aprendizado da técnica cirúrgica levou ao surgimento de ferramentas complementares. Este trabalho descreve a curva de aprendizado dos alunos sujeitos da pesquisa, utilizando um modelo alternativo para a prática de anastomose vascular. Objetivos Avaliar a curva de aprendizado da técnica de anastomose vascular e do desenvolvimento de habilidades manuais a partir da utilização de um modelo experimental de baixo custo. Métodos Este trabalho é um estudo experimental e prospectivo, com a realização de anastomoses vasculares do tipo terminolateral em balões de látex durante cinco fases sucessivas, iniciadas após orientação teórico-prática de uma cirurgiã vascular experiente. Os sujeitos foram seis graduandos do curso de Medicina, do terceiro ao quinto ano, da Universidade Federal da Paraíba (UFPB), João Pessoa, Paraíba, Brasil. A interpretação do material coletado acerca da qualidade das anastomoses e do tempo utilizado seguiu a análise de agrupamento. Resultados Houve redução do tempo de realização das anastomoses de todos os alunos, com diferença estatística da fase 1 quando comparada às fases 4 e 5, bem como tendência crescente no índice de qualidade ao longo das fases. Porém, não foi detectada diferença estatística a partir do teste de Friedman, apropriado para dados com nível de mensuração ordinal (escala de 1 a 5 na avaliação da qualidade). Conclusões O modelo de treinamento utilizado foi efetivo para incremento do aprendizado dessa técnica, acreditando-se que amostras de maior tamanho ou com maior número de fases em trabalhos futuros poderiam demonstrar redução do tempo associada a melhora da qualidade da anastomose realizada com significância estatística.

Abstract Background In order to reduce difficulties with learning surgical techniques, supplementary tools for training were developed. This paper describes the learning curve followed by student volunteer research subjects who used an alternative model for practicing vascular anastomosis. Objectives To evaluate the vascular anastomosis technique learning curve and development of manual skills using a low-cost experimental model. Methods Experimental and prospective study using end-to-side vascular anastomosis in latex balloons over five successive phases, initiated after theoretical and practical guidance given by experienced vascular surgeon. The study subjects were six undergraduate medical students from Universidade Federal da Paraíba (UFPB), João Pessoa, PB, Brazil, in their third to fifth years of the course. Cluster analysis was used to interpret the data collected on the quality of anastomoses and the time taken. Results The time taken to perform anastomosis reduced for all students, with statistical differences from phase 1 compared to phases 4 and 5. There was also a trend to increasing scores on the quality index as the phases progressed. However, no statistical differences were detected using the Friedman test, which is appropriate for data measured with ordinal levels (quality was assessed on a scale of 1 to 5). Conclusions It was found that the training model used was effective for increasing learning of this technique. It is believed that future studies with larger samples or a higher number of phases could demonstrate both reduced time and improved quality of the anastomoses performed with statistical significance.

New training model using chickens intestine for pediatric intestinal anastomosis

Abstract Purpose: To develop a new low-cost, easy-to-make and available training model using chickens' intestine for infant intestinal anastomosis. Methods: Segments of chicken intestine were used to create an intestinal anastomosis simulator. We tried to perform an end-to-end, end-to-side and side-to-side anastomosis. Handsewn sutured anastomosis were performed in single layered with interrupted prolene 5-0 suture. The parameters analyzed were cost, intestine's diameter and length, anastomosis patency and flow-through and leakage amount. Results: In all cases it was possible to make the anastomosis in double layered without difficulties, different from the usual ones. There was a positive patency at all anastomoses after the end of the procedure, with no need for reinterventions. Conclusion: The new training model using chickens' intestine for infant intestinal anastomosis is low-cost, easy-to-make and easy available.

Routine use of v-lock® suture for bariatric anastomosis is safe: comparative results from consecutive case series / Uso rotineiro da sutura v-lock® para anastomoses em obesidade é seguro: resultados de estudo clínico comparativo

ABSTRACT Background: In high-income countries, morbid obesity is a growing health problem that has already reached epidemic proportions. When performing a laparoscopic gastric bypass several operative methods exist. Aim: To describe the institutional experience using a knotless unidirectional barbed suture (V-Loc 180/Covidien, Mansfield, MA) to create a hand-sewn gastrojejunostomy (GJ) and jejunojejunostomy (JJ) during bariatric surgery. Methods: Evaluation of a case series of 87 morbidly obese patients who underwent laparoscopic gastric bypass with a hand-sewn gastrojejunostomy (GJA) and jejunojejunostomy (JJA) between 01/2015 and 06/2017. The patients were divided into two groups: in group I, GJA und JJA sutures were performed using the knotless unidirectional barbed suture; in group II, GJA and JJA were sutured with resorbable multifilament thread (Vicryl® 3/0 Ethicon, Livingstone, UK). The recorded data on gender, age, BMI, ASA score, operative time, postoperative morbidity, length of hospital stay, and reoperation, were analyzed and compared. Results: All procedures were completed laparoscopically with no mortality. The mean operative time was 123.23 (±30.631) in group I and 127.57 (±42.772) in group II (p<0.05). The postoperative complications did not differ significantly between the two groups. Early complications were observed for two patients (0.9%) in the barbed suture group and for one patient (0.42%) in the multifilament suture group (p<0.05). In group I two patients (0.9%) required reoperation: on the basis of jejunojejunal stenosis in one patient, and local abscess near the gastrojejunostomy, without a leakage, in the other. In group II one patient (0.42%) required reoperation due to stenosis of the GJA. The duration of hospital admission was similar for both groups: 3.36 (±0.743) days in group I vs. 3.38 (±1.058) days in group II (p<0.05). Conclusion: The novel anastomotic technique is a safe and effective method and can be applied to gastrojejunal anastomosis and jejunojejunal anastomosis in laparoscopic gastric bypass.

RESUMO Racional : Em países de alta renda, a obesidade mórbida é um problema crescente de saúde que já atingiu proporções epidêmicas. Ao realizar um bypass gástrico laparoscópico, existem vários métodos operatórios. Objetivo: Descrever a experiência institucional utilizando uma sutura farpada unidirecional sem nós (V-Loc 180/Covidien, Mansfield, MA) para criar gastrojejunostomia (JJ) e jejunojejunostomia (JJ) costuradas à mão durante a cirurgia bariátrica. Métodos: Avaliação de uma série de casos com 87 pacientes obesos mórbidos submetidos ao bypass gástrico por videolaparoscopia com gastrojejunostomia (JJA) e jejunojejunostomia (JJA) suturados à mão entre 01/2015 e 06/2017. Os pacientes foram divididos em dois grupos; no grupo I, GJA e JJA as suturas foram realizadas com a sutura farpada unidirecional sem nós e, no grupo II, com sutura multifilamentar reabsorvível (Vicryl® 3/0 Ethicon, Livingstone, UK). Foram analisados ​​e comparados os dados registrados sobre gênero, idade, IMC, escore ASA, tempo operatório, morbidade pós-operatória, tempo de internação hospitalar e reoperação. Resultados: Todos os procedimentos foram concluídos por laparoscopia sem mortalidade. O tempo cirúrgico médio foi 123,23 (±30,631) no grupo I e 127,57 (±42,772) no grupo II (p<0,05). As complicações pós-operatórias não diferiram significativamente entre os dois grupos. Complicações precoces foram observadas em dois pacientes (0,9%) no grupo de sutura farpada e um (0,42%) no de sutura multifilamentar (p<0,05). No grupo I, dois pacientes (0,9%) necessitaram de reoperação; um devido à estenose jejunojejunal e abscesso local próximo à gastrojejunostomia, sem vazamento, no outro. No grupo II, um paciente (0,42%) necessitou de reoperação por estenose da GJA. O tempo de internação hospitalar foi semelhante nos dois grupos: 3,36 (±0,743) dias no grupo I vs. 3,38 (±1,058) dias no grupo II (p<0,05). Conclusão: A nova técnica de anastomose é método seguro e eficaz e pode ser aplicado nas anastomoses gastrojejunal e jejunojejunal no bypass gástrico laparoscópico.

A novel approach to lower rectal anastomosis: technique innovation and the preliminary report of twenty cases / Uma nova abordagem para a anastomose retal mais baixa: inovação técnica e relatório preliminar de cinte casos

Background and aims: To describe a practical technique innovation (transanal 'Pull-through' approach) as a feasible, safe and effective alternative to the conventional transabdominal stapler low rectal anastomosis in lesions of minimal anatomical distinction from the adjacent intact mucosa. Material and methods: Prospective case-series of patients with low rectal cancers, familial adenomatous polyposis (FAP) and ulcerative colitis undergoing Pull-through transection and very low rectal anastomosis using linear TA-90 noncutting stapler and circular stapler-cutter. Results: In this series, twenty patients (11 men and 9 women) underwent proctectomy by the transanal Pull-through technique. Barring one of the patients that developed a pelvic abscess in the immediate postop follow-up, surgical procedure and the long-term follow-up period was uncomplicated with no critical findings of leakage, stenosis and bleeding. The postop rate of infection and fecal incontinence was not significantly different between genders and different age groups of the study. The mean operative time was calculated 169.9 ± 11.1 minutes. Conclusion: Pull-through transection procedure using the TA-90 non-cutting stapler is a safe, efficient and economically sound technique implicated in low-lying rectal lesions. The transanal 'Pull-through' approach is particularly helpful in situations where the direct visualization of lower rectal mucosa changes the prognosis through determining the marginal extent of intact/involved mucosa (e.g., FAP, villous adenomas, rectal polyps and post-neoadjuvant chemoradiotherapy tumors).

Experiência e objetivos: Descrever uma inovação técnica prática (abordagem transanal pull-through) como uma alternativa viável, segura e eficaz à anastomose transabdominal retal baixa convencional com grampos em lesões com mínima diferenciação anatômica com respeito à mucosa intacta adjacente. Material e métodos: Estudo prospectivo de série de casos de pacientes com cânceres retais baixos, polipose adenomatosa familiar e colite ulcerativa submetidos à transecção pull-through e a uma anastomose retal muito baixa com o uso de um grampeador linear não cortante TA-90 e um grampeador cortante circular. Resultados: Nesta série, 20 pacientes (11 homens, 9 mulheres) foram submetidos a uma proctectomia pela técnica transanal pull-through. À exceção de um dos pacientes, que apresentou um abcesso pélvico no seguimento pós-operatório imediato, não ocorreram complicações com o procedimento cirúrgico e ao longo do prolongado período de seguimento, nem houve achados críticos de vazamento, estenose ou sangramento. O percentual de infecção e incontinência fecal no pós-operatório não foi significativamente diferente entre gêneros e nas diferentes faixas etárias dos pacientes envolvidos no estudo. O tempo cirúrgico médio foi de 169,9 ± 11,1 minutos. Conclusão: O procedimento de transecção pull-through com o uso do grampeador não cortante TA-90 é técnica segura, eficaz e economicamente confiável para uso em lesões retais baixas. A abordagem transanal pull-through tem particular utilidade em situações nas quais a visualização direta de alterações na mucosa retal mais baixa muda o prognóstico, mediante a determinação da extensão marginal da mucosa intacta/envolvida (p. ex., FAP, adenomas vilosos, pólipos retais e tumores pós-quimiorradioterapia neoadjuvante).

Efficacy and safety of a NiTi CAR 27 compression ring for end-to-end anastomosis compared with conventional staplers: A real-world analysis in Chinese colorectal cancer patients

OBJECTIVES: This study aimed to evaluate the safety and efficacy of a new nickel-titanium shape memory alloy compression anastomosis ring, NiTi CAR 27, in constructing an anastomosis for colorectal cancer resection compared with conventional staples. METHODS: In total, 234 consecutive patients diagnosed with colorectal cancer receiving sigmoidectomy and anterior resection for end-to-end anastomosis from May 2010 to June 2012 were retrospectively analyzed. The postoperative clinical parameters, postoperative complications and 3-year overall survival in 77 patients using a NiTi CAR 27 compression ring (CAR group) and 157 patients with conventional circular staplers (STA group) were compared. RESULTS: There were no statistically significant differences between the patients in the two groups in terms of general demographics and tumor features. A clinically apparent anastomotic leak occurred in 2 patients (2.6%) in the CAR group and in 5 patients (3.2%) in the STA group (p=0.804). These eight patients received a temporary diverting ileostomy. One patient (1.3%) in the CAR group was diagnosed with anastomotic stricture through an electronic colonoscopy after 3 months postoperatively. The incidence of postoperative intestinal obstruction was comparable between the two groups (p=0.192). With a median follow-up duration of 39.6 months, the 3-year overall survival rate was 83.1% in the CAR group and 89.0% in the STA group (p=0.152). CONCLUSIONS: NiTi CAR 27 is safe and effective for colorectal end-to-end anastomosis. Its use is equivalent to that of the conventional circular staplers. This study suggests that NiTi CAR 27 may be a beneficial alternative in colorectal anastomosis in Chinese colorectal cancer patients.

Microanastomosis venosa mecánica coupler®: un importante aporte tecnológico a la microcirugía vascular / Coupler® venous mechanic microanastomosis: an important technological contribution to microvascular surgery

Objetivo: El objetivo del presente trabajo es dar a conocer la experiencia de nuestro grupo de Cirugía Plástica, en sutura mecánica microvascular utilizando el dispositivo Coupler® (Synovis Corp, Birmingham, AL) para las anastomosis venosas realizadas en pacientes sometidos microcirugía reconstructiva. Material y Método: Revisión retrospectiva de los últimos 48 colgajos libres operados entre marzo de 2009 y febrero de 2013. Todas las anastomosis microquirúrgicas venosas fueron realizadas con el dispositivo Coupler® y las anastomosis arteriales con sutura separada o continua de nylon 9-0 ó 10-0. Los datos recolectados fueron: datos personales y médicos del paciente, localización del defecto, colgajo utilizado, diámetro de los vasos, anastomosis arterial, Coupler® utilizado, tiempo de anastomosis, complicaciones postoperatorias, trombosis arterial y trombosis venosa. Resultados: Fueron realizados 48 colgajos libres para reconstrucción de extremidad inferior (n = 25, 52,1 por ciento); cabeza-cuello (n = 15, 31 por ciento); mama (n = 5, 10,4 por ciento) y extremidad superior (n = 3, 6,3 por ciento). Los colgajos utilizados fueron: Anterolateral de muslo o ALT (n = 25, 52,1 por ciento), Radial (n = 10, 20,8 por ciento), Perforante de Arteria Epigástrica Inferior o DIEP (n = 5, 10,4 por ciento), Dorsal Ancho (n = 2, 4,2 por ciento), Recto Abdominal (n = 2, 4,2 por ciento), Fíbula (n = 2, 4,2 por ciento), Escápula (n = 1, 2,1), y Gracilis (n = 1, 2,1 por ciento). El diámetro promedio del dispositivo Coupler® utilizado en el total de los casos fue de 2,51 +/- 0,46 mm. El tiempo promedio para la anastomosis venosa fue de 13,5 +/- 7,3 min. Un total de 4 colgajos se perdieron (8,3 por ciento), ninguno a causa de falla venosa. Conclusiones: El Coupler® venoso es un elemento seguro, efectivo y rápido para la realización de las anastomosis microquirúrgicas, es fácil de aprender y su implementación debiese ser considerada en todo centro donde se realice microcirugía.

Aim: The aim of the present paper is to show the experience of the Plastic Surgery Division at the University of Chile Clinical Hospital, with the Coupler® anastomotic device (Synovis Corp, Birmingham, AL) for venous microanastomoses in patients undergoing reconstructive microsurgery. Material and Methods: A retrospective review of 48 consecutive patients with free flaps between March 2009 and in February 2013. All microsurgical venous anastomoses were performed with the Coupler® device and the arterial anastomoses with interrupted or continuous 9-0 or 10-0 nylon sutures. The collected data were: personal and medical patient information, location of the defect, flap used, vessels diameter, arterial anastomoses, Coupler® used, time of anastomosis, postoperative complications, arterial and venous thrombosis. Results: A total of 48 free flaps were performed for reconstruction of lower extremity (n = 25, 52.1%); head-neck (n = 15, 31%); breast (n = 5, 10.4%) and upper extremity (n = 3, 6.3%). The flaps used were: Anterolateral thigh or ALT (n = 25, 52.1%), Radial (n = 10, 20.8%), Deep Inferior Epigastric Artery Perforator or DIEP (n = 5, 10.4%), Latisimus Dorsi (n = 2, 4.2%), Rectus Abdominus (n = 2, 4.2%), Fibula (n = 2, 4.2%), Scapula (n = 1, 2.1%), and Gracilis (n = 1, 2.1%). The Coupler device average diameter used was 2.51 ± 0.46 mm. The average time for the venous anastomosis was 13.5 ± 7.3 minutes. A total of 4 flaps were lost (8.3%), none due to venous thrombosis. Conclusions: The Coupler® System for venous anastomoses is a safe, effective and quick method for microsurgical anastomoses, it is easy to learn and its implementation should be considered in every microvascular surgery center.

Comparison of standard 4-row versus 6-row3-D linear cutter stapler in creation of gastrointestinal system anastomoses: a prospective randomized trial

OBJECTIVE: This prospective study was conducted to compare the clinical outcomes of a 6-row 3-D linear cutter with the standard 4-row linear cutter in patients who underwent elective gastrointestinal surgery anastomosis. METHOD: Patients who underwent elective open gastrointestinal surgery that included stapled anastomosis using a linear cutter (Proximate®, Ethicon Endo-Surgery, Cincinnati, OH) between January 2011 and May 2011 were included in the study. The patients were randomly assigned to two groups according to the linear cutter that was used in the surgery: the standard 4-row cutter (the S group) or the new 6-row cutter (the N group). The groups were compared based on the patient demographic data, the laboratory parameters, the preoperative diagnosis, the surgery performed, the operation time, intra-or postoperative complications, the time to oral tolerance and the length of the hospital stay. RESULTS: The S group included 11 male and nine female patients with a mean age of 65 ± 12 (35-84) years, while the N group included 13 male and eight female patients with a mean age of 62 ±11 (46-79) years (p =0.448, p = 0.443, respectively). Anastomotic line bleeding was observed in eight (40%) patients in the S group and in one (4.7%) patient in the N group (p = 0.006). Dehiscence of the anastomosis line was observed in two (10%) patients in the S group and none in the N group (p =0.131). Anastomotic leakage developed in three (15%) patients in the S group and in one (4.7%) patient in the N group (p = 0.269). The mean hospital stay was 12.65 ± 6.1 days in theS group and 9.52 ± 2.9 days in the N group (p = 0.043). CONCLUSION: The 6-row 3-D linear cutter is a safe and easily applied instrument that can be used to create anastomoses in gastrointestinal surgery. The new stapler provides some usage benefits and is also superior to the standard linear cutter with regard to anastomotic line bleeding.

Modificação da técnica de alotransplante pulmonar unilateral em ratos / Technical modification of unilateral lung transplantation in rats

A crescente demanda de pesquisa em transplantes requer modelos eficientes e baratos que permitam resultados confiáveis para que, posteriormente, possam ser reproduzidos em animais de grande porte e, finalmente, aplicados clinicamente. O modelo de transplante pulmonar unilateral esquerdo em ratos tem demonstrado ser uma alternativa útil para estes propósitos. Apresentamos uma nova variante para esta técnica, a qual consiste no isolamento e ligadura da artéria pulmonar contralateral, permitindo a circulação do sangue somente no pulmão transplantado. Este modelo é exeqüível e reprodutível; no entanto, o tempo de sobrevida é relativamente curto, não permitindo avaliação do pulmão transplantado por períodos superiores a três horas.

The increasing demand in transplantation research requires efficient and less expensive animal models in order to obtain reliable results that are reproducible in larger animal models and, ultimately, applied clinically. The model of unilateral left lung transplantation in rats has proven to be a useful alternative for those purposes. We demonstrate a technical modification of this model, which consists of the isolation and ligation of the contralateral (right) pulmonary artery, allowing blood circulation exclusively in the transplanted lung. This model is feasible and reproducible. However, the short survival time restricts the assessment of the transplanted lung to a maximum period of three hours.

Testing of a new prototype surgical stapler that automates the rollover sleeve technique for venous anastomoses

The creation of successful vascular anastomoses is of primary importance in many surgical fields. Numerous attempts to automate this process have been made. These techniques have slowly gained acceptance, but their use is still limited. This report details feasibility testing of a new prototype stapler that automates the rollover sleeve technique for venous vascular anastomoses. Male and female mongrel dogs (n=7) (25-32 kg) were used. A segment of the right (n=5) or left (n=2) iliac vein was harvested for interposition grafts after the contra lateral side was transected. In each dog, two end-to-end venous anastomoses at the interposition grafts were performed. The standard anastomosis employed continuous mattress sutures. The experimental anastomosis was performed with a new prototype surgical stapler. The stapled anastomosis was proximal and the sutured was distal. In all experiments, it was possible to perform the experimental anastomosis with the stapler. Complications included two small leaks, one due to misfiring of a single pin in one experimental site. These leaks required suture reinforcement. One dog died of hemorrhage due to a slipped suture at the vein harvest site. One vein had thrombus seen at the sutured site although no technical abnormalities at either of the anastomoses could be found. After two weeks, grafts were inspected grossly and histologically. Healing appeared normal. There was a trend for less inflammatory cells infiltrating stapled sites; however, this was not statistically significant. The experiments demonstrate that this device can automate the rollover sleeve technique for venous anastomoses.

Mid-term Outcomes of Side-to-Side Stapled Anastomosis in Cervical Esophagogastrostomy

This study was conducted to evaluate the mid-term results of cervical esophagogastric anastomosis using a side-to-side stapled anastomosis method for treatment of patients with malignant esophageal disease. A total of 13 patients were reviewed retrospectively from January 2001 to November 2005 who underwent total esophagectomy through a right thoracotomy, gastric tube formation through a midline laparotomy and finally a cervical esophagogastric anastomosis. Average patient age was 62.6 yr old and the male to female ratio was 11:2. The mean anastomosis time was measured to be about 32.5 min; all patients were followed for about 22.8+/-9.9 months postoperatively. There were no early or late mortalities. There were no complications of anastomosis site leakage or conduit necrosis. A mild anastomotic stricture was noted in one patient, and required two endoscopic bougination procedures at postoperative 4th month. Construction of a cervical esophagogastric anastomosis by side-to-side stapled anastomosis is relatively easy to apply and can be performed in a timely manner. Follow up outcomes are very good. We, therefore, suggest that the side-to-side stapled anastomosis could be used as a safe and effective option for cervical esophagogastric anastomosis.

Mid-term Outcomes of Side-to-Side Stapled Anastomosis in Cervical Esophagogastrostomy

This study was conducted to evaluate the mid-term results of cervical esophagogastric anastomosis using a side-to-side stapled anastomosis method for treatment of patients with malignant esophageal disease. A total of 13 patients were reviewed retrospectively from January 2001 to November 2005 who underwent total esophagectomy through a right thoracotomy, gastric tube formation through a midline laparotomy and finally a cervical esophagogastric anastomosis. Average patient age was 62.6 yr old and the male to female ratio was 11:2. The mean anastomosis time was measured to be about 32.5 min; all patients were followed for about 22.8+/-9.9 months postoperatively. There were no early or late mortalities. There were no complications of anastomosis site leakage or conduit necrosis. A mild anastomotic stricture was noted in one patient, and required two endoscopic bougination procedures at postoperative 4th month. Construction of a cervical esophagogastric anastomosis by side-to-side stapled anastomosis is relatively easy to apply and can be performed in a timely manner. Follow up outcomes are very good. We, therefore, suggest that the side-to-side stapled anastomosis could be used as a safe and effective option for cervical esophagogastric anastomosis.

Mid-Term Follow Up of Patients Using The St. Jude Medical Aortic Connector System for Proximal Vein Graft in CABG

The aortic connector system may reduce stroke during proximal venous anastomosis. However, the overall anastomotic patency rate has been generally reported to be low. From October 2002 to March 2004, 68 patients who received proximal anastomosis using the St. Jude Aortic Connector System were included in the study. There were 47 men and 21 women and their mean age was 65.68+/-6.68 yr old (52 to 85 yr). Grafts were evaluated by coronary angiography or multi-slice 16 channel 3-D CT at 6 days and at 6 months postoperatively. In the immediate postoperative period, no stenosis was observed by either angiography (n=22) or 3D CT (n=46). At 6-month postoperatively, we performed either angiography (n=7) or 3-D CT (n=52). Of these patients, 5 patients showed graft stenosis in the midportion, and 3 in the ostium. There were no stroke. Simple, and effective proximal anastomosis with good protection from cerebrovascular accident was achieved especially when calcification or atheromatous plaque was observed at the ascending aorta in the operation room. However, our mid term patency results raise concerns related to venous graft stenosis in the midportion. Therefore, longer follow up is recommended.

Perineum push-up device to facilitate transabdominal suturing of the lower rectum.

Pressure on the perineum by the fist facilitates the placement of sutures into the rectal remnant, but put the assisting surgeon on an awkward and strenuous posture. The perineum push-up device to facilitate transabdominal suturing of the lower rectum was invented. The assisting surgeon can push up the perineum more comfortably with his abdominal wall or thigh. The device was tested in fifteen patients. The average distance that can be pushed up is 4.2 cm, which is a significant distance, facilitating in the maneuver of the distal rectal stump.

Vesicourethral anastomosis facilitated by a new disposable instrument

The author presents a prototype of a disposable device that enables, in one single movement, the passing of all suture stitches in the urethral stump that will be anastomosed to the bladder or to a neobladder, with the advantage of a regular distribution of these stitches around the urethral circumference. In tests with animals, the device showed to be easily applicable, effective and safe.

The Martin-Gruber anastomosis in brazilians: an anatomical study

Communications between nerves are relatively common, and individual variations in their anatomical organization have been described. Knowledge of the prevalence of such variations is necessary when estabilishing the diagnosis of neuropathies and surgical landmarks. In this study, 64 anterior forearm regions of cadavers of blacks and whites of both sexes, were dissected to examine the communications between the median and ulnar nerves (Martin-Gruber anastomosis). This anastomosis was found in five cases (7,8%), one of which was bilateral. There were no significant gender or racial differences in the incidence of this connection. The anastomosis in Brazilians observed here, the impoprtance of an adequate investigation of these connections needs to be underscored. Understanding the existence of this variations, its location and its possible presentation is important for correct patient assistance.

Cirugía laparoscópica colorrectal: experiencia inicial / Laparoscopic colorectal surgery: initial experience

Antecedentes: La cirugía laparoscópica colónica es un procedimiento novedoso, cuyos primeros resultados aún no permiten sacar conclusiones respecto de su verdadera utilidad. Objetivo: Análisis clínico retrospectivo de pacientes intervenidos por esta vía. Lugar de aplicación: Práctica hospitalaria y privada. Diseño: Estudio observacional retrospectivo basado en criterios clínicos. Población: Selección de 30 pacientes (1,5 por ciento) intervenidos por afecciones colorrectales, sobre un total de 1950; entre 1992 y 1996. Métodos: Exclusión de pacientes con grandes eventraciones, tumores adheridos a pared u otros órganos, ostomías, obstrucción o perforación. Resultados: Mortalidad: 3,3 por ciento, complicaciones: 16,7 por ciento. Conversión, 25,9 por ciento. Promedio de ganglios resecados, 15. No hubo diferencias en la conversión respecto de afecciones benignas o malignas, segmento operado, aunque en el recto medio fueron todos convertidos (3/3). El intervalo de confianza esperado para el éxito laparoscópico fue del 53,3-88,9 por ciento. Conclusiones: La cirugía laparoscópica colorrectal puede ser realizada con igual amplitud que la cirugía a cielo abierto. El índice de conversión es alto, aunque con un mayor entrenamiento y una mejor selección de casos puede ser disminuído

Urethrovesical anastomosis: a surgical technique improvement

Uma das dificuldades encontradas durante a prostatectomia radical tem sido a anastomose do colo vesical com a uretra remanescente. Existem disponíveis aos urologistas alguns instrumentos produzidos especialmente para facilitar a realizaçäo da anastomose na prostatectomia radical. Entretanto, além de significar material cirúrgico adicional ao arsenal já existente, estes instrumentos especiais representam um custo financeiro importante. Com a finalidade de simplificar o procedimento, o autor tem utilizado a bainha do ressectoscópio 24 French, com a finalidade de expor a uretra remanescente e assim facilitar a sua sutura com o colovesical neo-formado

Anastomose intestinal por compressäo com o dispositivo russo AKA: análise dos resultados / Compression intestinal anastomosis with Russiam AKA: analysis of the clinical, radiologic and endoscopic results

Um estudo prospectivo foi realizado para analisar os resultados da anastomose por compressäo com o dispositivo AKA, em pacientes selecionados. Esta técnica foi aplicada em 24 pacientes, 15 com anastomoses colorretais altas, cinco com anastomoses colorretais baixas e quatro com anastomoses ileorretais. A maioria dos pacientes apresentou boa evoluçäo pós-operatória, com eliminaçäo inconsciente do anel anastomótico. Algumascomplicaçöes, no entanto, como deiscência, sangramento e estenose foram observadas. Os controles radiológicos e endocópicos se mostraram dentro da normalidade. Näo foi observada mortalidade relacionada com a técnica. Este dispositivo é de baixo custo financeiro, apresentando, no entanto, limitaçöes no seu emprego

Anastomosis de cuernos uterino por laparoscopía. Modelo experimental en la rata / Anastomosis of uterine horns using laparoscopy. Experimental model in the rat

Objetivo. Describir una nueva técnica de microcirugía laparoscópica de anastomosis de cuernos uterinos en la rata, útil para la enseñanza e investigación. Sede. Laboratorio de cirugía experimental de un hospital de tercer nivel de atención. Material y métodos. Se emplearon ratas hembras de la cepa Wistar de 250 a 300 g de peso, equipo e instrumental de laparoscopia con ópticas de 30 y 70º, 4 mm de diámetro. Técnica quirúrgica. Una vez identificados el útero y los cuernos uterinos, con una pinza bipolar se electrocauteriza un segmento del cuerno uterino de aproximadamente 4 mm, seccionándose con tijera la zona lesionada. Para la anastomosis se emplean dos variables, dependiendo de la longitud de la sutura. Conclusión. La cirugía laparoscópica requiere de un entrenamiento continuo, en modelos de laboratorio, de fácil disponibilidad y bajo costo, la rata ofrece estas posibilidades