Use of flaps in inguinal lymphadenectomy in metastatic penile cancer

ABSTRACT Purpose: Reviewing surgical procedures using fasciocutaneous and myocutaneous flaps for inguinal reconstruction after lymphadenectomy in metastatic penile cancer. Material and Methods: We reviewed the current literature of the Pubmed database according to PRISMA guidelines. The search terms used were "advanced penile cancer", "groin reconstruction", and "inguinal reconstruction", both alone and in combination. The bibliographic references used in the selected articles were also analyzed to include recent articles into our research. Results: A total of 54 studies were included in this review. About one third of penile cancers are diagnosed with locally advanced disease, often presenting with large lymph node involvement. Defects in the inguinal region resulting from the treatment of metastatic penile cancer are challenging for the surgeon and cause high patient morbidity, rendering primary closure unfeasible. Several fasciocutaneous and myocutaneous flaps of the abdomen and thigh can be used for the reconstruction of the inguinal region, transferring tissue to the affected area, and enabling tensionless closure. Conclusions: The reconstruction of defects in the inguinal region with the aid of flaps allows for faster postoperative recovery and reduces the risk of complications. Thus, the patient will be able to undergo potential necessary adjuvant treatments sooner.

Cirugía robótica en el Centro Médico ABC: experiencia en los primeros 500 procedimientos realizados / Robotic surgery at ABC Medical Center: first 500 procedures experience

Resumen Antecedentes: La cirugía robótica se utiliza en múltiples especialidades quirúrgicas a nivel mundial. Objetivo: Documentar la experiencia inicial del programa de cirugía robótica en un hospital de práctica privada. Material y método: Se incluyen las primeras 500 cirugías robóticas realizadas en el Centro Médico ABC, abarcando un periodo de tres años. Se documentan especialidades involucradas así como datos transoperatorios principales. Resultados: De 500 pacientes, 367 (73.4%) fueron de sexo masculino y 133 (26.4%) de sexo femenino. Las tres cirugías más realizada fueron prostatectomía radical (269), seguido de histerectomía (64) y plastia inguinal (33). Un total de 40 médicos certificados de cinco especialidades realizaron la totalidad de los procedimientos. Conclusiones: El iniciar un programa en un centro médico privado tiene diversas implicaciones. La creación de un comité de cirugía robótica integrado por médicos especialistas certificados en cirugía robótica de cada especialidad y autoridades del hospital para la acreditación de lineamientos tanto para la certificación como la recertificación de sus médicos puede beneficiar a programas como el nuestro por crear un centro de excelencia de cirugía robótica, disminuyendo complicaciones y mejorando resultados.

Abstract Background: Robotic surgery is used in different surgical specialties worldwide. Objective: To documents the initial experience in a private hospital in the use robotic surgery in different surgical areas. Material and Methods: We included the first 500 robotic surgeries in our hospital in a 3 year period, documenting specialty and operative information. Results: Of the 500 patients, 367 (73.4%) were male and 133 (26.4%) female. The three most frequent surgeries performed were Radical Prostatectomy (269), Hysterectomy (64) an inguinal repair (33). A total of 40 certified surgeons ranging from 5 specialties performed the total number of surgeries. Conclusions: There are several implications in starting a robotic program in a private hospital setting. The creation of a robotic committee, formed by robotic certified physicians and hospital authorities, has helped in the certification process of its staff, lowering the complication rate and obtaining better surgical results.

Redução de hérnia escrotal com protusão de omento em um cão / Reducing escrotal hernia with oment protusion in dog

Hérnia é uma protrusão de vísceras através de um orifício adquirido, tendo como constituintes o anel, conteúdo e saco herniário. As hérnias escrotais ocorrem quando, por algum defeito no anel inguinal, alguma víscera se desloca por ele, chegando até a bolsa escrotal. Sua etiologia não é completamenteelucidada, sendo a elevação da pressão intra-abdominal um dos prováveis desencadeadores. Em caninos, essa é uma condição rara e os poucos relatos citam em animais jovens. Objetivou-se descrever a ocorrência de uma hérnia escrotal unilateral esquerda com protrusão de omento maior em um cão da raça Dachshund com 14 anos de idade e com 12,1 kg de peso corporal. Para a redução do conteúdo à cavidade abdominal, foi necessária a realização de incisão na região inguinal cranial, abertura do saco herniário e a orquiectomia. Destaca-se a importância do tratamento cirúrgico da hérnia escrotal, bem como a inclusão dessa afecção no diagnóstico diferencial para afecções testiculares de cães adultos ou idosos.

Hernia is a protrusion of viscera through an acquired orifice, having as constituents the ring, contents and hernial sac. Scrotal hernias occur when, due to a defect in the inguinal ring, some viscera travel through it, reaching the scrotum. Its etiology is not completely elucidated, and the increase in intra-abdominal pressure is one of the probable triggers. In canines, this is a rare condition and the few reports mention it in young animals. The objective was to describe the occurrence of a left unilateral scrotal hernia with protrusion of the greater omentum in a 14-year-old Dachshund dog weighing 12.1 kg of body weight. To reduce the content of the abdominal cavity, it was necessary to make an incision in the cranial inguinal region, open the hernial sac and orchiectomy. The importance of surgical treatment of scrotal hernia is highlighted, as well as the inclusion of this condition in the differential diagnosis for testicular disorders of adult or elderly dogs.

Does a bilateral polypropylene mesh alter the duct deferens morphology, testicular size and testosterone levels? Experimental study in rats

Abstract Purpose To evaluate the effect of a PP mesh on duct deferens morphology, testicular size and testosterone levels. Methods Forty adult male rats were distributed into groups: 1) no surgery; 2) inguinotomy; 3) mesh placed on the duct deferens; and 4) mesh placed on the spermatic funiculus. After 90 postoperative days, the inguinal region was resected, and blood samples were collected for the measurement of serum testosterone (pg/dl). The ducts deferens were sectioned in three axial sections according to the relationship with the mesh — cranial, medial and caudal. The wall thickness and duct deferens lumen area were measured. Results The morphology of the duct deferens was preserved in all groups. The mesh placement did not alter this morphology in any of the analyzed segments. Surgery, with or without mesh placement, did not alter the morphology, wall thickness or lumen area (p>0.05). In all operated groups, serum testosterone levels were similar (p>0.05) but there was a decrease in testicle size (p<0.05). Conclusion Surgery, with or without mesh placement, did not alter the morphology of the duct deferens and, although this treatment resulted in testicular size reduction, it did not affect serum testosterone levels.

Initial experience of video endoscopic inguinal Lymphadenectomy in a center located at northeast brazilian region

ABSTRACT Introduction: Video endoscopic inguinal lymphadenectomy - VEIL - has emerged as an alternative to reduce post-surgical complications (PSC) in patients with penile cancer submitted to inguinal lymphadenectomy (IL). In some series, these PSC are observed in more than 50% of patients. The objectives of the present study are to describe the initial experience of VEIL in a Hospital in Teresina, PI, Brazil, and to analyze PSC incidence. Material and Methods: Retrospective descriptive study of patients submitted to VEIL from March 2014 to November 2015. Data were collected regarding surgical time, bleeding, complications, lymph node number, conversion, global complications, drainage time, cellulitis, lymphocele, cutaneous necrosis, miocutaneous necrosis and hospitalization time. Results: 20 lower limbs of 11 patients were operated. Mean age was 51.4 (24-72) years. Mean surgical time was 85 (60-120) minutes. No patient showed intrasurgical complications, bleeding > 50 mL or conversion. Three surgeries evolved with lower limb edema, 2 with lymphoceles and one patient had cutaneous necrosis and another bulging of surgical wound. Mean time of hospitalization was 4 (2-11) days. A mean of 5.8 (1-12) lymph nodes were dissected in each surgery. Conclusion: VEIL is a safe and easy technique with lower incidence of PSC that can be reproduced in small centers.

Use of indocyanine green angiography in microsurgical subinguinal varicocelectomy - lessons learned from our initial experience

ABSTRACT Microsurgical subinguinal varicocelectomy (MSV) is generally considered the gold standard nowadays in view of the lower risk of complications and recurrence. To achieve complete ligation of veins while preserving testicular artery (TA) during the procedure remains challenging despite the application of high power optical magnification and micro-Doppler ultrasonography. The use of intraoperative indocyanine green angiography (ICGA) with infrared fluorescence operative micro-scope in MSV potentially lowers the incidence of TA injury and shortens the learning curve of novice surgeons. We present our initial experience in the application of the technique in nine patients and explore the potential of the new adjunct.

Unilateral extravesical ureteral reimplantation via inguinal incision for the correction of vesicoureteral reflux: a 10-year experience

ABSTRACT Introduction and Objective: Multiple options exist for the surgical management of vesicoureteral reflux (VUR). We report on our 10-year experience using the inguinal approach to extravesical ureteral reimplantation (EVR). Materials and Methods: Patient characteristics of age, gender, and reflux grade were obtained and outcomes of operative time, hospital stay, and radiographic resolution were assessed. Results: 71 girls and 20 boys with a mean age of 74 months (range 14-164) underwent inguinal EVR via a 3.5-cm inguinal mini-incision. Mean follow up was 10.9 months (range 0.4-69.7). Average grade of reflux was 2.80. Average operative time was 91 minutes (range 51-268). The procedure was successful in 87 of 91 patients (95.6%). The 3 cases of reflux that persisted were all grade 1 and managed expectantly. Contralateral reflux developed in 9 cases, all of which resolved after treatment with either Deflux or ureteral reimplant. There were 4 case of urinary retention that resolved after a brief period of CIC or indwelling catheterization. There were no cases of ureteral obstruction. Most patients were discharged on post-operative day 1 (85/91) and no hospitalization extended beyond 3 days. Conclusions: The inguinal approach to extravesical ureteral reimplantation should be considered as a potentially minimally invasive alternative to endoscopic and robotic treatment of VUR with a success rate more comparable to traditional open approaches. We feel it is the method of choice in cases of unilateral VUR requiring surgical correction.

Novel retrograde puncture method to establish preperitoneal space for laparoscopic direct inguinal hernia repair with internal ring suturing

The aim of this study was to explore the clinical efficacy of a novel retrograde puncture approach to establish a preperitoneal space for laparoscopic direct inguinal hernia repair with inguinal ring suturing. Forty-two patients who underwent laparoscopic inguinal hernia repair with retrograde puncture for preperitoneal space establishment as well as inguinal ring suturing between August 2013 and March 2014 at our hospital were enrolled. Preperitoneal space was successfully established in all patients, with a mean establishment time of 6 min. Laparoscopic repairs were successful in all patients, with a mean surgical time of 26±15.1 min. Mean postoperative hospitalization duration was 3.0±0.7 days. Two patients suffered from postoperative local hematomas, which were relieved after puncturing and drainage. Four patients had short-term local pain. There were no cases of chronic pain. Patients were followed up for 6 months to 1 year, and no recurrence was observed. Our results demonstrate that preperitoneal space established by the retrograde puncture technique can be successfully used in adult laparoscopic hernioplasty to avoid intraoperative mesh fixation, and thus reduce medical costs.

Feasibility, complications and oncologic results of a limited inguinal lymph node dissection in the management of penile cancer

In patients with penile cancer (PeCa) and increased risk of inguinal lymphatic dissemination, inguinal lymphadenectomy offers a direct histological staging as the most reliable tool for assessment of the nodal metastasic status and a definitive oncologic treatment simultaneously. However, peri- and/or postoperative mutilating sequalae often occurn. We report on clinical outcome and complications of a limited inguinal lymph node (LN) dissection.

Expanded criteria for Video Endoscopic Inguinal Lymphadenectomy (VEIL) in penile cancer: palpable lymph nodes

Introduction Open inguinal lymphadenectomy is the gold standard for the treatment of inguinal metastasis in patients with penile cancer (PC). Recently the Video Endoscopic Inguinal Lymphadenectomy (VEIL) was proposed as an option to reduce the morbidity of the procedure in patients without palpable inguinal lymph nodes (PILN), however the oncological equivalency in patients with PILN remains poorly studied. The aims of this video are the demonstration of VEIL in patients with PILN and present the preliminary experience comparing patients with and without PILN. Materials and Methods The video illustrates the procedure performed in two cases that were previously underwent partial penectomy for PC with PILN. Data from the series of 15 patients (22 limbs operated) with PILN underwent VEIL were compared with our series of VEIL in 25 clinically N0 patients (35 limbs operated). Results The comparison between the groups with and without PILN found, respectively, these outcomes: age 52,45 × 53,2 years, operative time 126,8 × 95,5 minutes, hospital stay 5. × 3.1 days, drainage time 6.7 × 5.7 days, 9 resected lymph nodes on average in both groups, global complications 32% × 26%, cellulitis 4.5% × 0%, lymphocele 23% in both groups, skin necrosis 0% × 3%, myocutaneous necrosis 4.5% × 0%, pN+ 33% × 32%, cancer specific mortality 7% × 5% and mean follow-up 17.3 × 35.3 months. None of the variables presented p < 0.05. Conclusions VEIL is a safe complementary procedure for treatment of PC, even in patients with PILN. Oncological results in patients with PILN seem to be appropriate but are still very premature. Prospective multicenter studies with larger samples and long-term follow-up should be conducted to determine the oncological equivalence of VEIL compared with open surgery in patients with PILN. .

Extending boundaries in minimally invasive procedures with simultaneous bilateral video endoscopic inguinal lymphadenectomy (veil) for penile cancer: initial Denver health medical center and ABC school of medicine experience and surgical considerations

Purpose To report the surgical technique, procedural outcomes, and feasibility of simultaneous bilateral Video Endoscopic Inguinal Lymphadenectomy (VEIL) in the management of patients with indication for inguinal lymphadenectomy. Surgical Technique: VEIL was applied in all patients using the oncological landmarks (the adductor longus muscle medially, the sartorius muscle laterally and the inguinal ligament superiorly). A 1.5 cm incision was made 2 cm distally to the lower vertex of the femoral triangle. A second incision was made 2 cm proximally and 6 cm medially. Two 10 mm Hasson trocars were inserted in these incisions and the working space was insufflated with CO2 at 5-15 mmHg. The final trocar was placed 2 cm proximally and 6 cm laterally from the first port. Results: A total of 5 VEIL procedures in 3 patients were performed. Two patients underwent simultaneous bilateral VEIL while another underwent simultaneous bilateral surgery with VEIL on the right and open lymphadenectomy on the left side due to an enlarged node. All laparoscopic procedures were successfully performed without conversion and maintained the oncological templates. One lymphocele occurred in the patient who underwent the open procedure. None of the patients presented with skin necrosis after the procedure. Mean number of nodes retrieved was 6 from each side and 2 patients presented with positive inguinal nodes. After one year of follow-up no recurrences were observed. Conclusion: Simultaneous lymphadenectomy procedures are feasible. Improvement in operative and anesthesia time could decrease the morbidity associated with inguinal lymphadenectomy while maintaining the oncological principles. .

Experimental canine model for sentinel lymph node biopsy in the vulva using technetium and patent blue dye / Modelo canino experimental para a pesquisa do linfonodo sentinela na vulva usando tecnécio e azul patente

PURPOSE: This paper aims to study and define the experimental model of sentinel lymph node biopsy of the vulva in bitches. METHODS: 0.2 ml of 99mTc phytate was injected intradermally, using a fine gauge insulin needle in the anterior commissure of the vulva. Thirty minutes after 99mTc injection, the inguinal mapping was performed using a gamma probe. After this, 0.5 ml of blue dye (bleu patenté V Guerbet 2.5 percent) was injected in the same place. After 15 minutes, a 3 cm long inguinal incision was made at point maximum uptake followed by careful dissection, guided by visualization of a bluish afferent lymphatic system that points to the sentinel lymph node (SLN). RESULTS: It was observed that 88 percent of SLN were identified. It wasn´t found a significant difference among the presence or not of sentinel lymph node in the sides, which is an indication of a good consistency. It was observed a high (88 percent) and significant (χ2=12.89 and p=0.0003) intercession between both methods (blue dye and radiation). CONCLUSION: The experimental model adopted is feasible, becoming advantageous in applying the association of Patent blue and 99mTc.

OBJETIVO: Definir um modelo experimental para a pesquisa do linfonodo sentinela na vulva de cadelas. MÉTODOS: 0,2 ml de tecnécio diluído em fitato (99mTc) foi injetado por via intradérmica na comissura anterior da vulva. Trinta minutos após a injeção de 99mTc, o mapeamento inguinal foi realizada utilizando uma sonda gama. Após isto, 0,5 ml de corante azul (bleu Patente Guerbet V 2,5 por cento) foram injetados no mesmo lugar. Após 15 minutos, uma incisão inguinal de três centímetros foi feita no ponto de captação máxima seguido de dissecção cuidadosa, guiada através da visualização de um sistema linfático aferente corado em azul que apontava para o linfonodo sentinela (LS). RESULTADOS: Foi observado que em 88 por cento das vezes o LS foi identificado. Não foi encontrada diferença significativa entre a presença ou não de linfonodo sentinela nos lados direito e esquerdo, o que é uma indicação de uma boa consistência do método. Foi observada uma alta (88 por cento) e significativa (χ2 = 12,89 e p = 0,0003) intercessão entre os dois métodos (corante azul e radiação). CONCLUSÃO: O modelo experimental adotado é viável, tornando-se vantajoso na aplicação da associação de Azul Patente e 99mTc.

Histología del anillo inguinal interno en pacientes con hernia inguinal indirecta: serie de casos observacional y descriptiva / Age associated changes in the histology of indirect inguinal hernia rings

Background: This study has the purpose to investigate the microscopic basic histological structure of the internal inguinal ring in patients operated on for primary indirect inguinal hernia. Patients and Methods: A sample of 72 consecutive male patients older than 15 years-of-age with unilateral inguinal hernia submitted to elective surgery was studied. The primary outcome measure was the histological findings of the internal inguinal ring. All samples were processed only by histochemical techniques. Patients were divided in 3 groups according to age. Group I: patients between 15 and 40 years-of-age. Group II: patients between 41 and 70 years-of-age. Group III: patients older than 71 years. Results: All samples from the internal inguinal ring were constituted by fibrous fascial tissue with elastic fibers which were thicker in younger patients and thinner in older patients. Adipose tissue between elastic fibers was absent in younger patients and was abundant in older patients. Vascular sclerosis was minimal in Group I, moderate in Group II, and important in Group III. Acute or chronic inflammatory cells were absent in all patients. Conclusions: The histological characteristics of the internal inguinal ring in patients with indirect inguinal hernia consist on reduced density and thickness of elastic fibers and increased adipose tissue between elastic fibers. Vascular sclerosis was more severe as the age of the patients increased. These histological changes were related to normal aging.

Introducción: El presente estudio tiene como objetivo investigar la estructura histológica básica del anillo inguinal interno en pacientes operados por hernia inguinal indirecta primaria. Pacientes y Métodos: Se estudió una muestra de 72 pacientes consecutivos mayores de 15 años de edad con hernia inguinal indirecta unilateral sometidos a cirugía electiva. El objetivo principal fue la histología básica del anillo inguinal interno. Las muestras fueron procesadas con técnicas histoquímicas. Los pacientes se dividieron en 3 grupos de acuerdo a la edad. Grupo I: pacientes entre 15 y 40 años de edad. Grupo II: pacientes entre 41 y 70 años. Grupo III: pacientes mayores de 71 años de edad. Resultados: Todas las muestras histológicas del anillo inguinal estuvieron constituidas por tejido fascial fibroso con fibras elásticas gruesas en pacientes jóvenes y delgadas en pacientes mayores. La esclerosis vascular fue mínima en el grupo I, moderada en el grupo II e importante en el grupo III. No se encontraron células inflamatorias agudas o crónicas. Conclusiones: Las características histológicas básicas del anillo inguinal interno consisten en fibras elásticas que disminuyen su densidad y se adelgazan con la edad y en un aumento simultáneo del tejido adiposo entre estas fibras. La esclerosis vascular se presenta y es más severa en la medida que la edad de los pacientes aumenta. Estos cambios histológicos se relacionan al envejecimiento normal.

Epithelioid malignant mesothelioma of tunica vaginalis with deciduoid features: An unusual malignancy clinically masquerading an inguinal hernia.

Paratesticular/scrotal and inguinal canal mass lesions in elderly patients may pose a diagnostic challenge to both the surgeon as well as the pathologist. In most cases, these represent hernial sacs with their contents, and true neoplasms like lipomas, rhabdomyosarcomas, and fibrous pseudotumors are infrequent. Malignant mesotheliomas arising from the tunica layers are rare cause of inguinal and paratesticular tumors. Herein, we report a case of an elderly patient who presented with an inguinal hernia which pathologically had features of deciduoid malignant mesothelioma.

Morphologic evaluation of the use of a latex prosthesis in videolaparoscopic inguinoplasty: an experimental study in dogs / Avaliação morfológica da utilização de prótese de latex na inguinoplastia videolaparoscópica: estudo experimental em cães

PURPOSE: To evaluate the morphological aspects of the behavior of 4 types of latex biomembranes implanted in preperitoneal videolaparoscopic inguinoplasty. METHODS: Sixteen inguinoplasties were performed in 12 dogs: group 1 received an impermeable latex biomembrane in the right inguinal region and a prolene prosthesis, as control, in the contralateral inguinal region; groups 2, 3 and 4 received latex biomembranes respectively containing impermeable polyamide, 1-mm thick porous polyamide and 0.5-mm thick porous polyamide. Macro- and microscopic evaluations of the inguinal region and of the removed implants were made on the 7th, 14th, 21st and 28th days in group 1 and on the 28th postoperative day in the other groups. RESULTS: We observed absence of hematoma, seroma and infection; presence of tortuosities; induction of vascular neoformation, inflammatory reaction and collagen deposition, and full encystment of the latex biomembranes, except that with fine porous polyamide, which was partially incorporated, with the formation of microcysts. No latex biomembrane induced fibrosis as observed in the prolene control group. CONCLUSIONS: The biomembranes maintain induction of the healing process without fibrosis, are fully encysted and, except for the one with fine porous polyamide, are not incorporated into adjacent tissues. The latex biomembrane, with or without polyamide, is not recommended as a separate material for preperitoneal inguinoplasty.

OBJETIVO: Avaliar aspectos morfológicos do comportamento de 4 tipos de biomembranas de latex, colocadas pré-peritonealmente em cães, por inguinoplastia videolaparoscópica. MÉTODOS: Dezesseis inguinoplastias em 12 cães: grupo 1, com biomembrana de latex impermeável inguinal direita em quatro cães e prótese de prolene, como controle, contra-lateral; grupos 2, 3 e 4, com biomembrana de latex respectivamente de poliamida impermeável, poliamida porosa com 1mm de espessura e poliamida porosa com 0,5mm de espessura. Avaliou-se a região inguinal e as peças retiradas macro e microscopicamente, no grupo 1 no 7º, 14º, 21º e 28º dias e nos demais grupos no 28º dia pós-operatório. RESULTADOS: ausência de hematoma, seroma e infecção; presença de tortuosidade; indução de neoformação vascular, reação inflamatória, deposição de colágeno e encistamento total das biomembranas de latex, exceto com poliamida porosa fina que se incorporou apenas parcialmente, com formação de microcistos. Nenhuma biomembrana de latex induziu fibrose como no grupo controle prolene. CONCLUSÕES: As biomembranas mantêm indução do processo de cicatrização sem fibrose, sofrem encistamento e, exceto com poliamida porosa fina, não se incorporam aos tecidos vizinhos. A biomembrana de latex, com e sem poliamida, isoladamente não é recomendada para inguinoplastia pré-peritoneal.

Aspectos morfológicos da utilização intraperitoneal de prótese de dupla face na inguinoplastia em cães / Morphological features of utilization intraperitoneal double-sided prostheses in inguinoplasty in dogs

OBJETIVO: Avaliar os aspectos morfológicos do comportamento de prótese de dupla face aplicada em inguinoplastia laparotômica em cães, com fixação intraperitoneal com a face de látex voltada às vísceras. MÉTODOS: Vinte cães distribuídos em dois grupos (n=10) foram submetidos à laparotomia infraumbilical com fixação da prótese de dupla face em uma região inguinal e de uma prótese controle de polipropileno contralateral. Foram pesquisados no 14° e 28° dia de pós-operatório achados macroscópicos referentes à obstrução e fístula intestinais, encistamento, incorporação e aderências. A análise microscópica envolveu o processo inflamatório e reparador. RESULTADOS: Não ocorreram processos infecciosos, obstrução ou fístula intestinal. As próteses apresentaram boa acomodação e incorporação. As aderências ocorreram em maior prevalência e intensidade com a prótese de polipropileno (p<0,05). As aderências com a borda da prótese de dupla face ocorreram em 65 por cento na média dos grupos, sendo que, destas, 35 por cento em média a aderência se fazia com o disco de polipropileno na face parietal. A análise dos achados microscópicos não mostrou diferença estatística entre as próteses (p>0,05). CONCLUSÃO: A prótese de dupla face na sua face parietal soma as vantagens do potencial de incorporação aos tecidos observados com o polipropileno às de biocompatibilidade do látex na sua face visceral. A pequena distância entre o disco de polipropileno e a borda da prótese de dupla face (2 cm) aliada à sua fixação com apenas cinco grampos é insuficiente para evitar que o epíploon migre em direção ao processo inflamatório desencadeado pelo polipropileno na face parietal.

OBJECTIVE: To asses the morphological features of the behavior of a double-sided prostheses using inguinoplasty laparotomy in dogs with latex side turned to the visceras. METHODS: Twenty dogs were divided into two groups of 10 and submitted into infraumbilical laparotomy with double-sided prostheses fixed in an inguinal area and in the other side area a control prostheses of polipropilene (PPL). Macroscopics itens were studied on the 14th and 28th day post-operatory, and they were related to obstruction and intestinal fistulas, encystation, fusion and especially sticker. The microscopic analysis covered the inflammatory process in its acute, chronic and restored phase RESULTS: Infectious process, obstruction or intestinal fistula did not happen. The prostheses presented good accommodation and incorporation. The stickers happened with more prevalent and intensity with the PPL (p<0,05) prostheses. The stickers with double-sided prostheses happened 65 percent in its two groups average, from these 35 percent in average the sticker happened with the PPL disc in the parietal side. The macroscopic itens analysis did not show any statistical difference between prostheses (p>0,05). CONCLUSION: The double-sided prostheses in its parietal side adds the advantages of the incorporation's potential to the noticed material with PPL to the biocompatibility from the latex in its visceral side. The little distance between the PPL disc and the edge of the double-sided prostheses (2cm) allied to its sticking with just five staples is not enough to avoid gaps, through which the epíploon migrated towards to the inflammatory process provoked by PPL in the parietal side.

Video endoscopic inguinal lymphadenectomy (VEIL): minimally invasive resection of inguinal lymph nodes

OBJECTIVES: Describe and illustrate a new minimally invasive approach for the radical resection of inguinal lymph nodes. SURGICAL TECHNIQUE: From the experience acquired in 7 operated cases, the video endoscopic inguinal lymphadenectomy (VEIL) technique was standardized in the following surgical steps: 1) Positioning of the inferior member extended in abduction, 2) Introduction of 3 work ports distal to the femoral triangle, 3) Expansion of the working space with gas, 4) Retrograde separation of the skin flap with a harmonic scalpel, 5) Identification and dissection of the long saphenous vein until the oval fossa, 6) Identification of the femoral artery, 7) Distal ligature of the lymph node block at the femoral triangle vertex, 8) Liberation of the lymph node tissue up to the great vessels above the femoral floor, 9) Distal ligature of the long saphenous vein, 10) Control of the saphenofemoral junction, 11) Final liberation of the surgical specimen and endoscopic view showing that all the tissue of the region was resected, 12) Removal of the surgical specimen through the initial orifice, 13) Vacuum drainage and synthesis of the incisions. COMMENTS: The VEIL technique is feasible and allows the radical removal of inguinal lymph nodes in the same limits of conventional surgery dissection. The main anatomic repairs of open surgery can be identified by the endoscopic view, confirming the complete removal of the lymphatic tissue within the pre-established limits. Preliminary results suggest that this technique can potentially reduce surgical morbidity. Oncologic follow-up is yet premature to demonstrate equivalence on the oncologic point of view.

Vital dye is enough for inguinal sentinel lymph node biopsy in melanoma patients

OBJETIVO: a importância da detecção gama intra-operatória combinada com corante vital para biópsia de linfonodo sentinela é bem aceita. Nós avaliamos a eficácia do azul patente V na identificação do linfonodo sentinela inguinal. MÉTODOS: Noventa e quatro pacientes portadores de melanoma cutâneo de membro inferior foram submetidos a biópsia de linfonodo sentinela de acordo com protocolo estabelecido. Foram randomizados em dois grupos: Grupo Azul, onde o linfonodo sentinela foi identificado primariamente com o corante vital azul patente V (Guerbet) e o Grupo Sonda, onde o linfonodo sentinela foi identificado primariamente pela sonda de detecção gama (Neoprobe). A idade mediana foi de 44,2 anos e a espessura mediana de Breslow foi 2,1 mm. Linfocintilografia pré-operatória, mapeamento linfático com azul patente V e detecção gama intra-opertaória foram realizados em todos os pacientes. O exame histopatológico do linfonodo sentinela consistiu de hematoxilina-eosina e imunohistoquímica. Se micrometástase estivesse presente, linfadenectomia completa era realizada. O linfonodo sentinela era considerado como identificado pelo corante vital se estivesse azul e identificado pela sonda de detecção gama se demonstrasse pelo menos 10 vezes ou mais radioatividade do que o fundo. RESULTADOS: Foram exploradas 94 regiões inguinais, 145 linfonodos sentinelas foram excisados (70 dirigidos primariamente pelo corante vital e 75 dirigidos pela sonda de detecção gama). Todos os linfonodos sentinelas identificados pela linfocintilografia foram excisados. No grupo azul, todos os linfonodos sentinela foram primariamente idenficados pelo corante vital e todos se apresentavam quentes na leitura pela sonda. No grupo sonda, todos os linfonodos sentinelas foram primariamente identificados pela sonda e estavam corados pelo azul. A coincidência da sonda com o corante vital foi de 100%. CONCLUSAO: Azul patente V foi suficiente para identificar linfonodo sentinela inguinal em pacientes com melanoma cutâneo.