Índice de sucesso de exodontias realizadas com extrator minimamente traumático / Exodonticssuccess index performed with a minimally traumatic extractor / Índice de éxito de exodonciarealizado com unextractor traumático mínimo

Introdução:Técnicas para extração dentária vêm sendo aperfeiçoadas objetivando um procedimento que diminua o esforço profissional, o tempo cirúrgicoeamenize as dores e os processos inflamatórios. Neste sentido os extratores minimamente traumáticos,com a exodontia vertical, propõem-se a preservar o osso alveolar e proporcionar uma recuperação mais rápida e confortável para o paciente. Objetivo:Avaliar a efetividade do kit para extração minimamente traumática da Maximus® (Contagem, Minas Gerais, Brasil) na exodontia de raízes residuais de incisivos, caninos e pré-molares unirradiculares. Metodologia:Trata-se de um ensaio clínico, prospectivo e analítico. Os pacientes foram operados utilizando o dispositivo, sendo avaliados os dados demográficos, tempo cirúrgico, dor e conforto após a cirurgia, bem como o grau de satisfação profissional com o uso do dispositivo. Para verificar diferenças significativas foi utilizado o teste de Mann-Whitney e a busca de associações foi realizada com o Exato de Fisher. Para todos os testes foi estabelecida uma significância com p<0,05.Resultados:Quarenta elementos foram removidos, o tempo cirúrgico foi em média 16,28 minutos, níveis de dor e conforto imediatamente após a cirurgia se mantiveram baixos (p<0,0001), e o grau de satisfação profissional se manteve alto (p<0,0001). A taxa de sucesso do dispositivo foi de 93,3% para os elementosincisivos e 20% para os elementos caninos e pré-molares (p<0,0001).Conclusões:A eficácia do extrator é determinada pelo tamanho da superfície radicular cobertas com fibras periodontais e a localização do dente. No entanto pode ser bem indicada no planejamento de reabilitações implantosuportadas em região anterior de maxila e mandíbula (AU).

Introduction:Techniques for tooth extraction have been improvedaiming at a procedure that reduces professional effort, surgical time, pain and inflammatory processes. In this sense, minimally traumatic extractors with vertical extraction, propose to preserve the alveolar bone and provide a faster and more comfortablerecovery for the patient. Objective:To evaluate the effectiveness of the Maximus® Minimally Traumatic Extraction Kit (Contagem, Minas Gerais, Brasil) in the extraction of uniradicular residual roots from incisors, canines and premolars.Methodology:Thisis a clinical, prospective and analytical trial. Patients were operated on using the device, and demographic data, surgical time, pain and comfort after surgery were evaluated, as well as the degree of professional satisfaction with the use of the device.To verify significant differences, the Mann-Whitney test was used and the search for associations was performed with Fisher's exact test. For all tests, significance was set at p<0.05.Results:Forty elements were removed, surgical time averaged 16.28 minutes, levels of pain and comfort immediately after surgery remained low (p<0.0001), and the degree of job satisfaction remained high (p<0.0001). The success rate of the device was 93.3% for the incisor elements and 20% for the canine and premolar elements (p<0.0001).Conclusions:The effectiveness of the extractor is determined by the size of the root surface covered with periodontal fibers and the location of the tooth. However, can be well indicated in planning implanted rehabilitation in the anterior region of the maxilla and mandible (AU).

Introducción: Se han mejorado las técnicas de extracciónde dientescon el objetivo de un procedimiento que reduzca el esfuerzo profesional, el tiempo quirúrgico, el dolor y los procesos inflamatorios. En este sentido, los extractores mínimamente traumáticos con extracción vertical tienen como objetivo preservar el hueso alveolar y proporcionar una recuperación más rápida y cómoda para el paciente. Objetivo: Evaluar la efectividad del Kit de Extracción Mínimamente Traumática Maximus® (Contagem, Minas Gerais, Brasil) en la extracción de raíces residuales de incisivos, caninos y premolares uniradiculares. Metodología: Es un ensayo clínico, prospectivo y analítico. Los pacientes fueron intervenidos con el dispositivo y se evaluaron datos demográficos, tiempo quirúrgico, dolor y comodidad después de la cirugía, así como el grado de satisfacción laboral con el uso del dispositivo. Para verificar diferencias significativas se utilizó la prueba de Mann-Whitney y la búsqueda de asociaciones se realizó mediante la prueba exacta de Fisher. Para todas las pruebas, la significancia se estableció en p <0,05. Resultados:Se retiraron cuarenta ítems, el tiempo quirúrgico promedió 16,28 minutos, los niveles de dolor y comodidad inmediatamente después de la cirugía permanecieron bajos (p<0,0001) y el grado de satisfacción laboral se mantuvo alto (p<0,0001). La tasa de éxito del dispositivo fue del 93,3% para los elementos incisivos y del 20% para los elementos caninos y premolares (p<0,0001).Conclusiones: La efectividad del extractor está determinada por el tamaño de la superficie radicular cubierta por fibras periodontales y la ubicación del diente. Sin embargo, puede resultar muy adecuado para planificar la rehabilitación con implantes en la región anterior del maxilar y la mandíbula (AU).

Robotic endoscopy. A review of the literature

Abstract Purpose To present new endoscopic robotic devices in the context of minimally invasive procedures with high precision and automation. Methods Review of the literature by December 2018 on robotic endoscopy. Results We present the studies and investments for robotic implementation and flexible endoscopy evolution. We divided them into forceps manipulation platforms, active endoscopy and endoscopic capsule. They try to improve forceps handling and stability and to promote active movement. Conclusion The implementation and propagation of robotic models depend on doing what the endoscopist is unable to. The new devices are moving forward in this direction.

Brazilian and argentinean multicentric study in the surgical minimally invasive treatment of pilonidal cyst / Estudo multicêntrico brasileiro e argentino no tratamento cirúrgico do cisto pilonidal por técnica minimamente invasiva

ABSTRACT Background: The pilonidal cyst is an infection of the skin and the subcutaneous tissue, secondary to a chronic inflammation with a greater frequency in the sacrococcygeal region, and associated to the presence of hair. The treatment is eminently surgical. Aim: To demonstrate the endoscopic treatment of pilonidal cyst. Method: Prospective study with 67 patients who had as surgical indication the diagnosis of pilonidal cyst. They were submitted to a surgical procedure from June 2014 to March 2018. The equipment used was the Meinero fistuloscope, a shutter, a monopolar electrode, a brush and endoscopic forceps. Results: Of the 67 patients, 67% (n=45) were male and 33% (n=22) female, with a mean age of 25 years (17-45). Surgical time in average was 40 min (20-120) and mean healing time of four weeks (3-12). Surgical complications were presented in 7% cases (n=5) and recurrences in 9% (n=6). Conclusion: The endoscopic treatment of the pilonidal cyst is feasible and presents good surgical results.

RESUMO Racional: O cisto pilonidal é infecção da pele e do tecido subcutâneo, secundário à inflamação crônica, com maior frequência na região sacrococcígea, e associado à presença de pelos nesta região. O tratamento é eminentemente cirúrgico. Objetivo: Demonstrar os resultados do tratamento endoscópico de cisto pilonidal. Método: Estudo prospectivo, com 67 pacientes que tiveram como indicação cirúrgica o diagnóstico de cisto pilonidal. Os equipamentos utilizados foram o fistuloscópio Meinero, um obturador, um eletrodo monopolar, uma escova e pinça endoscópica. Resultados: Dos 67 pacientes 67% (n=45) eram homens e 33% (n=22) mulheres, com média de idade de 25 anos (17-45). O tempo cirúrgico teve com média 40 min (20-120) e o tempo médio de cicatrização de quatro semanas (3-12). Complicações cirúrgicas ocorreram em 7% da amostra (n=5) e recidivas da doença em 9% (n=6). Conclusão: O tratamento endoscópico do cisto pilonidal é viável e apresenta bons resultados cirúrgicos.

Safety and short term outcomes of a new truly minimally-invasive mesh-less and dissection-less anchoring system for pelvic organ prolapse apical repair

ABSTRACT Objective To evaluate the safety and short term outcomes of a new, truly minimally-invasive, mesh-less and dissection-less anchoring system for pelvic floor apical repair. Methods A prospective study was conducted using the NeuGuide™ device system for pelvic floor apical repair. The primary effectiveness outcome was centro-apical pelvic floor prolapse by POP-Q after six months. The primary safety outcome was intra-operative, immediate (first 48 h) post-operative complications and adverse effects after six months. A standardized questionnaire (UDI-6) to assess quality of life at entry and during follow-up visits was used. Patients’ six months-follow-up and evaluation are reported. Results The mean age of the study population (n=10) was 63.8±12.0 years. All patients had a previous prolapse surgery. Five had a previous hysterectomy and two had stress urinary incontinence symptoms. During surgery six patients had a concurrent colporrhaphy. There was no injury to the bladder, rectum, pudendal nerves, or major pelvic vessels and no febrile morbidity was recorded. At six months, no cases of centro-apical recurrence were noted. Patients were satisfied with the procedure and had favorable quality of life scores. Using the UDI-6 questionnaire an improvement, in all domains was seen. Moreover, although the sample size was small, the improvement in urge and overflow incontinence related domains were demonstrated to be statistically significant. Conclusions This new NeuGuide™ device allows rapid and safe introduction of a suspending suture through the sacrospinous ligament and makes sacrospinous ligament fixation easy to perform, while avoiding dissection and mesh complications.

The First Experiences of Robotic Single-Site Cholecystectomy in Asia: A Potential Way to Expand Minimally-Invasive Single-Site Surgery?

PURPOSE: Herein, we firstly present the robotic single-site cholecystectomy (RSSC) as performed in Asia and evaluate whether it could overcome the limitations of conventional laparoscopic single-site cholecystectomy. MATERIALS AND METHODS: From October 2013 to November 2013, RSSC for benign gallbladder (GB) disease was firstly performed consecutively in five patients. We evaluated these early experiences of RSSC and compared factors including clinicopathologic factors and operative outcomes with our initial cases of single-fulcrum laparoscopic cholecystectomy (SFLC). RESULTS: Four female patients and one male patient underwent RSSC. Neither open conversion nor bile duct injury or bile spillage was noted during surgery. In comparisons with SFLC, patient-related factors in terms of age, sex, Body Mass Index, diagnosis, and American Society of Anesthesiologist score showed no significant differences between two groups. There were no significant differences in the operative outcomes regarding intraoperative blood loss, bile spillage during operation, postoperative pain scale values, postoperative complications, and hospital stay between the two groups (p<0.05). Actual dissection time (p=0.003) and total operation time (p=0.001) were significantly longer in RSSC than in SFLC. There were no drain insertion or open conversion cases in either group. CONCLUSION: RSSC provides a comfortable environment and improved ergonomics to laparoscopic single-site cholecystectomy; however, this technique needs to be modified to allow for more effective intracorporeal movement. As experience and technical innovations continue, RSSC will soon be alternative procedure for well-selected benign GB disease.

Combination 20 and 23-gauge transconjunctival vitrectomy: A new approach.

The advent of smaller gauge instrumentation allows for minimally invasive vitreoretinal surgery (MIVS) as compared to conventional pars plana vitrectomy. Sutureless posterior segment surgery has the advantages of faster wound healing, minimal surgical trauma, decreased convalescence period besides reduced postoperative astigmatism; however, slower gel removal and limited peripheral vitreous dissection are disadvantages with smaller gauge systems. We herein describe a new technique combining 23-gauge and 20-gauge vitrectomy to improve the effectiveness and outcomes of vitreoretinal surgery.

Comparative study between computer assisted-navigation and conventional technique in minimally invasive surgery total knee arthroplasty, prospective control study.

BACKGROUND: Both Minimally Invasive surgery (MIS) and Computer-Assisted Surgery (CAS) are useful in Total Knee Arthroplasty (TKA). Minimally invasive total knee arthroplasty was associated with decreased blood loss, shorter hospital stays, and increased range of motion. Computer-assisted surgery in total knee arthroplasty was developed to improve the positioning of implants during surgery. OBJECTIVE: To evaluate radiographic results relative to component position and limb alignment when using a navigation system compared with conventional technique in MIS-TKA. MATERIAL AND METHOD: A prospective control study was performed in 180 patients who underwent total knee arthroplasty by one surgeon. All patients were randomly divided into two groups, Conventional and Navigation TKA. Intra-, post-operative data, and postoperative limb alignment were recorded for comparison in both groups. RESULTS: The postoperative mechanical axis was within 3 degrees of neutral mechanical alignment in 94% of the navigation group and 87% in conventional group (p = 0.13). Registration time of navigation group is 13.58 minutes. No statistical significant difference was found in tourniquet time and postoperative blood loss in both groups. CONCLUSION: The use of navigation in total knee arthroplasty increases accuracy in limb and implants alignment, and does not increase complications and surgical times.

Repair of inguinal hernia by a simple technique--a preliminary observation.

There are many techniques of repair of inguinal hernia but no single procedure has proved to be a complete one. Our primary aim is to find a simple, steady, durable, safe and low cost procedure that has least chance of recurrence as well as disability. The procedure followed in the technique of hernia repair is like that of Desarde with some modifications. The procedure was started with the poor patients (rickshaw pullers, day labours, laundry men) as they are reluctant to undergo operations until there is pain or obstruction. They work in discomfort even with the large hernia. One hundred and six patients were operated for repair of inguinal hernia by this technique in between 1996 and December 2002. Eighty-six patients came for follow-up for more than one occasions. No recurrence has been detected in these patients as yet, but 20 out of 106 never reported.

A Comparative Study of Pericostal and Submuscular Bar Fixation Technique in the Nuss Procedure

We evaluated the safety and stability of the less-invasive submuscular bar fixation method in the Nuss procedure. One hundred and thirteen patients undergoing the Nuss procedure were divided into three groups according to the bar fixation technique employed. Group 1 consisted of 25 patients who had undergone bilateral pericostal bar fixation, group 2 consisted of 39 patients with unilateral pericostal one, and group 3 included 49 patients with bilateral submuscular one. The patients' age ranged from 2 to 25 yr, with an average of 7.2+/-5.67 yr. Bar dislocation occurred in 1 patient (4%) in Group 1, 2 patients (5.1%) in Group 2, and 1 patient (2.0%) in Group 3 (p=0.46). Hemothorax was noted in 2 patients (8%) in Group 1, 2 (5.1%) in Group 2, and none (0%) in Group 3 (Group 1 vs. Group 3, p=0.028). The mean operation time was shorter in Group 3 than Group 1 (50.1+/-21.00 in Group 3 vs. 67.2+/-33.07 min in Group 1, p=0.041). The submuscular bar fixation results in a decrease in technique-related complications and operation time and is associated with favorable results with regard to the prevention of bar dislodgement.

No scalpel vasectomy--an overview.

Male sterilisation is less popular because of fear of loss of virility and loss of physical strength. No scalpel vasectomy is a surgical attempt to reduce complications and thereby allays the fear in the minds of the couples. Despite the introduction of the advanced technique the acceptance of male sterilisation has not gone up. Though with aggressive IEC compaign has failed to produce the desired result, but a camp based approach was successfully adopted in some states of India. Technique of no scalpel vasectomy has been summarised in the article with diagrams. Some postoperative instructions should be given to the client after discharge. No scalpel vasectomy is the gold standard for vasectomy today. Training is mandatory for experienced surgeons. Government of India funds and supports both the training and service activity.

Single Transconjunctival Incision and Two-point Fixation for the Treatment of Noncomminuted Zygomatic Complex Fracture

The ultimate goal in treating zygomatic complex fracture is to obtain an accurate, stable reduction while minimizing external scars and functional deformity. The present authors present our experiences with a single transconjunctival incision and two-point (inferior orbital rim and frontozygomatic suture) fixation in 53 patients with zygomatic complex fracture which were not comminuted. All patients had transconjunctival approaches with lateral canthal extensions, and six out of 53 patients also had an additional small (about less than 2 cm) gingivobuccal incision to achieve an accurate reduction. There were 3 minor complications, and the overall esthetics and functional results were satisfactory with a long term follow-up. Our method has the following advantages in the reduction of zygomatic complex fracture; It leaves only an inconspicuous lateral canthal scar. In addition, it provides excellent simultaneous visualization of the inferior orbital rim and frontozygomatic suture area. Hence, twopoint fixation through a single incision can be performed with a satisfactory stability.

Medicina y robótica / Medicine and robotics

Han pasado 20 años desde el ingreso de la robótica a la sala de operaciones y al campo de la Medicina. En estos años se ha realizado un progreso significativo en integrar la tecnología robótica a distintas especialidades de la Medicina. En particular el área de la Cirugía en asociación con la instrumentación quirúrgica mínimamente invasiva. En este artículo se revisan las pricipales aplicaciones de los robots en las distintas especialidades de la Medicina, así como las necesidades requeridas para la implementación de un programa robótico quirúrgico y una proyección de este campo en el futuro. El término robot se utilizó por primera vez en 1923, por el escritor checo Karel Capek en su drama "Rossum Universal Robots". La palabra deriva del checo robota (labor tediosa o servil) (1). Posteriormente, en la clásica novela "I, Robot" de Isaac Asimov se plantean las "Tres reglas de la robótica": 1. Un robot no puede dañar a un ser humano, o a través de la inacción, permitir que uno sea dañado. 2. Un robot debe obedecer todas las órdenes dadas por humanos, excepto cuando dichas órdenes puedan contradecir a la primera regla. 3. Un robot debe proteger su propia existencia, excepto cuando por hacer eso contradiga a la primera y segunda regla. Una definición más actualizada de un robot sería: "una máquina o ingenio electrónico programable, capaz de manipular objetos y realizar operaciones antes reservadas sólo a las personas".

Obtenção minimamente invasiva de veia safena para cirurgia de revascularização do miocárdio / Minimally invasive procurement of saphenous veins for coronary artery bypass grafting

OBJETIVO: Analisar, comparativamente, a obtenção minimamente invasiva com o uso do MINI-HARVEST® e com instrumental tradicional adaptado. MÉTODO: De junho de 1996 a janeiro de 1999, 63 pacientes submetidos à cirurgia de revascularização do miocárdio tiveram suas veias safenas retiradas segundo técnica minimamente invasiva. Nos 30 primeiros pacientes da série utilizou-se método de visão direta com auxílio de dois afastadores de Langenbeck, e nos 33 restantes utilizou-se o MINI-HARVEST®. RESULTADOS: A idade média dos pacientes era de 61 ± 8,75 anos, sendo 52 homens e 11 mulheres. Quarenta e cinco pacientes eram diabéticos, 45 apresentavam sobrepeso/obesidade, 25 eram tabagistas ativos, 32 apresentavam história pregressa de infarto do miocárdio. O tempo médio de retirada da veia safena com afastadores Langenbeck foi de 34,2 ± 8,14 minutos e com o MINI-HARVEST® de 39,20 ± 9,12 minutos. A extensão de veia retirada foi similar nos dois grupos, variando de 10 a 30 cm. Houve uma deiscência superficial no grupo com afastadores de Langenbeck. Houve necessidade de reversão para método tradicional de retirada em dois casos do grupo MINI-HARVEST® e um do grupo Langenbeck. A incidência de infarto transoperatório foi 4,5 por cento (três) no grupo Langenbeck e 3,1 por cento(dois) no grupo MINI-HARVEST®. CONCLUSÕES: Podemos concluir que o método de obtenção de veia safena minimamente invasivo sob visão direta é efetivo e seguro, tanto com o uso de instrumentos tradicionais adaptados para este fim, como com afastadores especialmente constituídos, ressaltando-se que o MINI-HARVEST® dispensa a presença de um auxiliar.

Radiología intervencionista en el tratamiento del osteoma osteoide / Osteoid osteoma: percutaneous treatment with CT guidance

Propósito. El osteoma osteoide (OO) es un tumor óseo benigno que se caracteriza por producir dolor nocturno intenso y permanente, por lo cual requiere su extirpación. Si bien durante años el tratamiento de elección ha sido la cirugía, el advenimiento de técnicas percutáneas guiadas por imágenes como la resección con aguja trefina (RT) y más recientemente la ablación por radiofrecuencia (RF), consigue la eliminación del nido tumoral y con ello la supresión de los síntomas en forma mucho menos invasiva. Material y métodos. Entre junio de 1990 y febrero de 2004 se trataron 65 lesiones en 60 pacientes con diagnóstico presuntivo de OO. Se realizaron 49 RT y 16 RF. En 5 RT se complementó con curetaje y en 1 con alcoholización. Los procedimientos fueron guiados por TC bajo anestesia general o raquídea con 24 hs de hospitalización. Se tomaron muestras para anatomía patológica (AP). A los 30 días del procedimiento se constató la desaparición de los síntomas y la ausencia de complicaciones tardías...

Cirugía coronaria miniinvasiva asistida por computadora (robótica) / Computer-aided minimally invasive coronary surgery (robotics)

El principio básico de los robots utilizados corrientemente es el de brazos manipuladores con una arquitectura serial de articulaciones y conexiones. La movilidad de las articulaciones está provista por actores mecánicos que se manejan eléctrica o hidráulicamente. Los robots usados hoy en cirugía cardíaca son los llamados on line, porque el operador está en control permanente del sistema por vía de una interfase hombre-máquina. El concepto es combinar las habilidades humanas, como el juicio y la percepción, con la mecánica precisa del robot mediante tecnología mejorada por computadora. A causa de que los movimientos manuales del cirujano son convertidos en señales electrónicas por el input device de la consola, el paciente no necesita estar en la misma sala de operaciones ni ciudad que el cirujano para ser operado. El concepto de inmovilización virtual para eliminar los efectos del movimiento cardíaco también es atrayente. Moviendo la cámara y los instrumentos sincrónicamente con las excursiones del corazón, se puede crear una imagen de inmovilidad virtual, de modo de trabajar con la imagen detenida.

Open laparoscopic access for primary troccar using modified Hasson' s technique

To describe the safety and efficacy of open laparoscopic access for the primary trocar using modified Hasson's technique for laparoscopic surgery in children. All 100 laparoscopic procedures performed at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between January 1999 and April 2001 using modified Hasson's technique were prospectively evaluated. They were aged from 3 months to 12 years. One hundred children who had open laparoscopic access during the study period had diagnosis of acute appendicitis [n=57], impalpable undescended testes [n=29], gallstones [n=5], varicocele [n=3] and others [n=6]. Three children had minor operative complications [2 cases of pre-peritoneal placement of trocar, which were recognized immediately and the other had omental bleeding]. Two children had post-operative complications related to primary access [one port infection and other port site hematoma]. Access to the abdominal cavity was generally secured in 3-12 minutes [average 4 +/- 2]. Clinic follow-up ranged from 3-14 months. Open laparoscopic access using modified Hasson's technique was associated with no major or life-threatening complications. Minor operative [3%] and post-operative [2%] complications occurred in the first 100 cases. Modified Hasson's technique for the primary trocar for accessing the abdominal cavity is a safe and effective method, and is recommended for all laparoscopic procedures in children

Cirugía en la incontinencia de orina de esfuerzo: cinta suburetral media de prolene(r): experiencia prospectiva del Hospital Dr. Sótero del Río / Surgery in the female urinary stress incontinence: tension-free prolene(r) suburethral slings: prospective experience of Hospital Dr. Sótero del Río

La Incontinencia de Orina de Esfuerzo (IOE) femenina es una patología de alta prevalencia, que deteriora la calidad de vida. Ninguna técnica quirúrgica ha obtenido resultados óptimos al largo plazo en su tratamiento. Por ello han habido muchas modificaciones en la técnica quirúrgica. Desde hace ya 8 años se comenzaron a publicar los primeros reportes sobre las cintas suburetrales (TVT®) sin tensión con resultados muy promisorios. En el último tiempo hemos podido conocer los primeros resultados de seguimiento a 5 años de esta técnica mínimamente invasiva. El propósito de este trabajo es evaluar nuestros resultados de las pacientes operadas de IOE con la cinta suburetral sin tensión con malla de Prolene® construida en nuestro hospital. La técnica consiste en la colocación de una cinta de Prolene® suburetral de 30 x 1,1 cm por vía vaginal anterior, sin tensión, fijándose a los tejidos paravaginales y retropúbicos por fibrosis sin suturas, creando un uroligamento artificial reforzando el piso pélvico, entregando soporte posterior a la uretra. Requiere sólo una incisión vaginal de 1,5 cm y dos incisiones de 5 mm a nivel suprapúbico, bajo anestesia regional. Pacientes: El grupo está formado por 124 mujeres, portadoras de incontinencia de orina de esfuerzo tipo I, II y III, incluyendo pacientes con incontinencia de esfuerzo pura, mixta y/o recidivada. Su edad promedio es de 55,3 (18-78) años, utilizando 5,84 (1-20) paños /día. 21 pacientes tenían IOE recidivada y 23 utilizaban anticolinérgicos preoperatoriamente. En 34 casos se realizó cirugía combinada de IOE más patología ginecológica por vía vaginal o laparoscópica.

Dilating missile trocar for primary port establishment: a cadaver study.

The missile trocar was developed for controllable entry force, smaller fascial defects and post-operative pain improvement. The trocar was composed of a fascial-dilating long-conical head and a handle. Accompanied with this trocar, the authors designed a rectus sheath-hooking instrument to promote negative intra-abdominal pressure during the trocar puncture. The hooking procedure allowed room air to pass through the central canal of the trocar and fill the space between the intestinal loops and the trocar tip. The abdominal access procedure succeeded in forty-five attempts in fresh cadavers. No second attempt was done. The trocar accessed into the peritoneal cavity at every attempt without intestinal penetration. The missile trocar may be an alternative device for establishment of the primary port. Its efficacy and safety still has to be proved.

Cinta vaginal libre de tensión: una solución mínimamente invasiva para el tratamiento de la incontinencia de orina / Tension free vaginal tape: a minimally invasive procedure for the treatment of urinary incontinence

Se presenta el caso clínico de una paciente con incontinencia de orina de esfuerzo por deficiencia intríseca del esfínter y patología ginecológica benigna asociada, la que es resuelta a travéz de cirugía vaginal y una técnica para incontinencia mínimamente invasiva de soporte subretral libre de tensión (TVT), Tensión-free Vaginal Tape, (Johnson y Johnson)