Histerectomía videolaparoscópica / Videolaparoscopic Hysterectomy

RESUMEN Introducción: La histerectomía constituye la segunda causa más frecuente de cirugía mayor en la mujer. Tres tipos de histerectomías son usadas en la actualidad: la histerectomía vaginal, la histerectomía abdominal y la histerectomía mínimamente invasiva. Esta última variedad se comenzó a realizar en Matanzas a finales de la pasada década. Objetivo: Evaluar las características clínicas epidemiológicas de las pacientes histerectomizadas por cirugía video laparoscópica. Métodos: Se realizó un estudio descriptivo y prospectivo. El universo lo conformaron todas las pacientes en las que se implementó esta técnica quirúrgica y se tomó como muestra al propio universo, 96 pacientes. Resultados: Predominó la edad comprendida entre 40 y 49 años con 44 pacientes; la raza negra con 51 pacientes; diagnóstico de miomatosis uterina con 87 casos; tiempo quirúrgico de 61-90 min con 57 pacientes y estadía hospitalaria de hasta 24 h en 93 de las pacientes. Se presentaron 3 complicaciones en total y el número de casos convertidos fue 0. Conclusiones: La histerectomía videolaparoscópica es implementada de forma segura y eficaz. Se realizó predominantemente en mujeres mayores de 40 años, con diagnóstico de miomatosis uterina. El tiempo quirúrgico promedio es mayor que el reportado en la literatura. La estadía hospitalaria es de 24 horas como promedio y se reincorporaron a sus actividades habituales rápidamente(AU)

ABSTRACT Introduction: Hysterectomy is the second most frequent type of major surgery among women. Three types of hysterectomy are currently used: vaginal hysterectomy, abdominal hysterectomy, and minimally invasive hysterectomy. This last variety began to be performed in Matanzas at the end of the last decade. Objective: To evaluate the clinical-epidemiological characteristics of patients hysterectomized. Methods: A descriptive and prospective study was carried out. The population was made up of all the patients operated on by this surgical technique. The whole population itself was taken as a sample (96 patients). Results: There was predominance of the age group 40-49 years (44 patients), the black race (51 patients), diagnosis of uterine myomatosis (87 cases), surgical time of 61-90 min (57 patients), and hospital stay of up to 24 hours (93 patients). There were three complications and the number of converted cases was 0. Conclusions: Videolaparoscopic hysterectomy is implemented safely and effectively. It was performed predominantly in women over 40 years of age and diagnosed with uterine myomatosis. Average surgical time is greater than that reported in the scientific literature. Hospital stay is 24 hours as an average. The patients returned to their usual activities quickly(AU)

Evaluación de la calidad de vida en pacientes sometidos a simpaticotomía videotoracoscópica por Hiperhidrosis palmar / Quality of Life Assessment in Patients Who Underwent Videothoracoscopic Sympathicotomy for Palmar Hyperhidrosis

RESUMEN Introducción: La hiperhidrosis es un trastorno primario caracterizado por sudación excesiva, que afecta con mayor frecuencia las palmas de las manos. La enfermedad trae consigo limitaciones que interfieren en las relaciones sociales, laborales, interpersonales y afectivas del individuo, y genera desde etapas tempranas de la vida, afectación psíquica dada fundamentalmente por complejos y disminución de la autoestima. Objetivo: Determinar cómo influye la simpaticotomía videotoracoscópica en el nivel de vida de los pacientes con diagnóstico de Hiperhidrosis palmar. Métodos: Se realizó un estudio retrospectivo, transversal y descriptivo de 82 pacientes con diagnóstico de Hiperhidrosis palmar, a los cuales se les realizó Simpaticotomía videotoracoscópica uniportal. Se aplicó la encuesta de Rivas-Milanez que evalúa la calidad de vida antes y después de la cirugía. Resultados: Predominó el sexo femenino, el nivel de satisfacción de los pacientes fue del 97,6 por ciento, se presentó sudoración compensatoria en el 34,1 por ciento de los operados y la mejoría de la calidad de vida fue del 93,2 por ciento. La sudoración compensatoria fue bien tolerada en la mayoría de los pacientes. Conclusiones: La simpaticotomía videotoracoscópica en la hiperhidrosis palmar logra mejorar la calidad de vida de los pacientes(AU)

ABSTRACT Introduction: Hyperhidrosis is a primary disorder characterized by excessive sweating, affecting most frequently the palms of the hands. The disease brings about limitations that interfere in the individual's social, occupational, interpersonal and affective relationships, and produces, from the early stages of life, psychic damage manifested fundamentally through complexes and a decrease in self-esteem. Objective: To determine how videothoracoscopic sympathicotomy influences the living standard of patients diagnosed with palmar hyperhidrosis. Methods: A retrospective, cross-sectional and descriptive study was carried out in 82 patients with a diagnosis of palmar hyperhidrosis, who were performed single-port videothoracoscopic sympathicotomy. We applied the Rivas-Milanez survey, which evaluates quality of life before and after surgery. Results: The female sex predominated, the level of satisfaction of the patients was 97.6 percent, compensatory sweating occurred in 34.1 percent of the intervened patients, and improvement of quality of life was 93.2 percent. Compensatory sweating was tolerated well in most patients. Conclusions: Videothoracoscopic sympathicotomy in palmar hyperhidrosis is an adequate treatment for improving the quality of life of patients(AU)

Comparison between curettage adenoidectomy and endoscopic-assisted microdebrider adenoidectomy in terms of Eustachian tube dysfunction / Comparação entre adenoidectomia por curetagem e adenoidectomia por microdebridador assistida por endoscopia, em relação à disfunção tubária

Abstract Introduction Adenoidectomy can be performed with many ways, including curettage and microdebrider endoscopic-assisted adenoidectomy. Those two techniques have advantages and disadvantages. Objective The objective of this study is to research the effects of curettage adenoidectomy and endoscopic-assisted microdebrider adenoidectomy on the tympanum pressures in pediatric patients with adenoid hypertrophy without otitis media with effusion. Methods This prospective descriptive study was performed with 65 patients who had a normal tympanic membrane and normal tympanogram and then underwent adenoidectomy or adenotonsillectomy for adenoid and tonsil hypertrophy. The subjects were randomly divided into two groups: curettage adenoidectomy group and endoscopic microdebrider-assisted adenoidectomy group. They underwent tympanometry, and the preoperative as well as 1st and 7th day postoperative values of the tympanum pressures were compared within and among the groups. Results There were 32 patients in the curettage adenoidectomy group and 33 patients in the microdebrider adenoidectomy group. Statistically significant differences were observed in the median tympanum pressure on the preoperative and 1st and 7th postoperative days for both the left and right ears with curettage adenoidectomy (p < 0.001, p < 0.001). This difference occurred on the 1st postoperative day, and the value returned to normal on the 7th day. There was no significant difference in the median tympanum pressure on the preoperative and 1st and 7th postoperative days for both the left and right ears in the microdebrider adenoidectomy group (p = 0.376, p = 0.128). Conclusion Postoperative Eustachian tube dysfunction is seen less often with the endoscopic-assisted microdebrider adenoidectomy technique than with the conventional adenoidectomy technique.

Resumo Introdução A adenoidectomia pode ser realizada de várias maneiras, inclusive por curetagem e por microdebridador, assistida por endoscopia. Essas duas técnicas têm algumas vantagens e desvantagens. Objetivo O objetivo deste estudo foi investigar os efeitos da técnica de adenoidectomia por curetagem e da adenoidectomia por microdebridador assistida por endoscopia sobre a pressão timpânica em pacientes pediátricos com hipertrofia adenoideana sem otite média com efusão. Método Estudo descritivo prospectivo feito com 65 pacientes que apresentavam membrana timpânica e timpanograma normais, que foram então submetidos à adenoidectomia ou adenotonsilectomia por hipertrofia adenoamigdaliana. Os pacientes foram divididos aleatoriamente em dois grupos: grupo adenoidectomia por curetagem e grupo adenoidectomia por microdebridador assistida por endoscópio. Todos os pacientes fizeram timpanometria e os valores das pressões do tímpano pré-operatórios e pós-operatórios no 1º e 7º dias foram comparados intragrupos e entre os grupos. Resultados Foram incluídos 32 pacientes no grupo adenoidectomia por curetagem e 33 pacientes no grupo adenoidectomia com microdebridador. Diferenças estatisticamente significantes foram observadas na mediana da diferença entre a pressão timpânica no pré-operatório e no 1º e 7º dias de pós-operatório para ambas as orelhas, direita e esquerda, na adenoidectomia por curetagem (p < 0,001, p < 0,001). Essa diferença ocorreu no 1º dia do pós-operatório e o valor retornou ao normal no 7º dia. Não houve diferença significante na mediana entre pressão timpânica no pré-operatório e no 1º e 7º dias de pós-operatório para as orelhas direita e esquerda no grupo de adenoidectomia com microdebridador (p = 0,376, p = 0,128). Conclusão A disfunção tubária no pós-operatório é observada menos frequentemente com a técnica de adenoidectomia por microdebridador assistida por endoscopia quando comparada com a técnica convencional.

Minimally invasive video-assisted mitral valve replacement with a right chest small incision in patients aged over 65 years

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

Treatment of Blowout fracture with video-assisted surgery / Tratamento de fratura Blowout com auxílio de vídeo-cirurgia

ABSTRACT Posterior fractures of the orbital floor are challenging, since an incomplete visualization of the defect through conventional surgical accesses may compromise the surgical outcome. The use of the endoscope as an auxiliary method during orbital reconstructions may be considered as a tool of considerable importance, mainly due to the visualization of the whole extension of fracture and adaptation of meshes or bone grafts. This study aims to report a clinical case of a patient diagnosed with extensive blowout fracture showing diplopy, enophthalmos, and ophthalmoplegia in supraversion, who underwent a subciliary approach combined with transantral video assisted surgery. There were no intercurrences on the procedure. Currently, patient has 1 year of follow up, with reestablished orbital function and architecture.

RESUMO As fraturas posteriores do assoalho orbital são desafiadoras, visto que a incompleta visualização do defeito por meio dos acessos cirúrgicos convencionais poderá comprometer o resultado cirúrgico. O uso do endoscópio como método auxiliar durante as reconstruções orbitais pode ser considerado uma ferramenta de grande importância principalmente para visualização de toda a extensão da fratura e adaptação das malhas ou enxertos ósseos. Este trabalho tem como objetivo relatar um caso clínico de um paciente diagnosticado com uma extensa fratura blowout apresentando clinicamente diplopia, enoftalmo e oftalmoplegia em supraversão, o qual foi submetido a tratamento através da abordagem subciliar combinada com a cirurgia vídeo-assistida transantral. O procedimento foi realizado sem intercorrências, estando o paciente com 1 ano de acompanhamento, com função e arquitetura orbital restabelecidos.

Experiencia inicial en la adaptación del instrumental del tratamiento video asistido modificado de las fistulas perianales complejas (VAMAFT) / Initial experience in the adaptation of the instruments of the modified assisted video treatment of complex perianal fistulas (VAMAFT)

Introducción: Las fístulas perianales tienen dos problemas fundamentales, la tasa de recurrencia y de incontinencia fecal postoperatoria, complicaciones que varían en frecuencia dependiendo de varios factores como el tipo de fistula, la técnica quirúrgica usada y la experiencia del cirujano. Debido a esto existen técnicas quirúrgicas no conservadoras y conservadoras de esfínteres donde se incluye el tratamiento video asistido que aparece desde el año 2006 y en la cual se utiliza un sistema de video endoscopio sofisticado y de alto valor económico el cual hemos adaptado a nuestro medio. Pacientes y método: De septiembre del 2015 al 2017 en la Unidad de Coloproctología del Hospital Domingo Luciani IVSS se realizó un estudio prospectivo experimental, donde se incluyeron 18 pacientes con fístulas perianales complejas diagnosticadas previamente con Ecofistulografía 3D y los cuales se operaron con un sistema adaptado usando citoscopio pediátrico de 4 mm y energía láser. Se evaluaron parámetros referentes a la técnica así como la tasa de éxito y riesgo de incontinencia. Resultados: Tiempo quirúrgico de 40 a 80 minutos, con tasa de éxito de 89%, recidiva en 2 pacientes, con tiempo de seguimiento entre 12 a 36 meses y sin cambios en la escala de incontinencia pre y post quirúrgica. Conclusión: El tratamiento video asistido modificado para fistulas anales (VAMAFT) es una técnica innovadora y factible de realizar al adaptar algunos instrumentos, con una tasa de éxito adecuada y sin riesgo de incontinencia, pero más trabajos aleatorizados con mayor números de pacientes deben ser realizados.

Introduction: Anal fistulas have two basic problems, rate of recurrence and postoperative anal incontinence. These complications vary according to several factors such as type of anal fistula, surgical technique and the surgeon´s experience. For each cases there are different surgical techniques with and without conservation of anal sphincters like conservative video assisted anal fistula treatment, described in 2006, this technique uses a sophisticated and expensive endoscope system but that we modified to use in our hospitals. Patients and method: Between September 2015 to 2017 in the Unit of Coloproctology of Domingo Luciani Hospital, was perfomed a prospective and experimental trial in 18 patients with anal complex fistulas previously diagnosed using tridimensional anal ultrasound and operated with a modified system consisting of pediatric cystoscope of 4 mm and laser energy. Some parameters were evaluated including surgical technique, recurrence and anal incontinence rate. Results: Surgical times were between 40 to 80 minutes, success rate of 89%, recurrence in two patients with follow up of 12 to 36 months and no changes in pre and post surgical anal incontinence scale. Conclusion: Video assited modified anal fistula treatment (VAMAFT) is an innovative and feasible surgical technique to do adapting some instruments, with suitable success rate and without anal incontinence risk but many randomized research with more patients have to be perfomed.

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.

Full-Videoendoscopic Interlaminar Surgery for the Treatment of Lumbar Disc Herniations ­ A Series of 50 Cases

The present study aims to describe the results of full-videoendoscopic surgery through the interlaminar route for central lumbar disc herniation in a series of 50 cases in Brazil. This is a retrospective single-center study. With the aim of describing safety, the present study reports the complication and revision rates. The clinical results were collected with the visual analogue scale (VAS) and with the Oswestry Disability Index (ODI) (a questionnaire to evaluate functional disability) at the preoperative visit and at 6 months postsurgery. The average surgical time was 20 minutes (range: 9­40 minutes), and 100% of the procedures were performed in an outpatient setting. The mean VAS scores improved from 9.4 to 1.1 (p < 0.001), and the mean ODI scores decreased from 69 to 9 points in the last follow-up (p < 0.001). There was 1 case (2%) with hernia recurrence, 1 case with intraoperative root injury (2%), and 2 cases (4%) that required lumbar fusion due to a preexisting instability. No infections were observed. The full-videoendoscopic surgery is a modern option for treating lumbar disc herniation. In the present study, we have observed that the use of this technique for the removal of fragments affecting the vertebral canal presented satisfactory clinical results, low complication rates, and that it has demonstrated its feasibility in an outpatient setting without prolonged hospitalization.

Comparison of King Vision video laryngoscope and Macintosh laryngoscope: a prospective randomized controlled clinical trial / Comparação entre o videolaringoscópio King Vision e o laringoscópio Macintosh: um ensaio clínico prospectivo randomizado e controlado

Abstract Background and objectives We compared the efficiency of the King Vision video laryngoscope and the Macintosh laryngoscope, when used by experienced anesthesiologists on adult patients with varying intubating conditions, in a prospective randomized controlled clinical trial. Methods A total of 388 patients with an American Society of Anesthesiologists physical status of I or II, scheduled for general anesthesia with endotracheal intubation. Each patient was intubated with both laryngoscopes successively, in a randomized order. Intubation success rate, time to best glottic view, time to intubation, time to ventilation, Cormack-Lehane laryngoscopy grades, and complications related to the laryngoscopy and intubation were analyzed. Results and conclusions First pass intubation success rates were similar for the King Vision and the Macintosh (96.6% vs. 94.3%, respectively, p > 0.05). King Vision resulted in a longer average time to glottic view (95% CI 0.5-1.4 s, p < 0.001), and time to intubation (95% CI 3-4.6 s, p < 0.001). The difference in time to intubation was similar when unsuccessful intubation attempts were excluded (95% CI 2.8-4.4 s, p < 0.001). Based on the modified Mallampati class at the preoperative visit, the King Vision improved the glottic view in significantly more patients (220 patients, 56.7%) compared with the Macintosh (180 patients, 46.4%) (p < 0.001). None of the patients had peripheral oxygen desaturation below 94%. Experienced anesthesiologists may obtain similar rates of first pass intubation success and airway trauma with both laryngoscopes. King Vision requires longer times to visualize the glottis and to intubate the trachea, but does not cause additional desaturation.

Resumo Justificativa e objetivos Comparamos a eficiência do videolaringoscópio King Vision e do laringoscópio Macintosh, quando usados por anestesiologistas experientes em pacientes adultos com diferentes condições de intubação, em um estudo clínico prospectivo randomizado e controlado. Métodos Foram selecionados 388 pacientes com estado físico ASA I ou II (de acordo com a classificação da American Society of Anesthesiologists - ASA), programados para anestesia geral com intubação traqueal. Cada paciente foi intubado com ambos os laringoscópios sucessivamente, em uma ordem aleatória. A taxa de sucesso da intubação, o tempo até a melhor visibilização da glote, o tempo de intubação, o tempo de ventilação, a classificação de Cormack-Lehane (graus) e as complicações relacionadas à laringoscopia e intubação foram analisados. Resultados e conclusões As taxas de sucesso na intubação na primeira tentativa foram similares para o King Vision e o Macintosh (96,6% vs. 94,3%, respectivamente, p > 0,05). As médias dos tempos até a melhor visibilização da glote (IC 95% 0,5-1,4 s, p < 0,001) e de intubação (IC 95% 3-4,6 s, p < 0,001) foram maiores no King Vision. A diferença no tempo de intubação foi semelhante quando as tentativas malsucedidas de intubação foram excluídas (IC 95% 2,8-4,4 s, p < 0,001). Com base na classificação de Mallampati modificada na consulta pré-operatória, o King Vision melhorou significativamente a visibilização da glote em mais pacientes (220 pacientes, 56,7%) em comparação com o Macintosh (180 pacientes, 46,4%) (p < 0,001). Nenhum dos pacientes apresentou dessaturação periférica de oxigênio abaixo de 94%. Os anestesiologistas experientes podem obter taxas semelhantes de sucesso na primeira tentativa de intubação e de traumas das vias aéreas com ambos os laringoscópios. O King Vision requer tempos mais longos até a visibilização da glote e de intubação traqueal, mas não causa dessaturação adicional.

Cystoscopy-assisted laparoscopy for bladder endometriosis: modified light-to-light technique for bladder preservation

ABSTRACT Introduction Endometriosis is a disease with causes still unclear, affecting approximately 15% of women of reproductive age, and in 1%-2% of whom it may involve the urinary tract. The bladder is the organ most frequently affected by endometriosis, observed around 85% of the cases. In such cases, the most effective treatment is partial cystectomy, especially via videolaparoscopy. Study Objective, Design, Size and Duration In order to identify and delimit the extent of the intravesical endometriosis lesion, to determine the resection limits, as well as to perform an optimal reconstruction of the organ aiming for its maximum preservation, we performed a cystoscopy simultaneously with the surgery, employing a modified light-to-light technique in 25 consecutive patients, from September 2006 to May 2012. Setting Study performed at Campinas Medical Center – Campinas – Sao Paulo – Brazil.Participants/materials, setting and methods: Patients aged 27 to 47 (average age: 33.4 years) with deep endometriosis with total bladder involvement were selected for the study. The technique used was conventional laparoscopy with a transvaginal uterine manipulator and simultaneous cystoscopy (the light-to-light technique). A partial videolaparoscopic cystectomy was performed with cystoscopy-assisted vesical reconstruction throughout the entire surgical time. The lesions had an average size of 2.75cm (ranging from 1.5 to 5.5cm). The average surgical time was 137.7 minutes, ranging from 110 to 180 minutes. Main Results Postoperative follow-up time was 32.4 months (12-78 months), with clinical evaluation and a control cystoscopy performed every six months. No relapse was observed during the follow-up period. Conclusions A cystoscopy-assisted partial laparoscopic cystectomy with a modified light-to-light technique is a method that provides adequate identification of the lesion limits, intra or extravesically. It also allows a safe reconstruction of the organ aiming for its maximum preservation.

Quiste celómico del pericardio / Pericardial celomic cyst

Con el descubrimiento y el desarrollo de la cirugía de mínimo acceso, la videotoracoscopia no solo se emplea para la confirmación diagnóstica de esta entidad como lo hiciera Otto Pickhardt, en el año 1931, sino que resulta de gran utilidad para su tratamiento con resultados satisfactorios. Se presenta un paciente masculino, de 28 años de edad, con un quiste celómico del pericardio, asintomático, encontrado en una radiografía de tórax de rutina, localizado en el ángulo cardiofrénico derecho. Se interviene quirúrgicamente por vía videotoracoscópica sin complicaciones(AU)

With the discovery and development of minimal access surgery, videothoracoscopy is not only used to confirm the diagnosis of this entity as did Otto Pickhardt, in 1931, it is useful for treatment with satisfactory results. A male patient, 28-year-old with a pericardial coelomic cyst asymptomatic, found in a routine chest X-ray, located in the right cardiophrenic angle is presented. It is surgically intervenes via videothoracoscopy without complications(AU)

Changes in the distance between carina and orotracheal tube during open or videolaparoscopic bariatric surgery / Mudanças da distância entre a carina e o tubo orotraqueal durante cirurgia bariátrica aberta ou laparoscópica

ABSTRACTOBJECTIVE: To examine whether there are changes in the distance between the orotracheal tube and carina induced by orthostatic retractor placement or by pneumoperitoneum insufflation in obese patients undergoing gastroplasty.METHODS: 60 patients undergoing bariatric surgery by two techniques: open (G1) or videolaparoscopic (G2) gastroplasty were studied. After tracheal intubation, adequate ventilation of both hemitoraxes was confirmed by lung auscultation. The distance orotracheal tube-carina was estimated with the use of a fiber bronchoscope before and after installation of orthostatic retractors in G1 or before and after insufflation of pneumoperitoneum in patients in G2.RESULTS: G1 was composed of 22 and G2 of 38 patients. No cases of endobronchial intubation were detected in either group. The mean orotracheal tube-carina distance variation was estimated in -0.03 cm (95% CI 0.06 to -0.13) in the group of patients undergoing open gastroplasty and in -0.42 cm (95% CI -0.56 to -1.4) in the group of patients undergoing videolaparoscopic gastroplasty. The extremes of variation in each group were: 0.5 cm to -1.6 cm in patients undergoing open surgery and 0.1 cm to -2.2 cm in patients undergoing videolaparoscopic surgery.CONCLUSIONS: There was no significant change in orotracheal tube-CA distance after placement of orthostatic retractors in patients undergoing open gastroplasty. There was a reduction in orotracheal tube-CA distance after insufflation of pneumoperitoneum in patients undergoing videolaparoscopic gastroplasty. We recommend attention to lung auscultation and to signals of ventilation monitoring and reevaluation of orotracheal tube placement after peritoneal insufflation.

RESUMOOBJETIVO: Analisar se há mudanças na distância entre o tubo orotraqueal (TOT) e a carina (CA) induzidas pelo afastador ortostático ou pelo pneumoperitônio em pacientes obesos submetidos a gastroplastia.MÉTODOS: Foram estudados 60 pacientes submetidos à cirurgia bariátrica por duas técnicas: aberta (G1) ou videolaparoscópica (G2). Após a intubação orotraqueal, a ventilação adequada de ambos os hemitórax foi confirmada por meio da ausculta pulmonar. A distância TOT-CA foi estimada com o uso de um fibrobroncoscópio antes e após a instalação dos afastadores ortostáticos no G1 ou antes e após a insuflação do pneumoperitônio nos pacientes no G2.RESULTADOS: Integraram o G1 22 pacientes e 38 o G2. Não houve casos de intubação endobrônquica em nenhum dos grupos. A média de variação da distância TOT-CA foi -0,03 cm (95% IC 0,06 a -0,13) no grupo dos pacientes submetidos à gastroplastia aberta e -0,42 cm (95% IC -0,56 a -1,4) no grupo dos pacientes submetidos à gastroplastia videolaparoscópica. Os extremos de variação em cada grupo foram: 0,5 cm a -1,6 cm no dos pacientes submetidos à cirurgia aberta e 0,1 cm a -2,2 cm no dos pacientes submetidos à cirurgia videolaparoscópica.CONCLUSÕES:Não houve alteração significativa na distância TOT-CA após instalação dos afastadores ortostáticos nos pacientes submetidos à gastroplastia aberta. Houve redução na distância TOT-CA após a insuflação do pneumoperitônio nos pacientes submetidos à gastroplastia videolaparoscópica. Sugerimos atenção à ausculta pulmonar e aos sinais de monitoração da ventilação e reavaliação do posicionamento do TOT após insuflação peritoneal.

Application of indocyanine green video angiography in surgical treatment of intracranial aneurysms / Aplicação da angiografia intraoperatória com indocianina verde no tratamento cirúrgico de aneurismas cerebrais

Indocyanine green (ICG) video angiography has been used for several medical indications in the last decades. It allows a real time evaluation of vascular structures during the surgery. This study describes the surgical results of a senior vascular neurosurgeon. We retrospectively searched our database for all aneurysm cases treated with the aid of intraoperative ICG from 2009 to 2014. A total of 61 aneurysms in 56 patients were surgically clipped using intraoperative ICG. Clip reposition after ICG happened in 2 patients (3.2%). Generally, highly variable clip adjustment rates of 2%–38% following ICG have been reported since the introduction of this imaging technique. The application of ICG in vascular neurosurgery is still an emerging challenge. It is an adjunctive strategy which facilitates aneurismal evaluation and treatment in experienced hands. Nevertheless, a qualified vascular neurosurgeon is still the most important component of a high quality work.

A angiografia intraoperatória com indocianina verde (ICG) já foi aplicada em diversas situações clínicas por vários anos. O ICG permite avaliação em tempo real de estruturas vasculares durante a cirurgia. Este artigo descreve os resultados cirúrgicos do autor sênior. Avaliamos retrospectivamente os casos de aneurismas intracranianos operados de 2009 a 2014. Um total de 61 aneurismas em 56 pacientes foram operados com ICG. O reposicionamento do clip ocorreu em 2 casos (3.2%). Geralmente, taxas variáveis de reposicionamento do clip têm sido descritas (2%–38%). A aplicação de ICG na neurocirurgia vascular ainda é um desafio crescente. É um artifício que auxilia na avaliação e tratamento de aneurismas intracranianos em mãos experientes. No entanto, um neurocirurgião vascular continua sendo o principal componente de um resultado cirúrgico de alto nível.

Cirugía videolaparoscópica en la hernia hiatal gigante / Laparoscopic surgery for the treatment of giant hiatal hernias

Introducción: la hernia hiatal es una enfermedad adquirida y de las más frecuentes que afectan el aparato digestivo superior. El término hernia hiatal gigante se utiliza cuando el contenido de la hernia supera un tercio del estómago (30 por ciento en el tórax), o tienen un diámetro mayor de 5 cm. Objetivo: describir los resultados obtenidos en el tratamiento quirúrgico de la hernia hiatal gigante realizado por cirugía laparoscópica en el Centro Nacional de Cirugía de Mínimo Acceso. Métodos: se realizó un estudio retrospectivo, descriptivo y longitudinal, donde se incluyeron todos los pacientes intervenidos quirúrgicamente por hernia hiatal gigante en el Centro Nacional de Cirugía de Mínimo Acceso en el período comprendido entre enero de 2011 a diciembre de 2013. Resultados: la hernia tuvo un tamaño medio de 7 cm con rangos entre 6 y 15 cm. La técnica realizada con mayor frecuencia fue la herniorrafia hiatal más fundoplicatura de Nissen-Rossetti en 70 por ciento de los pacientes. Hubo 3 recidivas que requirieron reintervención y no hubo fallecidos. Conclusiones: la cirugía videolaparoscópica es la técnica de elección para el tratamiento de la hernia hiatal gigante, siempre que sea realizada por equipos quirúrgicos que tengan experiencia en procederes laparoscópicos de avanzada, lo que permite obtener resultados satisfactorios en cuanto a morbilidad y mortalidad(AU)

Introduction: hiatal hernia is an acquired disease and it is common in the upper gastrointestinal tract. The expression Giant hiatal hernia is called a hernia that exceeds one third of the stomach (30 por ciento in the thorax) and measures over 5cm diameter. Objective: to describe the results of the laparoscopic surgery for the treatment of giant hiatal hernias at the National Center of the Minimal Access Surgery. Methods: a retrospective, descriptive and longitudinal study was performed on patients with giant hiatal hernia and surgical treatment between January 2011 and December 2013 at the National Center for Minimal Access Surgery in Havana, Cuba. Results: the hernia size was 7 cm as average, ranging from 6 to 15 cm. The most used technique was hiatal herniorrhaphy plus Nissen-Rossetti funduplication in 70 por ciento of patients. There were 3 recurrences that required reoperation. No deaths were observed in this series. Conclusions: laparoscopic surgery is the best technique for the treatment of giant hiatal hernia, provided that the surgical teams have enough experience in advanced laparoscopic procedures, which can allow good results in terms of morbidity and mortality rates(AU)

Tratamento videolaparoscópico para retirada de dispositivo intrauterino em fossa ilíaca direita / Laparoscopic treatment for removal of intrauterine device in the right iliac fossa

Dispositivo intrauterino pode sofrer expulsão da cavidade uterina. Objetivo: Descrever um caso de tratamento videolaparoscópico para retirada de dispositivo intrauterino de fossa ilíaca direita. Material e Métodos: Jovem do sexo feminino apresentou dor em fossa ilíaca direita de quatro dias de duração. No exame físico, apresentava dor abdominal localizada em fossa ilíaca direita, com discreta resistência de parede e dor à percussão e descompressão brusca na região. Em tomografia computadorizada, evidenciou-se dispositivo intrauterino fora do útero, na fossa ilíaca direita. Foram utilizadas as bases de dados SciELO, MedLine, Sobracil e PubMed no período compreendido de Abril a Junho de 2014. Vinte e dois artigos foram relacionados, entretanto somente os 10 artigos que compõem as referências bibliográficas foram selecionados por conter informações relevantes acerca do tema. Resultados: Na videolaparoscopia, pôde ser observado DIU em fossa ilíaca direita, próximo ao intestino, fora do útero, sem aderência, sem perfurações evidentes ou maiores complicações. Conclusão: A videolaparoscopia permite a retirada adequada de dispositivo intrauterino localizado indevidamente fora da cavidade uterina; permite inclusive avaliação adequada de toda a região pélvica para excluir lesões associadas.(AU)

Intrauterine device may suffer expulsion of the uterine cavity. Objective: To describe a laparoscopic treatment of the case for removal of intrauterine device right iliac fossa. Material and Methods: Young female presented pain in the right iliac fossa of four days. On physical examination, showed abdominal pain localized in the right iliac fossa, with thin wall of resistance and pain on percussion and rebound in the region. In CT scan it was seen an intrauterine device outside the uterus, in the right iliac fossa. The SciELO, MedLine, Sobracil and PubMed databases were used in the period April to June 2014. Twenty-two articles were related, though only 10 articles that make up the references were selected because they contain important information about the theme. Results: In the laparoscopy it could be observed the IUD in the right iliac fossa, near the intestine, outside the uterus, without grip, with no obvious or larger perforations complications.Conclusion: Laparoscopy allows adequate removal of intrauterine device located improperly outside the uterine cavity; even allows proper evaluation of the entire pelvic region to rule out associated injuries.(AU)

Quiste paraovárico gigante en la infancia: Reporte de un caso / Giant paraovarian cyst in childhood: Case report

Introducción: Los quistes paraováricos son de diagnóstico infrecuente en la edad pediátrica. Objetivos: Dar a conocer un caso clínico de quiste paraovárico gigante en la infancia y su manejo a través de una técnica laparoscópica modificada. Caso Clínico: Paciente de 13 años con cuadro de dolor abdominal intermitente de 15 días de evolución, localizado en el hemiabdomen izquierdo, asociado a aumento de volumen abdominal progresivo. Las imágenes diagnósticas no fueron concluyentes, describiendo una formación quística gigante que ocupaba todo el abdomen, sin precisar su origen. Exámenes de laboratorio y marcadores tumorales dentro de los parámetros normales. Se realizó quistectomía transumbilical videoasistida, un procedimiento laparoscópico modificado, con intención diagnóstica y terapéutica con resultado exitoso. Estudio histológico compatible con quiste paraovárico gigante. El examen citológico resultó negativo para células tumorales. La paciente permaneció asintomática durante el seguimiento postoperatorio. Conclusiones: La quistectomía transumbilical videoasistida es una técnica segura y constituye una excelente alternativa diagnóstica y terapéutica para el tratamiento de quistes paraováricos gigantes.

Introduction: Paraovarian cysts are very uncommon in children. Objective: To present a case of giant paraovarian cyst case in a child and its management using a modified laparoscopic-assisted technique. Case report: A 13-year-old patient with a 15 day-history of intermittent abdominal pain, located in the left hemiabdomen and associated with progressive increase in abdominal volume. Diagnostic imaging was inconclusive, describing a giant cystic formation that filled up the abdomen, but without specifying its origin. Laboratory tests and tumor markers were within normal range. Video-assisted transumbilical cystectomy, a modified laparoscopic procedure with diagnostic and therapeutic intent, was performed with a successful outcome. The histological study reported giant paraovarian cyst. Cytology results were negative for tumor cells. The patient remained asymptomatic during the postoperative follow-up. Conclusions: The video-assisted transumbilical cystectomy is a safe procedure and an excellent diagnostic and therapeutic alternative for the treatment of giant paraovarian cysts.

General anesthesia type does not influence serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in video laparoscopic bariatric surgery

OBJECTIVES: Video laparoscopic bariatric surgery is the preferred surgical technique for treating morbid obesity. However, pneumoperitoneum can pose risks to the kidneys by causing a decrease in renal blood flow. Furthermore, as in other surgical procedures, laparoscopic bariatric surgery triggers an acute inflammatory response. Neutrophil gelatinase-associated lipocalin is an early and accurate biomarker of renal injury, as well as of the inflammatory response. Anesthetic drugs could offer some protection for the kidneys and could attenuate the acute inflammatory response from surgical trauma. The objective of this study was to compare the effects of two types of anesthetics, propofol and sevoflurane, on the serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in laparoscopic bariatric surgery. METHODS: Sixty-four patients scheduled for laparoscopic bariatric surgery were randomized into two anesthesia groups and were administered either total intravenous anesthesia (propofol) or inhalation anesthesia (sevoflurane). In the perioperative period, blood samples were collected at three time points (before anesthesia, 6 hours after pneumoperitoneum and 24 hours after pneumoperitoneum) and urine output was measured for 24 hours. Acute kidney injuries were evaluated by examining both the clinical and laboratory parameters during the postoperative period. The differences between the groups were compared using non-parametric tests. ReBEC (http://www.ensaiosclinicos.gov.br/rg/recruiting/): RBR-8wt2fy RESULTS: None of the patients developed an acute kidney injury during the study and no significant differences were found between the serum neutrophil gelatinase-associated lipocalin levels of the groups during the perioperative period. CONCLUSION: The choice of anesthetic drug, either propofol or sevoflurane, did not affect the serum levels of neutrophil gelatinase-associated lipocalin during the perioperative ...

How to perform a coronary artery anastomosis in complete endoscopic fashion with robotic assistance / Como realizar anastomose coronariana totalmente endoscópica com assistência robótica

Current technology in robotic surgery allows us to perform myocardial revascularization procedures in a totally endoscopic fashion. We will describe the technique of choice for left internal mammary artery to left anterior descendent artery anastomosis with the use of cardiopulmonary bypass machine. The method is efficient and there is long term follow-up showing similar patency of the graft when compared to conventional methods (when performed through sternotomy).

A tecnologia atual em cirurgia robótica permite realizar-se procedimento de revascularização do miocárdio de modo totalmente endoscópico. Descreveremos aqui a técnica de escolha para anastomose de artéria mamaria interna esquerda em artéria coronariana descendente anterior com uso de circulação extracorpórea. O método e eficaz e já existe acompanhamento a longo prazo mostrando patência do enxerto semelhante ao método convencional por esternotomia.