Future trend of minimally invasive surgery platform and surgical procedure / 中华胃肠外科杂志

In the past 30 years, minimally invasive surgery has been greatly improved with the development of the energy platform, instrument platform, and imaging platform. Taking colorectal cancer surgery as an example, the five elements of surgical procedure have developed to a certain extent. The surgical approach has undergone a process from large to small. The range of resection ranges from simple bowel resection to radical resection/extended radical resection, and then to surgery that focuses on preserving organ function. With the recognition of the direction of normal lymphatic drainage and the characteristics of tumor lymphatic metastasis, lymph node dissection has been gradually standardized. The reconstruction of the digestive tract has changed from manual sutures to full endoscopic anastomosis, and then to the concept of functional anastomosis. The removal of the specimen has improved from large incision through the abdominal wall, to small laparoscopic incision, and then to the natural cavity. The evolution of these procedures depends on the advancement of technology platforms and equipment, and the recognition of new concepts. The development of minimally invasive platform must be in the direction of ensuring the implementation of the most optimized surgical approach. The platform is more secure, integrated, multifunctional, and intelligent. In the future, minimally invasive procedures must be aimed at maximizing the benefits of patients. The procedures are more scientific, functional, comfortable and diverse. Surgical innovation has promoted the development of the platform. The platform and the surgical procedure promote each other's development.

Cirugía mínimamente invasiva del cáncer gástrico / Minimally invasive surgery for gastric cancer

Resumen La cirugía estándar del cáncer gástrico ha sido definida en las últimas décadas por evidencia principalmente entregada desde oriente, donde se han incorporado actualizaciones para el manejo mínimamente invasivo, especialmente en estadios iniciales de esta enfermedad. Existe evidencia actual, entregada por múltiples estudios randomizados y controlados, que comparan la cirugía mínimamente invasiva y cirugía abierta en cáncer gástrico. Es así que podemos afirmar con suficiente respaldo, que en cáncer gástrico incipiente la gastrectomía subtotal laparoscópica se puede considerar como el tratamiento estándar. Sin embargo, aún se deben esperar más resultados para aseverar lo mismo en el caso de las gastrectomías totales, tanto para cáncer incipiente como avanzado. Nuestro objetivo en esta actualización es incluir la evidencia actual disponible en el manejo del cáncer gástrico en relación al tratamiento mínimamente invasivo.

Standard surgery for gastric cáncer has been defined in recent decades by evidence mainly from the East, where updates for minimally invasive management have been incorporated, especially in the early stages of this disease. There is current evidence from múltiple randomized and controlled studies comparing minimally invasive surgery and open surgery in gastric cancer. Consequently, we can affirm with sufficient support that in early gastric cancer, laparoscopic distal gastrectomy can be considered as the standard treatment. However, more results should be expected to make the same statement for total gastrectomies, both for early and locally advanced gastric cancer. The aim in this update is to report on the current available evidence in the management of gastric cancer with minimally invasive treatment.

Advances in fetal surgery / Avanços em cirurgia fetal

ABSTRACT This paper discusses the main advances in fetal surgical therapy aiming to inform health care professionals about the state-of-the-art techniques and future challenges in this field. We discuss the necessary steps of technical evolution from the initial open fetal surgery approach until the development of minimally invasive techniques of fetal endoscopic surgery (fetoscopy).

RESUMO São discutidos os principais avanços na terapia cirúrgica do feto, tendo como objetivo informar profissionais da área da saúde sobre qual o estado atual da arte e quais seus desafios futuros. São debatidos os passos que foram necessários para a evolução da técnica inicial, quando a cirurgia fetal era realizada a céu aberto, até o desenvolvimento de técnicas minimamente invasivas, de cirurgia endoscópica fetal (fetoscopia).

Cirugía mínimamente invasiva en Venezuela: estado actual de la atención pública / Minimally invasive surgery in Venezuela: public attention current status

El propósito del trabajo es describir el estado actual de la cirugía mínimamente invasiva (CMI) en Venezuela, con el fin último de incentivar políticas públicas dirigidas a dotar a los hospitales del país con el recurso humano e instrumental necesarios para el desarrollo de procedimientos diagnósticos y terapéuticos destinado a solucionar el problema que representa el cupo quirúrgico en la población de menores recursos económicos. La metodología de investigación está guiada por el paradigma positivista lógico, de enfoque empirico análitico, de raíz epistémica positivista, utilizando lenguaje cuantitativo. Desde el punto de vista heurístico la información procede del Ministerio del Poder Popular para la Salud, Sociedad Venezolana de Cirugía, círculos quirúrgicos, bibliografía nacional e internacional. El estudio de la investigación de campo y del marco teórico referencial nos permite contextualizar el tema y generar conclusiones, así como recomendaciones acordes con el fenómeno de estudio

The purpose of the study is to describe the minimally invasive surgery current state in Venezuela with the last end of motivate public policies toward provide the country's hospitals with the human resource and the necessary instrumental for the development of diagnostic and therapeutic procedures in order to solve the problem of the surgical needs in the population with low economic resources. The research methodology is guide by the logic positivist paradigm, with the empirical analytic focus and using quantitative language. From the heuristic point of view the data comes from the popular health agency. Venezuelan surgical society, surgical circles, national and international bibliograpy. The field research study permits to contextualize the theme and generate preliminary considerations and also recommendations in concordance with the phenomenon in study

Vias de acesso para tratamento de cálculos urinários: influência da introdução da videolaparoscopia / Access way for treatment of urinary calculi: impact of the introduction of laparoscopy

Avaliar a influência da laparoscopia na rotina cirúrgica do Serviço de Urologia do HC-UFMG. Métodos: Foi feita uma análise retrospectiva de todas as cirurgias, para tratamento de cálculos, realizadas no HC-UFMG entre janeiro de 2004 e outubro de 2008. Resultados: No total foram realizados 613 procedimentos e 4.850 litotripsias extracorpóreas (LECOs). Ao estratificarmos o tipo de procedimento cirúrgico realizado em função do tempo, temos que: no período inicial do estudo (2004), houve apenas seis (4,7%) casos de litíase tratados pela via laparoscópica, já no ano de 2008, os procedimentos laparoscópicos corresponderam a 17 (15,2%) casos. Conclusões: As principais modalidades no tratamento de cálculos urinários são os procedimentos endoscópicos e a LECO. A laparoscopia, apesar de ter indicações limitadas, vem ganhando espaço frente à cirurgia aberta, principalmente nos casos refratários a tratamentos menos invasivos.

This paper aims to determine the influence of the laparoscopy in the treatment of urinary stones in a tertiary hospital (HC-UFMG). Methods: We reviewed our data from January 2004 to October 2008. All patients, who underwent surgery in our institution for the treatment of urinary calculi, were enrolled. Results: Six hundred and thirteen procedures and 4,850 shock wave lithotripsy (SWL) were performed. In the first year of the study (2004), only six (4.7%) cases were done by laparoscopic approach, whereas in the last year (2008) a total of 17 (15.2%) cases were performed using the laparoscopic technique. Conclusion: The SWL and the endoscopic surgery remained as the first line treatment of urinary stones, during the whole period studied. The laparoscopic technique, despite its limitations, is getting acceptance (over the traditional open procedure) and is indicated in those cases where minimally invasive techniques have failed.

Troca valvar e reposicionamento do músculo papilar com neocordas de PTFE: cirurgia videoassistida via periareolar / Mitral valve replacement and and papillary muscle relocation with PTFE neochordae: video-assisted surgery with periareolar approach

A abordagem-padrão para a cirurgia da válvula mitral, em muitos centros, é a cirurgia minimamente invasiva videoassistida. Ainda está em ampla discussão se este acesso apresenta apenas avanços estéticos ou não. Neste artigo, relata-se o caso de substituição mitral e reposicionamento do músculo papilar, abordando-se por video via periareolar. Nesta técnica, a menor incisão, utilizando-se área com vantagem plástica, tem grande potencial para a redução do trauma cirúrgico, para bom resultado estético e para a redução do tempo de recuperação no pós-operatório.

The standard approach to mitral valve surgery in many centers is minimally invasive video-assisted surgery, withwidespread discussions still under way over whether this technique offers more than merely cosmetic advances. This paper presents a case study of mitral replacement and papillary muscle relocation using a video-assistedperiareolar approach. Through this technique, a smaller incision, using an area with a plastic advantage, offersgreat potential for reducing surgical trauma, with good cosmetic results and a shorter post-operative recovery time for the patient.

[Simulation of endoscopic procedures: an innovation to improve laparoscopic technical skills]

Laparoscopic surgery is a technically more demanding procedure compared to open surgery. Safe realistic training and unbiased quantitative assessment of technical skills are required for laparoscopic surgery. Virtual reality [VR simulators may he useful tools for training and assessing basic and advanced surgical skills and procedures to assess the acquisition of laparoscopic skills using virtual reality simulators systematic review of the literature. The simulator can be used to objectively assess the laparoscopic skills of surgeons and distinguish between novices and experienced laparoscopic surgeons. [Evidence level III-B]. 2. The target group as well as the benefit of a three-day poetical course for laparoscopic surgery can be determined by the simulator [Evidence level III-C]. 3. Novices in laparoscopic surgery seem to benefit mostly from simulation training [Evidence level III-B]. 4. Steepness and plateau of a learning curve may be more dependent on the level of performance required by the particular training session rather than the number of repetitions during a training session. [Evidence level III-B]. 5. Clinical background and understanding of the clinical value of a training program lead to faster acquisition and improvement of laparoscopic skills. As performed on the laparoscopy simulator [Evidence level III-B]. 6. Non technical skills such as visual-spatial perception and stress coping positively correlates with virtual laparoscopic skills [Evidence level III-B]. To date, the best method for teaching laparoscopic surgery has not been defined. However. the use of virtual simulators for laparoscopy training is useful when learning basic techniques allow the surgeon to improve hand dexterity and coordination in laparoscopic surgery

Current Application of Minimally Invasive Surgery for Gastrointestinal Diseases / 대한소화기학회지

The advent of minimally invasive surgery (MIS) brought a major deviation in trend from conventional surgery. Since the introduction of first laparoscopic cholecystectomy in 1985, many operations for gastrointestinal diseases adopted MIS technique in a relatively short period of time. These MIS operations yielded better outcomes when compared to their open counterparts: less pain, shorter hospital stay, faster recovery, and better cosmetics. More complex surgical procedures for benign and malignant diseases of gastrointestinal tract are currently being performed by MIS technique with the improvement in equipment, instrumentation, and surgical skills. At the forefront of MIS, lies robotics. This paper briefly reviews the current status of MIS in the field of gastrointestinal diseases.

Nova técnica para cesárea / New method for cesarean section

Apresentamos nova técnica de cesárea,previamente descrita na literatura euro-americana.A incisão da pele é similar à classicamente descrita por Pfannenstiel.O tecido celular subcutâneo é seccionado transversalmente na área estritamente necessária com bisturi elétrico.A fáscia (ou aponeurose) nunca é dissecada dos músculos reto-abdominais;estes são divulsionados de maneira digital.O peritônio parietal é aberto transversalmente por divulsão digital.Não se realiza descolamento do peritônio visceral.A histerotomia é realizada com divulsão digital ou quando indicado,com tesoura.A sutura dos 2/3 externos do miométrio com o peritônio visceral é realizada com pontos separados de poliglactina 910-0.O peritônio parietal e os músculos reto-abdominais não são suturados.A aponeurose é suturada com pontos separados de poliglactina 910-0.Tecido celular subcutâneo é aproximado com pontos invertidos de poliglecaprone 25 - 1.A pele é suturada com ponto intradérmico de poliglecaprone 25 - 3-0.Manipula-se menos tecido,há menor morbidade materna,menor risco de hematomas e menos dor pós-operatória.O método é baseado em princípios de cirurgia minimamente invasiva.O número de planos a serem suturados é reduzido de oito para quatro

Resección abdómino-perineal laparoscópica (experiencia inicial) / Abdomino-perineal laparoscopic resection (initial experience)

Antecedentes: el tratamiento laparoscópico del cáncer colorrectal plantea controversias desde el punto de vista de la cirugía oncológica. El rol de esta vía de abordaje en estos pacientes se mantiene bajo debate. Objetivos: evaluar factibilidad, seguridad y resultados en una serie inicial de resecciones abdómino-perineales laparoscópicas. Lugar de aplicación: Servicio de Cirugía General de Hospital Privado afiliado a la Universidad Nacional de La Plata. Diseño: estudio clínico observacional retrospectivo. Población: 12 pacientes intervenidos quirúrgicamente por cáncer de recto en los que se realizó resección abdómino-perineal laparoscópica, diciembre de 1994 y julio de 2002. Métodos: se analizan la técnica quirúrgica, el tiempo operatorio, las complicaciones intra operatorias y postoperatorias, la estadía hospitalaria y el seguimiento oncológico de cada paciente. Resultados: el tiempo operatorio promedio fue de 165 minutos. No hubo conversiones. Como complicaciones intraoperatorias registramos un caso de lesión vesical y enterotomía. El promedio de hospitalización fue de 7.6 días. El seguimiento máximo fue de 4 años y el mínimo de 1 mes y durante el mismo se constató una recurrencia loco-regional sin implantes en sitio de trócares. La mortalidad operatoria fue del 8.3 por ciento. Conclusiones: la resección abdómino-perineal laparoscópica por cáncer de recto es factible. Las ventajas del abordaje mininvasivo representadas por la menor alteración del status inmunológico, disminución de la morbilidad como así también el mayor confort postoperatorio la hacen una alternativa válida frente a la cirugía convencional

Procedimiento simplificado para la corrección del envejecimiento centrofacial / Simplified process in correcting centrofacial aging

El levantamiento centrofacial es un procedimiento que ha probado ampliamente sus beneficios y ventajas en la corrección del envejecimiento de la región central de la cara, estableciendo un nuevo enfoque, con múltiples indicaciones y grandes beneficios para los pacientes. En este trabajo el autor describe su procedimiento con las maniobras y detalles técnicos que le han permitido obtener mejores resultados y reducir posibles complicaciones. Analiza su experiencia en 564 casos realizados en los últimos 10 años, plantea indicaciones, complicaciones y resultados a largo plazo.