Videolaringoscopía para intubación pediátrica, en comparación con la intubación orotraqueal clásica. Hospital Vicente Corral Moscoso, Cuenca, 2018 / Video laryngoscopy for pediatric intubation, compared to classical orotracheal intubation. Vicente Corral Moscoso Hospital, Cuenca, 2018

Introduction: A relevant aspect in pediatric anesthesia is the management of the airway. Anatomical differences in this population makes them more susceptible to devices designed for their management. Video laryngoscopy improves panoramic vision of the glottis. Objective: To compare the use of video laryngoscopy with direct laryngoscopy for orotracheal intubation in pediatric patients. Methods: With an observational descriptive design, 276 cases were studied, patients from 5 to 17 years old, undergoing planned surgery, with general anesthesia plus orotracheal intubation. The specialist decided on the handling device. The data was transcribed from the forms and analyzed with the SPSS 22.0 program. The descriptive analysis was based on median, mode, average, minimum value, maximum value. Standard deviation and range dispersion measurements. A value of p ≤ 0.05 was considered statistically significant. Results: The average age of the study was 9.83 years. With direct laryngoscopy 97.4% intubation was performed at the first attempt and with video laryngoscopy 88.4% (p = 0.003). In 94.2% of cases of direct laryngoscopy, a successful intubation was performed in less than 10 seconds, with video laryngoscopy it was 75.2% (p = 0.000). Complications occurred in 6.6% of intubations with video laryngoscopy versus 2.6% with conventional laryngoscopy (p = 0.103). 56.2% of specialists prefer direct laryngoscopy to manage a pediatric airway without predictors of difficulty. Conclusions: Video laryngoscopy provides additional support in routine airway management, always requiring prior knowledge and skills. The evidence to support one technique over another is insufficient.

Introduction: A relevant aspect in pediatric anesthesia is the management of the airway. Anatomical differences in this population makes them more susceptible to devices designed for their management. Video laryngoscopy improves panoramic vision of the glottis. Objective: To compare the use of video laryngoscopy with direct laryngoscopy for orotracheal intubation in pediatric patients. Methods: With an observational descriptive design, 276 cases were studied, patients from 5 to 17 years old, undergoing planned surgery, with general anesthesia plus orotracheal intubation. The specialist decided on the handling device. The data was transcribed from the forms and analyzed with the SPSS 22.0 program. The descriptive analysis was based on median, mode, average, minimum value, maximum value. Standard deviation and range dispersion measurements. A value of p ≤ 0.05 was considered statistically significant. Results: The average age of the study was 9.83 years. With direct laryngoscopy 97.4% intubation was performed at the first attempt and with video laryngoscopy 88.4% (p = 0.003). In 94.2% of cases of direct laryngoscopy, a successful intubation was performed in less than 10 seconds, with video laryngoscopy it was 75.2% (p = 0.000). Complications occurred in 6.6% of intubations with video laryngoscopy versus 2.6% with conventional laryngoscopy (p = 0.103). 56.2% of specialists prefer direct laryngoscopy to manage a pediatric airway without predictors of difficulty. Conclusions: Video laryngoscopy provides additional support in routine airway management, always requiring prior knowledge and skills. The evidence to support one technique over another is insufficient.

Video-assisted ovariohysterectomy in domestic cats (Felis catus, Linnaeus, 1758) using two access portals

PURPOSE : To describe video-assisted ovariohysterectomy (OHE) with two portals access in adult intact queens. METHODS Fifty-two females cats were used. A 4 mm cannula was positioned in the abdomen through an incision close to the umbilicus (first portal), and a pneumoperitoneum was established. A second portal was positioned in the midline of the pre-pubic region. Females were positioned in right lateral recumbency to locate the left ovarian pedicle, and the uterine horn was held by a transcutaneous suture. The pedicle was cauterized and incised. The procedure was then performed on the contralateral ovary. The ovaries were exteriorized from the abdomen, along with the uterus, through the second access point. The uterine body was exposed, fixed and sectioned, and the abdominal incisions were sutured. RESULTS Surgeries were performed in an average of 41.4±14.2 minutes. The main complications included hypotension (7.7%) and subcutaneous emphysema (7.7%), and 13.5% of the surgeries were converted to laparotomy. CONCLUSION Ovariohysterectomy using a video-assisted technique and two access portals is safe, has minimal risks and is effective for the spaying of queens.

New head-mounted display system applied to endoscopic management of upper urinary tract carcinomas

Purpose We tested a new head-mounted display (HMD) system for surgery on the upper urinary tract. Surgical Technique Four women and one man with abnormal findings in the renal pelvis on computed tomography and magnetic resonance imaging underwent surgery using this new system. A high definition HMD (Sony, Tokyo, Japan) is connected to a flexible ureteroscope (Olympus, Tokyo, Japan) and the images from the ureteroscope are delivered simultaneously to various participants wearing HMDs. Furthermore, various information in addition to that available through the endoscope, such as the narrow band image, the fluoroscope, input from a video camera mounted on the lead surgeon’s HMD and the vital monitors can be viewed on each HMD. Results Median operative duration and anesthesia time were 53 and 111 minutes, respectively. The ureteroscopic procedures were successfully performed in all cases. There were no notable negative outcomes or incidents (Clavien-Dindo grade ≥1). Conclusion The HMD system offers simultaneous, high-quality magnified imagery in front of the eyes, regardless of head position, to those participating in the endoscopic procedures. This affordable display system also provides various forms of information related to examinations and operations while allowing direct vision and navigated vision. .

Single-incision videolaparoscopic appendectomy with conventional videolaparoscopy equipment / Videoapendicectomia por incisao unica com material de videolaparoscopia convencional

Background : Acute appendicitis is the most common surgical emergency in daily practice, and is approached laparoscopically in many centers. Efforts have been undertaken for the development of minimally invasive techniques that reduce tissue trauma and offer improved cosmetic results, one of such being the single-incision laparoscopic surgery (SILS). Aim : To present a minimally invasive technique for appendectomy (SILS) undertaken with conventional instruments. Method : Eleven patients were treated in the emergency care center presenting abdominal pain in the right iliac fossa that was suggestive of appendicitis. Diagnostic investigation was subsequently conducted, including physical examination, laboratory and imaging exams (CT scan with intravenous contrast or total abdominal ultrasound), and the results were consistent with acute appendicitis. Thus, after consent, these patients underwent SILS appendectomy under general anesthesia with three trocars (two 10 mm and one 5 mm), using conventional and optical laparoscopic tweezers (10 mm, 30º). The base and pedicle of the appendix were ligated with titanium LT 400 clips. The procedure occurred uneventfully. Inclusion criteria were absence of diffuse peritonitis, BMI (body mass index) less than 35 and absence of serious comorbidities or sepsis. Results : Seven men and four women were operated with average age of 25.7 years and underwent appendectomy through this technique. Mean procedure duration was of 37.2 min. Regarding surgical findings, three had appendicitis in stage 1, four in stage 2 and four in stage 3. All patients improved well, without surgical complications, and did not require conversion to open surgery or conventional laparoscopy technique. Conclusion : Appendectomy conducted through Single Incision Laparoscopic Surgery is a feasible and promising technique that can be performed with conventional laparoscopic instruments. .

Racional : Apendicite aguda é a emergência cirúrgica mais comum na prática diária, sendo em muitos centros, abordada por laparoscopia. Esforços têm sido voltados para o desenvolvimento de técnicas minimamente invasivas, reduzindo o trauma tecidual e melhorando os resultados cosméticos, dentre essas, a "single incision laparoscopic surgery" (SILS). Objetivo : Apresentar técnica minimamente invasiva para apendicectomia com incisão única e com instrumentos convencionais. Método : Onze pacientes foram atendidos em serviço de emergência devido à dor abdominal em fossa ilíaca direita sugestiva de apendicite. Procedeu-se a investigação diagnóstica, incluindo exames físico, laboratoriais e de imagem (tomografia computadorizada com contraste venoso ou ecografia de abdome total), cujos resultados foram compatíveis com apendicite aguda. Assim, após consentimento, esses pacientes foram submetidos à apendicectomia por SILS, sob anestesia geral, com dois trocárteres de 10 mm e um de 5 mm, com uso de pinças laparoscópicas convencionais e ótica de 10 mm e 30 º. A base e o pedículo do apêndice foram ligados com clipes de titânio LT 400, sem intercorrências. Critérios de inclusão foram pacientes com apendicite aguda mas sem peritonite generalizada com índice de massa corpórea menor que 35 e ausência de comorbidades graves e ou sepse. Resultados : Foram operados sete homens e quatro mulheres com idade média de 25,7 anos com esta técnica. A duração média do procedimento foi de 37,2 min. Em relação aos achados cirúrgicos, três pacientes apresentavam apendicite em fase 1, quatro em fase 2 e quatro em fase 3. Todos evoluíram bem, sem complicações cirúrgicas e não houve necessidade de conversão ...

Video-assisted anal fistula treatment: technical considerations and preliminary results of the first brazilian experience / Tratamento cirurgico videoassistido da fistula anorretal: consideracoes sobre a tecnica e resultados preliminares da primeira experiencia brasileira

Backgroung : Anorectal fistula represents an epithelized communication path of infectious origin between the rectum or anal canal and the perianal region. The association of endoscopic surgery with the minimally invasive approach led to the development of the video-assisted anal fistula treatment. Aim : To describe the technique and initial experience with the technique video-assisted for anal fistula treatment. Technique : A Karl Storz video equipment was used. Main steps included the visualization of the fistula tract using the fistuloscope, the correct localization of the internal fistula opening under direct vision, endoscopic treatment of the fistula and closure of the internal opening which can be accomplished through firing a stapler, cutaneous-mucosal flap, or direct closure using suture. Results : The mean distance between the anal verge and the external anal orifice was 5.5 cm. Mean operative time was 31.75 min. In all cases, the internal fistula opening could be identified after complete fistuloscopy. In all cases, internal fistula opening was closed using full-thickness suture. There were no intraoperative or postoperative complications. After a 5-month follow-up, recurrence was observed in one (12.5%) patient. Conclusion : Video-assisted anal fistula treatment is feasible, reproducible, and safe. It enables direct visualization of the fistula tract, internal opening and secondary paths. .

Racional : A fístula anorretal é um trajeto epitelizado que estabelece comunicação de origem infecciosa entre o reto ou canal anal com a região perianal. Representa a fase crônica do abscesso anorretal. A associação da videocirurgia com o procedimento minimamente invasivo levou ao desenvolvimento do tratamento cirúrgico videoassistido da fístula anorretal anal). Objetivo : Descrever a técnica empregada na experiência preliminar nos primeiros casos realizados no Brasil. Técnica : As principais etapas da operação são a visualização do trajeto fistuloso através da fistuloscopia sob irrigação empregando equipamento específico Karl Storz, a correta localização do orifício interno sob visão direta, o tratamento endoscópico da fístula por eletrocoagulação e o tratamento do orifício interno que pode ser feito por grampeador, avanço de retalho mucoso ou sutura simples. Resultados : A distância entre a rima anal e o orifício externo foi de 5,5 cm. O tempo operatório foi de 31,75 (18-45) min em média. Em todos os casos, o orifício interno pôde ser identificado após fistuloscopia completa que foi tratado por meio de sutura simples. Não ocorreram complicações intra ou pós-operatórias. Após seguimento de cinco meses, um (12,5%) caso evoluiu com recidiva. Conclusão : O tratamento videoassistido da fístula anorretal demonstrou-se factível, seguro e reprodutível. Possibilita estudo direto de todo o trajeto fistuloso conseguindo identificação de trajetos acessórios bem como do orifício interno. .

Comparison of the TruView infant EVO2 PCD and C-MAC video laryngoscopes with direct Macintosh laryngoscopy for routine tracheal intubation in infants with normal airways

OBJECTIVE: Videolaryngoscopy has mainly been developed to facilitate difficult airway intubation. However, there is a lack of studies demonstrating this method's efficacy in pediatric patients. The aim of the present study was to compare the TruView infant EVO2 and the C-MAC videolaryngoscope with conventional direct Macintosh laryngoscopy in children with a bodyweight ≤10 kg in terms of intubation conditions and the time to intubation. METHODS: In total, 65 children with a bodyweight ≤10 kg (0-22 months) who had undergone elective surgery requiring endotracheal intubation were retrospectively analyzed. Our database was screened for intubations with the TruView infant EVO2, the C-MAC videolaryngoscope, and conventional direct Macintosh laryngoscopy. The intubation conditions, the time to intubation, and the oxygen saturation before and after intubation were monitored, and demographic data were recorded. Only children with a bodyweight ≤10 kg were included in the analysis. RESULTS: A total of 23 children were intubated using the C-MAC videolaryngoscope, and 22 children were intubated using the TruView EVO2. Additionally, 20 children were intubated using a standard Macintosh blade. The time required for tracheal intubation was significantly longer using the TruView EVO2 (52 sec vs. 28 sec for C-MAC vs. 26 sec for direct LG). However, no significant difference in oxygen saturation was found after intubation. CONCLUSION: All devices allowed excellent visualization of the vocal cords, but the time to intubation was prolonged when the TruView EVO2 was used. The absence of a decline in oxygen saturation may be due to apneic oxygenation via the TruView scope and may provide a margin of safety. In sum, the use of the TruView by a well-trained anesthetist may be an alternative for difficult airway management in pediatric patients. .

Infecção cirúrgica em colecistectomia videolaparoscópica usando ácido peracético como esterilizante dos instrumentais / Surgical infection in a videolaparoscopic colecistectomy when using peracetic acid for the sterilization of instruments

OBJETIVO: Determinar a frequência de infecção de sítio cirúrgico em pacientes submetidos à colecistectomia videolaparoscópica usando o ácido peracético como esterilizante. MÉTODOS: Foi realizado estudo retrospectivo descritivo do tipo coorte transversal. O ácido peracético foi usado para esterilização seguindo protocolo preconizado pelo fabricante. Foram observados os critérios e indicadores de processo e estrutura para prevenção de infecção de sítio cirúrgico no pré e intraoperatório. Para a vigilância epidemiológica, consultas ambulatoriais eram agendadas para o 15º e entre o 30º e 45º dias após a alta. RESULTADOS: Entre 247 pacientes foram diagnosticados dois casos de infecção de sítio cirúrgico (0,8%). Um paciente reinternou para antibioticoterapia sistêmica e punção percutânea; no outro, a infecção foi superficial e acompanhada ambulatorialmente. CONCLUSÃO: Eticamente não é permitida a realização de um estudo prospectivo pelo fato do ácido peracético ter sido proibido para a esterilização de instrumentais que penetrem em órgãos e cavidades; contudo, estes resultados encorajam estudo prospectivo caso-controle, comparando o uso dele (controle histórico) com a esterilização por óxido de etileno.

OBJECTIVE: To determine the frequency of surgical site infection in patients undergoing laparoscopic cholecystectomy with instruments sterilized by peracetic acid. METHODS: We conducted a retrospective, cohort, descriptive, cross-sectional study. Peracetic acid has been used for sterilization following the protocol recommended by the manufacturer. We observed the criteria and indicators of process and structure for preventing surgical site infection pre and intraoperatively. For epidemiological surveillance, outpatient visits were scheduled for the 15th and between the 30th and 45th days after discharge. RESULTS: Among the 247 patients, there were two cases of surgical site infection (0.8%). One patient was readmitted to systemic antibiotic therapy and percutaneous puncture; in the other the infection was superficial and followed at the clinic. CONCLUSION: Ethical issues prevent the conduction of a prospective study because of peracetic acid have been banned for the sterilization of instruments that penetrate organs and cavities. Nevertheless, these results encourage prospective case-control studies comparing its use (historical control) with ethylene oxide sterilization.

Comparison of Video-Assisted Minilaparotomy, Open, and Laparoscopic Partial Nephrectomy for Renal Masses

PURPOSE: Minimally invasive management of small renal tumors has become more common. We compared the results of partial nephrectomy by video-assisted minilaparotomy surgery (VAMS), open, and laparoscopic techniques. MATERIALS AND METHODS: We retrospectively compared clinicopathological, oncological, and functional outcomes in 271 patients who underwent partial nephrectomy for renal tumors at one institution from 1993 to 2007; including 138 by VAMS, 102 by open, and 31 by laparoscopic technique. RESULTS: Mean follow-up was 47.7+/-29.1 months. No statistically significant differences in the three groups were found in tumor size, tumor location, estimated blood loss, complication rate, preoperative glomerular filtration rate (GFR), and GFR at last follow-up. Ischemic time was shorter in the open (26.9 min) and VAMS (29.3 min) groups than in the laparoscopic group (31.0 min, p=0.021). Time to normal diet and hospital stay were shorter in the VAMS (1.8 days and 5.4 days) and laparoscopic (1.8 days and 4.7 days) groups than in the open group (2.4 days and 7.3 days, p=0.036 and p<0.001, respectively). Of 180 patients with cancer, positive surgical margins occurred in 2 of 82 patients (2.4%) in the VAMS group, none of 75 patients in the open group, and 3 of 23 patients (13.0%) in the laparoscopic group (p=0.084). In the VAMS, open, and laparoscopic groups, 5-year disease-free survival was 94.8%, 95.8%, and 90.3% (p=0.485), and 5-year cancer-specific survival was 96.3%, 98.6%, and 100%, respectively (p=0.452). CONCLUSION: Partial nephrectomy using VAMS technique provides surgical, oncologic, and functional outcomes similar to open and laparoscopic techniques.

Conocimientos y prácticas de los enfermeros instrumentistas sobre la técnica de limpieza y desinfección del instrumental de Cirugía videoendoscópica en el Hospital Nacional Hipólito Unanue 2009 / Knowledge and practices of the nurses instrumentalists on the technology of cleanliness and disinfection of the instruments of of video-endoscopic surgery in the Hospital Nacional Hipolito Unanue 2009

Introducción: El funcionamiento y manejo del Instrumental de cirugía videoendoscópica, diariamente se ve involucrado con su limpieza y desinfección, ya que de ello depende una buena esterilización para proteger la salud e integridad del paciente; por ende, la función del enfermero instrumentista se asocia íntimamente con la limpieza y desinfección del instrumental de cirugía videoendoscópica. Objetivo: Determinar los conocimientos y prácticas que tienen los enfermeros instrumentistas sobre la técnica de limpieza y desinfección del instrumental de cirugía videoendoscópica. Metodología: La presente investigación es de tipo Cuantitativo porque mide y cuantifica las variables de estudio, es de nivel Aplicativo ya que permite tomar los resultados del estudio a fin de establecer estrategias para mejorar la técnica de limpieza y desinfección del instrumental de cirugía videoendoscópica, y el método es Descriptivo Transversal. Resultados y Conclusiones: El 68 por ciento de los enfermeros instrumentistas del Hospital Nacional Hipólito Unanue, conocen la técnica de limpieza y desinfección del instrumental de cirugía videoendoscópica, según los datos obtenidos a través de un cuestionario, sin embargo, el 32 por ciento desconocen la realización del lavado meticuloso del instrumental, debido a que no se ponen de acuerdo el tiempo que debe estar sumergido el instrumental en el enzimático y en el desinfectante de alto nivel, ya que cada fabricante varia el tiempo que este debe estar sumergido; según los criterios de fabricación

Introduction: The operation and management of Instrumental videoendoscopic surgery, daily is involved with its cleaning and disinfection, because of this depends a good sterilization to protect the health and integrity of the patient; hence, the role of nurse instrumentalist associated closely with the cleaning and disinfection of instrumental videoendoscopic surgery. Objective: To determine the knowledge and practices that have the nurses instrumentalists on the technique of cleaning and disinfection of the instruments of videoendoscopic surgery. Methodology: This research is Quantitative because it measures and quantifies the variables of study, is level Software in that it allows the results of the study to establish strategies to improve the technique of cleaning and disinfection of the instrumentation of videoendoscopic surgery, and the method is descriptive. Findings and Conclusions: 68 per cent of the nurses instrumentalists of the National Hospital Hipolito Unanue, aware of the technique of cleaning and disinfection of the instruments of videoendoscopic surgery, according to data obtained through a questionnaire, however, 32 per cent unaware of the realization of washing meticulous instrumental, because it did not agree the time that must be submerged the instrumental in the enzyme in the disinfectant high level, since each manufacturer varies the time that this should be submerged; according to the criteria of manufacture

Infecção por micobactérias de crescimento rápido após procedimentos videocirúrgicos: a hipótese do glutaraldeído / Rapidly growing mycobacteria infection after videosurgical procedures: the glutaraldehyde hypothesis

Between August 2006 and February 2007, in the state of Rio de Janeiro, Brazil, a massive outbreak of RGM infections after video laparoscopy was mainly associated to the recently described Mycobacterium massiliense species. All confirmed and probable cases reports described the use of high-level disinfection of medical devices by using 2 percent glutaraldehyde (2 percent GA) for 30 min before the surgical procedures. We investigated the susceptibility of the M. massiliense isolates recovered during the outbreak to high-level disinfection after 30 min, 1h, 6h and 10h of exposure to the commercial disinfectants. Reference strains for official mycobactericidal tests such as Mycobacterium abscessus, Mycobacterium bovis, Mycobacterium chelonae, Mycobacterium neoaurum and Mycobacterium smegmatis were included as controls. Although all the reference strains were eliminated in 30 min of exposure to 2 percent GA, we observed the recovery of all M. massiliense clinical isolates even after 10h of exposure. This study suggests that failures in high-level disinfection and the high tolerance of these M. massiliense clinical strains to the 2 percent GA were strongly associated to the magnitude of the outbreak.

Hemitiroidectomía mediante videoendoscopia, experiencia en el Hospital Hermanos Ameijeiras / Hemithyroidectomy by videoendoscopy: an experience from Hermanos Ameijeiras Clinical Surgical Hospital

Se presentan las 4 primeras pacientes operadas de hemitiroidectomía videoendoscópica en el Hospital Hermanos Ameijeiras, para introducir una técnica que elimine la cicatriz en el cuello de los(as) pacientes que necesitan un tratamiento quirúrgico por una enfermedad tiroidea. Se escogieron 4 pacientes con nódulos benignos del tiroides menores de 3 cm, remitidas para tratamiento quirúrgico por el servicio de endocrinología de nuestro centro, de enero a junio de 2009. Se les explicó en detalles el proceder y firmaron un consentimiento informado para participar en el estudio. En las 4 pacientes se pudo realizar la operación planificada, el promedio de tiempo quirúrgico fue de 2,9 h. El efecto cosmético fue mayor en las pacientes 2, 3 y 4 al no quedar ninguna cicatriz en el cuello. La laringoscopia posoperatoria demostró movilidad normal de las cuerdas vocales en las 4 pacientes. La cirugía videoendoscópica del tiroides es una realidad que no podemos obviar, y realmente tiene un único impacto demostrado hasta el momento actual, que es la posibilidad de eliminar la cicatriz residual en el cuello que tanto preocupa a los(as) pacientes jóvenes(AU)

These are the cases of the first patients operated on of Hemithyroidectomy by videoendoscopy in Hermanos Ameijeiras Clinical Surgical Hospital to introduce a technique eliminating the neck scar of patients needing surgical treatment by thyroid disease. Four patients presenting with benign thyroid nodules referred to surgical treatment by Endocrinology service of our institution from January to June, 2009. Procedure was explained in details and they signed the informed consent to participate in study. In four patients it was possible to perform the planned operation; the surgical time average was of 2, 9 hr. Cosmetic effect was greater in patients 2, 3 and 4 without neck scar. Postoperative laryngoscopy showed a normal motility of vocal cords in the four patients. Thyroid videoendoscopy surgery is a reality that cannot be obviated and with a unique impact proved until present time that is the possibility to eliminate the neck residual scar so worrying for young patients(AU)

Colecistectomía videolaparoscópica en el paciente geriátrico / Videolaparoscopic cholecystectomy in geriatric patient

Se presenta la experiencia del equipo quirúrgico en colecistectomía videolaparoscópica, en una serie prospectiva de 48 pacientes de ambos sexos, de 60 o mas años de edad, operados entre marzo y julio del año 2003, en el Departamento y Servicio de Cirugía del Hospital Barros Luco Trudeau; analizando la patología médica asociada, presente en el 70,83 por ciento de los pacientes; los hallazgos más relevantes del estudio ecotomográfico preoperatorio (97,91 por ciento de los pacientes); las cifras de conversión a cirugía laparotómica (14,57 por ciento) y los resultados en términos de morbilidad (8,33 por ciento) y mortalidad (0 por ciento).

Videolaparoscopic cholecystectomy. Analysis of the clinical and functional aspects of mechanical lifting of the abdominal wall

BACKGROUND: Mechanical lifting of the abdominal wall, a method based on traction and consequent elevation of the abdominal wall, is an alternative procedure to create enough intra-abdominal space necessary for videolaparoscopic surgery, dispensing the need for intraperitoneal gas insufflation. OBJECTIVE: This study aims to evaluate the technical feasabilility of this procedure to carry out a videolaparoscopic cholecystectomy, while analyzing the clinical and functional aspects of this technique. PATIENTS AND METHODS: In the Digestive Tract Surgery Discipline of the Medical School at the University of Sao Paulo, Sao Paulo, SP, Brazil, was created the equipment to perform videolaparoscopic surgery using this method. The equipment has two sections: an external part which consisted of a frame attached to the operating table, inside which there is a sliding steel cable, moved by a ratched which is located at the lower end of one of the frame rods; the internal rod, the support, has an "L" shape, and its horizontal branch is made up of three turning rods and which is connected to the steel cable after insertion into the abdominal cavity. Ten patients underwent videolaparoscopic cholecystectomy using this equipment. The time taken to install the equipment, the operating area characteristics, the interference from the lifting equipment on surgical movements and on the intra-operative cholangiography, the measurements made of the force used during traction and extension of the abdominal wall elevation, and the medication required for postoperative analgesia were all evaluated. RESULTS: There were no intra-operative complications, and in none of the cases was it found necessary to convert to open surgery. We considered the insertion a safe and uncomplicated procedure, and the traction system efficient. Apart from the elevation of the abdominal wall, the distribution of the viscera inside the abdominal cavity is fundamental for the operating area. Depending on the position of the epigastric trocar, the lifting equipment can interfere with the surgical instruments mobility. It may be necessary to reposition the support to perform the intra-operative cholangiography. The tensional force applied to the peritoneal surface by the lifting rods is small, and no additional postoperative pain was observed using this procedure.

ABC de la cirugia laparascópica / ABC of the surgery laparascopica

Manual que guia al cirujano en los principios básicos en los desarollo de la cirugia laparascópica, enseña trucos que hacen su desarollo más facil y seguro, sus capitulos contienen todo lo que hay que saber de la práctica de la cirugia laparascópica

ABC de la cirugia laparascópica / ABC of the surgery laparascopica

Manual que guia al cirujano en los principios básicos en los desarollo de la cirugia laparascópica, enseña trucos que hacen su desarollo más facil y seguro, sus capitulos contienen todo lo que hay que saber de la práctica de la cirugia laparascópica

Insuflador alternativo para cirurgia videoendoscópica experimental / Alternative insufflator to experimental videoendoscopic surgery

É indiscutível a importância de um pneumoperitônio eficiente para a realização segura da cirurgia videolaparoscópica. A avançada tecnologia moderna proporcionou o desenvolvimento de insufladores eletro-eletrônicos muito eficientes, porém de elevado custo. Este trabalho tem o objetivo de apresentar um modelo alternativo de insuflador eletro-mecânico para uso principalmente em videocirurgia experimental, de baixo custo e de grande eficiência. Este modelo é capaz de proporcionar um pneumoperitônio com controle permanente da pressão intracavitária desejada e reposição adequada em tempo hábil das eventuais perdas pressóricas. O sistema é perfeitamente adequado à cirurgia videolaparoscópica experimental em cadáver humano e em animais de laboratório, podendo ainda seu uso ser expandido a alguns procedimentos cirúrgicos in vivo