ABSTRACT
Introducción. La cirugía mínimamente invasiva es el abordaje quirúrgico ideal en cirugía abdominal. No obstante, se ha incursionado en técnicas menos invasivas como la cirugía laparoscópica por puerto único (CLPU). Reportamos nuestra experiencia de CLPU. Métodos. Revisión retrospectiva de los pacientes llevados a CLPU en nuestro hospital, en el periodo comprendido entre noviembre de 2009y julio de 2011. Se utilizó un guante acoplado a un retractor de fascia para conformar un multipuerto híbrido. Resultados. Se obtuvieron 80 pacientes, con una edad (años) y peso(kg) promedio de 8,6 y 32,1, respectivamente. El paciente con menor edad tenía 8 días y el más pequeño pesaba 2,5 kg. El tiempo quirúrgico promedio fue de 48,2 minutos. La hospitalización promedio fue de48,7 horas. Se realizaron diversos procedimientos: apendicectomías no perforadas (55%), biopsias hepáticas (15%), apendicectomía perforada(7,5%), y los siguientes casos aislados; colecistectomía, resección del ivertículo de Meckel, ooforectomía, cistectomía de ovario, biopsiaintestinal, resección de bazo accesorio torcido. Se completó exitosamente el procedimiento en 78 casos, dos casos se convirtieron en laparoscopia convencional y ninguno en cirugía abierta. No se presentaron complicaciones relacionadas con la técnica quirúrgica. Las complicaciones postoperatorias se presentaron en 5 casos: una infección del sitio operatorio superficial, tres abscesos intestinales residuales, uno de ellos con obstrucción intestinal y una evisceración; estos dos últimos casos requirieron reintervención. Éstas se presentaron al inicio de nuestra curva de aprendizaje. Conclusiones. El CLPU en niños es una técnica reproducible en nuestro medio, segura y se puede aplicar a diferentes procedimientos y edades, incluso hasta en edad neonatal. El tiempo fue disminuyendo con la curva de aprendizaje. Además, se logró un resultado cosmético excelente dado por una cicatriz umbilical casi imperceptible (AU)
Background. Minimally invasive surgery is the current accepted approach for abdominal surgery. However, less invasive techniques such as single incision laparoscopic surgery (SILS) are being used more frequently and we believe it will become the standard choice for abdominal surgery. This report describes our initial experience with Single Port Incision Surgery (SILS).Methods. We reviewed all the patients who underwent SILS in our hospital between November 2009 and July 2011. We used a surgical glove attached to a wound retractor to yield a multi-port hybrid. Results. We present 80 patients with a mean age of 8.6 years and mean weight of 32,1 kg. The youngest patient was 8 days old and the smallest patient weighed 2.5 kg. The average duration of surgery was48.2 minutes. The average length of stay was 48.7 hours. Different procedures were performed: appendectomies for early appendicitis (55%),hepatic biopsies (15%), appendectomies for perforated appendicitis(7.5%), and the following isolated cases: cholecystectomy, Meckels diverticulum resection, oophorectomy, salpingo-oophorectomy, ovarian cystectomy, bowel biopsy, and a resection of an accessory spleen torsion. SILS was successfully completed in 78 cases, and 2 cases were converted to standard laparoscopy and none to open surgery. There were no intraoperative surgical complications. Postoperative complications presented in 5 cases: a superficial incisional site infection, two residual abdominal abscesses, one bowel obstruction and one evisceration. The last two cases subsequently resulted in reoperation and occurred early in our learning curve. Conclusions. SILS is a reproducible and viable technique that maybe used successfully in pediatric surgery. It may be used safely in different procedures and age groups, even in neonates. Time of surgery decreased with our learning curve. Additionally, excellent cosmetic results were obtained as evidenced by imperceptible umbilical scarring (AU)
Subject(s)
Humans , Laparoscopy/methods , Abdomen/surgery , /methods , Child Health Services/methods , Minimally Invasive Surgical Procedures/methods , ColombiaABSTRACT
BACKGROUND: Minimally invasive surgery is the current accepted approach for abdominal surgery. However, less invasive techniques such as single incision laparoscopic surgery (SILS) are being used more frequently and we believe it will become the standard choice for abdominal surgery. This report describes our initial experience with Single Port Incision Surgery (SILS). METHODS: We reviewed all the patients who underwent SILS in our hospital between November 2009 and July 2011. We used a surgical glove attached to a wound retractor to yield a multi-port hybrid. RESULTS: We present 80 patients with a mean age of 8.6 years and mean weight of 32,1 kg. The youngest patient was 8 days old and the smallest patient weighed 2.5 kg. The average duration of surgery was 48.2 minutes. The average length of stay was 48.7 hours. Different procedures were performed: appendectomies for early appendicitis (55%), hepatic biopsies (15%), appendectomies for perforated appendicitis (7.5%), and the following isolated cases: cholecystectomy, Meckel's diverticulum resection, oophorectomy, salpingo-oophorectomy, ovarian cystectomy, bowel biopsy, and a resection of an accessory spleen torsion. SILS was successfully completed in 78 cases, and 2 cases were converted to standard laparoscopy and none to open surgery. There were no intraoperative surgical complications. Postoperative complications presented in 5 cases: a superficial incisional site infection, two residual abdominal abscesses, one bowel obstruction and one evisceration. The last two cases subsequently resulted in reoperation and occurred early in our learning curve. CONCLUSIONS: SILS is a reproducible and viable technique that may be used successfully in pediatric surgery. It may be used safely in different procedures and age groups, even in neonates. Time of surgery decreased with our learning curve. Additionally, excellent cosmetic results were obtained as evidenced by imperceptible umbilical scarring.
Subject(s)
Laparoscopy/methods , Child , Colombia , Female , Hospitals, Pediatric , Humans , Laparoscopy/instrumentation , Male , Retrospective StudiesABSTRACT
The three-dimensional structure of the highly toxic crotoxin from Crotalus durissus terrificus was modelled based on sequence analysis and the refined structure of calcium-free phospholipase of Crotalus atrox venom. Small-angle x-ray scattering experiments were performed on aqueous solutions of crotoxin. The radial distribution function derived from these scattering experiments and the one calculated from the model structure are in good agreement. Crotoxin consists of a basic and an acidic subunit. The model strongly suggests that the overall folding motif of phospholipases has been preserved in both subunits. The basic domain has an intact active site. The residues that are expected to contact the lipid tails of the phospholipid are different from other phospholipases, but they are all hydrophobic. The acidic domain consists of three independent chains interconnected by disulfide bonds. Compared to other phospholipases the active site for the greater part has been preserved in this domain, but it is not very well shielded from solvent. Most residues normally in contact with the lipid tails of the phospholipid are missing, which might explain the acidic subunit's lack of phospholipase activity. A homology between the third chain of the acidic domain and neurophysins suggests that the acidic domain may act as a chaperone for the basic domain.
Subject(s)
Crotoxin/chemistry , Amino Acid Sequence , Animals , Computer Simulation , Crotalid Venoms , Crotoxin/toxicity , Macromolecular Substances , Models, Chemical , Molecular Sequence Data , Molecular Structure , Protein Conformation , Structure-Activity RelationshipABSTRACT
alpha-crotamine is a small toxic protein (42 amino acid residues with three disulphide bridges) present in the venom of Crotallus durissus terrificus. Molecular parameters (Rg = 13.7 A, S = 3,000 A2, V = 9,200 A3 and Dmax = 40 A) were derived from SAXS curves obtained from a solution of this protein at pH = 4.5. An excellent agreement between the experimental distance distribution curve and that calculated from a model consisting of two lobes linked by the Cys(18)-Cys(30) disulphide bridge.
Subject(s)
Crotalid Venoms , Amino Acid Sequence , Chromatography, Gel , Crotalid Venoms/isolation & purification , Disulfides , Molecular Sequence Data , Protein Conformation , Software , X-Ray Diffraction/methodsABSTRACT
The radius of gyration of crotamine is determined by the small angle x-ray scattering technique. Several molecular solutions have been studied to correct for concentration effects. The apparent molecular radius of gyration is also determined as a function of pH. An important change between pH 9.5 and 12.5 is attributed to a dominant effect of molecular aggregation.
