[Usefulness of indocyanine green (ICG) in robotic reconstructive surgery.] / Utilidad de indocianina verde en cirugía reconstructiva robótica.

The experience with robotic reconstructive surgery has been reported previously. Many studies have demonstrated that the use of robotic surgery for those procedures is safe and effective. However, the characteristics related to those cases, make reconstructive surgery a very complex procedure that is usually managed in some referral centers only. Indocyanin green (ICG) is a substance that could be visualized using near-infrared fluorescence (NIRF). This fluorescence could help the surgeon for orientation and evaluation of viability of the tissues. OBJECTIVE: This article describes the literature and our experience using ICG for reconstructive surgery of the ureter. METHODS: We describe the literature and our approach for the evaluation and treatment of the ureteral stricture using ICG. CONCLUSION: The use of ICG has demonstrate to be safe, easy to perform and reproducible. In this article, we showed the ICG usefulness for complex reconstructive cases. Prospective studies with long follow up and bigger simple will permit a better evaluation of its results.

La experiencia con la cirugía reconstructiva asistida por robot ha sido reportada previamente. Dichos estudios han demostrado que el uso del robot en este tipo de procedimientos es seguro y eficaz. Sin embargo, las características de este tipo de casos hacen que la cirugía reconstructiva sea altamente compleja y por ende realizada solo en algunos centros de referencia. La ausencia de tacto durante la cirugía robótica hace que el cirujano dependa de ciertas claves visuales para su orientación. La indocianina verde (ICV) es un tinte que puede ser visualizado usando fluorescencia cercana a la luz infrarroja (FCLI). Dicha fluorescencia puede ser utilizada tanto para la orientación del cirujano como para la evaluación de la viabilidad de tejidos.OBJETIVO: En este artículo describimos el uso reportado en la literatura y nuestra experiencia utilizando ICV en cirugía reconstructiva, principalmente ureteral.MÉTODOS: Describimos nuestro abordaje en la evaluación y tratamiento de pacientes con estrechez ureteral usando ICV. A la vez, hacemos una revisión de los estudios previos realizados sobre este tema.CONCLUSIÓN: El uso de ICV ha demostrado ser seguro, fácil de realizar y repetir. La literatura y nuestra experiencia demuestra su utilidad en casos reconstructivos complejos. Estudios prospectivos a largo plazo y mayor escala permitirán evaluar mejor estos resultados.

Utilidad de indocianina verde en cirugía reconstructiva robótica / Usefulness of indocyanine green (ICG) in robotic reconstructive surgery

La experiencia con la cirugía reconstructiva asistida por robot ha sido reportada previamente. Dichos estudios han demostrado que el uso del robot en este tipo de procedimientos es seguro y eficaz. Sin embargo, las características de este tipo de casos hacen que la cirugía reconstructiva sea altamente compleja y por ende realizada solo en algunos centros de referencia. La ausencia de tacto durante la cirugía robótica hace que el cirujano dependa de ciertas claves visuales para su orientación. La indocianina verde (ICV) es un tinte que puede ser visualizado usando fluorescencia cercana a la luz infrarroja (FCLI). Dicha fluorescencia puede ser utilizada tanto para la orientación del cirujano como para la evaluación de la viabilidad de tejidos. Objetivo: En este artículo describimos el uso reportado en la literatura y nuestra experiencia utilizando ICV en cirugía reconstructiva, principalmente ureteral. Métodos: Describimos nuestro abordaje en la evaluación y tratamiento de pacientes con estrechez ureteral usando ICV. A la vez, hacemos una revisión de los estudios previos realizados sobre este tema. Conclusión: El uso de ICV ha demostrado ser seguro, fácil de realizar y repetir. La literatura y nuestra experiencia demuestra su utilidad en casos reconstructivos complejos. Estudios prospectivos a largo plazo y mayor escala permitirán evaluar mejor estos resultados

The experience with robotic reconstructive surgery has been reported previously. Many studies have demonstrated that the use of robotic surgery for those procedures is safe and effective. However, the characteristics related to those cases, make reconstructive surgery a very complex procedure that is usually managed in some referral centers only. Indocyanin green (ICG) is a substance that could be visualized using near-infrared fluorescence (NIRF). This fluorescence could help the surgeon for orientation and evaluation of viability of the tissues.Objective: This article describes the literature and our experience using ICG for reconstructive surgery of the ureter. Methods: We describe the literature and our approach for the evaluation and treatment of the ureteral stricture using ICG. Conclusion: The use of ICG has demonstrate to be safe, easy to perform and reproducible. In this article, we showed the ICG usefulness for complex reconstructive cases. Prospective studies with long follow up and bigger simple will permit a better evaluation of its results

Preoperative International Prostate Symptom Score Predictive of Inguinal Hernia in Patients Undergoing Robotic Prostatectomy.

PURPOSE: Studies have shown that encountering an inguinal hernia during robotic radical prostatectomy is not uncommon. We reviewed our experience with simultaneous robotic prostatectomy and mesh hernia repair to identify variables predictive of a hernia. MATERIALS AND METHODS: Our cohort consisted of 693 consecutive men who underwent robotic radical prostatectomy as performed by 1 surgeon. Hernias were repaired with mesh composed of equal parts of absorbable polyglecaprone-25 and nonabsorbable polypropylene monofilament. Preoperative variables potentially predictive of an inguinal hernia were evaluated. RESULTS: Inguinal hernias were encountered in 55 of 639 patients (8.6%), of which 22.3% were bilateral for a total of 68 hernia sides. Only 26 of 55 hernias (47.2%) were evident preoperatively. Men with a preoperative I-PSS (International Prostate Symptom Score) of 15 or greater had a 22.4% chance (30 of 134) of requiring a hernia repair compared with 5% in those without such a score (OR 5.54, 95% CI 3.13-9.81, p <0.0001). There were no differences between the hernia and nonhernia groups in prostate size, body mass index, age, blood loss, transfusions, operative time, length of stay or any Clavien grade II-V complication. In 47 patients there was 1 recurrence at a median followup of 27.9 months. There were no cases of mesh associated pain or erosion. CONCLUSIONS: Independent of prostate size, men with preoperative lower urinary tract dysfunction were at 5 times the risk of a hernia at robotic radical prostatectomy (22.4% vs 5%). Given that half of the hernias were subclinical, patients with an I-PSS of 15 or greater should be counseled about the potential need for hernia repair at robotic radical prostatectomy.

The technique of single stage pure robotic nephroureterectomy.

PURPOSE: To describe a novel technique for a single setup approach for robotic radical nephroureterectomy (RANU) that does not require patient repositioning, port reassignment, or redocking of the robotic arms. MATERIALS AND METHODS: Twenty consecutive patients underwent RANU at a single institution between January 2009 and January 2012. We implemented a unique port placement strategy based on a modified paramedian line (MPL), which allowed sufficient access to both the upper abdomen and the deep pelvis for radical NU with bladder cuff excision and concomitant lymphadenectomy. RESULTS: The mean operative time was 161.3 minutes (range 91-330 minutes), mean estimated blood loss was 98.8 (range 50-200), and the mean hospital stay was 3 days (median 2 days, range 1-16 days). None of the procedures were converted to open or required blood transfusions. Lymphadenectomy was performed on 16 out of 20 patients, and the mean number of lymph nodes removed per patient when lymphadenectomy was performed was 14.1 (range 2-35). Three patients had positive lymph nodes. One patient had prolonged postoperative ileus, and one had a hospital course that was complicated by pneumonia. Mean patient follow-up was 13.5 months (range 1-24 months); one patient was found to have a recurrence at 3 month follow-up. CONCLUSION: The use of our MPL line for novel port placement allows for an effective, efficient, and reproducible method for RANU without the need for repositioning of the patient or the robot.

Estudio de discromatopsia en postulantes a la Marina de Guerra del Perú / Discromatopsia study in postulantes to the Marian of War of the Peru

La visión de colores es uno de las más importantes facutades de la visión humana, por dicho motivo se realizó un estudio descriptivo, transversal en 735 jóvenes de 17-19 años postulante a estudios militares navales durante el período de enero-agosto de 1998, en los cuales se evaluó la percepción de colores dentro del examen oftalmológico general a través del Test de Platos Pseudoisocrómatico del Ishihara con el objetivo de determinar la incidencia de discromatopsias, frecuencia por sexos, tipo de discromatopsia, frecuencia de la lectura de los Platos utilizados. Se encontró que la prevalencia de esta patología fue de 3.4 por ciento, siendo afectado predominantemente el sexo masculino, el tipo de discromatopsia más frecuente fue el congénito en la totalidad de casos, los Platos anormalmente leídos con más frecuencia fueron: El plato con figura Nº 74 en un 84 por ciento es leído como 21, el Plato con la Figura Nº 5 en un 44 por ciento es leído como 2. La discromatopsia debe ser evaluado en la población en general especialmente en personal militar y en aquellos en quienes represente un riesgo ocupacional. Por tal motivo un diagnóstico temprano en niños es altamente importante para una futura orientación profesional.