ABSTRACT
OBJECTIVES. To report the first case series of transvaginal NOTES cholecystectomy in humans in Costa Rica and its clinical potential in the treatment of abdominal diseases in this country. PATIENTS AND METHODS. We present a series of three cases of adult female patients of 44, 58 and 69 years of age (average 57 years), symptomatic, with a gall bladder polyp diagnosed by an abdominal ultrasound, who underwent a transvaginal cholecystectomy modified with laparoscopic technique. A 5 mm trocar was inserted through the umbilicus to create and to monitor the pneumoperitoneum, as well as to possibilitate endoscopic vision during the intravaginal introduction of an endoscope and a forceps device for cephalic retraction of the gall bladder. Through the intraumbilical trocar a conventional laparoscopic hook device was also inserted for dissection of the pedicle and hepatic bed, and also a laparoscopic clip applier for clipping of the cystic artery and duct. The gall bladder was extracted through the vagina. RESULTS. The three cases were successfully performed without intra- or postoperative complications. The average operative time was 107 minutes (range 100-115 minutes). The patients were discharged within 24 hours. At the 1-month follow-up, none of the patients complained neither of incisional pain nor dyspareunia. CONCLUSION. The transvaginal NOTES cholecystectomy combined with laparoscopic technique is feasible, safe, reproducible, and constitutes one step further in the development of pure NOTES procedures. More effort in technological investigation and dedication is to be required to apply this technique to other more complex procedures.
Subject(s)
Cholecystectomy/methods , Gallbladder Diseases/surgery , Natural Orifice Endoscopic Surgery , Polyps/surgery , Adult , Aged , Costa Rica , Female , Humans , Middle Aged , Natural Orifice Endoscopic Surgery/methods , VaginaABSTRACT
OBJETIVO. Reportar la primera serie de casos de colecistectomía NOTES transvaginal en humanos en Costa Rica y su potencial clínico en el abordaje de patologías abdominales en este país. PACIENTES Y MÉTODOS. Presentamos una serie de tres casos de pacientes femeninas adultas de 44, 58 y 69 años (promedio 57 años), asintomáticas, con diagnóstico de pólipo vesicular por un ultrasonido abdominal, sometidas a una colecistectomía por vía transvaginal modificada con técnica laparoscópica. Se insertó un trócar de 5 mm a través del ombligo para creación y monitoreo del pneumoperitoneo, así mismo posibilitando visión endoscópica durante la introducción intravaginal de un endoscopio y una pinza para retracción cefálica de la vesícula. A través del trócar intraumbilical se insertó un dispositivo laparoscópico de gancho convencional para disección del pedículo y cama hepática, y posteriormente una clipadora laparoscópica para clipeo de la arteria y conducto cístico. La extracción de la vesícula se realizó por vía transvaginal. RESULTADOS. Los tres casos fueron realizados con éxito, sin presentar ninguna complicación intra o postoperatoria. El tiempo operatorio promedio fue de 107 minutos (rango 100-115 minutos). Las pacientes fueron egresadas al cabo de 24 horas. En el control postoperatorio al mes, ninguna paciente refirió dolor incisional ni dispareunia. CONCLUSIÓN. La colecistectomía NOTES transvaginal combinada con técnica laparoscópica es viable, segura, reproducible y constituye un paso más en el desarrollo de la cirugía NOTES pura. Mayores esfuerzos en investigación tecnológica y dedicación se requieren para generalizar esta técnica a otros procedimientos más complejos.
OBJECTIVES. To report the first case series of transvaginal NOTES cholecystectomy in humans in Costa Rica and its clinical potential in the treatment of abdominal diseases in this country. PATIENTS AND METHODS. We present a series of three cases of adult female patients of 44, 58 and 69 years of age (average 57 years), asymptomatic, with a gall bladder polyp diagnosed by an abdominal ultrasound, who underwent a transvaginal cholecystectomy modified with laparoscopic technique. A 5 mm trocar was inserted through the umbilicus to create and to monitor the pneumoperitoneum, as well as to possibilitate endoscopic vision during the intravaginal introduction of an endoscope and a forceps device for cephalic retraction of the gall bladder. Through the intraumbilical trocar a conventional laparoscopic hook device was also inserted for dissection of the pedicle and hepatic bed, and also a laparoscopic clip applier for clipping of the cystic artery and duct. The gall bladder was extracted through the vagina. RESULTS. The three cases were successfully performed without intra- or postoperative complications. The average operative time was 107 minutes (range 100-115 minutes). The patients were discharged within 24 hours. At the 1-month follow-up, none of the patients complained neither of incisional pain nor dyspareunia. CONCLUSION. The transvaginal NOTES cholecystectomy combined with laparoscopic technique is feasible, safe, reproducible, and constitutes one step further in the development of pure NOTES procedures. More effort in technological investigation and dedication is to be required to apply this technique to other more complex procedures.
Subject(s)
Humans , Female , Adult , Middle Aged , Cholecystectomy, Laparoscopic , Colposcopy , Endosonography , Costa RicaABSTRACT
Syncope is a symptom characterized by transient and autolimited loss of consciousness, generally accompanied by the inhability to stand upright and maintain postural tone, spontaneous recovery and without sequelae. It is produced by a sudden cerebral global and transient hypoperfussion. After assessment of the symptoms and its possible mechanism, it is mandatory to determine if it is an essential syncope or otherwise another entity resembling a syncope, in order to discard it rapidly....Other details are commented in the article
Subject(s)
Humans , Male , Adult , Algorithms , Syncope/diagnosis , ElectrophysiologyABSTRACT
Syncope is a symptom characterized by transient and autolimited loss of consciousness, generally accompanied by the inhability to stand upright and maintain postural tone, spontaneous recovery and without sequelae. It is produced by a sudden cerebral global and transient hypoperfussion. After assessment of the symptoms and its possible mechanism, it is mandatory to determine if it is an essential syncope or otherwise another entity resembling a syncope, in order to discard it rapidly....Other details are commented in the article
Subject(s)
Humans , Male , Adult , Syncope/diagnosis , Algorithms , ElectrophysiologyABSTRACT
BACKGROUND: Biventricular pacing improves the clinical status and ventricular function in patients with congestive heart failure (CHF) and intraventricular conduction delay. However, patient selection criteria including NYHA functional class, rhythm, PR interval, QRS duration (QRSd), left ventricular ejection fraction (LVEF), left ventricular diastolic diameter (LVDD), and other variables are not clearly defined. OBJECTIVE: To determine which and how many patients referred for an initial cardiac transplantation evaluation may be eligible for biventricular pacing (BP) according to the criteria of recently completed trials of cardiac resynchronization therapy (CRT). METHODS: This was a retrospective review of 200 patients, whose mean age was 51 +/- 13 years (173 men). Sinus rhythm was present in 88% of the patients, 107 had a QRSd > 120 ms, and 38% had left bundle branch block. LVDD was 72.5 +/- 12 mm and LVEF 21.7 +/- 9.3%; 54% had mitral regurgitation. RESULTS: When NYHA class, electrocardiographic, and ventricular function criteria were considered separately, a high proportion of patients appeared to be candidates for CRT: 70.5% were in NYHA functional class III/IV, 34% had QRSd > or = 150 ms, 60% had LVDD > or = 60 mm and 53.5% LVEF < or = 35%. However, the proportions of patients eligible for CRT were different according to the selection criteria of recently completed trials: 18% of the patients with InSync criteria, 13% of the patients with MUSTIC SR criteria, 0.5% with MUSTIC AF criteria, 27% of patients with MIRACLE criteria, and 35% of the patients with CONTAK CD criteria (without considering indications for implantable cardioverter defibrillator). CONCLUSION: In this population-based study, a wide range of patients (13% to 35%) would have been candidates for CRT, according to the selection criteria of different completed trials.
