La cirugía endoscópica en las unidades de cirugía ambulatoria / Endoscopic surgery in a day surgery unit

INTRODUCCIÓN: Coincidiendo con el auge de la cirugía endoscópica en todo el mundo se observa una tendencia desigual en la realización de dicha cirugía en el seno de unidades de cirugía sin ingreso. MATERIAL Y MÉTODO: Se realiza un estudio estadístico descriptivo de 511 pacientes operados en una cirugía mayor ambulatoria multidisciplinaria mediante técnicas de cirugía endoscópica. Programa estadístico Stat View 5.0.1 para Windows. RESULTADOS: Los 511 pacientes se distribuyeron entre las especialidades de Urología, 48,%%, Cirugía Ortopédica, 46,4%, Cirugía General, 4,1% y Ginecología, 1%. El 72% fueron varones y la edad media fue de 52 años. Las técnicas endoscópicas suponen un 4,9% de toda la cirugía realizada en la unidad habiéndose producido oscilaciones que fueron del 2,5% al 9,8%. Las artroscopias de rodilla y las exéresis de tumores vesicales superficiales fueron las técnicas más utilizadas. El porcentaje de ingresos no deseados fue del 2,3% y el de complicaciones, siempre menores, del 14,9%. CONCLUSIONES: En nuestra unidad el porcentaje de cirugía endoscópica es bajo y estable en los últimos años. Las características de la lista de espera, la falta de impulso en la promoción de la cirugía ambulatoria y tal vez la falta de entusiasmo en los profesionales, son las causas que determinan la situación actual (AU)

BACKGROUND: As endoscopic surgery increases worldwide its development is controversial in ambulatory surgical units. MATERIAL AND METHODS: A descriptive study was carried out including 511 patients operated on with endoscopic procedures in a multidisciplinary ambulatory surgical unit. Statistical analysis was performed using the Stat View 5.0.1 program. RESULTS: Patients belonged to different surgical specialities, Urology 48.5 per cent, Orthopaedic Surgery 46.4 per cent, General Surgery 4.1 per cent and Gynaecology 1 per cent. A 32 per cent of patients were male and the mean age was 52 years. Endoscopic surgical procedures were 4.9 per cent of the total number of procedures performed in the unit, varying from 2.5 per cent to 9.8 per cent over the period of time studied. Knee arthroscopies and bladder superficial tumour excisions were the most frequent procedures. A 2.3 per cent of unexpected hospital admissions were registered and 14.9 per cent of patients suffered minor complications. CONCLUSION: The study shows a low and stable percentage of endoscopic ambulatory surgery. The characteristics of the waiting list, the low promotion of ambulatory surgery and the lack of enthusiasm between surgeons are the causes of the present situation (AU)

[Analysis of the absorcion's factors of irrigating fluid during transurethral resection of the prostate]. / Análisis de los factores de reabsorción de líquido de irrigación durante la RTU de próstata.

OBJECTIVES: In this study it was our intention to evaluate the relation between the reabsorption of irrigating fluid and three variables: time of the intervention, volume of solution of glicina employee and weight of the fragments, during the RTU of prostate fulfilled to low hydraulic pressure. MATERIAL AND METHOD: We study 74 patients that RTU of prostate was performed with suprapúbica derivation with Amplatz's pod 30 ch. The ethanol was monitored in expired air every 15 minutes during the intervention. Likewise we annotated the time of the intervention, the volume of glicina used and the weight of the fragments extracted. Statistically Anova's text was in use for comparison of averages. RESULTS: 13,6% of the patients absorbed irrigating fluid in some quantity. The range of absorption belongs to 100 cc until 2.000 cc. We did not find a statistically significant difference in the averages of time of resection, volume of glicina and weight of the fragments between the group of patients that had absortion of irrigating fluid and they that didn't had. CONCLUSIONS: Our data show that the operative time, the volume of irrigating fluid and the weight of the resected fragments do not influence the reabsorption of liquid of irrigation when a RTU is realized to low hydraulic pressure.

Análisis de los factores de reabsorción de líquido de irrigación durante la RTU de próstata / Analysis of the absorcion´s factors of irrigating fluid during transurethral resection of the prostate

Objetivos: En este estudio fue nuestra intención evaluar la relación entre la reabsorción de líquido de irrigación y tres variables: tiempo de la intervención, volumen de solución de glicina empleado y peso de los fragmentos, durante la RTU de próstata realizada a baja presión hidráulica. Material y método: Estudiamos 74 pacientes a los que se realizó RTU de próstata con derivación suprapúbica con vaina de Amplatz 30 ch. Se monitorizó el etanol en aire expirado cada 15 minutos durante la intervención. Así mismo se anotaron el tiempo de la intervención, el volumen de glicina utilizado y el peso de los fragmentos extraídos. Estadísticamente se utilizó el Test de Anova para comparación de medias. Resultados: Un 13,6 % de los pacientes absorbieron líquido de irrigación en alguna cantidad. El rango de absorción es de 100 cc hasta 2.000 cc. No se encontró una diferencia estadísticamente significativa entre las medias del tiempo de resección, del volumen de glicina y del peso de los fragmentos entre el grupo de pacientes que había reabsorbido líquido de irrigación y los que no reabsorbieron. Conclusiones: Nuestro estudio pone de manifiesto que el tiempo operatorio, el volumen de líquido de irrigación y el peso de los fragmentos resecados no influyen en la reabsorción de líquido de irrigación cuando se realiza una RTU a baja presión hidráulica (AU)

Objetives: In this study it was our intention to evaluate the relation between the reabsorption of irrigating fluid and three variables: time of the intervention, volume of solution of glicina employee and weight of the fragments, during the RTU of prostate fulfilled to low hydraulic pressure. Material and method: We Study 74 patients that RTU of prostate was performed with suprapúbica derivation with Amplatz’s pod 30 ch. The ethanol was monitored in expired air every 15 minutes during the intervention. Likewise we annotated the time of the intervention, the volume of glicina used and the weight of the fragments extracted. Statistically Anova’s text was in use for comparison of averages. Results: 13,6 % of the patients absorbed irrigating fluid in some quantity. The range of absorption belongs to 100 cc until 2.000 cc. We did not find a statistically significant difference in the averages of time of resection, volume of glicina and weight of the fragments between the group of patients that had absortion of irrigating fluid and they that didn´t had. Conclusions: Our data show that the operative time, the volume of irrigating fluid and the weight of the resected fragments do not influence the reabsorption of liquid of irrigation when a RTU is realized to low hydraulic pressure (AU)

[Quality analysis of the statistical used resources (material and methods section) in thesis projects of a university department]. / Análisis de calidad de los recursos estadísticos (sección material y método) en los proyectos de tesis de un departamento universitario.

INTRODUCTION AND OBJECTIVES: Studies about quality in thesis and investigation projects in biomedical sciences are unusual, but very important in university teaching because is necessary to improve the quality elaboration of the thesis. The objectives the study were to determine the project's quality of thesis in our department, according to the fulfillment of the scientific methodology and to establish, if it exists, a relation between the global quality of the project and the statistical used resources. MATERIAL AND METHODS: Descriptive study of 273 thesis projects performed between 1995-2002 in surgery department of the Zaragoza University. The review realized for 15 observers that they analyzed 28 indicators of every project. Giving a value to each of the indicators, the projects qualified in a scale from 1 to 10 according to the quality in the fulfillment of the scientific methodology. RESULTS: The mean of the project's quality was 5.53 (D.E: 1.77). In 13.9% the thesis projects was concluded with the reading of the work. The three indicators of statistical used resources had a significant difference with the value of the quality projects. DISCUSSION: The quality of the statistical resources is very important when a project of thesis wants to be realized by good methodology, because it assures to come to certain conclusions. In our study we have thought that more of the third part of the variability in the quality of the project of thesis explains for three statistical above-mentioned articles.

Análisis de calidad de los recursos estadísticos (sección material y método) en los proyectos de tesis de un departamento universitario / Quality analysis of the statistical used resources (material and methods section) in thesis projects of a universitary department

INTRODUCCIÓN Y OBJETIVOS: Los estudios sobre la calidad de tesis y proyectos de investigación en ciencias biomédicas son muy escasos, pero de enorme interés para la docencia universitaria, por la necesidad académica de mejorar la calidad del proceso de elaboración de la tesis. Los objetivos del estudio fueron determinar la calidad de los proyectos de tesis de nuestro departamento, según el cumplimiento de la metodología científica y establecer, si existe, una relación entre la calidad global del proyecto y los recursos estadísticos utilizados. MATERIAL Y MÉTODO: Estudio descriptivo en el que se analizaron 273 proyectos de tesis realizados entre 1995 y 2002 en el departamento de Cirugía de la Universidad de Zaragoza. La revisión se realizó por 15 observadores que analizaron 28 indicadores de cada proyecto. Dando un valor ponderado a cada uno de los indicadores, se calificaron los proyectos en una escala de 0 a 10 según la calidad en el cumplimiento de la metodología científica. RESULTADOS: La media de las calificaciones de los proyectos fue de 5,53 (D.E: 1,77.) Un 13,9% de los proyectos de tesis se concluyeron con la defensa y lectura del trabajo. En los tres indicadores de recursos estadísticos se encontró una diferencia estadísticamente significativa con la valoración de la calidad de los proyectos. DISCUSIÓN: La calidad de los recursos estadísticos es de suma importancia cuando se quiere realizar un proyecto de tesis con buena metodología, ya que asegura llegar a conclusiones ciertas. En nuestro estudio hemos encontrado que más de la tercera parte de la variabilidad en la calidad del proyecto de tesis se explica por los tres ítems estadísticos referidos

INTRODUCTION AND OBJETIVES: Studies about quality in thesis and investigation projects in biomedical sciences are unusual, but very important in university teaching because is necessary to improve the quality elaboration of the thesis. The objectives the study were to determine the project's quality of thesis in our department, according to the fulfillment of the scientific methodology and to establish, if it exists, a relation between the global quality of the project and the statistical used resources. MATERIAL AND METHODS: Descriptive study of 273 thesis projects performed between 1995-2002 in surgery department of the Zaragoza University. The review realized for 15 observers that they analyzed 28 indicators of every project. Giving a value to each of the indicators, the projects qualified in a scale from 1 to 10 according to the quality in the fulfillment of the scientific methodology. RESULTS: The mean of the project´s quality was 5.53 (D.E: 1.77). In 13.9% the thesis projects was concluded with the reading of the work. The three indicators of stadistical used resources had a significal difference with the value of the quality projects. DISCUSSION: The quality of the statistical resources is very important when a project of thesis wants to be realized by good methodology, because it assures to come to certain conclusions. In our study we have thought that more of the third part of the variability in the quality of the project of thesis explains for three statistical above-mentioned articles

[Modified technique for transurethral resection of the prostate with suprapubic drainage and local anesthesia]. / Técnica modificada para la resección transuretral de próstata con drenaje suprapúbico y anestesia local.

PURPOSE: To establish a technique for transurethral resection of the prostate (TURP), combining the use of local anaesthesia with an Amplatz suprapubic tube, in patients at high surgical risk. MATERIALS AND METHOD: A study was carried out in 32 patients who underwent TURP with a 30 F Amplatz suprapubic tube following local anaesthesia. This technique was indicated where surgery presented a general risk, in elderly patients, and for patients refusing to undergo spinal intradural or general anaesthesia. The mean age of the patients was 70 years (61-82 years). The risk of surgery was assessed according to the ASA classification. RESULTS: According to the ASA classification, 7 patients were ASA III (21.9%), and 25 patients were ASA IV (78.1%). In 31 of the 32 patients the operation was completed in one session. When questioned about the pain they felt, 11 patients reported no pain, 12 slight discomfort and 3 occasional pain. In the latter three patients, intravenous sedation was enhanced with 0.1 mg etomidate per kg body weight. The volume of the resected fragments ranged from 18 to 120 ml, with a mean of 47 ml, except in one patient with 205 ml who required two treatment sessions. CONCLUSIONS: Large prostate resection in patients at high surgical risk was performed comfortably using a combination of local anaesthesia and an Amplatz suprapubic tube. This procedure is one possible option to be considered as an alternative to other treatments.

Técnica modificada para la resección trnsuretral de próstata con drenaje suprapúbico y anestesia local / Modified technique for transurethral prostatic resection using a suprapubic tube and local anaesthesia

INTRODUCCIÓN: Describimos una técnica para la resección transuretral (RTU) de próstata combinando el uso de anestesia local con un tubo de Amplatz suprapúbico en pacientes con alto riesgo quirúrgico. MATERIAL Y MÉTODOS: Nuestro estudio comprende 32 pacientes sometidos a RTU de próstata con un tubo de Amplatz suprapúbico de 30 Fr bajo anestesia local. Esta técnica se indicó en aquellos casos con alto riesgo quirúrgico. La edad media fue de 70 años (61-82 años). Evaluamos el riesgo quirúrgico de acuerdo a la clasificación ASA.RESULTADOS: De acuerdo con la clasificación ASA del riesgo quirúrgico, se agrupó a los pacientes en los siguientes grupos: 7 pacientes (21,9 por ciento) presentaban ASA III y 25 pacientes (78,1 por ciento) ASA IV. En 31 de 32 pacientes la cirugía se completó en una sesión. Interrogados acerca del dolor percibido, 11 pacientes refirieron no haber sentido dolor, 12 pacientes refirieron una molestia leve, y 3 pacientes un dolor esporádico. En los últimos tres pacientes se incrementó la dosis de sedación intravenosa con 0,1 mg/kg de peso corporal de Etomidato. El volumen medio de los fragmentos resecados fue de 47 ml, con un rango ente 18 y 120 ml, excepto en un paciente con un volumen de 205 ml que precisó dos sesiones quirúrgicas. CONCLUSIONES: La resección de próstatas de gran volumen en pacientes con riesgo quirúrgico se puede realizar con un mínimo de confort para el paciente utilizando una combinación de anestesia local y tubo de Amplatz suprapúbico. Este procedimiento es una opción a tener en cuenta como tratamiento alternativo a otros métodos (AU)

PURPOSE: To establish a technique for transurethral resection of the prostate (TURP), combining the use of local anaesthesia with an Amplatz suprapubic tube, in patients at high surgical risk. MATERIALS AND METHOD: A study was carried out in 32 patients who underwent TURP with a 30 F Amplatz suprapubic tube following local anaesthesia. This technique was indicated where surgery presented a general risk, in ederly patients, and for patients refusing to undergo spinal intradural or general anaesthesia. The mean age of the patients was 70 years (61-82 years). The risk of surgery was assessed according to the ASA classification. RESULTS: According to the ASA classification, 7 patients were ASA III (21,9%), and 25 patients were ASA IV (78,1%). In 31 of the 32 patients the operation was completed in one session. When questioned about the pain they felt, 11 patients reported no pain, 12 slight discomfort and 3 ocassional pain. In the latter three patients, intravenous sedation was enhanced with 0,1 mg etomidate per kg body weight. The volume of the resected fragments ranged from 18 to 120 ml, with a mean of 47 ml, except in one patient with 205 ml who required two treatment sessions. CONCLUSIONS: Large prostate resection in patients at high surgical risk was performed comfortably using a combination of local anaesthesia and an Amplatz suprapubic tube. This procedure is one possible option to be considered as an alternative to other treatments (AU)