A novel dissector device that separates anatomic structures during laparoscopic surgery.

OBJECTIVE: To describe a novel dissector device useful in laparoscopy, better definition of anatomic structures to have a better dissection, separation, and cleaning of the structures. METHOD: The endoscopic dissector DisePad was designed and developed at the experimental surgery department of Centro Médico Nacional 20 de Noviembre, and properly patented at Instituto Mexicano de la Propiedad Industrial (title 3512). RESULTS: The tip of the device is the most important component, by its direct contact with the different tissues, consists of a cotton-polyester black cloth impregnated with a special gel immersed into a hot saline solution. Once soaked the tip maintains the solution temperature on itself. CONCLUSIONS: This device has been used in 364 laparoscopic procedures demonstrating, its utility to visualize, separate and clean anatomical structures without thermal lesion, tear, hemorrhage or visceral perforation.

OBJETIVO: Describir un nuevo dispositivo disector en laparoscopia, con una mejor definición de las estructuras anatómicas para obtener una mejor disección,separación y limpieza de las estructuras. MÉTODO: El disector endoscópico DisePad fue diseñado y desarrollado en el servicio de cirugía experimental del Centro Médico Nacional 20 de Noviembre, y patentado ante el Instituto Mexicano de la Propiedad Industrial (registro n.º 3512). RESULTADOS: El componente más importante del disector es la punta que tiene contacto con los tejidos: es una tela de algodón-poliéster negra impregnada en un gel (patentado) que, al ser sumergido en un termo con solución salina caliente, permite retener la temperatura. CONCLUSIONES: Este dispositivo ha sido utilizado en 364 procedimientos quirúrgicos por vía laparoscópica y ha demostrado ser útil para visualizar, separar y limpiar estructuras anatómicas sin producir daño por lesión térmica, desgarre, hemorragia ni perforación visceral.

Effect of autologous transplant of peripheral blood mononuclear cells in combination with proangiogenic factors during experimental revascularization of lower limb ischemia.

Peripheral blood mononuclear cells (PBMCs) contain a cell fraction of mononuclear progenitor cells (MPCs), which own significant angiogenic potential. Autologous transplant of PBMC and/or platelet-rich plasma (PRP) promotes endothelial cells differentiation in experimental lower limb ischemia, which is considered a safe and effective strategy to support revascularization, either in animal models or clinical trials. In addition, thrombin has been proposed to enrich biological scaffolds, hence increasing MPC viability after intramuscular administration, whereas proangiogenic mediators such as vascular endothelial growth factor (VEGF), tumor necrosis factor alpha (TNF-α), inhibitor of the plasminogen activator-1 (PAI-1), and chemokine (CXCL1; GRO-α) participate in the endothelial response to ischemia, through their proangiogenic effects over endothelial cells proliferation, survival, migration, endothelial integrity maintenance, and physiologic vascular response to injury. In the present study, we describe the effect of autologous PBMCs transplant and PRP, either with or without thrombin, over proangiogenic mediators (measured by enzyme-linked immunosorbent assay) and revascularization response (angiographic vascular pattern at 30 days after vascular occlusion) in a rat model of lower limb ischemia. The group treated with PBMC + PRP significantly induced PAI-1, an effect that was prevented by the addition of thrombin. Furthermore, treatment with PBMC + PRP + thrombin resulted in the induction of VEGF. GRO-α showed a sensitive induction of all proangiogenic mediators. All treatments significantly stimulated revascularization, according to angiographic assessment, whereas higher effect was observed with PBMC + PRP treatment (p < .0001). In conclusion, autologous PBMC transplant stimulates revascularization during experimental ischemia of the lower limb, whereas particular effects over proangiogenic and fibrinolytic mediators may be attributed to PBMCs and its combination with PRP and thrombin.

[Vascular microsurgery course: 40 years at the Centro Médico Nacional 20 de Noviembre (ISSSTE) and 33 years at the Faculty of Medicine of the UNAM]. / Curso de microcirugía vascular: 40 años en el Centro Médico Nacional 20 de Noviembre del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado y 33 años en la Facultad de Medicina de la Universidad Nacional Autónoma de México.

On June 1977, "Centro Médico Nacional 20 de Noviembre," in Mexico City, implemented the first vascular microsurgery course. The aim was to develop clinical applications of microsurgery focus on surgical specialties, due to the necessity to develop microsurgical skills. On August 1964 we started the program course at the surgical department of the School of Medicine at Universidad Nacional Autónoma de México (UNAM). Actually, our course is given five times a year at 20 de Noviembre hospital, and four times at the UNAM. One June 2017, the Experimental Surgical Department at "Centro Médico Nacional 20 de Noviembre" reached 40 continuous or uninterrupted years of successfully teaching the microsurgical vascular skills. The aim of this study is to evaluate the satisfaction degree among the students. For that propose, a written survey was applied one year later, after successfully completed the course. These results reveal a satisfaction rate of 80% among these students.

El Curso de Microcirugía Vascular (CMV) inició en el Centro Médico Nacional (CMN) 20 de Noviembre en la Ciudad de México, en junio de 1977, con la idea de poder desarrollar aplicaciones clínicas de microcirugía en todas las especialidades quirúrgicas. En vista de la gran demanda hacia la microcirugía como destreza, en agosto de 1984 iniciamos el programa de Microcirugía Vascular en el Departamento de Cirugía de la Facultad de Medicina de la Universidad Nacional Autónoma de México (UNAM). El CMV se imparte cinco veces al año en el CMN 20 de Noviembre del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado y cuatro en la Facultad de Medicina de la UNAM. En junio de 2017, el Servicio de Cirugía Experimental del CMN 20 de Noviembre cumple 40 años ininterrumpidos de impartir con éxito el CMV. Con el fin de evaluar el CMV de acuerdo con el nivel de satisfacción, a partir de 2016 se implementó el uso de un cuestionario. La finalidad es dar seguimiento repitiendo el cuestionario un año después para valorar las habilidades adquiridas. Los porcentajes demuestran que más del 80% de los alumnos están satisfechos con las destrezas adquiridas en el CMV.

Single-port endo-laparoscopic surgery in combined abdominal procedures.

Single-port endo-laparoscopic surgery has gained support in the surgical community because it is perceived to offer a better postoperative outcome as it requires only a single incision. We write this prospective observational study to ascertain the feasibility and safety of this technique in patients otherwise requiring two operations. Five patients who underwent double procedures with a single-port device were reviewed: Case 1, a transabdominal preperitoneal hernia repair and gastric wedge resection; Case 2, cholecystectomy and diaphragmatic hernia repair; Case 3, oophorectomy and incisional hernia repair; Case 4, anterior resection of the rectum and hepatic segmentectomy; and Case 5, left adrenalectomy and cholecystectomy. Patient demographics, type of port used, operative time, complications and incision length were collected. Mean operative time for the cases ranged from 100 to 315 min. Incision length for the single-port device was 2 cm. In Case 2, an additional 5-mm port was used and an intraoperative complication involving a laceration of the liver occurred during the suturing of the gallbladder fundus. An additional 8-cm lower abdominal incision (Pfannenstiel) was required in Case 4 to complete the colonic anastomosis and for specimen retrieval. Single-port endo-laparoscopic surgery is a feasible and safe technique for approaching double procedures. It drastically reduces the number of scars that a double procedure creates, and if difficulty arises, another port can always be added to ease the operation. It can also potentially reduce the number of admissions and anesthesia that a patient undergoes.

[Prevalence of Barrett's esophagus in non-selected patients submitted to esophagogastroduodenoscopy and associated risk factors]. / Prevalencia de esófago de Barrett en pacientes no seleccionados sometidos a esofagogastroduodenoscopia y factores de riesgo asociados.

OBJECTIVE: To establish the prevalence of the Barrett esophagus (BE) in non-selected patients who underwent upper gastrointestinal endoscopy (UGE) and identified risk factors associated. METHODS: Case-control study on patients who underwent UGE between 2001-2003. Demographic data was gathered as well as the presence of esophagitis, H. pylori, hiatal hernia presence and length, nighttime symptoms, smoking, and alcohol consumption. RESULTS: The global frequency of EB was 0.26%. Average age in patients with EB was 57.3 +/- 17 years old against 49 +/- 15 years old on the control group (p = 0.16). 69% of the patients with EB were men compared to 56% on the control group (p = 0.41). No difference regarding the presence of hiatal hernia was found between EB (79.6%) and patients without EB (72.5%) (p = 0.75). However, patients with EB presented a longer hiatal hernia (p < 0.05). There was no difference regarding the presence of esophagitis (p = 0.32), H. pylori (p = 0.61), smoking (p = 0.39), alcohol consumption (p = 0.34), nocturnal symptoms (p = 0.53) or extra-esophageal manifestations (p = 0.31). A significant difference existed regarding the presence of heartburn and the length of symptoms: patients with EB stated a history longer than 5 years in comparison with the control group (p < 0.005 and < 0.01 respectively). CONCLUSIONS: The frequency of EB was 0.26% in Mexican non-selected population; the extents of hiatal hernia and history heartburn as well as a longer duration of symptoms were significantly associated to EB.