ABSTRACT
New generation devices that combine high-flow insufflation with smoke aspiration using continuous gas recirculation ]so-called Insufflator/aspirator systems (IAS)] have recently been developed to generate pneumoperitoneum. The use of an IAS could have an impact on surgical compared to conventional insufflation systems (CIS). The present study aimed to compare the clinical effectiveness/safety, healthorganizational, and pathological/oncological outcomes of the CIS versus IAS during robot-assisted radical prostatectomy (RARP). Methods: Comparative retrospective cohort study including patients with non-metastatic prostate cancer treated with RARP by four expert surgeons at a robotic referral centre between January 2020 and December 2021. A CIS was used until 15 March 2021, and the IAS thereafter. Data were extracted from the Institutional Review Board-approved (#1064) retro and prospective institutional database. Results: The final analysis included 299 patients (143 CIS; 156 IAS). We found no statistically significant differences in demographic data and preoperative results, allowing adequate group comparison. The rate of complications of any degree (9.1% and 1.9%, P<0.05) and major complications (4.2% and 0.6%, P<0.05) were lower in the IAS group. Accordingly, the hospital stay was shorter in the IAS group (P<0.05); however, the small size of this statistically significant difference probably lacks clinical value (1.9±1.6 vs. 1.6±0.8 days). There was no significant difference in surgical time, bleeding, pathological findings, or oncological results. Conclusions: Data from this large group of patients showed that the rate of overall complications, the rate of major complications, and the length of stay were lower in the IAS group. Implementing the IAS in RARP patients increased the occurrence of SCE and affected our daily practice of transversus abdominis plane block. Interpretation of the results should be made with caution since the design of this study did not allow for the identification of a causal relationship.
ABSTRACT
Introducción: En mujeres postmenopáusicas el bajo peso y la obesidad son factores de riesgo para la Osteoporosis; sin embargo, está por definir la influencia de su cambio en la respuesta terapéutica con bisfosfonatos para la prevención de la fractura. Objetivo: Describir asociación entre índice de masa corporal (IMC) y masa ósea en mujeres en post menopausia, así como identificar las variaciones en peso e IMC durante el tratamiento con bisfosfonatos. Material y Métodos: En 296 mujeres quienes entre 2009-2014 concurrieron consecutivamente a la Clínica de Climaterio y Osteoporosis (ClimOS) La Habana (n=103), y al Departamento de Enfermedades Metabólicas Óseas de la Fundación Jiménez Díaz, Madrid (n=193) se determinó peso, talla, IMC, y mediante DXA la densidad mineral ósea en columna lumbar y cadera. En 80 de ellas se evaluó la influencia del peso corporal inicial y su variación temporal durante el uso de bisfosfonatos. Análisis estadístico: Promedio y desviación estándar para variables cuantitativas, frecuencias para las variables cualitativas y las Pruebas T Students y X2 para diferencias entre ellas. Correlación de Pearson para precisar influencia del peso inicial y el IMC y su diferencia en la respuesta a los bisfosfonatos. Se utilizó valor p<0,05 para la significación estadística. Resultados: Bajo peso se identificó 4/296, más de la mitad presentaron sobrepeso/obesidad. Las mujeres evaluadas en la ClimOs presentaron peor estatus óseo en cadera. No se encontró asociación del peso corporal ni del IMC sobre la respuesta al tratamiento con BPS. Conclusiones: La influencia del peso corporal sobre una nueva fractura fue controversial, se sugiere incluir la variación ponderal como parte del tratamiento para la osteoporosis(AU)
Introduction: Low weight and obesity are risk factors for osteoporosis in postmenopausal women; however, the influence of its change on a therapeutic response to biophosphonates for the prevention of fractures has not been defined yet. Objective:To describe the association between the body mass index (BMI) and bone mass in postmenopausal women, as well as to identify changes in weight and BMI during the treatment with biophosphonates. Material and methods: Weight, height, and BMI was determined in 296 women who came consecutively to the Climateric and Osteoporosis Clinic (ClimOS) in Havana from 2009 to 2014 (n=103), and to the Department of Metabolic Bone Diseases, Jiménez Díaz Foundation, Madrid (n=193); also, bone mineral density in lumbar spine and hip was measured by DXA. The influence of initial body weight and its temporal variation with the use of biophosphonates (BPS) was evaluated in 80 of them. Statistical analysis: standard statistical average for qualitative variables, frequencies for the qualitative variables, Student´s t-Tests, and X2 test for differences among them. Pearson´s correlation to specify the influence of the initial weight and BMI, and their differences in the response to biophosphonates. Besides, p<0,05 value was used for statistical significance. Results:Low weight was identified 4/296; more than half of them were overweight or obese. Women who were evaluated in ClimOs, presented a worse bone status on the hip. Neither association of body weight nor BMI was found on the response to treatment with (BPS). Conclusions: The influence of body weight on a new fracture was controversial; it is suggested to include ponderal variation as part of the treatment for osteoporosis(AU)