Factors Associated With Peripheral Nerve Injury After Pelvic Laparoscopy: The Importance of Surgical Positioning.

BACKGROUND: Nerve damage after abdominal and pelvic surgery is rare but potentially serious. The incidence of peripheral nerve injury is difficult to assess, and rates of between 0.02% and 21% have been cited in the literature. Signs and symptoms of this type of injury may appear immediately after surgery or a few days later. PURPOSE: This study was developed to assess the rate of peripheral nerve injury after pelvic laparoscopy and to identify associated risk factors. METHODS: A pilot prospective cohort study was conducted between March 2018 and April 2019 on 101 patients with a 1-month follow-up using two semistructured clinical interviews. We carried out a descriptive analysis followed by univariable and multivariable logistic regression analyses. RESULTS: Thirteen patients were found to have peripheral nerve injuries, representing a rate of 12.9%. Overall, 14 injuries (five severe and nine mild) were detected. One patient had two mild injuries. In this study, the risk of injury was found to increase 1.77-fold (OR = 1.77, 95% CI [1.13, 2.76], p = .007) for each hour the patient was in the Trendelenburg position. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The longer the patient is in the Trendelenburg position, the greater the risk of peripheral nerve damage. Patients aged 60 years or less also face a higher risk of nerve injury.

Paratiroides intratiroideas / Intrathyroid parathyroid glands

Una glándula paratiroidea intratiroidea tiene una localización ectópica poco frecuente. La localización intratiroidea de las 4 glándulas paratiroideas es muy infrecuente. Se describe un caso clínico con 4 glándulas intratiroideas y una sistematización en la búsqueda intraoperatoria en esta situación (AU)

Intrathyroid localization of an ectopic parathyroid gland is unusual. Localization of all 4 parathyroid glands in this area is extremely rare. We describe a case of secondary hyperparathyroidism with intrathyroid localization of all 4 parathyroid glands. A systematized intraoperative strategy for identifying these glands is proposed (AU)

[Implantation of laparoscopic colon surgery in a general surgery department]. / Implantación de la cirugía laparoscópica de colon en un servicio de cirugía general.

OBJECTIVE: To evaluate the viability, safety and short-term results of laparoscopic colon surgery during the first few years after its introduction in our department. METHOD: Between January 2002 and December 2005, laparoscopic surgery was performed in patients with surgical indication for benign colon disease. After 2003, patients with malignant disease were also included. A database was created and demographic data, surgical indication, technique, conversion rate, morbidity and postoperative length of stay were recorded. All patients were operated on by the same team of three surgeons. RESULTS: Ninety consecutive patients, with a mean age of 59.2 years (20-88) underwent laparoscopic surgery. Of these, 53 were men (59%). In total, 32 patients had previously undergone one or more open laparotomies (35.5%). Surgery was indicated for benign disease in 60 patients (66%). Distribution was left colon in 79 patients and right colon in 11 patients. The most frequent technique was sigmoidectomy (67.7%). The conversion rate was 12.2%. Operating time was 199 min. (120-340) and length of postoperative stay was 7.5 days (4-57). Morbidity was 18.8% and mortality was 1.1%. CONCLUSIONS: Laparoscopic surgery of the colon is safe and reproducible. Our short-term results are similar to those of previous studies. We believe that prior experience of laparoscopic surgery is important and that a stable surgical team minimizes the effect of the learning curve.

Implantación de la cirugía laparoscópica de colon en un servicio de cirugía general / Implantation of laparoscopic colon surgery in a general surgery department

Objetivo. El objetivo de este estudio fue documentar la factibilidad, la seguridad y los resultados a corto plazo de la cirugía laparoscópica de colon durante los primeros años de implantación de dicha técnica en nuestro servicio. Método. Entre enero de 2002 y diciembre de 2005, se propuso cirugía laparoscópica a los pacientes con indicación quirúrgica por afección benigna de colon. A partir de 2003, se incluyó también a los pacientes con enfermedad maligna. Se creó una base de datos, actualizada, donde se incluyeron los datos demográficos, la indicación quirúrgica, la técnica, la tasa de conversión, la morbilidad y la estancia postoperatoria. Todos los pacientes fueron intervenidos por un mismo equipo de 3 cirujanos. Resultados. Fueron intervenidos 90 pacientes consecutivos, con media de edad de 59,2 (intervalo, 20-88) años. De ellos, 53 (59%) eran varones. En total, 32 (35,5%) pacientes presentaban una o más laparotomías previas por vía abierta. La indicación fue por causa benigna en 60 (66%) casos. La distribución fue de 79 casos en colon izquierdo y 11 en colon derecho. La técnica más frecuente fue la sigmoidectomía (67,7%). La tasa de conversión fue del 12,2%. El tiempo de intervención, 199 (120-340) min y la estancia postoperatoria, de 7,5 (4-57) días. La morbilidad fue del 18,8% y la mortalidad, del 1,1%. Conclusiones. La cirugía laparoscópica de colon es segura y reproducible. Nuestros resultados a corto plazo son comparables a los resultados históricos publicados. Creemos que la experiencia laparoscópica previa es importante y que un equipo quirúrgico estable minimiza el impacto de la curva de aprendizaje (AU)

Objective. To evaluate the viability, safety and short-term results of laparoscopic colon surgery during the first few years after its introduction in our department. Method. Between January 2002 and December 2005, laparoscopic surgery was performed in patients with surgical indication for benign colon disease. After 2003, patients with malignant disease were also included. A database was created and demographic data, surgical indication, technique, conversion rate, morbidity and postoperative length of stay were recorded. All patients were operated on by the same team of three surgeons. Results. Ninety consecutive patients, with a mean age of 59.2 years (20-88) underwent laparoscopic surgery. Of these, 53 were men (59%). In total, 32 patients had previously undergone one or more open laparotomies (35.5%). Surgery was indicated for benign disease in 60 patients (66%). Distribution was left colon in 79 patients and right colon in 11 patients. The most frequent technique was sigmoidectomy (67.7%). The conversion rate was 12.2%. Operating time was 199 min. (120-340) and length of postoperative stay was 7.5 days (4-57). Morbidity was 18.8% and mortality was 1.1%. Conclusions. Laparoscopic surgery of the colon is safe and reproducible. Our short-term results are similar to those of previous studies. We believe that prior experience of laparoscopic surgery is important and that a stable surgical team minimizes the effect of the learning curve (AU)