Colecistectomía laparoscópica transumbilical. Resultados con el dispositivo de gel y revisión de la literatura / Laparoscopic transumbilical cholecystectomy. Results with the gel device and literature review

Introducción La aparición de la cirugía con una única incisión transumbilical ha venido a abrir una nueva época en el abordaje mínimamente invasivo de la colecistectomía. La existencia de puertos específicos para este abordaje facilita su realización. Introducción Presentamos la experiencia inicial de nuestro grupo, entre julio de 2008 y junio de 2009 y una puesta al día de la bibliografía sobre el tema. Pacientes y método Se realizó un estudio prospectivo, longitudinal y de intervención, que incluyó a 30 pacientes con colelitiasis sintomática, entre el 10 de julio de 2008 y el 30 de junio de 2009, a los que se les realizó una colecistectomía por una única incisión transumbilical (técnica laparoendoscopic single site surgery), sin apoyo en otros puertos de minilaparoscopia ni puntos tractores. Pacientes y método Las intervenciones se realizaron utilizando un puerto de gel (R-Port®, Tri-Port®) y pinzas de laparoscopia rectas convencionales y articuladas. Pacientes y método Se estudiaron el tiempo quirúrgico, la necesidad de analgesia postoperatoria, la estancia media, las conversiones y las complicaciones. Resultados La edad media fue de 34,8 años (rangos que fluctúan entre 21 y 53 años), con un body mass index de entre 21 y 39,5kg/m2 (media de 25,8kg/m2). La duración media de la intervención fue de 65,1min (rango que varía entre 40 y 150min) y la estancia media fue menor de 24h. El dolor postoperatorio medido con la escala visual analógica fue bajo. Hasta la fecha se han presentado 2 infecciones de herida y una fuga biliar. Conclusiones La colecistectomía laparoendoscopic single site surgery es una operación técnicamente reproducible por cirujanos con experiencia en cirugía mínimamente invasiva, segura, que requiere una curva de aprendizaje mayor que la colecistectomía laparoscópica convencional (AU)

Introduction The appearance of single transumbilical incision surgery has opened a new era in the minimally invasive approach of cholecystectomy. Specific ports for this technique have made it easier to perform. Introduction We report our initial experience, from July 2008 to June 2009 and give an updated bibliographic review. Patients and methods A prospective, longitudinal and interventional study that included 30 patients with symptomatic cholelithiasis, from 10 July 2008 to 30 June 2009, on whom a single transumbilical incision laparoscopic cholecystectomy was performed (LESS technique), without other minilaparoscopic ports or traction stitches. Patients and methods A gel port was used for all surgeries (R-Port, Tri-Port®), as well as straight and roticulating laparoscopic graspers. Patients and methods Surgical time, analgesia requirements, postoperative hospital stay, conversions and complications were registered. Results The median age was 34.8 years (range, from 21 to 53), with a BMI between 21kg/m2 and 39.5kg/m2 (mean 25.8kg/m2). Surgical time was 65.1 minutes (ranging from 40 to 150) and postoperative length stay was less than 24 hours. Postoperative pain was measured with the VAS scale, giving a low score. Up to now, two wound infections and a bile leak have been observed. Conclusions LESS cholecystectomy is a safe and feasible technique performed by experienced surgeons in minimally invasive surgery, and requires a greater learning curve than that of the conventional laparoscopic cholecystectomy (AU)

[Laparoscopic transumbilical cholecystectomy. Results with the gel device and literature review]. / Colecistectomía laparoscópica transumbilical. Resultados con el dispositivo de gel y revisión de la literatura.

INTRODUCTION: The appearance of single transumbilical incision surgery has opened a new era in the minimally invasive approach of cholecystectomy. Specific ports for this technique have made it easier to perform. We report our initial experience, from July 2008 to June 2009 and give an updated bibliographic review. PATIENTS AND METHODS: A prospective, longitudinal and interventional study that included 30 patients with symptomatic cholelithiasis, from 10 July 2008 to 30 June 2009, on whom a single transumbilical incision laparoscopic cholecystectomy was performed (LESS technique), without other minilaparoscopic ports or traction stitches. A gel port was used for all surgeries (R-Port, Tri-Port), as well as straight and roticulating laparoscopic graspers. Surgical time, analgesia requirements, postoperative hospital stay, conversions and complications were registered. RESULTS: The median age was 34.8 years (range, from 21 to 53), with a BMI between 21 kg/m(2) and 39.5 kg/m(2) (mean 25.8 kg/m(2)). Surgical time was 65.1 minutes (ranging from 40 to 150) and postoperative length stay was less than 24 hours. Postoperative pain was measured with the VAS scale, giving a low score. Up to now, two wound infections and a bile leak have been observed. CONCLUSIONS: LESS cholecystectomy is a safe and feasible technique performed by experienced surgeons in minimally invasive surgery, and requires a greater learning curve than that of the conventional laparoscopic cholecystectomy.

[Serum PTH levels as a predictive factor of hypocalcaemia after total thyroidectomy]. / Determinación de paratirina en suero como factor predictivo de hipocalcemia tras tiroidectomía total.

INTRODUCTION: Postoperative parathyroid hormone (PTH) levels as a predictor of hypocalcaemia in patients subjected to total thyroidectomy is analyzed. MATERIAL AND METHOD: Prospective study involving 67 patients who underwent total thyroidectomy due to a benign disease. Serum PTH and ionised calcium were measured 20 h after surgery. Sensitivity, specificity and predictive values of PTH and ionised calcium levels were calculated to predict clinical and analytical hypocalcaemia. RESULTS: A total of 42 (62.7%) patients developed hypocalcaemia (ionised calcium<0.95 mmol/l), but only 20 (29.9%) presented with symptoms. PTH concentration the day after surgery was significantly lower in the group that developed symptomatic hypocalcaemia (5.57+/-6.4 pg/ml) than in the asymptomatic (21.5+/-15.3 pg/ml) or normocalcaemic (26.8+/-24.9 pg/ml) groups (p=0.001). Taking the value of 13 pg/ml as a cut-off point of PTH levels, sensitivity, specificity, positive predictive value and negative predictive value were 54%, 72%, 76% and 48%, respectively. On the other hand, sensitivity for predicting symptomatic hypocalcaemia was 95% and specificity was 76%. The test showed a high incidence of false positives (11/30, 36%). Negative predictive value was 97% and positive predictive value was 65%. In multivariate analysis, PTH and ionised calcium were the only perioperative factors that showed an independent predictive value as risk indicators of symptomatic hypocalcaemia. CONCLUSIONS: Normal PTH levels 20 h after surgery practically rule out the subsequent appearance of hypocalcaemia symptoms. On the other hand, low PTH levels are not necessarily associated to symptomatic hypocalcaemia due to the high number of false positives.

Determinación de paratirina en suero como factor predictivo de hipocalcemia tras tiroidectomía total / Serum PTH levels as a predictive factor of hypocalcaemia after total thyroidectomy

Introducción: se analiza el valor de la determinación postoperatoria de paratirina como indicador de riesgo de hipocalcemia tras tiroidectomía total. Material y método: estudio prospectivo de 67 pacientes sometidos a tiroidectomía total por enfermedad benigna. Se determinó la concentración de paratirina y calcio iónico a las 20h de postoperatorio. Se calculó la sensibilidad, la especificidad y los valores predictivos positivo (VPP) y negativo (VPN) de las concentraciones de paratirina y calcio iónico para predecir la aparición de hipocalcemia sintomática o no. Resultados: presentaron hipocalcemia (Ca iónico<0,95 mmol/l) 42 pacientes (62,7%) pacientes, pero únicamente 20 (29,9%) mostraron síntomas. La concentración de paratirina a las 20h de la intervención fue inferior en el grupo con hipocalcemia sintomática (5,57±6,4pg/ml) que en el grupo de hipocalcemia sin síntomas (21,5±15,3pg/ml) y que entre los pacientes normocalcémicos (26,8±24,9pg/ml) (p=0,001). Con un punto de corte para la paratirina en 13pg/ml, la sensibilidad, la especificidad, el VPP y el VPN de paratirina para predecir la aparición de hipocalcemia analítica fueron del 54, el 72, el 76 y el 48%, respectivamente. Por otro lado, la sensibilidad para predecir hipocalcemia sintomática fue del 95% y la especificidad, el 76%. El test presentó alta incidencia de falsos positivos (11/30) (36%). El VPN fue del 97% y el VPP, el 65%. Paratirina y calcio iónico en el análisis multivariable fueron los únicos factores con valor predictivo como indicadores de riesgo de hipocalcemia sintomática. Conclusiones: una concentración normal de paratirina a las 20h de la intervención prácticamente descarta la aparición posterior de síntomas de hipocalcemia. Por contra, cifras de paratirina bajas no se acompañan necesariamente de síntomas debido al elevado número de falsos positivos (AU)

Introduction: Postoperative parathyroid hormone (PTH) levels as a predictor of hypocalcaemia in patients subjected to total thyroidectomy is analyzed. Matherial and method: Prospective study involving 67 patients who underwent total thyroidectomy due to a benign disease. Serum PTH and ionised calcium were measured 20h after surgery. Sensitivity, specificity and predictive values of PTH and ionised calcium levels were calculated to predict clinical and analytical hypocalcaemia. Results: A total of 42 (62.7%) patients developed hypocalcaemia (ionized calcium<0.95mmol/l), but only 20 (29.9%) presented with symptoms. PTH concentration the day after surgery was significantly lower in the group that developed symptomatic hypocalcaemia (5.57±6.4pg/ml) than in the asymptomatic (21.5±15.3pg/ml) or normocalcaemic (26.8±24.9pg/ml) groups (p=0.001). Taking the value of 13pg/ml as a cut-off point of PTH levels, sensitivity, specificity, positive predictive value and negative predictive value were 54%, 72%, 76% and 48%, respectively. On the other hand, sensitivity for predicting symptomatic hypocalcaemia was 95% and specificity was 76%. The test showed a high incidence of false positives (11/30, 36%). Negative predictive value was 97% and positive predictive value was 65%. In multivariate analysis, PTH and ionised calcium were the only perioperative factors that showed an independent predictive value as risk indicators of symptomatic hypocalcaemia. Conclusions: Normal PTH levels 20h after surgery practically rule out the subsequent appearance of hypocalcaemia symptoms. On the other hand, low PTH levels are not necessarily associated to symptomatic hypocalcaemia due to the high number of false positives (AU)