Modelo animal de entrenamiento en pieloplastia laparoscópica / Animal Model for Training in Laparoscopic Pyeloplasty

Objetivos: Con el advenimiento de la laparoscopia se han desarrollado múltiples técnicas quirúrgicas que han revolucionado la práctica urológica. La pieloplastia laparoscópica ha sido una de las técnicas de mayor desarrollo; sin embargo, existen muy pocos modelos de entrenamiento que permitan al cirujano disminuir su curva de aprendizaje. Se describe un modelo animal de entrenamiento para la técnica de pieloplastia laparoscópica. Métodos: Se realizaron 8 procedimientos de pieloplastia laparoscópica utilizando el modelo animal (Gallus gallus) en el laboratorio de prácticas laparoscópicas del Servicio de Urología del Hospital Universitario de Caracas. Se comparó los tiempos de preparación del modelo y los tiempos operatorios de cada cirujano. Se realizó análisis estadístico calculando el tiempo operatorio medio, la desviación estándar, las frecuencias y los porcentajes. Se consideró un valor significativo p < 0,05. Resultados: El procedimiento de pieloplastia laparoscópica se realizó exitosamente en todos los casos por dos cirujanos. El tiempo de preparación osciló entre un máximo de 14 minutos y un mínimo de 6 minutos, siendo igual para ambos cirujanos en el cuarto caso. El tiempo operatorio osciló entre un máximo de 65 minutos y un mínimo de 43 minutos, observándose diferencias significativas al comparar los tiempos de forma individual de cada cirujano. Solo un caso presentó filtración al comprobar la permebilidad de la pieza. Conclusiones: El modelo animal de entrenamiento para pieloplastia laparoscópica que se describe es económico, reproducible, de fácil disponibilidad y permite desarrollar habilidades y destrezas quirúrgicas laparoscópicas, necesarias para cirugía reconstructiva, y técnicas que ameriten sutura intracorpórea (AU)

Objective: With the coming of the laparoscopy, multiple surgical techniques have been developed that have revolutionized the urological practice. The laparoscopic pyeloplasty has been one of the techniques most developed. However, there are very few training models that permit the surgeon to decrease the learning curve. An animal model of training for the laparoscopic pyeloplasty technique is described. Methods: Eight procedures of laparoscopic pyeloplasty were performed using the animal model (Gallus gallus) in the laparoscopic practice laboratory of the Urology Service of the University Hospital of Caracas. The preparation times of the model and the operation times of each surgeon were compared. The statistical analysis was made calculating the mean operation time, standard deviation, frequencies and percentages. A significant value was considered as p < 0.05. Results: The laparoscopic pyeloplasty procedure was performed successfully in all of the cases by two surgeons. The preparation time ranged from a maximum of 14 minutes to a minimum of6 minutes, this being the same for both surgeons in the fourth case. The operation time ranged from a maximum of 65 minutes to a minimum of 43 minutes, observing significant differences when comparing the times individually for each surgeon. Only one case had filtration when comparing the patency of the specimen. Conclusions: The animal model of training of laparoscopic pyeloplasty that is described is economical, reproducible, of easy availability and it makes it possible to develop laparoscopic surgical skills and competency necessary for reconstructive surgery and techniques that warrant intracorporeal suture (AU)

[Animal model for training in laparoscopic pyeloplasty]. / Modelo animal de entrenamiento en pieloplastia laparoscópica.

OBJECTIVE: With the coming of the laparoscopy, multiple surgical techniques have been developed that have revolutionized the urological practice. The laparoscopic pyeloplasty has been one of the techniques most developed. However, there are very few training models that permit the surgeon to decrease the learning curve. An animal model of training for the laparoscopic pyeloplasty technique is described. METHODS: Eight procedures of laparoscopic pyeloplasty were performed using the animal model (Gallus gallus) in the laparoscopic practice laboratory of the Urology Service of the University Hospital of Caracas. The preparation times of the model and the operation times of each surgeon were compared. The statistical analysis was made calculating the mean operation time, standard deviation, frequencies and percentages. A significant value was considered as p < 0.05. RESULTS: The laparoscopic pyeloplasty procedure was performed successfully in all of the cases by two surgeons. The preparation time ranged from a maximum of 14 minutes to a minimum of 6 minutes, this being the same for both surgeons in the fourth case. The operation time ranged from a maximum of 65 minutes to a minimum of 43 minutes, observing significant differences when comparing the times individually for each surgeon. Only one case had filtration when comparing the patency of the specimen. CONCLUSIONS: The animal model of training of laparoscopic pyeloplasty that is described is economical, reproducible, of easy availability and it makes it possible to develop laparoscopic surgical skills and competency necessary for reconstructive surgery and techniques that warrant intracorporeal suture.

[Laparoscopic vesical autoaugmentation: an animal model in rabbits (Oryctolagus cuniculus)]. / Autoaumento vesical por laparoscopia. Modelo experimental en conejos (Oryctolagus cuniculus).

INTRODUCTION: Small contracted bladder remains a challenge in clinical urological practice and treatment options are not always effective. Urothelium sparing surgical techniques represent a reasonable therapeutical option. We aimed to evaluate the feasibility of a rabbit model (Oryctolagus cuniculus) in the teaching and training setting for laparoscopic vesical autoaugmentation. METHODS: Transperitoneal laparoscopic bladder autoaugmentation was performed in five New Zealand male rabbits (Oryctolagus cuniculus). A three port technique was used for all cases. Circumferential detrusorectomy was performed with vascular pedicles sparing, subsequently submucosal detailed blunt dissection allowed the creation of a bladder diverticulum which was verified intraoperatively. Eye-ball cystometry was performed preoperatively and postoperatively to verify bladder capacity variations. Postoperatively cystometry was done immediately after the procedure and 7 and 15 days postoperatively. Statistical analysis was performed with T-student model. A p-value < 0.05 was considered of significance for the analysis. Surgical procedure and perioperative animal care was minutely precised according to the Guidelines of the Institute of Laboratory Animal Resources, Commission on Life Sciences, National Research Council. RESULTS: Five New Zealand male rabbits (Oryctolagus cuniculus) were surgically treated as described. Median operative time was 68.8 minutes (range 44 -120). Median preoperatory bladder capacity for the series was 25.8 cc (7-52). Median postoperative bladder capacity was diminished in 33% immediately after the operation. Then, bladder capacity augmented 72% and 52% for 7th and 15th postoperative days, respectively. Percentage variation in bladder capacity is statistically significant. Two operative complications (mucosal tear) were reported. A postoperatory abscess was observed in one animal. CONCLUSION: The rabbit (Oryctolagus cuniculus) model for the laparoscopic bladder autoaugmentation is feasible for teaching, training and research. Bigger series and longer follow-up should be addressed.

Autoaumento vesical por laparoscopia. Modelo experimental en conejos (oryctolagus cuniculus) / Laparoscopic vesical autoaugmentation: ana animal model in rabbits (Oryctolagus cuniculus)

Introducción: La vejiga pequeña y contraída representa un cuadro clínico de difícil terapéutica y no siempre efectiva. Se presenta la cirugía preservadora de urotelio como una opción que permite el aumento de la capacidad vesical. Nuestro objetivo fue evaluar la factibilidad del conejo (Oryctolagus cuniculus) como modelo experimental de enseñanza, entrenamiento y aplicación de técnica para el autoaumento vesical por laparoscopia. Material y Métodos: Cinco conejos (Oryctolagus cuniculus), machos, New Zealand, fueron intervenidos laparoscópicamente por técnica transperitoneal de tres puertos, realizándose autoaumento vesical mediante detrusorectomía. Se realizó cistometría simple preoperatoria y postoperatoria inmediata, mediata y tardía, para verificar modificaciones de capacidad vesical. Resultados: 5 conejos machos fueron operados en un tiempo promedio de 68,8 minutos (rango 44-120). Se realizó medición de la capacidad vesical preoperatoria con promedio de 25.8cc (7-52) disminuyendo la postoperatoria inmediata en un 33%. Se verificó aumento de capacidad vesical postoperatoria de 72% y 52% para el séptimo y decimoquinto 0día, respectivamente. Estos porcentajes fueron estadísticamente significativos con 95% de confianza. Se presentaron 2lesiones vesicales como complicación transoperatoria y un absceso como complicación postoperatoria. Conclusiones: El modelo animal en conejos para la técnica de autoaumento vesical por laparoscopia es un modelo factible para enseñanza, entrenamiento y aplicación (AU)

Introduction: Small contracted bladder remains a challenge in clinical urological practice and treatment options are not always effective. Urothelium sparing surgical techniques represent a reasonable therapeutical option. We aimed to evaluate the feasibility of a rabbit model (Oryctolagus cuniculus) in the teaching and training setting for laparoscopicvesical autoaugmentation. Methods: Transperitoneal laparoscopic bladder autoaugmentation was performed in five New Zealand male rabbits (Oryctolagus cuniculus). A three port technique was used for all cases. Circumferential detrusorectomy was performed with vascular pedicles sparing, subsequently submucosal detailed blunt dissection allowed the creation of a bladder diverticulum which was verified intraoperatively. Eye-ball cystometry was performed preoperatively and postoperatively to verify bladder capacity variations. Postoperatively cystometry was done immediately after the procedure and 7 and 15days postoperatively. Statistical analysis was performed with T-student model. A p-value < 0.05 was considered of significance for the analysis. Surgical procedure and perioperative animal care was minutely precised according to the Guidelines of the Institute of Laboratory Animal Resources, Commission on Life Sciences, National Research Council. Results: Five New Zealand male rabbits (Oryctolagus cuniculus) were surgically treated as described. Median operative time was 68.8 minutes (range 44 -120). Median preoperatory bladder capacity for the series was 25.8 cc (7-52). Median postoperative bladder capacity was diminished in 33% immediately after the operation. Then, bladder capacity augmented 72%and 52% for 7th and 15th postoperative days, respectively. Percentage variation in bladder capacity is statistically significant. Two operative complications (mucosal tear) were reported. A postoperatory abscess was observed in one animal. Conclusion: The rabbit (Oryctolagus cuniculus) model for the laparoscopic bladder autoaugmentation is feasible for teaching, training and research. Bigger series and longer follow-up should be addressed (AU)

Crosectomía y escleroterapia con espuma frente a safenectomía como tratamiento de las varices producto de reflujo en la unión safenofemoral / Crossectomy and foam sclerotherapy versus saphenectomy as treatment for varicose veins produced by reflux at the saphenofemoral

Introducción. El tratamiento de la enfermedad varicosa producto del reflujo de la unión safenofemoral ha variadoen los últimos años con el advenimiento de novedosas técnicas menos traumáticas. En el presente estudio se describeuna técnica y se describen sus ventajas en relación con otros procedimientos actuales. Pacientes y métodos. Se tratade un estudio prospectivo, comparativo, de una muestra seleccionada de 36 casos. Se realizó una crosectomía y unaescleroterapia con espuma de etoxiesclerol en 18 casos y una safenectomía convencional en los restantes. Resultados.Para la técnica descrita, el tiempo quirúrgico promedio fue de 30 minutos. El tiempo promedio de hospitalización fue deun día, con un reintegro a las actividades cotidianas en la segunda semana en todos los casos y una elevada tasa de satisfacción(94,4%). En el seguimiento durante un período de 3 a 12 meses no se encontraron recurrencias. Se describióun caso de hiperpigmentación como única complicación postoperatoria asociada con el procedimiento. Se demostró unbeneficio con respecto a la safenectomía convencional en cuanto a tasa de complicaciones menores postoperatorias (5,5frente a 33,3%, p < 0,05). Conclusión. La escleroterapia con espuma en el tratamiento de la insuficiencia venosa superficiales una técnica que ha demostrado su eficacia. La técnica propuesta, es decir, la crosectomía y la esclerosis con espumaes una técnica factible, con una tasa de éxito comparable a la safenectomía, que ofrece las ventajas del tratamientomínimamente invasivo sin la necesidad de requerir en el área quirúrgica equipos de alto coste, lo cual la hace más accesiblepara centros no especializados

Introduction. Treatment of varicose vein disease resulting from reflux in the saphenofemoral junction haschanged in recent years with the advent of novel, less traumatic techniques. In this study we outline one such technique anddescribe its advantages compared to other procedures currently in use. Patients and methods. We conducted a prospective,comparative study of a selected sample of 36 cases. Crossectomy and ethoxysclerol foam sclerotherapy were performed in18 cases and the others were treated by means of a conventional saphenectomy. Results. For the technique reported here,average surgery time was 30 minutes. Average hospitalisation time was one day, with return to daily activities during thesecond week in all cases and a high rate of satisfaction (94.4%). No relapses were found during the 3 to 12-month followupperiod. One case of hyperpigmentation was reported as the only post-operative complication associated to theprocedure. The benefits of this procedure over those obtained using conventional saphenectomy were proved by the lowerrate of post-operative complications (5.5 versus 33.3%, p < 0.05). Conclusions. Foam sclerotherapy in the treatment ofsuperficial venous insufficiency is a technique that has been shown to be effective. The technique proposed here, that is tosay, crossectomy and foam sclerosis is a feasible technique, with a success rate comparable to that of saphenectomy. Thefact that it offers the advantages of minimally invasive treatment without requiring high-cost equipment in the surgicalarea makes it more readily available for use in non-specialised centres

Venas perforantes incompetentes. Tratamiento endoscópico con bisturí armónico / Incompetent perforating veins. Endoscopic treatment with harmonic scalpel

Introducción. La cirugía endoscópica de perforantes (CEP) es un procedimiento seguro y eficaz para el tratamiento de la insuficiencia venosa crónica con incompetencia de perforantes. Entre los adelantos de la cirugía moderna contamos con el bisturí armónico (BA) con corte y coagulación en un sitio preciso, con un daño térmico lateral mínimo; este instrumento facilitará la realización del procedimiento. Objetivo. Demostrar la utilidad del BA en la CEP. Pacientes y métodos. Estudio prospectivo de 39 pacientes consecutivos, intervenidos en la Unidad de Fleblogía del Hospital Universitario de Caracas, clasificados según CEAP: C4 7 por ciento, C5 45 por ciento, C6 48 por ciento; se realiza CEP con BA, y se determina el tiempo quirúrgico, la visualización de perforantes en el canal de trabajo y la evolución posoperatoria. Resultados. El procedimiento se realizó en un tiempo promedio de 37 minutos (20-60 min), y se identificaron 2-4 perforantes en el canal de Linton, donde se obtuvo una óptima visualización. No se presentaron complicaciones asociadas al uso del BA. El seguimiento de los pacientes muestra una mejoría de los síntomas en el 100 por ciento, y la reclasificación del 72 por ciento de los pacientes C6 en C5 en un tiempo de seguimiento de 4-10 semanas. Conclusión. El BA constituye un método seguro y fiable que permite la realización de la CEP, disminuye el tiempo quirúrgico y deja un espacio de trabajo adecuado, sin complicaciones asociadas a su uso (AU)