Incidental benign metastasizing leiomyoma in a patient with bone sarcoma: a case report.

Background. The benign metastasizing leiomyoma is an exceptionally rare entity; it presents with ectopic leiomyoma nodules with a benign pattern. Symptoms vary according to the anatomic location. The diagnosis is histopathological, usually in patients with history of hysterectomy. Case Presentation. A 36-year-old female with 2-month history of left knee pain was diagnosed with bone fibrosarcoma. A CT scan showed pulmonary nodules. The patient started neoadjuvant chemotherapy. Conservative surgery of pelvic limb was achieved. A new CT scan reported pulmonary nodules that remained in relation to the previous CT. A nodule resection by thoracotomy and TOB (transoperative biopsy) was performed. The final pathology report described benign proliferative lesions consistent with benign metastatic leiomyoma. Conclusions. Benign metastatic leiomyoma is a rare condition presenting with uterine and extrauterine nodules most commonly in the lung. The diagnosis is histopathological. The surgical procedure must be reserved for selected patients.

Irrigation with bupivacaine at the surgical bed for postoperative pain relief after laparoscopic cholecystectomy.

PURPOSE: The aim of this study was to evaluate the effect of bupivacaine irrigated at the surgical bed on postoperative pain relief in laparoscopic cholecystectomy patients. METHODS: This study included 60 patients undergoing elective laparoscopic cholecystectomy who were prospectively randomized into 2 groups. The placebo group (n=30) received 20cc saline without bupivacaine, installed into the gallbladder bed. The bupivacaine group (n=30) received 20cc of 0.5% bupivacaine in at the same surgical site. Pain was assessed at 0, 6, 12, and 24 hours by using a visual analog scale (VAS). RESULTS: A significant difference (P=.018) was observed in pain levels between both groups at 6 hours postoperatively. The average analgesic requirement was lower in the bupivacaine group, but this did not reach statistical significance. CONCLUSIONS: In our study, the use of bupivacaine irrigated over the surgical bed was an effective method for reducing pain during the first postoperative hours after laparoscopic cholecystectomy.

Evaluation of a surgical simulator as used by students with different experience levels.

BACKGROUND: Historically, the operating room has been the training setting for both surgeons and students. Nowadays, an alternative is represented by surgical simulators. In the same way a not-very-well-built mirror cannot reflect trustworthy images (distortion), a not well-built, calibrated or programmed simulator will be unable to reflect the training level of the operator. Our aim is to indirectly evaluate the Surgical SIM® simulator. METHODS: Twelve surgical residents were classified according to novices, intermediates and experts, and 15 tasks were applied with three dimensions of evaluation in each using the Surgical SIM® simulator. Pearson's correlation test was used to establish validity. RESULTS: In general, from the three dimensions evaluated, results showed a statistically significant difference for time (p = 0.001), trajectory (p = 0.01) and errors (p = 0.001). CONCLUSIONS: Effectiveness of Surgical SIM® was indirectly demonstrated.

Colectomía Subtotal Laparoscópica. Resultados en el Texas Endosurgery Institute / Laparoscopic subtotal colectomy: results from the Texas Endosurgery Institute

BACKGROUND: Laparoscopy is currently and progressively gaining acceptance for the management of colorectal disease. More bleeding and longer operating time were initially considered as contraindications to perform laparoscopic colon resections. Other obstacles were technical difficulties, the learning curve and the need for specialized instruments; however, improvements in surgical techniques and technological developments have allowed subtotal laparoscopic colectomy to be feasible. METHODS: This was a retrospective and descriptive study conducted from April 1992 to July 2006. Forty-four patients underwent laparoscopic subtotal colectomy at Texas Endosurgery Institute in San Antonio, TX. Measured variables to evaluate efficacy and safety were operating time, length of hospital stay, time to resume normal diet, conversion to open procedure, morbidity and mortality. RESULTS: Cancer, familial adenomatous polyposis and ulcerative colitis were the main surgical indications. The procedure was technically successful in 88% of patients. There were five conversions (11.3%). Mean operating time was 210 min. Morbidity and mortality rates were 29% and 2.2%, respectively. Mean length of hospital stay and time to resume normal diet were 11 and 4 days, respectively. CONCLUSIONS: Laparoscopic subtotal colectomy in our institute may be considered as an effective and safe method in the management of colorectal disease.

[Laparoscopic subtotal colectomy. Results from the Texas Endosurgery Institute]. / Colectomía Subtotal Laparoscópica. Resultados en el Texas Endosurgery Institute.

BACKGROUND: Laparoscopy is currently and progressively gaining acceptance for the management of colorectal disease. More bleeding and longer operating time were initially considered as contraindications to perform laparoscopic colon resections. Other obstacles were technical difficulties, the learning curve and the need for specialized instruments; however, improvements in surgical techniques and technological developments have allowed subtotal laparoscopic colectomy to be feasible. METHODS: This was a retrospective and descriptive study conducted from April 1992 to July 2006. Forty-four patients underwent laparoscopic subtotal colectomy at Texas Endosurgery Institute in San Antonio, TX. Measured variables to evaluate efficacy and safety were operating time, length of hospital stay, time to resume normal diet, conversion to open procedure, morbidity and mortality. RESULTS: Cancer, familial adenomatous polyposis and ulcerative colitis were the main surgical indications. The procedure was technically successful in 88% of patients. There were five conversions (11.3%). Mean operating time was 210 min. Morbidity and mortality rates were 29% and 2.2%, respectively. Mean length of hospital stay and time to resume normal diet were 11 and 4 days, respectively. CONCLUSIONS: Laparoscopic subtotal colectomy in our institute may be considered as an effective and safe method in the management of colorectal disease.

Esplenectomía laparoscópica: experiencia de 12 años en dos instituciones privadas / Laparoscopic splenectomy: twelve-year experience in two private institutions

Introducción: en 1991, Delaitre y colaboradores reportaron la primera esplenectomía laparoscópica exitosa. Ésta se ha convertido en el procedimiento de elección en pacientes con enfermedades hematológicas que requieren tratamiento quirúrgico. Las ventajas potenciales del abordaje laparoscópico sobre el convencional son menor estancia intrahospitalaria, retorno más rápido a la vía oral y disminución en las tasas de morbilidad y mortalidad. Material y métodos: de junio de 1993 a diciembre de 2004, 42 pacientes fueron sometidos a esplenectomía laparoscópica tanto en el Texas Endosurgery Institute como en el Hospital “San José” del Tecnológico de Monterrey. Las variables utilizadas para valorar eficacia y seguridad fueron tiempo quirúrgico, estancia intrahospitalaria, inicio de la vía oral, conversión a procedimiento abierto, morbilidad y mortalidad. Resultados: las enfermedades hematológicas representaron el diagnóstico más común. El procedimiento fue técnicamente exitoso en 95 % de los casos. Solamente hubo dos conversiones a cirugía convencional. El tiempo quirúrgico promedio fue de 120 minutos. La tasa de mortalidad fue de 2.3 % y la estancia intrahospitalaria y el inicio de la vía oral promedios, de cuatro y dos días, respectivamente. Conclusiones: nuestra serie contribuye a reafirmar que actualmente la esplenectomía laparoscópica representa un método seguro y efectivo, conservando además algunas de las ventajas de los procedimientos mínimamente invasivos.

BACKGROUND: In 1991, Delaitre et al. reported the first successful laparoscopic splenectomy. This procedure has become the best option in patients with hematological diseases and who require surgical treatment. The potential advantages of the laparoscopic approach over the conventional surgery are shorter length of hospital stay, shorter time to resume normal diet and decreased rates of morbidity and mortality. METHODS: From June 1993 to December 2004, 42 patients underwent laparoscopic splenectomy in our two surgical care centers: Texas Endosurgery Institute and Hospital San José-TEC de Monterrey. The measured variables to evaluate efficacy and safety were operating time, length of hospital stay, time to resume normal diet, conversion to open procedure, morbidity and mortality. RESULTS: Hematological diseases were the most common diagnosis. The procedure was technically successful in 95% of the patients. There were two conversions to open surgery. The mean operating time was 120 min. Mortality rate was 2.3%. The mean length of hospital stay and time to resume normal diet were 4 and 2 days, respectively. CONCLUSIONS: We regard that our series contributes to supporting laparoscopic splenectomy as a safe and effective method, retaining some advantages of minimally invasive techniques.

[Laparoscopic splenectomy: Twelve-year experience in two private institutions]. / Esplenectomía laparoscópica. Experiencia de 12 años en dos instituciones privadas.

BACKGROUND: In 1991, Delaitre et al. reported the first successful laparoscopic splenectomy. This procedure has become the best option in patients with hematological diseases and who require surgical treatment. The potential advantages of the laparoscopic approach over the conventional surgery are shorter length of hospital stay, shorter time to resume normal diet and decreased rates of morbidity and mortality. METHODS: From June 1993 to December 2004, 42 patients underwent laparoscopic splenectomy in our two surgical care centers: Texas Endosurgery Institute and Hospital San José-TEC de Monterrey. The measured variables to evaluate efficacy and safety were operating time, length of hospital stay, time to resume normal diet, conversion to open procedure, morbidity and mortality. RESULTS: Hematological diseases were the most common diagnosis. The procedure was technically successful in 95% of the patients. There were two conversions to open surgery. The mean operating time was 120 min. Mortality rate was 2.3%. The mean length of hospital stay and time to resume normal diet were 4 and 2 days, respectively. CONCLUSIONS: We regard that our series contributes to supporting laparoscopic splenectomy as a safe and effective method, retaining some advantages of minimally invasive techniques.

Colocación de marcapaso epicárdico permanente en un recién nacido con bloqueo AV completo congénito / Placement of a definite epicardial pacemaker in a newborn with complete A-V Block

El bloqueo AV completo congénito aislado es una condición poco frecuente estimada en 1 de 20,000 nacimientos vivos. El pronóstico se ha modificado en los últimos 35 años así como también las indicaciones para la colocación de marcapaso definitivo. El propósito de este reporte es describir un caso de este tipo diagnosticado en útero, describir la técnica quirúrgica para la colocación del marcapaso epicárdico y revisar el concepto actual de pronóstico e indicaciones para inplantar un marcapaso permanente. El recién nacido, obtenido por cesárea a las 38 semanas, fue masculino eutrófico con peso de 3030 g y sin cardiopatía congénita asociada. El electrocardiograma mostró bloqueo AV completo con QRS normales, frecuencia auricular de 140 lpm y ventricular de 55 lpm. Se observó durante una semana sin presentar insuficiencia cardiaca pero con frecuencia ventricular promedio de 50 lpm. Se colocó entonces un marcapaso epicárdico permanente VVIR a través de laparatomía media y resección del apéndice xifoides, instalando un cable unipolar de 35 cm de tipo tornillo en el ventrículo derecho y la fuente se fijó en una bolsa de politetrafluoroetileno al peritoneo parietal. La evolución posterior fue satisfactoria y se egresó una semana después en buenas condiciones. Concluimos que en recién nacidos con bloqueo AV completo congénito aislado y frecuencias ventriculares menores a 55 lpm es conveniente reducir el riesgo de muerte súbita implantando un marcapaso definitivo en este periodo y que la técnica quirúrgica descrita es segura y facilita el recambio de la fuente en el futuro.