ABSTRACT
La extracción de la catarata produce una significante y sustancial reducción de la presión intraocular en individuos con glaucoma de ángulo abierto, hipertensión ocular y glaucoma por cierre angular. Remover la catarata mejora la interpretación de las pruebas perimétricas. Es recomendable restablecer las imágenes de base del nervio óptico, así como el campo visual después de la extracción de la catarata. La secuencia de cirugía de catarata y cirugía de glaucoma disminuye la probabilidad de complicaciones y aumenta el éxito quirúrgico. Tiene múltiples beneficios realizar la cirugía de catarata antes que la cirugía de glaucoma, mientras que la cirugía de catarata después de la trabeculectomía incrementa el riesgo de fallo de la filtración. Como la cirugía de glaucoma mínimamente invasiva continúa mejorando en términos de eficacia, esta juega un rol importante en la cirugía combinada de glaucoma y catarata en pacientes con glaucoma en estadios inicial y moderado. La combinación de cirugía de catarata con implante valvular o trabeculectomía por uno o dos sitios, también ofrece ventajas en pacientes con glaucoma avanzado. La presente revisión tiene como objetivo resumir el papel de la cirugía de catarata en el tratamiento del glaucoma teniendo en cuenta el efecto en la presión intraocular y las ventajas que ofrece en aquellos pacientes con ambas condiciones(AU)
Cataract extraction produces a significant, substantial reduction in intraocular pressure in people with open-angle glaucoma, ocular hypertension and angle closure glaucoma. Cataract removal improves the interpretation of perimetric tests. After cataract extraction it is advisable to re-establish the base optic nerve images and the visual field. The cataract surgery - glaucoma surgery sequence reduces the chances of complications and increases surgical success. It is very beneficial to perform cataract surgery before glaucoma surgery, whereas cataract surgery following trabeculectomy increases the risk of filtration failure. Minimally invasive glaucoma surgery continues to improve in terms of efficacy, thus playing an important role in combined glaucoma-cataract surgery in patients with early-stage, moderate glaucoma. Combined cataract surgery and valve implant or one- or two-site trabeculectomy is also advantageous in patients with advanced glaucoma. The present review is aimed at summarizing the role of cataract surgery in the treatment of glaucoma in terms of its effect on intraocular pressure and its advantages for patients with both conditions. Key words: phacoemulsification, cataract, glaucoma, trabeculectomy, combined surgery, MIGS(AU)
Subject(s)
Humans , Combined Modality Therapy/adverse effects , Glaucoma, Open-Angle/therapy , Phacoemulsification/adverse effects , Trabeculectomy/methodsABSTRACT
La extracción de la catarata produce una significante y sustancial reducción de la presión intraocular en individuos con glaucoma de ángulo abierto, hipertensión ocular y glaucoma por cierre angular. Remover la catarata mejora la interpretación de las pruebas perimétricas. Es recomendable restablecer las imágenes de base del nervio óptico, así como el campo visual después de la extracción de la catarata. La secuencia de cirugía de catarata y cirugía de glaucoma disminuye la probabilidad de complicaciones y aumenta el éxito quirúrgico. Tiene múltiples beneficios realizar la cirugía de catarata antes que la cirugía de glaucoma, mientras que la cirugía de catarata después de la trabeculectomía incrementa el riesgo de fallo de la filtración. Como la cirugía de glaucoma mínimamente invasiva continúa mejorando en términos de eficacia, esta juega un rol importante en la cirugía combinada de glaucoma y catarata en pacientes con glaucoma en estadios inicial y moderado. La combinación de cirugía de catarata con implante valvular o trabeculectomía por uno o dos sitios, también ofrece ventajas en pacientes con glaucoma avanzado. La presente revisión tiene como objetivo resumir el papel de la cirugía de catarata en el tratamiento del glaucoma teniendo en cuenta el efecto en la presión intraocular y las ventajas que ofrece en aquellos pacientes con ambas condiciones(AU)
Cataract extraction produces a significant, substantial reduction in intraocular pressure in people with open-angle glaucoma, ocular hypertension and angle closure glaucoma. Cataract removal improves the interpretation of perimetric tests. After cataract extraction it is advisable to re-establish the base optic nerve images and the visual field. The cataract surgery - glaucoma surgery sequence reduces the chances of complications and increases surgical success. It is very beneficial to perform cataract surgery before glaucoma surgery, whereas cataract surgery following trabeculectomy increases the risk of filtration failure. Minimally invasive glaucoma surgery continues to improve in terms of efficacy, thus playing an important role in combined glaucoma-cataract surgery in patients with early-stage, moderate glaucoma. Combined cataract surgery and valve implant or one- or two-site trabeculectomy is also advantageous in patients with advanced glaucoma. The present review is aimed at summarizing the role of cataract surgery in the treatment of glaucoma in terms of its effect on intraocular pressure and its advantages for patients with both conditions. Key words: phacoemulsification, cataract, glaucoma, trabeculectomy, combined surgery, MIGS(AU)
Subject(s)
Humans , Combined Modality Therapy/adverse effects , Glaucoma, Open-Angle/therapy , Phacoemulsification/adverse effects , Trabeculectomy/methodsABSTRACT
Summary Benign prostatic hyperplasia (BPH) is a common condition in adult men and its incidence increases progressively with aging. It has an important impact on the individual's physical and mental health and its natural progression can lead to serious pathological situations. Although the initial treatment is pharmacological, except in specific situations, the tendency of disease progression causes a considerable portion of the patients to require surgical treatment. In this case, there are several options available today in the therapeutic armamentarium. Among the options, established techniques, such as open surgery and endoscopic resection using monopolar energy, still prevail in the choice of surgeons because they are more accessible, both from a socioeconomic standpoint in the vast majority of medical services and in terms of training of medical teams. On the other hand, new techniques and technologies arise sequentially in order to minimize aggression, surgical time, recovery and complications, optimizing results related to the efficacy/safety dyad. Each of these techniques has its own peculiarities regarding availability due to cost, learning curve and scientific consolidation in order to achieve recognition as a cutting-edge method in the medical field. The use of bipolar energy in endoscopic resection of the prostate, laser vaporization and enucleation techniques, and videolaparoscopy are examples of new options that have successfully traced this path. Robot-assisted surgery has gained a lot of space in the last decade, but it still needs to dodge the trade barrier. Other techniques and technologies will need to pass the test of time to be able to conquer their space in this growing market.
Resumo A hiperplasia prostática benigna (HPB) é uma condição comum em homens adultos, de incidência progressiva com o envelhecimento, com importante impacto nas saúdes física e mental do indivíduo e história natural que pode levar a situações patológicas graves. Embora o tratamento inicial, salvo em situações específicas, seja farmacológico, a tendência de progressão da doença leva uma considerável parcela dos pacientes a necessitar do tratamento cirúrgico. Neste caso, existem diversas opções hoje disponíveis no arsenal terapêutico. Dentre estas, as técnicas consagradas, como as cirurgias por via aberta e a ressecção endoscópica por energia monopolar, ainda ocupam extenso terreno na escolha dos cirurgiões por serem mais acessíveis, tanto do ponto de vista socioeconômico na imensa maioria dos serviços médicos quanto do de aprendizado por parte das equipes médicas. Por outro lado, novas técnicas e tecnologias surgem sequencialmente no intuito de minimizar a agressão, o tempo cirúrgico, as complicações, bem como favorecer a recuperação, otimizando resultados em relação ao binômio eficácia/segurança. Cada uma destas tem seu próprio curso em relação à disponibilidade de acesso em decorrência de custo, curva de aprendizagem e consolidação científica, a fim de atingir conceituação e utilização de ponta no meio médico. O uso da energia bipolar na ressecção endoscópica da próstata, as técnicas de vaporização e enucleação a laser e a videolaparoscopia são exemplos de novas opções que trilharam esse caminho com sucesso. A cirurgia robô-assistida tem conquistado bastante espaço na última década, embora ainda esbarre na barreira comercial. Outras técnicas e tecnologias devem passar pelo crivo do tempo para poderem cavar espaço neste mercado que, tempo após tempo, torna-se mais vasto.
Subject(s)
Humans , Male , Prostatectomy/trends , Prostatectomy/methods , Prostatic Hyperplasia/surgery , Disease ProgressionABSTRACT
OBJECTIVE: The aim of this study is to compare Holmium laser enucleation of the prostate with another minimally invasive technique, the laparoscopic simple prostatectomy. MATERIALS AND METHODS: We compared outcomes of a series of 40 patients who underwent laparoscopic simple prostatectomy (n=20) with laser enucleation of the prostate (n=20) for large adenomas (>100 grams) at our institution. Study variables included operative time and catheterization time, hospital stay, pre- and post-operative International Prostate Symptom Score and maximum urinary flow rate, complications and economic evaluation. Statistical analyses were performed using the Student t test and Fisher test. RESULTS: There were no significant differences in patient age, preoperative prostatic size, operating time or specimen weight between the 2 groups. Duration of catheterization (P=.0008) and hospital stay (P<.0001) were significantly less in the laser group. Both groups showed a statistically significant improvement in functional variables at 3 months post operatively. The cost utility analysis for Holmium per case was 2589 euros versus 4706 per laparoscopic case. In the laser arm, 4 patients (20%) experienced complications according to the modified Clavien classification system versus 5 (25%) in the laparoscopic group (P>.99). CONCLUSION: Holmium enucleation of the prostate has similar short term functional results and complication rates compared to laparoscopic simple prostatectomy performed in large glands with the advantage of less catheterization time, lower economic costs and a reduced hospital stay.
Subject(s)
Laparoscopy , Lasers, Solid-State/therapeutic use , Prostatectomy/methods , Prostatic Hyperplasia/surgery , Aged , Humans , Male , Prostatic Hyperplasia/pathologyABSTRACT
Introdução: Os procedimentos aplicados nos problemas de envelhecimento facial devem ficar restritos aos tecidos brandos e às relações com o volume prévio do esqueleto. Eles podem ser realizados mediante diversas técnicas: dissecção ampla e aberta, endoscópica e mini-invasiva. O objetivo é apresentar nossa concepção de ritidoplastias mini-invasivas e ritidoplastias completas através de mini-incisões, após 18 anos de experiência. Métodos: A ritidoplastia mini-invasiva é realizada através de mini-incisões localizadas na linha do cabelo da região frontal, região temporal, na fossa triangular da orelha, no sulco submentoniano e nas pálpebras. Ampla dissecção é realizada para liberar a fáscia parietal do arco zigomático para elevar em continuidade com o SMAS e o platisma num único plano. Essas estruturas são seletivamente fixadas em posições mais elevadas, restaurando a posição dos tecidos brandos e o contorno da face. Resultados: Nossa experiência se apoia em 672 pacientes, operados durante 19 anos, com mínimo de complicações a serem registradas, tendo sido evitadas as incisões pré-auriculares em 89% dos pacientes. Estão registrados os detalhes e táticas de como realizar cirurgias com segurança e a qualidade dos resultados. Conclusões: Diferentes procedimentos são descritos para mostrar como realizamos as ritidoplastias com minivias de acesso, de acordo com as regiões tratadas e sem cicatrizes pré-auriculares em 89% dos casos operados.
Introduction: A restoring procedure of the ageing process of the face should consider the conditions of the soft tissues and the relationship between them and the existing skeletal volume. This could be done through different approaches: open, endoscopic or mini-invasive. To present our concept of mini-invasive facelift, a full facelift through minimal incisions, product of eighteen years of experience. Methods: The mini-invasive facelift is done through minimal incisions located on the frontal hairline, temporal area, triangular fossae of the auricle, submentalis sulcus and eyelids. A wide dissection is performed to liberate the parieto-temporal fascia from the zigomatic arch, to pull it up in continuity with the SMAS and the platysma as one continuous layer or composite flap. These structures are selectively fixed to a higher position restoring the location of the soft tissues and the contour of the face. Results: We have done this procedure to 672 patients, along 19 years, with minimal complications (described also), and avoiding the pre-auricular incisions in 89% of our patients. In this paper details and tips to perform this procedure in a safer way and to get the most natural results are presented. Conclusions: Different approaches are described to perform a face lift with specific mini access views according to the regions to be treated , without periauricular scar round 89% of the operated cases.
