Transumbilical laparoscopic urological surgery: are special devices strictly necessary?

OBJECTIVE: To evaluate the safety and feasibility of transumbilical laparoscopic surgery using conventional laparoscopic instruments and ports. PATIENTS AND METHODS: Since January 2008 we have been using laparoscopic transumbilical procedures. Patient selection was determined by any situation, pathological or not, for which laparoscopy was deemed appropriate as the standard of care in our practice. Exclusion criteria included patients who had undergone multiple abdominal procedures. The Veress needle was placed through the umbilicus, to allow insufflation with carbon dioxide. A 10-mm trocar was placed in the peri-umbilical site for the laparoscope, followed by placing two additional 5-mm peri-umbilical trocars. The entire procedure was done using conventional laparoscopic instruments. At the end of surgery the trocars were removed and all three peri-umbilical skin incisions were united for specimen retrieval. Patients undergoing surgery using this approach were evaluated prospectively and data were collected during and after surgery for analysis. RESULTS: Six procedures were performed using this technique (three nephrectomies, one adrenalectomy, one ureterolithotomy and one retroperitoneal mass resection). The mean operative duration and blood loss were 70.5 min and 108.3 mL, respectively. There were no complications during surgery and no patients needed a blood transfusion. Analgesia comprised metamizole (1 g intravenous every 6 h) and ketoprofen (100 mg intravenous every 12 h). The time to first oral intake was 8 h and the mean hospital stay was 28 h. CONCLUSION: Laparoscopic transumbilical surgery seems to be feasible and safe even using conventional laparoscopic instruments, and can be considered a potential alternative for traditional laparoscopic urological procedures.

Colesterolose da vesícula biliar / Cholesterolosis of the gallbladder

O objetivo do presente estudo é determinar a prevalência de colesterolose da vesícula biliar em pacientes com colecistite aguda e ou crônica submetidos à colecistectomia e se existe diferença de idade e sexo entre pacientes submetidos à colecistectomia, 100 (10,9 por cento) apresentavam colesterolose da vesícula biliar. Näo houve diferença na idade média entre pacientes sem (46,1 anos) e com colesterolose (42,2 anos). A distribuiçäo por sexo também foi similar entre os 2 grupos. Näo houve diferença na incidência de colecistite aguda entre os pacientes sem (23,3 por cento) e com colesterolose (20 por cento). Dos pacientes com colesterolose, fora identificados cálculos de colesterol em 97 (97 por cento), cálculos de biblirrubinato em 1 (1 por cento) e colecistite aguda acalculosa em 2 (2 por cento) pacientes. Pólipos de colesterol foram observados em 3 pacientes (3 por cento) com colesterolose. Conclui-se que a prevalência de colesterolose da vesícula biliar em pacientes submetidos a colecistectomia por colecistite é elevada e que näo existe diferença de idade e sexo entre pacientes submetidos à colecistectomia com e sem colesterolose