[Efectos sobre el perfil metabólico, el índice de masa corporal, la composición corporal y la comorbilidad en adolescentes con obesidad mórbida, que han fallado al manejo conservador para bajar de peso, operados de manga gástrica laparoscópica. Reporte del primer grupo de cirugía bariátrica pediátrica en México].

INTRODUCTION: Obesity is a world pandemic; in Mexico 3 out of 10 adolescents suffer from it. Conservative management of morbid obesity is not effective and bariatric surgery is the only useful therapy. International pediatric bariatric surgery series are scarce and in Mexico there is limited experience. METHOD: We analyze the metabolic repercussions, comorbidities and complications in our series of Mexican adolescents with morbid obesity who underwent a gastric sleeve between 2011 and 2015. RESULTS: 54 morbid obese adolescents were included, 10 fulfilled criteria for surgery. 5 were male, mean age 14.3 ± 1.4 years, weight 117.3 ± 15.2 kg, initial body mass index 43.71 ± 4.1, waist 130.3 ± 6.8 cm, 8 dyslipidemia, 6 metabolic syndrome, 5 liver steatosis, 4 hypertension, 3 type-2 diabetes. Complications: 2 atelectasis, 1 fistula, 1 pneumonia, 1 cholelithiasis; no patient developed nutritional deficits. Weight loss of 33% one-year after surgery and 23% at 2 years. Body fat decreased 22.4% and water content increased 36.1%. Excess weight loss was significant p = 0.001. Two-years after surgery severe steatosis and diabetes had subsided, lipid profile improved and only one patient remained hypertensive. DISCUSSION: Our results demonstrate that all serious comorbidities associated to morbid obesity were improved (diabetes, dyslipidemia and hypertension) and will confer a better prognosis for these children. CONCLUSIONS: Gastric sleeve is useful in morbid obese adolescents. Longer follow-up is needed.

INTRODUCCIÓN: La obesidad es una pandemia mundial; 3 de cada 10 adolescentes en México la padecen. En la obesidad mórbida, el manejo conservador es un fracaso y la cirugía bariátrica es el único tratamiento útil. No hay experiencia en México y los reportes internacionales son aislados. MÉTODO: Análisis de las repercusiones metabólicas, efecto sobre la comorbilidad y complicaciones, en adolescentes con obesidad mórbida operados con manga gástrica de 2011 a 2015. RESULTADOS: De 54 pacientes con obesidad mórbida, 10 cumplieron criterios; 5 varones; edad de 14.3 ± 1.4 años; peso de 117.3 ± 15.2 kg; índice de masa corporal basal de 43.71 ± 4.1; cintura de 130.3 ± 6.8 cm; 8 con dislipidemia; 6 con síndrome metabólico; 5 con esteatosis hepática; 4 con hipertensión; 3 con diabetes tipo 2. Complicaciones: 2 atelectasias, 1 fístula, 1 neumonía, 1 colelitiasis; ninguno con carencia nutricional. Disminución del peso al año del 33% y a los 2 años del 23%. Disminución de la grasa del 22.4%. Aumento de agua corporal del 36.1%. Pérdida del exceso de peso significativa p = 0.001. A los 2 años, remisión de esteatosis grave y de diabetes, el perfil lipídico mejoró, la hipertensión arterial persistió solo en uno. DISCUSIÓN: Lo más destacado es la mejoría o curación de la comorbilidad, con curación de la diabetes, la hipertensión y la dislipidemia, que dará mejor pronóstico a estos niños. CONCLUSIONES: La manga gástrica es útil en adolescentes con obesidad mórbida, con mejoría de la comorbilidad grave. Se requiere un mayor seguimiento.

Adaptation to a dynamic visual perspective in laparoscopy through training in the cutting task.

BACKGROUND: Laparoscopic surgery demands of surgeons special skills acquired only through practice. Laparoscopic training systems traditionally have an optical system that, once positioned, remains fixed and cannot refresh the perspective unless the task is interrupted and the camera repositioned. During a surgery, the visual perspective changes constantly to relocate the surgical target. This difference is a limitation for any novice surgeon. This report proposes the use of a mechatronic system that allows the trainee to handle optics dynamically during training in the cutting task and thereby adapt to dynamic relocation of the surgical target. METHODS: The study was conducted in two phases. The first phase involved using fixed optics to cut a circle drawn on a piece of cloth. The second phase involved the same cutting task but with the visual perspective changed dynamically by the user via a mechatronic assistant. RESULTS: The data show that by adapting to dynamic optics, medical trainees can quickly and easily handle and locate the task with real-time changes in visual perspective and can also improve task quality. A significant statistical difference was found between the two methods performed (p < 0.0025). Variance analysis also was applied to the mean values of the scores achieved by both groups (p < 0.0001). CONCLUSIONS: A new laparoscopic training method has been developed. It applies real-time dynamic optics that trainees assist by means of a mechatronic device harnessed to their body. This new training tool allows resident trainees to adapt quickly to the work environment of dynamic optics and thus enter the surgical scenario more rapidly and confidently after mastering the visual-spatial aspect of the laparoscopic approach.

Laparoscopic Nissen solo surgery using PMAT (first experience).

This article describes the use of a Postural Mechatronic Assistant Trainer (PMAT) in pediatric Nissen surgery. This mechatronic system enables users to establish the logistical considerations for solo surgery and determine the advantages this new tool offers for the autonomous handling of optics.

Tonatiuh II: assisting manipulator for laparoscopic surgery.

In this article we show the design of the Tonatiuh II robotic manipulator. This robotic assistant has an original electromechanical configuration and respects the laparoscope center of insertion as an invariant point for navigation in the work space. The manipulator went through several stages before reaching its final version. Surgical trials have shown the robot to be useful in the operating room and as a training assistant in specialty microsurgery.