Implementation and Validation of a Novel and Inexpensive Training Model for Laparoscopic Inguinal Hernia Repair.

Purpose: The aim of this study was to develop and validate a reproducible low-cost model useful for the development and acquisition of skills and competencies required for endoscopic hernia repairs. Methods: Ten general surgery residents (PGY3) were instructed to construct the model and perform the maneuvers necessary for the simulation of laparoscopic inguinal hernioplasty by the trans-abdominal pre-peritoneal (TAPP) technique. They practiced for 4 weeks in the model, and the time required to perform simulated hernioplasty by the laparoscopic TAPP technique in the initial session was compared to the time required after 4 weeks of training. Results: The time required to perform the exercise was significantly lower than in the initial session (p < 0.01). The time required by residents to complete the exercise in the initial session was significantly longer than that used by expert surgeons in the same task (p < 0.01), and although a significant difference persisted, this difference was substantially reduced to 3.60 min after the residents completed 4-week training in the model (p < 0.01). An independent expert, blinded to the level of training of the person who performed the exercise, could recognize all residents as novices and all experienced surgeons as experts in the initial session of the exercise with the model, but after 4 weeks of training, they did not recognize 4 of the 10 residents as novices (p < 0.05). Conclusion: The routine implementation of training in this model could be very useful in the laparoscopic inguinal hernioplasty teaching-learning process.

Whole-body electrical stimulation as a strategy to improve functional capacity and preserver lean mass after bariatric surgery: a randomized triple-blind controlled trial.

BACKGROUND/OBJECTIVES: Bariatric surgery (BS) is a successful, long-lasting treatment option for obese. The early postoperative (PO) period is followed by dietary restriction and physical inactivity, leading to declines in muscle mass and functional capacity. Whole-body electromyostimulation (WB-EMS) may be a feasible and potential early rehabilitation strategy post BS. The aim was to evaluate the effects of WB-EMS with exercise training (Fe) on functional capacity, body composition, blood biomarkers, muscle strength, and endurance post BS. SUBJECTS/METHODS: This is a randomized, triple-blind, sham-controlled trial. Thirty-five volunteers underwent a Roux-en-Y gastric bypass and were randomized into a WB-EMS (WB-EMSG) or control group (ShamG). Preoperative evaluations consisted of maximal and submaximal exercise testing, body composition, blood biomarkers, quadriceps strength, and endurance. After discharge, functional capacity and body composition were obtained. Exercise training protocols in both groups consisted of 14 dynamic exercises, 5 days per week, completing 30 sessions. The WB-EMSG also underwent an electrical stimulation protocol (Endurance: 85 Hz, 350 ms, 6 s of strain, 4 f of rest; Strength: 30 Hz, 350 ms, 4 s of strain, 10 seconds of rest, with bipolar electrical pulse). After intervention, subjects were reevaluated. RESULTS: The protocol started on average 6.7 ± 3.7 days after discharge. Both groups presented with a decline in functional capacity after BS (p < 0.05) and a reduction in all body composition measurements (p < 0.05). The exercise training program led to significant improvements in functional capacity (ShamG - PO: 453.8 ± 66.1 m, Post: 519.2 ± 62.8 m; WB-EMSG- PO: 435.9 ± 74.5, Post: 562.5 ± 66.4 m, p < 0.05), however, only the WB-EMSG demonstrated significant changes of distance walked (interaction time vs group effect, p < 0.05). In addition, adiponectin significantly increased only in the WB-EMSG (p < 0.05). The WB-EMSG was also able to preserve muscle strength, endurance, and fatigue index, while the ShamG demonstrated significant decline (p < 0.05). CONCLUSION: WB-EMS + Fe can be an attractive and feasible method following BS to enhance functional capacity and prevent deterioration of muscle function in the early PO. CLINICAL TRIAL REGISTRATION: ReBEC, RBR-99qw5h, on 20 February 2015.

La vagina como sitio de extracción y puerto laparoscópico en NOSE y NOTES / The vagina as an extraction site and laparoscopic port in NOSE and NOTES

El objetivo del presente estudio es evaluar nuestra experiencia inicial utilizando la vagina para el retiro de especímenes quirúrgicos o como puerto laparoscópico en intervenciones de cirugía a través de orificios naturales (NOTES). Métodos: Analizamos retrospectivamente los datos de pacientes femeninos, intervenidos en el Instituto Medico La Floresta, Caracas, Venezuela, desde Junio de 2009 a junio de 2015. Dichos pacientes fueron sometidas a intervenciones involucrando resecciones laparoscópicas de órganos sólidos como pancreatectomías distales, esplenectomías y miomectomías uterinas, utilizando la vagina como sitio de extracción. También incluimos pacientes sometidas a apendicectomía transvaginal híbrida NOTES y a colecistectomía transvaginal híbrida. Reportamos el procedimiento técnico, las complicaciones relacionadas con el acceso transvaginal y el seguimiento clínico. Resultados: Cuatro pacientes fueron sometidas a pancreatectomía distal con esplenectomía, siete a esplenectomía laparoscópica, cuatro casos fueron resecciones de masas anexiales y seis miomectomías uterinas. Tres pacientes fueron intervenidas para apendicectomía laparoscópica hibrida transvaginal y cuatro a colecistectomía hibrida trans-vaginal. En todos los casos el espécimen quirúrgico fue retirado a través de la vagina. Todas las pacientes reportaron manchado vaginal mínimo por un máximo de 14 días (media de 8), sangramiento escaso durante el coito por un máximo de 54 días (media de 32) y ninguna paciente reportó dispareunia u otras molestias relacionadas con el acceso vaginal a los seis meses. Conclusiones: El uso de la vagina como sitio de extracción para especímenes quirúrgicos es posible y seguro, incluso en casos de órganos sólidos o especímenes contaminado(AU)

The objective of this study is to evaluate our initial experience, using the vagina, for the removal of surgical specimens, or as a laparoscopic port in surgical interventions through natural orifices "NOTES" or (natural orifice translumenal endoscopic surgery). Methods: We retrospectively analyzed data from female patients operated at the La Floresta Medical Institute in Caracas, Venezuela, from June 2009 to June 2015, who underwent interventions involving laparoscopic resections of solid organs, such as distal pancreatectomies, splenectomies, and uterine myomectomies. Using the vagina as an extraction site. We also included patients undergoing hybrid NOTES trans-vaginal appendectomy and hybrid trans-vaginal cholecystectomy. We report the technical procedure, complications related to trans-vaginal access and clinical follow-up. Results: Four patients underwent distal pancreatectomy with splenectomy, seven underwent laparoscopic splenectomy, four cases were resections of adnexal masses and six were uterine myomectomies. Three patients underwent surgery for trans-vaginal hybrid laparoscopic appendectomy and four for trans-vaginal hybrid cholecystectomy. In all cases, the surgical specimen was removed through the vagina. All patients reported minimal vaginal blood spotting for a maximum of 14 days (average of 8), scarce bleeding during intercourse for a maximum of 54 days (average of 32), and no patient reported dyspareunia or other discomfort related to vaginal access after six months. Conclusions: The use of the vagina as an extraction site for surgical specimens is possible and safe, even in cases of solid organs or contaminated specimens(AU)

3D Volumetry and its Correlation Between Postoperative Gastric Volume and Excess Weight Loss After Sleeve Gastrectomy.

BACKGROUND: The volume of the postoperative gastric remnant is a key factor in excess weight loss (EWL) after sleeve gastrectomy (SG). Traditional methods to estimate gastric volume (GV) after bariatric procedures are often inaccurate; usually conventional biplanar contrast studies are used. METHODS: Thirty patients who underwent SG were followed prospectively and evaluated at 6 months after the surgical procedure, performing 3D CT reconstruction and gastric volumetry, to establish its relationship with EWL. The gastric remnant was distended with effervescent sodium bicarbonate given orally. Helical CT images were acquired and reconstructed; GV was estimated with the software of the CT device. The relationship between GV and EWL was analyzed. RESULTS: The study allowed estimating the GV in all patients. A dispersion diagram showed an inverse relationship between GV and %EWL. 55.5% of patients with GV ≤ 100 ml had %EWL 25-75% and 38.8% had an %EWL above 75% and patients with GV ≥ 100 ml had an %EWL under 25% (50% of patients) or between 25 and 75% (50% of this group). The Pearson's correlation coefficient was R = 6.62, with bilateral significance (p ≤ .01). The Chi-square result correlating GV and EWL showed a significance of .005 (p ≤ .01). The 3D reconstructions showed accurately the shape and anatomic details of the gastric remnant. CONCLUSIONS: 3D volumetry CT scans accurately estimate GV after SG. A significant relationship between GV and EWL 6 months after SG was established, seeming that GV ≥ 100 ml at 6 months of SG is associated with poor EWL.

Arte y anatomía de la sonrisa / The art and anatomy of the smile

En el presente artículo se abordan los distintos tipos de sonrisa existentes, en función a sus características anatómicas y su relación con la patología. Así mismo, se establece un paralelismo entre la clasificación de Rubin y el mundo del Arte y la Literatura.

Residuos sólidos y semisólidos peligrosos: caracterización, transporte, tratamiento y disposición final (rellenos de seguridad)

Contenido: Evolución de la gestión de residuos especiales.- Caracterización de los residuos especiales.- Componentes de un sistema de gestión.- Planta integrada de destinación de residuos.- Aspectos administrativos y control de gestión.- Tecnología de incineración de residuos.- Aspectos de seguridad

Residuos sólidos y semisólidos peligrosos : caracterización, transporte, tratamiento y disposición final (rellenos de seguridad)

Contenido: Evolución de la gestión de residuos especiales.- Caracterización de los residuos especiales.- Componentes de un sistema de gestión.- Planta integrada de destinación de residuos.- Aspectos administrativos y control de gestión.- Tecnología de incineración de residuos.- Aspectos de seguridad

Residuos sólidos y semisólidos peligrosos : caracterización, transporte, tratamiento y disposición final (rellenos de seguridad)

Contenido: Evolución de la gestión de residuos especiales.- Caracterización de los residuos especiales.- Componentes de un sistema de gestión.- Planta integrada de destinación de residuos.- Aspectos administrativos y control de gestión.- Tecnología de incineración de residuos.- Aspectos de seguridad

Autotrasplante microquirúrgico de tejidos. Experiencia de 10 años en el Servicio de Cirugía Plástica, del Hospital General de México / Microsurgical autotransplant of tissues. A 10 years experiencie in the Plastic Surgery Service of the Hospital General de Mexico

La microcirugía vascular representa uno de los avances más importantes de la cirugía plástica. Los trasplantes de tejidos autólogos revascularizados con técnicas microquirúrgicas forman parte del trabajo de los cirujanos plásticos. Se presentan 40 casos de trasplante de diversos tejidos autólogos registrados en el Servicio de Cirugía Plástica, del Hospital General de México, durante los 10 últimos años. Se incluyen colgajos libre de epiplón, musculares, cutáneos, óseos y microcutáneos, así como, reconstrucciones de pulgares con ortejos y reconstrucciones de esófago con yeyuno. El porcentaje global de supervivencia de los trasplantes fue de 92.5 por ciento; el promedio en tiempo quirúrgico fue de 10 horas y el tiempo de estancia hospitalaria en la mayoría fue de 20 días. Se desarrolló un criterio de evaluación final de resultados que no depende exclusivamente de la sobrevida del tejido trasplantado, sino de la calificación clínica de otros parámetros como el porcentaje de viabilidad del trasplante, la calidad de la cicatriz circundante, la función que se logró y el aspecto estético. Con esto se concluyó que hubo 70 por ciento de pacientes con resultado excelente, 15 por ciento con resultado bueno, 2.5 por ciento con resultado regular y 12.5 por ciento con mal resultado. Conseguir 85 por ciento de resultados entre buenos y excelentes demuestra las bondades del procedimiento

Avulsión total de piel cabelluda. Peculiaridades etiológicas en México y presentación de un caso / Totally avulsed scalp. Etiological pecularities in Mexico and case report

En este artículo se presenta un caso extremo de avulsión total de piel cabelluda y los distintos procedimientos quirúrgicos que se utilizaron para su reconstrucción. Igualmente se aborda la problemática particular de dichos casos en México, donde la utilización generalizada de molinos de nixtamal para el molido de maíz provoca gran número de casos