Implementación quirúrgica de la histerectomía vía laparoscópica en el Hospital General Santa María del Puerto (Cádiz) / Surgical implementation of laparoscopic hysterectomy at the Hospital General Santa María del Puerto (Cádiz)

OBJETIVO: aportar nuestra experiencia en la introducción e implementación de la vía de abordaje laparoscópica para la realización de procedimientos quirúrgicos de histerectomía. MATERIAL Y MÉTODOS: estudio descriptivo observacional prospectivo de las 60 primeras histerectomías laparoscópicas realizadas en el Hospital General Santa María del Puerto (Cádiz), por el mismo equipo quirúrgico, estudiando variables tales como el porcentaje de complicaciones y efectos adversos, tiempo quirúrgico, conversión a laparotomía, pérdida hemática o estancia hospitalaria, entre otras. RESULTADOS: se realizaron 50 histerectomías totales y 10 supracervicales. La indicación quirúrgica más frecuente fue la miomatosis uterina. La edad media de las pacientes fue de 51 años, con un índice de masa corporal medio de 27,74 y un porcentaje de pacientes con laparotomía previa del 31,6%. El porcentaje de complicaciones fue del 5%, registrándose una lesión intestinal, una lesión vesical y una fístula vesicovaginal. El porcentaje de conversión a laparotomía fue del 3,3%. El tiempo quirúrgico medio de los procedimientos fue de 115 minutos. Por último, la estancia hospitalaria media fue de 2,55 días, con una pérdida hemática media de 0,7 gr/dl de hemoglobina. CONCLUSIONES: nuestros resultados confirman que la vía de abordaje laparoscópica es un método seguro y reproducible (con una correcta curva de aprendizaje), para la realización de histerectomías en ginecología, aportando importantes ventajas respecto al abordaje laparotómico clásico

OBJECTIVE: Contribute with our experience in the introduction and implementation of the laparoscopic approach, for the performance of hysterectomy surgical procedures. MATERIAL AND METHODS: Prospective observational descriptive study of the first 60 laparoscopic hysterectomies performed at the Hospital General Santa María del Puerto (Cádiz), by the same surgical team. Studying variables such as the percentage of complications and adverse effects, surgical time, conversion to laparotomy, blood loss or hospital stay, among others. RESULTS: 50 total and 10 supracervical hysterectomies were performed. The most frequent surgical indication was uterine myomatosis. The mean age of the patients was 51 years, with an average body mass index of 27.74 and a percentage of patients with a previous laparotomy of 31.6%. The percentage of complications was 5%, with an intestinal lesion, a bladder lesion and a vesicovaginal fistula. The conversion rate to laparotomy was 3.3%. The mean surgical time of the procedures was 115 minutes. Finally, the mean hospital stay was 2.55 days, with an average blood loss of 0.7 gr/dl of hemoglobin. CONCLUSIONS: Our results confirm that the laparoscopic approach is a safe and reproducible method (with a correct learning curve), for the performance of hysterectomies in gynecology, providing important advantages over the classical laparotomic approach

Customized versus Population-Based Birth Weight References for Predicting Fetal and Neonatal Undernutrition.

OBJECTIVES: The aim of our study was to construct a model of customized birth weight curves based on a Spanish population and to compare the ability of this customized model to our population-based chart to predict a neonatal ponderal index (PI) <10th percentile. METHODS: We developed a model that can predict the 10th percentile for a fetus according to gestational age and gender as well as maternal weight, height, and age. We compared the ability of this customized model to that of our own population-based model to predict a neonatal PI <10th percentile. Data from a large database were used (32,854 live newborns, from 1993 through 2012). Only singleton pregnancies with a gestational age at delivery of 32-42 weeks were included. RESULTS: In the entire pregnant population, the customized method was superior to the population-based method for detecting newborns with a PI <10th percentile (sensitivity: 55 vs. 40.96%; specificity: 99.6 vs. 91.23%; positive predictive value: 11.49 vs. 9.55%, and negative predictive value: 98.84 vs. 98.55%, respectively). In pregnant women with a BMI >90th percentile, the sensitivity was 75%, compared to 50% in the population-based method. In pregnant women with a height >90th percentile, the sensitivity was almost as high as in the population-based method (61.53 vs. 33.33%). CONCLUSION: The customized birth weight curve is superior to the population-based method for the detection of newborns with a PI <10th percentile. This is especially the case in women in the higher scales of height and weight as well as in preterm babies.