Reparación de válvula mitral y cierre de comunicación interauricular, asistida por robot: experiencia inicial / Robotic mitral valve repair and closure of atrial septal defect: report of 13 procedures

Background Robot-assisted minimally invasive heart surgery is an effective alternative when compared with classical approaches. It has a low mortality and postoperative complications and its long-term durability is comparable with conventional techniques. Aim: To report short- and long-term results with the use of a robot-assisted transthoracic approach. Patients and Methods: Review of patients undergoing heart surgery between 2015 and 2019 using a robot assisted minimally invasive technique in a single center. We analyzed demographic characteristics, surgical and early ultrasound results. Results: Thirteen procedures were reviewed, nine mitral valve repairs (MVR) in patients aged 61 ± 21 years (seven males) and four atrial septal defect (ASD) closures in patients aged from 24 to 52 years (three men). For MVR, the average extracorporeal circulation and myocardial ischemia times were 120 ± 20.9 and 89 ± 21 minutes, respectively. The median hospitalization was four days. Two cases of MVR had postoperative complications. There was no mortality. All cases showed improvement in their symptoms. Ultrasound findings showed no postoperative mitral insufficiency except in one case. Conclusions: We report very good results in both complex mitral repair and CIA closure, comparable to centers with high standards in minimally invasive robot-assisted heart surgery.

[Robotic mitral valve repair and closure of atrial septal defect. Report of 13 procedures]. / Reparación de válvula mitral y cierre de comunicación interauricular, asistida por robot: experiencia inicial.

Background Robot-assisted minimally invasive heart surgery is an effective alternative when compared with classical approaches. It has a low mortality and postoperative complications and its long-term durability is comparable with conventional techniques. AIM: To report short- and long-term results with the use of a robot-assisted transthoracic approach. PATIENTS AND METHODS: Review of patients undergoing heart surgery between 2015 and 2019 using a robot assisted minimally invasive technique in a single center. We analyzed demographic characteristics, surgical and early ultrasound results. RESULTS: Thirteen procedures were reviewed, nine mitral valve repairs (MVR) in patients aged 61 ± 21 years (seven males) and four atrial septal defect (ASD) closures in patients aged from 24 to 52 years (three men). For MVR, the average extracorporeal circulation and myocardial ischemia times were 120 ± 20.9 and 89 ± 21 minutes, respectively. The median hospitalization was four days. Two cases of MVR had postoperative complications. There was no mortality. All cases showed improvement in their symptoms. Ultrasound findings showed no postoperative mitral insufficiency except in one case. CONCLUSIONS: We report very good results in both complex mitral repair and CIA closure, comparable to centers with high standards in minimally invasive robot-assisted heart surgery.

Curación asistida por presión negativa comparada con curación convencional en el tratamiento del pie diabético amputado. Ensayo clínico aleatorio / Negative-pressure wound therapy versus standard wound dressing in the treatment of diabetic foot amputation. A randomised controlled trial

Introducción Las heridas del pie diabético secundarias a amputación son complejas y de difícil tratamiento. Actualmente, la curación asistida por presión negativa (CAPNE) es ampliamente utilizada para el tratamiento de diversos tipos de heridas. Sin embargo, en la literatura médica hay escasas pruebas científicas sólidas sobre la aplicación de este tipo de curación en heridas del pie diabético amputado. El objetivo de este estudio es comparar la efectividad de la CAPNE con la de la curación convencional en heridas del pie diabético secundarias a amputación. Pacientes y método Ensayo clínico aleatorio. Sujetos mayores de 18 años, diabéticos de tipo II, con herida por amputación del pie, asignados a curación con CAPNE (grupo A) o a curación convencional (grupo B). La variable respuesta fue el tiempo en alcanzar el 90% de granulación. Se estimó un tamaño de muestra de 11 pacientes por grupo. La CAPNE se preparó con una espuma de éster de poliuretano, sonda Nelaton n.o 16, apósito transparente adhesivo y aspiración central a 100mmHg. La herida se curó cada 48 a 72h y se evaluó semanalmente. Se utilizó estadística descriptiva y analítica. Resultados Veinticuatro sujetos con un promedio de edad de 61,8 ± 9,0 años (79% varones), 12 sujetos en cada grupo. El tiempo promedio para alcanzar el 90% de granulación fue significativamente menor en el grupo A (18,8 ± 6 días frente a 32,3 ± 14 días), p=0,007. Conclusión La CAPNE reduce en un 40% el tiempo de granulación de la herida en el pie diabético amputado comparado con el de la curación convencional

Introduction Foot amputation wounds in patients with diabetes are complex and treatment is often difficult. At the moment negative pressure wound therapy (NPWT) is widely used for the treatment of several types of wounds. Nevertheless, the clinical evidence to support the application of this dressing in foot amputation wounds in patients with diabetes is scarce. The aim of this study was to evaluate the efficacy of NPWT compared with standard wound dressing to treat diabetic foot amputation wounds. Patients and method Randomised controlled trial. Diabetic patients aged 18 years or older with a foot amputation wound were assigned to treatment with NPWT (A group) or standard wound dressing (B group). Primary efficacy end point was time in reaching 90% of wound granulation. A size of sample of 11 patients per group was used. NPWT was prepared with a polyurethane ether foam dressing, a Nelaton catheter, a transparent adhesive drape and continuous negative pressure of 100mmHg. The wound was treated every 48–72h and evaluated weekly. Descriptive and analytical statistics were used. Results There were 24 patients, with a mean age of 61.8±9 years (79% men), 12 in each group. The average time to reach 90% of granulation was lower in A group (18.8±6 days versus 32.3±13.7 days), a statistically significant difference (P=0.007). Conclusion NPWT reduces the granulation time of diabetic foot amputation wounds by 40%, compared with the standard wound dressing (AU)

[Negative-pressure wound therapy versus standard wound dressing in the treatment of diabetic foot amputation. A randomised controlled trial]. / Curación asistida por presión negativa comparada con curación convencional en el tratamiento del pie diabético amputado. Ensayo clínico aleatorio.

INTRODUCTION: Foot amputation wounds in patients with diabetes are complex and treatment is often difficult. At the moment negative pressure wound therapy (NPWT) is widely used for the treatment of several types of wounds. Nevertheless, the clinical evidence to support the application of this dressing in foot amputation wounds in patients with diabetes is scarce. The aim of this study was to evaluate the efficacy of NPWT compared with standard wound dressing to treat diabetic foot amputation wounds. PATIENTS AND METHOD: Randomised controlled trial. Diabetic patients aged 18 years or older with a foot amputation wound were assigned to treatment with NPWT (A group) or standard wound dressing (B group). Primary efficacy end point was time in reaching 90% of wound granulation. A size of sample of 11 patients per group was used. NPWT was prepared with a polyurethane ether foam dressing, a Nelaton catheter, a transparent adhesive drape and continuous negative pressure of 100 mmHg. The wound was treated every 48-72 h and evaluated weekly. Descriptive and analytical statistics were used. RESULTS: There were 24 patients, with a mean age of 61.8 +/- 9 years (79% men), 12 in each group. The average time to reach 90% of granulation was lower in A group (18.8 +/- 6 days versus 32.3 +/- 13.7 days), a statistically significant difference (P = 0.007). CONCLUSION: NPWT reduces the granulation time of diabetic foot amputation wounds by 40%, compared with the standard wound dressing.

Nefrectomía radical laparoscópica en el tratamiento de tumores renales estadío T2 / Laparoscopic radical nephrectomy for the treatment of T2 renal tumors

La nefrectomía radical laparoscópica (NRL) es en la actualidad la vía de abordaje de elección para tumores renales en estadío T1 (<7 cms). Tumores en estadío T2 se presentan como un desafío para esta técnica debido al tamaño tumoral y a la posibilidad de mayores complicaciones intra operatorias. Presentamos nuestra experiencia en NRL en pacientes con tumores renales en estadío T2 (> 7cms). Material y métodos: Análisis prospectivo de 121 pacientes sometidos a NRL por cáncer renal entre julio de 2001 y agosto de 2006. De ellos 40 pacientes se encontraban con tumores renales iguales o mayores de 7 cms (T2). Correspondieron a 32 hombres y 8 mujeres, cuya edad promedio fue 61,6años. El tamaño tumoral promedio al TAC de abdomen fue de 8,84 cms (r: 7-14 cms). Fueron sometidos a NRL transperitoneal pura 36 (90 por ciento) pacientes y mano asistida 4 (10 por ciento).Resultados: Tiempo operatorio promedio: 150,9 minutos (r: 90-300), Sangrado promedio: 283 cc. (r:20-2000). Hubo 3 (7,5 por ciento) complicaciones intra operatorias y 2 (5 por ciento) conversiones. Hubo 3 (7,5 por ciento) complicaciones post operatorias menores y 2 (5 por ciento) mayores. El promedio de hospitalización fue de4,7 días. El análisis anatomopatológico informa estadío pT2 en 24 (60 por ciento) pacientes, pT1 en 5 (12,5 por ciento),pT3a en 7 (17,5por ciento ), pT3b en 3 (7,5por ciento ) y 1 (2,5 por ciento) paciente sin cáncer (Pielonefritis xantogranulomatosafocal). El seguimiento promedio es de 16,1 meses (r: 1-42). En este lapso 2 (5por ciento) pacientes presentaron recidivas locales, uno a los 8 meses post operatorio y otro al mes, este último fallece 8 meses después de la cirugía. Conclusiones: La NRL en tumores renales estadío T2 ha demostrado resultados comparables conlas realizadas en estadío T1, si bien es técnicamente más difícil, se presenta como primera opción en centros con experiencia en cirugía laparoscópica. Si bien esta es la serie más extensa en publicarse en nuestro país,...

Laparoscopic radical nephrectomy (LRP) is currently the preferred approach for T1 renal tumors. Tumors larger than 7 cm are challenging due to their increased size and elevated relation with introoperative complications. Material and methods: A total of 121 patients underwent LRN between July 2001 and August 2006. Out of these, 40 patients presented with T2 tumors (equal or larger than 7 cm). Male to female ratio was 4:1. Mean age was 61.6 years. All but 4 patients (10 percent) underwent transperitoneal LRP.Results: Mean operative time was 150.9 minutes (range 90 to 300), operative bleeding was 283 ml (range 20 to 2000). There were 3 intraoperative complications (7.5 percent) and 2 conversions to open surgery (5 percent). There were 3 (7.5 percent) minor and 2 (5percent) mayor postoperative complications. Mean hospital stay was 4.7 days. Pathological analysis revealed pT1, pT2, pT3a and pT3b in 5 (12.5 percent), 24(60 percent), 7 (17,5 percent) and 3 (7,5 percent) respectively, in 1 (2,5percent) patient there was no tumor in the surgical specimen. Mean follow up was 16.1 months (range 1 to 42). Two patients (5 percent) showed local recurrence, at 1and 8 months respectively. Conclusions: LRP in T2 tumors is technically more difficult, however in experienced hands it can be offered as a first choice. Results are comparable with T1 stage tumors. This is the larges series Publisher in our country, however longer follow-up is mandatory before definite conclusions can be drawn.

Sling sub-uretral de fascia autóloga como tratamiento de la incontinencia urinaria por falla esfinteriana: experiencia del Instituto de Rehabilitación Infantil Teletón de Santiago / Suburethral autologous fascia swing for the management of urinary incontinence secondary to sphincter deficience

Se presenta nuestra serie clínica constituida por 14 pacientes de sexo masculino, portadores de Incontinencia Urinaria (IU) debido a vejiga neurogénica con falla esfinteriana, quienes luego de fracaso de tratamiento médico, fueron sometidos a tratamiento quirúrgico para mejorar su continencia, entre los años 1998 y 2006. La cirugía realizada consistió en elevar el cuello vesical con una cinta (Sling) de Fascia de músculo Recto Anterior, pasada por debajo del Cuello Vesical o Uretra Prostática y fijada a la aponeurosis del mismo músculo. En la mayoría de los casos, se realizó una Entero-Cistoplastía de ampliación(ECP) en el mismo acto quirúrgico. La complicación más frecuente, derivada del Sling, fue la estenosis uretral (2 casos). Se obtuvo un alto grado de satisfacción en cuanto a continencia: el 57 por ciento de los pacientes está completamente continente y el 21,5 por ciento se moja a grandes esfuerzos.

We report our experience in 14 consecutive male patients with urinary incontinence secondary to neurogenic bladder with sphincter deficiency. All patients underwent surgical management between 1998 and 2006. Surgery was indicated only after medical treatment failure. Anterior rectus fascia was used as a hammock to suspend the bladder neck by anchoring the fascia to the muscle’s aponeurosis. In most cases simultaneous augmentation cystoplasty was performed. Urethral stenosis was observed in 2 cases. Patient satisfaction was achieved in most cases with a 57 percent ofcomplete continence and 21.5 percent of minor stress incontinence.

[Endoluminal stent-graft placement for acute dissection of the descending aorta complicated with rupture. Report of one case]. / Tratamiento endoluminal de disección aguda complicada en aorta descendente. Comunicación de un caso.

Acute dissection of the aorta, although not common, has early and highly lethal complications. The type A dissection is treated with surgery. Patients with type B dissections are treated with surgery if they have complications like rupture, growth or visceral ischemia. Surgery, however, has complications such as spinal cord ischemia. Endovascular grafts have less mortality and complications. We report a 59 years old male patient with a type B dissection complicated with rupture. He was treated successfully with the placement of an endoluminal graft. He was discharged five days after the procedure in good conditions. After one year of follow up, the patient remains asymptomatic.

Tumor de células de Leydig bilateral sincrónico. ¿Es posible el tratamiento quirúrgico conservador? / Bilateral syncronic Leydig-cell tumor is a conservative treatment?

Los tumores de células de Leydig (TCL) corresponden al 1 a 3 por ciento de todos los tumores testiculares y son el tipo histológico más frecuente entre los tumores de estroma gonadal. Generalmente son unilaterales, describiéndose sólo en un 5 a 10 por ciento un desarrollo bilateral. Su frecuencia sigue una distribución bimodal, con mayor incidencia en prepúberes y entre la tercera y cuarta década de la vida. Su presentación más habitual es una masa escrotal palpable, pudiendo originar androgenización en niños o feminización en adultos.

Tratamiento endoluminal de disección aguda complicada en aorta descendente: Comunicación de un caso / Endoluminal stent-graft placement for acute dissection of the descending aorta complicated with rupture: Report of one case

Acute dissection of the aorta, although not common, has early and highly lethal complications. The type A dissection is treated with surgery. Patients with type B dissections are treated with surgery if they have complications like rupture, growth or visceral ischemia. Surgery, however, has complications such as spinal cord ischemia. Endovascular grafts have less mortality and complications. We report a 59 years old male patient with a type B dissection complicated with rupture. He was treated successfully with the placement of an endoluminal graft. He was discharged five days after the procedure in good conditions. After one year of follow up, the patient remains asymptomatic.