Cancer risk-reducing surgery: Brazilian society of surgical oncology guideline part 1 (gynecology and breast).

BACKGROUND: Risk-reducing operations are an important part of the management of hereditary predisposition to cancer. In selected cases, they can considerably reduce the morbidity and mortality associated with cancer in this population. OBJECTIVES: The Brazilian Society of Surgical Oncology (BSSO) developed this guideline to establish national benchmarks for cancer risk-reducing operations. METHODS: The guideline was prepared from May to December 2021 by a multidisciplinary team of experts to discuss the surgical management of cancer predisposition syndromes. Fourteen questions were defined and assigned to expert groups that reviewed the literature and drafted preliminary recommendations. Following a review by the coordinators and a second review by all participants, the groups made final adjustments, classified the level of evidence, and voted on the recommendations. RESULTS: For all questions including risk-reduction bilateral salpingo-oophorectomy, hysterectomy, and mastectomy, major agreement was achieved by the participants, always using accessible alternatives. CONCLUSION: This and its accompanying article represent the first guideline in cancer risk reduction surgery developed by the BSSO, and it should serve as an important reference for the management of families with cancer predisposition.

Single-incision videolaparoscopic appendectomy with conventional videolaparoscopy equipment.

BACKGROUND: Acute appendicitis is the most common surgical emergency in daily practice, and is approached laparoscopically in many centers. Efforts have been undertaken for the development of minimally invasive techniques that reduce tissue trauma and offer improved cosmetic results, one of such being the single-incision laparoscopic surgery (SILS). AIM: To present a minimally invasive technique for appendectomy (SILS) undertaken with conventional instruments. METHOD: Eleven patients were treated in the emergency care center presenting abdominal pain in the right iliac fossa that was suggestive of appendicitis. Diagnostic investigation was subsequently conducted, including physical examination, laboratory and imaging exams (CT scan with intravenous contrast or total abdominal ultrasound), and the results were consistent with acute appendicitis. Thus, after consent, these patients underwent SILS appendectomy under general anesthesia with three trocars (two 10 mm and one 5 mm), using conventional and optical laparoscopic tweezers (10 mm, 30º). The base and pedicle of the appendix were ligated with titanium LT 400 clips. The procedure occurred uneventfully. Inclusion criteria were absence of diffuse peritonitis, BMI (body mass index) less than 35 and absence of serious comorbidities or sepsis. RESULTS: Seven men and four women were operated with average age of 25.7 years and underwent appendectomy through this technique. Mean procedure duration was of 37.2 min. Regarding surgical findings, three had appendicitis in stage 1, four in stage 2 and four in stage 3. All patients improved well, without surgical complications, and did not require conversion to open surgery or conventional laparoscopy technique. CONCLUSION: Appendectomy conducted through Single Incision Laparoscopic Surgery is a feasible and promising technique that can be performed with conventional laparoscopic instruments.

Single-incision videolaparoscopic appendectomy with conventional videolaparoscopy equipment / Videoapendicectomia por incisao unica com material de videolaparoscopia convencional

Background : Acute appendicitis is the most common surgical emergency in daily practice, and is approached laparoscopically in many centers. Efforts have been undertaken for the development of minimally invasive techniques that reduce tissue trauma and offer improved cosmetic results, one of such being the single-incision laparoscopic surgery (SILS). Aim : To present a minimally invasive technique for appendectomy (SILS) undertaken with conventional instruments. Method : Eleven patients were treated in the emergency care center presenting abdominal pain in the right iliac fossa that was suggestive of appendicitis. Diagnostic investigation was subsequently conducted, including physical examination, laboratory and imaging exams (CT scan with intravenous contrast or total abdominal ultrasound), and the results were consistent with acute appendicitis. Thus, after consent, these patients underwent SILS appendectomy under general anesthesia with three trocars (two 10 mm and one 5 mm), using conventional and optical laparoscopic tweezers (10 mm, 30º). The base and pedicle of the appendix were ligated with titanium LT 400 clips. The procedure occurred uneventfully. Inclusion criteria were absence of diffuse peritonitis, BMI (body mass index) less than 35 and absence of serious comorbidities or sepsis. Results : Seven men and four women were operated with average age of 25.7 years and underwent appendectomy through this technique. Mean procedure duration was of 37.2 min. Regarding surgical findings, three had appendicitis in stage 1, four in stage 2 and four in stage 3. All patients improved well, without surgical complications, and did not require conversion to open surgery or conventional laparoscopy technique. Conclusion : Appendectomy conducted through Single Incision Laparoscopic Surgery is a feasible and promising technique that can be performed with conventional laparoscopic instruments. .

Racional : Apendicite aguda é a emergência cirúrgica mais comum na prática diária, sendo em muitos centros, abordada por laparoscopia. Esforços têm sido voltados para o desenvolvimento de técnicas minimamente invasivas, reduzindo o trauma tecidual e melhorando os resultados cosméticos, dentre essas, a "single incision laparoscopic surgery" (SILS). Objetivo : Apresentar técnica minimamente invasiva para apendicectomia com incisão única e com instrumentos convencionais. Método : Onze pacientes foram atendidos em serviço de emergência devido à dor abdominal em fossa ilíaca direita sugestiva de apendicite. Procedeu-se a investigação diagnóstica, incluindo exames físico, laboratoriais e de imagem (tomografia computadorizada com contraste venoso ou ecografia de abdome total), cujos resultados foram compatíveis com apendicite aguda. Assim, após consentimento, esses pacientes foram submetidos à apendicectomia por SILS, sob anestesia geral, com dois trocárteres de 10 mm e um de 5 mm, com uso de pinças laparoscópicas convencionais e ótica de 10 mm e 30 º. A base e o pedículo do apêndice foram ligados com clipes de titânio LT 400, sem intercorrências. Critérios de inclusão foram pacientes com apendicite aguda mas sem peritonite generalizada com índice de massa corpórea menor que 35 e ausência de comorbidades graves e ou sepse. Resultados : Foram operados sete homens e quatro mulheres com idade média de 25,7 anos com esta técnica. A duração média do procedimento foi de 37,2 min. Em relação aos achados cirúrgicos, três pacientes apresentavam apendicite em fase 1, quatro em fase 2 e quatro em fase 3. Todos evoluíram bem, sem complicações cirúrgicas e não houve necessidade de conversão ...