Diverticulotomía endoscópica utilizando Ligasure™ / Endoscopic diverticulotomy using Ligasure™

INTRODUCCIÓN: El tratamiento endoscópico del divertículo de Zenker es considerado viable, efectivo y seguro. La utilización de la técnica sellado-sección mediante Ligasure™ proporciona una adecuada y rápida disección del tejido, logrando una hemostasia efectiva. PACIENTES Y MÉTODOS: Estudio retrospectivo, descriptivo, de todos los pacientes con divertículo de Zenker que fueron tratados a través de una diverticulotomía endoscópica utilizando el Ligasure ™. El procedimiento se realizó en la unidad de endoscopias, bajo sedación profunda controlada por el endoscopista. Posteriormente, los pacientes ingresaron para observación y, después del alta, se realizó un seguimiento por consultas externas. RESULTADOS: Ocho pacientes, 5 mujeres y 3 hombres, edad media: 78 ±15 años; 25% ASA I; 36% ASA II; 14% ASA III, y 25% ASA IV. Síntoma principal: disfagia. Tamaño de los divertículos: 1 a 7 cm. Éxito técnico: 100%. Complicaciones: un paciente con HDA. Estancia media: 24h. Siete pacientes: asintomáticos; un paciente con mejoría parcial, necesitando reintervención endoscópica. Cirugía y morbimortalidad: 0%. CONCLUSIÓN: El tratamiento del divertículo de Zenker mediante diverticulotomía endoscópica con Ligasure™ proporciona una gran eficacia, rapidez y seguridad, por lo que podría plantearse como primera elección de tratamiento

INTRODUCTION: Endoscopic treatment of Zenker diverticulum is considered feasible, effective and safe. The use of the Ligasure ™ vessel sealer provides adequate and quick dissection of tissue, achieving effective haemostasis. PATIENTS AND METHODS: Retrospective, descriptive study of all patients with Zenker diverticulum who were treated by endoscopic diverticulotomy using Ligasure™. The procedure was performed in the endoscopy unit under deep sedation controlled by the endoscopist. Patients were subsequently admitted for observation and, after discharge, were followed-up in the outpatient clinic. RESULTS: Eight patients, 5 women and 3 men, mean age 78 ±15 years, 25% ASA I, 36% ASA II, 14% ASA III and 25% ASA IV. Main symptom: dysphagia. Diverticula size: 1-7 cm. Technical success: 100%. Complications: one patient with upper gastrointestinal bleeding. Average stay: 24 h. Seven patients: asymptomatic; one patient with partial improvement, requiring repeat endoscopic intervention. Surgery and morbidity and mortality: 0%. CONCLUSION: The treatment of Zenker diverticulum by endoscopic diverticulotomy using the Ligasure ™ vessel sealer is highly effective, fast and safe, and could be considered the treatment of choice

Endoscopic diverticulotomy using Ligasure™. / Diverticulotomía endoscópica utilizando Ligasure™.

INTRODUCTION: Endoscopic treatment of Zenker diverticulum is considered feasible, effective and safe. The use of the Ligasure™ vessel sealer provides adequate and quick dissection of tissue, achieving effective haemostasis. PATIENTS AND METHODS: Retrospective, descriptive study of all patients with Zenker diverticulum who were treated by endoscopic diverticulotomy using Ligasure™. The procedure was performed in the endoscopy unit under deep sedation controlled by the endoscopist. Patients were subsequently admitted for observation and, after discharge, were followed-up in the outpatient clinic. RESULTS: Eight patients, 5 women and 3 men, mean age 78±15 years, 25% ASA I, 36% ASA II, 14% ASA III and 25% ASA IV. Main symptom: dysphagia. Diverticula size: 1-7cm. Technical success: 100%. COMPLICATIONS: one patient with upper gastrointestinal bleeding. Average stay: 24h. Seven patients: asymptomatic; one patient with partial improvement, requiring repeat endoscopic intervention. Surgery and morbidity and mortality: 0%. CONCLUSION: The treatment of Zenker diverticulum by endoscopic diverticulotomy using the Ligasure™ vessel sealer is highly effective, fast and safe, and could be considered the treatment of choice.

Improved tribo-mechanical behavior of CaP-containing TiO2 layers produced on titanium by shot blasting and micro-arc oxidation.

The combination of shot blasting (SB) and micro-arc oxidation (or anodic oxidation--AO) in titanium surfaces was shown to provide enhanced conditions for cell differentiation and osseointegration than those provided by SB or AO alone. This study associated both methods aiming to attain titania layers on Ti with adequate tribo-mechanical features for bone implants. SB was performed using alumina particles, and titania layers were grown by AO using a CaP-based electrolyte. Mechanical properties and scratch resistance were characterized at nanoscale by instrumented indentation and nanoscratch, and correlated with morphological and microstructural changes (XRD, SEM, EDS, AFM, and profilometry). Analytical methods were employed to correct roughness and substrate effects on the indentation results. CaP-containing TiO2 layers were produced on AO and SB + AO. The latter presented small pore size and inhomogeneous layer thickness and Ca/P ratios, caused by the non-uniform surface straining by SB that affects the oxide growth kinetics in the electrochemical process. Elastic modulus of SB + AO layer (37 GPa) were lower than the AO one (45 GPa); both of them were smaller than bulk Ti (130 GPa) and close to bone values. The hardness profiles of AO and SB + AO were similar to the substrate ones. Because of the improved load bearing capacity and unique layer features, the critical load to remove the SB + AO titania coating in scratch tests was three times as much or higher than in AO. Results indicate improved mechanical biocompatibility and tribological strength of anodic titania layers grown on sand blasted Ti surfaces.