Comparación de dos técnicas de sección vascular en lavaricocelectomía laparoscópica. Estudio prospectivo / Comparing two vascular division techniques in laparoscopic varicocelectomy. A prospective study

Introducción: El varicocele es la dilatación anormal del plexopampiniforme. Puede afectar al 15-20% de los varones preadolescentes-adultos. La importancia de su diagnóstico radica en que puede inducirhipotrofia testicular y problemas de fertilidad en la etapa adulta. El objetivo de este estudio es evaluar si existe mayor índice de complicaciones,incluyendo la recurrencia del varicocele, dependiendo de la técnica deoclusión vascular utilizada: clip y sección o sellador vascular, en latécnica de Palomo laparoscópico en nuestro centro.Material y métodos: Estudio longitudinal prospectivo que se realizade 2017 a 2021. Se crean dos grupos terapéuticos según el método deoclusión vascular utilizada durante la varicocelectomía laparoscópica:clip y sección o sellador vascular. Los pacientes son incluidos en ungrupo mediante asignación sistemática consecutiva alternante. Se realizael análisis de las variables: edad, grado de varicocele según la clasifica-ción de Dubin-Amelar, complicaciones postquirúrgicas, seguimiento yrecurrencia del varicocele, según el método empleado.Resultados: Se intervinieron un total de 37 niños, con edad mediade 12 años (10-15 años) y una media de seguimiento de 12 meses. En20 pacientes (54,1%), se utilizó clip y sección, y en los 17 restantes(45,9%), sellador vascular. El 24,3% presentaba varicocele Grado IIsintomático y el 75,7%, Grado III. El 32,4% de los niños presentó algunacomplicación postquirúrgica durante el seguimiento. El 29,7% de lospacientes presentó hidrocele tras la intervención, perteneciendo 8 niñosal grupo de sellado y 3 niños al de clipaje. El 13,5% de estos precisóreintervención por este motivo. Ningún paciente presentó recurrenciadel varicocele. Conclusiones: La técnica de Palomo laparoscópica es una técnicasegura y efectiva que presenta buenos resultados en pacientes pediátricos...(AU)

Introduction: Varicocele is the abnormal dilatation of the pampiniform plexus. It occurs in 15-20% of pre-adolescent/adult males.Varicocele diagnosis is important since it can induce testicular hyper-trophy and fertility issues in adulthood. The objective of this studywas to assess whether complications, including varicocele recurrence,depend on the vascular occlusion technique used –clipping + divisionvs. vascular sealer–in the laparoscopic Palomo technique used inour institution. Materials and methods: A longitudinal, prospective study wascarried out from 2017 to 2021. Two therapeutic groups were createdaccording to the vascular occlusion method used during laparoscopicvaricocelectomy –clipping + division vs. vascular sealer. Patients wererandomly allocated to the groups in a systematic alternating consecutivemanner. Variables –age, varicocele grade according to the Dubin-Amelarclassification, postoperative complications, follow-up, and varicocelerecurrence– were analyzed according to the method employed.Results: A total of 37 boys, with a mean age of 12 years (10-15years) and a mean follow-up of 12 months, were studied. In 20 patients (54.1%), clipping + division was used, and in the remaining 17(45.9%), the vascular sealer was employed. 24.3% had symptomaticGrade II varicocele and 75.7% had Grade III varicocele. 32.4% of thechildren had postoperative complications during follow-up. 29.7% ofthe patients had hydrocele following surgery –8 boys from the seal-ing group and 3 boys from the clipping group–, with 13.5% requiringre-intervention as a result of this. None of the patients had varicocelerecurrence. Conclusions: The laparoscopic Palomo technique is safe and ef-fective, with good results in pediatric patients and few postoperativecomplications, regardless of the vascular occlusion device used...(AU)

Osteotomía de descarga ambulatoria mínimamente invasiva en el tratamiento de la úlcera de pie diabético: análisis de 25 pacientes / Minimally invasive offloading osteotomy in the treatment of diabetic foot ulcer: Analysis of 25 patients

Introducción: La diabetes mellitus y sus complicaciones suponen uno de los mayores problemas sanitarios en la actualidad. La úlcera del pie diabético es una de las complicaciones más características. Material, métodos y objetivo: El objetivo es describir los resultados y complicaciones obtenidos en una serie de 25 casos de úlcera neuropática tratada mediante osteotomías de descarga mínimamente invasivas y ambulatorias. Resultados: Del total de intervenciones, 18 fueron sobre úlceras refractarias a un tratamiento conservador previo de una duración media±desviación estándar de 29,28±18,42 meses. El período de seguimiento fue 26,46±4,89 meses. Las tasas agrupadas de respuesta al tratamiento fueron: 100% cicatrización de la úlcera (tiempo medio de cicatrización 22,41±7,01 días), 5,56% recurrencia de la úlcera, 16,67% translocación de la úlcera. En 7 casos se realizó una intervención preventiva sobre áreas con lesiones preulcerosas. Del total, únicamente 3 presentaron infección leve en la zona de la intervención. Conclusiones: La osteotomía de descarga mínimamente invasiva ambulatoria es un procedimiento técnicamente sencillo, que presenta una alta tasa de éxito con mínimas complicaciones en nuestra serie. (AU)

Introduction: Diabetes mellitus and its complications are one of the main burdensome health problems at the present time. The diabetic foot is one of the most characteristic complications. Material, methods and objective: The objective of this work is to describe the results and complications obtained in a series of 25 cases of diabetic foot treated by minimally invasive offloading osteotomies. Results: Of the total number of interventions, 18 were performed on refractory ulcers with prior conservative treatment, for a mean (±SD) duration of 29.28±18.42 months. The mean follow-up period was 26.46±4.89 months. Weighted pooled rates of response to treatment were as follows: 100% for ulcer healing (with a mean healing time of 22.41±7.01 days), 5.56% for ulcer recurrence, and 16.67% for ulcer transfer. In 7cases, a preventive intervention was performed on areas with pre-ulcerative lesions. Of the total number of cases, only 3presented mild infection in the intervention area. Conclusions: Minimally invasive offloading osteotomy is a technically simple intervention, which presents a high success rate with minimal complications in our series. (AU)

Laparoscopic approach for xanthogranulomatous pyelonephritis and pyonephrosis.

INTRODUCTION: Xanthogranulomatous pyelonephritis (XGPN) is a rare form of chronic renal inflammation, caused by long-term obstruction of the urinary tract. Pyonephrosis is a severe suppurative complication of acute obstructive pyelonephritis. Although minimally invasive approaches have many advantages, the safe dissection of the kidney may not be always achievable. MATERIALS AND METHODS: We reviewed 27 cases diagnosed with either XGPN or pyonephrosis, who underwent laparoscopic total nephrectomy between October 2016 and March 2022 in our department. All interventions were performed using the Karl Storz 3D laparoscopic system. The surgical approach was standard transperitoneal nephrectomy for the majority of XGPN, while pyonephrosis cases were carried out in a retroperitoneally. All procedures were performed or supervised by the same surgeon. RESULTS: The mean operative time was 269.85 minutes (range 145-360). The mean hemoglobin drop after surgery was 1.41 g/dl (range 0.3-2.3 g/dl). Difficult dissection was encountered in 13 cases (48.14%). Nine out of 13 interventions were carried out in a complete intracorporeal fashion, while conversion to open surgery was needed in 4 cases. Vascular complications involving the major blood vessels comprised of one case of inferior vena cava (IVC) tear. Digestive tract-related complications comprised two fistulas of the descending colon and one peritoneal breach. Multiorgan resection was performed in 6 cases. CONCLUSION: Total nephrectomy in cases of XGPN and pyonephrosis is a challenging procedure. The laparoscopic approach is feasible, as most complications are resolved intracorporeally. However, it may remain reserved for large-volume centers with experienced surgeons.

Hidden blood loss in minimally invasive surgery for osteoporotic vertebral fractures. / [Artículo traducido] Sangrado oculto intraoperatorio en cirugía mínimamente invasiva de fracturas vertebrales osteoporóticas.

INTRODUCTION AND AIM: Minimally invasive surgery (MIS) of the spine prevents the collapse of osteoporotic vertebral fractures (OVF) with lower complication and bleeding rates than open surgery. However, the possibility of hidden blood loss (HBL) has been recently described, referring to the loss of blood diffused into tissues and lost through hemolysis. This study aimed to estimate the postoperative impact of HBL in patients undergoing MIS for OVF. MATERIALS AND METHODS: This was a retrospective study of a series of patients who had MIS for OVF. A descriptive analysis of recorded variables was performed, and total blood volume, total bleeding, HBL, and hemoglobine drop were calculated. This was followed by a comparative analysis between HBL (<500ml vs. ≥500ml) and the variables of hospital stay and postoperative evolution. Binary logistic regression models were performed to rule out confounding factors. RESULTS: A total of 40 patients were included, 8 men and 32 women, with a mean age of 76.6 years. The mean HBL was 682.5ml. An HBL greater than 500ml is found to be an independent risk factor for torpid postoperative evolution (P=0.035), while it does not predict a longer hospital stay (P=0.116). In addition, a higher HBL was observed in surgeries of greater technical complexity and longer surgical time. CONCLUSIONS: Although MIS techniques have shown less intraoperative bleeding than open surgery, HBL should be diagnosed because it is associated with a torpid evolution. The use of a diagnostic and therapeutic algorithm may help minimize its impact.

[Minimally invasive offloading osteotomy in the treatment of diabetic foot ulcer: Analysis of 25 patients]. / Osteotomía de descarga ambulatoria mínimamente invasiva en el tratamiento de la úlcera de pie diabético: análisis de 25 pacientes.

INTRODUCTION: Diabetes mellitus and its complications are one of the main burdensome health problems at the present time. The diabetic foot is one of the most characteristic complications. MATERIAL, METHODS AND OBJECTIVE: The objective of this work is to describe the results and complications obtained in a series of 25 cases of diabetic foot treated by minimally invasive offloading osteotomies. RESULTS: Of the total number of interventions, 18 were performed on refractory ulcers with prior conservative treatment, for a mean (±SD) duration of 29.28±18.42 months. The mean follow-up period was 26.46±4.89 months. Weighted pooled rates of response to treatment were as follows: 100% for ulcer healing (with a mean healing time of 22.41±7.01 days), 5.56% for ulcer recurrence, and 16.67% for ulcer transfer. In 7cases, a preventive intervention was performed on areas with pre-ulcerative lesions. Of the total number of cases, only 3presented mild infection in the intervention area. CONCLUSIONS: Minimally invasive offloading osteotomy is a technically simple intervention, which presents a high success rate with minimal complications in our series.

Hidden blood loss in minimally invasive surgery for osteoporotic vertebral fractures.

INTRODUCTION AND AIM: Minimally invasive surgery (MIS) of the spine prevents the collapse of osteoporotic vertebral fractures (OVF) with lower complication and bleeding rates than open surgery. However, the possibility of hidden blood loss (HBL) has been recently described, referring to the loss of blood diffused into tissues and lost through hemolysis. This study aimed to estimate the postoperative impact of HBL in patients undergoing MIS for OVF. MATERIALS AND METHODS: This was a retrospective study of a series of patients who had MIS for OVF. A descriptive analysis of recorded variables was performed, and total blood volume (TBV), total bleeding (TB), HBL, and Hb drop were calculated. This was followed by a comparative analysis between HBL (<500mL vs. ≥500mL) and the variables of hospital stay and postoperative evolution. Binary logistic regression models were performed to rule out confounding factors. RESULTS: A total of 40 patients were included, 8 men and 32 women, with a mean age of 76.6 years. The mean HBL was 682.5mL. An HBL greater than 500mL is found to be an independent risk factor for torpid postoperative evolution (p=0.035), while it does not predict a longer hospital stay (p=0.116). In addition, a higher HBL was observed in surgeries of greater technical complexity and longer surgical time. CONCLUSIONS: Although MIS techniques have shown less intraoperative bleeding than open surgery, HBL should be diagnosed because it is associated with a torpid evolution. The use of a diagnostic and therapeutic algorithm may help minimize its impact.

Comparación de los resultados oncológicos entre cirugía radical por laparotomía versus la de mínima invasión en cáncer temprano de cérvix / Comparison of oncologic outcomes between radical laparotomy surgery versus minimally invasive surgery for early cervical cancer

Introducción: la histerectomía radical con linfadenectomía pélvica es el tratamiento estándar para las pacientes con cáncer de cérvix en estadios tempranos que no desean preservar la fertilidad. Objetivos: comparar tasas de supervivencia global, periodo libre de enfermedad y recurrencia entre histerectomía radical por mínima invasión (CMI) versus cirugía abierta. Además analizar las características histopatológicas, complicaciones intraoperatorias, posoperatorias tempranas y tardías entre ambas técnicas. Metodología: estudio observacional de cohorte retrospectivo entre 2011 y 2017. Se incluyeron mayores de 18 años con diagnóstico de carcinoma de cuello uterino en estadios IA1 (invasión del espacio linfovascular) a IB1 (FIGO 2009) con seguimiento hasta diciembre 2020. Se hizo análisis bivariado utilizando chi cuadrado, prueba exacta de Fisher o U Mann Whitney para determinar las diferencias entre las técnicas quirúrgicas frente a características sociodemográficas, clínicas, complicaciones intraoperatorias, tempranas y tardías. Se calcularon tasas de supervivencia global y densidades de recurrencia con el tiempo aportado por las pacientes. Resultados: de 113 pacientes llevadas a histerectomía radical, 75 se excluyeron del análisis. La supervivencia global fue 100% para las del grupo de laparotomía versus 97.6% en CMI. La tasa de recurrencia global fue de 8 casos y la del grupo de CMI 14.1 por 1.000 personas/año de observación. El grupo de laparotomía no presentó recaídas. Hubo diferencia significativa en la mediana de sangrado intraoperatorio (600 cc laparotomía versus 100 cc laparoscopia, p= 0.002); 11.4% requirieron transfusión intraoperatoria (25% laparotomía versus 2.4% mínima invasión, p=0,006). Conclusiones: las pacientes llevadas a cirugía por laparoscopia tuvieron una mayor proporción de recurrencia y mortalidad en comparación con el abordaje por técnica abierta.

Introduction: radical hysterectomy with pelvic lymphadenectomy is the standard treatment for early cervical cancer patients who do not wish to preserve fertility. Objetives: this study compares overall survival, disease-free survival, and recurrence rates of patients undergoing minimally invasive radical hysterectomy (MIS) versus open surgery. Likewise, the histopathological characteristics, intraoperative complications, early and late postoperative complications, are analyzed for both techniques, Methodology: an observational retrospective cohort study between 2011 and 2017. Patients over 18 years of age diagnosed with cervical carcinoma in stages IA1 (lymph vascular space invasion) and IB1 (FIGO 2009) receiving follow-up care until December 2020, were included. The Chi-square test, Fisher ́s exact test or Mann Whitney U test were used for bivariate analysis, to determine the differences between the techniques with regards to sociodemographic, clinical characteristics and intraoperative early and late complications. Overall survival rates and recurrence densities were calculated with data provided by the patients. Results: of the 113 patients undergoing radical hysterectomy, 75 were excluded from the analysis. Overall survival was 100% in the laparotomy group versus 97.6% in the MIS group. The overall recurrence rate was of 8 cases, 14.1 per 1.000 person-years of observation in the MIS group. Patients in the laparotomy group developed no recurrences. There was a significant difference in median intraoperative blood loss (600 cc in laparotomy versus 100 cc in laparoscopy, p= 0.002); 11.4% of patients required intraoperative transfusion (25% in the laparotomy group versus 2.4% in the MIS group, p=0.006). Conclusions: patients who underwent laparoscopic surgery had a higher recurrence and mortality rate than that of open approach

El papel de la cirugía mínimamente invasiva de columna en el tratamiento de las metástasis vertebrales: una revisión narrativa / The role of minimally invasive spine surgery in the treatment of vertebral metastasis: A narrative review

Introducción: Las metástasis vertebrales son un problema muy frecuente y asocian un deterioro importante de la calidad de vida en los pacientes oncológicos. El objetivo de esta revisión es determinar el encaje de las técnicas quirúrgicas mínimamente invasivas dentro del manejo de esta entidad. Métodos: Se realizó una revisión bibliográfica en las bases de datos Google Scholar, PubMed, Scopus y Cochrane. Se revisaron los artículos publicados en los últimos 10 años que fueran de una relevancia y calidad adecuadas. Resultados: Tras el cribado de los 2.184 trabajos identificados inicialmente en las distintas bases de datos, se incluyeron un total de 24 artículos en esta revisión. Conclusión: La cirugía mínimamente invasiva de columna es especialmente útil en pacientes oncológicos frágiles con metástasis vertebrales por la reducida comorbilidad que presentan las técnicas que se engloban en ella en comparación con la de la cirugía abierta convencional. Los avances en tecnología aplicada a la cirugía, como la navegación y la robótica, mejoran la precisión y reducen las complicaciones de esta técnica.(AU)

Background: Spinal metastases are a very common problem which dramatically affects the quality of life of cancer patients. The objective of this review is to address the issue of how minimally invasive surgery can play an important role in treating this pathology. Methods: A literature review was performed, searching in the Google Scholar, PubMed, Scopus and Cochrane databases. Relevant and quality papers published within the last 10 years were included in the review. Results: After screening the 2184 initially identified registers, a total of 24 articles were included for review. Conclusion: Minimally invasive spine surgery is specially convenient for fragile cancer patients with spinal metastases, because of its reduced comorbidity compared to conventional open surgery. Technological advances in surgery, such as navigation and robotics, improve accuracy and safety in this technique.(AU)

[Translated article] The role of minimally invasive spine surgery in the treatment of vertebral metastasis: A narrative review / El papel de la cirugía mínimamente invasiva de columna en el tratamiento de las metástasis vertebrales: una revisión narrativa

Introducción: Las metástasis vertebrales son un problema muy frecuente y asocian un deterioro importante de la calidad de vida en los pacientes oncológicos. El objetivo de esta revisión es determinar el encaje de las técnicas quirúrgicas mínimamente invasivas dentro del manejo de esta entidad. Métodos: Se realizó una revisión bibliográfica en las bases de datos Google Scholar, PubMed, Scopus y Cochrane. Se revisaron los artículos publicados en los últimos 10 años que fueran de una relevancia y calidad adecuadas. Resultados: Tras el cribado de los 2.184 trabajos identificados inicialmente en las distintas bases de datos, se incluyeron un total de 24 artículos en esta revisión. Conclusión: La cirugía mínimamente invasiva de columna es especialmente útil en pacientes oncológicos frágiles con metástasis vertebrales por la reducida comorbilidad que presentan las técnicas que se engloban en ella en comparación con la de la cirugía abierta convencional. Los avances en tecnología aplicada a la cirugía, como la navegación y la robótica, mejoran la precisión y reducen las complicaciones de esta técnica.(AU)

Background: Spinal metastases are a very common problem which dramatically affects the quality of life of cancer patients. The objective of this review is to address the issue of how minimally invasive surgery can play an important role in treating this pathology. Methods: A literature review was performed, searching in the Google Scholar, PubMed, Scopus and Cochrane databases. Relevant and quality papers published within the last 10 years were included in the review. Results: After screening the 2184 initially identified registers, a total of 24 articles were included for review. Conclusion: Minimally invasive spine surgery is specially convenient for fragile cancer patients with spinal metastases, because of its reduced comorbidity compared to conventional open surgery. Technological advances in surgery, such as navigation and robotics, improve accuracy and safety in this technique.(AU)

El papel de la cirugía mínimamente invasiva de columna en el tratamiento de las metástasis vertebrales (parte 1): una revisión clínica / The role of minimally invasive spine surgery in the treatment of vertebral metastasis (part 1): A clinical review

Las metástasis espinales representan una importante carga sobre la calidad de vida en los pacientes afectados por una enfermedad oncológica activa, debido a la alta incidencia de síndromes dolorosos, deformidad espinal y deterioro neurológico. La cirugía juega un papel determinante a la hora de mejorar la calidad de vida mediante el control del dolor, el restablecimiento de la función neurológica y el mantenimiento de la estabilidad espinal, además de contribuir a la respuesta de la terapia médica. La cirugía mínimamente invasiva (MIS) es una opción de tratamiento en determinados pacientes con alto riesgo quirúrgico, ya que tiene una baja tasa de complicaciones, de sangrado intraoperatorio, de estancia hospitalaria y ofrece resultados similares a la cirugía abierta. Presentamos en esta revisión el papel de la MIS en esta enfermedad, y algunos casos tratados en nuestro centro hospitalario.(AU)

Spinal metastases represent a significant burden on the quality of life in patients affected by active oncological disease due to the high incidence of pain syndromes, spinal deformity, and neurological impairment. Surgery plays a decisive role in improving quality of life by controlling pain, restoring neurological function and maintaining spinal stability, as well as contributing to the response to medical therapy. Minimally invasive surgery (MIS) is a treatment option in certain patients with high surgical risk since it has a low rate of complications, intraoperative bleeding, hospital stay, and offers similar results to open surgery. In this review, we present the role of MIS in this pathology and some cases treated in our hospital.(AU)

[Translated article] The role of minimally invasive spine surgery in the treatment of vertebral metastasis (Part 1): A clinical review / El papel de la cirugía mínimamente invasiva de columna en el tratamiento de las metástasis vertebrales (parte 1): una revisión clínica

Las metástasis espinales representan una importante carga sobre la calidad de vida en los pacientes afectados por una enfermedad oncológica activa, debido a la alta incidencia de síndromes dolorosos, deformidad espinal y deterioro neurológico. La cirugía juega un papel determinante a la hora de mejorar la calidad de vida mediante el control del dolor, el restablecimiento de la función neurológica y el mantenimiento de la estabilidad espinal, además de contribuir a la respuesta de la terapia médica. La cirugía mínimamente invasiva (MIS) es una opción de tratamiento en determinados pacientes con alto riesgo quirúrgico, ya que tiene una baja tasa de complicaciones, de sangrado intraoperatorio, de estancia hospitalaria y ofrece resultados similares a la cirugía abierta. Presentamos en esta revisión el papel de la MIS en esta enfermedad, y algunos casos tratados en nuestro centro hospitalario.(AU)

Spinal metastases represent a significant burden on the quality of life in patients affected by active oncological disease due to the high incidence of pain syndromes, spinal deformity, and neurological impairment. Surgery plays a decisive role in improving quality of life by controlling pain, restoring neurological function and maintaining spinal stability, as well as contributing to the response to medical therapy. Minimally invasive surgery (MIS) is a treatment option in certain patients with high surgical risk since it has a low rate of complications, intraoperative bleeding, hospital stay, and offers similar results to open surgery. In this review, we present the role of MIS in this pathology and some cases treated in our hospital.(AU)

Gastroesophageal reflux after sleeve gastrectomy: The dimension of the problem.

Sleeve gastrectomy is a safe and effective bariatric surgery in terms of weight loss and longterm improvement or resolution of comorbidities. However, its achilles heel is the possible association with the development with the novo and/or worsening of pre-existing gastroesophageal reflux disease. The anatomical and mechanical changes that this technique induces in the esophagogastric junction, support or contradict this hypothesis. Questions such as «what is the natural history of gastroesophageal reflux in the patient undergoing gastric sleeve surgery?¼, «how many patients after vertical gastrectomy will develop gastroesophageal reflux?¼ and «how many patients will worsen their previous reflux after this technique?¼ are intended to be addressed in the present article.

Is laparoscopic TAPP the preferred approach for the treatment of inguinal hernia? Technique, indications and future perspectives.

The repair of inguinal hernia is one of the most frequently performed surgeries in General Surgery units. The laparoscopic approach for these hernias will be clearly considered as the gold standard, based on its advantages over the open approach. There are no clear advantages of the transabdominal preperitoneal approach (TAPP) over the totally preperitoneal approach (TEP), although it has been shown to be more reproducible, presenting a shorter learning curve, although it presents more possibilities of developing trocar site hernias. Laparoscopic TAPP could be superior to TEP in the following indications: incarcerated hernias, emergencies, previous preperitoneal surgery, previous Pfanestiel-type incision, recurrent hernias, inguinoscrotal hernias and obese, being also a better alternative for females. Robotic TAPP is a safe approach with similar results to laparoscopy; however, it is related to an increase in costs and operating time. The value of this technology for the repair of complex hernias (multiple recurrences, inguino-scrotal or after previous preperitoneal surgery) remains to be determined, since they represent a certain challenge for the conventional laparoscopic approach. On the other hand, robotic repair of inguinal hernias may be a way to reduce the learning curve before addressing complex ventral hernias. Finally, artificial intelligence applied to the laparoscopic approach to inguinal hernia will undoubtedly have a significant impact in the future especially to determine the best the indications for this approach, on the performance of a safer technique, on the correct selection of meshes and fixation mechanisms, and on learning curve.

EHS guidelines for inguinal hernia repair. The reality of the current situation in Spain. A proposal to standardize its implementation during surgical training.

Laparoscopic inguinal hernia repairs are underused in our country and do not fulfil to the recommendations of the European Hernia Society (EHS) guidelines. Thus, it is essential to establish measures that increase its use. We propose that the Spanish Association of Surgeons (AEC) promote these actions and that they should be incorporated into the specialty program. The proposed measures include Standardization of learning; reinforce anatomical knowledge; regulated practices with simulators; promote the use of the open posterior approach; rotations through centers of excellence; accreditation of specialized units and use a registry of activity as quality control.

Cirugía robótica hepática: una nueva realidad. Análisis descriptivo de 220 casos de cirugía hepática mínimamente invasiva en 182 pacientes / Robotic liver surgery: A new reality. Descriptive analysis of 220 cases of minimally invasive liver surgery in 182 patients

Introducción El nivel de recomendación del abordaje robótico en la cirugía hepática es controvertido. Se realiza un análisis descriptivo, retrospectivo yunicéntrico de los resultados a corto plazo de la cirugía hepática robótica y laparoscópica en un mismo periodo.MétodosAnálisis descriptivo del abordaje robótico y laparoscópico sobre 220 resecciones en 182 pacientes sometidos a cirugía hepática mínimamente invasiva.ResultadosEntre abril de 2018 y junio de 2022 se realizaron 92 resecciones hepáticas robóticas (RHR) en 83 pacientes y 128 laparoscópicas (RHL) en 99 pacientes. Se observaron más resecciones mayores (p<0,001) y más resecciones múltiples (p=0,002) en el grupo CHL. El porcentaje de resecciones anatómicas fue similar (RHR: 64,1 vs. RHL: 56,3%). En el grupo CHL el tiempo medio operatorio fue de 212min (DE: 52,1), las pérdidas hemáticas de 276,5ml (100-1.000) y la tasa de conversión del 12,1%. La estancia media hospitalaria fue de 5,7 días (DE: 4,9), la morbilidad fue del 27,3%, con un 2% de mortalidad. En el grupo CHR el tiempo medio operatorio fue de 217min (DE: 53,6), las pérdidas hemáticas fueron de 169,5ml (100-900) y la tasa de conversión del 2,5%. La estancia media hospitalaria fue de 4,1 días (DE: 2,1) y la morbilidad fue del 15%, con mortalidad nula.ConclusiónLa cirugía mínimamente invasiva hepática es una técnica segura y reproducible. La CHR permite realizar resecciones hepáticas con seguridad y parece ser una técnica no inferior a la CHL, pero para determinar el abordaje mínimamente invasivo de elección en cirugía hepática se requieren estudios aleatorizados. (AU)

Introduction The level of recommendation of the robotic approach in liver surgery is controversial. The objective of the study is to carry out a single-center retrospective descriptive analysis of the short-term results of the robotic and laparoscopic approach in liver surgery during the same period.MethodsDescriptive analysis of the short-term results of the robotic and laparoscopic approach on 220 resections in 182 patients undergoing minimally invasive liver surgery.ResultsBetween April 2018 and June 2022, a total of 92 robotic liver resections (RLR) were performed in 83 patients and 128 laparoscopic (LLR) in 99 patients. The LLR group showed a higher proportion of major surgery (P<.001) and multiple resections (P=.002). The two groups were similar in anatomical resections (RLR 64.1% vs. LLR 56.3%). In the LLS group, the average operating time was 212min (SD 52.1). Blood loss was 276.5ml (100-1000) and conversion 12.1%. Mean hospital stay was 5.7 (SD 4.9) days. Morbidity was 27.3% and 2% mortality. In the RLS group, the mean operative time was 217min (SD 53.6), blood loss 169.5ml (100.900), and conversion 2.5%. Mean hospital stay was 4.1 (SD 2.1) days. Morbidity was 15%, with no mortality.ConclusionMinimally invasive liver surgery is a safe technique, and in particular, RLS allows liver resections to be performed safely and reproducibly; it appears to be a non-inferior technique to LLS, but randomized studies are needed to determine the minimally invasive approach of choice in liver surgery. (AU)

Pancreatectomía corporocaudal laparoscópica y robótica, de elección y de futuro / Laparoscopic and robotic distal pancreatectomy: The choice and the future

Introducción La pancreatectomía distal (PD) mínimamente invasiva (MIS) está actualmente bien establecida, ya sea mediante técnica laparoscópica (PDL) o robótica (PDR).MétodosDe 83 PD realizadas entre enero del 2018 y marzo del 2022, se realizaron 57 casos (68,7%) mediante MIS, 35 PDL y 22 PDR (da Vinci Xi). Se evalúa la experiencia de ambos procedimientos y el valor del abordaje robótico. Se analizan en detalle los casos de conversión.ResultadosEl tiempo quirúrgico medio en las PDL y PDR fue de 201,2 (DE 47,8) y 247,54 (DE 35,8) min, (p=0,486). No se observaron diferencias en estancia hospitalaria ni en tasa de conversión, 6 (5-34) vs. 5,6 (5-22) días y 4 (11,4%) vs. 3 (13,6%) casos, respectivamente, (p=0.126). La tasa de reingresos fue de 3/35 (11,4%) y 6/22 (27,3%) casos, PDL vs. PDR respectivamente, (p=0.126).No existieron diferencias en morbilidad (Dindo-Clavien ≥ III) entre ambos grupos. La mortalidad fue de un caso en el grupo robótico (un paciente con conversión precoz por afectación vascular). La tasa de resecciones R0 fue mayor en el grupo robótico (77,1% vs. 90,9%) alcanzando la significación estadística, p=0,04.ConclusionesLa PDMIS es un procedimiento seguro y factible en pacientes seleccionados. Una planificación quirúrgica y la implementación escalonada basada en la experiencia previa ayudan a afrontar procedimientos técnicamente exigentes. Se sugiere que la PDR podría ser el abordaje de elección en la pancreatectomía corporocaudal, no siendo inferior a la PDL. (AU)

Introduction Distal pancreatectomy (DP) is currently well established as a minimally invasive surgery (MIS) procedure, using either a laparoscopic (LDP) or robotic (RDP) approach.MethodsOut of 83 DP performed between January 2018 and March 2022, 57 cases (68.7%) were performed using MIS: 35 LDP and 22 RDP (da Vinci Xi). We have assessed the experience with the 2techniques and analyzed the value of the robotic approach. Cases of conversion have been examined in detail.ResultsThe mean operative times for LDP and RDP were 201.2 (SD 47.8) and 247.54 (SD 35.8)min, respectively (p=0,486). No differences were observed in length of hospital stay or conversion rate: 6 (5–34) vs. 5.6 (5–22) days, and 4 (11.4%) vs. 3 (13.6%) cases, respectively (p=0.126). The readmission rate was 3/35 patients (11.4%) treated with LDP and 6/22 (27.3%) cases of RDP (p=0.126).There were no differences in morbidity (Dindo-Clavien≥III) between the 2groups. Mortality was one case in the robotic group (a patient with early conversion due to vascular involvement). The rate of R0 resection was greater and statistically significant in the RDP group (77.1% vs. 90.9%) (P=,04).ConclusionsMinimally invasive distal pancreatectomy (MIDP) is a safe and feasible procedure in selected patients. Surgical planning and stepwise implementation based on prior experience help surgeons successfully perform technically demanding procedures. RDP could be the approach of choice in distal pancreatectomy, and it is not inferior to LDP. (AU)

Hernia obturatriz izquierda, obstrucción intestinal y hernia inguinal bilateral: Reporte de caso / Left obturator hernia, intestinal obstruction and bilateral inguinal hernia: a case report

RESUMEN La hernia obturatriz tiene una incidencia de menos del 1% de todas las hernias de la pared abdominal, se presentan predominantemente en mujeres de edad avanzada y se caracteriza por la protrusión de las vísceras intraabdominales hacia el agujero obturador. El diagnóstico preoperatorio suele ser difícil debido a la falta de manifestaciones externas obvias, síntomas y signos inespecíficos y falta de sospecha clínica. El retraso en el diagnóstico y en el tratamiento de esta afección generalmente conduce a una alta tasa de mortalidad. Reportamos el caso de una paciente con hernia obturatriz complicada y hernia inguinal bilateral, la cual fue resuelto por cirugía mínimamente invasiva, no hubo complicaciones en la evolución postoperatoria, siendo su estancia hospitalaria siete días.

SUMMARY Obturator hernia has an incidence of less than 1% of all abdominal wall hernias, it is predominantly observed in elder women and it is characterized by protrusion of intra-abdominal viscera into the shutter hole. The preoperative diagnosis is difficult due to the lack of external manifestations, nonspecific symptoms and lack of clinical suspicion. Delaying diagnosis and treatment is associated with high mortality. We report the case of a female patient with a complicated obturator hernia with concomitant bilateral inguinal hernias that underwent minimally invasive surgery with no complications and a seven day stay in hospital.

La escisión total del mesorrecto transanal en el tratamiento del cáncer del recto como nueva técnica en Cuba / Total Excision of the Transanal Mesorectum as a New Technique for Treating Rectal Cancer in Cuba

Introducción: Las indicaciones de la Microcirugía Transanal Endoscópica han evolucionado desde la cirugía de tumoraciones rectales hasta otras enfermedades pélvicas. La asociación de esta y la escisión total del mesorrecto transanal ofrece una serie de ventajas. Objetivo: Determinar las indicaciones, describir la técnica quirúrgica y mostrar los resultados a largo plazo obtenidos en la realización de la escisión total del mesorrecto transanal en el tratamiento del cáncer del recto medio y bajo. Métodos: Se realizó un estudio observacional descriptivo y prospectivo de los pacientes con cáncer del recto medio y bajo sometidos a esta técnica quirúrgica en el período comprendido entre febrero de 2017 y febrero de 2022 en el Centro Nacional de Cirugía de Mínimo Acceso. Resultados: Se operaron 13 pacientes, 9 con cáncer del recto bajo y 4 con cáncer del recto medio y un promedio de edad de 56,2 años (rango 28-76). El promedio de tiempo quirúrgico fue de 183 minutos (rango 120-270) y las pérdidas hemáticas estimadas de 68 mililitros. La incidencia de morbilidad mayor fue de 15,4 por ciento y la media de estadía hospitalaria de 5,4 días. La media del período de seguimiento fue de 35 (rango 9-69) meses con una recidiva local de 7,7 por ciento y una supervivencia global a los 5 años de 100 por ciento. Conclusiones: La escisión total del mesorrecto transanal combinado con cirugía laparoscópica es una técnica factible y segura. La introducción de la variante técnica utilizando el instrumental de la Microcirugía Transanal Endoscópica es más ergonómica y disminuye los costos(AU)

Introduction: The indications for transanal endoscopic microsurgery have evolved from surgery of rectal tumors to other pelvic diseases. The association between this and total excision of the transanal mesorectum offers a series of advantages. Objective: To determine the indications, to describe the surgical technique and to show the long-term outcomes obtained in the performance of total excision of the transanal mesorectum for treating cancer of the middle and lower rectum. Methods: A descriptive and prospective observational study was carried out of patients with cancer of the middle and lower rectum who underwent this surgical technique in the period from February 2017 to February 2022 at Centro Nacional de Cirugía de Mínimo Acceso. Results: Thirteen patients were operated on, 9 with cancer of the lower rectum and 4 with cancer of the middle rectum, as well as an average age of 56.2 years (range 28-76). The average surgical time was 183 minutes (range 120-270) and estimated blood loss was 68 milliliters. The incidence of highest morbidity was 15.4 percent and mean hospital stay was 5.4 days. The median follow-up period was 35 (range 9-69) months, with a local recurrence of 7.7 percent and an overall 5-year survival of 100 percent . Conclusions: Total excision of the transanal mesorectum combined with laparoscopic surgery is a feasible and safe technique. The introduction of the variant technique using the instruments of endoscopic transanal microsurgery is more ergonomic and reduces costs(AU)

[Translated article] The role of minimally invasive spine surgery in the treatment of vertebral metastasis: A narrative review.

BACKGROUND: Spinal metastases are a very common problem which dramatically affects the quality of life of cancer patients. The objective of this review is to address the issue of how minimally invasive surgery can play an important role in treating this pathology. METHODS: A literature review was performed, searching in the Google Scholar, PubMed, Scopus and Cochrane databases. Relevant and quality papers published within the last 10 years were included in the review. RESULTS: After screening the 2184 initially identified registers, a total of 24 articles were included for review. CONCLUSION: Minimally invasive spine surgery is specially convenient for fragile cancer patients with spinal metastases, because of its reduced comorbidity compared to conventional open surgery. Technological advances in surgery, such as navigation and robotics, improve accuracy and safety in this technique.

[Translated article] The role of minimally invasive spine surgery in the treatment of vertebral metastasis (Part 1): A clinical review.

Spinal metastases represent a significant burden on the quality of life in patients affected by active oncological disease due to the high incidence of pain syndromes, spinal deformity, and neurological impairment. Surgery plays a decisive role in improving quality of life by controlling pain, restoring neurological function and maintaining spinal stability, as well as contributing to the response to medical therapy. Minimally invasive surgery (MIS) is a treatment option in certain patients with high surgical risk since it has a low rate of complications, intraoperative bleeding, hospital stay, and offers similar results to open surgery. In this review, we present the role of MIS in this pathology and some cases treated in our hospital.