Autoaumento vesical por laparoscopia. Modelo experimental en conejos (oryctolagus cuniculus) / Laparoscopic vesical autoaugmentation: ana animal model in rabbits (Oryctolagus cuniculus)

RESUMEN

Introducción: La vejiga pequeña y contraída representa un cuadro clínico de difícil terapéutica y no siempre efectiva. Se presenta la cirugía preservadora de urotelio como una opción que permite el aumento de la capacidad vesical. Nuestro objetivo fue evaluar la factibilidad del conejo (Oryctolagus cuniculus) como modelo experimental de enseñanza, entrenamiento y aplicación de técnica para el autoaumento vesical por laparoscopia. Material y Métodos: Cinco conejos (Oryctolagus cuniculus), machos, New Zealand, fueron intervenidos laparoscópicamente por técnica transperitoneal de tres puertos, realizándose autoaumento vesical mediante detrusorectomía. Se realizó cistometría simple preoperatoria y postoperatoria inmediata, mediata y tardía, para verificar modificaciones de capacidad vesical. Resultados: 5 conejos machos fueron operados en un tiempo promedio de 68,8 minutos (rango 44-120). Se realizó medición de la capacidad vesical preoperatoria con promedio de 25.8cc (7-52) disminuyendo la postoperatoria inmediata en un 33%. Se verificó aumento de capacidad vesical postoperatoria de 72% y 52% para el séptimo y decimoquinto 0día, respectivamente. Estos porcentajes fueron estadísticamente significativos con 95% de confianza. Se presentaron 2lesiones vesicales como complicación transoperatoria y un absceso como complicación postoperatoria. Conclusiones: El modelo animal en conejos para la técnica de autoaumento vesical por laparoscopia es un modelo factible para enseñanza, entrenamiento y aplicación (AU)

ABSTRACT

Introduction: Small contracted bladder remains a challenge in clinical urological practice and treatment options are not always effective. Urothelium sparing surgical techniques represent a reasonable therapeutical option. We aimed to evaluate the feasibility of a rabbit model (Oryctolagus cuniculus) in the teaching and training setting for laparoscopicvesical autoaugmentation. Methods: Transperitoneal laparoscopic bladder autoaugmentation was performed in five New Zealand male rabbits (Oryctolagus cuniculus). A three port technique was used for all cases. Circumferential detrusorectomy was performed with vascular pedicles sparing, subsequently submucosal detailed blunt dissection allowed the creation of a bladder diverticulum which was verified intraoperatively. Eye-ball cystometry was performed preoperatively and postoperatively to verify bladder capacity variations. Postoperatively cystometry was done immediately after the procedure and 7 and 15days postoperatively. Statistical analysis was performed with T-student model. A p-value < 0.05 was considered of significance for the analysis. Surgical procedure and perioperative animal care was minutely precised according to the Guidelines of the Institute of Laboratory Animal Resources, Commission on Life Sciences, National Research Council. Results: Five New Zealand male rabbits (Oryctolagus cuniculus) were surgically treated as described. Median operative time was 68.8 minutes (range 44 -120). Median preoperatory bladder capacity for the series was 25.8 cc (7-52). Median postoperative bladder capacity was diminished in 33% immediately after the operation. Then, bladder capacity augmented 72%and 52% for 7th and 15th postoperative days, respectively. Percentage variation in bladder capacity is statistically significant. Two operative complications (mucosal tear) were reported. A postoperatory abscess was observed in one animal. Conclusion: The rabbit (Oryctolagus cuniculus) model for the laparoscopic bladder autoaugmentation is feasible for teaching, training and research. Bigger series and longer follow-up should be addressed (AU)