Robotic assisted eTEP ventral hernia repair: Brazilian early experience.

PURPOSE: The enhanced view totally extraperitoneal (eTEP) concept first applied to inguinal hernias has become an important tool in the armamentarium of ventral hernia repair. The purpose of this report is to date the first brazilian robotic-assisted eTEP ventral hernia repair case series. METHODS: A review of a prospectively maintained database was conducted in patients who underwent robotic-assisted enhanced view totally extraperitoneal (eTEP) for ventral hernia repair between June 2018 and January 2020. Patients demographics, preoperative hernia characteristics, intraoperative variables and postoperative outcomes were evaluated. RESULTS: Our review identified 74 patients submitted to the procedure. Thirty-one patients (41.8%) presented primary ventral hernias (PVHs) and 43 patients (58.2%) presented incisional hernias (IHs). Female patients were predominant in both groups PVHs and IHs with 17 (22.9%) and 22 (29.7%) respectively, with a total of 39 patients (52.7%). Mean BMI was 29.1 kg/m2 (range 21.3-48.0 kg/m2) with higher mean BMI rates of 30.3 kg/m2 in the IHs group (range 22-48 years). A lateral dock setup was utilized in 55 cases (74.4%), having the inferior and superior dock setup in 18 (24.3%) and 1 (1.3%) cases respectively. Mean console time was 148.3 (range 75-277 min) and 192.6 min (range 66-301 min) in the PVHs and IHs groups respectively. There were no intraoperative complications or conversions. Average length of stay was 1.5 days. Four patients were readmitted within 30 days of surgery. There were no reoperation or cases of intraparietal herniation in this cohort. No hernia recurrence was verified during the mean 230.7 days of follow up in both groups. CONCLUSION: We present the first brazilian series to-date of the robotic assisted eTEP approach for ventral hernia repairs. Although long term outcomes require further analysis, its feasibility and reproducibility in experienced surgeons hands are evident, with safe and acceptable early postoperative outcomes.

Transabdominal midline reconstruction by minimally invasive surgery: technique and results.

BACKGROUND: The introduction of the minimally invasive approach changed the way abdominal surgery was carried out. Open suture and mesh reinforcement in ventral hernia repair used to be the surgeon's choice of procedure. Although the laparoscopic approach, with defect bridging and mesh fixation, has been described since 1993, the procedure remains largely unchanged. Evidence shows that defect closure and retro-muscular mesh positioning have the best outcomes and are the best surgical practice. We therefore aimed to develop and demonstrate a procedure which combined the good results of open surgery using the Rives-Stoppa principles, particularly in terms of recurrence, with all the benefits of minimally invasive surgery. METHODS: Between October 2012 and February 2014, 15 post-bariatric surgery patients underwent laparoscopic midline incisional hernia repair. The peritoneal cavity was accessed through a 5-mm optical view cannula at the superior left quadrant. A suprapubic and two right and left lower quadrant cannulas were inserted for inferior access and dissection. The defect adhesions were released. The whole midline was closed with an endoscopic linear stapler, including the defect, from the lower abdomen, 4 cm below the umbilicus, until the epigastric region, including posterior sheath mechanical suturing and cutting in the same movement. A retrorectus space was created in which a retro-muscular mesh was deployed. Fixation was done using a hernia stapler against the posterior sheath from the peritoneal cavity to the abdominal wall muscles. Selection was based on xifo-umbilical incisional midline hernias post open bariatric surgery. Pregnant women, cancer patients, or patients with clinical contraindications were excluded. RESULTS: The patients mean age was 51.2 years (range 39-67). Four patients were men and eleven women. Two had well-compensated fibromyalgia, four had diabetes, and five had hypertension. The mean BMI was 29.5 kg/m2 (range 23-31.6). Surgery was performed successfully in all cases through four ports; the number of incisional hernias was 3 ± 2, with a mean maximum width of 3.75 cm (range 2.1-9) and maximum length of 14 cm (7.5-20.5). The mean surgical time was 114.3 min (range 85-170), and the median hospital stay was 1.4 days. No intra-operative or immediate post-operative complication or death occurred. One patient had a seroma treated conservatively 1 week after surgery and another had a retro-muscular infection treated with percutaneous drainage. CT-Scans made before and after the procedure, showed total closure of the defect. QOL questionnaire showed satisfaction, acceptance, and no complaints. CONCLUSION: Although the study involved a small number of patients, it has proved the technique to be feasible, easy to perform, and have the combined benefits of laparoscopic and open surgery. The results, shown by CT-scan, peri-operative, and QOL findings, were good.

Toxicidade reprodutiva do extrato hidroalcóolico de Samanea tubulosa Benth em ratas wistar / Reproductive toxicity study in Wistar rats treated with hydroalcoholic extract of the pods of bordão-de-velho (Samanea tubulosa Benth)

RESUMOO objetivo deste trabalho foi avaliar possíveis efeitos do extrato das vargens de bordão-de-velho (Samanea tubulosa benth) sobre a reprodução em ratas Wistar. O extrato foi preparado a partir da secagem e trituração das vagens, seguida por maceração com etanol e, posteriormente, concentrado em rotavapor. Ratas Wistar gestantes foram tratadas com 75 mg.100 g-1 de peso corporal de extrato de S. tubulosa e o grupo controle recebeu 1ml/100 g-1 de peso corporal de solução salina por gavagem durante 19 dias. Após eutanásia no 20º dia, as seguintes variáveis foram analisadas: peso corporal fetal, peso dos fetos e placentas, número de corpos lúteos e de reabsorções, implantação, fetos vivos e mortos. O extrato de vagens de S. tubulosa apresenta toxicidade para o feto causando malformações, reabsorções fetais e diminuição pronunciada do peso ao nascer. Contudo, o extrato de vagens de S. tubulosanão influencia no número de corpos lúteos e número de implantações.

ABSTRACTThe aim of this study was to evaluate possible effects of pods from bordão-de-velho (Samanea tubulosa benth) extract on the reproduction of female rats.The extract was prepared by maceration wtith ethanol of dried and crushed pods, then it was concentrated in rotary evaporator. The pregnant Wistar rats were treated with a dose of 75 mg.100 g-1of body weight of Samanea tubulosa extract, by gavage , whereas the control group received 1ml.100g-1of saline by the same route for 19 days. After the euthanasia of the animals at day 20th,the following variables were analyzed: fetal body weight, weight of fetuses and placentas, number of corpora lutea, resorption points, live and dead fetuses and number of embryonic implantations. The extract from S. tubulosa pods, at the dose studied, showed toxicity causing fetal abnormalities, fetal resorption and pronounced decrease in the weight of offspring at birth. On the other hand, , the treatment with extract of S.tubulosa pods had no influence over corpora lutea and implantation numbers.

[Prostitution: causes and future perspectives in a group of young girls]. / Prostituição: causas e perspectivas de futuro em um grupo de jovens.

This is a descriptive exploratory study developed at the city of Natal/RN, through interviews with 10 young girls that made sexual programs at the Meio and Ponta Negra beaches. The purpose was to identify the reasons that made young girls to opt for this activity and the future perspectives of this group. Authors identified that the principal cause that leads these kids to become prostitutes was the lack of financial conditions, and, also, that they believe in future, to be able to work, to leave the prostitution, to have a profession and a better life. Therefore, there is a need for decisions by the responsible agencies and for society in general to give alternatives to these young kids to leave prostitution and mainly to prevent the ingress of new adolescents in this activity.

[The importance of symbolic interactionism in nursing practice]. / A importância do interacionismo simbólico na prática de enfermagem.

The nurse should combine, in their daily practice, technical abilities with a profound comprehension of the main object oh their work, the human being. Symbolic Interactionism is an approach which enables the nursery professional to understand patients by the meaning they value their living experiences. The use of qualitative methods in nursery research is essential because it studies the humans beings and their relationship with the environment, allowing the understanding of the living experiences. These kind of approaches should be even more applied in nursery practice as they open new ways for professional knowledge and enrich practical skills.