Resumo
Purpose: To compare laparoscopic gynecological surgery training between a developed country's reference center (host center) and a public reference service in a developing country (home center), and use the technicity index (TI) to compare outcomes and to determine the impact of laparoscopic gynecological surgery fellowship training on the home center's TI. Methods: The impact of training on the home center was assessed by comparing surgical performance before and after training. TI was assessed in 2017 in the host center, and before and after training in the home center. Epidemiological and clinical data, and information on reason for surgery, preoperative images, estimated intraoperative bleeding, operative time, surgical specimen weight, hospital stay length, complication and reintervention rates were collected from both institutions. Home center pre-training data were retrospectively collected between 2010 and 2013, while post-training data were prospectively collected between 2015 and 2017. A two-tail Z-score was used for TI comparison. Results: The analysis included 366 hysterectomies performed at the host center in 2017, and 663 hysterectomies performed at the home center between 2015 and 2017. TI in the host center was 82.5%, while in the home center it was 6% before training and 22% after training. There were no statistical differences in length of hospital stay, preoperative uterine volume, surgical specimen weight and complication rate between centers. However, significantly shorter mean operative time and lower blood loss during surgery were observed in the host center. Conclusions: High-quality laparoscopic training in a world-renowned specialized center allowed standardizing laparoscopic hysterectomy procedures and helped to significantly improve TI in the recipient's center with comparable surgical outcomes.
Assuntos
Humanos , Saúde Pública , Laparoscopia , Países em Desenvolvimento , Técnicas de Diagnóstico Obstétrico e GinecológicoResumo
A onça-pintada encontra-se classificada como "quase ameaçada" na lista vermelha de animais ameaçados da União Internacional para Conservação da Natureza (IUCN), com tendência ao declínio na América Latina, o que pode afetar o fluxo gênico elevando o risco de endogamia. Técnicas de reprodução assistida (TRAs) como colheita de sêmen e inseminação artificial (IA), são ferramentas que podem se tornar essenciais a manutenção da diversidade genética desses animais. A colheita de sêmen pode ser realizada por eletroejaculação (EEJ) ou colheita farmacológica (CF), sendo que podem ser aplicadas individualmente ou associadas, embora EEJ tenha se mostrado mais eficiente em inseminação artificial (IA) com sêmen a fresco. Para realização de IA a utilização de progestina oral (altrenogest), seguida da aplicação de gonadotropinas exógenas (Gonadotropina Coriônica equina-eCG e Hormônio Luteinizante suíno-pLH), tem se mostrado eficiente, promovendo ovulações consistentes. IA intratubárica (IA-IT) mostrou-se eficiente, tendo a vantagem de utilizar sêmen com baixo número de espermatozoides. O sucesso alcançado com o nascimento do primeiro filhote de Panthera onca utilizando TRAs se deve a vários fatores, dentre eles, a utilização de um novo protocolo hormonal ajustado à espécie; e a utilização da IA-IT, que possibilitou a utilização de sêmen com reduzido número de espermatozoides viáveis por inseminação.(AU)
The jaguar is classified as "near threatened" according International Union for Conservation of Nature red list, with a decreasing trend in the population of Latin America, increasing the risk of inbreeding. Assisted reproduction techniques (ARTs), such as semen collection and artificial insemination (AI), are tools that can become essential to maintain the genetic diversity of jaguars. Semen collection can be performed by electroejaculation (EEJ) or pharmacological collection (PC); and can be applied individually or associated, however EEJ was more efficient for artificial insemination (AI) with fresh semen. To perform Artificial Insemination (AI), oral progestin (altrenogest) followed exogenous gonadotropins (Gonadotropin Chorionic equine-eCG e Hormone Luteinizing porcine-pLH) application was efficient, promoting consistent ovulations. Similarly, laparoscopic oviductal insemination (IA-IT) was efficient, with the advantage to use low viable spermatozoa number by insemination. The success of jaguar cub birth using ARTs is due to several factors, among than, a new hormonal protocol adjusted to the species; and the use of IA-IT, which allowed the reduction in the number of sperm by insemination.(AU)
Assuntos
Animais , Inseminação Artificial/veterinária , Panthera , Análise do Sêmen/veterinária , Laparoscopia/métodos , Técnicas de Reprodução Assistida/instrumentaçãoResumo
Purpose: To explore the effect of different gastrointestinal reconstruction techniques on laparoscopic distal gastrectomy of gastric cancer on the nutritional and anemia status, and quality of life (QoL) of patients. Methods: Eligible patients were randomly divided into three groups (n=36/group): Billroth I anastomosis group, Billroth II combined with Braun anastomosis group, and Roux-en-Y anastomosis group. Related indicators were compared and analyzed. Results: The general data were comparable among the three groups (all P>0.05). Among the surgical-related indicators and postoperative recovery indicators, only the comparison of the operation time was statistically significant (P=0.004). The follow-up time was 5~36 months (average 27.9 months). In terms of nutritional and anemia indicators, only the differences in the levels of prealbumin, hemoglobin and serum ferritin in 24 months after operation showed significant differences (P=0.015, P=0.003, P=0.005, respectively). There were no significant differences in hospital readmission rate, overall survival, and QoL among the three groups (all P>0.05). Conclusions: In laparoscopic gastrectomy for stage II~III distal gastric cancer, Billroth I anastomosis has shorter operation time than Billroth II combined with Braun anastomosis and Roux-en-Y anastomosis and advantages in the improvement of nutritional status and anemia recovery.
Assuntos
Humanos , Pacientes , Qualidade de Vida , Neoplasias Gástricas , Estado Nutricional , GastrectomiaResumo
O objetivo deste estudo foi identificar o melhor acesso laparoscópico para visualização e manipulação das estruturas umbilicais no interior da cavidade abdominal de fetos bovinos. Foram utilizados nove fetos de bezerros de vacas no terço final da gestação, todos submetidos à laparoscopia com dois portais de acesso, primeiro no flanco direito e depois na região ventral do abdômen, onde foram verificadas as possibilidades de acesso às estruturas umbilicais. Em ambas as abordagens, os portais de acesso permitiram visualizar e manipular as estruturas de interesse, mas a abordagem lateral foi mais eficaz com melhor visualização e manipulação. Os acessos ventrais não proporcionavam a mesma facilidade de visualização e manipulação, pois as estruturas umbilicais fixadas na parede abdominal ficavam muito próximas aos portais. Esses resultados demonstram que a laparoscopia pode ser utilizada para manipulação e visualização das estruturas umbilicais, sendo a abordagem lateral mais eficaz.
Assuntos
Animais , Bovinos , Umbigo , Laparoscopia , Cavidade Abdominal , FetoResumo
Purpose Develop a 3D model for the simulation of laparoscopic inguinal hernioplasty transabdominal preperitoneal (TAPP). Methods This is an experimental study, 18 participants were selected, divided into three groups, experimental (GE) surgeons in training, control (GC) experienced surgeons and Shaw (GS) nonexperienced surgeons. The simulation in the 3D model was carried out in 6 sessions fulfilling the 5 stages. Opening the peritoneum with the creation of the preperitoneal space; identification of important structures; hernia identification and reduction; placement and fixation of the mesh in Coopers ligament and closure of the peritoneum. Results In the 1st stage, the GE obtained an average of 1.25 ± 0.42 in the 1st session and 3.25 ± 0.62 in the 6th session (p = 0.05) and in the 5th stage 0.91 ± 0.29 in the first session. 1st session and 1.91 ± 0.29 in the 6th session (p = 0.001), with no significant difference between groups. The learning and skill curve in the SG represented 1.08 ± 0.29 1st and 3.50 ± 0.90 6th session (p = 0.001). Conclusions The creation of a systematization of training in simulation applied to the three-dimensional model enabled gain in laparoscopic skills and underpinned its theoretical and practical foundations.(AU)
Assuntos
Treinamento por Simulação , Hérnia Inguinal , Laparoscopia , Impressão TridimensionalResumo
This work aims to describe the clinical, laboratory, and anatomopathological findings of two bovines, one affected by cecocolic intussusception, and the other by dilation with cecal torsion. The clinical examination demonstrated metallic resonance from the right flank, ruminal and intestinal hypomotility, and abdominal distension, in addition to alterations in feces characteristics. Was observed in the two animals leukocytosis by neutrophilia with regenerative shift to the left, and hyperfibrinogenemia. The analysis of ruminal fluid revealed impairment of the microbiota and an increase in chloride levels. The laparoscopic examination performed on one of the animals showed dilation of the colon, the cecum with hyperemia and serous edema, with a dividing halo between affected and unaffected portions, in addition to reddish peritoneal fluid. In the laparotomy, an enlarged cecum was found, with gaseous and liquid contents, swollen and turgid colon, and peritonitis. In addition to the findings observed during surgery, the anatomopathological examination demonstrated, in bovine 01, intestinal intussusception in the region of the cecocolic valve, and, in bovine 02, twisting of the loop at the ileocecocolic junction. Despite the low occurrence of digestive system disorders in cattle, cecal torsion and intussusception represent serious intestinal clinical conditions. These reports take the attention to the importance of a multidisciplinary approach to provide a correct diagnosis of intestinal diseases.
O objetivo deste trabalho foi descrever os achados clínicos, laboratoriais e anatomopatológicos de dois bovinos, um acometido por intussuscepção cecocólica e o outro por dilatação com torção de ceco. O diagnóstico de ambos os casos foi base-ado nos achados clínicos, laboratoriais, videolaparoscópicos, cirúrgicos e anatomopatológicos. No exame clínico evidenciou-se ressonância metálica no flanco direito, hipomotilidade ruminal e intestinal, distensão abdominal, além de alteração nas carac-terísticas das fezes. Observou-se nos dois animais leucocitose por neutrofilia com desvio para esquerda regenerativo e hiperfi-brinogenia. A análise do fluido ruminal revelou comprometimento da microbiota e elevação nos teores de cloretos. O exame videolaparoscópico, realizado no bovino dois (02), evidenciou dilatação do cólon, ceco com hiperemia e edema de serosa com halo divisório entre porção acometida e não acometida, além de líquido peritoneal de coloração avermelhada. Na laparotomia constatou-se ceco dilatado por conteúdo gasoso e líquido, cólon edemaciado e túrgido e, peritonite. No exame anatomopato-lógico, constatou-se, no bovino um (01), intussuscepção intestinal na região de válvula ceco-cólica e, no bovino (02) torção de alça na junção ileocecocólica. Apesar da baixa ocorrência, a torção de ceco e a intussuscepção acarretam condição intestinal grave e devem ser inseridas na lista de diagnósticos diferenciais das enfermidades digestivas de bovinos. Estes relatos chamam a atenção para a importância da abordagem multidisciplinar no diagnóstico das enfermidades intestinais.
Assuntos
Animais , Bovinos , Intussuscepção/diagnóstico , Laparoscopia , Obstrução Intestinal/diagnóstico , Trato GastrointestinalResumo
This work aims to describe the clinical, laboratory, and anatomopathological findings of two bovines, one affected by cecocolic intussusception, and the other by dilation with cecal torsion. The clinical examination demonstrated metallic resonance from the right flank, ruminal and intestinal hypomotility, and abdominal distension, in addition to alterations in feces characteristics. Was observed in the two animals leukocytosis by neutrophilia with regenerative shift to the left, and hyperfibrinogenemia. The analysis of ruminal fluid revealed impairment of the microbiota and an increase in chloride levels. The laparoscopic examination performed on one of the animals showed dilation of the colon, the cecum with hyperemia and serous edema, with a dividing halo between affected and unaffected portions, in addition to reddish peritoneal fluid. In the laparotomy, an enlarged cecum was found, with gaseous and liquid contents, swollen and turgid colon, and peritonitis. In addition to the findings observed during surgery, the anatomopathological examination demonstrated, in bovine 01, intestinal intussusception in the region of the cecocolic valve, and, in bovine 02, twisting of the loop at the ileocecocolic junction. Despite the low occurrence of digestive system disorders in cattle, cecal torsion and intussusception represent serious intestinal clinical conditions. These reports take the attention to the importance of a multidisciplinary approach to provide a correct diagnosis of intestinal diseases.(AU)
O objetivo deste trabalho foi descrever os achados clínicos, laboratoriais e anatomopatológicos de dois bovinos, um acometido por intussuscepção cecocólica e o outro por dilatação com torção de ceco. O diagnóstico de ambos os casos foi base-ado nos achados clínicos, laboratoriais, videolaparoscópicos, cirúrgicos e anatomopatológicos. No exame clínico evidenciou-se ressonância metálica no flanco direito, hipomotilidade ruminal e intestinal, distensão abdominal, além de alteração nas carac-terísticas das fezes. Observou-se nos dois animais leucocitose por neutrofilia com desvio para esquerda regenerativo e hiperfi-brinogenia. A análise do fluido ruminal revelou comprometimento da microbiota e elevação nos teores de cloretos. O exame videolaparoscópico, realizado no bovino dois (02), evidenciou dilatação do cólon, ceco com hiperemia e edema de serosa com halo divisório entre porção acometida e não acometida, além de líquido peritoneal de coloração avermelhada. Na laparotomia constatou-se ceco dilatado por conteúdo gasoso e líquido, cólon edemaciado e túrgido e, peritonite. No exame anatomopato-lógico, constatou-se, no bovino um (01), intussuscepção intestinal na região de válvula ceco-cólica e, no bovino (02) torção de alça na junção ileocecocólica. Apesar da baixa ocorrência, a torção de ceco e a intussuscepção acarretam condição intestinal grave e devem ser inseridas na lista de diagnósticos diferenciais das enfermidades digestivas de bovinos. Estes relatos chamam a atenção para a importância da abordagem multidisciplinar no diagnóstico das enfermidades intestinais.(AU)
Assuntos
Animais , Bovinos , Intussuscepção/diagnóstico , Obstrução Intestinal/diagnóstico , Trato Gastrointestinal , LaparoscopiaResumo
ABSTRACT: This study aimed to evaluate laparoscopy with abdominal ultrasound exams to establish accurate diagnosis and prognosis. The experimental design was a prospective clinical study. Nine adult crossbred bovines suffering from abdominal disorders were admitted to the cattle clinic for clinical examinations. Abdominal ultrasound was carried out, and complete blood counts were performed. Subsequently, exploratory laparoscopy was performed. After surgery (exploratory laparoscopy on the right or left side), animals with a severe prognosis or untreatable clinical condition were euthanised and necropsied. During laparoscopy, circumscribed reticuloperitonitis could not be detected, nor could other abnormalities in the cranioventral region of the abdomen previously observed on ultrasound and confirmed during necropsy. However, alterations due to peritoneal damage, such as adhesions, were observed dorsally in addition to alterations in macroscopic aspects of the peritoneal fluid. Exploratory standing laparoscopy through the paralumbar fossae may constitute a supplementary procedure for diagnosing abdominal disorders in cattle, but it is not suitable in cases of diseases characterised by focal lesions concentrated in the cranioventral region of the abdomen. When associated with clinical, laboratory, and ultrasound examinations, this technique may improve the accurate diagnosis and prognosis of abdominal disorders in cattle.
RESUMO: Este estudo teve como objetivo avaliar a laparoscopia com exames de ultrassom abdominal para estabelecer um diagnóstico e prognóstico precisos. O desenho experimental foi um estudo clínico prospectivo. Nove bovinos adultos mestiços com distúrbios abdominais foram utilizados. Os bovinos admitidos na Clínica de Bovinos foram submetidos a exame clínico, adicionalmente foram realizadas hemograma e ultrassonografia abdominal. Posteriormente, foi realizada laparoscopia exploratória. Após a cirurgia (laparoscopia exploratória no lado direito ou esquerdo), nove animais com manifestações clínicas graves e intratáveis foram sacrificados e necropsiados. Durante a laparoscopia, não foi possível detectar reticuloperitonite circunscrita, bem como outras anormalidades na região crânio-ventral do abdome, previamente observadas na ultrassonografia e confirmadas durante a necropsia. No entanto, alterações devido a dano peritoneal, como aderências, foram observadas dorsalmente. É possível que a laparoscopia exploratória em apoio quadrupedal através da fossa paralombar constitua um procedimento complementar para o diagnóstico de distúrbios abdominais em bovinos, embora não seja adequado em casos de doenças caracterizadas por lesões focais concentradas na região cranioventral do abdome. Quando associada a exames clínicos, laboratoriais e de ultrassom, essa técnica pode melhorar o diagnóstico e prognóstico preciso dos distúrbios abdominais em bovinos.
Resumo
This study aimed to evaluate laparoscopy with abdominal ultrasound exams to establish accurate diagnosis and prognosis. The experimental design was a prospective clinical study. Nine adult crossbred bovines suffering from abdominal disorders were admitted to the cattle clinic for clinical examinations. Abdominal ultrasound was carried out, and complete blood counts were performed. Subsequently, exploratory laparoscopy was performed. After surgery (exploratory laparoscopy on the right or left side), animals with a severe prognosis or untreatable clinical condition were euthanised and necropsied. During laparoscopy, circumscribed reticuloperitonitis could not be detected, nor could other abnormalities in the cranioventral region of the abdomen previously observed on ultrasound and confirmed during necropsy. However, alterations due to peritoneal damage, such as adhesions, were observed dorsally in addition to alterations in macroscopic aspects of the peritoneal fluid. Exploratory standing laparoscopy through the paralumbar fossae may constitute a supplementary procedure for diagnosing abdominal disorders in cattle, but it is not suitable in cases of diseases characterised by focal lesions concentrated in the cranioventral region of the abdomen. When associated with clinical, laboratory, and ultrasound examinations, this technique may improve the accurate diagnosis and prognosis of abdominal disorders in cattle.(AU)
Este estudo teve como objetivo avaliar a laparoscopia com exames de ultrassom abdominal para estabelecer um diagnóstico e prognóstico precisos. O desenho experimental foi um estudo clínico prospectivo. Nove bovinos adultos mestiços com distúrbios abdominais foram utilizados. Os bovinos admitidos na Clínica de Bovinos foram submetidos a exame clínico, adicionalmente foram realizadas hemograma e ultrassonografia abdominal. Posteriormente, foi realizada laparoscopia exploratória. Após a cirurgia (laparoscopia exploratória no lado direito ou esquerdo), nove animais com manifestações clínicas graves e intratáveis foram sacrificados e necropsiados. Durante a laparoscopia, não foi possível detectar reticuloperitonite circunscrita, bem como outras anormalidades na região crânio-ventral do abdome, previamente observadas na ultrassonografia e confirmadas durante a necropsia. No entanto, alterações devido a dano peritoneal, como aderências, foram observadas dorsalmente. É possível que a laparoscopia exploratória em apoio quadrupedal através da fossa paralombar constitua um procedimento complementar para o diagnóstico de distúrbios abdominais em bovinos, embora não seja adequado em casos de doenças caracterizadas por lesões focais concentradas na região cranioventral do abdome. Quando associada a exames clínicos, laboratoriais e de ultrassom, essa técnica pode melhorar o diagnóstico e prognóstico preciso dos distúrbios abdominais em bovinos.(AU)
Assuntos
Animais , Bovinos , Bovinos/anormalidades , Ultrassonografia/veterinária , Laparoscopia/veterinária , Sinais e Sintomas , Doenças do Sistema Digestório/diagnósticoResumo
This study aimed to evaluate laparoscopy with abdominal ultrasound exams to establish accurate diagnosis and prognosis. The experimental design was a prospective clinical study. Nine adult crossbred bovines suffering from abdominal disorders were admitted to the cattle clinic for clinical examinations. Abdominal ultrasound was carried out, and complete blood counts were performed. Subsequently, exploratory laparoscopy was performed. After surgery (exploratory laparoscopy on the right or left side), animals with a severe prognosis or untreatable clinical condition were euthanised and necropsied. During laparoscopy, circumscribed reticuloperitonitis could not be detected, nor could other abnormalities in the cranioventral region of the abdomen previously observed on ultrasound and confirmed during necropsy. However, alterations due to peritoneal damage, such as adhesions, were observed dorsally in addition to alterations in macroscopic aspects of the peritoneal fluid. Exploratory standing laparoscopy through the paralumbar fossae may constitute a supplementary procedure for diagnosing abdominal disorders in cattle, but it is not suitable in cases of diseases characterised by focal lesions concentrated in the cranioventral region of the abdomen. When associated with clinical, laboratory, and ultrasound examinations, this technique may improve the accurate diagnosis and prognosis of abdominal disorders in cattle.(AU)
Este estudo teve como objetivo avaliar a laparoscopia com exames de ultrassom abdominal para estabelecer um diagnóstico e prognóstico precisos. O desenho experimental foi um estudo clínico prospectivo. Nove bovinos adultos mestiços com distúrbios abdominais foram utilizados. Os bovinos admitidos na Clínica de Bovinos foram submetidos a exame clínico, adicionalmente foram realizadas hemograma e ultrassonografia abdominal. Posteriormente, foi realizada laparoscopia exploratória. Após a cirurgia (laparoscopia exploratória no lado direito ou esquerdo), nove animais com manifestações clínicas graves e intratáveis foram sacrificados e necropsiados. Durante a laparoscopia, não foi possível detectar reticuloperitonite circunscrita, bem como outras anormalidades na região crânio-ventral do abdome, previamente observadas na ultrassonografia e confirmadas durante a necropsia. No entanto, alterações devido a dano peritoneal, como aderências, foram observadas dorsalmente. É possível que a laparoscopia exploratória em apoio quadrupedal através da fossa paralombar constitua um procedimento complementar para o diagnóstico de distúrbios abdominais em bovinos, embora não seja adequado em casos de doenças caracterizadas por lesões focais concentradas na região cranioventral do abdome. Quando associada a exames clínicos, laboratoriais e de ultrassom, essa técnica pode melhorar o diagnóstico e prognóstico preciso dos distúrbios abdominais em bovinos.(AU)
Assuntos
Animais , Bovinos , Bovinos/anormalidades , Ultrassonografia/veterinária , Laparoscopia/veterinária , Sinais e Sintomas , Doenças do Sistema Digestório/diagnósticoResumo
Purpose: The benefits of laparoscopic approaches to treat colorectal cancer (CRC) and colorectal liver metastases (CRLM) separately are well established. However, there is no consensus about the optimal timing to approach the primary tumor and CRLM, whether simultaneously or staged. The objective of this review with practical reports is to discuss technical aspects required for patient selection to perform simultaneous laparoscopic approaches for CRC and CRLM. Methods: Literature review of oncological factors associated with patient selection for surgical treatment of CRLM and the use of laparoscopy in those cases, and report of technical aspects for simultaneous CRC and CRLM approaches. Results: Simultaneous laparoscopic resection has been successful in many series of selected patients, although it seems to be safer to perform minor and major liver resection with non-extended colorectal resections, and to avoid two high-risk procedures at the same time. Conclusions: Simultaneous CRC and CRLM resections seem to be safe when patients are carefully selected, also considering the risk of recurrence concerning oncologic outcomes. The pre-planning of simultaneous resection is mandatory to plan trocar positioning, procedure sequencing, and patient position.(AU)
Assuntos
Humanos , Laparoscopia , Tomada de Decisões , Neoplasias Colorretais , Metástase Neoplásica , Neoplasias HepáticasResumo
Purpose: To develop a model for simulated training of ureteropyelic anastomosis in laparoscopicpyeloplasty. Methods: Longitudinal and experimental study, with 16 participants. A synthetic instrument was produced to simulate the renal pelvis and the proximal portion of the ureter positioned on a platform within laparoscopic simulators, thereby resulting in the realistic simulation of the ureteropelvic anastomosis. A step-by-step guide was also developed for the accomplishment of the ureteropelvic anastomosis training model. Results: In the evaluation of all participants suture training, a decrease was found in the time needed to perform the anastomosis, with a median of 17.83 min in the 1st step and 14.21 min in the last one (p = 0.01). Regarding the knots, in the 1st step, 5% of them were considered firm, with an evolution to 30% in the last step (p = 0.011). Conclusion: We noticed improvement in the ability to perform the ureteropelvic anastomosis by participants with no experience with it. Therefore, even unexperienced participants can improve their skills with this training. Moreover, we observed the effectiveness of the model use, confirmed by the participants opinion and its validation by expert surgeons.(AU)
Assuntos
Treinamento por Simulação , Anastomose Cirúrgica/veterinária , Laparoscopia/veterinária , UreterResumo
Com o objetivo de promover, por meio de acesso único e com o uso de endoscópio flexível, ampla exploração da cavidade peritoneal de equinos em estação, foi concebida uma cânula laparoscópica para dar sustentação ao endoscópio e possibilitar o acesso sob visualização. O procedimento foi realizado a partir da fossa paralombar. Após pequena incisão cutânea, o endoscópio foi inserido na cânula e os músculos e o peritônio foram divulsionados mediante rotação da cânula. Logo depois da perfuração do peritônio, foi realizada a exploração da cavidade e a identificação das estruturas. Em seguida à exploração do lado ipsilateral ao acesso, realizou-se a transposição do conjunto cânula/endoscópio ventralmente à porção caudal do cólon descendente, seguida de exploração do lado contralateral. Concluída a técnica, foi executado, para fins de comparação, o mesmo procedimento por meio da fossa paralombar contralateral. Foi possível a transposição do conjunto cânula/endoscópio para o lado contralateral ao acesso em todos os procedimentos. Também foi possível a identificação da maioria das estruturas abdominais tanto pelo acesso esquerdo quanto pelo direito. A abordagem por acesso único mostrou-se viável para a exploração ampla da cavidade peritoneal, demonstrando ser uma alternativa à técnica laparoscópica convencional.(AU)
A laparoscopic cannula was designed to support a single access approach with a flexible endoscope for the wide exploration of the peritoneal cavity of standing horses. It provides support to the endoscope and allows access to the peritoneal cavity with a visual aid. This procedure was performed through the paralumbar fossa. After a small cutaneous incision, the endoscope was inserted into the cannula, and the muscles and peritoneum were divulsed through the rotation of the cannula. After the peritoneal perforation, cavity exploration and identification of structures were performed. After the exploration of the ipsilateral side of the access, the cannula/endoscope was transposed ventrally to the caudal portion of the descending colon; this was followed by the exploration of the contralateral side. Once this process was completed, the same procedure was performed through the contralateral paralumbar fossa for comparison. It was possible to transpose the cannula/endoscope set to the contralateral access side in all procedures. Further, it was possible to identify most of the abdominal structures in both the left and right access. This single access approach proved to be feasible for the extensive exploration of the peritoneal cavity, thereby indicating it can be an alternative to the conventional laparoscopic technique.(AU)
Assuntos
Animais , Peritônio/diagnóstico por imagem , Endoscópios/veterinária , Cirurgia Vídeoassistida/veterinária , Cânula , Cavalos , Procedimentos Cirúrgicos Minimamente Invasivos/métodosResumo
Purpose To assess the impact of three-dimensional (3D) vision use on operative time (OT) in laparoscopic Roux-en-Y gastric bypass (LRYGB) with hand-sewn anastomoses. Methods We analyzed a prospectively collected database of patients who underwent LRYGB. We included all patients operated on with either 2D or 3D vision. Demographics and clinical characteristics, operative time, hospital stay and 30-day postoperative complications were collected for all patients and analyzed. Results During the study time, out of 143 patients who underwent LRYGB for morbid obesity, 111 were considered eligible. Seventy-eight patients were operated with 2D vision and 33 patients with 3D vision. Demographics and clinical characteristics were not different among groups. Mean OT was 203±51 and 167±32 minutes in the 2D and 3D groups respectively (p<0.001). Multivariate analyses showed that increasing age and BMI were independently related to prolonged OT, while 3D vision (OR 6.675, 95% CI 2.380-24.752, p<0.001) was strongly associated with shorter OT. Conclusions The use of 3D vision in LRYGB significantly reduced the OT, though intra- and postoperative complication rates and the length of hospital stay were not affected. Despite its limitations, our study supports the value of 3D vision laparoscopy in bariatric surgery.(AU)
Assuntos
Humanos , Derivação Gástrica/métodos , Cirurgia Bariátrica/métodos , Duração da Cirurgia , Anastomose em-Y de Roux , Imageamento TridimensionalResumo
Purpose. To determine by histomorphometric analysis whether CO2 pneumoperitoneum interferes with collagen deposition in surgical wounds in the aponeurosis of rats.. Methods. This experiment involved 80 male Wistar rats, randomly allocated into four groups according to pneumoperitoneum period (PRE: 30 min preoperatively; POST: 30 min postoperatively; PP: 30 min pre- and postoperatively; C: control group). CO2 pneumoperitoneum was insufflated to 5 mmHg of pressure. A laparotomy was performed; 1 cm of the left colon was then resected, and an end-to-end anastomosis was performed to simulate surgical trauma, after which the abdominal wall was closed. On postoperative days 7 or 14, a sample of the abdominal wall was collected, stained with picrosirius red and observed under polarized light in an optical microscope. The amount of collagen was estimated by computerized histomorphometric analysis.. Results. There were no significant differences in collagen deposition between the control and experimental groups on postoperative days 7 (p=0.720) or 14 (p=0.933). The amount of collagen increased as expected in all groups between postoperative days 7 and 14 (p=0.0003).. Conclusion. At 5 mmHg, CO2 pneumoperitoneum does not interfere with collagen deposition in abdominal wall surgical wounds in rats.(AU)
Assuntos
Animais , Ratos , Ratos/lesões , Ratos/cirurgia , Pneumoperitônio/complicações , Pneumoperitônio/diagnóstico , Laparoscopia , Dióxido de CarbonoResumo
Purpose To determine by histomorphometric analysis whether CO2 pneumoperitoneum interferes with collagen deposition in surgical wounds in the aponeurosis of rats. Methods This experiment involved 80 male Wistar rats, randomly allocated into four groups according to pneumoperitoneum period (PRE: 30 min preoperatively; POST: 30 min postoperatively; PP: 30 min pre- and postoperatively; C: control group). CO2 pneumoperitoneum was insufflated to 5 mmHg of pressure. A laparotomy was performed; 1 cm of the left colon was then resected, and an end-to-end anastomosis was performed to simulate surgical trauma, after which the abdominal wall was closed. On postoperative days 7 or 14, a sample of the abdominal wall was collected, stained with picrosirius red and observed under polarized light in an optical microscope. The amount of collagen was estimated by computerized histomorphometric analysis. Results There were no significant differences in collagen deposition between the control and experimental groups on postoperative days 7 (p=0.720) or 14 (p=0.933). The amount of collagen increased as expected in all groups between postoperative days 7 and 14 (p=0.0003). Conclusion At 5 mmHg, CO2 pneumoperitoneum does not interfere with collagen deposition in abdominal wall surgical wounds in rats.(AU)
Assuntos
Animais , Ratos/cirurgia , Laparoscopia/métodos , Laparoscopia/veterinária , Pneumoperitônio , Cicatrização , Dióxido de CarbonoResumo
Purpose To compare the operative outcomes of laparoscopic surgical treatment for bowel endometriosis in a public teaching hospital versus in a private referral hospital. Methods The indications for surgery, type and time of operation, length of hospital stay, need for a temporary stoma, rate of conversion to open surgery, and postoperative complications were evaluated. Results One hundred eighty-one patients were included (150 patients, 82.9%, in a private hospital). In the private hospital, there were more patients with infertility [56% vs. 29%; P=0.01] as an indication for surgery) and segmental resection was more common in the private hospital (48% vs. 29%, p=0.05). The average operative time (211.9±83.4 minutes vs. 128 ± 55 minutes, p 0.001) as well as the length of hospital stay (3.97±1.7 days vs. 1.56±0.85 days, p 0.001) was higher in the public hospital; the rate of conversion to open surgery was significantly lower in the private hospital (2% vs. 32.3%, p 0.001). Operations performed at the public hospital were associated with higher rates of postoperative complications (Clavien-Dindo II and II) (38.7% x 11.3%, p=0.021; OR 3.2, CI 95% 1.2-8.0). Conclusion Laparoscopic surgery in private centers was associated with reductions in major complications, surgical times, lengths of stay and rates of conversion to open surgery compared to that in public teaching hospitals.(AU)
Assuntos
Humanos , Laparoscopia , Endometriose , Hospitais , Avaliação de Resultados em Cuidados de SaúdeResumo
Com o objetivo de promover, por meio de acesso único e com o uso de endoscópio flexível, ampla exploração da cavidade peritoneal de equinos em estação, foi concebida uma cânula laparoscópica para dar sustentação ao endoscópio e possibilitar o acesso sob visualização. O procedimento foi realizado a partir da fossa paralombar. Após pequena incisão cutânea, o endoscópio foi inserido na cânula e os músculos e o peritônio foram divulsionados mediante rotação da cânula. Logo depois da perfuração do peritônio, foi realizada a exploração da cavidade e a identificação das estruturas. Em seguida à exploração do lado ipsilateral ao acesso, realizou-se a transposição do conjunto cânula/endoscópio ventralmente à porção caudal do cólon descendente, seguida de exploração do lado contralateral. Concluída a técnica, foi executado, para fins de comparação, o mesmo procedimento por meio da fossa paralombar contralateral. Foi possível a transposição do conjunto cânula/endoscópio para o lado contralateral ao acesso em todos os procedimentos. Também foi possível a identificação da maioria das estruturas abdominais tanto pelo acesso esquerdo quanto pelo direito. A abordagem por acesso único mostrou-se viável para a exploração ampla da cavidade peritoneal, demonstrando ser uma alternativa à técnica laparoscópica convencional.(AU)
A laparoscopic cannula was designed to support a single access approach with a flexible endoscope for the wide exploration of the peritoneal cavity of standing horses. It provides support to the endoscope and allows access to the peritoneal cavity with a visual aid. This procedure was performed through the paralumbar fossa. After a small cutaneous incision, the endoscope was inserted into the cannula, and the muscles and peritoneum were divulsed through the rotation of the cannula. After the peritoneal perforation, cavity exploration and identification of structures were performed. After the exploration of the ipsilateral side of the access, the cannula/endoscope was transposed ventrally to the caudal portion of the descending colon; this was followed by the exploration of the contralateral side. Once this process was completed, the same procedure was performed through the contralateral paralumbar fossa for comparison. It was possible to transpose the cannula/endoscope set to the contralateral access side in all procedures. Further, it was possible to identify most of the abdominal structures in both the left and right access. This single access approach proved to be feasible for the extensive exploration of the peritoneal cavity, thereby indicating it can be an alternative to the conventional laparoscopic technique.(AU)
Assuntos
Animais , Peritônio/diagnóstico por imagem , Endoscópios/veterinária , Cirurgia Vídeoassistida/veterinária , Cânula , Cavalos , Procedimentos Cirúrgicos Minimamente Invasivos/métodosResumo
For ethical and organic reasons, surgical and analgesic techniques that minimize and adequately control pain should be studied. Ovariohysterectomy is the most common surgical technique in veterinary medicine and is performed in female dogs for elective or therapeutic purposes. Both conventional and minimally invasive surgical techniques are used in veterinary medicine; however, the minimally invasive laparoscopic technique is considered superior to the conventional technique because it is associated with a less painful and faster post-operative recovery. However, for various reasons, the laparoscopic technique is not yet widely used in veterinary medicine, and the conventional ovariohysterectomy is still the most common. The aim of this study, therefore, was to validate the efficacy of the combination of dipyrone, scopolamine, and meloxicam after conventional or two-port laparoscopic-assisted ovariohysterectomies in female dogs. Additionally, this study sought to assess recovery after the two surgical modalities while receiving the same analgesic protocol. Fourteen healthy adult female dogs were spayed and then evaluated using the Visual Analogue Scale, the Melbourne Scale, and the short form of the Glasgow Composite Measure Pain Scale for 72 hours after surgery. The analgesic protocol was efficient for pain control after both techniques, with minimal differences between the groups.
Devido a razões éticas e orgânicas, técnicas cirúrgicas e analgésicas que minimizam e controlam adequadamente a dor devem estudadas. A ovário-histerectomia é a técnica cirúrgica mais realizada em medicina veterinária, seja aplicada com fins eletivos ou terapêuticos. As técnicas cirúrgicas convencionais e minimamente invasivas são utilizadas em medicina veterinária, e as laparoscópicas são consideradas superiores, pois promovem menor dor e mais rápida recuperação pós-operatória. Embora esta modalidade cirúrgica seja considerada superior, por diferentes razões ainda não é tão difundida na medicina veterinária, sendo a técnica convencional de ovário-histerectomia a mais utilizada em cadelas. Por estas razões, o objetivo deste estudo foi validar a eficácia do protocolo dipirona, escopolamina e meloxicam em cadelas submetidas a ovário-histerectomia convencional ou videoassistida por dois portais, assim como avaliar a recuperação dos animais submetidos a duas modalidades cirúrgicas junto ao referido protocolo analgésico. Assim, 14 cadelas adultas saudáveis foram submetidas a ovário-histerectomia e avaliadas por meio da Escala Visual Analógica, Escala de Melbourne e Forma reduzida da Escala Composta de Glasgow até 72 horas após a realização do procedimento cirúrgico. O protocolo analgésico foi eficiente para controle da dor nos animais submetidos a ambas as técnicas cirúrgicas, e mínimas diferenças foram observadas entre os grupos.
Assuntos
Feminino , Animais , Cães , Dipirona/administração & dosagem , Dipirona/uso terapêutico , Doenças do Cão/terapia , Escopolamina/administração & dosagem , Escopolamina/uso terapêutico , Histerectomia/veterinária , Meloxicam/administração & dosagem , Meloxicam/uso terapêutico , Ovário/patologiaResumo
For ethical and organic reasons, surgical and analgesic techniques that minimize and adequately control pain should be studied. Ovariohysterectomy is the most common surgical technique in veterinary medicine and is performed in female dogs for elective or therapeutic purposes. Both conventional and minimally invasive surgical techniques are used in veterinary medicine; however, the minimally invasive laparoscopic technique is considered superior to the conventional technique because it is associated with a less painful and faster post-operative recovery. However, for various reasons, the laparoscopic technique is not yet widely used in veterinary medicine, and the conventional ovariohysterectomy is still the most common. The aim of this study, therefore, was to validate the efficacy of the combination of dipyrone, scopolamine, and meloxicam after conventional or two-port laparoscopic-assisted ovariohysterectomies in female dogs. Additionally, this study sought to assess recovery after the two surgical modalities while receiving the same analgesic protocol. Fourteen healthy adult female dogs were spayed and then evaluated using the Visual Analogue Scale, the Melbourne Scale, and the short form of the Glasgow Composite Measure Pain Scale for 72 hours after surgery. The analgesic protocol was efficient for pain control after both techniques, with minimal differences between the groups.(AU)
Devido a razões éticas e orgânicas, técnicas cirúrgicas e analgésicas que minimizam e controlam adequadamente a dor devem estudadas. A ovário-histerectomia é a técnica cirúrgica mais realizada em medicina veterinária, seja aplicada com fins eletivos ou terapêuticos. As técnicas cirúrgicas convencionais e minimamente invasivas são utilizadas em medicina veterinária, e as laparoscópicas são consideradas superiores, pois promovem menor dor e mais rápida recuperação pós-operatória. Embora esta modalidade cirúrgica seja considerada superior, por diferentes razões ainda não é tão difundida na medicina veterinária, sendo a técnica convencional de ovário-histerectomia a mais utilizada em cadelas. Por estas razões, o objetivo deste estudo foi validar a eficácia do protocolo dipirona, escopolamina e meloxicam em cadelas submetidas a ovário-histerectomia convencional ou videoassistida por dois portais, assim como avaliar a recuperação dos animais submetidos a duas modalidades cirúrgicas junto ao referido protocolo analgésico. Assim, 14 cadelas adultas saudáveis foram submetidas a ovário-histerectomia e avaliadas por meio da Escala Visual Analógica, Escala de Melbourne e Forma reduzida da Escala Composta de Glasgow até 72 horas após a realização do procedimento cirúrgico. O protocolo analgésico foi eficiente para controle da dor nos animais submetidos a ambas as técnicas cirúrgicas, e mínimas diferenças foram observadas entre os grupos.(AU)