The impact of laparoscopic gynecological surgery training on the technicity index of a developing country center

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.

Laparoscopic adrenalectomy: comparison between pneumoperitoneum and the use of a laparoscopic lift device in dog cadavers / Adrenalectomia laparoscópica: comparação entre o pneumoperitônio e o uso de dispositivo paraliftlaparoscopy em cadáveres de cães

This study evaluated the feasibility of abdominal liftfor laparoscopic adrenalectomy and compared it with the conventional laparoscopic technique using pneumoperitoneum with medicinal CO2 in dog cadavers. The total surgical time (TST), adrenalectomy time (AT), and gland integrity after removal were evaluated. Thirty-eight adrenalectomies were performed in 19 cadavers. Regardless of the antimere, the TST was significantly lower in the CO2 procedures than in the lift laparoscopy procedures (P=0.001). When comparing the techniques between antimeres, the TST was significantly higher on the left side with lift laparoscopy than with CO2 (P=0.015) and similar between the techniques on the right side of the animals (P=0.086). In the comparison of AT, regardless of the execution side, no differences were observed between the techniques (P=0.05). The same was observed when AT was evaluated separately using antimeres (P=0.902). Of the 38 adrenals evaluated, 92.1% were removed in a single block, and 32.29% had a superficial lesion in the capsule. There was no difference between the groups in the removal capacity in a single block (P=0.340) and capsule integrity (P=0.287). Abdominal lift for laparoscopic adrenalectomy is a feasible technique in dog cadavers; however, it requires a longer surgical time than the conventional technique. The traction force used to elevate the abdominal wall must be evaluated.

O presente trabalho teve como objetivo avaliar a exequibilidade da adrenalectomia laparoscópica utilizando dispositivo de elevação da parede abdominal via liftlaparoscopy e comparar com a técnica laparoscópica convencional utilizando pneumoperitônio com CO2 medicinal em cadáveres de cães. Para isso, avaliou-se tempo cirúrgico total (TCT), tempo de adrenalectomia (TA) e integridade das glândulas após remoção. Foram realizadas 38 adrenalectomias em 19 cadáveres. Independentemente do antímero, o TCT foi significativamente menor nos procedimentos com CO2 do que com liftlaparoscopy (P=0,001). Na comparação das técnicas entre antímeros, o TCT foi significativamente maior no lado esquerdo com liftlaparoscopy do que com CO2 (P = 0,015) e semelhante entre as técnicas no lado direito dos animais (P=0,086). Já na comparação do TA, independente do lado de execução, não foram observadas diferenças entre os métodos (P=0,05). O mesmo foi observado quando o TA foi avaliado separadamente por antímero (P=0,902). Das 38 adrenais avaliadas, 92,1% foram removidas em um único bloco e destas, 32,29% apresentaram lesão superficial na cápsula. Não houve diferença entre grupos para capacidade de remoção em um único bloco (P=0,340) e da integridade da cápsula (P=0,287). A adrenalectomia laparoscópica por elevação da parede abdominal é factível de ser realizada em cadáveres de cães, entretanto, demanda maior tempo cirúrgico quando comparada à técnica convencional. Além disso, a força de tração empregada para elevar a parede abdominal necessita ser avaliada.

In vivo embryo development in bitches inseminated laparoscopically after ovulation time estimated based on a single progesterone determination

Logistic and economical limitations are often the causes of dog owners not accurately monitoring the estrous cycle and the optimal insemination time. The aim of this study was to evaluate in vivo early embryonic development in bitches, after the analysis of sequential vaginal cytologies associated to single progesterone measurement and single laparoscopic insemination with high quality semen (fresh and with high spermatozoa concentration) or low-quality semen (frozen/thawed and with low spermatozoa concentration) at 48 h post- ovulation time predicted on a single progesterone measurement. Ten bitches were inseminated with 250 x 106 fresh spermatozoa (80% motility), and ten with 80 x 106 frozen/thawed spermatozoa (60% motility) in the cranial part of each uterine horn. Seven days later, ovariohysterectomy was performed and the oviducts and uterine horns and body were flushed to recover embryos and unfertilized oocytes. In 80% of the bitches inseminated with fresh and 50% of bitches inseminated with frozen/thawed semen, embryos at 2 to 8 cells stage were recovered mostly from the, oviducts. This study indicates that pregnancies can be obtained with a single laparoscopic intrauterine insemination after single serum progesterone measurement, although with a low number of embryos. This result should be taken into account in case economic or logistic restrictions that affect the possibility of owners to plan an accurate monitoring of the optimal breeding time using fresh and frozen semen.(AU)

Effects of oxygen supplementation in ewes subjected to laparoscopic ovum pick-up under total intravenous anesthesia / Efeitos da suplementação de oxigênio em ovelhas submetidas à aspiração de folículos por laparoscopia sob anestesia intravenosa total

Laparoscopy procedures are useful tools to perform some assisted reproductive biotechnologies in ewes, it requi-res general anesthesia and manoeuvres that might result in alteration of the cardiopulmonary function. For this reason, this study aimed to investigate the effects of oxygen supplementation as a therapeutic measure to mitigate these alterations in ewes submitted to laparoscopic ovum pick-up (LOPU) under total intravenous anesthesia (TIVA). Twenty-four healthy adult ewes were submitted to two LOPUs with a 21 days interval, under ketamine-midazolam anesthesia, and receiving each of the two experimental in random order, oxygen treatment (OT) 50 mL/kg/min of oxygen via endotracheal tube and control treatment (CT) not receive any inhalation treatment. Heart rate (HR), respiratory rate (fR), peripheral oxygen saturation (SpO2), mean arterial pressure (MAP), rectal temperature (RT), end-tidal CO2 concentration (EtCO2) and recovery anesthesia time were evaluated during LOPU, arterial blood gases and electrolytes were evaluated after induction of anesthesia and at the end of the LOPU. Variables were compared between groups and moments using ANOVA. MAP, SpO2, PaO2, SaO2 and pH were higher in OT, while EtCO2, PaCO2, temperature loss and recovery time were lower. These results allow to conclude that oxy-gen supplementation in ewes submitted to LOPU under TIVA provides benefits in order to mitigate physiological alterations.(AU)

Os procedimentos de laparoscopia são ferramentas úteis para realizar algumas biotecnologias de reprodução assistida em ovelhas, requer anestesia geral e manobras que podem resultar em alteração da função cardiopulmonar. Por esse motivo, este estudo teve como objetivo investigar os efeitos da suplementação de oxigênio como medida terapêutica para atenuar as alterações em ovelhas submetidas à Aspiração Folicular guiada por Laparoscopia (LOPU) sob anestesia venosa total (TIVA). Vinte e quatro ovelhas adultas saudáveis foram submetidas a duas LOPUs com intervalo de 21 dias, sob anestesia com cetamina-midazolam, recebendo cada um dos dois experimentos em ordem aleatória, tratamento com oxigênio (OT) 50 mL/kg/min de oxigênio via tubo endotraqueal e tratamento de controle (CT) não recebem nenhum tratamento por inalação. Frequência cardíaca (FC), frequência respiratória (FR), saturação periférica de oxigênio (SpO2), pressão arterial média (PAM), temperatura retal (TR), concentração expirada de CO2 (EtCO2) e tempo de recuperação da anestesia foram avaliados durante LOPU, arterial gasometria e eletrólitos foram avaliados após a indução da anestesia e ao final da COL. As variáveis foram comparadas entre grupos e momentos por meio de ANOVA. PAM, SpO2, PaO2, SaO2 e pH foram maiores no TO, enquanto EtCO2, PaCO2, perda de temperatura e tempo de recuperação foram menores. Estes resultados permitem concluir que a suplementação de oxigênio em ovelhas submetidas a LOPU sob TIVA proporciona benefícios no sentido de atenuar as alterações fisiológicas.(AU)

Colheita de sêmen e inseminação artificial em onças-pintadas (Panthera onca) / Semen collection and artificial insemination in jaguars (Panthera onca)

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)

Pyometra in a tiger (Panthera tigris)

Background: Captive tigers can live a long life, around 26 years. Among the diseases described some of non-infectious origin are quite common, such as chronic kidney disease, spondylosis, and biliary cysts or tumors. On the other hand, pyometra has been frequently reported in lions, who have a higher risk of developing the disease than tigers and leopards. Pyometra is a disease with few descriptions in tigers and it may be related to the physiological features of the species. The animal is listed as Endangered on the International Union for the Conservation of Nature Red List of Threatened. The present report aims to describe the diagnosis and treatment of pyometra in a captive tigress. Case: A 7-year-old entire female tiger (Panthera tigris) weighing 140 kg was presented with a 3-day history of anorexia and prostration. For clinical examinations, collection of laboratory and imaging tests, the patient initially underwent dissociative anesthesia to allow catheterization of the cephalic vein and intravenous general anesthesia for orotracheal intubation followed by anesthetic maintenance in isoflurane. On general physical examination, the animal had normal colored mucosa, vital parameters within normal limits, and a body condition score of 6 on a scale of 9. There was no presence of vulvar secretion. The blood count and the biochemical exams showed values within the normal range for the species. The chest X-ray in the right and left views did not demonstrate pulmonary abnormalities. Ultrasonographic examination of the abdomen showed distension of the uterine body and horns, which have intraluminal hyperechoic fluid content without flocculation. Based on the imaging exam, the diagnosis was suggestive of pyometra. Exploratory celiotomy was performed via ventral midline, confirming the condition, which was treated by ovariohysterectomy. The surgical technique was performed as described for therapeutic ovariohysterectomy in dogs and cats. Culture of uterine content identified Escherichia coli. The histological analysis identified diffuse endometritis associated with follicular cysts. The tiger had complete recovery without any complications. The patient was releasing 13 days after the surgical procedure and in the last contact four months after the surgery, it was in perfect health conditions. Discussion: Pyometra in large exotic felids has been occasionally reported, mainly in animals more than 10 years of age. Although the tigress in the report is estimated to be seven years old. The patient in question started with anorexia and prostration and as there was already a history of cystic endometrial hyperplasia, a possible pyometra was suspected, despite being uncommon in the species. There was not vaginal discharge. The definitive diagnosis was by means of ultrasound examination and ovariohysterectomy was performed. Abdominal surgery for these large felids is complex, due to the intra-abdominal volume the flank approach or by laparoscopic is suggested, however in this case a ventral midline incision was performed without intercurrences and complications in the post-operative period. The surgical technique like that used in small animals was effective for the treatment of pyometra in the tigress with the use of ovariohysterectomy. Culture of uterine content identified Escherichia coli, which has been the most commonly isolated pathogen in pyometra of large felids. It was concluded that, as in bitches with pyometra, early diagnosis and surgical treatment is ideal for the patient's recovery.

Broad uterine ligament plication by toggle use during laparoscopic surgery / [Plicatura do ligamento largo do útero com utilização de toggle por videocirurgia]

The aim of the present study is to describe the surgical technique and complications of uterine elevation by laparoscopic surgery, using the broad uterine ligament plication with toogles. Five mares of different breeds, weight and age were selected, presenting poor perineal conformation and pendulous uterus. The surgical technique was performed with a toogle applicator, 0.6mm sterile nylon thread and toogles, using three portals on each side of the flank. After one month, a new laparoscopy was performed, with only one portal on each side, to observe uterine positioning and healing. The average surgical time reached in this study was 82 minutes per procedure, and the uterus of all mares was successfully raised, remaining in a more horizontal orientation and presenting satisfactory healing. There are only two articles published with uteropexy in mares, where the proposed techniques take longer, which consequently increases the surgical risk.

O objetivo do presente estudo é descrever a técnica cirúrgica e as complicações da elevação uterina por cirurgia laparoscópica, utilizando-se a plicatura do ligamento uterino com aplicação de toogles. Foram selecionadas cinco éguas de diferentes raças, peso e idade, as quais apresentavam baixa conformação perineal e útero pendular. A técnica cirúrgica foi realizada com aplicador de toogles, fio de nylon estéril de 0,6mm e toogles, sendo utilizados três portais de cada lado do flanco. Após um mês, uma nova laparoscopia foi realizada, com apenas um portal de cada lado, para observar o posicionamento uterino e a cicatrização. O tempo cirúrgico médio alcançado neste estudo foi de 82 minutos por procedimento, e o útero de todas as éguas foi elevado com sucesso, permanecendo em uma orientação mais horizontal e apresentando cicatrização satisfatória. Existem apenas dois artigos publicados com a utilização da uteropexia em éguas, porém nestes as técnicas propostas demoram mais, o que, consequentemente, aumenta o risco cirúrgico.

Laparoscopic approaches in bovine fetuses' umbilical structures: lateral or ventral approach?

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.

Biliary peritonitis in a dog after perforation of the gallbladder during laparoscopic cholecystectomy

Background: Iatrogenic gallbladder perforation during laparoscopic cholecystectomy (LC) is a common complication and occurs in at least one third of human patients undergoing LC. This is attributed to the fragility of the gallbladder wall associated with mucocele and cholecystitis, in addition to the need for repetitive gripping and traction of the gallbladder during its manipulation with laparoscopic instruments. As complications from this event are rare in human patients, conversion to laparotomy is not routinely indicated and the adverse consequences of bile spillage are minimized by abundant irrigation of the peritoneal cavity and adequate antimicrobial therapy. On the other hand, there is little information regarding the outcome of laparoscopic management of this complication in laparoscopic cholecystectomies in dogs, particularly since most surgeons indicate conversion in these cases. Thus, we describe a case of biliary peritonitis that developed in a dog after laparoscopic management of iatrogenic perforation of the gallbladder during a laparoscopic cholecystectomy, in a case of gallbladder mucocele. To the best of our knowledge, there are no reports of biliary peritonitis following laparoscopic management of iatrogenic gallbladder perforation during LC in dogs. Case: A 14-year-old Poodle was referred for clinical evaluation with selective appetite, recurrent episodes of hyporexia, and abdominal discomfort. Ultrasound findings characterized chronic liver disease and gallbladder mucocele. The patient was referred for laparoscopic cholecystectomy, during which the gallbladder was iatrogenically perforated, with extravasation of a large volume of bile content. This complication was managed by copious abdominal irrigation via laparoscopic access and antimicrobial therapy. On the second postoperative day, the patient started to present apathy, hyporexia, emesis, and jaundice. The patient remained hospitalized in the intensive care unit for stabilization and monitoring through hematological examinations and serial abdominal ultrasound. Due to progressive worsening of the clinical picture, an exploratory laparotomy was performed ten days after the initial surgical procedure. This examination showed multiple adhesions and the presence of bile residues adhered to numerous points on the peritoneal surface and pancreas. Despite the intensive treatment instituted, death occurred 10 h after the second surgical procedure. Discussion: The high risk of gallbladder perforation during laparoscopic cholecystectomies correlates with the dissection step or repetitive grasping and traction of the gallbladder with laparoscopic instruments. Conversion is not routinely indicated and laparoscopic management is considered effective in humans. However, in this case, the presence of a large volume of extravasated semisolid bile content and its adherence to the mesothelial surface made it impossible to remove it in its entirety despite the abundant irrigation of the abdominal cavity, resulting in a picture of biliary peritonitis in the postoperative period. In view of the reported negative outcome, the authors encourage the adoption of measures that minimize the risk of gallbladder perforation when performing LC in dogs. These include the use of atraumatic instruments or aspiration of bile content before surgical manipulation. Cases in which such a complication is recorded should be carefully monitored to enable early diagnosis and treatment of biliary peritonitis. Furthermore, conversion should be considered when there is extravasation of large volumes of bile, particularly in the presence of gallbladder mucocele, until future studies establish the safety and effectiveness of laparoscopic management of this complication.

Laparocistotomia para correção de urolitíase vesical em equino: relato de cirurgia a campo / Laparocystotomy for correction of vesical urolithiasis in equine: field surgery report

A urolitíase é uma condição rara, mas considerada de emergência na rotina de equinos. Este trabalho relata um caso de correção de urolitíase vesical em equino pela técnica cirúrgica de laparocistotomia parainguinal a campo. Para isso, foi realizado atendimento de um equino macho, sem raça definida, com histórico de disúria e hematúria exacerbada após exercício. Após realização de exame clínico, a suspeita diagnóstica de urolitíase vesical foi confirmada por meio de ultrassonografia transretal, sendo indicado o tratamento cirúrgico. Diante da impossibilidade de realização do procedimento em centro cirúrgico, optou-se por operá-lo em condições a campo. Para o acesso à cavidade abdominal, optou-se pela laparotomia parainguinal. A bexiga foi localizada e esvaziada por punção. Procedeu-se cistotomia para remoção do urólito, seguida da lavagem da bexiga com solução fisiológica para remoção de possíveis detritos. A cistorrafia foi realizada em dois planos de sutura do tipo Schmieden-Cushing, com fio absorvível sintético, seguida pela laparorrafia. O pós-operatório consistiu em curativos diários da ferida cirúrgica, duchas e administração de antimicrobiano e anti-inflamatório. Conclui-se que o exame ultrassonográfico foi fundamental para o correto diagnóstico e que a escolha da técnica cirúrgica de laparocistotomia parainguinal realizada a campo oferece resultados satisfatórios para o tratamento de equino com urolitíase vesical.

Urolithiasis is a rare condition, but it is considered an emergency in the equine routine. The present work reports a correction case of vesical urolithiasis in equines by the surgical technique of parainguinal laparocystotomy in the field. A male horse, of mixed breed, with a history of dysuria and exacerbated hematuria after exercise was treated. After performing the clinical examination, the diagnostic suspicion of bladder urolithiasis was confirmed through transrectal ultrasonography and the surgical treatment was indicated. Given the impossibility of performing the procedure in the operating room, it was decided to operate the animal in field conditions. For access to the abdominal cavity, parainguinal laparotomy was chosen. The bladder was located and emptied by puncture. A cystotomy was performed to remove the urolith, followed by washing the bladder with saline solution to remove possible debris. The cistorrhaphy was performed in two planes of Schmieden-Cushing suture, with synthetic absorbable suture, followed by laparorrhaphy. The postoperative period consisted of daily dressings of the surgical wound, showers, and administration of antimicrobial and anti-inflammatory. It is concluded that the ultrasound examination was essential for the correct diagnosis and that the choice of the surgical technique of parainguinal laparocystotomy performed in the field offers satisfactory results for the treatment of horses with bladder urolithiasis.

Effects of different gastrointestinal reconstruction techniques on nutrition, anemia, and quality of life in laparoscopic distal gastrectomy for gastric cancer

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.

Alternative use of endocavitary probe to guide minimally invasive partial nephrectomy: is it reasonable?

Purpose: To describe the use of endocavitary ultrasound probe as an auxiliary tool when performing partial nephrectomy in cases of endophytic renal tumors, to standardize the method, and to report the preliminary results achieved with this technique. Methods: Fifteen patients diagnosed with completely endophytic underwent partial nephrectomy with the use of an endocavitary ultrasound probe. This article describes the technique involved in partial nephrectomy and details the preparation of the endocavitary ultrasound probe to ensure its safe use. Results: All the patients had a RENAL score between 8 and 11. The median time of warm ischemia was 26 and 18 minutes for laparoscopic or robot-assisted surgery, respectively. The median duration of surgery was 150 minutes, and the median console time was 145 minutes for the laparoscopic and robot-assisted surgery groups, respectively. The median estimate of blood loss was 200 mL. Only three patients in the laparoscopic group had focal positive surgical margins. There were no cases of infection at the site of probe entry. Conclusions: Intraoperative use of an endocavitary ultrasound probe for partial nephrectomy is possible and a safe alternative to the excision of endophytic tumors when neither robotic probes nor laparoscopic probes are available.

Tranexamic acid effects in postoperative bleeding outcomes in laparoscopic sleeve gastrectomy: a controlled study

Purpose: To demonstrate through a controlled study whether the use of tranexamic acid in bariatric surgeries is effective for bleeding control. Methods: Prospective, comparative, and double-blind study performed with patients from 18 to 65 years old submitted to bariatric surgery. The selected patients received venous tranexamic acid (TXA) during the induction of anesthesia or not (CG). The anesthesia and thromboprophylaxis protocols were similar among the groups. For statistical analysis, the χ2 and analysis of variance tests were performed at a significance level of p < 0.05, using the statistical program SPSS 21.0®. Results: Sixty-one patients were included in the study, 31 in the control group and 30 in the TXA group (GTXA). In the intraoperative period, the bleeding volume was greater in the CG than in the GTXA. In the postoperative period, the tranexamic acid group had a higher value hematocrit, absence of surgical reoperations due to bleeding complications, and shorter hospitalization time than the control group. Conclusions: The use of tranexamic acid was effective in reducing bleeding rates and of hospital stay length, in addition to demonstrating the clinical safety of its use, for not having been associated with any thromboembolic events.

Simulated training model in a low cost for laparoscopic inguinal hernioplasty

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)

Celioscopy and partial salpingectomy in a pregnant bitch / Celioscopia e salpingectomia parcial em fêmea canina gestante

This case report presents a celioscopy procedure followed by partial salpingectomy (PS) in a pregnant bitch referred to elective video assisted ovariohysterectomy. Through celioscopy it was visualized the embryonic vesicles and PS was performed after conversion to minioceliotomy. The puppies were born by eutocic delivery without clinical alterations. The case suggested that short and regular pneumoperitoneum is not deleterious to dog fetus and video surgery could be used in pregnant bitches. PS allows the fetus development and promotes bitch neutering.

Este trabalho relata um caso de celioscopia seguido de salpingectomia parcial (SP) em fêmea canina gestante encaminhada à ovariohisterectomia eletiva videoassistida. Por celioscopia foram identificadas vesículas gestacionais e a SP foi aplicada após conversão para miniceliotomia. Não foram observadas alterações clínicas nos filhotes, os quais nasceram por parto eutócico. Sugere-se que o pneumoperitônio regular por tempo reduzido não seja deletério para fetos caninos e a videocirurgia pode ser aplicada em caninos gestantes. A SP permite a continuidade do desenvolvimento fetal e a esterilização de fêmeas caninas.

Efeitos da PEEP na ventilação controlada a volume sobre parâmetros hemodinâmicos em suínos submetidos ao pneumoperitônio associado ao cefalodeclive / Effects of PEEP on hemodynamic variables in pigs submitted to volume-controlled ventilation under pneumoperitoneum associated to cephalodeclive

Videolaparoscopic procedures have gained prominence due to their low invasiveness, causing less surgical trauma and better post-surgical recovery. However, the increase in intra-abdominal pressure due to the institution of pneumoperitoneum can alter the patient's homeostasis. Therefore, volume-controlled ventilation, associated with positive end-expiratory pressure (PEEP), improves arterial oxygenation and prevents pulmonary collapse, but it can lead to important hemodynamic changes. The aim of this study was to evaluate, comparatively, the effects of positive end expiratorypressure (PEEP) on hemodynamic variables of pigs submitted to volume-controlled ventilation, during pneumoperitoneum and maintained in head-down tilt and determine which PEEP value promotes greater stability on hemodynamic variables. Twenty-four pigs were used, between 55 and 65-day-old, weighing between 15 and 25 kg, randomly divided into 3 distinct groups differentiated by positive end-expiratory pressure: PEEP 0 (volume-controlled ventilation and PEEP of 0 cmH2O), PEEP 5 (volume-controlled ventilation and PEEP of 5 cmH2O) and PEEP 10 (volume-controlled ventilation and PEEP of 10 cmH2O). Volume-controlled ventilation was adjusted to 8 mL/kg of tidal volume and a respiratory rate of 25 movements per min. Anesthesia was maintained with continuous infusion of propofol (0.2 mg/kg/min) and midazolam (1 mg/kg/h). Pneumoperitoneum was performed with carbon dioxide (CO2), keeping the intraabdominal pressure at 15 mmHg and the animals were positioned on a 30° head-down tilt. The evaluations of hemodynamic variables started 30 min after induction of anesthesia (M0), followed by measurements at 15-min intervals (from M15 to M90), completing a total of 7 evaluations. The variables of interest were collected over 90 min and submitted to analysis of variance followed by Tukey's post-hoc test, with P < 0.05. The PEEP 10 group had higher values of CVP and mCPP, while the PEEP 5 group, mPAP and PVR were higher. The PEEP 0 group, on the other hand, had higher means of CI. Regarding the moments, there were differences in HR, SAP, DAP, MAP, CO, IC and TPR. According to the literature, important hemodynamic effects due to pneumoperitoneum are reported, which can be caused by the pressure used in abdominal insufflation, CO2 accumulation, duration of the surgical procedure, hydration status and patient positioning. Mechanical ventilation associated with PEEP can also cause an increase in intrathoracic pressure and, therefore, reduce cardiac output. Cardiovascular changes are proportional to the PEEP used. Central venous pressure (PVC) measure the patient's preload, and intrathoracic pressure can interfere with this parameter. The peak pressure values in the PEEP 10 group were higher than the other groups, demonstrating that the increase in intrathoracic pressure results in higher PVC values. Regarding PAPm and PCPm, these variables can be influenced according to the PEEP values and the patient's position. In relation to CI, the increase in PEEP may reflect on intrathoracic pressure, resulting in greater compression of the heart, with a consequent reduction in cardiac output and cardiac index. Therefore, it is concluded that the PEEP effects of 0 cmH2O and 5 cmH2O on hemodynamics are discrete, under the proposed conditions.(AU)

Celioscopy and partial salpingectomy in a pregnant bitch / Celioscopia e salpingectomia parcial em fêmea canina gestante

This case report presents a celioscopy procedure followed by partial salpingectomy (PS) in a pregnant bitch referred to elective video assisted ovariohysterectomy. Through celioscopy it was visualized the embryonic vesicles and PS was performed after conversion to minioceliotomy. The puppies were born by eutocic delivery without clinical alterations. The case suggested that short and regular pneumoperitoneum is not deleterious to dog fetus and video surgery could be used in pregnant bitches. PS allows the fetus development and promotes bitch neutering.(AU)

Este trabalho relata um caso de celioscopia seguido de salpingectomia parcial (SP) em fêmea canina gestante encaminhada à ovariohisterectomia eletiva videoassistida. Por celioscopia foram identificadas vesículas gestacionais e a SP foi aplicada após conversão para miniceliotomia. Não foram observadas alterações clínicas nos filhotes, os quais nasceram por parto eutócico. Sugere-se que o pneumoperitônio regular por tempo reduzido não seja deletério para fetos caninos e a videocirurgia pode ser aplicada em caninos gestantes. A SP permite a continuidade do desenvolvimento fetal e a esterilização de fêmeas caninas.(AU)

Ressecção de cisto renal único por meio de videolaparoscopia em cão / Resection of simple kidney cyst through videolaparoscopy in dogs

As práticas cirúrgicas dentro da medicina veterinária vêm se aperfeiçoando ao longo do tempo com o desenvolvimento de técnicas cada vez menos invasivas, visando à diminuição da dor e a recuperação mais rápida da função das estruturas operadas. Este relato teve como objetivo evidenciar os benefícios da técnica de ressecção de um cisto renal por meio de videolaparoscopia em um canino, fêmea, da raça Golden Retriever, castradoe com 10 anos que apresentava histórico de apatia. No exame ultrassonográfico foi evidenciada estrutura cortical no rim direito, sugestiva de cisto renal. Foi realizada a confirmação do diagnóstico e posterior drenagem do cisto de forma percutânea videoassistida, seguida de sua ressecção e omentopexia por técnica laparoscópica a fim de garantir boa condição cicatricial, drenagem de urina e aporte de células de defesa. A técnica apresentou ausência de complicações durante o procedimento, mínima dor no pós-operatório e recuperação rápida do paciente. A análise histopatológica do fragmento retirado do cisto confirmou o diagnóstico de cisto epitelial benigno, que é a forma mais comum de cistos renais, fornecendo um bom prognóstico para o paciente. Não houve complicações ou sinais de recidiva três meses após o procedimento. Os cistos renais ocorrem com pouca frequência em animais domésticos e geralmente não causam sinais clínicos, porém se em grande número ou tamanho considerável podem causar doença renal crônica cursando com sinais clínicos sistêmicos além da deformação renal e dor abdominal. No caso relatado, a ressecção cirúrgica do cisto renal simples por videocirurgia foi eficaz, sem complicações e preservou a função do órgão.

Surgical practices within veterinary medicine have been improving over time with the development of increasingly less invasive techniques, aimed at reducing pain and faster recovery of the function of operated structures. This report aimed to highlight the benefits due a technique of resection of a simple renal cyst through video laparoscopy. A ten years old canine, female, Golden Retriever had history of apathy. Ultrasound examination found a cortical structure in the right kidney, suggestive of renal cyst. Diagnosis was confirmed and the cyst was drained through percutaneously video-assisted technique, followed by its resection and omentopexy by laparoscopic technique in order to ensure a good healing condition, urine drainage and supply of defense cells. The technique showed no complications during the procedure, less pain in the postoperative period and faster recovery of the patient. Histopathology of the fragment removed from the cyst was performed and the diagnosis of benign epithelial cyst was confirmed, which is the most common form of renal cysts, providing a good prognosis for the patient. There were no complications or signs of recurrence three months after the procedure. Renal cysts occur infrequently in domestic animals and generally do not cause clinical signs, but if in large numbers or considerable size is presented, they can cause chronic kidney disease with systemic clinical signs in addition to renal deformation and abdominal pain. In this case, laparoscopic resection of the simple renal cyst was effective, without complications and preserved the organ's function.

Hernioplastia com aplicação de tela por laparoscopia em equino com hérnia incisional / Hernioplasty with laparoscopy mesh application in equine with incisional hernia

Background: Incisional hernia in the midline can be a consequence of abdominal surgeries, which incidence is around5.7-18%. Surgical indication occurs in cases of large hernias, and the most common techniques used involve the closingof the musculature in a primary way, with sutures, and the implantation of a mesh on the abdominal wall. Laparoscopichernioplasty emerged as a less invasive option, showing superiority when compared with open surgical techniques in human medicine, however there are few reports describing this technique in equines. So, the aim of this paper is to report acase of hernioplasty, using laparoscopic mesh, in a horse with midline incisional hernia.Case: A 13-year-old castrated male Brasileiro de Hipismo horse, weighing 415 kg, practitioner of classic equestrian, presented an incisional hernia after 14 days from an exploratory laparotomy surgery realized to treat colic syndrome. After 6months, the patient was referred to a Veterinary Medicine Teaching Hospital for the correction of the defect in the abdominal wall. During palpation, the animal did not present local pain or other sign of inflammation, and the hernia measuredapproximately 20 cm in diameter. The animal was submitted to general anesthesia and placed in dorsal decubitus for thehernioplasty surgical procedure. An incision was made in cranial region of the midline, close to the xiphoid to introduce asingle port; the abdomen was inflated with CO2 gas (12 mmHg) and the operating table was tilted in order to displace theorgans cranially, facilitating the laparoscopic procedure. The abdomen was inspected and the presence of a single adherence could be observed, which was disrupted with endoscopic forceps. The mesh was introduced through the single port...

Hernioplastia com aplicação de tela por laparoscopia em equino com hérnia incisional / Hernioplasty with laparoscopy mesh application in equine with incisional hernia

Background: Incisional hernia in the midline can be a consequence of abdominal surgeries, which incidence is around5.7-18%. Surgical indication occurs in cases of large hernias, and the most common techniques used involve the closingof the musculature in a primary way, with sutures, and the implantation of a mesh on the abdominal wall. Laparoscopichernioplasty emerged as a less invasive option, showing superiority when compared with open surgical techniques in human medicine, however there are few reports describing this technique in equines. So, the aim of this paper is to report acase of hernioplasty, using laparoscopic mesh, in a horse with midline incisional hernia.Case: A 13-year-old castrated male Brasileiro de Hipismo horse, weighing 415 kg, practitioner of classic equestrian, presented an incisional hernia after 14 days from an exploratory laparotomy surgery realized to treat colic syndrome. After 6months, the patient was referred to a Veterinary Medicine Teaching Hospital for the correction of the defect in the abdominal wall. During palpation, the animal did not present local pain or other sign of inflammation, and the hernia measuredapproximately 20 cm in diameter. The animal was submitted to general anesthesia and placed in dorsal decubitus for thehernioplasty surgical procedure. An incision was made in cranial region of the midline, close to the xiphoid to introduce asingle port; the abdomen was inflated with CO2 gas (12 mmHg) and the operating table was tilted in order to displace theorgans cranially, facilitating the laparoscopic procedure. The abdomen was inspected and the presence of a single adherence could be observed, which was disrupted with endoscopic forceps. The mesh was introduced through the single port...(AU)