RESUMO
OBJECTIVES: To evaluate the safety and efficacy of catheter-directed hemorrhoidal embolization (CDHE) by microcoil embolization for rectal bleeding due to hemorrhoids classified as Goligher grade I-III. METHODS: Eighty patients (62.5% males) with a mean age of 48 ± 9 years were recruited prospectively. All patients had symptomatic bleeding hemorrhoids. All patients were classified according to Goligher classification: grade I (13.7%), grade II (71.1%), grade III (15%), and no grade IV were recruited in this study. In all cases, microcoils were used to embolize the superior rectal artery(SRA), and microspheres if recurrence of bleeding occurred. Follow-up evaluation (1, 3, 6, and 12 months) included clinical examination and anoscopy. A questionnaire was conducted to determine improvement regarding bleeding, quality of life before, and the degree of patient satisfaction of each participant. RESULTS: Technical success was achieved in 100% of the cases. Fifty-five (68.7%) participants had the absence of rectal bleeding after 12 months of embolization. VAS and QL improved 4 points and 1.5 respectively after embolization. A total of 25/80 (31.3%) had a recurrence in rectal bleeding. Seventeen (21.3%) patients underwent a second embolization, and four patients (5%) were treated with open hemorrhoidectomy. No major complications were observed. Sixteen participants had minor complications. Subjective post-treatment symptom and QL surveys showed significant differences from the baseline survey. Likewise, the degree of satisfaction in the telephone survey at 12 months revealed a high degree of patient satisfaction (8.3±1.1). CONCLUSIONS: The present study demonstrates that CDHE is a feasible, well-tolerated, ambulatory, anal sphincter-sparing procedure for the treatment of internal hemorrhoids. CLINICAL RELEVANCE STATEMENT: CDHE is a simple procedure, well tolerated and accepted by patients, that preserves the anal sphincter and presents few complications when metal devices or microspheres are used as embolic agents. KEY POINTS: ⢠The technical success rate of CDHE, defined as the closure of all the SRA in their distal segment, was achieved 100% of all patients. However, a second embolization treatment was required since 21.25% of the patients experienced rectal bleeding. ⢠Overall, CDHE's safety profile is acceptable. After the procedure and 1 year of follow-up, no significant complications were observed. ⢠Encouraging clinical outcomes have demonstrated CDHE in individuals with hemorrhoids and mild prolapse Goligher grades I-III with persistent rectal bleeding.
Assuntos
Hemorroidas , Masculino , Humanos , Adulto , Pessoa de Meia-Idade , Feminino , Hemorroidas/complicações , Hemorroidas/terapia , Canal Anal , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento , Tratamentos com Preservação do Órgão , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , CatéteresRESUMO
BACKGROUND: Breast hypertrophy can cause a variety of symptoms and affect lifestyle and quality of life. Breast reduction, being the most effective treatment, is sometimes difficult to establish as standard treatment in obese patients (difficulties to differentiate symptoms from macromastia or from obesity, higher rate of complications). AIM: To evaluate the effect of reduction mammaplasty (quality of life and symptoms) in obese patients comparing with non-obese. METHODS: This is a prospective study of patients undergoing reduction mammaplasty. Patients were allocated in non-obese (BMI < 29) and obese (BMI > 30). Demographic data, comorbidities, specific symptoms questionnaire, data from the surgical procedure, Spanish version of the Health-Related Quality of Life (SF-36) questionnaire, complications and sequels were recorded and collected before the operation and at 1 month and 1 year after. Chi-square, Fisher's exact t test, McNemar, Mann-Whitney U and Kruskal-Wallis tests were used for statistical analysis. RESULTS: One hundred twenty-one consecutive patients were operated on; 54 (44.6 %) obese and 67 (55.4 %) non-obese. The average age of patients was 40.7 (18-78), average volume of resected tissue was 1.784 g (401-5.790), and average hospital stay was 2.94 days (1-11). There were no differences between obese and normal BMI patients with regard to length of hospital stay, complications, sequels, or reoperations. Symptoms improved in both groups. Physical and mental components of the SF-36 improved at 1 year in both groups (p < 0.001). The mental health component improved at 1 month (p < 0.001) in both groups. CONCLUSIONS: Obese patients should be considered for reduction mammaplasty surgery in the same way as women of normal weight. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Assuntos
Mama/anormalidades , Hipertrofia/cirurgia , Mamoplastia , Qualidade de Vida , Adolescente , Adulto , Idoso , Mama/cirurgia , Feminino , Humanos , Hipertrofia/complicações , Hipertrofia/etiologia , Pessoa de Meia-Idade , Obesidade/complicações , Estudos Prospectivos , Resultado do Tratamento , Adulto JovemRESUMO
The laparoscopic adrenalectomy is considered as the procedure of choice for the treatment of adrenal hyperplasia and tumor lesions. However, some special situations may limit the use of this method due to the difficulty to locate the gland and perform the lesion excision. We analyze 2 patients of a left adrenal tumor, explaining how they have overcome the difficulties in both situations. The first case was a patient with a history of intra-abdominal surgery and the other patient suffered from severe obesity. We performed with the use of the gamma probe, and the 2 cases, was of great help to access and glandular localization. The help of gamma probe test was achieved in the surgical bed, that removal was complete. The use of the portable gamma probe facilitated the access to the left adrenal gland as well as conducting the glandular excision without delay, despite the difficulties due to the intra abdominal surgery caused by the previous surgery, and in the case of severe obesity.
Assuntos
Adrenalectomia/métodos , Compostos Radiofarmacêuticos , Adenoma/cirurgia , Neoplasias das Glândulas Suprarrenais/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The extirpation of Meckel's diverticulum (MD) via conventional or laparoscopic surgery is the definitive treatment. However, certain circumstances may modify or alter this situation and require the application of exceptional measures.We report a case under our observation who previously had an exploratory abdominal laparotomy for a suspected MD; however, the findings were negative. At that time, the diagnosis was established based on low-level gastrointestinal bleeding and isotopic tests that confirmed the existence of the diverticulum. Given the findings of gamma-graphic exploration and the previous negative surgical exploration, a decision was made to remove the lesion by laparoscopic radioguided surgery.The patient underwent bilateral laparoscopic radioguided surgery using a gamma radiation detection probe. The exploration of the abdominal cavity noted the existence of the diverticulum about 60 to 70â cm from the ileocecal valve. In this way, it was possible to proceed with the resection of the bowel loop and perform an intracorporeal anastomosis termino lateral. The postoperative course was uneventful, and the patient was discharged on the fifth postoperative day.We believe that the combination of radioguided surgery and single photon emission computed tomography/computed tomography could be useful for treating lesions in locations that are surgically difficult because of the characteristics of the lesion itself or the peculiarities of an individual patient.
Assuntos
Divertículo Ileal/cirurgia , Compostos Radiofarmacêuticos , Pertecnetato Tc 99m de Sódio , Adulto , Humanos , Doenças do Íleo/etiologia , Laparoscopia , Laparotomia/efeitos adversos , Masculino , Divertículo Ileal/diagnóstico por imagem , Cintilografia , Aderências Teciduais/etiologiaRESUMO
BACKGROUND: Research in computer vision and mobile robotics has developed a family of popular algorithms known as Visual Simultaneous Localization And Mapping (Visual SLAM). These algorithms can provide 3D models of body cavities using the images obtained from standard monocular endoscopes. The 3D models can be used to estimate hernia defect measurements during laparoscopic ventral hernia repair (LVHR). METHODS: We conducted a descriptive and comparative prospective study to analyze results from 15 patients who underwent LVHR. Three methods of measurement were used in each patient: two classical methods (needle and tape) and a new visual SLAM measurement (VSM) method. The major and minor axes of the ellipse-shaped hernia defect were measured. RESULTS: Both axes could be measured using the VSM method in all patients except one (93%). The tape method measured 63% of the axes, but was difficult to perform because of patient comorbidities and because of limited range of motion of the laparoscopic tools. The needle method obtained 73% of measurements, because of patient comorbidities. The tape method was the most accurate (accuracy up to 0.5 cm because of tape resolution). The needle method was relatively inaccurate, with a mean error of >3 cm. The VSM method was as accurate as the tape method. The mean time taken to perform measurements was 40 s for the VSM method (range 29-60 s), 169 s for the needle method (range 66-300 s), and 186 s for the tape method (range 110-322 s). CONCLUSIONS: The needle method is relatively inaccurate and invasive. The tape method is accurate, but is not easy to perform and is relatively time consuming. The VSM method is noninvasive and fast and is as accurate as the tape method.
Assuntos
Hérnia Ventral/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Cirurgia Assistida por Computador/métodos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Telas CirúrgicasRESUMO
Simultaneous localization and mapping (SLAM) methods provide real-time estimation of 3-D models from the sole input of a handheld camera, routinely in mobile robotics scenarios. Medical endoscopic sequences mimic a robotic scenario in which a handheld camera (monocular endoscope) moves along an unknown trajectory while observing an unknown cavity. However, the feasibility and accuracy of SLAM methods have not been extensively validated with human in vivo image sequences. In this work, we propose a monocular visual SLAM algorithm tailored to deal with medical image sequences in order to provide an up-to-scale 3-D map of the observed cavity and the endoscope trajectory at frame rate. The algorithm is validated over synthetic data and human in vivo sequences corresponding to 15 laparoscopic hernioplasties where accurate ground-truth distances are available. It can be concluded that the proposed procedure is: 1) noninvasive, because only a standard monocular endoscope and a surgical tool are used; 2) convenient, because only a hand-controlled exploratory motion is needed; 3) fast, because the algorithm provides the 3-D map and the trajectory in real time; 4) accurate, because it has been validated with respect to ground-truth; and 5) robust to inter-patient variability, because it has performed successfully over the validation sequences.
Assuntos
Endoscopia/métodos , Hérnia/patologia , Herniorrafia/métodos , Interpretação de Imagem Assistida por Computador/métodos , Reconhecimento Automatizado de Padrão/métodos , Cirurgia Assistida por Computador/métodos , Algoritmos , Humanos , Aumento da Imagem/métodos , Imageamento Tridimensional/métodos , Miniaturização , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Interface Usuário-Computador , Gravação em Vídeo/métodosRESUMO
INTRODUCTION: Minimally invasive surgical techniques have extended to all the fields of surgery. Breast surgery can also benefit from these concepts because of their special characteristics, reduction of aggressiveness, avoiding or hiding scars. The aim of our work is to introduce a new surgical approach for the resection of a large volume of breast parenchyma, including complete subcutaneous mastectomy and reconstruction using a pure muscular latissimus dorsi flap, with or without prosthetic material, through a minimal cutaneous incision. PATIENTS AND METHOD: Retrospective analysis of our series of 5 cases using our surgical technique which allows us to establish proper indications. We analyse the technical details, complications and results. RESULTS: Five patients were operated using this technique (1 giant hamartoma, 1 multicentred in situ carcinoma with Paget's disease, 1 multicentred infiltrating carcinoma and 2 malignant tumours arising in the external part of the breast). We performed oncological resections (2 partial resections and 3 complete subcutaneous mastectomies) including sentinel lymph node biopsy or total axillary lymphadenectomy. After a mean follow-up of 10 months no local relapses were found and the cosmetic results were excellent. CONCLUSIONS: Minimally invasive surgical techniques through a posterior axillary line vertical incision enable total or partial subcutaneous mastectomy and a breast reconstruction, using muscular flaps or prosthetic material, to be performed.