RESUMEN
BACKGROUND: Laparoscopic surgery changed the management of numerous surgical conditions. It was associated with many advantages over open surgery, such as decreased postoperative pain, faster recovery, shorter hospital stay and excellent cosmesis. Since two decades single-incision endoscopic surgery (SIES) was introduced to the surgical community. SIES could possibly result in even better postoperative outcomes than multi-port laparoscopic surgery, especially concerning cosmetic outcomes and pain. However, the single-incision surgical procedure is associated with quite some challenges. METHODS: An expert panel of surgeons has been selected and invited to participate in the preparation of the material for a consensus meeting on the topic SIES, which was held during the EAES congress in Frankfurt, June 16, 2017. The material presented during the consensus meeting was based on evidence identified through a systematic search of literature according to a pre-specified protocol. Three main topics with respect to SIES have been identified by the panel: (1) General, (2) Organ specific, (3) New development. Within each of these topics, subcategories have been defined. Evidence was graded according to the Oxford 2011 Levels of Evidence. Recommendations were made according to the GRADE criteria. RESULTS: In general, there is a lack of high level evidence and a lack of long-term follow-up in the field of single-incision endoscopic surgery. In selected patients, the single-incision approach seems to be safe and effective in terms of perioperative morbidity. Satisfaction with cosmesis has been established to be the main advantage of the single-incision approach. Less pain after single-incision approach compared to conventional laparoscopy seems to be considered an advantage, although it has not been consistently demonstrated across studies. CONCLUSIONS: Considering the increased direct costs (devices, instruments and operating time) of the SIES procedure and the prolonged learning curve, wider acceptance of the procedure should be supported only after demonstration of clear benefits.
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Endoscopía/métodos , Apendicectomía/métodos , Colecistectomía Laparoscópica , Colectomía/métodos , Endoscopía/educación , Endoscopía/instrumentación , Humanos , Curva de Aprendizaje , Tempo Operativo , Procedimientos Quirúrgicos Robotizados/métodosRESUMEN
BACKGROUND: It is not yet clearly known whether laparoscopic ventral hernia repair (LVHR) is superior to the open approach in recurrent hernias. The aim of this study is to determine the safety and efficacy of laparoscopic technique for ventral hernias and investigate whether these outcomes are affected by the number of previous failed repairs. METHODS: Data from 124 consecutive patients who underwent LVHR using a standardized technique between September 2007 and June 2014 were collected prospectively. In all repairs, a composite prosthesis was tailored to overlap the defect by at least 5 cm and fixed with a double crown of spiral tacks. Clinical follow-up visits were performed at 1 week, 1, 6, and 12 months, and yearly thereafter. Patients were classified in 3 groups (0, 1, and ≥ 2) according to the number of previous hernia repairs for further statistical analysis. RESULTS: Long-term surveillance was available in 116 (93%) patients. Of these, 96 (82.8%) were recurrent hernias. There were 2 (1.7%) conversions, both in recurrent cases, and in 3 (2.6%) patients a hybrid access was used. Mean operating time was 55 min. There was an overall postoperative complication rate of 16%, with no mortality. During a mean follow-up of 30 (range 20-90) months, 3 (2.6%) recurrences were diagnosed 6, 8, and 9 months after surgery, respectively. A univariate analysis related to demographic, clinical, and perioperative variables did not find any significant relationship between the number of previous recurrences and operating time, conversion rate, hospital length of stay, overall morbidity, or recurrence. CONCLUSIONS: This study suggests that laparoscopic approach in recurrent incisional hernias is a safe and feasible alternative to open techniques. Furthermore, our experience supports the idea that LVHR may be the best option for recurrent cases in properly selected patients, independently of the number of previous recurrences.
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Hernia Ventral/cirugía , Herniorrafia/métodos , Laparoscopía/métodos , Adulto , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Herniorrafia/efectos adversos , Humanos , Laparoscopía/efectos adversos , Masculino , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Recurrencia , Mallas Quirúrgicas/efectos adversos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Recently, there has been speculation about the possibility of fusing intestinal tissue using bipolar sealing devices. In this study we compare in a porcine model the anastomoses created using the LigaSure(®) device with those created with a stapler after section and closure of a rectal stump. METHODS: Thirty pigs underwent laparoscopic colorectal anastomosis. In group A (n = 15), the division of the intestine and distal stump closure were done with a 10-mm LigaSure Atlas(®) device. In group B, these steps were carried out using an endoscopic stapler. Subsequently, the colorectal anastomosis was performed using circular stapling in both groups. The 4-week follow-up included health status, weight gain, blood tests, X-rays, and colonoscopy. Anastomotic tissue was processed to study the mechanical tensile strength and histopathology. RESULTS: There was no difference in the rate of conversion to open surgery or in average operating time between the groups. In the sealing device group, there was a significantly higher rate of failure in rectal stump closure (p = 0.042). There was one death in group B due to anastomotic leak. There was no difference in adhesion formation or stenosis. Mid-section anastomosis area was 89.7 mm(2) in group A compared with 100 mm(2) in group B (p = 0.52). In tensile strength studies, the maximum load resisted by the sample was 13.8 ± 4.9 N (group A) versus 15.7 ± 4.4 N (group B) (p = 0.17). There was no difference between the groups in degree of reepithelialization, number of inflammatory cells, or the presence of microabscesses. CONCLUSIONS: Division and sealing of the rectal stump with the LigaSure(®) device is feasible in the proposed experimental model, but it is less reliable than conventional closure with a stapler, since it has a significantly greater failure rate. Therefore, The LigaSure(®) device should not be used for this purpose in the clinical setting as this could lead to serious and dramatic complications.
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Colon/cirugía , Laparoscopía/métodos , Recto/cirugía , Técnicas de Sutura/instrumentación , Anastomosis Quirúrgica/instrumentación , Fuga Anastomótica/prevención & control , Animales , Enfermedades del Colon/cirugía , Modelos Animales de Enfermedad , Diseño de Equipo , Femenino , PorcinosRESUMEN
BACKGROUND: Single incision laparoscopic appendectomy (SILA) has been proposed as an alternative to conventional laparoscopic appendectomy (CLA). OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of SILA when compared with CLA through a systematic review. METHODS: We performed an electronic search of EMBASE, PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) that compared SILA with CLA were included. RESULTS: Six RCTs met eligibility criteria, which included a total of 800 patients, 401 in the SILA group and 399 in the CLA group. There were no significant differences in terms of overall complications (odds ratio [OR] 0.93; 95% confidence interval [CI] 0.59-1.47; p = 0.77). SILA had a higher technical failure rate (OR 3.30; 95% CI 1.26-8.65; p = 0.01) and required a longer operative time (mean difference [MD] 4.67; 95% CI 1.76-7.57; p = 0.002). SILA was associated with better cosmetic results (standardized MD -0.4; 95% CI -0.64 to -0.16; p = 0.001) and earlier return to normal activity (MD -0.64; 95% CI -1.09 to -0.20; p = 0.005), although these advantages should be taken with caution due to the small number of studies reporting these two items and the short follow-up in the evaluation of cosmetic results. There were no significant differences in terms of postoperative pain or length of hospital stay between groups. CONCLUSIONS: SILA is comparable to CLA in selected patients, although it is associated with a higher technical failure rate and longer operative time. Further randomized trials are needed to determine if SILA really offers benefits over CLA.
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Apendicectomía/métodos , Laparoscopía/métodos , Humanos , Tiempo de Internación , Tempo Operativo , Dolor Postoperatorio/epidemiología , Complicaciones Posoperatorias/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
INTRODUCTION: Laparoscopic surgery through a single incision is an innovative concept which is a challenge for surgeons to implement and develop. The interest aroused by these techniques in Spain led to the Endoscopy Section of the Spanish Association of Surgeons (AEC) to start a National Register for Single-Incision Surgery (RNCIU). The aim of this study was to collect the primary clinical data, techniques, and the possible complications of these techniques in Spain. MATERIAL AND METHODS: Data were gathered using a form available on the AEC website. The forms included in this study correspond to those received between June 2010 and June 2011. RESULTS: A total of 35 centers had taken part during the study period, with 1,198 forms being collected. The surgeries performed included 62.2% cholecystectomies, 22% appendectomies, and 7.8% colectomies. Procedures on solid organs (3.4%), bariatric surgery (2.7%), and various hernia repairs (1.9%), were also registered. The overall incidence of complications was 0.8%. The mortality rate in the series was 0.1%. CONCLUSIONS: Single incision laparoscopic surgery is a novel concept that is not beyond our scientific community. The results of the Register demonstrate the feasibility of numerous effective and safe procedures. Finally, the RNCIU is an important data source to be able to study sub-groups of diseases in detail, with the aim of advancing the knowledge of these techniques and generating scientific evidence.
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Laparoscopía/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Laparoscopía/efectos adversos , Masculino , Persona de Mediana Edad , Registros , Sistema de Registros , España , Adulto JovenRESUMEN
Background: During transanal total mesorectal excision (TaTME), sustained dilation of the anal canal occurs, which can cause anatomical and functional damage to the sphincter complex. This study aimed to analyze the impact of laparoscopic total mesorectal excision (LaTME) and TaTME in anorectal sphincter function. Materials and Methods: An observational study was conducted comparing two cohorts of patients who underwent LaTME or TaTME for rectal cancer. The two groups were paired for comparison based on age, gender, and distance of the neoplasm to the anal margin. The anorectal function was assessed by manometry before surgery and at least 6 months after primary intervention or stoma closure. The intestinal function was assessed using the low anterior resection syndrome (LARS) score. Results: Twenty-two patients were included. There were no significant differences in baseline characteristics between groups except for the time between surgery and testing. A decrease in the mean resting and squeeze pressures between pre- and postoperative manometry was observed in both the treatment groups, the difference being only significant in the squeeze pressure values (TaTME P = .003; LaTME P = .004). After surgery, squeeze pressure reduction correlated with a worsening of the LARS point count (rho 0.587; P = .004). The time elapsed since surgery was negatively correlated with the LARS point count (rho -0.696; P = .001) and the difference between pre- and postoperative mean squeeze pressures (rho -0.499; P = .018). Conclusion: Manometric findings after TME are comparable between the laparoscopic and the transanal approach. Deterioration of both anal sphincter function and LARS improves with time after surgery.
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Canal Anal/cirugía , Complicaciones Posoperatorias/cirugía , Neoplasias del Recto/cirugía , Recto/cirugía , Cirugía Endoscópica Transanal , Adulto , Anciano , Defecación , Femenino , Humanos , Laparoscopía , Masculino , Manometría , Persona de Mediana Edad , Periodo Posoperatorio , Proctectomía , Síndrome , Resultado del TratamientoRESUMEN
One of the aims of the new technologies and techniques in minimally invasive surgery (MIS) is to achieve a surgery without or with minimal visible scars. Natural orifice transluminal endoscopic surgery (NOTES) might be considered to be a paradigm of this development but it has not yet been possible to implement this universally. Nevertheless, the resultant innovation of research into NOTES has enabled "bridge technologies" to be introduced that allow MIS to be developed with the required standards of efficiency and safety. The aim of this paper is to review the concept of single incision surgery and to classify the available tools for its development and implementation.
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Laparoscopía/métodos , HumanosRESUMEN
COVID-19 has spread worldwide, with more than 2.5 million cases and over 80,000 deaths reported by the end of April 2020. In addition to pulmonary symptoms, gastrointestinal symptoms have been increasingly recognized as part of the disease spectrum. COVID-19-associated coagulopathy has recently emerged as a major component of the disease, leading to high morbidity and mortality. Ischemic colitis has been reported to be associated with a hypercoagulable state, However few cases have been reported of COVID-19 associated with ischemic colitis. We would like to report a case of a 53 year old man with medical history of type 2 diabetes, and hypercholesterolemia, with ishchemic colitis as first manifestation of infection of COVID 19.
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Betacoronavirus , Colitis Isquémica/diagnóstico , Infecciones por Coronavirus/complicaciones , Diabetes Mellitus Tipo 2 , Hipercolesterolemia , Neumonía Viral/complicaciones , COVID-19 , Colitis Isquémica/complicaciones , Colitis Isquémica/diagnóstico por imagen , Colitis Isquémica/cirugía , Diagnóstico Diferencial , Humanos , Ileostomía , Masculino , Persona de Mediana Edad , Pandemias , SARS-CoV-2 , Tomografía Computarizada por Rayos XRESUMEN
Introduction: Abdominal wall complications are one of the most controversial issues regarding single-incision endoscopic surgery. The aim of this study was to analyze the incidence and risk factors of incisional hernia after single-incision endoscopic cholecystectomy. Materials and Methods: An observational retrospective study was performed, on a cohort of patients cholecystectomized laparoscopically through a transumbilical single incision due to gallbladder lithiasis or polyps. Postoperative complications were analyzed, with special interest in the incisional hernia rate, whose results were assessed in the long-term follow-up. Univariate and multivariate analyses were also performed to evaluate possible variables associated with the appearance of incisional hernia. Cumulative sum charts (CUSUM) were used to identify trends in the incisional hernia risk. Results: Some 109 patients were included in the study. With a mean follow-up of nearly 38 months, an incisional hernia incidence of 5.5% was found, with 67% being diagnosed during the first year of follow-up. In the Cox regression analysis, two variables showed an independent association with the emergence of incisional hernia, body mass index (hazard ratio [HR] 1.30; 95% confidence interval [CI 1.053-1.606]; P .015), and wound infection (HR 26.32; [3.186-217.40]; P .002]. CUSUM charts showed a decrease in the risk of incisional hernia after the first 10 cases. Conclusions: Single-incision endoscopic cholecystectomy is associated with a substantially high risk of postoperative incisional hernia (5.5%).
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Colecistectomía Laparoscópica/efectos adversos , Hernia Incisional/etiología , Infección de la Herida Quirúrgica/complicaciones , Herida Quirúrgica/complicaciones , Pared Abdominal/cirugía , Adulto , Anciano , Índice de Masa Corporal , Colecistectomía Laparoscópica/métodos , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Hernia Incisional/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Ombligo/cirugíaRESUMEN
BACKGROUND: Oxytocin is the most widely used drug in the induction of labor, but it could have potential adverse effects that derive from uterine hyperstimulation. AIM: To determine the benefits and drawbacks of oxytocin continuation versus oxytocin discontinuation after the active phase of induced labor. METHODS: We systematically searched Pubmed, EMBASE, Scopus, ClinicalTrials.gov and Cochrane Library Plus until October 2017, for randomized controlled trials comparing oxytocin continuation with oxytocin discontinuation when the active phase of labor is reached were included. Data was collected by three reviewers and quality of the included studies assessed using the methodology recommended in the Cochrane Handbook. StatsDirect software was used to calculate risk ratios for binary variables and weighted mean differences for continuous variables. A fixed-effects or random-effects model was used as appropriate. RESULTS: Nine studies were selected including 1538 women, 774 in the oxytocin continuation group and 764 in the oxytocin discontinuation group. The incidence of cesarean sections (14.3% vs. 8.6%; relative risk, 1.67; 95% confidence interval: 1.25-2.23), uterine hyperstimulation (12.4% vs. 4.7%; relative risk, 2.59; 95% confidence interval: 1.70-3.93) and nonreassuring fetal heart rate (19.2% vs.12.5%; relative risk, 1.55; 95% confidence interval: 1.18-2.02) were significantly higher in the oxytocin continuation group. An increase in the duration of the second stage of labor in the oxytocin discontinuation group was observed (pooled mean difference, -7.03; 95% confidence interval: -9.80 to -4.26). CONCLUSIONS: After the active phase of induced labor, oxytocin continuation increases the risk of cesarean section, uterine hyperstimulation and alterations to the fetal heart rate.
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Trabajo de Parto Inducido/métodos , Oxitócicos/administración & dosificación , Oxitocina/administración & dosificación , Cesárea , Femenino , Frecuencia Cardíaca Fetal , Humanos , Inicio del Trabajo de Parto/efectos de los fármacos , Trabajo de Parto/efectos de los fármacos , Embarazo , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
INTRODUCTION: The use and utility of social media (SM) among Spanish general surgeons is unknown. METHODS: Between October and December 2017 an online survey was carried out to the members of the Spanish Association of Surgeons, in which data on the profile of use and opinion on the usefulness of SM were collected. RESULTS: 360 valid responses were obtained, 310 from surgeons who had an active SM profile. The most popular networks were: Facebook (86%), LinkedIn (61,6%), YouTube (60,6%) and Twitter (54,2%). LinkedIn and Twitter stood out as the most used SM for professional purposes. Surgeons with a SM profile were younger (42.4±11 years versus 51.6±8 years; P<.001). Gender did not show influence on presence in SM. The majority of respondents have profiles in more than one network (3.6±1 accounts) and 73.5% reported daily access to them; 19.7% of the surgery departments to which the respondents belong have a SM account. Among SM utilities in the professional field, training activities (87%) and connectivity among professionals (84%) were the most outstanding; 14.1% of respondents use SM to interact with patients. CONCLUSIONS: SM is useful as a tool for the acquisition, updating and dissemination of scientific knowledge, also proving valuable as a new form of interaction among surgeons. Other issues such as privacy or surgeon-patient relationship represent a barrier to its use.
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Cirugía General , Red Social , Cirujanos/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Autoinforme , Sociedades Médicas , EspañaRESUMEN
BACKGROUND: Single-incision laparoscopic surgery has sparked a great deal of interest in the surgical community in recent years, including bariatric surgery. However, we still do not definitively know if this type of surgical approach provides benefits over conventional techniques without increasing morbidity and mortality. OBJECTIVE: To evaluate the safety and efficacy of single-incision laparoscopic bariatric surgery (SILBS) compared with conventional laparoscopic bariatric surgery (CLBS). MATERIALS AND METHODS: We searched the most important databases. Randomized clinical trials and observational studies comparing SILBS with CLBS were included. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. RESULTS: Fourteen studies complied with the inclusion criteria for our analysis, which included 2357 patients (1179 SILBS group versus 1178 CLBS group). The duration of surgery was longer in the SILBS group and no major intraoperative complications were observed in these series. A small improvement in postoperative pain was indicated in the SILBS group. The overall morbidity rate was 5% in the SILBS group and 4.8% in the CLBS. There was 1 perioperative death in 1 study, which occurred in an adjustable gastric banding (AGB) group, at .1% of all cases of AGB and .005% of all SILBS cases. When cosmesis was evaluated, patients in the SILBS group were more satisfied with the scar outcome. CONCLUSION: SILBS is a feasible technique to use in selected patients. However, there is insufficient evidence to recommend its widespread use compared with a conventional approach. More studies are needed to analyze the safety of this technique and its possible benefits.
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Cirugía Bariátrica/métodos , Laparoscopía/métodos , Estética , Humanos , Tempo Operativo , Dolor Postoperatorio/prevención & controlRESUMEN
BACKGROUND: The aim of this systematic review was to compare postoperative outcomes between pancreaticogastrostomy and pancreaticojejunostomy after pancreaticoduodenectomy. METHODS: Six databases were systematically reviewed to identify randomized controlled trials comparing pancreaticogastrostomy and pancreaticojejunostomy. Studies reporting postoperative complications, reoperations, and mortality were included (PROSPERO registration number CRD42013005383). RESULTS: The search provided a total of 1,646 references. Seven studies were selected including 1,121 patients, 562 in the pancreaticogastrostomy group and 559 in the pancreaticojejunostomy group. Overall incidence of pancreatic fistula and the incidence of more severe fistulas (grade B/C) were lower in the pancreaticogastrostomy group (relative risk 0.67; 95% confidence interval (CI) 0.52 to 0.86; p = 0.002 and relative risk 0.61; 95 % CI 0.40 to 0.93; p = 0.02). Abdominal collections were more frequent in the pancreaticojejunostomy group. However, pancreaticogastrostomy was associated with an increased risk of postoperative intraluminal hemorrhage, and there were no differences in overall morbidity, reoperations, or mortality. CONCLUSIONS: In this systematic review and meta-analysis, a reduction in the incidence of postoperative pancreatic fistula in the pancreaticogastrostomy group was observed. Although this evidence comes from randomized trials, pancreaticogastrostomy cannot be considered superior to pancreaticojejunostomy due to the presence of clinical heterogeneity among studies and the absence of differences in overall morbidity, reoperations, and mortality.
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Conductos Pancreáticos/cirugía , Fístula Pancreática/epidemiología , Pancreaticoduodenectomía , Pancreatoyeyunostomía , Hemorragia Posoperatoria/epidemiología , Estómago/cirugía , Humanos , Incidencia , Tiempo de Internación , Pancreaticoduodenectomía/mortalidad , Pancreatoyeyunostomía/mortalidad , Readmisión del Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto , ReoperaciónAsunto(s)
Hernia Incisional/epidemiología , Laparoscopía/efectos adversos , Complicaciones Posoperatorias/epidemiología , Instrumentos Quirúrgicos/efectos adversos , Humanos , Incidencia , Hernia Incisional/etiología , Laparoscopía/instrumentación , Laparoscopía/métodos , Complicaciones Posoperatorias/etiologíaAsunto(s)
Enfermedades del Colon/diagnóstico por imagen , Enfermedades del Íleon/diagnóstico por imagen , Intususcepción/diagnóstico por imagen , Enfermedades del Colon/etiología , Enfermedades del Colon/cirugía , Humanos , Enfermedades del Íleon/etiología , Enfermedades del Íleon/cirugía , Intususcepción/etiología , Intususcepción/cirugía , Masculino , Divertículo Ileal/complicaciones , Divertículo Ileal/diagnóstico por imagen , Divertículo Ileal/cirugía , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
BACKGROUND: The components separation technique has been proposed as the best solution when facing large abdominal wall defects. In counterpart, this sometimes comes at the price of high rates of wound complications and recurrence. Moreover, the components separation method alone seems insufficient for huge defects, in which it is impossible to reapproximate the rectus muscles without tension. For these cases, we illustrate a novel operation using a modified components separation technique. METHODS: Twenty-eight patients with giant midline incisional hernias were treated with a combination of the components separation (bilateral sliding rectus abdominis advancement flaps), an autologous multilayer repair, and a retromuscular mesh reinforcement. RESULTS: Twenty-four (85%) patients have been analyzed. Transverse defect size ranged from 15 to 25 cm (average, 18.8 cm). Wound complications occurred in nine (37%) cases; three of them required drainage of a subcutaneous abscess. After a mean follow-up of 22 (range, 12-48) months, one (4%) recurrence was identified. CONCLUSIONS: Multilayer myofascial-mesh repair was associated with a low recurrence rate, and wound complications were managed without issues. This approach is a reliable technique for most surgeons and may constitute a new part of the armamentarium for the repair of challenging defects.
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Fasciotomía , Hernia Ventral/cirugía , Herniorrafia/métodos , Recto del Abdomen/cirugía , Colgajos Quirúrgicos , Mallas Quirúrgicas , Anciano , Femenino , Estudios de Seguimiento , Herniorrafia/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/prevención & control , Resultado del TratamientoRESUMEN
BACKGROUND: Ergonomic issues are frequently reported by surgeons performing laparoendoscopic single-site (LESS) surgery. However, few studies have analysed this issue. METHODS: We used a web format survey to evaluate the opinion of surgeons with experience in this laparoscopic technique. This survey collected demographic information, surgical experience, physical and psychological symptoms, and technical problems related to this type of surgery. RESULTS: Some 78 surgeons filled out the questionnaire. All participants had clinical experience in this type of laparoscopic approach, and 68 % had performed more than 30 procedures. Two or more musculoskeletal symptoms were reported during or after performing LESS surgery by 81 % of all surgeons. Surgeons with more experience in this approach reported fewer symptoms and technical difficulties. CONCLUSIONS: LESS surgery is accompanied by musculoskeletal problems and technical difficulties for surgeons. Technological advancements and greater surgical experience in the technique will alleviate these issues. More in-depth ergonomic studies are needed.
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Competencia Clínica , Endoscopía Gastrointestinal/métodos , Laparoscopía/métodos , Dolor Musculoesquelético/epidemiología , Salud Laboral , Adulto , Actitud del Personal de Salud , Ergonomía , Femenino , Cirugía General , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: Laparoscopic surgery requires a different set of skills than conventional surgery. The aim of this study was to evaluate the usefulness of a low-cost simulator and camera for the acquisition of basic laparoscopic skills. MATERIAL AND METHODS: This randomised trial involved 48 subjects (32 students and 16 surgeons). Two exercises were used, object transfer and cutting. Students were divided into two groups (n=8). One group performed the exercises in the operating theatre with the conventional laparoscopic camera. The second group performed the exercises in a classroom with a low cost micro-camera. Both groups were evaluated before and after five training sessions. Two groups of students were used as controls (n=8), and were evaluated two times without training. The surgeons were divided in two groups (n=8), one was evaluated in the theatre and the other one in the classroom. RESULTS: The trained groups showed significant improvements in the first exercise (P <0.001) compared with non-trained groups. There were no differences in scores between the groups with different cameras. The surgeons had better scores than students (P <0.001). CONCLUSIONS: The improvements in laparoscopic skills on this simulator with a low-cost camera were not significantly different from those gained using the simulator with the conventional laparoscopic camera. This simulator was able to differentiate between experienced and inexperienced subjects.
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Educación Médica/economía , Educación Médica/métodos , Laparoscopía , Modelos Anatómicos , Adulto , Costos y Análisis de Costo , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/economía , Procedimientos Quirúrgicos Mínimamente Invasivos/educación , Estudios Prospectivos , Adulto JovenRESUMEN
AIM: The continual advances in our knowledge of the pathogenesis and hormonal disorders of morbid obesity lead to new studies in experimental animals and the development of new technical options. The aim is to asses whether ileal transposition can be a good treatment of morbid obesity associated with diabetes mellitus due to the action of intestinal peptide Glp-1 (enteroglucagon) compared to gastric bypass and vertical gastroplasty (VGB). MATERIAL AND METHODS: Trial environment: experimental animals ZDF rats (Zucker Diabetic Fatty rats). Subjects of the study: three groups of 10 animals each one divided as: a) ileal tranposition; b) gastro-jejunal bypass; c) vertical gastroplasty. Parameters to determine: weight loss, levels of glycaemia, enteroglucagon, insulin and ghrelin in blood, one week before the operation as a baseline control, and 15 days after the surgical procedure. RESULTS: Gastrojejunal bypass produces the most significant weight loss. There is a significant decrease in intake in all groups. Hyperinsulinaemia and hyperglycaemia tend to decrease after surgery in all groups, but in ileal transposition there is better control of ketosis. After gastrojejunal bypass and ileal transposition, we observed an increase in GLP-1 levels but were only significant in ileal transposition. CONCLUSIONS: Ileal transposition produces a decrease in plasma glucose and better control of diabetes mellitus, which could benefit patients affected by morbid obesity and poor metabolic control. More studies are needed on other models of obesity. A model of exogenous and reversible obesity could be a good option to study the real benefits of the interventions.