External pringle maneuver in laparoscopic liver resection: a safe, cheap and reproducible way to perform it / Manobra de pringle extracorpórea em ressecções hepáticas laparoscópicas: maneira segura, barata e reproduzível de realizá-la

ABSTRACT Background: Laparoscopic liver resection is performed worldwide. Hemorrhage is a major complication and bleeding control during hepatotomy is an important concern. Pringle maneuver remains the standard inflow occlusion technique. Aim: Describe an extracorporeal, efficient, fast, cheap and reproducible way to execute the Pringle maneuver in laparoscopic surgery, using a chest tube. Methods: From January 2014 to March 2020, our team performed 398 hepatectomies, 63 by laparoscopy. We systematically encircle the hepatoduodenal ligament and prepare a tourniquet to perform Pringle maneuver. In laparoscopy, we use a 24 Fr chest tube, which is inserted in the abdominal cavity through a small incision. We thread the cotton tape through the tube, pulling it out through the external end, outside the abdomen. To perform the tourniquet, we just need to push the tube as we hold the tape, clamping both with one forceps. Results: The 24 Fr chest tube is firm and works perfectly to occlude blood inflow as the cotton band is tightened. It has an internal diameter of 5,5 mm, sufficient for a laparoscopic grasper pass through it to catch the cotton band, and an external diameter of 8 mm, which allows to be inserted in the abdomen through a tiny incision. The cost of this tube and the cotton band is less than US$ 1. No complications related to the method were identified in our patients. Conclusions: The extracorporeal Pringle maneuver presented here is a safe, cheap and reproducible method, that can be used for bleeding control in laparoscopic liver surgery.

RESUMO Racional: Ressecções hepáticas laparoscópicas são realizadas em todo mundo. A hemorragia é complicação grave e o controle do sangramento durante a hepatotomia é preocupação importante. A manobra de Pringle continua sendo a técnica padrão de oclusão do influxo sanguíneo. Objetivo: Descrever uma maneira eficiente, rápida, barata e reproduzível de executar a manobra de Pringle extracorpórea, em operação laparoscópica, utilizando um dreno de tórax. Métodos: De janeiro/2014 a março/2020, realizamos 398 hepatectomias, 63 por laparoscopia. Nós sistematicamente laçamos o ligamento hepatoduodenal e preparamos um torniquete para a manobra de Pringle. Na laparoscopia, usamos um dreno de tórax 24 Fr, inserido na cavidade abdominal através de uma pequena incisão. Passamos a fita de algodão através do tubo, puxando-a pela extremidade externa, fora do abdome. Para apertar o torniquete, basta pressionar o tubo enquanto seguramos a fita, prendendo ambos com uma pinça. Resultados: O dreno de tórax 24 Fr é firme e funciona perfeitamente para ocluir influxo de sangue, à medida que apertamos o torniquete. Tem diâmetro interno de 5,5 mm, suficiente para passar uma pinça laparoscópica e puxar a fita de algodão, e um diâmetro externo de 8 mm, permitindo a inserção no abdome através de uma pequena incisão. O custo do tubo e fita é inferior a US$ 1, valor insignificante. Não foram identificadas complicações relacionadas ao método em nossos pacientes. Conclusões: A manobra extracorpórea de Pringle apresentada aqui é método seguro, barato e reproduzível, que pode ser utilizado para o controle do sangramento em hepatectomias laparoscópicas.

Extravasación intraabdominal de líquido posterior a artroscopía de cadera: Reporte de un caso / Intraabdominal fluid extravasation after hip arthroscopy: Case report

Intraabdominal fluid extravasation (IAFE) is a rare complication of hip arthroscopy which has a wide range of clinical presentations, from mild abdominal distention to abdominal compartment syndrome and cardiorespiratory arrest. There are few detailed reports of cases in literature, therefore, considering risk factors, high pathological suspicion and training in ultrasound are key points to prevent complications and health costs. In this report, the case of a 29 year old male patient with severe abdominal pain during the immediate postoperative period of an arthroscopic hip surgery is presented, which led to a review of the literature on the subject.

La extravasación intraabdominal de líquido es una complicación poco frecuente de la artroscopia de cadera que presenta un amplio rango de manifestaciones clínicas, desde leve distensión abdominal hasta síndrome compartimental y paro cardiorrespiratorio. Hay escasos reportes de casos en la literatura, por lo que la alta sospecha considerando factores de riesgo y el ultrasonido son claves para prevenir sus complicaciones y costos asociados. En este reporte, se presenta el caso de un paciente masculino de 29 años con dolor abdominal intenso durante el postoperatorio inmediato de una artroscopia de cadera, lo que llevó a una revisión de la literatura sobre el tema.

Computed tomographic anatomy of the abdominal region of cat

The purpose of this study was to identify the anatomic structures of the abdominal region of cat through computed tomography [CT] to be used by veterinary radiologists, clinicians and surgeons. The abdominal region of four cats were scanned twice, with and without using contrast medium in a same position, using high-resolution imaging protocol. Slice intervals were 11 mm and were adjusted so that each vertebra was sectioned at least once. CT cuts taken with and without contrast were compared for accurate identification of specific anatomic structures. Two animals were fixed by routine anatomical method and dissected for use as reference models. Finally, important structures and landmarks were identified and labeled on the CT images