Epidemiological insights into thoracic and lumbar sympathectomies in Brazil: a comparative analysis of open versus video-assisted procedures

Purpose: To investigate the profile of hospital admissions for sympathectomies performed in the Brazilian Unified Health System (SUS), comparing open and video-assisted techniques. Methods: Data on sympathectomies were collected from the SUS Department of Informatics (DATASUS), recorded between 2014 and 2023. The data were tabulated, and descriptive statistics and correlation analyses were performed. Results: There was reduction in the number of admissions for all sympathectomies during the analyzed period. The use of video-assisted surgeries was higher than that of open surgeries for thoracic procedures, but lower for lumbar procedures. The costs of hospital admission for the procedures were similar, although the length of stay and mortality associated with open surgeries were higher, both in thoracic and lumbar sympathectomies. Conclusions: The collected data were not individualized, preventing follow-up. Additionally, the study did not account for procedures performed in the private healthcare system. Despite its limitations, this study provides an overview of sympathectomies in Brazil, indicating that, although open sympathectomies are potentially more disadvantageous, they are still widely performed, especially for lumbar procedures.

Resección videoasistida transumbilical de duplicación intestinal tipo tubular no comunicante / Videoasisted transumbilical resction of non communicating tubular intestinal duplication

Las duplicaciones intestinales constituyen malformaciones quísticas o tubulares, que pueden aparecer en proximidad en todo el tubo digestivo. El abordaje videoasistido transumbilical combina las ventajas conocidas de la cirugía mínima invasiva convencional con el ahorro de tiempo y costo de material de la cirugía abierta. Se reporta el caso de pre- escolar masculino de 4 años de edad quien presentó varios episodios de dolor abdominal difuso acompañado de vómitos e hiporexia de 4 meses de evolución. Los estudios de imagen revelaron lesión de ocupación de espacio quística en hemiabdomen inferior derecho. Se realizó laparoscopia diagnóstica más resección transumbilical de lesión sacular del borde mesentérico del íleon, a 60 cm de la válvula ileocecal, así como anastomosis ileoileal termino-terminal. El paciente egresó al quinto día post-operatorio en óptimas condiciones. La biopsia reportó duplicación intestinal tipo tubular no comunicante. Concluimos que este abordaje es factible y ventajoso en el paciente pediátrico(AU)

Intestinal duplications are cystic or tubular malformations, which can appear in proximity to the entire digestive tract. The transumbilical video-assisted approach combines the known advantages of conventional minimally invasive surgery with the savings in time and material cost of open surgery. The case of a 4-year-old male preschooler who presented several episodes of diffuse abdominal pain accompanied by vomiting and hyporexia of 4 months of evolution is reported. Imaging studies revealed cystic space-occupying lesion in the lower right abdomen. Diagnostic laparoscopy plus transumbilical resection of a saccular lesion located on the mesenteric edge of the ileum, nearly 60 cm from the ileocecal valve, and a two layer end-to-end ileo-ileal anastomosis was performed. The patient was discharged on the fifth postoperative day in optimal conditions. The biopsy reported noncommunicating tubular type intestinal duplication. We conclude that this approach is feasible and advantageous in the pediatric patient(AU)

Intervenciones quirúrgicas mínimamente invasivas complementarias a la ortodoncia quirúrgicamente asistida: Resumen estructurado de evidencia / Minimally Invasive Surgical Interventions Complementary to surgically assisted orthodontics: Structured summary of evidence

Introducción: Existen procedimientos quirúrgicos que pueden generar una disminución en la duración de los tratamientos de ortodoncia (TO) mediante una aceleración del movimiento dental. La técnica más estudiada corresponde a la corticotomía clásica, la cual muchas veces es desechada por los pacientes debido a su invasividad. Es por esto que nacen las intervenciones quirúrgicas mínimamente invasivas (IQMI), tales como las micro osteoperforaciones (MOP) y la piezocisión, que buscan el mismo resultado, pero sin realizar colgajos de espesor total, otorgándole al paciente nuevas alternativas terapéuticas para acortar el tratamiento de ortodoncia. La evidencia al respecto aún es controversial, debido a que la certeza de la evidencia es baja o muy baja con relación a estos procedimientos. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metaanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos 39 revisiones sistemáticas que en conjunto incluyeron 43 estudios primarios, de los cuales, 31 corresponden a ensayos aleatorizados. Concluimos que las intervenciones quirúrgicas mínimamente invasivas podrían aumentar la tasa de movimiento dental a las 12 semanas, la distancia total acumulada, la tasa de movimiento dental y reducir la duración total de tratamiento, pero la certeza de la evidencia es incierta. Además, podrían resultar en poca o ninguna diferencia sobre el índice gingival, la profundidad de sondaje y el índice de placa.

Introduction: There are surgical procedures that can generate a decrease in the orthodontic (OT) treatments duration through a Acceleration of tooth movement. The most studied technique corresponds to classical corticotomy, which is often discarded by patients due to its invasiveness. This is why minimally invasive surgical interventions (MISI) are born, such as micro osteoperforations (MOP) and piezocision, which seek the same result, but without making total thickness flaps, giving the patient new therapeutic alternatives to shorten orthodontic treatment. The evidence on this is still controversial, because the certainty of the evidence is low or very low in relation to these procedures. Methods: A search was performed using Epistemonikos, the biggest database for systematic reviews in health, which is maintained by screening of multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. Data from systematic reviews were extracted, and analysis of the primary studies was performed, including a meta-analysis and a summary of findings table using GRADE approach. Results and conclusions: We identified 39 systematic reviews that together included 43 primary studies, of which 31 correspond to randomized clinical trials. We conclude that minimally invasive surgical interventions could increase the rate of tooth movement at 12 weeks, distance total accumulated, the rate of tooth movement and reduce the total duration of treatment, but the certainty of the evidence is uncertain. In addition, they could result in little or no difference in gingival index, probing depth and plaque index.

VAAFT PROCEDURE (Video-assisted Anal Fistula Treatment) versus open method in the treatment of high fistula in ano

Background: A common acquired anorectal condition is anal fistula. The treatment approaches that have been employed have been linked to erratic outcomes and sometimes life-threatening consequences. Video-assisted anal fistula treatment (VAAFT), a minimally invasive method, was introduced for adult patients in 2011. Objective: To know the efficacy of the VAAFT procedure in treating high anal fistulas and to compare it to open methods in the Basrah province. Methods: The present study was performed on 200 patients with high fistulas in ano in Basrah province. We divided the patients into 2 groups: Group A: treated by the VAAFT technique and Group B: treated by open fistulotomy Results: The patients treated with VAFFT revealed no occurrence of the following postoperative complication: Infection, incontinence, recurrence, anal stenosis, and bleeding. There was lower incidence of pain, short time for wound healing, rapid return to work, and more patient satisfaction compared with open fistulotomy Conclusion: An innovative method for managing ano fistula is VAAFT. Compared with traditional methods, it has a lot of benefits. It is day case surgeryno open wound.no damage to anal sphincter and no risk of incontinence, it is more affordable.it allow for clear identification of internal office, whole tract and its associated branches and cavity. The instrument can be used for multiple patients after good sterilization and disinfection. (AU)

Anatomical description of the extratemporal facial nerve under high-definition system: a microsurgical study in rats

Purpose: To describe the microsurgical anatomical aspects of the extratemporal facial nerve of Wistar rats under a high-definition video system. Methods: Ten male Wistar rats (12­15 weeks old), without veterinary diseases, weighing 220­280 g, were used in this study. All animals in this study were submitted to the same protocol and by the same surgeon. A 10-mm incision was made below the bony prominence of the right or left ear, and extended towards the angle of the mandible. The dissection was performed and the main branches of the facial nerve were dissected. Results: The main trunk of the facial nerve has a length of 0.88 ± 0.10 mm and a length of 3.81 ± 1.03 mm, measured from its emergence from the stylomastoid foramen to its bifurcation. Seven branches originating from the facial nerve were identified: posterior auricular, posterior cervical, cervical, mandibular, buccal, temporal, and zygomatic. Conclusions: The anatomy of the facial nerve is comparable to that of humans, with some variations. The most observed anatomical division was the distribution in posterior auricular, posterior cervical, cervical, mandibular, buccal, temporal, and zygomatic branches. There is no statistical difference between the thickness and distance of the structures compared to the contralateral side.

Videolaparoscopic prostatectomy in porcine model for training residents

ABSTRACT Introduction: Surgical training models prepare the resident for a more ethical surgical practice as well as providing a less steep learning curve. In urology, there are well-known models of pyeloplasty simulation, urethro-vesical anastomosis and nephrectomy, which have helped in the training of urology residents (1-3). Learning laparoscopic prostatectomy is a difficult surgery and requires advanced surgical skill from the surgeon (4), requires operate without a direct view of the surgical field in a two-dimensional space and with longer instruments (5). Laparoscopic prostatectomy step by step makes the surgeon's learning curve less difficult, lead to less intraoperative complications, such as blood loss, while also enabling shorter operative time and less positive surgical margins (6). The objective of surgical models is to simulate surgical procedures in a reliable way thus preparing the surgeon for his daily practice, surgical simulations in animal models have been described to compensate for inadequate clinical exposure (7). The canine model of prostate cancer has many similarities with humans. Despite trying to develop a model that is as credible as possible, there are ethical issues in several countries, such as Brazil, that do not allow the use of live dogs for scientific experimentation and there is a difficulty in not standardizing the animals used (8, 9). The swine surgical training model is widely known, accepted and used as a valuable tool in the teaching of new surgeons (10). The porcine video laparoscopic prostatectomy model allows the urologist in training to exercise the skills required in a real surgical situation, practicing them in a single session (10). We will present an experimental model in pigs for training urology residents in laparoscopic radical prostatectomy with current techniques (11-13). The limitations found are that the prostate has no limits as well defined as in humans, the urethra is long and coiled, the fat surrounding the pelvic organs is scarce and there is no postoperative follow-up for evaluating functionality after the procedure, as well as the effectiveness of the surgery with surgical margins. However, it is similar in surgical model presented, it is reproducible and can provide a realistic simulation environment to the beginner surgeon. Material and Methods: In this paper, according to the institutional protocol approved by the institutional ethics and research committee FMUSP n° 964/2017 and protocol was in accordance with current international regulations for the use of animals in Research: Reporting In Vivo Experiments (ARRIVE) guide. Ten male pigs weighing 20 to 22kg were used. The animals were anesthetized with a combination of Telazol (5mg/kg), Xylazine (1.5mg/kg), Cetamine (22mg/kg) and Atropine (0.04mg/kg) for orotracheal intubation followed by Isoflurane (2%). Animals were euthanized at the end of the procedure with a lethal dose of KCl (2mEq/kg). The trocar insertion points were marked using the epigastric vessels and umbilical region as reference points. Initially, urethral catheterization was performed using a hydrophilic Nitinol guidewire, followed by a perineal incision to dissect the tortuous urethra of the porcine model. A malleable urethral catheter 8Fr was inserted into their bladder. The animal was placed in the Trendelenburg position inserted and 12mm trocars were inserted in its umbilical region, utilizing 10mm in the surgeon's dominant hand, 5mm in his non-dominant hand of the surgeon, and 5mm in the first assistant's trocar. The surgeon replicates the steps performed in a laparoscopic radical prostatectomy in humans, including the bladder catheterization, dissection of the anterior bladder plane, the vesicular and prostatic dissection, the suture of the dorsal venous plexus, a prostatectomy, an urethral vesical anast omosis, as well as the waterproof test, even including the performing of surgical steps using current concepts of anterior urethral suspension as the reconstruction of the posterior plane of the rhabdosphincter. Results: All steps of surgery could be reproduced in all ten porcine cases. No significant bleeding was observed and the surgical time was gradually reduced fifty percent from case one to last cases. Conclusions: The porcine model allowed the surgeon to replicate all the steps usually performed in a laparoscopic radical prostatectomy. The junior surgeons are better prepared to such difficult surgery. However, further studies will be necessary to prove the impact of the animal model presented in urological clinical practice.

Cirugía torácica por puerto único. Experiencia inicial / Uniportal thoracic surgery. Initial Experience / Cirurgia torácica de portal único. Experiência inicial

Resumen: Introducción: La cirugía torácica videoasistida es hoy un procedimiento aceptado por ser seguro, factible y efectivo para el tratamiento de casi todas las enfermedades del tórax. En el 2010 se comienzan a publicar procedimientos complejos por un solo puerto, con una gran expansión a nivel mundial. Esta vía de abordaje es al menos equiparable a la multiportal en lo que concierne a resultados en el postoperatorio, o incluso mejor en lo referente a dolor, neuralgia intercostal y estadía hospitalaria. Realizamos un análisis retrospectivo de los procedimientos uniportales entre septiembre de 2018 y agosto de 2020. Resultados: 40 pacientes fueron sometidos a procedimientos por vía uniportal torácica. De estos, 18 pacientes fueron sometidos a resecciones anatómicas (45%), 19 a resecciones atípicas (no anatómicas), una timectomía y dos biopsias pleurales. Se realizaron 12 lobectomías (30%), 3 neumonectomías (7,5%) y 3 segmentectomías (7,5%). Se convirtieron a cirugía abierta 6 pacientes (15%) y falleció un paciente por sepsis respiratoria. En cuanto a las complicaciones tuvimos en las resecciones anatómicas ocho complicaciones (cinco mayores), en las no anatómicas 4 complicaciones (2 mayores). Del postoperatorio un paciente con dolor de más de un mes de evolución, uno con parestesias en el territorio intercostal y dos con disnea. Las resecciones anatómicas tuvieron una media de internación de 8 días y 5.8 días de drenaje pleural, mientras que las no anatómicas 5,5 días de internación y 3.3 días de drenaje pleural. Conclusión: la cirugía uniportal es segura y practicable en centro de bajo volumen.

Abstract: Introduction: video assisted thoracic surgery is widely accepted today as a safe, feasible and effective procedure to treat almost all thoracic conditions. In 2010, uniportal complex procedures begin to appear in scientific publications around the world, evidencing major expansion. This surgical approach is at least comparable to the multiportal approach in terms of postoperative results or even in regards to pain, intercostal neuralgia and length of hospital stay. We performed a retrospective study of uniportal procedures between September 2018 and August 2020. Results: 40 patients underwent uniportal thoracic surgeries. 18 of these were subject to anatomic resections (45%), 19 to atypical resection (non-anatomic), one thymectomy and two pleural biopsies, 12 lobectomies (30%), 3 neumomectomies (7,5%) and 3 segmentomectomies (7,5%). In 6 patients the procedure was converted to an open surgery (15%) and one patient died for respiratory sepsis. As to the occurrence of complications, 8 complications were seen in anatomic resections (5 major complications) and 4 complications in non-anatomic resections (2 major complications). One patient reported pain that lasted over one week in the postoperative stage, another one referred paresthesia and two reported dyspnea. Length of stay in the hospital was 8 days in anatomic resections and 5.8 days of pleural drainage, whereas in non-anatomic resections it was 5.5 and 3.3 respectively. Conclusion: uniportal surgery is safe and feasible in a relatively small health center.

Resumo: Introdução: a cirurgia torácica videoassistida é hoje um procedimento aceito por ser seguro, viável e eficaz para o tratamento de quase todas as doenças torácicas. Em 2010, começaram a ser publicados procedimentos complexos por porta única com grande expansão mundial. Essa abordagem é pelo menos comparável à abordagem multiporta em termos de resultados pós-operatórios ou ainda melhor em termos de dor, neuralgia intercostal e internação hospitalar. Realizamos uma análise retrospectiva dos procedimentos uniportais entre setembro de 2018 e agosto de 2020. Resultados: 40 pacientes foram submetidos a procedimentos por via torácica uniportal. Destes, 18 pacientes foram submetidos a ressecções anatômicas (45%), 19 foram submetidos a ressecções atípicas (não anatômicas), uma timectomia e duas biópsias pleurais. Foram realizadas 12 lobectomias (30%), 3 pneumectomias (7,5%) e 3 segmentectomias (7,5%). Seis pacientes (15%) foram convertidos para cirurgia aberta e um paciente morreu de sepse respiratória. Em relação às complicações, tivemos 8 complicações (5 maiores) nas ressecções anatômicas, 4 complicações (2 maiores) nas ressecções não anatômicas. No pós-operatório, um paciente com dor há mais de um mês de evolução, um com parestesia em território intercostal e dois com dispneia. As ressecções anatômicas tiveram internação média de 8 dias e 5,8 dias de drenagem pleural, enquanto as não anatômicas tiveram 5,5 dias de internação e 3,3 dias de drenagem pleural. Conclusão: a cirurgia uniportal é segura e praticável em um centro de baixo volume.

Endometriose: aspectos clínicos do diagnóstico ao tratamento / Endometriosis: clinical aspects from diagnosis to treatment

A suspeita clínica de endometriose geralmente envolve a história clínica da paciente e exame físico, abordando sua sintomatologia e história pessoal e familiar. Entretanto, a apresentação clínica da doença varia consideravelmente, sem características clínicas patognomônicas, fato que dificulta o seu diagnóstico. Um diagnóstico presuntivo de endometriose pode ser fortemente sugerido pela ultrassonografia transvaginal e pela ressonância magnética em casos de endometrioma ou endometriose infiltrativa profunda. No entanto, esses exames de imagem não possuem a sensibilidade e a especificidade necessárias quando se trata de endometriose peritoneal superficial. O biomarcador sérico mais utilizado na investigação da endometriose foi o CA-125, que não apresenta sensibilidade (70%-75%) suficiente para sua indicação na prática clínica. Portanto, apesar de seu risco e alto custo, a videolaparoscopia e a análise anatomopatológica subsequente ainda se apresentam como o procedimento padrão-ouro para o diagnóstico definitivo de endometriose. Assim, com o objetivo de demonstrar quais exames seriam necessários para o diagnóstico dessa doença, realizamos uma revisão sistemática da literatura, cujos dados estão descritos a seguir.(AU)

Resultados perinatais de cirurgias fetais minimamente invasivas: experiência de dois centros de referência / Perinatal results of minimally invasive fetal surgeries: the experience of two reference centers

Objetivo: Analisar os resultados perinatais das cirurgias fetais minimamente invasivas realizadas em dois centros de referências no Rio de Janeiro ­ Brasil. Metodologia: Foi realizado estudo descritivo retrospectivo através de revisão de prontuários entre 2011 e 2019. Os desfechos analisados foram complicações maternas, complicações durante a gestação, morbidade e mortalidade neonatal. Complicações maternas foram consideradas todas as complicações anestésicas, complicações infecciosas e/ou necessidade de hemotransfusão. Resultados: Foram incluídas 50 gestantes, sendo 20 gestações múltiplas, totalizando 70 fetos. As patologias fetais incluídas foram: síndrome de transfusão feto-fetal (STFF), hérnia diafragmática congênita (HDC), mielomeningocele (MMC), obstrução do trato urinário inferior (OTUI), derrame pleural e síndrome de obstrução congênita da via aérea superior e síndrome de banda amniótica. A média de idade das gestantes foi de 33 anos, e 72% não tinham comorbidades. Antibiotico profilático foi realizado em 82% das cirurgias e 72% das pacientes receberam tocólise. A idade gestacional média no momento da cirurgia foi de 25 semanas e o tempo médio de cirurgia foi de 80 minutos. Em relação às complicações maternas, 8% tiveram complicações anestésicas, 12% tiveram complicações infecciosas e 6% necessitaram de hemotransfusão. No momento da cirurgia, 22% das gestantes tiveram algum tipo de complicação e 72% tiveram complicações anteparto após a cirurgia. A idade gestacional média no parto foi de 33 semanas, 83% nasceram vivos e 69% tiveram alta da UTI neonatal. Conclusão: Apesar da pequena amostra, os nossos resultados são semelhantes aos descritos na literatura internacional. A prematuridade é uma das principais complicações encontradas em nosso estudo.

Objective: To analyze the perinatal results of minimally invasive fetal surgeries performed in 2 reference centers in Rio de Janeiro ­ Brazil. Methodology: It was a retrospective descriptive study based on the analysis of medical records between 2011 and 2019. Outcomes were maternal complications, pregnancy complications, neonatal morbidity and neonatal mortality. Results: Fifty patients were included, 20 were multiple pregnancy, totaling 70 fetuses. The pathologies included were Twin-twin Transfusion Syndrome (TTTS), Congenital Diaphragmatic Hernia (CDH), Myelomeningocele (MMC), Lower Urinary Tract Obstruction, Pleural Effusion, Congenital Upper Airway Obstruction Syndrome (CHAOS) and Amniotic Band Syndrome. The mean age of patients was 33 years and 72% had no comorbidity. A total of 82% received prophylactic antibiotics, 72% received tocolysis. Mean gestational age at surgery was 25 weeks and mean surgery time was 80 minutes. Regarding maternal complications, 8% had anesthetic complications, 12% had infectious complications and 6% required blood transfusion. A total of 22.0% of surgeries had intraoperative complications and 76.6% had antepartum complications after surgery. The mean gestational age at delivery was 33 weeks, 82.9% of fetuses undergoing surgery were born alive and 75.7% were discharged from the NICU. Conclusion: Although our small sample, the results found are compatible with those shown at the literature. Prematurity was one of the main problems found in our study.

Gravidez ectópica em cicatriz de cesárea: série de casos com três possibilidades terapêuticas diferentes / Cesarean scar pregnancy: case series with three different types of management

A gestação ectópica em cicatriz de cesariana prévia é um evento iatrogênico raro, que vem crescendo junto com o aumento das taxas de cesariana. Ela não exi- be manifestação clínica específica, o que dificulta o diagnóstico e não apresenta tratamento preconizado, embora esteja associada a grandes complicações obsté- tricas como hemorragia incoercível, acretismo placentário e rotura uterina. Dessa forma, o presente artigo relata três casos clínicos em que diferentes tratamentos foram propostos, objetivando discutir algumas possibilidades terapêuticas como a aspiração manual intrauterina (AMIU) associada com o uso de metotrexato, lapa- roscopia e laparotomia, comparando os resultados encontrados.(AU)

Ectopic cesarean scar pregnancy is a rare iatrogenic event, which has been increase with growing in the percentage of cesarean delivery. It does not exhibit specific cli- nical manifestation, making diagnosis difficult and does not have yet recommended treatment, although is associated with major obstetrics complication such incoer- cible hemorrhage, abnormally invasive placenta and uterine rupture. Therefore, the present article reports three clinical cases witch different types of management, ai- ming discuss some possibilities such intrauterine manual aspiration after systemic methotrexate, laparoscopy or laparotomy surgical, comparing results.(AU)

Histerectomía videolaparoscópica / Videolaparoscopic Hysterectomy

RESUMEN Introducción: La histerectomía constituye la segunda causa más frecuente de cirugía mayor en la mujer. Tres tipos de histerectomías son usadas en la actualidad: la histerectomía vaginal, la histerectomía abdominal y la histerectomía mínimamente invasiva. Esta última variedad se comenzó a realizar en Matanzas a finales de la pasada década. Objetivo: Evaluar las características clínicas epidemiológicas de las pacientes histerectomizadas por cirugía video laparoscópica. Métodos: Se realizó un estudio descriptivo y prospectivo. El universo lo conformaron todas las pacientes en las que se implementó esta técnica quirúrgica y se tomó como muestra al propio universo, 96 pacientes. Resultados: Predominó la edad comprendida entre 40 y 49 años con 44 pacientes; la raza negra con 51 pacientes; diagnóstico de miomatosis uterina con 87 casos; tiempo quirúrgico de 61-90 min con 57 pacientes y estadía hospitalaria de hasta 24 h en 93 de las pacientes. Se presentaron 3 complicaciones en total y el número de casos convertidos fue 0. Conclusiones: La histerectomía videolaparoscópica es implementada de forma segura y eficaz. Se realizó predominantemente en mujeres mayores de 40 años, con diagnóstico de miomatosis uterina. El tiempo quirúrgico promedio es mayor que el reportado en la literatura. La estadía hospitalaria es de 24 horas como promedio y se reincorporaron a sus actividades habituales rápidamente(AU)

ABSTRACT Introduction: Hysterectomy is the second most frequent type of major surgery among women. Three types of hysterectomy are currently used: vaginal hysterectomy, abdominal hysterectomy, and minimally invasive hysterectomy. This last variety began to be performed in Matanzas at the end of the last decade. Objective: To evaluate the clinical-epidemiological characteristics of patients hysterectomized. Methods: A descriptive and prospective study was carried out. The population was made up of all the patients operated on by this surgical technique. The whole population itself was taken as a sample (96 patients). Results: There was predominance of the age group 40-49 years (44 patients), the black race (51 patients), diagnosis of uterine myomatosis (87 cases), surgical time of 61-90 min (57 patients), and hospital stay of up to 24 hours (93 patients). There were three complications and the number of converted cases was 0. Conclusions: Videolaparoscopic hysterectomy is implemented safely and effectively. It was performed predominantly in women over 40 years of age and diagnosed with uterine myomatosis. Average surgical time is greater than that reported in the scientific literature. Hospital stay is 24 hours as an average. The patients returned to their usual activities quickly(AU)

Videolaringoscopía para intubación pediátrica, en comparación con la intubación orotraqueal clásica. Hospital Vicente Corral Moscoso, Cuenca, 2018 / Video laryngoscopy for pediatric intubation, compared to classical orotracheal intubation. Vicente Corral Moscoso Hospital, Cuenca, 2018

Introduction: A relevant aspect in pediatric anesthesia is the management of the airway. Anatomical differences in this population makes them more susceptible to devices designed for their management. Video laryngoscopy improves panoramic vision of the glottis. Objective: To compare the use of video laryngoscopy with direct laryngoscopy for orotracheal intubation in pediatric patients. Methods: With an observational descriptive design, 276 cases were studied, patients from 5 to 17 years old, undergoing planned surgery, with general anesthesia plus orotracheal intubation. The specialist decided on the handling device. The data was transcribed from the forms and analyzed with the SPSS 22.0 program. The descriptive analysis was based on median, mode, average, minimum value, maximum value. Standard deviation and range dispersion measurements. A value of p ≤ 0.05 was considered statistically significant. Results: The average age of the study was 9.83 years. With direct laryngoscopy 97.4% intubation was performed at the first attempt and with video laryngoscopy 88.4% (p = 0.003). In 94.2% of cases of direct laryngoscopy, a successful intubation was performed in less than 10 seconds, with video laryngoscopy it was 75.2% (p = 0.000). Complications occurred in 6.6% of intubations with video laryngoscopy versus 2.6% with conventional laryngoscopy (p = 0.103). 56.2% of specialists prefer direct laryngoscopy to manage a pediatric airway without predictors of difficulty. Conclusions: Video laryngoscopy provides additional support in routine airway management, always requiring prior knowledge and skills. The evidence to support one technique over another is insufficient.

Introduction: A relevant aspect in pediatric anesthesia is the management of the airway. Anatomical differences in this population makes them more susceptible to devices designed for their management. Video laryngoscopy improves panoramic vision of the glottis. Objective: To compare the use of video laryngoscopy with direct laryngoscopy for orotracheal intubation in pediatric patients. Methods: With an observational descriptive design, 276 cases were studied, patients from 5 to 17 years old, undergoing planned surgery, with general anesthesia plus orotracheal intubation. The specialist decided on the handling device. The data was transcribed from the forms and analyzed with the SPSS 22.0 program. The descriptive analysis was based on median, mode, average, minimum value, maximum value. Standard deviation and range dispersion measurements. A value of p ≤ 0.05 was considered statistically significant. Results: The average age of the study was 9.83 years. With direct laryngoscopy 97.4% intubation was performed at the first attempt and with video laryngoscopy 88.4% (p = 0.003). In 94.2% of cases of direct laryngoscopy, a successful intubation was performed in less than 10 seconds, with video laryngoscopy it was 75.2% (p = 0.000). Complications occurred in 6.6% of intubations with video laryngoscopy versus 2.6% with conventional laryngoscopy (p = 0.103). 56.2% of specialists prefer direct laryngoscopy to manage a pediatric airway without predictors of difficulty. Conclusions: Video laryngoscopy provides additional support in routine airway management, always requiring prior knowledge and skills. The evidence to support one technique over another is insufficient.

Manejo de la fístula anorrectal compleja: LIFT, colgajo de avance y otras técnicas / Management of complex anorectal fistula: LIFT, endorectal advancement flap and others techniques

Resumen Las fístulas anorrectales complejas son un desafío para el coloproctólogo. Son una patología frecuente que afecta la calidad de vida de los pacientes. La patogénesis aún no está clara, estarían involucradas citoquinas y el proceso de transición de epitelio a mesénquima. El gold standard para su estudio es la resonancia nuclear magnética, su uso por sí mismo disminuye la recurrencia. El objetivo del tratamiento es lograr la curación sin afectar la función del esfínter evitando las recidivas. Existen múltiples técnicas, siendo la de mayor aceptación la ligadura interesfinteriana del trayecto fistuloso, con tasa de curación sobre el 70%, con mínimo impacto en continencia. Esta revisión incluye otras técnicas como el colgajo endorrectal de avance, uso de sellante, permacol, células madres, Anal fistula plug, Video asisted anal fistula treatment, Over the scope clip y fistula laser closure.

Complex anal fistula are a challenge for colorectal surgeons. It is a common pathology in population. Pathogenesis is still unclear, it would be involved citokines and the process of epitelial to eesenchymal transition. The gold standard for study is MRI, its use reduces recurrences. The goal of treatment is heal the fistula without damaging the function of the sphincter and avoid recurrences. There are multiple techniques, the most accepted is ligation of intersphincteric fistula tract with cure rate over 70%, with minimal impact in continence. This review includes other techniques like rectal advancement flap, fibrin glue, permacol, stem cells, anal fistula plug, video asisted anal fistula treatment, over the scope clip and fistula laser closure.

Uso de cânula rígida com rosca e endoscópio flexível para videolaparoscopia de acesso único em equinos em estação / Use of threaded rigid cannula and flexible endoscope for single access video laparoscopy in standing horses

Com o objetivo de promover, por meio de acesso único e com o uso de endoscópio flexível, ampla exploração da cavidade peritoneal de equinos em estação, foi concebida uma cânula laparoscópica para dar sustentação ao endoscópio e possibilitar o acesso sob visualização. O procedimento foi realizado a partir da fossa paralombar. Após pequena incisão cutânea, o endoscópio foi inserido na cânula e os músculos e o peritônio foram divulsionados mediante rotação da cânula. Logo depois da perfuração do peritônio, foi realizada a exploração da cavidade e a identificação das estruturas. Em seguida à exploração do lado ipsilateral ao acesso, realizou-se a transposição do conjunto cânula/endoscópio ventralmente à porção caudal do cólon descendente, seguida de exploração do lado contralateral. Concluída a técnica, foi executado, para fins de comparação, o mesmo procedimento por meio da fossa paralombar contralateral. Foi possível a transposição do conjunto cânula/endoscópio para o lado contralateral ao acesso em todos os procedimentos. Também foi possível a identificação da maioria das estruturas abdominais tanto pelo acesso esquerdo quanto pelo direito. A abordagem por acesso único mostrou-se viável para a exploração ampla da cavidade peritoneal, demonstrando ser uma alternativa à técnica laparoscópica convencional.(AU)

A laparoscopic cannula was designed to support a single access approach with a flexible endoscope for the wide exploration of the peritoneal cavity of standing horses. It provides support to the endoscope and allows access to the peritoneal cavity with a visual aid. This procedure was performed through the paralumbar fossa. After a small cutaneous incision, the endoscope was inserted into the cannula, and the muscles and peritoneum were divulsed through the rotation of the cannula. After the peritoneal perforation, cavity exploration and identification of structures were performed. After the exploration of the ipsilateral side of the access, the cannula/endoscope was transposed ventrally to the caudal portion of the descending colon; this was followed by the exploration of the contralateral side. Once this process was completed, the same procedure was performed through the contralateral paralumbar fossa for comparison. It was possible to transpose the cannula/endoscope set to the contralateral access side in all procedures. Further, it was possible to identify most of the abdominal structures in both the left and right access. This single access approach proved to be feasible for the extensive exploration of the peritoneal cavity, thereby indicating it can be an alternative to the conventional laparoscopic technique.(AU)

Comparison of channelled videolaryngoscope and intubating laryngeal mask airway for tracheal intubation in obese patients: a randomised clinical trial / Comparação de videolaringoscópio com canal e máscara laríngea na intubação traqueal de pacientes obesos: estudo clínico randomizado

Abstract Background: Obesity causes various difficulties in intubation and ventilation, which are confronted due to increased fat tissue in the upper airway and diminished compliance in the chest wall. Videolaryngoscopes and Intubating Laryngeal Mask Airway (ILMA) are good options as recommended by the American Society of Anesthesologists (ASA) difficult airway guidelines. We aimed to compare ILMA and Airtraq (a channeled videolaryngoscope) in obese patients. Methods: Eighty patients with ASA physical status 1-3, aged between 18 and 65 years and with a body mass index greater than 35 kg.m-2, who were undergoing elective surgery requiring orotracheal intubation, were included in the study. Patients were intubated with one of the devices cited. Results: There was no difference between the number of intubation attempts, insertion times and need for optimisation manoeuvres of Airtraq and ILMA. The intubation with Airtraq was accomplished in a shorter period of time than in that in the ILMA group (29.9 ± 22.1s vs. 50.7 ± 21.2s; p < 0.001). A significant difference was found when the times of total intubation were compared (29.9 ± 22.1s vs. 97.4 ± 42.7s; p < 0.001). The mean arterial pressure statistically increased after device insertion in the ILMA group (p < 0.05). Conclusions: Airtraq appears to be superior to ILMA in obese patients, with a total of time intubation of less than 60 seconds and with low mean arterial pressure changes. However, ILMA is still a useful tool that provides both ventilation and intubation throughout the whole intubation process.

Resumo Justificativa: A obesidade dificulta a ventilação manual e intubação traqueal devido ao acúmulo de tecido adiposo na via aérea superior e a complacência diminuída na caixa torácica. Os videolaringoscópios e as Máscaras Laríngeas para Intubação (MLI) são alternativas boas para o manuseio da via aérea difícil, de acordo com as diretrizes da Sociedade Americana de Anestesologia (ASA). O objetivo do estudo foi comparar o uso da MLI e do Airtraq, um videolaringoscópio com canal, em pacientes obesos. Método: Estudamos 80 pacientes com classificação ASA I-III, com idades entre 18 e 65 anos e índice de massa corporal acima de 35 kg.m-2, submetidos a cirurgia eletiva com indicação de intubação orotraqueal. Os pacientes foram intubados empregando-se um dos seguintes dispositivos: MLI ou Airtraq. Resultados: Não houve diferença entre o número de tentativas de intubação, tempo de inserção do dispositivo e necessidade de manobras de otimização para o Airtraq e MLI. A intubação com Airtraq foi realizada mais rapidamente do que no Grupo MLI (29,9 ± 22,1 s vs. 50,7 ± 21,2 s; p < 0,001). Houve diferença significante na comparação do tempo total para intubação (29,9 ± 22,1 s vs. 97,4 ± 42,7 s; p < 0,001). Houve aumento estatisticamente significante da pressão arterial média após a inserção do dispositivo no Grupo MLI (p < 0,05). Conclusões: Airtraq parece ser superior a MLI em pacientes obesos, apresentando tempo total de intubação abaixo de 60 segundos e com menor variação na pressão arterial média. Todavia, a MLI ainda é ferramenta útil que propicia tanto ventilação quanto intubação durante todo o processo de manejo da via aérea.

Impact of Grade I obesity on respiratory mechanics during video laparoscopic surgery: prospective longitudinal study / Impacto da obesidade Grau I na mecânica respiratória durante cirurgia videolaparoscópica: estudo longitudinal prospectivo

Abstract Introduction and objectives: The association pneumoperitoneum and obesity in video laparoscopy can contribute to pulmonary complications, but has not been well defined in specific groups of obese individuals. We assessed the effects of pneumoperitoneum in respiratory mechanics in Grade I obese compared to non-obese. Methods: Prospective study including 20 patients submitted to video laparoscopic cholecystectomy, normal spirometry, divided into non-obese (BMI ≤ 25 kg.m-2) and obese (BMI > 30 kg.mg-2), excluding Grade II and III obese. We measured pulmonary ventilation mechanics data before pneumoperitoneum (baseline), and five, fifteen and thirty minutes after peritoneal insufflation, and fifteen minutes after disinflation (final). Results: Mean BMI of non-obese was 22.72 ± 1.43 kg.m-2 and of the obese 31.78 ± 1.09 kg.m-2, p < 0.01. Duration of anesthesia and of peritoneal insufflation was similar between groups. Baseline pulmonary compliance (Crs) of the obese (38.3 ± 8.3 mL.cm H2O-1) was lower than of the non-obese (47.4 ± 5.7 mL.cm H2O-1), p = 0.01. After insufflation, Crs decreased in both groups and remained even lower in the obese at all moments assessed (GLM p < 0.01). Respiratory system peak pressure and plateau pressure were higher in the obese, albeit variations were similar at moments analyzed (GLM p > 0.05). The same occurred with elastic pressure, higher in the obese at all times (GLM p = 0.04), and resistive pressure showed differences in variations between groups during pneumoperitoneum (GLM p = 0,05). Conclusions: Grade I obese presented more changes in pulmonary mechanics than the non-obese during video laparoscopies and the fact requires mechanical ventilation-related care.

Resumo Justificativa e objetivos: Em videolaparoscopias, a associação de pneumoperitônio e obesidade pode contribuir para complicações pulmonares, mas não está bem definida em grupos específicos de obesos. Avaliamos os efeitos do pneumoperitônio na mecânica respiratória dos obesos Grau I em comparação aos não obesos. Métodos: Estudo prospectivo envolvendo 20 pacientes submetidos à colecistectomia videolaparoscópica, com espirometria normal, separados em não-obesos (IMC ≤ 25 kg.m-2) e obesos (IMC > 30 kg.mg-2), excluídos obesos Grau II e III. Mensuramos dados da mecânica ventilatória pulmonar antes do pneumoperitônio basal, após cinco, quinze e trinta minutos da insuflação peritoneal e quinze minutos após a desinsuflação final. Resultados: O IMC médio dos não obesos foi de 22,72 ± 1,43 kg.m-2 e dos obesos 31,78 ± 1,09 kg.m-2, p < 0,01. A duração da anestesia e da insuflação peritoneal foram semelhantes entre os grupos. A complacência pulmonar (Crs) basal dos obesos (38,3 ± 8,3 mL.cm H2O-1) foi inferior aos não obesos (47,4 ± 5,7 mL.cm H2O-1), p = 0,01. Após a insuflação, a Crs diminuiu nos dois grupos e permaneceu ainda mais baixa nos obesos em todos os momentos avaliados (GLM p < 0,01). A pressão de pico e a pressão de platô do sistema respiratório foram mais elevadas nos obesos, mas apresentaram semelhantes variações nos momentos analisados (GLM p > 0,05). O mesmo ocorreu com a pressão elástica, mais elevada nos obesos em todos tempos (GLM p = 0,04), e a pressão resistiva apresentou diferenças nas variações entre os grupos durante o pneumoperitônio (GLM p = 0,05). Conclusão: Obesos Grau I apresentam maiores alterações na mecânica pulmonar que os não obesos em videolaparoscopias e este fato recomenda cuidados relacionados a ventilação mecânica.

Evaluación de la calidad de vida en pacientes sometidos a simpaticotomía videotoracoscópica por Hiperhidrosis palmar / Quality of Life Assessment in Patients Who Underwent Videothoracoscopic Sympathicotomy for Palmar Hyperhidrosis

RESUMEN Introducción: La hiperhidrosis es un trastorno primario caracterizado por sudación excesiva, que afecta con mayor frecuencia las palmas de las manos. La enfermedad trae consigo limitaciones que interfieren en las relaciones sociales, laborales, interpersonales y afectivas del individuo, y genera desde etapas tempranas de la vida, afectación psíquica dada fundamentalmente por complejos y disminución de la autoestima. Objetivo: Determinar cómo influye la simpaticotomía videotoracoscópica en el nivel de vida de los pacientes con diagnóstico de Hiperhidrosis palmar. Métodos: Se realizó un estudio retrospectivo, transversal y descriptivo de 82 pacientes con diagnóstico de Hiperhidrosis palmar, a los cuales se les realizó Simpaticotomía videotoracoscópica uniportal. Se aplicó la encuesta de Rivas-Milanez que evalúa la calidad de vida antes y después de la cirugía. Resultados: Predominó el sexo femenino, el nivel de satisfacción de los pacientes fue del 97,6 por ciento, se presentó sudoración compensatoria en el 34,1 por ciento de los operados y la mejoría de la calidad de vida fue del 93,2 por ciento. La sudoración compensatoria fue bien tolerada en la mayoría de los pacientes. Conclusiones: La simpaticotomía videotoracoscópica en la hiperhidrosis palmar logra mejorar la calidad de vida de los pacientes(AU)

ABSTRACT Introduction: Hyperhidrosis is a primary disorder characterized by excessive sweating, affecting most frequently the palms of the hands. The disease brings about limitations that interfere in the individual's social, occupational, interpersonal and affective relationships, and produces, from the early stages of life, psychic damage manifested fundamentally through complexes and a decrease in self-esteem. Objective: To determine how videothoracoscopic sympathicotomy influences the living standard of patients diagnosed with palmar hyperhidrosis. Methods: A retrospective, cross-sectional and descriptive study was carried out in 82 patients with a diagnosis of palmar hyperhidrosis, who were performed single-port videothoracoscopic sympathicotomy. We applied the Rivas-Milanez survey, which evaluates quality of life before and after surgery. Results: The female sex predominated, the level of satisfaction of the patients was 97.6 percent, compensatory sweating occurred in 34.1 percent of the intervened patients, and improvement of quality of life was 93.2 percent. Compensatory sweating was tolerated well in most patients. Conclusions: Videothoracoscopic sympathicotomy in palmar hyperhidrosis is an adequate treatment for improving the quality of life of patients(AU)

Comparison between curettage adenoidectomy and endoscopic-assisted microdebrider adenoidectomy in terms of Eustachian tube dysfunction / Comparação entre adenoidectomia por curetagem e adenoidectomia por microdebridador assistida por endoscopia, em relação à disfunção tubária

Abstract Introduction Adenoidectomy can be performed with many ways, including curettage and microdebrider endoscopic-assisted adenoidectomy. Those two techniques have advantages and disadvantages. Objective The objective of this study is to research the effects of curettage adenoidectomy and endoscopic-assisted microdebrider adenoidectomy on the tympanum pressures in pediatric patients with adenoid hypertrophy without otitis media with effusion. Methods This prospective descriptive study was performed with 65 patients who had a normal tympanic membrane and normal tympanogram and then underwent adenoidectomy or adenotonsillectomy for adenoid and tonsil hypertrophy. The subjects were randomly divided into two groups: curettage adenoidectomy group and endoscopic microdebrider-assisted adenoidectomy group. They underwent tympanometry, and the preoperative as well as 1st and 7th day postoperative values of the tympanum pressures were compared within and among the groups. Results There were 32 patients in the curettage adenoidectomy group and 33 patients in the microdebrider adenoidectomy group. Statistically significant differences were observed in the median tympanum pressure on the preoperative and 1st and 7th postoperative days for both the left and right ears with curettage adenoidectomy (p < 0.001, p < 0.001). This difference occurred on the 1st postoperative day, and the value returned to normal on the 7th day. There was no significant difference in the median tympanum pressure on the preoperative and 1st and 7th postoperative days for both the left and right ears in the microdebrider adenoidectomy group (p = 0.376, p = 0.128). Conclusion Postoperative Eustachian tube dysfunction is seen less often with the endoscopic-assisted microdebrider adenoidectomy technique than with the conventional adenoidectomy technique.

Resumo Introdução A adenoidectomia pode ser realizada de várias maneiras, inclusive por curetagem e por microdebridador, assistida por endoscopia. Essas duas técnicas têm algumas vantagens e desvantagens. Objetivo O objetivo deste estudo foi investigar os efeitos da técnica de adenoidectomia por curetagem e da adenoidectomia por microdebridador assistida por endoscopia sobre a pressão timpânica em pacientes pediátricos com hipertrofia adenoideana sem otite média com efusão. Método Estudo descritivo prospectivo feito com 65 pacientes que apresentavam membrana timpânica e timpanograma normais, que foram então submetidos à adenoidectomia ou adenotonsilectomia por hipertrofia adenoamigdaliana. Os pacientes foram divididos aleatoriamente em dois grupos: grupo adenoidectomia por curetagem e grupo adenoidectomia por microdebridador assistida por endoscópio. Todos os pacientes fizeram timpanometria e os valores das pressões do tímpano pré-operatórios e pós-operatórios no 1º e 7º dias foram comparados intragrupos e entre os grupos. Resultados Foram incluídos 32 pacientes no grupo adenoidectomia por curetagem e 33 pacientes no grupo adenoidectomia com microdebridador. Diferenças estatisticamente significantes foram observadas na mediana da diferença entre a pressão timpânica no pré-operatório e no 1º e 7º dias de pós-operatório para ambas as orelhas, direita e esquerda, na adenoidectomia por curetagem (p < 0,001, p < 0,001). Essa diferença ocorreu no 1º dia do pós-operatório e o valor retornou ao normal no 7º dia. Não houve diferença significante na mediana entre pressão timpânica no pré-operatório e no 1º e 7º dias de pós-operatório para as orelhas direita e esquerda no grupo de adenoidectomia com microdebridador (p = 0,376, p = 0,128). Conclusão A disfunção tubária no pós-operatório é observada menos frequentemente com a técnica de adenoidectomia por microdebridador assistida por endoscopia quando comparada com a técnica convencional.