Is YouTube a reliable tool for approaching robotic assisted transabdominal preperitoneal surgery? A critical review of the available resources.

INTRODUCTION: The robotic transabdominal preperitoneal approach (rTAPP) is a relatively recent technique for the treatment of inguinal hernia. To achieve optimal results, the 10 golden rules described must be followed. Surgeons in training often review videos to familiarize themselves with new techniques, YouTube being one of the most used platforms. The objective of this study is to carry out an evaluation of the 10 most viewed videos on YouTube of inguinal hernia repair by transabdominal preperitoneal approach (rTAPP) to determine if the 10 golden rules are met. METHODS: Identify and evaluate the 10 videos with the highest number of views related to rTAPP. Three experienced Surgeons evaluated compliance with the 10 golden rules using a Likert scale. Data were analyzed in Excel (Microsoft) and plotted with Tableau (Tableau Inc). The consistency between evaluators was determined using Cronbach's alpha, considering a value >0.7 acceptable. RESULTS: The average overall evaluation was 3.63 with a range of 2.6 to 4.9. The scores related to compliance with the rules 1, 2, 9, 10 were satisfactory; on the other hand, rules 3, 4, 5, 7 and 8 were weak, particularly rule number 7. Internal consistency was observed between raters with a Cronbach's alpha of 0.98. CONCLUSIONS: The lack of compliance with the 10 golden rules in most of the videos demonstrates that the use of videos (YouTube) is not an adequate resource for learning robot-assisted inguinal hernia cure.

Robot-assisted duodenal switch with DaVinci Xi: surgical technique and analysis of a single-institution experience of 661 cases.

Metabolic and bariatric surgery is an effective treatment for the management of obesity and related comorbidities. Although the duodenal switch has demonstrated superior results in terms of resolution of obesity-related comorbidities and weight loss, it is one of the less performed procedures. The use of robotic surgical platforms offers many advantages in obese patients and is particularly useful in technically demanding procedures such as duodenal switch. Observational, retrospective and analytical study of cases corresponding to robot-assisted duodenal switch performed between 2016 and 2021. We describe our technique using the system DaVinci Xi. Operative and perioperative variables, postoperative complications, and readmission rate were determined. A total of 661 patients underwent duodenal switch which correspond to the 20.7% of the total bariatric procedures performed in this period. A clear decrease in surgical time and length of stay was observed as the number of cases progressively increased. The complication rate during the first 30 days was 9.1%. Among these, only 1.9% corresponded to major complications, being strictures the most frequent (0.9%), followed by leaks (0.45%). Readmission rate in this period was 6.1%. Between 30 and 90 days postoperatively, the complication rate was 0.91%. Robotic-assisted duodenal switch is a safe surgery with a low complication rate. This procedure is highly effective in terms of durable weight loss in obese and super-obese patients. Robotic DaVinci Xi system allows surgeons to achieve a high level of proficiency and master technique resulting in reduction of surgical time and length of stay.

Robotic surgery: financial impact of surgical trays optimization in bariatric and thoracic surgery.

The incorporation of new technologies in the surgical field, such as the robotic da Vinci System, has made it possible to offer a series of advantages to the patient and the surgeon, with important benefits for both. However, cost continues to be a limiting factor to the adoption of this technology. The development of strategies to maximize the measures that can lead to reduced expenses is a key factor to improve cost-benefit ratio. According to some studies, more than 50% of the costs of a surgical procedure are related to materials and medical supplies, which is why any measure aimed at optimizing their use is pertinent. Our institution, the Orlando Regional Medical Center (ORMC), created a working group whose main purpose is to optimize the Robotic OR process. Their first step was to optimize the surgical trays, and this was carried out in four stages: observation, modification, trial period, and cost analysis. The specialties involved in this initiative were Bariatric and Thoracic Surgeries. Once the optimization process ended, the number of laparoscopic/thoracoscopy instruments in the trays decreased by 63 and 87% for bariatric and thoracic surgery, respectively; and the number of conventional surgery instruments was also reduced by 47 and 64%, for the same specialties, respectively. The financial analysis concluded that implementing this measure will lead to an estimated six-figure savings per year.

Diverticulitis cecal. A propósito de un caso / Cecal Diverticulitis. A Case Report

La diverticulosis cecal es una entidad poco común, representando el 3,6% de los casos de enfermedad diverticular y su complicación más frecuente es la diverticulitis. Caso clínico : Presentamos el caso de un paciente de 79 años quien consultó por presentar dolor en fosa ilíaca derecha, náuseas y escalofríos; laboratorio leucocitos 16900uL (neutrófilos 79%), proteína C reactiva 4,51mg/l. Se realiza laparoscopia evidenciando tumor de ciego de 2 x 3cm de coloración violácea con signos de inflamación pericecal, se realizó hemicolectomía derecha. El informe histopatológico informó divertículo verdadero isquémico de ciego. Conclusión : La diverticulitis cecal es una patología poco frecuente que puede presentarse como un abdomen agudo, por lo que se debe mantener un alto índice de sospecha en pacientes mayores de 40 años de edad. El abordaje laparoscópico es un método seguro y eficaz para el diagnóstico y tratamiento de estos pacientes(AU)

Cecal diverticulosis is an uncommon condition, representing 3.6% of diverticular disease cases, with its most common complication being diverticulitis. Case report: We present the case of a 79-year-old patient who consulted for right iliac fossa pain, nausea, and chills; laboratory findings showing a white blood cell count of 16,900/µL (neutrophils 79%) and C-reactive protein of 4.51 mg/L. Laparoscopy revealed a 2 x 3 cm purple-colored cecal tumor with signs of pericecal inflammation, right hemicolectomy was performed. Histopathological analysis confirmed a true ischemic cecal diverticulum. Conclusion: Cecal diverticulitis is an infrequent condition that can mimic an acute abdomen, necessitating a high index of suspicion, especially in patients over 40 years of age. Laparoscopic approach proves to be a safe and effective method for diagnosis and treatment in these patients(AU)

Trauma abdominal penetrante por heridas de arma blanca. Manejo laparoscópico vs convencional. Estudio prospectivo y comparativo / Penetrating abdominal trauma due to stab wounds. Laparoscopic vs conventional management. Prospective and comparative study

La evaluación y el manejo del trauma abdominal ha presentado cambios significativos en los últimos tiempos. La laparoscopia en el trauma abdominal penetrante ha sido de gran utilidad principalmente como método diagnóstico, sin embargo, se debería considerar como herramienta terapéutica.Objetivo: Determinar la eficacia del manejo laparoscópico vs el convencional en el tratamiento de pacientes con trauma abdominal penetrante por heridas de arma blanca.Métodos : Estudio experimental, prospectivo, comparativo. La población de estudio estuvo representada por pacientes con diagnóstico de traumatismo abdominal penetrante por herida de arma blanca que ingresaron a la emergencia de cirugía del Hospital Dr. Miguel Pérez Carreño durante el periodo enero 2019 a julio 2021.Resultados : Fueron incluidos 48 pacientes, 28 pacientes del grupo control y 20 pacientes del grupo experimental. Ambos grupos fueron comparables con respecto a edad y sexo. El índice de severidad del trauma (PATI) fue similar en ambos grupos. Las complicaciones y el tiempo quirúrgico no tuvieron diferencias estadísticamente significativas. Las cirugías negativas representaron el 15 % en el grupo laparoscópico vs 11 % en el abordaje convencional. El porcentaje de conversión fue de 15 %. La estancia hospitalaria fue menor en el grupo laparoscópico 3,25 vs 4,6 días (p = 0,04).Conclusión: La cirugía laparoscópica puede considerarse el abordaje de elección en pacientes hemodinámicamente estables con trauma abdominal penetrante por herida de arma blanca, siendo un método seguro y eficaz, brindando los beneficios propios de la cirugía mínimamente invasiva, con baja tasa de complicaciones y una recuperación más rápida(AU)

The evaluation and management of abdominal trauma have changed significantly in recent times. Laparoscopic approach in penetrating abdominal trauma has been useful as diagnostic method, however, its therapeutic value should be considered. Objective: To determine the efficacy of laparoscopy versus laparotomy approach as treatment in patients with penetrating abdominal trauma caused by stab wounds. Methods: We conducted an experimental, prospective and comparative study. Study population was represented by patients with diagnosis of penetrating abdominal trauma due to stab wounds who were admitted to the emergency room of Dr. Miguel Pérez Carreño Hospital between January 2019 and July 2021.Results : 48 patients were included, 28 in the control group and 20 patients in the experimental group. No differences were found between groups regarding age and sex. The penetrating abdominal trauma index (PATI) was similar in both groups. Differences in complications and surgical time were not statistically significant. Non-therapeutic surgeries represented 15 % in laparoscopic group and 11 % in laparotomy group. The conversion percentage was 15 %. Hospital stay were shorter in laparoscopic group, 3.25 vs 4.6 days (p = 0.04). Conclusion: Laparoscopic surgery can be considered the approach of choice in hemodynamically stable patients with penetrating abdominal trauma due to stab wounds. It is a safe and effective method, providing the benefits of minimally invasive surgery, with a low rate of complications and faster patient recovery(AU)

Exploración de las vías biliares como tratamiento de la litiasis coledociana: manejo laparoscópico vs. convencional. Estudio prospectivo y comparativo / Common bile duct exploration as treatment of choledocal lithiasis: laparoscopic vs conventional approach. Prospective and comparative study

La litiasis coledociana es una complicación poco frecuente asociada a la litiasis vesicular. Puede ser resuelta mediante colangiopancreatografía retrógrada endoscópica (CPRE) o en su defecto, una exploración de las vías biliares por abordaje convencional (cirugía abierta) o laparoscópico. Objetivos: Determinar la efectividad del abordaje laparoscópico versus el convencional en la exploración de las vías biliares como tratamiento de la litiasis coledociana. Métodos : Se realizó un estudio prospectivo y comparativo con una muestra de 31 pacientes con litiasis coledociana seleccionados de manera no aleatoria. Resultados : Ambos grupos fueron comparables en edad, sexo, frecuencia de litiasis vesicular y CPRE preoperatoria. El tiempo quirúrgico promedio fue 4,52 versus 3,49 horas para los abordajes laparoscópico y convencional respectivamente. En el grupo laparoscópico se usó tubo de Kehr en 21% de los pacientes y en 79 % sutura primaria. En el grupo convencional se usó tubo de Kehr en 29% de los pacientes y en 71 % sutura primaria. La fuga biliar fue la complicación más frecuente. La estancia hospitalaria fue 3,14 días en el grupo laparoscópico versus 5,23 días en el grupo convencional, sin diferencia estadísticamente significativa. Conclusión : No se logró demostrar una superioridad evidente de alguno de los grupos estudiados, sin embargo nuestros pacientes podrían beneficiarse de las ventajas del abordaje laparoscópico en términos de tener menor dolor postoperatorio y una reincorporación más rápida a sus actividades habituales. Estudios similares con mayor número de casos son necesarios para llegar a datos más concluyentes(AU)

Common bile duct (CBD) lithiasis are an unusual complication associated to gallbladder stones. It can be resolved by endoscopic retrograde cholangiopancreatography (ERCP) or, alternatively, a CBD exploration by conventional (open surgery) or laparoscopic approach.Objectives : To determine the effectiveness of laparoscopic approach versus conventional approach in CBD exploration as a treatment for choledochal lithiasis.Methods : A prospective and comparative study was carried out with a non-random intentionally selected sample consisting of 31 patients with CBD stones.Results : Both groups had no statistical differences regarding age, sex, frequency of gallbladder stones, and preoperatory ERCP. The average surgical time was 4.52 versus 3.49 hours for the laparoscopic and conventional approaches, respectively. In laparoscopic group, Kehr tube was used in 21% of patients and primary closure in 79%. In conventional group, Kehr tube was used in 29% of patients versus 71% of patients with primary closure. Biliary leak was the most frequent complication. Hospital stay was 3.14 days in the laparoscopic group versus 5.23 days in the conventional group, with no statistically significant difference.Conclusion : It was not possible to demonstrate an evident superiority of any of the groups studied, however our patients could benefit from the advantages of the laparoscopic approach in terms of less postoperative pain and faster return to their usual activities. Similar and larger studies are necessary to achieve stronger and conclusive data(AU)

Incidencia de infección del sitio quirúrgico en el Servicio de Cirugía I, hospital Dr. Miguel Pérez Carreño. 2019-2021. Estudio observacional / Surgical site infection incidence in surgery service I, Hospital Dr. Miguel Pérez Carreño. 2019-2021 Observational study

La infección del sitio quirúrgico es uno de los tipos más frecuentes de infección asociada al cuidado de la salud, tiene un impacto en el estado físico y mental de los pacientes, aumentando el riesgo de mortalidad. El objetivo de este estudio es determinar la incidencia de infección del sitio quirúrgico en cirugías electivas y de emergencia, y su distribución según la patología. Métodos: Estudio retrospectivo y observacional en el cual se incluyeron pacientes del servicio de Cirugía General I del Hospital Miguel Pérez Carreño, entre enero de 2019 y julio de 2021, a quienes se les realizó un procedimiento quirúrgico. Resultados: Se incluyeron 1341 pacientes. La incidencia global de infección de sitio quirúrgico fue de 9,77%, la mayoría de las infecciones fueron en cirugías de emergencia con una incidencia de 10,7% y de 4,17% en cirugías electivas. Las patologías con mayor porcentaje de infección fueron el trauma abdominal, seguido de la obstrucción intestinal. La incidencia de infección del sitio quirúrgico en patología apendicular fue de 10,4%. El microorganismo aislado con mayor frecuencia en los cultivos realizados fue E. coli. Conclusiones: La infección del sitio quirúrgico es una complicación frecuente en la cirugía de emergencia y requiere ser considerada y prevenida en el trauma abdominal, las obstrucciones intestinales y las peritonitis apendiculares. Conocer la incidencia de está complicación y comparar con estudios internacionales es fundamental para establecer protocolos propios para su control y prevención(AU)

Surgical site infection is one of the most frequently reported types of healthcare-associated infections, it has a negative impact on patients physical and mental health and increase the risk of mortality. The objective of this study is to determine the incidence of surgical site infection in elective and emergency surgeries, and its distribution according to the pathology. Methods: Retrospective and observational study, in which patients from the General Surgery Service I of the Hospital Miguel Pérez Carreño were included, between January 2019 and July 2021, who went under a surgical procedure. Results: In total 1341 patients were included. The overall incidence of surgical site infection was 9.77%, most of the infections were in emergency surgery with an incidence of 10.7% and 4.17% in elective surgeries. The pathologies with the highest percentage of infection were abdominal trauma followed by bowel obstruction. The incidence of surgical site infection in appendicular pathology was 10.4%. The most frequently isolated pathogens in the cultures performed was E. coli. Conclusions: Surgical site infection is a frequent complication in emergency surgery and needs to be considered and prevented in abdominal trauma, bowel obstructions, and complicated appendicitis. Knowledge of the incidence of this complication and comparing it with international studies is essential to establish own protocols for its control and prevention(AU)

Neoplasia Mucinosa de apéndice. Abordaje laparoscópico. Reporte de caso / Neoplastic appendiceal mucinous lesion. Laparoscopic approach. Case report

El mucocele apendicular es la dilatación quística del apéndice con acumulación de material mucinoso. Su forma de presentación más frecuente es dolor en fosa ilíaca derecha, sin embargo, la mitad de los casos son asintomáticos. En el presente trabajo se presenta caso de un paciente con diagnóstico incidental de mucocele apendicular, al cual se le realizó apendicectomía laparoscópica como tratamiento definitivo. Caso clínico: Paciente masculino de 44 años sin antecedentes patológicos conocidos, quien se realiza ultrasonido abdominal que informa tumor quístico en fosa ilíaca derecha. Se decide resolución quirúrgica laparoscópica. Informe histológico: mucocele apendicular sin evidencia de malignidad y recuperación satisfactoria del paciente. Conclusión: La neoplasia mucinosa del apéndice es una patología poco frecuente, puede presentarse con una variedad de manifestaciones clínicas hasta un hallazgo incidental. El tratamiento es fundamentalmente quirúrgico y el abordaje laparoscópico es de elección en pacientes sin evidencia de ruptura y diseminación de la enfermedad(AU)

The appendicular mucocele is a cystic dilation of the appendix with accumulation of mucinous material. The most frequent form of presentation is pain in the right iliac fossa; however, half of the cases are asymptomatic patients. In the present work we present a case of a patient with an incidentally diagnosis of appendicular mucocele who underwent laparoscopic appendectomy as definitive treatment. Clinical case: A 44-year-old male patient with no known pathological history, who underwent an abdominal ultrasound that reported a cystic tumor in the right iliac fossa. Laparoscopic surgical resolution was decided, the histological examination revealed appendicular mucocele without evidence of malignancy and satisfactory recovery of the patient. Conclusion: Mucinous neoplasia of the appendix is an uncommon pathology, patients are often asymptomatic or have nonspecific symptoms, and the diagnosis is made incidentally in the course of other examination. Treatment is primarily surgical and the laparoscopic approach is the choice in patients without evidence of rupture and dissemination of the disease(AU)

impacto de la pandemia COVID-19 en el personal médico de los servicios de cirugía general del Hospital Dr. Miguel Pérez Carreño: estudio de cohorte / Impact of the COVID-19 Pandemic on the Medical Staff of General Surgery Services at Dr. Miguel Pérez Carreño Hospital. Cohort study

Las patologías quirúrgicas continúan siendo motivo de consulta habitual en los servicios de emergencia de nuestros hospitales, requiriendo una rápida evaluación y resolución oportuna aún en tiempos de pandemia, siendo muy probable que pacientes asintomáticos, con sospecha o confirmación de infección por COVID-19 ameriten una intervención quirúrgica.Objetivo : Analizar la incidencia de casos de COVID-19 y evaluar su correlación con el uso de equipos de protección personal en los médicos residentes y adjuntos de los servicios de cirugía general del Hospital Dr. Miguel Pérez Carreño.Métodos : Se realizó una investigación de tipo observacional, descriptiva y transversal. La muestra estuvo constituida por 32 médicos quienes respondieron anónimamente una encuesta electrónica realizada por el comité académico del Posgrado de Cirugía General.Resultados : El porcentaje global de participación fue 50,79%. Resultaron positivos para la prueba Reacción en Cadena de Polimerasa el 42% de los residentes y 9% de los médicos especialistas. El lugar más frecuente de probable contacto fue el hospital en 90% de los casos. El 50% de los médicos identificaron a un personal de salud como su fuente de contagio. Se reportó uso constante de equipo de protección personal y gel alcoholado en 47% y 72% de los casos respectivamente.Conclusión : El aumento de casos de COVID-19 en la población general y en el personal de salud debe alertarnos acerca de la necesidad de tomar medidas estrictas de protección en forma precoz orientadas a disminuir la incidencia de casos y por ende la morbilidad y la mortalidad asociada a la infección por el nuevo coronavirus(AU)

Surgical pathologies continue to be a common reason for consultation in the emergency services of our hospitals, requiring a rapid evaluation and timely resolution even in times of pandemic, and it is highly probable that asymptomatic patients, with suspected or confirmed COVID-19 infection, merit a surgical intervention.Objective : To analyze the incidence of COVID-19 cases and evaluate its correlation with the use of personal protective equipment (PPE) in resident and staff surgeons of General Surgery services at Dr. Miguel Pérez Carreño Hospital.Methods : An observational, descriptive and cross-sectional research was carried out. The sample consisted of 32 physicians who anonymously responded to an electronic survey conducted by the academic committee of the General Surgery residency program.Results : The overall percentage of participation was 50.79%. 42% of residents and 9% of specialist physicians were positive for the Polymerase Chain Reaction test. The most frequent place of probable contact was the hospital in 90% of the cases. 50% of the doctors identified a health personnel as their source of infection. Constant use of PPE and alcohol gel was reported in 47% and 72% of the cases, respectively.Conclusion : The increase in COVID-19 cases in the general population and in health personnel should alert us to the need to take stricter protection measures early in order to reduce the incidence of cases and, therefore, the morbidity and mortality associated with infection with the new coronavirus(AU)

¿Es YouTube una herramienta fiable para la enseñanza de cura de hernia inguinal asistida por robot? Una revisión crítica de los recursos disponibles / Is YouTube a reliable tool for approaching robotic assisted transabdominal preperitoneal surgery? A critical review of the available resources

Introducción: La cirugía transabdominal preperitoneal asistida por robot (rTAPP) es una técnica relativamente reciente para el tratamiento de hernia inguinal. Para alcanzar resultados óptimos se deben cumplir las 10 reglas de oro descritas. Los cirujanos en formación suelen revisar vídeos para familiarizarse con nuevas técnicas siendo YouTube una de las plataformas más utilizada. El objetivo de este estudio es realizar una evaluación de los 10 vídeos más vistos en YouTube de reparación de hernia inguinal por rTAPP para determinar si se cumplen las 10 reglas de oro. Métodos: Identificar y evaluar los 10 vídeos con mayor número de visualizaciones relacionados con la rTAPP. Tres Cirujanos con experiencia evaluaron el cumplimiento de las 10 reglas de oro utilizando una escala de Likert. Los datos fueron analizados en Excel (Microsoft) y graficados con Tableau (Tableau Inc). La consistencia entre evaluadores se determinó mediante el alfa de Cronbach, considerándose aceptable un valor > 0,7. Resultados: La evaluación general promedio fue de 3,63 con un rango de 2,6 a 4,9. Las puntuaciones relacionadas con el cumplimiento de las reglas 1, 2, 9, 10 fueron satisfactorias; en cambio, las reglas 3, 4, 5, 7 y 8 fueron débiles, en particular la regla número 7. Se observó consistencia interna entre los evaluadores con un alfa de Cronbach de 0,98. Conclusiones: La falta de cumplimiento con las 10 reglas del oro en la mayoría de los vídeos demuestra que el uso de vídeos (YouTube) no es un adecuado recurso para el aprendizaje de cura de hernia inguinal asistida por robot.(AU)

Introduction: The robotic transabdominal preperitoneal approach (rTAPP) is a relatively recent technique for the treatment of inguinal hernia. To achieve optimal results, the 10 golden rules described must be followed. Surgeons in training often review vídeos to familiarize themselves with new techniques, YouTube being one of the most used platforms. The objective of this study is to carry out an evaluation of the 10 most viewed vídeos on YouTube of inguinal hernia repair by transabdominal preperitoneal approach (rTAPP) to determine if the 10 golden rules are met. Methods: Identify and evaluate the 10 vídeos with the highest number of views related to rTAPP. Three experienced surgeons evaluated compliance with the 10 golden rules using a Likert scale. Data were analyzed in Excel (Microsoft) and plotted with Tableau (Tableau Inc.). The consistency between evaluators was determined using Cronbach's alpha, considering a value >0.7 acceptable. Results: The average overall evaluation was 3.63 with a range of 2.6–4.9. The scores related to compliance with the rules 1, 2, 9 and 10 were satisfactory; on the other hand, rules 3, 4, 5, 7 and 8 were weak, particularly rule number 7. Internal consistency was observed between raters with a Cronbach's alpha of 0.98.Conclusions: The lack of compliance with the 10 golden rules in most of the vídeos demonstrates that the use of vídeos (YouTube) is not an adequate resource for learning robot-assisted inguinal hernia cure.(AU)