Efectividad de la colecistectomía laparoscópica de puerto único asistida con imanes bajo anestesia espinal

Objetivo: Determinar la efectividad de la colecistectomía laparoscópica de puerto único asistida por imanes bajo anestesia espinal en el tratamiento quirúrgico de la colecistopatía litiásica crónica. Material y Métodos: Estudio prospectivo de cohorte en 51 pacientes entre octubre de 2019 y febrero de 2021. 17 pacientes fueron sometidos a colecistectomía laparoscópica de puerto único asistida por imanes y 34 a colecistectomía laparoscópica convencional por un mismo equipo quirúrgico. Se aplicó la técnica quirúrgica descrita por Dominguez et al y SAGES, bajo anestesia espinal. Se realizó estadística descriptiva e inferencial, analizando el dolor postoperatorio a las 3, 6, 12, 24 y 72 h y la satisfacción de los pacientes. Resultados: Se encontró diferencia significativa en el dolor postoperatorio en el grupo de estudio a las 6 h (p = 0,022), 12 h (p = 0,039), 24 h (p = 0,025) y 72 h (p < 0,001). En la satisfacción se encuentra un RR de 3 (p = 0,001), sin diferencia significativa en el tiempo operatorio y horas de hospitalización postquirúrgicas. Conclusiones: La colecistectomía laparoscópica de puerto único asistida por imanes, bajo anestesia espinal, ha demostrado efectividad en la reducción importante del dolor postoperatorio a partir de las 6 h, y en la superación de las expectativas en los intervenidos, sin aumento significativo de tiempo operatorio ni estancia hospitalaria.

Aim: To determine the effectiveness of magnet-assisted single-port laparoscopic cholecystectomy under spinal anesthesia in surgical treatment of chronic lithiasic cholecystopathy. Materials and Method: Prospective cohort study in 51 patients between October 2019 and February 2021. 17 patients underwent magnet-assisted single-port laparoscopic cholecystectomy and 34 underwent conventional laparoscopic cholecystectomy by the same surgical team. The surgical technique described by Dominguez and SAGES was used, under spinal anesthesia. Descriptive and inferential statistics were performed, analyzing postoperative pain at 3, 6, 12, 24 and 72 hours and patient satisfaction. Results: A significant difference in postoperative pain was found in the study group at 6 h (p = 0.022), 12 h (p = 0.039), 24 h (p = 0.025) and 72 h (p < 0.001). In satisfaction, there is an RR of 3 (p = 0.001), with no significant difference in operative time and postoperative hospitalization hours. Conclusions: Magnet-assisted single-port laparoscopic cholecystectomy under spinal anesthesia has shown effectiveness in significantly reducing postoperative pain after 6h, associated with significantly exceeding expectations in those operated on, without a significant increase in operative time or hospital stay.

Apendicectomía laparoscópica por puerto único versus técnica de tres puertos: estudio clínico aleatorizado / Single-port laparoscopic appendectomy versus three-port technique: a randomized clinical trial

Introducción: En la búsqueda de nuevas y mejores alternativas quirúrgicas que permitan disminuir el trauma a la pared abdominal, ha surgido la cirugía por puerto único (PU), un procedimiento que consiste en la realización de la cirugía laparoscópica a través de una incisión única, generalmente en la cicatriz umbilical. Los resultados han sido alentadores y nuevas investigaciones al respecto son necesarias. Objetivo: Comparar la técnica quirúrgica de la apendicectomía laparoscópica por puerto único (PU) versus técnica estándar de 03 puertos (AL3P) en el tratamiento de pacientes con apendicitis aguda. Metodología: Estudio prospectivo, aleatorizado, incluyó 158 pacientes distribuidos en 2 grupos (71 PU, 89 AL3P), desde junio de 2013 a junio de 2016, comparándose variables demográficas, tiempo quirúrgico, complicaciones trans y postoperatorias, conversión, dolor postoperatorio, beneficios estéticos y satisfacción. Resultados: La edad, sexo, IMC, evolución, medicación previa, recuento leucocitario y fase de la enfermedad fue similar en ambos grupos. El tiempo operatorio promedio en PU fue de 48 min, menor que en AL3P (p˂0,001), y se evidenció disminución del mismo posterior a la curva de aprendizaje de 30 casos. No hubo conversión en PU a cirugía abierta. La tasa de complicaciones intra Y postoperatorias fue similar en ambos grupos (p=0,486 y p=0,887). La estancia hospitalaria fue menor en los pacientes de PU (p˂0,001) con mejor resultado estético (p=0,036) y mayor grado de satisfacción (p=0,047). Conclusión: La apendicectomía por PU demostró ser una técnica factible, segura y reproducible en nuestro medio(AU)

Introduction: In the search for new and better surgical alternatives to reduce the trauma to the abdominal wall, it has emerged single port surgery (SP), a procedure that involves performing laparoscopic surgery through a single incision, usually in the umbilicus. The results have been encouraging and further investigations are needed in this regard. Objective: To compare laparoscopic single port appendectomy (SP) versus standard 03 ports laparoscopic technique (AL3P) in the treatment of patients with acute appendicitis. Materials and Methods: Prospective, randomized study, included 158 patients divided into 2 groups (71 SP, 89 AL3P), from June 2013 to June 2016, comparing demographic variables, surgical time, trans and postoperative complications, conversion, postoperative pain, aesthetic benefits and satisfaction. Results: Age, sex, BMI, evolution, premedication, white blood cell count and stage of the disease was similar in both groups. Mean operative time was 48 min on the SP, lower than in AL3P (p˂0,001), and decreased following the learning curve of 30 cases. There was no conversion of SP to open surgery. The rate of intraoperative and postoperative complications was similar in both groups (p = 0.486 and p = 0.887). The hospital stay was lower in patients SP (p˂0,001), with better cosmetic outcome (p = 0.036) and greater satisfaction (p=0.047). Conclusion: SP appendectomy proved to be a feasible, safe and reproducible technique in our environment(AU)

Dispositivos monopuerto / Single port devices

Introducción: La cirugía laparoscópica tiene como avance importante el abordaje monopuerto, que está en constante perfeccionamiento y donde influye para su éxito el dispositivo de acceso del que se disponga. Estos procederes de cirugía laparoscópica por un puerto único se realizan con el uso de dispositivos monopuerto, a través de un guante quirúrgico, por endoscopia flexible o por múltiples trócares en una incisión, pero la primera opción facilita el trabajo y disminuye complicaciones. Objetivo: Actualizar la información existente sobre dispositivos monopuerto para tenerla en consideración a la hora de realizar el proceder. Métodos: Se realizó una revisión bibliográfica sobre dispositivos monopuerto en la cirugía mínimamente invasiva desde marzo hasta abril del año 2020. Se revisaron artículos, libros especializados y citas bibliográficas de estudios elegidos de los cuales fueron seleccionados 25 para esta revisión. Desarrollo: Después de la revisión de 25 bibliografías citadas se detallaron las características de los principales dispositivos. Conclusiones: Existe una amplia gama de dispositivos monopuerto, cuya eficacia se evidencia en la bibliografía consultada, y que la revisión de este tema debe ser tomada en cuenta por los especialistas a la hora de realizar esta cirugía(AU)

Introduction: Laparoscopic surgery has as an important advance the single-port approach, which is in constant improvement and where the available access device influences its success. These procedures of laparoscopic surgery by a single port are performed with the use of single port devices, through a surgical glove, by flexible endoscopy or by multiple trocars in an incision, but the first option facilitates the work and reduces complications. Objective: Update the existing information on single-port devices to take it into consideration when carrying out the procedure. Methods: A bibliographic review on single port devices in minimally invasive surgery was carried out from March to April 2020. Articles, specialized books and bibliographic citations of selected studies were reviewed, of which 25 were selected for this review. Development: After reviewing 25 cited bibliographies, the characteristics of the main devices were detailed. Conclusions: There is a wide range of single-port devices, whose effectiveness is evidenced in the consulted bibliography, and that the review of this topic should be taken into account by specialists when performing this surgery(AU)

Evaluación de factores asociados a formación de colecciones intraabdominales en apendicectomía monopuerto para apendicitis aguda complicada.

OBJETIVO: Comparar los desenlaces entre la apendicectomía por laparoscopia por puerto único y multipuerto, y establecer si existe diferencia en el riesgo de colección intraabdominal posoperatoria. MÉTODO: Se realizó un estudio retrospectivo, observacional, mediante 116 historias clínicas de pacientes llevados a apendicectomía laparoscópica por único puerto y multipuerto en dos centros médicos. RESULTADOS: Desarrollaron colección intraabdominal 12 (10.3%) pacientes. No se encontraron diferencias entre ambas técnicas en cuanto al desarrollo de colección intraabdominal (p = 0.242), no hubo diferencia entre ambas técnicas en cuanto a sangrado intraoperatorio (p = 0.012) y el tiempo quirúrgico fue mayor en el grupo de puerto único (17.4 minutos en promedio). El 62.5% de los pacientes con sangrado > 50 ml desarrollaron colección intraabdominal. CONCLUSIONES: No se evidenció superioridad de ninguna de las dos intervenciones en apendicitis complicada, pero sí se confirma que la apendicectomía laparoscópica por puerto único es un procedimiento seguro, factible, no inferior y con tasas similares de complicaciones en comparación con la técnica convencional de apendicectomía laparoscópica. OBJECTIVE: To compare the decreases between the appendectomy by single port vs. multiport laparoscopy and to establish if there is a difference in the risk of postoperative intra-abdominal collection. METHOD: Retrospective study was carried out using 116 medical records of patients undergoing laparoscopic appendectomy through a single port and multiport in two medical centers. RESULTS: 12 (10.3%) patients developed an abdominal collection. No differences were found between the two techniques in terms of intra-abdominal collection development (p = 0.242), there was no difference between the two techniques in terms of intraoperative bleeding (p = 0.012), the surgical time was greater in the single-port group (17.4 min on average). 62.5% of patients with bleeding > 50 mL developed intra-abdominal collection. CONCLUSIONS: There was no evidence of superiority of either of the two interventions in complicated appendicitis, but it does confirm that single-port laparoscopic appendectomy is a safe, feasible, noninferior procedure and with similar complication rates compared to the conventional laparoscopic appendectomy technique.

Single port endoscopic mastectomy: surgical technique and first case in Mexico.

Las innovaciones técnicas han permitido realizar un sinnúmero de cirugías endoscópicas y laparoscópicas, entre ellas la mastectomía preservadora de piel y pezón por puerto único, que ha sido reportada como bien tolerada, con un excelente resultado cosmético y con el mismo pronóstico oncológico que la cirugía tradicional. Esta técnica, común en Asia, presenta diversos retos técnicos y económicos. Presentamos la primera aproximación en nuestro país sobre este abordaje en una paciente con cáncer de mama. Para realizar esta cirugía es preciso el entrenamiento en mínima invasión y en cirugía mamaria, así como una adecuada selección de las pacientes.Technical innovations and scientific advances have allowed to perform countless endoscopic and laparoscopic surgical procedures. Among these, Single port endoscopic Mastectomy has been reported as well tolerated, with great aesthetic results and the same oncologic prognosis as traditional surgery. This popular approach in Asian countries presents many technical and economic challenges. We present the first endoscopic approach in our country: a female patient with infiltrating ductal carcinoma in the left breast. We understand that to carry out this procedure, adequate patient selection, great minimal invasive and breast surgery skills are necessary.

Conventional Laparoscopic Appendectomy Versus Single-Port Laparoscopic Appendectomy, a Multicenter Randomized Control Trial: A Feasible and Safe Alternative to Standard Laparoscopy.

Background: Acute appendicitis represents one of the main causes of surgical emergencies. It can be approached as open appendectomy or laparoscopic appendectomy (LA). LA uses different modalities, such as conventional laparoscopic appendectomy (CLA) or single-port laparoscopic appendectomy (SPLA). The aim of this work is to compare the results of CLA versus SPLA in patients diagnosed with Acute Appendicitis. Materials and Methods: A comparative multicenter prospective study of patients undergoing LA with a clinical diagnosis of acute appendicitis was presented. They were divided into two groups (CLA group and SPLA group). Results: A total of n = 147 patients were included (72 CLA and 75 SPLA). Preoperative and intraoperative times were shorter for patients undergoing CLA (P = .002; P = .068). Postoperative and reinsertion time was lower for SPLA (P = .000; P = .0004). There were no differences in postoperative complications. The type of approach showed statistically significant differences with respect to pain within the first 12 hours of the postoperative period, as well as at discharge, while no differences were observed in relation to cosmetic satisfaction when the two approaches were compared. Conclusion: SPLA technique presented less intraoperative time, shorter time of labor reinsertion, and less postoperative pain. There were no statistically significant differences in postoperative complications.

Single incision laparoscopic surgery (SILS TM) using an umbilical hernial approach for cryptorchidectomy of a degenerated testis in a dog / Aplicação do portal único (SILS TM) por acesso herniário umbilical para criptorquidectomia de testículo degenerado em cão

SILS TM via an umbilical hernia opening was used in the correction of an abdominal cryptorchidism in a dog. The SILS TM port was inserted through a 2.5 cm skin incision on the umbilical hernia and pneumoperitoneum was established with CO2. A 10mm telescope, 5mm laparoscopic Babcock clamp, and a clamp with combined cutting and coagulation features were used for the dissection and removal of the testicle through the SILS TM port. The treatment proved to be effective, easy, and quick to perform. However, the lack of triangulation between clamps and telescope limited the movement of the instruments, making it more laborious than a multiple-trocar approach. It can be concluded that the use of a SILS TM port through a pre-existing opening of the abdominal wall enables a reduction of the risks associated with multiple incisions; such as injury and manipulation of internal organs, pain, bleeding, and development of new hernias.(AU)

Objetivou-se proceder um tratamento para um caso de criptorquidismo canino, utilizando-se abordagem laparoscópica com portal único SILS TM, por meio de acesso abdominal via abertura de hérnia umbilical. Realizou-se uma incisão de 2,5 cm da pele em cima da hérnia umbilical, por onde introduziu-se trocater SILS TM, seguido do estabelecimento do pneumoperitônio com CO2. Utilizou-se ótica de 10mm, pinça laparoscópica de apreensão tipo Babcock de 5mm e pinça com corte e coagulação simultâneos para liberação e retirada do testículo e do trocater SILS TM, pelo acesso herniário. O tratamento proposto mostrou-se efetivo, de execução relativamente fácil e rápida. Entretanto, a ausência de triangulação entre as pinças e a óptica resultou em maior limitação na movimentação dos instrumentais, em comparação ao procedimento realizado com utilização de múltiplos portais. Pode-se concluir que a utilização do trocater SILS TM em uma falha pré-existente da parede abdominal possibilita significativa redução dos riscos potenciais de múltiplas incisões, como lesão de órgãos internos, manipulação, dor, sangramento e formação de novas hérnias.(AU)

Single incision laparoscopic surgery (SILSTM) using an umbilical hernial approach for cryptorchidectomy of a degenerated testis in a dog / Aplicação do portal único (SILSTM) por acesso herniário umbilical para criptorquidectomia de testículo degenerado em cão

ABSTRACT: SILSTM via an umbilical hernia opening was used in the correction of an abdominal cryptorchidism in a dog. The SILSTMport was inserted through a 2.5 cm skin incision on the umbilical hernia and pneumoperitoneum was established with CO2. A 10mm telescope, 5mm laparoscopic Babcock clamp, and a clamp with combined cutting and coagulation features were used for the dissection and removal of the testicle through the SILSTM port. The treatment proved to be effective, easy, and quick to perform. However, the lack of triangulation between clamps and telescope limited the movement of the instruments, making it more laborious than a multiple-trocar approach. It can be concluded that the use of a SILSTM port through a pre-existing opening of the abdominal wall enables a reduction of the risks associated with multiple incisions; such as injury and manipulation of internal organs, pain, bleeding, and development of new hernias.

RESUMO: Objetivou-se proceder um tratamento para um caso de criptorquidismo canino, utilizando-se abordagem laparoscópica com portal único SILSTM, por meio de acesso abdominal via abertura de hérnia umbilical. Realizou-se uma incisão de 2,5 cm da pele em cima da hérnia umbilical, por onde introduziu-se trocater SILSTM, seguido do estabelecimento do pneumoperitônio com CO2. Utilizou-se ótica de 10mm, pinça laparoscópica de apreensão tipo Babcock de 5mm e pinça com corte e coagulação simultâneos para liberação e retirada do testículo e do trocater SILSTM, pelo acesso herniário. O tratamento proposto mostrou-se efetivo, de execução relativamente fácil e rápida. Entretanto, a ausência de triangulação entre as pinças e a óptica resultou em maior limitação na movimentação dos instrumentais, em comparação ao procedimento realizado com utilização de múltiplos portais. Pode-se concluir que a utilização do trocater SILSTM em uma falha pré-existente da parede abdominal possibilita significativa redução dos riscos potenciais de múltiplas incisões, como lesão de órgãos internos, manipulação, dor, sangramento e formação de novas hérnias.

Initial experience with single-port robotic hysterectomy / Experiência inicial com histerectomia robótica por portal único

ABSTRACT Objective: This article presents the first series of robotic single-port hysterectomy cases performed at a hospital in Brazil. Methods: From November 2014 to October 2016, 11 patients were indicated to undergo, and nine of them were submitted to single-port hysterectomy using da Vinci Single-Site® platform. However, in two patients, due to multiple previous abdominal surgeries, large uterine volume, and/or a uterus with no mobility, a pneumoperitoneum was performed with a Verres needle, and the pelvic cavity was assessed using a 5mm optics endoscope. In these cases, single-port surgery was not recommended; therefore, multiportal robotic access was chosen, and no intercurrent events were reported. Nine single-port cases were operated on by the same surgeon at Hospital Israelita Albert Einstein. Patient data analyzed included age, body mass index, previous surgeries, and clinical diagnosis. Surgical data included operative time, skin incision, report of intraoperative complications, need for conversion to laparotomy, need for transfer to intensive care unit, need for blood transfusion, inadvertent injury to other organs, length of hospital stay, and death. Results: All cases were completed with da Vinci Single-Site® system, with no intercurrent events. Four patients presented with adenomyosis as the surgical indication, two had uterine myoma, one endometrial cancer, one endometrial polyp, and one desquamative inflammatory vaginitis. The mean age of patients was 44 years (range, 40 to 54 years), and body mass index varied between 23.4 and 33.2kg/m2 (mean 26.4). No complications occurred in any of the cases, such as intestinal or bladder injury, bleeding, or the need for a second surgery. All nine procedures were completed with the robotic single-port access, and no patient required a blood transfusion. Conclusion: Although this study merely presented an initial series of patients submitted to robotic single-port surgery, it demonstrated that the method is feasible and safe, suggesting the possible use of this technique in elective hysterectomy and other gynecological procedures in the future, as described in large reference centers of advanced surgery worldwide. Specifically, in gynecological practice, existing evidence on the use of robot-assisted, single-port surgery seems promising, and although it is not indicated in all cases, it should be considered as a surgical option. Nonetheless, further randomized and controlled clinical studies are necessary to establish the preeminence of robot-assisted, single-port surgery versus single-incision and conventional laparoscopy.

RESUMO Objetivo: Apresentar a primeira série de casos de histerectomia usando sistema robótico de portal único (single-port) em hospital no Brasil. Métodos: No período de novembro de 2014 a outubro 2016, de modo inédito no Brasil, 11 pacientes tiveram indicação inicial e 9 delas foram submetidas à histerectomia por portal único, com a plataforma da Vinci Single-Site®. Em duas pacientes, devido a múltiplas cirurgias abdominais prévias, grande volume uterino e/ou útero sem mobilidade, optou-se pela instalação de pneumoperitônio com agulha de Verres e inspeção da cavidade pélvica com ótica de 5mm, constatando-se, nestes casos, não ser viável a cirurgia por single-port, levando-se, assim, à opção pela técnica robótica multiportal, sem intercorrências. Os nove casos single-port foram operados por um mesmo cirurgião, no Hospital Israelita Albert Einstein. Os dados analisados das pacientes foram idade, índice de massa corporal, cirurgias anteriores e diagnóstico clínico. Os dados relacionados à cirurgia foram tempo operatório, incisão da pele, registro de complicações intraoperatórias, necessidade de conversão para laparotomia, necessidade de transferência para unidade de terapia intensiva, necessidade de transfusão sanguínea, lesão inadivertida de outros órgãos, tempo de internação e óbito. Resultados: Todos os casos foram concluídos sem intercorrências com a plataforma da Vinci Single-Site®. Quatro pacientes apresentavam adenomiose como indicação cirúrgica, duas apresentavam mioma uterino, uma câncer de endométrio, um pólipo endometrial e uma hidrorreia. A média de idade das pacientes foi 44 anos (variando de 40 a 54 anos) e o índice de massa corporal variou entre 23,4 a 33,2kg/m2 (média de 26,4). Nenhum caso teve qualquer tipo de complicação, como lesão intestinal ou vesical, sangramento ou necessidade de reabordagem cirúrgica. Todos os nove procedimentos foram concluídos com o portal único robótico, e nenhuma paciente necessitou de transfusão sanguínea. Conclusão: Apesar deste trabalho apresentar apenas uma série inicial de pacientes operadas por portal único robótico, ele demonstra a factibilidade do método e indica a possibilidade futura de adotar esta técnica em histerectomias eletivas e em outros procedimentos ginecológicos, assim como descrito em grandes centros de referência em cirurgia avançada no mundo. Especificamente na prática ginecológica, a evidência existente sobre o uso de portal único robô-assistido parece ser promissora e, ainda que nem todos os casos tenham indicação, é necessário que exista esta opção no arsenal cirúrgico. No entanto, estudos clínicos aleatorizados e controlados são necessários, a fim de se estabelecer a superioridade da cirurgia robótica por portal único diante da cirurgia laparoscópica com incisão única e da cirurgia laparoscópica convencional.

Apendicectomía laparoscópica por sistema «glove port¼: nuestros primeros 100 casos / Laparoscopic appendicectomy by 'glove port' system: Our first 100 cases

Resumen Introducción: La apendicectomía laparoscópica por puerto único supone un avance en las técnicas mínimamente invasivas. El objetivo de este estudio es mostrar nuestra serie de 100 casos de apendicitis aguda, intervenidos mediante técnica de puerto único utilizando el sistema «glove port¼, exponiendo nuestra técnica, resultados y seguimiento de nuestros pacientes. Material y métodos: Exponemos la serie de 100 casos intervenidos desde febrero de 2013 hasta enero de 2017 detallando los elementos que componen el sistema «glove port¼. Resultados: De las 100 apendicitis intervenidas, hubo 3 colecciones postoperatorias y una infección de herida quirúrgica, lo que muestra los buenos resultados obtenidos con esta técnica, haciendo hincapié en el excelente resultado estético. También señalamos que es un sistema económico que no encarece la laparoscopia convencional. Conclusiones: La apendicectomía laparoscópica por puerto único es segura, eficaz, económica y útil para que el cirujano adquiera habilidad en el abordaje laparoscópico por puerto único.

Abstract Introduction: Single port laparoscopic appendectomy is an advance in minimally invasive techniques. The objective of this study is to show our series of 100 cases of acute appendicitis, operated through a single port technique using the 'glove port' system, exposing our technique, results and follow up of our patients. Material and methods: We present the series of 100 cases intervened from February 2013 to January 2017 detailing the elements that make up the 'glove port' system. Results: Of the 100 operated appendicitis, there were 3 postoperative collections and 1 surgical wound infection, which shows the good results obtained with this technique, emphasizing the excellent aesthetic result. We also point out that it is an economic system that does not make conventional laparoscopy more expensive. Conclusions: Single port laparoscopic appendectomy is safe, effective, economical and useful for the surgeon to acquire skills in a single port laparoscopic approach.

LESS ovariohysterectomy in cats using a new homemade multiport / Ovário-histerectomia por LESS em gatas com um novo multiportal artesanal

The purpose of this study was to assess the use of a homemade multiport for LESS (laparoendoscopic single-site surgery) ovariohysterectomy (OVH) in cats. Intra and postoperative variables of the surgery steps, technical challenges, complications and evolution of surgical time by a surgeon in training were evaluated. Twenty queens were selected for LESS OVH. The multiport device was manufactured of a conical-shaped ethylene polytereftalate (PET) bottle, urethral catheter no. 8, latex balloon no. 11, a 3.5mm and a 6mm laparoscopic trocars. Hemostasis was carried out using bipolar diathermy. Mean total surgical time was 14.54±5.12 minutes. Approach to right and left ovarian pedicles and abdominal access for insertion of the multiport device were the most time consuming surgical steps. LESS ovariohysterectomy using a new homemade multiport device is feasible and safe. Thus, the proposed technique may be considered as a minimally invasive alternative to ovariohysterectomy in the feline specie.(AU)

Objetivou-se avaliar o emprego do novo dispositivo multiportal artesanal para realização de ovariohisterectomia por LESS (cirurgia laparoendoscópica por único acesso) em gatas, analisando variáveis intraoperatórias de tempo cirúrgico das diferentes etapas que compõem o procedimento, suas possíveis dificuldades técnicas de execução e complicações trans e pós-operatórias. Avaliou-se ainda a curva de aprendizado deste procedimento, realizado por um cirurgião não proficiente na técnica. Vinte gatas foram submetidas à laparoscopia. Para a confecção do multiportal foi utilizado um recipiente de politereftalato de etileno (PET), uma sonda uretral nº8, um balão de látex nº11, um portal de videocirurgia de 3,5mm, e um de 6mm. O sistema de coagulação foi o bipolar. O tempo cirúrgico médio foi de 14,54±5,12 minutos. A abordagem aos pedículos ovarianos direito e esquerdo e o acesso para introdução do portal foram as etapas que apresentaram maior tempo de execução. A OVH videoassistida empregando o novo dispositivo multiportal é factível, não demonstrando complicações. Acredita-se, portanto, que a técnica proposta torna-se uma alternativa para realização minimamente invasiva de ovariohisterectomia em felinos.(AU)

LESS ovariohysterectomy in cats using a new homemade multiport / Ovário-histerectomia por LESS em gatas com um novo multiportal artesanal

ABSTRACT: The purpose of this study was to assess the use of a homemade multiport for LESS (laparoendoscopic single-site surgery) ovariohysterectomy (OVH) in cats. Intra and postoperative variables of the surgery steps, technical challenges, complications and evolution of surgical time by a surgeon in training were evaluated. Twenty queens were selected for LESS OVH. The multiport device was manufactured of a conical-shaped ethylene polytereftalate (PET) bottle, urethral catheter no. 8, latex balloon no. 11, a 3.5mm and a 6mm laparoscopic trocars. Hemostasis was carried out using bipolar diathermy. Mean total surgical time was 14.54±5.12 minutes. Approach to right and left ovarian pedicles and abdominal access for insertion of the multiport device were the most time consuming surgical steps. LESS ovariohysterectomy using a new homemade multiport device is feasible and safe. Thus, the proposed technique may be considered as a minimally invasive alternative to ovariohysterectomy in the feline specie.

RESUMO: Objetivou-se avaliar o emprego do novo dispositivo multiportal artesanal para realização de ovariohisterectomia por LESS (cirurgia laparoendoscópica por único acesso) em gatas, analisando variáveis intraoperatórias de tempo cirúrgico das diferentes etapas que compõem o procedimento, suas possíveis dificuldades técnicas de execução e complicações trans e pós-operatórias. Avaliou-se ainda a curva de aprendizado deste procedimento, realizado por um cirurgião não proficiente na técnica. Vinte gatas foram submetidas à laparoscopia. Para a confecção do multiportal foi utilizado um recipiente de politereftalato de etileno (PET), uma sonda uretral nº8, um balão de látex nº11, um portal de videocirurgia de 3,5mm, e um de 6mm. O sistema de coagulação foi o bipolar. O tempo cirúrgico médio foi de 14,54±5,12 minutos. A abordagem aos pedículos ovarianos direito e esquerdo e o acesso para introdução do portal foram as etapas que apresentaram maior tempo de execução. A OVH videoassistida empregando o novo dispositivo multiportal é factível, não demonstrando complicações. Acredita-se, portanto, que a técnica proposta torna-se uma alternativa para realização minimamente invasiva de ovariohisterectomia em felinos.

Uniportal video-assisted thoracoscopic surgery, Argentinian experience.

The acceptance of uniportal video-assisted thoracoscopic surgery (VATS) for minor and major thoracic procedures is growing in South America. This study presents the experience with uniportal VATS in Buenos Aires, Argentina. In a retrospective study, 181 patients were operated with uniportal VATS technique between December 2013 and October 2016. Uniportal procedures included minor and major procedures. Uniportal VATS were analyzed en terms of morbidity, mortality, conversion rate, hospital stay. A total of 181 patients were analyzed. 59% were males and 41% females. The mean age was 58.7. The uniportal VATS procedures included pneumothorax 30, interstitial lung 5, complicated pleural effusion 35, pleurectomy biopsy pleurodesis 40, pericardial effusion 10, mediastinal tumor (posterior) 5, wedge resection 30, anatomical segment resection 6, and lobectomy 20. There were 2 conversions in major resection procedures due to technical difficulties. There was 1 revision for postoperative hemothorax. The mean hospital stay was 4.9 days for the whole group. Uniportal VATS is a safe technique in thoracic surgery. Maintains the oncological principles of traditional open procedures. There are lower, few general complications, lower pain level, lower postoperative morbidity and mortality. Reduces surgical trauma, and reduces the postoperative hospital stay.

Actualidad de la cirugía robótica / Present time of the robotic surgery

Introducción: la cirugía robótica es ya una realidad. Aunque la historia de la cirugía se remonta a más de 2000 años; las últimas dos décadas del siglo XX han mostrado una marcada revolución en la medicina, debido a todos los cambios que ha provocado en la manera de hacer, enseñar y practicar la cirugía. Objetivo: exponer aspectos generales y actuales de la robótica aplicada a la medicina y en especial a la cirugía; así como el impacto que la cirugía robótica ha tenido en la enseñanza médica. Métodos: se realizó una revisión sistemática a partir de la consulta de artículos científicos indexados relacionados con el tema. Las fuentes de información consultadas fueron: Pubmed, Ebsco y Scielo. La información se analizó y seleccionó en correspondencia con el tema y los objetivos. Resultados: la cirugía robótica ha evolucionado hasta ser un campo aparte con un enorme potencial para su desarrollo presente y futuro. Los robots que se utilizan para este tipo de cirugías han tenido una gran aceptación en la comunidad científica por las ventajas significativas como la posibilidad de llegar a partes del cuerpo donde un humano no podría llegar y accionar. Conclusiones: esta revisión muestra que la tecnología robótica es capaz de ofrecer resultados satisfactorios y un adecuado tratamiento a los pacientes. Esto garantiza un riesgo de intervención mucho menor y una óptima recuperación en el menor tiempo posible, al crearse programas muy eficaces para su aprendizaje(AU)

Introduction: Robotic surgery is already a reality. Although surgery history dates back from more than 2000 years, the last two decades of the twentieth century have shown a marked revolution in medicine, due to all the changes it has caused in the way of doing, teaching and practicing surgery. Objective: To present general and current aspects of robotics applied to medicine and especially to surgery, as well as the impact of robotic surgery in medical teaching. Methods: A systematic review was carried out based on the consultation of indexed scientific articles related to the topic. The sources of information consulted were PubMed, Ebsco and Scielo. The information was analyzed and chosen in correspondence with the topic and objectives. Results: Robotic surgery has evolved into a separate field with enormous potential for its present and future development. The robots used for this type of surgeries have had a great acceptance among the scientific community, for the significant advantages, such as the possibility to arrive at body areas a human could not arrive and act on. Conclusions: This review shows that robotic technology is able to offer patients satisfactory outcomes and adequate treatment. This guarantees a much lower intervention risk and an optimum recovery in the shortest possible time, creating very effective programs for their learning(AU)

Actualidad de la cirugía robótica / Present time of the robotic surgery

Introducción: la cirugía robótica es ya una realidad. Aunque la historia de la cirugía se remonta a más de 2000 años; las últimas dos décadas del siglo XX han mostrado una marcada revolución en la medicina, debido a todos los cambios que ha provocado en la manera de hacer, enseñar y practicar la cirugía. Objetivo: exponer aspectos generales y actuales de la robótica aplicada a la medicina y en especial a la cirugía; así como el impacto que la cirugía robótica ha tenido en la enseñanza médica. Métodos: se realizó una revisión sistemática a partir de la consulta de artículos científicos indexados relacionados con el tema. Las fuentes de información consultadas fueron: Pubmed, Ebsco y Scielo. La información se analizó y seleccionó en correspondencia con el tema y los objetivos. Resultados: la cirugía robótica ha evolucionado hasta ser un campo aparte con un enorme potencial para su desarrollo presente y futuro. Los robots que se utilizan para este tipo de cirugías han tenido una gran aceptación en la comunidad científica por las ventajas significativas como la posibilidad de llegar a partes del cuerpo donde un humano no podría llegar y accionar. Conclusiones: esta revisión muestra que la tecnología robótica es capaz de ofrecer resultados satisfactorios y un adecuado tratamiento a los pacientes. Esto garantiza un riesgo de intervención mucho menor y una óptima recuperación en el menor tiempo posible, al crearse programas muy eficaces para su aprendizaje(AU)

Introduction: Robotic surgery is already a reality. Although surgery history dates back from more than 2000 years, the last two decades of the twentieth century have shown a marked revolution in medicine, due to all the changes it has caused in the way of doing, teaching and practicing surgery. Objective: To present general and current aspects of robotics applied to medicine and especially to surgery, as well as the impact of robotic surgery in medical teaching. Methods: A systematic review was carried out based on the consultation of indexed scientific articles related to the topic. The sources of information consulted were PubMed, Ebsco and Scielo. The information was analyzed and chosen in correspondence with the topic and objectives. Results: Robotic surgery has evolved into a separate field with enormous potential for its present and future development. The robots used for this type of surgeries have had a great acceptance among the scientific community, for the significant advantages, such as the possibility to arrive at body areas a human could not arrive and act on. Conclusions: This review shows that robotic technology is able to offer patients satisfactory outcomes and adequate treatment. This guarantees a much lower intervention risk and an optimum recovery in the shortest possible time, creating very effective programs for their learning(AU)

Laparoendoscopic single-site retroperitoneoscopic adrenalectomy: bilateral step-by-step technique.

BACKGROUND: Laparoscopic adrenalectomy is the gold standard surgical approach for small benign adrenal tumors [1]. Several surgical approaches were developed in order to overcome the difficulty to access the adrenal glands, located in the upper retroperitoneum space [2-4]. Laparoendoscopic single-site posterior retroperitoneoscopic adrenalectomy (LESS-PRA) is an emerging technique that reduced the multiple trocar-related trauma and improved cosmetic outcomes while minimizing postoperative morbidity [5-8]. The aim of this study was to describe our step-by-step technique for LESS-PRA and to compare our perioperative outcomes with the conventional 3-port lateral retroperitoneoscopic adrenalectomy (LRA). METHODS: A retrospective review was carried out from February 2008 to January 2016 that included 100 patients with adrenal tumors smaller than 4 cm. Study exclusion criteria were defined as tumor size greater than 4 cm, patients older than 80 years, and body mass index (BMI) greater than 40. A total of 20 patients underwent LESS-PRA and 80 patients underwent 3-port lateral retroperitoneoscopic laparoscopic adrenalectomy. Patient's demographic data and perioperative outcomes were compared and statistically analyzed. The cosmetic satisfaction was evaluated with a visual analog scale. RESULTS: Estimated blood loss was higher in LRA (100 vs. 50 ml; p = 0.35). Operative time was longer in LESS-PRA than LRA (100.0 vs. 60 min; p < 0.001). Analgesic time necessary for LRA was longer than LESS-PRA (40 vs. 24 h; p < 0.001). Cosmetic satisfaction score was higher in LESS-PRA (9.5 vs. 8.6; p = 0.03). There were no significant differences in perioperative complications and length of hospital stay. No conversion to conventional laparoscopic or open surgery was necessary. CONCLUSION: LESS-PRA presented comparable functional and perioperative outcomes to LRA for small adrenal tumors. Although LESS-PRA was associated with longer operative time, it provided inferior estimated blood loss, analgesic time, and improved cosmetic satisfaction.

Resección total del mesorrecto por vía transanal en cáncer de recto: análisis de resultados de una serie preliminar en un hospital universitario / Transanal total mesorectal excision in rectal cancer: analysis of a preliminary series in universitary hospital

Introducción: La resección total del mesorrecto por vía transanal es un abordaje híbrido que combina el uso de una plataforma transanal y laparoscopia convencional. Objetivos: Realizar el análisis de casos seleccionados con cáncer de recto medio e inferior en los cuales se utilizó un abordaje transanal combinado para su resolución y la descripción de la técnica quirúrgica. Materiales y métodos. Corresponde a una serie prospectiva de pacientes con diagnóstico de cáncer de recto de tercio medio e inferior con resección mesorrectal asistida por monopuerto endoanal entre octubre de 2012 y diciembre de 2015, en Hospital Clínico Universidad de Chile. Se utilizó estadística descriptiva para el análisis de los datos. Resultados: Fueron sometidos a cirugía por cáncer de recto medio e inferior un total de 29 pacientes utilizando monopuerto transanal. De estos, 22 fueron de sexo masculino y 7 de sexo femenino, con edad promedio de 55,5 años e IMC de 26,4. La distancia media al margen anal fue 4,8 cm. Todos recibieron neoadyuvancia. Se realizaron 17 Ta-TME (58,6%) y 12 Ta-TME con abordaje interesfintérico (41,4%). La anastomosis fue coloanal manual en 15 pacientes (51,7%) y grapada en 14 (48,3%). El abordaje laparoscópico se utilizó en 26 pacientes y el abierto en 3, registrando 4 conversiones (15,4%). El tiempo operatorio promedio fue de 282 min. La estadía hospitalaria media fue de 9 días. Conclusión: El monopuerto endoanal aparece como una herramienta útil en la disección total del mesorrecto por su seguridad y factibilidad. Creemos que es necesaria la realización de trabajos prospectivos aleatorizados, donde es relevante la comparación de resultados oncológicos y funcionales a largo plazo.

Introduction: Transanal total mesorectal excision is a hybrid approach that combines the use of a conventional laparoscopic and a transanal platform. Objectives: To conduct an analysis of selected cases with medium and lower rectal cancer, were a combined transanal approach was used and description of the surgical technique. Materials and methods: Prospective series of patients diagnosed with middle and lower third rectal cancer with mesorectal resection assisted by endoanal single port, between October 2012 and December 2015 at University of Chile Clinical Hospital. Descriptive statistics were used for data analysis. Results: A total of 29 patients underwent surgery for middle and lower rectal cancer using a transanal single port. Gender distribution was 22 male and 7 female patients, with a mean age of 55.5 years and a mean BMI of 26.4. The mean distance from the anal margin was 4.8 cm. All patients received neoadjuvant therapy. The surgeries performed were 17 Ta-TME (58.6%) and 12 Ta-TME with intersphincteric approach (41.4%). The colo-anal anastomosis was hand sewn in 15 patients (51.7%), and stapled in 14 (48.3%). The laparoscopic approach was used in 26 patients and the open approach in 3, with 4 conversions (15.4%). The mean operative time was 282 min. The mean hospital stay was 9 days. Conclusion: The endoanal single port appears as a useful tool in total mesorectal dissection for its safety and feasibility. We believe we need randomized prospective studies, where comparison of oncological and functional long-term results is relevant.

Single port radical prostatectomy: current status.

The aim of this study is to analyze the current literature on single port radical prostatectomy (LESS-RP). Single port radical prostatectomy laparoendoscopic (LESS-RP) has established itself as a challenge for urological community, starting with the proposal of different approaches: extraperitoneal, transperitoneal and transvesical, initially described for laparoscopy and then laparoscopy robot-assisted. In order to improve the LESS-RP, new instruments, optical devices, trocars and retraction mechanisms have been developed. Advantages and disadvantages of LESS-RP are controversial, while some claim that it is a non-trustable approach, regarding the low cases number and technical difficulties, others acclaim that despite this facts some advantages have been shown and that previous described difficulties are being overcome, proving this is novel proposal of robotics platform, the Da Vinci SP, integrating the system into "Y". The LESS-RP approach gives us a new horizon and opens the door for rapid standardization of this technique. The few studies and short series available can be result of a low interest in the application of LESS-RP in prostate, probably because of the technical complexity that it requires. The new robotic platform, the da Vinci SP, shows that it is clear that the long awaited evolution of robotic technologies for laparoscopy has begun, and we must not lose this momentum.

Efficacy and safety of a new single-port model for appendectomy: Experimental study on swine.

CONTEXT: With the cooperation of surgeons and the engineering division of the company Bhio supply(©) (Esteio-RS, Brazil), a permanent single port was developed. AIMS: An experimental study assessed the safety and efficacy of the device using a swine laparoscopic appendectomy model (right salpingo-oophorectomy). SETTINGS AND DESIGN: Experimental randomised study. MATERIALS AND METHODS: A total of 20 pigs were randomised for the conventional laparoscopic (CL) three-trocar technique or the single Centry port (CPort) with two working channels, aided by a transparietal thread. Operative times, surgical complications, CO2 use, and pneumoperitoneal pressure were checked. Pressure and chromopertubation tests assessed the ligatures. STATISTICAL ANALYSIS USED: For quantitative outcomes, the Fisher's exact test analysed the samples to compare the surgeons in each group, the ANOVA test for parametric data (volume and pressure) and the Student's t-test for analysis of the fascial incision length. The binaries and isolated occurrence events were described in percentages. RESULTS: For all cases, pneumoperitoneum was maintained. The CPort group, however, resulted in higher CO2 use (26.18 l; standard deviation [SD] ± 11.09) than CL group (5.69 l; SD ± 2.44) (P < 0.01). The mean pressure in CPort group (6.604 mmHg, SD ± 1.793) was comparatively lower than in CL group (7.382 mmHg, SD ± 1.833) (P = 0.363). There was no statistical difference between operative times, ligature safety or adverse surgical events between the different groups and surgeons. CONCLUSION: The surgical technique used with the single port showed no differences in safety and efficacy. Though it does require more CO2 use, its working dynamics did not lead to increased operative times. The results were similar between the two surgeons in the study, suggesting that they can be reproduced.

Single-port unilateral transaxillary totally endoscopic thyroidectomy: A survival animal and cadaver feasibility study.

BACKGROUND: Single-port unilateral axillary thyroidectomy has great potential to become a valid alternative technique for thyroid surgery. We tested the technique in a study on live animals and cadavers to evaluate the feasibility and reproducibility of the procedure. MATERIALS AND METHODS: Institutional review board (IRB) approval was obtained in our university by the Council of Ethics for the study in surviving animals and cadavers. Subtotal thyroidectomy using unilateral axillary single port was performed in five dogs and five cadavers. Performing incision in the axillary fossa, a disposable single port was inserted. The dissection progressed for creating a subcutaneous tunnel to the subplatysmal region; after opening the platysma muscle and separation of the strap muscles, the thyroid gland was identified. After key anatomical landmarks were identified, the dissection was started at the upper pole towards the bottom, and to the isthmus. Specimens were extracted intact through the tunnel. Clinical and laboratorial observations of the experimental study in a 15-day follow-up and intraoperative data were documented. RESULTS: All surgeries were performed in five animals which survived 15 days without postoperative complications. In the surgeries successfully performed in five cadavers, anatomical landmarks were recognised and intraoperative dissection of recurrent nerves and parathyroid glands was performed. Mean operative time was 64 min (46-85 min) in animals and 123 min (110-140 min) in cadavers, with a good cosmetic outcome since the incision was situated in the axillary fold. CONCLUSION: The technique of single-port axillary unilateral thyroidectomy was feasible and reproducible in the cadavers and animal survival study, suggesting the procedure as an alternative to minimally invasive surgery of the neck.