Evaluation of a simple valve mechanism used to stabilize intraabdominal pressure during surgically induced pneumoperitoneum in small animals.

BACKGROUND: Preventing sudden changes in intraabdominal pressure (IAP) during surgical pneumoperitoneum may reduce adverse events. This study aimed to describe a valve system that stabilizes intraabdominal pressure, minimizing complications of erratic fluctuations in IAP. METHODS: Five male Sprague-Dowley rats were submitted to pneumoperitoneum, with the insufflator set sequentially at 5, 10, and 15 mmHg for each rat. Measures of IAP were taken initially without the valve and then using the same insufflator levels with the valve system regulated to three different pressures (5, 10, and 15 mmHg). The mean of the three highest registered pressures during a 15-min observation was used as the maximal pressure, and the mean of the three lowest registered pressures was used as the minimal pressure for each experimental setting. RESULTS: Without the valve system, the pressure level set by the insufflator correlated poorly with the actual IAP. When the valve system was used, the IAP pressure was limited by the valve settings regardless of the insufflator settings. Also, the variability of IAP was significantly higher when no valve was used than in all situations that had implementation of the system. CONCLUSIONS: The valve system was very effective in stabilizing IAP, allowing a reproducible and reliable estimate of IAP and greatly reducing the variability resulting from the cycling mechanism of the insufflator. Due to the small dimensions of intracorporeal cavities in the newborn, this mechanism may help to improve safety when neonatal video-assisted surgery is performed.

Veress needle insertion into the left hypochondrium for creation of pneumoperitoneum: diagnostic value of tests to determine the position of the needle in unselected patients.

OBJECTIVE: To assess the effectiveness of the Veress needle puncture in the left hypochondrium and the accuracy of the tests described for the intraperitoneal correct positioning of the tip of the Veress needle in an unselected population. METHODS: Ninetyone patients consecutively scheduled for Videolaparoscopy had the abdominal wall punctured in the left hypochondrium. There were no exclusion criteria. The patients received general anesthesia and mechanical ventilation according to the protocol. After puncturing five tests were used to confirm the positioning of the needle tip within the peritoneal cavity: aspiration test--AT; resistance to infusion--Pres; recovery of the infused fluid--Prec, dripping test--DT, and test of initial intraperitoneal pressure--IIPP. The test results were compared with results from literature for groups with defined exclusion criteria. The results were used for calculating sensitivity (S) specificity (E), positive predictive value (PPV) and negative predictive value (NPV). Inferential statistical methods were used to analyze the findings. RESULTS: There were 13 failures. AT had E = 100% and NPV 100%. Pres had S = 100%, E = 0; PPV = 85.71%; NPV does not apply. Prec: S = 100%, E = 53.84%, PPV = 92.85%, NPV = 100%. DT: S = 100%, E = 61.53%, PPV = 93.97% NPV 100%. In IIPP, S, E, PPV and NPV were 100%. CONCLUSION: The puncture in the left hypochondrium is effective and the performed tests guide the surgeon regardless of sex, BMI, or previous laparotomy.

Punção com agulha de Veress no hipocôndrio esquerdo para a criação do pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pacientes não selecionados / Veress needle insertion into the left hypochondrium for creation of pneumoperitoneum: diagnostic value of tests to determine the position of the needle in unselected patients

OBJETIVO: Verificar a eficiência da punção com agulha de Veress no hipocôndrio esquerdo, a acurácia dos testes descritos para o correto posicionamento intraperitoneal da ponta da agulha de Veress em população não selecionada. MÉTODOS: Noventa e um pacientes, sem quaisquer critérios de exclusão, consecutivamente agendados para procedimentos videolaparoscópicos, tiveram a parede abdominal puncionada no hipocôndrio esquerdo. Os pacientes receberam anestesia geral e ventilação controlada mecânica segundo o protocolo. Após a punção foram utilizadas cinco provas para testar o posicionamento da ponta da agulha no interior da cavidade peritoneal: prova da aspiração - PA, da resistência à infusão - Pres, da recuperação do líquido infundido - Prec, prova do gotejamento - PG, e a prova da pressão intraperitoneal inicial - PPII. Os resultados foram considerados para cálculo da sensibilidade (S) e da especificidade (E) e valores preditivos positivos (VPP) e valores preditivos negativos (VPN). Métodos inferenciais estatísticos foram utilizados na análise dos achados. RESULTADOS: Ocorreram 13 fracassos. A PA teve E=100 por cento e VPN=100 por cento. Pres teve S=100 por cento; E=0; VPP=85,71 por cento VPN= não se aplica. Prec: S=100 por cento; E= 53,84 por cento; VPP= 92,85 por cento; VPN= 100 por cento. PG: S=100 por cento; E= 61,53 por cento; VPP= 93,97 por cento VPN= 100 por cento. Na PPII, a S, E, VPP e VPN foram de 100 por cento. CONCLUSÃO: A punção no hipocôndrio esquerdo é eficiente, as provas realizadas orientam o cirurgião a despeito do gênero, IMC ou operações prévias.

Objective: To assess the effectiveness of the Veress needle puncture in the left hypochondrium and the accuracy of the tests described for the intraperitoneal correct positioning of the tip of the Veress needle in an unselected population. Methods: Ninetyone patients consecutively scheduled for Videolaparoscopy had the abdominal wall punctured in the left hypochondrium. There were no exclusion criteria. The patients received general anesthesia and mechanical ventilation according to the protocol. After puncturing five tests were used to confirm the positioning of the needle tip within the peritoneal cavity: aspiration test - AT; resistance to infusion - Pres; recovery of the infused fluid - Prec, dripping test - DT, and test of initial intraperitoneal pressure - IIPP. The test results were compared with results from literature for groups with defined exclusion criteria. The results were used for calculating sensitivity (S) specificity (E), positive predictive value (PPV) and negative predictive value (NPV). Inferential statistical methods were used to analyze the findings. Results: There were 13 failures. AT had E = 100 percent and NPV 100 percent. Pres had S = 100 percent, E = 0; PPV = 85.71 percent; NPV does not apply. Prec: S = 100 percent, E = 53.84 percent, PPV = 92.85 percent, NPV = 100 percent. DT: S = 100 percent, E = 61.53 percent, PPV = 93.97 percent NPV 100 percent. In IIPP, S, E, PPV and NPV were 100 percent. Conclusion: The puncture in the left hypochondrium is effective and the performed tests guide the surgeon regardless of sex, BMI, or previous laparotomy.

Intraperitoneal pressure and volume of gas injected as effective parameters of the correct position of the Veress needle during creation of pneumoperitoneum.

OBJECTIVE: The aim of this work was to establish reliable parameters of the correct position of the Veress needle in the peritoneal cavity during creation of pneumoperitoneum. METHODS: The Veress needle was inserted into the peritoneal cavity of 100 selected patients, and a carbon-dioxide flow rate of 1.2 L/min and a maximum pressure of 12 mm Hg were established. Intraperitoneal pressure (IP) and the volume of gas injected (VG) were recorded at the beginning of insufflation and at every 20 seconds. Correlations were established for pressure and volume in function of time. Values of IP and VG were predicted at 1, 2, 3, and 4 minutes of insufflation, by applying the following formulas: IP = 2.3083 + 0.0266 x time +8.3 x 10(-5) x time(2) - 2.44 x 10(-7) x time(3); and VG = 0.813 + 0.0157 x time. RESULTS: A strong correlation was observed between IP and preestablished time points during creation of the pneumoperitoneum, as well as between VG and preestablished time points during creation of the pneumoperitoneum, with a coefficient of determination of 0.8011 for IP and of 0.9604 for VG. The predicted values were as follows: 1 minute = 4.15; 2 minutes = 6.27; 3 minutes = 8.36; and 4 minutes = 10.10 for IP (mm Hg); and 1 minute = 1.12; 2 minutes = 2.07; 3 minutes = 3.01; and 4 minutes = 3.95 for VG (L). CONCLUSIONS: Values of IP and VG at given time points during insufflation for creation of the pneumoperitoneum, using the Veress needle, can be effective parameters to determine whether the needle is correctly positioned in the peritoneal cavity.

Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review.

BACKGROUND: The aim of this study was to assess the prevalence, risks, and outcomes of injuries caused by the Veress needle described in the literature. METHODS: Iatrogenic injuries caused by Veress needle insertion during diagnostic or therapeutic laparoscopies in humans were researched, with no language restriction, in the Medline, Lilacs, Embase, Scielo, and Cochrane Library databases. The following words were combined: "Veress" or "insufflation needle" or "pneumoperitoneum needle," and "complications" or "injuries" or "lesions." The bibliographic references of the selected articles were also analyzed. We considered the following: (1) number of injuries described in the literature, (2) relationship between number of injuries and number of patients who underwent Veress needle insertion in the studies that reported Veress needle injury, (3) organs and structures injured (retroperitoneal vessels, digestive tract, and self-limited, minor injuries), and (4) outcome (death, conversion to laparotomy, laparoscopic repair, spontaneous resolution). RESULTS: Thirty-eight selected articles included 696,502 laparoscopies, with 1,575 injuries (0.23%), 126 (8%) of which involved blood vessels or hollow viscera (0.018% of all laparoscopies). Of the 98 vascular injuries, 8 (8.1%) were injuries to major retroperitoneal vessels. There were 34 other reported retroperitoneal injuries, but the authors were not specific as to which vessel was injured. Of the 28 injuries to hollow viscera, 17 were considered major injuries, i.e., 60.7% (0.0024% of the total cases assessed). CONCLUSION: The insertion of the Veress needle in the abdominal midline, at the umbilicus, poses serious risk to the life of patients. Therefore, further studies should be conducted to investigate alternative sites for Veress needle insertion.

[Evaluation of tests performed to confirm the position of the Veress needle for creation of pneumoperitoneum in selected patients: a prospective clinical trial]. / Valor das provas de posicionamento da ponta da agulha de Veress para a criação do pneumoperitônio artificial em pacientes selecionados: ensaio clínico prospectivo.

PURPOSE: To evaluate tests performed to confirm the position of the Veress needle inserted into the left hypochondrium for creation of pneumoperitonium. METHODS: One hundred patients were submitted to laparoscopic procedure with left hypochondrium puncturing. Needle positioning tests were evaluated. The aspiration test was considered positive when organic material was aspirated; the injection test was considered positive when no increased resistance to liquid injection was observed; the recovery test was considered positive when the liquid injected was not recovered; the saline drop test was considered positive when drops of saline in the syringe disappeared quickly; the initial intraperitoneal pressure test was considered positive when pressure levels were 8 pounds mmHg. A positive aspiration test indicated iatrogenic injury, whereas a positive result in any of the other tests indicated that the tip of the needle was correctly positioned in the peritoneal cavity. Sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of the tests were calculated by correlating results considered true positives (a), false positives (b), false negatives (c) and true negatives (d), according to the formulas: SE = [a/(a + c)] x 100; SP = [d/(b + d)] x 100; PPV = [a/(a + b)] x 100; NPV = [d(c + d)] x 100. RESULTS: With regard to the aspiration test, SE and PPV were not applicable, SP was 100% and NPV was 100%. With regard to the injection test, SE was 0%, SP was 100%, PPV was inexistent and NPV was 90%. Both recovery and saline drop tests yielded the following results: SE was 50%, SP was 100%, PPV was 100% and NPV was 94.7%. The initial intraperitoneal pressure test yielded the following results: SE, SP, PPV and NPV were 100%. CONCLUSIONS: When inserting the Veress needle into the left hypochondrium, a negative aspiration test guarantees the absence of iatrogenic injury; the injection test is not reliable to determine incorrect needle positioning, but it accurately detects correct needle positioning; recovery and saline drop tests are not reliable to determine correct needle positioning, but they accurately detect incorrect needle positioning; the initial intraperitoneal pressure test is reliable to determine both correct and incorrect needle positioning, and proved to be the most reliable of the tests analyzed.

Veress needle insertion in the left hypochondrium in creation of the pneumoperitoneum / Punção no hipocôndrio esquerdo com agulha de Veress para a criação do pneumoperitônio

PURPOSE: To test the efficacy of the puncture in the left hypochondrium as an alternative method. METHODS: Sixty-two patients randomly distributed into two groups were studied: Group LH, puncture in the left hypochondrium (n=30), and Group ML, puncture in the abdominal midline (n=32). The following were assessed: needle positioning tests, number of failed attempts at needle insertion, and time needed for creation of pneumoperitoneum. Gas flow, volume and intraperitoneal pressure were recorded at every 20 seconds, until a 12 mmHg pressure was reached inside the peritoneal cavity. RESULTS: A similar number of positive results for the needle positioning tests were observed in both groups. Two failed attempts to reach the peritoneal cavity were observed in Group ML and one in Group LH. The time necessary for the creation of pneumoperitoneum was on average 3 minutes and 46 seconds for Group LH, and 4 minutes and 2 seconds for Group ML. Average gas flow, volume and pressure were equivalent for both groups. CONCLUSION: Puncture in the left hypochondrium was as effective as puncture in the abdominal midline for the creation of pneumoperitoneum.

OBJETIVO: Avaliar a eficácia e segurança da punção alternativa no hipocôndrio esquerdo. MÉTODOS: Sessenta e dois pacientes distribuídos aleatoriamente em dois grupos foram estudados prospectivamente: grupo HE, punção no hipocôndrio esquerdo (n=30) e grupo LM, punção na linha média do abdome (n=32). Foram avaliados os testes de posicionamento da agulha, o número de tentativas frustradas e a duração da instalação do pneumoperitônio. Os fluxos correntes, as pressões intraperitoneais e os volumes injetados foram registrados a cada 20 segundos, até 12 mmHg. RESULTADOS: O número de resultados positivos aos testes de posicionamento da agulha foi semelhante em ambos os grupos. Ocorreram duas tentativas infrutíferas de punção no grupo LM e uma no grupo HE. O tempo necessário para o estabelecimento do pneumoperitônio foi, em média, 3 minutos e 46 segundos para o Grupo HE e 4 minutos e 2 segundos para o grupo LM. As médias dos fluxos, das pressões e dos volumes foram respectivamente equivalentes entre os grupos.. CONCLUSÃO: A punção no HE foi tão eficaz no estabelecimento do pneumoperitônio quanto a punção na LM do abdome.

Veress needle insertion in the left hypochondrium in creation of the pneumoperitoneum.

PURPOSE: To test the efficacy of the puncture in the left hypochondrium as an alternative method. METHODS: Sixty-two patients randomly distributed into two groups were studied: Group LH, puncture in the left hypochondrium (n=30), and Group ML, puncture in the abdominal midline (n=32). The following were assessed: needle positioning tests, number of failed attempts at needle insertion, and time needed for creation of pneumoperitoneum. Gas flow, volume and intraperitoneal pressure were recorded at every 20 seconds, until a 12 mmHg pressure was reached inside the peritoneal cavity. RESULTS: A similar number of positive results for the needle positioning tests were observed in both groups. Two failed attempts to reach the peritoneal cavity were observed in Group ML and one in Group LH. The time necessary for the creation of pneumoperitoneum was on average 3 minutes and 46 seconds for Group LH, and 4 minutes and 2 seconds for Group ML. Average gas flow, volume and pressure were equivalent for both groups. CONCLUSION: Puncture in the left hypochondrium was as effective as puncture in the abdominal midline for the creation of pneumoperitoneum.

Evaluation of the positioning of the tip of the Veress needle during creation of closed pneumoperitoneum in pigs.

PURPOSE: Erroneous punctures and insufflations are frequent with the use of the Veress needle. Mistaken injections of gas in the preperitoneal space are not rare. The purpose of this research is to evaluate the correct positioning of the tip of the needle during creation of pneumoperitoneum. METHODS: The needle was inserted into the peritoneal cavity. Tests to assess the positioning of the needle tip were carried out. Pressure, flow rate and volume were periodically recorded and the needle was removed, being immediately reinserted into the right hypochondrium and placed in the preperitoneal space. RESULTS: The liquid flow test was always positive in the peritoneal cavity. No resistance to saline injection into the peritoneal cavity was observed, but increased resistance to saline injection into the preperitoneal space was observed in 45.5% of the cases. Some saline was recovered in 63.5% of the cases in the peritoneal cavity, and in 54.5% in the preperitoneal space. Saline drop test was positive in 66.6% of the cases in the peritoneal cavity and in 45.5% in the preperitoneal space. In the peritoneal cavity, initial pressure lower than 5 mm Hg was observed, and this pressure gradually increased during 123 seconds until reaching 15 mm Hg. In the preperitoneal space, initial pressure was 15 mm Hg. CONCLUSIONS: Aspiration, liquid flow and saline drop tests are important, whereas recovery test is inconclusive. Initial pressure of approximately 5 mm Hg indicates that the tip of the needle is in the peritoneal cavity. The peritoneal cavity should hold ten times as much volume of gas as the preperitoneal space. The increase in pressure and volume in the peritoneal cavity can be predicted by statistics.

Efeitos determinados pelo pneumoperitônio com nitrogênio e dióxido de carbono sobre a hemodinâmica e funções renais de cães / Effects of pneumoperitoneum with nitrogen and CO2 on canine hemodynamic and renal function

Justificativa e Objetivo - O Pneumoperitânio (P), determinando aumento na pressão íntra-abdominal, e a absorção do dióxido de carbono (CO2) podem desencadear alterações em diversos órgãos, como os rins. O objetivo deste estudo foi avaliar as alterações na hemodinâmica e função renais determinadas pelo pneumoperitânio com nitrogênio e com dióxido de carbono em cães. Método - Dezesseis animais anestesiados com tiopental sódico e fentanil foram divididos em 2 grupos: Grupo 1 - P com nitrogênio; Grupo 2 - P com dióxido de carbono, e submetidos ao P de 10 e 15 mmHg. Foram estudados: frequência cardíaca, pressão arterial média, pressão de átrio direito, pressão de artéria pulmonar ocluída, índices cardíaco e de resistência vascular sistêmica, vasopressina plasmática, depuração de PHR, fluxo sanguíneo renal, resistência vascular renal, hematócrito, sódio e potássio plasmático, volume urinário, osmolalidade plasmática e urinária, depuração osmolar , de água livre, de sódio, de potássio e de creatinina, excreção urinária e fracionária de sódio e potássio, pH e PaCO2. Os dados foram coletados em 4 momentos: M1 (antes do P), M2 (30 minutos após P de 10 mmHg), M3 (30 minutos após P de 15 mmHg) e M4 (30 minutos após a deflação do P). Resultados - Os resultados mostram aumentos na frequência cardíaca, nas pressões de átrio direito e de artéria pulmonar ocluída e índice cardíaco, em ambos os grupos durante o P. Houve diminuição na depuração, na excreção fracionária e na excreção urinária de sódio após a deflação do P e na osmolalidade urinária no transcorrer do experimento, em ambos os grupos. Conclusões - O pneumoperitânio com nitrogênio e dióxido de carbono não determinou alterações na hemodinâmica e função renais. O pneumoperitânio determinou alterações na hemodinâmica cardiovascular que não repercutiram sobre os rins. A compressão do parênquima renal pode ter sido responsável por alterações na absorção renal do sódio.

La manipulación colónica laparascópica y la exfoliación celular: investigación experimental / Laparoscopic colonic manipulation and cellular exfoliation: experimental research

Se especula que la manipulación traumática del colon portador de una neoplasia, durante la ejecución de una colectomía laparoscópica podría aumentar la exfoliación de células malignas dentro de la cavidad peritoneal, y por consiguiente ser una de las causas de los implantes cutáneos. Objetivo: desarrollar un modelo de cáncer colónico experimental con similitud al del hombre y determinar si la manipulación laparoscópica instrumental del carcinoma de colon y recto comparada con la laparotomía, aumenta la exfoliación de células malignas en la cavidad peritoneal, instrumental y trócares. Material y Métodos: se desarrolló un protocolo de cáncer colorrectal experimental con inyección subcutánea de 1-2Dimethylhydrazina a una dosis de 20 mg/Kg de peso, semanalmente y durante 20 semanas, en ratas Wistar, sexo masculino. Se operaron a la semana 21º, dividiéndolas en 2 grupos (1 y 2). Grupo 1 (n 23) sometidas a laparotomía y manipulación instrumental del colon. Grupo 2 (n 17) se efectuó neumoperitoneo con CO2 hasta una presión de 12 mmHg, laparoscopía y manipulación instrumental del colon y recto. Un tercer grupo lo constituyeron las ratas controles (n5). Se realizó citología de: líquido de lavado peritoneal pre y pos manipulación intestinal, del instrumental convencional y laparoscópico, de la aguja de Verres y de los trócares. Se efectuó el estudio del colon y recto, ganglios mesentéricos, hígado y peritoneo. Resultados: El 80 por ciento de las ratas desarrollaron adenocarcinomas de colon. No existió diferencia significativa entre la exfoliación celular de ambos grupos de animales. Conclusiones: El carcinoma colorrectal inducido por la 1-2 dimethylhydrazina tiene características muy similares al del ser humano y es un modelo válido para la investigación. La manipulación instrumental con una prolija técnica durante los procedimientos laparoscópico no aumenta la exfoliación celular. (AU)

La manipulación colónica laparascópica y la exfoliación celular: investigación experimental / Laparoscopic colonic manipulation and cellular exfoliation: experimental research

Se especula que la manipulación traumática del colon portador de una neoplasia, durante la ejecución de una colectomía laparoscópica podría aumentar la exfoliación de células malignas dentro de la cavidad peritoneal, y por consiguiente ser una de las causas de los implantes cutáneos. Objetivo: desarrollar un modelo de cáncer colónico experimental con similitud al del hombre y determinar si la manipulación laparoscópica instrumental del carcinoma de colon y recto comparada con la laparotomía, aumenta la exfoliación de células malignas en la cavidad peritoneal, instrumental y trócares. Material y Métodos: se desarrolló un protocolo de cáncer colorrectal experimental con inyección subcutánea de 1-2Dimethylhydrazina a una dosis de 20 mg/Kg de peso, semanalmente y durante 20 semanas, en ratas Wistar, sexo masculino. Se operaron a la semana 21º, dividiéndolas en 2 grupos (1 y 2). Grupo 1 (n 23) sometidas a laparotomía y manipulación instrumental del colon. Grupo 2 (n 17) se efectuó neumoperitoneo con CO2 hasta una presión de 12 mmHg, laparoscopía y manipulación instrumental del colon y recto. Un tercer grupo lo constituyeron las ratas controles (n5). Se realizó citología de: líquido de lavado peritoneal pre y pos manipulación intestinal, del instrumental convencional y laparoscópico, de la aguja de Verres y de los trócares. Se efectuó el estudio del colon y recto, ganglios mesentéricos, hígado y peritoneo. Resultados: El 80 por ciento de las ratas desarrollaron adenocarcinomas de colon. No existió diferencia significativa entre la exfoliación celular de ambos grupos de animales. Conclusiones: El carcinoma colorrectal inducido por la 1-2 dimethylhydrazina tiene características muy similares al del ser humano y es un modelo válido para la investigación. La manipulación instrumental con una prolija técnica durante los procedimientos laparoscópico no aumenta la exfoliación celular.

Colecistectomía laparoscópica: ventajas de la laparoscopia abierta / Laparoscopic cholecystectomies with open technique: adventages

Se analizan 400 colecistectomías laparoscópicas realizadas con la técnica abierta y se estudió la inserción del primer trócar según técnica de Fitzgibbons. No hubo mortalidad atribuible al procedimiento. En 1 caso hubo sangrado del orificio del primer trócar que requirió laparotomía exploradora (mediana supraumbilical) en el postoperatorio inmediato, con evacuación del hemoperitoneo y coagulación de los puntos sangrantes. La equimosis periumbilical fue la complicación local más común, resuelta siempre espontáneamente. Esta técnica tiene la ventaja de colocar el primer trócar bajo visión directa sin presión y luego iniciar el neumoperitoneo

Colecistectomía laparoscópica: ventajas de la laparoscopia abierta / Laparoscopic cholecystectomies with open technique: adventages

Se analizan 400 colecistectomías laparoscópicas realizadas con la técnica abierta y se estudió la inserción del primer trócar según técnica de Fitzgibbons. No hubo mortalidad atribuible al procedimiento. En 1 caso hubo sangrado del orificio del primer trócar que requirió laparotomía exploradora (mediana supraumbilical) en el postoperatorio inmediato, con evacuación del hemoperitoneo y coagulación de los puntos sangrantes. La equimosis periumbilical fue la complicación local más común, resuelta siempre espontáneamente. Esta técnica tiene la ventaja de colocar el primer trócar bajo visión directa sin presión y luego iniciar el neumoperitoneo (AU)

Colecistectomía por video celioscopía: propuesta técnica y resultados / Video-laparoscopic cholecystectomy: technique and results

Se presenta una casuítica personal de 286 colecistectomías por video celioscopia realizadas en un período de 22 meses, sin mortalidad, sin conversiones ni reintervenciones. Se hacen algunas consideraciones técnicas, y se propone la colangiografía operatoria sistemática

Colecistectomía por video celioscopía: propuesta técnica y resultados / Video-laparoscopic cholecystectomy: technique and results

Se presenta una casuítica personal de 286 colecistectomías por video celioscopia realizadas en un período de 22 meses, sin mortalidad, sin conversiones ni reintervenciones. Se hacen algunas consideraciones técnicas, y se propone la colangiografía operatoria sistemática

Colocación de catéter percutáneo con radioscopía para neumoperitoneo prequirúrgico / Placement of percutaneous catheters with radioscopy for preoperative pneumoperitoneum

Relatamos nuestra experiencia en un método sencillo y eficaz de realizar neumoperitoneo preoperatorio madiante la colocación percutánea con técnica de Seldinger de un catéter permanente, bajo control radioscópico. Se revisaron las historias clínicas de 45 pacientes, la gran mayoría de ellos obesos, portadores de eventraciones y hernias abdominales que fueron sometidos a este procedimiento en el período comprendido entre junio de 1989 y junio de 1991. Se colocaron en total 47 catéteres. No hubo complicaciones inmediatas, solo 3 pacientes presentaron complicaciones mediatas, debiéndose recolocar el catéter en 2 de ellos. Las inyecciones de aire así como el control de catéter son efectuadas por el Servicio de Cirugía. El procedimiento se realiza en forma ambulatoria con una duración aproximada de 20 minutos, siendo el tiempo promedio de permanencia del catéter de 50 días. Describimos la técnica empleada, los resultados obtenidos así como las complicaciones observadas.

Colocación de catéter percutáneo con radioscopía para neumoperitoneo prequirúrgico / Placement of percutaneous catheters with radioscopy for preoperative pneumoperitoneum

Relatamos nuestra experiencia en un método sencillo y eficaz de realizar neumoperitoneo preoperatorio madiante la colocación percutánea con técnica de Seldinger de un catéter permanente, bajo control radioscópico. Se revisaron las historias clínicas de 45 pacientes, la gran mayoría de ellos obesos, portadores de eventraciones y hernias abdominales que fueron sometidos a este procedimiento en el período comprendido entre junio de 1989 y junio de 1991. Se colocaron en total 47 catéteres. No hubo complicaciones inmediatas, solo 3 pacientes presentaron complicaciones mediatas, debiéndose recolocar el catéter en 2 de ellos. Las inyecciones de aire así como el control de catéter son efectuadas por el Servicio de Cirugía. El procedimiento se realiza en forma ambulatoria con una duración aproximada de 20 minutos, siendo el tiempo promedio de permanencia del catéter de 50 días. Describimos la técnica empleada, los resultados obtenidos así como las complicaciones observadas.

Colecistectomia laparoscópica / Laparoscopic cholecystectomy

Fueron intervenidos por vía laparoscópica 100 pacientes, 78 por presentar litiasis vesicular sintomática no complicada, 17 por colelitiasis aguda, 3 por litiasis vesicular y coledociana y 2 por presentar pólipo vesicular. En 6 oportunidades debió laparotomizarse a los pacientes: 1 por cirrosis hepática, 2 por hemorragia del lecho, 2 por esclerosis del hilio y 1 por insuflación de los mesos y epiplón durante el neumoperitoneo. Como complicaciones postoperatorias una paciente presentó hematoma de la vaina de los rectos, otra supuración a nivel del ombligo y 3 enfisema subcutáneo regional. Otro enfermo desarrolló colección biliar subhepática que se resolvió mediante punción y evacuación bajo guía ecográfica. El promedio de internación de los enfermos fue de 34,5 horas, y el reintegro a sus tareas se registró antes de la semana. La colecistectomía laparoscópica constituye un excelente procedimiento ya que cumple con los mismos objetivos de la cirugía convencional pero con mejor resultado estético, menor agresión y dolor postoperatorio, inferior tiempo de intervención y por lo tanto más bajo costo

Colecistectomia laparoscópica / Laparoscopic cholecystectomy

Fueron intervenidos por vía laparoscópica 100 pacientes, 78 por presentar litiasis vesicular sintomática no complicada, 17 por colelitiasis aguda, 3 por litiasis vesicular y coledociana y 2 por presentar pólipo vesicular. En 6 oportunidades debió laparotomizarse a los pacientes: 1 por cirrosis hepática, 2 por hemorragia del lecho, 2 por esclerosis del hilio y 1 por insuflación de los mesos y epiplón durante el neumoperitoneo. Como complicaciones postoperatorias una paciente presentó hematoma de la vaina de los rectos, otra supuración a nivel del ombligo y 3 enfisema subcutáneo regional. Otro enfermo desarrolló colección biliar subhepática que se resolvió mediante punción y evacuación bajo guía ecográfica. El promedio de internación de los enfermos fue de 34,5 horas, y el reintegro a sus tareas se registró antes de la semana. La colecistectomía laparoscópica constituye un excelente procedimiento ya que cumple con los mismos objetivos de la cirugía convencional pero con mejor resultado estético, menor agresión y dolor postoperatorio, inferior tiempo de intervención y por lo tanto más bajo costo