[Classic and new-generation commercial thickeners. Organoleptic qualities and usefulness in the diagnostic tests of dysphagia]. / Espesantes comerciales clásicos y de nueva generación. Cualidades organolépticas y utilidad en las pruebas diagnósticas de la disfagia.

INTRODUCTION: Introduction: thickeners are widely used in swallowing disorders, both for diagnosis and to achieve a safe and effective diet. Recently, products composed of gums have been commercialized in the Spanish market in order to improve the organoleptic and physical qualities of thickened foods. Objective: to compare thickening agents of clinical scope marketed in Spain, and to verify their organoleptic and physical characteristics, to be used in the diagnostic procedures and the feeding of patients with dysphagia. Method: the organoleptic (appearance, colour, smell, taste, aftertaste) and physical (solubility, stability) properties of eight thickeners (4 classic starch-based and 4 new gum-based) were assessed in a sample of 44 healthy subjects. In addition, their usefulness in diagnostic tests was studied by mixing them with dyes and water-soluble contrasts. Results and conclusions: new-generation thickeners, based on gums, generally obtain better scores for their physical and organoleptic qualities than conventional thickeners. Starch thickeners are more suitable for diagnostic tests, as gum thickeners present some peculiarities in their mixtures with dyes and contrasts that must be taken into account in diagnostic tests.

INTRODUCCIÓN: Introducción: los espesantes son muy utilizados en los trastornos de la deglución, tanto para su diagnóstico como para conseguir una alimentación segura y eficaz. Recientemente se han comercializado en el mercado español productos compuestos por gomas con el fin de mejorar las cualidades organolépticas y físicas de los alimentos espesados. Objetivo: comparar agentes espesantes de ámbito clínico comercializados en España y verificar sus características organolépticas y físicas para ser utilizados en los procedimientos diagnósticos y en la alimentación del paciente con disfagia. Método: se valoraron las propiedades organolépticas (apariencia, color, olor, sabor y regusto) y físicas (solubilidad y estabilidad) de ocho espesantes (4 clásicos con almidón y 4 nuevos a base de gomas) en una muestra de 44 sujetos sanos. Además, se estudió su utilidad en las pruebas diagnósticas al mezclarlos con colorantes y contrastes hidrosolubles. Resultados y conclusiones: los espesantes de nueva generación, a base de gomas, obtienen en general mejores puntuaciones en sus cualidades físicas y organolépticas con respecto a los espesantes convencionales. Los espesantes con almidón son más adecuados en las pruebas diagnósticas, ya que los espesantes con gomas presentan algunas peculiaridades en las mezclas con colorantes y contrastes que deben ser tenidas en cuenta en dichas pruebas.

Experiencia inicial en Buenos Aires con la cirugía transoral robótica (TORS) / Initial experience with transoral robotic surgery (TORS) in Buenos Aires

Antecedentes: la cirugía robótica es una alternativa a la cirugía abierta, microcirugía láser CO2, o quimiorradioterapia en vía aerodigestiva superior. El robot permite trasladar la técnica quirúrgica abierta a un abordaje mínimamente invasivo, con acceso por boca, para patología benigna y maligna. Actualmente se emplean diferentes terapéuticas con similares resultados oncológicos. Objetivo: introducir una herramienta quirúrgica para abordaje bucal. Comunicar la experiencia inicial con el uso del robot. Evaluar la preservación de respiración y deglución. Analizar variables que determinaron una disminución en la hospitalización. Material y métodos: 13 mujeres y 11 hombres. Edad entre 16 y 82 años, media de 55,08. Total 24 pacientes con enfermedad inflamatoria crónica (8), tumores benignos (4) y malignos (12). Variables consideradas en cirugía robótica: tiempo y lugar de internación, complicaciones, estado respiratorio y deglutorio, uso de técnicas reconstructivas. Se realizó videoendoscopia de deglución para objetivar la seguridad del método. Resultados: tiempo medio de internación: 1,92 días. El 83,3% internado 1 día. El 79,9% en internación general. Unidad cerrada: 20,1%. Ninguna traqueostomía. Cicatrización del lecho por segunda. Sin complicaciones. Edema de lengua: 2 pacientes. Conclusiones: la cirugía robótica favorece la exéresis con baja morbilidady máxima preservación de tejidos sanos. Disminuye: edema posoperatorio, uso colgajos para reparar el lecho, traqueotomía temporaria, tiempo de internación. La videoendoscopia de deglución demuestra utilidad para determinar la deglución segura. Limitante del presente trabajo es el tamaño de la muestra. Es importante incrementar el número de pacientes para valorizar supervivencia y calidad de vida.

Background: robotic surgery is an alternative to open surgery, CO2 laser microsurgery, or chemoradiation for the upper aero-digestive tract. This system allows surgeons to use the open surgical technique in a minimally invasive approach through the mouth to treat benign and malignant disorders. Different treatments are currently used with similar oncologic outcomes. Objective: the aim of this study was to introduce a surgical tool through transoral approach, report the initial experience with the use of the robotic system, evaluate respiratory and digestive functional preservation and analyze the variables associated with shorter hospital length of stay. Material and methods: A total of 24 patients (13 women and 11 men, mean age 55.08 years [16-82]) were included. Eight patients had chronic inflammatory disease, four had benign tumors and 12 had cancer. The variables considered in robotic surgery were hospital length of stay, place of postoperative care, complications, respiratory and swallowing function and use of reconstructive techniques. Flexible endoscopic evaluation of swallowing was performed to document safe function. Results: mean length of stay was 1.92 days; 83.3% stayed for one day; 79.9% were admitted to the general ward and 20.1% stayed in intensive or intermediate care units. None of the patients required tracheostomy. Healing of the surgical bed occurred by secondary intention. There were no complications. Tongue edema occurred in two patients. Conclusions: robotic surgery favors tumor removal with low morbidity and maximum preservation of healthy tissues while reducing postoperative edema, use of flaps for reconstruction, temporary tracheostomy and hospital length of stay. Flexible endoscopic evaluation of swallowing is useful to determine safe swallowing function. The main limitation of our study is the sample size. It is important to increase the number of patients to evaluate survival and quality of life.

Píloro doble. Presentación de un caso y revisión de la literatura / Double pylorus. Case report and literature review

RESUMEN El doble píloro es una comunicación anormal entre el antro gástrico y el bulbo duodenal y representa un raro hallazgo endoscópico. Se presentó un paciente de 80 años de edad, con antecedentes de hipertensión arterial, fumador inveterado, tomador de aspirina, que presentó melena aproximadamente 15 días antes del ingreso. La videoendoscopia reveló la existencia de dos orificios similares en el antro, que se comunicaban con el bulbo duodenal de manera independiente que fueron catalogados como píloros. La comunicación se constató con el paso del endoscopio a su través. Se impuso tratamiento médico con inhibidores de la bomba de protones y la evolución fue favorable. Es el cuarto caso reportado en la literatura en nuestro país y el primero en la provincia de Matanzas (AU).

ABSTRACT Double pylorus is an abnormal communication between the gastric antrum and the duodenal bulb and represents a rare endoscopic finding. It is presented the case of a patient aged 80 years, with a background of arterial hypertension, inveterate smoker, taking aspirin, who presented melena about 15 days before the admission. The video-endoscopy revealed the existence of two similar orifices in the antrum that were independently communicating with the duodenal bulb and they went catalogued like pylori. The communication was proved by passing the endoscope through it. He was treated with IBP (the Spanish acronym for proton bomb inhibitors) and the evolution was favorable. It is the fourth case reported in the literature in Cuba and the first one in Matanzas (AU).

Píloro doble. Presentación de un caso y revisión de la literatura / Double pylorus. Case report and literature review

RESUMEN El doble píloro es una comunicación anormal entre el antro gástrico y el bulbo duodenal y representa un raro hallazgo endoscópico. Se presentó un paciente de 80 años de edad, con antecedentes de hipertensión arterial, fumador inveterado, tomador de aspirina, que presentó melena aproximadamente 15 días antes del ingreso. La videoendoscopia reveló la existencia de dos orificios similares en el antro, que se comunicaban con el bulbo duodenal de manera independiente que fueron catalogados como píloros. La comunicación se constató con el paso del endoscopio a su través. Se impuso tratamiento médico con inhibidores de la bomba de protones y la evolución fue favorable. Es el cuarto caso reportado en la literatura en nuestro país y el primero en la provincia de Matanzas.

ABSTRACT Double pylorus is an abnormal communication between the gastric antrum and the duodenal bulb and represents a rare endoscopic finding. It is presented the case of a patient aged 80 years, with a background of arterial hypertension, inveterate smoker, taking aspirin, who presented melena about 15 days before the admission. The video-endoscopy revealed the existence of two similar orifices in the antrum that were independently communicating with the duodenal bulb and they went catalogued like pylori. The communication was proved by passing the endoscope through it. He was treated with IBP (the Spanish acronym for proton bomb inhibitors) and the evolution was favorable. It is the fourth case reported in the literature in Cuba and the first one in Matanzas.

Swallowing disorders in Parkinson's disease. / Trastornos de la deglución en la enfermedad de Parkinson.

INTRODUCTION: Parkinson's disease is a type of chronic neurodegenerative pathology with a typical movement pattern, as well as different, less studied symptoms such as dysphagia. Disease-related disorders in efficacy or safety in the process of swallowing usually lead to malnutrition, dehydration or pneumonias. The aim of this study was identifying and analyzing swallowing disorders in Parkinson's disease. SUBJECTS AND METHODS: The initial sample consisted of 52 subjects with Parkinson's disease to whom the specific test for dysphagia SDQ was applied. Nineteen participants (36.5%) with some degree of dysphagia in the SDQ test were selected to be evaluated by volume-viscosity clinical exploration method and fiberoptic endoscopic evaluation of swallowing. RESULTS: Disorders in swallowing efficiency and safety were detected in 94.7% of the selected sample. With regards to efficiency, disorders were found in food transport (89.5%), insufficient labial closing (68.4%) and oral residues (47.4%), relating to duration of ingestion. Alterations in security were also observed: pharynx residues (52.7%), coughing (47.4%), penetration (31.64%), aspiration and decrease of SaO2 (5.3%), relating to the diagnosis of respiratory pathology in the previous year. CONCLUSION: The SDQ test detected swallowing disorders in 36.5% of the subjects with Parkinson's disease. Disorders in swallowing efficiency and safety were demonstrated in 94.7% of this subset. Disorders of efficiency were more frequent than those of safety, establishing a relationship with greater time in ingestion and the appearance of respiratory pathology and pneumonias.

Drug-induced sleep-endoscopy in children's sleep related breathing disorders. / Exploración videosomnoscópica bajo sueño inducido en los trastornos respiratorios del sueño en niños.

INTRODUCTION: Drug-induced sedation endoscopy is a valid tool to assess site obstruction of the upper airway responsible for children's obstructive Sleep Apnea The aim is to show the experience of an ENT department with Drug-induced sedation endoscopy in children selected for sleep apnea surgery METHODS: Includes 56 cases between 2 and 12 years old (mean age: 59,13±27,29 months) presenting at the Otorhinolaryngology consultation clinic with snoring and apnea. Prior polysomnography had been practiced and mean AHI was 6,32±8,71. The distribution of cases was 10 persistent sleep apnea (17.85%), 15 clinical disproportion (26.78%) and 31 conventional (55.35%). All sleep endoscopies were performed in the operating room and Chan classification was used to assess the areas of collapse. RESULTS: In cases of residual disease the most affected regions were the side walls of the oropharynx (70%) and turbinate (70%) and the most frequently applied surgery was total tonsillectomy followed by second tongue tonsil reduction and turbinate radiofrequency. In clinical cases of desproportion, the most affected regions were the oropharyngeal side walls (93.3%) and adenoids (66.6%). The most frequently applied surgery in this group was adenoidectomy and radiofrequency tonsillotomy. CONCLUSION: Drug-induced sedation endoscopy is a technique that can be incorporated easily into medical practice, mostly in children with residual sleep apnea syndrome or those suspected to have some cause other than adenotonsillar hypertrophy.

Prognóstico da videocirurgia da região frontal com técnica modificada de fixação / Prognosis of frontal region video surgery with a modified fixation technique

INTRODUÇÃO: A videoendoscopia tem se estabelecido como procedimento de escolha no tratamento da ptose do supercílio e das rugas da região frontal. O acesso minimamente invasivo produz vantagens em relação à tradicional incisão coronal. Diversos métodos de fixação são relatados na literatura, apresentando resultados semelhantes. Nesta série de casos, descrevemos a fixação direta com agulha. OBJETIVO: Avaliar o prognóstico da videocirurgia, utilizando-se a técnica direta com agulha. MÉTODO: Avaliação fotográfica computadorizada de 37 pacientes submetidos à videoendoscopia da região frontal com a fixação direta com agulha, realizada em dois hospitais privados na cidade de Porto Alegre-RS. Resultados: A elevação média do supercílio foi de 5,7 mm no terço lateral e de 4,4 mm no terço medial. Após um pequeno descenso da elevação, no primeiro mês pós-operatório, o reposicionamento do supercílio permaneceu inalterado nas medidas subsequentes até 24 meses. CONCLUSÃO: A fixação direta com agulha é capaz de produzir resultados duráveis, seguros e reprodutíveis no período em que foram realizadas as medições.

INTRODUCTION: Video endoscopy has become a procedure of choice for the treatment of eyebrow ptosis and forehead wrinkles. This minimally invasive technique has several advantages over traditional coronal incision. Several fixation methods are reported in the literature, with similar results. In this study, we describe direct needle fixation. OBJECTIVE: To evaluate the prognosis of video endoscopic surgery using a direct needle technique. METHOD: Computerized photographic evaluations of 37 patients undergoing video endoscopy of the frontal region with needle direct fixation were conducted in two private hospitals in the city of Porto Alegre in Rio Grande do Sul, Brazil. RESULTS: The mean eyebrow elevations were 5.7 and 4.4 mm in the lateral and middle third measurements. After a small dip in elevation in the first month after surgery, the repositioning of the eyebrow remained unchanged in subsequent measurements up to 24 months later. CONCLUSION: Direct needle fixation produced lasting, reliable, and reproducible results during the period in which measurements were made.

[Drug-induced sleep videoendoscopy: clinical usefulness and literature review]. / Exploración videoendoscópica con sueño inducido, utilidad clínica y revisión de la literatura.

Fiberoptic examination of the pharynx under drug-induced sleep is a test that helps to detect the areas of vibration and collapse in patients with sleep-disordered breathing. This article is a review of the available literature on the subject, aimed at helping otolaryngologists to understand the procedure and to resolve some controversies surrounding it.

Videoendoscopia digestiva superior en el Centro Médico de Diagnóstico de Alta Tecnología Las Heroínas de Mérida del estado venezolano de Mérida / Upper gastrointestinal video endoscopy at the Diagnostic Medical Center of High Technology Las heroínas de Mérida of Mérida state in Venezuela

Se efectuó un estudio descriptivo y transversal de los 1 742 pacientes mayores de 18 años en los que se realizó de forma satisfactoria la videoendoscopia del tracto digestivo superior en el Centro Médico de Diagnóstico de Alta Tecnología Las Heroínas de Mérida del Estado Mérida (Venezuela), desde el 2008 hasta el 2011, con vistas a describir los hallazgos a través de dicho procedimiento. En la casuística predominaron el sexo femenino (63,3 por ciento) y el grupo etario de 46-61 años, con una edad promedio de 55,8 años; además, 30,6 por ciento de las pruebas resultaron normales. El dolor epigástrico (48,6 por ciento), la dispepsia (43,5 por ciento) y el reflujo gastroesofágico (8,6 por ciento) fueron las principales causas de remisión, en tanto la gastritis (32,4 por ciento) constituyó el diagnóstico endoscópico más frecuente, específicamente sus variedades eritematosa y eritemato-erosiva, con 66,0 y 13,0 por ciento, respectivamente. Del total, 10 pacientes presentaron cáncer gástrico y 9, cáncer esofágico. Se pudo concluir que el procedimiento permitió el diagnóstico preciso de las enfermedades del tracto digestivo superior, así como una atención terapéutica adecuada(AU)

A descriptive and cross-sectional study was conducted in 1 742 patients over 15 years, in whom the video endoscopy of upper gastrointestinal tract was successfully performed at the Diagnostic Medical Center of High Technology Las Heroínas de Mérida of Mérida state (Venezuela), from 2008 to 2011, with the purpose of describing the findings through this procedure. Female sex (63.3 percent) and age group of 46-61 years with a mean age of 55.8 years predominated in the case material, and 30.6 percent of the tests were normal. Epigastric pain (48.6 percent), dyspepsia (43.5 percent) and gastroesophageal reflux (8.6 percent) were the main reasons for referrals, while gastritis (32.4 percent) constituted the most frequent endoscopic diagnosis, specifically its erythematous and erythematous-erosive varieties, with 66.0 and 13.0 percent, respectively. Of the total, 10 patients had gastric cancer and 9, esophageal cancer. It was concluded that the procedure allowed accurate diagnosis of upper gastrointestinal tract diseases as well as an appropriate therapeutic care(AU)

Videoendoscopia digestiva superior en el Centro Médico de Diagnóstico de Alta Tecnología "Las Heroínas de Mérida" del estado venezolano de Mérida / Upper gastrointestinal video endoscopy at the Diagnostic Medical Center of High Technology "Las heroínas de Mérida" of Mérida state in Venezuela

Se efectuó un estudio descriptivo y transversal de los 1 742 pacientes mayores de 18 años en los que se realizó de forma satisfactoria la videoendoscopia del tracto digestivo superior en el Centro Médico de Diagnóstico de Alta Tecnología "Las Heroínas de Mérida" del Estado Mérida (Venezuela), desde el 2008 hasta el 2011, con vistas a describir los hallazgos a través de dicho procedimiento. En la casuística predominaron el sexo femenino (63,3 %) y el grupo etario de 46-61 años, con una edad promedio de 55,8 años; además, 30,6 % de las pruebas resultaron normales. El dolor epigástrico (48,6 %), la dispepsia (43,5 %) y el reflujo gastroesofágico (8,6 %) fueron las principales causas de remisión, en tanto la gastritis (32,4 %) constituyó el diagnóstico endoscópico más frecuente, específicamente sus variedades eritematosa y eritemato-erosiva, con 66,0 y 13,0 %, respectivamente. Del total, 10 pacientes presentaron cáncer gástrico y 9, cáncer esofágico. Se pudo concluir que el procedimiento permitió el diagnóstico preciso de las enfermedades del tracto digestivo superior, así como una atención terapéutica adecuada.

A descriptive and cross-sectional study was conducted in 1 742 patients over 15 years, in whom the video endoscopy of upper gastrointestinal tract was successfully performed at the Diagnostic Medical Center of High Technology "Las Heroínas de Mérida" of Mérida state (Venezuela), from 2008 to 2011, with the purpose of describing the findings through this procedure. Female sex (63.3%) and age group of 46-61 years with a mean age of 55.8 years predominated in the case material, and 30.6% of the tests were normal. Epigastric pain (48.6%), dyspepsia (43.5%) and gastroesophageal reflux (8.6%) were the main reasons for referrals, while gastritis (32.4%) constituted the most frequent endoscopic diagnosis, specifically its erythematous and erythematous-erosive varieties, with 66.0 and 13.0%, respectively. Of the total, 10 patients had gastric cancer and 9, esophageal cancer. It was concluded that the procedure allowed accurate diagnosis of upper gastrointestinal tract diseases as well as an appropriate therapeutic care.

Tempo de fechamento faríngeo correlacionado com consistências, volumes, gênero e idade em videoendoscopia da deglutição / Pharyngeal contraction time on fiberoptic endoscopic evaluation of swallowing: correlation with consistency, volume, gender, and age

O peristaltismo constritor é um dos principais componentes da fase faríngea da deglutição. Foram estudados os efeitos das consistências e volumes de alimento ofertado sobre a duração do fechamento faríngeo (white-out) por meio da videoendoscopia da deglutição em 61 indivíduos com deglutição normal. Os resultados foram correlacionados com gênero (24 masculinos e 37 femininos) e idade (20 a 77 anos). Foram ofertadas amostras alimentares de 5 e 10mL, nas consistências liquido, liquido espessado, pastoso e sólido a todos os indivíduos, obtendo-se 394 vídeos do período de fechamento faríngeo nas diversas consistências e volumes. As imagens foram digitalizadas e analisadas quadro-a-quadro no programa Adobe® Premiere® 6.5. Não houve diferença estatisticamente significante no tempo de fechamento faríngeo comparando-se entre as diferentes consistências e volumes. Não houve diferença quando comparados com gênero ou idade dos indivíduos. Conclui-se que o tempo de fechamento faríngeo não sofre impacto das diferentes consistências e volumes, assim como o gênero e idade em indivíduos com deglutição normal.

Peristaltic constriction is one of the main components of the pharyngeal phase of swallowing. This study assessed the effects of various food consistencies and volumes on pharyngeal contraction time (as measured by duration of white-out during fiberoptic endoscopy) in 61 subjects with no swallowing problems. Results were correlated with gender (24 male, 37 female) and age (range, 2077 years). Food was provided in 5 and 10mL samples in various consistencies (fluid, thickened fluid, pureed, and solid) to all participants; a total of 394 video recordings of pharyngeal contraction during the passage of these various food consistencies and volumes were obtained. Footage was digitized and frame-by-frame analysis was carried out in the Adobe® Premiere® 6.5 software package. There were no statistically significant differences in pharyngeal contraction time during swallowing of the various food consistencies and volumes provided. Furthermore, there were no statistically significant differences between male and female patients or across different age. We conclude that sample consistency, bolus volume, gender and age have no impact on pharyngeal contraction time among individuals with no pathological changes in swallowing.

Disfagia orofaríngea na dermatomiosite: relato de caso e revisão de literatura / Oropharyngeal dysphagia in dermatomyosites: case report and literature review

Os autores apresentam um caso raro de dermatomiosite, cursando com disfagia orofaríngea grave. Paciente do sexo feminino, branca, 13 anos, acompanhada no ambulatório de Reumatologia, foi encaminhada à Divisão de Clínica Otorrinolaringológica do Hospital das Clínicas da FMUSP, com queixa de dificuldade para deglutição de sólidos. Conforme o protocolo do grupo de disfagia, realizou avaliação fonoaudiológica e otorrinolaringológica, com anamnese dirigida, ênfase para os órgãos fonoarticulatórios, integridade dos pares cranianos e complementação diagnóstica com exame de videoendoscopia da deglutição. Diagnosticado quadro de disfagia orofaríngea grave, com aspiração de saliva e alimentos em todas as consistências testadas. Orientado suspender a alimentação por boca e introduzir dieta por sonda nasoenteral. Iniciou fonoterapia e indução medicamentosa de xerostomia, associado ao tratamento da doença de base. Evoluiu com melhora clínica, comprovada pela videoendoscopia da deglutição, com possibilidade de retorno à alimentação via oral. Os autores atentam para a ocorrência de disfagia orofaríngea associada a quadro de dermatomiosite, ressaltam a importância da avaliação clínica e apresentam a videoendoscopia da deglutição como um bom exame para refinamento diagnóstico e seguimento destes pacientes.

We present a rare case of dermatomyosites associated with severe oropharyngeal dysphagia. A 13 year old female patient, being followed at the Rheumatologic Department, was referred to the Otolaryngology Department of the University of São Paulo School of Medicine Hospital. She complained of swallowing problems, especially with solids. Following our dysphagia study protocol, we employed a speech pathologist and otolaryngology evaluation, mainly for clinical history, examination of anatomical structures involved with swallowing events, cranium nerves integrity and videoendoscopic swallowing study. We diagnosed severe oropharyngeal dysphagia, with aspiration of saliva and food of all consistencies. We advised against oral feeding and recommended a diet through a gastric tube. She started with therapy and xerostomia medication, together with the treatment of the base disease. The patient showed a significant improvement, noticed by the clinical evaluation and the control videoendoscopic swallowing study, with the possibility of returning to oral feeding. The authors stress the incidence of oropharyngeal dysphagia in dermatomyosites and suggest the videoendoscopic swallowing study as a good exam for diagnosis and follow-up of these patients.

Videoendoscopia via posterior para cirurgia de hérnia de disco lombar / The microendoscopic discectomy. A new trend in the treatment of lumbar disc disease

Os autores apresentam a técnica de abordagem videoendoscópica posterior da coluna lombar em 63 casos operados com seguimento médio de 1 ano e 8 meses. A técnica videoendoscópica, via posterior, da coluna lombar, conhecida como MED (Microendoscopic Discectomy) foi idealizada com a finalidade de transformar a cirurgia convencional, já bem estabelecida e padronizada, em uma cirurgia minimamente invasiva sob os princípios da cirurgia videoendoscópica. Portanto, por essa via de acesso, podem-se realizar todos os procedimentos efetuados a céu aberto, tais como hemilaminectomia, facetectomia medial, foraminotomia, retração da raiz nervosa e a discectomia. Os resultados iniciais em 63 cirurgias apontam para a tendência à recuperação mais rápida do paciente, que obtém alta hospitalar no mesmo dia da cirurgia e retorno ao trabalho em 15 dias, ou menos, em 50% dos nossos casos. A incisão cirúrgica é bastante reduzida (1,6 cm). Não houve infecção em nossos casos. Como principais desvantagens, citamos o aumento do tempo cirúrgico e a dificuldade da técnica cirúrgica que impõe treinamento específico. Em um futuro próximo, será possível a realização dessa cirurgia em nível ambulatorial e sob anestesia local, permitindo, inclusive, a realização em pacientes idosose de alto risco.

The authors report their experience with 63 cases of lumbar disc operated on through videoendoscopic technique. The microendoscopic discectomy (MED) was done by a posterior approach with fluoroscopic control through a paramedian 16 mm incision. The initial results, with a mean follow up of 1 year and 8 months, point out to a short hospitalization time, early return to work and no case of infection. The main disadvantage is the prolonged time of surgery till you get familiar with the technique. This minimally invasive technique will allow in the near future that lumbar disc surgery will be performed under local anesthesia and as a dayclinic procedure.