Posoperatorio del donante vivo de riñón: diferencia con pacientes sometidos a nefroctomías laparoscópicas por otras causas / No disponible

Debido al incremento de la nefrectomía laparoscópica para trasplante renal de donantes vivos en nuestro hospital en los últimos años (en 2017, 332 trasplantes renales de donante vivo, de los que 47 se hicieron en Andalucía y 17 de ellos en nuestro centro), se ha realizado un estudio prospectivo en el cual se analizaron, con 6 variables, el impacto que tiene el posoperatorio de la nefrectomía laparoscópica en los donantes vivos con respecto al resto de pacientes que se someten al mismo procedimiento por otras causas en nuestra unidad. El objetivo principal del estudio es analizar las implicaciones y el impacto que tiene el posoperatorio de la nefrectomía laparoscópica en los diferentes procesos. Se parte de la hipótesis de que las implicaciones que tiene el donante vivo afectarán al desarrollo de su posoperatorio (mayor dolor, mayor estancia hospitalaria...), comparado con el resto de pacientes que se someten a la misma intervención por otros motivos. Se identificó en este estudio que este tipo de cirugía implica mayor estancia hospitalaria, con respecto a la misma cirugía por otros motivos, pero no existe un resultado en el número de pacientes estudiados de mayor dolor en estos pacientes con respecto a los otros citados. Mostraremos los cuidados enfermeros que seguimos en nuestra unidad con estos pacientes. Para ello tomaremos como referencia los patrones funcionales de Gordon, determinando los diagnósticos enfermeros, así como los criterios de resultados (NOC) y las intervenciones de enfermería (NIC)

Due to the increase of laparoscopic nephrectomy in live donors for renal transplantation during the last years in our hospital (in 2017, 332 live donor renal transplants, of these 47 were done in Andalusia, and 17 in our hospital). A prospective study was conducted to analyse 6 variables, the Impact of postoperative laparoscopic nephrectomy in live donors compared to those patients who underwent the same procedure for different reasons in our unit. The primary aim of the study is to examine the implications and impact of postoperative laparoscopic nephrectomy in different processes. It is assumed that the live donor's implications will affect the postoperative period (pain, length of hospital stay...), compared to the rest of the patients who undergo the same procedure for different reasons. A study identified that this type of surgery involves unnecessarily prolonged stay in hospital, with regards to the same surgery but for different reasons. However, there is no evidence of difference between the number of patients studied with severe pain and the aboye mentioned. We will show the nursing care that we follow with these patients in our unit. We will take as reference Gordon's functional health patterns, identifying nursing diagnosis as well as the nursing outcomes classification (NOC) and nursing interventions

Patient-reported extremity symptoms after robot-assisted laparoscopic cystectomy.

AIMS AND OBJECTIVES: To describe patient-reported extremity symptoms after robot-assisted laparoscopic cystectomy in patients with bladder cancer. BACKGROUND: Preventive activities for remaining patient safety due to correct positioning play an important part in perioperative nursing care.Extremity injuries are well-known after prolonged surgery, especially in robot-assisted urologic surgery in the steep Trendelenburg position. The risk of injury increases due to patient-related and operative risk factors. METHODS: A quantitative prospective observational study was conducted. Patients were followed up with the QuickDASH (Disabilities in the Arm, Shoulder and Hand), Lower Extremity Functional Scale (LEFS) and a study-specific questionnaire 7-10 days and monthly, up to six months after surgery in patients with extremity symptoms. The study adheres to STROBE (strengthening the reporting of observational studies in epidemiology) guidelines, see Supporting information File S1. RESULTS: Out of the 94 included participants, 46.8% (n = 44) experienced extremity symptoms 7-10 days after surgery. Pain, numbness and weakness were the most frequent symptoms. There was a discrepancy between the patients reported symptoms and the documentation in the patient records. Only 13.6% (n = 3) of the reported pain was documented, respectively 27.5% (n = 11) of other symptoms. CONCLUSION: A large proportion of the patients report postoperative extremity symptoms after robot-assisted laparoscopic cystectomy. Prevention of complications in the perioperative setting, are together with follow-ups, important nursing activities for maintaining patient safety and may both prevent and detect postoperative extremity symptoms and injuries. RELEVANCE TO CLINICAL PRACTICE: This study reveals the need of accurate documentation regarding extremity symptoms in digital patient records, as well as continuous follow-ups during the hospital stay and after hospital discharge to enable detection of treatable extremity injuries. The result of this study also indicates the importance of nursing activities such as evidence-based positioning guidelines in the operating theatre for optimal positioning.

A pilot study of non-routine events in gynecological surgery: Type, impact, and effect.

OBJECTIVE: Quantifying non-routine events (NREs) assists with identify underlying sociotechnical factors that could lead to adverse events. NREs are considered any event that is unusual or atypical during surgical procedures. This study aimed to use prospective observations to characterize the occurrence of non-routine events in gynecological surgeries. METHODS: Observational data were collected prospectively within one surgical gynecology department over a five month period. Researchers captured NREs in real time using a validated tablet PC-based tool according to the NRE type, impact, whom was affected, and duration. Researchers also noted what surgical approach (i.e. open, laparoscopic, robotic) was used. RESULTS: Across 45 surgical cases, 554 non-routine events (M = 12.31 NREs per case, SD = 9.81) were identified. The majority of non-routine events were external interruptions (40.3%), teamwork (26.7%), or equipment (21.3%). The circulating nurse was most frequently affected by NREs (43.2%) followed by the entire surgical team (13.7%). There was no statistically significant difference in non-routine events based on surgical approach. CONCLUSION: Non-routine events are prevalent in the gynecological surgical setting. Identifying the sociotechnical factors that influence non-routine events are important in determining interventions that will combat the associated risks. Interventions focusing on teamwork, managing external interruptions, and coordinating equipment may have the greatest impact to reduce or eliminate NREs in gynecological surgeries.

Urinary catheterisation management after laparoscopic hysterectomy: a national overview and a nurse preference survey.

The aim of this study was to evaluate the catheterisation regimes after a laparoscopic hysterectomy (LH) in Dutch hospitals and to assess the nurses' opinion on this topic. This was particularly relevant as no consensus exists on the best moment to remove a urinary catheter after an LH. All 89 Dutch hospitals were successfully contacted and provided information on their catheterisation regime after LH: 69 (77.5%) hospitals reported removing the catheter the next morning after the LH, while nine hospitals (10.1%) removed it directly at the end of the procedure. The other 11 hospitals had different policies (four hours, up to two days). Additionally, all nurses working in the gynaecology departments of the hospitals affiliated to Leiden University were asked to fill in a self-developed questionnaire. Of the 111 nurses who completed the questionnaire (response rate 81%), 90% was convinced that a direct removal was feasible and 78% would recommend it to a family member or friend. Impact Statement What is already known on this subject? Although an indwelling catheter is routinely placed during a hysterectomy, it is unclear what the best moment is to remove it after an LH specifically. To fully benefit from the advantages associated with this minimally invasive approach, postoperative catheter management, should be, amongst others, optimal and LH-specific. A few studies have demonstrated that the direct removal of urinary catheter after an uncomplicated LH is feasible, but the evidence is limited. What the results of this study add? While waiting for the results of the randomised trials, this present study provides insight into the nationwide catheterisation management after an LH. Despite the lack of consensus on the topic, catheterisation management was quite uniform in the Netherlands: most Dutch hospitals removed the urinary catheter one day after an LH. Yet, this was not in line with the opinion of the surveyed nurses, as the majority would recommend a direct removal. This is interesting as nurses are closely involved in the patients' postoperative care. What are the implications of these findings for clinical practice and/or further research? Although randomised trials are necessary to determine an optimal catheterisation management, the findings of this present study are valuable if a new urinary catheter regime has to be implemented.

Perioperative nursing intervention on patients undergoing laparoscopic gastric stromal tumor resection.

This study aimed to investigate the effectiveness of perioperative nursing intervention on patients undergoing laparoscopic gastric stromal tumor resection. Sixty patients with gastric stromal tumor were selected from our hospital and evenly divided into group A and group B. Patients in both groups underwent laparoscopic resection. Patients in group A were given conventional nursing intervention before and after surgery, while those in group B were given comprehensive nursing intervention. Various indicators were compared between the two groups. The amount of bleeding of group B was less than that of group A, and the first anal exsufflation of group B was also earlier than that of group A; the differences had statistical significance (p less than 0.05). Patients in group B felt less pain than patients in group A; except for 72 h after surgery, difference of pain degree between group A and B had statistical significance in other periods (p less than 0.05); the number of cases with complications and categories of complications of group B were less than those of group A, and the difference had statistical significance (p less than 0.05). The efficacy satisfaction of group B was also higher than that of group A, and the difference was statistically significant (p less than 0.05). Perioperative nursing intervention is beneficial and positive and has bright development prospects.

Aplicación del protocolo ERAS (Enhanced Recovery After Surgery) y cirugía laparoscópica en el manejo de los pacientes con cáncer de vejiga / Application of ERAS (Enhanced Recovery After Surgery) and laparoscopic surgery in the management of patients with bladder cancer

Objectivo: El programa ERAS (Enhanced recovery after surgery) se ha convertido en la base del manejo perioperatorio en diversas especialidades quirúrgicas. Sin embargo, no hay evidencia suficiente que confirme su aplicación en cistectomía radical. Metodos: Hemos analizado a 124 pacientes sometidos a cistectomía radical. Para el análisis retrospectivo, los pacientes se dividieron en dos grupos: Grupo A (n=72) se han incluido a los pacientes cuya cirugía fue realizada antes de la instauración del programa ERAS; y el Grupo B (n=52) incluyó a los pacientes que se trataron siguiendo las variables incluidas en el protocolo ERAS. El objetivo principal fue valorar el tiempo de estancia hospitalaria y la permanencia en unidades de cuidados intensivos (UCI). Otras variables del estudio fueron el uso de hemoderivados, la fluidoterapia administrada y las complicaciones médicas y quirúrgicas. Resultados: La estancia hospitalaria y en UCI fue significativamente más corta (p<0,001) en los pacientes tratados siguiendo el protocolo ERAS (Grupo B), lo que llevó a reducir 7 días de hospitalización y 25,7 horas de estancia en UCI. En cuanto al reemplazo de fluidos siguiendo el protocolo ERAS, nuestro estudio mostró una reducción estadísticamente significativa en la cantidad total de fluido administrado, tanto cristaloides como coloides, (p<0,001). La necesidad de transfusión sanguínea también fue menor en el grupo B con una diferencia estadísticamente significativa (p<0,001). No se observaron diferencias estadísticas en cuanto a la incidencia de complicaciones quirúrgicas. Conclusiones: La aplicación del protocolo ERAS en cistectomía radical disminuye el tiempo de estancia hospitalaria, la permanencia en UCI, la necesidad de fluidos y la administración de hemoderivados. Sin embargo, se necesitan más y mayores estudios para probar la eficacia de ERAS en pacientes sometidos a cistectomía radical (AU)

Objective: The enhanced recovery after surgery program (ERAS) has become the base of perioperative management in various surgical specialties. However, limited data are available for radical cystectomy. Methods: We have analyzed 124 patients undergoing radical cystectomy. For retrospective analysis, the patients were divided into two groups: Group A (n=72) included patients whose surgery was performed before the introduction of the ERAS protocol; and Group B (n=52) included patients who were treated following the items included in the ERAS protocol. The main objective was to assess the length of hospital stay and the permanence in intensive care units (ICU). Other variables were the use of intraoperative blood products, fluid-therapy and medical and surgical complications. Results: Hospital and ICU stay were significantly shorter (p<0.001) in Group B for patients following the ERAS protocol, which led to reduce 7 hospitalization days and 25.7 hours of overall ICU stay. Regarding fluid replacement following the ERAS protocol, our study showed a statistically significant reduction in the total amount of fluid administered, both crystalloids and colloids, in Group B (p<0.001). The need of blood transfusion was also lower in Group B with a statistically significant difference (p<0.001). No statistical differences were observed regarding the incidence of surgical complications. Conclusions: Introduction of ERAS protocol in radical cystectomy decreases the length of hospital stay, permanence in critical care units, and the need for fluidtherapy and blood product transfusion. However, more and larger studies are needed to prove the efficacy of ERAS for patients undergoing radical cystectomy (AU)

Laparoscopic assistance by operating room nurses: Results of a virtual-reality study.

BACKGROUND: Laparoscopic assistance is often entrusted to a less experienced resident, medical student, or operating room nurse. Data regarding laparoscopic training for operating room nurses are not available. OBJECTIVES: The aim of the study was to analyse the initial performance level and learning curves of operating room nurses in basic laparoscopic surgery compared with medical students and surgical residents to determine their ability to assist with this type of procedure. DESIGN: The study was designed to compare the initial virtual reality performance level and learning curves of user groups to analyse competence in laparoscopic assistance. PARTICIPANTS: The study subjects were operating room nurses, medical students, and first year residents. METHODS: Participants performed three validated tasks (camera navigation, peg transfer, fine dissection) on a virtual reality laparoscopic simulator three times in 3 consecutive days. Laparoscopic experts were enrolled as a control group. Participants filled out questionnaires before and after the course. RESULTS: Nurses and students were comparable in their initial performance (p>0.05). Residents performed better in camera navigation than students and nurses and reached the expert level for this task. Residents, students, and nurses had comparable bimanual skills throughout the study; while, experts performed significantly better in bimanual manoeuvres at all times (p<0.05). CONCLUSION: The included user groups had comparable skills for bimanual tasks. Residents with limited experience reached the expert level in camera navigation. With training, nurses, students, and first year residents are equally capable of assisting in basic laparoscopic procedures.

Validity and reliability of a pain location tool for pediatric abdominal surgery.

For children with surgical problems, pain location conveys important clinical information. We developed a Location and Level of Intensity of Postoperative Pain (Lolipops) tool consisting of a body outline with a seven-sector abdominal grid, the International Association for the Study of Pain Revised Faces Pain Scale, and a recording chart. The aim of the study was to assess the validity and reliability of Lolipops. Children aged 5-14 years who had undergone laparoscopic appendectomy took both nurse- and investigator-administered Lolipops, and an investigator administered Varni Thompson Pediatric Pain Questionnaires, within 24 hours of surgery. The average age of the 42 participants was 10.7 years; 64% were boys; 24 (57.1%) had acute appendicitis, 13 (31%) had perforated appendicitis, and 5 (11.9%) were uninflamed. Pain scores were higher at the laparoscopic port incision sites than in upper abdominal sites distant from incisions or expected inflammation, mean (SD) 3.3 (2.3) and 1.1 (1.8), respectively (p < .0001). In children with acute appendicitis, pain scores were higher in the right iliac fossa than in upper abdominal sites, mean (SD) 3.3 (2.5) and 0.4 (0.7), respectively (p = .001). In children with perforated appendicitis, Lolipops demonstrated a more widespread pain pattern. Correlations between nurse and investigator were fair to moderate with an overall intraclass correlation coefficient of 0.597. This study presents a new tool to measure the location of pain in pediatric surgical patients and shows it to be valid and reliable.

Pautas prácticas de enfermería en cirugía urológica laparoscópica / No disponible

Hemos realizado una revisión sobre la actividad enfermera intraoperatoria en estos procesos, elaborando una guía práctica de fácil manejo, que ayude a adquirir los conocimientos y habilidades necesarios que capaciten unos cuidados enfermeros de calidad. Principales diagnósticos enfermeros: ansiedad, temor, riesgo de infección, aspiración, lesiones perioperatorias y caídas. 96 cirugías laparoscópicas justifican la necesidad de adquirir los conocimientos y habilidades necesarios para la correcta actuación enfermera. Hemos realizado un plan de cui dados enfermeros estandarizado. La alta especialización de estos procesos precisa un personal altamente cualificado, enfermería es clave en el desarrollo de estas técnicas, pues influye de forma activa en el buen desarrollo de las mismas, favoreciendo el trabajo en equipo, minimizando los tiempos quirúrgicos y asegurando una atención de calidad (AU)

We have carried out a revision about the intraoperatory nurse activity in these processes, elaborating a practical guide of easy handling, which helps to acquire the necessary knowledge and skills that enable quality nurse care. Main nurse diagnoses: anxiety, fear, risk of infection, aspiration, perioperatory injuries and falls. 96 laparoscopic surgeries justify the need to acquire knowledge and necessary skills to the correct nursing performance. We have carried out a standardized nursing care plan. The high specialization of these processes needs highly qualified staff, nursing is key in the development of these techniques as it is influential actively in the correct development of them, favoring the teamwork, minimizing surgical time and guaranteeing attention of quality (AU)

Lista de verificação de materiais ópticos de videocirugia: efetividade do instrumento / Checklist of optical materials of videosurgery: effectiveness of the instrument

Avaliar a efetividade do uso da lista de verificação como instrumento de checagem padronizada para verificar o funcionamento e a estrutura de ópticas e cabos de fibra óptica usados em videocirurgias e analisar se, ao implantar a lista de verificação, ocorreu redução no número de ópticas danificadas.....

High-output stomas: challenges with a large laparostomy wound.

This article explores the management of patients with high-output stomas fashioned under acute surgical conditions where management may be difficult owing to the presence of a large laparostomy wound. Available products that meet the technical demands required to manage these patients, achieve optimal wound healing, manage high-output stoma and encourage patient independence are considered. A number of strategies to meet the physical and nutritional requirements of these patients are discussed along with the importance of the multidisciplinary team working together to provide holistic care.

Obesidad mórbida. Guía para elaborar una trayectoria clínica / Morbid obesity

La obesidad mórbida (OM) es una enfermedad grave, causada por diversos factores genéticos y ambientales, que se asocia a múltiples elementos de comorbilidad que repercuten de forma muy importante en la cantidad y calidad de vida. La cirugía de la obesidad es compleja, no exenta de complicaciones, cuyo objetivo no es alcanzar un peso ideal ni curar la obesidad, sino reducir significativamente las comorbilidades asociadas y mejorar el bienestar de los pacientes. En este contexto, La Sociedad Española para el Estudio de la Obesidad (SEEDO) y la Sociedad Española de Cirugía de la Obesidad (SECO) han elaborado un documento de consenso que proporciona a los distintos profesionales implicados en el tratamiento de la OM una orientación práctica a la hora de desarrollar sus propios protocolo en su ámbito de trabajo. Siguiendo las recomendaciones de la SECO, el equipo de Cirugía General del Servicio del Aparato Digestivo del Hospital Universitario de Bellvitge (HUB) elaboró la trayectoria clínica de este proceso quirúrgico, ya que constituye una herramienta que facilita la atención sistemática y multidisciplinar de grupos de pacientes que presentan un curso clínico predecible, como son los pacientes obesos mórbidos ya sean intervenidos por laparotomía o bien mediante laparoscopia (AU)

Morbid obesity (MO) is a serious disease caused by genetic and environmental factors, which is associated with multiple comorbid factors that impact very significantly on the amount and life quality. Obesity surgery is a complex surgery, but not without complications, which objective is to achieve an ideal weight or cure obesity, reducing comorbidities and improving the welfare of patients. The Spanish Society for the Study of Obesity (SEED) and the Spanish Society of Obesity Surgery (SECO) have developed a consensus document that allows the various professionals involved in the treatment of OM practical guidance in developing their own protocols in their work environment. In this context, the general and digestive service of the HUB team developed the clinical course of this surgical procedure because it is a tool that facilitates systematic care and multidisciplinary group of patients with a predictable clinical course, such as whether morbidly obese patients operated by laparotomy or laparoscopy(AU)

The nursing and financial implications of laparoscopic colorectal surgery: data from a randomized controlled trial.

AIM: The issue of cost effectiveness of laparoscopic surgery remains uncertain and its impact on the ward nursing staff is unaddressed. This study investigated these issues using patients from a single centre admitted to a randomized controlled trial. METHOD: All patients recruited into the Australasian Laparoscopic Colon Cancer Study (ALCCaS) from The Queen Elizabeth Hospital between January 1999 and March 2005 were included in this study. Data relating to hospital cost were collated from the Hospital Patient Costing System. Nursing interventions were calculated in minutes per patient, using the excelcare Software database. RESULTS: Data from 97 patients were analysed (laparoscopy, 53; open surgery, 44). The median number of hours of nursing input per patient was 80 (27.5-907) h in the open surgery group and 58.5 (15-684.5) h in the laparoscopy group. This difference was further increased after exclusion of patients converted from laparoscopy to open surgery. The median total cost of the procedure was AUS $9698/£ 5631 (AUS $3862-90,397) in the open surgery group and AUS $10,951/£ 6219 (AUS$2337-66,237) in the laparoscopy group. CONCLUSION: These data suggest that laparoscopic colorectal surgery is equivalent in price to open surgery and there may be added benefits in reduced nursing intensity.

Prostatectomía radical abierta vs laparoscópica / No disponible

Evaluación comparativa de la necesidad de los cuidados de enfermería entre la prostatectomía radical abierta (PRA) vs laparoscópica (PRL);para garantizar una óptima calidad asistencial en los cuidados enfermeros postoperatorios. Para ello se realiza un estudio retrospectivo, descriptivo y comparativo. Se evalúan 101 cirugías prostáticas radicales realizadas desde enero2007 hasta mayo 2009, de las cuales 48 fueron laparoscópicas y 53 por vía abierta. Se utilizan como variables la hemorragia, presencia de dolor y demanda de analgesia; evolución de la herida quirúrgica y necesidad de drenaje, estancia media hospitalaria, necesidad de movilización, necesidad de higiene, necesidad de eliminación y necesidad de alimentación.Un 16% de los pacientes intervenidos por cirugía abierta precisaron de hemotransfusión frente al 0% de la laparoscópica. El 54,7% de los pacientes intervenidos por PRA presentaron dolor controlado respecto al 89,6% de las PRL. Referente a las complicaciones de la herida quirúrgica en la PRL fueron 0% mientras que en la PRA un 11%. La estancia media hospitalaria fue de 5,7 días en la PRA, siendo de 3,5 días en la PRL. Alas 48 h de la intervención quirúrgica el 92,7% de los pacientes intervenidos por PRL deambulan frente al 44,2% de los intervenidos por PRA.No se han observado diferencias en las necesidades de eliminación y alimentación.Son varias las ventajas que se pueden apreciar en los pacientes intervenidos mediante técnica laparoscópica: menos estancia hospitalaria, dolormás controlado, ausencia de complicaciones en la herida quirúrgica, no precisan de hemotransfusión y movilización precoz (AU)

Comparative evaluation about the necessity of nursing cares among the open radical prostatectomy (ORP) vs laparoscopic (LOP); to guaranteean optimum welfare quality in the postsurgical nursing cares.For that reason a retrospective, descriptive and comparative study is carried out. 101 radical prostatic surgeries carried out during January2007 until May 2009 are evaluated, of which 48 were laparoscopic and 53 were traditional surgery.Haemorrhage, presence of pain and demand for analgesia are used as variables; evolution of the surgical wound and need for drainage, hospitalaverage stay, need for mobilization, need for hygiene, need for removal and need for feeding.A 16% of the patients who underwent surgery needed transfusion whereas 0% of the laparoscopic. 54,7% of the patients who underwent surgery on by ORP presented controlled pain, 89,6% of the RLP. As to the complications of the surgical wound in the RLP were 0% whereas in the ORP, 11%. The hospital average stay were 5,7 days in the ORP, being of 3,5 days in the RLP. 48 Hours after the operation, 92,7% of the patients operated by RLP stroll but 44,2% of the ones operated by ORP did it.Differences have not been observed about the need for removal and feeding.The advantages that can be noticed in the patients operated with laparoscopic technique are several: less hospital stay, more controlled pain,absence of complications in the surgical wound, do not need transfusion and precocious mobilization (AU)

Procedure and outcomes of Roux-en-Y gastric bypass.

Bariatric surgery is an effective intervention for weight loss in the morbidly obese patient and can result in resolution of associated comorbidities. However, it is a complex area of practice and care, as these patients suffer a series of comorbidities that can compromise outcomes after surgery. Nurses must be aware of these comorbidities and anticipate the required interventions to ensure timely and effective treatment, and to minimize potential problems. This article reviews the technical procedures of the laparoscopic Roux-en-Y gastric bypass (LRYGBP)--which is considered the gold standard in bariatric surgery--and outlines its complications and outcomes. Other forms of bariatric surgery are briefly discussed in comparison to the LRYGBP. With knowledge in this area, nurses are in a ideal position to educate and prepare patients for life after surgery, and to diminish their anxiety during adaptation to this new phase of life.

Laparoscopic-assisted colon surgery.

Laparoscopic-assisted colon surgery is a safe alternative to conventional open colectomy. Using the laparoscopic approach, the surgeon uses tools through port sites to mobilize the section of colon to be removed, avoiding a large laparotomy incision. Usually, two to three 5-mm port site are created. Although this procedure often requires a small incision to remove the diseased portion of the colon, the incision is much smaller, causing less postoperative pain and shortening the hospital stay. This leads to a faster return to activities of daily living for the patient.

Pediatric laparoscopy.

Significant developments in minimally invasive surgery (MIS) for the adult population have led to increased application of MIS techniques for pediatric patients. Laparoscopy is the most common MIS procedure used in pediatrics. Traditional surgical procedures that are now being performed laparoscopically include gastrostomy, pyloromyotomy, and repair of congenital diaphragmatic hernia and imperforate anus. All perioperative team members must be prepared to provide appropriately sized instruments and equipment to facilitate use of MIS techniques in the pediatric population and must ensure safe patient care to achieve optimal patient outcomes.

Nefrectomía radical abierta y laparoscópica: estudio comparativo de cuidados de enfermería y calidad de vida / No disponible

En la Fundación Puigvert se ha introducido la nefrectomía laparoscópica como innovación quirúrgica durante el año 2001. Desde enero de 2001 se emplean ambas técnicas quirúrgicas simultáneamente, disminuyendo progresivamente el número de nefrectomías abiertas en beneficio de la cirugía laparoscópica, lo cual nos exige no sólo conocer las diferencias clínicas existentes entre ambas, sino discernirlos cuidados de enfermería a proporcionar según la demanda asistencial. Como equipo de enfermería consideramos que es imprescindible poseer un cuerpo de conocimientos, habilidades y actitudes que se adapten a los cambios e innovaciones. De este modo podremos identificar necesidades de salud, planificar cuidados de enfermería adecuados, prevenir complicaciones y contribuir a la adaptación del paciente a la vida diaria fomentando la independencia en todas sus necesidades según el modelo conceptual de Virginia Henderson. El objetivo de este estudio es describir desde un punto de vista comparativo la evolución posquirúrgica de la nefrectomía radical abierta y laparoscópica durante la hospitalización y el alta domiciliaria, en función de los cuidados de enfermería requeridos según el modelo conceptual de Virginia Henderson (AU)

In the Puigvert Foundation the laparoscopic nephrectomy has been introduced as surgical innovation during 2001. From January 2001both surgical techniques are used simultaneously, decreasing progressively the number of open nephrectomies for the benefit of the laparoscopic surgery, which requires that us not only to know the existing clinical differences between both, but to discern the cares of nursing to provide according to the demand. We, as a nursing team, consider that it is essential to possess a corps of knowledge, skills and attitudes that could be adapted to changes and innovations. In this way, we will be able to identify health needs, plan adequate nursing cares, prevent complications, and contribute to the adaptation of the patient to daily life encouraging the independence in all their needs according to the conceptual model of Virginia Henderson. The goal of this study is to describe from a comparative point of view the post-surgical evolution of the open radical nephrectomy and laparoscopic during the hospitalization and the house discharge, according to the nursing cares required according to the conceptual model of Virginia Henderson (AU)

Men's experiences following laparoscopic radical prostatectomy: a qualitative descriptive study.

BACKGROUND: Laparoscopic radical prostatectomy is a less invasive surgical option to the open retropubic approach for prostate cancer that will likely grow in popularity commensurate with availability. However, since little is known about what men experience throughout the postoperative period, our ability to ensure informed decision-making remains compromised. OBJECTIVES: The aim of this study was to explore what men experience following laparoscopic radical prostatectomy and how adequately their pre- and postoperative needs are being met. DESIGN: This was a qualitative descriptive study. PARTICIPANTS: Nineteen men, aged 46-76, who had undergone laparoscopic radical prostatectomy within the previous 3-6 months period were recruited from the treatment and control arms of a randomized controlled trial. Men who were not in the trial were recruited via letters mailed from surgeons' offices. METHODS: Data were generated during loosely structured individual (n=5) and focus group interviews (n=3). Inductive content analysis helped to ensure that participants' perspectives were accurately represented. RESULTS: Men had actively sought information prior to surgery but seemed unprepared for the intensity of discomfort and incontinence they experienced. They particularly valued opportunities for informal discussion with former prostatectomy patients; however, erectile dysfunction remained a major concern and most did not know where to turn for help. CONCLUSION: Nurses could play a pivotal role in the laparoscopic radical prostatectomy experience by ensuring men are well informed both pre- and postoperatively. Facilitating contact with other men who have undergone laparoscopic radical prostatectomy (LRP) and initiating conversation about potential side-effects such as urinary incontinence and erectile dysfunction would be an important starting point. Particularly in light of early discharge and concerns regarding erectile dysfunction, additional follow-up seems warranted.

Estudio comparativo entre nefrectomía radical abierta y laparoscópica: experiencia inicial / No disponible

El término laparoscopia se le da a un grupo de operaciones realizadas con la ayuda de una cámara colocada en el abdomen. Su desarrollo, en estos últimos años, ha suscitado estudios que la comparan con la cirugía convencional. Los resultados han favorecido a la laparoscopia haciendo de esta técnica quirúrgica un procedimiento de primera elección. En este artículo queda manifiesto que se hace competitiva en costes y gasto hospitalario reduciendo el tiempo de estancia y complicaciones derivadas del abordaje quirúrgico (AU)

The term laparoscopy occurs him to a surgery group made with the aid of a placed camera in the abdomen. Its development, in recent years, has provoked studies that compare it with the conventional surgery. The results have favored to the laparoscopia doing of this surgical technique a procedure of first election. In this article it is demonstrated that becomes in costs and hospitable cost reducing to the time of stay competitive and complications derived from the surgical boarding (AU)