Esterilización tubaria transvaginal: serie de casos / Transvaginal tubal sterilization

Antecedentes: La esterilización tubaria transvaginal, es una forma de abordar la esterilización quirúrgica, en la actualidad poco popularizada. Objetivo: Evaluar la colpotomía posterior como vía para la esterilización tubaria. Método: Análisis de 100 fichas clínicas de mujeres multíparas en estado no puerperal, a solicitud voluntaria de esterilización. Resultados: Hubo un 3 por ciento de complicaciones. Conversiones en el 4 por ciento y un tiempo operatorio promedio de 25,2 minutos. Conclusión: La colpotomía posterior es una buena alternativa quirúrgica para efectuar la esterilización tubaria, con baja morbilidad.

Background: Transvaginal tubal sterilization is a way for surgical sterilization, that currently is not widely used. Objective: To evaluate the posterior colpotomy as a pathway for tubal sterilization. Method: Analysis of 100 medical records of multiparous women non puerperal state, who request voluntary sterilization. Results: There were 3 percent of complications, 4 percent of conversions and a mean operative time of 25.2 minutes. Conclusion: The posterior colpotomy is a good surgical alternative to perform tubal sterilization with low morbidity and cost.

Enfermedad inflamatoria pélvica / Pelvic inflammatory disease

Cada año miles de mujeres experimentan un episodio de enfermedad inflamatoria pélvica (EIP) aguda y estas son sometidas a un creciente riesgo de molestias crónicas en el hemiabdomen inferior, embarazo ectópico, dolores por adherencias, infertilidad tubárica, dispareunia, el piosálpinx, los abscesos tuboováricos y muchas de ellas requerirán intervenciones quirúrgicas. Las complicaciones y secuelas de la EPI son penosamente graves para la enferma, la familia y la sociedad. Aproximadamente un 12 por ciento de mujeres se convierten en infértiles después de un simple episodio, casi un 25 por ciento después de dos episodios y casi un 50 por ciento después de tres episodios. Su diagnóstico y tratamiento tiene también un impresionante costo económico. Se realizó una revisión del tema con el objetivo de aumentar nuestros conocimientos y mejorar la calidad del diagnóstico, complicaciones, tratamiento y manejo en general de las pacientes con enfermedad inflamatoria pélvica (AU)

Every year thousands of women has an event of acute pelvic inflammatory disease (PID) leading to a increasing risk of chronic discomforts in the lower hemi-abdomen, ectopic pregnancy, pains due to adhesions, tubal infertiliy, dyspareunia, the pyosalpinx, tubo-ovarian and more of then requiring surgical interventions. The complications and sequelae of PIE are distressing for patients, the family and the society. Approximately a 12 percent of women overcomes infertile after a single event, almost a 25 percent after two events and almost a 50 percent after three events. Its diagnosis and treatment had a high economic budget. This subject was analyzed to increase our knowledge and to improve the diagnosis quality, complications, treatment and management in general of patients presenting with pelvic inflammatory disease (AU)

Enfermedad inflamatoria pélvica / Pelvic inflammatory disease

Cada año miles de mujeres experimentan un episodio de enfermedad inflamatoria pélvica (EIP) aguda y estas son sometidas a un creciente riesgo de molestias crónicas en el hemiabdomen inferior, embarazo ectópico, dolores por adherencias, infertilidad tubárica, dispareunia, el piosálpinx, los abscesos tuboováricos y muchas de ellas requerirán intervenciones quirúrgicas. Las complicaciones y secuelas de la EPI son penosamente graves para la enferma, la familia y la sociedad. Aproximadamente un 12 por ciento de mujeres se convierten en infértiles después de un simple episodio, casi un 25 por ciento después de dos episodios y casi un 50 por ciento después de tres episodios. Su diagnóstico y tratamiento tiene también un impresionante costo económico. Se realizó una revisión del tema con el objetivo de aumentar nuestros conocimientos y mejorar la calidad del diagnóstico, complicaciones, tratamiento y manejo en general de las pacientes con enfermedad inflamatoria pélvica

Every year thousands of women has an event of acute pelvic inflammatory disease (PID) leading to a increasing risk of chronic discomforts in the lower hemi-abdomen, ectopic pregnancy, pains due to adhesions, tubal infertiliy, dyspareunia, the pyosalpinx, tubo-ovarian and more of then requiring surgical interventions. The complications and sequelae of PIE are distressing for patients, the family and the society. Approximately a 12 percent of women overcomes infertile after a single event, almost a 25 percent after two events and almost a 50 percent after three events. Its diagnosis and treatment had a high economic budget. This subject was analyzed to increase our knowledge and to improve the diagnosis quality, complications, treatment and management in general of patients presenting with pelvic inflammatory disease

Notes: apendicectomías transvaginales hibridas en humanos con instrumentos laparoscópicos convencionales: descripción de la técnica quirúrgica / Notes: hybrid transvaginal apendicectomy on humans with regulars laparoscopics instrument: surgical technique description

La apendicectomía es la intervención quirúrgica abdominal, más comunmente practicada, actualmente la apendicectomía laparoscópica constituye la modalidad terapéutica ideal, en la búsqueda de técnicas quirúrgicas menos invasivas, se propone la realización de apendicectomía por orificios naturales, siendo la vía transvaginal el acceso para el desarrollo del procedimiento. En la presente investigación se expone y describe la técnica quirúrgica NOTES: apendicectomía hibrida transvaginal con instrumentos laparoscópicos convencionales. El acceso transvaginal parece ser factible y seguro con instrumental laparoscópico convencional, para la realización de apendicectomías en cuadros clínicos no complicados. Es indispensable el entrenamiento en cirugía laparoscópica convencional. La triangulación laparoscópica desaparece, lo que dificulta la maniobrabilidad. No es necesario el uso de trócares para acceder a la cavidad abdominal.

The apendicectomy is the most common surgical procedure practice. Laparoscopic apendicectomy it is the gold standard. Searching for less invasive procedure it is propose the transvaginal apendicectomy for selected cases. The investigation describes the technique of NOTES: hybrid transvaginal apendicectomy, using regular laparoscopics instruments. The transvaginal access it is feasible way to perform the apendicectomy. It is essential to be trained on advance laparoscopic technique. The triangulation trough transvaginal way is lost. It is not necessary to use throcars to access trough transvaginal way.

Anterior vaginal wall prolapse: a randomized controlled trial of SIS graft versus traditional colporrhaphy.

INTRODUCTION AND HYPOTHESIS: This study seeks to compare the small intestine submucosa (SIS) graft with traditional colporrhaphy (TC) for surgical treatment of anterior vaginal prolapse. METHODS: Subjects were randomly assigned to SIS (n = 29) or to TC (n = 27) preoperatively and outcomes analyzed at 12 months postoperatively. The primary outcome was the absence of POP-Q stage >or= II prolapse, and secondary outcome was improvement in quality of life. Data were compared with independent samples or paired Student's t test. RESULTS: SIS group had 86.2% anatomic cure compared to 59.3% in TC (p = 0.03). SIS improved point Ba measurement significantly (-1.93 cm versus -1.37 cm, p = 0.02). Both operations significantly improved quality of life, although there were no differences between the groups. We observed a greater number of complications in the SIS group, with no infections or erosion. CONCLUSIONS: SIS repair improved point Ba significantly. However, there were no differences observed in quality of life between the techniques.

Notes: colecistectomía trans-vaginal video asistida: con instrumentos laparoscópicos convencionales: descripción de la técnica quirúrgica / Notes: video assisted trans-vaginal cholecystectomy with conventional laparoscopic instruments: a description of surgical technique

Las vías de abordaje para la realización de la colecistectomía han cambiado dramáticamente en los últimos 20 años, desde la cirugía abierta hasta la cirugía de invasividad mínima y ahora desde 2007 se comienza a realizar cirugía a través de orificios naturales. Con la ausencia de instrumentos ideales, puede ser posible crear accesos seguros a través del abordaje trans-vaginal con el uso de instrumentos laparoscópicos convencionales en pacientes bien seleccionados. Describir una nueva técnica quirúrgica para la realización de colecistectomía transvaginal video asistida con instrumentos laparoscópicos convencionales. Descripción de la técnica: con la paciente bajo anestesia general, colocada en posición ginecológica, accedemos a la cavidad abdominal a través de la cicatriz umbilical. Insertando un trocar de 10mm bajo visión directa, a través de este se vigilará la entrada a través de la colpotomía, a través de la vagina se introducirá una pinza de grasper de 5mm y la óptica de 30°. Con el grasper transvaginal se sujetara la vesícula y a través del portal umbilical el cirujano realizará la disección de los elementos de triangulo de Calot, extrayendo la pieza por vía vaginal. El acceso trans-vaginal es factible y seguro con material laparoscópico convencional, para la realización de colecistectomía. Es indispensable el entrenamiento en laparoscopia convencional. El cirujano debe adaptarse a los ángulos de visualización ofrecidos.

The access to perform a cholecystectomy has changed dramatically in the last 20 years, from open surgery to minimal invasive surgery such as laparoscopy and now since 2007, starting toperform through natural orifices. In the absence of ideals instruments, it could be possible to create safes access through trans-vaginal way with regular laparoscopic instruments in well selected patients. Describe a new surgical technique to perform a trans-vaginal cholecystectomy video assisted, with common laparoscoic instruments. Technical description: with the patient under general anesthesia, placed her in gynecological position, we get access to the abdominal cavity through umbilicus, inserting a 10mm trocar, them under direct vision we perform the trans-vaginal access inserting one grasping forceps and 30º scope. The vaginal grasping forceps will hold the gallbladder between the fundus and the infundibulus, exposing the Calot triangle. Through the umbilicus trocar the surgeon dissect de cystic duct and artery, them it will be separated from its bed. The gallbladder is taking out side from the abdomen through vaginal way. The trans-vaginal access is a feasibly way to perform cholecystectomy with common laparoscopic instruments. It is indispensable to dominate basic laparoscopic techniques, and before start practicing this procedure, it has to perform under animal’s models.

Colecistectomía transvaginal asistida por minilaparoscopia: con uso de instrumental convencional: experiencia inicial / Transvaginal cholecystectomy assisted with minilaparoscopy: with conventional instruments: initial experience

Describir la técnica quirúrgica en la colecistectomía transvaginal sin cicatriz visible con el uso de instrumental laparoscópico convencional, en el Hospital “Dr. Domingo Luciani”. Caracas. Se presenta caso de paciente femenina de 52 años de edad, con litiasis vesicular sintomática a quien se le practica colecistectomía transvaginal. Se realizó colecistectomía transvaginal sin complicaciones intraoperatorias. No se administraron analgésicos orales ni parenterales, el alta hospitalaria se dio a las 12 horas del procedimiento. Evolución satisfactoria de la paciente con un seguimiento de 30 días. La cirugía asistida por minilaparoscopia puede considerarse intermedia entre el NOTES, y la cirugía laparoscópica. El siguiente caso demuestra la factibilidad y seguridad del procedimiento realizado por cirujanos generales con entrenamiento laparoscópico y con el uso de instrumental convencional.

Describe the surgical technique in the transvaginal cholecystectomy without a scar using conventional laparoscopic instruments, in the “Dr. Domingo Luciani” Hospital. Caracas. Presents female patient 52 years old, with sintomatic gallstones who is practicing transvaginal cholecystectomy. Was performed transvaginal cholecystectomy without intraoperative complications. No analgesics were administered oral or parenteral, was discharged at 12 hours of the procedure. There was a satisfactory progress of the patient with a follow upof 30 days. Minilaparoscopy assisted surgery can be considered intermediate between NOTES, and laparoscopic surgery. The following case demonstrates the feasibility and safety of the procedure performed by general surgeons with laparoscopic training and the use of conventional instruments.

Limiting factors for cytopathological diagnosis of high-grade squamous intraepithelial lesions: a cytohistological correlation between findings in cervical smears and loop electrical excision procedure.

The present study sought possible factors leading to the cytological diagnosis of atypical squamous cells of uncertain significance (ASCUS) in cases of high-grade squamous intraepithelial lesions (HSIL). Based on retrospective histopathological analysis of loop electrical excision procedure (LEEP) products that diagnosed HSIL, two study groups were randomly selected. The first was consisted of cases with two consecutive Papanicolaou (Pap) smears with the diagnosis of ASCUS. The second (control) group was represented by cases diagnosed as HSIL by cytology. From the Pap smears diagnosed as ASCUS, the sampling limitations was different from control group (P < 0.05). The median size of the largest lesion in each case with ASCUS was 2.66 mm (+/- 1.71 mm). In the control group, the median size of the largest lesion was 5.15 mm (+/-2.58 mm) (P < 0.05). The size of the lesion and sample limitations led patients with cervical intraepithelial neoplasms to be diagnosed as ASCUS for two consecutive times, after a 6-mo period.

Chain removal of myomata by colpotomy.

Multiple myomectomy was performed in 67 women between June 1996 and July 1998. In almost every case, myomas were sutured one to another with a single stitch of 1 silk, forming a chain, and taken out through the vaginal cul-de-sac. We believe this method reduces the risk of losing myomas inside the peritoneal cavity and shortens operating time. (J Am Assoc Gynecol Laparosc 6(3):337-338, 1999)