RESUMO
INTRODUCTION: 3D laparoscopy allows the surgeon to regain the sense of depth and improve accuracy. The aim of the study was to assess the impact of 3D in bariatric surgery. PATIENTS AND METHODS: A retrospective cohort study was conducted. All our patients who underwent bariatric surgery (sleeve gastrectomy (SG) or gastric bypass (GB)) between 2013 and 2016 were included. We compared 3D laparoscopy cohort and 2D laparoscopy cohort. Variables are as follows: age, sex, DM, hypertension, surgeon experience, and type of intervention. Comparisons of operative time, hospital stay, conversion, complications, reoperation, and exitus are completed. RESULTS: Three hundred twelve consecutive patients were included. 56.9% of patients underwent GB and 43.1% SG. Global complications were 3.2% (fistula 2.5%, hemoperitoneum 0.3%, others 0.4%). One hundred four procedures were performed in the 3D cohort and 208 in the 2D cohort. The 2D cohort and 3D cohort were similar regarding the following: percentage of GB vs SG, age, gender, learning curve, diabetes mellitus 2, hypertension, and sleep apnea. The operating time and hospital stay were significantly reduced in the 3D cohort (144.07 ± 58.07 vs 172.11 ± 76.11 min and 5.12 ± 9.6 vs 7.7 ± 13.2 days. It was the same when we stratified the sample by type of surgery or experience of the surgeon. Complications were reduced in the 3D cohort in the surgeries performed by novice surgeons (10.2 vs 1.8%, p = 0.034). CONCLUSIONS: The use of 3D laparoscopy in bariatric surgery in our center has helped reducing the operating time and hospital stay, and improving the safety of the surgery, either in GB or SG, being equally favorable in novice or more experienced surgeons.
Assuntos
Cirurgia Bariátrica/educação , Cirurgia Bariátrica/métodos , Laparoscopia/educação , Laparoscopia/métodos , Curva de Aprendizado , Obesidade Mórbida/cirurgia , Adulto , Cirurgia Bariátrica/efeitos adversos , Competência Clínica , Feminino , Gastrectomia/efeitos adversos , Gastrectomia/educação , Gastrectomia/métodos , Derivação Gástrica/efeitos adversos , Derivação Gástrica/educação , Derivação Gástrica/métodos , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Reoperação , Estudos Retrospectivos , Cirurgiões/educação , Cirurgiões/normas , Resultado do TratamentoRESUMO
Malignant pheochromocytoma is a rare disease and surgical resection is the only curative treatment. There are no definitive histological or cytological criteria of malignancy, as it is impossible to determine this condition in the absence of advanced locoregional disease or metastases. We report a case of a patient with a giant retroperitoneal tumour, the second largest to be published, which was diagnosed as a malignant pheochromocytoma; it was treated with surgery. The literature is reviewed to evaluate tumour features and criteria to distinguish between benign and malignant pheochromocytomas.
