Use of electrosurgical units in the endoscopic resection of gastrointestinal tumors / Empleo de las unidades electroquirúrgicas en la resección endoscópica de neoplasias digestivas

Electrosurgical units (ESUs) are indispensable devices in our endoscopy units. However, many endoscopists are not well-trained on their use and their physical bases are usually not properly studied or understood. In addition, comparative data concerning the settings that may be applied in different circumstances are scarce in the medical literature. Given that it is important to be aware of their strengths and risks, we conducted a review of the available information and research on this topic

Las unidades electroquirúrgicas (UES) son dispositivos indispensables en nuestras unidades de endoscopia. Sin embargo, muchos endoscopistas no están bien entrenados en su uso y sus bases físicas generalmente no son estudiadas o comprendidas adecuadamente. Además, los datos comparativos sobre los ajustes que pueden aplicarse en diferentes circunstancias son escasos en la literatura médica. Dado que es importante conocer sus fortalezas y riesgos, realizamos una revisión de la información existente y la investigación sobre este tema

15 años de cirugía cardiaca infantil miniinvasiva; evolución y tendencias / 15 years of minimally invasive paediatric cardiac surgery; development and trends

INTRODUCCIÓN: Los abordajes miniinvasivos en cirugía cardiaca infantil no son habituales. Pocos grupos presentan programas y experiencia, quedando limitados a cardiopatías simples. Presentamos una casuística recopilada a lo largo de 15 años y más de 200 pacientes. MATERIAL Y MÉTODOS: En el año 2000 comenzamos un programa de acceso submamario, ampliándolo progresivamente a casos complejos y edades menores. En 2009 incorporamos el abordaje axilar, con idénticas pautas. En 2013 iniciamos la cirugía por miniesternotomía inferior, ampliando la cartera de servicios. Entre julio del 2000 y diciembre del 2014 se intervino a 203 pacientes: 102 por vía submamaria, 50 por axilar, 44 por miniesternotomía inferior, 4 por toracotomía lateral-posterior y 3 por miniesternotomía superior. RESULTADOS: Por patologías, la más frecuente fue la comunicación interauricular ostium secundum (128), seguida del seno venoso (20), comunicación interventricular (20), ostium primum (16) y otras (19). Un caso fue reconvertido a esternotomía. No hubo eventos neurológicos. Las medias de edad fueron 7,8/3,7 y 1,8 años, con medias de peso de 28,1/16,1 y 9,4 kg en los accesos submamario, axilar y miniesternotomía, respectivamente. Los resultados estéticos han sido excelentes. CONCLUSIONES: Tras 15 años de experiencia acumulada, la cirugía miniinvasiva es segura y eficaz, con resultados estéticos excelentes. La introducción gradual de diferentes accesos alternativos permite establecer pautas de aprendizaje. La versatilidad de accesos (submamario, axilar, miniesternotomía) facilita la selección de abordajes en función de cardiopatía y edad/peso

INTRODUCTION: The minimally invasive approach is seldom reported in paediatric cardiac surgery. Teams gathering experience are scarce, with programs focused on simple cases. The experience is presented on a series of over 200 cases operated on in the past 15 years. MATERIAL AND METHODS: A sub-mammary approach program was started in 2000, which was gradually extended to include more complex and younger patients. The axillary incision was adopted in 2009, following the same steps. In 2013, the mini-sternotomy incision was introduced, increasing our armamentarium. From July 2000 until December 2014, 203 patients were operated on. The sub-mammary approach was used in 102 cases, axillary in 50 patients, mini-sternotomy in 44, postero-lateral thoracotomy in 4 cases, and upper mini-sternotomy in 3. RESULTS: By diagnosis, ostium secundum atrial septal defect was the most common (128), followed by sinus venosus (20), ventricular septal defect (20), ostium primum (16), and others (19). One patient was converted to sternotomy. No neurological events were detected. The mean age was 7.8/3.7 and 1.8 years, and the mean weight was 28.1/16.1 and 9.4 Kg. in the sub-mammary, axillary and mini-sternotomy approaches, respectively. The aesthetic results were excellent. CONCLUSIONS: Based on our 15 years of experience, minimally invasive surgery is safe and yields excellent cosmetic results. The gradual introduction of alternative approaches (sub-mammary, axillary, mini-sternotomy) allowed us to set-up guidelines and learning curves. The wide range of incisions enables the most appropriate one to be selected depending on age/weight and cardiac condition

Síndrome compartimental agudo en antebrazo: una infrecuente complicación del cateterismo transradial / Acute compartment syndrome in the forearm: a rare complication of transradial catheterization

El Síndrome Compartimental Agudo es una situación de urgencia quirúrgica, que requiere un diagnóstico y tratamiento tempranos con la finalidad de evitar una pérdida de función del miembro o incluso de la viabilidad del mismo. Se presenta el caso de un Síndrome Compartimental Agudo en antebrazo derecho tras cateterismo transradial para angioplastia coronaria. La incidencia de esta complicación en los procedimientos transradiales es del 0,004% según algunas series. El síndrome compartimental constituye una complicación posible de los cateterismos transradiales, no presenta una distribución por sexo ni por edades, y su diagnóstico se realiza fundamentalmente por los hallazgos clínicos. Su tratamiento es quirúrgico urgente, mediante la realización de fasciotomías de los compartimentos afectos. Los procedimientos vasculares transradiales presentan una baja tasa de complicaciones vasculares. La posibilidad de aparición de complicaciones graves, tales como el síndrome compartimental, hace necesario conocer este cuadro y su manejo

Acute Compartment Syndrome is a surgical emergency situation that requires early diagnosis and treatment in order to avoid a loss of limb function or even the viability. The case of an acute compartment syndrome in right forearm occurs after transradial catheterization for coronary angioplasty. The incidence of this complication in transradial procedures is 0.004% according to some series. Compartment syndrome is a possible complication of transradial catheterization, no distribution by sex and age, and diagnosis is made primarily by clinical findings. Surgical treatment is urgent, by performing fasciotomies affections compartments. Transradial vascular procedures have a low rate of vascular complications. The possibility of occurrence of serious complications such as compartment syndrome, is necessary to know that painting and its management

[The mechanoreceptor tactile diagnostics of thoracic diseases].

The novel system of tactile analysis was used in the mechanoreceptor device. The local pressure measurement is carried out in in cameras, divided by the elastic membrane from the analyzed organ. The devise allows fast and adequate real-time measurement of tissue density and elasticity. The results, acquired with the use of the mechanoreceptor device were checked microscopically. The study showed high compatibility and adequacy of the novel mechanoreceptor.

Cirugía torácica videoasistida, trasplante pulmonar y mediastinitis, temas destacados de cirugía torácica en 2010 / Video-assisted thoracic surgery, lung transplantation and mediastinitis: major issues in thoracic surgery in 2010

Se han revisado los aspectos destacados de la cirugía torácica en relación con los avances producidos en nuestraespecialidad durante el año 2010, analizando el 43.º Congreso SEPAR realizado en A Coruña y los artículospublicados en nuestra revista, ARCHIVOS DE BRONCONEUMOLOGÍA. Las principales áreas de interés se han relacionadocon el desarrollo de la cirugía torácica videoasistida, el trasplante pulmonar y la mediastinitis descendente. Lanueva clasificación TNM (7.ª edición) presentada el pasado año se ha mantenido como actualidad durante elpresente año. Por otra parte, el primer Foro de Cirujanos Torácicos y el Curso sobre Actualización en CirugíaTorácica, junto al área de enfermería, han constituido un excelente programa docente(AU)

We reviewed the major issues in thoracic surgery relating to the advances made in our specialty in 2010. Todo this, the 43rd Congress of the Spanish Society of Pneumology and Thoracic Surgery held in La Coruña andthe articles published in the Society’s journal, ARCHIVOS DE BRONCONEUMOLOGÍA, were reviewed. The main areas ofinterest were related to the development of video-assisted thoracic surgery, lung transplantation anddescending mediastinitis. The new tumor-node-metastasis (TNM) classification (7th edition), presented lastyear, was still a topical issue this year. The First Forum of Thoracic Surgeons and the Update in ThoracicSurgery together with the Nurses’ Area have constituted an excellent teaching program(AU)

Objective assessment of the alterations in wrist mobility with the fastrak(®) system following dorsal capsulodesis.

The treatment for scapholunate dissociation is challenging and its management is varied depending on type, severity and duration of injury, and surgeon's preferred technique. This study aimed to objectively assess the variations in the range and patterns of wrist movements using the Fastrak(®) system in patients having undergone Blatt's dorsal capsulodesis (BDC). The wrist movements were successively measured between the operated and unoperated wrists, while the patients performed set tasks. Seventeen patients agreed to participate in the study. Following BDC the mean flexion loss was 23° (range 10°-38°). However, functional tasks revealed that the BDC did not adversely affect the function of the operated wrist. This novel study demonstrates objectively the functional restrictions that patients are likely to experience postoperatively following BDC. It would be interesting to note the pattern of wrist motion using the Fastrak(®) system in various other clinical settings.

[Intraoperative pedography]. / Intraoperative Pedographie : Das besondere Instrument.

THE PROBLEM: Intraoperative assessment of the restored or maintained physiological plantar force distribution during foot and ankle corrections is very difficult. THE SOLUTION: Intraoperative assessment of the restored or maintained physiological plantar force distribution during foot and ankle corrections with intraoperative pedography (IP). SURGICAL TECHNIQUE: Bilateral pedography with the "Kraftsimulator Intraoperative Pedographie" (KIOP, R-Innovation, Coburg, Germany) and a mat sensor (Pliance, custom-made, Novel, Munich, Germany) in the preparation room under anesthesia. Three measurements each side with a total force corresponding to half of the body weight are performed. Transfer of the patient to the operating room and correction including definitive internal fixation following the planning and findings. Sterile draping of the sensor mat and usage of a sterile KIOP for IP of the operated foot with three measurements, and assessment and comparison with preoperative, contralateral and physiological pedographic findings. When a correction of the force distribution is indicated, modification of the correction and internal fixation and renewed IP. POSTOPERATIVE MANAGEMENT: IP has no influence on the postoperative management. RESULTS: IP was validated in an earlier study. In a prospective, randomized, controlled clinical study, the potential clinical benefit of IP in a sufficient number of cases in comparison to cases treated without IP was analyzed. 100 cases were included until April 11, 2008. 52 patients were randomized for the use of IP. Mean interruption of the operative procedure for the IP was 321 +/- 39 s. In 24 of the 52 patients (46%), the correction was modified after IP during the same operation. The changes were done most commonly in midfoot correction arthrodeses (64%), and least commonly in subtalar joint arthrodeses (25%).

Is intraoperative pedography helpful in clinical use--preliminary results of 100 cases from a consecutive, prospective, randomized, controlled clinical study.

BACKGROUND: The purpose of this study was to assess the clinical use, and to analyze the potential clinical benefit of intraoperative pedography (IP) in a sufficient number of cases in comparison with cases treated without IP. METHODS: Patients (age 18 years and older) which sustained an arthrodesis and/or correction of the foot and ankle were included. RESULTS: One hundred cases were included (ankle correction arthrodesis, n=12; subtalar joint correction arthrodesis, n=14; arthrodesis without correction midfoot, n=15; correction arthrodesis midfoot, n=26; correction forefoot, n=33). Fifty-two patients were randomized for the use of IP. In 24 of the 52 patients (46%), the correction was modified after IP during the same operation. CONCLUSIONS: In 46% of the cases a modification of the surgical correction was made after IP in the same surgical procedure. Whether IP improve the plantar force distribution of the foot and the mid- or long-term clinical outcome has to be critically analyzed when longer follow-up is completed.

Comparative study of nail sampling techniques in onychomycosis.

Onychomycosis is a common problem. Obtaining accurate laboratory test results before treatment is important in clinical practice. The purpose of this study was to compare results of curettage and drilling techniques of nail sampling in the diagnosis of onychomycosis, and to establish the best technique and location of sampling. We evaluated 60 patients suffering from distal and lateral subungual onychomycosis and lateral subungual onychomycosis using curettage and vertical and horizontal drilling sampling techniques from three different sites of the infected nail. KOH examination and fungal culture were used for detection and identification of fungal infection. At each sample site, the horizontal drilling technique has a better culture sensitivity than curettage. Trichophyton rubrum was by far the most common pathogen detected by both techniques from all sampling sites. The drilling technique was found to be statistically better than curettage at each site of sampling, furthermore vertical drilling from the proximal part of the affected nail was found to be the best procedure for nail sampling. With each technique we found that the culture sensitivity improved as the location of the sample was more proximal. More types of pathogens were detected in samples taken by both methods from proximal parts of the affected nails.

Minimally invasive intraoperative stiffness measurement of lumbar spinal motion segments.

OBJECTIVE: To test a new tiny-tipped intraoperative diagnostic tool that was designed to provide the surgeon with reliable stiffness data on the motion segment during microdiscectomy. A decrease in stiffness after nuclectomy and a measurable influence of muscle tension were assumed. If the influence of muscle tension on the motion segment could at least be ruled out, there should be no difference with regard to stiffness between women and men. If these criteria are met, this new intraoperative diagnostic tool could be used in further studies for objective decision-making regarding additional stabilization systems after microdiscectomy. METHODS: After evaluation of the influence of muscle relaxation during in vivo measurements with a spinal spreader between the spinous processes, 21 motion segments were investigated in 21 patients. Using a standardized protocol, including quantified muscle relaxation, spinal stiffness was measured before laminotomy and after nuclectomy. RESULTS: The decrease in stiffness after microdiscectomy was highly significant. There were no statistically significant differences between men and women. The average stiffness value before discectomy was 33.7 N/mm, and it decreased to 25.6 N/mm after discectomy. The average decrease in stiffness was 8.1 N/mm (24%). CONCLUSION: In the moderately degenerated spine, stiffness decreases significantly after microdiscectomy. Control for muscle relaxation is essential when measuring in vivo spinal stiffness. The new spinal spreader was found to provide reliable data. This spreader could be used in further studies for objective decision-making about additional stabilization systems after microdiscectomy.

Handheld gamma probe used to detect accessory spleens during initial laparoscopic splenectomies.

BACKGROUND: Preoperative determination of the accessory spleen still is a major factor in the failure of both laparoscopic and conventional techniques. This study aimed to evaluate the practicability and efficacy of a handheld gamma probe in identifying accessory spleens at the initial intervention. METHODS: This study evaluated 17 patients undergoing laparoscopic splenectomy attributable to benign hematologic disorders. All the patients had preoperative ultrasonography, computed tomography (CT) scan, and nuclear scintigraphic examination of the abdominal cavity to assess the size of the spleen, and to determine the existence of the accessory spleen or spleens. For all the patients, a handheld gamma probe count was used intraoperatively as an adjuvant method to define the presence and location of the accessory splenic tissue. Control nuclear scintigraphic examinations of all the patients were performed 1 month after the surgical procedure. RESULTS: In two cases, intraoperatively accessory splenic tissue was detected by gamma probe, confirming the preoperative CT findings for the patients. One of these patients had three accessory spleens, although preoperative CT scan showed only two of them. However, by the help of the gamma probe, a third spleen located retroperitoneally was defined. For two patients, laparoscopic exploration and handheld gamma probe count did not identify any accessory splenic tissue, although preoperative CT scan indicated accessory spleens. For detecting accessory splenic tissue, the sensitivities of the studied techniques were 0% for ultrasonography, 75% for CT scan, 0% for preoperative nuclear scintigraphy, 75% for laparoscopic exploration, and 100% for perioperative gamma probe examination. CONCLUSION: Preoperative imaging methods for accessory spleen determination still have limited benefits because of their limited sensitivity. Thus, the handheld gamma probe technique may be an adjuvant method for laparoscopic exploration ensuring that no accessory splenic tissue is missed during the initial surgical treatment of benign hematologic disorders.

Comparación de resultados quirúrgicos: un mínimo control, por favor / Comparison of surgical results: minimum standardization, please

No disponible

Hemorroidectomía con el uso del bisturí armónico / Hemorrhoidectomy using the harmonic scalpel

Presentar la experiencia obtenida por los autores en el uso del bisturí armónico en pacientes con hemorroides grado III y IV, a quienes se les practicó hemorroidectomía por nuestro equipo quirúrgico del Centro Policlínico La Viña, Valencia. Es un estudio retrospectivo donde se revisaron las historias de 40 pacientes que acudieron a la consulta quirúrgica entre enero del año 2000 y agosto de 2003 con diagnóstico de hemorroides grado III y IV, a quienes se les practicó hemorroidectomía. Centro Policlínico La Viña, Valencia hospital privado. La técnica de hemorroidectomía con bisturí armónico resultó satisfactoria: redujo el tiempo quirúrgico y el sangrado intraoperatorio minimizando el daño tisular, permitió menor estancia hospitalaria y rápido retorno a las actividades cotidianas. Se presentaron dos sangramientos posoperatorios leves, uno por actividad física prescoz. No se evidenciaron complicaciones tardias como estenosis anal ni ectropión. Los autores concluyen que la hemorroidectomía con el uso del bisturí armónico es una alternativa favorable en la técnica quirúrgica, asociada a un mínimo de complicaciones intra y postoperatorias, considerando el instrumento como una opción factible y casi ideal para dicho procedimiento.

La gestiónen la práctica diaria / Management in daily practice

No disponible

No disponible

La gestión en la práctica diaria. Réplica / Management in daily practice. In reply

No disponible

No disponible

La biopsia intraoperatoria: seguridad diagnóstica, experiencia y correlación de resultados / Intraoperative biopsy: diagnostic accuraccy, experience and correlations of results

La biopsia intraoperatoria es una herramienta de apoyo muy valorada por los cirujanos desde hace muchos años. Las indicaciones y contraindicaciones han cambiado en el tiempo y esto hace variar su seguridad diagnóstica. Se analiza una serie de 105 procedimientos consecutivos y se muestran los resultados obtenidos (95,23 por ciento de índice de aciertos, sensibilidad de 86,66 por ciento, especificidad de 98,66 por ciento y valor predictivo de 96,29 por ciento), demostrando que este procedimiento en nuestro medio se mantiene dentro del rango de series de mayores volúmenes y que es plenamente válido, confiable y vigente. Se recomienda que las mediciones de seguridad diagnóstica sean efectuadas periódicamente por los departamentos de Anatomía Patológica y Laboratorios de Histopatología.

Diagnostic mini-video assisted thoracic surgery. Effectiveness and accuracy of new generation 2.0 mm instruments.

OBJECTIVE: Recently 2.0 mm mini-VATS has aroused much interest among surgeons involved with endoscopic surgery. We report our initial experience with the first first 54 patients who underwent this procedure. The aim of this study is to evaluate the effectiveness and accuracy of mini-VATS. METHODS: 54 patients were undertaken to mini-VATS for diagnostic purposes. Patients were randomly selected and the indication for operation was set by the classic VATS criteria. 35 (65%) patients were treated under general anesthesia, while 19 (35%) patients were treated under local anesthesia. RESULTS: The average length of hospital stay was 1.8 +/- 0.9 days. The days of requirement for narcotic analgesia were 1.9 +/- 1.0. Diagnostic accuracy was 100%; morbidity and mortality rates were 0%. CONCLUSIONS: The high diagnostic accuracy and low operative danger, combined with less postoperative pain, due to minor surgical trauma and faster patient recovery, has established mini-VATS as a dynamic competitor to the classic VATS procedure. Since high technology is a strong partner in endoscopic surgery, a strong potentiality for evolution exists.

Digestive hemorrhages of obscure origin.

BACKGROUND: The diagnosis of digestive bleeding in some cases can require a diagnostic laparotomy when other methods have been ineffective. Video-laparoscopy can provide such cases with a certain diagnosis and the possibility of performing a simultaneous surgical treatment. METHODS: Our experience using video-laparoscopic to treat digestive hemorrhages of obscure origin involved 16 patients. The examined patients presented with the following diseases: Meckel's diverticulum (8 cases), gastric leiomyoma (1 case), small bowel leiomyoma (4 cases), jejunum leiomyosarcoma (1 case), small bowel melanoma (1 case), and Peutz-Jeghers syndrome (1 case). RESULTS: In all these patients the laparoscopic approach allowed us to identify the origin and site of the hemorrhages, and subsequently to treat the identified lesions. In one patient, an intraperitoneal resection of the diverticulum was performed using Endo-Gia (TM30NIF; Tyco Auto-Suture). In the remaining cases, a minilaparatomy was performed for resection of the disordered loop. CONCLUSIONS: Video-laparoscopy is very useful for avoiding explorative laparatomies on patients affected by digestive hemorrhages of obscure origin. In these cases, the video-laparoscopic approach allows full and meticulous explorations of the small bowel to be performed, and seems to be useful for diagnosis through direct observation of the lesions. Moreover, if necessary, video-laparoscopy can be used for the effective treatment of the diseases.

Early clinical experience with the 6 French Angio-Seal device: immediate closure of femoral puncture sites after diagnostic and interventional coronary procedures.

The objective of this study was to assess the early safety and efficacy of the novel 6 Fr Angio-Seal device for routine clinical use after diagnostic cardiac catheterization and coronary angioplasty. In a prospective study, we used the 6 Fr Angio-Seal device in 180 consecutive patients (131 male, 49 female, mean age 60.7 years) for closure of femoral arterial puncture sites immediately after diagnostic (n = 108) or interventional (n = 72) coronary procedures independent of the coagulation status. All patients were monitored for 24 hr after the procedure and followed for 30 days. The closure device was successfully deployed in 95.4% after diagnostic catheterization versus 98.6% after coronary angioplasty (P = 0.963). Immediate hemostasis was achieved in 91.5% versus 90.1% of the patients (P = 0.993). Major complications were observed 1.9% versus 2.8% of the patients (P = 0.885). During 30-day follow-up, no late events or complications were reported. The 6 Fr Angio-Seal device is a safe and effective device that allows for immediate closure of femoral puncture sites after both diagnostic and interventional procedures with a low rate of major complications.