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1.
Khirurgiia (Mosk) ; (11): 20-23, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714525

RESUMO

Endoscopic surgery is being actively developed in China due to scientific and technological progress and state support. Video-endoscopic surgery as one of these directions is actively used for lymph node dissection during mastectomy and breast reconstruction. This method results not only good functional and aesthetic results, but also positive outcomes of cancer treatment.


Assuntos
Neoplasias da Mama/cirurgia , Excisão de Linfonodo/métodos , Mamoplastia/métodos , Mastectomia/métodos , Cirurgia Vídeoassistida/métodos , Neoplasias da Mama/patologia , China , Humanos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática
2.
Khirurgiia (Mosk) ; (9): 44-51, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31532166

RESUMO

OBJECTIVE: To determine validity and adequacy of the assessment of experience acquisition in video-assisted hemithyroidectomy, to compare surgical outcomes at the learning stage and in delayed period. MATERIAL AND METHODS: Experience acquisition was studied via assessment of the duration of video-assisted hemithyroidectomy in 67 patients who were operated by the same surgeon. Time of surgery was analyzed through between-group comparison of surgical outcomes. These groups were defined arbitrarily, in exponential fashion, using the logarithm method and moving average. Risks of failure regarding duration of surgery and postoperative complications were investigated using CUSUM analysis. RESULTS: Minimum period of experience accumulation in video-assisted hemithyroidectomy (26 procedures) was determined using logarithmic analysis, maximum period (66 interventions) - using CUSUM analysis. Other approaches also showed sharp nature of the learning curve.CUSUM analysis of failures at the learning stage showed 2-fold decrease of their probability after 66 operations. However, even experience acquisitiondoes not exclude risk of failures in hemithyroidectomy. CONCLUSION: Arbitrary division of the cohort of patients seems to be unreasonable because clear number of operations necessary to achieve sustainable results does not follow it.Mathematical methods adequately reflect experience accumulation and allow determining the required number of interventions for stable results and minimum complication rate.


Assuntos
Curva de Aprendizado , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Cirurgia Vídeoassistida/métodos , Estudos de Coortes , Humanos , Tireoidectomia/efeitos adversos , Tireoidectomia/estatística & dados numéricos , Cirurgia Vídeoassistida/efeitos adversos , Cirurgia Vídeoassistida/estatística & dados numéricos
3.
Braz J Cardiovasc Surg ; 34(4): 428-435, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454196

RESUMO

OBJECTIVE: To analyze and summarize the clinical safety and feasibility of minimally invasive video-assisted mitral valve replacement via a right thoracic minimal incision in patients aged over 65 years. METHODS: The clinical data of 45 patients over 65 years old who had mitral valve disease were analyzed retrospectively from January 2014 to January 2017 at Union Hospital, Fujian Medical University. The patients were divided into two groups; 20 patients in group A, who underwent minimally invasive video-assisted mitral valve replacement via a right thoracic minimal incision, and 25 patients in group B, who underwent conventional mitral valve replacement. We collected and analyzed their relevant clinical data. RESULTS: The operation was completed successfully in both groups. Compared with group B, group A was clearly superior for postoperative analgesia time, postoperative hospital length of stay, thoracic drainage liquid, blood transfusion, and length of incision. There were no differences between the two groups in postoperative severe complications and mortality. More patients in group B had pulmonary infections and poor incision healing, while more patients in group A had postoperative pneumothorax and subcutaneous emphysema. CONCLUSION: In patients aged over 65 years, minimally invasive video-assisted mitral valve replacement with a small incision in the right chest had the same clinical safety and efficacy as the conventional method.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valva Mitral/cirurgia , Cirurgia Vídeoassistida/métodos , Idoso , Ecocardiografia/métodos , Feminino , Humanos , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , Ferida Cirúrgica , Toracotomia/métodos
4.
Comput Methods Programs Biomed ; 177: 253-268, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31319954

RESUMO

BACKGROUND AND AIM: Surgical telepresence has been implemented using Mixed reality (MR) but, MR is theory based and only used for investigating research. The Aim of this paper is to propose and implement a new solution by merging augmented video (generating in local site) and virtual expertise surgeon hand (remote site). This system is to improve the visualization of surgical area, overlay accuracy in the merged video without having any discoloured patterns on hand, smudging artefacts on surgeon hand boundary and occluded areas of surgical area. METHODOLOGY: The Proposed system consists of an Enhanced Multi-Layer Mean Value Cloning (EMLMV) algorithm that improves the overlay accuracy, visualization accuracy and the processing time. This proposed algorithm includes trimap and alpha matting as a pre-processing stage of merging process, which helps to remove the smudging and discoloured artefacts surrounded by remote surgeon hand. RESULTS: Results showing that the proposed system improved the accuracy by reducing the overlay error of merging image from 1.3 mm (Millimeter) to 0.9 mm. Furthermore, it improves the visibility of surgeon hand in the final merged image from 98.4% (visibility of pixels) to 99.1% (visibility of pixels). Similarly, the processing time in our proposed solution is reduced, which is computed as 10 s to produce 50 frames, whilst, the state of art solution computes 11 s for the same number of frames. CONCLUSION: The proposed system focuses on the merging of augmented reality video (local site), and the virtual reality video (remote site) with the accurate visualization. we consider discoloured areas, smudging artefacts and occlusion as the main aspects to improve the accuracy of merged video in terms of overlay error and visualization error. So, the proposed system would produce the merged video with the removal of artefacts around the expert surgeon hand.


Assuntos
Realidade Aumentada , Neoplasias da Mama/diagnóstico por imagem , Mama/cirurgia , Mandíbula/cirurgia , Reconstrução Mandibular/métodos , Telemedicina/métodos , Cirurgia Vídeoassistida/métodos , Algoritmos , Simulação por Computador , Sistemas Especialistas , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imagem Tridimensional/métodos , Reprodutibilidade dos Testes , Software , Cirurgia Assistida por Computador/métodos , Interface Usuário-Computador , Gravação em Vídeo
5.
Int J Comput Assist Radiol Surg ; 14(10): 1763-1774, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31250255

RESUMO

PURPOSE: To facilitate intraoperative localization of lung nodules, this study used model-based shape matching techniques to analyze the inter-subject three-dimensional surface deformation induced by pneumothorax. METHODS: Contrast- enhanced computed tomography (CT) images of the left lungs of 11 live beagle dogs were acquired at two bronchial pressures (14 and 2 cm[Formula: see text]). To address shape matching problems for largely deformed lung images with pixel intensity shift, a complete Laplacian-based shape matching solution that optimizes the differential displacement field was introduced. RESULTS: Experiments were performed to confirm the methods' registration accuracy using CT images of lungs. Shape similarity and target displacement errors in the registered models were improved compared with those from existing shape matching methods. Spatial displacement of the whole lung's surface was visualized with an average error of within 5 mm. CONCLUSION: The proposed methods address problems with the matching of surfaces with large curvatures and deformations and achieved smaller registration errors than existing shape matching methods, even at the tip and ridge regions. The findings and inter-subject statistical representation are directly available for further research on pneumothorax deformation modeling.


Assuntos
Pneumotórax/diagnóstico por imagem , Toracoscopia/métodos , Cirurgia Vídeoassistida/métodos , Algoritmos , Animais , Modelos Animais de Doenças , Cães , Humanos , Tomografia Computadorizada por Raios X/métodos
6.
Rev. argent. coloproctología ; 30(2): 65-70, Jun. 2019. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1025568

RESUMO

Introducción: Las fístulas perianales tienen dos problemas fundamentales, la tasa de recurrencia y de incontinencia fecal postoperatoria, complicaciones que varían en frecuencia dependiendo de varios factores como el tipo de fistula, la técnica quirúrgica usada y la experiencia del cirujano. Debido a esto existen técnicas quirúrgicas no conservadoras y conservadoras de esfínteres donde se incluye el tratamiento video asistido que aparece desde el año 2006 y en la cual se utiliza un sistema de video endoscopio sofisticado y de alto valor económico el cual hemos adaptado a nuestro medio. Pacientes y método: De septiembre del 2015 al 2017 en la Unidad de Coloproctología del Hospital Domingo Luciani IVSS se realizó un estudio prospectivo experimental, donde se incluyeron 18 pacientes con fístulas perianales complejas diagnosticadas previamente con Ecofistulografía 3D y los cuales se operaron con un sistema adaptado usando citoscopio pediátrico de 4 mm y energía láser. Se evaluaron parámetros referentes a la técnica así como la tasa de éxito y riesgo de incontinencia. Resultados: Tiempo quirúrgico de 40 a 80 minutos, con tasa de éxito de 89%, recidiva en 2 pacientes, con tiempo de seguimiento entre 12 a 36 meses y sin cambios en la escala de incontinencia pre y post quirúrgica. Conclusión: El tratamiento video asistido modificado para fistulas anales (VAMAFT) es una técnica innovadora y factible de realizar al adaptar algunos instrumentos, con una tasa de éxito adecuada y sin riesgo de incontinencia, pero más trabajos aleatorizados con mayor números de pacientes deben ser realizados.


Introduction: Anal fistulas have two basic problems, rate of recurrence and postoperative anal incontinence. These complications vary according to several factors such as type of anal fistula, surgical technique and the surgeon´s experience. For each cases there are different surgical techniques with and without conservation of anal sphincters like conservative video assisted anal fistula treatment, described in 2006, this technique uses a sophisticated and expensive endoscope system but that we modified to use in our hospitals. Patients and method: Between September 2015 to 2017 in the Unit of Coloproctology of Domingo Luciani Hospital, was perfomed a prospective and experimental trial in 18 patients with anal complex fistulas previously diagnosed using tridimensional anal ultrasound and operated with a modified system consisting of pediatric cystoscope of 4 mm and laser energy. Some parameters were evaluated including surgical technique, recurrence and anal incontinence rate. Results: Surgical times were between 40 to 80 minutes, success rate of 89%, recurrence in two patients with follow up of 12 to 36 months and no changes in pre and post surgical anal incontinence scale. Conclusion: Video assited modified anal fistula treatment (VAMAFT) is an innovative and feasible surgical technique to do adapting some instruments, with suitable success rate and without anal incontinence risk but many randomized research with more patients have to be perfomed.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Fístula Retal/cirurgia , Fístula Retal/diagnóstico , Cirurgia Vídeoassistida/métodos , Complicações Pós-Operatórias , Recidiva , Incontinência Fecal/etiologia
7.
World Neurosurg ; 122: 43-47, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31108065

RESUMO

BACKGROUND: The intraoperative use of neurophysiological monitoring (IONM) and indocyanine green video angiography (ICGVA) for aneurysm clipping have evolved during the last years. Both modalities are useful and safe by allowing greater rates of complete aneurysm occlusion with less intraoperative complications and postoperative neurologic deficits. We report a case of attempted aneurysm clipping in which the combined use of ICGVA and IONM was crucial for intraoperative decision-making. CASE DESCRIPTION: A 62-year-old woman was operated for an incidental 6-mm aneurysm at the origin of the right fronto-opercular branch. During aneurysm clipping, IONM amplitudes dropped drastically, despite patency of the parent artery and perforators in ICGVA. Several attempts for clipping were made with recurring drops in IONM amplitudes, which forced us to leave the aneurysm untreated. The patient had a postoperative left-sided hemiparesis that improved on follow-up. Thereafter, the aneurysm was treated with stent-assisted coiling. CONCLUSIONS: The combination of IONM and ICGVA during aneurysm surgery allows for a better assessment of vascular integrity and patient's postoperative outcome than ICGVA alone. Simultaneous evaluation of vessel patency and integrity of the somatosensory and motor pathways illustrates the complementarity of testing different modalities for intraoperative decision-making and for maximizing safeness in aneurysm clipping.


Assuntos
Aneurisma Intracraniano/cirurgia , Angiografia Cerebral/métodos , Corantes , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Verde de Indocianina , Aneurisma Intracraniano/diagnóstico por imagem , Monitorização Neurofisiológica Intraoperatória/métodos , Pessoa de Meia-Idade , Stents , Resultado do Tratamento , Cirurgia Vídeoassistida/métodos
8.
Eur J Pediatr ; 178(7): 1105-1111, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31119438

RESUMO

Airway management in children is associated with anatomical and physiological challenges compared with adults. Pierre Robin sequence (PRS) is a condition characterized by micrognathia, glossoptosis, and cleft palate and related to a difficult airway. Both the Airtraq™ and GlideScope® have never been previously directly compared in PRS. Our aim was to evaluate the performance of these two airway devices in a PRS manikin for ethical and practical reasons. Between April and July 2017, 26, pediatric intensive care clinical fellows or trainees from a tertiary pediatric center were recruited to participate. In this prospective and randomized crossover trial, all participants first set up the Airtraq™ and the GlideScope® and then used these videolaryngoscopes to intubate an AirSim® PRS manikin. Our primary outcome measure was the duration of the successful intubation attempt. Duration of the successful intubation attempt was 18.1 (14.2-34.9 [10.2-51.3]) s for the Airtraq™ compared to 31.1 (18.7-55.6 [6.2-119]) s for the GlideScope® (p = 0.045). Setup time was 50.0 ± 6.9 s for the Airtraq™ and 27.8 ± 8.6 s for the GlideScope® (p < 0.001).Conclusion: Even though setup time was longer, the characteristics of intubation performance were superior with the Airtraq™ relative to the GlideScope® in an AirSim® PRS manikin. What is Known: • Several case reports have described the successful use of Airtraq™ to intubate children with Pierre Robin sequence. • The GlideScope® has demonstrated similar rates of first-attempt successful intubation to flexible fiberoptic bronchoscopy in a Pierre Robin sequence manikin. What is New: • In the hands of pediatric non-airway specialists, the characteristics of intubation performance, including the duration of the successful intubation attempt, are superior with the Airtraq™ compared with the GlideScope® in a Pierre Robin sequence manikin. • Setup time for the Airtraq™ is, however, longer relative to that for the GlideScope®.


Assuntos
Obstrução das Vias Respiratórias/terapia , Intubação Intratraqueal/instrumentação , Laringoscópios , Laringoscopia/instrumentação , Cirurgia Vídeoassistida/métodos , Criança , Estudos Cross-Over , Humanos , Manequins , Fatores de Tempo
9.
Medicine (Baltimore) ; 98(21): e15624, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124942

RESUMO

BACKGROUND: Endotracheal intubation (ETI) is a life-saving procedure taught to medical students. We examined the influence of the order of teaching ETI through direct laryngoscopy (DL) and video laryngoscopy (VL) on learning by measuring the intubation time and learning curve of trainees, in order to explore ways to improve ETI performance. METHODS: Twenty trainees were randomly divided into 2 groups. In the DL-first group, trainees used DL to perform ETI 10 times and then used VL 10 times, while the order was reversed in the VL-first group. Intubation time, number of intubation attempts, the Cormack-Lehane (CL) classification, and adverse events were recorded. The primary outcome was the cumulative summation (CUSUM). The CUSUM equation is defined as (Equation is included in full-text article.), where ct is the cumulative sum. RESULTS: ETI was attempted on 400 patients. The difference in the mean times for the first 10 intubations between the 2 groups was not significant (P > .05). Mean intubation time for second series in the DL-first group was significantly shorter than that of the first series (P < .05), while there were no differences between the 2 series in the VL-first group (P > .05). The mean intubation time in the second series of the DL-first group was shorter than for the first series of the VL-first group (P < .05), while the mean intubation time of the first series by the DL-first group did not differ from the second series by the VL-first group (P > .05). Eighteen attempts were required to achieve an 80% intubation success rate for the DL-first group, while more than 20 attempts were required for the trainees in the VL-first group. CONCLUSION: We consider that teaching trainees DL for tracheal intubation first. CLINICAL TRIAL NUMBER: ChiCTR-OOR-16008364.


Assuntos
Intubação Intratraqueal/métodos , Laparoscopia/educação , Estudantes de Medicina/psicologia , Ensino , Cirurgia Vídeoassistida/educação , Adulto , Competência Clínica , Feminino , Humanos , Laparoscopia/métodos , Aprendizagem , Masculino , Cirurgia Vídeoassistida/métodos
10.
Medicine (Baltimore) ; 98(22): e15862, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145338

RESUMO

BACKGROUND: To compare the clinical feasibility and oncological outcomes of video endoscopic inguinal lymph node dissection (VE-ILND) and open inguinal lymph node dissection (O-ILND) in the management of penile cancer. METHODS: We searched published articles in the PubMed, Embase, Cochrane Library, Web of science, China National Knowledge Infrastructure, and Wanfang databases. Data were extracted by 2 independent authors, and meta-analysis was performed by using Review Manager software version 5.3. RESULTS: Ten studies were included. Compared with the O-ILND group, the VE-ILND group exhibited less intraoperative blood loss (standardized mean difference [SMD] = 3.12; 95% confidence intervals [95% CIs] [1.27, 4.98]; P = .001), shorter hospital stay (SMD = 1.77; 95% CIs [0.94, 2.60]; P < .001), shorter drainage time (SMD = 2.69; 95% CI [1.47, 3.91]; P < .001), reduced wound infection rate (odds ratio [OR] = 10.62; 95% CI [4.01, 28.10]; P < .001); reduced skin necrosis rate (OR = 7.48; 95% CI [2.79, 20.05]; P < .001), lower lymphedema rate (OR = 3.23; 95% CI [1.51, 6.88]; P = .002), equivalent lymphocele rate (OR = 0.83; 95% CI [0.31, 2.23]; P = .720), and parallel recurrence rate (OR = 1.54; 95% CI [0.41, 5.84]; P = 0.530). However, the number of dissected lymph nodes (OR = 0.25; 95% CI [0.03, 0.47]; P = .030) was slightly increased in the O-ILND group. GRADE recommendations of primary outcomes were shown in a summary of findings table. CONCLUSIONS: For perioperative outcomes, VE-ILND is superior to O-ILND. For short-term oncological outcomes, VE-ILND is comparable to O-ILND. However, long-term oncological control still requires further verification.


Assuntos
Endoscopia/métodos , Canal Inguinal/cirurgia , Excisão de Linfonodo/métodos , Neoplasias Penianas/cirurgia , Cirurgia Vídeoassistida/métodos , Estudos de Viabilidade , Humanos , Tempo de Internação , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Neoplasias Penianas/patologia , Resultado do Tratamento
11.
A A Pract ; 13(5): 159-161, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30985323

RESUMO

Ex utero intrapartum treatment procedures are mainly indicated to secure the airways of fetuses featuring a risk of obstruction at birth while ensuring uteroplacental circulation. This report documents a successful intubation case with a C-MAC video laryngoscope during an ex utero intrapartum treatment procedure in a newborn featuring an infiltrative neck mass. Despite technical challenges faced in this procedure, the C-MAC video laryngoscope allowed an optimal view of airway structures. This novel approach, where laryngoscopy relies on the usage of C-MAC to optimize intubation conditions, may lead to increased chances of success in this particular scenario.


Assuntos
Intubação Intratraqueal/instrumentação , Pescoço/anormalidades , Cirurgia Vídeoassistida/métodos , Adulto , Parto Obstétrico , Feminino , Humanos , Histerotomia , Laringoscopia , Anormalidades Linfáticas/diagnóstico , Anormalidades Linfáticas/cirurgia , Idade Materna , Pescoço/diagnóstico por imagem , Pescoço/embriologia , Pescoço/cirurgia , Gravidez , Resultado do Tratamento , Malformações Vasculares/diagnóstico , Malformações Vasculares/cirurgia
12.
J Surg Res ; 239: 166-172, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30836298

RESUMO

BACKGROUND: To study the feasibility of laparo-endoscopic single-site (LESS) cholecystectomy through a 10-mm incision using a miniature magnetically anchored and controlled laparoscopy system and a grasper system. METHODS: The miniature magnetically anchored and controlled laparoscopy system consisted of a miniature magnetically anchored camera (MMAC), an external magnetic anchoring unit, and a vision output device. The camera weighed 9.8 g and measured Φ10 mm × 50 mm. The magnetically anchored and controlled grasper system consisted of a magnetically anchored grasper (MAG), an external magnetic anchoring unit, and a push-pull device. The MAG had a titanium alloy clip head and a magnetic tail. The laparoscopy system and grasper system were used simultaneously to perform LESS cholecystectomy through a single 10-mm incision in model canines. RESULTS: LESS cholecystectomy through a 10-mm incision using the MMAC and MAG was attempted in six dogs. The mean operative time was 85.75 ± 7.14 min. The operation was completed successfully in four cases, with failure occurring in one case due to gallbladder rupture and in another due to bile duct injury. The MMAC provided clear imaging, and the MAG provided sufficient exposure to perform the cholecystectomy. The use of multiple magnetically anchored and controlled instruments did not result in notable collisions. CONCLUSIONS: The designed MMAC and MAG system could be easily maneuvered. LESS cholecystectomy may be feasible through a single 10-mm incision with the simultaneous use of multiple magnetically anchored and controlled instruments.


Assuntos
Colecistectomia Laparoscópica/instrumentação , Doenças da Vesícula Biliar/cirurgia , Imãs , Cirurgia Vídeoassistida/instrumentação , Animais , Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Cães , Desenho de Equipamento , Estudos de Viabilidade , Vesícula Biliar/lesões , Vesícula Biliar/cirurgia , Humanos , Modelos Animais , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Ruptura/etiologia , Cirurgia Vídeoassistida/efeitos adversos , Cirurgia Vídeoassistida/métodos
15.
Actas urol. esp ; 43(2): 99-105, mar. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-178338

RESUMO

Introducción: La IU tras PR es uno de los factores con mayor impacto en la calidad de vida de los pacientes y en el gasto sanitario asociado. La definición de IU es muy variable en la literatura. De igual modo, son múltiples los factores predictores estudiados que influyen en la recuperación de la continencia posquirúrgica, siendo los más importantes los factores intraoperatorios. Material y métodos: Estudio retrospectivo y observacional, desde septiembre del 2008 hasta marzo del 2015. Se realiza el análisis de factores intraoperatorios mediante la visualización, con un editor de vídeos, de 148 pacientes tratados mediante prostatectomía radical asistida por robot, junto con otros factores perioperatorios asociados a la continencia y descritos en la literatura. Valoramos la continencia mediante cuestionarios ICQ, pérdidas urinarias contabilizadas con absorbentes y entrevista clínica en el primer, el tercer y el sexto mes, y al año de la cirugía. Definimos continencia como el no uso de absorbente o uno como protección social o ICQ ≤ 7. Analizamos mediante regresión logística binaria y lineal qué relación tienen las variables intraoperatorias y perioperatorias sobre la continencia urinaria medidas el primer, el tercer y el sexto mes, y al año de la cirugía, y sobre la estabilidad de la continencia. Resultados: En nuestro estudio el 72,9% de los pacientes conseguían estar continentes al año de la cirugía, con un tiempo medio de estabilización de la misma a los 4,3 meses. En nuestro análisis de regresión logística binaria de las variables intraoperatorias, no hemos encontrado una relación significativa con la variable continencia, analizadas durante el primer año. En el análisis de regresión logística lineal hemos encontrado que las suturas libres de tensión tienen un efecto directo positivo (p ≤ 0,05) sobre el tiempo de estabilidad de la continencia, al igual que las pérdidas urinarias medidas en el primer mes de la cirugía. Conclusión: En conclusión, en nuestro estudio encontramos que aquellas suturas libre de tensión pueden ayudar a la estabilidad precoz de la continencia. No hemos encontrado otros predictores intraoperatorios que influyan en la continencia urinaria. Las pérdidas urinarias medidas en el primer mes se relacionan con la recuperación precoz de la continencia


Introduction: UI after RP is a factor that has a major impact on patients' quality of life and the associated healthcare costs. The definition of UI is very variable in the literature. Similarly, a great many predictors have been studied that affect recovery of continence after surgery, the most important of which are intraoperative. Material and methods: a retrospective and observational study performed between September 2008 and March 2015. We studied intraoperative factors through visualisation using a video editor of 148 patients who underwent robot-assisted radical prostatectomy, together with other perioperative factors associated with continence, and described in the literature. We assessed continence through ICQ questionnaires, urinary loss calculated by pad count, and clinical interview in the first, third, sixth month and at one year after surgery. We defined continence as not having to use a pad or using a pad for protection socially, or an ICQ ≤ 7. We used binary and lineal logistic regression analysis to study the relationship between the intraoperative and perioperative variables on urinary continence measured at the first, third, sixth month and one year after the operation, and on continence stability. Results: In our study, 72.9% of the patients were continent at one year after surgery with a mean continence stabilisation time at 4.3 months. In our lineal logistic regression analyses we found no significant relationship with the continence variable analysed during the first year. In the lineal logistic regression analysis we found that tension-free sutures had a direct positive effect (P≤.05) on the stability time of continence, as well as the urinary losses measured in the first month after surgery. Conclusion: In conclusion, we found in our study that the tension-free sutures were able to help towards early stability of continence. We found no other intraoperative predictors that influenced urinary continence. The urinary losses measured in the first month related to early recovery of continence


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Incontinência Urinária/diagnóstico , Diagnóstico Precoce , Prostatectomia/métodos , Robótica/métodos , Cirurgia Vídeoassistida/métodos , Indicadores Básicos de Saúde , Gravação em Vídeo , Estudos Retrospectivos , Estudo Observacional , Inquéritos e Questionários , Modelos Logísticos , Cuidados Intraoperatórios
17.
World Neurosurg ; 125: 277-284, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30776513

RESUMO

BACKGROUND: Distal outflow occlusion and extracranial-intracranial bypass represent a possible option for the surgical management of complex middle cerebral artery (MCA) aneurysm. A limitation of the distal clipping strategy combined to bypass is related to the difficulties in predicting intraoperatively the good blood flow supply to the brain territory distal to the aneurysm and the extent and speed of aneurysmal thrombosis. METHODS: We present an innovative approach in which contrast-enhanced ultrasound (CEUS) and indocyanine green videoangiography (ICG-VA) have been synergistically used to study the effect of distal clipping on the aneurysm flow and the parenchymal blood flow after the bypass. We used this approach in a patient harboring a fusiform, partially thrombosed distal left MCA aneurysm. RESULTS: The patient was treated by a superficial temporal artery-MCA bypass, followed by MCA clipping immediately distally to the aneurysm. ICG-VA was used to evaluate bypass patency and brain perfusion in the area supplied by the bypass. CEUS was used to confirm the characteristics of the aneurysm and to explore the proximal MCA compartment immediately after dural opening, and to verify in real time the effect on aneurysm flow determined by distal outflow occlusion. Postoperative imaging confirmed aneurysm occlusion and patency of the bypass. The patient did not experience any neurologic sequelae. CONCLUSIONS: We present the first report of a synergistic intraoperative utilization of ICG-VA and CEUS in studying parenchymal perfusion and aneurysm flow in complex neurovascular procedures.


Assuntos
Angiografia Cerebral/métodos , Revascularização Cerebral/métodos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Cirurgia Vídeoassistida/métodos , Sistemas de Computação , Meios de Contraste , Humanos , Verde de Indocianina , Infarto da Artéria Cerebral Média/cirurgia , Aneurisma Intracraniano/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Masculino , Adulto Jovem
18.
J Cardiovasc Med (Hagerstown) ; 20(3): 137-144, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30601192

RESUMO

AIMS: We sought to analyze the early and follow-up results of minimally invasive video-assisted mitral valve repair. With particular focus on degenerative disease, results were stratified according to type of lesion, strategy of repair and surgical technique. METHODS: We retrospectively built a database over 241 patients who received mitral repair for severe regurgitation through right minithoracotomy in the 2009-17 period. Cause was degenerative in 92.1%, restrictive in 5.8% and mixed in the remainders. Clinical and echocardiographic follow-up (98.7% complete, average duration 2.9 years ±â€Š1.4) was obtained through contact of in-house and territorial cardiologists. Recurrent mitral regurgitation at follow-up was defined as being at least mild-to-moderate (2+). RESULTS: Operative mortality was 1.7%, and related to the technique in one case. Five-year actuarial survival was 95% ±â€Š2; there was no valve-related death and one reoperation. At follow-up, we observed eight cases of 2+ regurgitation and one instance of 4+ regurgitation (4-year actuarial freedom: 92% ±â€Š4). Freedom from recurrent regurgitation was significantly lower in the 'restrictive' subgroup vs. the 'degenerative' subgroup (P = 0.02); no statistically significant difference in freedom from recurrence was observed among patients who received mitral repair using a 'resect' vs. 'nonresection' strategy (P = 0.46), and in those who received the Totally Endoscopic technique (endoaortic balloon occlusion, no costal spreading) vs. controls (external aortic clamp, costal spreading) (P = 0.98). CONCLUSION: Durability of minimally invasive mitral repair is optimal. Nonresection repair techniques are at least noninferior to previous approaches based on leaflet resection.


Assuntos
Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Toracotomia/métodos , Cirurgia Vídeoassistida/métodos , Idoso , Bases de Dados Factuais , Ecocardiografia , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Anuloplastia da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/fisiopatologia , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Toracotomia/efeitos adversos , Toracotomia/mortalidade , Fatores de Tempo , Resultado do Tratamento , Cirurgia Vídeoassistida/efeitos adversos , Cirurgia Vídeoassistida/mortalidade
19.
Int J Gynecol Cancer ; 29(1): 223, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30640709

RESUMO

OBJECTIVE: To demonstrate a robotic-assisted psoas hitch with ureteral reimplantation. METHODS: We gleaned video footage from a robotic-assisted psoas hitch procedure performed for a patient with an isolated pelvic recurrence of ovarian cancer. RESULTS: We demonstrate trocar placement and a robotic-arm docking strategy for pelvic recurrence of ovarian cancer. We also show surgical steps involved in a psoas hitch and reimplantation of a transected ureter into the bladder. Special emphasis is placed on guiding the surgeon using key robotic instruments and materials to optimize the robotic completion of this procedure. Key components of the procedure, including en bloc tumor excision and ureteral transection, are shown. The bladder is placed on traction using the fourth arm, and the avascular planes of dissection, including the space of Retzius and the paravesical spaces, are shown. The bladder is then backfilled to allow the surgeon to determine the ideal placement of the ureteral reimplantation to ensure the anastomosis is tension free. The surgeon then demonstrates where and how to place anchoring sutures from the bladder to the psoas muscle. The ureter is examined to determine where it can be implanted in the bladder with zero tension or angulation, which would compromise function and healing. The ureter is prepared for reimplantation, including trimming, tagging, and spatulation. An instrument tie technique is used to implant the ureter into the bladder and a ureteral stent is placed. Robotic-assisted psoas hitch with ureteral reimplantation has been described in the literature.1-4 CONCLUSIONS: Through the use of still photographs and video, we demonstrate the technique of robotic-assisted psoas hitch with ureteral reimplantation.


Assuntos
Recidiva Local de Neoplasia/cirurgia , Neoplasias Ovarianas/cirurgia , Neoplasias Pélvicas/cirurgia , Músculos Psoas/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Ureter/cirurgia , Cirurgia Vídeoassistida/métodos , Feminino , Humanos , Prognóstico , Reimplante
20.
Int Braz J Urol ; 45(2): 325-331, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30676302

RESUMO

INTRODUCTION: Video endoscopic inguinal lymphadenectomy - VEIL - has emerged as an alternative to reduce post-surgical complications (PSC) in patients with penile cancer submitted to inguinal lymphadenectomy (IL). In some series, these PSC are observed in more than 50% of patients. The objectives of the present study are to describe the initial experience of VEIL in a Hospital in Teresina, PI, Brazil, and to analyze PSC incidence. MATERIAL AND METHODS: Retrospective descriptive study of patients submitted to VEIL from March 2014 to November 2015. Data were collected regarding surgical time, bleeding, complications, lymph node number, conversion, global complications, drainage time, cellulitis, lymphocele, cutaneous necrosis, miocutaneous necrosis and hospitalization time. RESULTS: 20 lower limbs of 11 patients were operated. Mean age was 51.4 (24-72) years. Mean surgical time was 85 (60-120) minutes. No patient showed intrasurgical complications, bleeding > 50 mL or conversion. Three surgeries evolved with lower limb edema, 2 with lymphoceles and one patient had cutaneous necrosis and another bulging of surgical wound. Mean time of hospitalization was 4 (2-11) days. A mean of 5.8 (1-12) lymph nodes were dissected in each surgery. CONCLUSION: VEIL is a safe and easy technique with lower incidence of PSC that can be reproduced in small centers.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Canal Inguinal/cirurgia , Excisão de Linfonodo/métodos , Neoplasias Penianas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Cirurgia Vídeoassistida/métodos , Adulto , Idoso , Brasil/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Adulto Jovem
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