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1.
Anticancer Res ; 40(1): 401-404, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892593

RESUMO

BACKGROUND/AIM: Bile leakage after liver surgery is still a problem to be solved. Here, we introduce a simple new technique, the Clip on Staple method, a preventive measure for bile leakage after anatomical liver resection using a stapling device. PATIENTS AND METHODS: Before liver parenchymal transection, the roots of Glissonean pedicles for target segments were dissected and divided using the Endo-GIA™ Tri-Staple™ Curved Tip. After the parenchymal transection was completed, the full length of the stapled stump was reinforced by multiple clips. The DS Titanium Ligation Clip was used as the clipping device. RESULTS: Twenty patients underwent this technique during anatomical liver resections with stapling devices. No patient developed postoperative bile leakage of any grade. There was no reoperation or readmission within 90 days. CONCLUSION: The Clip on Staple method is simple and offers a preventive effect for postoperative bile leakage after anatomical liver resection using stapling devices.


Assuntos
Bile/metabolismo , Fígado/cirurgia , Instrumentos Cirúrgicos , Grampeamento Cirúrgico , Idoso , Idoso de 80 Anos ou mais , Hepatectomia , Humanos , Processamento de Imagem Assistida por Computador , Pessoa de Meia-Idade , Resultado do Tratamento
2.
World Neurosurg ; 133: 283-290, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31505282

RESUMO

BACKGROUND: Traditional manual retraction to access deep-seated brain lesions has been associated with complications related to vascular compromise of cerebral tissue. Various techniques have been developed over time to minimize injury, such as self-sustaining retractors, neuronavigation, and endoscopic approaches. Recently, tubular retractors, such as the ViewSite Brain Access System (VBAS), have been developed to reduce mechanical damage from retraction by dispersing the force of the retractor radially over the parenchyma. Therefore, we sought to review the current literature to accurately assess the indications, benefits, and complications associated with use of VBAS retractors. METHODS: A literature search for English articles published between 2005 and 2019 was performed using the MEDLINE database archive with the search terminology "Vycor OR ViewSite OR Brain-Access-System NOT glass." The VBAS website was also examined. Only articles detailing neurosurgical procedures using the VBAS tubular retractor system alone, or in combination with other retractors, were included. Postoperative morbidity and mortality were analyzed to estimate complications linked to using the retractor. RESULTS: Twelve publications (106 patients) met the inclusion criteria. The VBAS retractor was used for tumor resections, hematoma evacuations, cyst removal, foreign body extractions, and lesion resection in toxoplasmosis and multiple sclerosis. These cases were subdivided into groups based on lesion location, size, and resection volume for further analysis. Gross total resection was achieved in 63% of tumor excisions, and subtotal resection was achieved in 37%. Hematoma evacuation was successful in all cases. There were 3 short-term postoperative complications linked to the retractor, with an overall complication rate of 2.8%. CONCLUSIONS: This report is the first formal assessment of the VBAS, highlighting technical considerations of the retractor from the surgeon's perspective, patient outcomes, and complications. The retractor is a safe and efficacious tubular retraction system that can be used for tumor biopsy and resection, colloid cyst removal, hematoma evacuation, and removal of foreign bodies. However, further randomized controlled trials are indicated to accurately assess complication rates and outcomes.


Assuntos
Neoplasias Encefálicas/cirurgia , Microcirurgia/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Instrumentos Cirúrgicos , Humanos
3.
Int J Oral Maxillofac Surg ; 49(1): 99-106, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31230766

RESUMO

This randomized controlled trial (RCT) (ClinicalTrials.gov ID: NCT03001791) compared excisional biopsies of fibrous hyperplasia performed using a CO2 laser (140Hz, 400µs, 33mJ), Er:YAG laser (35Hz, 297µs, 200mJ, air-water cooling), or scalpel (15c blade). Clinical parameters recorded were duration of the intervention, intraoperative bleeding, need for electrocauterization and/or suturing, postoperative side effects, complications, pain, and intake of analgesics. Histopathological linear measurements of the thermal damage zone were performed on the laser biopsies. Results showed that the duration of the intervention was significantly shorter for both lasers compared to the scalpel (P<0.001). Intraoperative bleeding occurred less frequently with the CO2 laser (P<0.001). Additional electrocautery was used in 92% of Er:YAG laser interventions (P<0.001). Postsurgical complications, pain, and the intake of analgesics did not differ between the groups. The measured thermal damage zones differed significantly between the CO2 laser (median of 72.6µm) and Er:YAG laser (30.9µm) (P<0.001). This RCT showed that CO2 laser, Er:YAG laser, and scalpel are all adequate for excisional biopsies of small lesions in the oral mucosa. While patient postoperative morbidity is similar, the ideal instrument can be selected according to the surgical advantages preferred for the individual situation.


Assuntos
Terapia a Laser , Lasers de Gás , Lasers de Estado Sólido , Biópsia , Dióxido de Carbono , Humanos , Instrumentos Cirúrgicos
5.
Gastrointest Endosc ; 91(1): 203-204, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31865990
8.
Anticancer Res ; 39(12): 6799-6806, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810945

RESUMO

BACKGROUND/AIM: In order to overcome postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP), we have developed a new simple technique-Clip on Staple method. PATIENTS AND METHODS: In Clip on Staple method, pancreatic parenchyma was divided using a stapling device with a stepped-height staple design to make linear compression line, and thereafter, the full length of the staple line was reinforced by multiple clips. Clinical outcomes were retrospectively compared between Clip on Staple group (n=23) and Non-Clip group (n=38). RESULTS: The incidence of clinically relevant POPF (CR-POPF) was significantly lower in the Clip on Staple group than in the Non-Clip group (4.3 and 36.8%, p=0.005). Multivariate logistic regression analysis revealed that only Clip on Staple method was an independent predictive factor of a decrease in the occurrence of CR-POPF. CONCLUSION: The Clip on Staple method, a simple and easily applicable technique even in laparoscopic surgery, significantly reduced the occurrence of CR-POPF among patients undergoing DP.


Assuntos
Pâncreas/cirurgia , Pancreatectomia/efeitos adversos , Fístula Pancreática/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Instrumentos Cirúrgicos , Grampeamento Cirúrgico/métodos , Idoso , Feminino , Humanos , Incidência , Laparoscopia , Masculino , Pancreatectomia/métodos , Fístula Pancreática/epidemiologia , Fístula Pancreática/etiologia , Complicações Pós-Operatórias/etiologia , Análise de Regressão
9.
Prensa méd. argent ; 105(11): 775-782, dic2019. graf
Artigo em Inglês | LILACS, BINACIS | ID: biblio-1049768

RESUMO

Antecedentes: En la cirugía video-laparoscópica, aparecieron nuevas complicaciones, donde se incluyen las relacionadas con las eventraciones de los orificios de los trocares (EOT). Objetivos: Observar la aparición de hernias a través de los orificios de los trocares en la cirugía video laparoscópica. Diseño: Prospectivo, protocolizado y cooperativo Lugar de aplicación: Servicio de Guardia del HNC. Clínica Privada Caraffa. Servicio de Cirugía General "Pablo Luis Mirizzi". HNC Material y Método: Entre diciembre de 2005 y diciembre del 2018 hemos intervenido quirúrgicamente 81 pacientes con EOT. 49 eran del sexo femenino y los 32 restantes del masculino con un promedio de 49, 05 de edad (rango: 25-85 años). En un primer grupo (no complicados), 62 de 73 pacientes presentaban tumor y dolor en la región umbilical y peri umbilical y los otros 11 con dolor y tumor en región epigástrica. Los 8 pacientes restantes que conforman el grupo II (complicados), ingresaron por un cuadro abdominal oclusivo. Resultados: En los pacientes no complicados, se decidió la reparación de la eventración mediante la utilización de una malla de polipropileno. Asimismo, en dos complicados se utilizó este procedimiento. Por otro lado, en el grupo complicado, una paciente presentaba una peritonitis fecal, donde se realizó una diversión de los cabos. En otro paciente, se realizó una resección intestinal. En los otros cuatro restantes, solamente se comprobó una necrosis de epiplón, el cual fue resecado. Conclusiones: A través de los años, con el incremento de los procedimientos laparoscópicos, ha comenzado a observarse un llamativo número de EOT.


Background: in surgery video-laparoscopic, appeared new complications, including those related to the port site incisional hernia (PIH). Objectives: Observe the emergence of hernias through the holes of trocars in the video laparoscopic surgery. Design: Prospective, cooperative and protocoled. Place of application: Emergency Room of the HNC. Private Clinic Caraffa. General Surgery Service. "Pablo Luis Mirizzi". HNC. Methods: Between December 2005 and December of 2018 we have intervened surgically 81 patients with PIH. 49 were female and the 32 remaining of the male with an average of 49.05 of age (range: 25-85 years). In the first group (No complicated), 62 of 73 patients showed tumour and pain in the umbilical region and perumbilical and the other 11 with pain and tumour in epigastric region. The 8 remaining patients comprising Group II (Complicated), were by an occlusive abdominal picture. Results: In uncomplicated patients (Group I), it was decided to repair of PIH using a polypropylene mesh. In addition, this procedure was used in two complicated. On the other hand, the complicated group (Group II), a patient presented a faecal peritonitis, which was a fun of los capes. In another patient, was a bowel Resection. The other four remaining, only found a necrosis of omentum, which was resected. Conclusions: Through the years, with the increase in laparoscopic procedures, it has begun to observe a striking number of PIH.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Instrumentos Cirúrgicos , Telas Cirúrgicas , Estudos de Casos e Controles , Laparoscopia , Cirurgia Vídeoassistida , Hérnia Abdominal/complicações
10.
J Craniomaxillofac Surg ; 47(11): 1706-1711, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31677988

RESUMO

The treatment of non-syndromic scaphocephaly with spring-activated cranioplasty offers acceptable outcomes with the potential for reduced surgical morbidity when compared with cranial vault remodelling procedures. A disadvantage of this technique is the need for a second operative intervention to remove the implanted devices. There are many descriptions of the surgical technique for performing spring-activated cranioplasty available in the literature; however, little is documented regarding the procedures used for device removal. The published accounts of spring removal demonstrate a wide range of approaches, from the reopening and dissection of the entire previous surgical field, to attempts to limit the incisions and dissection. In this study we describe our technique for the minimally invasive removal of cranial springs used in the treatment of scaphocephaly. Our technique focuses on minimal soft tissue disruption and uses a Kirschner wire cutter to divide the spring at its mid-point so as to relieve any residual internal forces acting on the footplates.


Assuntos
Craniossinostoses/cirurgia , Craniotomia/instrumentação , Craniotomia/métodos , Procedimentos Cirúrgicos Reconstrutivos , Craniossinostoses/diagnóstico , Humanos , Lactente , Crânio/cirurgia , Instrumentos Cirúrgicos
11.
J Med Life ; 12(3): 301-307, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31666835

RESUMO

Hysterectomy is the most common gynecological surgical intervention; therefore, there are many technical variations in different healthcare systems around the world. We aimed to review, step by step, the technique of laparoscopic hysterectomy as well as to present the available variety of surgical instruments impartially so that the operative team can decide in an informed manner the model and characteristics of the equipment used. The surgical technique is presented based on the experience of the authors, focusing mainly on intraoperative recommendation and suggestions. Advantages and disadvantages of the available instruments are also extensively detailed. Surgical positioning, as well as inserting the uterine manipulator are essential steps. The open technique is used to create pneumoperitoneum. The utero-ovarian ligament or the infundibulopelvic ligament is identified, coagulated and cut. The round ligament is incised, entering the space between the two layers of the broad ligament and advancing caudally in this space, which, if correctly identified, should be avascular. The uterine vessels located on the posterior sheet of the broad ligament are dissected and coagulated. The vaginal wall is sectioned with the help of the manipulator's cap, making it easier to expose the insertion line of the vagina on the cervix. The uterus is removed through the vagina or through a trans-parietal incision. Thereafter, the vagina is sutured using separate Vicryl sutures. Between 2011 and 2016, laparoscopic hysterectomy had an increasing trend all over Europe. With a reported percentage of 3%, Romania ranks last in hysterectomies performed laparoscopically. The laparoscopic approach offers the advantages of minimal invasiveness: less pain, faster recovery and early social reintegration; therefore, this trend of improvement should become more accepted.


Assuntos
Histerectomia/instrumentação , Laparoscopia/instrumentação , Coagulação Sanguínea , Feminino , Humanos , Pessoa de Meia-Idade , Instrumentos Cirúrgicos , Útero/cirurgia
12.
Lancet ; 394(10213): 2002-2011, 2019 11 30.
Artigo em Inglês | MEDLINE | ID: mdl-31708188

RESUMO

BACKGROUND: Tricuspid regurgitation is a prevalent disease associated with high morbidity and mortality, with few treatment options. The aim of the TRILUMINATE trial is to evaluate the safety and effectiveness of TriClip, a minimally invasive transcatheter tricuspid valve repair system, for reducing tricuspid regurgitation. METHODS: The TRILUMINATE trial is a prospective, multicentre, single-arm study in 21 sites in Europe and the USA. Patients with moderate or greater triscuspid regurgitation, New York Heart Association class II or higher, and who were adequately treated per applicable standards were eligible for enrolment. Patients were excluded if they had systolic pulmonary artery pressure of more than 60 mm Hg, a previous tricuspid valve procedure, or a cardiovascular implantable electronic device that would inhibit TriClip placement. Participants were treated using a clip-based edge-to-edge repair technique with the TriClip tricuspid valve repair system. Tricuspid regurgitation was graded using a five-class grading scheme (mild, moderate, severe, massive, and torrential) that expanded on the standard American Society of Echocardiography grading scheme. The primary efficacy endpoint was a reduction in tricuspid regurgitation severity by at least one grade at 30 days post procedure, with a performance goal of 35%, analysed in all patients who had an attempted tricuspid valve repair procedure upon femoral vein puncture. The primary safety endpoint was a composite of major adverse events at 6 months, with a performance goal of 39%. Patients were excluded from the primary safety analysis if they did not reach 6-month follow-up and did not have a major adverse event during previous follow-ups. The trial has completed enrolment and follow-up is ongoing; it is registered with ClinicalTrials.gov, number NCT03227757. FINDINGS: Between Aug 1, 2017, and Nov 29, 2018, 85 patients (mean age 77·8 years [SD 7·9]; 56 [66%] women) were enrolled and underwent successful TriClip implantation. Tricuspid regurgitation severity was reduced by at least one grade at 30 days in 71 (86%) of 83 patients who had available echocardiogram data and imaging. The one-sided lower 97·5% confidence limit was 76%, which was greater than the prespecified performance goal of 35% (p<0·0001). One patient withdrew before 6-month follow-up without having had a major adverse event and was excluded from analysis of the primary safety endpoint. At 6 months, three (4%) of 84 patients experienced a major adverse event, which was less than the prespecified performance goal of 39% (p<0·0001). Single leaflet attachment occurred in five (7%) of 72 patients. No periprocedural deaths, conversions to surgery, device embolisations, myocardial infarctions, or strokes occurred. At 6 months, all-cause mortality had occurred in four (5%) of 84 patients. INTERPRETATION: The TriClip system appears to be safe and effective at reducing tricuspid regurgitation by at least one grade. This reduction could translate to significant clinical improvement at 6 months post procedure. FUNDING: Abbott.


Assuntos
Cateterismo Cardíaco/métodos , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Tricúspide/cirurgia , Idoso , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Feminino , Seguimentos , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Complicações Pós-Operatórias , Estudos Prospectivos , Índice de Gravidade de Doença , Instrumentos Cirúrgicos , Resultado do Tratamento
13.
Surg Technol Int ; 35: 201-213, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31694060

RESUMO

When Jacques and Pierre Curie first researched ultrasonic energy and piezoelectric effects in the 1880s, they likely had no idea of the profound impact it would eventually have on surgical patients. Today in operating rooms around the world, ultrasonic energy is used for tissue manipulation, dissection, cutting, and coagulation. Surgeons including but not limited to the specialties of gynecology, general surgery, colorectal, thoracic, breast, and bariatric have activated ultrasonic energy in thousands of patients. As a mainstay surgical energy device, patients have benefited from the ultrasonic versatility of its cutting and coagulating effects. The ability of ultrasonic energy to be used near vital organs with precision by adjusting for tissue tension, power settings, and activation time has accounted for its safety and clinical outcomes. This overview of the mechanics of ultrasonic energy and the evolution of the HARMONIC® (UltraCision, Providence, Rhode Island, now owned by Ethicon Endo-Surgery, Inc., Cincinnati, Ohio) surgical tools since 1988 provides readers an understanding of this energy platform and its distinct advantages. Clinical implications of key research and clinical studies are explored and discussed with a focus on patient and surgical outcomes. Research in a variety of fields and tissues is presented with a special emphasis on the gynecological patient.


Assuntos
Instrumentos Cirúrgicos , Dissecação , Humanos , Terapia por Ultrassom
14.
Zootaxa ; 4624(2): zootaxa.4624.2.5, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31716224

RESUMO

Description of the final instar of Acanthagrion trilobatum Leonard, 1977 and A. speculum Garrison, 1985 is based on associated specimens from San José, Turrialba and Sarapiquí Provinces, Costa Rica. Illustrations of these two species and a comparative table summarizing the main features of all larvae of Acanthagrion described to date are provided. The larva of A. trilobatum is distinguished from that of A. speculum by shorter lateral caudal lamellae (length 7 mm vs. 8.2 mm), lateral carina of abdominal segments 2-8 with spiniform setae on posterior 1/3 (lateral carinae of only S6-8 with spiniform setae in A. speculum), and male gonapophyses incurved (straight in A. speculum).


Assuntos
Besouros , Odonatos , Animais , Costa Rica , Larva , Masculino , Instrumentos Cirúrgicos
15.
Medicine (Baltimore) ; 98(48): e18105, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770232

RESUMO

RATIONALE: The ingestion of a foreign body (FB) with complete impaction of the esophagus is not common. Here we report a rare case of successful retrieval of a spherical stone in the esophagus of a man with mental retardation, using gallbladder grasping forceps and rigid endoscope. PATIENT CONCERNS: A mental retarded man came to the emergency department presenting with recurrent nausea, vomiting, and dysphagia after swallowing a spherical stone. He had previously undergone an FB extraction under general anesthesia by fiberoptic esophagoscopy, which failed. DIAGNOSIS: The diagnosis of FB ingestion was confirmed by anteroposterior plain film x-ray of the chest and chest computed tomography (CT), which showed the ingested spherical FB in the upper esophagus. INTERVENTIONS: After multiple failed attempts using other instruments, the FB was successfully removed with gallbladder grasping forceps through a rigid esophagoscope. OUTCOMES: The patient was discharged without any complications. The nasogastric tube was extubated at the 10-day follow-up. LESSONS SUBSECTIONS AS PER STYLE: For esophageal retrieval of uncommon FBs, the instrument used is crucial. We report our experience retrieving a large and spherical FB in the upper esophagus using gallbladder grasping forceps. This proved to be an effective strategy, eliminating the need for thoracotomy.


Assuntos
Esofagoscopia/instrumentação , Esôfago/lesões , Corpos Estranhos/cirurgia , Instrumentos Cirúrgicos , Adulto , Esofagoscopia/métodos , Esôfago/cirurgia , Humanos , Deficiência Intelectual/complicações , Masculino
16.
Medicine (Baltimore) ; 98(48): e18153, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770257

RESUMO

RATIONALE: Migration of endoclips and stitches into the duodenum after laparoscopic hepatectomy is incredibly rare with a poorly understood mechanism. PATIENT CONCERNS: A 56-year-old woman who underwent laparoscopic left hepatectomy and cholecystectomy in August 2016 was admitted to our hospital with nausea and vomiting in December 2017. DIAGNOSES: Abdominal computed tomography (CT) scan showed high density shades in duodenal ampulla. Esophagogastroduodenoscopy showed deformation of the duodenal ampulla into two lumens; hem-o-lock clips and stitches were detected in the upper lumen. Contrast enhanced CT scan revealed gastric cancer with liver metastasis (GCLM). INTERVENTIONS: The hem-o-lock clips and stitches were present in the wall of the duodenum; therefore, no attempt was made to remove them. High quality liquid diet, partial parenteral nutrition, and chemotherapy were administered to the patient. OUTCOMES: In September 2018, the patient died of hepatic failure caused by GCLM. LESSONS: This rare complication of the migration of endoclips and stitches into the duodenum after laparoscopic hepatectomy can cause epigastric pain and duodenal obstruction. The complication could be potentially avoided using absorbable endoclips and stitches or by performing of ultrasonic dissection by a skilled operator.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Obstrução Duodenal , Migração de Corpo Estranho , Hepatectomia/efeitos adversos , Complicações Pós-Operatórias , Instrumentos Cirúrgicos/efeitos adversos , Colecistectomia Laparoscópica/métodos , Tratamento Conservador/métodos , Obstrução Duodenal/diagnóstico por imagem , Obstrução Duodenal/etiologia , Obstrução Duodenal/fisiopatologia , Obstrução Duodenal/terapia , Endoscopia do Sistema Digestório/métodos , Feminino , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/diagnóstico , Migração de Corpo Estranho/fisiopatologia , Hepatectomia/métodos , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Administração dos Cuidados ao Paciente/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
19.
BMC Health Serv Res ; 19(1): 695, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615497

RESUMO

BACKGROUND: Bar code- or radio frequency identification (RFID)-based medical instrument management systems have gradually been introduced in the field of surgical medicine for the individual management and identification of instruments. We hypothesized that individual management of instruments using RFID tags can provide previously unavailable information, particularly the precise service life of an instrument. Such information can be used to prevent medical accidents caused by surgical instrument failure. This study aimed to predict the precise service life of instruments by analyzing the data available in instrument management systems. METHODS: We evaluated the repair history of instruments and the usage count until failure and then analyzed the data by the following three methods: the distribution of the instrument usage count was determined, an instrument failure probability model was generated through logistic regression analysis, and survival analysis was performed to predict instrument failure. RESULTS: The usage count followed a normal distribution. Analysis showed that instruments were not used uniformly during surgery. In addition, the Kaplan-Meier curves plotted for five types of instruments showed significant differences in the cumulative survival rate of different instruments. CONCLUSIONS: The usage history of instruments obtained with RFID tags or bar codes can be used to predict the probability of instrument failure. This prediction is significant for determining the service life of an instrument. Implementation of the developed model in instrument management systems can help prevent accidents due to instrument failure. Knowledge of the instrument service life will also help in developing a purchase plan for instruments to minimize wastage.


Assuntos
Dispositivo de Identificação por Radiofrequência , Instrumentos Cirúrgicos/normas , Análise de Falha de Equipamento/instrumentação , Análise de Falha de Equipamento/métodos , Utilização de Equipamentos e Suprimentos , Humanos , Análise de Regressão , Instrumentos Cirúrgicos/estatística & dados numéricos
20.
World Neurosurg ; 131: 399-407, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31658582

RESUMO

BACKGROUND: Sacral fractures are a challenge regarding treatment and classification. Surgical techniques using spinal navigation systems can improve treatment, especially if used in collaboration among different specialists. METHODS: Between 2015 and 2017, we treated 25 consecutive cases of sacral fracture. Twelve patients (48%) underwent mechanical ventilation due to hypovolemic shock for severe thoracoabdominal trauma; bleeding was blocked with pelvic packing in 9 cases (36%) and transcatheter embolization in 2 cases (8%). External fixation was used in 7 cases (28%). In 20 cases (80%) spinal fractures were associated. All patients were operated on using spinal navigation by a team of neurosurgeons and orthopedic surgeons. RESULTS: The mean time from first observation to surgery was 18 days (range 8-31). Surgical treatment consisted of iliosacral fixation in 19 cases (76%) and spinopelvic fixation in 6 cases (24%). The mean number of screws for spinopelvic fixation was 9.67 (range 6-17) with a mean operation time of 323.67 minutes (range 247-471); in iliosacral osteosynthesis the mean screw number was 1.37 (range 1-3) and mean surgical time was 78.93 minutes (range 61-130). Postoperative computed tomography showed the correct screw placement. Wound infection occurred in 2 cases (8%), managed with vacuum-assisted closure therapy; in 1 case (4%) a sacral screw was removed for decubitus. CONCLUSIONS: Navigation systems in instrumented spinopelvic and sacropelvic reconstruction provide greater safety, reducing learning times and malpositioning. Multidisciplinary management allows us to achieve optimal results, especially when the sacral fracture is combined with spinal and pelvic lesions. The use of navigation systems could represent an important advancement.


Assuntos
Neuronavegação/métodos , Sacro/lesões , Fraturas da Coluna Vertebral/cirurgia , Acidentes por Quedas , Acidentes de Trânsito , Adolescente , Adulto , Idoso , Parafusos Ósseos , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Sacro/cirurgia , Instrumentos Cirúrgicos , Tomografia Computadorizada por Raios X , Adulto Jovem
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