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1.
Artigo em Inglês | MEDLINE | ID: mdl-32131965

RESUMO

PURPOSE OF THE STUDY In this randomized prospective study, we monitored and compared perioperative changes in skeletal muscle enzymes blood levels in open and mini-invasive stabilization of thoracolumbar spine fractures. The established hypothesis was to confirm higher blood levels of muscle enzymes in open stabilization. MATERIAL AND METHODS This study included 38 patients with the mean age of 46.4 years. 19 injuries were managed in an open procedure and 19 procedures were mini-invasive. Venous blood was taken intermittently at short intervals to determine the levels of skeletal muscle enzymes. The catalytic concentration of creatine kinase was determined via an enzymatic UV-test, and the concentration of myoglobin via electro-chemiluminescent immunoassay. Enzyme levels were processed statistically. The Wilcoxon test was used. RESULTS The median increase in the values of both enzymes is higher in the mini-invasive method than in the open method in both the surgery phase for the injury and in the extraction phase. The median increase in the values of both enzymes is higher in both methods for the primary procedure phase compared to the extraction phase. All results are statistically significant at p of <0.05. All tests were calculated using the MATLAB Statistics Toolbox. DISCUSSION A very surprising finding, when testing the hypothesis of the levels increasing mainly in open stabilization, was confirming the opposite. Both enzymes were higher in the mini-invasive approach to stabilising the spine after the injury, but also after the extraction. This contradicts the available literature. However, this can be explained by the methodology of enzyme levels determination in the previously published studies. We believe that this phenomenon can be partially caused by an iatrogenic mini-compartment of muscles in the postoperative period, absence of wound drainage, but also by higher muscle contusion when inserting bolts through the tubes via small incisions, when the tubes penetrate to the entry points relatively violently and the muscles in this area are affected more than in the classical skeletization. CONCLUSIONS Analysis of biochemical changes in open and mini-invasive surgery did not confirm the hypothesis that levels of creatine kinase and myoglobin enzymes increase especially in open stabilization. On the contrary, they were statistically significantly higher in mini-invasive procedures. Key words: creatine kinase, myoglobin, muscle enzymes, spine fracture, spine surgery, miniinvasive surgery.


Assuntos
Creatina Quinase , Doenças Musculares , Mioglobina , Fraturas da Coluna Vertebral , Creatina Quinase/metabolismo , Humanos , Vértebras Lombares , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Doenças Musculares/diagnóstico , Doenças Musculares/etiologia , Mioglobina/metabolismo , Estudos Prospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas
2.
Chirurgia (Bucur) ; 115(1): 80-88, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155402

RESUMO

Adrenalectomy is nowadays a procedure routinely performed by minimally invasive surgery. In this article we aim to describe in depth our technique for laparoscopic and robotic left and right adrenalectomies, by using four cases and discussing the advantages and disadvantages of each technique.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias das Glândulas Suprarrenais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Resultado do Tratamento
3.
Surg Clin North Am ; 100(2): 219-236, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32169177

RESUMO

Robotic minimally invasive direct coronary artery bypass is the most common robotic coronary procedure performed worldwide. It can be used to treat isolated left anterior descending (LAD) stenosis or can be coupled with percutaneous coronary intervention to diseased non-LAD targets in patients with multivessel disease. Virtually all types of mitral valve repair can be performed using the robot; valve replacement can also be undertaken. The robot can be used to repair atrial septal defects and resect cardiac myxoma. Increased cost of the robotic procedure may be offset by fewer perioperative complications, shorter hospital stay, and faster postoperative recovery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Ponte de Artéria Coronária , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Insuficiência da Valva Mitral/cirurgia , Revascularização Miocárdica , Intervenção Coronária Percutânea
4.
Surg Clin North Am ; 100(2): 237-248, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32169178

RESUMO

Minimally invasive surgery for diseases of the chest offsets the morbidity of painful thoracic incisions while allowing for meticulous dissection of major anatomic structures. This benefit translates to improved outcomes and recovery following the surgical management of benign and malignant esophageal pathologic condition, mediastinal tumors, and lung resections. This anatomic region is particularly amenable to a robotic approach given the fixed space and need for complex intracorporeal dissection. As robotic platforms continue to evolve, more complex thoracic surgical interventions will be facilitated, translating to improved outcomes for our patients.


Assuntos
Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Esofagectomia , Humanos , Doenças do Mediastino/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Pneumonectomia , Cirurgia Torácica Vídeoassistida
5.
Medicine (Baltimore) ; 99(10): e19442, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150097

RESUMO

INTRODUCTION: Giant juvenile breast fibroadenoma can cause deformity and should be excised. Cosmesis is an important consideration in young patients. PATIENT CONCERNS: The patient was admitted to our hospital for a mass of 6 × 6 cm in her left breast. DIAGNOSE: A giant juvenile fibroadenoma. INTERVENTIONS: With the help of Mammotome, we translated the larger mass to smaller one and removed it via a small circumareolar incision with no residual tumor. OUTCOMES: There was no recurrence of disease after 2 years. CONCLUSION: Mammotome-combined resection is a new approach that can be used to excise giant fibroadenomas with a minimal incision, and provides a favorable contour to the breast.


Assuntos
Neoplasias da Mama/cirurgia , Fibroadenoma/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Feminino , Fibroadenoma/diagnóstico por imagem , Humanos , Mamoplastia , Procedimentos Cirúrgicos Minimamente Invasivos , Monitorização Intraoperatória , Satisfação do Paciente , Ultrassonografia Doppler , Adulto Jovem
6.
Rev Med Suisse ; 16(686): 525-530, 2020 Mar 18.
Artigo em Francês | MEDLINE | ID: mdl-32186797

RESUMO

Penile erection implants are considered to be the «â€…Gold Standard ¼ for the treatment of erectile dysfunction with an organic component that escapes pharmacological and mechanical treatment. The place of preoperative information is fundamental. It is a simple and minimally invasive surgery. Penile Erection Implants are becoming more and more a full-fledged treatment line, which can be offered at the same time as other Erectile Dysfunction treatments. In this article, we will discuss the presentation of the different implants available, the elements underlying their indication, the place of preoperative information, the mains steps of the surgical procedure, the outcomes and satisfaction rates.


Assuntos
Disfunção Erétil/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Prótese de Pênis , Humanos , Masculino , Satisfação do Paciente , Resultado do Tratamento
7.
Zhonghua Yi Xue Za Zhi ; 100(3): 192-196, 2020 Jan 21.
Artigo em Chinês | MEDLINE | ID: mdl-32008285

RESUMO

Objectives: To evaluate the effect of minimally invasive lateral lumbar interbody fusion (LLIF/OLIF) on the sagittal balance of adult degenerative scoliosis. Methods: From January 2014 to June 2017, a total of 23 patients with degenerative scoliosis underwent staged minimally invasive surgery in Shanghai Ruijin Hospital. All patients were implanted with LLIF or OLIF cage from the lateral approach first, and was followed by the posterior percutaneous pedicle screw fixation or pedicle screw fixation via Wiltse approach. If the sagittal deformity correction was not satisfactory after the first surgery, a posterior osteotomy can be performed during the second stage operation. A biplanar X-ray of the whole spine was taken with the EOS imaging system before and after surgery. The EOS software was used to measure and evaluate the patient's sagittal balance parameters including pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), the sagittal vertical axis (SVA) and the coronal Cobb angle. The visual analogue scale (VAS) score for low back pain, the Oswestry Disability Index (ODI) score were evaluated before and after surgery. Paired t test or repeated measures ANOVA was used to compare the data before and after surgery. Results: There were 6 males and 17 females with a mean age of (72±4) years (62-79 years). Nine patients were treated with LLIF and 14 patients with OLIF. Sixteen cases were implanted with three cages, five with two cages and two with four cages. The mean follow-up period was 24.2 months (15-42 months). After the first operation, the Cobb angle of the patient was significantly improved (18°±7° vs 33°±8°, t=13.2, P<0.01). All the parameters for sagittal balance, including PI-LL (20°±8° vs 31°±8(o)), SVA ((5.3±2.0) cm vs (8.2±3.5) cm), PT (16°±6° vs 23°±4°) were all significantly improved as well (t=6.8, 4.5, 9.0, ALL P<0.01). At the last follow-up, the VAS score of low back pain (3.4±1.1 vs 6.3±1.0) and ODI scores (27.3%±3.0% vs 47.1%±5.9%) were also significantly improved (t=11.3, 17.8, both P<0.01). No major complications occurred in this group. Conclusions: Minimally invasive LLIF/OLIF can significantly improve the coronal and sagittal balance of adult degenerative scoliosis. Staged minimally invasive surgery can significantly alleviate pain and improve function in these patients.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Escoliose/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , China , Avaliação da Deficiência , Feminino , Humanos , Vértebras Lombares , Masculino , Estudos Retrospectivos , Escoliose/patologia , Resultado do Tratamento , Escala Visual Analógica
8.
Clin Oral Investig ; 24(3): 1125-1135, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32052179

RESUMO

OBJECTIVE: The aim of this systematic review was to explore the efficacy of different minimal invasive surgical (MIS) and non-surgical (MINST) approaches for the treatment of intra-bony defect in terms of clinical attachment level (CAL) gain and periodontal pocket depth (PPD) reduction. METHODS: A detailed review protocol was designed according to PRISMA guideline. Online search was conducted on PubMed, Cochrane library and Embase. Only randomized clinical trials (RCTs) testing MIS or MINST procedure, with or without the application of a regenerative tool for the treatment of intra-bony defect, were included. Cochrane checklist for risk of bias assessment was used. Network meta-Analysis (NMAs) was used to rank the treatment efficacy. RESULTS: Nine RCTs accounting for 244 patients and a total of 244 defects were included. Only two studies were at low risk of bias. CAL gain for included treatment ranged from 2.58 ± 1.13 mm to 4.7 ± 2.5 mm while PPD reduction ranged from 3.19 ± 0.71 mm to 5.3 ± 1.5 mm. On the basis of the ranking curve, MINST showed the lowest probability to be the best treatment option for CAL gain. Pairwise comparisons and treatment rankings suggest superiority for regenerative approaches (CAL difference 0.78 mm, (0.14-1.41); P < 0.05) and surgical treatment elevating only the buccal or palatal flap (CAL difference: 0.95 mm, (0.33-1.57); P < 0.05). CONCLUSIONS: Minimally invasive surgical (MIS) and non-surgical (MINST) periodontal therapy show promising results in the treatment of residual pocket with intra-bony defect. CLINICAL RELEVANCE: MIS procedures represent a reliable treatment for isolated intra-bony defect.


Assuntos
Perda do Osso Alveolar/cirurgia , Perda do Osso Alveolar/terapia , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Cirúrgicos Bucais , Humanos , Meta-Análise em Rede , Bolsa Periodontal , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
10.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(2): 256-259, 2020 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-32030960

RESUMO

Objective: To review the research progress of total endoscopic minimally invasive technique in treating cervical nerve root canal stenosis (CNRCS). Methods: The related literature at home and abroad was extensively reviewed. The research history, current situation, research progress, advantages and disadvantages of minimally invasive treatment of CNRCS under total endoscope were summarized. Results: In recent years, with the continuous development of minimally invasive technique of total endoscope in spine surgery, the surgical treatment methods are also constantly innovated. Compared with the traditional open surgery, minimally invasive treatment of CNRCS under total endoscope can obtain better effectiveness, keep the stability of the cervical segment to the maximum extent, reduce the impact on the activity of the cervical spine and the occurrence of related surgical complications, which is an effective minimally invasive technology. Conclusion: The minimally invasive treatment of CNRCS under total endoscope has achieved some results, which is expected to be one of the indispensable means to treat CNRCS, but it still needs to be improved.


Assuntos
Cavidade Pulpar , Constrição Patológica , Descompressão Cirúrgica , Endoscópios , Foraminotomia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos
12.
Zhonghua Yi Xue Za Zhi ; 100(4): 265-269, 2020 Feb 04.
Artigo em Chinês | MEDLINE | ID: mdl-32075353

RESUMO

Objective: To compare and analyze the effect of minimally invasive surgery and traditional open surgery in patients with spinal canal tumors, including intraspinal and extraspinal communication tumors. Methods: From 2017 to 2019, 31 patients (minimally invasive channel group) were included in the neurosurgery department of Huashan Hospital Affiliated to Fudan University, and 38 patients (open operation group) were selected as the control group. From the aspects of intraoperative condition, operative effect, postoperative muscle injury, postoperative complications, postoperative spinal stability, the minimally invasive access group and the open operation group were compared and analyzed. Results: The bleeding volume (70.2 ml±4.9 ml), operation time (164.7 min±16.0 min) and hospitalization days (9.5±2.5) in the minimally invasive access group were significantly lower than those in the open operation group (P<0.001). The creatine kinase CK (363.9 U/L±51.6 U/L) in the minimally invasive group was significantly lower than that in the open group (514.2 U/L±68.3 U/L) (P<0.001). According to Panjabi standard, the effect of spinal cord stability in minimally invasive group was significantly lower than that in open operation group (P<0.001), and the symptom improvement rate in minimally invasive group was significantly higher than that in open hand group (P<0.05). Conclusions: Compared with the open surgery, the amount of bleeding, the length of incision, the time of operation and the days of hospitalization were significantly shorter, the degree of muscle damage was also significantly reduced, the incidence of complications was lower, the impact of spinal stability was smaller, and the overall advantage was obvious.


Assuntos
Vértebras Lombares , Neoplasias da Coluna Vertebral , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos , Resultado do Tratamento
13.
Zhonghua Yi Xue Za Zhi ; 100(4): 274-278, 2020 Feb 04.
Artigo em Chinês | MEDLINE | ID: mdl-32075355

RESUMO

Objective: To explore the application, advantages and disadvantages of minimally invasive surgery for lumbar schwannoma. Methods: this study was a prospective, non-randomized controlled study with a trial group (minimally invasive surgery group) and a control group (traditional laminectomy group).For the patients with lumbar schwannoma hospitalized in the neurosurgical spinal ward of Beijing Tian Tan hospital, the surgeon communicated with them one-on-one to inform the patients of the advantages and disadvantages of minimally invasive surgery through channels and traditional laminectomy. After the surgical risks and their respective advantages and disadvantages were identified, patients who underwent minimally invasive surgery to remove tumors through the channel were admitted to the channel surgery group according to the wishes of the patients; otherwise, patients who underwent traditional laminectomy were included in the control group. From December 2017 to March 2019, a total of 15 patients (experimental group) were treated with minimally invasive surgery. A total of 15 patients with tumors similar in size and location to those in the experimental group were selected from the control group who were hospitalized during the same period for traditional laminectomy. Relevant clinical data of the two groups of patients were collected and analyzed, including preoperative lesion imaging characteristics, intraoperative blood loss, operation time, postoperative hospital stay, postoperative complications, symptom improvement, etc. Results: the operating time of the experimental group and the control group was (157±27) min and (158±29) min, respectively (P=0.897). Intraoperative blood loss was (66±27) ml and (110±43) ml, respectively (P=0.020). The mean hospital stay was (7.60±1.29) days and (11.67±1.23) days, respectively (P=0.000). Postoperative JOA scores were 26.73±2.84 and 26.60±2.41, respectively (P=0.891). Postoperative VAS scores were 0.40±1.12 and 0.27±0.71, respectively (P=0.699).The mean blood loss and hospital stay in the experimental group were significantly lower than those in the control group, the difference in operation time between the two groups was not significant, and there was no difference in neurological function results. Conclusion: In certain types of lumbar schwannoma tumors (non-giant tumors), minimally invasive resection through channels has the advantages of less surgical trauma, less bleeding, faster recovery and definite curative effect, which is a safe and effective surgical treatment.


Assuntos
Neurilemoma , Fusão Vertebral , Humanos , Laminectomia , Vértebras Lombares , Procedimentos Cirúrgicos Minimamente Invasivos , Neurilemoma/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
15.
Chirurg ; 91(1): 85-100, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31940067

RESUMO

Achilles tendon ruptures can be treated conservatively with a therapeutic shoe or an orthosis. Prospective randomized trials show comparable results to surgical treatment, with the right indications, correct performance and reasonable patient compliance. The target groups for conservative treatment are inactive patients and patients with substantial general risk factors. Surgical treatment of the Achilles tendon has changed over the decades. The direct open suture technique was replaced by minimally invasive procedures with percutaneous sutures. Chronic ruptures and/or defect situations that if untreated would lead to unstable healing, can be treated by an open reconstructive or minimally invasive procedure. Reconstructive techniques include turn-down flaps and aponeurotic reconstructive repair as well as a free tendon transfer using the flexor hallucis longus tendon or hamstrings. The gold standard for follow-up treatment is an early functional treatment.


Assuntos
Tendão do Calcâneo , Traumatismos dos Tendões , Tendão do Calcâneo/lesões , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Prospectivos , Ruptura Espontânea , Traumatismos dos Tendões/cirurgia , Transferência Tendinosa , Resultado do Tratamento
16.
Khirurgiia (Mosk) ; (1): 85-88, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994505

RESUMO

Mini-thoracotomy is one of the most popular minimally invasive approaches. This approach is used in the treatment of congenital and acquired heart diseases and characterized less surgical trauma, intraoperative blood loss, pain syndrome severity, risk of infectious complications and better cosmetic results. Successful correction of atrial septal defect (ASD) through right-sided mini-thoracotomy is reported in the article.


Assuntos
Comunicação Interatrial/cirurgia , Veias Pulmonares/cirurgia , Toracotomia/métodos , Cardiopatias/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Veias Pulmonares/anormalidades , Resultado do Tratamento
17.
Kyobu Geka ; 73(1): 49-56, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-31956250

RESUMO

Esophagectomy with mediastinal lymphadenectomy is a standard surgical procedure for esophageal cancer treatment, however, it is highly invasive operation and has possibility of reduction the patients' quality of life( QOL). Thoracoscopic esophagectomy was introduced to reduce the surgical invasiveness since the 1990s and it has been widely performed now. Surgical procedure has been changed from left lateral decubitous position to prone position, and robot surgery or mediastinoscopic surgery has been applied currently. Many reports indicated good short term results compared to open surgery, especially reduction of the postoperative pulmonary complication. On the other hand, there is no scientific evidence of long term survival benefit, therefore, further researches are required including an ongoing phase Ⅲ randomized controlled trial( RCT)[ Japan Clinical Oncology Group( JCOG) 1409].


Assuntos
Neoplasias Esofágicas , Qualidade de Vida , Neoplasias Esofágicas/cirurgia , Esofagectomia , Humanos , Japão , Excisão de Linfonodo , Procedimentos Cirúrgicos Minimamente Invasivos , Toracoscopia , Resultado do Tratamento
19.
Urologe A ; 59(2): 142-148, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31974660

RESUMO

BACKGROUND: Localized renal cell carcinoma is increasingly relevant in daily urological practice due to earlier diagnosis and higher life expectancy. OBJECTIVES: To analyze and compare current treatment evidence for localized renal cell carcinoma regarding new aspects of nephron-sparing surgery, the different surgical approaches and focal therapy. METHODS: A systematic search was performed to identify relevant publications from 2018 and 2019. RESULTS: Prospective randomized trials comparing nephrectomy with partial nephrectomy, the three different surgical approaches with each other, and focal therapy with surgery are still lacking. Positive effects on survival by partial nephrectomy could be demonstrated, even though partial nephrectomy has a higher morbidity than radical nephrectomy. Older patients (>75 years) with advanced localized renal cell carcinoma did not appear to benefit from partial nephrectomy so far, but minimally invasive surgical approaches are underrepresented in such studies. Minimally invasive partial nephrectomy is superior to the open approach, and robot-assisted partial nephrectomy has better results than laparoscopy. Focal therapy of kidney tumors is technically safe and feasible, but relevant comparisons with partial nephrectomy are still lacking. CONCLUSIONS: Partial nephrectomy is still the gold standard treatment for localized renal cell carcinoma, it should be preferably performed by a robot-assisted approach. Focal therapy can serve as an alternative in highly selected cases.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Laparoscopia , Nefrectomia/métodos , Procedimentos Cirúrgicos Robóticos , Robótica , Carcinoma de Células Renais/patologia , Humanos , Neoplasias Renais/patologia , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Prospectivos , Radiocirurgia , Resultado do Tratamento
20.
J Surg Oncol ; 121(4): 662-669, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31930513

RESUMO

BACKGROUND: We aimed to evaluate the safety and efficacy of a clinical pathway (CP) for enhanced recovery after surgery (ERAS) in gastric cancer patients, including early oral feeding and discharge on postoperative day 4. METHODS: We performed a prospective, single-center, phase II clinical trial. Based on proposed indications for an ERAS CP in our retrospective study, we enrolled 133 patients younger than 65 years who were undergoing minimally invasive subtotal gastrectomy. The primary endpoint was the ERAS CP completion rate. Secondary endpoints included complication, mortality, hospital stay, and readmission. RESULTS: Among 133 patients, six patients were dropped out from this study. The ERAS CP completion rate (77.2%, 98 of 127) was comparable to the historical control group that completed a conventional CP (85.4%, P = .085). The postoperative complication incidence (13.4%, 15 of 127) was also similar to that of the conventional CP group (9.5%, P = .174). We identified reduced hospital stays (4.7 ± 1.3 vs 7.2±2.3 days; P < .001) and lower hospital costs ($7771 vs 8539; P < .001) in the ERAS CP group compared with the conventional CP group. CONCLUSIONS: An ERAS CP can be safely and effectively adopted for patients with gastric cancer without increasing the complication rate and could shorten hospital stays. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01642953).


Assuntos
Procedimentos Clínicos , Neoplasias Gástricas/cirurgia , Feminino , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Gastrectomia/normas , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Estudos Prospectivos
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