Initial results of endourological treatment of renoureteral lithiasis by means of flexible ureteroscopy and percutaneous surgery in an outpatient procedure in a tertiary care center.

OBJECTIVE: Urinary lithiasis is a prevalent disease with a high socioeconomic impact, where endourological surgery has shown excellent results with minimal complications. For its part, outpatient surgery is an efficient, safe and quality care model. We present our experience in the outpatient endourological treatment of lithiasis and a review of the main series. MATERIAL AND METHODS: Prospective analysis of 85 flexible or percutaneous procedures for the treatment of lithiasis, carried out in our center between January 2021 and April 2022. The main objective was to analyze the rate of unplanned admission and the success and incidence of complications as secondary objectives. The patients were selected following the inclusion criteria of the care process. RESULTS: The mean age was 56 ± 14 years. Urine culture was positive in 13.9% of the patients, 38% had a pre-surgical double-J catheter. Median stone surface was 55 mm 2 (961 ± 323 Hounsfield Units). 73 flexible and 12 percutaneous procedures were performed. 8 patients required immediate unplanned admission and another 2 during the first month. 94% were stone-free at the third month. No intraoperative complications were detected, although 16.5% of the patients presented some type of postoperative complication. CONCLUSION: In our experience, with a strict selection of patients and following a care process with multidisciplinary participation, endourological procedures are feasible and safe in the outpatient setting. Periodic monitoring of the results is essential for the sake of a constant improvement of the process.

Anesthesia management in a patient with Churg-Strauss syndrome in the ambulatory setting: A case report.

Eosinophilic granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome, is a rare type of vasculitis with multisystemic involvement. Very few authors have described the anaesthesia technique in these patients. We present the first report on ambulatory surgery in a patient with EGPA. This case dispels concerns about the safety of day surgery and reports successful regional anaesthesia management in a patient with EGPA.

Systematic review of the implantation of penile prosthesis in major ambulatory surgery.

INTRODUCTION AND OBJECTIVE: Penile prosthesis (PP) implantation is an effective option for erectile dysfunction. Although initially PP surgery was carried out in an inpatient setting, there is a growing trend to implant PP as a major ambulatory surgery (MAS). This study aimed to perform a systematic review of the literature to identify available evidence of the implantation of PP under MAS setting and go carry out a comparison between MAS and inpatient procedures. MATERIAL AND METHODS: PubMed, EMBASE, Cochrane Library and MEDES electronic databases and non-indexed supplements for scientific congresses were searched to identify articles related to the surgical implantation of PP in MAS up to February 2021. Key search terms included penile prosthesis, erectile dysfunction, ambulatory surgery, ambulatory care, and surgery. RESULTS: Among 171 publications retrieved (51 PubMed, 73 EMBASE, 3 Cochrane, 2 using MEDES and 42 manual searching), 5 studies were finally selected. There were no significant differences between MAS or inpatient setting in terms of the type of device, surgical approach, or location of reservoir. Complication rates observed in both groups were similar. Implantation of PP in MAS was less expensive than inpatient surgery and was associated with acceptable patient satisfaction rates and adequate pain control. CONCLUSIONS: Studies demonstrated that outpatient PP surgery can achieve similar outcomes in terms of safety and satisfaction to implantation of PP in the inpatient setting, while it could reduce costs and improve the efficiency. This research could support decision makers to extend PP surgery into the ambulatory setting.

Initial results of the implementation of an ambulatory mini percutaneous nephrolithotomy program.

OBJECTIVE: To present our program for ambulatory mini percutaneous nephrolithotomy (mini-PCNL) and evaluate its initial results. MATERIAL AND METHODS: We analyzed the implementation of the protocol into the clinical practice with the first 30 outpatient mini-PCNL cases performed in our center between April 2021 and September 2022. Demographic characteristics, perioperative variables, complications and need for unplanned health care, stone-free rate (SFR), stone type and patient satisfaction with the major ambulatory surgery (MAS) process were collected. RESULTS: A total of 30 patients with a mean age of 60.2 ±â€¯11.6 years who met the inclusion criteria underwent surgery. The mean stone size was 15 mm [range: 5-20]. No intraoperative complications were recorded. All patients except one were discharged the same day of surgery as planned. In the month following discharge, the rate of complications, emergency department (ED) revisits or hospital readmissions rates were 0%. Stone-free-rate (SFR) at 3 months was 83%. Overall satisfaction with the whole perioperative process was assessed with the EVAN-G questionnaire, obtaining 124.3 points out of a maximum of 150, which is equivalent to a 78.6% level of satisfaction. CONCLUSION: Ambulatory mini-PCNL can be implemented as a treatment option in centers with experience in endourology, an established MAS Unit, and strictly selected patients. Our initial results show an adequate safety profile and high overall satisfaction perceived by patients undergoing the ambulatory approach.

Holmium laser enucleation of the prostate (HoLEP) as same-day surgery: A safe and feasible option.

OBJECTIVE: To study the feasibility of holmium laser enucleation (HoLEP) performed as a same-day surgery. MATERIAL AND METHODS: Prospective observational study including 25 patients submitted to HoLEP. Patients were discharged the same day if they met the established criteria. RESULTS: The mean age of the patients was 65.1 years and prostate volume was 45.8cc. All patients were discharged the same day of surgery. The overall complication rate at 30 days was 12% (Clavien I 100%). The rate of re-hospitalization was 0%. Patient satisfaction rate with the day surgery pathway was 95%. CONCLUSIONS: The initial analysis of our results suggests that outpatient HoLEP is a safe and effective alternative with low rate of complications. According to satisfaction rates, patients prefer the day surgery pathway for the performance of HoLEP.

Predictive Factors of Admission in Outpatient Laparoscopic Surgery. / Factores con valor predictivo de ingreso en cirugía laparoscópica ambulatoria.

INTRODUCTION: The aim of the study is to analyze the rate of no planificated hospitalization after ambulatory surgical procedures by laparoscopy, and identify associated risk factors to failure in the ambulatory manage of this patients. METHODS: A prospective observational study was performed during 18 months and included 297 patients treated with ambulatory laparoscopies performed at University Hospital La Fe of Valencia. The need for hospital admission, same day after surgery, was considered the main variable. Variables were recorded for preoperatives, intraoperatives o postoperatives factors. To identify risk factors and variables associated with complications, statistical analyses were calculated with logistic regression models. RESULTS: After laparoscopic surgery, the 8.1% of patients required hospitalization. This rate was significantly superior in gynecologic surgery, patients with previous surgery complications, superior ASA classified (II and III) and smokers. Likewise, patients with pneumoperitoneum time over 45minutes presented a higher hospitalization rate; also founded in patients with anesthetic or surgery complications (including conversion to laparotomy). At least, the rate of hospitalization was significantly superior in relation with postoperative nausea and vomiting (PONV). CONCLUSION: The rate of patients who need hospitalization after ambulatory laparoscopic surgery was 8.1%, of which 5.5% were general surgeries and 12.1% were gynecologic surgeries. The mots relationated factors with ambulatory manage failure, analyzed with multiple regression, were the appearance of surgery complications, the pneumoperitoneum time over 100minutes and the PONV.

Causes of unplanned admission after orthopedic procedures in ambulatory surgery. / Causas de ingresos no deseados tras la realización de procedimientos quirúrgicos de cirugía ortopédica y traumatología en cirugía mayor ambulatoria.

OBJECTIVE: Orthopaedic procedures performed in Day Surgery Units provide important advantages which disappear when patients require admission when postoperative recovery is not as expected. The aim of this study was to analyse the reasons for unplanned hospital admissions after orthopaedic procedures in a Day Surgery Unit and their relationship between variables such as patient age, anaesthetic risk and technique, procedure or duration. METHODS: Ambispective cohort study of 5,085 patients who underwent surgical orthopaedic procedures between 1995 and 2017. Thirty-nine variables provided by the Unit's database were analysed. The database was opened on the day of admission and closed the 30th postoperative day. RESULTS: Of the patients, 98.2% were discharged from the Unit. Seventy-four (1.5%) required overnight admission. This percentage showed significant differences in relation to the type of procedure, type of anaesthesia and duration, which conditioned overnight admission due to inadequate postoperative pain management, nausea or wound complications. Seventeen patients (0.3%) required readmission after discharge due to complications that arose at home, such as wound infection, which was the most common. CONCLUSIONS: Unplanned admissions are more frequently related to general anaesthesia, lengthy surgeries and procedures such as arthroscopy, hallux valgus corrections or removal of osteosynthesis material. The major reasons for unplanned admissions were inadequate postoperative pain management for overnight admissions and wound infection for admissions after discharge.

Major ambulatory surgery for the treatment of breast cancer: Factors conditioning conversion to conventional hospitalization. / Cirugía mayor ambulatoria del cáncer de mama: factores relacionados con la conversión a hospitalización convencional.

INTRODUCTION: The main step in curative treatment for breast cancer is surgery. Its use in an ambulatory setting can contribute towards more efficient healthcare, providing additional benefits for patients. In this study, we analyze the results obtained with this treatment method and identify factors related with conversion to hospitalization. METHODS: Results were analyzed from the 206 surgeries performed for breast cancer in 2016, using three different methods: day surgery, overnight ambulatory (23h) and conventional hospitalization. The ambulatory success and conversion rates were calculated for the global sample and stratified, distinguishing between conservative surgery, mastectomy and axillary surgery. A univariate analysis was performed to identify the factors involved in conversion. RESULTS: For the global sample, the ambulatory surgery rate was 61.2%, 16.5% conversions and a success rate of 83.4%. For conservative surgery, ambulatory, success and conversion rates were 78.8%, 88.6 and 11.4%, respectively. For mastectomies, the ambulatory rate was 28.6%, with 62.9% success and 37.1% conversions. The 11 axillary surgeries were performed as day surgeries. Factors associated with conversion were mastectomy vs. vs. conservative surgery and the appearance of postoperative complications. CONCLUSIONS: Ambulatory surgery for the surgical treatment of breast cancer should be standard care. Optimized results require adequate patient selection and the performance of surgical technique that needs to be as careful and as conservative as possible.

Analgesia con bloqueo TAP y bomba elastomérica en la reparación de hernias ventrales (primarias e incisionales) abdominales por laparoscopia en régimen de cirugía mayor ambulatoria / Analgesia with TAP block and elastomeric pump in the repair of ventral (primary and incisional) abdominal hernias by laparoscopy in major outpatient surgery

Antecedentes: El dolor moderado severo es una limitación para la incorporación de procedimientos en cirugía mayor ambulatoria (CMA), siendo uno de los principales motivos de reingreso o consulta a urgencias en las primeras horas del postoperatorio. Representa un indicador de calidad para las unidades de CMA. Algún estudio ya mide la eficacia de las bombas elastoméricas en el domicilio en CMA, pero no para la reparación de eventración de línea media por laparoscopia. Objetivo: Se diseñó un estudio para medir el dolor postoperatorio en la reparación de hernias ventrales, primarias o incisionales, de línea media por vía laparoscópica (malla fijada con tackers y cola de cianocrialato) con un diámetro transverso inferior a los 8 centímetros, en pacientes ASA I-II. Se valoró la viabilidad de la utilización de las bombas elastoméricas, con infusión continua de antinfl amatorio, opiáceos débiles y antieméticos en el domicilio del paciente. Pacientes y métodos: Estudio prospectivo observacional en pacientes ASA I-II, intervenidos de reparación de hernia ventral por laparoscopia, bajo una estrategia de control de dolor multimodal. Se realizó anestesia general endovenosa, con propofol y remifentanilo, junto a perfusión de lidocaína, y bloqueo TAP ecoguiado con levobupivacaína y mepivacaína con punción bilateral. Se inició la analgesia endovenosa intraoperatoriamente y para domicilio se pautó bomba elastomérica con dexketoprofeno, tramadol y ondansetrón, que se inció en la zona de recuperación postanestésica, junto a paracetamol fi jo y metamizol de rescate. La enfermería integrante de la unidad de hospitalización a domicilio se encargó del control postoperatorio en el domicilio del paciente. Se midió a las 24 h y 48 h el dolor postoperatorio a través de las escalas EVA y Andersen, además de las complicaciones que hubieran surgido (disfunción del dispositivo, náuseas/vómitos, complicaciones quirúrgicas)...(AU)

Background: Severe moderate pain is a limitation for the incorporation of procedures in major ambulatory surgery (MOS), being one of the main reasons for readmission or consultation to the emergency department in the first postoperative hours. It represents a quality indicator for AMC units. Some studies have already measured the efficacy of elastomeric pumps in the home in the AMC, but not for laparoscopic repair of midline eventration. Objective: A study was designed to measure postoperative pain in the repair of ventral, primary or incisional, midline hernias by laparoscopy (mesh fixed withtackers and cyanocryalate glue) with a transverse diameter of less than 8 centimeters, in ASA I-II patients. The feasibility of using elastomeric pumps withcontinuous infusion of anti-inflammatory drugs, weak opioids and antiemetics at the patient’s home was assessed. Patients and methods: Prospective observational study in ASA I-II patients who underwent laparoscopic ventral hernia repair under a multimodal pain control strategy. Intravenous general anesthesia was performed with propofol and remifentanil, together with lidocaine perfusion, and ultrasound-guided TAP block with levobupivacaine and mepivacaine with bilateral puncture. Intravenous analgesia was started intraoperatively and an elastomeric pump with dexketoprofen, tramadoland ondansetron was prescribed for home use, which was started in the postanesthetic recovery area, together with fixed paracetamol and rescue metamizole. The nursing staff of the home hospitalization unit was in charge of postoperative monitoring at the patient’s home. Postoperative pain was measured at 24 h and 48 h using the VAS and Andersen scales, as well as any complications that might have arisen (device dysfunction, nausea/vomiting, surgical complications). Patient satisfaction was measured by means of a survey at 30 days, during the postoperative follow-up with the surgeon.(AU)

Recommendations on Testing Before Outpatient Dermatologic Surgery. / Recomendaciones en la petición de pruebas preoperatorias en cirugía dermatológica ambulatoria.

INTRODUCTION: Short-duration ambulatory surgery for the removal of skin tumors under local anesthesia is increasingly common in dermatology. Preoperative assessment has traditionally targeted the identification of any unknown diseases or other health conditions that might lead to changes in plans for anesthesia or surgery. Hospitals and specialists differ greatly in the tests they order in patients about to undergo outpatient dermatologic surgery given that hardly any finding would be likely to contraindicate or lead to changes in the procedure. This study aimed to provide guidance for those ordering tests before outpatient dermatologic surgery. METHODS: In 2017 our hospital developed a protocol to standardize preoperative testing for outpatient dermatologic surgery. We designed an observational, descriptive, retrospective analysis of tests ordered for patients scheduled for such surgery before and after the protocol was applied. RESULTS: Fewer tests were ordered after the protocol was introduced. We detected no statistically significant differences in relation to type of surgery planned or postoperative complications. CONCLUSIONS: Patients about to undergo outpatient dermatologic surgery under local anesthesia who have no unusual health risks may not require preoperative testing.

Perioperative factors that contribute to postoperative pain and/or nausea and vomiting in ambulatory laparoscopic surgery. / Factores perioperatorios que contribuyen a la aparición de dolor o náuseas y vómitos postoperatorios en cirugía laparoscópica ambulatoria.

INTRODUCTION: Both postoperative pain and postoperative nausea and vomiting are major factors that determine the time and quality of recovery in laparoscopic surgery. OBJECTIVE: To determine the perioperative factors that contribute to the appearance of postoperative pain and postoperative nausea and vomiting in outpatient laparoscopic surgery. MATERIAL AND METHODS: A prospective study was conducted on a cohort of 297 patients undergoing laparoscopic ambulatory surgery. A record was made of preoperative factors (usual medication, anaesthetic risk, etc.), intraoperative (surgical and anaesthetic times, drugs, CO2 pressure, etc.), and postoperative factors (major and minor complications, recovery times, etc.). As dependent variables, the postoperative symptoms considered were, nausea, vomiting, and/or postoperative pain. RESULTS: Considering as a combined variable the occurrence of níusea, vomiting or moderate/severe pain (4 or more points on a visual analogue scale), one or more of these symptoms occurred in 58.7% of the patients (95% CI: 52.8-64.4). Using a logistic regression, the variables associated with the appearance of symptoms were: female gender (OR: 3.4), waiting time over 45minutes prior to surgery (OR: 4.9) and no anti-emetic prophylaxis (OR: 12.2). CONCLUSIONS: In patients undergoing ambulatory laparoscopic surgery, one in 4had postoperative nausea and vomiting, and approximately half of moderate-intensity pain before discharge. Considering the overall the occurrence of pain and/or postoperative níusea and vomiting, these symptoms affect more than half of the patients being operated on, and are more frequent in women and in those who have to wait to access the operating room.

Análisis integral de la colecistectomía en una unidad de cirugía ambulatoria y corta estancia. Experiencia de los últimos 7 años / Integral analysis of cholecystectomy in an outpatient surgery and short-stay unit. Experience of the last 7 years

Introducción: La colecistectomía laparoscópica ambulatoria (CLA) se considera en la actualidad un trazador representativo de la calidad de un servicio de cirugía general. La gran diversidad de unidades de cirugía ambulatoria dificulta la comparativa de los diferentes indicadores de calidad. Objetivo: Conocer los resultados del manejo de la CLA en un centro integrado y como afecta a sus indicadores de calidad. Pacientes y método: Estudio observacional prospectivo entre 2015 y 2021 de las colecistectomías programadas en unidad integrada. Resultados: Se intervinieron 887 pacientes, el 76,5 % (n = 679) programados en régimen ambulatorio. La pernocta no planificada (PNP) media fue del 25,2 % (n = 171), siendo el índice de sustitución del 57,8 %. Las principales causas de PNP fueron: intolerancia digestiva (48,5 %), cirugía compleja (29,2 %) y el dolor (12,8 %). Los tiempos quirúrgicos fueron superiores en los pacientes en régimen de ingreso (p < 0,001) y en aquellos que causaron PNP (p < 0,001). Un tiempo quirúrgico superior a los 45 minutos fue causa de PNP de forma significativa (p = 0,007). La tasa global de infección de sitio quirúrgico fue del 3,1 %,siendo la infección profunda del 0,59 %. Ningún paciente reingresó en las primeras 24 horas, siendo la asistencia a urgencias a 30 días del 8,2 % (n = 73),reingresando el 1,91 % (n = 17) de los pacientes, con una tasa de reintervención del 0,35 % (n = 3). La tasa de fístula biliar fue del 0,67 %. Conclusión: La CLA es una técnica segura y expansiva, aunque la obtención de parámetros de calidad estandarizados es complejo por la diversidad de unidades.(AU)

Introduction: Ambulatory laparoscopic cholecystectomy (ALC) is currently considered a representative tracer of the quality of a general surgery service. The great diversity of day surgery units makes it difficult to compare the different quality index. Objective: To know the results of the management of the CLA in an integrated center and how it affects its quality index. Patients and method: Prospective observational study between 2015 and 2021 of scheduled cholecystectomies in an integrated unit. Results: 887 patients were operated on, 76.5 % (n = 679) programmed on an outpatient basis. The average unplanned overnight stay (PNP) was 25.2 % (n = 171), with the replacement rate being 57.8 %. The main causes of PNP were: digestive intolerance (48.5 %), complex surgery (29.2 %) and pain (12.8 %). Surgical times were higher in patients on admission (p < 0.001) and in those who caused PNP (p < 0.001). Surgical time greater than 45 minutes was a significant cause of PNP (p = 0.007). The overall rate of surgical site infection was 3.1 %, with deep infection being 0.59 %. No patient was readmitted in the first 24 hours, with 30-day emergency care being 8.2 % (n = 73), readmission rate of 1.91 % (n = 17), with a reoperation rate of 0.35 % (n = 3). The biliary fistula rate was 0.67 %. Conclusion: CLA is a safe and expansive technique, although obtaining quality standard parameters is complex due to the diversity of units.(AU)

[Comparative analysis of efficiency indicators in ambulatory surgery]. / Análisis comparativo de indicadores de eficiencia en cirugía mayor ambulatoria.

OBJECTIVE: To find comparative elements for quality control in major ambulatory surgery (MAS) units. METHOD: Descriptive and comparative study of the Ambulatory Care Index (AI) and Substitution Index (SI) in the Santa Cristina Hospital Surgery Service (Madrid, Spain) compared to Key Indicators (KI) of the National Health Service (NHS). RESULTS: 7,817 MAS procedures (between 2006 and 2014) were analysed. The average annual AI was 54%, higher (p <0.0001) than «ambulatory surgery¼ KI. The hernia outpatient procedures (average 72%) were also superior to the national KI (p <0.0001), but ambulatory haemorrhoidectomy (average 33.6%) was clearly lower (p <0.0001). CONCLUSIONS: KI of the NHS are useful and allow to establish a proper development in the global AI and hernia outpatient surgery with opportunities for improvement in haemorrhoidectomy. Their collection should be careful, not including minor surgeries. Also, their usefulness could be increased if data was broken down by speciality and by complexity.

Desflurane versus propofol in post-operative quality of recovery of patients undergoing day laparoscopic cholecystectomy. Prospective, comparative, non-inferiority study. / Desflurano versus propofol en la calidad de recuperación de pacientes intervenidos de colecistectomía laparoscópica ambulatoria. Estudio prospectivo, comparativo de no inferioridad.

OBJECTIVE: Recently, the evaluation of postoperative results has focused on the opinion of the patient as of great relevance. Our objective was to evaluate the quality of recovery by questionnaire (QoR-15) in patients undergoing laparoscopic cholecystectomy, comparing desflurane versus a total intravenous technique with propofol (TIVA). A non-inferiority hypothesis was proposed between both techniques. MATERIAL AND METHODS: Prospective longitudinal cohort study in patients undergoing laparoscopic cholecystectomy in which multimodal management was applied including low pneumoperitoneum pressures, deep neuromuscular block and pain prevention strategy and PONV. Anaesthesia maintenance was performed with either desflurane or propofol at the discretion of the anaesthesiologist. QoR-15 was evaluated pre-and 24hours after surgery. RESULTS: Sixty-one patients were evaluated: 29 in the desflurane group and 32 in the TIVA group with no differences in demographic parameters, ASA grade, and preoperative QoR-15 questionnaire. The duration of the intervention was superior in TIVA group, 55 ± 15 vs. 45 ± 9min in desflurane group; p =.05. The desflurane group received more fentanyl than the TIVA group: 200 ± 65 vs. 113 ± 38µg; p =.05. No differences in pain, PONV or time of stay between groups. QoR-15 at 24h decreased 7% relative to baseline, with no differences between groups. CONCLUSIONS: The quality of recovery evaluated by the patient was as favourable in the patients of the desflurane group as in those of the TIVA group in patients undergoing laparoscopic cholecystectomy as outpatients.

Survey on the practice of anaesthesiologists in inguinal hernia surgery in Galicia. / Encuesta sobre la práctica de los anestesiólogos en la cirugía de hernia inguinal en Galicia.

OBJECTIVES: To evaluate the preference in the anaesthetic technique by anaesthesiologists for the management of inguinal hernia surgery in Galicia. MATERIAL AND METHODS: Using the National Catalogue of Hospitals of the Ministry of Health and Consumer Affairs in Galicia, a questionnair was sent to the Heads of Anaesthesiology Service and Coordinators of the Postanaesthesia Care Unit (PACU) with 11 questions on the anaesthetic technique chosen by anaesthesiologists in the management of patients for inguinal hernia surgery, as well as their reasons. RESULTS: The questionnaire was sent to 11 hospitals: 8 with PACU and 3 District. A total of 94 professionals responded, 56% with more than 10 years of experience, who performed between 8-10 procedures/month (58%) on an outpatient basis (61.54%). The most used anaesthetic technique was intradural in 52.8%, compared to 41.8% of general anaesthesia. Respondents with more than 10 years of experience preferred spinal anaesthesia in 38.6% of cases, compared to those with less experience (6.8%) (P=.037). One in 4 of those who chose general anaesthesia used ultrasound-guided interfascial blocks (27.5%). The local anaesthetic most used in intradural anaesthesia was hyperbaric bupivacaine (70.8%) at doses higher than 7mg. CONCLUSION: Intradural anaesthesia with hyperbaric bupivacaine was the technique most chosen by anaesthesiologists for the management of inguinal hernia surgery. The anaesthetic techniques chosen among the different hospitals did not follow a homogenous distribution. In this survey, there was a tendency to choose the technique associated with the experience of the anaesthesiologist.

Office stent placement under local anesthesia is a safe and efficient procedure for the management of multiple ureteral disorders. / La colocación de catéteres doble J con anestesia local en régimen ambulatorio es un procedimiento seguro y eficiente para el manejo de distintas patologías ureterales.

OBJECTIVE: To assess the outcomes of ureteral stent placement under local anesthesia for the management of multiple ureteral disorders. METHODS: Retrospective study of 45 consecutive ureteral stents placed under local anesthesia from January 2015 to July 2016. Inclusion criteria were hemodynamically stable patients with urinary obstruction, urinary fistula or for prophylactic ureteral localization during surgery. Five minutes before the procedure, 10ml of lidocaine gel and 50ml of lidocaine solution were instilled in the bladder. A 4.8Fr ureteral stent was placed using a 15.5Fr flexible cystoscope under fluoroscopic control. Characteristics of procedures and outcomes were analysed. RESULTS: A total of 45 procedures (33 placement, 12 replacements) were attempted in 37 patients, of which 40 (89%) were successful. There were 10 male (27%) and 27 female patients (73%) with a mean age of 58.6 years (±17.5). Main indications for stent placement were stones (37.8%), extrinsic ureteral compression (28.9%) and surgery ureteral localization (22.2%). The reasons for failing to complete a procedure were the inability to pass the guidewire/stent in 4 cases (8.8%) or to identify the ureteral orifice in 1 (2.2%). Postoperative complications occurred in 8 patients (17.8%) (7 Clavien I, 1 Clavien IIIa). No procedure was prematurely terminated due to pain. Statistical analysis did not find significant successful predictors. The outpatient setting provided a fourfold cost decrease. CONCLUSIONS: Ureteral stent placement can be safely and effectively performed under local anesthesia in the office cystoscopy room. This procedure could free operating room time, reduce costs and minimize side effects of general anesthesia.

Tratamiento quirúrgico ambulatorio en la solución de las afecciones de la glándula tiroides / Outpatient surgical treatment in the solution of the thyroid gland conditions

RESUMEN Introducción: La cirugía tiroidea es uno de los procedimientos más comúnmente realizados en la cirugía de cabeza y cuello. Era tradicional que los pacientes tuvieran estancias hospitalarias que, en ocasiones, superaban los 3 días. Objetivo: Describir los resultados de la cirugía mayor ambulatoria, en la solución de las afecciones quirúrgicas de la glándula tiroides. Métodos: Se realizó un estudio descriptivo en 307 pacientes con afecciones de la glándula tiroides que recibieron tratamiento quirúrgico ambulatorio. Se confeccionó modelo de recogida de datos para las variables: edad, sexo, afección tiroidea, tipo de intervención quirúrgica, método anestésico y complicaciones. Se calcularon frecuencias absolutas y relativas. Resultados: El grupo de edades más frecuente fue entre los 30-39 años (32,57 %), predominó el sexo femenino (91,53 %). Las afecciones tiroideas más frecuentes fueron el bocio adenomatoso (23,13 %) y el carcinoma (20,85 %), la intervención quirúrgica más frecuente fue la tiroidectomía total (39,08 %); se aplicó analgesia quirúrgica acupuntural en 39 pacientes (12,71 %), 8 pacientes presentaron complicaciones posoperatorias (2,6 %). La estancia hospitalaria fue inferior a 24 horas en el 99,02 % de los pacientes. Conclusiones: La cirugía mayor ambulatoria se emplea en la solución de las afecciones quirúrgicas de la glándula tiroides, más frecuente en las afecciones benignas, en pacientes mayores de 19 años de edad, con predominio del sexo femenino, la intervención quirúrgica realizada con mayor frecuencia es la tiroidectomía total. Con mayor frecuencia se aplica anestesia general orotraqueal; se reserva la analgesia quirúrgica acupuntural para casos seleccionados.

ABSTRACT Introduction: Thyroid surgery is one of the most commonly performed procedures in otorhinolaryngology, and head and neck surgery. Traditionally, it presented hospital stays that were sometimes longer than 3 days. Objective: To describe the results of major outpatient surgery in the solution of surgical conditions of the thyroid gland. Methods: A descriptive study was carried out in 307 patients with thyroid gland disorders who received outpatient surgical treatment. A data collection model was created for the variables: age, sex, thyroid disease, type of surgical intervention, anesthetic method and complications, absolute and relative frequencies were calculated. Results: The most frequent age group was between 30-39 years (32.57 %), females predominated (91.53 %). The most frequent thyroid conditions were adenomatous goiter (23.13 %) and carcinoma (20.85 %), the most frequent surgical intervention was total thyroidectomy (39.08 %), surgical acupuncture analgesia was applied in 39 patients (12.71 %), 8 patients presented postoperative complications (2.6 %). The hospital stay was less than 24 hours in 99.02 % of the patients. Conclusions: Major outpatient surgery is used in the solution of surgical conditions of the thyroid gland, more frequent in benign conditions, in patients over 19 years of age, with a predominance of females, the surgical intervention performed with greater frequency is total thyroidectomy. The most frequent was general orotracheal anesthesia, reserving acupuncture surgical analgesia for selected cases.

Experiencia de la cirugía del cáncer de mama durante la pandemia de COVID-19 / Experience of breast cancer surgery during the COVID-19 pandemic

Introducción: La pandemia por COVID-19ha tenido un importante impacto en todos los ámbitos; uno de los más afectados ha sido la sanidad. La pandemia ha supuesto una reorganización de los recursos tanto humanos como materiales, dada la saturación del sistema sanitario. Como especialistas en el cáncer de mama hemos tenido que adaptarnos a esta situación, reorganizando y ajustando los cuidados a los medios profesionales e infraestructuras de los que disponíamos en cada momento. La incidencia variable a lo largo del año ha permitido desarrollar una actividad normalizada en algunas ocasiones. Nos proponemos describir nuestra experiencia en la cirugía del cáncer de mama durante este año de pandemia de COVID-19.Material y métodos: Estudio observacional retrospectivo de pacientes intervenidas de neoplasia de mama desde el 14 de marzo de 2020 hasta el 14 de marzo de 2021.Resultados: Se han intervenido 138 neoplasias de mama en 136 mujeres.La edad media fue de 62 años (36-88). Hubo 86 pacientes (63,2%) en régimen de cirugía mayor ambulatoria y 50 pacientes (36,8%) con ingreso. El tiempo medio desde el diagnóstico hasta la visita en consultas externas fue de 5,7 días y el tiempo medio desde el diagnóstico hasta el inicio del tratamiento de 45 días.Conclusiones: Durante este año de pandemia de COVID-19 hemos podido asegurar la asistencia y tratamiento de las mujeres con cáncer de mama con adecuados intervalos entre el diagnóstico y el tratamiento. A este proceso ha contribuido la implementación previa de la cirugía mayor ambulatoria en el cáncer de mama. (AU)

Introduction: The COVID-19 pandemic has had an important impact in all areas; health service has been one of the most affected. The pandemic has led to a reorganization of human and material resources and has caused a saturation of the health service. As specialists in breast cancer, we have adapted to this situation by reorganizing and adapting care to the professional environments and infrastructures that were available when necessary. The incidence has varied during 2020 and it has made possible to normalize the work on some occasions. We would like to describe our experience in breast cancer surgery during this COVID-19 pandemic year.Material and methods: Retrospective observational study of patients operated on breast cancer from 14th March 2020 to 14th March 2021.Result: A number of 138 breast cancer have been operated on 136 women. The average age is 62 years (36-8); there were 86 patients operated on major ambulatory surgery regimen (63.2%) and 50 patients (36.8%) were hospitalized. The average time from diagnosis to outpatient visit was 5.7 days and the average time from diagnosis to the beginning of the treatment of 45 days.Conclusions: During this COVID-19 pandemic year, we have been able to ensure the care and treatment of women with breast cancer with adequate time intervals between diagnosis and treatment. This process has also been favored by the prior establishment of major ambulatory surgery in our medical center.

As vantagens da consulta de enfermagem presencial à pessoa submetida a cirurgia ambulatória / The advantages of the in-person nursing consultation to the person submitted to ambulatory surgery / Las ventajas de la consulta de enfermería presencial para la persona sometida a cirugía ambulatoria

Resumo Enquadramento: Os progressos médicos e tecnológicos e a melhoria das técnicas anestésicas, têm contribuído para o desenvolvimento da cirurgia ambulatória. Enfatiza a necessidade de cuidados mais humanizados e adequados às necessidades multidimensionais da pessoa submetida à cirurgia ambulatória. Objetivos: Conhecer a perspetiva dos enfermeiros acerca das vantagens da existência da consulta de enfermagem presencial pós-cirurgia ambulatória. Metodologia: Estudo qualitativo, exploratório descritivo; recolha de dados (entrevista semiestruturada). Participantes: enfermeiros de uma unidade hospitalar do norte de Portugal. Efetuada análise de conteúdo segundo o referencial de Bardin. O estudo respeitou os princípios éticos e de integridade científica. Resultados: Os enfermeiros referem que a consulta de enfermagem presencial pós-cirurgia ambulatória permite o acompanhamento do doente; avaliação de eventuais complicações; segurança; favorece a expressão de sentimentos/emoções; validação da educação para a saúde; avaliação do grau de satisfação do doente; favorece a comunicação empática. Conclusão: A consulta de enfermagem presencial é um momento crucial para a realização de educação para a saúde, contribuindo para o bem-estar do doente e para o desenhar de objetivos realistas e alcançáveis.

Abstract Background: Medical and technological advances and the improvement of anesthetic techniques have contributed to the development of outpatient surgery. The multidimensional needs of the person undergoing outpatient surgery call for more humanized and adequate care. Objectives: To know nurses' perspective of the advantages of having a face-to-face nursing consultation after outpatient surgery. Methodology: A qualitative, exploratory, descriptive study with data collection through semi-structured interviews to nurses from a hospital unit in northern Portugal. Content analysis was carried out according to Bardin's method. The study respected the ethical-moral principles. Results: The nurses report that the face-to-face nursing consultation after outpatient surgery allows for patient follow-up, assessment of complications, safety, expression of feelings and emotions, validation of health education, assessment of the patient's level of satisfaction, and empathic communication. Conclusion: The face-to-face nursing consultation is a crucial moment for providing health education, thus improving the patient's well-being, and to define realistic and achievable goals.

Resumen Marco contextual: El progreso médico, los avances tecnológicos y la mejora de las técnicas anestésicas han propiciado el desarrollo de la cirugía ambulatoria. Destaca la necesidad de una atención más humanizada y adecuada a las necesidades multidimensionales de la persona sometida a una cirugía ambulatoria. Objetivos: Conocer la perspectiva de los enfermeros sobre las ventajas de que exista la consulta de enfermería presencial tras una cirugía ambulatoria. Metodología: Estudio cualitativo, exploratorio y descriptivo; la recogida de datos se llevó a cabo mediante entrevista semiestructurada. Los participantes fueron enfermeros de una unidad hospitalaria del norte de Portugal. El análisis de contenido se realizó según el referente de Bardin. El estudio siguió los principios de ética e integridad científica. Resultados: Los enfermeros mencionaron que la consulta de enfermería presencial tras la cirugía ambulatoria permite el seguimiento del paciente; la evaluación de posibles complicaciones, y la seguridad; favorece la expresión de sentimientos/emociones; la validación de la educación para la salud; la evaluación del grado de satisfacción del paciente, y la comunicación empática. Conclusión: La consulta de enfermería presencial es un momento crucial para la educación para la salud, que contribuye al bienestar del paciente y al diseño de objetivos realistas y alcanzables.

Hiperparatiroidismo primario: experiencia en cirugía por mini abordaje unilateral / Primary hyperparathyroidism: experience in surgery by unilateral mini-approach

INTRODUCCIÓN: En el hiperparatiroidismo primario el origen del trastorno, como su nombre lo indica, está en la propia glándula paratiroides, la cual genera una secreción autónoma y excesiva. La cirugía de las glándulas paratiroides evolucionó en forma considerable en los últimos 30 a 40 años, pasamos de exploraciones cervicales exhaustivas, hasta una época en que gracias al desarrollo tecnológico y sobre todo medicina nuclear, podemos localizar en forma preoperatoria el tejido patológico; siendo esta a su vez la base fundamental en la realización de procedimientos más selectivos. OBJETIVO: mostrar la casuística de cirugía por mini abordaje de la glándula paratiroides en el hiperparatiroidismo primario en un centro mutual de Montevideo. MATERIAL Y MÉTODOS: Realizamos un estudio observacional descriptivo y retrospectivo. Se estudió una muestra de 18 pacientes con diagnóstico de hiperparatiroidismo primario y con sospecha de lesión única los cuales fueron intervenidos en un centro mutual de la ciudad de Montevideo entro julio de 2017 y enero de 2020. CONCLUSIÓN: La cirugía por mini abordaje de la glándula paratiroides puede ser aplicada en el hiperparatiroidismo primario en pacientes seleccionados con las ventajas de; tener un menor tiempo quirúrgico, ser ambulatoria (reintegro al hogar en pocas horas), indemnidad de la logia tiroidea contralateral, mejor resultado estético con similar tasa de éxito que la cirugía convencional.

BACKGROUND: In primary hyperparathyroidism, the origin of the disorder, as its name indicates, is in the parathyroid gland itself, which generates excessive and autonomous secretion. Parathyroid gland surgery has evolved dramatically in the last 30 to 40 years, from exhaustive cervical examinations, to nowadays when, thanks to technological development and especially nuclear medicine, we can locate pathological tissue preoperatively; this, in fact, is the fundamental basis for the performance of more selective procedures. OBJECTIVE: to show the casuistry of mini-approach surgery of the parathyroid gland in primary hyperparathyroidism in a mutual center in Montevideo. METHODS: We carried out a descriptive and retrospective observational study. We studied a sample of 18 patients diagnosed with primary hyperparathyroidism and a single suspicious lesion, who underwent surgery in a private center in the city of Montevideo from July 2017 to January 2020. CONCLUSION: Mini-approach surgery of the parathyroid gland can be applied in primary hyperparathyroidism in selected patients, with the advantages of a shorter surgical time, ambulatory (return home in a few hours), keeping the indemnity of the contralateral thyroid loggia, a better cosmetic result with a similar success rate than conventional surgery.