[Laparoscopic transumbilical cholecystectomy. Results with the gel device and literature review]. / Colecistectomía laparoscópica transumbilical. Resultados con el dispositivo de gel y revisión de la literatura.

INTRODUCTION: The appearance of single transumbilical incision surgery has opened a new era in the minimally invasive approach of cholecystectomy. Specific ports for this technique have made it easier to perform. We report our initial experience, from July 2008 to June 2009 and give an updated bibliographic review. PATIENTS AND METHODS: A prospective, longitudinal and interventional study that included 30 patients with symptomatic cholelithiasis, from 10 July 2008 to 30 June 2009, on whom a single transumbilical incision laparoscopic cholecystectomy was performed (LESS technique), without other minilaparoscopic ports or traction stitches. A gel port was used for all surgeries (R-Port, Tri-Port), as well as straight and roticulating laparoscopic graspers. Surgical time, analgesia requirements, postoperative hospital stay, conversions and complications were registered. RESULTS: The median age was 34.8 years (range, from 21 to 53), with a BMI between 21 kg/m(2) and 39.5 kg/m(2) (mean 25.8 kg/m(2)). Surgical time was 65.1 minutes (ranging from 40 to 150) and postoperative length stay was less than 24 hours. Postoperative pain was measured with the VAS scale, giving a low score. Up to now, two wound infections and a bile leak have been observed. CONCLUSIONS: LESS cholecystectomy is a safe and feasible technique performed by experienced surgeons in minimally invasive surgery, and requires a greater learning curve than that of the conventional laparoscopic cholecystectomy.

[Serum PTH levels as a predictive factor of hypocalcaemia after total thyroidectomy]. / Determinación de paratirina en suero como factor predictivo de hipocalcemia tras tiroidectomía total.

INTRODUCTION: Postoperative parathyroid hormone (PTH) levels as a predictor of hypocalcaemia in patients subjected to total thyroidectomy is analyzed. MATERIAL AND METHOD: Prospective study involving 67 patients who underwent total thyroidectomy due to a benign disease. Serum PTH and ionised calcium were measured 20 h after surgery. Sensitivity, specificity and predictive values of PTH and ionised calcium levels were calculated to predict clinical and analytical hypocalcaemia. RESULTS: A total of 42 (62.7%) patients developed hypocalcaemia (ionised calcium<0.95 mmol/l), but only 20 (29.9%) presented with symptoms. PTH concentration the day after surgery was significantly lower in the group that developed symptomatic hypocalcaemia (5.57+/-6.4 pg/ml) than in the asymptomatic (21.5+/-15.3 pg/ml) or normocalcaemic (26.8+/-24.9 pg/ml) groups (p=0.001). Taking the value of 13 pg/ml as a cut-off point of PTH levels, sensitivity, specificity, positive predictive value and negative predictive value were 54%, 72%, 76% and 48%, respectively. On the other hand, sensitivity for predicting symptomatic hypocalcaemia was 95% and specificity was 76%. The test showed a high incidence of false positives (11/30, 36%). Negative predictive value was 97% and positive predictive value was 65%. In multivariate analysis, PTH and ionised calcium were the only perioperative factors that showed an independent predictive value as risk indicators of symptomatic hypocalcaemia. CONCLUSIONS: Normal PTH levels 20 h after surgery practically rule out the subsequent appearance of hypocalcaemia symptoms. On the other hand, low PTH levels are not necessarily associated to symptomatic hypocalcaemia due to the high number of false positives.