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A abordagem laparoscópica tornou-se o padrão de atendimento para muitos procedimentos cirúrgicos.A cirurgia robótica é tipicamente realizada por laparoscopia;preocupações anestésicas para laparoscopia convencional e cirurgia robótica são semelhantes. A laparoscopia requer insuflação de CO2para criar espaço para visualização e manobras cirúrgicas.O aumento associado da pressão intra-abdominal, juntamente com a absorção de CO2e os efeitos do posicionamento cirúrgico, resultam em alterações neuroendócrinas e mecânicas que afetam a função cardiopulmonar. A abordagem laparoscópica tornou-se um padrão de tratamento para muitos procedimentos cirúrgicos abdominais, comparada com a laparotomia, a laparoscopia permite incisões menores, reduz a resposta ao estresse perioperatório, reduz a dor pós-operatória e resulta em menor tempo de recuperação.A laparoscopia requer insuflação de gás intra ou extraperitoneal, geralmente dióxido de carbono (CO2), para criar espaço para visualização e manobras cirúrgicas. A cirurgia robótica geralmente é realizada por laparoscopia e é mais comumente usada para cirurgia ginecológica e urológica, embora o uso esteja se expandindo em outras especialidades. As preocupações anestésicas para pacientes submetidos à cirurgia laparoscópica e robótica diferem daquelas para pacientes submetidos à cirurgia abdominal aberta.Eles incluem os efeitos fisiológicos do pneumoperitônio, absorção de CO2e posicionamento necessário para a cirurgia.Além disso, alguns procedimentos laparoscópicos/robóticos demoram mais do que a alternativa aberta. A laparoscopia requer a criação de um pneumoperitônio por insuflação de gás, geralmente dióxido de carbono (CO2), para abrir espaço no abdome para visualização e manipulação cirúrgica. more...

Distal pancreatectomy; Pancreatic cancer Pancreatectomia distal; Càncer de pàncrees Pancreatectomía distal; Cáncer de páncreas Background Robot-assisted distal pancreatectomy (RDP) is increasingly used as an alternative to laparoscopic distal pancreatectomy (LDP) in patients with resectable pancreatic cancer but comparative multicenter studies confirming the safety and efficacy of RDP are lacking. Methods An international, multicenter, retrospective, cohort study, including consecutive patients undergoing RDP and LDP for resectable pancreatic cancer in 33 experienced centers from 11 countries (2010–2019). The primary outcome was R0-resection. Secondary outcomes included lymph node yield, major complications, conversion rate, and overall survival. Results In total, 542 patients after minimally invasive distal pancreatectomy were included: 103 RDP (19%) and 439 LDP (81%). The R0-resection rate was comparable (75.7% RDP vs. 69.3% LDP, p = 0.404). RDP was associated with longer operative time (290 vs. 240 min, p < 0.001), more vascular resections (7.6% vs. 2.7%, p = 0.030), lower conversion rate (4.9% vs. 17.3%, p = 0.001), more major complications (26.2% vs. 16.3%, p = 0.019), improved lymph node yield (18 vs. 16, p = 0.021), and longer hospital stay (10 vs. 8 days, p = 0.001). The 90-day mortality (1.9% vs. 0.7%, p = 0.268) and overall survival (median 28 vs. 31 months, p = 0.599) did not differ significantly between RDP and LDP, respectively. Conclusions In selected patients with resectable pancreatic cancer, RDP and LDP provide a comparable R0-resection rate and overall survival in experienced centers. Although the lymph node yield and conversion rate appeared favorable after RDP, LDP was associated with shorter operating time, less major complications, and shorter hospital stay. The specific benefits associated with each approach should be confirmed by multicenter, randomized trials. more...

Study Objective We performed a long-term follow-up to quantify the impairment of sexual quality of life (SQL) and health-related QL (HRQL) in sexually active women after laparoscopic excision of deep infiltrating endometriosis (DIE). Design Prospective case-control study. Setting Hospital Clinic of Barcelona. Patients A total of 193 patients (after dropout and exclusions) were divided into 2 groups: one hundred twenty-nine premenopausal women with DIE (DIE group) and 64 healthy women who underwent tubal ligation (C group). Interventions All patients underwent laparoscopic surgery: laparoscopic endometriosis surgery in the DIE group and laparoscopic tubal ligation in the C group. All women were followed for at least 36 months, and they completed the Medical Outcomes Study 36-item short form questionnaire to assess their HRQL and 3 self-administered questionnaires that evaluate different aspects of SQL: the generic Sexual Quality of Life–Female questionnaire, the Female Sexual Distress Scale to evaluate “sexually related distress,” and the Brief Profile of Female Sexual Function to screen hypoactive sexual desire disorder. The patients with DIE as well as the controls completed the 4 questionnaires before surgery, and the patients with DIE also completed the questionnaires at 6 and 36 months after surgery. Measurements and Main Results A comparison of the patients and controls before surgery showed a statistically significant impairment in SQL and HRQL among the patients with DIE. A statistically significant improvement in SQL and HRQL was observed in the DIE group 6 months after surgery, with scores being similar to those of the C group. An evaluation 36 months after surgery showed that SQL and HRQL were better than presurgical SQL and HRQL in the DIE group, with a slight reduction compared with the 6-month evaluation. Conclusion SQL and HRQL improved in patients with DIE undergoing complete laparoscopic endometriosis resection and were comparable to those of healthy women at 6 months after surgery, showing a slight reduction at 36 months of follow-up. more...

Complications; Procedure video recording; Reintervention Complicaciones; Procedimiento de grabacion de video; Reintervención Complicacions; Procediment d'enregistrament de vídeo; Reintervenció Introduction: Recording every procedure could diminish the postoperative complication rates in bariatric surgery. The aim of our study was to evaluate the correlation between recording every bariatric surgery and their postoperative analysis in relation to the early or late postoperative complications. Methods: Seven hundred fifteen patients who underwent a bariatric procedure between January 2018 and December 2019 were included in a retrospective analysis. There were: 589 laparoscopic sleeve gastrectomies (LSGs); 110 Roux-en-Y bypasses (RYGBs) and 16 gastric bands (LAGBs). The video recording was systematically used, and all patients were enrolled in the IFSO registry. Results: There were 15 patients (2.1%) with surgical postoperative complications: 5 leaks, 8 hemorrhages and 2 stenosis. Most complications were consequent to LSG, except for two, which occurred after RYGB. In four cases a site of active bleeding was identified. After reviewing the video, in three cases the site was correlated with an event which occurred during the initial procedure. Three out of five cases of leak following sleeve were treated purely endoscopically, and no potential correlated mechanism was identified. Two other possible benefits were observed: a better evaluation of the gastric pouch for the treatment of the ulcer post bypass and the review of one per operative incident. Two negative diagnostic laparoscopies were performed. The benefit of the systematic video recording was singled out in eight cases. All the other cases were completed by laparoscopy with no conversion. Conclusion: To record every bariatric procedure could help in understanding the mechanism of certain complications, especially when the analysis is performed within the team. Still, recording the procedure did not prevent the negative diagnostic laparoscopy, but it could play a significant role for the medico-legal aspect in the future. more...

Cost-effectiveness; Laparoscopic surgery; Multicenter studies Rendibilitat; Cirurgia laparoscòpica; Estudis multicèntrics Rentabilidad; Cirugía laparoscópica; Estudios multicéntricos Background: The studies which address the impact of costs of robotic vs. laparoscopic approach on quality of life (cost-effectiveness studies) are scares in general surgery. Methods: The Spanish national study on cost-effectiveness differences among robotic and laparoscopic surgery (ROBOCOSTES) is designed as a prospective, multicentre, national, observational study. The aim is to determine in which procedures robotic surgery is more cost-effective than laparoscopic surgery. Several surgical operations and patient populations will be evaluated (distal pancreatectomy, gastrectomy, sleeve gastrectomy, inguinal hernioplasty, rectal resection for cancer, Heller cardiomiotomy and Nissen procedure). Discussion: The results of this study will demonstrate which treatment (laparoscopic or robotic) and in which population is more cost-effective. This study will also assess the impact of previous surgical experience on main outcomes. Project PI20/00008, funded by Instituto de Salud Carlos III (ISCIII) and co-funded by the European Union. more...

Resumen: Introducción: A pesar de que la evidencia actual respalda ampliamente el abordaje laparoscópico para las resecciones de colon y recto en función de su seguridad y resultados oncológicos, el desarrollo y adopción del mismo ha sido lento y aún hoy no es de rutina en la mayoría de los centros. Se presenta la experiencia inicial en la Clínica Quirúrgica 2 del Hospital Maciel. Métodos: Estudio retrospectivo que comprende 41 resecciones laparoscópicas en el período 2016-2018. Resultados: El tiempo operatorio medio fue de 3 h para las colectomías y 4 h para las resecciones de recto. El porcentaje de conversión fue de 10%, la falla de sutura del 12% y la mortalidad a 30 días del 13%. Discusión: El abordaje laparoscópico para la colectomía y resección de recto es seguro y con aceptables resultados oncológicos de acuerdo a nuestros resultados. La curva de aprendizaje se sustenta en el volumen anual de cirugías, la realización de otros procedimientos de laparoscopía avanzada y el entrenamiento en simuladores. Conclusiones: nuestra experiencia muestra resultados inmediatos similares a los reportados en la literatura nacional, aunque el tiempo seguimiento aún es insuficiente para analizar los resultados oncológicos a largo plazo. Abstract: Introduction: Although current evidence widely supports the laparoscopic approach for resections of the colon and rectum according to their safety and oncological results, the development and adoption of the same has been slow and even today is not routine in most centers. The initial experience is presented in the Surgical Clinic 2 of the Maciel Hospital. Methods: A retrospective study comprising 41 laparoscopic resections in the period 2016-2018. Results: The mean operative time was 3 hours for colectomies and 4 hours for rectal resections. The conversion rate was 10%, the suture failure was 12% and the 30-day mortality was 13%. Discussion: The laparoscopic approach for colectomy and rectal resection is safe and with acceptable oncological results according to our results. The learning curve is based on the annual volume of surgeries, the performance of other advanced laparoscopy procedures and training in simulators. Conclusions: our experience shows immediate results similar to those reported in the national literature, although the follow-up time is still in sufficient to analyze the long-termoncological results. Resumo: Introdução: Embora as evidências atuais apóiem amplamente a abordagem laparoscópica para ressecções do cólon e do reto de acordo com sua segurança e resultados ontológicos, o desenvolvimento e a adoção dos mesmos têm sido lentos e até hoje não é rotineiro na maioria dos casos os centros. A experiência inicial é apresentada na Clínica Cirúrgica 2 do Hospital Maciel. Métodos: Estudo retrospectivo com 41 ressecções laparoscópicas no período 2016-2018. Resultados: O tempo operatório médio foi de 3 horas para colectomias e 4 horas para ressecções retais. A taxa de conversão foi de 10%, a falha na sutura foi de 12% e a mortalidade em 30 dias foi de 13%. Discussão: A abordagem laparoscópica para a colectomia e ressecção retal é segura e com resultados ontológicos aceitáveis de acordo com nossos resultados. A curva de aprendizado é baseada no volume anual de cirurgias, no desempenho de outros procedimentos avançados de laparoscopia e no treinamento em simuladores. Conclusões: nossa experiência mostra resultados imediatos semelhantes aos relatados na literatura nacional, embora o tempo de seguimento ainda seja insuficiente para analisar os resultados ontológicos em longo prazo. more...

Introduction: the botulinum toxin A (BTA) has been used to achieve a chemical component separation, and it has been used with favorable outcomes for the repair of complex ventral hernia (CVH) with and without loss of domain (LD). The aim of this study is to describe our early experience with the chemical component separation in the United Sates. Methods: a retrospective observational study of all patients who underwent ventral hernia repair for CVH with or without LD between July 2018 and June 2020. Preoperative BTA was injected in all patients via sonographic guidance bilaterally, between the lateral muscles to achieve chemical denervation before the operation. Patient demographics, anatomical location of the hernia, perioperative data and postoperative data are described. Results: 36 patients underwent this technique before their hernia repair between July 2018 to June 2020. Median age was 62 years (range 30-87). Median preoperative defect size was 12cm (range 6-25) and median intraoperative defect size was 13cm (range 5-27). Median preoperative hernia sac volume (HSV) was 1338cc (128-14040), median preoperative abdominal cavity volume (ACV) was 8784cc (5197-18289) and median volume ration (HSV/ACV) was 14%. The median OR time for BTA administration was 45 minutes (range 28-495). Seroma was the most common postoperative complication in 8 of the patients (22%). Median follow up was 43 days (range 0-580). Conclusion: preoperative chemical component separation with BTA is a safe and effective adjunct to hernia repair in CVH repairs where a challenging midline fascial approximation is anticipated. RESUMO Introdução: a toxina botulínica A (TBA) tem sido usada para alcançar a separação química dos componentes, com resultados favoráveis para o reparo de hérnias ventrais complexas (HVC) com ou sem perda de domínio (PD). O objetivo deste estudo é descrever nossa experiência inicial com a separação química dos componentes nos Estados Unidos. Métodos: estudo retrospectivo observacional com todos os pacientes submetidos a reparo de hérnia ventral complexa com ou sem PD entre julho de 2018 e junho de 2020. A TBA pré-operatória foi injetada em todos os pacientes, guiada por ultrassonografia, bilateralmente entre os músculos laterais para alcançar a denervação química antes da operação. Dados demográficos dos pacientes, local da hérnia, dados peri-operatórios e pós-operatórios são descritos. Resultados: 36 pacientes foram submetidos a esta técnica antes do reparo da hérnia. A idade mediana foi 62 anos (30-87). O tamanho mediano pré-operatório do defeito herniário foi 12cm (6-25) e o defeito mediano intra-operatorio foi 13cm (5-27). O volume mediano do saco herniário pré-operatório foi 1.338mL (128-14.040), o volume mediano da cavidade abdominal pré-operatório foi 8.784 (5.197-18.289) mL e a razão dos volumes foi 14%. A duração mediana da operação para aplicação da TBA foi 45 minutos (28-495). O seroma foi a complicação mais comum no pós-operatório, em oito pacientes (22%). O seguimento pós-operatório mediano foi de 43 dias (0-580). Conclusão: a separação pré-operatória de componentes com TBA é tratamento adjuvante seguro e eficaz em reparos de HVC em que aproximação da fáscia é antecipadamente desafiadora. more...

Les lesions iatrogèniques de la via biliar són causades principalment durant una colecistectomia, una intervenció molt comuna a la nostra societat. Des de la introducció de la laparoscòpia a la dècada dels 80, aquesta tècnica ha esdevingut la tècnica gold standard. Però tot i els anys d' experiència, existeix una notable problemàtica en relació a la iatrogènia. La seva incidència, la detecció, la clínica, els criteris diagnòstics, el maneig terapèutic, la evolució i el pronòstic a llarg termini, fan que sigui un tema controvertit, objecte d'estudi en aquest treball. Las lesiones iatrogénicas de la vía biliar son producidas en su mayoría tras una colecistectomía, una intervención muy común en nuestra sociedad.Desde la introducción de la laparoscopia en la década de los 80, esta técnica se ha erigido como la gold standard. No obstante, existe una notable problemática en relación con las lesiones iatrogénicas. Su incidencia, detección, clínica, criterio y sistemática en el diagnóstico, manejo terapéutico, evolución y pronóstico a largo plazo continúa siendo un tema controvertido, objeto de estudio en este trabajo. more...

Donat l'increment en l'esperança de vida, valorem el tractament radical del càncer de pròstata en pacients > 70 anys. L'objectiu és analitzar la incidència, severitat i maneig de la morbiditat perioperatòria de la prostatectomia radical (PR) en funció de la tècnica quirúrgica. De 500 PR revisem, retrospectivament, 70 pacients > 70 anys (40 Retropúbiques i 30 Laparoscòpiques). S'empra la classificació de Clavien modificada per analitzar les complicacions. La proporció de complicacions és en PRR 57,5% i en PRL 33%. Les complicacions en la PRL són de menor gravetat. Els beneficis atribuïts a la laparoscòpia es mantenen en pacients d'edat avançada. more...

Background Trocar site incisional hernia (TSIH) is the most frequent complication associated with laparoscopic surgery. Few studies currently describe its incidence or risk factors. The aim of this report is to determine the real incidence of TSIH and to identify risk factors. Methods A cross-sectional prospective study was performed including consecutive patients who underwent a laparoscopic procedure during a 4 months period. All the patients were assessed both clinically (TSIHc) and by an ultrasonographic examination (TSIHu). The main variable studied was the incidence of TSIH. A multivariate analysis was performed to identify risk factors. Results 76 patients were included. 27.6% of patients were clinically diagnosed as having TSIH (TSIHc) but only 23.7% of those cases were radiologically confirmed (TSIHu). In the logistic regression analysis, age > 70 years (OR 3.462 CI 1.14–10.515, p = 0.028) and body mass index (BMI) ≥ 30 kg/m2 (OR 3.313 CI 1.037–10.588, p = 0.043) were identified as risk factors for TSIH. The size of the trocar also showed statistically significant differences (p Conclusions TSIH is under-diagnosed due to the lack of related symptomatology and the inadequacy of the postoperative follow-up period. We detected discrepancies between the clinical and ultrasonographic examinations. TSIHu should be considered as the gold standard for the diagnosis of TSIH. Risk factors such as age, BMI and size of the trocar were confirmed. Patients should be followed-up for a minimum of 2 years. Trial registration The study has been retrospectively registered in Clinicaltrials.gov on June 4, 2020 under registration number: NCT04410744 more...

For years, robotic laparoscopic surgery has motivated research and initiatives with the development of robotic systems offering different kind of solutions, being Bitrack a new option. At present the market is dominated by DaVinci, which has become a benchmark in this speciality. Laparoscopic robots offer precision and accessibility since their instruments are endowed with 3 DoF, for their orientation, which are missing in standard laparoscopy. This paper presents the Bitrack system, which is a new laparoscopic surgical robot, designed at UPC, and currently undergoing the process of certification by a spin-off created for its exploitation, RSS. This new robot aims to obtain the same benefits and accuracy as the current benchmark but overcoming some dependencies that current robotic surgery poses. Many reports on studies that evaluate the contribution of robotics do not doubt on the improvements achieved with the use of robots in what refers to surgical quality and that more complex surgeries can be addressed than those performed by laparoscopy [1, 2]. The Bitrack system apart from these clear contributions of robotics also provides the concept of hybrid surgery. This concept implies the capability of performing an intervention alternating standard laparoscopy with other robot assisted phases according to the needs in each stage of the procedure. This performance has been achieved thanks to the Bitrack friendly design which allows a quick interchange of robotized instruments by their manual counterparts, less than a minute each, using the same conventional trocar. This paper presents the robot architecture and the experimental results achieved with the operational prototype. more...

For more than a century, conventional (open) appendectomy was the only standard treatment for appendicitis. However, the videolaparoscopic approach (VLP), a contemporary and more sophisticated technique, has revolutionized the management of this pathology. Objective: this study aims to carry out a descriptive and cross-sectional analysis of hospital admissions for conventional and laparoscopic appendectomy performed by SUS in Brazil. Methods: this is a descriptive and cross-sectional study, carried out through the analysis of secondary data, from the Hospital Information System (SIH), on appendectomies (conventional and laparoscopic) that occurred in the Unified Health System (SUS), in the Brazil, from 2009 to 2018. Results: videolaparoscopic surgery showed a lower number of deaths from procedures, a lower mortality rate and a higher cost per hospitalization, compared to conventional surgery. The average length of days of hospital stay had no statistically significant difference between the techniques. In addition, for both techniques (either open or VLP), the data suggest an increasing increase in the total number and average value of hospitalization. As for the temporal evolution, for both techniques, the numbers suggest a decreasing rate for the average hospital stay and the mortality rate. Final considerations: video appendectomy at SUS presented more assistance and financial advantages, suggesting that funding policies and incentives to expand the realization of this method be created, compared to the open method. Por mais de um século, a apendicectomia convencional (aberta) foi o único tratamento padrão para apendicite. Entretanto, a abordagem videolaparoscópica (VLP), técnica contemporânea e mais sofisticada, revolucionou o manejo desta patologia. Objetivo: este estudo tem por objetivo realizar uma análise descritiva e transversal sobre as internações hospitalares por apendicectomia convencional e videolaparoscópica realizadas pelo SUS no Brasil. Métodos: trata-se de um estudo descritivo e transversal, realizado por meio da análise de dados secundários, oriundo do Sistema de Informações Hospitalares (SIH), sobre as apendicectomias (convencional e videolaparoscópica) ocorridas no Sistema Único de Saúde (SUS), no Brasil, no período de 2009 a 2018. Resultados: a cirurgia videolaparoscópia apresentou menor número de óbitos por procedimentos, menor taxa de mortalidade e maior custo por internação, em relação a cirurgia convencional. O tempo médio de dias de permanência hospitalar não teve diferença estatisticamente significamente entre as técnicas. Além disso, para ambas as técnicas (seja aberta ou VLP), os dados sugerem um crescente aumento no número total e valor médio de internação. Quanto à evolução temporal, para ambas as técnicas, os números sugerem uma taxa decrescente para o tempo médio de internação e a taxa de mortalidade. Considerações finais: a apendicectomia por vídeo no SUS apresentou mais vantagens assistenciais e financeiras, sugerindo-se que criem-se políticas de financiamento e estímulo para ampliação da realização deste método, frente ao método aberto. more...

Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina Introduction: Hepatocellular carcinoma (HCC) is one of the most common neoplasms in the world and 3rd cause of cancer related death. Hepatic resection, termodestruction and hepatic transplant are the only real therapeutics with curative intent, particularly when it concerns to tumours with 2cm or more. Organ transplant is obtained by paying the price of a higher risk of per-operative morbidity and a necessity of a lifetime immunosuppression, which allows tumoral resection and sick organ replacement. This option relays on the availability of a viable donor organ, which must be immunologically compatible. Resection surgery presents itself with a higher recurrence rate, but lower short-term morbimortality. However, it can still allow a worsening rise in hepatocellular disfunction. Therefore, looking for a reduced surgical aggression, we have been observing a rise in the use of the laparoscopic liver resection (LLR) in HCC, with advantages in short-term outcomes. Nevertheless, there is still the need to evaluate the extension of its long-term clinical and oncologic outcomes.Objectives: Using a propensity score matching (PSM), we are set to compare the peri-operative outcomes such as surgical complications, morbimortality, disease-free survival and global survival between the two groups of patients, operated by laparoscopy and via open surgery, in patients who were submitted to hepatectomy due to HCC.Methods and materials: For this study we took advantage of the patient pool from our general surgery department of Centro Hospitalar e Universitário de Coimbra (CHUC) since January 1990 until December 2019. Consequently, we selected the cases of minor hepatic resection which we separated in two groups: group 1 – patients submitted to LLR and group 2 – patients submitted to open liver resection (OLR). Propensity scores (PSs) were calculated for both, based on their demographic and clinical data, which we than run through a PSM, concluding in 30 patients in the LLR group and 101 in the OLR one. The morbidity and mortality were defined using the Dindo-Clavien classification, as for the post-hepatectomy liver failure, it was defined accordingly with the International Study Group of Liver Surgery (ISGLS). Overall survival and disease-free survival were analysed through the Kaplan-Meier and log rank methods.Results: After the PSM, in what concerns to the pre-operative characteristics, groups were well matched across the different demographic and clinical data.Relatively to the comparison between de two surgical procedures, we underline important lower transfusion values for the laparoscopic group (P more...

Objective To analyze the applicability and efficiency of amulti-approach laparoscopic training in improving basic laparoscopic skills of obstetrics and gynecology (OBGYN) residents. Methods Cross-sectional, observational and descriptive study, developed at the Experimentation and Surgery Training Center (CETEC, in the Portuguese acronym) of the Hospital Israelita Albert Einstein with OBGYN residents. Theoretical and practical tests were applied to 24 OBGYN residents to assess their laparoscopic skills before and after their participation in an 8-week course. The course involved theoretical lectures and practical laparoscopic surgery exercises developed using rubber models, black boxes, virtual simulators and animal models (pigs). Results There was an overall improvement in the ability of the residents, with an increase in the number of correct answers in the theoretical evaluation and decrease in the time needed to perform practical tests (needle holder assembly and laparoscopic node). The course was evaluated by the students as highly relevant for both improving their surgical skills and motivating them to continue practicing. Conclusion Laparoscopic training using multiple approaches resulted in significant improvement of surgical skills with a high satisfaction level of the participants. Further studies are still needed to measure the long-term retention of these acquired skills. Resumo Objetivo Analisar a aplicabilidade e eficiência de um treinamento em laparoscopia com múltiplas abordagens, em melhorar as habilidades laparoscópicas básicas de residentes de ginecologia e obstetrícia (GO). Métodos Estudo transversal, observacional e descritivo, desenvolvido no Centro de Treinamento em Experimentação e Cirurgia (CETEC) do Instituto de Pesquisa do Hospital Albert Einstein com residentes de GO. Foram aplicadas avaliações teóricas e práticas a 24 residentes de GO com o objetivo de avaliar suas habilidades laparoscópicas antes e após sua participação em um curso de 8 semanas. O curso envolveu palestras teóricas e exercícios práticos de cirurgia laparoscópica através de modelos de borracha, caixas pretas, simuladores virtuais e modelos animais (porcos). Resultados Houve uma melhora geral na habilidade dos residentes, comaumento do número de respostas corretas na avaliação teórica e diminuição do tempo na execução dos testes práticos (montagem do porta-agulha e realização de nó laparoscópico). O curso foi avaliado pelos alunos como altamente relevante por melhorar suas habilidades cirúrgicas e motivá-los a continuar praticando. Conclusão O treinamento laparoscópico utilizando múltiplas abordagens resultou em melhora significativa das habilidades cirúrgicas atrelado a alto nível de satisfação dos participantes. Novos estudos ainda são necessários para mensurar a retenção destas habilidades adquiridas a longo prazo. more...

Background: Median arcuate ligament syndrome(MALS) is a rare condition thatmay cause significant clinical manifestations, including abdominal pain and weight loss. Its diagnosis may be difficult and very often delayed. The laparoscopic approach became the standard treatment of MALS. Aim: To assess the outcome of laparoscopic treatment in patients with MALS. Method: The data of sixpatients with MALS who were subjected to laparoscopic sectioning of the median arcuate ligament were retrospectively reviewed.The following data were evaluated: age, gender, clinical and diagnostic tests findings, ASA score, operative findings and complications, postoperative complications and mortality, hospital stay duration, and hospital readmission.The diagnosis of MALS was established by CT angiography and/or MR angiography. Results: There were four (66.7%) women and two (33.3%) men aged from 32 to 60 years. The main symptoms were epigastric pain (100%) and weight loss (66.7%). The findings of high-grade stenosis of the proximal celiac axis and poststenotic dilation confirmed on angiography confirmed the diagnosis in all patients. Surgical procedure was uneventful in all patients. The only postoperative complication was urinary retention that occurred in a male. At three-month follow-up, all patients were asymptomatic. Conclusion: Laparoscopic treatment of MALS is safe and effective in relieving the clinical manifestations of patients., Graphical Abstract more...

SARAS aims to develop assistive surgical robots for laparoscopic MIS, autonomously operating in the same workspace of either a teleoperated surgical robot or a manually driven surgical tool. The auxiliary robots autonomously decide which task perform to assist the main surgeon, planning motions for executing the task considering the dynamics of human driven tools and patient's organs (predictable only within a short time horizon). This paper proposes a control architecture for surgical robotic assistive tasks in MIS using a hierarchical multi-level Finite State Machine (hFSM) as the cognitive control and a two-layered motion planner for the execution of the task. The hFSM models the operation starting from atomic actions to progressively build up more complex levels. The two-layer architecture of the motion planner merges the benefits of an offline geometric path construction method with those of online trajectory reconfiguration and reactive adaptation. more...

Robotizing laparoscopic surgery not only allows achieving better accuracy to operate when a scale factor is applied between master and slave or thanks to the use of tools with 3 DoF, which cannot be used in conventional manual surgery, but also due to additional informatic support. Relying on computer assistance different strategies that facilitate the task of the surgeon can be incorporated, either in the form of autonomous navigation or cooperative guidance, providing sensory or visual feedback, or introducing certain limitations of movements. This paper describes different ways of assistance aimed at improving the work capacity of the surgeon and achieving more safety for the patient, and the results obtained with the prototype developed at UPC. more...

Hoy en día es posible realizar una intervención quirúrgica laparoscópica con solo una incisión en el ombligo, por la que se insertan todos los instrumentos quirúrgicos. Estas nuevas técnicas conllevan complicaciones relacionadas con la triangulación del instrumental, dónde la solución pasa por el uso del magnetismo; proponiendo así una gran innovación en el campo de la medicina. El objetivo de este proyecto es diseñar, desarrollar y evaluar varios modelos de pinzas laparoscópicas magnéticas para pediatría. Se propone diseñar unas pinzas con un imán interno en la parte posterior, que será atraído por un imán externo más grande sobre la pared abdominal, permitiendo así el movimiento de la pinza con el tejido sujetado, en diferentes direcciones, sin necesidad de ocupar tanto volumen de campo quirúrgico. Para ello se han estudiado nuevas estructuras, mecanismos, materiales, y diferentes métodos de fabricación. Todos los modelos han sido fabricados y ensayados experimentalmente, simulando el proceso de una intervención quirúrgica de colecistectomía (extracción de la vesícula biliar), con buenos resultados. Finalmente, se detalla la propuesta de diseño con mejores prestaciones, que se fabricará en plástico polieteretercetona (PEEK) y de acuerdo con la normativa vigente. Como conclusión, en este proyecto se ha propuesto un diseño funcional de unas pinzas laparoscópicas, se ha validado su viabilidad técnica, se han detallado los diferentes pasos a seguir para su comercialización, y se han proporcionado evaluaciones económicas sobre la viabilidad del producto final. more...

Routine adoption of laparoscopy in clinical practice and Medical Residency has not been widely evaluated in Brazil so far. Aim: To take an overview on the adoption and limitations concerning the use of laparoscopic techniques among Brazilian colorectal surgeons. Methods: A questionnaire was sent to 1870 SBCP filiated members, containing personal and professional data such as sex, age, length and local of practice, SBCP filliation, number of procedures, treatment of cancer and laparoscopy limitations. Results: 418 members (22.4%) sent their response (80% men and 20% women). 110 members (26.3%) affirmed they don’t perform any laparoscopic procedure, while 308 (73.7%) have already adopted laparoscopy as a routine. An average number of 7.6 laparoscopic colorectal procedures were declared to be performed per month (1 to 40 procedures). Laparoscopic adoption rates were favourably influenced by young age members (46% vs. 28%) and affiliation to University hospitals (p = 0.01). Conversely, surgeons from private clinic showed a greater tendency of no adoption. Among the 308 responders, 106 (34.4%) have already surpassed more than 100 laparoscopic cases, and 167 (54.2%) reported an experience of more than 50 operated patients. The group of surgeons not using minimally invasive techniques incriminated lack of training (73.6%) and laparoscopic instruments availability (27.3%) as the main reasons for no adoption. Conclusions: Adoption rate of laparoscopic techniques to treat colorectal diseases is still low (at least 17%). Future efforts should focus on providing supervised training, proctorship during the initial experience and help instrumental acquisition in centers willing to change their routine and perspectives. Resumo: Durante as últimas décadas, a incorporação de técnicas minimamente invasivas no tratamento de doenças colorretais testemunhou um progresso lento e firme, principalmente após o reconhecimento da segurança oncológica e melhor evolução. A adoção rotineira na prática clínica e na Residência Médica no Brasil ainda não amplamente avaliada até agora. Objetivos: O presente estudo visou avaliar a adoção e as limitações relativas ao uso de técnicas laparoscópicas entre cirurgiões colorretais brasileiros. Métodos: um questionário foi enviado a 1870 membros filiados à Sociedade Brasileira de Coloproctologia (SBCP) em 2006. As questões foram enviadas por email, incluindo dados pessoais (sexo, idade) e profissionais (tempo e local de prática, filiação à SBCP, número mensal de procedimentos laparoscópicos, tratamento de câncer e limitações para realizar laparoscopia na rotina. Resultados: Entre os 1870 membros, 418 (22.4%) mandaram sua resposta, com uma maior participaçãoo de homens (80%) em comparação às mulheres (20%). A idade média foi de 43 (28–80) anos. A distribuição entre membros titulares e não titulares foi semelhantes (48% vs. 52%). As atividades profissionais foram desenvolvidas em clínica privada (84%), hospitais privados (73%), hospitais públicos (50%) e hospitais universitários (53%). Entre os que responderam (418), 110 (26.3%) não realizavam procedimentos laparoscópicos, enquanto 308 (73.7%) já haviam adotado o acesso laparoscópico rotineiramente na prática clínica. Um número médio de 7.6 procedimentos colorretais laparoscópicos são realizados por mês (1–40). Cerca de 13% dos cirurgiões iniciaram sua experiência laparoscópica diretamente com procedimentos colorretais, enquanto a maioria (87%) começaram por outros procedimentos no trato digestivo. A adoção da laparoscopia foi positivamente influenciada pela idade jovem dos membros (46% vs. 28%) e pela filiação a hospitais universitários (p = 0,01). Inversamente, cirurgiões trabalhando na prática privada demonstraram uma menor tendência em adotar o método. A maioria dos cirurgiões (93%) que adoraram a laparoscopia afirmou incluir pacientes com câncer colorretal em suas indicações operatórias. Entre os que responderam 106 (34,4%) já realizaram mais de 100 procedimentos laparoscópicos, e 167 (54,2%) reportaram experiência maior que 50 casos. Dentre aqueles que não adotaram técnicas minimamente invasivas, a falta de treinamento (73,6%) ou a indisponibilidade de instrumental laparoscópico (27,3%) foram incriminadas como os principais fatores limitantes. Conclusões: o índice de adoção de técnicas laparoscópicas no tratamento de doenças intestinais ainda é baixo (pelo menos 17%) entre cirurgiões colorretais brasileiros. Esforços futuros de nossa Sociedade Médica devem focar na provisão de treinamento supervisionado, na criação de oportunidades para preceptoria durante a experiência inicial e na obtenção de instrumental em centros que queiram mudar sua rotina e perspectivas. Keywords: Laparoscopy, Laparoscopic surgery, Adoption, Colorectal surgery, Training, Palavras-chave: Laparoscopia, Cirurgia laparoscópica, Adoção, Cirurgia colorretal, Treinamento more...

Ferreira G.S., Franco C.A.D., Santos C.L., Atallah F.A., Estupnañ O.F.T., Silva S.J.Q. & Oliveira A.L.A. [Laparoscopic ovariectomy in dogs and cats]. Ovariectomia laparoscópica em cadelas e gatas. Revista Brasileira de Medicina Veterinária, 35(Supl. 1):55-60, 2013. Curso de Pós-Graduação em Ciência Animal, Universidade Estadual do Norte Fluminense Darcy Ribeiro, Av. Alberto Lamego, 2000, Parque Califórnia, Campos dos Goytacazes, RJ 28013-602, Brasil. E-mail: gigisanfer@gmail.com Ovariosalpingohisterectomy (OSH) and ovariectomy (OVE) consist of effective contraceptive methods used in dogs and cats. The minimally invasive surgical techniques (TCMI) are used by veterinary professionals with the goal of Minimar the postoperative complications. The aim of this study was the evaluation of complications during the peri-and post-operative dogs and cats undergoing ovariectomy (OVE) by laparoscopy using monopolar electrosurgery system, as well as compare the surgical time obtained after the procedure in both species. Were operated 6 bitches and 6 cats, No Restriction Race (SRR), through the technique for laparoscopic ovariectomy. After inspection of the cavity with the laparoscope was performed to identify and hold the right ovary, the same being pulled allowing hemostasis using monopolar electrocautery for coagulation complex ovarian arterial (CAVO) and ligaments own suspensory ligament of the ovary, then sectioned with scissors. The same procedure was performed in the left ovary. There were no intraoperative complications that culminate with the conversion from laparoscopy to laparotomy, in any of the operated animals. The mean operative time of six dogs was operated 50min07s ± 16min2s and cats of 25min33s ± 7min01s. Among the postoperative complications occurred, a dog developed subcutaneous emphysema and other moderate bitch presented seroma in two portals. We conclude that the technique of laparoscopic ovariectomy using monopolar electrosurgery, provides satisfactory results with low morbidity. The mean operative time of operated cats was lower than the bitches. The postoperative complications were minimal, occurring only in bitches., Ovariosalpingohisterectomia (OSH) e ovariectomia (OVE) consistem em métodos contraceptivos eficientes utilizados em cadelas e gatas. As técnicas cirúrgicas minimamente invasivas (TCMI) são utilizadas por profissionais veterinários com o objetivo de minimar as complicações pós-operatórias. O objetivo deste trabalho consistiu da avaliação das complicações ocorridas durante o período trans e pós-operatório de cadelas e gatas submetidas a ovariectomia (OVE) por meio da laparoscopia utilizando eletrocirurgia no sistema monopolar, assim como comparar o tempo cirúrgico obtido após realização do procedimento em ambas as espécies. Foram operados 6 cadelas e 6 gatas, Sem Restrição a Raça (SRR), através da técnica laparoscópica para a ovariectomia. Após a inspeção da cavidade com o laparoscópio foi realizada a identificação e preensão do ovário direito, sendo o mesmo tracionado permitindo a hemostasia utilizando eletrocautério monopolar para coagulação do complexo arteriovenoso ovariano (CAVO) e dos ligamentos próprio e ligamento suspensório do ová- rio, em seguida seccionados com tesoura. O mesmo procedimento foi realizado no ovário esquerdo. Não houveram intercorrências intra-operatórias que culminassem com a conversão da videolaparoscopia para laparotomia, em nenhum dos animais operados. O tempo cirúrgico médio das seis cadelas operadas foi de 50min07s±16min2s e das gatas de 25min33s±7min01s. Dentre as complicações pós operatórias ocorridas, uma cadela desenvolveu enfisema subcutâneo moderado e outra cadela apresentou seroma em dois portais. Conclui-se que a realização da técnica de ovariectomia por laparoscopia, utilizando eletrocirurgia monopolar, apresenta resultados satisfatórios, com baixa morbidade. O tempo cirúrgico médio das gatas operadas foi menor do que o das cadelas. As complicações pós-operatórias foram mínimas, ocorrendo apenas nas cadelas. more...