Robotic surgery has been used for a long time; it is earning space and its use is expanding in daily medical practice in several surgical specialties, with advantages over traditional surgical methods. This Technical Note presents an endoscopic robotic posterior shoulder approach that allows the surgeon to perform latissimus dorsi transfer endoscopically. This Technical Note describes the use of the da Vinci robot (Intuitive Surgical, Sunnyvale, CA) for transfers related to rotator cuff tears.
Robotic surgery has been used for a long time. With advantages over traditional surgical methods, it is earning space and expanding use to daily medical practice in several surgical specialties. This Technical Note presents an endoscopic robotic posterior shoulder approach using the DaVinci® robot. It can allow the surgeon to perform latissimus dorsi transfer endoscopically and associate it with levator scapulae and rhomboid minor mini-open transfers to treat accessory nerve lesions with trapezium muscle palsy. This technique is an alternative to Eden-Lange and triple-tendon transfer.
DESCRITORES -Cirurgia bariátrica.Obesidade mórbida. Diabetes mellitus. Derivação gástrica.RESUMO -Introdução -O diabetes mellitus tipo 2 (DMT2) é uma das maiores causas de morte no mundo devido a sua relação direta com as doenças cardiovasculares. Apesar dos avanços da terapêutica, a maioria dos pacientes nunca atinge os objetivos terapêuticos necessários para prevenção de suas complicações. A cirurgia metabólica abre um campo para novas perspectivas no controle desta doença. Objetivos -Descrever o tratamento cirúrgico de pacientes portadores de diabetes mellitus tipo 2, e os resultados encontrados após os procedimentos, além de discutir os mecanismos das alterações metabólicas encontradas no pós-operatório destes pacientes. ABSTRACT -Introduction -Type 2 diabetes mellitus ( T2DM), is the major cause of mortality worldwide, mainly secondary to cardiovascular events. In spite of the recent advances in the medical treatment, an expressive number of patients remain uncontrolled. Metabolic surgery may open new frontiers to control this devastating disease. Aim -To describe the surgical alternatives to treat surgically T2DM patients, including some proposed mechanisms of action that are behind the metabolic improvement. Methods -PubMed and Lilacs database were searched according to the following keywords: bariatric surgery, morbid obesity, diabetes mellitus, gastric bypass. Results -Some conventional procedures over the gastrointestinal tract have an important effect on T2DM control, without a direct effect of weight loss. Some studies report that rearranging the gastrointestinal tract anatomy is the key factor that lead to that beneficial metabolic effect of surgery. All bariatric operations lead to T2DM improvement, but with distinct mechanisms underlying that effect. Conclusion -There is a trend to stimulate research in this new exciting field. Randomized controlled trials are demanded, comparing surgical versus the best medical treatment of T2DM. After those results, the exact role of gastrointestinal tract surgery will be defined and its benefit over medical treatment as well. INTRODUÇÃOO diabetes mellitus tipo 2 (DMT2) é uma das maiores causas de morte no mundo devido à sua relação direta com as doenças cardiovasculares, cerebrovasculares e insuficiência renal. Além disso, é responsável por um grande número de complicações como a cegueira, as amputações, a disfunção erétil, a diarréia e a gastroparesia8. O tratamento clínico para essa doença avançou consideravelmente, mas continua deixando a maioria dos pacientes susceptíveis às suas graves complicações.
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