IntroductionDespite dating more than 30 years after the first laparoscopic appendectomy,
ileocecal appendix resection is still performed by laparotomy in more than 90% of
cases, in our country.AimTo describe a technique for laparoscopic removal of the ileocecal appendix with
three portals, at low cost and very good aesthetic appearance.TechniqueThree incisions, one umbilical and two suprapubic are made; permanent material
used comprises: grasping forceps, hook, scissors, needle holders, three metal
trocars and four other usual instruments, and a single strand of cotton. There is
no need to use of operative extractors bags, clips, endoloops, staples or bipolar
or harmonic energy instruments. Allows triangulation and instrumentation in the
conventional manner.ConclusionThe proposed technique is safe and reproducible, easily teachable, at very low
cost and can be applied in general hospitals with conventional laparoscopic
equipment.
-Background -Mechanical lifting of the abdominal wall, a method based on traction and consequent elevation of the abdominal wall, is an alternative procedure to create enough intra-abdominal space necessary for videolaparoscopic
Traumatic diaphragmatic hernia is rare, but is of utmost importance due to its high morbidity and mortality. It is markedly important in patients with blunt abdominal trauma, and diagnosis is difficult because of the numerous associated injuries. A patient with few symptoms of chronic traumatic diaphragmatic hernia is described, who underwent surgery due to a gastric volvulus. Laparoscopic surgery permits repair of these injuries through an abdominal approach, avoiding a thoracic incision or selective intubation.
-Background: Currently, bariatric surgery is the most effective therapy for morbid obesity, and the laparoscopic approach is considered gold-standard for Rouxen-Y gastric bypass. Totally robotic Roux-en-Y gastric bypass has been proposed as a major evolution in minimally invasive bariatric surgery and its use is becoming more widespread. Aim: To provide an early report of the first Brazilian case-series of totally robotic gastric bypass and perioperative short-term outcomes. There was no mortality, leak or stricture. Conclusion: Even with surgeons in early learning curves, the robotic approach within a well-structured training model was safe and reproducible for the surgical treatment of the morbid obesity.
RESUMO -Racional:Atualmente a cirurgia bariátrica é o tratamento mais eficaz para a obesidade mórbida. Embora ainda tenha algumas dificuldades, a abordagem laparoscópica tem-se tornando o padrão-ouro para o by-pass gástrico em Y-deRoux. O uso da robótica representa grande evolução no campo da cirurgia bariátrica minimamente invasiva e seu uso tem sido cada vez mais difundido. Objetivo: Relatar a primeira experiência brasileira em cirurgia bariátrica totalmente robótica. Métodos: Foram avaliados todos os pacientes submetidos à cirurgia bariátrica totalmente robótica em dois centros de excelência em cirurgia bariátrica. Foram registrados a incidência demográfica, índice de massa corporal, tempos operatórios, duração da internação hospitalar, mortalidade e todas as complicações em até 30 dias. As equipes cirúrgicas receberam treinamento específico para aprendizagem da técnica robótica e todos os procedimentos foram feitos com supervisão. Resultados: O procedimento foi realizado por cinco equipes cirúrgicas em 68 pacientes (52 mulheres -76,5%), com idade média de 40,5 anos e IMC médio de 41,3. O tempo médio operatório total foi de 158 minutos e a média de permanência hospitalar foi de 48 h. O percentual de complicações perioperatórias foi de 5,9%. Não houve mortalidade, fístulas ou estenoses. Conclusão: Mesmo com cirurgiões em período inicial da curva de aprendizagem, o by-pass gástrico por abordagem totalmente robótica é opção técnica segura e reproduzível no tratamento cirúrgico da obesidade mórbida, desde que respeitado modelo de treinamento bem estruturado.
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