Navegando por Palavras-chave "Minimally invasive surgery"

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    Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review
    (Springer, 2009-07-01) Azevedo, Joao Luiz Moreira Coutinho [UNIFESP]; Azevedo, Otavio Cansancao [UNIFESP]; Miyahira, Susana Abe [UNIFESP]; Miguel, Gustavo Peixoto Soares [UNIFESP]; Becker, Otavio Monteiro [UNIFESP]; Hypolito, Octavio Henrique Mendes [UNIFESP]; Machado, Afonso Cesar Cabral Guedes [UNIFESP]; Cardia, Wellington [UNIFESP]; Aguiar-Yamaguchi, Gilmara Silva [UNIFESP]; Godinho, Lola [UNIFESP]; Almeida, Carlos Eduardo Saldanha [UNIFESP]; Moreira, Camila Hobi [UNIFESP]; Freire, Dalmer Faria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background the aim of this study was to assess the prevalence, risks, and outcomes of injuries caused by the Veress needle described in the literature.Methods Iatrogenic injuries caused by Veress needle insertion during diagnostic or therapeutic laparoscopies in humans were researched, with no language restriction, in the Medline, Lilacs, Embase, Scielo, and Cochrane Library databases. the following words were combined: Veress'' or insufflation needle'' or pneumoperitoneum needle,'' and complications'' or injuries'' or lesions.'' the bibliographic references of the selected articles were also analyzed. We considered the following: (1) number of injuries described in the literature, (2) relationship between number of injuries and number of patients who underwent Veress needle insertion in the studies that reported Veress needle injury, (3) organs and structures injured (retroperitoneal vessels, digestive tract, and self-limited, minor injuries), and (4) outcome (death, conversion to laparotomy, laparoscopic repair, spontaneous resolution).Results Thirty-eight selected articles included 696,502 laparoscopies, with 1,575 injuries (0.23%), 126 (8%) of which involved blood vessels or hollow viscera (0.018% of all laparoscopies). of the 98 vascular injuries, 8 (8.1%) were injuries to major retroperitoneal vessels. There were 34 other reported retroperitoneal injuries, but the authors were not specific as to which vessel was injured. of the 28 injuries to hollow viscera, 17 were considered major injuries, i.e., 60.7% (0.0024% of the total cases assessed).Conclusion the insertion of the Veress needle in the abdominal midline, at the umbilicus, poses serious risk to the life of patients. Therefore, further studies should be conducted to investigate alternative sites for Veress needle insertion.
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    Robot-assisted ureteral reconstruction using a tubularized peritoneal flap: a novel technique in a chronic porcine model
    (Springer, 2017) Brandao, Luis Felipe [UNIFESP]; Laydner, Humberto; Akca, Oktay; Autorino, Riccardo; Zargar, Homayoun; De, Shubha; Krishnam, Jayram; Pallavi, Patil; Monga, Manoj; Stein, Robert J.; Magi-Galluzzi, Cristina; Andreoni, Cassio [UNIFESP]; Kaouk, Jihad H.
    To evaluate the feasibility and functional outcomes in porcine models of a novel robotic surgical technique for the treatment of complex ureteral injuries and strictures. Six pigs underwent robotic ureteral reconstruction using a long tabularized peritoneal flap and followed for 6-9 weeks after the surgery. Ureteral flap vascularity, intra-renal pressure, patency of the conduct, endoscopic aspect of the flap, renal function and histopathology were evaluated. All animals successfully underwent ureteral reconstruction using a tubularized peritoneal flap. Median operative time was 223 min (162-360). Flap tubularization suture took 31 min (19-47), and proximal anastomosis took 20 min (15-38). Bladder mobilization with psoas hitch and distal anastomosis took 9 min (7-12) and 23 min (13-46), respectively. On follow-up, significant shrinkage of the ureteral flap in both length and width was observed. Antegrade pyelograms confirmed dilation and tortuosity of the proximal ureter, dilation of the renal pelvis, and major and minor calyxes without any definitive strictures. Microscopically, focal urothelial lining was seen in the neoureter. Creatinine level was significantly higher at the end of the follow-up period (p = 0.003). Robot-assisted ureteral reconstruction using a tubularized peritoneum flap is technically feasible and reproducible. The flap sustained abundant vascular supply after different intervals of follow-up and the peritoneal mesenchymal cells differentiated into urothelium and myofibroblasts. Further studies are needed to address the issue of functional obstruction to improve long-term renal function outcomes.