RESUMEN

BACKGROUND: The aim of this work is to present the face, content, and construct validation of the virtual immersive operating room simulator (VIORS) for procedural training of surgeons' laparoscopic psychomotor skills and evaluate the immersive training experience. METHODS: The VIORS simulator consists of an HMD Oculus Rift 2016 with a visor on a 1080 × 1200 pixel OLED screen, two positioning sensors with two adapted controls to simulate laparoscopic instruments, and an acrylic base to simulate the conventional laparoscopic setup. The immersion consists of a 360° virtual operating room environment, based on the EndoSuite at Hospital Infantil de Mexico Federico Gomez, which reproduces a configuration of equipment, instruments, and common distractions in the operating room during a laparoscopic cholecystectomy procedure. Forty-five surgeons, residents, and medicine students participated in this study: 27 novices, 13 intermediates, and 5 experts. They completed a questionnaire on the realism and operating room immersion, as well as their capabilities for laparoscopic procedural training, scored in the 5-point Likert scale. The data of instrument movement were recorded and analyzed using 13 movement analysis parameters (MAPs). The experience during training with VIORS was evaluated through NASA-TLX. RESULTS: The participants were enthusiastic about the immersion and sensation levels of the VIORS simulator, with positive scores on the realism and its capabilities for procedural training using VIORS. The results proved that the VIORS simulator was able to differentiate between surgeons with different skill levels. Statistically significant differences were found in nine MAPs, demonstrating their construct validity for the objective assessment of the procedural laparoscopic performance. At cognitive level, the inversion experience proves a moderate mental workload when the laparoscopic procedure is carried out. CONCLUSION: The VIORS simulator has been successfully presented and validated. The VIORS simulator is a useful and effective device for the training of procedural laparoscopic psychomotor skills.

Asunto(s)

Colecistectomía Laparoscópica , Laparoscopía , Humanos , Quirófanos , Interfaz Usuario-Computador , Competencia Clínica , Laparoscopía/métodos , Simulación por Computador

RESUMEN

OBJECTIVE: To assess the effect of Fetal Endoscopic Tracheal Occlusion (FETO) on neonatal survival in fetuses with left congenital diaphragmatic hernia (CDH) and moderate lung hypoplasia. STUDY DESIGN: CDH fetuses with moderate pulmonary hypoplasia (observed/expected lung area to head ratio between 26% and 35%, or between 36% and 45% with liver herniation) were prospectively recruited. Included patients were matched to a control group who were ineligible for FETO. Primary outcomes were survival at 28 days, at discharge, and at 6 months of age, respectively. RESULTS: 58 cases were recruited, 29 treated with FETO and 29 matched controls. Median gestational age (GA) at balloon placement and removal were 29.6 and 33.6 weeks, respectively. FETO group showed significantly lower GA at delivery (35.2 vs. 37.1 weeks, respectively, p < 0.01), higher survival at 28 days (51.7 vs. 24.1%, respectively, p = 0.03), at discharge (48.3 vs. 24.1%, respectively, p = 0.06), and at six months of age (41.4 vs. 24.1%, respectively, p = 0.16), and significantly lower length of ventilatory support (17.8 vs. 32.3 days, p = 0.01) and NICU stay (34.2 vs. 58.3 days, p = <0.01) compared to controls. CONCLUSION: FETO was associated with a non-significant increase in survival and significantly lower neonatal respiratory morbidity among CDH fetuses with moderate lung hypoplasia.

Asunto(s)

Obstrucción de las Vías Aéreas , Oclusión con Balón , Hernias Diafragmáticas Congénitas , Anomalías del Sistema Respiratorio , Femenino , Fetoscopía , Feto , Edad Gestacional , Hernias Diafragmáticas Congénitas/complicaciones , Hernias Diafragmáticas Congénitas/cirugía , Humanos , Lactante , Recién Nacido , Pulmón/anomalías , Pulmón/diagnóstico por imagen , Embarazo , Tráquea/cirugía , Resultado del Tratamiento , Ultrasonografía Prenatal

RESUMEN

The aim of this study is to present the SurgeForce system, a tissue handling training device for analysis of dynamic force applied to the tissue and objective assessment of basic surgical skills during the suture process. The SurgeForce system consists of a mechanical base formed by two platforms joint with three stainless steel springs and a three axial digital accelerometer attached to the upper platform, which detects the dynamic force caused by a surgeon when performing a suture task over a synthetic tissue pad. Accelerometer data is sent to a control unit where preprocessing to transform the raw data into a force signal is done, and then, the force signal is sent to a computer application, which register the force exerted over the synthetic tissue pad. For validation, 17 participants (6 surgeons and 11 medical students) performed three simple interrupted sutures with knot tying using the SurgeForce system. Ten force-based metrics were proposed to evaluate their performance during the suturing task. Results of the validation showed statistical differences in 8 of 10 force-based parameters for assessment of basic surgical skills during the suture task. The SurgeForce system demonstrated its capacity to differentiate force-based performance of surgeons and medical students. The SurgeForce system has been successfully validated. This system was able to distinguish force performance between experts and novices, showing its potential to distinguish surgeons with basic suture skills from those who are not yet prepared.

Asunto(s)

Laparoscopía , Estudiantes de Medicina , Cirujanos , Competencia Clínica , Humanos , Técnicas de Sutura , Suturas

RESUMEN

BACKGROUND: Laparoscopic surgery requires a new set of skill to be learned by the surgeons, of which the most relevant is tissue manipulation. Excessive forces applied to the tissue can cause rupture during manipulation or ischemia when confronting both sides of the tissue. The aim of this study is to establish the construct validity of the SurgForce system for objective assessment of advanced laparoscopic skills, based on the force signal generated during suture tasks, and the development of force parameters for evaluating tissue handling interaction. METHODS: The SurgForce system, a tissue handling training device that measures dynamic force, was used to capture the force generated by surgeons with different levels of laparoscopic experience. For construct validity, 37 participants were enrolled in this study: 19 medical students, 12 residents of surgical specialties and 6 expert surgeons. All participants performed an intracorporeal knotting suture task over a synthetic tissue pad with a laparoscopic box-trainer. The force performance of the participants was analyzed using 11 force-based parameters with the application of the SurgForce system. Statistical analysis was performed between novice, intermediate, and expert groups using a Kruskal-Wallis test, and between the pairs of groups using a Mann-Whitney U-test. RESULTS: Overall, 9 of the 11 force-related parameters showed significant differences between the three study groups. Results between the pairs of groups presented significant differences in 5 force parameters proposed. Construct validity results demonstrated that the SurgForce system was able to differentiate force performance between surgeons with different levels of laparoscopic experience. CONCLUSION: The SurgForce system was successfully validated. This force system showed its potential to measure the force exerted on tissue for objective assessment of tissue handling skills in suturing tasks. Furthermore, its compact design allows the use of this device in conventional laparoscopic box-trainers.

Asunto(s)

Competencia Clínica , Laparoscopía/educación , Laparoscopía/instrumentación , Técnicas de Sutura/educación , Técnicas de Sutura/instrumentación , Femenino , Humanos , Masculino , Fenómenos Mecánicos , Procedimientos Neuroquirúrgicos , Reproducibilidad de los Resultados

RESUMEN

OBJECTIVE: To evaluate natural history of fetuses congenital diaphragmatic hernia (CDH) prenatally diagnosed in countries where termination of pregnancy is not legally allowed and to predict neonatal survival according to lung area and liver herniation. METHODS: Prospective study including antenatally diagnosed CDH cases managed expectantly during pregnancy in six tertiary Latin American centres. The contribution of the observed/expected lung-to-head ratio (O/E-LHR) and liver herniation in predicting neonatal survival was assessed. RESULTS: From the total population of 380 CDH cases, 144 isolated fetuses were selected showing an overall survival rate of 31.9% (46/144). Survivors showed significantly higher O/E-LHR (56.5% vs 34.9%; P < .001), lower proportion of liver herniation (34.8% vs 80.6%, P < .001), and higher gestational age at birth (37.8 vs 36.2 weeks, P < 0.01) than nonsurvivors. Fetuses with an O/E-LHR less than 35% showed a 3.4% of survival; those with an O/E-LHR between 35% and 45% showed 28% of survival with liver up and 50% with liver down; those with an O/E-LHR greater than 45% showed 50% of survival rate with liver up and 76.9% with liver down. CONCLUSIONS: Neonatal mortality in CDH is higher in Latin American countries. The category of lung hypoplasia should be classified according to the survival rates in our Latin American CDH registry.

Asunto(s)

Viabilidad Fetal/fisiología , Cabeza/patología , Hernia/diagnóstico , Hernias Diafragmáticas Congénitas/diagnóstico , Hernias Diafragmáticas Congénitas/mortalidad , Hepatopatías/diagnóstico , Pulmón/patología , Adulto , Pesos y Medidas Corporales , Cefalometría/métodos , Femenino , Cabeza/diagnóstico por imagen , Cabeza/embriología , Hernia/congénito , Hernia/mortalidad , Hernia/patología , Hernias Diafragmáticas Congénitas/patología , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , América Latina/epidemiología , Hepatopatías/congénito , Hepatopatías/mortalidad , Hepatopatías/patología , Pulmón/diagnóstico por imagen , Pulmón/embriología , Masculino , Tamaño de los Órganos , Embarazo , Pronóstico , Sistema de Registros/normas , Tasa de Supervivencia , Ultrasonografía Prenatal , Adulto Joven

RESUMEN

Resumen ANTECEDENTES: El secuestro broncopulmonar suele diagnosticarse antes del nacimiento como una masa sólida intratorácica, homogénea e hiperecogénica, casi siempre localizada en el lóbulo inferior pulmonar. Su signo patognomónico es la demostración con Doppler color de la arteria nutricia sistémica dentro de la masa pulmonar. La historia natural de la enfermedad ha demostrado que durante la vida fetal en la mayoría de los casos la masa puede tener regresión espontánea. Una proporción importante de casos tiene rápido crecimiento de la masa con hidrotórax, compresión pulmonar e hidrops. Estos casos son de mal pronóstico y elevada mortalidad perinatal y, en estas circunstancias, la cirugía fetal es la única opción que puede mejorar el pronóstico. Para este propósito se han intentado varias técnicas de cirugía fetal pero la ideal sigue siendo un tema de controversia. OBJETIVO: Describir los métodos diagnósticos, factores pronóstico y discutir las repercusiones perinatales de cada una de las diferentes técnicas de cirugía fetal descritas en la bibliografía para el tratamiento de fetos complicados con secuestro broncopulmonar. METODOLOGÍA: La búsqueda se efectuó en Medline y PubMed de todos los artículos en inglés y español publicados entre 1990 y 2019 que tuvieran las palabras clave "bronchopulmonary sequestration", "secuestro broncopulmonar", "fetal surgery" y "cirugía fetal". Se eligieron los que describían casos de secuestro broncopulmonar tratados con alguna técnica de cirugía fetal. RESULTADOS: Se encontraron 150 artículos pero solo se seleccionaron 29 estudios que describían casos con diagnóstico prenatal de secuestro broncopulmonar tratados con alguna técnica de cirugía fetal. Para tratar el secuestro broncopulmonar grave se describieron varias técnicas de intervención fetal, entre ellas: cirugía fetal abierta, colocación de catéter de derivación toraco-amniótica, oclusión del vaso nutricio sistémico mediante guía ecográfica con láser, radiofrecuencia, embolización o escleroterapia con inyección de alcohol intravascular e, incluso, broncoscopia fetal. CONCLUSIONES: Al parecer la coagulación láser del vaso nutricio es la técnica con mejores resultados perinatales que evita la muerte fetal, la morbilidad pulmonar y la necesidad de cirugía posnatal en prácticamente todos los casos tratados; se propone como el único tratamiento potencialmente curativo.

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Abstract BACKGROUND: The bronchopulmonary sequestration (BPS) is usually diagnosed prenatally as an intrathoracic hyperechoic, homogeneous, solid mass usually located in the lower pulmonary lobe. The pathognomonic sign is the demonstration of its systemic feeding artery into the lung mass by using color Doppler ultrasound. Natural history data reports that a significant proportion of BPS cases usually regress in the intrauterine period. However, a proportion of cases showed a rapid and progressive growth with development of massive pleural effusion and hydrops. Such cases present the poorest prognosis and high perinatal mortality and therefore, fetal intervention should be considered to improve prognosis. Different fetal surgery procedures have been attempted for such purposes. However, the optimal fetal therapeutica strategy remains controversial. OBJECTIVE: In the present manuscript, we describe and discuss the perinatal outcome of the different published fetal interventions in fetuses complicated with BPS. METHODOLOGY: We search in the English and Spanish literature (Medline and PubMed) for cases complicated with BPS and treated with any fetal surgical intervention including the key words "broncopulmonary sequestration" and "fetal surgery" from 1990 to 2019. RESULTS: A total of 150 references were reviewed including only 26 studies describing pregnancies with prenatal diagnosis of bronchopulmonary sequestration that were treated with any fetal surgical intervention. Several fetal surgery procedures have been attempted for the management of complicated fetuses with severe BPS. These include open fetal surgery, placement of thoracoamniotic shunts, and occlusion of the feeding blood vessel by ultrasound-guided intrafetal laser coagulation, radiofrequency ablation, coil embolization, sclerotherapy with intravascular alcohol injection and fetal bronchoscopy. CONCLUSIONS: Laser coagulation of the feeding artery appears to be the best intervention, avoiding fetal death, neonatal pulmonary morbidity and the need for postnatal surgery in virtually all cases postulating itself as the only potential curative management.

RESUMEN

BACKGROUND: Diverse techniques have been described for pediatric inguinal hernia repair, based on extraperitoneal [1-4] and intraperitoneal [5-8] methodologies. In this video, we describe a novel technique to repair pediatric inguinal hernia using an Endo Close™ suturing device by percutaneous puncture with a single incision. METHODS: With a transumbilical approach, a 5-mm trocar is inserted for a 30° laparoscope. A 3-mm incision is made, and the Endo Close™ suturing device (Covidien, Minneapolis, MN, USA), with a 2-0 polypropylene suture retained by the stylet, is inserted perpendicularly to the skin. An extraperitoneal dissection is made on a side the inguinal ring and the needle of the device penetrates the peritoneum through the inferior border. Then, the stylet mechanism is pushed to free the lasso inside the cavity. At the same incision site, the needle of the Endo Close™ is inserted again, but an extraperitoneal dissection is made on the other side of the ring, ensuring that the needle penetrates at the same exit orifice. Now, the suture lasso is recovered and retracted to close the ring. Finally, the suture is extracted and knots are tied extracorporeally at the level of the skin. RESULTS: A total of 34 patients (20 females and 14 males) underwent surgery with this procedure. Operative time for unilateral repair was 10-15 and 25-30 min for the bilateral repair (29 unilateral/5 bilateral). The patients experienced minimal postoperative pain. The follow-up period was 12 months with no complications, no recurrence and without cases of postoperative hydrocele. There were no injuries to the structures as vessels or vas deferens, and the esthetic outcome was excellent. CONCLUSIONS: The technique presents a simple, safe and reliable method to repair inguinal hernias in children. The long-term results of this novel technique will be evaluated in future studies.

Asunto(s)

Hernia Inguinal/cirugía , Laparoscopios , Laparoscopía , Técnicas de Sutura/instrumentación , Niño , Femenino , Humanos , Masculino

RESUMEN

In this article, we describe the construction and validation of a laparoscopic trainer using an iPhone 5 and a plastic document holder case. The abdominal cavity was simulated with a clear plastic document holder case. On 1 side of the case, 2 holes for entry of laparoscopic instruments were drilled. We added a window to place the camera of the iPhone, which works as our camera of the trainer. Twenty residents carried out 4 tasks using the iPhone Trainer and a physical laparoscopic trainer. The time of all tasks were analyzed with a simple paired t test. The construction of the trainer took 1 hour, with a cost of

Asunto(s)

Competencia Clínica , Educación Médica Continua/economía , Educación Médica Continua/métodos , Gastroenterología/educación , Laparoscopía/educación , Teléfono Inteligente , Costos y Análisis de Costo , Diseño de Equipo , Humanos

RESUMEN

BACKGROUND: Several disorders might require vaginal reconstruction, such as congenital abnormalities, injury, or cancer. Reconstructive techniques for which non-vaginal tissue is used can be associated with complications. We assessed the use of engineered vaginal organs in four patients with vaginal aplasia caused by Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS). METHODS: We invited to participate four consecutive patients who presented over a 3-year period with congenital vaginal aplasia due to MRKHS. Patients were aged 13-18 years. We obtained a vulvar biopsy of autologous tissue from every patient. We cultured, expanded, and seeded epithelial and muscle cells onto biodegradable scaffolds. The organs were constructed and allowed to mature in an incubator in a facility approved for human-tissue manufacturing. We used a perineal approach to surgically implant these organs. We recorded history, physical examination, vaginoscopy, serial tissue biopsies, MRIs, and self-administered Female Sexual Function Index questionnaire results for all patients, with a follow-up of up to 8 years. FINDINGS: We noted no long-term postoperative surgical complications. Yearly serial biopsies showed a tri-layered structure, consisting of an epithelial cell-lined lumen surrounded by matrix and muscle, with expected components of vaginal tissue present. Immunohistochemical analysis confirmed the presence of phenotypically normal smooth muscle and epithelia. The MRIs, which showed the extent of the vaginal aplasia before surgery, showed the engineered organs and the absence of abnormalities after surgery, which was confirmed with yearly vaginoscopy. A validated self-administered Female Sexual Function Index questionnaire showed variables in the normal range in all areas tested, such as desire, arousal, lubrication, orgasm, satisfaction, and painless intercourse. INTERPRETATION: Vaginal organs, engineered from the patient's own cells and implanted, showed normal structural and functional variables with a follow-up of up to 8 years. These technologies could be useful in patients requiring vaginal reconstruction. FUNDING: Wake Forest University and Hospital Infantil de México Federico Gómez.

Asunto(s)

Trastornos del Desarrollo Sexual 46, XX/cirugía , Anomalías Congénitas/cirugía , Conductos Paramesonéfricos/anomalías , Ingeniería de Tejidos/métodos , Vagina/cirugía , Adolescente , Estudios de Cohortes , Femenino , Humanos , Conductos Paramesonéfricos/cirugía , Proyectos Piloto , Vagina/citología

RESUMEN

BACKGROUND: Various methods for evaluating laparoscopic skill have been reported, but without detailed information on the configuration used they are difficult to reproduce. Here we present a method based on the trigonometric relationships between the instruments used in a laparoscopic training platform in order to provide a tool to aid in the reproducible assessment of surgical laparoscopic technique. MATERIALS AND METHODS: The positions of the instruments were represented using triangles. Basic trigonometry was used to objectively establish the distances among the working ports RL, the placement of the optical port h', and the placement of the surgical target OT. RESULTS: The optimal configuration of a training platform depends on the selected working angles, the intracorporeal/extracorporeal lengths of the instrument, and the depth of the surgical target. We demonstrate that some distances, angles, and positions of the instruments are inappropriate for satisfactory laparoscopy. CONCLUSIONS: By applying basic trigonometric principles we can determine the ideal placement of the working ports and the optics in a simple, precise, and objective way. In addition, because the method is based on parameters known to be important in both the performance and quantitative quality of laparoscopy, the results are generalizable to different training platforms and types of laparoscopic surgery.

Asunto(s)

Simulación por Computador , Laparoscopía/instrumentación , Competencia Clínica , Laparoscopía/normas

RESUMEN

The training systems used by starting laparoscopic surgeons for visual and motor adaptation employ zero-degree optics. However, as new laparoscopic surgery techniques make such optics obsolete, there is a need to design training and adaptation tools with other optics.

Asunto(s)

Competencia Clínica , Laparoscopía/métodos , Dispositivos Ópticos , Animales , Diseño de Equipo , Humanos , Internado y Residencia

RESUMEN

BACKGROUND AND PURPOSE: Laparoscopes used in laparoscopic surgery are manipulated by human means, passive systems or robotic systems. All three methods accumulate downtime when the laparoscope is cleaned and the optical perspective is adjusted. This work proposes a new navigation system that autonomously handles the laparoscope, with a view to reducing latency, and that allows real-time adjustment of the visual perspective. METHODS: The system designed is an intuitive mechatronic system with three degrees of freedom and a single active articulation. The system uses the point of insertion as the invariant point for navigation and has a work space that closely resembles an inverted cone. RESULTS: The mechatronic system has been tested in a physical trainer, cutting and suturing chicken parts, as well as in laparoscopic ovariohysterectomies in dogs and pediatric surgeries. In all the procedures, surgeons were able to auto-navigate and there was no visual tremor while using the system. Surgeons performed visual approaches in real time and had both hands free to carry out the procedure. CONCLUSION: This new mechatronic system allows surgeons to perform solo surgery. Cleaning and positioning downtime are reduced, since it is the surgeon him/herself who handles the optics and selects the best visual perspective for the surgery.

Asunto(s)

Laparoscopios , Laparoscopía/métodos , Postura/fisiología , Animales , Diseño de Equipo , Humanos , Análisis y Desempeño de Tareas , Evaluación de la Tecnología Biomédica

RESUMEN

BACKGROUND: Pediatric surgical site infection (SSI) rates in the United States range from 2.5% to 4.4%. There is little data regarding their risk factors among children. We quantified SSI rates and identified risk factors of SSI in a tertiary care pediatric teaching hospital in Mexico City. METHODS: All neurosurgical, cardiovascular, and general surgical patients who underwent operation between Aug 1, 1998, and Jan 31, 1999, were followed-up daily during hospitalization. On postoperative day 30, a full review of microbiology reports and medical records was performed. Univariate and multivariate analyses were done to identify risk factors. RESULTS: Four hundred twenty-eight of 530 children completed follow-up. The overall SSI rate was 18.7%. Forty percent of SSI were superficial incisional, 21% were deep incisional, and 39% were organ/space infections. For clean, clean-contaminated, contaminated, and dirty procedures, SSI infection rates were 12.4%, 24.4%, 14.3%, and 32.4%, respectively. Open drains (OR = 2.3; 95% CI = 1.3-4.2; P <.005) and surgery that lasted 90 or more minutes (OR = 2.9; 95% CI = 1.6-5.1; P <.001) were associated with infection. CONCLUSIONS: Our rates are greater than comparable reported data among children. Duration of surgery and use of open drains were associated with SSI.

Asunto(s)

Hospitales Pediátricos/estadística & datos numéricos , Vigilancia de Guardia , Infección de la Herida Quirúrgica/epidemiología , Preescolar , Infección Hospitalaria/epidemiología , Femenino , Hospitales Pediátricos/normas , Hospitales de Enseñanza/normas , Hospitales de Enseñanza/estadística & datos numéricos , Hospitales Urbanos/normas , Hospitales Urbanos/estadística & datos numéricos , Humanos , Lactante , Masculino , México/epidemiología , Estudios Prospectivos , Procedimientos Quirúrgicos Operativos/efectos adversos , Infección de la Herida Quirúrgica/prevención & control

RESUMEN

UNLABELLED: Gastroesophageal reflux (GER) is a common disease in children less one year old. It is present around 10% of unselected infant population. 40-50% have abnormal 24 h pH monitoring. An early diagnosis and treatment should be done in order to avoid complications. AIM: To establish the consensus for the diagnosis and treatment of children with GER, to rule out similar diseases avoid the use of unnecessary drugs and the secondary side effects as well as unnecessary surgery. METHOD: The consensus was done with the participation of general pediatricians, pediatrics gastroenterologist, pediatric surgeons, radiologist and endoscopist. An initial paper was done by pediatric surgeon and pediatric gastroenterologist who submitted to the rest of participants. Second stage: the paper was review through E-mail for all participants who send their suggestions and modifications. A new paper was done and discussed by medical and surgery area. During the Congress of Pediatric Surgery, in an open session was discuss again with the participation of the main authors and all the audience present. Finally, a paper was done and review for the main authors.

Asunto(s)

Reflujo Gastroesofágico/terapia , Niño , Reflujo Gastroesofágico/diagnóstico , Humanos , México , Guías de Práctica Clínica como Asunto

RESUMEN

Introducción. Objetivo: mostrar la experiencia inicial con esplenectomía laparoscópica (EL) en enfermedades hematológicas.Material y métodos. Estudio prospectivo, longitudinal, de pacientes con enfermedades hematológicas a quienes se les realizó EL en el período de mayo de 1995 a junio de 1999. Resultados. Se intentó EL en 25 pacientes, con esferocitosis hereditaria (23) o púrpura trombocitopénica (2), con edad promedio de 7 años y peso de 25 kg. Se tuvo éxito en 24 (96 por ciento). Se observó una conversión por hemorragia. En tres pacientes se realizó concomitantemente colecistectomía. El tiempo quirúrgico promedio fue de 175 min. La estancia hospitalaria promedio fue de 3 días. Todos los pacientes incrementaron significativamente su cifra de plaquetas después de la operación y ninguno requirió transfusión o medicación postoperatoria. No hubo fallecimientos y las complicaciones fueron mínimas. Conclusiones. La EL puede realizarse en niños con trastornos hematológicos de manera segura. La morbimortalidad es comparable a la reportada en esplenectomía abierta y conlleva además los beneficios de la cirugía de mínima invasión.

Asunto(s)

Humanos , Masculino , Femenino , Preescolar , Esplenectomía , Laparoscopía , Hiperesplenismo , Enfermedades Hematológicas/complicaciones , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos

RESUMEN

Introducción. La cirugía laparoscópica ha probado su eficacia, incluyendo procedimientos de Urología Pediátrica, con excelentes resultados y pocas complicaciones.Se reporta la experiencia en este hospital con nefrectomías laparoscópicas con abordaje retroperitoneal en pacientes pediátricos. Material y métodos. Se realizó un estudio en pacientes sometidos a nefrectomía laparoscópica con abordaje retroperitoneal, en el período comprendido de 1994 a 2001, revisando: edad, sexo, diagnósticos, tiempo quirúrgico y sangrado transoperatorio, ayuno y estancia postoperatoria, así como complicaciones. Resultados. Se realizaron 16 nefrectomías laparoscópicas en 12 pacientes, excluyéndose 3 pacientes por problemas técnicos. El promedio de edad fue de 84 meses (variación de 59-116 meses). Los diagnósticos fueron: obstrucción de la unión pieloureteral, hipoplasia o displasia quística, megauréter y glomerulonefritis. La estancia intrahospitalaria fue de 5.8 días. El tiempo quirúrgico de 117.7 min (variación 70-270) y el anestésico de 158.8 min en promedio. Las complicaciones fueron: 1 caso de hematoma duodenal, 2 casos de sangrado y 1 caso con perforación del peritoneo.Conclusión. Este estudio, al igual que en 2 series de la literatura médica, orienta a que la nefrectomía laparoscópica es un procedimiento seguro con baja incidencia de complicaciones, siempre y cuando sea realizado por personal capacitado.

Asunto(s)

Humanos , Masculino , Femenino , Preescolar , Laparoscopía , Nefrectomía , Espacio Retroperitoneal , Procedimientos Quirúrgicos Urológicos/métodos

RESUMEN

Introducción. El empiema fibropurulento (estadio II de Light) que no responde a la terapia antibiótica y al drenaje simple con pleurostomía desarrolla restricción pulmonar, necesitando en la gran mayoría de los casos una toracotomía amplia con liberación del pulmón. Objetivo: informar la experiencia de los autores con la técnica de cirugía toracoscópica en el manejo del empiema en niños.Casos clínicos. Cinco pacientes consecutivos con edades que variaron de 1 a 18 años, antecedente de neumonía y con diagnóstico de empiema fibropurulento fueron intervenidos tempranamente por toracoscopia. El tiempo operatorio fue de 42ñ8.1 minutos. En el postoperatorio la fiebre sólo se presentó dentro de las primeras 24 horas y la disminución franca de la leucocitosis en la biometría hemática se observó entre el segundo y tercer días. Los tubos torácicos fueron usados 72 horas en forma rutinaria. El promedio de estancia postoperatoria fue de 7ñ3 días y el de los días-hospital fue de 7ñ3 días. Conclusiones. La cirugía toracoscópica resultó ser un excelente procedimiento con mínima morbilidad en el paciente y que condiciona corta estancia en el hospital. Se recomienda este procedimiento como opción en el manejo de empiema cuando se cuente con el recurso tecnológico antes de una pleurostomía por punción (estadio II de Light) y después de ser tratado con antibióticos apropiados sin lograr una respuesta adecuada.

Asunto(s)

Humanos , Masculino , Femenino , Lactante , Preescolar , Adolescente , Toracoscopía , Empiema Pleural , Niño , Neumonía/complicaciones

RESUMEN

Introducción. La acalasia es un trastorno motor del esófago poco frecuente en niños con lesiones neuromusculares reconocidas. La esofagomiotomía con la realización de un mecanismo antirreflujo concomitante es el método terapéutico de elección en los pacientes pediátricos. Casos clínicos. Se reportan 2 casos de pacientes pediátricos con diagnóstico de acalasia manejados por laparoscopia en el Hospital Infantil de México Federico Gómez con excelentes resultados. Realizándoseles esofagomiotomía a través de 4 trocares, asistida con penendoscopia para la localización exacta de la unión esofagogástrica, efectuándose una miotomía eficaz y segura al verificar la integridad de la mucosa. Actualmente ambos casos cursaron asintomáticos, observándose recuperación después de 6 y 9 meses de seguimiento. Conclusión. La cirugía de mínima invasión adquiere día con día mayor aceptación en el tratamiento definitivo de la acalasia por sus grandes ventajas. El auxilio con endoscopia facilita la técnica y aumento la seguridad en manos experimentadas

Asunto(s)

Humanos , Femenino , Preescolar , Adolescente , Acalasia del Esófago/cirugía , Acalasia del Esófago/diagnóstico , Esofagostomía , Endoscopía

RESUMEN

Introducción. La colecistectomía en niños es una cirugía poco frecuente; actualmente se considera a la laparoscopia el método de elección, dado las ventajas que tiene sobre métodos tradicionales. Objetivo: reportar las primera serie de casos pediátricos en México. Material y métodos. Estudio observacional descriptivo, serie de casos de colecistectomía laparoscópica en 5 años (octubre de 1993 a octubre de 1998). Analizándose: edad, sexo, diagnósticos asociados, síntomas y signos métodos diagnósticos, indicación de la cirugía, técnica quirúrgica, tiempo operatorio, complicaciones, porcentaje de conversión y estancia hospitalaria entre otros. Se describe la técnica operatoria. Resultados. Se estudiaron 22 casos de 2 a 16 años de edad; 13 niñas. La mayoría con colecistitis crónica litiásica. Con anemia hemolítica en 2 pacientes. El tiempo quirúrgico fue de 60 a 240 minutos. No existieron complicaciones como: sangrado, retención de CO2, embolismo aéreo, etc. Una conversión. Promedio del íleo postoperatorio: 24 horas. En promedio 3.6 dosis de analgésicos. La estancia hospitalaria fue menor de 2 días en 15 casos y 1 de 33 por osteomielitis asociada. El seguimiento varió de 4 a 48 meses sin complicaciones. Conclusión. Este trabajo demuestra que la colecistectomía por esta vía en la actualidad es la técnica de elección en niños dado que los resultados son excelentes y lo más relevante es que la agresión es mínima

Asunto(s)

Humanos , Masculino , Femenino , Lactante , Preescolar , Adolescente , Cálculos de la Vejiga Urinaria/cirugía , Colecistitis/fisiopatología , Colecistitis/cirugía , Colecistectomía Laparoscópica/métodos , Pediatría , Tiempo de Internación , México , Factores de Tiempo