Asunto(s)
Procedimientos Endovasculares , Aneurisma Intracraneal , Microcirugia , Humanos , Aneurisma Intracraneal/cirugía , Procedimientos Endovasculares/métodos , Microcirugia/métodos , Microcirugia/instrumentación , Instrumentos Quirúrgicos , Metaanálisis como Asunto , Procedimientos Neuroquirúrgicos/métodosRESUMEN
OBJECTIVE: This work aims to review the existing use of robotics in plastic surgery. METHODS: A meticulous selection process identified 22 articles relevant to this scoping review. RESULTS: The literature on the use of robotics in plastic surgery is sparse. Nonetheless, this review highlights emerging benefits in microsurgery, breast reconstruction, and transoral surgery. CONCLUSION: This scoping review identifies critical articles reporting the emerging use of robotics in plastic surgery. While the scientific medical community has yet to extensively document its use, the available evidence suggests a promising future for robotics in this field.
Asunto(s)
Procedimientos Quirúrgicos Robotizados , Humanos , Procedimientos Quirúrgicos Robotizados/tendencias , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos de Cirugía Plástica/tendencias , Procedimientos de Cirugía Plástica/métodos , Cirugía Plástica/tendencias , Cirugía Plástica/métodos , Microcirugia/tendencias , Microcirugia/métodos , Microcirugia/instrumentación , Mamoplastia/métodos , Mamoplastia/tendenciasRESUMEN
PURPOSE: To evaluate the use of the latest generation smartphone camera in performing arterial microanastomosis in rats. METHODS: Ten Wistar rats were divided into 2 groups and underwent anastomosis of the right carotid artery with the aid of magnification from a microscope (group M) and a smartphone camera (group S), to compare patency in 72 hours, as well as to measure the weight of the animals, diameter of the carotid arteries and anastomosis time. RESULTS: There was no statistical difference between the weight of the animals or the diameter of the carotid arteries. There was a statistical difference for the time spent on anastomoses, which was greater in group S, with higher rates of thrombosis (p < 0.05). CONCLUSIONS: Although our patency and anastomosis time results were statistically lower in the smartphone group, there was success in some cases. As the segment continues to progress, it is likely that the results will improve in line with the evolution of camera technology.
Asunto(s)
Anastomosis Quirúrgica , Arterias Carótidas , Microscopía , Microcirugia , Ratas Wistar , Teléfono Inteligente , Animales , Microcirugia/instrumentación , Microcirugia/métodos , Microscopía/instrumentación , Microscopía/métodos , Anastomosis Quirúrgica/instrumentación , Anastomosis Quirúrgica/métodos , Arterias Carótidas/cirugía , Masculino , Factores de Tiempo , Grado de Desobstrucción Vascular , Ratas , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: The objective of the study was to analyze the results of endoscopic laser microsurgery for early glottic carcinoma treatment (Stages I and II) at a Tertiary Center in Mexico City. MATERIALS AND METHODS: Descriptive, retrospective review of 40 patients with early glottic carcinoma who were treated with endoscopic laser microsurgery with curative intent at our institution from November 2003 to December 2013. RESULTS: The study yielded 4 pTis, 19 pT1a, 8 pT1b, and 9 pT2 patients. Mean patient follow-up time was 7.4 years (range 3-12.9 years). Post-operative bleeding requiring surgical intervention occurred in 1 (2.5%) patient. Kaplan-Meier results at 3 and 5-year estimates were as follows: overall survival was 92.5 and 87%, respectively; laser only local control was 94.9 and 91.6%, respectively; and disease specific survival and ultimate local control rate were 97.5% for both time periods. We found a 97.5% (39/40) organ preservation rate. CONCLUSIONS: Laser microsurgery for glottic carcinoma treatment is an emerging technique in Mexico. Our results are promising as reported by other authors in Europe and United States of America, which support the replicability of the surgical technique refined by Dr. Wolfgang Steiner.
OBJETIVO: Analizar los resultados del tratamiento del carcinoma glótico temprano (estadios I y II) con microcirugía láser en un hospital de tercer nivel en Ciudad de México. MÉTODO: Estudio descriptivo y retrospectivo en 40 pacientes con cáncer glótico temprano tratados con microcirugía láser de noviembre de 2003 a diciembre de 2013. RESULTADOS: Se estudiaron 4 pTi, 19 pT1a, 8 pT1b y 9 pT2. El tiempo promedio de seguimiento fue de 7.4 años (rango: 3 - 12.9). Se presentó un sangrado posoperatorio con revisión quirúrgica (2.5%). Las curvas de Kaplan-Meier de estimación a 3 y 5 años mostraron una sobrevida total del 92.5 y 87%, respectivamente; control local solo con láser del 94.9 y 91.6%, respectivamente; sobrevida específica de la enfermedad y control local global del 97.5%, para ambos periodos de tiempo. El porcentaje de conservación del órgano fue del 97.5% (39/40). CONCLUSIONES: La microcirugía láser para el tratamiento del cáncer glótico temprano es una técnica que se aplica paulatinamente en México. Nuestros resultados son prometedores y equiparables a los reportados por otros autores en Europa y en los Estados Unidos de América, lo que sustenta la reproducibilidad de la técnica quirúrgica implementada por el Dr. Wolgang Steiner.
Asunto(s)
Glotis/cirugía , Neoplasias Laríngeas/cirugía , Terapia por Láser/métodos , Microcirugia/métodos , Cirugía Endoscópica por Orificios Naturales/métodos , Anciano , Causas de Muerte , Supervivencia sin Enfermedad , Femenino , Hospitales Urbanos/estadística & datos numéricos , Humanos , Intubación Intratraqueal , Estimación de Kaplan-Meier , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/patología , Terapia por Láser/instrumentación , Tiempo de Internación/estadística & datos numéricos , Masculino , México , Microcirugia/instrumentación , Persona de Mediana Edad , Boca , Cirugía Endoscópica por Orificios Naturales/instrumentación , Recurrencia Local de Neoplasia/epidemiología , Hemorragia Posoperatoria/epidemiología , Estudios Retrospectivos , Centros de Atención Terciaria/estadística & datos numéricos , Resultado del TratamientoAsunto(s)
Infecciones por Coronavirus , Dispositivos de Protección de los Ojos , Microcirugia/instrumentación , Neuroendoscopios , Procedimientos Neuroquirúrgicos/instrumentación , Pandemias , Neumonía Viral , Betacoronavirus , COVID-19 , Humanos , Microcirugia/métodos , Procedimientos Neuroquirúrgicos/métodos , Equipo de Protección Personal , SARS-CoV-2 , Encuestas y CuestionariosRESUMEN
BACKGROUND: Intraspinal tumors are 10 to 15 times less common than brain tumors. The midline approach with extensive laminectomies represents the current gold-standard for resection, causing instability, muscle damage, and kyphosis among other well-known complications. Minimally invasive series reported their results using retractor-based systems. We analyzed a patient series treated with a non-expansile tubular approach, describing the technique, grade of resection, and clinical outcomes. METHODS: A series of consecutive cases operated between 2016 and October 2018 were analyzed retrospectively. The database included age, sex, clinical presentation, intraspinal location (intra/extradural), number of laminotomies, grade of resection, surgical time, bleeding, and follow-up. The initial and follow-up clinical condition was analyzed using the Frankel scale. RESULTS: A total of 13 patients underwent surgery: 3 intraspinal/extradural (23%), 8 intradural/extramedullary (61.5%), and 2 intramedullary tumors (15.3%); these were classified as 5 meningiomas (38.4%), 4 neurofibromas (30.7%), 2 schwannomas (15.3%), 1 hemangioblastoma (7.6%), and 1 astrocytoma (7.6%). Eleven (84.61%) patients had complete motor improvement, 1 patient had partial improvement, and 1 patient had no improvement (7.6% each). An 18-mm working channel tube was used for extramedullary lesions and 20-mm tubes for intramedullary injuries. Total tumor resection was achieved in 11 patients (84.6%) and subtotal in 2 patients (15.38%) corresponding to intramedullary tumors. CONCLUSIONS: Although this study consisted of a small series, we have shown the possibility of resecting intraspinal tumors (some intradural-intramedullary) with non-expansile tubes in a safe and effective way with no complications. Most of the patients had complete neurological improvement at the end of follow-up.
Asunto(s)
Descompresión Quirúrgica/métodos , Fijadores Internos , Microcirugia/métodos , Neoplasias de la Médula Espinal/cirugía , Neoplasias de la Columna Vertebral/cirugía , Adulto , Anciano , Descompresión Quirúrgica/instrumentación , Diseño de Equipo , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Meningioma/diagnóstico por imagen , Meningioma/cirugía , Microcirugia/instrumentación , Persona de Mediana Edad , Neurilemoma/diagnóstico por imagen , Neurilemoma/cirugía , Neurofibroma/diagnóstico por imagen , Neurofibroma/cirugía , Estudios Retrospectivos , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Adulto JovenRESUMEN
One of the main difficulties in intracranial aneurysms (IA) surgery refers to the choice of the appropriate clip(s) to be implanted. Although the imaging exams currently available ensure visualization of IA's morphology, they do not bring an accurate reference positioning for the surgeon in executing the surgery procedure nor efficiently contribute to planning the surgery. Unfortunately, for IA's largely inaccessible regions, there is not an efficient method of treatment planning. Therefore, we propose a novel method that allows the generation of a 3D biomodel of the IA region under investigation using additive manufacturing technology (AM). Thus, a physical copy of the IA is produced and offers the surgeon a full view of the anatomy of that region of the brain. The aim of this study is the creation of a flexible 3D physical model (elastomer) through the AM technique, in order to allow the clip selection prior to the surgery. DICOM angio-CT images from eight patients who underwent IA surgery were transformed into STL format and then built on a 3D printer. Preoperative surgical clip selection was performed and then compared with those used in surgery. At the end of the study, all 3D IA biomodels were reproduced for microsurgical clipping selection and it was possible to predict the metal clip to be used in the surgery. In addition, the proposed methodology helps to clarify the surgical anatomy and to avoid excessive manipulation of the intracranial arteries and prolonged surgical time. The major advantage of this technology is that the surgeon can closely study complex cerebrovascular anatomy from any perspective using realistic 3D biomodels, which can be handheld, allowing simulation of intraoperative situations and anticipation of surgical challenges.
Asunto(s)
Arterias Cerebrales/diagnóstico por imagen , Aneurisma Intracraneal/diagnóstico por imagen , Modelos Anatómicos , Planificación de Atención al Paciente , Impresión Tridimensional , Anciano , Encéfalo/irrigación sanguínea , Arterias Cerebrales/anomalías , Arterias Cerebrales/cirugía , Femenino , Humanos , Aneurisma Intracraneal/cirugía , Masculino , Microcirugia/instrumentación , Microcirugia/métodos , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/instrumentación , Procedimientos Neuroquirúrgicos/métodos , Instrumentos Quirúrgicos , Tomografía Computarizada por Rayos XRESUMEN
ABSTRACT BACKGROUND: Polypectomy of colorectal polyps is the mainstay of colorectal cancer prevention. Identification of the best polypectomy technique is imperative. OBJECTIVE: This review aims at comparing efficacy of nine different resection methods for small colorectal polyps (<10 mm). METHODS: We searched and selected only randomized controlled trials. Primary outcome was complete resection rates of small polyps by histological eradication. Secondary outcomes were: adverse events, retrieval tissue failures rates and duration of procedure. RESULTS: Eighteen trials including 3215 patients and 5223 polyps were analysed. Overall, cold polypectomy had a significantly shorter time of procedure than hot polypectomy (RD -5.92, 95%CI -9.90 to -1.94, P<0.05), with no statistical difference on complete histological eradication (RD 0.08, 95%CI -0.03 to 0.19, P>0.05). Regarding cold polypectomy techniques, cold snare was found superior to cold forceps on complete and en-bloc resection rates and less time consuming. When comparing endoscopic mucosal resection (EMR) with hot-snare and cold-snare, the latter showed no-inferiority on histological eradication, adverse events or retrieval tissue failure rates. CONCLUSION: Cold polypectomy is the best technique for resection of small colorectal polyps. Among cold methods, dedicated cold snare was found superior on histological eradication. Cold snare endoscopic mucosal resection might be considered an option for polyps from 5 to 9 mm.
RESUMO CONTEXTO: A polipectomia de pólipos colorretais é a base da prevenção do câncer colorretal. A identificação da melhor técnica de polipectomia é imperativa. OBJETIVO: Esta revisão tem como objetivo comparar a eficácia de nove diferentes métodos de ressecção para pólipos colorretais pequenos (<10 mm). MÉTODOS: Pesquisamos e selecionamos apenas ensaios clínicos randomizados. O desfecho primário foi taxas de ressecção completa de pólipos pequenos por confirmação histológica. Os desfechos secundários foram: eventos adversos, taxas de falha de recuperação do espécime e duração do procedimento. RESULTADOS: Dezoito estudos, incluindo 3215 pacientes e 5223 pólipos foram analisados. No geral, a polipectomia a frio teve um tempo de procedimento significativamente menor do que a polipectomia a quente (RD -5,92; IC 95% -9,90 a -1,94; P<0,05), sem diferença estatística na erradicação histológica (RD 0,08; IC 95% -0,03 a 0,19; P>0,05). Em relação às técnicas de polipectomia a frio, a alça fria foi considerada superior ao uso de pinça fria nas taxas de ressecção completa e em bloco, além de um menor tempo de procedimento. Ao comparar a ressecção endoscópica da mucosa utilizando alça quente ou alça fria, esta última mostrou não-inferioridade na erradicação histológica, eventos adversos ou taxas de falha do tecido de recuperação. CONCLUSÃO: A polipectomia a frio mostrou ser a melhor técnica para ressecção de pequenos pólipos colorretais. Entre os métodos frios, a alça fria dedicada foi considerada superior na erradicação histológica. ressecção endoscópica da mucosa com alça fria pode ser considerado uma opção para pólipos de 5 a 9 mm.
Asunto(s)
Humanos , Pólipos del Colon/cirugía , Colonoscopía/métodos , Microcirugia/métodos , Instrumentos Quirúrgicos , Neoplasias Colorrectales/prevención & control , Colonoscopía/efectos adversos , Colonoscopía/instrumentación , Microcirugia/efectos adversos , Microcirugia/instrumentaciónRESUMEN
Technological advances such as optical instruments and surgical tools have enabled the considerable contributions of microsurgery to surgical therapies. Accordingly, surgical therapeutics has provided the latest information across a wide range of medical specialties, including immunology and pharmacology, despite specialization according to organs and organ systems. The International Society for Experimental Microsurgery, an academic organization, has utilized experimental microsurgery technology in the identification of curative concepts for diseases that remain difficult to treat. For this publication to mark the 32nd anniversary of the Brazilian Surgical Society, I introduced the following types of technology related to the further development of microsurgical technological innovations in the future: high-resolution three-dimensional (3D) video and touch-sensitive microsurgery robots.
Asunto(s)
Microcirugia/métodos , Procedimientos Quirúrgicos Robotizados/educación , Investigación Biomédica Traslacional/métodos , Brasil , Humanos , Imagenología Tridimensional , Microcirugia/educación , Microcirugia/instrumentación , Microcirugia/tendencias , Procedimientos Quirúrgicos Robotizados/tendencias , Cirugía Asistida por Computador/educación , Cirugía Asistida por Computador/métodos , Investigación Biomédica Traslacional/educación , Investigación Biomédica Traslacional/tendenciasRESUMEN
Abstract Technological advances such as optical instruments and surgical tools have enabled the considerable contributions of microsurgery to surgical therapies. Accordingly, surgical therapeutics has provided the latest information across a wide range of medical specialties, including immunology and pharmacology, despite specialization according to organs and organ systems. The International Society for Experimental Microsurgery, an academic organization, has utilized experimental microsurgery technology in the identification of curative concepts for diseases that remain difficult to treat. For this publication to mark the 32nd anniversary of the Brazilian Surgical Society, I introduced the following types of technology related to the further development of microsurgical technological innovations in the future: high-resolution three-dimensional (3D) video and touch-sensitive microsurgery robots.
Asunto(s)
Humanos , Investigación Biomédica Traslacional/métodos , Procedimientos Quirúrgicos Robotizados/educación , Microcirugia/métodos , Brasil , Imagenología Tridimensional , Cirugía Asistida por Computador/educación , Cirugía Asistida por Computador/métodos , Investigación Biomédica Traslacional/educación , Investigación Biomédica Traslacional/tendencias , Procedimientos Quirúrgicos Robotizados/tendencias , Microcirugia/educación , Microcirugia/instrumentación , Microcirugia/tendenciasRESUMEN
BACKGROUND: Polypectomy of colorectal polyps is the mainstay of colorectal cancer prevention. Identification of the best polypectomy technique is imperative. OBJECTIVE: This review aims at comparing efficacy of nine different resection methods for small colorectal polyps (<10 mm). METHODS: We searched and selected only randomized controlled trials. Primary outcome was complete resection rates of small polyps by histological eradication. Secondary outcomes were: adverse events, retrieval tissue failures rates and duration of procedure. RESULTS: Eighteen trials including 3215 patients and 5223 polyps were analysed. Overall, cold polypectomy had a significantly shorter time of procedure than hot polypectomy (RD -5.92, 95%CI -9.90 to -1.94, P<0.05), with no statistical difference on complete histological eradication (RD 0.08, 95%CI -0.03 to 0.19, P>0.05). Regarding cold polypectomy techniques, cold snare was found superior to cold forceps on complete and en-bloc resection rates and less time consuming. When comparing endoscopic mucosal resection (EMR) with hot-snare and cold-snare, the latter showed no-inferiority on histological eradication, adverse events or retrieval tissue failure rates. CONCLUSION: Cold polypectomy is the best technique for resection of small colorectal polyps. Among cold methods, dedicated cold snare was found superior on histological eradication. Cold snare endoscopic mucosal resection might be considered an option for polyps from 5 to 9 mm.
Asunto(s)
Pólipos del Colon/cirugía , Colonoscopía/métodos , Microcirugia/métodos , Colonoscopía/efectos adversos , Colonoscopía/instrumentación , Neoplasias Colorrectales/prevención & control , Humanos , Microcirugia/efectos adversos , Microcirugia/instrumentación , Instrumentos QuirúrgicosRESUMEN
OBJECTIVE: Basilar tip aneurysms (BTAs) have a complex anatomy, making them difficult to treat. We describe our surgical results for BTAs. METHODS: From 2004 to 2015 (12 years), a total of 25 small BTAs and two giant BTAs were treated in the Hospital do Servidor Público Estadual de São Paulo. RESULTS: In 23 patients harboring aneurysms positioned anteriorly or straight, all aneurysms were clipped (complete exclusion in all on follow-up angiography). In two patients with posteriorly positioned aneurysms, there was residual neck. All patients submitted to surgical treatment of small aneurysms presented with late Glasgow Outcome Scale scores of 4 or 5. Two patients with giant aneurysms died. CONCLUSION: Surgical treatment of these lesions may be accomplished with quite high success rates and low morbidity.
Asunto(s)
Arteria Basilar/cirugía , Aneurisma Intracraneal/cirugía , Microcirugia/métodos , Instrumentos Quirúrgicos , Anciano , Femenino , Humanos , Masculino , Microcirugia/instrumentación , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
ABSTRACT Basilar tip aneurysms (BTAs) have a complex anatomy, making them difficult to treat. We describe our surgical results for BTAs. Methods: From 2004 to 2015 (12 years), a total of 25 small BTAs and two giant BTAs were treated in the Hospital do Servidor Público Estadual de São Paulo. Results: In 23 patients harboring aneurysms positioned anteriorly or straight, all aneurysms were clipped (complete exclusion in all on follow-up angiography). In two patients with posteriorly positioned aneurysms, there was residual neck. All patients submitted to surgical treatment of small aneurysms presented with late Glasgow Outcome Scale scores of 4 or 5. Two patients with giant aneurysms died. Conclusion: Surgical treatment of these lesions may be accomplished with quite high success rates and low morbidity.
RESUMO Os aneurismas do topo da artéria basilar (BTAs) têm anatomia complexa tornando-os tecnicamente difíceis de serem tratados. Nós descrevemos nossos resultados cirúrgicos em BTAs. Métodos: De 2004 a 2015 (12 anos), foram tratados no Hospital do Servidor Público Estadual de São Paulo um total de 25 BTAs pequenos e 2 BTAs gigantes. Resultados: Nos 23 pacientes portadores de aneurismas direcionados anteriormente ou neutros, cem por cento dos aneurismas foram tratados (oclusão de 100% na angiografia de seguimento). Em pacientes com aneurismas direcionados posteriormente (2 pacientes), houve colo residual. Todos os pacientes submetidos ao tratamento cirúrgico de pequenos aneurismas apresentaram Glasgow Outcome Scale (GOS) tardio de 4 ou 5. Nos 2 aneurismas gigantes, houve 2 casos de mortalidade (100%). Conclusão: Em mãos experientes, o tratamento cirúrgico destas lesões pode ser realizado com taxas de sucesso bastante elevadas e baixa morbidade.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Instrumentos Quirúrgicos , Arteria Basilar/cirugía , Aneurisma Intracraneal/cirugía , Microcirugia/métodos , Resultado del Tratamiento , Microcirugia/instrumentaciónRESUMEN
UNLABELLED: Paraclinoid aneurysms are lesions located adjacent to the clinoid and ophthalmic segments of the internal carotid artery. In recent years, flow diverter stents have been introduced as a better endovascular technique for treatment of these aneurysms. METHOD: From 2009 to 2014, a total of 43 paraclinoid aneurysms in 43 patients were surgically clipped. We retrospectively reviewed the records of these patients to analyze clinical outcomes. RESULTS: Twenty-six aneurysms (60.5%) were ophthalmic artery aneurysms, while 17 were superior hypophyseal artery aneurysms (39.5%). The extradural approach to the clinoid process was used to clip these aneurysms. One hundred percent of aneurysms were clipped (complete exclusion in 100% on follow-up angiography). The length of follow-up ranged from 1 to 60 months (mean, 29.82 months). CONCLUSION: Surgical clipping continues to be a good option for the treatment of paraclinoid aneurysms.
Asunto(s)
Enfermedades de las Arterias Carótidas/cirugía , Aneurisma Intracraneal/cirugía , Microcirugia/métodos , Arteria Oftálmica/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Adulto , Anciano , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/cirugía , Angiografía Cerebral , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Microcirugia/instrumentación , Persona de Mediana Edad , Arteria Oftálmica/diagnóstico por imagen , Complicaciones Posoperatorias , Estudios Retrospectivos , Factores de Riesgo , Estadísticas no Paramétricas , Instrumentos Quirúrgicos , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/instrumentaciónRESUMEN
ABSTRACT Paraclinoid aneurysms are lesions located adjacent to the clinoid and ophthalmic segments of the internal carotid artery. In recent years, flow diverter stents have been introduced as a better endovascular technique for treatment of these aneurysms. Method From 2009 to 2014, a total of 43 paraclinoid aneurysms in 43 patients were surgically clipped. We retrospectively reviewed the records of these patients to analyze clinical outcomes. Results Twenty-six aneurysms (60.5%) were ophthalmic artery aneurysms, while 17 were superior hypophyseal artery aneurysms (39.5%). The extradural approach to the clinoid process was used to clip these aneurysms. One hundred percent of aneurysms were clipped (complete exclusion in 100% on follow-up angiography). The length of follow-up ranged from 1 to 60 months (mean, 29.82 months). Conclusion Surgical clipping continues to be a good option for the treatment of paraclinoid aneurysms.
RESUMO Aneurismas paraclinóideos são lesões localizadas adjacentes aos segmentos clinóideos e oftálmicos da artéria carótia interna. Os stents desviadores de fluxo tem sido crescentemente aplicados com sucesso. Métodos De 2009 a 2014, um total de 43 aneurismas paraclinóideos foram clipados em 43 pacientes. Analisamos retrospectivamente os dados dos pacientes e desfechos clínicos. Resultados Vinte seis aneurismas (60,5%) foram de artéria oftálmica e 17 de artéria hipofisária superior (39,5%). O acesso extradural à clinóide foi utilizado para todos aneurismas. Cem por cento dos aneurismas foram clipados com oclusão de 100% na angiografia controle. O tempo de follow-up oscilou de 1 a 60 meses, com media de 29 meses. Conclusão A clipagem cirúrgica é uma opção boa e segura para o tratamento de aneurismas paraclinóideos.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de las Arterias Carótidas/cirugía , Aneurisma Intracraneal/cirugía , Microcirugia/métodos , Arteria Oftálmica/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Angiografía Cerebral , Arteria Carótida Interna , Arteria Carótida Interna/cirugía , Aneurisma Intracraneal , Microcirugia/instrumentación , Arteria Oftálmica , Complicaciones Posoperatorias , Estudios Retrospectivos , Factores de Riesgo , Estadísticas no Paramétricas , Instrumentos Quirúrgicos , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/instrumentaciónRESUMEN
A microcirurgia é o conjunto de procedimentos cirúrgicos realizados com o auxílio de um meio óptico de magnificação. Constitui uma das áreas tecnicamente mais sofisticadas da prática médica, que combina precisão manual, experiência técnica e conhecimento de ciências básicas. Na medicina veterinária vêm sendo aplicada tanto na realização de projetos de pesquisa na área de medicina experimental, quanto em procedimentos dentro da rotina da clínica cirúrgica. O treinamento é um processo longo e difícil, que requer grande habilidade manual, paciência, dedicação exclusiva e treinamento contínuo. Seguindo uma rotina básica de treino, o cirurgião dominará as técnicas e proporcionará aos pacientes, uma melhor qualidade de vida, pois será capaz de realizar procedimentos de reconstrução tecidual, para reparação de defeitos específicos, transplantes de órgãos, entre diversas outras técnicas.
Microsurgery is the set of surgical procedures performed with the aid of an optical magnifying means. Is one of the most technically sophisticated areas of medical practice that combines manual precision, technical experience and knowledge of basic sciences. In veterinary medicine are being applied both in conducting research projects in the area of experimental medicine, as in routine procedures within the surgical clinic. Trainingis a long and difficult process, which requires great dexterity, patience, dedication exclusive and continuous training. Following a basic workout routine, the surgeon will master the techniques and will give patients a better quality of life, it will be able to perform procedures for tissue reconstruction to repair specific defects, organ transplants, among many other techniques.
La microcirugía es un conjunto de procedimientos quirúrgicos realizados con la ayuda de un media óptico de magnificación. Contituye una de las áreas técnicamente mas sofisticadas de la práctica médica, que combina precisión manual, experiencia técnica y conocimiento de las ciencias básicas. En la medicina veterinaria viene siendo aplicada tanto en la realización de proyectos de investigación en el área de la medicina experimental, como en procedimientos dentro de la rutina de la clínica quirúrgica. El entrenamiento es un proceso largo y difícil, que requiere de grande habilidad manual, paciencia, dedicación exclusiva y entrenamiento contínuo. Siguiendo una rutina básica de entrenamiento el cirujano dominará las técnicas y proporcionará a los pacientes una mejor calidad de vida, pues será capaz de realizar procedimientos de reconstrucción de tejidos para la reparación de defectos específicos, transplantes de órganos, entre otras técnicas.
Asunto(s)
Aprendizaje , Educación en Veterinaria , Microcirugia/educación , Microcirugia/instrumentación , Microcirugia/métodos , Microvasos , Anastomosis QuirúrgicaRESUMEN
A microcirurgia é o conjunto de procedimentos cirúrgicos realizados com o auxílio de um meio óptico de magnificação. Constitui uma das áreas tecnicamente mais sofisticadas da prática médica, que combina precisão manual, experiência técnica e conhecimento de ciências básicas. Na medicina veterinária vêm sendo aplicada tanto na realização de projetos de pesquisa na área de medicina experimental, quanto em procedimentos dentro da rotina da clínica cirúrgica. O treinamento é um processo longo e difícil, que requer grande habilidade manual, paciência, dedicação exclusiva e treinamento contínuo. Seguindo uma rotina básica de treino, o cirurgião dominará as técnicas e proporcionará aos pacientes, uma melhor qualidade de vida, pois será capaz de realizar procedimentos de reconstrução tecidual, para reparação de defeitos específicos, transplantes de órgãos, entre diversas outras técnicas.(AU)
Microsurgery is the set of surgical procedures performed with the aid of an optical magnifying means. Is one of the most technically sophisticated areas of medical practice that combines manual precision, technical experience and knowledge of basic sciences. In veterinary medicine are being applied both in conducting research projects in the area of experimental medicine, as in routine procedures within the surgical clinic. Trainingis a long and difficult process, which requires great dexterity, patience, dedication exclusive and continuous training. Following a basic workout routine, the surgeon will master the techniques and will give patients a better quality of life, it will be able to perform procedures for tissue reconstruction to repair specific defects, organ transplants, among many other techniques.(AU)
La microcirugía es un conjunto de procedimientos quirúrgicos realizados con la ayuda de un media óptico de magnificación. Contituye una de las áreas técnicamente mas sofisticadas de la práctica médica, que combina precisión manual, experiencia técnica y conocimiento de las ciencias básicas. En la medicina veterinaria viene siendo aplicada tanto en la realización de proyectos de investigación en el área de la medicina experimental, como en procedimientos dentro de la rutina de la clínica quirúrgica. El entrenamiento es un proceso largo y difícil, que requiere de grande habilidad manual, paciencia, dedicación exclusiva y entrenamiento contínuo. Siguiendo una rutina básica de entrenamiento el cirujano dominará las técnicas y proporcionará a los pacientes una mejor calidad de vida, pues será capaz de realizar procedimientos de reconstrucción de tejidos para la reparación de defectos específicos, transplantes de órganos, entre otras técnicas.(AU)
Asunto(s)
Microcirugia/educación , Microcirugia/instrumentación , Microcirugia/métodos , Aprendizaje , Microvasos , Educación en Veterinaria , Anastomosis QuirúrgicaRESUMEN
OBJECTIVE: To study the ideal patient's head positioning for the anterior circulation aneurysms microsurgery. METHOD: We divided the study in two parts. Firstly, 10 fresh cadaveric heads were positioned and dissected in order to ideally expose the anterior circulation aneurysm sites. Afterwards, 110 patients were submitted to anterior circulation aneurysms microsurgery. During the surgery, the patient's head was positioned accordingly to the aneurysm location and the results from the cadaveric study. The effectiveness of the position was noted. RESULTS: We could determine mainly two patterns for head positioning for the anterior circulation aneurysms. CONCLUSION: The best surgical exposure is related to specific head positions. The proper angle of microscopic view may minimize neurovascular injury and brain retraction.
Asunto(s)
Cabeza/cirugía , Aneurisma Intracraneal/cirugía , Microcirugia/métodos , Procedimientos Neuroquirúrgicos/métodos , Posicionamiento del Paciente/métodos , Adolescente , Adulto , Anciano , Puntos Anatómicos de Referencia , Craneotomía/métodos , Femenino , Humanos , Masculino , Ilustración Médica , Microcirugia/instrumentación , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/instrumentación , Valores de Referencia , Reproducibilidad de los Resultados , Resultado del Tratamiento , Adulto JovenRESUMEN
Objective To study the ideal patient's head positioning for the anterior circulation aneurysms microsurgery. Method We divided the study in two parts. Firstly, 10 fresh cadaveric heads were positioned and dissected in order to ideally expose the anterior circulation aneurysm sites. Afterwards, 110 patients were submitted to anterior circulation aneurysms microsurgery. During the surgery, the patient's head was positioned accordingly to the aneurysm location and the results from the cadaveric study. The effectiveness of the position was noted. Results We could determine mainly two patterns for head positioning for the anterior circulation aneurysms. Conclusion The best surgical exposure is related to specific head positions. The proper angle of microscopic view may minimize neurovascular injury and brain retraction. .
Objetivo Estudar o posicionamento da cabeça para a cirurgia de aneurismas cerebrais da circulação anterior. Método Dividimos o estudo em duas partes. Inicialmente, dez cabeças de cadáveres frescos foram posicionadas e dissecadas de modo a expor, de maneira ideal, os principais sítios de aneurismas na circulação anterior do cérebro. Posteriormente, 110 pacientes foram submetidos a microcirurgia para clipagem de aneurismas cerebrais da circulação anterior. Durante as cirurgias, as cabeças foram posicionadas de acordo com a localização específica de cada aneurisma e o resultado obtido no estudo dos cadáveres. Cada paciente teve sua posição avaliada quanto a sua eficácia. Resultados Obtivemos basicamente dois padrões de posicionamento da cabeça para cirurgias de aneurismas cerebrais da circulação anterior. Conclusão A melhor exposição cirúrgica está relacionada à posição específica da cabeça para cada localização aneurismática. O ângulo de visão microscópica adequado minimiza lesões neurovasculares e a excessiva retração cerebral. .