RESUMO
BACKGROUND: Laparoscopic cholecystectomy is generally performed using 4 ports by transperitoneal access. Recent developments regarding laparoscopic surgery have been directed toward reducing the size or number of ports to achieve the goal of minimally invasive surgery, by minilaparoscopy, natural orifice access, and the transumbilical approach. The aim of this article is to describe our laparoscopic transumbilical cholecystectomy technique using conventional laparoscopic instruments and ports. METHODS: The Veress needle was placed through the umbilicus, which allowed carbon dioxide inflow. A 5-mm trocar was placed in the periumbilical site for the laparoscope followed by the placement of 2 additional 5-mm periumbilical trocars. The entire procedure was performed using conventional laparoscopic instruments. At the end of the surgery, trocars were removed, and all 3 periumbilical skin incisions were united for specimen retrieval. RESULTS: Five transumbilical cholecystectomies were performed following this technique. The mean BMI was 26.6 kg/m(2). The mean operative time and blood loss were 46.2 minutes and 55 mL, respectively. No intraoperative complications occurred. Analgesia was performed using dipyrone (1g IV q6h) and ketoprofen (100 mg IV q12 h). Time to first oral intake was 8 hours. Mean hospital stay was 19.2 hours. CONCLUSION: Laparoscopic transumbilical cholecystectomy seems to be feasible even using conventional laparoscopic instruments and can be considered a potential alternative for traditional laparoscopic cholecystectomy.
Assuntos
Doenças Biliares/cirurgia , Colecistectomia Laparoscópica/métodos , Umbigo/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
INTRODUCTION: Laparoscopic radical prostatectomy is a minimally invasive approach for the treatment of localized prostate cancer. The most technically demanding and time-consuming part of this procedure is the urethrovesical anastomosis. Here we describe our technique for the urethrovesical anastomosis with a posterior fixation, using a running suture with two monofilament absorbable sutures. TECHNICAL CONSIDERATIONS: The first step comprises two X-shaped stitches placed in the posterior wall of the anastomosis (at 7 and 5 o'clock). Each suture is independently tied, leaving the knot (and consequently the needle) on the outside. The 7 and 5 o'clock sutures are then used to perform a clockwise (left wall) and a counterclockwise (right wall) running suture, respectively, and will meet at the 12 o'clock position for the third and final knot. An abdominal Penrose drain is routinely used for monitoring possible anastomotic leakages and is withdrawn when the 24-hour output is less than 100 mL. The patient is discharged as soon as the drain is removed. We performed this technique in 12 consecutive transperitoneal laparoscopic radical prostatectomies, with a mean anastomosis time of 37 minutes, mean operative time of 144 minutes, and mean hospital stay of 2.4 days. The average Foley catheter permanence was 9 days, and no bladder neck sclerosis/stricture was observed with a minimum follow-up of 12 months. CONCLUSIONS: The described technique is a feasible and safe method for urethrovesical anastomosis. Although we had positive results in this initial cohort, further studies with larger series are needed to confirm these findings.
Assuntos
Laparoscopia , Prostatectomia/métodos , Técnicas de Sutura , Uretra/cirurgia , Bexiga Urinária/cirurgia , Anastomose Cirúrgica/métodos , Humanos , MasculinoRESUMO
A prevalência de litíase da vesícula biliar determinada em pacientes hospitalizados na cidade de Curitiba. Um total de 384 pacientes com mais de 20 anos de idade foram selecionados aleatoriamente em quatro hospitais gerais e submetidos a exame ultra-sonográfico da visícula biliar. Dos 384 pacientes, 327 mostravam vesícula biliar normal (85,2%) e 57 (14,8%) apresentavam litíase da visícula biliar (48 pacientes) ou tinhan sido previamente submetidos à colecistectomia por litíase vesicular (nove pacientes). Dos 48 pacientes com litíase vesicular, somente seis referiam cólica biliar (12,5%). A prevalência desta litíase aumentou com a idade e a paridade