RESUMO
Endoscopic axillary lymphatic dissection is a viable surgical option, but has not been taken with great enthusiasm; several factors have accounted for this, including the lack of an effective experimental model to acquire skills and abilities. The aim of this study was to develop a training tool for endoscopic axillary dissection and to evaluate its applicability in a porcine model. Twenty endoscopic dissections of the axilla were performed in ten female pigs of four to six months by a single surgeon with blunt dissection and CO(2). A surgical workflow was divided into temporal operative phases. Time necessary to perform this action was compared throughout the study. The mean dissection time was 26 +/- 7 minutes. The axillary content was separated from the other anatomical elements under complete visualization (85%). Intraoperative complications occurred in two dissections (10%). Residual fibrofatty tissue was removed from the axilla in three dissections. This data defined a pig model for commencement of training in endoscopic axillary dissection in the laboratory. Bringing these core elements together led to the development of a model for acquiring advanced laparoscopic skills, which may be applicable to other endoscopic axillary procedures.
Assuntos
Competência Clínica , Endoscopia/métodos , Excisão de Linfonodo/métodos , Animais , Axila , Modelos Animais de Doenças , Feminino , Humanos , Complicações Intraoperatórias , Suínos , Fatores de Tempo , Fluxo de TrabalhoRESUMO
OBJECTIVES: To assess the feasibility, effectiveness and morbidity associated with Endoscopic Axillary Dissection. METHODS: All studies published from 1990 until December 2008 in MEDLINE, LILACS, and COCHRANE. These studies were selected by two levels of criteria. Methodological designs, operating parameters, and postoperative follow-up were selected from each publication. RESULTS: We extracted 49 citations and 12 were analyzed. The average age was 54.95+/-5.84 years. The surgical time was longer than the open procedure. The average number of extracted nodes exceeded ten. Technical problems and intra-operative complications had a rare occurrence. The recurrence was 0.5% (4/752). Two port metastases were registered. The methodological quality score average was 14.75. CONCLUSIONS: This procedure meets the tumor control and staging requirements. It has shown similar results to the traditional procedure in terms of patient recovery, although the available evidence is not methodologically appropriate and does not justify its oncological safety.
Assuntos
Neoplasias da Mama/cirurgia , Endoscopia/métodos , Excisão de Linfonodo/métodos , Linfonodos/cirurgia , Idoso , Axila , Neoplasias da Mama/patologia , Ensaios Clínicos como Assunto/estatística & dados numéricos , Medicina Baseada em Evidências , Feminino , Seguimentos , Humanos , Excisão de Linfonodo/efeitos adversos , Linfonodos/patologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Saúde da MulherRESUMO
El estado de los ganglios que drenan el tumor primario permanece como el más potente predictor de supervivencia y recurrencia en los pacientes con melanoma, los otros factores predictores de las metástasis ganglionares no han reemplazado la resección quirúrgica y el examen histopatológico como el más preciso método para la identificación de diseminación de la enfermedad. Debido a que el ganglio centinela es el primer sitio de drenaje ganglionar, su estado tumoral puede ser usado como predictor del estado tumoral de los restantes ganglios del vaciamiento regional, por lo tanto, su detallado análisis histopatológico y molecular proporciona una información más precisa del estadiaje que el examen patológico de rutina de numerosos ganglios removidos al azar. Esta información identifica a los pacientes quienes se benefician de la completa linfadenectomía, la cual es la única opción terapéutica efectiva para el control local y cura potencial. La actual controversia se mantiene respecto a si el mapeo linfático y la biopsia de ganglio centinela es un procedimiento diagnóstico o una intervención terapéutica. El siguiente trabajo nos permitirá evidenciar el rol de la linfadenectomía en el melanoma, particularmente a la luz de los ensayos clínicos en curso
The disease status of the tumor-draining regional lymph node remains the most important predictor of survival and recurrence in patients with melanoma; others predictor factors of nodal metastases do not have to replace surgical resection and histopathologic examination as the most accurate method for assessing spread of disease to the lymph nodes. Because the sentinel lymph node is the first nodal drainage site, its tumor status can be used to predict the tumor status of the remaining nodes in the regional draining; furthermore, its detailed histopathological and molecular analysis provides far more accurate staging information than standard pathological assessment of the numerous nodes randomly removed. This assessment identifies patients who may benefit from a completion lymphadenectomy which is the only effective therapeutic option for local control and potential cure. Current controversy remains regarding whether lymphatic mapping and sentinel node biopsy is a diagnostic procedure or a therapeutic intervention. This study allows us to reflect the role of lymphadenectomy in melanoma, particularly at light on ongoing clinical trials