RESUMO
BACKGROUND: 26 years have passed from the first laparoscopic cholecystectomy in Mexico. Since then the laparoscopy has been adopted of variable way and has extended into different specialties. OBJECTIVE: To identify the place that laparoscopic approaches occupy at the present time in Mexico. METHOD: We searched the codes that had the word laparoscopy or laparoscopic in the records of the Automated System of Hospitable Discharges in 2015. Based on the obtained information there was realized a descriptive and retrospective study. RESULTS: We found 55 different procedures in a total of 30,174. Of them, 79.7% in women and 20.3% in men. The most common age was between 25 and 29 years. The ten first ones were cholecystectomy, appendectomy, total abdominal laparoscopic hysterectomy, procedures to create esophago-gastric sphincter competence, unilateral salpingo-oophorectomy, partial cholecystectomy, ovarian resection, umbilical hernia repair, incidental appendectomy and unilateral oophorectomy (94.6%). The States with the major number are Mexico City, State of Mexico, Jalisco, Guanajuato and Sonora. CONCLUSIONS: The laparoscopic procedures have increase in the national health systems and there is concordance of the most common with the international statistics. However, is necessary to diversify them and reduce the times of hospital stay. Its application is in process and it still face challenges in relation to availability of organizational elements, equipment, infrastructure and training, although there are different ways to overcome them.
ANTECEDENTES: Han pasado 26 años desde la primera colecistectomía laparoscópica en México. Desde entonces, la laparoscopía se ha adoptado de forma variable y se ha extendido a diferentes especialidades. OBJETIVO: Identificar el sitio que ocupan los abordajes laparoscópicos en México. MÉTODO: Se buscaron los códigos que tuvieran la palabra laparoscopia o laparoscópica en los registros del Sistema Automatizado de Egresos Hospitalarios en 2015. Con los datos obtenidos se realizó un estudio descriptivo y retrospectivo. RESULTADOS: Se encontraron 55 procedimientos diferentes en un total de 30,174. De ellos, el 79.7% en mujeres y el 20.3% en hombres. La edad más común fue entre los 25 y 29 años. Los diez primeros fueron colecistectomía, apendicectomía, histerectomía total abdominal laparoscópica, procedimientos para creación de competencia esfinteriana esofagogástrica, salpingo-ooforectomía unilateral, colecistectomía parcial, escisión local o destrucción de ovario, plastia umbilical, apendicectomía incidental y ooforectomía unilateral (94.6% del total). Los Estados con el mayor número reportado fueron Ciudad de México, Estado de México, Jalisco, Guanajuato y Sonora. CONCLUSIONES: Los procedimientos laparoscópicos han ido en aumento en los sistemas de salud nacionales y hay concordancia de los más comunes con las estadísticas internacionales. Sin embargo, es necesario diversificarlos y disminuir los tiempos de estancia hospitalaria. Su aplicación está en proceso y aún enfrentan retos en relación con la disponibilidad de elementos organizacionales, equipo, infraestructura y entrenamiento, aunque existen diferentes alternativas para vencerlos.
Assuntos
Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , México , Estudos RetrospectivosRESUMO
BACKGROUND AND OBJECTIVES: The ultrasonically activated scalpel is a surgical instrument that is used in minimally invasive surgery to safely cut and seal vessels. This study reported the experimental observations of the use of a laparoscopic ultrasonic scalpel, including its safety and feasibility. in sealing vessels of different diameters in an in vivo animal model during both physiological and supraphysiological blood pressure (BP) conditions. METHODS: One healthy female swine was used. We performed resections of the omentum, biopsies in different regions of the liver, and a hysterectomy. Vessels with diameters ranging from 2 to 10 mm were sealed with the ultrasonic scalpel under regular hemodynamic conditions and during pharmacologically induced arterial hypertension (BP challenge). RESULTS: For 10 random cuts made in the omentum and during the hysterectomy, the ultrasonic scalpel was effective and fast, with no immediate or delayed bleeding. Bipolar energy, sutures, and hemoclips were not required to control bleeding. No bleeding was observed in sealed vessels up to 8 mm, even during BP challenges sustained for longer than 5 minutes. When testing vessels of 10 mm, bleeding occurred in 1 common iliac vein before 10 minutes of waiting (the point of bleeding was easily identified) and bleeding occurred in 1 of the common iliac arteries during the BP challenge. CONCLUSION: Our findings corroborate that the ultrasonic scalpel can safely seal arteries up to 8 mm in diameter to prevent or control bleeding during laparoscopic procedures, even when BP exceeds normal levels.