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INTRODUCTION: This study was undertaken to identify which minimally invasive technique medical students prefer for cholecystectomy and what factors determine their decision. METHODS: Brazilian medical students watched a video reviewing the advantages and disadvantages of six different surgical approaches to cholecystectomy: open surgery, conventional laparoscopy, mini-laparoscopy (MINI), single-incision laparoscopic surgery, natural-orifice transluminal endoscopic surgery, and robotic surgery. Respondents then answered questions about hypothetical situations in which the participants would be submitted to elective cholecystectomy. RESULTS: One hundred eleven medical students completed the survey, 60 females (54%) and 51 males (46%). Most students were 19-26 years old. When asked whether they would consider an open cholecystectomy if minimally invasive surgery (MIS) techniques were available, only 9% answered yes. Senior medical students were the least willing to consider open surgery (P = .036). When asked if they would prefer conventional laparoscopy, MINI, or robotic surgery for their cholecystectomy, 85% of the women and 63% of the men chose MINI (P = .025). When asked if they would consider a single-incision laparoscopic surgery or natural-orifice transluminal endoscopic surgery approach, 94 respondents (84%) answered no. When asked to rank which factors they consider the most important when choosing a surgical technique, they ranked safety of the procedure first (58%) and surgeon experience second (30%). CONCLUSION: When Brazilian medical students were asked to select a surgical approach for cholecystectomy, most chose MINI. The preference for MINI was strongest amongst female medical students. Both female and male medical students ranked safety as the most important factor.

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We describe the original technique used for the treatment of a patient who presented with pain and bulging in the abdomen, who was diagnosed with Spigelian hernia (SH) using ultrasound. In this case, the hernia occurred in the anterolateral abdominal wall with herniation of the distal ileum and mesentery, in addition to a large right inguinal hernia. A mini-laparoscopic approach was proposed; due to Child-A hepatic cirrhosis, it was done by a hybrid technique, using a harmonic scalpel. The primary closure of the hernia defects was performed, followed by the placement of a polypropylene mesh in the preperitoneal space. The mesh was fixed. In this case, the inguinal hernia was homolateral to the SH. Following the surgery, the patient had no further complications, being discharged the day after the procedure.

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A female patient, 59-year-old, was complaining of abdominal pain in the right hypochondrium and mesogastrium for 6 months. Ultrasonography and abdominal computed tomography were performed, both confirming a large hepatic cyst (10.6 cm × 7.6 cm × 7.3 cm) on the left lobe. A hybrid minilaparoscopic resection was proposed. We opted for unroofing the cyst, and the procedure was uneventfully performed, with a total surgical time of 60 min. In the post-operative the patient did well, with minimal abdominal pain, being discharged on the 5th post-operative day, after drain removal due to the use of intravenous antibiotic therapy.

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BACKGROUND AND OBJECTIVES: Inguinal hernia repair is among the most common procedures performed worldwide and the laparoscopic totally extraperitoneal (TEP) approach is a recognized and effective surgical technique. Although technically advantageous because of the option of no mesh fixation and no need for creation of a peritoneal flap resulting, in less postoperative pain and faster recovery, TEP has not achieved the popularity it deserves, mainly because of its complexity and steep learning curve. Minilaparoscopy was first described in the 1990s and has recently gained significantly from better instrumentation that may increase TEP's effectiveness and acceptance. We performed a prospective study, to analyze the outcomes of minilaparoscopy in pain and operative time when compared to the conventional laparoscopic technique in hernia repair. METHODS: Fifty-eight laparoscopic inguinal hernia repairs were performed: 36 by traditional laparoscopic technique and 22 by minilaparoscopic instruments (mini). A study protocol was applied prospectively for data collection. Variables analyzed were early postoperative pain (at hour 6 after procedure), pain at discharge, use of on-demand analgesics, and operative time. RESULTS: The mini group presented reduced early postoperative pain and operative time. The present study also suggests less postoperative pain at discharge with mini procedures, although this difference was not statistically significant. No difference between the groups regarding on-demand use of analgesics was found. CONCLUSIONS: This study corroborates findings in previously published papers that have shown the feasibility of minilaparoscopy in laparoscopic TEP hernia repair and its benefits regarding postoperative pain, operative time, and aesthetic outcomes.

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PURPOSE: The use of minilaparoscopic instruments has gained interest in recent years, permitting a less invasive treatment for many surgical procedures. Its application in urological surgeries has not been established yet. METHODS: Between November 2012 and December 2014, 32 patients underwent minilaparoscopic surgeries, using 3.5-mm instruments. The procedures performed included pyeloplasties (16 cases), radical nephrectomies (2), simple nephrectomies (4), renal cyst decortication (5), ureterolithotomy (2) ureteral reimplantation (2) and partial ureterectomy (1). RESULTS: All the procedures were performed minilaparoscopically, except for one simple nephrectomy and one renal cyst decortication that were converted to a standard laparoscopic approach, due to intensive perioperative bleeding. One pyeloplasty had to be reoperated for a urinary fistula repair. All the patients had good-to-excellent cosmetic outcomes, except for one patient who developed keloids at her scars. Functional results were comparable to the ones described in the literature. CONCLUSION: Minilaparoscopy is a feasible option for patients and physicians searching for a even less invasive procedure compared with the laparoscopic approach, with better cosmetic and the same functional and oncologic outcomes.

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bjetivo: Comparar las técnicas laparoscópicas emergentes demayor popularidad en el ámbito quirúrgico, aplicando modelosmatemáticos­teóricos para el cálculo del daño tisular, de manerade poder identificar y predecir que técnicas causan menor traumaparietal y menor morbilidad en el paciente para un procedimientoquirúrgico en común. Métodos:Estudio comparativo, descriptivoy observacional. Se agrupan 13 técnicas de cirugía de mínima inva-sión aplicadas para un procedimiento en común, "colecistecto-mía", con la finalidad de comparar el daño tisular que ocasionacada una de las mismas, calculado por modelos teóricos-matemá-ticos diseñados para tal fin, bajo normas estandarizadas por ungrupo de expertos en el tema, "Consenso de Mazatlán 2013", conel fin de estandarizar las técnicas de medición de las incisiones einstrumentos, de manera de obtener resultados acordes con la rea-lidad en cada uno de los procedimientos. Resultados:La técnicaNOTES presenta los índices más bajos de daño tisular parietal alno producir trauma alguno en su variedad pura y al no utilizar lapared abdominal para la extracción de la pieza quirúrgica en susvariedades híbridas. Las técnicas abordaje abdominal (no LESS),reducen a menos del 50% el daño tisular que ocasiona la laparos-copia tradicional, sin diferencia significativa entre ellas. Las plata-formas multivalvulares no muestran reducción del daño parietalfrente a la colecistectomía laparoscopia tradicional. Conclusión:Las técnicas laparoscópicas que reducen significativamente el trau-ma parietal frente al estándar de oro para colecistectomía aplicanuno o más de las siguientes consideraciones: Extracción de losórganos o piezas quirúrgicas por orificios naturales, sustitución depuertos por dispositivos magnéticos y/o agujas percutáneas, usode óptica con canal operatorio, y utilización de puertos e instru-mentos de menor calibre(AU)

Objective: To compare the most popular emerging surgical lapa-roscopic techniques, applying models for mathematicians-theore-tical for the calculation of the tissue damage, in order to be ableto identify and predict which techniques cause reduced parietaltrauma and less morbidity in the patient for a surgical procedurein common. Methods: Comparative, descriptive and observationalstudy. There were grouped 13 minimally invasive surgery techni-ques applied to a procedure in common, "cholecystectomy", inorder to compare the tissue damage that causes each of them, cal-culated by theoretical-mathematicians models designed for thispurpose, under standardized rules by a group of experts in thefield, "Mazatlan Consensus 2013", to standardize measurement ofincisions and instruments techniques, in order to get results com-mensurate with the reality in each of the procedures. Results:Thetechnique NOTES presents the lowest rates of parietal tissuedamage by not producing any trauma in its sheer variety and doesnot use the abdominal wall for the extraction of the surgical spe-cimen in its hybrid varieties. The technical approach to abdominal(not LESS), reduced to less than 50% the tissue damage that cau-ses traditional laparoscopy, without significant difference betweenthem. Multivalvulars platforms are not against traditional laparos-copy cholecystectomy parietal harm reduction. Conclusion:Thelaparoscopic techniques that significantly reduce the parietal trau-ma against the gold standard for cholecystectomy apply one ormore of the following considerations: removal of organs or surgicalparts through natural openings, replacement of ports by percuta-neous needle or magnetic devices, use of optics with operativechannel, and use of ports and instruments for the smaller caliber

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