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Objective: We present the applications and experiences of robot-assisted laparoscopic and thoracoscopic surgery (RALTS) in pediatric surgery. Materials and Methods: A prospective, observational, and longitudinal study was conducted from March 2015 to March 2018 that involved a non-random sample of a pediatric population that was treated with RALTS. The parameters examined were: gender, age, weight, height, diagnoses, surgical technique, elapsed time of console surgery, estimated bleeding, need for hemotransfusion, complications, surgical conversions, postoperative hospital stay, and follow-up. The Clavien-Dindo classification of complications was used. The surgical system used was the da Vinci model, Si version (Intuitive Surgical, Inc., Sunnyvale, CA. U.S.A), with measures of central tendency. Results: In a 36-months period, 186 RALTS cases were performed, in 147 pediatric patients and an adult; 53.23% were male, and the remaining were female. The average age was 83 months, ranging from 3.5 to 204 months, plus one adult patient of 63 years. The stature was an average of 116.6 cm, with a range of 55-185 cm; the average weight was 26.9 kg, with a range of 5-102 kg; the smallest patient at 3.5 months was 55 cm in stature and weighed 5.5 kg. We performed 41 different surgical techniques, grouped in 4 areas: urological 91, gastrointestinal and hepatobiliary (GI-HB) 84, thoracic 6, and oncological 5. The console surgery time was 137.2 min on average, ranging from 10 to 780 min. Surgeon 1 performed 154 operations (82.8%), and the remainder were performed by Surgeon 2, with a conversion rate of 3.76%. The most commonly performed surgeries were: pyeloplasty, fundoplication, diaphragmatic plication, and removal of benign tumors, by area. Hemotransfusion was performed for 4.83%, and complications occurred in 2.68%. The average postoperative stay was 2.58 days, and the average follow-up was 23.5 months. The results of the 4 areas were analyzed in detail. Conclusion: RALTS is safe and effective in children. An enormous variety of surgeries can be safely performed, including complex hepatobiliary, and thoracic surgery in small children. There are few published prospective series describing RALTS in the pediatric population, and most only describe urological surgery. It is important to offer children the advantages and safety of minimal invasion with robotic assistance; however, this procedure has only been slowly accepted and utilized for children. It is possible to implement a robust program of pediatric robotic surgery where multiple procedures are performed.

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INTRODUCTION: Surgical site infection (SSI) following hydrocelectomy is relatively uncommon, but it is one of the main post-operative problems. We aimed to describe the prevalence of SSI following hydrocelectomy among adult patients, and to assess predisposing risk factors for infection. METHODOLOGY: This retrospective cohort study was carried out at a university hospital and included hydrocelectomies performed between January 2007 and December 2014. Diagnosis of SSI was performed according to the Center for Diseases Control (CDC) guidelines. Multivariable logistic regression analysis was used to identify independent risk factors. RESULTS: A total of 196 patients were included in the analysis. Overall, 30 patients were diagnosed with SSI (15.3%) and of these, 63.3% (19/30) were classified as having superficial SSI, while 36.7% (11/30) had deep SSI. The main signs and symptoms of infection were the presence of surgical wound secretion (70%) and inflammatory superficial signs such as hyperemia, edema and pain (60%). Among the 53 patients presenting chronic smoking habits, 26.4% (14/53) developed SSI, which was associated with a higher risk for SSI (odds ratio [OR] = 2.84, 95% confidence interval [CI] = 1.27 to 6.35, p < 0.01) in the univariate analysis. In the adjusted multivariable analysis, smoking habits were also statistically associated with SSI after hydrocelectomy (odds ratio [OR] = 2.84, 95% confidence interval [CI] = 1.30 to 6.24, p = 0.01). No pre-, intra-, or post-operative variable analyzed showed an independent association to SSI following hydrocelectomy. CONCLUSIONS: Smoking was the only independent modifiable risk factor for SSI in the multivariate analysis.

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OBJECTIVE: To review the existing literature on when and how to treat patients with asymptomatic bacteriuria (AB) who undergo urological surgery, as uncertainty about this issue persists. METHODS: A systematic review was conducted to compare the different timing of administration of antibiotic prophylaxis in patients with AB undergoing urological surgery. We used predefined inclusion and exclusion criteria, and we also developed a specific quality scale to assess the quality of the papers included. RESULTS: Nine studies met the inclusion criteria. Of the nine studies included, eight evaluated antibiotic prophylaxis regardless of the presence of AB, as their purpose was to evaluate the effectiveness of antibiotic prophylaxis for urological procedures. Of these, four studies showed a significant reduction in the rate of infections in the intervention group compared with placebo, or with the same antibiotic therapy but using different durations of therapy. Four studies found no significant differences in infectious complications between the intervention and comparison arms. Only one study assessed the duration of antibiotic prophylaxis in patients with AB. CONCLUSIONS: With the available evidence, antibiotic therapy should be considered only for procedures in which studies have shown a clinical benefit in the prevention of infection. It is important to establish the duration and type of treatment for antimicrobial therapy for surgical prophylaxis in patients with AB who are going to receive urological invasive procedures.

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Background and objectives: Although many features of robotic prostatectomy are similar to those of conventional laparoscopic urological procedures (such as laparoscopic prostatectomy), the procedure is associated with some drawbacks, which include limited intravenous access, relatively long operating time, deep Trendelenburg position, and high intra-abdominal pressure. The primary aim was to describe respiratory and hemodynamic challenges and the complications related to high intra-abdominal pressure and the deep Trendelenburg position in robotic prostatectomy patients. The secondary aim was to reveal safe discharge criteria from the operating room. Methods: Fifty-three patients who underwent robotic prostatectomy between December 2009 and January 2011 were prospectively enrolled. Main outcome measures were non-invasive monitoring, invasive monitoring and blood gas analysis performed at supine (T0), Trendelenburg (T1), Trendelenburg + pneumoperitoneum (T2), Trendelenburg-before desufflation (T3), Trendelenburg (after desufflation) (T4), and supine (T5) positions. Results: Fifty-three robotic prostatectomy patients were included in the study. The main clinical challenge in our study group was the choice of ventilation strategy to manage respiratory acidosis, which is detected through end-tidal carbon dioxide pressure and blood gas analysis. Furthermore, the mean arterial pressure remained unchanged, the heart rate decreased significantly and required intervention. The central venous pressure values were also above the normal limits. Conclusion: Respiratory acidosis and "upper airway obstruction-like" clinical symptoms were the main challenges associated with robotic prostatectomy procedures during this study. .

Justificativa e objetivos: Embora muitas características da prostatectomia robótica sejam semelhantes àquelas de laparoscopias urológicas convencionais (como a prostatectomia por laparoscopia), o procedimento está associado a alguns inconvenientes, incluindo acesso intravenoso limitado, tempo cirúrgico relativamente longo, posição de Trendelenburg profunda e pressão intra-abdominal alta. O objetivo principal foi descrever as alterações respiratória e hemodinâmica e as complicações relacionadas à pressão intra-abdominal elevada e à posição de Trendelenburg profunda em pacientes submetidos à prostatectomia robótica. O objetivo secundário foi revelar critérios seguros de alta do centro cirúrgico. Métodos: Foram inscritos prospectivamente 53 pacientes submetidos à prostatectomia robótica entre dezembro de 2009 e janeiro de 2011. As medidas de desfecho primário foram: monitoramento não invasivo, monitoramento invasivo e gasometria feita em decúbito dorsal (T0), Trendelenburg (T1), Trendelenburg + pneumoperitônio (T2), Trendelenburg pré-desinsuflação (T3), Trendelenburg pós-desinsuflação (T4) e posições supinas (T5). Resultados: O principal desafio clínico em nosso grupo de estudo foi a escolha da estratégia de ventilação para controlar a acidose respiratória, que é detectada por meio da pressão de dióxido de carbono expirado e da gasometria. Além disso, a pressão arterial média permaneceu inalterada e a frequência cardíaca diminuiu significativamente e precisou de intervenção. Os valores da pressão venosa central também estavam acima dos limites normais. Conclusão: A acidose respiratória e sintomas clínicos "semelhantes à obstrução ...

Justificación y objetivos: Aunque muchas características de la prostatectomía robótica sean similares a las de las laparoscopias urológicas convencionales (como la prostatectomía laparoscópica), el procedimiento está asociado con algunos inconvenientes, incluyendo el acceso intravenoso limitado, tiempo quirúrgico relativamente largo, posición de Trendelenburg profunda y presión intraabdominal alta. El objetivo principal fue describir las alteraciones respiratorias y hemodinámicas y las complicaciones relacionadas con la presión intraabdominal elevada y con la posición de Trendelenburg profunda en pacientes sometidos a prostatectomía robótica. El objetivo secundario fue revelar criterios seguros de alta del quirófano. Métodos: Cincuenta y tres pacientes sometidos a prostatectomía robótica entre diciembre de 2009 y enero de 2011 fueron incluidos en un estudio prospectivo. Las principales medidas de resultado fueron: monitorización no invasiva, monitorización invasiva y gasometría realizada en decúbito dorsal (T0), Trendelenburg (T1), Trendelenburg + neumoperitoneo (T2), Trendelenburg predesinsuflación (T3), Trendelenburg posdesinsuflación (T4) y posiciones supinas (T5). Resultados: Cincuenta y tres pacientes sometidos a prostatectomía robótica fueron incluidos en el estudio. El principal reto clínico en nuestro grupo de estudio fue la elección de la estrategia de ventilación para controlar la acidosis respiratoria, que es detectada por medio de la presión de dióxido de carbono espirado y la gasometría. Además, la presión arterial media permaneció inalterada, y la frecuencia cardíaca disminuyó significativamente y fue necesario intervenir. Los valores de la presión venosa central también estaban por encima de los límites normales. ...

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BACKGROUND AND OBJECTIVES: Although many features of robotic prostatectomy are similar to those of conventional laparoscopic urological procedures (such as laparoscopic prostatectomy), the procedure is associated with some drawbacks, which include limited intravenous access, relatively long operating time, deep Trendelenburg position, and high intra-abdominal pressure. The primary aim was to describe respiratory and hemodynamic challenges and the complications related to high intra-abdominal pressure and the deep Trendelenburg position in robotic prostatectomy patients. The secondary aim was to reveal safe discharge criteria from the operating room. METHODS: Fifty-three patients who underwent robotic prostatectomy between December 2009 and January 2011 were prospectively enrolled. Main outcome measures were non-invasive monitoring, invasive monitoring and blood gas analysis performed at supine (T0), Trendelenburg (T1), Trendelenburg + pneumoperitoneum (T2), Trendelenburg-before desufflation (T3), Trendelenburg (after desufflation) (T4), and supine (T5) positions. RESULTS: Fifty-three robotic prostatectomy patients were included in the study. The main clinical challenge in our study group was the choice of ventilation strategy to manage respiratory acidosis, which is detected through end-tidal carbon dioxide pressure and blood gas analysis. Furthermore, the mean arterial pressure remained unchanged, the heart rate decreased significantly and required intervention. The central venous pressure values were also above the normal limits. CONCLUSION: Respiratory acidosis and "upper airway obstruction-like" clinical symptoms were the main challenges associated with robotic prostatectomy procedures during this study.

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La expectativa de vida ha ido aumentando en Chile y en el mundo, lo que ha causado un gran impacto a nivel del número de cirugías que se realiza en la población añosa. El objetivo de este trabajo es describir la experiencia de nuestro centro en cirugías urológicas en pacientes mayores de 80 años y analizar que factores aumentan el riesgo de complicaciones postquirúrgicas.Materiales y método: Análisis retrospectivo de 138 cirugías urológicas realizadas en 120 pacientes mayores de 80 años, durante los años 2000 a 2012. Se obtuvo información sociodemográfica, riesgo quirúrgico (ASA), tipo y duración de cirugía realizada, complicaciones post-operatorias (escala de Clavien) y tiempo de hospitalización. Los datos obtenidos fueron analizados mediante el programa SPSS v17. Se realizó análisis multivariado y se estableció el riesgo relativo para el desarrollo de complicaciones. Se consideró signi ficativo p<0,05. Resultado: La edad promedio de los pacientes fue de 84+/-3.7 años, 86.2 por ciento fueron hombres. El 96.7 por ciento presentaba algún tipo de comorbilidad, con predominio de hipertensión arterial (60,84 por ciento) y diabetes mellitus tipo 2 (24,16 por ciento). La mayoría de las intervenciones fue de complejidad intermedia (77.27 por ciento), donde la anestesia regional (56,8 por ciento) y la vía endo urológica (84,78 por ciento) fueron las más utilizadas, con un tiempo operatorio promedio de 62+/-52.4 minutos. El riesgo quirúrgico prevalente fue ASA2 (62.7 por ciento). El promedio de hospitalización fue de 2,8+/-2.7 días. El 15.21 por ciento de los pacientes presentó algún tipo de complicación, con predominio de clasifi cación tipo 1 de Clavien (38 por ciento). En el análisis multivariado se evidenció como factores de riesgo signi ficativos para complicaciones, edad mayor a 90 años (p=0.03), presencia de insu ciencia renal (p=0.01), portar 4 o más comorbilidades (p=0.04), cirugía mayor a 3 horas (p=0.03) y tener riesgo quirúrgico ASA3 (p=0.04)...

Life expectancy has been increasing in Chile and in the World. This has caused a great impact over the number of surgeries being performed in the elderly population. The aim of this paper is to describe the experience of our center in urological surgery in patients older than 80 years and analyze which factors increase the risk of postoperative complications.Materials and methods: Retrospective analysis of 138 urological surgeries performed in 120 patients older than 80 years, during the years 2000-2012. Sociodemographic information, surgical risk (ASA), type and duration of surgery, postoperative complications (Clavien scale) and length of hospitalization was obtained. The data were analyzed using SPSS v17. Multivariate analysis was performed and the relative risk for developing complications was established. Signi cance was p <0.05. Average age of the patients was 84 +/- 3.7 years, 86.2percentwere men. The 96.7 percenct had some kind of comorbidity, with prevalence of hypertension (60.84 percent) and diabetes mellitus type 2 (24.16 percent). Most of the interventions was of intermediate complexity (77.27percent), where regional anesthesia (56.8 percent) and endourological aproach (84.78 percent) were the most used, with average operative time of 62 +/- 52.4 minutes. Most common Surgical risk was ASA2 (62.7 percent). Average hospital stay was 2.8 +/- 2.7 days. 15.21 percent of patients had some type of complication, with a predominance of type 1 Clavien classication (38 percent). The multivariate analysis showed signi cant risk factors for complications: age greater than 90 years (p = 0.03), renal failure (p = 0.01), carrying 4 or more comorbidities (p = 0.04), surgery Langer than 3 hours (p = 0.03) and ASA3 surgical risk (p =.04). No mortality was reported in our series. In this study, although most of our patients underwent endourological procedures, we evidence that surgery in patients older than 80 years is feasible...

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INTRODUCTION: Recent research on vasectomy shows that combining cautery and fascial interposition (FI) achieves the most effective occlusion of the vas and minimizes the risk of failure. We present a technique that combines cautery and FI and is suitable for low-resource settings. SURGICAL TECHNIQUE: The surgical technique consists of 1) exposing the vas with the no-scalpel approach; 2) cauterizing the epithelium of lumen of the vas using a portable battery-powered cautery device; 3) performing FI by grasping internal spermatic fascia and applying a free tie with suture material on the fascia to cover the prostatic stump of the vas and separate the two ends of the cut vas; and 4) excising a small 0.5 to 1 cm of the testicular stump. COMMENTS: To maximize vasectomy effectiveness, vasectomy providers should consider learning thermal cautery and FI to occlude vas deferens.

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