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      Colecistectomía transvaginal híbrida y por incisión umbilical única asistida con imanes: serie de casos Translated title: Magnet assisted transvaginal hybrid approach cholecystectomy and magnet assisted single umbilical incision cholecystectomy

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          Abstract

          Introducción. Describimos nuestra experiencia inicial en pacientes con diagnóstico de colelitiasis a quienes se les practicó colecistectomía por vía híbrida transvaginal y, en otro grupo, por incisión umbilical única. En ambos grupos se utilizaron imanes durante la disección y extracción de la vesícula biliar. Pacientes y métodos. Se presenta una serie clínica de casos intervenidos por colelitiasis, divididos en dos grupos. Uno se intervino por abordaje a través de una incisión umbilical única (single incision laparoscopic cholecystectomy) y, otro, por vía transvaginal híbrida, en ambos casos con la ayuda de imanes. Se reportan la duración de las cirugías, el tiempo de hospitalización, las complicaciones y el seguimiento posoperatorio durante tres meses. Resultados. Se operaron 23 pacientes, 10 por vía transvaginal híbrida y 13 por incisión umbilical única. No hubo conversiones a colecistectomía laparoscópica de cuatro puertos o abierta. Para la disección y extracción de la vesícula, se utilizaron un clip imantado de 2.500 gauss y un imán externo de 15.000 gauss. Fue mayor la duración de la cirugía en el grupo de abordaje por incisión umbilical única. No hubo complicaciones posoperatorias mayores. No se presentaron complicaciones abdominales ni ginecológicas asociadas al acceso transvaginal, durante el seguimiento posoperatorio. Conclusión. En la colecistectomía por laparoscopia, tanto el abordaje transvaginal híbrido como por incisión umbilical única fueron tan seguros, eficaces y reproducibles como la técnica tradicional, en manos de cirujanos con experiencia en cirugía laparoscópica. En el grupo de abordaje transvaginal híbrido, el tiempo quirúrgico fue menor que en el grupo de incisión umbilical única, pero ambas técnicas tienen tiempos quirúrgicos aceptables. Es más fácil adaptar la técnica transvaginal híbrida, por lo menos, inicialmente pues no requiere instrumental especial. El uso de imanes brinda una excelente exposición del triángulo de Calot y brinda la posibilidad de realizar tracción y contratracción durante la cirugía. El efecto estético en ambas técnicas es patente. Se requieren estudios prospectivos y de distribución aleatoria para determinar la aplicabilidad clínica de ambos accesos, en forma universal.

          Translated abstract

          Introduction. Report of our initial experience with hybrid transvaginal cholecystectomy and with single incision transumbilical cholecystectomy in patients with the diagnosis of uncomplicated cholelithiasis using anchor magnetic device in both types of approach. Patients and methods. Prospective clinical case series. Patients were divided into two groups: Single Incision Transumbilical Laparoscopic Cholecystectomy (SILC) and Hybrid Transvaginal Cholecystectomy. An anchor magnetic device for intraoperative manipulation of the gallbladder was used in both groups. Operating time, length of hospital stay, complications, and postoperative course are reported. Results. A total of 23 patients were included, 10 by the hybrid transvaginal approach and 13 by the single incision umbilical approach. A magnetic retraction system was used for retraction, dissection and extraction of the gallbladder. Operating time was longer for the umbilical approach. There were no major complications. None of the patients registered abdominal or gynecological complaints, including discomfort at sexual intercourse. Conclusion. Both approaches are safe and comparable to the traditional technique at centers where laparoscopy is performed regularly. Although the umbilical approach registered shorter operating time, both types of procedure recorded acceptable operating times. The use of the magnetic device allows excellent exposure of Calot´s triangle and facilitates traction and retraction during the procedure. The good cosmetic result is evident for both approaches. Further prospective trials should be done in order to determine the clinical applicability of these two types of cholecystectomy.

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          Most cited references45

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          Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity.

          A novel endoscopic peroral transgastric approach to the peritoneal cavity was tested in a porcine model in acute and long-term survival experiments. Transgastric peritoneoscopy was evaluated in 50-kg pigs. After upper endoscopy, the peritoneal cavity was accessed by needle-knife puncture of the gastric wall, followed by extension of the incision either with a pull-type sphincterotome or by balloon dilation. The peritoneal cavity was examined, and a liver biopsy specimen was obtained. The gastric wall incision was closed with clips. Twelve acute and 5 survival experiments were performed. Both techniques of gastric wall incision were without complication. The acute experiments demonstrated the technical feasibility of the approach. In the survival experiments, all pigs recovered and gained weight. The peroral transgastric approach to peritoneal cavity technically is feasible and has the potential to be an alternative to laparoscopy and laparotomy.
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            Single-port laparoscopy in colorectal surgery.

            Laparoscopy is the approach of choice for the majority of colorectal disorders that require a minimally invasive abdominal operation. As the emphasis on minimizing the technique continues, natural orifice surgery is quickly evolving. The authors utilized an embryologic natural orifice, the umbilicus, as sole access to the abdomen to perform a colorectal procedure. Herein, we present our initial experience of single-port laparoscopic colorectal surgery using a Uni-X Single-Port Access Laparoscopic System (Pnavel Systems, Morganville, New Jersey, USA) with a multi-channel cannula and specially designed curved laparoscopic instrumentation. The abdomen was approached through a 3.5 cm incision via the umbilicus and a single-port access device was utilized to perform a right hemicolectomy on a patient with an unresectable caecal polyp and a body mass index of 35. Ligation of the ileocolic artery was done with a LigaSure Device (Covidien Ltd, Norwalk, Connecticut, USA), and was followed by colonic mobilization, extraction and extracorporeal ileocolic anastomosis. The total operative time was 115 min with minimal blood loss. Hospital stay was 4 days with no undue sequelae. Single-port laparoscopic surgery may allow common colorectal laparoscopic operations to be performed entirely through the patient's umbilicus and enable an essentially scarless procedure. Additional experience and continued investigation are warranted.
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              Laparoendoscopic single site (LESS) cholecystectomy.

              The journey from conventional "open" operations to truly "minimally invasive" operations naturally includes progression from operations involving multiple trocars and multiple incisions to operations involving access through the umbilicus alone. Laparoscopic operations through the umbilicus alone, laparoendoscopic single site surgery (LESS), offer improved cosmesis and hopes for less pain and improved recovery. This study was undertaken to evaluate our initial experience with LESS cholecystectomy and to compare our initial experience to concurrent outcomes with more conventional multiport, multi-incision laparoscopic cholecystectomy. All patients referred for cholecystectomy over a 6-month period were offered LESS. Outcomes, including blood loss, operative time, complications, and length of stay were recorded. Outcomes with our first LESS cholecystectomies were compared to an uncontrolled group of concurrent patients undergoing multiport, multi-incision laparoscopic cholecystectomy at the same hospital by the same surgeon. Twenty-nine patients of median age 50 years undergoing LESS cholecystectomy from November 2007 until May 2008 were compared to 29* patients, median age 48 years, undergoing standard multiport, multiple-incision laparoscopic cholecystectomy over the same time period. Median operative time for patients undergoing LESS cholecystectomy was 72 min and was not different from that of patients undergoing multiport, multi-incision laparoscopic cholecystectomy (p = 0.81). Median length of hospital stay was 1.0 day for patients undergoing LESS cholecystectomy and was not different from patients undergoing standard laparoscopic cholecystectomy (p = 0.46). Operative estimated blood loss was less than 100 cc for all patients. No patients undergoing attempted LESS cholecystectomy had conversions to "open" operations; two patients had an additional trocar(s) placed distant from the umbilicus to aid in exposure. Three patients undergoing LESS cholecystectomy had complications: two were troubled by pain control and another had urinary retention. LESS cholecystectomy is a safe and effective alternative to standard laparoscopic cholecystectomy. It can be undertaken without the expense of added operative time and provides patients with minimal, if any, apparent scarring. We believe LESS cholecystectomy will be driven by consumer demand, and therefore, laparoscopic surgeons will need to become proficient with LESS procedures.
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                Author and article information

                Journal
                rcci
                Revista Colombiana de Cirugía
                rev. colomb. cir.
                Asociación Colombiana de Cirugía (Bogotá, Distrito Capital, Colombia )
                2011-7582
                2619-6107
                June 2010
                : 25
                : 2
                : 121-130
                Affiliations
                [02] Chía orgnameUniversidad de la Sabana Colombia
                [01] Chía orgnameUniversidad de la Sabana Colombia
                Article
                S2011-75822010000200006 S2011-7582(10)02500206
                092be7d8-c9b2-4693-b5ab-50e669f6e361

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 06 April 2010
                : 14 May 2010
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 46, Pages: 10
                Product

                SciELO Colombia

                Categories
                Artículos originales

                SILC,NOTES,cirugía asistida por vídeo,vagina,colecistectomía laparoscópica,video-assisted surgery,laparoscopic,cholecystectomy

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