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Gastrectomia parcial laparoscópica assistida por endoscopia flexível em modelo de nódulo gástrico em cadáveres de cãesSantos, Fabiane Reginatto dos January 2016 (has links)
A videocirurgia é uma especialidade em crescimento dentro da medicina veterinária, muitos trabalhos descrevem suas vantagens em comparação às técnicas convencionais em diversos procedimentos de rotina e experimentais. A maior parte dos trabalhos publicados está relacionada às cirurgias do sistema reprodutor. Outros sistemas, como o gastrintestinal, ainda são pouco explorados. Os tumores de estômago, apesar de incomuns nos animais domésticos, tem maior incidência na espécie canina. Entre eles, os tumores benignos normalmente são pequenos e delimitados, possuem bom prognóstico e a ressecção cirúrgica é considerada o tratamento de eleição. O presente estudo teve como objetivo desenvolver um modelo de nódulo gástrico e avaliar sua ressecção por laparoscopia, assistida por endoscopia flexível. Para o estudo, foram utilizados 10 cadáveres de cães com peso entre 15 e 30 kg. O modelo de nódulo gástrico foi realizado em etapa aberta, através da aplicação de látex líquido entre as camadas muscular e submucosa na região próxima ao cárdia, no fundo gástrico. Com o objetivo de testar o acesso laparoscópico para sua ressecção, foram inseridos cinco portais para passagem do instrumental laparoscópico, sendo a ressecção do nódulo promovida pelo uso de grampeador laparoscópico. Nos dez cadáveres foi possível a formação do nódulo gástrico e sua visualização pela mucosa gástrica, via gastroscopia. A exérese dos nódulos com uso de carga única de 45 mm de comprimento apresentou limitações quanto à oclusão e secção do estômago. Nos três primeiros animais, o tecido excedeu o comprimento da carga resultando na incompleta oclusão do estômago, nos demais, a oclusão foi satisfatória, entretanto para completa exérese do fragmento foi necessário o auxílio de tesoura. O estudo possibilitou a partir do desenvolvimento do modelo de nódulo gástrico uma simulação adequada na ressecção laparoscópica de pequenos tumores com uso de dispositivo de sutura mecânica em conjunto com a endoscopia flexível. / The laparoscopic surgery is a growing specialty within veterinary medicine, many papers describe its advantages compared to conventional techniques in various routine and experimental procedures. Most of the published work is related to the surgeries of the reproductive system. Other systems, such as the gastrointestinal, are still poorly explored. Tumors of the stomach, although uncommon in domestic animals, have a higher incidence in the canine species. Among them, benign tumors are usually small and delimited, have good prognosis and surgical resection is considered the treatment of choice. The present study aimed to develop a gastric nodule model and to evaluate its laparoscopic resection, assisted by flexible endoscopy. For the study, 10 cadavers of dogs weighing between 15 and 30 kg were used. The gastric nodule model was performed in the open stage by the application of liquid latex between the muscular and submucosal layers in the region close to the cardia, in the gastric fundus. In order to test the laparoscopic access for its resection, five portals were inserted to pass the laparoscopic instruments, being resection of the node promoted by the use of laparoscopic stapler. In the ten cadavers it was possible to form the gastric node and its visualization through the gastric mucosa, via gastroscopy. Excision of the nodules with a single load of 45 mm in length presented limitations on occlusion and section of the stomach. In the first three animals, the tissue exceeded the length of the load resulting in incomplete occlusion of the stomach, in the others, the occlusion was satisfactory, however for complete exertion of the fragment it was necessary the aid of scissors. The study allowed the development of the gastric nodule model to simulate laparoscopic resection of small tumors using a mechanical suture device in conjunction with flexible endoscopy.
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Apport des nouvelles technologies dans l’exploration de la cavité péritonéale et la détection de la carcinose péritonéale : endoscopie péritonéale souple et chromoendoscopie virtuelle / Contribution of new technologies in the exploration of the peritoneal cavity and the detection of peritoneal carcinomatosis : peritoneal flexible endoscopy and virtual chromoendoscopyNajah, Haythem 28 November 2018 (has links)
Le pronostic de la carcinose péritonéale (CP) s’est nettement amélioré et son traitement permet aujourd’hui chez certains patients sélectionnés d’atteindre des survies prolongées. L’un des facteurs pronostics majeurs est l’étendue de la CP, évaluée par l’Indice de carcinose péritonéale (PCI). La prise en charge de la CP doit évoluer vers un double objectif : une évaluation précise du caractère chirurgicalement totalement extirpable des lésions (possibilité d’une CCR complète) et une détection la plus précoce possible de la maladie. Or sur ces deux objectifs, nos examens d’imagerie sont régulièrement mis en défaut, et ce n’est souvent qu’on moment de la laparotomie qu’une évaluation précise de la CP est possible.Dans ce projet nous nous sommes intéressés à l’apport potentiel de deux nouvelles technologies dans l’exploration de la CP : l’endoscopie péritonéale souple et la chromoendoscopie virtuelle.Dans la première partie de cette thèse, nous présentons notre technique d’exploration péritonéale par monotrocart (SILPE) au cours de laquelle nous réalisons en plus de l’endoscopie rigide, une endoscopie souple. Nous avons montré que cette technique est sûre et faisable. Dans une série de 183 SILPE, cette procédure a pu être réalisée dans 90,2% des cas. Cinq complications post-opératoires ont été observées (3%). La valeur prédictive positive de la SILPE pour prédire une CCR complète était de 79,5%. Le PCI était de 9,7±7,5 lors de la SILPE et de 13,5±9,6 lors de la laparotomie (p<0,0001). Le nombre de régions explorées était 13,0±0,3 en laparotomie et 12,2±1,6 en SILPE (p<0,0001). Le nombre de régions envahies était 6,9±4,5 en laparotomie et 5,4±3,8 en SILPE (p<0,0001). La sensibilité globale de la SILPE dans la détection de la CP dans les différentes régions était de 75%, avec une spécificité de 97%, soit une précision de 85%. Dans la deuxième partie de cette thèse, nous avons étudié l’apport de la chromoendoscopie virtuelle dans l’exploration de la cavité péritonéale et la détection de la CP.Nous sommes partis de l’hypothèse que le péritoine, comme tout autre organe soumis à un processus métastatique, subit des modifications selon le principe de la niche métastatique, pouvant être détectées par cette technologie. Le FICE est un système de chromoendoscopie virtuelle, qui contient 10 réglages différents permettant d’obtenir 10 images virtuelles, construites à partir d’images ayant des longueurs d’ondes réduites différentes. Nous avons d’abord mené une étude de faisabilité clinique au cours de laquelle des endoscopies péritonéales avec le système FICE étaient réalisées. Grâce à un système d’évaluation par deux questionnaires, nous avons déterminés les trois canaux du FICE adaptés à l’exploration du péritoine (canaux 2, 6 et 9). Pour la luminosité, la LB a été jugée meilleure (p<0,0001). En ce qui concerne la qualité du contraste, l’architecture vasculaire, la différentiation des organes, et la détection des nodules de CP, le canal 2 du FICE était jugé supérieur (p<0,0001). Dans un 2ème travail, nous avons créé un modèle murin de CP naissante. Les souris ont été opérées puis sacrifiées à des dates différentes. L’intervention consistait en une endoscopie péritonéale souple, au cours de laquelle les nodules de CP étaient pris en photo en LB et en FICE. 935 images correspondant à 85 nodules ont été analysées. Nous avons ensuite décomposé chaque image endoscopique en ces trois composantes élémentaires R-G-B. Nous avons par la suite comparé les contrastes obtenues avec ces différentes longueurs d’ondes. Nous avons pu ainsi déterminer la longueur d’onde du spectre de la LB qui donnait le meilleur contraste entre nodule de CP et péritoine avoisinant. Il s’agit de la lumière monochromatique à 460 nm (p<0,0001), avec un contraste moyen à 0,240±0,151. Ces résultats ont fait l’objet d’un dépôt de brevet via InsermTransfert. / The prognosis of peritoneal carcinomatosis (PC) has improved and today, its treatment could lead to long-term survivals in some selected patients. One of the major prognosis factors of this condition is the extent of the disease measured in terms of Peritoneal cancer index (PCI). The management of PC has to evolve towards two main goals: first an accurate evaluation of the disease burden in order to recognize the patients amenable to complete cytoreduction (CCR), and second an early detection of the disease. Unfortunately, current imaging methods strongly lack sensitivity in determining small tumor nodules, and it is often only at the time of laparotomy that an accurate evaluation of the PCI is possible.In this work, we have studied the potential role of two new techniques in the evaluation of PC: peritoneal flexible endoscopy and virtual chromoendoscopy.In the first part of the thesis, we present our technique of single incision laparoscopic peritoneal exploration (SILPE), in which we perform a peritoneoscopy with both a rigid endoscope and a flexible endoscope. Through a series a 183 SILPE, we showed that this technique is safe and feasible. The SILPE procedure was successful in 90.2% of the cases. Five postoperative complications were observed (3%). The positive predictive value of SILPE to predict CCR was 79.5%. The PCI was 9.7±7.5 at the time of SILPE, and 13.5±9.6 at the time of laparotomy (p<0.0001). The number of the regions explored by SILPE was 12.2±1.6, and by laparotomy 13.0±0.3 (p<0.0001). The number of affected regions was 5.4±3.8 at the time of SILPE and 6.9±4.5 at the time of laparotomy (p<0.0001). The overall sensitivity of SILPE in the detection of PC in the different regions was 75%, with a specificity of 97%, thus an accuracy rate of 85%. In the second part of this thesis, we have studied the role of virtual chromoendoscopy in the peritoneal exploration and PC detection. We started from the hypothesis that, as any organ subject to a metastatic process, the peritoneum would change according to the theory of the metastatic niche, changes that could be detected by this technology. FICE is a virtual chromoendoscopy system that is merchandised with 10 factory-determined presets, built from different reduced single-wavelength images. We have first carried out a feasibility study in human in which peritoneal endoscopies using the FICE system were performed. Thanks to an evaluation plan based on two questionnaires, we have determined the three FICE channels suitable for peritoneal exploration (channels 2, 6, and 9). For brightness, white light endoscopy was judged superior to all FICE channels (p<0.0001). FICE Channel 2 was superior to white light endoscopy and other FICE channels, in terms of contrast, visualization of vascular architecture, differentiation between organs, and detection of PC (p<0.0001). In a second study, we created a murine model of an incipient PC. Mice had peritoneal explorations with FICE at different times. For each PC nodule detected, one white light endoscopy and 10 FICE images were recorded. 935 images corresponding to 85 nodules were analyzed. Each image was then divided into its elementary red, green and blue band images. Therefore, we compared the contrasts obtained with each wavelength. Thus, we’ve determined the wavelength of the white light specter that provides the highest contrast between PC nodule and background peritoneum. It was the monochromatic light with a wavelength at 460 nm (p<0.0001), with a mean contrast value of 0.240±0.151. A patent via InsermTransfert has been filed.
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The development, validation and analysis of new endosurgical procedures in upper gastrointestinal surgery / by Justin Raymond Bessell.Bessell, Justin Raymond January 1995 (has links)
Bibliography: leaves 197-220. / xv, 220 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Analyses some general problems of laparoscopy, particularly in relation to induced physiological disturbances; by development and evaluation of new applications in laparoscopic gastrointestinal surgery ; and by assessing the efficacy of laparoscopic procedures which have already entered rountine practice. / Thesis (M.D.)--University of Adelaide, Dept. of Surgery, 1996?
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Carbon Dioxide Pneumoperitoneum - Hemodynamic Consequences and Thromboembolic ComplicationsLindberg, Fredrik January 2002 (has links)
<p>The laparoscopic way of performing general surgical procedures was introduced all over the Western world in a few years around 1990. No previous scientific studies of the safety of this new way of performing general surgery had been undertaken.</p><p>In an animal study, it was shown that carbon dioxide pneumoperitoneum (CO<sub>2</sub>PP) causes an increase in inferior caval vein (ICV) pressure, although there were no effects on the ICV blood flow. There were gradual increases in systemic, pulmonary and ICV vascular resistance, which remained after exsufflation. These effects on vascular resistance could not be reproduced in a second animal study, presumably due to a different form of anesthesia. In this study, there was only indirect evidence of CO<sub>2</sub> PP decreasing urine output. No increase in vasopressin, which is commonly seen during CO<sub>2</sub> PP, was found, indicating that vasopressin may play a role in the decreased urine output during CO<sub>2</sub> PP but that there must be other contributing factors as well. Only brief effects on the renal arterial blood flow were seen.Renal venous pressure increased to that of the ICV.</p><p>A literature review indicated that thromboembolic complications do occur after laparoscopic cholecystectomy (LC). The relative frequencies indicated an underreporting of deep vein thrombosis (DVT) in relation to pulmonary embolism (PE).</p><p>In a clinical study, activation of the coagulation after LC was demonstrated. There were differences between the groups receiving dextran and low molecular weight heparin as prophylaxis. A further clinical study showed the incidence of DVT, as demonstrated by phlebography, to be 2.0 % (95 % confidence interval 0-6.0 %) 7-11 days after LC, even though thromboembolism prophylaxis was given in shorter courses than those scientifically proven to be effective against DVT. D-dimer values increased at the first postoperative day and even further at the time of phlebography, suggesting that the effects of LC on coagulation and/or fibrinolysis may be of longer duration than previously known.</p>
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Carbon Dioxide Pneumoperitoneum - Hemodynamic Consequences and Thromboembolic ComplicationsLindberg, Fredrik January 2002 (has links)
The laparoscopic way of performing general surgical procedures was introduced all over the Western world in a few years around 1990. No previous scientific studies of the safety of this new way of performing general surgery had been undertaken. In an animal study, it was shown that carbon dioxide pneumoperitoneum (CO2PP) causes an increase in inferior caval vein (ICV) pressure, although there were no effects on the ICV blood flow. There were gradual increases in systemic, pulmonary and ICV vascular resistance, which remained after exsufflation. These effects on vascular resistance could not be reproduced in a second animal study, presumably due to a different form of anesthesia. In this study, there was only indirect evidence of CO2 PP decreasing urine output. No increase in vasopressin, which is commonly seen during CO2 PP, was found, indicating that vasopressin may play a role in the decreased urine output during CO2 PP but that there must be other contributing factors as well. Only brief effects on the renal arterial blood flow were seen.Renal venous pressure increased to that of the ICV. A literature review indicated that thromboembolic complications do occur after laparoscopic cholecystectomy (LC). The relative frequencies indicated an underreporting of deep vein thrombosis (DVT) in relation to pulmonary embolism (PE). In a clinical study, activation of the coagulation after LC was demonstrated. There were differences between the groups receiving dextran and low molecular weight heparin as prophylaxis. A further clinical study showed the incidence of DVT, as demonstrated by phlebography, to be 2.0 % (95 % confidence interval 0-6.0 %) 7-11 days after LC, even though thromboembolism prophylaxis was given in shorter courses than those scientifically proven to be effective against DVT. D-dimer values increased at the first postoperative day and even further at the time of phlebography, suggesting that the effects of LC on coagulation and/or fibrinolysis may be of longer duration than previously known.
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A surgical confocal microlaparoscope for real-time optical biopsiesTanbakuchi, Anthony Amir January 2009 (has links)
The first real-time uorescence confocal microlaparoscope has been de- veloped that provides instant in vivo cellular images, comparable to those provided by histology, through a nondestructive procedure. The device in- cludes an integrated contrast agent delivery mechanism and a computerized depth scan system. The instrument uses a fiber bundle to relay the image plane of a slit-scan confocal microlaparoscope into tissue. The confocal laparoscope was used to image the ovaries of twenty-one patients in vivo using uorescein sodium and acridine orange as the uorescent contrast agents. The results indicate that the device is safe and functions as designed. A Monte Carlo model was developed to characterize the system performance in a scattering media representative of human tissues. The results indicate that a slit aperture has limited ability to image below the surface of tissue. In contrast, the results show that multi-pinhole apertures such as a Nipkow disk or a linear pinhole array can achieve nearly the same depth performance as a single pinhole aperture. The model was used to determine the optimal aperture spacing for the multi-pinhole apertures. The confocal microlaparoscope represents a new type of in vivo imaging device. With its ability to image cellular details in real time, it has the potential to aid in the early diagnosis of cancer. Initially, the device may be used to locate unusual regions for guided biopsies. In the long term, the device may be able to supplant traditional biopsies and allow the surgeon to identify early stage cancer in vivo.
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Surgical robotics - visual autonomous cauterization system (VACS) conceptual design /Spooner, Nicholas A. January 1900 (has links)
Thesis (M.App.Sc.) - Carleton University, 2007. / Includes bibliographical references (p. 82-89). Also available in electronic format on the Internet.
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Avaliação hemodinâmica e homogasomêtrica de cadelas submetidas à ovariohisterectomia videolaparoscópica, sob anestesia geral intravenosa contínua com propofol e fentanil, com ou sem o uso de infusão contínua de atracúrio, mediante ventilação controlada com pressão expiratória final positiva ou não.Muccillo, Marcelo de S. January 2008 (has links)
A cirurgia laparoscópica requer a criação de um espaço de trabalho intraabdominal, através do pneumoperitônio, e para isto utiliza-se o dióxido de carbono (CO2). As alterações sistêmicas relacionadas ao sistema respiratório ocorrem pelo aumento da pressão intra-abdominal, resultando em diminuição da complacência pulmonar, atelectasia, hipercarbia e hipóxia. A insuflação de CO2 com pressões intraabdominais acima de 8 mmHg produz alterações hemodinâmicas significantes, caracterizadas por decréscimo do débito cardíaco, elevação da pressão arterial. Para que a homeostase hemodinâmica e respiratória seja mantida são necessários protocolos anestésicos adequados e métodos de ventilação mecânica como, por exemplo, a pressão expiratória final positiva final (PEEP). O presente trabalho teve por objetivo avaliar e comparar quatro protocolos anestésicos e ventilatórios distintos em cadelas submetidas à ovariohisterectomia videolaparoscópica eletiva, com uso de pneumoperitônio com CO2 e 12 mmHg de pressão intra-abdominal, sob anestesia geral total intravenosa. Para isso, 16 caninos foram distribuídos em quatro grupos: no grupo 1 (Zeepbloq) os animais receberam atracúrio (0,5 mg.kg-1), propofol (5 mg.kg-1) e fentanil (2 mcg.kg-1), todos em bolus, por via intravenosa, e seguiu-se com infusão contínua de atracúrio (0,5 mg.kg-1/hora), propofol (0,4 mg.kg-1/minuto) e fentanil (2 mcg.kg-1/hora) por bomba de infusão, e não foi realizada PEEP; no grupo 2 (Peepbloq) administrou-se o mesmo protocolo anestésico, porém realizou-se a PEEP de 10 cm de água; no grupo 3 (Zeep) os animais receberam o mesmo protocolo anestésico, com exceção bloqueador neuromuscular, e não foi realizada PEEP; no grupo 4 (PEEP) os indivíduos receberam o mesmo protocolo do grupo 3, porém realizou-se PEEP. Para o procedimento cirúrgico foi realizado pneumoperitônio de 12 mmHg com CO2 com duração variável. Foram avaliadas as seguintes variáveis: pressão arterial média, freqüência respiratória, saturação de oxigênio na hemoglobina, pressão parcial de dióxido de carbono expirado, freqüência cardíaca, eletrocardiografia e tempo do procedimento anestésico, do pneumoperitônio. Para hemogasometria foi realizada a coleta de sangue arterial, sendo obtidas variáveis de pH, pressão parcial de O2 e CO2, bicarbonato, CO2 total, excesso/déficit de bases e saturação arterial de oxigênio na hemoglobina. Não foram observados valores que representassem diferença estatística significativa entre os grupos (p<0,05). No entanto, houve diferença significativa (p<0,05) entre momentos avaliados a para pressão arterial de oxigênio, a pressão arterial média e a temperatura, independente do protocolo empregado. Ambos os protocolos empregados, anestésico e de ventilação, foram satisfatórios e, de acordo com a metodologia empregada, pode-se concluir que animais submetidos à ventilação com PEEP não apresentaram benefícios significativos quando comparados com animais ventilados com ZEEP, independente do uso ou não de bloqueador neuromuscular. / The laparoscopic surgery requires the creation of a space in the abdominal cavity through pneumoperitoneum and that using the carbon dioxide (CO2). The systemic changes related to the respiratory system occur by increased intra-abdominal pressure, resulting in decreased lung compliance, atelectasis, hypercarbia and hypoxia. The CO2 insufflation with intra-abdominal pressure over 8 mmHg produces significant hemodynamic changes, characterized by decreased cardiac output, blood pressure elevation. For the hemodynamic and respiratory homeostasis is maintained anesthetic protocols are necessary and appropriate methods of mechanical ventilation, such as the positive end-expiratory pressure (PEEP). This study aimed to evaluate and compare four different protocols anesthetics and ventilatory in female dogs submitted to ovariohysterectomy videolaparoscopic elective, with the use of pneumoperitoneum with CO2 and 12 mmHg of intra-abdominal pressure, under general anesthesia total intravenous. A total of 16 dogs were distributed into four groups: in group 1 (Zeepbloq) the animals received atracurium (0.5 mg.kg-1), propofol (5 mg.kg-1) and fentanyl (2 mcg . kg-1), all bolus, intravenously, and followed up with continuous infusion of atracurium (0.5 mg.kg-1/hour), propofol (0.4 mg.kg-1/minute) and fentanyl (2 mcg.kg-1/hour) by infusion pump, and was not held PEEP, in group 2 (Peepbloq) administered to the same protocol anesthetic, but was held on PEEP of 10 cm of water, in group 3 (Zeep) the animals received the same protocol anesthetic, except neuromuscular blocker, and was not held PEEP, and in group 4 (PEEP) individuals received the same protocol as the group 3, but was held PEEP. For the surgical procedure was performed abdominal pressure of 12 mmHg with CO2. We evaluated the following variables: mean arterial pressure, respiratory rate, oxygen saturation in hemoglobin, end tidal of carbon dioxide expired, heart rate, electrocardiography and time of the anesthetic procedure and of the pneumoperitoneum. Arterial blood was sampled for arterial blood gas analyses, and variables obtained from pH, arterial pressure of CO2 and O2, bicarbonate, CO2 total, balance of bases and arterial oxygen saturation in hemoglobin. There were no evaluate parameters that represented statistically significant difference between groups (p <0.05). However, there was a significant difference (p <0.05) between moments evaluated for the blood pressure of oxygen, the mean blood pressure and temperature, independent of protocol employee. Both protocols employees, anaesthetic and ventilation, were satisfactory and in accordance with the methodology employed, we can conclude that animals treated with ventilation PEEP did not show significant benefits when compared with animals ventilated with ZEEP, regardless of whether or not to use atracurium.
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Ovário-histerectomia minilaparoscópica em gatas hígidasLawall, Thaíse January 2015 (has links)
A ovário-histerectomia (OVH) é um procedimento cirúrgico realizado de maneira rotineira na clínica de pequenos animais, com objetivo terapêutico ou de promover a esterilização reprodutiva nas fêmeas. Muitas abordagens pela técnica convencional aberta já foram descritas e com viabilidade comprovada. No segmento da cirurgia de invasão mínima dentro da Medicina Veterinária, diversos métodos vêm sendo propostos variando entre si em relação ao posicionamento, quantidade e tamanho dos trocartes e método de hemostasia. Assim sendo, o objetivo deste estudo foi avaliar e descrever a viabilidade de realização da OVH em felinas com até 5 kg de peso corporal através de abordagem minilaparoscópica com uso de eltrocoagulação bipolar como método hemostático. A minilaparoscopia (MINI) não é uma modalidade recente na cirurgia laparoscópica humana. Considerada a evolução mais sofisticada da cirurgia laparoscopia, a MINI apresenta muitos outros benefícios além do estético; visto que a lesão relacionada ao dano cirúrgico não se resume as somas das incisões realizadas. A técnica reina pela delicadeza e precisão dos movimentos, sem perda da triangulação, essencial ao padrão laparoscópico. Foram avaliados os procedimentos de 15 felinas quanto à viabilidade e dificuldades do acesso minilaparoscópico, uso do cautério bipolar, o tamanho das incisões e a necessidade de ampliá-las, complicações trans e pós-operatórias assim como a dor demonstrada por esses pacientes. A avaliação da dor foi feita através de tabela específica para espécie felina com diretrizes estabelecidas e confiabilidade comprovada, auxiliada a outras duas tabelas de avaliação da dor. A conversão de minilaparoscopia à cirurgia aberta foi necessária em um dos quinze pacientes operados nesse estudo. Conclui-se que a realização da técnica de OVH por abordagem minilaparoscópica em gatas é factível. / Ovariohysterectomy (OHE) is a surgical procedure routinely performed in small animals practice, with therapeutic purpose or to promote reproductive sterilization in females. Numerous approaches have been described using conventional open technique and had their viability proven. In the segment of minimally invasive surgery in the Veterinary Medicine, several methods have been proposed, differing from each other in position, number and size of trocars and hemostasis method used. Thus, the goal of this study was to evaluate and describe the practicability of performing OHE in cats with up to 5 kg of body weight through minilaparoscopic approach, using bipolar eltrocoagulation as hemostatic method. The minilaparoscopy (MINI) is not a new modality in human laparoscopic surgery. Considered the most sophisticated evolution of laparoscopic surgery, the MINI has many other benefits beyond the aesthetic; since the injury caused by the damage of surgery is not just the sum of the incisions. The technique stands out for the delicacy and accuracy of the movement without loss of triangulation, essential for the laparoscopic model. The procedures of 15 female cats were evaluated for the viability and difficulties of minilaparoscopic approach, use of bipolar cautery, incision size and the need to enlarge it, trans and postoperative complications and pain demonstrated in these patients. Pain assessment was done through specific table for feline species with established guidelines and proven reliability, helped by other two pain assessment tables. The conversion from minilaparoscopy to open surgery was required in one of the fifteen patients operated on in this study. Therefore, the implementation minilaparoscopic approach for OHE technique is feasible in cats.
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Gastrectomia parcial laparoscópica assistida por endoscopia flexível em modelo de nódulo gástrico em cadáveres de cãesSantos, Fabiane Reginatto dos January 2016 (has links)
A videocirurgia é uma especialidade em crescimento dentro da medicina veterinária, muitos trabalhos descrevem suas vantagens em comparação às técnicas convencionais em diversos procedimentos de rotina e experimentais. A maior parte dos trabalhos publicados está relacionada às cirurgias do sistema reprodutor. Outros sistemas, como o gastrintestinal, ainda são pouco explorados. Os tumores de estômago, apesar de incomuns nos animais domésticos, tem maior incidência na espécie canina. Entre eles, os tumores benignos normalmente são pequenos e delimitados, possuem bom prognóstico e a ressecção cirúrgica é considerada o tratamento de eleição. O presente estudo teve como objetivo desenvolver um modelo de nódulo gástrico e avaliar sua ressecção por laparoscopia, assistida por endoscopia flexível. Para o estudo, foram utilizados 10 cadáveres de cães com peso entre 15 e 30 kg. O modelo de nódulo gástrico foi realizado em etapa aberta, através da aplicação de látex líquido entre as camadas muscular e submucosa na região próxima ao cárdia, no fundo gástrico. Com o objetivo de testar o acesso laparoscópico para sua ressecção, foram inseridos cinco portais para passagem do instrumental laparoscópico, sendo a ressecção do nódulo promovida pelo uso de grampeador laparoscópico. Nos dez cadáveres foi possível a formação do nódulo gástrico e sua visualização pela mucosa gástrica, via gastroscopia. A exérese dos nódulos com uso de carga única de 45 mm de comprimento apresentou limitações quanto à oclusão e secção do estômago. Nos três primeiros animais, o tecido excedeu o comprimento da carga resultando na incompleta oclusão do estômago, nos demais, a oclusão foi satisfatória, entretanto para completa exérese do fragmento foi necessário o auxílio de tesoura. O estudo possibilitou a partir do desenvolvimento do modelo de nódulo gástrico uma simulação adequada na ressecção laparoscópica de pequenos tumores com uso de dispositivo de sutura mecânica em conjunto com a endoscopia flexível. / The laparoscopic surgery is a growing specialty within veterinary medicine, many papers describe its advantages compared to conventional techniques in various routine and experimental procedures. Most of the published work is related to the surgeries of the reproductive system. Other systems, such as the gastrointestinal, are still poorly explored. Tumors of the stomach, although uncommon in domestic animals, have a higher incidence in the canine species. Among them, benign tumors are usually small and delimited, have good prognosis and surgical resection is considered the treatment of choice. The present study aimed to develop a gastric nodule model and to evaluate its laparoscopic resection, assisted by flexible endoscopy. For the study, 10 cadavers of dogs weighing between 15 and 30 kg were used. The gastric nodule model was performed in the open stage by the application of liquid latex between the muscular and submucosal layers in the region close to the cardia, in the gastric fundus. In order to test the laparoscopic access for its resection, five portals were inserted to pass the laparoscopic instruments, being resection of the node promoted by the use of laparoscopic stapler. In the ten cadavers it was possible to form the gastric node and its visualization through the gastric mucosa, via gastroscopy. Excision of the nodules with a single load of 45 mm in length presented limitations on occlusion and section of the stomach. In the first three animals, the tissue exceeded the length of the load resulting in incomplete occlusion of the stomach, in the others, the occlusion was satisfactory, however for complete exertion of the fragment it was necessary the aid of scissors. The study allowed the development of the gastric nodule model to simulate laparoscopic resection of small tumors using a mechanical suture device in conjunction with flexible endoscopy.
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