O desenvolvimento da técnica de transferência embrionária no oviduto mediante videolaparoscopia e a avaliação de produtividade da punção folicular laparoscópica (LOPU) associada à transferência embrionária laparoscópica e/ou por laparotomia videoassistida, ambas no oviduto, foram os objetivos do presente trabalho. Foram utilizados 53 animais, sendo as punções foliculares para obtenção dos oócitos realizadas em 9 ovelhas adultas estimuladas hormonalmente, chamadas doadoras. Os oócitos foram obtidos através de LOPU repetidamente com intervalo mínimo de um mês entre os procedimentos nas mesmas doadoras. Os oócitos puncionados foram maturados, fertilizados e mantidos em cultivo por até três. Os embriões clivados foram transferidos no segundo dia após a fertilização in vitro (FIV) em ovelhas receptoras com cio sincronizado. A transferência dos embriões (TE) foi realizada primeiramente em 10 receptoras por laparoscopia e em 34 receptoras por laparotomia videoassistida, sendo esta última dividida em duas etapas cronológicas. Para a realização da TE por videolaparoscopia, foi introduzido, inicialmente, um trocarte de 5 mm na linha média ventral próximo à glândula mamária para passagem da óptica. Um segundo portal, crânio-lateral ao primeiro, foi criado para introdução de pinça de manipulação de ovário. Confirmada a existência de corpo lúteo (CL) em um dos ovários, um trocarte foi inserido no lado oposto a esse para passagem de cateter de Foley. Sua função foi auxiliar na exposição e abertura da fímbria. Um cateter urinário, contendo os embriões foi então introduzido na porção inicial do oviduto para deposição dos mesmos. Obteve-se 8 fetos resultantes da transferência por laparoscopia (10 receptoras), 10 fetos resultantes da primeira etapa da transferência por laparotomia (14 receptoras) e 30 fetos resultantes da segunda etapa da laparotomia (20 receptoras). A média de fetos por sessão de LOPU foi de 1 para transferência laparoscópica, 1,3 na primeira etapa da transferência por laparotomia e 3,3 na segunda etapa de laparotomia. A transferência embrionária videolaparoscópica de embriões clivados no oviduto mostrou resultado positivo na produção de fetos, podendo ser considerada técnica promissora. Quando associada à LOPU, a transferência embrionária no oviduto por laparoscopia / laparotomia videoassistida, apresentou resultados superiores aos relatados na literatura com a transferência intra-uterina de embriões FIV. / The development of the technique of embryo transfer in oviduct through video-assisted laparoscopy and the demonstration of productive association between laparoscopic follicle aspiration (LOPU) and embryonic transfer laparoscopy and / or open surgery (video-assisted laparotomy)both in oviduct was the goal of the work. From the 53 animals used in the study, follicular puncture was used to obtain oocytes from 9 adult ewes for super-ovulated with hormonally stimulation, referred to as the donors. The oocytes were obtained through repeated LOPU with minimum intervals of one month from the same donor. The retrieved oocytes were matured, fertilized with frozen semen and cultured in vitro for up to two days after IVF. The cleaved embryos were transferred on the second day after IVF into synchronized receptor ewes. The transfer of embryos was first done in 10 receptors through laparoscopy and then in 34 receptors through video-assisted laparotomy, the latter being divided into two chronological stages. For the development of ET by video-assisted laparoscopy, a 5mm trocar was initially introduced ventral midline near the mammary gland for passage of the laparoscope. A second portal, in a craniolateral position was used for passage of another 5 mm trocar for introduction of forceps to manipulate the ovary. After confirming the existence of CL in one of the ovaries, a trocar was inserted on the opposite side for passage of the Foley catheter, to assist in the exposure and opening of the fimbria. A urinary catheter, containing the embryo, was then introduced into the initial portion of the oviduct for deposition of the embryos. There were 8 fetuses resulting from the transfer by laparoscopy (10 receptors), 10 fetuses resulting from the first stage of the transfer by laparotomy (14 receptors) and 30 fetuses resulting from the second stage of the laparotomy (20 receptors). The average number of fetuses per session of LOPU was 1 for laparoscopic transfer, 1.3 for the first stage of the transfer by laparotomy and 3.3 in the second stage of laparotomy. The technique of embryo transfer through video-assisted laparoscopy with cleaved embryos in oviduct was thus shown to a positive fetus\'s result of production, and will be promising. When associated with LOPU, the transfer of embryos in oviduct by laparoscopy / video-assisted laparotomy presented better results then other authors when compare intrauterine IVF embryo transfer.

Copies of author's previously published articles inserted. / Bibliography: leaves 187-209. / xiii, 209 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Documents the establishment of a reproducible model of carcinoma implanted into the abdominal wall of an immunocompetent Dark agouli rat to study the relationship between laparoscopy and the development of port site metastases. / Thesis (M.D.)--University of Adelaide, Dept. of Surgery, 1998?

<p>Roux-en-Y gastric bypass (RYGBP) sustains weight loss and ameliorates diseases common in the morbid obese (BMI>40 kg/m²), but leaves the stomach and duodenum inaccessible. Morbidly obese patients have increased operative risks and in other fields minimal surgery is known to facilitate the postoperative course.</p><p>The aim of this thesis was to evaluate hand-assisted laparoscopy in RYGBP and develop techniques to study the excluded stomach.</p><p>The hand-assisted technique was developed in 13 patients and subsequently compared to open surgery in a blinded, prospective, randomised trial of 50 patients.</p><p>Hand-assistance was feasible with a low need for conversions or re-operations. The duration of surgery was longer (150 versus 85 minutes) and postoperative results were similar to those in open surgery. Thus, the patients did not appear to derive benefits from hand-assisted laparoscopy. Interventional radiology accessed the excluded stomach and allowed endoscopy, barium studies and acid measurements. Chronic gastritis and low acid production were found. After RYGBP, 8 of 22 patients (36%) had duodenogastric bile reflux (DGBR), when studied by HIDA-scintigraphy. No DGBR was seen among controls. The gastric mucosa was evaluated by serology</p><p>(pepsinogen I (PGI), H. pylori and H,K-ATPase) in 64 patients before and 1-4 years after operation. RYGBP, in contrast to gastric restriction, had reduced PGI levels postoperatively. According to serology, the mucosa is atrophic or in a resting state.</p><p>This study focuses on safety in RYGBP. Hand-assisted laparoscopy was feasible, but not favourable compared to an optimised open procedure. The excluded stomach is no longer inaccessible and characterised by chronic gastritis, low acid production and frequent bile reflux.</p>

Roux-en-Y gastric bypass (RYGBP) sustains weight loss and ameliorates diseases common in the morbid obese (BMI&gt;40 kg/m2), but leaves the stomach and duodenum inaccessible. Morbidly obese patients have increased operative risks and in other fields minimal surgery is known to facilitate the postoperative course. The aim of this thesis was to evaluate hand-assisted laparoscopy in RYGBP and develop techniques to study the excluded stomach. The hand-assisted technique was developed in 13 patients and subsequently compared to open surgery in a blinded, prospective, randomised trial of 50 patients. Hand-assistance was feasible with a low need for conversions or re-operations. The duration of surgery was longer (150 versus 85 minutes) and postoperative results were similar to those in open surgery. Thus, the patients did not appear to derive benefits from hand-assisted laparoscopy. Interventional radiology accessed the excluded stomach and allowed endoscopy, barium studies and acid measurements. Chronic gastritis and low acid production were found. After RYGBP, 8 of 22 patients (36%) had duodenogastric bile reflux (DGBR), when studied by HIDA-scintigraphy. No DGBR was seen among controls. The gastric mucosa was evaluated by serology (pepsinogen I (PGI), H. pylori and H,K-ATPase) in 64 patients before and 1-4 years after operation. RYGBP, in contrast to gastric restriction, had reduced PGI levels postoperatively. According to serology, the mucosa is atrophic or in a resting state. This study focuses on safety in RYGBP. Hand-assisted laparoscopy was feasible, but not favourable compared to an optimised open procedure. The excluded stomach is no longer inaccessible and characterised by chronic gastritis, low acid production and frequent bile reflux.

No description available.

HIV epidemic is one of the major challenges to the South Africa’s socio-economic development. The incidence of tuberculosis is rising in sub-Saharan Africa, and in 2009 South Africa had the second highest incidence of tuberculosis in the world. Approximately 80% of incident tuberculosis cases in South Africa are HIV positive. In HIV positive individual, abdominal tuberculosis has been reported as the most common form of extra-pulmonary tuberculosis. HIV/AIDS has resulted in a resurgence of abdominal tuberculosis in South Africa. Making the diagnosis of abdominal tuberculosis is still difficult, though the condition is common. The role of laparoscopy in making the diagnosis is undefined. Method: All patients with clinically and radiologically suspected but histologically or microbiologically unconfirmed abdominal tuberculosis were referred to the investigating team and laparoscopy was performed to diagnose abdominal tuberculosis. Histology was performed on tissue biopsy specimens and TB culture on ascitic fluid and peripheral blood specimens. Results: From January 2008 to June 2010 a total of 190 patients were referred to us. No surgical intervention was taken in 60 patients; all of them were HIV positive. Twenty six of them died (43%) in the hospital during the evaluation period before the diagnostic laparoscopy, and the rest (57%) were unfit for anaesthesia. Forty nine patients required emergency laparotomy either for bowel obstruction or peritonitis and 39% of them died. Eighty one patients underwent diagnostic laparoscopy and 77% of them were HIV positive, in 16% the HIV status was unknown. Two percent had clinical ascites. Laparoscopic findings included intra-abdominal lymphadenopathy in 56, minimal ascitic fluid in 46, intra-abdominal mass in 17, and deposits on bowel wall, peritoneum or omentum in 20 patients. Fifty five patients (68%) had positive histology for tuberculosis. In 15 patients (19%) histology revealed non-specific inflammation, no pathology was found in one patient and no specimen was taken from one patient. Eighty percent of peritoneal deposits and 77% of lymph nodes were positive for tuberculosis, whereas 35% ascitic fluid culture was positive. In nine patients (11%) an alternative diagnosis was found (appendicitis, adenocarcinoma, lymphoma). Conclusion: Laparoscopy was feasible and showed a high yield to establish the diagnosis of abdominal tuberculosis and to provide an alternate diagnosis. Laparoscopy was useful to establish the gross features of abdominal tuberculosis and to provide the adequate specimens for examinations. Very poor follow negated the evaluation of the clinical response to anti tuberculosis therapy. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.

Background: How to optimally integrate simulation into a surgical training program is relatively unknown. We studied the effect of varying the practice schedule into either blocked or random patterns (termed contextual interference) on the long-term retention and transfer of surgical skills. Methods: 36 participants were randomized to practice 4 tasks from the Fundamental of Laparoscopic Surgery (FLS) program using one of three training schedules (blocked, random, no training). Skill was assessed using FLS scoring and hand-motion efficiency scores. Results: A positive benefit of training was seen over the controls for all 4 tasks (p<0.05). No difference was seen between the blocked and random groups in the amount of skill acquired, skill learned, or transfer of skill. Conclusion: The application of contextual interference was unable to differentiate between the blocked and random training groups. This could be due to the complexity of the tasks and/or the inexperience of the learners.

Background: How to optimally integrate simulation into a surgical training program is relatively unknown. We studied the effect of varying the practice schedule into either blocked or random patterns (termed contextual interference) on the long-term retention and transfer of surgical skills. Methods: 36 participants were randomized to practice 4 tasks from the Fundamental of Laparoscopic Surgery (FLS) program using one of three training schedules (blocked, random, no training). Skill was assessed using FLS scoring and hand-motion efficiency scores. Results: A positive benefit of training was seen over the controls for all 4 tasks (p<0.05). No difference was seen between the blocked and random groups in the amount of skill acquired, skill learned, or transfer of skill. Conclusion: The application of contextual interference was unable to differentiate between the blocked and random training groups. This could be due to the complexity of the tasks and/or the inexperience of the learners.

Diss. (sammanfattning) Uppsala : Univ., 2001. / Härtill 5 uppsatser.

Made available in DSpace on 2014-06-11T19:23:43Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-02-07Bitstream added on 2014-06-13T18:48:32Z : No. of bitstreams: 1 duarte_all_me_jabo.pdf: 292637 bytes, checksum: 6ba54a997864af0075b8c619c900785e (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A técnica de biópsia hepática guiada por videolaparoscopia em caprinos foi realizada em 12 animais machos, castrados, hígidos, sem raça definida e com idades de seis a 12 meses. Os animais foram submetidos à anestesia intravenosa e a laparoscopia consistiu na introdução da agulha de Veress no flanco direito para provocar pneumoperitôneo com dióxido de carbono e permitir a inserção da cânula e trocarte para introdução do endoscópio na cavidade abdominal acoplado a uma microcâmera e ao monitor de vídeo por um cabo de fibra ótica. Após a visualização do fígado, foi introduzida a agulha de biópsia hepática tru-cut no décimo primeiro espaço intercostal, a aproximadamente 12cm ventral à coluna vertebral, para punção e remoção de fragmento do lobo hepático direito. Em seguida, o pneumoperitônio foi desfeito e as incisões cutâneas foram suturadas. Os fragmentos hepáticos colhidos foram fixados em solução de Bouin por 24 horas e processados de forma rotineira para inclusão em parafina. Foram feitas avaliações clínicas e exames hemáticos no pré-jejum e às 24, 48 e 72 horas após a intervenção cirúrgica. Houve leucocitose com neutrofilia e aumento do fibrinogênio plasmático nas primeiras 24 horas pós-operatórias, indicando a ocorrência de processo inflamatório intra-abdominal discreto e fugaz, não mais observado na 488 hora pós-cirúrgica. A biópsia hepática com agulha tru-cut guiada por videolaparoscopia foi considerada segura e eficaz para uso em caprinos, permitindo a obtenção de fragmentos hepáticos suficientes para exame histopatológico. / The technique of videolaparoscopic guided hepatic biopsy was performed in 12 castrated male goats, healthy, without defined breed and aging from six to 12 months. Each animal received total intravenous anesthesia and was submitted to the laparoscopic procedure that consisted in the insertion of a Veress needle in the right flank in order to cause a pneumoperitoneum with carbon dioxide. This procedure was followed by cannulation and then by introduction of a rigid endoscope coupled with a microcamera. Afier visualization of the liver, a tru-cut hepatic biopsy needle was applied in the eleventh intercostal space about 12cm ventral to the spinal column for punch and removal of a fragment from the right hepatic lobe. Soon afier the drainage of the pneumoperitoneum, the small skin incisions were sutured. The biopsy fragments were fixed in Bouin's solution for 24 hours and then submitted to paraffin inclusion histologic routine. Clinical evaluation and hematologic exams were made during the pre-fasting period and again at 24, 48 and 72 hours afier the surgery. There was observed leucocytosis with increased neuthrophils and plasmatic fibrinogen levels at 24 hours afier the procedure, indicating the presence of a discrete intraabdominal inflammatory process that was no more observed at 48 hours. The videolaparoscopic guided hepatic biopsy with a tru-cut needle was considered efficacious and secure to be used in goats, allowing the obtention of hepatic tissue fragments suitable for histopathological examination.