A infecção de sítio cirúrgico é um dos principais problemas que pode acometer o paciente no perioperatório. Este tipo de infecção em cirurgia ortopédica consiste em problema grave devido à sua morbidade e custos elevados. O presente estudo teve como objetivo geral analisar a ocorrência e os fatores predisponentes de infecção de sítio cirúrgico em pacientes submetidos a cirurgias ortopédicas. Para tal, realizou-se estudo na abordagem metodológica quantitativa, com delineamento de pesquisa não-experimental, do tipo correlacional e longitudinal. A amostra foi composta por 93 pacientes submetidos a cirurgias ortopédicas limpas e eletivas. Para a coleta de dados, um instrumento foi elaborado e submetido à validação aparente e de conteúdo. A coleta de dados ocorreu no período de outubro de 2011 a março de 2012, em hospital privado filantrópico da cidade de Franca, estado de São Paulo. Na análise estatística dos dados empregou-se a análise bivariada (por meio de odds ratio, intervalo de confiança, teste Qui-quadrado com correção de Yates, teste t de \"Student\" e Mann-Whitney), regressão múltipla e regressão logística binária. A infecção de sítio cirúrgico foi detectada em 16 pacientes participantes da pesquisa, sendo a sua ocorrência de 17,2%. As variáveis investigadas relacionadas ao paciente foram a idade, Índice de Massa Corpórea, classificação ASA e a presença de doenças crônicas. As variáveis estudadas relacionadas ao procedimento anestésico cirúrgico foram a duração da anestesia, duração da cirurgia, uso de antibioticoprofilaxia e tempo total de internação. Os resultados evidenciaram diferença estatisticamente significante entre o grupo com e o grupo sem infecção, quando testado associação com a infecção de sítio cirúrgico e as variáveis classificação ASA e o tempo total de internação. Após ajuste do modelo de regressão logística binária, apenas a variável tempo total de internação mostrou-se com relação estatisticamente significativa com a presença ou não de infecção. Ressalta-se ainda que 75% dos casos de infecção foram diagnosticados após a alta hospitalar dos pacientes indicando a importância da vigilância epidemiológica pós- alta. / Surgical site infection is one of the main problems that can occur to patients in the perioperative period. This type of infection in orthopedic surgeries is a severe problem due to its morbidity and high costs. This quantitative, correlational, non- experimental and longitudinal study aimed to analyze the incidence and predisposing factors for surgical site infection in patients who underwent orthopedic surgery. The sample consisted of 93 patients who underwent clean and elective orthopedic surgeries. For data collection, an instrument was developed and submitted to face and content validation. Data collection occurred between October 2011 and March 2012, in a private philanthropic hospital in the city of Franca, state of São Paulo. Bivariate analysis (by means of odds ratios, confidence intervals, Chi-squared test with Yates correction, Student\'s t and Mann-Whitney tests), multiple regression and binary logistic regression were used for statistical analysis. Surgical site infection was detected in 16 patients who participated in the research, with an incidence of 17.2%. The variables investigated related to patients were age, Body Mass Index, ASA score and the presence of chronic diseases. Variables related to surgical anesthesia were the duration of anesthesia, duration of surgery, use of antibiotic prophylaxis and total length of hospitalization. The results showed statistically significant difference between the groups with and without infection, when testing association with surgical site infection, ASA score variables and total length of hospitalization. After adjustment of the binary logistic regression model, only the variable total length of hospitalization was statistically significant regarding the presence or not of infection. It is worth noting that 75% of infections were diagnosed after discharge from hospital, indicating the importance of epidemiological surveillance after discharge.

Die Endoskopie ist ein wesentlicher Bestandteil der Chirurgie. Nicht nur die Diagnostik, sondern speziell die operative Endoskopie bedarf der besonderen Kompetenz von Chirurgen. Dies wurde in der Vergangenheit in einigen Zentren eindeutig belegt. Zukünftig wird die chirurgische Endoskopie in ihrer Wertigkeit steigen. Die konventionelle Chirurgie wird schon heute zum Teil durch minimal invasive Verfahren abgelöst. Die Progredienz dieser Entwicklung ist absehbar. Dazu werden auch Kombinationen der flexiblen Endoskopie mit laparoskopischen Techniken und der Sonographie zunehmend zum Einsatz kommen. Daneben wird die Kooperation mit den Gastroenterologen intensiviert. Ein kürzlich verabschiedetes Konsensuspapier der Deutschen Gesellschaft für Verdauungsund Stoffwechselkrankheiten und der Deutschen Gesellschaft für Viszeralchirurgie unterstreicht den bilateralen Wunsch zur Zusammenarbeit. Ziele bestehen in der Optimierung der endoskopischen Leistungen. Patientenversorgung, Forschung und Lehre können so synergistisch weiter verbessert werden. Die Voraussetzung zur Durchsetzung dieser Ziele ist die gegenseitige Anerkennung der Kompetenz, die Unterstützung bei der Novellierung der Weiterbildungsordnung und die dem Bedarf und den Fortschritten angepasste Weiterentwicklung des Papiers. Daneben werden Chirurgen und Gastroenterologen die fachspezifischen Fragestellungen der intraluminalen Endoskopie auch weiterhin selbständig verfolgen. / Endoscopy between Surgery and Gastroenterology – the Point of View of the Chirurgische Arbeitsgemeinschaft für Endoskopie und Sonographie (CAES) Flexible endoscopy is an important part of surgery. Not only diagnostic investigation, but especially operative endoscopy needs surgical competence. This has been proven in several centers. In the future the status of surgical endoscopy will increase. Already today, conventional surgery has been replaced more and more by minimal invasive procedures. This evolution probably will continue. The combination of flexible endoscopy with laparoscopy and sonography will be routinely introduced into daily surgical work. At the same time cooperation with medical gastroenterologists is intensified. A recently realized agreement of the German Society for Digestive and Metabolic Diseases and the German Society for Visceral Surgery confirms the efforts to work together in this field. The goal is to optimize endoscopic performance. Patient\'\'s care, research, and teaching can be synergistically improved. Conditions for successful consensual work are the acceptance of each others competence, the support of activities for actual education programs and the development of the agreement, depending on further necessities and progress. Besides that, specifically related research in intraluminal endoscopy will be continued by surgeons and medical gastroenterologists. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background: Unplanned readmission has gained increasing interest as a quality marker for inpatient care, as it is associated with patient mortality and higher economic costs. Spinal neurosurgery is characterized by a lack of epidemiologic readmission data. The aim of this study was to identify causes and predictors for unplanned readmissions related to index diagnoses and surgical procedures. Methods: In this study, from 2015 to 2017, spinal neurosurgical procedures were recorded for surgical and non-surgical treated patients. The main reasons for an unplanned readmission within 30 days following discharge were identified. Multivariate logarithmic regression revealed predictors of unplanned readmission. Results: A total of 1172 patient records were examined, of which 4.27% disclosed unplanned readmissions. Among the surgical patients, the readmission rate was 4.06%, mainly attributable to surgical site infections, while it was 5.06% for the non-surgical patients, attributable to uncontrolled pain. A night-time surgery presented as the independent predictive factor. Conclusion: In the heterogeneous group of spinal neurosurgical patients, stratification into diagnostic groups is necessary for statistical analysis. Degenerative lumbar spinal stenosis and spinal abscesses are mainly affected by unplanned readmission. The surgical procedure dorsal root ganglion stimulation is an independent predictor of unplanned re-hospitalizations, as is the timing of surgery.

A prototype of a haptic and virtual reality simulator has been developed for simulation of the bone milling and material removal process occurring in several operations, e.g. temporal bone surgery or dental milling. The milling phase of an operation is difficult, safety critical and very time consuming. Reduction of operation time by only a few percent would in the long run save society large expenses. In order to reduce operation time and to provide surgeons with an invaluable practicing environment, this licentiate thesis discusses the introduction of a simulator system to be used in both surgeon curriculum and in close connection to the actual operations. The virtual reality and haptic feedback topics still constitute a young and unexplored area. It has only been active for about 10-15 years for medical applications. High risk training on real patients and the change from open surgery to endoscopic procedures have enforced the introduction of haptic and virtual reality simulators for training of surgeons. Increased computer power and the similarity to the successful aviation simulators also motivate to start using simulators for training of surgical skills. The research focus has been twofold: 1) To develop a well working VR-system for realistic graphical representation of the skull itself including the changes resulting from milling, and 2) to find an efficient algorithm for haptic feedback to mimic the milling procedure using the volumetric Computer Tomography (CT) data of the skull. The developed haptic algorithm has been verified and tested in the simulator. The visualization of the milling process is rendered at a graphical frame rate of 30 Hz and the haptic rendering loop is updated at 1000 Hz. Test results show that the real-time demands are fulfilled. The visual and haptic implementations have been the two major steps to reach the over all goal with this research project. A survey study is also included where the use of VR and haptic simulators in the surgical curriculum is investigated. The study starts with a historical perspective of the VR and haptic topics and is built up by answering different questions related to this topic and the implementation of simulators at the medical centres. The questions are of general concern for those developing surgical VR and haptic simulators. Suggested future work includes modelling, development and validation of the haptic forces occurring in the milling process and, based on this, implementation in the simulator system. Also, further development of the simulator should be done in close cooperation with surgeons in order to get appropriate feedback for further improvements of the functionality and performance of the simulator. / QC 20101112

No description available.

Abstract Minimally invasive surgery (MIS) techniques have seen rapid growth as methods for improved operational procedures. The main technology of MIS is based on image guided surgery (IGS) devices, namely surgical navigators, surgical robotics and image scanners. With their widespread use in various fields of surgery, methods and tools that may be used routinely in the hospital setting for “real world” assessment of the accuracy of these devices are lacking. In this thesis the concept of accuracy testing was developed to meet the needs of quality assurance of navigators and robots in a hospital environment. Thus, accuracy was defined as the difference between actual and measured distances from an origin, also including determination of directional accuracy within a specific volume. Two precision engineered accuracy assessment phantoms with assessment protocols were developed as advanced materials and methods for the community. The phantoms were designed to include a common region of surgical interest (ROSI) that was determined to roughly mimic the size of the human head. These tools and methods were utilized in accuracy assessment of two commercial navigators, both enabling the two most widely used tracking modalities, namely the optical tracking system (OTS) and the electromagnetic tracking system (EMTS). Also a study of the accuracy and repeatability of a prototype surgical interactive robot (SIRO) was done. Finally, the phantoms were utilized in spatial accuracy assessment of a commercial surgical 3D CT scanner, the O-Arm. The experimental results indicate that the proposed definitions, tools and methods fulfill the requirements of quality assurance of IGS devices in the hospital setting. The OTS and EMTS tracking modalities were nearly identical in overall accuracy but had unique error trends. Also, the accuracy of the prototype robot SIRO was in the range recommended in the IGS community. Finally, the image quality of the O-Arm could be analyzed using the developed phantoms. Based on the accuracy assessment results, suggestions were made when setting up each IGS device for surgical procedures and for new applications in minimally invasive surgery. / Tiivistelmä Mini-invasiivisen eli täsmäkirurgian tekniikoita ja teknologioita on alettu hyödyntää viime aikoina yhä enemmän. Tavoitteena on ollut parantaa kirurgisten operaatioiden tarkkuutta ja turvallisuutta. Täsmäkirurgiassa käytetyt teknologiat pohjautuvat kuvaohjattuihin kirurgisiin paikannuslaitteisiin. Kuvaohjattuihin laitteisiin kuuluvat navigaattorit, kirurgiset robotit ja kuvantalaitteet. Näiden laitteistojen kehittyminen on mahdollistanut tekniikoiden hyödyntämisen monialaisessa kirurgiassa. Paikannuslaitteistojen ja robottien yleistyminen on kuitenkin nostanut sairaaloissa esiin yleisen ongelman paikannustarkkuuden määrittämisessä käytännön olosuhteissa. Tässä väitöskirjassa esitetään kirurgisten yksiköiden käyttöön menetelmä sekä kaksi uutta fantomia ja protokollaa käytössä olevien paikannuslaitteistojen tarkkuuden määrittämiseen. Fantomit suunniteltiin sisältämään ennalta määritetty kirurginen kohdealue, mikä rajattiin käsittämään ihmisen kallon tilavuus. Fantomeita ja protokollaa hyödynnettiin kahden kaupallisen paikannuslaitteen tarkkuuden määrityksessä. Navigaattorit käyttivät optiseen ja elektromagneettiseen paikannukseen perustuvaa tekniikkaa. Lisäksi työssä kehitetyillä menetelmillä tutkittiin prototyyppivaiheessa olevan kirurgisen robotin paikannus- ja toistotarkkuutta sekä tietokonetomografialaitteen O-kaaren kuvan tarkkuuden määritystä. Kokeellisten tulosten perusteella työssä kehitetyt fantomit ja protokollat ovat luotettavia ja tarkkoja menetelmiä kirurgisten paikannuslaitteistojen tarkkuuden määrittämiseen sairaalaoloissa. Kirurgisten navigaattoreiden tarkkuuden määritystulokset osoittivat optisen ja elektromagneettisen paikannustekniikan olevan lähes yhtä tarkkoja. Prototyyppirobotin tarkkuus oli tulosten perusteella kirjallisuudessa esitettyjen suosituksien mukainen. Lisäksi O-kaaren kuvanlaatua voitiin tutkia kehitetyillä fantomeilla. Tarkkuudenmääritystulosten perusteella työssä ehdotetaan menetelmiä laitteistojen optimaalisesta käytöstä leikkaussalissa sekä laajennetaan niiden käyttömahdollisuuksia. Tuloksia voidaan hyödyntää myös paikannuslaitteistojen kehittämistyössä.

No description available.

No description available.

INTRODUÇÃO: Laparotomias de emergência apresentam alto risco de complicações e evoluem com deiscência da aponeurose (DA) em até 14,9% dos casos. O uso profilático de tela no fechamento da parede abdominal reduz a incidência de hérnia incisional após cirurgias eletivas, sem aumento significativo de morbidade. Porém, não há estudos que comprovem seu benefício na prevenção de DA e seu uso ainda é controverso em laparotomias de emergência e em cirurgias contaminadas ou infectadas. OBJETIVOS: Avaliar se o uso profilático de tela no fechamento da parede abdominal reduz a incidência de DA em pacientes submetidos a laparotomia de emergência, assim como a morbidade de sua aplicação. MÉTODOS: Foi realizado um ensaio clínico randomizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Indivíduos com alto risco para DA e indicação de laparotomia mediana de emergência foram randomizados em grupos de sutura (síntese contínua da aponeurose com fio de polidioxanona e agulha de 36 mm, com objetivo de alcançar a relação entre os comprimentos do fio e da incisão igual ou superior a quatro) ou de tela profilática (síntese da aponeurose como no grupo de sutura, reforçada com tela pré-aponeurótica de polipropileno). Alto risco foi definido segundo escore de risco pré-operatório de Rotterdam adaptado. A equipe cirúrgica permaneceu cega no intraoperatório (randomização somente após síntese completa da aponeurose). RESULTADOS: De junho de 2015 a fevereiro de 2018, foram randomizados 145 pacientes, dos quais 30 foram excluídos (20,7%) por óbito ou reoperação nos primeiros 30 dias, não relacionados a intervenção do estudo; 52 foram alocados no grupo de sutura e 63 no de tela profilática. Ambos foram equivalentes quanto a dados demográficos e características clínicas, exceto idade, cuja média foi maior no grupo de sutura (66,1 anos vs 61,0 anos, p = 0,03). Os pacientes foram classificados como ASA III ou IV em 44 (38,3%) casos. Dentre as operações, 49 (42,6%) foram contaminadas ou infectadas, 63 (54,8%) envolveram a realização de ostomia e 89 (77,4%) foram cirurgias colorretais. Os tempos de internação hospitalar e em UTI foram semelhantes. O tempo operatório médio foi 50,8 minutos mais longo no grupo de tela profilática (p = 0,01). A DA ocorreu em sete casos do grupo de sutura (13,5%) e em nenhum do grupo de tela profilática (p = 0,003). Não houve diferença estatística em relação ao número de participantes que apresentou ocorrências de sítio cirúrgico (SSO) [15 (28,8%) vs 27 (42,9%), p = 0,12] ou ocorrências de sítio cirúrgico que necessitaram de intervenção (SSOPI) [9 (17,3%) vs 14 (22,2%), p = 0,51]. Porém, algumas SSO foram mais frequentes no grupo de tela profilática: seroma [3 (5,8%) vs 12 (19,0%), p = 0,03], infecção de sítio cirúrgico (SSI) [4 (7,7%) vs 13 (20,6%), p = 0,05] e deiscência superficial de ferida operatória [3 (5,8%) vs 15 (23,8%), p = 0,008]. Sete casos do grupo de tela profilática tiveram deiscência superficial com exposição de tela e foram tratados com curativos locais e cicatrização por segunda intenção, havendo resolução completa em menos de 90 dias. Nenhum caso necessitou de remoção completa da tela. Das SSO do grupo de tela profilática, 92,3% tiveram resolução espontânea ou com intervenções à beira-leito, o que aconteceu em 73,3% do grupo de sutura. CONCLUSÕES: A tela profilática pré-aponeurótica em laparotomias de emergência é segura e evita DA, com morbidade aceitável, em 30 dias / INTRODUCTION: Emergency laparotomies have a high risk of complication with reports of fascial dehiscence (FD) in up to 14.9% of cases. The use of onlay mesh in the closure of abdominal wall reduces incidence of incisional hernia after elective surgeries without increased morbidity. However, there are no studies demonstrating its benefit in FD prevention and its use is controversial in emergency laparotomies and in contaminated or infected surgeries. OBJECTIVES: To evaluate whether the use of onlay mesh in the closure of the abdominal wall reduces the incidence of FD in patients submitted to emergency laparotomy, as well as the morbidity of its application. METHODS: A randomized clinical trial was conducted at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. Patients at high risk for FD and indication of emergency midline laparotomy were randomized either to the suture group (running suture with polidioxanone thread and 36 mm needle size, aiming to achieve suture-to-wound length ratio of 4:1) or to the prophylactic mesh group (fascial closure as in the suture group, reinforced with polypropylene onlay mesh). High risk was defined according to the adapted Rotterdam preoperative risk model. The surgical team was blinded to the groups during the intraoperative period (randomization occurred only after complete fascial suture). RESULTS: From June 2015 to February 2018, 145 patients were randomized, 30 of whom were excluded (20.7%) because of death or reoperation, not related to the mesh procedure, in the first 30 days; 52 were allocated in the suture group and 63 in the prophylactic mesh group. Both groups were equivalent for demographic data and clinical characteristics, except for age, whose mean was higher in the suture group (66.1 years vs 61.0 years, p = 0.03). Patients were classified as ASA III or IV in 44 (38.3%) cases. Among the operations, 49 (42.6%) were contaminated or infected, 63 (54,8%) involved ostomy formation and 89 (77.4%) were colorectal surgeries. Hospital length of stay (LOS) and intensive care unit LOS were similar. Mean operative time was 50.8 minutes longer in the prophylactic mesh group (p = 0.01). FD occurred in seven cases of the suture group (13.5%) and none in the prophylactic mesh group (p = 0.003). There was no statistical difference between the groups regarding the number of patients with surgical site occurrence (SSO) [15 (28.8%) vs 27 (42.9%), p = 0.12], or surgical site occurrences that required procedural interventions (SSOPI) [9 (17.3%) vs 14 (22.2%), p = 0.51]. However, some SSO were more frequent in the prophylactic mesh group: seroma [3 (5.8%) vs 12 (19.0%), p = 0.03], surgical site infection (SSI) [4 (7, 7%) vs 13 (20.6%), p = 0.05] and superficial wound dehiscence [3 (5.8%) vs 15 (23.8%), p = 0.008)]. Seven cases of the prophylactic mesh group had superficial wound dehiscence with mesh exposure, treated with local dressings and healing by second intention, with complete resolution in less than 90 days. No case required complete removal of mesh. Of the SSO in the prophylactic mesh group, 92.3% had spontaneous resolution or with bedside interventions; the same occurred in 73.3% of the suture group. CONCLUSIONS: The onlay prophylactic mesh in emergency laparotomy is safe and avoids FD, with acceptable morbidity in 30 days

A vídeo-laparoscopia é uma inovação tecnológica que trouxe indiscutíveis vantagens e também novos desafios, incluindo nestes, as diretrizes para o reprocessamento adequado dos instrumentais e seus acessórios. A autoclavação dos instrumentais laparoscópicos desmontados é mais segura, uma vez que a condução térmica é facilitada. No entanto, são artigos complexos, compostos por múltiplas peças e a sua remontagem no momento da cirurgia traz transtornos às equipes cirúrgicas, correndo o risco do não funcionamento ou de danos às peças pela montagem inadequada. Existe um arraigado conceito, entre os profissionais da saúde, que para o sucesso da esterilização ser alcançado, é necessário o contato direto do vapor com todas as superfícies dos materiais submetidos à autoclavação sem considerar também o raciocínio do calor latente. A destruição microbiana por meio da esterilização pelo vapor está essencialmente relacionada ao calor latente, gerado pela condensação deste em contato com a superfície fria do material, promovendo a termocoagulação das proteínas microbianas. É uma prática comum nos hospitais brasileiros a realização da autoclavação de instrumentos previamente montados, apesar de não haver comprovação científica consistente dessa prática. Isto posto, esta investigação teve o objetivo de avaliar a eficácia do processo de esterilização a vapor dos instrumentais laparoscópicos previamente montados, comparando os seus resultados com os desmontados, considerada neste estudo a melhor prática. Tratou-se de uma pesquisa experimental, laboratorial, com abordagem quantitativa. Foram selecionados dois modelos de maior complexidade dentre os instrumentos laparoscópicos para realização do estudo, sendo eles: trocarte com válvula tipo janela rosqueada de 5mm, composto por cinco peças desmontáveis e pinça para dissecção de 5mm, composta por quatro peças desmontáveis. Cada peça dos instrumentais foi considerada como uma unidade amostral na análise microbiológica. Este estudo teve então como Grupo Montado: instrumentais laparoscópicos montados; Grupo Desmontado: instrumentais laparoscópicos desmontados; Grupo Contagem Microbiana: instrumentais laparoscópicos submetidos aos procedimentos de contaminação desafio, encaminhados diretamente para o teste de contagem microbiana. O inóculo para a contaminação desafio constitui-se de suspensão do Geobacillus stearothermophilus, na forma esporulada, acrescido de sangue de carneiro desfibrinado esterilizado. Todos os instrumentais foram contaminados desmontados com o inóculo desafio. Os grupos Montado e Desmontado foram submetidos aos processos de limpeza manual, complementada pela limpeza automatizada em lavadora ultra-sônica com retrofluxo, enxágüe em água corrente e sob pressão. Por fim, foi realizado o enxágüe com água destilada esterilizada e secagem com ar comprimido medicinal. Na seqüência, foi realizado sorteio para composição dos Grupos Montado e Desmontado. Os instrumentais foram embalados individualmente em papel grau cirúrgico e submetidos à esterilização a vapor em autoclave com pré-vácuo. Após a esterilização, os instrumentais foram avaliados quanto à eficácia da esterilização, por meio dos resultados dos testes de cultura microbiológica, utilizando o método de inoculação direta. No Grupo Montado foram recuperados os microrganismos teste em três peças de uma mesma pinça (3/48) e em três peças de um mesmo trocarte (3/60), enquanto que no Grupo Desmontado o microrganismo teste não foi recuperado nas unidades amostrais estudadas. Nas condições desse experimento, os resultados obtidos refutaram a hipótese inicial da pesquisa quanto à segurança da autoclavação das pinças e dos trocartes utilizados em cirurgia laparoscópica previamente montados / The video laparoscopy is a technological innovation that brought unquestionable advantages and, also, new challenges, like: the policies for the adequate reprocessing of the instruments and its permanent accessories. The steam sterilization of disassembled laparoscopic instruments is much safer, once that the thermal conduction is facilitated. However, laparoscopic instruments are quite complex articles; they are composed by many parts and the reassemblage in site at the moment of the surgery brings many inconveniences to the surgical team, like the possibility of the instrument’s malfunctioning or non functioning at all, or even damages to the instruments due to inadequate assembling. There is a strong belief among the Healthcare Professionals about the necessity of the direct contact of the steam with all the surface of the materials submitted to the steam sterilization, which is correct, however it doesn´t consider the latent heat assumption as well. The destruction of the microbiological material throughout the steam sterilization is essentially related to the latent heat, created by the vapor condensation when in contact with the instrument´s cold surface, promoting the thermal-coagulation of microbiological proteins. Many hospitals use the steam sterilization of previously mounted instruments, although there´s not any consistent scientific evidence about the efficiency of this practice. Once stated this point, this investigation´s aim was: evaluate the effectiveness of the steam sterilization process of the previously mounted, permanent laparoscopic instruments. It was an experimental laboratorial research, using a quantitative approach. Two models of permanent laparoscopic instruments of major complexity were chosen for the experiments: a trocar with a 5mm screw window valve, composed by five dismountable parts and a 5mm dissection clamp, composed by four dismountable parts. Each part of the instruments was considered as a sample unit on the microbiological analysis. This study it had the Assembled Group was: mounted laparoscopic instruments; the Disassembled Group was: disassembled laparoscopic instruments; the Microbiological Counting Group was: laparoscopic instruments submitted to the - challenge contamination - procedures, being directed straight to the test of microbiological counting. The inoculants material used for the challenge contamination consisted on the suspension of the Geobacillus stearothermophilus, in its spore form, plus defibrinated and sterilized sheep blood. All the instruments were contaminated, disassembled with the challenge inoculants material. The Assembled and Disassembled groups were submitted to the manual cleaning processes, enhanced by the automatic cleaning in an ultrasonic washer with retro-flux, rinsed in running and under pressure water. At last, a rinsing with distilled water was performed; the drying process was made with medicinal compressed air. Then, a sorting was performed to decide about the composition of the Assembled and Disassembled groups. The instruments were individually packed in surgical paper and submitted to the steam sterilization in a pre-vacuum sterilizer machine. After the sterilization, the instruments were evaluated according to sterilization effectiveness throughout the microbiological culture test´s results, using the straight inoculation method. In the Assembled Group the microorganism´s tests were recovered in three parts of one same clamp (3/48) and in three parts of the same trocar (3/60), in the Disassembled Group the test microorganism wasn´t recovered in any of the sample unities. The results, under the conditions of the experiment, refuted the hypothesis of safety in the usage of the steam sterilization in previously mounted used clamps and trocar in laparoscopy