Der technische Fortschritt führte in jüngster Vergangenheit zur Neuentwicklung kleinerer Kamerasysteme und laparoskopischer Instrumente. So ist seit einiger Zeit die Durchführung der Cholezystektomie durch Inzisionen von 2-5 mm Größe (mikrolaparoskopische Cholezystektomie) anstatt der sonst üblichen 5-10 mm großen Hautschnitte (laparoskopische Cholezystektomie) möglich. Methoden: 25 Patienten wurden nach Randomisierung der laparoskopischen Gruppe und 25 der mikrolaparoskopischen Gruppe zugeordnet. Das Hauptzielkriterium der Studie war der postoperative Schmerzmittelverbrauch unter der patienten-kontrollierten Analgesie untersucht. Zusätzlich wurden die Häufigkeit von Konversionen, die Dauer des operativen Eingriffs, der postoperative Krankenhausaufenthalt, die perioperativen Schmerzen, die Fatigue, das kosmetische Resultat und die postoperative Arbeitsunfähigkeitsdauer untersucht. Ergebnisse: Alter, Body Mass Index und die Geschlechtsverteilung beider Gruppen waren vergleichbar. In jeder Gruppe erfolgte jeweils 1 Konversion (mikrolaparoskopische Cholezystektomie zur laparoskopischen Cholezystektomie; laparoskopische zu konventionellen Cholezystektomie). Der postoperative Krankenhausaufenthalt, die postoperative Arbeitsunfähigkeitsdauer, die Eingriffs- und die Narkosedauer zeigten für das mikrolaparoskopische und laparoskopische Verfahren keine wesentlichen Unterschiede. Die subjektive Schmerzwahrnehmung war beim Husten mit 340,5(204-410) in der mikrolaparoskopischen Gruppe niedriger als in der laparoskopischen Gruppe mit 406(357-514)(p / Background: Laparoscopic instruments have been minimised for abdominal videoendoscopic surgery. Whether micro-laparoscopic surgery will actually result in clinically relevant benefits for patients, has not yet been proven. Methods: Fifty patients were randomised to elective laparoscopic (MINI; n = 25) or micro-laparoscopic (MICRO; n = 25) cholecystectomy in a blinded fashion. Analgetic consumption during PCA, pain perception (visual analog score), and cosmetic result (patient's self-assessment) were evaluated postoperatively as clinically relevant endpoints. Results: Age, sex, BMI and operative time were not different between both groups. From surgery to the 3rd postoperative day, cumulative PCA morphine doses were comparable (MINI: 0,2(0,1-0,23) mg/kg bw; MICRO: 0,2(0,1-0,46) mg/kg bw; p>0,05) but overall VAS for pain while coughing was higher in the laparoscopic 406(357-514) compared to the micro-laparoscopic group 340,5(204-410) (p

Introdução: No ano de 2007, foram diagnosticados 190 casos de infecção hospitalar por Micobactéria de Crescimento Rápido (MCR) em pacientes submetidos a cirurgias videoassistidas em hospitais da região metropolitana de Vitória/ES. Os pacientes foram acompanhados na unidade de referência do Hospital Universitário Cassiano Antonio de Moraes da Universidade Federal do Espírito Santo (HUCAM/UFES), onde foi instituído tratamento específico e estabelecida investigação por métodos de imagens, sobretudo Tomografia Computadorizada (TC), para identificação do número, extensão e localização das lesões. Objetivo: Identificar a distribuição e a frequência dos achados de TC em pacientes com diagnóstico clínico e epidemiológico de infecção hospitalar por MCR após cirurgias laparoscópicas. Métodos: Foi conduzido um estudo descritivo utilizando os dados de prontuários da unidade de referência do HUCAM/UFES e as imagens das tomografias computadorizadas realizadas. Os exames foram analisados, em consenso, por dois radiologistas, que identificaram, separadamente, o comprometimento de pele/subcutâneo, de planos musculofasciais da parede abdominal e do intraperitoneal. Os padrões de comprometimento tabulados foram: densificações, coleções, nódulos maiores ou iguais a 1,0 cm (nódulos), nódulos menores que 1,0 cm (nódulos pequenos), nódulos com pseudocavitação e nódulos pequenos com pseudocavitação. Resultados: 26 pacientes atendiam aos critérios preestabelecidos. As infecções foram relacionadas a: nove cirurgias bariátricas, uma cirurgia bariátrica com colecistectomia, sete colecistectomias, uma colecistectomia somada à correção de hérnia inguinal com colocação de tela, três cirurgias para correção de refluxo gastroesofágico (CRGE), três laparoscopias diagnósticas, uma salpingectomia e uma apendicectomia.O menor intervalo de tempo entre a cirurgia e o exame de tomografia computadorizada foi de 8 dias, o maior, 351 dias, com média de 112 dias e mediana de 83. Todos os pacientes apresentaram algum achado de imagem no subcutâneo, sendo que seis pacientes tiveram comprometimento exclusivo na pele/subcutâneo, e os demais apresentaram comprometimento concomitante de planos musculofasciais e/ou intraperitoneal. Os achados no subcutâneo foram: densificação (88,4%), nódulo pequeno (61,5%), nódulo pequeno pseudocavitado (23,0%), nódulo (38,4%), nódulo pseudocavitado (15,3%) e coleção (26,9%); os achados nos planos musculofasciais foram: densificação (61,5%), nódulo pseudocavitado (3,8%) e coleção (15,3%); e os achados intraperitoneais foram: densificação (46,1%), nódulo pequeno (42,3%), nódulo (15,3%) e coleção (11,5%). Nenhum dos cinco pacientes que realizaram a biópsia subcutânea anteriormente à TC apresentou nódulo subcutâneo maior do que 1,0 cm; comparativamente, dentre aqueles que realizaram a biópsia após a TC, constatou-se que 10 pacientes (47,6%) apresentaram nódulos subcutâneos. A comparação entre os 16 pacientes com intervalo de tempo entre cirurgia e TC menor do que 3 meses e os 10 pacientes com intervalo maior do que 3 meses demonstrou que: os pacientes com menor intervalo de tempo apresentavam maior porcentagem de densificações no subcutâneo (100%), nos planos musculofasciais (81,2%) e intraperitoneais (70,0%); já no grupo com maior intervalo, as porcentagens foram de 66,6%, 30,0% e 10,0%, respectivamente. Conclusão: os achados tomográficos, em ordem decrescente de frequência, foram: a) no subcutâneo: densificação, nódulo pequeno, nódulo, nódulo pequeno pseudocavitado, nódulo pseudocavitado e coleção; b) nos planos musculofasciais: densificação, coleção e nódulo pseudocavitado; e c) intraperitoneal: densificação, nódulo pequeno, nódulo e coleção / Introduction: In 2007, 190 cases of hospital-acquired infection due to rapidly growing mycobacterial (RGM) were diagnosed in patients undergoing video-assisted surgery in the hospitals of the metropolitan region of Vitória, ES (Brazil). The patients were followed at the referral unit of the University Hospital Cassiano Antonio de Moraes of the Federal University of Espírito Santo (HUCAM), where specific treatment was instituted and research by imaging methods - particularly computed tomography (CT) - was initiated to identify the number, extent, and location of the lesions. Objective: To identify the distribution and frequency of CT findings in patients with clinical and epidemiological diagnosis of hospital-acquired RGM infection after laparoscopic surgery. Method: A descriptive study was conducted using medical records data from the referral unit of the HUCAM and the computed tomography (CT) images. The scans were analyzed by two radiologists, in consensus, who individually identified compromised skin/subcutaneous areas, muscle-fascial planes of the abdominal wall and intraperitoneal regions. The involvement patterns were tabulated as: densification, collections, nodules >= 1.0 cm (nodules), nodules < 1.0 cm (small nodules), pseudocavitated nodules, and small pseudocavitated nodules. Results: Twenty-six patients met the established criteria. The infections were related to 9 bariatric surgeries, 1 bariatric surgery with cholecystectomy, 7 cholecystectomies, 1 cholecystectomy along with inguinal hernia correction with screen placement, 3 surgeries for correction of gastroesophageal reflux, 3 diagnostic laparoscopies, 1 salpingectomy, and 1 appendectomy. The shortest time interval between surgery and CT examination was 8 days and the longest interval was 351 days, with a mean of 112 days and a median of 83 days. All patients presented subcutaneous involvement on the CT image; 6 patients had exclusive impairment in the skin/subcutaneous tissue whereas the others had concomitant impairment in musculo-fascial and/or intraperitoneal planes. The subcutaneous findings were: densification (88.4%), small nodules (61.5%), small pseudocavitated nodules (23.0%), nodules (38.4%), pseudocavitated nodules (15.3%), and collections (26.9%). The findings in the musculo-fascial planes were: densification (61.5%), pseudocavitated nodules (3.8%), and collections (15.3%). The intraperitoneal findings were: densification (46.1%), small nodules (42.3%), nodules (15.3%) and collections (11,5%). None of the 5 patients who underwent biopsy before CT showed subcutaneous nodules larger than 1.0 cm; in contrast, of those who underwent biopsy after CT, 10 patients (47.6%) had subcutaneous nodules. A comparison between the 16 patients with a time interval of less than 3 months between surgery and CT, and the 10 patients with an interval of more than 3 months showed that patients with a shorter time interval had a higher percentage of subcutaneous densification (100%), musculo-fascial plane densification (81.2%), and intraperitoneal densification (70.0%); for those with a longer interval, the percentages were 66.6%, 30.0%, and 10.0%, respectively. Conclusion: the subcutaneous CT findings in descending order of frequency were: densification, small nodules, nodules, small pseudocavitated nodules, pseudocavitated nodules, and collections. The musculo-fascial plane CT findings were: densification, collections, and pseudocavitated nodules. The intraperitoneal CT findings were: densification, small nodule, nodules and collections

Esse estudo teve como objetivos identificar os diagnósticos de enfermagem presentes em pacientes em pós-operatório imediato de colecistectomia, submetidos à anestesia geral com base na Taxonomia II da North American Nursing Diagnoses Association (NANDA) e no Modelo Conceitual de Horta; analisar os diagnósticos de enfermagem presentes nesses pacientes em relação aos fatores relacionados, características definidoras e fatores de risco e em relação ao seu estabelecimento e resolução no pós-operatório imediato; dentre os pacientes estudados que apresentaram o Diagnóstico de Enfermagem de Dor aguda, identificar as manifestações de dor apresentadas no pós-operatório imediato e compará-las com as características definidoras apresentadas pela NANDA e por outras literaturas. Para a etapa de coleta de dados, foi elaborado e validado um instrumento de coleta de dados com base no Modelo Conceitual de Wanda Horta. Foram avaliados 15 pacientes adultos no período pós-operatório imediato de colecistectomia laparoscópica, durante o período de setembro de 2004 a janeiro de 2005, no Centro de Recuperação Pós-anestésica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Para o estabelecimento dos diagnósticos de enfermagem, utilizou-se um modelo de processo raciocínio diagnóstico, sendo esses nomeados de acordo com a Taxonomia II da NANDA. Foram identificados nove diferentes diagnósticos de enfermagem: Integridade tissular prejudicada (100%), Risco para infecção (100%), Percepção sensorial perturbada (100%), Risco para aspiração (100%), Risco para função respiratória alterada (80%), Hipotermia (60%), Risco para temperatura corporal desequilibrada (40%), Nutrição desequilibrada: mais do que as necessidades corporais (33,3%) e Dor aguda (26,7%). Para cada diagnóstico foram identificados e discutidos os fatores relacionados e características definidoras. Os pacientes que manifestaram o diagnóstico de enfermagem de Dor aguda apresentaram as seguintes características definidoras: relato verbal, evidência observada, expressão facial e comportamento de defesa. Observamos que todas essas manifestações são características definidoras apresentadas pela NANDA (2002) para esse diagnóstico. Em relação ao seu estabelecimento e resolução no pós-operatório imediato, os diagnósticos de enfermagem Risco para aspiração, Percepção sensorial perturbada e Hipotermia foram resolvidos em 50 minutos após a sua identificação. Para os diagnósticos de Risco para função respiratória alterada, Risco para temperatura corporal desequilibrada e Dor aguda, o tempo médio de resolução foi de 63,7, 77,5 e 36 minutos, respectivamente. Destacamos que os diagnósticos de Integridade tissular prejudicada, Risco para infecção e Nutrição desequilibrada: mais do que as necessidades corporais estiveram presentes desde a admissão do paciente no Centro de recuperação pós-anestésica até o momento da alta do paciente. / This study aimed to identify what nursing diagnoses are present in patients who had been submitted to general anesthesia during the immediate post-operative period after cholecystectomy, based on North American Nursing Diagnoses Association (NANDA) Taxonomy II and on Horta?s Conceptual Model; to analyze the nursing diagnoses that were present in these patients in terms of related factors, defining characteristics and risk factors, as well as with respect to their development and solution in the immediate post-operative period; to identify, among those study participants who presented the Nursing Diagnosis of Acute pain, the pain manifestations they presented during the immediate post-operative period and to compare them with the defining characteristics presented by NANDA and other literature sources. With a view to data collection, we elaborated and validated a data collection instrument on the basis of Wanda Horta?s Conceptual Model. 15 adult patients were evaluated in the immediate post-operative period after laparoscopic cholecystectomy, between September 2004 and January 2005, at the Post-Anesthesia Recovery Center of the University of São Paulo at Ribeirão Preto Medical School Hospital das Clínicas. The nursing diagnoses were established by means of a diagnostic reasoning process model, and were named in accordance with NANDA Taxonomy II. We identified nine different nursing diagnoses: Impaired tissue integrity (100%), Risk for infection (100%), Sensory perception alterations (100%), Risk for aspiration (100%), Risk for altered respiratory function (80%), Hypothermia (60%), Risk for imbalanced body temperature (40%), Altered nutrition: more than body needs (33,3%) and Acute pain (26,7%). For each diagnosis, we identified and discussed the related factors and defining characteristics. Patients with the nursing diagnosis of Acute pain presented the following defining characteristics: verbal report, observed evidence, facial expression and defense behavior. We observe that all of these manifestations are defining characteristics NANDA (2002) presented for this diagnosis. With respect to their development and solution during the immediate post-operative period, the nursing diagnoses Risk for aspiration, Sensorial perception alterations and Hypothermia were solved within 50 minutes after their identification. For the diagnoses Risk for altered respiratory function, Risk for imbalanced body temperature and Acute pain, average solution time was 63.7, 77.5 and 36 minutes, respectively. We highlight that diagnoses of Impaired skin integrity, Risk for infection and Unbalanced nutrition: more than body requirements were present from the patient admission on Post anesthesia Care Unit until the patient?s discharge.

It has been estimated that LAGB represents about 42% of bariatric operations performed worldwide. There are a number of different adjustable gastric bands available. Few attempts have been made to compare the influence of band design differences for efficiency and complication rate. There are no accepted criteria for choosing this particular operation. In the dissertation we compared one year results after adjustable gastric banding using different adjustable gastric bands – SAGB and MiniMizer Extra. We have determined that laparoscopic adjustable gastric banding is effective and safe bariatric procedure: the average percentage of initial excess body mass index loss was 33,1 ± 21,9%; 34.1% of patients achieved fair, 30,6% - good, 9,4% - very good and 2,4% - excellent results according to BAROS; only 5 (4,9%) major complications were diagnosed. No radical differences were stated between the efficiency and complication rate of the compared adjustable gastric bands: the average percentage of initial excess body mass index loss in SAGB and MiniMizer Extra groups was 28,9 ± 21,3% and 36,8 ± 22.1% respectively, p=0.075; major complication rate was 0 (0%) and 5 (9.3%) respectively, p=0.069. Patients at the age of 40 and older achieved better results using MiniMizer Extra band - the average percentage of initial excess body mass index loss was 37,5 ± 20,8% versus 23,6 ± 13,8% in SAGB group, p=0.002. Patients with initial BMI ≤ 47 achieved better results using MiniMizer Extra band... [to full text] / Šiuo metu Pasaulyje skrandžio apjuosimo reguliuojama juosta operacijos sudaro apie 43 % visų chirurginių operacijų, atliekamų nutukimui gydyti. Iki šiol nėra pilnai ištirta operacijoje naudojamų skrandį apjuosiančių reguliuojamų juostų konstrukcijos skirtumų įtaka gydymo rezultatams, taip pat nėra priimtų pacientų atrankos šiai operacijai kriterijų. Disertacijoje palyginome vienerių metų nutukimo chirurginio gydymo rezultatus naudojant skirtingas skrandį apjuosiančias reguliuojamas juostas – SAGB ir MiniMizer Extra. Nustatėme, kad skrandžio apjuosimo reguliuojama juosta operacija yra efektyvus ir saugus nutukimo gydymo būdas: vidutinis procentinis perteklinio kūno masės indekso sumažėjimas buvo 33,1 ± 21,9%; vertinant pagal BAROS, 34.1% pacientų pasiekė patenkinamą, 30,6% - gerą, 9,4% – labai gerą ir 2,4% – puikų gydymo rezultatą; pasitaikė 5 (4,9%) „didžiosios” komplikacijos. Esminių skirtumų tarp lygintų juostų efektyvumo ir komplikacijų skaičiaus po vienerių metų po operacijos nenustatyta: vidutinis procentinis perteklinio kūno masės indekso sumažėjimas SAGB ir MiniMizer Extra grupėse buvo atitinkamai 28,9 ± 21,3% ir 36,8 ± 22.1%, p=0.075, o „didžiųjų” komplikacijų skaičius atitinkamai 0 (0%) ir 5 (9.3%), p=0.069. 40 metų ir vyresni pacientai geresnių rezultatų pasiekė naudojant MiniMizer Extra juostą - vidutinis procentinis perteklinio kūno masės indekso sumažėjimas buvo 37,5 ± 20,8% prieš 23,6 ± 13,8 % SAGB grupėje, p=0.002. Pacientai, kurių pradinis KMI ≤ 47, geresnių... [toliau žr. visą tekstą]

The doctoral dissertation analyses and compares general endotracheal and combined endotracheal epidural anesthesia’s impact on organ systems and describes the systems parameters in laparoscopic colorectal surgery. Comparing two perioperative analgesia techniques used in laparoscopic colorectal surgery the hemodynamic and respiratory parameters trends; the impact of anesthesia and postoperative analgesia methods on patients’ tracheal extubation time, intestinal motility recovery rate, duration of hospitalization and inflammatory response have been determined. Laparoscopic colorectal resection, even being a minimally invasive technique for laparoscopic surgery, stimulates the body's response to stress and pro-inflammatory mediator’s secretion. Perioperative pain management may also influence the immune response. The doctoral dissertation analyses the impact of epidural analgesia method on the body stress response, investigating variations of cortisol and interleukin-6 levels. The results showed that analgesia and patient satisfaction using epidural analgesia method for perioperative pain management were better. Tracheal extubation time was significantly shorter. Recovery of intestinal motility using epidural analgesia was significant and much prior than using intravenous analgesia. The use of epidural analgesia in laparoscopic colorectal surgery caused less stress response – less cortisol levels increase. It has not showed the increase in number of complications. / Disertacijoje analizuojama ir lyginama bendrosios endotrachėjinės ir kombinuotos endotrachėjinės epiduralinės anestezijos įtaka atskiroms organų sistemoms ir tas sistemas apibūdinantiems rodikliams laparoskopinių kolorektalinių operacijų metu. Darbe nagrinėjama dviejų perioperacinių skausmo malšinimo būdų įtaka hemodinamikos ir kvėpavimo sistemos parametrų kitimo tendencijoms, pacientų trachėjos ekstubacijos laikui, žarnyno motorikos atsinaujinimo greičiui, hospitalizacijos trukmei bei organizmo uždegiminiam atsakui. Laparoskopinės storosios žarnos rezekcinės operacijos, net ir būdamos minimaliai invazinės dėl laparoskopinės operacijos technikos, sužadina stresinį organizmo atsaką bei uždegimo mediatorių išskyrimą. Perioperacinis skausmo valdymas taip pat gali daryti įtaką imuniniam atsakui. Disertacijoje nagrinėjama epiduralinės analgezijos metodo įtaka organizmo stresiniam atsakui tiriant kortizolio kiekio kitimus ir interleukino-6, kaip vieno pagrindinių uždegimą skatinančių citokinų, koncentracijos kitimą taikant epiduralinę analgezijos metodiką. Gauti rezultatai parodė, kad analgezijai pasitelkiant epiduralinį skausmo malšinimo metodą, perioperacinis pacientų skausmo valdymas ir pasitenkinimas yra geresnis, trachėjos ekstubacijos laikas patikimai trumpesnis, žarnyno peristaltikos atsitaisymas ankstyvesnis, sukeliamas stresinis organizmo atsakas mažesnis (mažesnis kortizolio koncentracijos padidėjimas) ir nenustatyta komplikacijų padaugėjimo.

Thesis (M.S.)--State University of New York at Binghamton, Department of Systems Science and Industrial Engineering, 2009. / Includes bibliographical references (leaves: 150-155).

Introduction: Transabdominal laparoscopic (TAPP) approach in the therapy of inguinal hernia is a suitable alternative to classical open inguinal hernia repair mainly in the hands of an experienced surgeon. TAPP repair offers the possibility of gentle dissection with implantation of the mesh from posterior approach. Hypothesis and objectives of the work: The fixation of mesh through penetrating techniques using staples, clips or screws is associated with a significantly increased risk of developing a post-herniotomy inguinal pain syndrome (CPIP). The aim of the thesis is to review options of self-fixating meshes in laparoscopic TAPP procedure without additional fixation. Furthermore to evaluate effect of this technique on development of the chronic postoperative groin pain and also on frequency of hernia recurrence and mesh migration. Patients and methods: Data analysis included all patients, who underwent inguinal hernia surgery at our Surgical Department within the period from 1.10.12 to 31.12.14 and fulfilled the inclusion criteria. Standard surgical technique was used. Data were entered and subsequently analyzed on Herniamed platform. Results: There were 241 patients enrolled to the group of which 396 inguinal hernias were repaired. The minimal follow up was at 12 months. At the assessment in one...

La chirurgie laparoscopique reproduit fidèlement les principes de la chirurgie conventionnelle avec une agressioncorporelle minimale. Si cette chirurgie apparaît comme étant très avantageuse pour le patient, il s’agit d’une interventionchirurgicale difficile où la complexité du geste chirurgical est accrue, en comparaison avec la chirurgie conventionnelle.Cette complexité réside en partie dans la manipulation des instruments chirurgicaux et la visualisation dela scène chirurgicale (notamment le champ de visualisation restreint d’un endoscope classique). La prise de décisionsdu chirurgien pourrait être améliorée en identifiant des zones critiques ou d’intérêts non visibles dans la scènechirurgicale.Mes travaux de recherche visent à combiner la robotique, la vision par ordinateur et la fluorescence pour apporterune réponse à ces difficultés : l’imagerie de fluorescence fournira une information visuelle supplémentaire pour aiderle chirurgien dans la détermination des zones à opérer ou à éviter (par exemple, visualisation du canal cystique lorsd’une cholécystectomie). La robotique assurera la précision et l’efficience du geste du chirurgien ainsi qu’une visualisationet un suivi "plus intuitif" de la scène chirurgicale. L’association de ces deux technologies permettra de guideret sécuriser le geste chirurgical.Une première partie de ce travail a consisté en l’extraction d’informations visuelles dans les deux modalités d’imagerie(laparoscopie/fluorescence). Des méthodes de localisation 2D/3D en temps réel d’instruments chirurgicaux dansl’image laparoscopique et de cibles anatomiques dans l’image de fluorescence ont été conçues et développées.Une seconde partie a consisté en l’exploitation de l’information visuelle bimodale pour l’élaboration de lois de commandepour des robots porte-endoscope et porte-instrument. Des commandes par asservissement visuel d’un robotporte-endoscope pour suivre un ou plusieurs instruments dans l’image laparoscopique ou une cible d’intérêt dansl’image de fluorescence ont été mises en oeuvre.Dans l’objectif de pouvoir commander un robot porte-instrument, enfonction des informations visuelles fournies par le système d’imagerie, une méthode de calibrage basée sur l’exploitationde l’information 3D de la localisation d’instruments chirurgicaux a également été élaborée. Cet environnementmultimodal a été évalué quantitativement sur banc d’essai puis sur spécimens anatomiques.À terme ce travail pourra s’intégrer au sein d’architectures robotisées légères, non-rigidement liées, utilisant des robotsde comanipulation avec des commandes plus élaborées tel que le retour d’effort. Une telle "augmentation" descapacités de visualisation et d’action du chirurgien pourraient l’aider à optimiser la prise en charge de son patient. / Laparoscopic surgery faithfully reproduce the principles of conventional surgery with minimal physical aggression.If this surgery appears to be very beneficial for the patient, it is a difficult surgery where the complexity of surgicalact is increased, compared with conventional surgery. This complexity is partly due to the manipulation of surgicalinstruments and viewing the surgical scene (including the restricted field of view of a conventional endoscope). Thedecisions of the surgeon could be improved by identifying critical or not visible areas of interest in the surgical scene.My research aimed to combine robotics, computer vision and fluorescence to provide an answer to these problems :fluorescence imaging provides additional visual information to assist the surgeon in determining areas to operate or tobe avoided (for example, visualization of the cystic duct during cholecystectomy). Robotics will provide the accuracyand efficiency of the surgeon’s gesture as well as a visualization and a "more intuitive" tracking of the surgical scene.The combination of these two technologies will help guide and secure the surgical gesture.A first part of this work consisted in extracting visual information in both imagingmodalities (laparoscopy/fluorescence).Localization methods for 2D/3D real-time of laparoscopic surgical instruments in the laparoscopic image and anatomicaltargets in the fluorescence image have been designed and developed. A second part consisted in the exploitationof the bimodal visual information for developing control laws for robotics endoscope holder and the instrument holder.Visual servoing controls of a robotic endoscope holder to track one or more instruments in laparoscopic image ora target of interest in the fluorescence image were implemented. In order to control a robotic instrument holder withthe visual information provided by the imaging system, a calibration method based on the use of 3D information of thelocalization of surgical instruments was also developed. This multimodal environment was evaluated quantitativelyon the test bench and on anatomical specimens.Ultimately this work will be integrated within lightweight robotic architectures, not rigidly linked, using comanipulationrobots with more sophisticated controls such as force feedback. Such an "increase" viewing capabilities andsurgeon’s action could help to optimize the management of the patient.

Submitted by Verônica Esteves (vevenesteves@gmail.com) on 2018-01-11T14:25:05Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação Estêvão Braga.pdf: 573304 bytes, checksum: ad209c591d600ecfd064c313a95814b9 (MD5) / Approved for entry into archive by Verônica Esteves (vevenesteves@gmail.com) on 2018-01-11T14:26:31Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação Estêvão Braga.pdf: 573304 bytes, checksum: ad209c591d600ecfd064c313a95814b9 (MD5) / Made available in DSpace on 2018-01-11T14:26:31Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação Estêvão Braga.pdf: 573304 bytes, checksum: ad209c591d600ecfd064c313a95814b9 (MD5) Previous issue date: 2017 / Hospital Federal de Bonsucesso / Contexto: Apesar de diminuir com o envelhecimento, a incidência de náuseas e vômitos pósoperatórios (NVPO) permanece elevada em pacientes idosos, gerando possíveis repercussões pósoperatórias que podem ser catastróficas em indivíduos com menor reserva fisiológica. OBJETIVOS: Nosso objetivo principal foi testar a hipótese de que o uso único de palonosetrona na indução da anestesia, não é inferior ao uso da ondansetrona na indução, seguida do uso regular, em mulheres com 60 anos ou mais. MÉTODOS: Oitenta e duas mulheres com 60 anos ou mais, não fumantes, submetidas a colecistectomias laparoscópicas, receberam como intervenção palonosetrona 75 μg administradas por via endovenosa (ev) na indução de anestesia ou ondansetrona 4 mg, administrados iv na indução de anestesia seguido por administrações regulares de 4 mg a cada 8 horas no pós-operatório. A freqüência e intensidade das NVPO, os efeitos adversos, a necessidade de medicação de resgate e o nível de satisfação com a terapia antiemética foram avaliados no pós-operatório com 2, 6, 24 e 48 horas. RESULTADOS: Não houve diferença significativa durante os períodos de avaliação na freqüência e na intensidade das NVPO entre os grupos estudados. A freqüência total de náuseas pós-operatórias (0-48 horas) entre as pacientes que receberam palonosetrona e ondansetrona foi de 60 vs 55% (p = 0,65), e a freqüência total de vômitos foi de 35 vs 25% (p = 0,33), respectivamente. Não houve diferenças significativas nos efeitos adversos, no uso de medicação de resgate, como também no nível de satisfação com a terapia antiemética utilisada. CONCLUSÃO: A administração de dose única da palonosetrona na indução de anestesia foi tão eficaz quanto a administração da ondansetrona na indução, seguida de sua administração regular, para a profilaxia de NVPO em mulheres com 60 anos ou mais, submetidas a colecistectomia laparoscópica. / Background: Although decreases with aging, the incidence of postoperative nausea and vomiting ( PONV) remains high in elderly patients, generating possible postoperative repercussions that can be catastrophic in individuals with less physiological reserve. OBJECTIVES: Our primary objective was to test hypothesis that the single use of palonosetron at induction of anaesthesia, is non inferior to the use of ondansetron at induction, followed by regular doses, in women aged 60 years or older. METHODS: Eighty-two women aged 60 years or older, non-smokers, undergoing laparoscopic cholecystectomy received as intervention palonosetron 75 μg administered intravenously (iv) at the induction of anaesthesia or ondansetron 4 mg administered iv at the induction of anaesthesia followed by regular administrations of 4 mg every 8 hours postoperatively. The frequency and intensity of PONV, the frequency of adverse effects, the need for rescue medication and the level of satisfaction with antiemetic therapy were evaluated postoperatively at 2, 6, 24 and 48 hours. RESULTS: There was no significant difference in the frequency or intensity of PONV among the groups studied during the evaluation periods. The total frequency of postoperative nausea (0-48 hours) among patients receiving palonosetron and ondansetron was 60 vs 55% (p = 0.65), and the total frequency of vomiting was 35 vs 25% (p = 0.33), respectively. There were also no differences in adverse effects, use of rescue medication and level of satisfaction with antiemetic therapy. CONCLUSION: The administration of a single dose of palonosetron at the induction of anaesthesia was as effective as the regular administration of ondansetron at induction followed by regular administration for the prophylaxis of PONV in women 60 years of age or older who underwent laparoscopic cholecystectomy.

Submitted by Christiane Rodrigues da Silva (christianerdasilva@ufam.edu.br) on 2018-10-18T02:10:00Z No. of bitstreams: 4 Projeto Final_Christiane.doc: 14882816 bytes, checksum: 6f2443d86ff0e57a5ff5fc5c601ed125 (MD5) Carta de encaminhamento para Autodepósito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa Pública.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by PPGRACI Cirurgia (ppgraci@ufam.edu.br) on 2018-10-18T03:16:11Z (GMT) No. of bitstreams: 4 Projeto Final_Christiane.doc: 14882816 bytes, checksum: 6f2443d86ff0e57a5ff5fc5c601ed125 (MD5) Carta de encaminhamento para Autodepósito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa Pública.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Rejected by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br), reason: O Documento deve estar no formato PDF. Retorne ao sistema e faça o upload de uma versão neste formato. Dúvidas: ddbc@ufam.edu.br on 2018-10-18T12:29:56Z (GMT) / Submitted by Christiane Rodrigues da Silva (christianerdasilva@ufam.edu.br) on 2018-10-19T03:06:49Z No. of bitstreams: 4 Carta de encaminhamento para Autodepósito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa Pública.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) Projeto Final_Christiane.pdf: 5105546 bytes, checksum: 7e363fd433154b9aacfad042f4d44b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Rejected by PPGRACI Cirurgia (ppgraci@ufam.edu.br), reason: Já foi aceita a submissão da dissertação, na língua portuguesa, com abstract em inglês. Ressubmissão com o título do documento em inglês cria a expectativa que toda a dissertação foi traduzida, o que não ocorre com esta nova submissão. on 2018-10-19T16:11:42Z (GMT) / Submitted by Christiane Rodrigues da Silva (christianerdasilva@ufam.edu.br) on 2018-10-19T17:01:37Z No. of bitstreams: 4 Carta de encaminhamento para Autodepósito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa Pública.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) Projeto Final_Christiane.pdf: 5105546 bytes, checksum: 7e363fd433154b9aacfad042f4d44b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by PPGRACI Cirurgia (ppgraci@ufam.edu.br) on 2018-10-19T17:54:31Z (GMT) No. of bitstreams: 4 Carta de encaminhamento para Autodepósito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa Pública.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) Projeto Final_Christiane.pdf: 5105546 bytes, checksum: 7e363fd433154b9aacfad042f4d44b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2018-10-19T18:22:40Z (GMT) No. of bitstreams: 4 Carta de encaminhamento para Autodepósito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa Pública.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) Projeto Final_Christiane.pdf: 5105546 bytes, checksum: 7e363fd433154b9aacfad042f4d44b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-10-19T18:22:40Z (GMT). No. of bitstreams: 4 Carta de encaminhamento para Autodepósito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa Pública.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) Projeto Final_Christiane.pdf: 5105546 bytes, checksum: 7e363fd433154b9aacfad042f4d44b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-09-21 / BACKGROUND. Untreated pain leads to postoperative complications that prolong hospital stay. The association of analgesic drugs with different mechanisms of action, such as clonidine, allows the use of smaller doses of medication for better control of pain. OBJECTIVES. This dissertation aims to evaluate the use of multimodal analgesia in the control of postoperative pain in patients submitted to videolaparoscopic cholecystectomy (VLC); to compare the analgesic activities of intrathecal and intravenous clonidine for postoperative analgesia; to analyze the need for analgesic drugs in the immediate postoperative (tramadol / morphine) and to identify possible complications. METHOD. A prospective, randomized clinical trial was conducted with patients divided into three blocks, with 20 patients each one: Group I (n = 20) control, submitted to standard anesthesia; Group II (n = 20) intrathecal clonidine, submitted to standard anesthesia associated with the use of intrathecal clonidine; Group III (n = 20) intravenous clonidine, submitted to standard anesthesia associated with the use of intravenous clonidine. RESULTS. The pain scores between the groups did not present significant differences, but a greater analgesic need was observed in the control group (p = 0.005), as well as a higher incidence of nausea and vomiting (p = 0.240), probably due to side effects of morphine as rescue medication. Groups II and III presented a significant reduction of heart rate (p ˂ 0.001), but without clinical repercussion. CONCLUSIONS. In patients undergoing VLC there is evidence that the perioperative administration of alpha 2-agonists preserves hemodynamic stability, decreases opioid consumption and the incidence of nausea and vomiting in the postoperative. / JUSTIFICATIVA. A dor não tratada leva a complicações pós-operatórias que prolongam o tempo de internação hospitalar. A associação de fármacos analgésicos com diferentes mecanismos de ação, como a clonidina, permite usar doses menores de medicamentos para melhor controle da dor. OBJETIVOS. Esta dissertação tem por objetivo avaliar o emprego de analgesia multimodal no controle da dor pós-operatória de pacientes submetidos à colecistectomia por videolaparoscopia (CVLP); comparar as atividades analgésicas da clonidina intratecal e endovenosa para analgesia pós-operatória; analisar a necessidade de drogas analgésicas no pós-operatório imediato (tramadol/morfina) e identificar possíveis complicações. MÉTODO. Foi realizado um estudo de ensaio clínico prospectivo, experimental e randômico, com os pacientes divididos em 03 blocos, com 20 pacientes cada: Grupo I (n=20) controle, submetido à anestesia padrão; Grupo II (n=20) clonidina intratecal, submetido à anestesia padrão associada ao uso de clonidina intratecal; Grupo III (n=20) clonidina endovenosa, submetido à anestesia padrão associada ao uso de clonidina endovenosa. RESULTADOS. Os escores de dor entre os grupos não apresentaram valores com diferenças significativas, porém foi observada maior necessidade analgésica do uso da morfina no grupo controle (p = 0,005), assim como maior incidência de náuseas e vômitos (p=0,240), provavelmente devido aos efeitos colaterais da morfina como medicação de resgate. Os grupos II e III apresentaram uma redução significativa da frequência cardíaca (p ˂0,001), porém sem repercussão clínica. CONCLUSÕES. Nos pacientes submetidos à CVLP há evidências de que a administração perioperatória de alfa 2-agonistas preserva a estabilidade hemodinâmica, diminui o consumo de opióides e a incidência de náuseas e vômitos no pós-operatório.