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Transferência intratubárica videolaparoscópica de embriões ovinos fertilizados in vitro; Embryo transfer in oviduc of ovine in vitro fertilized by laparoscopy

Tabet, Alexandre de Faria
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 18/12/2007 PT
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37.24%
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...

Carga microbiana de trocartes reprocessaveis apos laparoscopias ginecologicas; Microbial load of reusables trocars after gynecology laparoscopy

Vanessa Aparecida Vilas-Boas
Fonte: Biblioteca Digital da Unicamp Publicador: Biblioteca Digital da Unicamp
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 29/07/2009 PT
Relevância na Pesquisa
37.04%
A transmissão de infecções hospitalares está relacionada à sobrevivência de microrganismos nas superfícies ambientais e no instrumental cirúrgico. Nos últimos anos, o Brasil tem se deparado com um cenário disperso em relação à validação do processo de limpeza e esterilização de instrumentos cirúrgicos utilizados em acessos minimamente invasivos, principalmente os procedimentos realizados por vídeo. Para implantação de medidas eficazes no reprocessamento é necessário saber como está o material em termos de contaminação e verificar se a carga microbiana trazida por esse instrumental é superior ao desafio microbiano imposto pelos indicadores biológicos. Deste modo, espera-se que a análise quanti-qualitativa dos microrganismos presentes em instrumentos cirúrgicos laparoscópicos após o uso clínico possa nortear a tomada de decisão pelos profissionais de saúde a contribuir para a melhoria do processo de trabalho visando à segurança do paciente. Objetivo: Identificar a carga microbiana presente nos trocartes reprocessáveis de 5 mm e 10 mm, usados para realização de laparoscopias ginecológicas. Material e Método: Tratase de um estudo exploratório descritivo. Um total de 57 trocartes de 5 mm e 10 mm de diâmetro foi recolhido na sala de operação...

Laparoscopia na abordagem inicial de tumores anexiais = : Laparoscopy for diagnosis and treatment of adnexal tumors; Laparoscopy for diagnosis and treatment of adnexal tumors

Amilcar Barreta
Fonte: Biblioteca Digital da Unicamp Publicador: Biblioteca Digital da Unicamp
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 09/08/2012 PT
Relevância na Pesquisa
37.38%
Introdução: O câncer de ovário é o sétimo câncer mais comum em mulheres. A sensibilidade e especificidade dos exames laboratoriais e de imagem não são adequadas para o diagnóstico de câncer de ovário. Atualmente o padrão-ouro para o diagnóstico do câncer de ovário é o exame histopatológico em parafina. Por este motivo, aproximadamente 10% das mulheres terão que ser operadas devido a um tumor anexial durante sua vida. A laparoscopia é comumente usada na tentativa de reduzir a morbidade cirúrgica nestes casos. Objetivo: Avaliar as diferenças nas características clínicas, no diagnóstico histopatológico, na duração da cirurgia e na incidência de complicações cirúrgicas em mulheres submetidas à laparoscopia e à laparotomia para diagnóstico e tratamento de tumores anexiais, e avaliar os fatores associados à falha da laparoscopia (conversão à laparotomia). Sujeitos e métodos: Para este estudo prospectivo foram convidadas a participar 210 mulheres com tumor anexial, dentre as quais foram incluídas 133 mulheres com indicação cirúrgica. Oitenta e oito mulheres foram submetidas à laparotomia e 45 foram submetidas à laparoscopia. Catorze das 45 laparoscopias foram convertidas à laparotomia durante o procedimento cirúrgico. Foi avaliado se idade...

LAPAROSCOPY VERSUS LAPAROTOMY IN THE REPAIR OF VENTRAL HERNIAS: systematic review and meta-analysis

CASTRO,Paula Marcela Vilela; RABELATO,Janayna Thainá; MONTEIRO,Gustavo Gomes Ribeiro; GUERRA,Guilherme Ciconelli del; MAZZURANA,Mônica; ALVAREZ,Guines Antunes
Fonte: Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE ; Colégio Brasileiro de Cirurgia Digestiva - CBCD ; Sociedade Brasileira de Motilidade Digestiva - SBMD ; Federação Brasileira de Gastroenterologia - FBG; Sociedade Brasileira de Hepatologia - SBH; Sociedade Brasileira de Endoscopia Digestiva - SOBED Publicador: Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE ; Colégio Brasileiro de Cirurgia Digestiva - CBCD ; Sociedade Brasileira de Motilidade Digestiva - SBMD ; Federação Brasileira de Gastroenterologia - FBG; Sociedade Brasileira de Hepatologia - SBH; Sociedade Brasileira de Endoscopia Digestiva - SOBED
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/2014 EN
Relevância na Pesquisa
37.16%
Objective To compare the laparotomy and laparoscopy techniques for correction of ventral hernia when related to perioperative complications, length of hospitalization, surgical time, and recurrence of hernia. Methods This was a systematic review of randomized controlled trials, which included studies retrieved from four databases (MEDLINE, Embase, Cochrane and LILACS), using a combination of the terms (Hernia, Ventral) and (Laparoscopy) and (Laparotomy). Results Six randomized trials were included, totaling 566 patients, 283 in the Laparoscopy group and 283 in the Laparotomy group. Laparoscopy reduced the risk of infection of the surgical wound (NNT = 5) and seroma formation (NNT = 13) and less length hospitalization (P = 0.02) compared to laparotomy in the correction of ventral hernias. Furthermore, laparoscopy increased the incidence of enterotomy (NNH = 25) and post operative pain (NNH = 8) and longer surgical time (P = 0.0009) when compared with laparotomy. There was no difference related to abscess (P = 0.79), hematoma (P = 0.43) and recurrency of ventral hernias (P = 0.25). Conclusions In the correction of ventral hernias, the use of laparoscopic technique is effective to reduce infections of the surgical wound and seroma formation...

Implementing laparoscopy in Brazil´s National Public Health System: the bariatric surgeons´ point of view

SUSSENBACH,Samanta; SILVA,Everton N; PUFAL,Milene Amarante; ROSSONI,Carina; CASAGRANDE,Daniela Schaan; PADOIN,Alexandre Vontobel; MOTTIN,Cláudio Corá
Fonte: Colégio Brasileiro de Cirurgia Digestiva Publicador: Colégio Brasileiro de Cirurgia Digestiva
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2014 EN
Relevância na Pesquisa
37.11%
BACKGROUND: Although Brazilian National Public Health System (BNPHS) has presented advances regarding the treatment for obesity in the last years, there is a repressed demand for bariatric surgeries in the country. Despite favorable evidences to laparoscopy, the BNPHS only performs this procedure via laparotomy. AIM: 1) Estimate whether bariatric surgeons would support the idea of incorporating laparoscopic surgery in the BNPHS; 2) If there would be an increase in the total number of surgeries performed; 3) As well as how BNPHS would redistribute both procedures. METHODS: A panel of bariatric surgeons was built. Two rounds to answer the structured Delphi questionnaire were performed. RESULTS: From the 45 bariatric surgeons recruited, 30 (66.7%) participated in the first round. For the second (the last) round, from the 30 surgeons who answered the first round, 22 (48.9%) answered the questionnaire. Considering the possibility that BNPHS incorporated laparoscopic surgery, 95% of surgeons were interested in performing it. Therefore, in case laparoscopic surgery was incorporated by the BNPHS there would be an average increase of 25% in the number of surgeries and they would be distributed as follows: 62.5% via laparoscopy and 37.5% via laparotomy. CONCLUSION: 1) There was a preference by laparoscopy; 2) would increase the number of operations compared to the current model in which only the laparotomy is available to users of the public system; and 3) the distribution in relation to the type of procedure would be 62.5% and 37.5% for laparoscopy laparotomy.

Single-incision laparoscopic appendectomy versus conventional laparoscopy in adults. A systematic review

Concha,Javier Alejandro Moraga; Cartes-Velásquez,Ricardo; Delgado,Carlos Manterola
Fonte: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia Publicador: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2014 EN
Relevância na Pesquisa
37.11%
PURPOSE: To determine the best treatment option for not complicated acute appendicitis (AA) in adult patients, between single incision laparoscopy (SIL) and conventional laparoscopy (CL), measured by morbidity associated with disease. METHODS: Systematic review. Articles of adults diagnosed with AA treated by SIL or CL were analyzed. Databases included: MEDLINE, LILACS, IBECS, Web of Science, Scopus and Cochrane, using MeSH terms and free words. The studies were analyzed using the MINCIR methodology. Variables included: conversion rate, morbidity, hospital stay, surgery duration, and methodological quality (MQ) of primary studies. Averages, medians and weighted averages were calculated. RESULTS: Thirteen articles were analyzed. For SIL and CL the conversion rate were 3.4% and 0.7 %, the morbidity were 8% and 6.5%, the hospital stay were 2.5 and 2.8 days, the surgery duration were 53.4 and 53.8 minutes, and the MQ were 14.3±6.6 and 16.0±6.9 points, respectively. CONCLUSION: With the exception of the conversion rate, there are no differences between single incision laparoscopy and conventional laparoscopy for the treatment of acute appendicitis in adults.

Accuracy of laparoscopy for assessing patients with endometriosis

Almeida Filho,Dilermando Pereira de; Oliveira,Laerte Justino de; Amaral,Vivian Ferreira do
Fonte: Associação Paulista de Medicina - APM Publicador: Associação Paulista de Medicina - APM
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/11/2008 EN
Relevância na Pesquisa
37.24%
CONTEXT AND OBJECTIVE: Diagnoses of endometriosis are based on observation of endometriotic lesions by means of laparoscopy, along with the pathological findings. The aim of this study was to evaluate the sensitivity and specificity of the macroscopic findings in relation to the histopathological findings. More specifically, we aimed to test the efficacy of laparoscopy alone for diagnosing endometriosis and to evaluate the laterality of endometriosis among the study population. DESIGN AND SETTING: Cross-sectional study on women undergoing laparoscopy due to pelvic pain or infertility, in the Gynecology Department of Hospital Santa Cruz in Curitiba, Paraná, Brazil, and Pontifícia Universidade Católica do Paraná. METHODS: A total of 976 patients underwent laparoscopy and biopsy due to pelvic pain and/or infertility. We analyzed the laparoscopic and histopathological findings from patients with pelvic endometriosis (n = 468) and patients without endometriosis (n = 508). RESULTS: In 468 (47.95%) of the cases, the clinical and laparoscopic findings were consistent with endometriosis, and this was confirmed histopathologically in 337 (34.5%). Among the remaining 508 patients, although the laparoscopy was performed for other reasons relating to acute pelvic pain...

Hans Frangenheim - Culdoscopy vs. Laparoscopy, the First Book on Gynecological Endoscopy, and "Cold light"

Litynski, Grzegorz S.
Fonte: Society of Laparoendoscopic Surgeons Publicador: Society of Laparoendoscopic Surgeons
Tipo: Artigo de Revista Científica
Publicado em //1997 EN
Relevância na Pesquisa
37.11%
In the United States, culdoscopy (a vaginal approach to view the abdomen) replaced laparoscopy for about 20 years, circa 1950-1970. In contrast to many of his colleagues, Hans Frangenheim of Wuppertal, Germany, was not satisfied with culdoscopy and turned to an abdominal approach. Frangenheim began publishing his experiences with gynecological laparoscopy in 1958 and stressed technical improvements. He constructed a CO2 insufflator, wrote the first book on gynecological endoscopy, and introduced "cold light" into laparoscopy. Frangenheim strongly stimulated the rise of gynecological laparoscopy in Europe in the 1960s and later.

Experimental study of the effect of intraperitoneal heparin on tumour implantation following laparoscopy

Neuhaus, S.; Ellis, T.; Jamieson, G.; Watson, D.
Fonte: BLACKWELL SCIENCE LTD Publicador: BLACKWELL SCIENCE LTD
Tipo: Artigo de Revista Científica
Publicado em //1999 EN
Relevância na Pesquisa
37.04%
BACKGROUND: Conclusions drawn from clinical reports of port site metastases following laparoscopic resection of intra-abdominal malignancy are now supported by a burgeoning experimental literature which suggests that laparoscopy promotes tumour metastasis to wounds. This study investigated the effect of intraperitoneal blood and heparin on the incidence of tumour cell implantation and port site metastasis. METHODS: Twenty-four Dark Agouti rats underwent laparoscopy with carbon dioxide insufflation and the instillation of a tumour cell suspension and/or blood into the peritoneal cavity. Rats were allocated randomly to one of the following study groups (six rats per group): (1) controls; (2) intraperitoneal blood (2 ml blood introduced from a syngeneic donor rat); (3) intraperitoneal heparin; (4) intraperitoneal blood and heparin. Rats were killed 7 days after the procedure, and the peritoneal cavity and port sites were examined for the presence of tumour. RESULTS: Tumour implantation and port site metastases were reduced by the intraperitoneal administration of heparin, but increased by the presence of intraperitoneal blood. CONCLUSION: The results of this study suggest that tumour implantation following laparoscopy is promoted by the presence of intraperitoneal blood and that this effect may be reduced by the use of intraperitoneal heparin.

Wound metastasis after laparoscopy with different insufflation gases

Neuhaus, S.; Watson, D.; Ellis, T.; Rowland, R.; Rofe, A.; Pike, G.; Mathew, G.; Jamieson, G.
Fonte: MOSBY-YEAR BOOK INC Publicador: MOSBY-YEAR BOOK INC
Tipo: Artigo de Revista Científica
Publicado em //1998 EN
Relevância na Pesquisa
37.04%
BACKGROUND: There is growing evidence that laparoscopy for malignancy is associated with an increased incidence of metastasis to port sites. This study investigated the effect of different insufflation gases on port-site metastasis after laparoscopy in an established animal model. METHODS: Forty-eight Dark Agouti rats with an established adenocarcinoma in the left flank underwent laparoscopic intraperitoneal tumor laceration. The gas used for insufflation was one of the following (12 rats in each group): (1) CO2, (2) N2O, (3) helium, or (4) air. Rats were killed 7 days after the procedure, and the port sites were examined for the presence of tumor metastasis. RESULTS: Tumor involvement of port sites was significantly less likely after helium insufflation than in the other groups (p < 0.0001). There was no significant difference between the air, CO2, and N2O groups. CONCLUSIONS: This study suggests that the development of metastases in port sites after laparoscopy may be influenced in part by the choice of insufflation gas used to create the pneumoperitoneum. In particular, helium was associated with a reduced rate of metastases.; Neuhaus, Susan J ; Watson, David I ; Ellis, Tanya ; Rowland, Robert ; Rofe, Alan M ; Pike, Gregory K ; Mathew...

The effect of laparoscopy on the movement of tumor cells and metastasis to surgical wounds

Mathew, G.; Watson, D.; Ellis, T.; De Young, N.; Rofe, A.; Jamieson, G.
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Artigo de Revista Científica
Publicado em //1997 EN
Relevância na Pesquisa
37.26%
Background: A variety of mechanisms have been proposed to explain tumor growth in port sites following laparoscopic cancer surgery. We devised two experimental models to determine whether carbon dioxide (CO2) insufflation during laparoscopic surgery influences the movement of tumor cells and leads to tumor implantation and growth in surgical wounds. Methods: Model 1: Viable adenocarcinoma cells were introduced into the upper abdomen of six syngeneic immunecompetent rats during laparoscopy with CO2 insufflation; the same procedure was followed for a further six rats during gasless laparoscopy. A length of plastic tubing introduced through the anterolateral aspect of the rats’ left lower abdominal wall was used to vent the insufflation gas through the abdomen of a recipient rat for 30 min. After 21 days, the peritoneal cavity and surgical wounds of the recipient rat were examined for implanted tumor. Model 2: A suspension of radiolabeled adenocarcinoma cells was introduced into the upper abdomen of five rats during laparoscopy with CO2 insufflation and an additional five rats during gasless laparoscopy. A length of plastic tubing introduced through the anterolateral aspect of the left lower abdominal flank was used to vent the insufflation gas through phosphate-buffered saline solution. After 30 min...

Tumour implantation following laparoscopy using different insufflation gases

Gupta, A.; Watson, D.; Ellis, T.; Jamieson, G.
Fonte: Blackwell Science Asia Publicador: Blackwell Science Asia
Tipo: Artigo de Revista Científica
Publicado em //2002 EN
Relevância na Pesquisa
37.04%
Background: Because of the possibility of intraperitoneal seeding and port-site recurrences following laparoscopic surgery, the role of laparoscopy in cancer surgery remains controversial. Previous experimental studies have suggested that chemical, metabolic and immunological changes following carbon dioxide (CO2) insufflation may be responsible for this phenomenon. Earlier experimental studies done by the University of Adelaide Department of Surgery have also shown that helium insufflation is associated with none of the adverse changes brought about by CO2 insufflation. Helium insufflation is also associated with lower rates of intra-abdominal tumour spread. The aim of this study was to determine whether these identified benefits apply to inert gases in general. Methods: Twenty-four Dark Agouti rats were randomized to undergo laparoscopy with 40 min insufflation using one of the following four gases (six rats in each group); CO2, helium, argon and nitrogen. A tumour cell suspension was injected into the abdominal cavity at the beginning of laparoscopy. The rats were killed 7 days after surgery, and the peritoneal cavity and port sites were examined for the presence of tumour. Results: Rats undergoing helium insufflation, had the least number of port-site recurrences and the least amount of intraperitoneal tumour spread. Argon and nitrogen pneumoperitoneum were associated with a large number of port-site recurrences and widespread tumour seeding. The effect of CO2 insufflation was intermediate. Conclusion: The choice of insufflation gas influences the incidence of port-site metastases and the degree of intraperitoneal tumour spread following laparoscopic cancer surgery. The reduced port-site recurrences and intraperitoneal spread that followed helium pneumoperitoneum is likely to be a unique property of this gas rather than a property of inert gases in general.; Anurag Gupta...

Metabolic and immunologic consequences of laparoscopy with helium or carbon dioxide insufflation: A randomized clinical study

Neuhaus, S.; Watson, D.; Ellis, T.; Lafullarde, T.; Jamieson, G.; Russell, W.
Fonte: Blackwell Science Asia Publicador: Blackwell Science Asia
Tipo: Artigo de Revista Científica
Publicado em //2001 EN
Relevância na Pesquisa
37.2%
Background: Previous studies using animal models have demonstrated that carbon dioxide (CO2) pneumoperitoneum during laparoscopy is associated with adverse physiological, metabolic, immunological and oncological effects, and many of these problems can be avoided by the use of helium insufflation. The present study was performed in patients to compare the effect of helium and CO2 insufflation on intraperitoneal markers of immunological and metabolic function. Methods: Eighteen patients undergoing elective upper gastrointestinal laparoscopic surgery were randomized to have insufflation achieved by using either helium (n = 8) or CO2 (n = 10) gas. Intraperitoneal pH was monitored continuously during surgery, and peritoneal macrophage function was determined by harvesting peritoneal macrophages at 5 min and 30 min after commencing laparoscopy, and then assessing their ability to produce tumour necrosis factor-α (TNF-α), and their phagocytic function. Results: Carbon dioxide laparoscopy was associated with a lower intraperitoneal pH at the commencement of laparoscopy, although this difference disappeared as surgery progressed. The production of TNF-α was better preserved by CO2 laparoscopy, but the insufflation gas used did not affect macrophage phagocytosis. Patients undergoing helium laparoscopy required less postoperative analgesia. Conclusion: The choice of insufflation gas can affect intraperitoneal macrophage function in the clinical setting...

Urogenital nonunion - the case for laparoscopy for the impalpable testis

Foley, P.; Sparnon, A.; Lipsett, J.
Fonte: Springer Publicador: Springer
Tipo: Artigo de Revista Científica
Publicado em //2005 EN
Relevância na Pesquisa
37.11%
A case of urogenital nonunion is presented to illustrate the importance of laparoscopy for the impalpable testis. A 4-year-old boy with an impalpable left testis underwent laparoscopy. This revealed not only the vas deferens entering the deep inguinal ring but also a small intraabdominal testis supplied by the testicular vessels. Exploration of the inguinal canal revealed the vas deferens terminating in a nubbin of tissue. Histology identified epididymal structures both adjacent to the testis and in the terminal nubbin of the vas deferens. This is an example of urogenital nonunion. Complete separation of the vas and testis with epididymal structures attached to each is very unusual, with only four other cases reported. Laparoscopy should be the initial procedure for impalpable testis. A blind-ending vas deferens found on exploration of the inguinal canal might be taken as evidence of the vanishing testis syndrome. However, this conclusion should not be drawn unless laparoscopy has demonstrated testicular vessels entering the internal inguinal ring.; P. T. Foley, A. L. Sparnon and J. Lipsett

The capacity of hysterosalpingography and laparoscopy to predict natural conception

Verhoeve, H.; Coppus, S.; van der Steeg, J.; Steures, P.; Hompes, P.; Bourdrez, P.; Bossuyt, P.; van der Veen, F.; Mol, B.
Fonte: Oxford University Press Publicador: Oxford University Press
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
Relevância na Pesquisa
37.32%
BACKGROUND Laparoscopy has been claimed to be superior to hysterosalpingography (HSG) in predicting fertility. Whether this conclusion is applicable to a general subfertile population can be questioned as data in support of this claim were collected in third line centres. The aim of this study was to assess the prognostic capacity of HSG and laparoscopy in a general subfertile population. METHODS In 38 centres, we prospectively studied a cohort of patients referred for subfertility between 2002 and 2004, who underwent HSG and/or laparoscopy as part of their subfertility work-up. Follow-up started immediately after tubal testing and ended 12 months thereafter. Time to pregnancy was censored at the of date last contact, when the woman was not pregnant or at the start of treatment. Kaplan–Meier curves for the occurrence of spontaneous intrauterine pregnancy were constructed for patients without tubal pathology, for those with unilateral tubal pathology and for patients with bilateral tubal pathology at HSG or laparoscopy. Multivariable Cox regression analysis was used to calculate fecundity rate ratios (FRRs) to express associations between tubal pathology and the occurrence of an intrauterine pregnancy. RESULTS Of the 3301 included patients...

Laparoscopy for diagnosing resectability of disease in patients with advanced ovarian cancer

Rutten, M.; Leeflang, M.; Kenter, G.; Mol, B.; Buist, M.
Fonte: Wiley Publicador: Wiley
Tipo: Artigo de Revista Científica
Publicado em //2014 EN
Relevância na Pesquisa
37.2%
Background The presence of residual tumour after primary debulking surgery is the most important prognostic factor in patients with advanced ovarian cancer. In up to 60% of cases, residual tumour of more than 1 cm is left behind, stressing the necessity of accurately selecting those patients who should be treated with primary debulking surgery and those who should receive neoadjuvant chemotherapy instead. Objectives To determine if performing an open laparoscopy after the diagnostic work-up of patients suspected of advanced ovarian cancer is accurate in predicting the resectability of disease. Search methods We searched MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Register of Diagnostic Test Accuracy Studies, MEDION and ISI Web of Science to February 2013. Furthermore, we checked references of identified primary studies and review articles. Selection criteria We included studies that evaluated the diagnostic accuracy of laparoscopy to determine the resectability of disease in patients who are suspected of advanced ovarian cancer and planned to receive primary debulking surgery. Data collection and analysis Two review authors assessed the quality of included studies using QUADAS-2 and extracted data on study and patients' characteristics...

Pain after laparoscopy

Mouton, W.; Bessell, J.; Otten, K.; Maddern, G.
Fonte: SPRINGER VERLAG Publicador: SPRINGER VERLAG
Tipo: Artigo de Revista Científica
Publicado em //1999 EN
Relevância na Pesquisa
37.04%
BACKGROUND: In the context of the much-heralded advantages of laparoscopic surgery, it can be easy to overlook postlaparoscopy pain as a serious problem, yet as many as 80% of patients will require opioid analgesia. It generally is accepted that pain after laparoscopy is multifactorial, and the surgeon is in a unique position to influence many of the putative causes by relatively minor changes in technique. METHODS: This article reviews the relevant literature concerning the topic of pain after laparoscopy. RESULTS: The following factors, in varying degrees, have been implicated in postlaparoscopy pain: distension-induced neuropraxia of the phrenic nerves, acid intraperitoneal milieu during the operation, residual intra-abdominal gas after laparoscopy, humidity of the insufflated gas, volume of the insufflated gas, wound size, presence of drains, anesthetic drugs and their postoperation effects, and sociocultural and individual factors. CONCLUSIONS: On the basis of the factors implicated in postlaparoscopy pain, the following recommendations can be made in an attempt to reduce such pain: emphathically consider each patients' unique sociocultural and individual pain experience; inject port sites with local anesthesia at the start of the operation; keep intra-abdominal pressure during pneumoperitoneum below 15 mmHg...

Laparoscopy to predict the result of primary cytoreductive surgery in advanced ovarian cancer patients (LapOvCa-trial): a multicentre randomized controlled study

Rutten, M.; Gaarenstroom, K.; Van Gorp, T.; van Meurs, H.; Arts, H.; Bossuyt, P.; Ter Brugge, H.; Hermans, R.; Opmeer, B.; Pijnenborg, J.; Schreuder, H.; Schutter, E.; Spijkerboer, A.; Wensveen, C.; Zusterzeel, P.; Mol, B.; Kenter, G.; Buist, M.
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
37.2%
Background: Standard treatment of advanced ovarian cancer is surgery and chemotherapy. The goal of surgery is to remove all macroscopic tumour, as the amount of residual tumour is the most important prognostic factor for survival. When removal off all tumour is considered not feasible, neoadjuvant chemotherapy (NACT) in combination with interval debulking surgery (IDS) is performed. Current methods of staging are not always accurate in predicting surgical outcome, since approximately 40% of patients will have more than 1 cm residual tumour after primary debulking surgery (PDS). In this study we aim to assess whether adding laparoscopy to the diagnostic work-up of patients suspected of advanced ovarian carcinoma may prevent unsuccessful primary debulking surgery for ovarian cancer. Methods: Multicentre randomized controlled trial, including all gynaecologic oncologic centres in the Netherlands and their affiliated hospitals. Patients are eligible when they are planned for PDS after conventional staging. Participants are randomized between direct PDS or additional diagnostic laparoscopy. Depending on the result of laparoscopy patients are treated by PDS within three weeks, followed by six courses of platinum based chemotherapy or with NACT and IDS 3-4 weeks after three courses of chemotherapy...

Carga microbiana dos trocartes de laparoscopia ginecológica, possíveis fontes de contaminação e repercussão clínica; Microbial load of trocars gynecological laparoscopy, possible source of contamination and clinical significance

Vanessa Aparecida Vilas Boas
Fonte: Biblioteca Digital da Unicamp Publicador: Biblioteca Digital da Unicamp
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 31/07/2014 PT
Relevância na Pesquisa
37.11%
Introdução: Instrumentos cirúrgicos utilizados em cirurgias minimamente invasivas podem oferecer risco de infecção cruzada. Identificar sua fonte de contaminação contribui para prevenção de infecção e prestação do cuidado com qualidade e segurança. Contudo, a infecção de sítio cirúrgico é complexa, multifatorial e pode ser subnotificada se não houver programa de vigilância pós-alta efetivo. Objetivos: avaliar a relação entre carga microbiana de trocartes e microbiota da paciente, bem como a ocorrência de infecção de sítio cirúrgico após laparoscopia ginecológica; validar um instrumento de vigilância pós-alta por contato telefônico para cirurgias vídeo-assistidas. Método: estudo realizado em hospital público especializado em saúde da mulher. Fase I - estudo longitudinal prospectivo, 2011-2012, no qual amostras da microbiota da paciente foram coletadas no dia da internação por esfregaço com zaragatoa nas regiões da pele, ponto de McBurney esquerdo, cicatriz umbilical e fundo de saco vaginal. Após laparoscopia, trocartes foram coletados com técnica asséptica, obtendo-se o lavado microbiológico por adição de água destilada estéril e agitação, filtrados por membrana. As amostras foram incubadas para análise microbiológica. Após alta hospitalar...

Results of the surgical treatment of non-advanced megaesophagus using Heller-Pinotti's surgery: Laparotomy vs. Laparoscopy

Lopes,Luiz Roberto; Braga,Nathália da Silva; Oliveira,Gustavo Carvalho de; Coelho Neto,João de Souza; Camargo,Marcelo Amade; Andreollo,Nelson Adami
Fonte: Faculdade de Medicina / USP Publicador: Faculdade de Medicina / USP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2011 EN
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INTRODUCTION: Dysphagia is the important symptom in achalasia, and surgery is the most common treatment. The Heller-Pinotti technique is the method preferred by Brazilian surgeons. For many years, this technique was performed by laparotomy, and now the laparoscopic method has been introduced. The objective was to evaluate the immediate and long-term results of patients submitted to surgery by either laparotomy or laparoscopy. MATERIALS AND METHODS: A total of 67 patients submitted to surgery between 1994 and 2001 with at least 5 years of follow-up were evaluated retrospectively and divided into two groups: laparotomy (41 patients) and laparoscopy (26 patients). Chagas was the etiology in 76.12% of cases. Dysphagia was evaluated according to the classification defined by Saeed et al. RESULTS: There were no cases of conversion to open surgery. The mean duration of hospitalization was 3.32 days for laparotomy and 2.54 days for laparoscopy (p<0.05). An improvement in dysphagia occurred with both groups reporting good or excellent results (laparotomy: 73.17% and laparoscopy: 73.08%). Mean duration of follow-up was 8 years. CONCLUSIONS: There was no difference between the two groups with respect to relief from dysphagia, thereby confirming the safety and effectiveness of the Heller-Pinotti technique...