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ABSTRACT Objective: To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). Materials and Methods: Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. Results: From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. Conclusion: VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.

https://doi.org/10.1590/s1677-5538.ibju.2023.0065

COMBINED HEART-LIVER-KIDNEY TRANSPLANTATION: THE FIRST EXPERIENCE IN LATIN AMERICA
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FERNANDES, Eduardo

; da SILVA, Filipe Roza

; SEGALOTE, Rodrigo

; ROCHA, Pedro Túlio

; MELLO, Felipe

; GIRÃO, Camila

; OLIVEIRA, Ronaldo

; SAVATTONE, Leandro

; CESAR, Camila

; SIQUEIRA, Munique

; BAAMONDE, Adolpho

; OLIVEIRA, Gabrielle

; FURTADO, Rodrigo

; TOBIAS, Camila

; RIBEIRO, Thays

; GALHARDO, Carlos

; MOURAD, Gabriel

; ROBALINHO, Felipe

; BRITO, Anderson

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2022, Volume 35 elocation e1668

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0102-672020210002e1668

Genetic tolerance to low temperatures in irrigated rice
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Streck, Eduardo Anibele

; Aguiar, Gabriel Almeida

; Silva, Pedro Ujacov da

; Fronza, Rafael Tobias Lang

; Magalhães Júnior, Ariano Martins de

Revista Ciência Agronômica

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2020, Volume 51 N. 3 elocation e20196938

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivou-se caracterizar a variabilidade genética para a tolerância a baixas temperaturas na fase de emergência de genótipos de arroz irrigado em condições de ambiente controlado e a campo. Foram avaliados 37 genótipos, com testemunhas intercaladas com diferentes níveis de tolerância à baixas temperaturas. O delineamento utilizado foi de blocos casualizados com 3 repetições. Os genótipos foram submetidos a germinação e emergência nos ensaios com temperatura controlada a 13 ºC (Ensaio I) e 17 ºC (Ensaio II) e em ambientes a campo, sem cobertura (Ensaio III) e com cobertura de polietileno (Ensaio IV), sendo monitorado a temperatura do solo. As avaliações foram realizadas diariamente por meio de contagem das plântulas emergidas e posterior inferência do índice de velocidade de emergência (IVE). Os resultados revelaram (experimento I a IV) que o IVE foi de 0,61 a 4,23, aumentando 0,4259 a cada 1 ºC de aumento de temperatura do solo. Os genótipos Ostiglia, Diamante, Baldo, Carnaroli, Selenio, Loto e Amarelo, da subespécie japonica e Ringo Miara-AC e Arelate, da subespécie indica, são fontes promissoras de tolerância genética à baixas temperaturas. Temperaturas abaixo de 17 ºC diminuem o número de plântulas emergidas e retardam o desenvolvimento de todos genótipos de arroz testados, afetando, em maior ou menor magnitude, negativamente no estande inicial de plantas por unidade de área.

ABSTRACT The aim of this study was to characterise genetic variability to low-temperature tolerance in the emergence stage of irrigated-rice genotypes under controlled and field conditions. Thirty-seven genotypes were evaluated, interspersed with controls of different levels of low-temperature tolerance. The design used was of randomised blocks with three replications. The genotypes were submitted to germination and emergence in controlled-temperature trials at 13 ºC (Trial I) and 17 ºC (Trial II), and in field environments with no cover (Trial III) and with a cover of polyethylene (Trial IV), where the soil temperature was monitored. The evaluations were carried out daily by counting the emerged seedlings and later inferring the speed of emergence index (SEI). The results showed (experiment I to IV) that the SEI varied from 0.61 to 4.23, increasing by 0.4259 for each 1 ºC increase in soil temperature. The genotypes Ostiglia, Diamante, Baldo, Carnaroli, Selenio, Loto e Amarelo, of subspecies japonica, and Ringo Miara-AC and Arelate, of subspecies indica, are promising sources of genetic tolerance to low temperature. Temperatures of less than 17 ºC reduce the number of emerged seedlings and delay development in each of the rice genotypes under test, with a greater or lesser negative effect on the initial plant stand per unit area.

https://doi.org/10.5935/1806-6690.20200058 301 downloads

Advances and challenges in the water sciences in Brazil: a community synthesis of the XXIII Brazilian Water Resources Symposium
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Paiva, Rodrigo Cauduro Dias de

; Chaffe, Pedro Luiz Borges

; Anache, Jamil Alexandre Ayach

; Fontes, Andrea Sousa

; Araujo, Ligia Maria Nascimento de

; Araujo, Anderson Nascimento de

; Bartiko, Daniel

; Bleninger, Tobias

; Amorim, Pablo Borges de

; Buarque, Diogo Costa

; Carlotto, Tomas

; Collischonn, Walter

; Detzel, Daniel Henrique Marco

; Fan, Fernando Mainardi

; Formiga-Johnsson, Rosa Maria

; Kobiyama, Masato

; Mannich, Michael

; Marques, Guilherme

; Michel, Gean Paulo

; Oliveira, Debora Yumi de

; Oliveira, Paulo Tarso Sanches de

; Pinheiro, Adilson

; Ruhoff, Anderson

; Siqueira, Vinicius Alencar

; Tassi, Rutineia

; Zanandrea, Franciele

RBRH

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2020, Volume 25 elocation e50

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Este artigo apresenta uma síntese das sessões especiais do XXIII Simpósio Brasileiro de Recursos Hídricos 2019, com o objetivo de compreender os principais avanços e desafios em recursos hídricos no Brasil. Foram analisados mais de 250 trabalhos e apresentações em 16 sessões especiais abrangendo temas como Variabilidade e Mudanças Climáticas, Desastres, Modelagem, Hidrologia de Grande Escala, Sensoriamento Remoto, Educação e Gestão de Recursos Hídricos. Esta avaliação destacou a diversidade única de atributos naturais e antrópicos dos recursos hídricos brasileiros, que oferece uma grande oportunidade para aprendizado sobre sistemas hidrológico e humano acoplados. A maioria das contribuições é relacionada a métodos e quantificação de fenômenos hídricos, existindo uma necessidade clara de incentivo a mais pesquisas em compreensão de fenômenos. Existe uma vasta rede de coautores, mas principalmente da academia e com certo grau de fragmentação regional. A comunidade da ABRhidro tem o desafio de aumentar a sua rede de colaboração, a cultura de análises de síntese, e construir uma agenda comum para a pesquisa em recursos hídricos. Também é o momento de alinhar esforços com a comunidade de recursos hídricos internacional, usando nossas experiências para contribuir ativamente na solução de questões relacionadas à água em nível global.

ABSTRACT In this paper we synthesize the special sessions of the XXIII Brazilian Water Resources Symposium 2019 in order to understand the major advances and challenges in the water sciences in Brazil. We analyzed more than 250 papers and presentations of 16 special sessions covering topics of Climate Variability and Change, Disasters, Modeling, Large Scale Hydrology, Remote Sensing, Education, and Water Resources Management. This exercise highlighted the unique diversity of natural and human water features in Brazil, that offers a great opportunity for understanding coupled hydrological and societal systems. Most contributions were related to methods and the quantification of water phenomena, therefore, there is a clear necessity for fostering more research on phenomena comprehension. There is a vast network of co-authorship among institutions but mostly from academia and with some degree of regional fragmentation. The ABRhidro community now has the challenge to enhance its collaboration network, the culture of synthesis analysis, and to build a common agenda for water resources research. It is also time for us to be aligned with the international water science community and to use our experiences to actively contribute to the tackling of global water issues.

https://doi.org/10.1590/2318-0331.252020200136 1129 downloads

Neuraxial labor analgesia: a literature review
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Aragão, Fábio Farias de

; Aragão, Pedro Wanderley de

; Martins, Carlos Alberto

; Leal, Karlla Fernanda Custódia Silva

; Tobias, Alexandro Ferraz

Revista Brasileira de Anestesiologia

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jun 2019, Volume 69 N. 3 Pages 291 - 298

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo O uso de técnicas de analgesia para o trabalho de parto tem se tornado cada vez mais frequente. As técnicas neuroaxiais são as mais comumente usadas e de maior eficácia. A dor do trabalho de parto traz uma série de consequências fisiológicas que podem ser negativas para a mãe e para o feto, e por isso deve ser tratada. Esta revisão de literatura foi feita na base de dados PubMed, de julho a novembro de 2016, e foram incluídos artigos em inglês ou portuguê publicados entre 2011 e 2016, ou mais antigos que fossem relevantes ao tema. As técnicas foram divididas nos tópicos: indução (peridural, raquiperidural combinada, raquianestesia contínua e peridural com punção dural) e manutenção da analgesia (infusão peridural contínua, analgesia peridural controlada pela paciente e bolus peridural intermitente). A analgesia peridural não altera a incidência de cesarianas nem o prognóstico fetal, e o desejo materno é indicação suficiente para seu início. A técnica combinada apresenta como vantagem um início mais rápido da analgesia, entretanto as pacientes estão sujeitas a maior incidência de prurido decorrente da administração intratecal de opioides. A analgesia controlada pela paciente parece ser uma excelente técnica, diminui o consumo de anestésicos locais e o número de intervenções do anestesiologista e aumenta a satisfação materna.

Abstract The use of analgesia techniques for labor has become increasingly frequent, with neuraxial techniques being the most commonly used and most effective. Labor pain entails a number of physiological consequences that may be negative for the mother and fetus, and therefore must be treated. This literature review was performed through a search in the PubMed database, from July to November 2016, and included articles in English or Portuguese, published between 2011 and 2016 or anteriorly, if relevant to the topic. The techniques were divided into the following topics: induction (epidural, combined epidural-spinal, continuous spinal, and epidural with dural puncture) and maintenance of analgesia (continuous epidural infusion, patient-controlled epidural analgesia, and intermittent epidural bolus). Epidural analgesia does not alter the incidence of cesarean sections or fetal prognosis, and maternal request is a sufficient indication for its initiation. The combined technique has the advantage of a faster onset of analgesia; however, patients are subject to a higher incidence of pruritus resulting from the intrathecal administration of opioids. Patient-controlled analgesia seems to be an excellent technique, reducing the consumption of local anesthetics, the number of anesthesiologist interventions, and increasing maternal satisfaction.

https://doi.org/10.1016/j.bjane.2018.12.014 2362 downloads

THORACOLUMBAR SPINAL ARTHRODESIS - EPIDEMIOLOGY AND COSTS
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NASCIMENTO, TOBIAS LUDWIG DO

; ROGÉRIO, LUIZ PEDRO WILLIMANN

; REIS, MARCELO MARTINS DOS

; ALMEIDA, LEANDRO PELEGRINI DE

; FINGER, GUILHERME

; GREGGIANIN, GABRIEL FRIZON

; NASCIMENTO, TADEU LUDWIG DO

; CECCHINI, ANDRÉ MARTINS DE LIMA

; CECCHINI, FELIPE MARTINS DE LIMA

; SFREDDO, ERICSON

Coluna/Columna

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jan 2017, Volume 16 N. 1 Pages 52 - 55

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

RESUMO Objetivo: Descrever a epidemiologia dos pacientes com fratura de coluna toracolombar submetidos à cirurgia no Hospital Cristo Redentor e os custos relacionados. Métodos: Estudo epidemiológico prospectivo entre julho de 2014 e agosto de 2015 de pacientes com fratura da coluna toracolombar com indicação de cirurgia. Foram analisadas as variáveis sexo, idade, custo da internação hospitalar, níveis fraturados, níveis de artrodese, infecção de sítio cirúrgico, ITU ou BCP, lesão medular, etiologia, dias de internação, tempo de procedimento e escala visual analógica (EVA) . Resultados: Foram avaliados 32 pacientes no período estudado, com média de idade de 38,68 anos. A relação entre homens e mulheres foi 4:1 e as causas mais frequentes foram queda de altura (46,87%) e acidentes de trânsito (46,87%). A transição toracolombar foi a mais acometida (40,62%) com a vértebra de L1 envolvida em 23,8% das vezes. Apresentaram déficit neurológico 40,62% dos pacientes. O tempo de permanência hospitalar teve mediana de 14 dias e os pacientes com déficit neurológico permaneceram internados por período mais prolongado (p <0,001), com aumento dos custos hospitalares (p= 0,015). O custo médio da internação foi de U$ 2.874,80. A presença de BCP aumentou o custo da internação e os pacientes com lesão medular tiveram mais BCP (p= 0,014). Conclusão: Políticas públicas com ênfase na redução de acidentes de trânsito e quedas podem ajudar a reduzir a incidência dessas lesões e estudos com foco nos gastos hospitalares e em reabilitação precisam ser realizados no Brasil para determinar o fardo socioeconômico do traumatismo vertebral e traumatismo medular.

ABSTRACT Objective: To describe the epidemiology of patients with thoracolumbar spine fracture submitted to surgery at Hospital Cristo Redentor and the related costs. Methods: Prospective epidemiological study between July 2014 and August 2015 of patients with thoracolumbar spine fracture with indication of surgery. The variables analyzed were sex, age, cost of hospitalization, fractured levels, levels of arthrodesis, surgical site infection, UTI or BCP, spinal cord injury, etiology, length of stay, procedure time, and visual analog scale (VAS) . Results: Thirty-two patients were evaluated in the study period, with a mean age of 38.68 years. Male-female ratio was 4:1 and the most frequent causes were fall from height (46.87%) and traffic accidents (46.87%). The thoracolumbar transition was the most affected (40.62%), with L1 vertebra involved in 23.8% of the time. Neurological deficit was present in 40.62% of patients. Hospital stay had a median of 14 days and patients with neurological deficit were hospitalized for a longer period (p<0.001), with an increase in hospital costs (p= 0.015). The average cost of hospitalization was U$2,874.80. The presence of BCP increased the cost of hospitalization, and patients with spinal cord injury had more BCP (p= 0.014) . Conclusion: Public policies with an emphasis on reducing traffic accidents and falls can help reduce the incidence of these injuries and studies focusing on hospital costs and rehabilitation need to be conducted in Brazil to determinate the burden of spinal trauma and spinal cord injury.

RESUMEN Objetivo : Describir la epidemiología de los pacientes con fractura de columna toracolumbar sometidos a cirugía en el Hospital Cristo Redentor y los costos relacionados. Métodos : Estudio epidemiológico prospectivo entre julio de 2014 y agosto de 2015 de pacientes con fracturas de la columna toracolumbar con indicación de cirugía. Se analizaron las variables sexo, edad, costo de hospitalización, niveles fracturados, niveles de artrodesis, infección del sitio quirúrgico, ITU o BCP, lesión de la médula espinal, etiología, duración de la estancia hospitalaria, tiempo del procedimiento y la escala visual analógica (EVA). Resultados: Fueron evaluados 32 pacientes durante el período de estudio, con un promedio de edad de 38,68 años. La relación entre hombres y mujeres fue de 4:1 y las causas más frecuentes fueron las caídas de altura (46,87%) y los accidentes de tránsito (46,87%). La transición toracolumbar fue la más afectada (40,62%) con la vértebra de L1 involucrada en 23,8% de los casos. Presentaron déficit neurológico 40,62% de los pacientes. La estancia hospitalaria tuvo mediana de 14 días y los pacientes con déficit neurológico permanecieron hospitalizados por un período más largo (p <0,001), con un aumento de los gastos de hospital (p= 0,015). El costo promedios de hospitalización fue de U$ 2.874,80. La presencia de BCP aumentó el costo de la hospitalización y los pacientes con lesión de la médula espinal tuvieron más BCP (p= 0,014) . Conclusión : Políticas públicas, con énfasis en la reducción de los accidentes de tránsito y las caídas pueden ayudar a reducir la incidencia de estas lesiones y los estudios centrados en los costos hospitalarios y de rehabilitación deben ser llevados a cabo en Brasil para determinar la carga socioeconómica del trauma espinal y la lesión de médula espinal.

https://doi.org/10.1590/s1808-185120171601162774 1650 downloads

Open suprapubic versus retropubic prostatectomy in the treatment of benign prostatic hyperplasia during resident's learning curve: a randomized controlled trial
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Carneiro, Arie

; Sakuramoto, Paulo

; Wroclawski, Marcelo Langer

; Forseto, Pedro Herminio

; Julio, Alexandre Den

; Bautzer, Carlos Ricardo Doi

; Lins, Leonardo Monte Marques

; Kataguiri, Andre

; Yamada, Fernanda Batistini

; Teixeira, Gabriel Kushiyama

; Tobias-Machado, Marcos

; Pompeo, Antonio Carlos Lima

International braz j urol

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apr 2016, Volume 42 N. 2 Pages 284 - 292

Abstract: En | Text: En | PDF: En

ABSTRACT Purpose: This study compared the suprapubic (SP) versus retropubic (RP) prostatectomy for the treatment of large prostates and evaluated perioperative surgical morbidity and improvement of urinary symptoms. Materials and Methods: In this single centre, prospective, randomised study, 65 consecutive patients with LUTS and surgical indication with prostate volume greater than 75g underwent open prostatectomy to compare the RP (32 patients) versus SP (33 patients) technique. Results: The SP group exhibited a higher incidence of complications (p=0.002). Regarding voiding pattern analysis (IPSS and flowmetry), both were significantly effective compared to pre-treatment baseline. The RP group parameters were significantly better, with higher peak urinary flow (SP: 16.77 versus RP: 23.03mL/s, p=0.008) and a trend of lower IPSS score (SP: 6.67 versus RP 4.14, p=0.06). In a subgroup evaluation of patients with prostate volumes larger than 100g, blood loss was lower in those undergoing SP prostatectomy (p=0.003). Patients with prostates smaller than 100g in the SP group exhibited a higher incidence of low grade late complications (p=0.004). Conclusions: The SP technique was related to a higher incidence of minor complications in the late postoperative period. High volume prostates were associated with increased bleeding when the RP technique was utilized. The RP prostatectomy was associated with higher peak urinary flow and a trend of a lower IPSS Score.

https://doi.org/10.1590/S1677-5538.IBJU.2014.0517 2412 downloads

Laparoscopic Treatment of Vesicovaginal Fistula
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Tobias-Machado, Marcos

; Mattos, Pablo Aloisio Lima

; Castro, Pedro Romanelli de

; Nishimoto, Ricardo Hissashi

; Pompeo, Antonio Carlos Lima

International braz j urol

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jun 2014, Volume 40 N. 3 Pages 435 - 436

Abstract: En | Text: En | PDF: En

Introduction Vesicovaginal fistula is a rare disease with great impact for the patients. Laparoscopic repair can be an interesting option in selected cases with goods results but few experience is reported.Objectives Detailed demonstration of our laparoscopic vesicovaginal fistula repair technique. Initial results for ten patients are provided Methods: We treated all cases by the same technique. The surgical steps were: Patient positioning in Lloyd-Davis; Cystoscopy and implant of guide wire on fistula and ureteral catheters (that was removed after procedure); Transperitoneal access and 4 or 5 ports in V or W shape; Opening the bladder wall; Dissection between bladder and vagina for tension free repair; Fistula resection; Vagina repair with Vicryl 3-0; Bladder repair with Vicryl 3-0; Peritoneum/omentum interposition; Positioning 20 Fr urethral catheter.Results Mean age was 50 years. Mean number of fistulas was 1,2. The most common etiology was gynecologic surgery (7). Mean operative time was 2,5 (1,8-3,2) hours. Mean blood loss was 150 (100-200)mL. Complication rate was 10% (one case of urinary infection treated conservatively). Mean hospital stay was 1,2 (1-2) days. Mean return to normal and activities was 20 (15-30) days. For nine patients mean sexual intercourse time was 3 (1-6) months. Success rate after 1 year was 90% (one case of recurrence in patient with previous radiotherapy). Mean follow-up was 36 (12-60) months.Conclusions Laparoscopic repair is feasible, reproducible and present all advantages of minimally invasive surgical procedure. Long term results are similar to conventional open approaches.

https://doi.org/10.1590/S1677-5538.IBJU.2014.03.23 1337 downloads

Expanded criteria for Video Endoscopic Inguinal Lymphadenectomy (VEIL) in penile cancer: palpable lymph nodes
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Carlos, Alexandre Stievano

; Romanelli, Pedro

; Nishimoto, Ricardo

; Montoya, Luis M.

; Juliano, Cesar Augusto Braz

; Costa Jr, Renato Meirelles M. da

; Pompeo, Antonio C. L.

; Tobias-Machado, Marcos

International braz j urol

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dec 2013, Volume 39 N. 6 Pages 893 - 894

Abstract: En | Text: En | PDF: En

Introduction Open inguinal lymphadenectomy is the gold standard for the treatment of inguinal metastasis in patients with penile cancer (PC). Recently the Video Endoscopic Inguinal Lymphadenectomy (VEIL) was proposed as an option to reduce the morbidity of the procedure in patients without palpable inguinal lymph nodes (PILN), however the oncological equivalency in patients with PILN remains poorly studied. The aims of this video are the demonstration of VEIL in patients with PILN and present the preliminary experience comparing patients with and without PILN. Materials and Methods The video illustrates the procedure performed in two cases that were previously underwent partial penectomy for PC with PILN. Data from the series of 15 patients (22 limbs operated) with PILN underwent VEIL were compared with our series of VEIL in 25 clinically N0 patients (35 limbs operated). Results The comparison between the groups with and without PILN found, respectively, these outcomes: age 52,45 × 53,2 years, operative time 126,8 × 95,5 minutes, hospital stay 5. × 3.1 days, drainage time 6.7 × 5.7 days, 9 resected lymph nodes on average in both groups, global complications 32% × 26%, cellulitis 4.5% × 0%, lymphocele 23% in both groups, skin necrosis 0% × 3%, myocutaneous necrosis 4.5% × 0%, pN+ 33% × 32%, cancer specific mortality 7% × 5% and mean follow-up 17.3 × 35.3 months. None of the variables presented p < 0.05. Conclusions VEIL is a safe complementary procedure for treatment of PC, even in patients with PILN. Oncological results in patients with PILN seem to be appropriate but are still very premature. Prospective multicenter studies with larger samples and long-term follow-up should be conducted to determine the oncological equivalence of VEIL compared with open surgery in patients with PILN.

https://doi.org/10.1590/S1677-5538.IBJU.2013.06.17 1253 downloads

10.

Laparoscopic radical prostatectomy for high risk localized and locally advanced disease
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Tobias-Machado, Marcos

; Starling, Eduardo S.

; Carlos, Alexandre Stievano

; Pompeo, Antonio C. L.

; Romanelli, Pedro

; Nishimoto, Ricardo

International braz j urol

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jun 2012, Volume 38 N. 3 Pages 430 - 431

Abstract: En | Text: En | PDF: En

991 downloads Cited 1 time in SciELO

11.

Seizure-like activity during etomidate-modified Wada test interfere with the evaluation of cognitive functions?
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Kowacs, Pedro André

; Mattei, Tobias Alécio

; Goulart, Carlos Rodrigo

; Rocha, Samantha F. Blattes da

; Ramina, Ricardo

; Simão, Cristiane A.

; Meneses, Murilo Sousa de

Arquivos de Neuro-Psiquiatria

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oct 2011, Volume 69 N. 5 Pages 846 - 847

Abstract: En | Text: En | PDF: En

2892 downloads

12.

Prospective comparative study between retroperitoneoscopic and hand-assisted laparoscopic approach for radical nephrectomy
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Tobias-Machado, Marcos

; Ravizzini, Pedro I.

; Pertusier, Leonardo O.

; Pedroso, Eduardo

; Wroclawski, Eric R.

International braz j urol

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jun 2009, Volume 35 N. 3 Pages 284 - 292

Abstract: En | Text: En | PDF: En

OBJECTIVE: No consensus has yet been established regarding the best minimally invasive access for radical ablation of renal tumors. Our objective was to prospectively compare the surgical results and oncologic management of two currently used endoscopic techniques. MATERIAL AND METHODS: Over a four-year period, 50 patients with renal tumors and clinical stage T1b-T2, smaller than 12 cm, underwent a radical nephrectomy at two reference institutions, 25 underwent retroperitoneoscopic radical nephrectomy (RRN) and 25 a hand-assisted laparoscopic radical nephrectomy (HALRN). Mean follow-up of both cohorts was 50 months. Operative parameters and oncological management were compared. RESULTS: The mean operative time was 180 min in RRN and 108 min in HALRN (p < 0.001). The time required to access the renal pedicle in RRN was 30 min. and in HALRN 40 min., Learning curve was shorter in HALRN than RRN. Mean blood loss was 100 mL in RRN and 242 mL in HALRN. Mean incision size for specimen retrieval in RRN was 6.5 cm and in HALRN 7.5 cm. One patient with intra operative occurrence of ascites and subsequent pathological stage pT2N0M0 grade 3 operated via HALRN, had neoplasic implants in the Hand-port incision 3 months after surgery followed by death 4 months after recurrence. One patient, with pathological stage pT3N0M0 grade 3 in RRN had metastasis after 36 months. CONCLUSION: Both, RRN and HALRN techniques are accepted minimally invasive options for endoscopic radical nephrectomy with equivalent long term oncological outcome in the treatment of renal tumors.

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13.

Video endoscopic inguinal lymphadenectomy (VEIL): Initial case report and comparison with open radical procedure
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Tobias-Machado, Marcos

; Tavares, Alessandro

; Molina Jr., Wilson R.

; Zambon, João Paulo

; Medina, Jimmy Angel

; Forseto Jr, Pedro H.

; Juliano, Roberto V.

; Wroclawski, Eric R.

Archivos Españoles de Urología (Ed. impresa)

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oct 2006, Volume 59 N. 8 Pages 849 - 852

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Objectives: Inguinal metastases are one of the major determinants of mortality in patients with penile cancer. In high risk patients, while prophylatic inguinal lymphadenectomy may offer survival advantages, it still carries a relatively high morbidity. We describe in this paper the first report of the Video Endoscopic Inguinal Lymphadenectomy (VEIL) in the clinical practice, a technique which aims at reducing the morbidity of the procedure without compromising the cancer control or reducing the template of the dissection. Methods: A 40-year old male with a pT2 penile cancer underwent prophylatic bilateral inguinal lymphadenectomy 6 weeks after partial penectomy. We performed the VEIL technique at the right and a standard radical inguinal lymphadenectomy through an inguinal incision at the left (control). After developing a plane deep to Scarpa’s fascia, locating 3 ports and infusing gas at 5-10 mmHg, a retrograde dissection with the same limits as the standard open surgery was performed. Intraoperative data, patology, post operatory evolution and oncological follow-up is described for both sides. Results: Operative time was 130 min for the VEIL and 90 min for open surgery. Eight and 7 lymphnodes were retrieved at the VEIL side and open side, respectively, and none of then showed positivity at pathology. There were no complications in the limb which underwent the VEIL and there was skin necrosis in the side of the open surgery. After 25 months of follow up, no signs of disease progression were noted. Asked about how he felt about both surgeries, the patient chose the endoscopic approach. Conclusions: VEIL is feasible in clinical practice. New studies with a greater number of patients and long-term follow-up may confirm the oncological ef.cacy and possible lower morbidity of these new approach.

Objetivos: Las metástasis inguinales son uno de los factores pronósticos más importantes de mortalidad en pacientes con cáncer de pene. La linfadenectomía inguinal profiláctica puede mejorar la supervivencia en pacientes de alto riesgo, pero conlleva una morbilidad relativamente alta. En este artículo comunicamos por primera vez la linfadenectomía inguinal videoendoscópica en la práctica clínica; la técnica busca reducir la morbilidad del procedimiento sin comprometer el control oncológico ni reducir el área de resección. Métodos: Paciente de 40 años de edad con cáncer de pene estadio pT2 que se somete a linfadenectomía inguinal bilateral profiláctica seis semanas después de una penectomía parcial. Realizamos la técnica de VEIL en el lado derecho y linfadenectomía inguinal radical abierta estándar en el lado izquierdo (control). Después de desarrollar un plano en profundidad hasta la fascia de Escarpa, insertar tres trocares e infundir gas a 5-10 mm Hg, se realiza una disección retrógrada con los mismos límites que en el procedimiento abierto estándar. Se describen los datos intraoperatorios, anatomopatológicos, postoperatorios y de seguimiento oncológico en ambos lados. Resultados: El tiempo operatorio fue de 130 minutos para la VEIL y 90 minutos para la cirugía abierta. Se obtuvieron ocho y siete ganglios respectivamente, siendo todos negativos en el estudio anatomopatológico. No hubo complicaciones en el lado de la VEIL, en el lado abierto se produjo necrosis cutánea. Después de 25 meses de seguimiento no hay signos de progresión de la enfermedad. Preguntado el paciente sobre cómo se sentía con ambas cirugías eligió el abordaje endoscópico. Conclusiones: La linfadenectomía inguinal videoendoscópica es factible en la práctica clínica. Nuevos estudios con mayor número de pacientes y seguimiento a largo plazo pueden confirmar la eficacia y posible menor morbilidad de este nuevo abordaje.

537 downloads Cited 3 times in SciELO

14.

Estudo comparativo entre supra-renalectomia laparoscópica pelos acessos transperitoneal e retroperitoneal
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Tobias-Machado, Marcos

; Lasmar, Marco Túlio Coelho

; Zambon, João Paulo

; Tristão, Rodrigo

; Forseto Jr, Pedro Hermínio

; Juliano, Roberto Vaz

; Wroclawski, Eric Roger

Revista da Associação Médica Brasileira

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aug 2006, Volume 52 N. 4 Pages 208 - 213

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVOS: Não há consenso sobre o melhor acesso minimamente invasivo para a ablação cirúrgica das supra-renais. O objetivo do presente estudo foi comparar prospectivamente os aspectos intra e pós-operatórios dos pacientes submetidos a cirurgia laparoscópica da supra-renal por meio de dois diferentes acessos: transperitoneal e retroperitoneal. MÉTODOS: Entre janeiro de 1994 e outubro de 2003, 40 pacientes (19 homens e 21 mullheres) com lesões adrenais, incluindo cinco casos de síndrome de Cushing, três de síndrome de Conn, dois neurogangliomas, sete feocromocitomas, 17 adenomas não funcionantes, um tumor virilizante e cinco casos de nódulo pós-tratamento de neoplasia primária não adrenal, foram submetidos a supra-renalectomia laparoscópica por dois cirurgiões. O protocolo foi prospectivo e a via de acesso videoendoscópica foi escolhida de acordo com a indicação do cirurgião. Vinte casos foram submetidos à cirurgia laparoscópica transperitoneal e outros 20 por acesso retroperitoneal. Comparamos o tempo cirúrgico, a perda sangüínea, o tempo para realimentação oral plena, o emprego de analgésicos, as complicações cirúrgicas, a taxa de conversão, o período de internação e o período de retorno às atividades habituais. RESULTADOS: Todos os procedimentos foram realizados com sucesso. O tempo cirúrgico médio e o período para realimentação oral médio foram respectivamente 3,6 horas e 24 horas no grupo transperitoneal e 2,5 horas e 12 horas no grupo retroperitoneal (p<0,05). Não houve diferenças significativas entre os dois grupos em relação a sangramento operatório, analgesia, período de internação e tempo para retorno às atividades habituais. No grupo de acesso transperitoneal, ocorreu um caso de hematoma retroperitoneal e outro que evoluiu com pancreatite pós-operatória. Nos pacientes operados pelo acesso retroperitoneal, houve um caso de hipercarbia intra-operatória, um caso de perfuração do peritôneo e um caso que evoluiu com pneumonia no pós-operatório. Em nenhum dos casos houve necessidade de conversão para cirurgia aberta. CONCLUSÃO: Não há diferenças relevantes entre os acessos transperitoneal e retroperitoneal para a abordagem laparoscópica das supra-renais. Nesta série não randomizada, o tempo cirúrgico e o período para realimentação foram menores no grupo retroperitoneal. A escolha do acesso endoscópico depende das peculiaridades de cada caso e da preferência do cirurgião.

OBJECTIVES: A prospective protocol was used to compare transperitoneal and retroperitoneal laparoscopic access for treatment of adrenal lesions. METHODS: Forty patients (19 male and 21 female) were submitted to laparoscopic adrenalectomy. Patients were operated by two surgeons. Twenty cases for each type of access (transperitoneal and retroperitoneal) were selected for analysis. Operative time, blood loss, time to oral intake, dose of analgesic, surgical complications, conversions, hospital stay and return to normal activities were compared for both approaches. RESULTS: All procedures were successfully completed. Operative mean time and time to oral intake were 3.6 h and 24 h for the transperitoneal and 2.5 h and 12 h for the retroperitoneal approach (p<0.05). There were no differences in blood loss, analgesia, hospital stay and time for return to normal activities. Complications were observed in two patients in the transperitoneal approach (retroperitoneal bleeding and pancreatitis) and there were three events in the retroperitoneal approach (hipercarbia, peritoneal laceration and pneumonia). No conversions occurred in this cohort of patients. CONCLUSION: Laparoscopic adrenalectomy is a safe and efficient treatment for an adrenal mass of up to 10 cm. There are no relevant differences between the transperitoneal and retroperitoneal approach. Choice of the laparoscopic approach rests upon particular aspects of each case or upon the surgeon's preference.

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15.

Video endoscopic inguinal lymphadenectomy (VEIL): minimally invasive resection of inguinal lymph nodes
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Tobias-Machado, M.

; Tavares, Alessandro

; Molina Jr, Wilson R.

; Forseto Jr, Pedro H.

; Juliano, Roberto V.

; Wroclawski, Eric R.

International braz j urol

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jun 2006, Volume 32 N. 3 Pages 316 - 321

Abstract: En | Text: En | PDF: En

OBJECTIVES: Describe and illustrate a new minimally invasive approach for the radical resection of inguinal lymph nodes. SURGICAL TECHNIQUE: From the experience acquired in 7 operated cases, the video endoscopic inguinal lymphadenectomy (VEIL) technique was standardized in the following surgical steps: 1) Positioning of the inferior member extended in abduction, 2) Introduction of 3 work ports distal to the femoral triangle, 3) Expansion of the working space with gas, 4) Retrograde separation of the skin flap with a harmonic scalpel, 5) Identification and dissection of the long saphenous vein until the oval fossa, 6) Identification of the femoral artery, 7) Distal ligature of the lymph node block at the femoral triangle vertex, 8) Liberation of the lymph node tissue up to the great vessels above the femoral floor, 9) Distal ligature of the long saphenous vein, 10) Control of the saphenofemoral junction, 11) Final liberation of the surgical specimen and endoscopic view showing that all the tissue of the region was resected, 12) Removal of the surgical specimen through the initial orifice, 13) Vacuum drainage and synthesis of the incisions. COMMENTS: The VEIL technique is feasible and allows the radical removal of inguinal lymph nodes in the same limits of conventional surgery dissection. The main anatomic repairs of open surgery can be identified by the endoscopic view, confirming the complete removal of the lymphatic tissue within the pre-established limits. Preliminary results suggest that this technique can potentially reduce surgical morbidity. Oncologic follow-up is yet premature to demonstrate equivalence on the oncologic point of view.

4421 downloads Cited 5 times in SciELO

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