Dissertations / Theses on the topic 'Miniimally invasive surgical procedures'
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Numburi, Uma D. "3D Imaging for Planning of Minimally Invasive Surgical Procedures." Cleveland State University / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=csu1308704453.
Full textBringman, Sven. "Minimally invasive hernia surgery /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-466-6/.
Full textHussain, Raabid. "Augmented reality based middle and inner ear surgical procedures." Thesis, Bourgogne Franche-Comté, 2020. http://www.theses.fr/2020UBFCI014.
Full textOtologic procedures involve manipulation of small, delicate and complex structures in the temporal bone anatomy which are in close proxmity of critical nerves and blood vessels. Augmented reality (AR) can highly benefit the otological domain by providing supplementary anatomical and navigational information unified on a single display. However, despite being composed of mainly rigid bony structures, the awareness and acceptance of possibilities of AR systems in otology is fairly low. This project aims at developing video-based AR solutions for middle and inner ear surgical procedures.We propose two applications of AR in this regard. In the first application, information about middle ear cleft structures is obtained from a preoperative CT-scan exam and overlayed onto the surgical video of the tympanic membrane. This system provides the surgeon with real-time information about the anatomical target structures and the surgical instrument behind the tympanic membrane without tympanomeatal flap elevation. As an extension of this system, we also propose to visualize the cochlear modiolus in the real-time surgical video of the middle and inner ear cleft enabling transmodiolar implantation of the cochlear implant through the external auditory canal.Both proposed AR systems are designed in a minimally invasive manner and are solely based on vision algorithms eliminating the need for traditional magnetic and optical tracking systems. The first trials showed an easy installation in the operating room environment. This work opens important perspectives into minimally invasive otologic procedures through AR-based solutions
Begg, Nikolai David Michael. "Design and development of a tissue retractor for use in minimally invasive surgical procedures." Thesis, Massachusetts Institute of Technology, 2009. http://hdl.handle.net/1721.1/62998.
Full textCataloged from PDF version of thesis.
Includes bibliographical references (p. 32).
Laparoscopic surgery is a widespread and rapidly growing surgical technique. One of the challenges facing surgeons performing laparoscopic procedures is the retraction of anatomical structures that restrict vision and access to the surgical site. Current solutions to this problem involve opening additional incisions, which causes increased risk and discomfort to the patient. This study proposes a design for a laparoscopic retractor that can be inserted and operated without the need for additional incisions. The anatomical principles relevant to the design are introduced. The inventive problem is investigated and expressed as a problem statement, and the design requirements for the device are listed and explained. The processes of initial concept generation and selection are described, as well as the various stages of design refinement and prototyping performed on the chosen concept. User feedback regarding the alpha prototype of the device is presented. Finally, recommendations are made for future development of the device.
by Nikolai David Michael Begg.
S.B.
Konh, Bardia. "Smart Surgical Needle Actuated by Shape Memory Alloys for Percutaneous Procedures." Diss., Temple University Libraries, 2016. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/375030.
Full textPh.D.
Background: Majority of cancer interventions today are performed percutaneously using needle-based procedures, i.e. through the skin and soft tissue. Needle insertion is known as one of the recent needle-based techniques that is used in several diagnostic and therapeutic medical procedures such as brachytherapy, thermal ablations and breast biopsy. The difficulty in most of these procedures is to attain a precise navigation through tissue reaching target locations. Insufficient accuracy using conventional surgical needles motivated researchers to provide actuation forces to the needle’s body for compensating the possible errors of surgeons/physicians. Therefore, active needles were proposed recently where actuation forces provided by shape memory alloys (SMAs) are utilized to assist the maneuverability and accuracy of surgical needles. This work also aims to introduce a novel needle insertion simulation to predict the deflection of a bevel tip needle inside the tissue. Development of a model to predict the behavior of the needle steering in the soft tissue has been always a point of interest as it could improve the performance of many percutaneous needle-based procedures. Methods: In this work first, the actuation capability of a single SMA wire was studied. The complex response of SMAs was investigated via a MATLAB implementation of the Brinson model and verified via experimental tests. The material characteristics of SMAs were simulated by defining multilinear elastic isothermal stress-strain curves. Rigorous experiments with SMA wires were performed to determine the material properties as well as to show the capability of the code to predict a stabilized SMA transformation behavior with sufficient accuracy. The isothermal stress-strain curves of SMAs were simulated and defined as a material model for the Finite Element Analysis of the active needle. In the second part of this work, a three-dimensional finite element (FE) model of the active steerable needle was developed to demonstrate the feasibility of using SMA wires as actuators to bend the surgical needle. In the FE model, birth and death method of defining boundary conditions, available in ANSYS, was used to achieve the pre-strain condition on SMA wire prior to actuation. This numerical model was validated with needle deflection experiments with developed prototypes of the active needle. The third part of this work describes the design optimization of the active using genetic algorithm aiming for its maximum flexibility. Design parameters influencing the steerability include the needle’s diameter, wire diameter, pre-strain, and its offset from the needle. A simplified model was developed to decrease the computation time in iterative analyses of the optimization algorithm. In the fourth part of this work a design of an active needling system was proposed where actuation forces of SMAs as well as shape memory polymers (SMPs) were incorporated. SMP elements provide two major additional advantages to the design: (i) recovery of the SMP’s plastic deformation by heating the element above its glass transition temperature, and (ii) achieving a higher needle deflection by having a softer stage of SMP at higher temperatures with less amount of actuation force. Finally, in the fifth and last part of this study, an Arbitrary-Lagrangian-Eulerian formulation in LS-DYNA software was used to model the solid-fluid interactions between the needle and tissue. A 150mm long needle was considered to bend within the tissue due to the interacting forces on its asymmetric bevel tip. Some additional assumptions were made to maintain a reasonable computational time, with no need of parallel processing, while having practical accuracies. Three experimental tests of needle steering in a soft phantom were performed to validate the simulation. Results: The finite element model of the active needle was first validated experimentally with developed prototypes. Several design parameters affecting the needle’s deflection such as the needle’s Young’s modulus, the SMA’s pre-strain and its offset from the neutral axis of the cannula were studied using the FE model. Then by the integration of the SMA characteristics with the automated optimization schemes an improved design of the active needle was obtained. Real-time experiments with different prototypes showed that the quickest response and the maximum deflection were achieved by the needle with two sections of actuation compared to a single section of actuation. Also the feasibility of providing actuation forces using both SMAs and SMPs for the surgical needle was demonstrated in this study. The needle insertion simulation was validated while observing less than 10% deviation between the estimated amount of needle deflection by the simulation and by the experiments. Using this model the effect of needle diameter and its bevel tip angle on the final shape of the needle was investigated. Conclusion: The numerical and experimental studies of this work showed that a highly maneuverable active needle can be made using the actuation of multiple SMA wires in series. To maneuver around the anatomical obstacles of the human body and reach the target location, thin sharp needles are recommended as they would create a smaller radius of curvature. The insertion model presented in this work is intended to be used as a base structure for path planning and training purposes for future studies.
Temple University--Theses
Sahlabadi, Mohammad. "A NOVEL BIOINSPIRED DESIGN FOR SURGICAL NEEDLES TO REDUCE TISSUE DAMAGE IN INTERVENTIONAL PROCEDURES." Diss., Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/508489.
Full textPh.D.
The needle-based procedures are usually considered minimally invasive. However, in insertion into soft tissues such as brain and liver, the tissue damage caused by needle insertion can be very significant. From the literature, it has been known that reduction in needle insertion and extraction forces as well as tissue deformation during the insertion results in less invasive procedure. This work aims to design and develop a new bioinspired design for surgical needles which reduce the insertion and extraction forces of the needle, and its damage to the tissue. Barbs in honeybee stinger decrease its insertion force significantly. Inspired by that finding, a new honeybee-inspired needle was designed and developed, and its insertion mechanics was studied. To study the insertion mechanics of honeybee-inspired needle, insertion tests into artificial and biological tissues were performed using both honeybee-inspired and conventional needles. The barb design parameters effects on needle forces were studied through multiple insertion and extraction tests into PVC gels. The design parameters values of the barbs were experimentally modified to further reduce the ultimate insertion and extraction forces of the needle. Bioinspired needle with modified barb design parameters values reduces the insertion force by 35%, and the extraction force by 20%. To show the relevance, the insertion tests into bovine liver and brain tissue were performed. Our results show that there was a 10-25% decrease in the insertion force for insertions into bovine brain, and a 35-45% reduction in the insertion force for insertions into the bovine liver using the proposed bioinspired needles. The bioinspired and conventional needles were manufactured in different scales and then used to study the size scale effect on our results. To do so, the insertion tests into tissue-mimicking PVC gels and liver tissues were performed. The results obtained for different sizes of the needle showed 25-46% decrease in the insertion force. The tissue deformations study was conducted to measure tissue deformation during the insertion using digital image correlation. The tissue deformation results showed 17% decrease in tissue deformation using barbed needles. A histological study was performed to accurately measure the damage caused by needle insertion. Our results showed 33% less tissue damage using bioinspired needles. The results of the histological study are in agreement with our hypothesis that reducing needle forces and tissue deformation lead to less invasive percutaneous procedures.
Temple University--Theses
Cuming, Richard G. "Factors Surgical Team Members Perceive Influence Choices of Wearing or not Wearing Personal Protective Equipment During Operative/Invasive Procedures." FIU Digital Commons, 2009. http://digitalcommons.fiu.edu/etd/111.
Full textNüssler, Emil Karl. "Surgical quality control of minimally invasive procedures, fast-track surgery and implant technology in gynaecological surgery in Sweden." Licentiate thesis, Umeå universitet, Obstetrik och gynekologi, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-157812.
Full textFastrez, Maxime. "Minimal-invasive management of deep infiltrating endometriosis: diagnosis and treatment." Doctoral thesis, Universite Libre de Bruxelles, 2018. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/271669.
Full textDoctorat en Sciences médicales (Médecine)
info:eu-repo/semantics/nonPublished
Martin, Aaron. "THE ROLE OF PAIN-RELATED CATASTROPHIZING IN OUTCOMES AND RECOVERY FROM MINIMALLY INVASIVE AND SURGICAL PROCEDURES FOR TREATING TEMPOROMANDIBULAR DISORDERS." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/3203.
Full textBrown, Jeffrey Dale. "In-vivo and postmortem biomechanics of abdominal organs under compressive loads : experimental approach in a laparoscopic surgery setup /." Thesis, Connect to this title online; UW restricted, 2003. http://hdl.handle.net/1773/8005.
Full textChen, Gang Redarce Tanneguy. "Design, modeling and control of a micro-robotic tip for colonoscopy." Villeurbanne : Doc'INSA, 2006. http://docinsa.insa-lyon.fr/these/pont.php?id=chen.
Full textBeyer, Stefanie, Bueren André O. von, Gunther Klautke, Matthias Guckenberger, Rolf-Dieter Kortmann, Sophie Pietschmann, and Klaus Müller. "A systematic review on the characteristics, treatments and outcomes of the patients with primary spinal glioblastomas or gliosarcomas reported in literature until March 2015." Universitätsbibliothek Leipzig, 2016. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-204105.
Full textMaazouz, Yassine. "A study of the rheological properties and injectability of calcium phosphate cements : application to minimally invasive surgical procedures and scaffold fabrication for tissue engineering through rapid prototyping." Doctoral thesis, Universitat Politècnica de Catalunya, 2018. http://hdl.handle.net/10803/663757.
Full textEl presente trabajo contempla dos aplicaciones permitidas por una propiedad específica y útil de los cementos de fosfato de calcio (CPCs): la inyectabilidad. Por un lado, los procedimientos quirúrgicos mínimamente invasivos que implican el uso de los cementos de fosfatos de calcio se basan en su inyectabilidad y por otro los procesos de fabricación aditiva basados en la microextrusión como por ejemplo el robocasting se fundamentan en esta propiedad para fabricar andamios impresos en 3D para el tratamiento de defectos óseos grandes. Esta tesis se divide en tres secciones diferentes. La primera consiste en un estudio de las diferencias en la inyectabilidad de pastas cuyas fases solidas esta compuestas por dos formas alotrópicas del fosfato tricálcico (TCP), respectivamente a- y ß-TCP. La reactividad de los polvos ha sido identificada como teniendo un rol significativo en la inyectabilidad de pastas de TCP. Las diferencias fueron más marcadas a una relación liquido-polvo baja, usando polvos finos e inyectando las pastas por cánulas finas. Sin embargo, como tendencia general, las pastas de fraguado más rápido fueron las menos inyectables, algunas excepciones a esta regla fueron encontradas. Por ejemplo, en ausencia de acelerante del fraguado las pastas de polvos finos de TCP fueron más inyectables que las de polvos gruesos a pesar de sus tiempos de fraguado más corto, esta tendencia fue invertida cuando se empleó soluciones de acelerante y los polvos gruesos resultaron más inyectables que los finos. En la segunda sección de esta tesis, cementos termosensibles fueron desarrollados mediante la combinación de CPCs con un hídrogel termosensible. Aunque los CPCs se usen para la regeneración ósea en una variedad importante de indicaciones clínicas, varios fenómenos fisicoquímicos pueden comprometer su uso para procedimientos quirúrgicos mínimamente invasivos o en sitios quirúrgicos altamente vascularizados, principalmente debido a su falta de inyectabilidad o su baja resistencia cohesiva al lavado por líquidos. La estrategia propuesta ha permitido ajustar la cohesión y las propiedades reológicas del cemento alcanzando una inyectabilidad clínicamente aceptable. Permitió evitar la separación de fases durante la inyección y mejoró la cohesión, evitando el lavado y desintegración de la pasta. Usando el conocimiento adquirido sobre la inyectabilidad de pastas de TCP, se estudió la fabricación aditiva de andamios mediante impresión 3D. Más precisamente, este estudio trató con la fabricación por robocasting empleando una mezcla reactiva de gelatina/a-TCP como tinta bioinspirada de andamios de hidroxiapatita/gelatina con una composición biocinética. Se obtuvo una red de poros totalmente interconectados de unos 300 µm, con los hilos compuestos de una matriz micro/nanoporosa de cristales aciculares de hidroxiapatita deficiente en calcio presentando una elevada superficie especifica. La gelatina fue correctamente retenida gracias a un procedimiento de entrecruzado químico. La reacción de fraguado de la tinta resultó en un aumento significativo del módulo elástico y de la resistencia a compresión, que se situó en el rango de la del hueso trabecular humano. Adicionalmente al retraso en el comienzo de la reacción de fraguado, permitiendo mientras la impresión de la tinta, la gelatina confirió propiedades viscoelasticas a los hilos extruidos para soportar su propio peso, y adicionalmente mejoró la adhesión y proliferación de células mesénquimales sobre el andamio. En su conjunto este trabajo abre perspectivas nuevas para el diseño de andamios de hidroxiapatita para ingeniería de tejido óseo con reactividad y reabsorción mejoradas.
Yrjänä, S. (Sanna). "Implementation of 0.23 T magnetic resonance scanner to perioperative imaging in neurosurgery." Doctoral thesis, University of Oulu, 2005. http://urn.fi/urn:isbn:9514279271.
Full textPimentel, Marcelo. "Influência da experiência prévia em laparoscopiaavançada nas habilidades básicas em cirurgia robótica avaliadas pelo simulador virtual de cirurgia dV-Trainer." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2017. http://hdl.handle.net/10183/172101.
Full textObjective: The actual impact of laparoscopic experience on robotic skills is uncertain. This study aimed to compare basic robotic surgical skills using the virtual reality simulator dVTrainer ® between laparoscopically experienced surgeons and first-year surgical residents. Methods: Twenty laparoscopically experienced surgeons (group 1) and 20 first-year surgical residents (group 2) were included. Each participant completed four trials of the following tasks on the dV-Trainer®: Peg Board 2, Ring and Rail 1 and Suture Sponge 1. Performance was recorded using a computerized built-in scoring algorithm. Scores and metrics were compared between groups 1 and 2 and between the 1st and subsequent trials Results: The overall scores for Peg Board 2 (738.04 ± 267.83 vs 730.39 ± 225.31, p = 0.57), Ring and Rail 1 (919.03 ± 242.69 vs 965.84 ± 222.96, p = 0.13) and Suture Sponge 1 (563.62 ± 185.50 vs 560.99 ± 152.71, p = 0.67) did not differ significantly between groups 1 and 2. Group 1 had better results for master workspace range in Peg Board 2 and Ring and Rail 1. Group 2 had higher scores for economy of motion in Peg Board 2 and Ring and Rail 1 and for excessive instrument force in Ring and Rail 1. In both groups, the overall scores in the 3rd or 4th trials were significantly higher than those in the 1st trial. Conclusions: There is no significant difference in basic robotic surgical skills between laparoscopically experienced surgeons and laparoscopically naïve surgical residents. Some slight differences were observed in specific metrics, but these differences were not sufficient to change the final results. We may assume that laparoscopic experience should not be an essential step in the learning curve of robotic surgery.
Hammer, Niels, Juliane Glätzner, Christine Feja, Christian Kühne, Jürgen Meixensbeger, Uwe Planitzer, Stefan Schleifenbaum, Bernhard N. Tillmann, and Dirk Winkler. "Human vagus nerve branching in the cervical region." Universitätsbibliothek Leipzig, 2015. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-161409.
Full textDorow, Marie, Margrit Löbner, Janine Stein, Alexander Pabst, Alexander Konnopka, Hans J. Meisel, Lutz Günther, Jürgen Meixensberger, Katarina Stengler, and Steffi G. Riedel-Heller. "The course of pain intensity in patients undergoing herniated disc surgery." Universitätsbibliothek Leipzig, 2016. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-206139.
Full textChevrie, Jason. "Flexible needle steering using ultrasound visual servoing." Thesis, Rennes 1, 2017. http://www.theses.fr/2017REN1S098/document.
Full textThe robotic guidance of a needle has been the subject of a lot of research works these past years to provide an assistance to clinicians during medical needle insertion procedures. However, the accurate and robust control of a needle insertion robotic system remains a great challenge due to the complex interaction between a flexible needle and soft tissues as well as the difficulty to localize the needle in medical images. In this thesis we focus on the ultrasound-guided robotic control of the trajectory of a flexible needle with a beveled-tip. We propose a 3D model of the interaction between the needle and the tissues as well as a needle tracking method in a sequence of 3D ultrasound volumes that uses the artifacts appearing around the needle. Both are combined in order to obtain good performances for the tracking and the modeling of the needle even when motions of the tissues can be observed. We also develop a control framework based on visual servoing which can be adapted to the steering of several kinds of needle-shaped tools. This framework allows an accurate placement of the needle tip and the compensation of the physiological motions of the patient. Experimental results are provided and demonstrate the performances of the different methods that we propose
Tormena, Renata Assef. "Histerectomia laparoscópica: estudo comparativo entre laparoscopia com múltiplas punções e punção única umbilical." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-04112016-114650/.
Full textHysterectomy is one of the most common surgical procedures in gynecology. Minimally invasive techniques bring benefits to patients and including early return to normal activities. This study included 42 women candidates to hysterectomy at the Gynecological Clinic Division of Clinics Hospital of São Paulo University Medical School. The patients were randomized in two groups: HLM (21 patients underwent to total laparoscopic hysterectomy with three abdominal incisions) and HLU (21 patients underwent to total laparoscopic hysterectomy with single umbilical incision). The surgical time, blood loss (pre and postoperative hemoglobin variation and total blood volume aspirated during the surgery), complications rate, acute inflammatory response (C-reactive protein, interleukin-6, interleukin-10, tumor necrosis factor alpha, vascular endothelium growth factor and leucogram), postoperative pain (Visual Analogical Pain Score) and patient satisfaction (Short Form 36 Health Survey) were analyzed. The operative time was significantly larger in the umbilical single incision hysterectomy group compared to the multiple incisions group (p = 0,001). Blood loss was similar in both groups. There were no major immediate complications; however, one hysterectomy started with single incision needed two additional trocars to remove extensive pelvic adhesions. In terms of inflammatory response, both groups were similar in terms of IL-6 (p = 0,833), IL- 10 (p = 0,420), TNF alfa (p = 0,098), VEGF (p =0,092) and leucogram (p = 0,712) measures. Although the C-reactive protein behavior was different between the groups, their average values showed no statistically significant difference in any evaluated moment (p = 0,666). Pain evaluation was similar in both groups. Twelve months after surgery we observed the presence of umbilical hernia in three patients submitted to single-port hysterectomy, with no significant difference compared to multiport hysterectomy (p = 0,098). There was improvement in quality of life, according assessment before and after surgery in both groups. Conclusions: Singleport laparoscopic hysterectomy did have significantly larger operative time than multiport laparoscopic hysterectomy; however, no difference was observed between the groups in terms of operative bleeding, inflammatory response, postoperative pain and quality of life. Both techniques for laparoscopic hysterectomy were feasible and safe. Single-port hysterectomy presented technical limitations in patients with large uterus or extensive pelvic adhesions
Vicente, José Ricardo Negreiros. "Estudo comparativo entre a via de acesso minimamente invasiva posterior e a via de acesso lateral direta nas artroplastias totais do quadril não cimentadas." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5140/tde-13022008-080950/.
Full textA therapeutic, comparative, prospective study was carried out to evaluate the minimally invasive posterior approach to total hip arthroplasty in relation to the traditional direct lateral approach. The study included 76 cases of primary total hip arthroplasty due to a diagnosis of primary or secondary osteoarthrosis. Patients were excluded from the study if they presented any type of coagulopathy and were using anticoagulants or platelet antiagregants; hypertension without medicinal control; any previous hip surgery; and sequelae of hip developmental dysplasia that might have led to an ectopic femoral head. The objective of our study was to evaluate the blood loss among patients for whom the minimally invasive posterior access is used. Regarding our patients\' ages, we observed a significant difference between the two groups: the mean age of the mini-incision group (50,1 years) was lower than the mean of the control group (56,8 years), p= 0.01. Lower total estimated bleeding was found in the mini-incision group (means of 1083,5 ml versus 1682,3 ml; p < 0.001) and lower intraoperative bleeding (means of 745,6 ml versus 1282,8 ml; p <0.001). There was difference in the need of allogenic transfusion between the two groups (8,8% versus 28,6%,p = 0.13). Our volumes of bleeding from the minimally invasive posterior approach were significantly higher than in the literature, but the mean quantity of transfused red cells and the proportion of transfused patients were both significantly lower than in the literature. Our final impression of the minimally invasive approach is positive with regard to lower blood loss, better clinical results after six months and a satisfactory alignment of the acetabular and femoral components.
Kaleff, Paulo Roland 1976. "Utilização de tecnica de incisão transversa minima no tratamento da sindrome do tunel do carpo." [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308844.
Full textDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Propósito:Avaliação de técnica de incisão transversa limitada no tratamento da síndrome do túnel do carpo, quanto à segurança cirúrgica e efetividade na abertura do Retináculo Flexor(RF). Método: Estudo prospectivo de Trinta procedimentos realizados em vinte e oito pacientes submetidos à técnica com incisão transversa mínima. A segurança da técnica e a abertura total do RF foram avaliadas através de questionário baseado em observações clinicas e inspeção endoscópica, respectivamente. Resultados: Não foram observadas complicações maiores. Um único paciente apresentou neuropraxia de N. interdigital. Dois pacientes apresentaram hematoma local pequeno. Em dois dos cinco primeiros casos, durante a inspeção endoscópica, observou-se abertura incompleta do RF, sendo necessária abertura complementar. Todos os pacientes apresentaram melhora do quadro clínico de dor noturna e parestesias. Conclusão: A técnica foi executada com segurança no grupo analisado, sem a ocorrência de complicações graves, e com abertura do RF na quase totalidade dos casos. Uma avaliação de longo prazo e com um número maior de pacientes é necessária.
Abstract: Purpose: To evaluate the application of a limited transverse incision technique to treat the Carpal tunnel syndrome, with concern to its safety and efficacy in the opening of the Flexor Retinaculum (FR). Method: A prospective analysis of thirty FR release procedures performed on twenty-eight patients subjected to the proposed incision technique. Safety and total opening of the FR were evaluated through a questionnaire and an endoscopic inspection respectively. Results: No major complications were observed. Two cases presented small local hematoma. One patient presented with transient neuropraxia of digital branch. In two of the first five cases, incomplete FR opening was identified during endoscopic revision with need of complementary opening. All patients showed symptom relief. Conclusion: The technique was safely performed on the prospection group, no major complications were detected and the opening of FR was observed in the majority of the patients. Long term results and with a larger series of patients should be evaluated in further studies.
Mestrado
Neurologia
Mestre em Ciências Médicas
Sawaia, Rogerio Naim 1970. "Estudo das complicações no tratamento das fraturas transtrocanterianas do fêmur utilizando pino deslizante extramedular com técnica minimamente invasiva, Sistema Minus." [s.n.], 2011. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309913.
Full textTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: INTRODUÇÃO: O tratamento cirúrgico das fraturas intertrocanterianas do fêmur ainda é motivo de estudo e controvérsias. As vantagens da utilização de técnicas minimamente invasivas para essas fraturas já despontam na literatura. O objetivo deste estudo foi avaliar as complicações da técnica minimamente invasiva que utiliza um implante e um instrumental desenvolvidos especificamente (Sistema Minus) para o tratamento dessas fraturas. CASUÍSTICA E MÉTODO: Foram estudados 172 pacientes com fratura intertrocanteriana do fêmur, tratados com o Sistema Minus, dos quais 52 pacientes foram excluídos do estudo por não terem preenchido os critérios de inclusão. No protocolo inicial foram registrados o gênero, a idade, detalhes operatórios como tempo cirúrgico, tempo de uso da fluoroscopia, qualidade da redução e da fixação da fratura. Como parâmetros clínicos foram incluídos a capacidade de marcha, dor, classificação da fratura segundo os critérios de Tronzo e o risco anestésico segundo a classificação de ASA. Dividimos as complicações em dois grupos. As complicações gerais, subdivididas em infecção e mortalidade e as complicações específicas, subdivididas em migração do implante, a perda da redução e a falta de união. Embora a migração do pino deslizante não seja considerada na literatura como uma complicação do DHS (Hrubna e Skotak, 2010)1, no presente estudo ela foi incluída. Cabendo salientar que foi considerada como migração, a impacção lateral da fratura sem a ocorrência de perda de redução. RESULTADOS: O gênero feminino ocorreu em 93 casos e obteve percentual de 77,5%, foi prevalente em relação ao masculino com 27 casos e 22,5%. A idade variou de 52 a 95 anos, com a média de 80,06 anos e desvio padrão de 7,87 anos. A média de idade do gênero masculino foi de 76,19 anos e desvio padrão de 8,321. O gênero feminino obteve a média de 81,18 anos com desvio padrão de 7,407. O tempo cirúrgico médio foi de 39,35 minutos, variando de 25 a 65 minutos. O tempo médio de radioscopia foi 1min7s, variando de 0,6 a 2 minutos e 3s. A redução foi considerada adequada em 92 casos (76,6%), quando obteve-se o alinhamento do eixo de carga, como valgo em 20 casos (16,6%) e como varo em oito casos (6,6%). O somatório médio do TAD (Tip Apex Distance) na incidência Ântero-posterior (AP) foi de 1,19cm, variando de 0,2 a 2,8cm; e no Perfil (P), de 1,14cm, variando de 0,3 a 2,52cm. Dos pacientes, 112 (93,3%) voltaram a andar e a dor pós-operatória em uma escala de 0 a 10, teve a média de 4,44. Dos 120 pacientes, 11 foram classificados como Tronzo I (9,1%), 24 como Tronzo II (20%), 58 como Tronzo III (48,3%), sete Tronzo III variante (5,8%) e 20 Tronzo IV (16,7%). As fraturas instáveis ocorreram em 85 (70,8%) pacientes, os quais 74 (61,6%) tinham idade superior a 75 anos. Já as fraturas estáveis em 35 (29,1%) pacientes, os quais 17 (14,1%) possuíam idade superior a 75 anos. Em relação ao risco anestésico, oito (6,6%) foram classificados como ASA I, 33 (27,5%) ASA II, 74 (61,6%) ASA III e cinco ASA IV (4,16%). Houve um caso de infecção (0,83%). Ocorreram 13 óbitos (10,8%) dentro do primeiro ano de pós-operatório. Desses, um (0,83%) foi classificado como Asa II, cinco (4,16%) como Asa III e sete (5,83%) Asa IV. Dos 85 pacientes com fraturas instáveis, 36 (30%) apresentaram complicações, como perda de redução em 7(5,88%) e migração do pino deslizante em 29 (24,1%). No grupo das 35 fraturas estáveis, as complicações ocorreram em 4 casos (3,33 %), sendo que a perda de redução ocorreu em um caso (0,83%) e a migração em 3 casos (2,5%). No total, a migração ocorreu em 33 casos (27,6%), sendo que desses, todos evoluíram para consolidação. A perda de redução ocorreu em oito (6,7%) e a falta de união, em um caso (0,83%). CONCLUSÃO: Concluímos que a técnica minimamente invasiva, Sistema Minus, é uma técnica segura, que permite a realização da cirurgia com baixa incidência de complicações, quando comparada aos demais métodos existentes
Abstract: INTRODUCTION: The surgical treatment of intertrochanteric fractures is still controversial, resulting in further studies. Many papers have appeared in reference to the advantages of minimal invasive procedures for these fractures. The aim of this study was to evaluate the complications of a minimal invasive procedure using a specific implant and instruments developed for the treatment of intertrochanteric fractures (Minus System). MATERIAL AND METHOD: One hundred and seventy two patients with intertrochanteric fractures of the femur were studied, and submitted to treatment with the Minus System. Fifty two patients were excluded from the study as they did not fulfil all criteria for inclusion. The initial protocol registered gender, age, operative details such as length of operation, length of fluoroscopy use, quality of reduction and fixation of the fracture. The clinical parameters considered included deambulatory ability, pain, Tronzo fracture classification and anesthesia risk according to ASA classification. Complications were divided into two groups: general complications (infection and mortality rate) and specific complications (implant migration, loss of reduction and non-union). Although the migration of a sliding nail has not been considered in the literature as a DHS complication (Hrubna e Skotak, 2010)1 RESULTS: There were 93 feminine cases (77.5%) prevailing on 27 masculine cases (22.5%). Age span was 52 to 95 years, with an average of 80.06 years (standard deviation of 7.87 years). The average age for men was 76.19 years with a standard deviation of 8.321. The average age for women was 81.18 years with a standard deviation of 7.407. The average operative length of time was 39.35 minutes (25 to 65 minutes). The average time of fluoroscopy was 1min 7sec (0.6 to 2min 3sec). Fracture reduction was considered adequate in 92 cases (76.6%), , in the present study it was taken into account. It is important to mention that migration here is the lateral impaction of the fracture without loss of reduction. when alignment with weight-bearing axis was obtained, valgus in 20 cases (16.6%) and varus in eight cases (6.6%). The average Tip Apex Distance (TAD) on an anteroposterior view was 1.19cm (variation of 0.2 to 2.52 cm) and lateral view was 1.14cm (variaton of 0.3 to 2.52cm). One hundred and twelve patients (93,3%) were able to walk with postoperative pain (average of 4.4 on a pain scale of 0 to 10). The classification of the 120 patients is as follows: 11 patients with Tronzo I (9,1%), 24 cases of Tronzo II (20%), 58 Tronzo III (48.3%), seven Tronzo III variant (5.8%) and 20 Tronzo IV (16.7%). Unstable fractures occured in 85 (70.8%) patients, and 74 (61.6%) were over 75 years of age. There were 35 stable fractures (29.1%), with 17 patients (14.1%) over 75 years of age. As to the anesthesia risk eight (6.6%) were classified as ASA I, 33 (27.5%) ASA II, 74 (61.6%) ASA III and five patients as ASA IV (4.16%). There was one case of infection (0.83%). During the first postoperative year there were 13 deaths (10.8%). Of these, one patient (0.83%) had been classified as ASA II, five (4.16%) as ASA III and seven (5.83%) as ASA IV. There were 36 patients (30%) with complications out of 85 patients with unstable fractures, with loss of reduction in seven (5.88%) and migration of the sliding nail in 29 (24.1%). In the group of 35 stable fractures there were complications in four cases (3.3 %), with loss of reduction in one case (0.83%) and migration in three (2.5%). The total number of migrations was 33 (27.5%), but resulted in union in all patients. The loss in reduction occurred in eight patients (6.7%) and non-union in one case (0.83%). CONCLUSION: The minimal invasive procedure, the Minus System, is a safe procedure, that provides adequate surgery with a low incidence of complications, when compared to other existing techniques
Doutorado
Fisiopatologia Cirúrgica
Doutor em Ciências
Cerqueira, Michael Antunes 1980. "Avaliação do impacto da crioablação focal versus vigilância ativa versus braquiterapia no tratamento do câncer de próstata de muito baixo risco." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312797.
Full textDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: O diagnóstico do câncer de próstata, assim como seu tratamento, traz impactos variados na vida de seu portador. Enquanto o impacto negativo nas funções sexual e miccional é mais evidente e valorizado, os aspectos emocionais e que envolvem qualidade de vida recebem menor atenção. Já o estresse psicológico pode trazer tanto impactos negativos na recuperação, como também risco de suicídio e de morte por doenças cardiovasculares, especialmente logo após diagnóstico. Neste contexto, avaliamos e confrontamos de forma abrangente o impacto de terapias minimamente invasivas nos pacientes com câncer de próstata de muito baixo risco: vigilância ativa versus braquiterapia versus crioablação focal através das seguintes ferramentas validadas: IIEF-5 (função erétil), IPSS (função miccional), escalas de Beck - BAI (ansiedade) - BHS (desesperança) - BDI (depressão), SF-36 (qualidade de vida) e termômetros emocionais. Houve uma diferença significativa entre os grupos, considerando as variáveis estudadas, sendo que pacientes submetidos a seguimento vigilante tendem a ser mais velhos e apresentar maior escore BHS (escala de Beck de desesperança) e menor escore SF-36 referente ao estado geral de saúde; enquanto pacientes submetidos a braquiterapia tendem a apresentar maior escore de IPSS. A crioablação focal de próstata se apresentou como uma boa alternativa de tratamento por apresentar menos sintomas irritativos miccionais, quando comparado à braquiterapia, por oferecer uma forma de tratamento ao câncer de próstata com melhores escores relacionados à desesperança (BHS) e estado geral de saúde (SF-36), quando comparada à vigilância ativa, e por manter a qualidade de vida destes pacientes
Abstract: The diagnosis of prostate cancer as well as its treatment bring different impacts on the life of its bearer. While the negative impact on sexual and voiding functions are more evident and valued, and emotional aspects that involve quality of life receive less attention. Psychological stress can have negative impacts on recovery as well as risk of suicide and death from cardiovascular diseases, especially right after diagnosis. In this context, we assess comprehensively the impact of minimally invasive therapies: active surveillance versus brachytherapy versus focal cryoablation in the treatment for very low risk prostate cancer, using the following validated tools: IIEF - 5 (erectile function), IPSS (bladder function), scales Beck ¿ BAI (anxiety) - BHS (hopelessness) - BDI (depression), SF -36 (quality of life) and emotional thermometers. There was a significant difference between the groups considering the variables studied, and patients undergoing active surveillance tend to be older and have higher scores BHS (Beck Hopelessness Scale) and lower SF-36 score for the general health, while patients undergoing brachytherapy tend to have higher IPSS score . Focal prostate cryoablation is presented as a good alternative treatment because presents less urinary irritative symptoms when compared to brachytherapy and offer a way of treating prostate cancer with best scores related to hopelessness (BHS) and general health (SF-36) compared to active surveillance, maintaining the quality of life of these patients
Mestrado
Fisiopatologia Médica
Mestre em Ciências
Brigido, Maurício Mandel. "Emprego de técnicas de neurocirurgia minimamente invasiva para o tratamento de aneurismas incidentais de circulação anterior." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5138/tde-09052018-093931/.
Full textIntroduction: Minimally invasive neurosurgery is already a reality in many centers across the world. The application of old concepts with the incorporation of new technologies allows the use of less invasive measures with the same effectiveness and safety. However, the real role of these techniques and their effect on the outcome of patients is still obscure. Objectives: To evaluate the safety and results of minimally invasive techniques in brain aneurysm clipping and determine the possibility of early hospital discharge. Methods: 111 adult patients with unruptured anterior circulation aneurysms were randomized and underwent a minimally invasive surgical approach, (36 by transpalpebral approach and 34 through a reduced minipterional craniotomy) or classical pterional approach (41 patients). The endoscope coupled to a smart phone was used along with the microscope during surgery (study group only). Patients in the study group were subjected to a specific protocol for assessment of early hospital discharge. Surgical, clinical/functional and aesthetic outcomes were evaluated along with long term quality of life. Results: In both groups, the demographics and characteristics of aneurysms were similar. The average time of surgery was lower in the study group (214 min. vs. 292 min, p = 0.0008). The need for blood transfusion was lower in the study group (1 patient vs 7 patients, p = 0.018). The number of ischemic events was lower in the study group (patients 4 patients vs. 8, p = 0.07), but events with clinical significance were similar (3 patients vs. 2 patients, p = 0.53). The presence of residual neck on control angiography was lower in the study group (6 patients vs 11, p = 0.021), but only small ones were found, 1.75 ± 0.68 mm, and only one control group patient required reoperation for this reason. The paralysis of the frontal branch of the facial nerve was lower in the study group, both temporary (3 vs 14, p = 0.008) and definitive (0 vs. 4, p = 0.032). The atrophy of the temporal muscle was less frequent and less severe in the study group (9 vs 14, p = 0.012). Most patients in the study group (91.4%), were discharged on the next day of the surgery and no patients had any related adverse events. Patients in the study group got asymptomatic faster (assessed by the Rankin scale, p = 0.26), but there was no difference between the groups among scores above 1 on the modified Rankin scale. One control group patient died postoperatively (0,9%). Conclusions: The results showed that the proposed minimally invasive alternatives are safe. Clinical and surgical results are equal or superior to conventional treatment in several topics. Early discharge in these patients is possible and safe. The described approaches (nanopterional or transpalpebral) are better alternatives to the classical pterional craniotomy to treat unruptured aneurysms of the anterior circulation
Quinto, Denise. "O uso de Dexmedetomidina pode diminuir a dor pós-operatória em pacientes submetidos a prostatectomia radical robótica?" Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5153/tde-12012015-143748/.
Full textIntroduction: Minimally invasive techniques are spreading in high incidence diseases like prostate cancer. Patients undergoing minimally invasive procedures seem to have a better pain control but many still require opioid analgesia that can induce undesirable side effects. The use of adjuvant agents as DEX intraoperatively can be desirable for their analgesic and opioid sparing effect. Purpose: Evaluate the impact of DEX use in patients undergoing robotic radical prostatectomy. Methods: The present retrospective study included 100 patients who underwent robotic-assisted laparoscopic prostatectomy. Forty-eight patients did not receive DEX was the control group and fifty-two received DEX infusion at a rate of 0,3-0,7mcg/kg/h and discontinued 30 minutes before the end of the procedure. Patients received opioid and non-opioid analgesia under prescription and anesthesiologist discretion. Opioid and non-opioid analgesia consumption and pain scores (measured by opioid and non-opioid analgesia consumption) were collected on postoperative period, immediate postoperative period and first postoperative period. Results: Our results demonstrated that compared with the groups(28,1%, 38,5%,25% e 15,4% had more than 5mg of morphine on postoperative care unit), patients that received DEX intraoperatively, required higher doses of morphine on postoperative care unit.The DEX group presented more patients with severe pain (84,6%) and fewer without pain(15,4%).The use of DEX intraoperatively lead to a reduction of non-opioid use in postanesthesia care unit and neither patients had non opioid analgesia , when morphine is associated to DEX 2,8% received, and with the other two groups 12,5% (p=0,083). The DEX and morphine received less morphine than the other groups on postanesthesia care unit (59% received any morphine)(p=0,135).On immediate postoperative period and first postoperative period , 100% received any morphine(p=0,555), this group had more patients with lesser pain, 48,7% had no pain on postanesthesia care unit e 51,3% on immediate postoperative period. The combination of DEX and morphine lead to an impressive reduction of pain on immediate postoperative period(10,3%),patients had about 8 times less severe pain than the group that did not receive neither morphine or DEX(81,3%)(p=0,000).Conclusion: The use of DEX infusion was not suitable regarding morphine spare and reduction of pain of the patients undergoing robotic-assisted radical prostatectomy. An association between DEX and Morphine seems to be the best option to relieve post-op pain and decrease morphine usage
Deus, Kleber Gontijo de. "Estudo randomizado de dois tipos de incisão para safenectomia em pacientes submetidos a revascularização miocárdica." Universidade Federal de Uberlândia, 2015. https://repositorio.ufu.br/handle/123456789/12848.
Full textObjetivo: Comparar a evolução quanto às complicações de dois tipos de incisão (convencional X miniincisão) para safenectomia em pacientes que se submeteram à cirurgia de Revascularização do Miocárdio. Métodos: No período de janeiro de 2012 a agosto de 2013, 66 pacientes foram selecionados, prospectivamente, para cirurgia de revascularização do miocárdio com circulação extracorpórea. Estes foram distribuídos em dois grupos: Convencional e Miniincisão, com 33 pacientes em cada grupo de forma randomizada e conhecimento da técnica apenas no início da cirurgia. No grupo Convencional, os pacientes receberam uma incisão no membro inferior de 7 a 10 centímetros. Os pacientes do grupo Miniincisão receberam uma incisão no membro inferior de 3 a 4 centímetros, ambos sem o uso de material especial para a colheita da veia safena. Resultados: Os grupos eram semelhantes quanto aos dados clínicos de pré-operatório. Houve predominância do sexo masculino, 63,7% e 81,9% nos grupos C e M respectivamente. Dentre as complicações do sítio cirúrgico analisadas, o edema (p = 0,011), hematoma (p = 0,020), deiscência (p = 0,012) e infecção (p = 0,012), foram significativamente maiores no grupo C comparado com o grupo M. Quando tratamos a variável infecção em relação ao Índice de Risco para Infecção Cirúrgica (IRIC), não houve diferença significante entre os grupos. Conclusão: A cirurgia de revascularização do miocárdio com miniincisão para safenectomia demonstrou um menor índice de complicações pós-operatórias como edema, hematoma, deiscência e infecção quando comparado com a safenectomia com incisão convencional.
Mestre em Ciências da Saúde
Lemos, Gustavo Caserta. ""Fatores de risco no tratamento do cálculo coraliforme por nefrolitotomia percutânea"." Universidade de São Paulo, 2003. http://www.teses.usp.br/teses/disponiveis/5/5153/tde-04102005-140034/.
Full textDuring a percutaneous nephrolithotomy (PNL) procedure there are cases with no difficulties and no complications. In the other hand, there are cases very hard to treat with a higher surgical risk and post-operative complications.The goal of this study is to analyze the pre, intra and postoperative risk factors related to surgical complications and nonsuccess rates of PNL as treatment for staghorn stone. Fifty-seven patients with seventy-two staghorn calculi were studied. There have been significant statistical correlation between complications and: postoperative urinary tract infections and the number of renal access required. When considering nonsuccess rate, there was association with the following risk factors: postoperative urinary tract infections and absence of dilatation of collecting system
Dejan, Ilinčić. "Procena endoskopske minimalno invazivne tireoidektomije u nodoznim oboljenjima štitaste žlezde." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2016. http://www.cris.uns.ac.rs/record.jsf?recordId=101347&source=NDLTD&language=en.
Full textINTRODUCTION: Surgical treatment of nodular thyroid disease is one of the most commonly performed procedures in endocrine surgery. In addition to traditional surgical methods, different techniques of minimally invasive thyreoid surgery have been developed. Clinical indications for the surgical treatment of nodular thyroid disease with minimally invasive video-assisted surgical technique are still insufficiently defined. The aim of the study was to estimate the incidence of complications (intraoperative and postoperative bleeding, paresis and paralysis of the laryngeal nerve, hypoparathyroidism) during and after minimally invasive thyroidectomy in benign nodular thyroid disease with a comparison with conventional thyroidectomy, to examine the intensity of postoperative pain, measured by a visual analog scale for seven postoperative days after surgery, as well as to examine the length of hospitalisation after minimally invasive thyroidectomy with a comparison with conventional thyroidectomy. METHODOLOGY: The study was conducted as a prospective, randomized controlled studies, from November 2014 to April 2016 and included the analysis of 100 patients operated at the Clinic for Thoracic Surgery, Institute for Pulmonary Diseases due to nodular thyroid disease. All subjects were divided into two basic groups according to the surgical technique: classical method (KM) and minimally invasive video-assisted method (MIVAM). Stages during the study included: analysis of data on preoperative morpho-functional diagnostic tests for thyroid disease (characteristic ultrasound findings, nodule caracteristics, volume of exchanged thyroid gland lobe), cytologic examination of aspirates of thyroid nodules obtained by fine needle, laboratory indicators of thyroid disorders gland in order to define the functional status and the presence of autoimmune thyroid disease; analysis of perioperative characteristics of surgical methods [incision length (cm), operative time (min), weight of removed pathoanatomic substrate (gr), intraoperative blood loss (ml)], the analysis of early postoperative complications (bleeding and hematoma, injury to lower recurrent laryngeal nerve (finding direct laryngoscopy at the end of the operation), hypocalcemia, the collapse of the trachea, laryngeal edema, seroma, infection, dehiscence] analysis nonsurgical complications, length of hospitalisation in hours, the intensity and duration of postoperative pain [(use of the visual analog scale (VAS) pain 1, 2 and 7 postoperative days)], late postoperative complications (6 months after surgery), the level of aesthetic satisfaction score (on control examination 6 months after surgery-cosmetic score). RESULTS: In the period of the study from November 2014 to April 2016, from 175 patients with nodular thyreoid disease 102 was observed after application of the inclusion/exclusion criteria. Since in the further analysis two patients was exluded (due to histological findings of malignancy ex tempore biopsy in one patient, and because of a perceived intraoperatively expressed adhesive changes in one patient underwent conversion) in statistical analysis patients were devided into two groups: group I patients - KM (n = 50) and group II patients - MIVAM (n = 50). The study included a total of 78 women and 22 men, it was observed that between the groups there was no statistically significant difference according to age (p = 0,16). There were no statistically significant differences between the groups in terms of the type of thyroid gland function and functional status, as well as in relation to the ultrasonographic characteristics of solitary (dominant) nodule in the subjects (the size of nodules, echogenicity nodes, the edge nodes, calcification, vascularization), the cytological diagnosis of fine needle aspiration puncture (benign, inappropriate, suspicious) and with respect to the lobe volume. The analysis of indicators of perioperative surgical methods in the group MIVAM was significantly smaller length compared to KM group (2,0 ± 0,5 cm vs. 7 ± 1,9 cm, p = 0,00), until the weight of pathoanatomic supstrate (18,3 6 ± 4 vs. 19 ± 6 5 2 g, p = 0,21), the operating time for performing a lobectomy (54 ± 14 vs. 61 ± 16 min, p = 0,25) or operative time to perform the surgery (72 ± 27 vs. 85 ± 24 min, p = 0,36) were not significantly different between the groups. The group MIVAM, early postoperative complications (bleeding, injury to the lower recurrent laryngeal nerve and hypocalcemia) occurred in 8% (4/50), and KM group in 10% (5/50), which was not statistically significant (p = 0,72). Compared to late postoperative complications, only one patient from group MIVAM registered the existence of keloids, while (permanent hypoparathyroidism, recurrent hyperthyroidism, a reaction to a foreign body) was not recorded. There was no statistically significant difference (p > 0,005 for all) in the presence of histological types of findings review the removed substrate (colloid goiter, follicular adenoma, cysts, papillary carcinoma and Hashimoto's thyroiditis). Patients in MIVAM groups have significantly lower average pain intensity by VAS scale at intervals after surgery 6h, 24h and 48 h (p < 0,05, for all). Total cosmetic score was significantly higher in MIVAM group compared to the KM group (18,9 ± 1,4 vs. 15,8 ± 1,3, p = 0,00). CONCLUSIONS: The incidence of early postoperative complications (intraoperative and postoperative bleeding, paresis and paralysis of the laryngeal nerve, hypocalcemia) were without significant differences between patients operated with minimally invasive method in comparison to the classical method. The average duration of minimally invasive thyroidectomy and classical thyroidectomy were without statistical significance difference, suggesting the appropriate level of surgical technique that enables the advantages of minimal invasiveness as surgical principles. Length of hospitalization after minimally invasive thyroidectomy was significantly shorter compared to conventional thyroidectomy, which significantly contributes to the overall recovery of the patient, lowering the cost of treatment. Minimally invasive thyroidectomy compared to conventional thyroidectomy, decreases the subjective feeling of postoperative pain, during hospitalization (6 and 24 h), as well as seven days after the intervention. In one-fifth of patients who underwent minimally invasive surgery method in the postoperative course of the subjective sensation of pain was not recorded. Cosmetic score as an indicator of patient satisfaction with the appearance of the scar was statistically higher in patients who underwent surgery less invasive surgical technique compared to patients who were operated by the classical method. According to the study, minimally invasive thyroidectomy has been demonstrated to be safe and superior to conventional open techniques for surgical treatment of nodular thyroid disease in patients with normal thyroid function with solitary/dominant nodule size < 35 mm.
Figueiredo, Eberval Gadelha. "Descrição técnica e avaliação anatômica da craniotomia minipterional." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5138/tde-14102008-104756/.
Full textINTRODUCTION: Pterional craniotomy is one of the most used and versatile approaches in neurosurgery. It constitutes a standard against which alternative surgical techniques to the same anatomic targets have been compared for years. This technique, however, is not without disadvantages. It requires complete dissection of the temporalis muscle. Poor outcomes are common and can be attributed to atrophy of the temporalis muscle and superficial temporal fat pad or to injury of the frontal branch of the facial nerve. Contemporary neurosurgical techniques strive to balance the need to minimize tissue trauma and to maximize anatomic exposure. Many surgical modifications have been described to minimize the size of the pterional craniotomy in an effort to decrease tissue trauma and improve cosmetic outcomes. In many instances, however, these modifications neither ensure a sufficient anatomic exposure nor guarantee satisfactory aesthetic outcomes. This thesis describes a novel technique, the minipterional craniotomy, and compares its anatomic exposure with that provided by the pterional technique. MATERIALS AND METHODS: The anatomic exposure offered by the minipterional and pterional techniques were compared in eight sides of cadaver heads using a computerized tracking system (Optotrak 3020, Nothern Digital, Waterloo, ON, Canada) to measure a predefined hexagonal area of surgical exposure, a robotic microscope (Surgiscope; Elekta Instruments, Inc, Atlanta, GA) to quantify angular exposure in the transverse and longitudinal axis for three anatomic targets (bifurcations of internal carotid and middle cerebral arteries and the middle point of the anterior communicating artery), and an image-guidance system (Medtronic Surgical Navigation Technologies, Louisville, CO) to evaluate the limits of exposure for each craniotomy. Data were submitted to statistical analysis using ANOVA. RESULTS: There were no statistical differences in the total area of surgical exposure between the two craniotomies (pterional=1524.7 +/- 305.0 mm2; minipterional = 1469.7 +/- 380.3 mm2; p>0.05) or among the ipsilateral, middle, and contralateral components of the area (p>0.05). There were no differences in angular exposure along the longitudinal and transverse axis angles for the three selected targets, the bifurcations of internal carotid and middle cerebral arteries, and the anterior communicating artery (p> 0.05). Except for the distal portion of the operculoinsular compartment of the sylvian fissure, no significant differences in the limits of the surgical exposure through the pterional and minipterional were apparent on the image-guidance system. CONCLUSION: The minipterional craniotomy provides comparable surgical exposure to that offered by the pterional technique.
Colafranceschi, Alexandre Siciliano. "Cirurgia torácica vídeo-assistida para a ablação da fibrilação atrial por radiofreqüência bipolar: exeqüibilidade, segurança e resultados iniciais." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5156/tde-25032009-172501/.
Full textBACKGROUND: Atrial fibrillation prevalence, its health system cost and the high morbidity and mortality associated with it have justified the search for a better understanding of its pathophysiology and new therapeutic management. The objective of this study was to assess the feasibility, the safety and the three months results of the video-assisted thoracoscopic surgery for the ablation of atrial fibrillation using bipolar radiofrequency. METHODS: Ten patients (90% male) with symptomatic and refractory atrial fibrillation underwent the proposed surgical procedure at the National Institute of Cardiology, Rio de Janeiro, Brazil, from May 2007 to May 2008. Peri and post-operative data were collected for analysis. Besides clinical evaluation, all patients have been submitted to an echocardiogram and a 24h Holter monitoring before and three months after the procedure. A pulmonary veins angiotomography was also performed three months after surgery. RESULTS: The surgical procedure was done as planned in all patients and 100% of the right pulmonary veins were isolated. Ninety per cent of the left pulmonary veins were confirmed to be electrically isolated. There was no surgical injury to any intra thoracic organ or death in this series. Two patients had post-operative pneumonia that required prolonged in hospital stay early in the experience. Nine of ten patients were in sinus rhythm just after surgery. There was one recurrence of atrial fibrillation within the three months follow up (11,1%). In general, eighty per cent (80%) of the patients are free of atrial fibrillation three months after surgery. There was a significant improvement in diastolic function measured by the relation E/E on the echocardiogram before and after the procedure (9,0 ± 2,23 to 7,7 ± 1,07; p=0,042). This was associated to an improvement of heart failure symptoms of New York Heart Association (2,4 ± 0,5 to 1,6 ± 0,7; p=0,011). There was no pulmonary vein stenosis in this cohort. CONCLUSIONS: Video-assisted thoracoscopic surgery for the treatment of atrial fibrillation is feasible and safe although it requires a learning curve to incorporate this new technique to clinical practice. The improvement on heart failure symptoms is associated to an improvement on diastolic left ventricular function
Ivan, Kuhajda. "Bilateralna torakoskopska simpatektomija kod osoba sa primarnom fokalnom hiperhidrozom." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2016. http://www.cris.uns.ac.rs/record.jsf?recordId=97489&source=NDLTD&language=en.
Full textPrimary focal hyperhidrosis (PFH) is a disorder of an unknown etiology, characterized by excessive sweating of predilective parts of the body. It affects men and women equally, with a peak incidence in the later second and early third decades of life, with incidence of up to 2,8% of the world population. It is caused by hyperactivity of the sympathetic nervous system to the sweat glands. It has been shown that PFH does not occur during the sleeping times, which suggests that emotional stimuli play an important role in this disorder. Bilateral thoracoscopic sympathectomy (BTS) is minimal invasive surgical procedure, which has evolved into an effective and permanent treatment for severe PFH, with low rate of morbidity and it can be performed as the one day surgical procedure. The aims of this investigation were: a) to examine the overall efficiency of BTS on permanent reduction of PFH of predilective parts of the body-palms, armpits, faces and soles; b) to examine the efficiency of BTS with different levels of transection among the persons with the PFH; c) to examine the influence of BTS on cardio-pulmonary function tests in persons with PFH after the operation; d) to examine the incidence, duration and intensity of compensatory sweating after BTS among persons with PFH; e) to examine the incidence, duration, localization and treatment of postoperative pain after BTS among persons with PFH; f) to determine postoperative complications of BTS among persons with PFH; g) to examine the influence of BTS on quality of life among persons with PFH. The working hypothesis of this investigation is that surgical procedure – minimal invasive BTS has the permanent effect on excessive sweating of predilective parts of the body among persons with PFH, followed by minimal morbidity, without clinical influence on cardio-pulmonary function and significantly improves the quality of life among persons with PFH. This was a prospective clinical study which included 435 patients with PFH, who have been operated with BTS, at the Clinic for Thoracic surgery, the Institute for pulmonary diseases of Vojvodina, Sremska Kamenica, between 2010 and 2014. The including criteria for the investigation were: a) persons with confirmed and estimated PFH accepted to participate in this investigation, fulfilling pre and postoperatively questionnaire about BTS effects and quality of life after the operation; b) absence of previous thoracic surgical procedures, rib fractures, massive pneumonias or pleural empyema; c) satisfactory cardio-respiratory function; d) absence of secondary hyperhidrosis. Primary focal hyperhidrosis was confirmed and estimated by anamnesis, clinical examination focused on qualitatively examination. Bilateral thoracoscopic sympathectomy was performed with general anesthesia, using harmonic scalpel for transection of sympathetic chain. Persons with PFH who underwent the BTS were classified into three groups, depending the level of transaction of sympathetic chain: a) transection at the level from the second to the forth thoracic sympathetic ganglion (T2-T4); b) transection at the level from the third to the forth thoracic sympathetic ganglion (T3-T4); c) transection at the level from the second to the third thoracic sympathetic ganglion (T2-T3). For the assessment of postoperative pain, compensatory sweating and quality of life next scales have been used: standardized numeric pain rating scale and Hyperhidrosis Disease Severity Scale (HDSS) for intensity of compensatory sweating and quality of life. Among 435 persons with PFH who underwent the BTS in this investigation, 142 (32,64%) were male and 293 (67,36%) female persons, with mean age of 29,68±7,6. There was no mortality or serious intraoperative complications that required operative conversio from minimal invasive surgical procedure to thoracotomy. Among 435 persons with PFH who underwent the BTS in this investigation, 142 (32,64%) were male and 293 (67,36%) female persons, with mean age of 29,68±7,6. Positive genetic factor has been found in 167 persons (38,62%). The most common localisation of excessive sweating in this investigation was the combination of palms, armpits and soles in 167 persons (38,39%). Before the operation, over 60% of persons estimated their quallity of life as bad or very bad. The operation was successfully performed in all patients bilaterally. There was no mortality in this investigation. There was one intraoperative complication, bleeding from intercostal vein, requiring conversion to minithoracotomy. Immediatelly postoperative success after BTS seven days after the operation was achieved in all persons accepted in two persons (0,46%) due to the postoperative complications: nervous ulnaris paresis and Horner syndrome in one person and Horener syndome in the other person. Postoperative morbidity after the BTS was recoreded in 32 persons (7,35%). Marked improvement, as significant reduction of sweating in persons with PFH was achieved in 428 operated persons (98,39%). Transection of sympathetic chain on level T3-T4 achieved improvement of quality of life in 85,03% operated persons with PFH. Compensatory sweating after the BTS has occurred in 316 (72,64%) operated persons, but only 2,53% operated persons declared compensatory sweating as severe. Postoperative pain was presented in 79,77% operated persons, with average duration of two weeks. Analgetics used only 24,21% of operated persons. There were 287 operated persons in this investigation, who claimed to have plantar hyperhidrosis before the operation and six months after the operation 185 persons (64,46%) claimed to have a reduction of plantar sweating. Although there was a clinical significance in changes of vital capacity after the BTS (from 4,49±1,15 L to 4,54±1,11 L), ther was no clinical significance. Changes in blood pressure and heart rate, although recoreded, had no clinical significance. Quality of life, before the BTS was recorded as bad or very bad in 265 persons (60,92%), and six months after the operation as excellent or good in 428 persons (98,39%) persons. Conclusion: In patients with PFH, BTS as minimal invasive surgical procedure, has a minimal morbidity and high success in treatment of excessive sweating, with improvemnet of quality of life in 98,39% operated person, with changes in cardio-pulmonary functions that are not clinical relevant.
Mendes, Carlos Ramon Silveira. "Impacto da microcirurgia endoscópica transanal sobre a função anorretal: avaliação clínica, funcional e da qualidade de vida." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5168/tde-23042018-123357/.
Full textBackground: The impact of transanal endoscopic microsurgery (TEM) on anorectal function remains poorly available, particularly when considering that the technique involves undertaking full- or partial-thickness excision of the rectal wall. Moreover, in spite of wide adoption of TEM, its impact on quality of life remains unknown since most evidence derives from retrospective studies. Objective: The objectives of the present study were to evaluate the impact of TEM on sphincter function determined by clinical (Wexner score), functional (anorectal manometry), and quality of life (FIQL) evaluations conducted before and after surgery. Design: prospective, observational, single-center, 23 consecutive patients with rectal lesions underwent were operated on using the TEO® equipment (Karl Storz, Tuttlingen, Germany). Wexner and FIQL scores were obtained before and after surgery (7 days, 30 days and 90 days postoperatively). Anorectal manometry was obtained before surgery, and postoperatively after 30 and 90 days. Main Outcome Measures: Wexner and FIQL scores; anorectal manometry results. Results: Fourteen patients were men. Mean age was 53.7 (24-81) yrs. Mean distance from the lesion to the dentate line was 7 (2-15) cm. A full- thickness resection was undertaken in 18 (78.3%) cases. Histopathology revealed adenoma in 14 (61%), neuroendocrine tumor in 5 (21.7%), invasive carcinoma in 3 (13%), and hyperplastic polyp in 1 (4.3%) case. Postoperative rectal wound separation occurred in 2 patients and 1 patient developed atrial fibrillation. The mean duration of postoperative follow-up was 5 (3-7) months. Overall, Wexner score significantly declined between postoperative days 7 and 30 (Wilcoxon, p = 0.03). Rectal compliance exhibited significant decline 30 days after surgery and recovery at 90 days after surgery (ANOVA, p = 0.04). It was not possible to measure any difference in the FIQL results before and after surgery. Limitations: small sample size; limited follow-up. Conclusions: Following TEM, a modest impact on anorectal function could be confirmed. Interestingly, anorectal function impairment after surgery was not due to sphincter dysfunction, but resulted from loss of rectal compliance. Ultimately, we could not detect a significant impact on quality of life after TEM
Jelena, Antić. "Klinički značaj minimalno invazivne hirurgije u terapiji akutnog apendicitisa u dečjem uzrastu." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2016. http://www.cris.uns.ac.rs/record.jsf?recordId=100926&source=NDLTD&language=en.
Full textIntroduction: Acute appendicitis is one of the most common abdominal surgical diseases in children. Operative treatment means open surgery or minimally invasive surgery (laparoscopic appendectomy). Although laparoscopic appendectomy, gained popularity among many surgeons, it is still not widely accepted in our region. The advantage of laparoscopic appendectomy compared to the open method in children is still not sufficiently defined and is the subject of further research. The aim of the research was to determine whether the length of hospital stay after laparoscopic surgery in children with acute appendicitis is shorter compared to the open method, as well as to determine whether there is a difference in the occurrence of postoperative complications after these two operative techniques. In addition, the aim of the research was to determine the effect of both methods of treatment on quality of life and everyday functioning. Methodology: This prospective, randomized controlled study was performed at the Clinic for Pediatric Surgery, Institute of Children and Youth Healthcare of Vojvodina, during a period of ten months. All patients with acute appendicitis, whose parents have given written consent, were included in research. All patients were divided into two basic groups, in relation to the surgical technique: open or laparoscopic appendectomy. Then, all of them were divided into three groups, depending on the degree of appendicitis (negative, uncomplicated and complicated appendicitis). Each participant had their own individual research protocol where we recorded preoperatively: age, sex, symptoms (type and length), physical examination, laboratory tests (white blood cell count, hematocrit), ultrasound finding, general state (ASA classification), associated diseases, time from admission to surgery, preoperative antibiotic therapy. During the operation we analyzed: type of surgery, degree of the appendicitis, the presence of peritonitis, associated pathology, length of surgery and duration of pneumoperitoneum (in laparoscopic appendectomy), hystopathologic findings of the appendix, a bacteriology. Postoperatively we analyzed: antibiotic therapy (type and length), oral intake, postoperative pain, fever, establishing peristalsis, the appearance of postoperative complications (wound infections, intra-abdominal abscesses, ileus) and length of hospitalization. Especially, we analyzed the quality of life of patients after surgery using the modified questionnaire SF 10 for children; and the establishment of daily activities using Activity Assessment Scale (AAS), modified for children; after each postoperative day, the first seven days, one month, three and six months after surgery. All patients were operated under general anesthesia. Open appendectomy was performed through incision in the right iliac fossa. Peritoneum was opened, the cecum was pulled out and classic appendectomy was made. Laparoscopic appendectomy is performed through three 5 mm ports. Pneumoperitoneum was created by the Hasson techique, through the infraumbilical incision, and the remaining two ports are set at right and left iliac region. Mezenteriolum was ligated by ultrasonic scissors. After putting intracorporal ligature, appendix was removed through the right port. Results: Over a period of ten months we operated 125 patients , aged 2 to 18 years, due to acute appendicitis. Laparoscopic technique was performed in 60 patients (48%), and the open method in 61 (48,8%). In 4 patients the conversion was made (operative technique changed from laparoscopic to open method). There were no statistically significant differences between the treatment groups with respect to the degree of appendix inflammation, the type and duration of symptoms, the diagnostic procedures, as well as the time from hospital admission to the surgery. Medium operative time was 65 minutes (25-185 min.) for laparoscopic group and 45,49 minutes (25-90 min.) for open appendectomy (the difference is statistically significant, p<0,001). Intestinal peristalsis, as well as the initiation of oral intake was significantly sooner established in the laparoscopic group. Postoperative complications (wound infections and intra-abdominal abscess formation In laparoscopic appendectomy) occurred after laparoscopy in 8,33% of patients (5/60), and in the open group in 4,91% (3/61), which was not statistically significant (c2 = 0,152, df = 1; p = 0,696). Length of hospital stay in children operated by laparoscopy was 5,95 } 1,21 days and by open technique 6,43 } 1,09 days, which is significantly longer (t = -2,206; p = 0,029). Results of the Mann-Whitney U test showed significantly better overall record of daily activities for a group of laparoscopic appendectomy (Z = -7,608; p = 0,000). In all tested indicators of quality of life, children from laparoscopic group had a higher score. Children with acute appendicitis treated by laparoscopic surgery achieved a high level of quality of life, significantly earlier (t = 2,407; p = 0,018). Conclusion: The advantage of minimally invasive surgery in the treatment of acute appendicitis in children is reflected in the faster re-establishment of functioning of the gastrointestinal tract, shorter hospitalization and therefore, a faster overall recovery, resuming normal activities and a good quality of life. Postoperative complications occur equally in both, open as well as in laparoscopic operative techniques.
Conrado, Luciana Archetti. "Prevalência do transtorno dismórfico corporal em pacientes dermatológicos e avaliação da crítica sobre os sintomas nessa população." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5133/tde-26032009-113115/.
Full textCosmetic concerns are increasingly pervading the contemporary societies, focusing on body shape and the skin perfection. Dermatologists and plastic surgeons are frequently consulted to evaluate and treat these concerns. Therefore it is important to be aware of the Body Dysmorphic Disorder, also known as dysmorphophobia, little studied until recently. This disorder is relatively common sometimes causing impairment involving a distorted perception of the body image characterized by an excessive preoccupation with an imagined or minimal appearance defect. Most of the patients experience some degree of impairment in social or occupational functioning and as a result, their obsessive thoughts, may lead to repetitive behaviors and in severe cases, to attempted suicide. Most individuals have poor insight and they do not acknowledge the defect is minimal or inexistent and seek out cosmetic treatments for a psychiatric disorder. The prevalence of this disorder among general population ranges from 1 to 2 % and in dermatological and cosmetic surgery patients ranges from 2, 9 to 16%. This study assessed the prevalence of Body Dysmorphic Disorder in dermatological patients. Trained interviewers used questionnaires (BDDQ) and semi-structured clinical interviews (SCID) to access patients seeking clinical or surgical cosmetic treatments (Cosmetic group, n=150), seeking dermatology in general (General group, n=150) and a control group of 50 subjects. Three independent psychiatrists assigned the best estimate diagnosis and 32 patients were diagnosed with the disorder (Cosmetic 14%, General 6, 7% and Control 2%). Prevalence differences in the three groups were significant, also for Cosmetic and Control groups. In the logistic regression a higher prevalence has been noticed in the Cosmetic group (when compared with General and Control groups), in patients that are not currently married and with less body mass index. The severity of the symptoms assessed by a validated scale (BDD-YBOCS) was moderate and the obsessions were significantly higher in the Cosmetic group as compared to the General one. Beliefs were assessed by a scale (BABS) and insight were significantly poorer in the Cosmetic group. None of the patients had been previously diagnosed. Psychiatric co-morbidities were frequent, mostly Major Depressive Disorder and Obsessive-Compulsive Disorder. Comparing two patients subgroups with just Body Dysmorphic Disorder and patients with Obsessive-Compulsive Disorder as comorbidity show no differences according to demographic variables, Axis I psychiatric comorbidity, symptoms severity and level of insight. The most frequent dermatological concerns were dyschromias, acne, the shape of the body and ageing. In the Cosmetical group most of the patients have performed clinical or surgical cosmetic treatments with poor results. Our findings provide further support for higher prevalence of Body Dysmorphic Disorder in dermatological patients, mainly those seeking cosmetic treatments and suggests that those patients might be more obsessive and having poorer insight into their symptoms. Taking into account the high prevalence of Body Dysmorphic Disorder in dermatological patients and cosmetic treatments that rarely improve symptoms there are compelling reasons for training professionals to systematically investigate, diagnose and refer these patients to adequate psychiatric treatment
Rossi, Janaína De. "Frontoplastia não endoscópica, com mínimas incisões para elevação do supercílio, em portadores de paralisia facial periférica." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5143/tde-24062014-164116/.
Full textNew forehead lift techniques assisted by endoscopic visualization or not, have currently been used to reduce the traditional bi-coronal incision. However, the results of surgeries performed with minimal incisions are unknown, especially when given in cases of sequelae of peripheral facial paralysis (PFP). Therefore, the objective of this prospective study was to assess the efficacy of nonendoscopic forehead lift with minimal incisions in PFP patient brow suspension, 24 months after surgery. Study variables were the position of the eyebrow assessed in millimeters on digital photographs, by software developed for this purpose. Brow position after 12 month and also between 36 and 78 months was exploratory analyzed. Patient\'s satisfaction and improvement was verbally inquired after surgery \"are you satisfied or not\" and \"are you looking worst, the same, better or much better\". The sample was composed of 20 adult patients who suffered PFP over 12 month and remain with paralysis of the temporal branch and eyebrow ptosis. Patients underwent forehead lift performed by two incisions in the lateral hair bearing area measuring 2.5 cm each. When desired medial eyebrow fixation a Reverdin needle was used and an extra incision measuring 1 cm each was placed centrally on hair bearing. Frontal and temporal flap detachment was performed by subgaleal plane and the release of the arcus marginalis was blindly accomplished by external palpation, minding anatomic parameters. No patient exhibited permanent sensitive or motor neural lesion after this procedure. Eyebrow position in the post-operative periods was higher than pre-operative (p < 0,05) confirming brow lift efficacy 24 months after surgery. Al the patients declared satisfied and qualified themselves as looking \"better\" or \"much better\"
Milanez, Adriano Márcio de Melo. "Estudo prospectivo e randomizado da revascularização do miocárdio minimamente invasiva com dissecção da artéria torácica interna esquerda por videotoracoscopia robótica." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/5/5156/tde-11012012-144551/.
Full textObjective: The aim of this study was to compare the patency of left internal mammary artery (LIMA) robotically harvested for left anterior descendent (LAD) artery minimally invasive bypass with conventional LIMA to LAD off-pump bypass. Method: From 2007 to 2010, 36 patients were randomized to either LIMA robotically harvested to LAD artery minimally invasive bypass or standard LIMA to LAD off-pump bypass. Patients assigned to robotic group underwent robotic endoscopic harvesting of LIMA with the AESOP system followed by a small left thoracotomy in the 4th intercostal space for off-pump LAD bypass. Patients assigned to standard group underwent full median sternotomy, open LIMA harvesting followed by off-pump LAD bypass. Transit time flow measurement was used for intraoperative evaluation of LIMA to LAD patency. After a mean 24-month follow-up, Multislice Computed Tomography was used to evaluate LIMA to LAD midterm patency. Results: The mean LIMA harvesting time in robotic group was 50.1 ± 11.2 min vs. 22.7 ± 3.3 min in conventional group. There was no significant difference in intraoperative LIMA to LAD flow between robotic and conventional groups (46.17 ± 20.11 mL/min vs. 48.61 ± 23.42 mL/min, p=0.86). There were no significant differences in incidence of wound infection (0 vs. 2, p=0,48) and reoperation for bleeding (0 vs. 1, p=1.00) between robotic and conventional groups respectively. In robotic group, Multislice CT revealed patent LIMA graft in 100% patients vs. 94.1% patients in conventional group (p=1.00). There was no mortality in the study group. Conclusions: Minimally invasive LAD bypass using LIMA graft robotically harvested was safe and feasible. Early and mid-term LIMA patency was similar between both techniques
Persaud-Sharma, Dharam. "An Assessment of Novel Biodegradable Magnesium Alloys for Endovascular Biomaterial Applications." FIU Digital Commons, 2013. http://digitalcommons.fiu.edu/etd/950.
Full textFilho, Joaquim Mauricio da Motta Leal. "Embolização seletiva das artérias prostáticas no tratamento da hiperplasia protática benigna." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5151/tde-31032014-155506/.
Full textBenign prostatic hyperplasia (BPH) is considered the most common neoplasm in men and is the main cause of lower urinary tract symptoms (LUTS) in the aging male. If left untreated or not effectively treated, can lead to acute urinary retention, incontinence, and urinary tract infections, progressing in severity with age. Despite the development of alternative techniques, transurethral resection of the prostate (TURP) is still considered the gold standard surgical treatment for BPH. However, TURP procedures can be associated with substantial morbidities such as bleeding, irritative urinary symptoms, erectile dysfunction and ejaculatory disorders. For this reason, the development of minimally invasive modalities for treatment of BPH has constituted an interesting field of research. The study objectives were: (1) to evaluate the feasibility, safety and efficacy of the prostatic artery embolization (PAE) in patients with urinary retention due to BPH, (2) to evaluate the percentage of reduction in prostate volume and quality of life after PAE in patients with urinary retention due to BPH. In the present study, a single-center prospective phase I study, 11 patients with urinary retention due to BPH were treated by PAE between August 2009 and November 2011. Physical examination, International Prostate Symptom Score (IPSS) and Quality of Life (QoL), prostate specific antigen (PSA) measurement, ultrasound (US) and magnetic resonance imaging (MRI), and urodynamic tests were performed at baseline, 1, 3, 6 and 12 months after PAE. Prostate size ranged from 30 to 90g, and embolizations were performed with 300- 500-?m Embosphere microspheres. Technical success (ie, bilateral PAE) was obtained in 75%, and clinical success (ie, catheter removal and symptom improvement) was obtained in 91% (10 of 11patients) of the cases. Postembolization syndrome manifested as mild pain in the perineum, retropúbica area, and/ or urethra. No major complications were observed. At the first year follow-up, symptoms were mild with the mean IPSS score was 2.8 points (p = 0.04), mean QoL was 0.4 points (p = 0.001), mean PSA decreased from 10.1 to 4.3 ng/mL (p = 0.003), mean prostate volume reduce from 69.7 to 46.3g (p = 0.002) and from 62 to 42.7 (p = 0.004) by MRI and US respectively, maximum urinary flow (Qmax) improved from 4.2 to 10.8 mL/sec (p = 0.009), detrusor pressure (Pdet) decreased from 85.7 to 51.5 cmH2O (p = 0.007), post-void residual decreased from 160.5 to 60ml (p = 0.04) and no erectile dysfunction was observed. PAE for the treatment of urinary retention caused by BPH demonstrated to be a feasible, safe and effective procedure. PAE can reduce the prostate volume greater than 30% and improve clinical symptoms and QoL
Marques, Carlos Frederico Sparapan. "Tratamento da neoplasia retal pela microcirurgia endoscópica transanal- TEM: fatores de risco para complicações pós-operatórias." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5168/tde-29102014-155628/.
Full textINTRODUCTION: Transanal endoscopic microsurgery (TEM) is a safe and efficient minimally invasive treatment for rectal benign and early malignant neoplasia. Postoperative complications may be severe. Controversy exists with regard to incidence and severity. OBJECTIVES: Evaluate risk factors related to incidence and severity of postoperative complications, and time course, in patients with rectal neoplasia treated by TEM. METHODS: Prospective study of postoperative complications using the Clavien-Dindo classification and grading system. Patients\' characteristics included age, sex, ASA score, neoadjuvant chemoradiotherapy (CRT), lesion height and size, pathologic margins, tumor histology, and suture type: through TEM or conventional retractor. RESULTS: Among fifty-three patients treated,overall morbidity rate was 50%. Incontinence was the most frequent complication (17.3%). One patient had persistent incontinence. Grade I and Grade II (GII) postoperative complication rates were both 21.1%, and Grade III (GIII) and IV rates were both 3.8%. There was no mortality. Of the patients with postoperative complications, 61.54% had lesions under the first rectal valve, compared with 38.46% of patients with lesions over the first valve (p=0.039). Patients submitted to CRT had a 24-fold greater chance of presenting GII complications (p=0.002), and a 7.03-fold greater chance of GIII (p=0.098). When the surgical defect was treated using the TEM device to perform the suture, there was a 16-fold less chance of having GIII complications (p=0.043). Fifty-three percent of complications occurred in the first 10 days, and 95% within 20 days. CONCLUSIONS: Postoperative complications after TEM for the treatment of rectal neoplasia are frequent, acceptable, and usually controllable with pharmacologic treatment. Patients with more distal lesions have more postoperative complications. Patients receiving neoadjuvant CRT and submitted to suture with a conventional anal retractor have more postoperative complications that require intervention under sedation. Over time the nature of complications is progressive and nonspecific, with most occurring within the first 20 days
Lin, Ching-lung, and 林景龍. "The Research of Minimally Invasive Surgical Procedures for New Device and Value Innovation - Base on the Atrial Septal Occluder." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/02570435067539863461.
Full text國立臺灣科技大學
管理研究所
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Due to the advance of medical technology, Cardiovascular surgery time is significantly shortened and medical risk is reduced. Through the innovation of medical equipment revolutionary design and the development of advanced cardiac catheterization procedure, using Atrial Septal Occluder can apply another choice at traditional open heart surgery, while doctors operate to achieve effective and easy to treat the Atrial Septal Defects. The case study is research by the company which agent Atrial Septal Occluder. It investigates the Research and development of medical equipment in the course of the qualifying requirements and regulations, and medical equipment product life cycle characteristics by analyzing external industry, relevant laws and regulations. In the innovation of product development and value creation, this research try to explore how patients cured rapidly, reduce complications and help the doctor improve surgery operation to push the Product materials and structural design innovation. According to the innovation, it would improve the intention and satisfaction of doctors and patients to use. Because of medical equipment must fit into existing surgical procedure, related processes and monitoring of technological innovation can more effectively enhance the synergy of innovative medical devices The study also will combine the theory in practice applied to the case company, play with the value of strategic thinking. The company agents this product and service from this case study have laid a good foundation for the current market. Through a good working relationship and share working experience with manufacturers, the case company could provide emerging markets with high quality products and services. It will help case company to integrate resources and open up new opportunities in the future.
Mendes, Andreia Filipa Graça. "Cirurgia minimamente invasiva na patologia anexial." Master's thesis, 2020. http://hdl.handle.net/10316/97621.
Full textAdnexal diseases are common and up to 10% of the patients undergo surgery, using minimally invasive techniques, in the last years. These have shown to shorten the hospital stay and recovery process, blood loss, pain and post-operative complications, improving the cosmetic result. The objective of this study is to evaluate published data considering the potential of minimally invasive surgical procedures in the treatment of benign and malignant adnexal pathology.Conventional laparoscopy is the gold-standard in the surgical treatment of benign lesions, because of the advantages associated with minimally invasive surgery and the decrease in the formation of abdominal and pelvic adhesions. Techniques such as single port laparoscopy, mini-laparoscopy and robotic surgery have failed to prove to be better alternatives, because of the increase in the operating time associated with them. Single port laparoscopy has a higher rate of post-operative complications (6,59% vs 2,85%) and a higher risk of incisional hernia (4 – 8,4% vs 0,3 – 5,4%). On the contrary, transvaginal natural orifice transluminal endoscopic surgery shortens the operation time and significantly improves the level of comfort after surgery and the cosmetic result. However, this is a difficult technique to perform and requires an experienced surgeon, which justifies its low use. When it comes to malignant lesions, conventional laparoscopy can be selected for the surgical staging of early stage ovarian cancer. The quality of staging is similar to laparotomic procedures, with no difference in the number of nodes excised. There is no difference in the survival, upstaging and intraoperative rupture rates of both approaches. In women with advanced stage ovarian cancer, diagnostic laparoscopy can evaluate tumour resectability with a sensitivity of 98%, avoiding unnecessary laparotomies and allowing an early start of neoadjuvant chemotherapy. As a therapeutic option, laparoscopy allows a complete cytoreduction in 50% to 85% of the cases, with no significant difference between this approach and laparotomy. However, laparoscopy is associated with residual disease in 43 to 100% of the cases. Robotic surgery, besides the increase in operative time, shows no difference in complications, survival and cytoreduction rates.Minimally invasive surgical procedures are the first choice when it comes to benign lesions and are used in early stage ovarian cancer. They are useful in the diagnosis process of advanced stage ovarian cancer and in the evaluation of resectability, although their use as a therapeutic option shows variable results. The introduction of new techniques besides laparoscopy, has failed to show superiority, with the increase in the operating time and similar outcomes.
A patologia anexial é comum e até 10% das mulheres afetadas são submetidas a cirurgia e nos últimos anos por vias minimamente invasivas. As vantagens são sobretudo um menor tempo de internamento e recuperação, perdas hemorrágicas, dor e complicações pós-operatórias, para além de melhores resultados estéticos. O objetivo desta revisão bibliográfica é avaliar o potencial da cirurgia minimamente invasiva no tratamento da patologia anexial benigna e maligna. Na abordagem cirúrgica da patologia benigna, a laparoscopia convencional é o gold-standard, devido às vantagens da cirurgia minimamente invasiva, associando a diminuição da formação de aderências abdominais e pélvicas. Técnicas como a laparoendoscopia de incisão única, a mini-laparoscopia e a cirurgia robótica não mostraram superioridade devido a um aumento significativo do tempo operatório. A laparoendoscopia apresenta uma taxa de complicações pós-operatórias (6,59% vs 2,85%) e risco de hérnia incisional superiores (4 - 8,4% vs 0,3 - 5,4%). Pelo contrário, a cirurgia endoscópica por culdostomia está associada à diminuição do tempo operatório e significativa melhoria do conforto no pós-operatório e resultado estético. Todavia, a técnica de culdostomia é de difícil domínio e necessita de um cirurgião experiente para sua realização, sendo por isso pouco realizada. Na abordagem cirúrgica da patologia maligna, a laparoscopia surge como uma alternativa válida no estadiamento do carcinoma do ovário em estádio precoce. A laparoscopia permite uma qualidade de estadiamento não inferior à laparotomia, sem diferença no número de gânglios excisados. Não se observam diferenças na sobrevivência, taxa de sobre-estadiamento e rotura intraoperatória entre as duas abordagens. No carcinoma em estádio avançado, a laparoscopia diagnóstica tem uma sensibilidade de 98% na avaliação da ressecabilidade tumoral, diminuindo o número de laparotomias desnecessárias e permitindo o início precoce de esquemas de quimioterapia neoadjuvante. Na sua vertente terapêutica, a laparoscopia está associada a taxas de citorredução completa que variam entre 50 a 85%, sem diferença significativa comparando com a laparotomia. No entanto, a laparoscopia está associada a doença residual em 43 a 100% dos casos. A cirurgia robótica, para além do tempo operatório superior, não apresenta diferença na taxa de complicações, citorredução e sobrevivência. A laparoscopia é a primeira linha na patologia benigna e é utilizada no carcinoma do ovário em estádio precoce. A sua utilização em estádios avançados mostra capacidade diagnóstica e de avaliação de ressecabilidade, porém, como terapêutica, apresenta resultados muito variáveis. A introdução de outras técnicas minimamente invasivas que não a laparoscopia não demonstrou superioridade, com tempos operatórios superiores e resultados semelhantes.
"A simulation system of vascular interventional radiology procedures for training endovascular skills." 2012. http://library.cuhk.edu.hk/record=b5549396.
Full text为了建立一套高仿真的介入手术训练模拟器,首先,我们要为病人的血管网重建三维模型。我们提出了一种自动的提取中心线的方法,用来从分割好的CTA/MRA体数据中获取病人血管网的中心线。基于改进的平行传递算法,沿着这些中心线,生成了一系列连续的标架。根据这些标架,我们构造了血管的横截面,并在此基础上生成了光滑连续的三维血管模型。
其次,作为血管介入术中最基础和最重要的手术器械,我们为导管和导线建立了物理模型。我们提出了一种基于最小势能原理的可变形的模型用于模拟导管和导线对于受力的反应。我们还提出了一个快速并且稳定的多网格算法来保证模拟的真实性和严格的实时交互要求。另外,我们做了几组实验。通过这些实验,验证了多网格算法在稳定性、实时性、模拟的真实性等方面满足了我们对于训练用模拟系统的要求。
再次,为了模拟血管栓塞术的手术过程,我们提出了一种模拟线圈填充血管瘤的过程的新方法。通过加总线圈弯曲变形的弹性势能、血管瘤变形的弹性势能以及外力做的功,我们建立了在血管栓塞术的环境下的总势能模型。为了求解这个模型,我们提出了一个基于有限元方法的求解器。从而模拟了线圈在介入医生的操作下慢慢的进入血管瘤,并缠绕起来的过程。
另外,我们提出了一个分层圆柱网格模型(LCGM)用于模拟在血管网中血流的运动。这一模型在几何上和拓扑结构上都非常适合我们的应用。我们将血液在血管中的流动近似为一维的层流,并用一组线性等式描述了血管网中流速与血压的关系。通过求解这一线性系统,得到了在分层圆柱网格模型下血流的速度场。依据这个血流的速度场,我们采用平流-扩散模型来模拟造影剂在血管中的传播的过程。
Vascular diseases have been becoming the number one cause of death worldwide in recent years. Millions of people were killed by vascular diseases each year. An increasingly promising therapy for treating vascular diseases is Vascular Interventional Radiology (VIR). VIR is a minimally invasive surgery (MIS) procedure, which has been widely used to cure stroke, angiostenosis, aneurysm and etc. A low risk, an accelerated recovery and a shorter stay in hospital are important advantages over the traditional vascular surgery. This therapy is performed by a guidewire-catheter combination inside the blood vessels under the guidance of the fluoroscopic imaging. Because of the complexity and particularity of these procedures, it is a great challenge to master hand-eye coordination, instrument manipulation and procedure protocols for each radiologist mandatory. An efficient and safe training system is needed urgently. In contrast to these traditional training methods, virtual reality (VR) based simulation systems is a pretty good surrogate.
In order to build a high fidelity interventional simulator for physician training, firstly, we reconstructed the three dimensional (3D) model for the vascular network of the patients. An method of automatic skeleton extraction was proposed to acquire the centerline of the vascular network from the segmented volume data from CTA/MRA. A series of continuing frames were generated along with the centerline based on improved parallel transporting method. According to these frames we built the crossections of the vessels and further the 3D vascular model with the smooth meshes.
Secondly, as the most basic and important instruments in the VIR procedure, the catheter and guidewire were modeled and simulated physically. We developed a deformable model to simulate complicated behaviors of guidewires and catheters based on the principle of minimum total potential energy. A fast and stable multigrid solver was proposed to ensure both realistic simulation and real time interaction. A series of experiments were conducted to evaluate our multigrid solver in terms of stability, time performance, the capability of simulating catheter behaviors and the realism of catheter deformation.
Thirdly, to simulate the procedure of embolization, we proposed a novel method to simulate the motion of coil and their interactions with the aneurysm. We formulated the total potential energy in the embolization circumstance by summing up the elastic energy deriving from the bending of coils, the potential energy due to the deformation of the aneurysm and the work by the external forces. A novel FEM-based approach was proposed to simulate the deformation of coils. And the motion of coils and their responses to every input from the interventional radiologist can be calculated globally.
Fourthly, we proposed our Layered Cylindrical Gird Model (LCGM) for simulating blood flow in vascular network, which is pretty suitable for sampling the vascular network geometrically and topologically. The blood flow in vessels was regarded as 1D laminar flow and formulated into a set of linear equations based on the Poiseuille law to describe the relationship between the speed of flow and the pressure. Solving those equations, we got the velocity fields in the blood flow. In terms of the velocity fields, an advection-diffusion model was adopted to simulate the propagation of contrast agent with the blood flow.
Finally, all above techniques and procedures were implemented and integrated into a simulation system for training the medical students to acquire the endovascular skill, and an empirical study was also designed based on a typical selective catheteriza- tion procedure to assess the feasibility and effectiveness of the proposed system.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
最后,我们将所有以上提到的技术和方法集成到模拟系统中用于训练医学院的学生,并使他们获得血管介入术的技能。并且,我们基于一个典型的导管插入术过程,使用经验分析的方法对模拟系统的可用性和效率进行了评估。
Li, Shun.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2012.
Includes bibliographical references (leaves 105-116).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstracts in also Chinese.
Abstract --- p.i
Acknowledgement --- p.vi
Chapter 1 --- Introduction --- p.1
Chapter 2 --- Vascular Modeling --- p.14
Chapter 2.1 --- Introduction and Related Work --- p.14
Chapter 2.2 --- Vascular Skeleton Graph Construction --- p.15
Chapter 2.2.1 --- Chamfer distance transform and Dijkstra's shortest-path algorithm --- p.17
Chapter 2.2.2 --- End vertices retrieval --- p.19
Chapter 2.2.3 --- The algorithm of vascular skeleton extraction --- p.21
Chapter 2.3 --- Vascular Modeling --- p.21
Chapter 2.3.1 --- Tubular Model --- p.21
Chapter 2.3.2 --- Bifurcation Model --- p.23
Chapter 3 --- Catheter Simulation --- p.28
Chapter 3.1 --- Introduction and Related Works --- p.28
Chapter 3.2 --- Catheter Simulation --- p.31
Chapter 3.2.1 --- Kirchhoff Theory of Elastic Rod --- p.32
Chapter 3.2.2 --- Problem Formulation --- p.34
Chapter 3.2.3 --- The Multigrid Iterative Solver --- p.38
Chapter 3.3 --- Collision detection --- p.45
Chapter 3.4 --- Validation of the Catheter Simulation Method --- p.47
Chapter 3.4.1 --- Stability --- p.49
Chapter 3.4.2 --- Time Performance --- p.50
Chapter 3.4.3 --- Preservation of Curved Tip --- p.51
Chapter 3.4.4 --- The realism of catheter deformation --- p.53
Chapter 4 --- Coil Embolization Simulation --- p.59
Chapter 4.1 --- Introduction and Related Work --- p.59
Chapter 4.2 --- Methodology --- p.61
Chapter 4.2.1 --- Total potential energy of a coil --- p.61
Chapter 4.2.2 --- The FEM-based numeric solver for interactive coil simulation --- p.61
Chapter 5 --- Angiography Simulation --- p.70
Chapter 5.1 --- Introduction and related works --- p.70
Chapter 5.2 --- The Equations of Fluid --- p.72
Chapter 5.3 --- Layered Cylindrical Gird Model --- p.73
Chapter 5.4 --- Numerical Method --- p.76
Chapter 5.4.1 --- Evaluation of the velocity field of blood flow --- p.76
Chapter 5.4.2 --- Evaluation of the density field --- p.78
Chapter 5.5 --- Results --- p.81
Chapter 6 --- System Implementation and Evaluation --- p.84
Chapter 6.1 --- Introduction and Related Work --- p.84
Chapter 6.2 --- System Construction --- p.85
Chapter 6.3 --- Empirical Study of the Training System --- p.89
Chapter 7 --- Conclusion and Discussion --- p.98
Chapter 7.1 --- Geometric Modeling of Vasculature --- p.99
Chapter 7.2 --- Catheterization Simulation --- p.99
Chapter 7.3 --- Embolization Simulation --- p.100
Chapter 7.4 --- Angiography Simulation --- p.101
Chapter 7.5 --- System and Evaluation --- p.102
Publication List --- p.103
Bibliography --- p.105
Anjos, Mariana Marques dos. "Cirurgia minimamente invasiva no tratamento do cancro do endométrio." Master's thesis, 2017. http://hdl.handle.net/10316/82375.
Full textObjetivos: Avaliar os resultados das técnicas minimamente invasivas, laparoscopia e cirurgia robótica, comparativamente com a abordagem convencional por laparotomia no tratamento do cancro do endométrio. Analisar as principais complicações e o risco de recidiva tumoral associados à laparoscopia e à cirurgia robótica. Materiais e métodos: Realizou-se uma pesquisa na base de dados PubMed de artigos publicados em inglês entre janeiro de 2008 e dezembro de 2016. Nesta revisão foram consultados documentos de consenso nacional e internacional de sociedades científicas. Resultados: O estadiamento cirúrgico do cancro do endométrio é um procedimento exequível e com taxas de complicações semelhantes quer por laparoscopia quer por laparotomia, verificando-se que o número de gânglios removidos na linfadenectomia foi superior por laparoscopia. A sobrevivência e a recorrência não apresentaram variações entre as técnicas. A cirurgia laparoscópica foi associada a um tempo operatório superior, mas a uma menor estadia hospitalar em relação à laparoscopia. Nas doentes submetidas a laparoscopia verificou-se menor dor no pós-operatório, um regresso mais célere às atividades e uma melhor qualidade de vida pós-cirúrgica. As doentes obesas submetidas a laparoscopia apresentaram uma menor taxa de complicações e em idosas os resultados peri-operatórios foram mais favoráveis nesta via de abordagem comparativamente com a laparotomia. A cirurgia robótica foi associada a um tempo operatório superior, mas a uma estadia hospitalar mais curta em relação à laparotomia. A sobrevivência e a recorrência apresentaram resultados semelhantes assim como as complicações intraoperatórias na cirurgia robótica e na laparotomia. Com a cirurgia robótica verificou-se uma redução significativa nas complicações pós-operatórias, da taxa de conversão em relação à cirurgia laparoscópica e na incidência de complicações infeciosas e lesões do ureter. Nas doentes obesas a cirurgia robótica apresentou menor tempo de hospitalização e menos complicações da ferida operatória comparativamente com a laparoscopia. Conclusões: A cirurgia minimamente invasiva, por laparoscopia ou cirurgia robótica mostrou vantagens em relação à laparotomia nas complicações pós-operatórias, tempo de hospitalização, recuperação e qualidade de vida sem compromisso dos resultados de sobrevivência e recorrência da doença. A cirurgia robótica mostrou ainda resultados vantajosos em mulheres obesas comparativamente com as outras abordagens.
Objectives: Evaluate the results of minimally invasive techniques, laparoscopy and robotic surgery, comparing with the conventional approach by laparotomy in the treatment of endometrial cancer. Analyse the main complications and the risk of tumour recurrence associated with laparoscopy and robotic surgery. Material and methods: A literature review between January 2008 and December 2016 was carried out on the PubMed database. National and international scientific societies guidelines were analysed for this review. Results: Surgical staging of endometrial cancer is a feasible procedure and with similar complications rates by laparoscopy or laparotomy and with a superior number of lymph nodes removed by laparoscopy. Survival and recurrence did not vary among techniques. Laparoscopic surgery was associated with a superior operative time but a smaller hospital stay comparing with laparoscopy. In patients submitted to laparoscopy it was verified less postoperative pain, a quicker return to activities and a better quality of life after surgery. Obese patients submitted to laparoscopy presented an inferior rate of complications and in elderly women the perioperative results were favourable to this approach comparing with laparotomy. Robotic surgery was associated to a longer operative time but an inferior hospital stay than laparotomy. Survival and recurrence presented similar results as well as intraoperative complications in robotic surgery and laparotomy. It was verified a significant reduction of postoperative complications, rate of conversion in relation to laparoscopy and the incidence of infectious complications and ureteral lesions with robotic surgery. In obese patients, robotic surgery presented a shorter hospital stay and fewer wound complications than laparoscopy. Discussion and conclusions: Minimally invasive surgery, by laparoscopy or robotic surgery showed advantages comparing with laparotomy considering postoperative complications, hospital stay, recovery and quality of life without a detrimental impact on survival and recurrence. Robotic surgery presented beneficial results in obese women comparing with other approaches.