Colecistectomia laparoscópica com três portais em cães viagaslessou pneumoperitônio com CO2

Detalhes bibliográficos
Autor(a) principal: Linhares, Marcella Teixeira
Data de Publicação: 2021
Tipo de documento: Tese
Idioma: por
Título da fonte: Manancial - Repositório Digital da UFSM
dARK ID: ark:/26339/001300000ctzm
Texto Completo: http://repositorio.ufsm.br/handle/1/24478
Resumo: The aims of this thesis were, in a first step, to evaluate the results of laparoscopic cholecystectomy (CL) via three-port access in dogs with benign gallbladder diseases in a retrospective study. The second step consisted of proposing and evaluating the feasibility of a gasless three-port access CL in canine cadavers, using a personalized device for mechanical elevation of the abdominal wall, and comparing it to the corresponding technique with pneumoperitoneum in certain surgical variables. In article 1, the medical records of 14 cases of CL performed by two surgeons with different proficiencies were reviewed. The average surgical time was 69.21± 21.7 min (range 45-104), there was no conversion in any of the patients and 85.7% of the dogs were discharged on the day of the procedure. Most intraoperative complications were classified as minor. Two patients had postoperative complications that required reintervention, one of which was unrelated to CL, anddied after the second surgical procedure. In the prospective study of article 2, 16 cadavers were divided into two groups, those from the GCG (n = 8) were submitted to CL using the multidirectional traction platform and those from the GCP (n = 8) underwent CL with pneumoperitoneum (10 mmHg). The total surgical time, the times of each stage of the procedure, and the intraoperative complications were recorded. The degree of difficulty of surgical approaches was assessed by the surgeon and auxiliary fromtwo types of adapted scales, a visual analog scale and a Likert scale. The proposed gasless CL technique was feasible in all animals. The total surgical time was longer for the GCG group (p=0.02), as well as the time for the stage of gallbladder dissection of the liver bed (p=0.03).For both scales, the degree of difficulty in performing the procedure was greater for the GCG in the stages of exposure and dissection of the cystic duct, hemostasis, and transection of the cystic duct, visualization of anatomical structures, and for the sum ofall steps (p<0.05). There was no difference in the incidence of intraoperative complications between the two techniques. Given the results presented, we conclude that CL with three-port access is a viable and safe approach for the treatment of benign gallbladder diseases in dogs, making it possible to reduce the surgical access injury by avoiding the use of an additional trocar, without increasing the complexity of the procedure considering the access of four-port. CL using the multidirectional traction platform was viable in canine cadavers and similar to the corresponding technique using pneumoperitoneum for the incidence of intraoperative complications. Even though the surgical time and the degree of difficulty for the execution of the proposed technique are higher, to enable a CL technique that does not require the use ofpneumoperitoneum represents a valuable alternative for patients unable to compensate for changes caused by abdominal insufflation.
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spelling Colecistectomia laparoscópica com três portais em cães viagaslessou pneumoperitônio com CO2Three-port laparoscopic cholecistectomy in dogs via gasless or CO2 pneumoperitoneumCirurgia biliar extra-hepáticaPneumoperitônioLaparoscopia gaslessElevação da parede abdominalExtrahepatic biliary surgeryPneumoperitoneumGasless laparoscopyAbdominal wall liftCNPQ::CIENCIAS AGRARIAS::MEDICINA VETERINARIAThe aims of this thesis were, in a first step, to evaluate the results of laparoscopic cholecystectomy (CL) via three-port access in dogs with benign gallbladder diseases in a retrospective study. The second step consisted of proposing and evaluating the feasibility of a gasless three-port access CL in canine cadavers, using a personalized device for mechanical elevation of the abdominal wall, and comparing it to the corresponding technique with pneumoperitoneum in certain surgical variables. In article 1, the medical records of 14 cases of CL performed by two surgeons with different proficiencies were reviewed. The average surgical time was 69.21± 21.7 min (range 45-104), there was no conversion in any of the patients and 85.7% of the dogs were discharged on the day of the procedure. Most intraoperative complications were classified as minor. Two patients had postoperative complications that required reintervention, one of which was unrelated to CL, anddied after the second surgical procedure. In the prospective study of article 2, 16 cadavers were divided into two groups, those from the GCG (n = 8) were submitted to CL using the multidirectional traction platform and those from the GCP (n = 8) underwent CL with pneumoperitoneum (10 mmHg). The total surgical time, the times of each stage of the procedure, and the intraoperative complications were recorded. The degree of difficulty of surgical approaches was assessed by the surgeon and auxiliary fromtwo types of adapted scales, a visual analog scale and a Likert scale. The proposed gasless CL technique was feasible in all animals. The total surgical time was longer for the GCG group (p=0.02), as well as the time for the stage of gallbladder dissection of the liver bed (p=0.03).For both scales, the degree of difficulty in performing the procedure was greater for the GCG in the stages of exposure and dissection of the cystic duct, hemostasis, and transection of the cystic duct, visualization of anatomical structures, and for the sum ofall steps (p<0.05). There was no difference in the incidence of intraoperative complications between the two techniques. Given the results presented, we conclude that CL with three-port access is a viable and safe approach for the treatment of benign gallbladder diseases in dogs, making it possible to reduce the surgical access injury by avoiding the use of an additional trocar, without increasing the complexity of the procedure considering the access of four-port. CL using the multidirectional traction platform was viable in canine cadavers and similar to the corresponding technique using pneumoperitoneum for the incidence of intraoperative complications. Even though the surgical time and the degree of difficulty for the execution of the proposed technique are higher, to enable a CL technique that does not require the use ofpneumoperitoneum represents a valuable alternative for patients unable to compensate for changes caused by abdominal insufflation.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESOs objetivos desta tese foram, em uma primeira etapa, avaliar os resultados da colecistectomia laparoscópica (CL) via três portais de acesso em cães com doenças benignas da vesícula biliar em um estudo retrospectivo. A segunda etapa consistiu na proposição e avaliação da exeqüibilidade de uma técnica correspondente na modalidade gaslessem cadáveres caninos, utilizando um dispositivo personalizado de elevação mecânica da parede abdominal, e compará-la à técnica com pneumoperitônio em determinadas variáveis cirúrgicas. No artigo 1, foram revisados os registros médicos de 14 casos de CL operados por dois cirurgiões com diferentes proeficiências. O tempo cirúrgico médio foi de 69,21 ± 21.7 min (variação 45-104), não houve conversão em nenhum dos pacientes e 85,7% dos cães receberam alta hospitalar no dia do procedimento. As complicações transoperatórias em sua maioria foram classificadas como menores. Dois pacientes apresentaram complicações pós-operatórias que exigiram reintervenção, sendo um dos casos não relacionado à CL, e vieram a óbito após o segundo procedimento cirúrgico. No estudo prospectivo do artigo 2, 16 cadáveres foram distribuídos em dois grupos, os do GCG (n=8) foram submetidos à CL com o uso da plataforma de tração multidirecional e os do GCP (n=8) submetidos à CL com pneumoperitônio (10 mmHg). O tempo operatório total, os tempos de cada etapa do procedimento e as complicações transoperatórias foram registrados. O grau de dificuldade das abordagens cirúrgicas foi avaliado pelo cirurgião e auxiliar a partir de duas escalas adaptadas, uma escala visual analógica e uma escala Likert. A técnica proposta de CL gasless foi exeqüível em todos os animais. O tempo cirúrgico total foi maior para o grupo GCG (p=0,02), assim como o tempo para a etapa de dissecção da vesícula biliar do leito hepático (p=0,03). Para ambas as escalas, o grau de dificuldade para execução do procedimento foi maior para o GCG nas etapas de exposição e dissecção do ducto cístico, hemostasia e transecção do ducto cístico, visualização de estruturas anatômicas e para o somatório de todas as etapas (p<0,05). Não houve diferença na incidência de complicações transoperatórias entre as duas técnicas. Diante dos resultados apresentados, concluímos que a CL com três portais de acesso é uma abordagem viável e segura para o tratamento de doenças benignas da vesícula biliar em cães, possibilitando a redução da lesão de acesso cirúrgico por dispensar um trocarte adicional, sem ampliar a complexidade do procedimento considerando o acesso de quatro portais. A CL utilizando a plataforma de tração multidirecional foi viável em cadáveres caninos e similar à técnica correspondente utilizando pneumoperitônio quanto à incidência de complicações transoperatórias. Ainda que o tempo cirúrgico e o grau de dificuldade para a execução da técnica proposta sejam superiores, viabilizar uma técnica de CL que dispense o uso de pneumoperitônio representa uma valiosa alternativa para pacientes incapazes de compensar as alterações promovidas pela insuflação abdominal.Universidade Federal de Santa MariaBrasilMedicina VeterináriaUFSMPrograma de Pós-Graduação em Medicina VeterináriaCentro de Ciências RuraisBrun, Maurício Velosohttp://lattes.cnpq.br/3913050752928325Pinto Filho, Saulo Tadeu LemosMüller, Daniel Curvello de MendonçaBeck, Carlos Afonso de CastroSilva, Marco Augusto MachadoLinhares, Marcella Teixeira2022-05-25T17:47:03Z2022-05-25T17:47:03Z2021-01-21info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisapplication/pdfhttp://repositorio.ufsm.br/handle/1/24478ark:/26339/001300000ctzmporAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessreponame:Manancial - Repositório Digital da UFSMinstname:Universidade Federal de Santa Maria (UFSM)instacron:UFSM2022-05-25T17:47:03Zoai:repositorio.ufsm.br:1/24478Biblioteca Digital de Teses e Dissertaçõeshttps://repositorio.ufsm.br/ONGhttps://repositorio.ufsm.br/oai/requestatendimento.sib@ufsm.br||tedebc@gmail.comopendoar:2022-05-25T17:47:03Manancial - Repositório Digital da UFSM - Universidade Federal de Santa Maria (UFSM)false
dc.title.none.fl_str_mv Colecistectomia laparoscópica com três portais em cães viagaslessou pneumoperitônio com CO2
Three-port laparoscopic cholecistectomy in dogs via gasless or CO2 pneumoperitoneum
title Colecistectomia laparoscópica com três portais em cães viagaslessou pneumoperitônio com CO2
spellingShingle Colecistectomia laparoscópica com três portais em cães viagaslessou pneumoperitônio com CO2
Linhares, Marcella Teixeira
Cirurgia biliar extra-hepática
Pneumoperitônio
Laparoscopia gasless
Elevação da parede abdominal
Extrahepatic biliary surgery
Pneumoperitoneum
Gasless laparoscopy
Abdominal wall lift
CNPQ::CIENCIAS AGRARIAS::MEDICINA VETERINARIA
title_short Colecistectomia laparoscópica com três portais em cães viagaslessou pneumoperitônio com CO2
title_full Colecistectomia laparoscópica com três portais em cães viagaslessou pneumoperitônio com CO2
title_fullStr Colecistectomia laparoscópica com três portais em cães viagaslessou pneumoperitônio com CO2
title_full_unstemmed Colecistectomia laparoscópica com três portais em cães viagaslessou pneumoperitônio com CO2
title_sort Colecistectomia laparoscópica com três portais em cães viagaslessou pneumoperitônio com CO2
author Linhares, Marcella Teixeira
author_facet Linhares, Marcella Teixeira
author_role author
dc.contributor.none.fl_str_mv Brun, Maurício Veloso
http://lattes.cnpq.br/3913050752928325
Pinto Filho, Saulo Tadeu Lemos
Müller, Daniel Curvello de Mendonça
Beck, Carlos Afonso de Castro
Silva, Marco Augusto Machado
dc.contributor.author.fl_str_mv Linhares, Marcella Teixeira
dc.subject.por.fl_str_mv Cirurgia biliar extra-hepática
Pneumoperitônio
Laparoscopia gasless
Elevação da parede abdominal
Extrahepatic biliary surgery
Pneumoperitoneum
Gasless laparoscopy
Abdominal wall lift
CNPQ::CIENCIAS AGRARIAS::MEDICINA VETERINARIA
topic Cirurgia biliar extra-hepática
Pneumoperitônio
Laparoscopia gasless
Elevação da parede abdominal
Extrahepatic biliary surgery
Pneumoperitoneum
Gasless laparoscopy
Abdominal wall lift
CNPQ::CIENCIAS AGRARIAS::MEDICINA VETERINARIA
description The aims of this thesis were, in a first step, to evaluate the results of laparoscopic cholecystectomy (CL) via three-port access in dogs with benign gallbladder diseases in a retrospective study. The second step consisted of proposing and evaluating the feasibility of a gasless three-port access CL in canine cadavers, using a personalized device for mechanical elevation of the abdominal wall, and comparing it to the corresponding technique with pneumoperitoneum in certain surgical variables. In article 1, the medical records of 14 cases of CL performed by two surgeons with different proficiencies were reviewed. The average surgical time was 69.21± 21.7 min (range 45-104), there was no conversion in any of the patients and 85.7% of the dogs were discharged on the day of the procedure. Most intraoperative complications were classified as minor. Two patients had postoperative complications that required reintervention, one of which was unrelated to CL, anddied after the second surgical procedure. In the prospective study of article 2, 16 cadavers were divided into two groups, those from the GCG (n = 8) were submitted to CL using the multidirectional traction platform and those from the GCP (n = 8) underwent CL with pneumoperitoneum (10 mmHg). The total surgical time, the times of each stage of the procedure, and the intraoperative complications were recorded. The degree of difficulty of surgical approaches was assessed by the surgeon and auxiliary fromtwo types of adapted scales, a visual analog scale and a Likert scale. The proposed gasless CL technique was feasible in all animals. The total surgical time was longer for the GCG group (p=0.02), as well as the time for the stage of gallbladder dissection of the liver bed (p=0.03).For both scales, the degree of difficulty in performing the procedure was greater for the GCG in the stages of exposure and dissection of the cystic duct, hemostasis, and transection of the cystic duct, visualization of anatomical structures, and for the sum ofall steps (p<0.05). There was no difference in the incidence of intraoperative complications between the two techniques. Given the results presented, we conclude that CL with three-port access is a viable and safe approach for the treatment of benign gallbladder diseases in dogs, making it possible to reduce the surgical access injury by avoiding the use of an additional trocar, without increasing the complexity of the procedure considering the access of four-port. CL using the multidirectional traction platform was viable in canine cadavers and similar to the corresponding technique using pneumoperitoneum for the incidence of intraoperative complications. Even though the surgical time and the degree of difficulty for the execution of the proposed technique are higher, to enable a CL technique that does not require the use ofpneumoperitoneum represents a valuable alternative for patients unable to compensate for changes caused by abdominal insufflation.
publishDate 2021
dc.date.none.fl_str_mv 2021-01-21
2022-05-25T17:47:03Z
2022-05-25T17:47:03Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/doctoralThesis
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dc.identifier.uri.fl_str_mv http://repositorio.ufsm.br/handle/1/24478
dc.identifier.dark.fl_str_mv ark:/26339/001300000ctzm
url http://repositorio.ufsm.br/handle/1/24478
identifier_str_mv ark:/26339/001300000ctzm
dc.language.iso.fl_str_mv por
language por
dc.rights.driver.fl_str_mv Attribution-NonCommercial-NoDerivatives 4.0 International
http://creativecommons.org/licenses/by-nc-nd/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Attribution-NonCommercial-NoDerivatives 4.0 International
http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Universidade Federal de Santa Maria
Brasil
Medicina Veterinária
UFSM
Programa de Pós-Graduação em Medicina Veterinária
Centro de Ciências Rurais
publisher.none.fl_str_mv Universidade Federal de Santa Maria
Brasil
Medicina Veterinária
UFSM
Programa de Pós-Graduação em Medicina Veterinária
Centro de Ciências Rurais
dc.source.none.fl_str_mv reponame:Manancial - Repositório Digital da UFSM
instname:Universidade Federal de Santa Maria (UFSM)
instacron:UFSM
instname_str Universidade Federal de Santa Maria (UFSM)
instacron_str UFSM
institution UFSM
reponame_str Manancial - Repositório Digital da UFSM
collection Manancial - Repositório Digital da UFSM
repository.name.fl_str_mv Manancial - Repositório Digital da UFSM - Universidade Federal de Santa Maria (UFSM)
repository.mail.fl_str_mv atendimento.sib@ufsm.br||tedebc@gmail.com
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