Navegando por Palavras-chave "Surgery, minimally invasive"

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    Avaliação do posicionamento da agulha de veress durante o estabelecimento do pneumoperitônio pela técnica fechada, em porcos
    (Colégio Brasileiro de Cirurgiões, 2004-10-01) Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Guindalini, Rodrigo Santa Cruz [UNIFESP]; Azevedo, Otávio Cansanção [UNIFESP]; Paiva, Vanessa Carla [UNIFESP]; Delorenzo, Aline; Moreira, Márcia Bento [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Sociedade Brasileira de Cirurgia Laparoscópica; Hospital do Servidor Público do Estado de São Paulo
    BACKGROUND: To establish reliable evidence regarding the adequate positioning of the tip of a Veress needle in the interior of the peritoneal sac during the establishment of the pneumoperitoneum by the closed technique. METHODS: In 11 pigs, the needle was introduced in the peritoneal sac through the left hipocondrium. Tests of positioning of the tip of the instrument were carried out. Gas (CO2) was injected, and pressures, flows and volumes were registered periodically. The correct intraperitoneal position of the needle was confirmed and, subsequently, removed, being reintroduced in the right hipocondrium and placed under direct vision in the pre-peritoneal space. The same parameters were surveyed. RESULTS: The test of the draining was always positive in the peritoneum. Resistance to the infusion of serum in the peritoneal sac was not observed, but resistance was detected on 45.5% of cases in the pre-peritoneal space. Some serum was recouped in 63.5% of cases in the peritoneal sac and in 54.5% in the pre-peritoneal space. The dripping flowed freely in 66.6% of cases in the peritoneal sac and in 45.5% in the pre-peritoneal space. In the peritoneal sac, = 5mmHg initial pressure increased gradually during 120 seconds until reaching 15 mmHg. In the pre-peritoneal space, the initial pressure was of 15mmHg and oscillated between 12 and 15mmHg. The volume of gas injected was of 1500 ml in the peritoneal sac and of 100 ml in the pre-peritoneal space. CONCLUSION: Initial pressure of ±5mmHg is indicative of the tip of the needle being placed in the peritoneal sac, inside of which there should fit ten times more gas than in the pre-peritoneal space. When the tip of the Veress needle is placed in the interior of the peritoneal sac, the increase of intraperitoneal pressures and volumes can be predicted by statistics.
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    Revascularização do miocárdio sem circulação extracorpória: análise dos resultados em 15 anos de experiência
    (Sociedade Brasileira de Cirurgia Cardiovascular, 1996-12-01) Buffolo, Enio [UNIFESP]; Andrade, José Carlos S [UNIFESP]; Branco, João Nelson Rodrigues [UNIFESP]; Teles, Carlos Alberto [UNIFESP]; Gomes, Walter José [UNIFESP]; Aguiar, Luciano F [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Myocardial revascularization without cardiopulmonary bypass is now a subject of increasing interest. The purpose of this paper is to present the results obtained during 15 years of experience. From September 1981 till March 1996,1549 patients we operated on without the use of cardiopulmonary bypass with an applicability of this alternative around 18% of the total revascularized patients in this period. The ages varied from 28 to 86 years (medium 57) with 1126 males and 423 females. The number of grafts varied from 1 to 5 (medium 1.7 grafts/patient). The technique did not constitute special limitation to use arterial grafts. The thoracic internal arteries were used 1140 times. In 1515 patients the revascularization was achieved through medsternotomy and in 34 through a minor left anterior thoracotomy. The mortality rate was 2.4% (38/1549) the main primary cause of death, low cardiac output in patients operated under acute ischemia after failed angioplasty or evolving mycardial infarction. In 8 patients the revascularization was performed under intraaortic balloon pump. The results of this 15 years experience permit the conclusion that myocardial revascularization without extracorporeal circulation is an excelent alternative of surgical treatment of coronary artery disease for a subset of patients with lower mortality and morbidity being specially indicated in high risk patients.