Navegando por Palavras-chave "minimally invasive"
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- ItemAcesso aberto (Open Access)Acesso endoscópico transnasal aos tumores selares(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2007-08-01) Santos, Rodrigo de Paula [UNIFESP]; Zymberg, Samuel Tau [UNIFESP]; Abucham, Julio [UNIFESP]; Gregório, Luiz Carlos [UNIFESP]; Weckx, Luc Louis Maurice [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Transsphenoidal surgery for sellar region tumors is traditionally done only by neurosurgeons. The use of endoscopes has permitted a direct transnasal approach to the sphenoidal sinus, without dissection of the septal mucosa, reducing postoperative morbidity. AIM: The purpose of this study was to assess the technical difficulties, and per and postoperative complications of the otolaryngological management of the endoscopic transnasal approach to the sellar region. MATERIAL AND METHOD: 159 patients undergoing sellar region surgery between March 2001 and December 2006 were assessed retrospectively. 91 patients who underwent 95 endoscopic transnasal procedures were included in this study. Study design: a clinical retrospective study. RESULTS: The endoscopic transnasal technique was feasible for every patient, independent of age, anatomical variations, tumor characteristics, tumor etiology, and previous surgical history. There was no need to remove the middle turbinate or septal deviations in any of the cases. The most significant peroperative complication was CSF leak during tumor removal (13.68%). Postoperative complications were: nasal bleeding (8.42%), CSF leak (8.42%), and meningitis (2.19). CONCLUSION: The transnasal endoscopic approach was accomplished with minimal invasion, preserving nasal structures in all 95 procedures, independent of age, anatomical variations, tumor characteristics,tumor etiology, and previous surgical history.
- ItemAcesso aberto (Open Access)Acucise™ endopyelotomy in a porcine model: procedure standardization and analysis of safety and immediate efficacy(Sociedade Brasileira de Urologia, 2004-02-01) Andreoni, Cássio [UNIFESP]; Srougi, Miguel [UNIFESP]; Ortiz, Valdemar [UNIFESP]; Clayman, Ralph V.; Universidade Federal de São Paulo (UNIFESP); University of California Division of UrologyPURPOSE: The study here presented was done to test the technical reliability and immediate efficacy of the Acucise device using a standardized technique. MATERIALS AND METHODS: 56 Acucise procedures were performed in pigs by a single surgeon who used a standardized technique: insert 5F angiographic catheter bilaterally up to the midureter, perform retrograde pyelogram, Amplatz super-stiff guidewire is advanced up to the level of the renal pelvis, angiographic catheters are removed, Acucise catheter balloon is advanced to the ureteropelvic junction (UPJ) level, the super-stiff guide-wire is removed and the contrast medium in the renal pelvis is aspirated and replaced with distilled water, activate Acucise at 75 watts of pure cutting current, keep the balloon fully inflated for 10 minutes, perform retrograde ureteropyelogram to document extravasation, remove Acucise catheter and pass an ureteral stent and remove guide-wire. RESULTS: In no case did the Acucise device present malfunction. The electrocautery activation time was 2.2 seconds (ranging from 2 to 4 seconds). The extravasation of contrast medium, visible by fluoroscopy, occurred in 53 of the 56 cases (94.6%). In no case there was any evidence of intraoperative hemorrhage. CONCLUSIONS: This study revealed that performing Acucise endopyelotomy routinely in a standardized manner could largely preclude intraoperative device malfunction and eliminate complications while achieving a successful incision in the UPJ. With the guidelines that were used in this study, we believe that Acucise endopyelotomy can be completed successfully and safely in the majority of selected patients with UPJ obstruction.
- ItemSomente MetadadadosAnatomic variations of the frontal sinus(Georg Thieme Verlag Kg, 2003-02-01) Ponde, J. M.; Metzger, P.; Amaral, G.; Machado, M.; Prandini, M.; Escola Bahiana Med; Universidade Federal de São Paulo (UNIFESP)Introduction: Minimally invasive approaches are increasing in popularity. We have undertaken an anatomic and radiological study of the frontal sinus that is frequently involved in the super-cilliary minicraniotomy used to access the parasellar region.Objective: We wanted to evaluate the prevalence and morphological characteristics of the frontal sinus in a certain population sample.Methods: 98 randomly assigned individuals were subjected to CT examinations. the antero-posterior diameter, sagittal diameter, transverse diameter and total volume of the frontal sinus were calculated.Results: the frontal sinus tended to be larger in males than in females with the exception of the transverse diameter (p < 0.10).Conclusion: Knowledge of the anatomic variations of the frontal sinus is important in surgical approaches through the superciliary arc in order to avoid complications such as infections and CSF fistula.
- ItemAcesso aberto (Open Access)Identificação do ramo externo do nervo laríngeo superior na tireoidectomia minimamente invasivo vídeo-assistida(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2005-06-01) Dedivitis, Rogério Aparecido [UNIFESP]; Guimarães, André V.; Universidade Federal de São Paulo (UNIFESP); Universidade Metropolitana de SantosThe minimally invasive video-assisted thyroidectomy (MIVAT) without gas infusion is considered safe and has advantages in terms of cosmetic results compared to the conventional approach. AIM: to present our findings regarding the identification of the external branch of the superior laryngeal nerve (EBSLN) during MIVAT. STUDY DESIGN: Transversal cohort study. MATERIAL AND METHOD: twelve patients underwent hemithyroidectomy for thyroid nodular disease through MIVAT method. The upper pedicle of the thyroid was dissected under the magnified view at 0-degree five-millimeter endoscope in order to achieve the identification of EBSLN in all cases. RESULTS: We identified 10 (83.3%) EBSLN out of 12 cases. The nerve ran medially to the branches of the superior thyroid artery in 8 cases (80%) and crossed anteriorly in 2 (20%). CONCLUSIONS: We identified the EBSLN in 83.3% of the cases, whose course was medial to the branches of the superior thyroid artery in 80% and crossing anteriorly in 20%. The ligation of the upper pedicle of the thyroid can be performed under direct view of the EBSLN.
- ItemSomente MetadadadosMinimally invasive pituitary surgery in a hemorrhagic necrosis of adenoma during pregnancy(Georg Thieme Verlag Kg, 2003-06-01) Gondim, Jackson; Ramos, Francisco; Pinheiro, Israel; Schops, Michele; Tella Junior, Oswaldo Inácio [UNIFESP]; Gen Hosp; Fed Univ Ceara; Universidade Federal de São Paulo (UNIFESP)A 29-year-old woman with a prolactin microadenoma was under good control with bromocriptine (BCP) therapy until she became pregnant, when the treatment was stopped. During the third trimester of pregnancy the patient presented a unilateral visual loss and intermittent headaches. BCP was restarted and one week later she developed a complete ophthalmoplegia on the other side. The patient was submitted to an endoscopic transnasal transeptal resection of a hematoma and tumoral tissue in the pituitary region. One month after surgery, at 39 weeks of gestation, the patient spontaneously delivered a healthy girl weighing 3 kg, with an Apgar score of 9 and 10 at five minutes. This is the first case in the literature of a pregnant woman with second and third cranial nerve lesions, submitted to minimally invasive neuroendoscopic transnasal transsphenoidal approach in the third trimester of pregnancy.
- ItemSomente MetadadadosRadiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article(Amer Assoc Neurological Surgeons, 2013-07-01) Marchi, Luis [UNIFESP]; Abdala, Nitamar [UNIFESP]; Oliveira, Leonardo; Amaral, Rodrigo; Coutinho, Etevaldo; Pimenta, Luiz; Universidade Federal de São Paulo (UNIFESP); Inst Patol Coluna; Univ Calif San DiegoObject. Indirect decompression of the neural structures through interbody distraction and fusion in the lumbar spine is feasible, but cage subsidence may limit maintenance of the initial decompression. the influence of interbody cage size on subsidence and symptoms in minimally invasive lateral interbody fusion is heretofore unreported. the authors report the rate of cage subsidence after lateral interbody fusion, examine the clinical effects, and present a subsidence classification scale.Methods. the study was performed as an institutional review board approved prospective, nonrandomized, comparative, single-center radiographic and clinical evaluation. Stand-alone short-segment (1- or 2-level) lateral lumbar interbody fusion was investigated with 12 months of postoperative follow-up. Two groups were compared. Forty-six patients underwent treatment at 61 lumbar levels with standard interbody cages (18 mm anterior/posterior dimension), and 28 patients underwent treatment at 37 lumbar levels with wide cages (22 mm). Standing lateral radiographs were used to measure segmental lumbar lordosis, disc height, and rate of subsidence. Subsidence was classified using the following scale: Grade 0, 0%-24% loss of postoperative disc height; Grade I, 25%-49%; Grade II, 50%-74%; and Grade III, 75%-100%. Fusion status was assessed on CT scanning, and pain and disability were assessed using the visual analog scale and Oswestry Disability Index. Complications and reoperations were recorded.Results. Pain and disability improved similarly in both groups. While significant gains in segmental lumbar lordosis and disc height were observed overall, the standard group experienced less improvement due to the higher rate of interbody graft subsidence. A difference in the rate of subsidence between the groups was evident at 6 weeks (p = 0.027), 3 months (p = 0.042), and 12 months (p = 0.047). At 12 months, 70% in the standard group and 89% in the wide group had Grade 0 or I subsidence, and 30% in the standard group and 11% in wide group had Grade II or III subsidence. Subsidence was detected early (6 weeks), at which point it was correlated with transient clinical worsening, although progression of subsidence was not observed after the 6-week time point. Moreover, subsidence occurred predominantly (68%) in the inferior endplate. Fusion rate was not affected by cage dimension (p > 0.999) or by incidence of subsidence (p = 0.383).Conclusions. Wider cages avoid subsidence and better restore segmental lordosis in stand-alone lateral interbody fusion. Cage subsidence is identified early in follow-up and can be accessed using the proposed classification scale.
- ItemAcesso aberto (Open Access)Supraorbital eyebrow approach to skull base lesions(Academia Brasileira de Neurologia - ABNEURO, 2002-06-01) Fernandes, Yvens Barbosa; Maitrot, Daniel; Kehrli, Pierre; Tella Jr, Oswaldo Ignácio De [UNIFESP]; Ramina, Ricardo; Borges, Guilherme; Universidade Estadual de Campinas (UNICAMP); Hôpital Hautepierre; Universidade Federal de São Paulo (UNIFESP)We report our experience with a supraorbital eyebrow minicraniotomy. This technique is suitable to lesions situated in the region of the anterior fossa, suprasellar cisterns, parasellar region and Sylvian fissure. A 50 mm incision in the eyebrow and a supraorbital minicraniotomy is performed. Sixteem patients harboring different lesions were operated on with good postoperative and cosmetic results. We conclude that this approach is safe and useful in selected cases.