Avaliação das respostas clínica e inflamatória sistêmicas na colec istectomia pelas vias de acesso portal único umbilical, NOTES transvaginal, laparoscópica e laparotômica: estudo experimental em suínos
Data
2013
Autores
Caetano Junior, Elesiario Marques 
Orientadores
Linhares, Marcelo Moura
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Avaliar as respostas clinica e inflamatoria do trauma cirurgico provocado pela colecistectomia pela vias de acesso portal unico umbilical, NOTES transvaginal, laparoscopia e laparotomia. Metodo: Vinte e oito femeas suinas foram distribuidas em quatro grupos de sete animais e submetidas a colecistectomia pelas vias portal unico umbilical, laparoscopica, laparotomica e NOTES exclusivamente transvaginal. Um grupo com cinco animais serviu de controle (Sham). Os animais foram monitorados e avaliados no transoperatorio quanto aos tempos anestesico e cirurgico, bem como a presenca de complicacoes. No pos-operatorio, foram avaliados quanto aos tempos de deambulacao e alimentacao, e a presenca de intercorrencias clinicas. Dosagens de procalcitonina, PCR e IFN- foram feitas no pre e pos-operatorio imediato, 2º e 7º dias de pos-operatorio, quando os animais foram sacrificados e necropsiados. Resultados: Todos os procedimentos foram realizados com sucesso conforme proposto em cada grupo. Houve apenas casos de complicacoes pequenas no transoperatorio, do tipo perfuracao da vesicula biliar e sangramento no leito hepatico em todos os grupos. O tempo anestesico-cirurgico foi maior no grupo NOTES vaginal em relacao aos demais grupos (p<0,001). Os tempos de recuperacao pos-anestesica, deambulacao, alimentacao e evolucao clinica foram semelhantes em todos os grupos. Os niveis de procalcitonina, PCR e IFN- tambem foram semelhantes entre eles. Nos achados da necropsia, apenas aderencias foram encontradas, sem diferenca entre os grupos. Conclusao: A colecistectomia com portal unico mostrou-se efetiva e semelhante a via laparoscopica e convencional. As vias de acesso portal unico umbilical e NOTES totalmente transvaginal mostraram-se factiveis e seguras, quando comparadas as vias de acesso laparoscopica e laparotomica. O tempo cirurgico foi maior na via NOTES em relacao as vias laparoscopica, portal unico umbilical e laparotomica. Nao houve diferenca significante da resposta inflamatoria entre os grupos estudados com base nos niveis sericos de PCR, IFN- e procalcitonina.
Abstract Objective: To evaluate clinical and inflammatory responses of the surgical trauma caused by single-port-access cholecystectomy through umbilical incision, transvaginal NOTES, laparoscopy and laparotomy. Method: Twenty-eight female pigs were divided into four groups of seven animals each and submitted to a laparoscopic and laparotomy umbilical single-port-access cholecystectomy and transvaginal NOTES exclusively. A group of five animals served as controls (Sham). The animals were monitored and evaluated intraoperatively regarding the anesthesia and surgical procedure times, as well as for the presence of complications. Postoperatively, they were evaluated regarding time to ambulation and feeding, and the presence of clinical events. Procalcitonin, CRP, and IFN level measurements were performed pre-and post-operatively, in the 2nd and 7th days after surgery, when the animals were sacrificed and necropsied. Results: All procedures were successfully performed as proposed in each group. There were only minor cases of complications during surgery, as the type of gallbladder perforation and bleeding from liver bed in all groups. The anesthesia and surgical procedure times were higher in the vaginal NOTES group when compared to the others (p <0.001). The periods of recovery after anesthesia, ambulation, feeding and the clinical evolution were similar in all groups. The procalcitonin, CRP, and IFN- levels were also similar between them. In the necropsy findings, only adhesions were found, with no difference between the groups. Conclusion: single-port cholecystectomy was effective and similar to laparoscopic and conventional surgeries. Single-port-umbilical access and transvaginal NOTES proved to be feasible and safe when compared to the laparoscopy and laparotomy access. The surgery time was greater via the NOTES approach regarding laparoscopy, single umbilical port and laparotomy approach. No significant inflammatory response between the analyzed groups based on the serum levels of CRP, procalcitonin and IFN- was observed.
Abstract Objective: To evaluate clinical and inflammatory responses of the surgical trauma caused by single-port-access cholecystectomy through umbilical incision, transvaginal NOTES, laparoscopy and laparotomy. Method: Twenty-eight female pigs were divided into four groups of seven animals each and submitted to a laparoscopic and laparotomy umbilical single-port-access cholecystectomy and transvaginal NOTES exclusively. A group of five animals served as controls (Sham). The animals were monitored and evaluated intraoperatively regarding the anesthesia and surgical procedure times, as well as for the presence of complications. Postoperatively, they were evaluated regarding time to ambulation and feeding, and the presence of clinical events. Procalcitonin, CRP, and IFN level measurements were performed pre-and post-operatively, in the 2nd and 7th days after surgery, when the animals were sacrificed and necropsied. Results: All procedures were successfully performed as proposed in each group. There were only minor cases of complications during surgery, as the type of gallbladder perforation and bleeding from liver bed in all groups. The anesthesia and surgical procedure times were higher in the vaginal NOTES group when compared to the others (p <0.001). The periods of recovery after anesthesia, ambulation, feeding and the clinical evolution were similar in all groups. The procalcitonin, CRP, and IFN- levels were also similar between them. In the necropsy findings, only adhesions were found, with no difference between the groups. Conclusion: single-port cholecystectomy was effective and similar to laparoscopic and conventional surgeries. Single-port-umbilical access and transvaginal NOTES proved to be feasible and safe when compared to the laparoscopy and laparotomy access. The surgery time was greater via the NOTES approach regarding laparoscopy, single umbilical port and laparotomy approach. No significant inflammatory response between the analyzed groups based on the serum levels of CRP, procalcitonin and IFN- was observed.
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Citação
CAETANO JUNIOR, Elisiário Marques. Avaliação das respostas clínica e inflamatória sistêmicas na colec istectomia pelas vias de acesso portal único umbilical, NOTES transvaginal, laparoscópica e laparotômica: estudo experimental em suínos. 2013. 111f. Tese (Doutorado em Ciência Cirúrgica Interdisciplinar) – Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 2013.