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Pesquisa : F02.784.629.529.274 [Categoria DeCS]
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Id: biblio-1280932
Autor: Rufach, Daniel; Santos, Silvia; Terebiznik, Marcelo.
Título: Simulación de intubación pediátrica con videolaringoscopio de bajo costo en contexto de pandemia por COVID-19 / Simulation of pediatric intubation using a low-cost videolaryngoscope in the setting of the COVID-19 pandemic
Fonte: Arch. argent. pediatr;119(4):270-273, agosto 2021. tab, ilus.
Idioma: en; es.
Resumo: En pacientes con infección por SARS-CoV-2 la intubación endotraqueal es un procedimiento con riesgo elevado de contagio. La videolaringoscopia complementa la protección del profesional, pero los videolaringoscopios comerciales son caros y no siempre están disponibles en las terapias intensivas pediátricas argentinas. El objetivo fue describir la práctica de intubación en un modelo de cabeza de simulación de lactante con un videolaringoscopio artesanal de bajo costo.Quince pediatras sin experiencia previa con el dispositivo participaron de una práctica de intubación en una cabeza de simulación con un videolaringoscopio artesanal. El tiempo promedio del primer intento fue de 116,4 segundos (intervalo de confianza del 95 % [IC95 %]: 84,8-148,0) y, el del siguiente fue de 44,2 segundos (IC95 %: 27,7­60,6). El tiempo disminuyó de forma significativa en el segundo intento (p : 0,0001). El dispositivo permitió la intubación exitosa en todos los intentos acortando la duración del procedimiento en la segunda práctica

In patients with SARS-CoV-2 infection, endotracheal intubation is a procedure with a high risk for transmission. A videolaryngoscopy is a supplementary level of health care provider protection, but commercial videolaryngoscopes are expensive and not always available in pediatric intensive care units in Argentina. Our objective was to describe intubation practice using an infant head mannequin with a low-cost, handcrafted videolaryngoscope.Fifteen pediatricians with no prior experience using the device participated in an intubation practice in a head mannequin with a handcrafted videolaryngoscope. The average time for the first attempt was 116.4 seconds (95 % confidence interval [CI]: 84.8-148.0) and, for the second one, 44.2 seconds (95 % CI: 27.7-60.6). Time decreased significantly for the second attempt (p: 0.0001).A successful intubation was achieved with the device in all attempts, and the procedure duration decreased with the second practice
Descritores: Pediatria/educação
Laringoscópios/economia
Treinamento por Simulação/métodos
COVID-19/prevenção & controle
Intubação Intratraqueal/instrumentação
Laringoscopia/economia
-Pediatria/economia
Fatores de Tempo
Gravação em Vídeo
Custos de Cuidados de Saúde
Competência Clínica/estatística & dados numéricos
Educação Médica Continuada/métodos
Curva de Aprendizado
COVID-19/transmissão
Internato e Residência/métodos
Intubação Intratraqueal/economia
Intubação Intratraqueal/métodos
Laringoscopia/educação
Laringoscopia/instrumentação
Laringoscopia/métodos
Manequins
Limites: Humanos
Lactente
Tipo de Publ: Estudo Observacional
Responsável: AR94.1 - Centro de Información Pediatrica


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Id: biblio-1115596
Autor: Gómez-Zuleta, Martín Alonso; Ruiz-Morales, Óscar-Fernando; Marulanda-Fernández, Hernando.
Título: Desarrollo de modelos educativos para el aprendizaje de nuevas técnicas endoscópicas: miotomía endoscópica por vía oral (POEM) y elastografía por ultrasonido endoscópico / Educational models for learning Peroral Endoscopic Myotomy (POEM) and Endoscopic Ultrasound Elastography
Fonte: Rev. colomb. gastroenterol;35(1):8-17, 2020. graf.
Idioma: es.
Resumo: Resumen Objetivos: presentar el desarrollo de modelos educativos para el aprendizaje de dos técnicas endoscópicas vigentes, ampliamente difundidas y de gran implicación clínica, con la única intención de permitir la adquisición de destrezas básicas y avanzadas a residentes y gastroenterólogos. Materiales y métodos: se idearon dos modelos sencillos, de muy bajo costo, fácilmente reproducibles y reutilizables, con los cuales se logra ejecutar la totalidad de los procedimientos descritos. Además, permiten al operador integrar el desarrollo de habilidades y la adquisición de los conceptos teóricos mínimos requeridos, sin las presiones generadas por el riesgo existente de complicaciones. Resultados: la tendencia actual a nivel mundial se conduce hacia el desarrollo de modelos de enseñanza que aceleren la curva de aprendizaje, así como de procedimientos altamente exigentes y asociados a complicaciones potencialmente graves. Con estos modelos es posible poner a prueba al endoscopista, mediante una evaluación continua y supervisada. Su implementación en unidades de gastroenterología es sencilla, sin la necesidad de una inversión superlativa o el desplazamiento a otros países. Conclusiones: se trata de un gran aporte al desarrollo científico y educativo de nuestro país, ya que la creación y la implementación de nuevas técnicas endoscópicas y su aprendizaje no deben ser asumidos por los pacientes. En este punto, estamos de acuerdo con los conceptos emitidos por diferentes asociaciones médicas respecto a que los cursos teórico-prácticos de corta duración -y en algunas ocasiones virtuales- no constituyen una formación mínima, requerida para lograr la acreditación.

Abstract Objectives: This article presents the development of educational models for learning two widespread recent endoscopic techniques which have great clinical implications. Its sole intention is to allow acquisition of basic and advanced skills by residents and gastroenterologists. Materials and methods: Two simple, very low cost, easily reproducible and reusable models were devised. Procedures are fully described in ways that allow the operator to integrate the development of skills and acquisition of the minimum theoretical concepts required without the pressures generated by risks of complications. Results: The current global trend is to develop teaching models that accelerate the learning curve for highly demanding procedures that are associated with potentially serious complications. With these models it is possible to test endoscopists through continuous supervised evaluations. Implementation by gastroenterology units can be done easily without the need for large investments or travel to other countries. Conclusions: This is a great contribution to the scientific and educational development of Colombia since neither development of new endoscopic techniques nor the process of learning how to perform them should put patients at risk. We agree with the ideas of numerous medical associations regarding theoretical-practical courses of short duration even though some virtual sessions, "do not constitute the minimum training required needed for accreditation".
Descritores: Modelos Educacionais
Técnicas de Imagem por Elasticidade
Miotomia
-Ensino
Ultrassom
Tecnologia de Baixo Custo
CYCLAMATESABDOMINAL INJURIES
Curva de Aprendizado
Limites: Humanos
Tipo de Publ: Ensaio Clínico Controlado Aleatório
Responsável: CO354 - Sociedad Colombiana de Gastroenterología


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Id: lil-794683
Autor: Kobayashi, Shuichiro; Yano, Masataka; Nakayama, Takayuki; Kitahara, Satoshi.
Título: Predictive risk factors of postoperative urinary incontinence following holmium laser enucleation of the prostate during the initial learning period
Fonte: Int. braz. j. urol;42(4):740-746, July-Aug. 2016. tab.
Idioma: en.
Resumo: ABSTRACT Purpose: To determine the predictive factors for postoperative urinary incontinence (UI) following holmium laser enucleation of the prostate (HoLEP) during the initial learning period. Patients and Methods: We evaluated 127 patients with benign prostatic hyperplasia who underwent HoLEP between January 2011 and December 2013. We recorded clinical variables, including blood loss, serum prostate-specific antigen levels, and the presence or absence of UI. Blood loss was estimated as a decline in postoperative hemoglobin levels. The predictive factors for postoperative UI were determined using a multivariable logistic regression analysis. Results: Postoperative UI occurred in 31 patients (24.4%), but it cured in 29 patients (93.5%) after a mean duration of 12 weeks. Enucleation time >100 min (p=0.043) and blood loss >2.5g/dL (p=0.032) were identified as significant and independent risk factors for postoperative UI. Conclusions: Longer enucleation time and increased blood loss were independent predictors of postoperative UI in patients who underwent HoLEP during the initial learning period. Surgeons in training should take care to perform speedy enucleation maneuver with hemostasis.
Descritores: Próstata/cirurgia
Hiperplasia Prostática/cirurgia
Incontinência Urinária/etiologia
Ressecção Transuretral da Próstata/efeitos adversos
Lasers de Estado Sólido/uso terapêutico
-Período Pós-Operatório
Índice de Massa Corporal
Modelos Logísticos
Análise Multivariada
Fatores de Risco
Antígeno Prostático Específico/sangue
Curva de Aprendizado
Hólmio
Limites: Humanos
Masculino
Idoso
Responsável: BR1.1 - BIREME


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Id: lil-794695
Autor: Favorito, Luciano A.
Título: Open retropubic prostatectomy for large prostates (Millin Surgery): Why not? It is safe! It is rapid! Complications are few and the learning curve is short!
Fonte: Int. braz. j. urol;42(4):635-636, July-Aug. 2016.
Idioma: en.
Descritores: Prostatectomia/métodos
-Tamanho do Órgão
Complicações Pós-Operatórias/etiologia
Prostatectomia/educação
Curva de Aprendizado
Limites: Humanos
Masculino
Tipo de Publ: Editorial
Responsável: BR1.1 - BIREME


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Id: lil-785715
Autor: Barbosa Junior, Humberto do Nascimento; Siqueira Junior, Tiberio Moreno; Barreto, Françualdo; Menezes, Leonardo Gomes; Luna, Mauro José Catunda; Calado, Adriano Almeida.
Título: 4-Ports endoscopic extraperitoneal radical prostatectomy: preliminary and learning curve results
Fonte: Int. braz. j. urol;42(3):438-448tab, graf.
Idioma: en.
Resumo: ABSTRACT Introduction There is a lack of studies in our national scenario regarding the results obtained by laparoscopic radical prostatectomy technique (LRP). Except for a few series, there are no consistent data on oncological, functional, and perioperative results on LRP held in Brazil. As for the LRP technique performed by extraperitoneal access (ELRP), when performed by a single surgeon, the results are even scarcer. Objective To analyze the early perioperative and oncologic results obtained with the ELRP, throughout the technical evolution of a single surgeon. Patients and methods A non-randomized retrospective study was held in a Brazilian hospital of reference. In the 5-year period, 115 patients underwent the ELRP procedure. Patients were divided into two groups, the first 57 cases (Group 1) and the following 58 cases, (Group 2). A comparative analysis between the groups of efficacy results and ELRP safety was carried out. Results The average age of patients was 62.8 year-old and the PSA of 6.9ng/dl. The total surgery time was 135.8 minutes on average, and the urethral-bladder anastomosis was 21.9 min (23.3 min versus 20.7 min). The positive surgical margins (PSM) rate was 17.1%, showing no difference between groups (16.4% versus 17.9%; p=0.835). There was statistical difference between the groups in relation to the anastomosis time, estimated blood loss and the withdrawal time of the urinary catheter. Conclusion The ELRP technique proved to be a safe and effective procedure in the treatment of prostate cancer, with low morbidity.
Descritores: Prostatectomia/métodos
Laparoscopia/métodos
Curva de Aprendizado
-Complicações Pós-Operatórias
Período Pós-Operatório
Prostatectomia/educação
Prostatectomia/estatística & dados numéricos
Neoplasias da Próstata/cirurgia
Neoplasias da Próstata/patologia
Fatores de Tempo
Brasil
Anastomose Cirúrgica
Estudos Retrospectivos
Resultado do Tratamento
Laparoscopia/educação
Laparoscopia/estatística & dados numéricos
Período Perioperatório
Gradação de Tumores
Duração da Cirurgia
Pessoa de Meia-Idade
Limites: Humanos
Masculino
Idoso
Responsável: BR1.1 - BIREME


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Pompeo, Antônio Carlos Lima
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Id: lil-782847
Autor: Carneiro, Arie; Sakuramoto, Paulo; Wroclawski, Marcelo Langer; Forseto, Pedro Herminio; Julio, Alexandre Den; Bautzer, Carlos Ricardo Doi; Lins, Leonardo Monte Marques; Kataguiri, Andre; Yamada, Fernanda Batistini; Teixeira, Gabriel Kushiyama; Tobias-Machado, Marcos; Pompeo, Antonio Carlos Lima.
Título: Open suprapubic versus retropubic prostatectomy in the treatment of benign prostatic hyperplasia during resident's learning curve: a randomized controlled trial
Fonte: Int. braz. j. urol;42(2):284-292, Mar.-Apr. 2016. tab, graf.
Idioma: en.
Resumo: ABSTRACT Purpose: This study compared the suprapubic (SP) versus retropubic (RP) prostatectomy for the treatment of large prostates and evaluated perioperative surgical morbidity and improvement of urinary symptoms. Materials and Methods: In this single centre, prospective, randomised study, 65 consecutive patients with LUTS and surgical indication with prostate volume greater than 75g underwent open prostatectomy to compare the RP (32 patients) versus SP (33 patients) technique. Results: The SP group exhibited a higher incidence of complications (p=0.002). Regarding voiding pattern analysis (IPSS and flowmetry), both were significantly effective compared to pre-treatment baseline. The RP group parameters were significantly better, with higher peak urinary flow (SP: 16.77 versus RP: 23.03mL/s, p=0.008) and a trend of lower IPSS score (SP: 6.67 versus RP 4.14, p=0.06). In a subgroup evaluation of patients with prostate volumes larger than 100g, blood loss was lower in those undergoing SP prostatectomy (p=0.003). Patients with prostates smaller than 100g in the SP group exhibited a higher incidence of low grade late complications (p=0.004). Conclusions: The SP technique was related to a higher incidence of minor complications in the late postoperative period. High volume prostates were associated with increased bleeding when the RP technique was utilized. The RP prostatectomy was associated with higher peak urinary flow and a trend of a lower IPSS Score.
Descritores: Prostatectomia/métodos
Hiperplasia Prostática/cirurgia
Curva de Aprendizado
-Complicações Pós-Operatórias
Próstata/cirurgia
Prostatectomia/educação
Prostatectomia/efeitos adversos
Fatores de Tempo
Estudos Prospectivos
Resultado do Tratamento
Estatísticas não Paramétricas
Sintomas do Trato Urinário Inferior/cirurgia
Duração da Cirurgia
Complicações Intraoperatórias
Corpo Clínico Hospitalar/educação
Pessoa de Meia-Idade
Limites: Humanos
Masculino
Idoso
Idoso de 80 Anos ou mais
Tipo de Publ: Ensaio Clínico Controlado Aleatório
Responsável: BR1.1 - BIREME


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Id: lil-777335
Autor: Tobias-Machado, Marcos; Mitre, Anuar Ibrahim; Rubinstein, Mauricio; Costa, Eduardo Fernandes da; Hidaka, Alexandre Kyoshi.
Título: Robotic-assisted radical prostatectomy learning curve for experienced laparoscopic surgeons: does it really exist?
Fonte: Int. braz. j. urol;42(1):83-89, Jan.-Feb. 2016. tab.
Idioma: en.
Resumo: ABSTRACT Background Robotic-assisted radical prostatectomy (RALP) is a minimally invasive procedure that could have a reduced learning curve for unfamiliar laparoscopic surgeon. However, there are no consensuses regarding the impact of previous laparoscopic experience on the learning curve of RALP. We report on a functional and perioperative outcome comparison between our initial 60 cases of RALP and last 60 cases of laparoscopic radical prostatectomy (LRP), performed by three experienced laparoscopic surgeons with a 200+LRP cases experience. Materials and Methods Between January 2010 and September 2013, a total of 60 consecutive patients who have undergone RALP were prospectively evaluated and compared to the last 60 cases of LRP. Data included demographic data, operative duration, blood loss, transfusion rate, positive surgical margins, hospital stay, complications and potency and continence rates. Results The mean operative time and blood loss were higher in RALP (236 versus 153 minutes, p<0.001 and 245.6 versus 202ml p<0.001). Potency rates at 6 months were higher in RALP (70% versus 50% p=0.02). Positive surgical margins were also higher in RALP (31.6% versus 12.5%, p=0.01). Continence rates at 6 months were similar (93.3% versus 89.3% p=0.43). Patient’s age, complication rates and length of hospital stay were similar for both groups. Conclusions Experienced laparoscopic surgeons (ELS) present a learning curve for RALP only demonstrated by longer operative time and clinically insignificant blood loss. Our initial results demonstrated similar perioperative and functional outcomes for both approaches. ELS were able to achieve satisfactory oncological and functional results during the learning curve period for RALP.
Descritores: Prostatectomia/métodos
Neoplasias da Próstata/cirurgia
Laparoscopia/métodos
Curva de Aprendizado
Procedimentos Cirúrgicos Robóticos/métodos
-Complicações Pós-Operatórias
Prostatectomia/reabilitação
Neoplasias da Próstata/patologia
Neoplasias da Próstata/reabilitação
Fatores de Tempo
Reprodutibilidade dos Testes
Estudos Retrospectivos
Perda Sanguínea Cirúrgica
Resultado do Tratamento
Laparoscopia/reabilitação
Duração da Cirurgia
Procedimentos Cirúrgicos Robóticos/reabilitação
Cirurgiões
Tempo de Internação
Pessoa de Meia-Idade
Limites: Humanos
Masculino
Idoso
Responsável: BR1.1 - BIREME


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Id: biblio-892883
Autor: Dias Neto, José Anastácio; Dall'oglio, Marcos F; Colombo J, João Roberto; Coelho, Rafael F; Nahas, William Carlos.
Título: The influence of previous robotic experience in the initial learning curve of laparoscopic radical prostatectomy
Fonte: Int. braz. j. urol;43(5):871-879, Sept.-Oct. 2017. tab, graf.
Idioma: en.
Projeto: FAPESP -\"Fundação de Amparo a Pesquisa do Estado de São Paulo\".
Resumo: ABSTRACT Introduction: This study analyzed the impact of the experience with Robotic-Assisted Laparoscopic Prostatectomy (RALP) on the initial experience with Laparoscopic Radical Prostatectomy (LRP) by examining perioperative results and early outcomes of 110 patients. LRPs were performed by two ro-botic fellowship trained surgeons with daily practice in RALP. Patients and Methods: 110 LRP were performed to treat aleatory selected patients. The patients were divided into 4 groups for prospective analyses. A transperitoneal approach that simulates the RALP technique was used. Results: The median operative time was 163 minutes (110-240), and this time significantly decreased through case 40, when the time plateaued (p=0.0007). The median blood loss was 250mL. No patients required blood transfusion. There were no life-threatening complications or deaths. Minor complications were uniformly distributed along the series (P=0.6401). The overall positive surgical margins (PSM) rate was 28.2% (20% in pT2 and 43.6% in pT3). PSM was in the prostate apex in 61.3% of cases. At the 12-month follow-up, 88% of men were continent (0-1 pad). Conclusions: The present study shows that there are multiple learning curves for LRP. The shallowest learning curve was seen for the operative time. Surgeons transitioning between the RALP and LRP techniques were considered competent based on the low perioperative complication rate, absence of major complications, and lack of blood transfusions. This study shows that a learning curve still exists and that there are factors that must be considered by surgeons transitioning between the two techniques.
Descritores: Prostatectomia/métodos
Neoplasias da Próstata/cirurgia
Competência Clínica
Laparoscopia/métodos
Curva de Aprendizado
Procedimentos Cirúrgicos Robóticos
-Estudos Prospectivos
Resultado do Tratamento
Duração da Cirurgia
Pessoa de Meia-Idade
Limites: Humanos
Masculino
Responsável: BR1.1 - BIREME


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Id: biblio-892877
Autor: Morris, Christopher; Hoogenes, Jen; Shayegan, Bobby; Matsumoto, Edward D.
Título: Towards development and validation of an intraoperative assessment tool for robot-assisted radical prostatectomy training: results of a Delphi study
Fonte: Int. braz. j. urol;43(4):661-670, July-Aug. 2017. tab, graf.
Idioma: en.
Resumo: ABSTRACT Introduction As urology training shifts toward competency-based frameworks, the need for tools for high stakes assessment of trainees is crucial. Validated assessment metrics are lacking for many robot-assisted radical prostatectomy (RARP). As it is quickly becoming the gold standard for treatment of localized prostate cancer, the development and validation of a RARP assessment tool for training is timely. Materials and methods We recruited 13 expert RARP surgeons from the United States and Canada to serve as our Delphi panel. Using an initial inventory developed via a modified Delphi process with urology residents, fellows, and staff at our institution, panelists iteratively rated each step and sub-step on a 5-point Likert scale of agreement for inclusion in the final assessment tool. Qualitative feedback was elicited for each item to determine proper step placement, wording, and suggestions. Results Panelist's responses were compiled and the inventory was edited through three iterations, after which 100% consensus was achieved. The initial inventory steps were decreased by 13% and a skip pattern was incorporated. The final RARP stepwise inventory was comprised of 13 critical steps with 52 sub-steps. There was no attrition throughout the Delphi process. Conclusions Our Delphi study resulted in a comprehensive inventory of intraoperative RARP steps with excellent consensus. This final inventory will be used to develop a valid and psychometrically sound intraoperative assessment tool for use during RARP training and evaluation, with the aim of increasing competency of all trainees.
Descritores: Prostatectomia/educação
Competência Clínica
Procedimentos Cirúrgicos Robóticos/educação
Treinamento por Simulação/métodos
-Prostatectomia/métodos
Análise e Desempenho de Tarefas
Urologia/educação
Técnica Delfos
Curva de Aprendizado
Procedimentos Cirúrgicos Robóticos/métodos
Internato e Residência
Pessoa de Meia-Idade
Limites: Humanos
Masculino
Adulto
Tipo de Publ: Estudo de Validação
Responsável: BR1.1 - BIREME


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Id: biblio-840815
Autor: Feng, Lang; Song, Jian; Zhang, Daoxin; Tian, Ye.
Título: Evaluation of the learning curve for transurethral plasmakinetic enucleation and resection of prostate using a mentor-based approach
Fonte: Int. braz. j. urol;43(2):245-255, Mar.-Apr. 2017. tab, graf.
Idioma: en.
Projeto: Beijing Municipal Administration.
Resumo: ABSTRACT Objective To analyze the mentor-based learning curve of one single surgeon with transurethral plasmakinetic enucleation and resection of prostate (PKERP) prospectively. Materials and Methods Ninety consecutive PKERP operations performed by one resident under the supervision of an experienced endourologist were studied. Operations were analyzed in cohorts of 10 cases to determine when a plateau was reached for the variables such as operation efficiency, enucleation efficiency and frequency of mentor advice (FMA). Patient demographic variables, perioperative data, complications and 12-month follow-up data were analyzed and compared with the results of a senior urologist. Results The mean operative efficiency and enucleation efficiency increased from a mean of 0.49±0.09g/min and 1.11±0.28g/min for the first 10 procedures to a mean of 0.63±0.08g/min and 1.62±0.36g/min for case numbers 31-40 (p=0.003 and p=0.002). The mean value of FMA decreased from a mean of 6.7±1.5 for the first 10 procedures to a mean of 2.8±1.2 for case numbers 31-40 (p<0.01). The senior urologist had a mean operative efficiency and enucleation efficiency equivalent to those of the senior resident after 40 cases. There was significant improvement in 3, 6 and 12 month’s parameter compared with preoperative values (p<0.001). Conclusions PKERP can be performed safely and efficiently even during the initial learning curve of the surgeon when closely mentored. Further well-designed trials with several surgeons are needed to confirm the results.
Descritores: Próstata/cirurgia
Mentores
Ressecção Transuretral da Próstata/educação
Ressecção Transuretral da Próstata/métodos
Curva de Aprendizado
-Complicações Pós-Operatórias
Hiperplasia Prostática/cirurgia
Qualidade de Vida
Fatores de Tempo
Estudos Prospectivos
Reprodutibilidade dos Testes
Análise de Variância
Seguimentos
Resultado do Tratamento
Lasers de Estado Sólido/uso terapêutico
Duração da Cirurgia
Pessoa de Meia-Idade
Limites: Humanos
Masculino
Idoso
Idoso de 80 Anos ou mais
Responsável: BR1.1 - BIREME



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