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Malafaia, Osvaldo
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Id: biblio-949217
Autor: Zilberstein, Bruno; Malafaia, Osvaldo; Czecko, Nicolau Gregori.
Título: The cost of being a doctor / O custo de ser médico
Fonte: ABCD arq. bras. cir. dig;31(2):e1368, 2018.
Idioma: en.
Descritores: Prática Profissional/tendências
Cirurgiões/tendências
-Procedimentos Cirúrgicos do Sistema Digestório/tendências
Brasil
Limites: História do Século XXI
Tipo de Publ: Artigo Histórico
Editorial
Responsável: BR1.1 - BIREME


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Id: biblio-1130527
Autor: Silva, Natasha Gabriela Oliveira da; Barbosa, Ana Beatriz Marques; Silva, Nathalie de Almeida; Araújo, Diego Neves; Assis, Thiago de Oliveira.
Título: Anatomical variations of the superior mesenteric artery and its clinical and surgical implications in humans / Variações anatômicas da artéria mesentérica superior e suas implicações clínicas e cirúrgicas em humanos
Fonte: ABCD arq. bras. cir. dig;33(2):e1508, 2020. tab, graf.
Idioma: en.
Resumo: ABSTRACT Introduction: Superior mesenteric artery (SMA) usually arises from the abdominal aorta, just below the celiac trunk and it supplies the midgut-derived embryonic structures. Anatomical variations in this vessel contribute to problems in the formation and/or absorption of this part of the intestine and its absence has been recognized as the cause of congenital duodenojejunal atresia. Objective: To analyze SMA anatomical variations in humans and the possible associated clinical and surgical implications. Methods: This is a systematic review of papers indexed in PubMed, SciELO, Springerlink, Science Direct, Lilacs, and Latindex databases. The search was performed by two independent reviewers between September and December 2018. Original studies involving SMA variations in humans were included. SMA presence/absence, level, place of origin and its terminal branches were considered. Results: At the end of the search, 18 studies were selected, characterized as for the sample, method to evaluate the anatomical structure and main results. The most common type of variation was when SMA originated from the right hepatic artery (6.13%). Two studies (11.11%) evidenced the inferior mesenteric artery originating from the SMA, whereas other two (11.11%) found the SMA sharing the same origin of the celiac trunk. Conclusion: SMA variations are not uncommon findings and their reports evidenced through the scientific literature demonstrate a great role for the development of important clinical conditions, making knowledge about this subject relevant to surgeons and professionals working in this area.

RESUMO Introdução: A artéria mesentérica superior (AMS), normalmente, tem sua origem a partir da aorta abdominal, um pouco abaixo do tronco celíaco e é responsável pela irrigação das estruturas derivadas, embrionariamente, do intestino médio. Variações anatômicas nesse vaso contribui para defeitos na formação e/ou absorção dessa parte do intestino e a sua ausência tem sido reconhecida como a causa da atresia duodenojejunal congênita. Objetivo: Analisar as variações anatômicas dela em humanos e as possíveis implicações clínicas e cirúrgicas associadas. Métodos: Trata-se de uma revisão sistemática de artigos indexados nas bases de dados PubMed, SciELO, Springerlink, Scienc Direct, Lilacs e Latindex. A busca ocorreu por dois revisores independentes entre setembro e dezembro de 2018. Foram incluídos artigos originais envolvendo as variações da AMS em humanos. Considerou-se para este estudo a presença/ausência da AMS, o nível, local de origem e seus ramos terminais. Resultados: Ao final da busca foram selecionados 18 artigos, caracterizados quanto à amostra, método para avaliar a estrutura anatômica e principais resultados. O tipo de variação mais comum foi aquele cuja AMS se originou da artéria hepática direita (6,13%). Dois estudos (11,11%) evidenciaram a artéria mesentérica inferior originando-se a partir da AMS, enquanto outros dois (11,11%) constataram ser ela compartilhada na mesma origem do tronco celíaco. Conclusão: Variações na AMS não são achados incomuns e seus relatos evidenciados através da literatura científica demonstram grande importância para o desenvolvimento de condições clínicas importantes, tornando o conhecimento sobre esse assunto relevante para os cirurgiões e profissionais atuantes nesta área.
Descritores: Artéria Celíaca/anatomia & histologia
Artéria Mesentérica Superior/anatomia & histologia
Cirurgiões
Artéria Hepática/anatomia & histologia
-Artéria Mesentérica Superior/cirurgia
Limites: Humanos
Tipo de Publ: Revisão Sistemática
Responsável: BR1.1 - BIREME


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Id: biblio-1248503
Autor: Vela, Javier; Cárcamo, Leonardo; Contreras, Caterina; Arenas, Claudia; Ramos, Juan Pablo; Rebolledo, Rolando; Varas, Julián; Martínez, Jorge; Jarufe, Nicolas; Achurra, Pablo.
Título: Self-confidence on acquired surgical skills to deal with severe trauma patients in recently graduated surgeons / Autoconfiança nas habilidades cirúrgicas adquiridas para lidar com pacientes com trauma grave em cirurgiões recém-formados
Fonte: ABCD arq. bras. cir. dig;34(1):e1561, 2021. tab, graf.
Idioma: en.
Projeto: Conicyt.
Resumo: ABSTRACT Background: Trauma is one of the leading causes of death in the world and proper surgical care is critical to impact mortality. In Chile, trauma associated death ranks first as mortality cause in population between 20 and 59 years old. Appropriate surgical skills are required to deal with these complex patients. Self-confidence to practice trauma procedures after the General Surgery Residency have not been reported in our country. Aim: Describe the level of self-confidence to deal with trauma procedures of surgeons who recently graduated from a General Surgery Residency. Method: Descriptive cross-sectional study. We designed and applied a survey in 2015, 2016 and 2017 to recently graduated surgeons, to inquire about self-confidence of surgical skills to deal with trauma scenarios. Eighteen trauma surgery procedures (including cervical, thoracic, abdominal and vascular procedures) were evaluated using a 5-grade Likert scale. The number of procedures performed during the residency was also queried. Results: Eighty-eight recently graduated surgeons from 11 different training programs in Chile were included. The report of competencies was high in procedures such as intestinal injuries, were 98% felt competent or very competent in their repair. On the other hand, in complex traumas such as major vessel injury, up to 76% reported not being competent. Self-confidence on procedures was directly associated with the number of procedures performed during residency. Conclusions: Recently graduated surgeons from General Surgery Programs report high levels of confidence to deal with low and intermediate complexity traumas, but a lower level of confidence to treat high complexity cases.

RESUMO Racional: Trauma é uma das principais causas de morte no mundo e cuidados cirúrgicos adequados são críticos para determinar a mortalidade. No Chile, morte associada a trauma é a primeira causa de mortalidade na população entre 20 e 59 anos. Para lidar com esses pacientes complexos, são necessárias habilidades cirúrgicas precisas para esses procedimentos. Autoconfiança de cirurgiões recentemente graduados na Residência em Cirurgia Geral para práticas de procedimentos de trauma no nosso país não tem sido reportada. Objetivo: Descrever nível de autoconfiança para lidar com procedimentos de trauma em cirurgiões recentemente graduados na residência de cirurgia geral. Método: Estudo transversal. Foi desenhada e aplicada uma enquete em 2015, 2016 e 2017 a cirurgiões recentemente graduados para pesquisar sobre autoconfiança e habilidades cirúrgicas para lidar com cenários de trauma. Foram avaliados 18 procedimentos cirúrgicos de trauma (incluindo procedimentos cervicais, torácicos, abdominais e vasculares) usando a 5-grade Likert Scale. O número total de procedimentos feitos durante a residência foi avaliado. Resultados: Foram incluídos 88 cirurgiões recentemente graduados. O nível de competência foi reportado como alto em procedimentos como trauma intestinal, onde 98% sentiu-se competente ou muito competente em sua reparação. Por outro lado, em traumas complexos como dano vascular maior, até 76% reportaram não se sentirem competentes. A autoconfiança nos procedimentos esteve diretamente associada com o número de procedimentos realizados. Conclusões: Cirurgiões recentemente graduados na residência de cirurgia geral reportam níveis altos de confiança para lidar com traumas de complexidade baixa e média, mas um nível menor de confiança para tratar casos de complexidade alta.
Descritores: Cirurgiões
Internato e Residência
-Chile
Estudos Transversais
Inquéritos e Questionários
Competência Clínica
Limites: Humanos
Adulto
Pessoa de Meia-Idade
Adulto Jovem
Responsável: BR1.1 - BIREME


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Texto completo SciELO Cuba
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Id: biblio-1156614
Autor: Villamil Martínez, Ramón; Ramírez Guirado, Alejandro; González López, Sergio Luis; González Sabín, Miguel Antonio; Muñoz Álvarez, María Amarilys.
Título: La cirugía pediátrica cubana ante la COVID-19: repercusión y enfrentamiento / Cuban pediatric surgery facing COVID-19: impacts and confrontations
Fonte: Rev. cuba. pediatr;92(supl.1):e1210, 2020.
Idioma: es.
Resumo: La COVID-19 tiene un impacto significativo en la salud pública a nivel internacional y nacional, por tanto, en la cirugía pediátrica. En Cuba, el Ministerio de Salud Pública ha implementado un protocolo para enfrentar esta contingencia. Como un complemento de este protocolo nacional, la cirugía pediátrica cubana ha pautado las Particularidades en la atención del paciente quirúrgico pediátrico, con el objetivo de presentar un análisis del impacto que ha tenido la COVID-19 en la especialidad, así como de las acciones de enfrentamiento que se acometen a corto, mediano y largo plazo, herramientas técnicas necesarias para realizar el trabajo de la cirugía pediátrica y otras especialidades afines en este contexto epidemiológico. La repercusión de la COVID-19 en la cirugía pediátrica para los pacientes, familiares, cirujanos y residentes de la especialidad no solo se pone de manifiesto ahora, sino que también tendrá consecuencias posteriores, razones por la que se trazan estrategias y acciones concretas, de las cuales algunas ya se han puesto en práctica y se han publicado. En general, la COVID-19 ha producido una verdadera crisis sanitaria sin precedentes que tiene y tendrá un negativo impacto biológico, psicológico y social en pacientes, familiares y la comunidad, no solo en el momento actual sino en el futuro. La cirugía pediátrica cubana sufre afectaciones, pero se toman previsiones, se aprenden lecciones y se implementan nuevos métodos que harán mejor la práctica asistencial y docente en el futuro(AU)

COVID-19 has a significative impact in public health at the national and international levels, and as a consequence in pediatric surgery. In Cuba, the Ministry of Public Health has implemented a protocol to face this contingency. As a complement of this national protocol, Cuban pediatric surgery as specialty has provided guidelines called Special features in the care of pediatric surgical patients, with the aim of presenting an analysis of the impact that COVID-19 has had in this specialty, as well as the confrontation actions that are being carried out in the short, medium and long terms, technical tools needed to perform the pediatric surgery work and in other related specialties in this epidemiological context. The impact of COVID-19 in pediatric surgery for patients, relatives, surgeons and residents of the specialty is not only manifesting now but it will have further consequences; so, there are strategies and concret actions being created, from which some has been already implemented and published. In general terms, COVID-19 has actually produced an unprecedented sanitary crisis that has and will have a negative biological, psychologic and social impact in patients, relatives and communities, not only in this moment but in the future times. Cuban pediatric surgery suffers affectations, but provisions have been taken, lessons are learned and new methods have been implemented that will make the care and teaching practices better in the future(AU)
Descritores: Proteínas do Sistema Complemento
Adaptação Psicológica
Características de Residência
Infecções por Coronavirus
Cirurgiões
Limites: Humanos
Responsável: CU1.1 - Biblioteca Médica Nacional


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Id: biblio-1279743
Autor: Landi, Leonardo; Nicolás, Emilio S; Lima, Melina; Battú, Camila C; Núñez, Florencia; Francia, Héctor.
Título: Conflictos del cirujano: ¿La vocación quirúrgica está en crisis? / Conflicts of surgeons: is surgical vocation in crisis?
Fonte: Rev. argent. cir;112(3):303-310, jun. 2020. graf, tab.
Idioma: es.
Resumo: RESUMEN Introducción: En los últimos años vemos un aumento de bibliografía que se refiere a problemas perso nales y psicológicos del cirujano, a la deserción en residencias de cirugía y a la falta de especialización de individuos jóvenes. Este aumento se observa sobre todo en revistas de jerarquía como Lancet o JAMA. ¿Pero cuál es la situación en la Argentina? ¿Consideramos que nos están pagando adecua damente por nuestra práctica? ¿Pensamos en abandonar nuestra especialidad? ¿Cuántos conflictos tenemos con pacientes por mes? Estimamos necesaria la realización de un trabajo regional que lo plasme. Objetivo: conocer la situación socioeconómica actual de los cirujanos. Material y métodos: estudio de corte transversal. Resultados: de 73 cirujanos encuestados de la provincia de Santa Fe, se recibió respuesta en un 57,5 %. El 87,8 % fueron hombres y 56,1% estaba dentro del grupo de edad adulto intermedio/mayor al momento del estudio. El 97,6 % de los cirujanos concordó en que sus ingresos no se corresponden con el tiempo invertido en la práctica. Consideraron abandonar su práctica diaria en el último año en un 26,2 %; la causa económica es el principal problema para el 72,7%. Discusión: la incomodidad del cirujano frente a su salario (97,6 %), la discrepancia de porcentajes en tre cirujanos y cirujanas (87,8% vs. 12,2%), la falta de cirujanos jóvenes (43,9%) y la alarmante cifra de cirujanos graduados por año (35 por año) son cuatro puntos clave que consideramos deberían abordar de manera urgente los entes políticos y, sobre todo, las Asociaciones de Cirugía.

ABSTRACT Background: In recent years we have witnessed more publications about personal and psychological issues affecting surgeons, residents quitting surgery residencies, and lack of specialization of young in dividuals. This growth can be observed especially in high-impact journals such as The Lancet or JAMA. But what is the situation in Argentina? Do we think that we are receiving adequate payment for our practice? Do we consider quitting our specialty? How many conflicts do we have with patients each month? We think that a regional work is necessary to reflect this situation. Objective: The aim of this study is to determine the current socioeconomic situation of surgeons. Material and methods: We conducted a cross-sectional study. Results: A total of 73 surgeons from the province of Santa Fe were contacted and 42 answers were received (response rate 57.5%): 87.8% were men and 56.1% corresponded to middle/older adulthood. Almost all surgeons (97.6%) agreed that their income did not reflect the time spent in practice. Up to 26.2% of survey respondents considered quitting their daily practice in the last year due to eco nomic reasons, which is the main problem for 72.7% of them. Discussion: Surgeons' discomfort with their salaries (97.6%), the discrepancy in percentages between male and female surgeons (87.8% vs. 12.2%), the lack of young surgeons (43.9%) and the alarming number of surgeons graduated per year (35 per year) are 4 key issues which we believe should be urgently addressed by political bodies and, especially, by surgery associations.
Descritores: Fatores Socioeconômicos
Cirurgiões/economia
-Argentina
Especialização/estatística & dados numéricos
Cirurgia Geral/estatística & dados numéricos
Estudos Transversais
Cirurgiões/estatística & dados numéricos
Limites: Humanos
Masculino
Feminino
Adulto
Pessoa de Meia-Idade
Responsável: AR144.1 - CIBCHACO - Centro de Información Biomedica del Chaco


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Id: biblio-1279741
Autor: Amarillo, Hugo A; Tacchi, Pablo; García, Martín; Sánchez Ruiz, Alejandro; Borquez, Vicente; Baistrocchi, Julio; Baistrocchi, Héctor; Díaz, Luis; Rodríguez, Gerardo Martín; Funes, Carlos; Ruiz, Hernán.
Título: Seguridad y entrenamiento de las colonoscopias por cirujanos. Estudio multicéntrico / Safety and training of colonoscopies by surgeons. A multicenter study
Fonte: Rev. argent. cir;112(3):274-292, jun. 2020. graf.
Idioma: es.
Resumo: RESUMEN Introducción: la seguridad de la colonoscopia realizada por cirujanos y el tratamiento de sus complica ciones han sido analizados aisladamente y en escasas publicaciones nacionales. Objetivos: el objetivo principal del estudio fue analizar las colonoscopias realizadas por cirujanos co lorrectales, sus complicaciones y resolución. El objetivo secundario fue comparar los resultados entre un hospital universitario y distintos centros del país dotados de cirujanos colorrectales que habían recibido entrenamiento en una residencia posbásica. Material y métodos: estudio multicéntrico, prospectivo a nivel nacional. Se incluyeron las colonosco pias realizadas entre 2011 y 2016 . Se analizaron como variables las complicaciones, edad, sexo, tipo de endoscopia, diagnóstico, tratamiento, sitio de realización y de entrenamiento del cirujano. Se ex presaron en promedios, porcentajes y rangos. El análisis estadístico consistió en el test exacto ordinal, relaciones y proporciones y exacto de Fisher. Se consideró significancia a p < 0,05. Resultados: de 24 907 procedimientos, 17 283 fueron diagnósticos y 17 202 provenían de centros del interior. Hubo 43 complicaciones (0,17%); 35 específicas: perforaciones (19), hemorragias (8), sín drome pospolipectomía (5) y técnicas (3), diagnosticadas y resueltas por el mismo equipo sin mor bimortalidad. No hubo diferencias en las complicaciones según el centro ni tipo de colonoscopia en incidencia o tratamiento. Todos los cirujanos se entrenaron en residencias de posgrado con programas de entrenamiento en colonoscopia. Conclusiones: existen similares resultados entre cirujanos provenientes de instituciones con residen cia posbásica y centros del interior al realizar colonoscopias. La colonoscopia realizada por cirujanos es un procedimiento seguro y posible de ser adquirido como competencia luego de un entrenamiento formal realizado en una residencia posbásica.

ABSTRACT Introduction: The safety of colonoscopies performed by surgeons and the management of their com plications has not been analyzed in depth in the low number of national publications. Objective: The primary endpoint of this study was to analyze the outcomes of colonoscopies perfor med by colorectal surgeons, in terms of complications. and their resolution. The secondary endpoint was to compare the results between a university hospital and different centers nationwide staffed with colorectal surgeons who had received formal training during a residency program in the surgical subspecialty. Material and methods: We conducted a multicenter, prospective and consecutive national study. The colonscopies performed between 2011 and 2016 were included. The variables analyzed included complications, age, sex, type of endoscopy, diagnosis, treatment, location were the procedure was performed and surgeon's training. The results were expressed as mean, percentage and range. The statistical analysis was performed using Fisher's exact test. A p value < 0.05 was considered statistically significant. Results: A total of 24,907 procedures were performed, 17,283 corresponded to diagnostic colonosco pies and 17,202 were made in provincial centers. Forty-four complications were recorded (0.17%), of which 35 were procedure-related complications: 19 perforations, 8 bleeding events, 5 post-polypec tomy syndromes and three related with the technique; all were diagnosed and solved by the same team without morbidity and mortality. There were no differences in the incidence of complications and how they were treated according to the center or type of colonoscopy. All the surgeons received colonoscopy training during a residency program in the surgical subspecialty. Conclusions: The results obtained in colonoscopies performed by surgeons trained in institutions with residency programs in surgical subspecialties are similar t Safe colonoscopies can be performed by surgeons who have been trained in institutions with a residency program in a surgical subspecialty and with a formal training program in colonoscopy.
Descritores: Colonoscopia/efeitos adversos
Cirurgia Colorretal/efeitos adversos
-Estudos Prospectivos
Cirurgiões/educação
Hemorragia
Hospitais Universitários
Internato e Residência
Limites: Humanos
Masculino
Feminino
Adolescente
Adulto
Pessoa de Meia-Idade
Idoso
Idoso de 80 Anos ou mais
Adulto Jovem
Tipo de Publ: Estudo Multicêntrico
Responsável: AR144.1 - CIBCHACO - Centro de Información Biomedica del Chaco


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Texto completo SciELO Brasil
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Id: lil-777328
Autor: Cabral, João Ferreira; Braga, Isaac Campos; Branco, Frederico; Cavadas, Vitor; Ferreira, Avelino Fraga; Ramos, Miguel Silva.
Título: What about vaginal extraction of the kidney? results of an online survey
Fonte: Int. braz. j. urol;42(1):78-82, Jan.-Feb. 2016. tab, graf.
Idioma: en.
Resumo: ABSTRACT Purpose We aimed to characterize surgeons opinion about the vaginal extraction of the kidney after transperitoneal laparoscopic nephrectomy. Matherial and Methods A 9-item questionnaire was published online (Survey Monkey TM) and publicized via email to a multidisciplinary pool of surgeons in Portugal. Data was collected and statistical analysis was performed using IBM SPSS Statistics, Version 21.0. Results Three hundred and fifty nine inquiries were sent, 154 surgeons completed the questionnaires (response rate of 43.0%). Fifty five point eight percent of the participants would choose the transvaginal approach for themselves or for a close relative. The most stated arguments were a better cosmesis (29.0%) expectancy of lower post operative pain (26.0%) and lower rate of incisional hernias (23.0%). Defenders of the transabdominal procedure justified with an expectancy of lower complication rate (39%), namely impairment of sexual function and fertility (22%). The female gender and the familiarity with transvaginal surgery were the stronger predictors of the option for this approach (70.6% vs 48.5%; p=0,016 and 85.3% vs 46.6%; p <0.001 respectively). Conclusions Contrasting with similar surveys published on transvaginal NOTES, the vaginal specimen extraction after conventional laparoscopic nephrectomy was fairly accepted by the inquired surgeons.
Descritores: Vagina
Cirurgia Endoscópica por Orifício Natural/métodos
Nefrectomia/métodos
-Complicações Pós-Operatórias
Padrões de Prática Médica/estatística & dados numéricos
Fatores Sexuais
Inquéritos e Questionários
Reprodutibilidade dos Testes
Resultado do Tratamento
Laparoscopia/métodos
Cirurgiões/estatística & dados numéricos
Pessoa de Meia-Idade
Limites: Humanos
Masculino
Feminino
Adulto
Responsável: BR1.1 - BIREME


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Texto completo SciELO Brasil
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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-1011900
Autor: Chammas Jr, Mario F; Mitre, Anuar I; Arap, Marco A; Hubert, Nicholas; Hubert, Jacques.
Título: Learning robotic pyeloplasty without simulators: an assessment of the learning curve in the early robotic era
Fonte: Clinics;74:e777, 2019. tab, graf.
Idioma: en.
Resumo: OBJECTIVE: To analyze our experience and learning curve for robotic pyeloplasty during this robotic procedure. METHODS: Ninety-nine patients underwent 100 consecutive procedures. Cases were divided into 4 groups of 25 consecutive procedures to analyze the learning curve. RESULTS: The median anastomosis times were 50.0, 36.8, 34.2 and 29.0 minutes (p=0.137) in the sequential groups, respectively. The median operative times were 144.6, 119.2, 114.5 and 94.6 minutes, with a significant difference between groups 1 and 2 (p=0.015), 1 and 3 (p=0.002), 1 and 4 (p<0.001) and 2 and 4 (p=0.022). The mean hospital stay was 7.08, 4.76, 4.88 and 4.20 days, with a difference between groups 1 and 2 (p<0.001), 1 and 3 (p<0.001) and 1 and 4 (p<0.001). Clinical and radiological improvements were observed in 98.9% of patients. One patient presented with recurrent obstruction. CONCLUSIONS: Our results demonstrate a high success rate with low complication rates. A significant decrease in hospital stay and surgical time was evident after 25 cases.
Descritores: Obstrução Ureteral/cirurgia
Laparoscopia/educação
Curva de Aprendizado
Procedimentos Cirúrgicos Robóticos/educação
Cirurgiões/educação
Pelve Renal/cirurgia
-Complicações Pós-Operatórias
Análise de Variância
Resultado do Tratamento
Laparoscopia/métodos
Estatísticas não Paramétricas
Duração da Cirurgia
Procedimentos Cirúrgicos Robóticos/métodos
Tempo de Internação
Limites: Humanos
Masculino
Feminino
Adolescente
Adulto
Pessoa de Meia-Idade
Idoso
Idoso de 80 Anos ou mais
Adulto Jovem
Responsável: BR1.1 - BIREME


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Id: biblio-1134249
Autor: Basatac, Cem; Akpinar, Haluk.
Título: Trifecta outcomes of robot-assisted partial nephrectomy: Results of the low volume surgeon
Fonte: Int. braz. j. urol;46(6):943-949, Nov.-Dec. 2020. tab.
Idioma: en.
Resumo: ABSTRACT Objective There is limited data regarding surgeon volume and partial nephrectomy outcomes. The aim of this study is to report trifecta outcomes of robot-assisted partial nephrectomy (RAPN) performed by the low volume surgeon. Materials and Methods Thirty-nine patients with clinical T1-2 renal tumors who underwent RAPN between 2012 and 2018 were included in this study. Trifecta was defined as negative surgical margins, warm ischemia time ≤20 minutes, and no operative complications. Patient demographics, R.E.N.A.L. nephrometry score, operation time, estimated blood loss, warm ischemia time, length of hospital stay, renal functions, and oncological outcomes were analyzed retrospectively. Complications were graded based on the modified Clavien-Dindo classification system. Results The median R.E.N.A.L. nephrometry score was 6 (4-10). RAPN was successfully performed in all but one patient. The median operation time was 180 (90-240) minutes. Warm ischemia was performed only by segmental renal artery control in 35 and, by main renal artery control in three patients. The off-clamp technique was used in two patients. The median warm ischemia time was 16 (0-31) minutes. Seven patients had a warm ischemia time of longer than 20 minutes. Three patients had postoperative complications. The surgical margin was positive in one patient. As a result, the trifecta was achieved in 30 of the 39 patients (77%). Conclusion RAPN is a safe and effective minimally invasive alternative in the treatment of renal masses. The present study suggests that reasonable trifecta rates can be achieved even by low volume surgeons.
Descritores: Procedimentos Cirúrgicos Robóticos
Neoplasias Renais/cirurgia
-Transfusão de Sangue
Estudos Retrospectivos
Resultado do Tratamento
Cirurgiões
Nefrectomia
Limites: Humanos
Responsável: BR1.1 - BIREME



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