Scientific letter
Single Port Laparoscopic Biliopancreatic Bypass Without Gastrectomy
Bypass biliopancreático laparoscópico sin gastrectomía por puerto único
Joaquín Resa Bienzobas
, Mónica Valero Sabater, Javier Lagos Lizán, José Luis García Calleja, José Antonio Fatás Cabeza
Corresponding author
Hospital Royo Villanova, Cirugía General, Zaragoza, Spain
Read
2830
Timeswas read the article
831
Total PDF
1999
Total HTML
Share statistics
array:24 [ "pii" => "S2173507713000926" "issn" => "21735077" "doi" => "10.1016/j.cireng.2013.07.004" "estado" => "S300" "fechaPublicacion" => "2013-03-01" "aid" => "767" "copyright" => "AEC" "copyrightAnyo" => "2011" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Cir Esp. 2013;91:202-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1656 "formatos" => array:3 [ "EPUB" => 14 "HTML" => 1178 "PDF" => 464 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0009739X1100368X" "issn" => "0009739X" "doi" => "10.1016/j.ciresp.2011.08.005" "estado" => "S300" "fechaPublicacion" => "2013-03-01" "aid" => "767" "copyright" => "AEC" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Cir Esp. 2013;91:202-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4458 "formatos" => array:3 [ "EPUB" => 11 "HTML" => 3479 "PDF" => 968 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta Científica</span>" "titulo" => "<span class="elsevierStyleItalic">Bypass</span> biliopancreático laparoscópico sin gastrectomía por puerto único" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "202" "paginaFinal" => "204" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Single port laparoscopic biliopancreatic bypass without gastrectomy" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 74299 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sección gástrica.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Joaquín Resa Bienzobas, Mónica Valero Sabater, Javier Lagos Lizán, José Luis García Calleja, José Antonio Fatás Cabeza" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Joaquín" "apellidos" => "Resa Bienzobas" ] 1 => array:2 [ "nombre" => "Mónica" "apellidos" => "Valero Sabater" ] 2 => array:2 [ "nombre" => "Javier" "apellidos" => "Lagos Lizán" ] 3 => array:2 [ "nombre" => "José Luis" "apellidos" => "García Calleja" ] 4 => array:2 [ "nombre" => "José Antonio" "apellidos" => "Fatás Cabeza" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173507713000926" "doi" => "10.1016/j.cireng.2013.07.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507713000926?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X1100368X?idApp=UINPBA00004N" "url" => "/0009739X/0000009100000003/v1_201305021700/S0009739X1100368X/v1_201305021700/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173507713000896" "issn" => "21735077" "doi" => "10.1016/j.cireng.2013.07.001" "estado" => "S300" "fechaPublicacion" => "2013-03-01" "aid" => "1008" "copyright" => "AEC" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Cir Esp. 2013;91:205-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2888 "formatos" => array:3 [ "EPUB" => 18 "HTML" => 2363 "PDF" => 507 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Myocardial Contusion and Pericardial Effusion After Blunt Chest Trauma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "205" "paginaFinal" => "206" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Contusión miocárdica y derrame pericárdico tras traumatismo esternal cerrado asintomático" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 543 "Ancho" => 1301 "Tamanyo" => 98978 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Echocardiogram 2D; parasternal short-axis plane: posterior pericardial effusion (arrow). (B) Thoracic CT: evidence of sternal fracture, as well as mild pericardial effusion (arrow).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Patricia Fariña Ruiz, Elisabeth Medina Darias, Carlos Enrique García Franco, Marcos Rodríguez Esteban" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ana Patricia" "apellidos" => "Fariña Ruiz" ] 1 => array:2 [ "nombre" => "Elisabeth" "apellidos" => "Medina Darias" ] 2 => array:2 [ "nombre" => "Carlos Enrique" "apellidos" => "García Franco" ] 3 => array:2 [ "nombre" => "Marcos" "apellidos" => "Rodríguez Esteban" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009739X12003892" "doi" => "10.1016/j.ciresp.2012.10.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X12003892?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507713000896?idApp=UINPBA00004N" "url" => "/21735077/0000009100000003/v1_201309090012/S2173507713000896/v1_201309090012/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173507713000938" "issn" => "21735077" "doi" => "10.1016/j.cireng.2013.07.005" "estado" => "S300" "fechaPublicacion" => "2013-03-01" "aid" => "797" "copyright" => "AEC" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Cir Esp. 2013;91:201-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2317 "formatos" => array:3 [ "EPUB" => 16 "HTML" => 1641 "PDF" => 660 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Acute Amoebic Appendicitis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "201" "paginaFinal" => "202" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Apendicitis aguda amebiásica" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 781 "Ancho" => 1000 "Tamanyo" => 334300 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Presence of numerous trophozoites presenting a “foamy”-looking cytoplasm and central karyosome in the appendix lumen.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Israel Abellán, Vicente Munitiz, Jesús Abrisqueta, Maria Jose López, Pascual Parrilla" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Israel" "apellidos" => "Abellán" ] 1 => array:2 [ "nombre" => "Vicente" "apellidos" => "Munitiz" ] 2 => array:2 [ "nombre" => "Jesús" "apellidos" => "Abrisqueta" ] 3 => array:2 [ "nombre" => "Maria Jose" "apellidos" => "López" ] 4 => array:2 [ "nombre" => "Pascual" "apellidos" => "Parrilla" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009739X11004210" "doi" => "10.1016/j.ciresp.2011.10.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X11004210?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507713000938?idApp=UINPBA00004N" "url" => "/21735077/0000009100000003/v1_201309090012/S2173507713000938/v1_201309090012/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Single Port Laparoscopic Biliopancreatic Bypass Without Gastrectomy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "202" "paginaFinal" => "204" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Joaquín Resa Bienzobas, Mónica Valero Sabater, Javier Lagos Lizán, José Luis García Calleja, José Antonio Fatás Cabeza" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Joaquín" "apellidos" => "Resa Bienzobas" "email" => array:1 [ 0 => "jjresa@comz.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Mónica" "apellidos" => "Valero Sabater" ] 2 => array:2 [ "nombre" => "Javier" "apellidos" => "Lagos Lizán" ] 3 => array:2 [ "nombre" => "José Luis" "apellidos" => "García Calleja" ] 4 => array:2 [ "nombre" => "José Antonio" "apellidos" => "Fatás Cabeza" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Royo Villanova, Cirugía General, Zaragoza, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Bypass</span> biliopancreático laparoscópico sin gastrectomía por puerto único" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 640 "Ancho" => 900 "Tamanyo" => 82057 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Exterior photo of the single port.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Laparoscopic surgery has won out over open surgery in the treatment of morbid obesity. This has contributed to less surgical trauma for the patient and has made surgery easier for surgeons. We are currently faced with the need to improve treatment by optimizing techniques and minimizing stress and patient complications. One of the options that we have been exploring is reducing the number of surgical wounds by the development of single-port techniques.</p><p id="par0010" class="elsevierStylePara elsevierViewall">After having tried several single-port devices and having performed a variety of techniques, including appendectomy, cholecystectomy, Hartmann's procedure, right hemicolectomy, left hemicolectomy, gastric sleeve or gastric bypass, we decided to perform laparoscopic biliopancreatic diversion without gastrectomy. The indications for this procedure are common to all bariatric surgery procedures, regardless of sex or BMI. However, we do not recommend this procedure in cases of super obesity due to the high level of technical difficulty.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Technique</span><p id="par0015" class="elsevierStylePara elsevierViewall">The patient is placed in an open-leg position with the left arm next to the body and the monitor above the right shoulder. The surgeon stands between the patient's legs while the assistant is on the patient's left side. A 3-cm abdominal incision is made around the left side of the navel. In all the procedures performed, the GelPort was used, a single-port device with a gel membrane that is flexible and allows for the use of conventional materials due to its easy triangulation. The system includes an Alexis wound protector/retractor, which is inserted first. Over the gel and before anchoring the retractor, we insert the triangulated trocars: one 5-mm trocar for the right hand, one 10-mm optical trocar (30°) and one 12-mm trocar for the left hand. The intervention is initiated in the anti-Trendelemburg position; grasping the stomach at the lesser curvature, a small window is made with the harmonic scalpel in the lesser omentum, near the gastric wall. Afterwards, the greater curvature of the stomach is dissected in order to comfortably insert the endostapler with our left hand diagonally towards the window of the lesser curvature. Three Roticulator 60-mm blue load endo-linear staplers are needed (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). The stomach is then opened along the edge of the greater curvature, 1<span class="elsevierStyleHsp" style=""></span>cm from the staple line.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The surgeon then moves to the left side of the patient, in the Trendelemburg position and, while focusing the camera on the cecum, 60<span class="elsevierStyleHsp" style=""></span>cm of ileum are measured and marked with a suture. We continue measuring until a total of 3<span class="elsevierStyleHsp" style=""></span>m are reached; an opening is made on the antimesenteric side, and at the initial position a 60-mm blue load endo-linear stapler is inserted in the small bowel and stomach to perform the gastrojejunal anastomosis. The intestine is sectioned and the orifice of the anastomosis is closed with another blue endo-linear stapler. We recover the ileum at the 60-cm mark with forceps as well as the distal end of the biliopancreatic limb. The GelPort is removed and the intestine is brought out in order to perform the intestinal anastomosis through the retractor of the device, which can be done either by hand or with endo-linear staples.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Once the anastomosis is finished, the mesentery is closed laparoscopically with a continuous Prolene suture.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The surgery is completed by removing the GelPort and closing the wound with continuous suture in the aponeurosis and skin staples. A Jackson-Pratt drain is always left in the left upper cuadrant.</p><p id="par0035" class="elsevierStylePara elsevierViewall">If difficulties are encountered, the placement of a trocar in the left upper cuadrant (where the drain is later inserted) makes the intervention much easier and provides a wide range of possibilities.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">In our opinion, laparoscopic surgery had been at a standstill, and new ideas needed to arise in order for advances to be made. The advent of devices that allow us to reduce the number of incisions to just one orifice opens a whole new set of possibilities, and we now differentiate between traditional laparoscopic surgery and single-port laparoscopic surgery.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We prefer techniques that avoid complex situations that may prolong the operation. We have tried to describe the method that currently seems to be the simplest for performing single-port laparoscopic biliopancreatic diversion. No surgeon should be criticized for using an additional trocar if this is able to reduce surgical time, improve safety and avoid complications.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Using a GelPort allows us to take advantage of the retractor in order to perform a manual extracorporeal anastomosis, which is faster and cheaper, and conventional materials can be used (without requiring articulated forceps). The umbilical location is less traumatic and more aesthetically pleasing, and we have found no access problems.</p><p id="par0055" class="elsevierStylePara elsevierViewall">At present, we are following a new path and are not quite sure where it leads. When single-port devices were designed, their application in advanced laparoscopic surgery had not been considered. Nevertheless, some of us believe that these products are perfectly indicated in obesity surgery, especially when surgical specimens should be extracted but also due to the reduced trauma that produces a beneficial psychological effect in patients due to aesthetic advantages. Time will tell if there are any other advantages.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Technique" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 3 => array:1 [ "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0020">Further reading</span>" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Resa Bienzobas J, et al. <span class="elsevierStyleItalic">Bypass</span> biliopancreático laparoscópico sin gastrectomía por puerto único. Cir Esp. 2013;91:202-4.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 74776 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Gastric incision.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 640 "Ancho" => 900 "Tamanyo" => 82057 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Exterior photo of the single port.</p>" ] ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0020">Further reading</span>" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Single incision transumbilical laparoscopic Roux-en-Y gastric bypass: a first case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.K. Huang" 1 => "J.Y. Houng" 2 => "C.J. Chiang" 3 => "Y.S. Chen" 4 => "P.H. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Obes Surg" "fecha" => "2009" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Single-laparoscopic incision transabdominal surgery sleeve gastrectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.M. Reavis" 1 => "M.W. Hinojosa" 2 => "B.R. Smith" 3 => "N.T. Nguyen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11695-008-9649-x" "Revista" => array:6 [ "tituloSerie" => "Obes Surg" "fecha" => "2008" "volumen" => "18" "paginaInicial" => "1492" "paginaFinal" => "1494" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18695946" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laparoscopic biliopancreatic diversión with distal preservation: technique and three-year followup" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.J. Resa" 1 => "J. Solano" 2 => "J.A. Fatás" 3 => "J.L. Blas" 4 => "A. Monzón" 5 => "A. García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Laparoendosc Adv Surg Technol A" "fecha" => "2004" "volumen" => "14" "paginaInicial" => "131" "paginaFinal" => "134" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Single-incision laparoscopic gastric by-pass for morbid obesity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.M. Tacchino" 1 => "F. Greco" 2 => "D. Matera" 3 => "G. Diflumeri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11695-010-0153-8" "Revista" => array:6 [ "tituloSerie" => "Obes Surg" "fecha" => "2010" "volumen" => "20" "paginaInicial" => "1154" "paginaFinal" => "1160" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20401544" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Single-incision laparoscopic biliopancreatic diversión" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.M. Tacchino" 1 => "F. Greco" 2 => "D. Matera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.soard.2009.11.008" "Revista" => array:6 [ "tituloSerie" => "Surg Obes Relat Dis" "fecha" => "2010" "volumen" => "6" "paginaInicial" => "444" "paginaFinal" => "445" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20080067" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735077/0000009100000003/v1_201309090012/S2173507713000926/v1_201309090012/en/main.assets" "Apartado" => array:4 [ "identificador" => "15076" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735077/0000009100000003/v1_201309090012/S2173507713000926/v1_201309090012/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507713000926?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 2 | 6 |
| 2024 October | 8 | 5 | 13 |
| 2024 September | 10 | 2 | 12 |
| 2024 August | 8 | 3 | 11 |
| 2024 July | 14 | 5 | 19 |
| 2024 June | 15 | 1 | 16 |
| 2024 May | 9 | 8 | 17 |
| 2024 April | 8 | 3 | 11 |
| 2024 March | 13 | 4 | 17 |
| 2024 February | 10 | 6 | 16 |
| 2024 January | 15 | 5 | 20 |
| 2023 December | 28 | 2 | 30 |
| 2023 November | 14 | 5 | 19 |
| 2023 October | 25 | 8 | 33 |
| 2023 September | 4 | 0 | 4 |
| 2023 August | 8 | 2 | 10 |
| 2023 July | 25 | 3 | 28 |
| 2023 June | 6 | 6 | 12 |
| 2023 May | 9 | 0 | 9 |
| 2023 April | 9 | 3 | 12 |
| 2023 March | 12 | 1 | 13 |
| 2023 February | 6 | 3 | 9 |
| 2023 January | 11 | 11 | 22 |
| 2022 December | 19 | 2 | 21 |
| 2022 November | 18 | 9 | 27 |
| 2022 October | 20 | 5 | 25 |
| 2022 September | 14 | 5 | 19 |
| 2022 August | 12 | 6 | 18 |
| 2022 July | 13 | 8 | 21 |
| 2022 June | 13 | 7 | 20 |
| 2022 May | 18 | 5 | 23 |
| 2022 April | 16 | 8 | 24 |
| 2022 March | 16 | 11 | 27 |
| 2022 February | 22 | 6 | 28 |
| 2022 January | 17 | 6 | 23 |
| 2021 December | 11 | 9 | 20 |
| 2021 November | 11 | 14 | 25 |
| 2021 October | 13 | 7 | 20 |
| 2021 September | 15 | 17 | 32 |
| 2021 August | 22 | 7 | 29 |
| 2021 July | 28 | 6 | 34 |
| 2021 June | 12 | 13 | 25 |
| 2021 May | 20 | 6 | 26 |
| 2021 April | 46 | 13 | 59 |
| 2021 March | 17 | 9 | 26 |
| 2021 February | 13 | 9 | 22 |
| 2021 January | 13 | 10 | 23 |
| 2020 December | 17 | 8 | 25 |
| 2020 November | 15 | 13 | 28 |
| 2020 October | 5 | 9 | 14 |
| 2020 September | 11 | 9 | 20 |
| 2020 August | 16 | 8 | 24 |
| 2020 July | 16 | 9 | 25 |
| 2020 June | 8 | 8 | 16 |
| 2020 May | 24 | 8 | 32 |
| 2020 April | 7 | 4 | 11 |
| 2020 March | 8 | 2 | 10 |
| 2020 February | 6 | 6 | 12 |
| 2020 January | 16 | 6 | 22 |
| 2019 December | 16 | 8 | 24 |
| 2019 November | 9 | 11 | 20 |
| 2019 October | 16 | 4 | 20 |
| 2019 September | 18 | 2 | 20 |
| 2019 August | 8 | 17 | 25 |
| 2019 July | 15 | 17 | 32 |
| 2019 June | 21 | 34 | 55 |
| 2019 May | 82 | 39 | 121 |
| 2019 April | 28 | 13 | 41 |
| 2019 March | 5 | 4 | 9 |
| 2019 February | 10 | 7 | 17 |
| 2019 January | 4 | 1 | 5 |
| 2018 December | 2 | 7 | 9 |
| 2018 November | 8 | 1 | 9 |
| 2018 October | 5 | 8 | 13 |
| 2018 September | 6 | 1 | 7 |
| 2018 August | 2 | 4 | 6 |
| 2018 July | 5 | 1 | 6 |
| 2018 June | 5 | 2 | 7 |
| 2018 May | 3 | 1 | 4 |
| 2018 April | 3 | 1 | 4 |
| 2018 March | 3 | 0 | 3 |
| 2018 February | 5 | 0 | 5 |
| 2018 January | 10 | 1 | 11 |
| 2017 December | 5 | 1 | 6 |
| 2017 November | 8 | 2 | 10 |
| 2017 October | 8 | 1 | 9 |
| 2017 September | 7 | 2 | 9 |
| 2017 August | 10 | 5 | 15 |
| 2017 July | 11 | 2 | 13 |
| 2017 June | 10 | 1 | 11 |
| 2017 May | 16 | 4 | 20 |
| 2017 April | 15 | 1 | 16 |
| 2017 March | 12 | 33 | 45 |
| 2017 February | 13 | 3 | 16 |
| 2017 January | 13 | 2 | 15 |
| 2016 December | 12 | 4 | 16 |
| 2016 November | 19 | 3 | 22 |
| 2016 October | 30 | 6 | 36 |
| 2016 September | 22 | 3 | 25 |
| 2016 August | 14 | 2 | 16 |
| 2016 July | 20 | 3 | 23 |
| 2016 June | 20 | 7 | 27 |
| 2016 May | 23 | 9 | 32 |
| 2016 April | 8 | 7 | 15 |
| 2016 March | 15 | 10 | 25 |
| 2016 February | 15 | 14 | 29 |
| 2016 January | 12 | 13 | 25 |
| 2015 December | 24 | 7 | 31 |
| 2015 November | 9 | 12 | 21 |
| 2015 October | 16 | 7 | 23 |
| 2015 September | 21 | 5 | 26 |
| 2015 August | 16 | 3 | 19 |
| 2015 July | 4 | 2 | 6 |
| 2015 June | 4 | 0 | 4 |
| 2015 May | 7 | 1 | 8 |
| 2015 April | 14 | 11 | 25 |
| 2015 March | 16 | 15 | 31 |
| 2015 February | 10 | 2 | 12 |
| 2015 January | 30 | 2 | 32 |
| 2014 December | 43 | 12 | 55 |
| 2014 November | 29 | 5 | 34 |
| 2014 October | 36 | 2 | 38 |
| 2014 September | 23 | 4 | 27 |
| 2014 August | 32 | 6 | 38 |
| 2014 July | 30 | 5 | 35 |
| 2014 June | 15 | 1 | 16 |
| 2014 May | 21 | 5 | 26 |
| 2014 April | 13 | 3 | 16 |
| 2014 March | 11 | 2 | 13 |
| 2014 February | 9 | 4 | 13 |
| 2014 January | 16 | 5 | 21 |
| 2013 December | 18 | 4 | 22 |
| 2013 November | 18 | 1 | 19 |
| 2013 October | 32 | 5 | 37 |
| 2013 September | 16 | 2 | 18 |
Show all
