Laparo-endoscopia por acceso único: experiencia inicial
Laparo-endoscopic single site (LESS)
Rene Sotelo1
, Juan Carlos Astigueta, Oswaldo Carmona, Robert De Andrade, Rafael Sanchez-Salas
Autor para correspondencia
renesotelo@cantv.net
renesotelo@mac.com
Correspondencia autor: Dr. Rene Sotelo Noguera Centro de Cirugía Robótica y Mínimamente Invasiva, Instituto Médico La Floresta, Av. Principal Urb. La Floresta, PB 707. Caracas, Venezuela. Tel.: +58 212 209 6240; 285 1015.
renesotelo@mac.com
Correspondencia autor: Dr. Rene Sotelo Noguera Centro de Cirugía Robótica y Mínimamente Invasiva, Instituto Médico La Floresta, Av. Principal Urb. La Floresta, PB 707. Caracas, Venezuela. Tel.: +58 212 209 6240; 285 1015.
Centro de Cirugía Robótica y Mínimamente Invasiva. Unidad de Urología. Instituto Médico La Floresta, Caracas-Venezuela
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Unidad de Urología. Instituto Médico La Floresta, Caracas-Venezuela" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "1" "correspondencia" => "Correspondencia autor: Dr. Rene Sotelo Noguera Centro de Cirugía Robótica y Mínimamente Invasiva, Instituto Médico La Floresta, Av. Principal Urb. La Floresta, PB 707. Caracas, Venezuela. Tel.: +58 212 209 6240; 285 1015." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Laparo-endoscopic single site (LESS)" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-11-30" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec88810" "palabras" => array:5 [ 0 => "LESS" 1 => "Prostatectomía simple" 2 => "Nefrectomía" 3 => "Histerectomía" 4 => "Enterocistoplastia" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec88809" "palabras" => array:5 [ 0 => "LESS" 1 => "Simple prostatectomy" 2 => "Nephrectomy" 3 => "Hysterectomy" 4 => "Enterocystoplasty" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Presentar nuestra experiencia inicial en LESS Surgery (Laparo-Endoscopic Single Site Surgery/Cirugía laparoendoscópica por acceso único), mediante uso de dispositivo multicanal, instrumentos estándar, articulables y otros adaptados para la consecución de los procedimientos.</p> <span class="elsevierStyleSectionTitle">Materiales y metodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Entre febrero y septiembre del 2008 se realizaron 28 procedimientos quirúrgicos LESS con puerto multicanal: prostatectomía simple transumbilical (PSTU) y transvesical (PSTV), nefrectomía simple (NS), enterocistoplastia de aumento (ECA) e histerectomía simple (HS). Los datos clínicos fueron recopilados de manera prospectiva y analizados retrospectivamente. Se utilizó dispositivo de acceso multicanal (R-Port). Los procedimientos fueron realizados en un centro por un solo cirujano (RS). La técnica quirúrgica empleada correspondió a la misma utilizada por vía laparoscópica convencional.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se realizaron 28 intervenciones quirúrgicas: PSTU(01), PSTV(20), NS(01), ECA(01), HS(05). La incisión de acceso fue realizada a nivel umbilical o infraumbilical. Solo un caso (nefrectomía) ameritó uso de trocar adicional de 2 mm. La edad media en años por procedimiento fue: PSTU, 67; PSTV, 68 (57–89); NS, 12; ECA, 20; HS, 46.4 (41–54). El tiempo quirúrgico medio en minutos fue: PSTU, 120; PSTV, 91 (45–210); NS, 120; ECA, 300; HS, 112 (90–160). El sangrado operatorio fue: PSTU, 200cc; PSTV, 337 cc (50-1500); NS, 100cc; EAC, 100cc; HS, 118cc. (100–160). La complicación observada fue hematuria profusa en dos casos de PSTV, ambos pacientes requirieron exploración postoperatoria con evolución satisfactoria.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">LESS es una alternativa factible y reproducible en patología uroginecológica de resolución quirúrgica. Mayores estudios, experiencias y seguimiento permitirán la evaluación objetiva de esta técnica.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objetive</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We present our initial experience in laparo-endoscopic single site (LESS) surgery, through multichannel port, articulated instruments and standard instruments adapted others adapted for the procedures.</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Between February and October 2008, 28 LESS surgical procedures with multi-port were performed (Transumbilical simple prostatectomy (PSTU) and transvesical (PSTV), simple nephrectomy (NS), Enterocystoplasty augmentation (ECA) and simple hysterectomy (HS)). The clinical data were collected prospectively and analyzed retrospectively. Was used access device Multichannel (R-Port). The procedures were performed for a single surgeon (RS). The surgical technique was the same route used by conventional laparoscopic.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Twenty-eight surgeries were performed: PSTU (01), PSTV (20), NS (01), ECA (01), HS (05). The incision was performed umbilical or infraumbilical. Only one case (nephrectomy) needed it placement of an additional trocar. The average age by procedure was PSTU and PSTV, 67 and 68 year-old (57-89 y) respectively; NS 12 year-old; RCT 20 year-old; HS 46.4 year-old (41 – 54 y). The operative time was: PSTU 120 minutes, PSTV 91 minutes (45-210 min); NS 120 minutes; RCT 300 minutes; HS 112 minutes(90-160 min). The operative bleeding was PSTU and PSTV 200 cc. and 337 cc (50-1500 cc) respectively; NS 100cc; EAC 100 cc; HS 118 cc (100-160 cc). The complication was haematury in two cases of PSTV, both patients required exploration postoperative endoscopic with satisfactory evolution.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">LESS is a feasible and reproducible surgical option in uro-gynecologic surgical treatment. Further studies, experience and follow-up will provide an objective assessment of the technique.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Referencias" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "the SAGES/ASAGE working group on natural orifice translumenal endoscopic surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Rattner" 1 => "A. 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| 2024 Octubre | 0 | 14 | 14 |
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| 2023 Agosto | 0 | 26 | 26 |
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| 2023 Abril | 0 | 1 | 1 |
| 2023 Marzo | 1 | 6 | 7 |
| 2023 Febrero | 0 | 3 | 3 |
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| 2022 Febrero | 0 | 2 | 2 |
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| 2021 Diciembre | 0 | 6 | 6 |
| 2021 Noviembre | 0 | 11 | 11 |
| 2021 Octubre | 0 | 6 | 6 |
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| 2020 Junio | 0 | 6 | 6 |
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| 2020 Abril | 0 | 3 | 3 |
| 2020 Marzo | 0 | 7 | 7 |
| 2020 Febrero | 0 | 2 | 2 |
| 2020 Enero | 0 | 19 | 19 |
| 2019 Diciembre | 0 | 20 | 20 |
| 2019 Noviembre | 0 | 9 | 9 |
| 2019 Octubre | 0 | 4 | 4 |
| 2019 Septiembre | 0 | 8 | 8 |
| 2019 Agosto | 0 | 7 | 7 |
| 2019 Julio | 0 | 10 | 10 |
| 2019 Junio | 0 | 30 | 30 |
| 2019 Mayo | 0 | 68 | 68 |
| 2019 Abril | 0 | 68 | 68 |
| 2019 Marzo | 0 | 2 | 2 |
| 2019 Febrero | 0 | 26 | 26 |
| 2019 Enero | 0 | 8 | 8 |
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| 2018 Noviembre | 0 | 9 | 9 |
| 2018 Octubre | 0 | 22 | 22 |
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| 2018 Agosto | 0 | 5 | 5 |
| 2018 Julio | 0 | 1 | 1 |
| 2018 Junio | 0 | 1 | 1 |
| 2018 Mayo | 0 | 6 | 6 |
| 2018 Abril | 0 | 3 | 3 |
| 2018 Marzo | 1 | 2 | 3 |
| 2018 Febrero | 2 | 1 | 3 |
| 2018 Enero | 0 | 3 | 3 |
| 2017 Diciembre | 2 | 4 | 6 |
| 2017 Noviembre | 3 | 8 | 11 |
| 2017 Octubre | 8 | 6 | 14 |
| 2017 Septiembre | 5 | 3 | 8 |
| 2017 Agosto | 6 | 3 | 9 |
| 2017 Julio | 8 | 8 | 16 |
| 2017 Junio | 5 | 7 | 12 |
| 2017 Mayo | 13 | 4 | 17 |
| 2017 Abril | 11 | 6 | 17 |
| 2017 Marzo | 18 | 16 | 34 |
| 2017 Febrero | 18 | 8 | 26 |
| 2017 Enero | 12 | 5 | 17 |
| 2016 Diciembre | 20 | 24 | 44 |
| 2016 Noviembre | 35 | 14 | 49 |
| 2016 Octubre | 43 | 22 | 65 |
| 2016 Septiembre | 16 | 5 | 21 |
| 2016 Agosto | 12 | 2 | 14 |
| 2016 Julio | 14 | 4 | 18 |
| 2016 Junio | 18 | 12 | 30 |
| 2016 Mayo | 19 | 42 | 61 |
| 2016 Abril | 7 | 19 | 26 |
| 2016 Marzo | 18 | 18 | 36 |
| 2016 Febrero | 7 | 25 | 32 |
| 2016 Enero | 13 | 29 | 42 |
| 2015 Diciembre | 11 | 16 | 27 |
| 2015 Noviembre | 16 | 16 | 32 |
| 2015 Octubre | 18 | 9 | 27 |
| 2015 Septiembre | 20 | 13 | 33 |
| 2015 Agosto | 12 | 5 | 17 |
| 2015 Julio | 9 | 8 | 17 |
| 2015 Junio | 6 | 4 | 10 |
| 2015 Mayo | 7 | 8 | 15 |
| 2015 Abril | 6 | 15 | 21 |
| 2015 Marzo | 7 | 6 | 13 |
| 2015 Febrero | 4 | 3 | 7 |
| 2015 Enero | 5 | 0 | 5 |
| 2014 Diciembre | 11 | 10 | 21 |
| 2014 Noviembre | 9 | 2 | 11 |
| 2014 Octubre | 19 | 4 | 23 |
| 2014 Septiembre | 12 | 1 | 13 |
| 2014 Agosto | 4 | 2 | 6 |
| 2014 Julio | 15 | 0 | 15 |
| 2014 Junio | 4 | 5 | 9 |
| 2014 Mayo | 9 | 0 | 9 |
| 2014 Abril | 2 | 4 | 6 |
| 2014 Marzo | 5 | 1 | 6 |
| 2014 Febrero | 3 | 4 | 7 |
| 2014 Enero | 5 | 1 | 6 |
| 2013 Diciembre | 6 | 1 | 7 |
| 2013 Noviembre | 9 | 7 | 16 |
| 2013 Octubre | 3 | 10 | 13 |
| 2013 Septiembre | 5 | 12 | 17 |
| 2013 Agosto | 2 | 5 | 7 |
| 2013 Julio | 2 | 0 | 2 |
| 2009 Febrero | 271 | 0 | 271 |
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