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Resultados preliminares de la implementación de la prostatectomía radical robótica en régimen de cirugía mayor ambulatoria
Preliminary results of the implementation of robotic radical prostatectomy in a major ambulatory surgery regimen
P. de Pablos-Rodrígueza,c,
Autor para correspondencia
pablos.rodriguez92@gmail.com

Autor para correspondencia.
, J.F. Suárez Novoa, M. Castells Estevea, X. Bonet Puntía, N. Picola Braua, A. Abella Serraa, E. López Picazoa, A. Cabrera Comab, A. Sánchez Alluevab, F. Vigués Juliàa
a Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, España
b Servicio de Anestesiología y Reanimación, Hospital Universitari de Bellvitge, Barcelona, España
c Escuela de doctorado de la Universidad de Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065"><span class="elsevierStyleBold">Introducci&#243;n</span></span><p id="par0005" class="elsevierStylePara elsevierViewall">La prostatectom&#237;a radical es considerada uno de los tratamientos de elecci&#243;n del c&#225;ncer de pr&#243;stata &#40;CaP&#41; organoconfinado&#46; El abordaje rob&#243;tico se ha impuesto como la t&#233;cnica est&#225;ndar dada su naturaleza m&#237;nimamente invasiva&#44; existiendo controversia sobre su superioridad en resultados funcionales frente al abordaje abierto o al laparosc&#243;pico<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">1-3</span></a>&#46; Los porcentajes de complicaci&#243;n y reingreso tras la prostatectom&#237;a radical rob&#243;tica &#40;PRR&#41; se sit&#250;an por debajo del 5&#37;&#44; con una estancia hospitalaria convencional de 24 a 48<span class="elsevierStyleHsp" style=""></span>horas<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Los avances en la cirug&#237;a m&#237;nimamente invasiva y en las t&#233;cnicas anest&#233;sicas han permitido transformar m&#250;ltiples cirug&#237;as al r&#233;gimen ambulatorio&#46; La cirug&#237;a mayor ambulatoria &#40;CMA&#41; ha demostrado beneficios sobre el paciente &#40;disminuci&#243;n del riesgo de infecci&#243;n nosocomial y de eventos tromb&#243;ticos&#44; mejor&#237;a en su percepci&#243;n de salud&#41; y sobre el sistema sanitario &#40;disminuci&#243;n de costes y optimizaci&#243;n de recursos hospitalarios&#41;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">5-7</span></a>&#46; Estas ventajas cobran especial importancia en la pandemia actual de la COVID-19&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Recientemente diversos centros de Estados Unidos y de Francia han publicado su experiencia de PRR ambulatoria&#44; obteniendo buenos resultados en t&#233;rminos de seguridad<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">8-10</span></a>&#46; En el presente estudio mostramos y evaluamos los resultados del primer programa de PRR en r&#233;gimen de CMA de nuestro pa&#237;s y uno de los primeros de Europa&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070"><span class="elsevierStyleBold">Material y m&#233;todos</span></span><p id="par0020" class="elsevierStylePara elsevierViewall">Analizamos retrospectivamente los primeros casos de PRR en r&#233;gimen ambulatorio intervenidos entre marzo de 2021 y mayo de 2022 en nuestro centro&#46; El protocolo de PRR en CMA fue dise&#241;ado por los servicios de urolog&#237;a y anestesia y aprobado por la direcci&#243;n del centro&#46; Todos los pacientes a los que se les propuso ser intervenidos en r&#233;gimen de CMA firmaron el consentimiento de la cirug&#237;a&#44; y por tanto no precisamos de la aprobaci&#243;n del comit&#233; de &#233;tica e investigaci&#243;n cl&#237;nica&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Recopilamos las caracter&#237;sticas basales de los pacientes &#40;edad&#44; IMC&#44; riesgo anest&#233;sico seg&#250;n la clasificaci&#243;n ASA&#44; cirug&#237;a abdominal previa&#41;&#44; resultados intraoperatorios &#40;tiempo quir&#250;rgico&#44; volumen de sangrado&#44; preservaci&#243;n de bandeletas&#44; necesidad de drenaje&#41; y datos del postoperatorio &#40;tiempo hasta retirada de sonda vesical&#44; necesidad de asistencia m&#233;dica no planificada y complicaciones al mes de la cirug&#237;a&#41;&#46; Se recogieron las caracter&#237;sticas oncol&#243;gicas al diagn&#243;stico de la enfermedad &#40;PSA&#44; estadificaci&#243;n&#44; ISUP&#44; RMN&#41; y el resultado anatomopatol&#243;gico tras la intervenci&#243;n&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Los criterios de inclusi&#243;n contemplaron&#58; edad inferior a 70<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; IMC &#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; capacidad de comprensi&#243;n de las instrucciones del circuito de CMA&#44; necesidad de acompa&#241;ante tras la cirug&#237;a&#44; disposici&#243;n de tel&#233;fono m&#243;vil&#44; domicilio sin barreras arquitect&#243;nicas&#44; vivienda a &#60;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>km del hospital&#44; ASA &#60;<span class="elsevierStyleHsp" style=""></span>III&#44; inicio de la cirug&#237;a antes de las 10&#58;00 de la ma&#241;ana&#44; CaP de riesgo bajo o intermedio y tama&#241;o prost&#225;tico &#60;<span class="elsevierStyleHsp" style=""></span>70<span class="elsevierStyleHsp" style=""></span>cent&#237;metros c&#250;bicos&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se excluyeron aquellos pacientes candidatos a linfadenectom&#237;a&#44; al&#233;rgicos a AINE o al l&#225;tex&#44; con antecedente de EPOC&#44; epilepsia o coronariopat&#237;a&#44; adictos a drogas por v&#237;a parenteral&#44; alteraci&#243;n en la coagulaci&#243;n cong&#233;nita o adquirida&#44; trombosis previa o que no cumplieran con alguno de los criterios de inclusi&#243;n descritos&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">En consultas se ofreci&#243; a los pacientes la posibilidad de ser intervenidos de forma ambulatoria o mediante ingreso convencional&#46; Tras la aceptaci&#243;n del r&#233;gimen ambulatorio&#44; la firma del consentimiento y el cumplimiento de sus requisitos&#44; fueron visitados por enfermer&#237;a de la Unidad Funcional de C&#225;ncer de Pr&#243;stata &#40;UFCaP&#41;&#44; quien les dio las instrucciones del proceso de CMA&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La cirug&#237;a consisti&#243; en una PRR transperitoneal mediante un abordaje anterior utilizando el sistema Da Vinci X&#174; o Xi&#174;&#44; seg&#250;n disponibilidad&#46; Fue realizada por dos cirujanos con m&#225;s de 100<span class="elsevierStyleHsp" style=""></span>PRR de experiencia&#44; asistidos por residentes en formaci&#243;n&#46; El control de la v&#237;a a&#233;rea fue realizado mediante intubaci&#243;n orotraqueal y la analgesia intraoperatoria se hizo con medicaci&#243;n endovenosa y anestesia local &#40;en la pared abdominal y en el saco de Douglas&#41;&#46; Las presiones del neumoperitoneo deb&#237;an oscilar entre 10 y 15<span class="elsevierStyleHsp" style=""></span>mmHg&#44; como m&#225;ximo&#44; durante toda la cirug&#237;a&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Tras un periodo de observaci&#243;n inferior a 8<span class="elsevierStyleHsp" style=""></span>horas en la unidad de readaptaci&#243;n de CMA se valoraron la estabilidad cl&#237;nica del paciente&#44; el buen control del dolor&#44; la ausencia de n&#225;useas&#47;v&#243;mitos&#44; la tolerancia a la dieta&#44; la capacidad de deambular y la comprensi&#243;n de instrucciones y normas de reconsulta&#46; Aun cumpliendo todos los criterios de alta hospitalaria&#44; se les ofreci&#243; la posibilidad de quedarse una noche ingresados si no se sent&#237;an preparados para marchar a su domicilio&#46; En ausencia de signos de alarma no se realizaron controles anal&#237;ticos&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La ma&#241;ana siguiente del alta hospitalaria la enfermera de la UFCaP contact&#243; telef&#243;nicamente para conocer el estado de salud de los pacientes y resolver dudas si las hubiera&#46; Adem&#225;s&#44; contaban con un n&#250;mero de tel&#233;fono disponible las 24<span class="elsevierStyleHsp" style=""></span>horas en caso de necesidad&#46; La primera visita presencial fue a los 7<span class="elsevierStyleHsp" style=""></span>d&#237;as para la retirada de la sonda y la revisi&#243;n de las heridas&#46; La visita m&#233;dica se realiz&#243; al mes de la cirug&#237;a&#46; En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> se resume la informaci&#243;n descrita del proceso perioperatorio&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075"><span class="elsevierStyleBold">Resultados</span></span><p id="par0060" class="elsevierStylePara elsevierViewall">Un total de 35 pacientes fueron intervenidos de PRR en r&#233;gimen de CMA&#46; La edad media fue de 60&#44;8 &#177;<span class="elsevierStyleHsp" style=""></span>6&#44;88<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; el IMC promedio fue de 27 &#177;<span class="elsevierStyleHsp" style=""></span>2&#44;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; todos presentaban un riesgo anest&#233;sico bajo &#40;ASA<span class="elsevierStyleHsp" style=""></span>I o<span class="elsevierStyleHsp" style=""></span>II&#41; y el 25&#44;71&#37; ten&#237;an alguna cirug&#237;a abdominal previa&#46; En las <a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a> se muestran las caracter&#237;sticas oncol&#243;gicas y no oncol&#243;gicas de los pacientes&#44; respectivamente&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">El tiempo quir&#250;rgico fue de 151&#44;66 &#177;<span class="elsevierStyleHsp" style=""></span>42&#44;15<span class="elsevierStyleHsp" style=""></span>minutos&#44; el sangrado promedio fue de 301&#44;2 &#177;<span class="elsevierStyleHsp" style=""></span>184&#44;38<span class="elsevierStyleHsp" style=""></span>mililitros y en todos los pacientes se intent&#243; hacer preservaci&#243;n de bandeletas unilateral o bilateral&#44; a criterio del cirujano&#46; En un paciente se produjo una apertura vesical incidental durante la disecci&#243;n del plano posterior prost&#225;tico que se identific&#243; y repar&#243; intraoperatoriamente&#46; Esta constituy&#243; la &#250;nica complicaci&#243;n intraoperatoria de la serie&#44; y tambi&#233;n fue el &#250;nico paciente en el que se dej&#243; drenaje&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Siete de los 35 pacientes &#40;20&#37;&#41; consultaron en urgencias en el mes siguiente de la cirug&#237;a&#46; En la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> se resumen los datos de atenci&#243;n m&#233;dica no planificada&#46; Dos pacientes acudieron en las primeras 24<span class="elsevierStyleHsp" style=""></span>horas postoperatorias por salida de orina perisonda que&#44; tras comprobar la adecuada funci&#243;n de la sonda&#44; fueron dados de alta&#46; Un paciente acudi&#243; al cuarto d&#237;a postoperatorio por una parafimosis que se resolvi&#243; en urgencias&#46; Un paciente present&#243; una infecci&#243;n urinaria febril tras la retirada de la sonda vesical al s&#233;ptimo d&#237;a postoperatorio&#44; requiriendo de ingreso hospitalario&#46; Dos pacientes acudieron a urgencias por episodios de hematuria&#46; El primero&#44; al cuarto d&#237;a&#44; fue dado de alta sin requerimiento de un tratamiento espec&#237;fico&#46; El segundo&#44; al decimocuarto d&#237;a postoperatorio&#44; requiri&#243; la instauraci&#243;n de lavados vesicales e ingreso hospitalario&#46; Por &#250;ltimo&#44; un paciente fue atendido al octavo d&#237;a postoperatorio por evisceraci&#243;n que requiri&#243; cirug&#237;a urgente&#46; Ning&#250;n paciente precis&#243; transfusi&#243;n sangu&#237;nea&#44; y la evoluci&#243;n posterior a las complicaciones fue satisfactoria en todos los casos&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> describimos las complicaciones del estudio seg&#250;n la clasificaci&#243;n de Clavien-Dindo y el tiempo hasta su aparici&#243;n&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080"><span class="elsevierStyleBold">Discusi&#243;n</span></span><p id="par0075" class="elsevierStylePara elsevierViewall">La PRR habitualmente ha requerido una estancia hospitalaria m&#237;nima de 24 a 48<span class="elsevierStyleHsp" style=""></span>horas&#46; A ra&#237;z de la publicaci&#243;n en 2010 de la primera serie de PRR en CMA<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a>&#44; diversos grupos de trabajo han incorporado esta modalidad a su pr&#225;ctica cl&#237;nica&#44; evidenciando buenos resultados en t&#233;rminos de seguridad<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">8-10</span></a>&#46; Si bien en nuestra serie se produjo una complicaci&#243;n grave al octavo d&#237;a postoperatorio&#44; no existi&#243; relaci&#243;n entre esta y la ambulatorizaci&#243;n del paciente&#44; y&#44; por tanto&#44; la aplicaci&#243;n del r&#233;gimen ambulatorio no repercuti&#243; negativamente sobre la seguridad de ning&#250;n paciente&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La incorporaci&#243;n de la laparoscopia en la prostatectom&#237;a ha permitido integrar los demostrados beneficios del perioperatorio &#40;sangrado intraoperatorio y recuperaci&#243;n postoperatoria&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a>&#44; con la obtenci&#243;n de similares resultados oncol&#243;gicos que la cirug&#237;a abierta<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">13</span></a>&#44; aunque existe controversia sobre la superioridad de la t&#233;cnica en el &#225;mbito funcional<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2&#44;14</span></a>&#46; Posteriormente&#44; la globalizaci&#243;n de la cirug&#237;a asistida por robot ha supuesto el segundo hito m&#225;s importante en el desarrollo de la prostatectom&#237;a&#46; La prostatectom&#237;a rob&#243;tica frente al abordaje abierto tambi&#233;n ha demostrado una clara disminuci&#243;n del sangrado intraoperatorio y un mejor control del dolor en el postoperatorio<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a>&#46; Estas ventajas han permitido reducir a la mitad los d&#237;as de ingreso hospitalario una vez superada la curva de aprendizaje<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a>&#46; Por contra&#44; la implementaci&#243;n de la cirug&#237;a rob&#243;tica ha supuesto un incremento de los costes relacionados con el acto quir&#250;rgico&#46; El r&#233;gimen de CMA permite disminuir los costes&#44; aumentar la disponibilidad de camas y de recursos humanos&#44; a la vez que permite reducir los gastos asociados a la cirug&#237;a rob&#243;tica&#46; Un an&#225;lisis de costes realizado en Francia compar&#243; los gastos del paciente ambulatorio frente al del ingreso convencional<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a>&#46; A pesar de que el grupo de ingreso present&#243; una estancia hospitalaria corta&#44; con un promedio de 1&#44;6<span class="elsevierStyleHsp" style=""></span>d&#237;as&#44; describen una reducci&#243;n del 10&#44;8&#37; de los costes por cada paciente ambulatorio&#58; 2&#46;550<span class="elsevierStyleHsp" style=""></span>&#8364; frente a 2&#46;860<span class="elsevierStyleHsp" style=""></span>&#8364;&#46; Si extrapolamos estos datos al promedio de 100<span class="elsevierStyleHsp" style=""></span>PRR realizadas anualmente en nuestro centro&#44; resulta que obtendr&#237;amos un ahorro anual de 31&#46;000<span class="elsevierStyleHsp" style=""></span>&#8364;&#46; Adem&#225;s&#44; la recuperaci&#243;n acelerada del paciente en su domicilio permite su pronta reincorporaci&#243;n a la vida laboral&#44; produciendo as&#237; beneficios econ&#243;micos indirectos dif&#237;cilmente tangibles&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">En nuestra serie decidimos excluir los pacientes candidatos a linfadenectom&#237;a &#40;LND&#41; por su potencial mayor tiempo quir&#250;rgico y riesgo postoperatorio&#46; En la literatura disponemos tanto de grupos que han seguido esta precauci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">6&#44;17</span></a> como de otros que s&#237; la han incorporado&#46; Abaza et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a>&#44; con 246 pacientes&#44; disponen de la serie m&#225;s larga de PRR en CMA hasta la fecha de un &#250;nico centro&#46; En su trabajo realizaron LND a todos sus pacientes&#44; con una media de ocho ganglios extra&#237;dos&#44; y describen un porcentaje de complicaciones del 4&#44;4&#37; y de asistencia m&#233;dica no programada del 4&#44;9&#37;&#46; Estos resultados avalan la seguridad de incluir la LND en el r&#233;gimen de CMA&#59; sin embargo&#44; una revisi&#243;n sistem&#225;tica reciente relacion&#243; la extensi&#243;n de la LND con el empeoramiento de los resultados intraoperatorios y postoperatorios&#44; entre ellos la estancia hospitalaria<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a>&#46; Otros grupos tambi&#233;n han asociado la realizaci&#243;n de la LND como un factor predictor de fracaso del r&#233;gimen ambulatorio<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a>&#46; Por esta raz&#243;n&#44; obviamos a los pacientes candidatos a LND al inicio de este protocolo&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La inclusi&#243;n de nuevas cirug&#237;as&#44; como la prostatectom&#237;a&#44; al r&#233;gimen de CMA no debe afectar la seguridad del paciente&#46; Se requiere la recogida&#44; el an&#225;lisis y la publicaci&#243;n de los resultados para garantizar la compatibilidad de ambos procesos&#46; En nuestra experiencia inicial no se produjo ninguna complicaci&#243;n grave en las primeras 48<span class="elsevierStyleHsp" style=""></span>horas postoperatorias que comprometiera la seguridad de los pacientes&#46; Creemos que el tiempo de monitorizaci&#243;n y de recuperaci&#243;n establecido en el r&#233;gimen ambulatorio es suficiente para predecir o actuar en casos de emergencia vital&#46; En un estudio retrospectivo de 7&#46;126 prostatectom&#237;as radicales se objetiv&#243; un porcentaje de complicaciones medicoquir&#250;rgicas que precisaron atenci&#243;n inmediata inferior al 1&#37;&#46; Sin embargo&#44; no se especifica el tiempo transcurrido hasta la aparici&#243;n de la complicaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Entre los principales indicadores de calidad de la CMA se encuentran la necesidad de ingreso inmediato no previsto &#40;la misma noche de la cirug&#237;a&#41;&#44; la necesidad de consulta a urgencias y el reingreso hospitalario en el mes siguiente a la cirug&#237;a<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a>&#46; En nuestra experiencia&#44; se produjo un 5&#44;71&#37; de pernoctaci&#243;n no prevista&#44; un 20&#37; de visitas a urgencias y un 8&#44;57&#37; de reingreso hospitalario en el mes siguiente a la cirug&#237;a&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> se contrastan estos resultados con los obtenidos por las principales series publicadas en la literatura&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">La necesidad de ingreso inmediato no previsto produce parad&#243;jicamente aquello que el r&#233;gimen ambulatorio intenta evitar&#46; Supone la b&#250;squeda imprevista de camas y de personal sanitario y repercute negativamente sobre la satisfacci&#243;n del paciente&#46; La literatura revela porcentajes por debajo del 5&#37;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">23&#44;24</span></a>&#46; Entre las causas m&#225;s frecuentes de ingreso se encuentran los factores sociales&#47;log&#237;sticos&#44; los quir&#250;rgicos y&#44; en menor medida&#44; los relacionados con la anestesia&#46; En nuestra serie&#44; dos pacientes &#40;5&#44;7&#37;&#41; precisaron ingreso inmediato&#46; Un paciente declin&#243; el alta por sensaci&#243;n de inestabilidad&#44; y un segundo ingres&#243; a criterio del cirujano&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Siete de los 35 pacientes consultaron en urgencias en el mes siguiente a la cirug&#237;a&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se recogen las complicaciones postoperatorias y el tiempo hasta su aparici&#243;n&#46; Dos de las siete visitas a urgencias acontecieron en el primer d&#237;a postoperatorio&#44; y en ambos casos el motivo de la visita fue la salida de orina en torno a la sonda vesical&#46; El Ministerio de Sanidad subdivide en dos grupos&#44; en su gu&#237;a de est&#225;ndares y recomendaciones de CMA&#44; la visita a urgencias en el postoperatorio&#58; la producida en las primeras 24<span class="elsevierStyleHsp" style=""></span>horas y la producida entre las 24<span class="elsevierStyleHsp" style=""></span>horas y los 28<span class="elsevierStyleHsp" style=""></span>d&#237;as<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a>&#46; En nuestros resultados consideramos que las consultas que m&#225;s penalizan el r&#233;gimen de CMA fueron las producidas en las primeras 24<span class="elsevierStyleHsp" style=""></span>horas&#44; por su relaci&#243;n directa con el proceso ambulatorio aun trat&#225;ndose de complicaciones leves &#40;Clavien<span class="elsevierStyleHsp" style=""></span>I&#41;&#46; El resto de las complicaciones producidas transcurrido el primer d&#237;a postoperatorio est&#225;n en relaci&#243;n con el proceso quir&#250;rgico y probablemente hubieran ocurrido de la misma manera en r&#233;gimen de hospitalizaci&#243;n&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">La correcta formaci&#243;n del paciente y sus acompa&#241;antes se considera tambi&#233;n un importante indicador de calidad del r&#233;gimen ambulatorio<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> y posiblemente podr&#237;a haber evitado la visita a urgencias de los pacientes con salida de orina perisonda&#46; La incorporaci&#243;n de avances tecnol&#243;gicos en los sistemas de informaci&#243;n permitir&#225; mejorar el entendimiento del proceso perioperatorio e incrementar la satisfacci&#243;n de los pacientes<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">26&#44;27</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Una de las cr&#237;ticas hacia la CMA es la creencia de que los beneficios econ&#243;micos que produce van en detrimento de la satisfacci&#243;n del paciente&#46; En este sentido&#44; Ploussard et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> describen un porcentaje de satisfacci&#243;n del 100&#37; y un control del dolor del 92&#37; previo al alta a su domicilio&#46; En otro estudio se recogi&#243; informaci&#243;n de satisfacci&#243;n en 214 cuestionarios de pacientes intervenidos de PRR con ingreso hospitalario convencional<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a>&#46; La movilizaci&#243;n precoz y la reincorporaci&#243;n temprana al trabajo fueron las dos principales prioridades demandadas por los pacientes&#46; Adem&#225;s&#44; el 97&#44;6&#37; de los pacientes reportaron un buen control del dolor postoperatorio&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Por el contrario&#44; Dobbs et al&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a>&#44; en una cohorte de prostatectom&#237;as con ingreso&#44; repartieron un cuestionario en el postoperatorio preguntando si quer&#237;an marchar el mismo d&#237;a&#44; obteniendo una respuesta negativa en el 68&#44;4&#37; de los casos&#46; Los motivos m&#225;s frecuentes por los que no se consideraban preparados para el alta fueron el dolor &#40;55&#44;9&#37;&#41; y el disconfort de la sonda &#40;44&#44;7&#37;&#41;&#46; En este centro se realizan cinco prostatectom&#237;as al d&#237;a y&#44; como se ha analizado previamente<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a>&#44; la cirug&#237;a y el alta tard&#237;as son factores que repercuten negativamente sobre el r&#233;gimen ambulatorio&#44; motivo por el cual consideramos excluir aquellas prostatectom&#237;as que empiezan transcurridas las 10&#58;00 de la ma&#241;ana&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Entre las limitaciones del estudio se encuentra la ausencia de un grupo control&#46; Dicha caracter&#237;stica impide la comparaci&#243;n de complicaciones y de asistencia m&#233;dica no prevista en el presente estudio&#46; Por otro lado&#44; no se ha recogido informaci&#243;n sobre la satisfacci&#243;n de los pacientes&#46; Esta variable la hemos empezado a recoger prospectivamente con un grupo control y esperamos que pueda elucidar la percepci&#243;n del paciente en la ambulatorizaci&#243;n de la prostatectom&#237;a&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Esta es la publicaci&#243;n de la primera serie de casos de PRR en r&#233;gimen de CMA en nuestro pa&#237;s y una de las primeras de Europa&#46; Describimos un porcentaje de ingreso inmediato no previsto del 5&#44;71&#37;&#44; y de asistencia a urgencias y de reingreso hospitalario a los 30<span class="elsevierStyleHsp" style=""></span>d&#237;as del 20 y del 8&#44;57&#37;&#44; respectivamente&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">La experiencia en la t&#233;cnica quir&#250;rgica&#44; un adecuado circuito de r&#233;gimen ambulatorio y el soporte de enfermer&#237;a de la UFCaP fueron elementos necesarios dentro de un marco tan presumiblemente exigente como puede ser la PRR en CMA&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085"><span class="elsevierStyleBold">Conclusi&#243;n</span></span><p id="par0140" class="elsevierStylePara elsevierViewall">La ausencia de complicaciones graves en el postoperatorio inmediato avala la PRR en r&#233;gimen de CMA como una t&#233;cnica segura dirigida a pacientes seleccionados&#46; La recopilaci&#243;n de una mayor casu&#237;stica&#44; la adici&#243;n de un grupo control y el an&#225;lisis de datos de satisfacci&#243;n nos permitir&#225; detectar el perfil de paciente que m&#225;s se beneficie de este r&#233;gimen&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicto de intereses</span><p id="par0145" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Reportar nuestra experiencia inicial de prostatectom&#237;a radical rob&#243;tica &#40;PRR&#41; en r&#233;gimen ambulatorio&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis retrospectivo de los pacientes intervenidos de PRR en cirug&#237;a mayor ambulatoria &#40;CMA&#41; en nuestro centro entre marzo de 2021 y mayo de 2022&#46; Recopilamos las caracter&#237;sticas basales de los pacientes&#44; los resultados intraoperatorios y los datos del postoperatorio &#40;necesidad de asistencia m&#233;dica no planificada y complicaciones al mes de la cirug&#237;a&#41;&#46; Se recogieron las caracter&#237;sticas oncol&#243;gicas al diagn&#243;stico de la enfermedad &#40;PSA&#44; estadificaci&#243;n&#44; ISUP&#44; RMN&#41; y el resultado anatomopatol&#243;gico tras la intervenci&#243;n&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Identificamos un total de 35 pacientes&#44; con una edad promedio de 60&#44;8 &#177;<span class="elsevierStyleHsp" style=""></span>6&#44;88 a&#241;os y un IMC de 27 &#177;<span class="elsevierStyleHsp" style=""></span>2&#44;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; Todos presentaban un riesgo anest&#233;sico bajo y un 25&#44;71&#37; ten&#237;an alguna cirug&#237;a abdominal previa&#46; El tiempo quir&#250;rgico fue de 151&#44;66 &#177;<span class="elsevierStyleHsp" style=""></span>42&#44;15 minutos y el sangrado promedio fue de 301&#44;2 &#177;<span class="elsevierStyleHsp" style=""></span>184&#44;38<span class="elsevierStyleHsp" style=""></span>mililitros&#46; Dos pacientes &#40;5&#44;7&#37;&#41; ingresaron la primera noche de la cirug&#237;a y 7 pacientes &#40;20&#37;&#41; consultaron en urgencias en el mes siguiente&#44; de los cuales 3 &#40;8&#44;57&#37;&#41; reingresaron&#46; Registramos una complicaci&#243;n intraoperatoria&#44; 7 complicaciones postoperatorias leves &#40;Clavien<span class="elsevierStyleHsp" style=""></span>I-II&#41; y una complicaci&#243;n grave &#40;Clavien<span class="elsevierStyleHsp" style=""></span>IIIb&#41;&#46; La complicaci&#243;n grave transcurri&#243; al octavo d&#237;a postoperatorio y no tuvo relaci&#243;n con la ambulatorizaci&#243;n del procedimiento&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La ausencia de complicaciones graves en el postoperatorio inmediato avala la PRR en r&#233;gimen de CMA como una t&#233;cnica segura dirigida a pacientes seleccionados&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To report our initial experience with robotic radical prostatectomy &#40;RRP&#41; as an outpatient procedure&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective analysis of patients who underwent RRP as major ambulatory surgery &#40;MAS&#41; at our center between March 2021 and May 2022&#46; We collected baseline patient characteristics&#44; intraoperative outcomes and postoperative data &#40;need for unplanned medical care and complications at one month after surgery&#41;&#46; Oncologic characteristics at disease diagnosis &#40;PSA&#44; staging&#44; ISUP&#44; MRI&#41; and postoperative pathologic outcomes were collected&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We identified a total of 35 patients with an average age of 60&#44;8 &#177;<span class="elsevierStyleHsp" style=""></span>6&#44;88<span class="elsevierStyleHsp" style=""></span>years and a BMI of 27 &#177;<span class="elsevierStyleHsp" style=""></span>2&#44;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; All patients had a low anesthetic risk and 25&#46;71&#37; had undergone previous abdominal surgery&#46; The surgical time was 151&#44;66 &#177;<span class="elsevierStyleHsp" style=""></span>42&#44;15<span class="elsevierStyleHsp" style=""></span>minutes and the average blood loss was 301&#44;2 &#177;<span class="elsevierStyleHsp" style=""></span>184&#44;38<span class="elsevierStyleHsp" style=""></span>milliliters&#46; Two patients &#40;5&#46;7&#37;&#41; were admitted for one night and 7 patients &#40;20&#37;&#41; consulted the emergency department in the following month&#44; of which 3 &#40;8&#46;57&#37;&#41; were readmitted&#46; We recorded one intraoperative complication&#44; 7 mild postoperative complications &#40;Clavien<span class="elsevierStyleHsp" style=""></span>I-II&#41; and one severe complication &#40;Clavien<span class="elsevierStyleHsp" style=""></span>IIIb&#41;&#46; The severe complication occurred on the eighth postoperative day and was not related to the procedure being ambulatory&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The absence of serious complications in the immediate postoperative period supports RRP in MAS as a safe technique for selected patients&#46;</p></span>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">PSA debut&#44; ng&#47;dl</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#44;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;09&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">RMN</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">34 &#40;97&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>1 lesi&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;57&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#62; 1 lesi&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;28&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Tama&#241;o de la lesi&#243;n&#44; cm<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;66&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PIRADS 3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PIRADS 4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">19 &#40;54&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PIRADS 5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;17&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Biopsia transperineal</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Biopsia por fusi&#243;n</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ISUP</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>N&#46;&#176; cilindros positivos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>N&#46;&#176; cilindros total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&#44;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;5&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;68&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;22&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Resultados de anatom&#237;a patol&#243;gica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Peso de la pieza&#44; gramos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">55&#44;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#44;43&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">pT</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>T2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27 &#40;77&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>T3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Derecha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;85&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60; 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Colocaci&#243;n de drenaje</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estancia en unidad de readaptaci&#243;n de CMA&#44; mediana &#40;rango&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7h 27min &#40;6h 22min - 10h 20min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">La preservaci&#243;n de neurobandeletas la decidi&#243; el cirujano principal mediante una escala tipo Likert en la que 0 corresponde a la ausencia de preservaci&#243;n y el 5 a la preservaci&#243;n completa&#46;</p> <p class="elsevierStyleNotepara" id="npar0015">Dos de los 35 pacientes &#40;5&#44;71&#37;&#41; se mantuvieron ingresados tras la cirug&#237;a&#46; Un paciente se sinti&#243; indispuesto por sensaci&#243;n de inestabilidad al inicio de la deambulaci&#243;n&#44; siendo dado de alta al d&#237;a siguiente&#46; Por otro lado&#44; el paciente que sufri&#243; la apertura vesical incidental se mantuvo ingresado a criterio del cirujano&#46; Present&#243; una f&#237;stula urinaria autolimitada a las 72<span class="elsevierStyleHsp" style=""></span>horas de la cirug&#237;a&#44; siendo dado de alta al quinto d&#237;a sin drenaje&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clasificaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#250;mero de pacientes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Descripci&#243;n de la complicaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tiempo hasta la complicaci&#243;n&#44; d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ausencia de complicaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clavien I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sensaci&#243;n de inestabilidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Salida de orina perisonda<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hematuria autolimitada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parafimosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clavien II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hematuria con necesidad de ingreso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infecci&#243;n urinaria febril&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clavien III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Evisceraci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clavien IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">A&#241;o de publicaci&#243;n&#44; autor principal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Pa&#237;s&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Edad&#44; media&#44; a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">IMC promedio&#44; kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">ERAS&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Tiempo quir&#250;rgico promedio&#44; minutos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Sangrado intraoperatorio promedio&#44; ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Drenaje&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Peso prost&#225;tico promedio&#44; gramos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Linfadenectom&#237;a&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Atenci&#243;n m&#233;dica no planificada&#44; &#37;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Complicaci&#243;n&#44; &#37;</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ingreso inmediato no previsto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Visita no prevista&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Leve &#40;Clavien I-II&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grave &#40;III-IV&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2019&#44; Bajpai<a class="elsevierStyleCrossRef" href="#tblfn0020">&#42;</a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EE&#46;UU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#44;6 &#40;consola&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2019&#44; Abaza<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">&#42;&#42;</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EE&#46;UU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">246&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">159&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">131&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2019&#44; Thomas<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Francia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120 &#40;consola&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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Información del artículo
ISSN: 02104806
Idioma original: Español
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