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ARTÍCULO ORIGINAL
Experiencia inicial en el tratamiento de enfermedad ginecológica benigna y maligna por laparoscopia en el Hospital Regional de Alta Especialidad de Oaxaca
Initial experience in the laparoscopic treatment of benign and malignant gynaecological diseases in the Hospital Regional de Alta Especialidad in Oaxaca
Sergio Vásquez-Ciriacoa, David Isla-Ortizb, Antonio Palomeque-Lopezc, Jaime Aron García-Espinozad,
Autor para correspondencia
Jaime_506@yahoo.com.mx

Autor para correspondencia: Aldama s/n, Colonia Paraje el Tule, San Bartolo Coyotepec, C.P. 71256, Oaxaca, México. Teléfono: +52 (951) 502 6202.
, Arturo Jarquín-Arremillad, Néstor Alonso Lechuga-Garcíad
a Servicio de Oncología Quirúrgica, Hospital Regional de Alta Especialidad de Oaxaca, Oaxaca, México
b Servicio de Ginecología Oncológica, Instituto Nacional de Cancerología, Ciudad de México, México
c Servicio de Oncología Quirúrgica, Hospital Aurelio Valdivieso de Oaxaca, Oaxaca, México
d Servicio de Cirugía General, Hospital Regional de Alta Especialidad de Oaxaca, Oaxaca, México
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Antecedentes</span><p id="par0005" class="elsevierStylePara elsevierViewall">La necesidad del ser humano por realizar el diagn&#243;stico de enfermedades en forma m&#225;s exacta lo motiv&#243; a introducir m&#233;todos invasivos de exploraci&#243;n de &#243;rganos abdominales&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La exploraci&#243;n del interior de nuestro organismo se inicia con la introducci&#243;n del cistoscopio por Nitze en la Real e Imperial Sociedad de Medicina de Viena en 1879&#44; instrumento mejorado en 1886 por Leiter&#44; al adaptarle una peque&#241;a l&#225;mpara incandescente de Edison<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El desarrollo de la laparoscopia abdominal lo inici&#243; Kelling&#44; en Dresde&#44; quien utiliz&#243; el cistoscopio urol&#243;gico descrito por Nitze&#44; que introdujo a trav&#233;s de un orificio abierto en la pared abdominal de un perro&#44; con la finalidad de inspeccionar el contenido intestinal&#46; A esta t&#233;cnica de exploraci&#243;n la denomin&#243; &#171;celioscopia&#187; y&#44; present&#243; los resultados en el Congreso de la Sociedad M&#233;dica y de Biolog&#237;a Germana&#44; en Hamburgo&#44; en septiembre de 1901<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Ott&#44; un ginec&#243;logo de San Petersburgo&#44; describi&#243; la &#171;ventroscopia&#187; con la que visualizaba el interior de la cavidad a trav&#233;s de una c&#225;nula iluminada por un fot&#243;foro frontal&#46; En 1910&#44; en Estocolmo&#44; Jacobeus<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">3</span></a> emple&#243; el cistoscopio en humanos&#44; lo introdujo en el abdomen a trav&#233;s de un trocar&#44; tras distender la cavidad con agua o aire&#44; para explorar su interior&#44; y denomin&#243; al m&#233;todo &#171;laparoscopia&#187;&#44; t&#233;cnica que reprodujo en el t&#243;rax&#46; En 1911 Berheim&#44; de Estados Unidos&#44; publico¿&#243; un trabajo titulado&#58; &#171;Organoscopia&#58; cistoscopia de la cavidad abdominal&#187;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">4</span></a>&#46; En 1916&#44; Goetze desarroll&#243; una aguja de punci&#243;n para mejorar la insuflaci&#243;n de aire&#59; Ordoff&#44; en 1920&#44; perfeccion&#243; la punta y la convirti&#243; en piramidal para facilitar su penetraci&#243;n&#59; Stone desarroll&#243; un dispositivo valvular en el trocar para impedir la salida del gas&#46; En 1929&#44; Kalk cre&#243; la visi&#243;n &#243;ptica de 135&#176; con visi&#243;n oblicua&#59; Zollikofer&#44; en 1934&#44; utiliz&#243; di&#243;xido de carbono en lugar de aire para la insuflaci&#243;n abdominal&#44; de modo que disminuye el riesgo de embolia gaseosa e irritaci&#243;n peritoneal<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En 1938 el h&#250;ngaro Veress&#44; m&#233;dico internista de Viena&#44; dise&#241;&#243; una aguja atraum&#225;tica para la creaci&#243;n de neumot&#243;rax&#44; que posee una vaina externa con la punta en bisel y un estilete interno romo&#44; que se exterioriza en el momento de penetrar en la cavidad abdominal&#44; con lo que evita da&#241;ar los &#243;rganos internos&#44; raz&#243;n por la cual fue adoptada inmediatamente para la producci&#243;n del neumoperitoneo<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Semm<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">6</span></a>&#44; un ginec&#243;logo e ingeniero de Kiev&#44; describi&#243; el insuflador autom&#225;tico&#44; y en 1966&#44; comenz&#243; la realizaci&#243;n de procedimientos quir&#250;rgicos bien elaborados&#59; adem&#225;s&#44; dise&#241;&#243; un gran n&#250;mero de instrumentos de corte&#44; coagulaci&#243;n&#44; ligadura y sutura para poder llevar a cabo esta cirug&#237;a&#44; por lo que se le considera el padre de la laparoscopia&#44; y desde ese momento&#44; la laparoscopia entr&#243; de lleno en el campo de la Ginecolog&#237;a<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">6</span></a>&#46; La historia de la histerectom&#237;a se remonta al siglo V a&#46; C&#46; ya que exist&#237;an referencias de la realizaci&#243;n de dicho procedimiento&#46; En el siglo II d&#46; C&#46; en &#233;poca de Hip&#243;crates se dice que Soranus de &#201;feso amput&#243; un &#250;tero por v&#237;a vaginal&#46; En 1517 en Italia&#44; Berengario de Capri realiz&#243; una histerectom&#237;a vaginal y desde 1825 se encuentran los primeros datos de intentos de ejecuci&#243;n de histerectom&#237;as&#46; Fue en 1846 cuando Bellinger realiz&#243; la primera histerectom&#237;a abdominal programada&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Una vez que&#44; a principios del a&#241;o 1900&#44; la tasa de mortalidad fue menor del 1&#37;&#44; la histerectom&#237;a comenz&#243; a ser una opci&#243;n en el tratamiento de enfermedades y s&#237;ntomas ginecol&#243;gicos y rompi&#243; el tab&#250; hist&#243;rico impuesto por Johnson&#44; director del London Medical Chirurgical Review&#44; quien declar&#243; en 1825&#58; &#171;Nosotros consideramos que la extirpaci&#243;n del &#250;tero no asociada con protrusi&#243;n o inversi&#243;n previas representa una de las operaciones m&#225;s crueles e impracticables concebidas o ejecutadas por el hombre<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">7</span></a>&#46; No es nuestra intenci&#243;n desalentar intervenciones quir&#250;rgicas audaces y novedosas&#44; pero existe un l&#237;mite que ser&#237;a imprudente sobrepasar&#187;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Esta t&#233;cnica quir&#250;rgica ha tenido una evoluci&#243;n vertiginosa&#46; En 1984&#44; Semm<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">6</span></a> realiz&#243; la primera histerectom&#237;a laparosc&#243;pica asistida v&#237;a vaginal&#59; luego la primera histerectom&#237;a totalmente laparosc&#243;pica fue realizada en Pensilvania en enero de 1988 por Reich et al&#46;&#44; y publicada en 1989<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">7</span></a>&#46; M&#225;s tarde&#44; el mismo doctor Semm&#44; de Alemania&#44; public&#243; los resultados de una t&#233;cnica supracervical&#44; conocida como &#171;classical abdominal Semm histerectomy&#187;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La cirug&#237;a oncol&#243;gica en un principio era rehuida por algunos&#44; por el riesgo de diseminaci&#243;n de c&#233;lulas tumorales y por la necesidad de desmenuzar el tumor para su extracci&#243;n&#44; aunque este paradigma cambi&#243; cuando Coptcoal&#44; en 1991&#44; present&#243; en el III Congreso de M&#237;nima Invasi&#243;n en Boston una nefrectom&#237;a radical por un carcinoma<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">9</span></a>&#44; y Ono et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">10</span></a> en 1993&#44; 2 casos de nefrectom&#237;a por carcinoma renal sin destrozar el ri&#241;&#243;n&#44; que se extrajo con la ayuda de una peque&#241;a incisi&#243;n&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La histerectom&#237;a representa la cirug&#237;a ginecol&#243;gica m&#225;s frecuentemente realizada en Estados Unidos&#44; con 555&#44;000&#44; y en Reino Unido&#44; con 100&#44;000 procedimientos anualmente realizados<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">En Estados Unidos en 1997&#44; el 63&#37; de las histerectom&#237;as se realizaban abiertas y solo el 9&#46;9&#37; por v&#237;a laparosc&#243;pica&#44; y el 1&#46;5&#37; era radical laparosc&#243;pica por enfermedad maligna&#59; para el 2001 se elev&#243; a 41 y 32&#37;&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La histerectom&#237;a radical laparosc&#243;pica es actualmente la cirug&#237;a realizada con mayor frecuencia&#44; con un &#237;ndice de complicaciones intraoperatorias como&#58; sangrado&#44; lesi&#243;n vesical y ureteral similar a las del abordaje abierto&#44; con ventajas como&#58; menor dolor postquir&#250;rgico&#44; tiempo de recuperaci&#243;n m&#225;s r&#225;pido<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">13</span></a>&#44; menor &#237;ndice de transfusiones sangu&#237;neas&#46; Sin embargo&#44; se ha reportado mayor tiempo quir&#250;rgico<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">14</span></a>&#46; Con respecto a los resultados patol&#243;gicos&#44; el an&#225;lisis retrospectivo de Taylor no mostr&#243; diferencias con respecto al n&#250;mero de ganglios y bordes quir&#250;rgicos positivos&#46; Parck et al&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">15</span></a>&#44; en un an&#225;lisis retrospectivo de 99 pacientes en etapas cl&#237;nicas IA1&#44; IA2&#44; obtuvieron resultados oncol&#243;gicos y complicaciones intraoperatorias similares&#46; Spirtos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">16</span></a> evaluaron a 78 pacientes&#46; Otro autor con Lee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">17</span></a> evaluaron a 24 pacientes con etapas cl&#237;nicas IA2 y IBI&#59; en ambos estudios se realiz&#243; histerectom&#237;a total abdominal radical laparosc&#243;pica tipo III con linfadenectom&#237;a p&#233;lvica y paraa&#243;rtica&#44; con seguimiento oncol&#243;gico a 3 y 5 a&#241;os&#44; con resultado similar al de la cirug&#237;a abierta&#46; Por otro lado&#44; Yan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">18</span></a>&#44; en un seguimiento a 12 a&#241;os&#44; demostraron que la supervivencia depende&#44; al igual que la cirug&#237;a abierta&#44; de la biolog&#237;a tumoral y no del procedimiento realizado&#46; La extensi&#243;n de la radicalidad &#40;parametrios&#44; borde vaginal&#41; tampoco se ve comprometida de acuerdo con el estudio de Ghezzi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">19</span></a> que trata espec&#237;ficamente de las complicaciones de las v&#237;as urinarias&#44; como lesi&#243;n vesical o ureteral&#46; En la retenci&#243;n aguda tampoco hubo diferencia estad&#237;stica en el grupo laparosc&#243;pico vs&#46; abierto<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">20</span></a>&#46; Incluso Choi et al&#46;&#44; en Corea<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">21</span></a>&#44; realizaron un estudio que comparaba la histerectom&#237;a total abdominal radical totalmente laparosc&#243;pica con la histerectom&#237;a radical laparosc&#243;pica asistida v&#237;a vaginal&#44; con resultados similares&#44; pero con una recuperaci&#243;n m&#225;s r&#225;pida y menor sangrado para el procedimiento totalmente laparosc&#243;pico&#46; Lo anterior convierte a dicho procedimiento en una opci&#243;n segura y viable de realizar<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">22&#44;23</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Por otro lado&#44; en un estudio se determin&#243; que el n&#250;mero de casos para una curva de aprendizaje es de 40&#44; y para disminuir los tiempos quir&#250;rgicos&#44; de 57&#46; Esta curva se acorta con un programa de entrenamiento b&#225;sico<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">24</span></a>&#44; al iniciar con procedimientos benignos y con la experiencia de haber realizado procedimientos abiertos previamente&#44; aunque este &#250;ltimo punto es m&#225;s debatible<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">25</span></a>&#46; El porcentaje de conversi&#243;n del procedimiento laparosc&#243;pico al abierto en un an&#225;lisis de 260 pacientes consecutivos&#44; independientemente del &#237;ndice de masa corporal &#40;IMC&#41;&#44; edad&#44; cirug&#237;a previa&#44; tama&#241;o del &#250;tero&#44; y tumor fue de 1&#46;5&#37;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">26&#44;27</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En el Hospital Regional de Alta Especialidad de Oaxaca la afecci&#243;n del tracto genital femenino es de las m&#225;s frecuentes&#44; y de ellas&#44; el c&#225;ncer cervicouterino predomina&#46; Se inici&#243; en agosto de 2013 el programa de cirug&#237;a ginecooncol&#243;gica laparosc&#243;pica &#40;o de m&#237;nima invasi&#243;n&#41;&#44; con la asesor&#237;a de un cirujano onc&#243;logo del Instituto Nacional de Cancerolog&#237;a y perito en la materia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Objetivo</span><p id="par0075" class="elsevierStylePara elsevierViewall">Presentar la experiencia inicial de 44 casos con enfermedad benigna y maligna ginecol&#243;gica&#44; tratados mediante cirug&#237;a de m&#237;nima invasi&#243;n&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Material y m&#233;todos</span><p id="par0080" class="elsevierStylePara elsevierViewall">Se evaluaron en forma consecutiva a partir de agosto de 2013 hasta octubre del 2014&#44; 44 casos de pacientes tratadas mediante cirug&#237;a laparosc&#243;pica por enfermedad ginecooncol&#243;gica&#46; Se recabaron los datos generales como&#58; edad&#44; peso&#44; talla e &#237;ndice de masa corporal &#40;IMC&#41;&#44; diagn&#243;stico preoperatorio&#44; d&#237;as de estancia hospitalaria&#44; tiempo quir&#250;rgico&#44; sangrado&#44; tama&#241;o del &#250;tero&#44; conversi&#243;n y causa de la conversi&#243;n en su caso&#44; diagn&#243;stico postquir&#250;rgico&#44; complicaciones intraoperatorias&#44; postoperatorias&#44; con un seguimiento a 30 d&#237;as como tiempo m&#237;nimo para ser incluidas&#44; y el reporte de anatom&#237;a patol&#243;gica&#58; histolog&#237;a&#44; n&#250;mero de ganglios&#44; parametrios y bordes quir&#250;rgicos&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Criterios de inclusi&#243;n</span><p id="par0085" class="elsevierStylePara elsevierViewall">Se incluy&#243; a todas las pacientes de 18 a&#241;os en adelante&#44; con cualquier enfermedad benigna &#40;masas anexiales&#44; miomatosis uterina de peque&#241;os&#44; medianos y grandes elementos&#41;&#44; maligna &#40;c&#225;ncer cervicouterino <span class="elsevierStyleItalic">in situ</span>&#44; c&#225;ncer cervicouterino microinvasivo &#91;IA1&#44; IA2&#93; invasivo &#91;IB1&#93; con tama&#241;o tumoral de 2<span class="elsevierStyleHsp" style=""></span>cm o menos&#44; c&#225;ncer de endometrio en etapas tempranas&#44; sarcoma uterino&#41; o afecci&#243;n sospechosa de malignidad &#40;tumor p&#233;lvico&#58; ovario&#44; hiperplasia endometrial simple o compleja con o sin atipia&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Criterios de exclusi&#243;n</span><p id="par0090" class="elsevierStylePara elsevierViewall">Tumores mayores de 2<span class="elsevierStyleHsp" style=""></span>cm en cuello uterino&#44; neuropat&#237;a o cardiopat&#237;a que contraindicara anestesia general&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Criterios de eliminaci&#243;n</span><p id="par0095" class="elsevierStylePara elsevierViewall">Pacientes en que se inici&#243; el procedimiento quir&#250;rgico laparosc&#243;pico&#44; pero se convirti&#243; el procedimiento por presentar datos de enfermedad avanzada&#44; con adenopat&#237;as retroperitoneales&#44; carcinomatosis peritoneal e implantes en epipl&#243;n supramesoc&#243;lico&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Para la estandarizaci&#243;n de la t&#233;cnica quir&#250;rgica se realizaron los 2 procedimientos iniciales bajo la supervisi&#243;n de un cirujano onc&#243;logo con experiencia en laparoscopia&#46; La t&#233;cnica quir&#250;rgica de la histerectom&#237;a total abdominal laparosc&#243;pica es con 5 trocares colocados de la siguiente manera&#58; puerto supraumbilical a 2<span class="elsevierStyleHsp" style=""></span>cm de la cicatriz umbilical&#44; de 10<span class="elsevierStyleHsp" style=""></span>mm para la c&#225;mara con visi&#243;n de 30&#176;&#44; 4 trocares de 5<span class="elsevierStyleHsp" style=""></span>mm&#44; 2 colocados en fosas il&#237;acas a 2 cm de la espina il&#237;aca anterior y superior&#44; y 2 colocados en los flancos derecho e izquierdo &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; La energ&#237;a utilizada en los primeros 5 casos&#44; fue&#58; Ligasure Atlas y en el resto de los casos energ&#237;a monopolar y Enseal&#44; auxiliados por manipulador uterino Ascleaup o Clermont Ferrand&#46; El procedimiento comenz&#243; con la identificaci&#243;n de estructuras anat&#243;micas &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#44; creaci&#243;n del espacio paravesical y pararrectal &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#44; y evaluaci&#243;n del parametrio &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41;&#46; La linfadenectom&#237;a p&#233;lvica es con energ&#237;a monopolar&#44; respetando los l&#237;mites convencionales &#40;vena circunfleja&#44; nervio obturador&#44; ur&#233;ter y 2<span class="elsevierStyleHsp" style=""></span>cm por arriba de la bifurcaci&#243;n de los vasos il&#237;acos comunes&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0025">fig&#46; 5</a>&#41;&#46; La extracci&#243;n de la pieza quir&#250;rgica es v&#237;a vaginal&#44; con cierre de la c&#250;pula vaginal mediante sutura continua con vycryl del 0 o 1 intracorp&#243;reo &#40;<a class="elsevierStyleCrossRef" href="#fig0030">fig&#46; 6</a>&#41;&#46; En el caso de masas anexiales&#44; el manejo inicial es con 3 trocares&#58; uno de 10<span class="elsevierStyleHsp" style=""></span>mm umbilical y 2 de 5<span class="elsevierStyleHsp" style=""></span>mm en regi&#243;n de fosa il&#237;aca derecha e izquierda&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados</span><p id="par0105" class="elsevierStylePara elsevierViewall">Se analiz&#243; a 44 pacientes&#44; tratadas mediante diversos procedimientos ginecooncol&#243;gicos y agrupadas de la siguiente manera&#58; 9 histerectom&#237;as radicales por c&#225;ncer cervicouterino invasivo&#44; 11 histerectom&#237;as simples por enfermedad benigna del &#250;tero &#40;miomatosis&#41;&#44; 7 histerectom&#237;a tipo I por c&#225;ncer cervicouterino <span class="elsevierStyleItalic">in situ</span>&#44; 12 ooforectom&#237;as por masas anexiales benignas&#44; 3 rutinas de endometrio&#44; una histerectom&#237;a m&#225;s linfadenectom&#237;a p&#233;lvica bilateral por sarcoma uterino y un complemento de rutina de ovario&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Del grupo de histerectom&#237;a radical el promedio de edad fue de 40&#46;2 a&#241;os&#44; con un IMC de 25&#46;8<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; sangrado de 238<span class="elsevierStyleHsp" style=""></span>ml&#44; tiempo quir&#250;rgico de 228&#160;min&#44; tama&#241;o del &#250;tero de 8&#46;4<span class="elsevierStyleHsp" style=""></span>cm&#44; estancia hospitalaria 2&#46;6 d&#237;as&#44; no hubo complicaciones transoperatorias ni postoperatorias&#46; El reporte histopatol&#243;gico fue de 4 pacientes con c&#225;ncer invasivo con un tama&#241;o del tumor de 1 a 1&#46;2<span class="elsevierStyleHsp" style=""></span>cm&#44; tipo histol&#243;gico 2 epidermoide&#44; 2 adenocarcinomas de 12 a 14 ganglios p&#233;lvicos disecados&#44; borde vaginal 0&#46;8&#47;1&#46;1<span class="elsevierStyleHsp" style=""></span>cm negativo&#44; parametrios negativos&#46; Solo una paciente requiri&#243; tratamiento adyuvante por un ganglio positivo&#44; 2 pacientes con c&#225;ncer cervicouterino microinvasivo IA2&#44; 13 ganglios p&#233;lvicos disecados&#44; borde vaginal y parametrios negativos&#44; 3 pacientes con diagn&#243;stico de c&#225;ncer cervicouterino <span class="elsevierStyleItalic">in situ</span> &#40;pacientes con diagn&#243;stico externo de c&#225;ncer invasivo por biopsia o cono externo&#44; y en las que no fue factible la revisi&#243;n de laminillas&#44; y con diagn&#243;stico citocolposc&#243;pico de carcinoma invasivo&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Del grupo de histerectom&#237;a tipo I por diagn&#243;stico de c&#225;ncer cervicouterino <span class="elsevierStyleItalic">in situ</span>&#44; el promedio de edad fue de 51 a&#241;os&#44; con un IMC de 23&#46;8 kg&#47;m<span class="elsevierStyleSup">2</span>&#44; sangrado de 283<span class="elsevierStyleHsp" style=""></span>ml&#44; tiempo quir&#250;rgico de 127&#160;min&#44; tama&#241;o del &#250;tero de 9<span class="elsevierStyleHsp" style=""></span>cm&#44; estancia hospitalaria de 2 d&#237;as&#46; Una paciente present&#243; conversi&#243;n por lesi&#243;n de la arteria il&#237;aca externa con sangrado de 1&#44;500<span class="elsevierStyleHsp" style=""></span>ml&#46; No hubo complicaciones como lesi&#243;n a vejiga&#44; recto o ur&#233;ter&#46; El reporte de enfermedad en todos los casos confirm&#243; el diagn&#243;stico <span class="elsevierStyleItalic">in situ</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Del grupo de histerectom&#237;a tipo I por diagn&#243;stico de miomatosis uterina&#44; el promedio de edad fue de 47 a&#241;os&#44; con un IMC de 27<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; sangrado de 305<span class="elsevierStyleHsp" style=""></span>ml&#44; tiempo quir&#250;rgico de 197&#160;min&#44; tama&#241;o del &#250;tero 14<span class="elsevierStyleHsp" style=""></span>cm&#44; estancia hospitalaria de 1&#46;9 d&#237;as&#46; En este grupo se presentaron 2 conversiones&#58; por perforaci&#243;n del cuerpo uterino por el manipulador uterino&#44; que no permiti&#243; su movilizaci&#243;n&#44; y por desgarro de la arteria uterina con sangrado de 900<span class="elsevierStyleHsp" style=""></span>ml transoperatorio&#46; Una paciente present&#243; desgarro parcial de la vejiga&#44; sin llegar a la rotura total&#44; que fue reparado mediante laparoscopia&#44; y finalmente&#44; una paciente present&#243; hematoma de pared abdominal extenso a las 2 semanas de postoperada&#44; y a las 4 semanas present&#243; prolapso de asas intestinales a trav&#233;s de la vagina&#46; No hubo complicaciones a &#243;rganos como vejiga&#44; recto ni ur&#233;ter &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Del grupo de salpingooforectom&#237;a por masa anexial&#44; el promedio de edad fue de 50 a&#241;os&#44; con un IMC de 29<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; sangrado de 30<span class="elsevierStyleHsp" style=""></span>ml&#44; tiempo quir&#250;rgico de 77&#160;min&#44; tama&#241;o del quiste de 9&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#44; estancia hospitalaria de un d&#237;a&#46; En este grupo no hubo complicaciones transoperatorias ni complicaciones postquir&#250;rgicas a los 30 d&#237;as de seguimiento&#59; el reporte histopatol&#243;gico en todos los casos fue benigno y un solo caso fue absceso tuboov&#225;rico &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Del grupo de c&#225;ncer de endometrio&#44; el promedio de edad fue 50&#46;3 a&#241;os&#44; con un IMC de 30&#46;3<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; sangrado 83<span class="elsevierStyleHsp" style=""></span>ml&#44; tiempo quir&#250;rgico 180&#160;min&#44; tama&#241;o del &#250;tero de 12&#46;6<span class="elsevierStyleHsp" style=""></span>cm&#44; estancia hospitalaria de 2&#46;3 d&#237;as&#44; sin conversiones ni complicaciones&#46; El reporte histopatol&#243;gico de 2 pacientes con tipo histol&#243;gico endometriode&#44; una con enfermedad limitada a endometrio y 12 ganglios p&#233;lvicos negativos&#59; otra con invasi&#243;n menor del 50&#37; de afecci&#243;n al miometrio y 14 ganglios p&#233;lvicos negativos&#46; El &#250;ltimo tipo fue carcinosarcoma con afecci&#243;n mayor al 50&#37; del miometrio y 7 de 14 ganglios p&#233;lvicos positivos &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Una paciente con diagn&#243;stico preoperatorio de sarcoma uterino&#44; con edad de 36 a&#241;os&#44; un IMC de 27 kg&#47;m<span class="elsevierStyleSup">2</span>&#44; sangrado de 100<span class="elsevierStyleHsp" style=""></span>ml&#44; tiempo quir&#250;rgico de 200&#160;min&#44; tama&#241;o del &#250;tero de 13<span class="elsevierStyleHsp" style=""></span>cm&#44; estancia de 2 d&#237;as&#44; sin complicaciones ni conversiones&#46; El reporte histopatol&#243;gico indic&#243; sarcoma uterino de alto grado&#44; con 15 ganglios p&#233;lvicos negativos&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Finalmente&#44; una paciente con diagn&#243;stico de complemento de rutina de ovario&#44; de 36 a&#241;os&#44; con un IMC de 27<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; sangrado de 50<span class="elsevierStyleHsp" style=""></span>ml&#44; tiempo quir&#250;rgico de 210&#160;min y tama&#241;o del &#250;tero de 8<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>cm&#46; El reporte de anatom&#237;a patol&#243;gica con epipl&#243;n inframesoc&#243;lico&#44; lavado peritoneal&#44; biopsia de peritoneo y ganglios p&#233;lvicos &#40;14 ganglios&#41; negativos a malignidad&#44; tama&#241;o del &#250;tero de 8<span class="elsevierStyleHsp" style=""></span>cm&#44; estancia hospitalaria de 2 d&#237;as &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Se destaca la no utilizaci&#243;n de antibi&#243;tico profil&#225;ctico&#44; ni preparaci&#243;n intestinal o vaginal&#44; sin evidencia de infecci&#243;n del sitio operatorio a un mes de seguimiento&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0150" class="elsevierStylePara elsevierViewall">Con el advenimiento de toda la infraestructura que gira alrededor de la cirug&#237;a laparosc&#243;pica&#44; la realizaci&#243;n de procedimientos cada vez m&#225;s complejos por esta v&#237;a se ha convertido en una realidad&#46; Un ejemplo de ello es la cavidad p&#233;lvica y la realizaci&#243;n de procedimientos como histerectom&#237;a total tipo I&#44; II o III&#44; de la clasificaci&#243;n de Piver&#58; linfadenectom&#237;a p&#233;lvica&#44; paraa&#243;rtica o paracaval<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">27&#44;28</span></a> o series de m&#225;s de 500 pacientes con c&#225;ncer endometrial&#44; tratadas con laparoscopia<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">29</span></a> con resultados a 4 a&#241;os similares al procedimiento abierto&#46; Incluso este beneficio se mantiene en pacientes obesas con IMC mayor de 40<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> y c&#225;ncer de endometrio<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">30</span></a>&#44; aunque existen reportes de que la obesidad se asocia a complicaciones importantes en el postoperatorio&#44; por las alteraciones metab&#243;licas que produce<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">31</span></a>&#46; Sin embargo&#44; la recurrencia y la supervivencia global a largo plazo a&#250;n est&#225;n siendo evaluadas&#46; Hasta el momento&#44; a mediano plazo &#40;37 meses&#41; del ASTEC Trial no existen diferencias con el procedimiento abierto&#46; Machana et al&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">32</span></a> evaluaron y compararon el procedimiento abierto versus el rob&#243;tico y laparosc&#243;pico para c&#225;ncer de endometrio&#44; con resultados favorables para estos 2 &#250;ltimos con respecto a menor sangrado<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">33</span></a>&#44; menor estancia hospitalaria y recuperaci&#243;n m&#225;s r&#225;pida<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">34</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Con respecto al c&#225;ncer de ovario&#44; Zhang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">35</span></a> analizaron a pacientes en etapas tempranas con resultados favorables a la laparoscopia&#44; con menor morbilidad y estancia hospitalaria&#46; As&#237; mismo&#44; es una herramienta importante para el estadiaje por menor &#237;ndice de complicaciones comparado con la laparotom&#237;a<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">36&#44;37</span></a>&#46; El reto acerca de la laparoscopia y el c&#225;ncer se ha superado hace mucho con la realizaci&#243;n de procedimientos v&#237;a laparosc&#243;pica&#44; como la operaci&#243;n de Whipple o la derivaci&#243;n biliodigestiva&#46; Con respecto al c&#225;ncer cervicouterino&#44; Mendivil et al&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">38</span></a> encontraron en un estudio retrospectivo de 5 a&#241;os de experiencia que los procedimientos laparosc&#243;picos para el tratamiento de dicha dolencia se asociaban a menor estad&#237;a hospitalaria&#44; &#40;2&#46;9 d&#237;as&#41; datos compatibles con nuestros resultados&#44; y a una supervivencia global de hasta el 89&#46;7&#37; a 60 meses<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">38&#44;39</span></a>&#46; En el Hospital Regional de Alta Especialidad de Oaxaca la cirug&#237;a de m&#237;nima invasi&#243;n se inici&#243; con enfermedades benignas &#40;miomatosis uterina y masas anexiales&#41;&#46; En dicho grupo se presentaron la mayor&#237;a de las complicaciones &#40;sangrado mayor de 500<span class="elsevierStyleHsp" style=""></span>ml&#44; despulimiento de vejiga&#44; lesi&#243;n vascular&#41; y&#44; posteriormente&#44; se continu&#243; con enfermedades malignas ginecol&#243;gicas&#44; con d&#237;as de estancia similares o m&#225;s cortos que los de la cirug&#237;a abierta&#44; ninguna complicaci&#243;n mayor&#44; como lesi&#243;n intestinal&#44; lesi&#243;n vesical o lesi&#243;n ureteral<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">40</span></a>&#44; sangrados similares o menores a los de los procedimientos abiertos<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">41</span></a>&#44; el tiempo quir&#250;rgico con una tendencia a ser mayor&#44; una cosecha de ganglios menor a la de la cirug&#237;a abierta&#44; pero con una integraci&#243;n m&#225;s r&#225;pida a las actividades normales&#46; Seg&#250;n la literatura internacional&#44; las complicaciones mayores antes mencionadas se reducen significativamente cuando el cirujano realiza m&#225;s de 30 histerectom&#237;as laparosc&#243;picas<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">42</span></a>&#44; resultados concordantes con los obtenidos en nuestra unidad&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Aunque en la actualidad el manejo de la enfermedad benigna y maligna de la pelvis por v&#237;a laparosc&#243;pica de la histerectom&#237;a simple&#44; radical y linfadenectom&#237;a p&#233;lvica es factible&#44; segura&#44; con menor estancia hospitalaria y recuperaci&#243;n m&#225;s pronta a sus actividades normales que la cirug&#237;a abierta<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">42</span></a>&#44; el reto institucional ser&#225; aumentar el n&#250;mero de ganglios disecados y disminuir los tiempos quir&#250;rgicos&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusiones</span><p id="par0165" class="elsevierStylePara elsevierViewall">El manejo de enfermedad benigna y maligna p&#233;lvica por laparosc&#243;pica es factible&#44; seguro&#44; con menor estancia hospitalaria y una recuperaci&#243;n m&#225;s pronta de las actividades cotidianas&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Responsabilidades &#233;ticas</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Protecci&#243;n de personas y animales</span><p id="par0170" class="elsevierStylePara elsevierViewall">Los autores declaran que para esta investigaci&#243;n no se han realizado experimentos en seres humanos ni en animales&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Confidencialidad de los datos</span><p id="par0175" class="elsevierStylePara elsevierViewall">Los autores declaran que han seguido los protocolos de su centro de trabajo sobre la publicaci&#243;n de datos de pacientes&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Derecho a la privacidad y consentimiento informado</span><p id="par0180" class="elsevierStylePara elsevierViewall">Los autores declaran que en este art&#237;culo no aparecen datos de pacientes&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicto de intereses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los autores reportan no tener conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La historia de la cirug&#237;a laparosc&#243;pica en afecciones ginecol&#243;gicas creci&#243; con los avances de Semm&#44; el perfeccionamiento de instrumentos&#44; equipos y energ&#237;as&#44; que permiti&#243; el desarrollo en todas las &#225;reas quir&#250;rgicas&#44; incluyendo la Oncolog&#237;a&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Presentar la experiencia inicial en el tratamiento de dolencias benignas y malignas ginecol&#243;gicas por laparoscopia&#44; en el Hospital Regional de Alta Especialidad de Oaxaca&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se analizaron 44 casos distribuidos en&#58; histerectom&#237;a radical tipo III por c&#225;ncer cervicouterino invasivo&#44; histerectom&#237;a tipo I por c&#225;ncer cervicouterino <span class="elsevierStyleItalic">in situ</span>&#44; histerectom&#237;a extrafascial por enfermedad benigna&#44; rutina de endometrio&#44; rutina de ovario y salpingooforectom&#237;a&#46; Variables&#58; edad&#44; &#237;ndice de masa corporal &#40;IMC&#41;&#44; tiempo quir&#250;rgico&#44; sangrado&#44; complicaciones transoperatorias y postoperatorias&#44; conversi&#243;n&#44; estancia hospitalaria y reporte de anatom&#237;a patol&#243;gica&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Histerectom&#237;a tipo III&#59; edad 40&#46;2 a&#241;os&#44; IMC 25&#46;8<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; sangrado 238<span class="elsevierStyleHsp" style=""></span>ml&#44; tiempo quir&#250;rgico 228<span class="elsevierStyleHsp" style=""></span>min&#44; estancia hospitalaria 2&#46;6 d&#237;as&#44; sin complicaciones transoperatorias o postoperatorias&#44; tama&#241;o del tumor 1&#46;1<span class="elsevierStyleHsp" style=""></span>cm&#44; 14 ganglios disecados&#44; borde vaginal y parametrios negativos&#46; Histerectom&#237;a tipo I por c&#225;ncer cervicouterino <span class="elsevierStyleItalic">in situ</span>&#58; 51 a&#241;os&#44; IMC 23&#46;8<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; sangrado 283<span class="elsevierStyleHsp" style=""></span>ml&#44; tiempo quir&#250;rgico 127<span class="elsevierStyleHsp" style=""></span>min&#44; &#250;tero de 9<span class="elsevierStyleHsp" style=""></span>cm&#44; estancia hospitalaria 2 d&#237;as&#44; una conversi&#243;n por lesi&#243;n de arteria il&#237;aca externa con sangrado de 1&#44;500<span class="elsevierStyleHsp" style=""></span>ml&#46; Rutina de endometrio&#58; 50&#46;3 a&#241;os&#44; IMC 30&#46;3<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; sangrado 83<span class="elsevierStyleHsp" style=""></span>ml&#44; tiempo quir&#250;rgico 180<span class="elsevierStyleHsp" style=""></span>min&#44; &#250;tero 12&#46;6<span class="elsevierStyleHsp" style=""></span>cm&#44; estancia hospitalaria 2&#46;3 d&#237;as&#44; sin complicaciones&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusi&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El manejo de afecciones benignas y malignas p&#233;lvicas por laparoscopia es factible&#44; seguro&#44; con menor estancia hospitalaria y una recuperaci&#243;n m&#225;s pronta de las actividades cotidianas&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Antecedentes"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objetivo"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Material y m&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusi&#243;n"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The history of laparoscopic surgery in gynaecological diseases progressed with the advances of Semm&#44; as well as with the development of tools&#44; equipment&#44; and energy that led to its development in all surgical areas&#44; including oncology&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To present the initial experience in the laparoscopic treatment of benign and malignant gynaecological disease in the Hospital Regional de Alta Especialidad in Oaxaca&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">An analysis was performed on a total of 44 cases&#44; distributed into&#58; type III radical hysterectomy for invasive cervical cancer&#44; hysterectomy type I cervical cancer <span class="elsevierStyleItalic">in situ</span>&#44; extrafascial hysterectomy for benign disease&#44; routine endometrium&#44; ovary and routine salpingo-oophorectomy&#46; The variables included age&#44; BMI&#44; surgical time&#44; bleeding&#44; intraoperative and postoperative complications&#44; conversion&#44; hospital stay&#44; and pathology report&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Hysterectomy type III&#59; age 40&#46;2 years&#44; BMI 25&#46;8<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; 238<span class="elsevierStyleHsp" style=""></span>ml bleeding&#44; operative time 228<span class="elsevierStyleHsp" style=""></span>min&#44; 2&#46;6-day hospital stay&#44; intraoperative or postoperative complications&#44; tumour size 1&#46;1<span class="elsevierStyleHsp" style=""></span>cm&#44; 14 lymph nodes dissected&#44; vaginal and negative parametrical edge&#46; Type I hysterectomy cervical cancer <span class="elsevierStyleItalic">in situ</span>&#58; 51 years&#44; BMI 23&#46;8<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; 80<span class="elsevierStyleHsp" style=""></span>ml bleeding&#44; operative time 127<span class="elsevierStyleHsp" style=""></span>minutes&#44; uterus of 9<span class="elsevierStyleHsp" style=""></span>cm&#44; length of stay of 2 days&#44; a conversion by external iliac artery injury&#44; with bleeding of 1500<span class="elsevierStyleHsp" style=""></span>ml&#46; Routine endometrium&#58; 50&#46;3 years&#44; BMI 30&#46;3<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; 83<span class="elsevierStyleHsp" style=""></span>ml bleeding&#44; operative time 180<span class="elsevierStyleHsp" style=""></span>minutes&#44; uterus 12&#46;6<span class="elsevierStyleHsp" style=""></span>cm&#44; length of stay 2&#46;3 days&#44; no complications&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The management of benign and malignant pelvic diseases using laparoscopy is feasible and safe&#44; with shorter hospital stays and a prompt recovery to daily activities&#46;</p></span>"
        "secciones" => array:5 [
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            "identificador" => "abst0030"
            "titulo" => "Background"
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          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objective"
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          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Material and methods"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusion"
          ]
        ]
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">1&#41; &#218;tero&#44; 2&#41; ligamento redondo&#44; 3&#41; ligamento infund&#237;bulo p&#233;lvico&#44; 4&#41; recto y 5&#41; vasos il&#237;acos externos&#46;</p>"
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">1&#41; Espacio pararrectal&#44; 2&#41; espacio paravesical&#44; 3&#41; ligamento infund&#237;bulo p&#233;lvico&#44; 4&#41; ur&#233;ter&#44; 5&#41; parametrio derecho&#46;</p>"
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">L&#237;mites de la linfadenectom&#237;a p&#233;lvica&#46; 1&#41; Fosa obturadora&#44; 2&#41; nervio genitocrural&#44; 3&#41; nervio obturador&#44; 4&#41; vasos il&#237;acos&#44; 5&#41; ur&#233;ter&#46;</p>"
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">L&#237;mite superior de la disecci&#243;n linf&#225;tica &#40;2<span class="elsevierStyleHsp" style=""></span>cm por arriba de la bifurcaci&#243;n de las il&#237;acas&#41;&#46;</p>"
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          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Pieza quir&#250;rgica&#46;</p>"
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        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">IMC&#58; &#237;ndice de masa corporal&#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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Edad &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sangrado &#40;mililitros&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tiempo quir&#250;rgico &#40;minutos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tama&#241;o del tumor &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Complicaciones mayores<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Estancia hospitalaria &#40;d&#237;as&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">250&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">240&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">270&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">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="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">240&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">250&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">220&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">230&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">650&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">240&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">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="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">240&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">230&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Promedio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">238&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">228&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => """
                  <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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Edad &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sangrado &#40;mililitros&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tiempo quir&#250;rgico &#40;minutos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tama&#241;o del &#250;tero &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Complicaciones mayores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Estancia hospitalaria &#40;d&#237;as&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Promedio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">283&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">C&#58; conversi&#243;n&#59; DV&#58; despulimiento de vejiga&#59; HPA&#58; hemorragia de pared abdominal&#59; IMC&#58; &#237;ndice de masa corporal&#59; LV&#58; lesi&#243;n vascular&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Edad &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Estancia Hospitalaria &#40;d&#237;as&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Complicaciones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">550&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">240&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>220&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">900&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&#44; LV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">360&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">240&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">280&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&#44; HPA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">350&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">255&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">155&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1800&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Promedio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">305&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">197&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Edad &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sangrado &#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tiempo quir&#250;rgico &#40;minutos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tama&#241;o tumoral &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Estancia hospitalaria &#40;d&#237;as&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Complicaciones mayores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">145&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Promedio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                0 => """
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">240&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 00097411
Idioma original: Español
DOI:10.1016/j.circir.2016.05.004
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