The insertion of the Veress needle in the abdominal midline, at the umbilicus, poses serious risk to the life of patients. Therefore, further studies should be conducted to investigate alternative sites for Veress needle insertion.

Purpose:To investigate the effectiveness of fibrin glue (laparoscopic via) into promote the hemostasis of a spleen injury on a heparinized porcine model. Methods: Eighteen Landrace porcine were submitted to laparoscopic spleen injury and randomly distributed: GHA (heparin plus adhesive), GH (heparin without adhesive) and GS (Sham -without heparin or adhesive). Ten minutes before the surgical procedures a single IV dose (200UI/kg) of heparin sodium was administrated only to groups GHA and GH. In the GHA, adhesive was applied after the mechanical injury and recorded the time until the polymerization and clot formation. Results: No significant differences occurred among the groups (Fisher test) considering the weight and surgery time. The blood amount in the abdominal cavity on GH was significantly higher in comparison to the sham group and especially with the GHA (p<0.004). No significant differences were observed in the body temperature, heart rate, cardiac output, means arterial pressure, pulmonary artery pressure during the experiment. The activated partial thromboplastin time (APTT) was lower in the GHA in comparison to GH (p<0.003). Conclusion: The fibrin biological adhesive applied by laparoscopy is effective for hemostasis of minor spleen injury in a porcine model under the effect of anticoagulant drug. Key words: Splenic Rupture. Fibrin Tissue Adhesive. Laparoscopy. Hemostasis, Surgical. Rabbits. RESUMO Objetivo:Investigar a eficácia da cola de fibrina (via laparoscópica) na hemostasia de uma lesão no baço de porco heparinizado. Métodos: Dezoito suínos Landrace foram submetidos a lesão do baço e distribuídos aleatoriamente: GHA (heparina adesivo), GH (heparina sem adesivo) e GS (Sham -sem heparina ou adesivo). Dez minutos antes dos procedimentos uma dose única (200UI/kg) de heparina sódica (EV) foi administrada nos grupos GHA e GH. A fibrina (GHA) foi aplicada após a lesão e registrado o tempo até a polimerização e formação do coágulo. Resultados: Não houve diferenças significativas entre os grupos (teste de Fisher), considerando o peso e o tempo de cirurgia. A quantidade de sangue na cavidade abdominal de GH foi significativamente maior em comparação ao GS e, especialmente, com o GHA (p<0,004). Não foram observadas diferenças significativas na temperatura corporal, frequência cardíaca, débito cardíaco, pressão arterial ou pressão da artéria pulmonar durante o experimento (20 minutos). O tempo de tromboplastina parcial ativada (TTPA) foi menor no GHA em relação ao GH (p<0,003). Conclusão: A cola de fibrina biológica aplicada por laparoscopia é eficaz para a hemostasia de lesões no baço menor em um modelo suíno sob o efeito de drogas anticoagulantes.

Values of IP and VG at given time points during insufflation for creation of the pneumoperitoneum, using the Veress needle, can be effective parameters to determine whether the needle is correctly positioned in the peritoneal cavity.

-Background -Two-layer intestinal anastomosis increases the inflammatory response while single-layer anastomosis results in a better wound healing. However the four main kinds of stitches which may be chosen in performing single layer intestinal sutures never before had been comparatively studied. Aim -To compare the four more commonly used types of single layer surgical anastomosis sutures of the digestive tract. Methods -Six mongrel dogs were operated, each one receiving two anastomosis: one at 30 cm from de Treitz angle -sero-submucosal technique, and the other at 60 cm -total technique. This placement was alternatively inverted. The four more commonly used types of single layer surgical anastomosis sutures of the digestive tract, namely: sero-submucosal stitches tied in the lumen, over the submucosa; sero-submucosal stitches tied in the exterior of the organ, over the serosa; total stitches tied in the lumen, over the mucosa; and total sutures tied in the exterior, over the serosa (Gambee's stitches) were tested. After euthanasia (7th post-operative day) macro and microscopic features were evaluated. Friedman's test was applied for morphometry and for evaluation of the peritoneal adhesions. Results -Statistical significance was demonstrated through major residual acute inflammation and proliferation in total sutures and more profuse adhesions with the sero-submucosal stitches tied in the lumen. The sero-submucosal stitches tied in the exterior over the serosa, had excellent realignment and regeneration of the layers. Conclusion -The sero-submucosal stitches tied in the exterior, over the serosa, were the best ones.

One of the most difficult challenges to surgeons is the treatment of wounds on the retro hepatic vena cava. The anatomic particularities of this venous segment make its approach and treatment difficult, contributing to a high morbidity and mortality. Several techniques have been described for the treatment of these types of lesions. In this particular case, authors have chosen the introduction of a fastened provisory intra caval prothesis, without primary suturing of the wounds. The provisory intra caval prothesis can be an option for the treatment of retro hepatic vena cava lesions.