Laparoscopic nephrectomy with single-portal access Sitracc® in swines

Abstract

PURPOSE:To analyze the viability of using SITRACC ® (single-portal access) to make partial or total nephrectomy in pigs and also to describe the technical difficulties found during these surgical procedures. METHODS: Ten pigs (Landrace specie) with 20kg in average were distributed in two groups: Group A -total right nephrectomyand Group B -partial left nephrectomy -. The anesthetic procedure was initially done with thiopental (10mg/kg) and maintained with halothane. The surgical procedures were performed inside the Surgical Technique Room from Pontifical Catholic University of Parana (PUCPR). RESULTS: It was analyzed the surgery duration, time to insert SITRACC ® , the volemic loss and the size of the organ. In the first surgeries, the surgical time and blood volume loss were higher (between 15 to 43 minutes and 120 to 400 mL, respectively). The more the procedure was performed, the more the surgeons were used to the technique, so the bleeding and the time of surgery was significantly reduced to 15 minutes and 50 mL of blood loss, respectively. The difficulties found were associated with the nippers, however that was not relevant for the surgical technique. It was also found that the intra-body suture caused an expressive volemic loss. CONCLUSION: The total and partial nephrectomy through umbilical single-access by using SITRACC ® was feasible and safe in pigs. Key words: Nephrectomy. Laparoscopy. Swine. RESUMO OBJETIVO: Analisar a viabilidade do uso do SITRACC® (portal único) para realização de nefrectomia total e parcial em suínos e descrever as dificuldades técnicas encontradas durante os atos cirúrgicos propostos. MÉTODOS: Foram operados 10 porcos da espécie Landrace, com peso médio de 20 Kg, distribuidos em dois grupos: Grupo A: nefrectomia total à direita e Grupo B: nefrectomia parcial à esquerda. A indução anestésica foi realizada com a administração de tiopental (10mg/Kg) e mantida com halotano. Os procedimentos cirúrgicos foram realizados na sala de Técnica Operatória da Pontifícia Universidade Católica do Paraná (PUCPR). RESULTADOS: Foram analisados tempo total de cirurgia, tempo de colocação do SITRACC ® , perda volêmica e tamanho da peça. Nas primeiras cirurgias realizadas o tempo cirúrgico e o volume do sangramento foram maiores (entre 15 -43 minutos e entre 120 -400 ml, respectivamente); à medida que se adquiriu prática com a técnica, esses apresentaram reduções significativas para menos que 15 minutos e 50 ml, respectivamente. A dificuldade encontrada foi na articulação das pinças, porém, não afetou a técnica cirúrgica. Além disso, houve dificuldade na realização da sutura intracorpórea acarretando uma perda volêmica maior. CONCLUSÃO: A nefrectomia total e parcial por acesso umbilical único com uso do SITRACC ® é plenamente viável e segura em suínos.

Temporal and comparative analysis between abdomen dissection methods for aorto-caval exposure

“…The anesthetic success depends essentially on the patient monitoring, time division in multiple procedures during surgery and rapid decision-making capacity of the anesthesiologist during non-routine events (WEINGER and SLAGLE, 2002). Since the duration of the surgery is related to the extent of volume loss, the factor time is important to ensure therapeutic success (MEYER, COUTINHO, GOUVEIA et al, 2012). Such evidence proves the relevance of comparative research on anatomico-surgical elements can minimize the duration of high-risk surgeries.…”