Acta cirurgica brasileira最新文献

Purpose: To develop and validate a trans oral endoscopic thyroidectomy vestibular approach (TOETVA) simulator.

Methods: The first phase of the project consisted of designing and developing a transoral thyroid surgery simulator based on real surgeries. The product has the oral cavity for attaching the three trocars and the cervical part containing the thyroid and adjacent structures. In the second phase, the simulator was validated by specialists who performed an endoscopic thyroidectomy procedure. They all filled a questionnaire about the simulator and the simulation based on the Likert scale.

Results: The simulator consists of a console similar to a human bust and a high-resolution camera system connected to a 22-inch monitor. The simulator had excellent results in the visual evaluation (face validity), with 100% of responses between good and excellent for the following characteristics: synthetic structures, design, visibility of the surgery field, resistance, resilience, fulcrum effect, ergonomics, surgical material, and practicality. The last three were rated higher, with more votes for excellent. For content validity, the items that received the best ratings were, precisely, the steps relating to the surgical procedure: opening the intermuscular midline, isthmotomy, and thyroidectomy.

Conclusions: The thyroidectomy training box showed great ability to simulate a TOETVA, with satisfactory evaluations concerning its visual and content validation.

Purpose: To compare robotic versus laparoscopic colectomies in colon cancer patients in general complications.

Methods: Nine databases were searched for randomized controlled trials (RCT) investigating patients with colon cancer, submitted to robotic surgery (RS) compared to a laparoscopic (LC) approach. The risk of bias was assessed using RoB 2.0 tool, and certainty of the evidence was evaluated by Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Data synthesis was performed using the software R. The meta-analysis of the included studies was carried out using the fixed-effects model (DerSimonian and Laird). Heterogeneity was measured using I2 analysis.

Results: A total of four studies were used with 293 patients. Three studies were used in this comparative LC vs. RS when evaluating infection rates on surgical wound sites. The odds ratio (OR) appeared to be slightly favorable to LC (OR = 3.05; 95% confidence interval-95%CI 0.78-11.96). In the hospitalization rates analysis, two randomized controlled trials were used, and the mean differences slightly favored the RS (MD = -0.54; 95%CI -2.28-1.19). GRADE evaluation detected a serious risk of bias due to RCT format and RoB-2 concurred.

Conclusion: Both types of procedures seem to have their own benefits, risks, and limitations. They seem close to equal in terms of postsurgical infection and hospitalization.

Purpose: Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of gallbladder (GB) disease in small animals. The aims of this study were to investigate and compare the effect of different types of dissectors during LC in rabbits; electrothermal bipolar vessel sealing device (EBVS-LigaSure) and standard electrosurgical dissection (bipolar Maryland) for dissection of the GB in LC, correlating liver function tests (LFTs) in pre and postoperative periods (days 0, 3, 7, 15); macroscopic checking 15 days after surgery through necropsy; histopathological, bacteriological through bacterial growth by culture and intraoperative complications.

Methods: Twenty rabbits were used, group (n = 10) using EBVS for GB dissection and cystic duct seal (GLL), and group (n = 10) using bipolar dissecting forceps and EVBS for cystic duct seal (GLE).

Results: A higher concentration of alkaline phosphatase was observed on GLL 15 days after surgery when compared to GLE. In addition, GLE resulted in a higher concentration of alanine aminotransferase at three days when compared to GLL.

Conclusion: In LC no significant statistical differences were found between EBVS and bipolar Maryland; both devices are equally safe and effective in LC. Further studies are required to evaluate the effectiveness of these devices in animals with gallbladder pathologies. Therefore, clinical studies are necessary.

Purpose: To describe the effects of melatonin associated with bacterial cellulose-based hydrogel on healing of skin wounds in diabetic rats.

Methods: Streptozotocin was used to induce diabetes in Wistar rats. After wound induction, animals were randomly divided into groups GC, GDCC, GDCB, and GDMCB. Animals were evaluated in days 3, 7, and 14 for the following variables: glycemic levels, histopathological and histochemical analyses, healing rate, morphometry and C-reactive protein.

Results: There was no change in glycemic levels in the diabetic animals as a result of the treatments; histopathological analyses showed better healing in GDCB and GDMCB groups, as well as histochemistry; at day 14, the highest healing rate was observed in animals from the GDMCB group, reaching almost 100%; morphometry revealed a significant increase of fibroblasts and reduction of macrophages and blood vessels in lesions treated with bacterial cellulose associated or not with melatonin when compared to the other experimental groups. There was also an increase in C-reactive protein in GDCC group at day 14.

Conclusion: Bacterial cellulose-based dressings associated with systemic melatonin showed beneficial results in experimentally induced wounds in diabetic rats, favoring the healing process.

Purpose: Artesunate (ART) has been implicated in regulating the many processes of liver injury, but its roles in liver regeneration still need to be illustrated.

Methods: In the present study, ART was used to pretreat hepatocyte cell line NCTC1469 to study the effect of ART on hepatocyte proliferation in vitro. Furthermore, the potency of ART as a regimen to promote liver regeneration and restore liver function was evaluated following partial hepatectomy (PH) on C57BL/6 mice.

Results: ART concentration-dependently promoted hepatocyte proliferation and reduced apoptosis. Cell cycle and Ki-67 immunohistochemical analyses demonstrated that ART supplementation promoted the proliferation of hepatocytes and accelerated liver regeneration. Our results provided evidence that ART improved liver function in a dose-dependent manner, as indicated by decreased serum alanine aminotransferase, aspartate aminotransferase, and increased albumin, and hepatocyte growth factor levels in PH mice. Meanwhile, ART promoted the PI3K/Akt/mTOR signaling in NCTC1469 cells and liver tissue of PH mice. In addition, PI3K inhibitor LY294002 blocked the promotion effect of ART on hepatocyte proliferation and cell cycle progression.

Conclusion: ART promoted hepatocyte proliferation via activation of the PI3K/Akt/mTOR pathway, which was beneficial to liver regeneration of PH-induced liver injury.

Purpose: Illicit cosmetic injections remain highly prevalent and can cause serious complications, including death. We aimed to explore existing literature regarding the use of illicit cosmetic injections globally.

Methods: We searched six databases with no language restriction from inception to 2022. We included all articles focused on adult patients of any gender who received any illicit cosmetic injection. Screening and data extraction followed standards from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews guidelines.

Results: After screening 629 abstracts and 193 full texts, 142 citations were included. We identified articles from 28 countries and three multi-country studies. Most were from high-income (75.3%) and upper-middle-income countries (21.8%). Of all patients whose gender identity was described, 49.9% were transgender women, and 40.8% were cisgender women. The anatomic regions most frequently injected were the buttocks (35%) and the breast (13.3%). The most frequently described complications were granuloma (41.5%), dermatological problems (41.5%), infection (35.9%), and pulmonary complications (34.5%).

Conclusions: We observed the impact of illicit silicone injections, particularly on cisgender women and transgender individuals. Existing barriers must be addressed, including healthcare prejudice and inadequate knowledge about care for gender minorities. This will require educating at-risk groups and enhancing policies to regulate these procedures.

Purpose: To histologically quantify the different tissues that make up the porcine ureter, (epithelial, connective, and muscular tissue) in the three segments labelled: cranial, middle and caudal, in order to identify the segment most compatible for use as a vascular graft.

Methods: Fifteen porcine ureters were collected, divided into the three segments, and the samples were stained with hematoxylin and eosin, picrosirius red and Weigert's resorcin-fuchsin. The immunohistochemistry technique was applied for alpha-smooth muscle actin. Collagen fibers, muscle, epithelium, and elastic fibers tissue were quantified, in the entire ureter, and divided into hemispheres, comparing the different segments.

Results: When comparing hemisphere segments, significant differences were observed (p < 0.01) for collagen and muscle tissue, with the cranial segment presenting the greatest amount of these components when compared to the middle and caudal. No significant difference was observed between the segments when comparing the entire ureters.

Conclusions: After comparing the segments by hemisphere, the cranial segment presented a slight advantage for use as a vascular graft due to presenting greater collagen fiber content.

Purpose: This study aimed to evaluate the effects of ozone therapy applied topically and/or by bagging on the healing of clean wounds induced in rat's skin.

Methods: One hundred and twenty male rats of about 16 weeks old was divided into five groups: G1) saline solution (0.9%); G2) sunflower oil; G3) ozonated sunflower oil; G4) ozone bagging; G5) association of ozonated sunflower oil and ozone bagging. The wounds were evaluated through macroscopic, morphometric, histopathologic, and tensile strength analyses.

Results: Analysis among groups showed a lower percentage of wound contraction in G1 compared to G4 only in M7D. The tensile strength of the wounds showed differences among groups in the seventh (M7D) and the 14th (M14D) postoperative day, and among time points in G1 (M14D > M7D). The elongation of the wounds showed differences in G3 (M7D > M14D). Histological evaluation of the wounds showed significant change in bleeding, mixed to mononuclear infiltrate, congestion, and tissue disorganization for tissue organization between groups and time points.

Conclusions: Ozone therapy applied topically and/or by bagging was not deleterious to the healing of clean wounds induced in rat's skin, but ozone bagging showed the best contribution to the healing process.

Purpose: To investigate the profile of hospital admissions for sympathectomies performed in the Brazilian Unified Health System (SUS), comparing open and video-assisted techniques.

Methods: Data on sympathectomies were collected from the SUS Department of Informatics (DATASUS), recorded between 2014 and 2023. The data were tabulated, and descriptive statistics and correlation analyses were performed.

Results: There was reduction in the number of admissions for all sympathectomies during the analyzed period. The use of video-assisted surgeries was higher than that of open surgeries for thoracic procedures, but lower for lumbar procedures. The costs of hospital admission for the procedures were similar, although the length of stay and mortality associated with open surgeries were higher, both in thoracic and lumbar sympathectomies.

Conclusions: The collected data were not individualized, preventing follow-up. Additionally, the study did not account for procedures performed in the private healthcare system. Despite its limitations, this study provides an overview of sympathectomies in Brazil, indicating that, although open sympathectomies are potentially more disadvantageous, they are still widely performed, especially for lumbar procedures.

Purpose: To evaluate the influence of patients' serum vitamin D levels on muscle strength characteristics and whether it impacts the durability of botulinum toxin (BT) treatment.

Methods: The muscle strength of the frontal and corrugator muscles was evaluated before and after the application of TB with pre- and post-application control measurements, and at weeks 2, 5 and 12. The effect of vitamin D on muscle strength and its interaction with BT were investigated in 20 patients. The muscle contraction force was measured by surface electromyography.

Results: The results revealed statistically significant differences between the frontal measurement groups at weeks 2 and 5, as well as for the corrugator in the same weeks and at week 12. Regarding vitamin D, significant differences were observed only in the initial group with vitamin D > 30 ng/mL compared to < 30 ng/mL for the frontal muscles. Patients with higher levels of vitamin D had higher average muscle strength compared to those with lower levels in all evaluations.

Conclusions: It was observed that vitamin D influences muscle strength and the necessary dosage of BT.