RESUMO
PURPOSE: The enhanced view totally extraperitoneal (eTEP) concept first applied to inguinal hernias has become an important tool in the armamentarium of ventral hernia repair. The purpose of this report is to date the first brazilian robotic-assisted eTEP ventral hernia repair case series. METHODS: A review of a prospectively maintained database was conducted in patients who underwent robotic-assisted enhanced view totally extraperitoneal (eTEP) for ventral hernia repair between June 2018 and January 2020. Patients demographics, preoperative hernia characteristics, intraoperative variables and postoperative outcomes were evaluated. RESULTS: Our review identified 74 patients submitted to the procedure. Thirty-one patients (41.8%) presented primary ventral hernias (PVHs) and 43 patients (58.2%) presented incisional hernias (IHs). Female patients were predominant in both groups PVHs and IHs with 17 (22.9%) and 22 (29.7%) respectively, with a total of 39 patients (52.7%). Mean BMI was 29.1 kg/m2 (range 21.3-48.0 kg/m2) with higher mean BMI rates of 30.3 kg/m2 in the IHs group (range 22-48 years). A lateral dock setup was utilized in 55 cases (74.4%), having the inferior and superior dock setup in 18 (24.3%) and 1 (1.3%) cases respectively. Mean console time was 148.3 (range 75-277 min) and 192.6 min (range 66-301 min) in the PVHs and IHs groups respectively. There were no intraoperative complications or conversions. Average length of stay was 1.5 days. Four patients were readmitted within 30 days of surgery. There were no reoperation or cases of intraparietal herniation in this cohort. No hernia recurrence was verified during the mean 230.7 days of follow up in both groups. CONCLUSION: We present the first brazilian series to-date of the robotic assisted eTEP approach for ventral hernia repairs. Although long term outcomes require further analysis, its feasibility and reproducibility in experienced surgeons hands are evident, with safe and acceptable early postoperative outcomes.
Assuntos
Hérnia Ventral , Hérnia Incisional , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Feminino , Hérnia Ventral/cirurgia , Herniorrafia/efeitos adversos , Humanos , Hérnia Incisional/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Telas CirúrgicasRESUMO
AIM: To compare the percentage of gutta-percha, sealer and voids and the influence of isthmuses in mesial root canals of mandibular molars filled with different techniques. METHODOLOGY: Canals in 60 mesial roots of mandibular first molars were prepared with ProTaper instruments to size F2 (size 25, 0.08 taper) and filled using a single-cone, lateral compaction, System B or Thermafil techniques. An epoxy resin sealer was labelled with Rhodamine-B dye to allow analysis under a confocal microscope. The percentage of gutta-percha, sealer and area of voids was calculated at 2, 4 and 6 mm from the apex, using Image Tool 3.0 software. Statistical analysis was performed using nonparametric Kruskal-Wallis and Dunn tests (P < 0.05). The influence of isthmuses on the presence or absence of voids was evaluated using the Fisher test. RESULTS: At the 2 mm level, the percentage of gutta-percha, sealer and voids was similar amongst the System B, lateral compaction and single-cone techniques. The single-cone technique revealed significantly less gutta-percha, more sealer and voids in comparison with the Thermafil technique at the 2 and 4 mm level (P < 0.05). The analysis of all sections (2, 4 and 6 mm) revealed that more gutta-percha and less sealer and voids were found in root canals filled with Thermafil and System B techniques (P < 0.05). The Fisher test revealed that the presence of isthmuses increased the occurrence of voids in the lateral compaction group only (P < 0.05). CONCLUSION: Gutta-percha, sealer filled area and voids were dependent on the canal-filling technique. The presence of isthmuses may influence the quality of root filling.
Assuntos
Guta-Percha , Obturação do Canal Radicular/métodos , Distribuição de Qui-Quadrado , Cavidade Pulpar/anatomia & histologia , Humanos , Mandíbula , Microscopia Confocal , Dente Molar , Estatísticas não ParamétricasRESUMO
AIM: To analyse the gutta-percha filled area of C-shaped molar teeth root filled with the modified MicroSeal technique with reference to the radiographic features and the C-shaped canal configuration. METHODOLOGY: Twenty-three mandibular second molar teeth with C-shaped roots were classified according to their radiographic features as: type I--merging, type II--symmetrical and type III--asymmetrical. The canals were root filled using a modified technique of the MicroSeal system. Horizontal sections at intervals of 600 mum were made 1 mm from the apex to the subpulpal floor level. The percentage of gutta-percha area from the apical, middle and coronal levels of the radiographic types was analysed using the Kruskal-Wallis test. Complementary analysis of the C-shaped canal configurations (C1, C2 and C3) determined from cross-sections from the apical third was performed in a similar way. RESULTS: No significant differences were found between the radiographic types in terms of the percentage of gutta-percha area at any level (P > 0.05): apical third, type I: 77.04%, II: 70.48% and III: 77.13%, middle third, type I: 95.72%, II: 93.17%, III: 91.13% and coronal level, type I: 98.30%, II: 98.25%, III: 97.14%. Overall, the percentage of the filling material was lower in the apical third (P < 0.05). No significant differences were found between the C-shaped canal configurations apically; C1: 72.64%, C2: 79.62%, C3: 73.51% (P > 0.05). CONCLUSIONS: The percentage of area filled with gutta-percha was similar in the three radiographic types and canal configuration categories of C-shaped molars. These results show the difficulty of achieving predictable filling of the root canal system when this anatomical variation exists. In general, the apical third was less completely filled.
Assuntos
Cavidade Pulpar/patologia , Guta-Percha/uso terapêutico , Dente Molar/patologia , Materiais Restauradores do Canal Radicular/uso terapêutico , Obturação do Canal Radicular/métodos , Bismuto/uso terapêutico , Hidróxido de Cálcio/uso terapêutico , Ligas Dentárias , Cavidade Pulpar/diagnóstico por imagem , Guta-Percha/química , Humanos , Processamento de Imagem Assistida por Computador , Mandíbula , Dente Molar/diagnóstico por imagem , Níquel , Radiografia , Materiais Restauradores do Canal Radicular/química , Irrigantes do Canal Radicular/uso terapêutico , Obturação do Canal Radicular/instrumentação , Preparo de Canal Radicular/instrumentação , Preparo de Canal Radicular/métodos , Hipoclorito de Sódio/uso terapêutico , Propriedades de Superfície , Titânio , Ápice Dentário/diagnóstico por imagem , Ápice Dentário/patologiaRESUMO
The value of antepartum fetal heart rate testing has been debated in the last few years. According to several research works, the fetal sleeping periods lead to falsely nonreactive tests. These increase the risk and costs of obstetric care. A randomized prospective clinical trial was undertaken in high risk pregnancies to compare the standard nonstress test with the fetal vibroacoustic stimulation. Acoustic stimulation during 5 seconds with a 75 Hz frequency and 74 dB intensity device was applied to the patients in the study group. Nonreactive results were obtained in 11% of the control group and 3.4% in the study group (z = 2.07, p = 0.00116). A reduction of 5 minutes in the length of the test was observed in the study group. Fetal acoustic stimulation should be considered an alternative to improve the efficacy of nonstress testing, by reducing falsely nonreactive tests results and the time it takes to perform them.