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The arrow indicates the tumor in the tail of the pancreas infiltrating the splenic vein; (B) dissection of the transverse mesocolon. The arrow indicates the inferior mesenteric vein; (C) placement of EndoGrab; (D) dissected tumor; the arrow indicates the splenic vein infiltrated by the tumor.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Salvador Morales-Conde, Mercedes Rubio-Manzanares, Isaías Alarcón, Antonio Barranco, María Socas" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Salvador" "apellidos" => "Morales-Conde" ] 1 => array:2 [ "nombre" => "Mercedes" "apellidos" => "Rubio-Manzanares" ] 2 => array:2 [ "nombre" => "Isaías" "apellidos" => "Alarcón" ] 3 => array:2 [ "nombre" => "Antonio" "apellidos" => "Barranco" ] 4 => array:2 [ "nombre" => "María" "apellidos" => "Socas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009739X13001577" "doi" => "10.1016/j.ciresp.2013.02.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] 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"titulo" => "Complications After Conservative Management of Blunt Liver Trauma: Biliary Fistula, Hemobilia and Biloma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "537" "paginaFinal" => "539" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Complicaciones en el manejo conservador del traumatismo hepático cerrado: fístula biliar, hemobilia y biloma" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 547 "Ancho" => 1456 "Tamanyo" => 101478 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hypodense lesions in the right liver lobe associated 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"<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "José" "apellidos" => "Noguera" ] 2 => array:2 [ "nombre" => "Isabel" "apellidos" => "Martínez" ] 3 => array:2 [ "nombre" => "Miguel" "apellidos" => "Oviedo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eventroplastia transvaginal híbrida" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 759 "Ancho" => 1700 "Tamanyo" => 233085 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Position of the abdominal trocars and laparoscopic visualization of mesh placement.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The development of new techniques such as natural orifice surgery seeks to improve clinical and aesthetic results in different fields. It has been successfully used to performed procedures such as appendectomies, cholecystectomies, and oncologic colon resections.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Nevertheless, there are few published reports about the use of this approach in the management of ventral hernias.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 58-year-old woman with hypothyroidism, 2 vaginal deliveries and surgery for epigastric hernia who consulted for pain and a mass along the scar of the previous surgery. Abdominal examination discovered a recurrent hernia, which was reductible, along with an aponeurotic defect measuring 4<span class="elsevierStyleHsp" style=""></span>cm in diameter. We proceeded with the repair using a hybrid transvaginal approach, starting with the preoperative administration of 2<span class="elsevierStyleHsp" style=""></span>g of amoxicillin-clavulanate and perineal/vaginal lavage of diluted povidone-iodine solution.</p><p id="par0015" class="elsevierStylePara elsevierViewall">With the patient in the modified Lloyd-Davies position, the surgeon stood on the left and the assistant surgeon stood between the patient's legs. Pneumoperitoneum was created with a transumbilical Veress needle, and then a 5-mm trocar was inserted in the left flank for the later use of forceps and the stapler to attach the prosthesis. Through the orifice of the Veress needle, a 3-mm trocar was introduced to provide access for mini-instruments (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was placed in forced Trendelenburg position. With the laparoscope (5<span class="elsevierStyleHsp" style=""></span>mm 0° optics, through the 5-mm port) an extra-long optical trocar (150<span class="elsevierStyleHsp" style=""></span>mm) was inserted through the posterior vaginal fornix (12<span class="elsevierStyleHsp" style=""></span>mm EndoPath<span class="elsevierStyleSup">®</span> Xcel™), which we later used to insert the mesh and optics (10<span class="elsevierStyleHsp" style=""></span>mm and 30°). The transvaginal trocar was protected with a sterile plastic sheath and the pouch of Douglas was washed with a povidone-iodine solution (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). After releasing the omental adhesions of the hernia sac using the 2 abdominal ports as working channels and the transvaginal trocar to insert the 30° optic, we proceeded with the mesh placement (Ethicon Physiomesh™ Flexible Composite Mesh). The patch was rolled up for insertion through the vaginal trocar without any further protection and subsequently fixed with 2 crowns of absorbable straps (Ethicon Securestrap™ 5<span class="elsevierStyleHsp" style=""></span>mm Absorbable Strap Fixation Device) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Afterwards, the 3 and 10<span class="elsevierStyleHsp" style=""></span>mm trocars were removed under direct vision (5<span class="elsevierStyleHsp" style=""></span>mm 0° optic through the trocar of the left flank) and the vaginal opening was closed vaginally with 2 polyglactin sutures (910<span class="elsevierStyleHsp" style=""></span>2/0) and the abdominal skin with monofilament (3/0). The patient had a favourable postoperative course and was discharged from the hospital 36<span class="elsevierStyleHsp" style=""></span>h after surgery and continued to be asymptomatic one month later.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The benefits of the laparoscopic approach in the treatment of ventral and abdominal wall hernias have been demonstrated in several studies, including lower risk of wound infection and shorter hospital stay, with recurrence rates that are lower than open surgery in many reports.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Furthermore, in order to minimize parietal aggression, mini-instruments have been developed, which allow for dissecting, resecting and manipulating different structures within the abdominal cavity through minimal 2–3<span class="elsevierStyleHsp" style=""></span>mm incisions with accuracy and safety. The transvaginal approach aims to avoid abdominal incisions and provide aesthetic, pain-related and structural benefits.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Thus, the combination of the benefits of these treatment approaches for abdominal wall disease is the basis for the development of the technique described. It avoids having to make an abdominal incision for placement of the 10–12<span class="elsevierStyleHsp" style=""></span>mm trocar usually used for the placement of the mesh and stitches, if necessary, with the potential risk for recurrent incisional hernia of 1%–6% according to the literature.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> Other groups have proposed inserting this 10–12<span class="elsevierStyleHsp" style=""></span>mm trocar through the aponeurotic hernia defect itself while using other 5<span class="elsevierStyleHsp" style=""></span>mm ports,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> thus avoiding the creation of another fascial defect.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Although septic complications associated with the transvaginal approach are rare (less than 1%),<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> to prevent possible intraabdominal and mesh contamination from being introduced through the transvaginal trocar, we applied the following measures: preoperative antibiotic prophylaxis, use of a sterile sheath for the entry of the transvaginal trocar in the perineum, change of gloves before handling the prosthesis and lavages of the pouch of Douglas through the transvaginal trocar with a povidone-iodine solution diluted to 20%. Other complications associated with the transvaginal approach are mild and uncommon, such as bleeding or local pain. A period of sexual abstinence is recommended for 2–3 weeks.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We believe that the technique we present is simple, safe and reproducible. It is a valid option in selected cases of women with no history of pelvic surgery or gynaecological problems (pelvic inflammatory disease, endometriosis, etc.) with umbilical hernias and aponeurotic defects smaller than 8<span class="elsevierStyleHsp" style=""></span>cm without contraindication for laparoscopic repair. The use of flexible endoscopes with the transvaginal access may also be useful for improving visualization at distant points of the pelvis and lateral wall of the abdomen.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Bruna M, Noguera J, Martínez I, Oviedo M. Eventroplastia transvaginal híbrida. Cir Esp. 2013;91:539–541.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 759 "Ancho" => 1700 "Tamanyo" => 233085 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Position of the abdominal trocars and laparoscopic visualization of mesh placement.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 949 "Ancho" => 1700 "Tamanyo" => 198046 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Protective plastic sheath, lavages and introduction of the mesh through the transvaginal trocar.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Natural orifice translumenal endoscopic surgery in humans: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.P. 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Year/Month | Html | Total | |
---|---|---|---|
2024 October | 11 | 6 | 17 |
2024 September | 14 | 12 | 26 |
2024 August | 19 | 15 | 34 |
2024 July | 12 | 10 | 22 |
2024 June | 11 | 3 | 14 |
2024 May | 16 | 14 | 30 |
2024 April | 19 | 4 | 23 |
2024 March | 14 | 5 | 19 |
2024 February | 12 | 2 | 14 |
2024 January | 23 | 2 | 25 |
2023 December | 29 | 4 | 33 |
2023 November | 14 | 4 | 18 |
2023 October | 30 | 5 | 35 |
2023 September | 6 | 2 | 8 |
2023 August | 16 | 2 | 18 |
2023 July | 11 | 5 | 16 |
2023 June | 6 | 4 | 10 |
2023 May | 23 | 3 | 26 |
2023 April | 12 | 1 | 13 |
2023 March | 12 | 2 | 14 |
2023 February | 28 | 8 | 36 |
2023 January | 15 | 4 | 19 |
2022 December | 21 | 3 | 24 |
2022 November | 17 | 7 | 24 |
2022 October | 17 | 6 | 23 |
2022 September | 20 | 5 | 25 |
2022 August | 27 | 7 | 34 |
2022 July | 11 | 9 | 20 |
2022 June | 33 | 5 | 38 |
2022 May | 21 | 4 | 25 |
2022 April | 60 | 8 | 68 |
2022 March | 37 | 9 | 46 |
2022 February | 37 | 7 | 44 |
2022 January | 35 | 9 | 44 |
2021 December | 55 | 9 | 64 |
2021 November | 49 | 10 | 59 |
2021 October | 28 | 9 | 37 |
2021 September | 8 | 11 | 19 |
2021 August | 33 | 8 | 41 |
2021 July | 16 | 11 | 27 |
2021 June | 15 | 11 | 26 |
2021 May | 23 | 12 | 35 |
2021 April | 64 | 21 | 85 |
2021 March | 18 | 6 | 24 |
2021 February | 25 | 11 | 36 |
2021 January | 16 | 9 | 25 |
2020 December | 15 | 15 | 30 |
2020 November | 16 | 6 | 22 |
2020 October | 11 | 4 | 15 |
2020 September | 19 | 14 | 33 |
2020 August | 15 | 9 | 24 |
2020 July | 13 | 11 | 24 |
2020 June | 25 | 7 | 32 |
2020 May | 19 | 7 | 26 |
2020 April | 14 | 6 | 20 |
2020 March | 14 | 4 | 18 |
2020 February | 15 | 8 | 23 |
2020 January | 17 | 5 | 22 |
2019 December | 24 | 7 | 31 |
2019 November | 15 | 6 | 21 |
2019 October | 11 | 8 | 19 |
2019 September | 9 | 9 | 18 |
2019 August | 13 | 2 | 15 |
2019 July | 7 | 9 | 16 |
2019 June | 43 | 17 | 60 |
2019 May | 79 | 32 | 111 |
2019 April | 39 | 16 | 55 |
2019 March | 9 | 5 | 14 |
2019 February | 14 | 9 | 23 |
2019 January | 8 | 7 | 15 |
2018 December | 11 | 3 | 14 |
2018 November | 20 | 15 | 35 |
2018 October | 16 | 4 | 20 |
2018 September | 15 | 4 | 19 |
2018 August | 15 | 1 | 16 |
2018 July | 16 | 1 | 17 |
2018 June | 12 | 0 | 12 |
2018 May | 11 | 5 | 16 |
2018 April | 7 | 0 | 7 |
2018 March | 6 | 0 | 6 |
2018 February | 7 | 0 | 7 |
2018 January | 12 | 0 | 12 |
2017 December | 10 | 0 | 10 |
2017 November | 14 | 2 | 16 |
2017 October | 10 | 2 | 12 |
2017 September | 16 | 2 | 18 |
2017 August | 16 | 3 | 19 |
2017 July | 19 | 1 | 20 |
2017 June | 25 | 8 | 33 |
2017 May | 21 | 1 | 22 |
2017 April | 28 | 5 | 33 |
2017 March | 37 | 34 | 71 |
2017 February | 39 | 8 | 47 |
2017 January | 17 | 4 | 21 |
2016 December | 25 | 5 | 30 |
2016 November | 32 | 1 | 33 |
2016 October | 48 | 3 | 51 |
2016 September | 96 | 2 | 98 |
2016 August | 15 | 4 | 19 |
2016 July | 19 | 4 | 23 |
2016 June | 23 | 3 | 26 |
2016 May | 20 | 10 | 30 |
2016 April | 13 | 16 | 29 |
2016 March | 23 | 18 | 41 |
2016 February | 20 | 11 | 31 |
2016 January | 9 | 11 | 20 |
2015 December | 14 | 11 | 25 |
2015 November | 23 | 10 | 33 |
2015 October | 28 | 14 | 42 |
2015 September | 25 | 8 | 33 |
2015 August | 25 | 5 | 30 |
2015 July | 16 | 3 | 19 |
2015 June | 10 | 0 | 10 |
2015 May | 7 | 6 | 13 |
2015 April | 20 | 8 | 28 |
2015 March | 16 | 3 | 19 |
2015 February | 14 | 3 | 17 |
2015 January | 14 | 1 | 15 |
2014 December | 31 | 11 | 42 |
2014 November | 18 | 5 | 23 |
2014 October | 19 | 4 | 23 |
2014 September | 19 | 3 | 22 |
2014 August | 10 | 4 | 14 |
2014 July | 18 | 2 | 20 |
2014 June | 9 | 4 | 13 |
2014 May | 13 | 2 | 15 |
2014 April | 15 | 2 | 17 |
2014 March | 10 | 4 | 14 |
2014 February | 20 | 4 | 24 |
2014 January | 14 | 13 | 27 |
2013 December | 3 | 2 | 5 |