Microlaparoscopia em ginecologia: análise de 16 casos e revisão da literatura

Microlaparoscopy represents the development of endoscopic surgery towards a minimally invasive surgical procedure. The advantages include fewer surgical complications, faster return to daily activities, more comfortable postoperative recovery, and satisfactory aesthetic results. The possibility of performing surgery under sedation may result in shorter hospitalization, lower hospital costs, and easier anesthetic procedures. The authors report their preliminary experience with the use of microlaparoscopy, using optics and 2mm instruments, as well as a review of the literature since the introduction of this new technique. The report of these 16 cases demonstrates that microlaparoscopy is a feasible technique with satisfactory results. On the other hand, this new technique requires precise indications and a training period for the development of the skills necessary for performing these surgeries.A microlaparoscopia representa a evolução da cirurgia endoscópica, visando um procedimento cirúrgico minimamente invasivo. As suas vantagens incluem a redução das complicações cirúrgicas, retorno às atividades mais rápido, período pós-operatório mais confortável e resultado estético satisfatório. A possibilidade da realização sob sedação pode resultar em internação hospitalar menor, diminuição dos custos hospitalares, além da simplificação do procedimento anestésico. Os autores relatam sua experiência inicial com a microlaparoscopia, utilizando óptica e instrumentais de 2mm, assim como uma revisão dos trabalhos publicados desde a introdução dessa nova técnica. O relato destes 16 casos mostrou ser a microlaparoscopia exeqüível, apresentando resultados satisfatórios. Por outro lado, o seu uso requer indicações precisas e treinamento para manipular o instrumental

Minimally invasive surgical treatment for early-stage ovarian cancer: a case report

Case report of a 54-year-old patient, with no complaints and noalterations detected during the physical examination, who underwenta routine pelvic ultrasound that showed a complex cyst on the rightovary which was confirmed with a CT scan. The serum CA125 levelwas elevated while other tumor markers – carcinoembryonic antigen,alphafetoprotein antigen and the beta human chorionic gonadotrophinwere normal. Videolaparoscopy was used for the diagnosis andtherapeutic management, revealing vegetating lesions on bothovaries but no other alterations. Biopsies were performed on thetumor masses and analyzed using the frozen section technique duringthe surgical procedure which revealed a serous neoplasm of lowmalignant potential - borderline. Next, ovarian carcinoma stagingwas performed in accordance with the standards recommended bythe International Federation of Gynecology and Obstetrics: bilateralsalpingo-oophorectomy, total abdominal hysterectomy, bilateralpelvic and para-aortic lymphadenectomy. To complete the staging,an omentectomy was performed by means of a 4 cm transverseincision in the epigastric region which was enlarged using a specialDexterity Protractor™retractor. The incision also enabled the removalof surgical specimens. The patient was discharged from the hospitalon the following day and recovered without any complications.Histological analysis confirmed the borderline tumor and no malignantcells were found on the other surgical specimens. Videolaparoscopy,minilaparotomy and the special retractor enabled adequate diagnosis,staging and removal of the localized ovarian tumor