Laparoscopic nephrectomy with single-portal access Sitracc® in swines Nefrectomia laparoscópica com portal único Sitracc® em suínos

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 nephrectomy - and 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.<br>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

The influence of simvastatin in induced peritoneal fibrosis in rats by peritoneal dialysis solution with glucosis 4.25% Influência da sinvastatina na fibrose peritoneal induzida em ratos pelo uso de solução de diálise peritoneal com glicose a 4,25%

PURPOSE: To investigate the influence of using simvastatin on the peritoneal fibrosis induced in rats using peritoneal dialysis solution with glucoses 4.25%. METHODS: Prospective controlled study in 20 non-uremic Wistar rats. The animals received a peritoneal infusion of 10 ml/100 g of peritoneal dialysis solution glucose 4.25% on a daily basis. The animals were divided in two groups: experimental and control. The experimental group received simvastatin 4 mg/kg/d, by a gastric tube. The control group did not receive any drug. The follow-up was 21 and 49 days. At the end, one surgical procedure was performed to get histological samples of visceral and parietal peritoneum. The samples were analyzed using Hematoxylin Eosin and Sirius Red, to evaluate the severity of the fibrosis. RESULTS: The analysis showed that the intensity of the fibrosis, the peritoneal thickness and the cell number in experimental and control groups were not statistically significant different in experimental and control groups. CONCLUSION: The simvastatin do not decrease the intensity of fibrosis on the peritoneal membrane that happens on rats on peritoneal dialysis.<br>OBJETIVO: Investigar a influência do uso da sinvastatina na fibrose peritoneal induzida em ratos pelo uso de solução de diálise peritoneal rica em glicose. MÉTODOS: Estudo prospectivo controlado, em ratos Wistar não urêmicos. Foram estudados 20 animais. Os animais foram submetidos diariamente à punção abdominal, sendo infundida solução de diálise peritoneal com glicose a 4,25% na dose de 10 ml/100 g de peso. Os animais foram divididos em dois grupos: experimental e controle. O grupo experimental recebeu sinvastatina na dose de 4 mg/kg/dia por gavagem. O grupo controle não recebeu nenhuma droga. Foram acompanhados por 21 e 49 dias. Ao final do período foram submetidos à procedimento cirúrgico para retirada de peritônio parietal e visceral. As amostras obtidas foram analisadas histologicamente, usando-se coloração Hematoxilina - Eosina e Sirius Red, para avaliação do grau de fibrose. RESULTADOS: A análise mostrou que a intensidade da fibrose, a espessura do peritônio e o número de células não atingiram diferença estatisticamente significante entre os grupos experimental e controle. CONCLUSÃO: A sinvastatina não foi capaz de alterar a intensidade da fibrose peritoneal induzida pelo uso de solução de diálise em ratos

Laparoscopic nephrectomy with single-portal access Gelpoint®in swines

PURPOSE: To analyze the viability of using Gelpoint® (single-port access) to make partial and total nephrectomy in pigs and 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 nephrectomy and Group B: partial left nephrectomy. The procedures were performed inside the Surgical Technique Room from Pontifícia Universidade Católica do Parana (PUCPR). RESULTS: In Group A, time to single-port insertion varied from one to two minutes and total time of the procedures were 20.4±8.2 minutes. Bleeding was under than 20 mL in 70% of animals. Time of instrument excision was 20.7±12 seconds and time of hilum dissection was 3.9±2.2 minutes. In Group B, after total contralateral nephrectomy two surgical procedures were not concluded due to bleeding. In this group, time of surgery was 6.8±4.2 minutes. With the exception of the second surgery, the highest blood volume loss was 50 mL. The mean excision time was 22.3 ± 22.3 seconds. CONCLUSION: Total and partial nephrectomy through umbilical single-access using GelPoint® was feasible and safe in pigs

Analysis of economic impact between the modality of renal replacement therapy

Abstract Introduction: Chronic kidney disease (CKD) is a major health problem, determining the reduction in life expectancy and an increased risk of cardiovascular disease. Method: An observational, cohort, retrospective, based on patient's medical records data with CKD under hemodialysis, peritoneal dialysis and kidney transplantation in the city of Curitiba, in the period from January to June 2014, evacuativo the financial impact on the Unified Health System (SUS) and the supplementary health. Results: The lowest cost of a kidney transplant in the first year was R$40,743.03 when cyclosporine was used and the highest was R$ 48,388.17 with the use of tacrolimus. In the second year post-transplant, hemodialysis and peritoneal dialysis have a higher cost compared to kidney transplant. Transplantation with deceased donor, treated with tacrolimus: R$67,023.39; Hemodialysis R$ 71,717.51 and automated peritoneal dialysis automatic R$ 69,527.03. Conclusions: After the first two years of renal replacement therapy, transplantation demonstrates lower costs to the system when compared to other modalities evaluated. Based on that, this therapy justifies improvements in government policies in this sector

Analysis of economic impact between the modality of renal replacement therapy

<div><p>Abstract Introduction: Chronic kidney disease (CKD) is a major health problem, determining the reduction in life expectancy and an increased risk of cardiovascular disease. Method: An observational, cohort, retrospective, based on patient's medical records data with CKD under hemodialysis, peritoneal dialysis and kidney transplantation in the city of Curitiba, in the period from January to June 2014, evacuativo the financial impact on the Unified Health System (SUS) and the supplementary health. Results: The lowest cost of a kidney transplant in the first year was R$40,743.03 when cyclosporine was used and the highest was R$ 48,388.17 with the use of tacrolimus. In the second year post-transplant, hemodialysis and peritoneal dialysis have a higher cost compared to kidney transplant. Transplantation with deceased donor, treated with tacrolimus: R$67,023.39; Hemodialysis R$ 71,717.51 and automated peritoneal dialysis automatic R$ 69,527.03. Conclusions: After the first two years of renal replacement therapy, transplantation demonstrates lower costs to the system when compared to other modalities evaluated. Based on that, this therapy justifies improvements in government policies in this sector.</p></div