Artigos Nacionais - Resumo

Ressecção gástrica laparoscópica com single-port utilizando uma nova plataforma

Machado MA, Makdissi FF,Surjan RC

Arq Bras Cir Dig 2014 Sep;27(2):157-9.

 

 

 

PDF (431)

INTRODUÇÃO:

Ressecções gastrointestinais laparoscópicas com portal único são possíveis, mas os problemas de triangulação e a necessidade de instrumentos articulados dificultam a realização destes procedimentos.

OBJETIVO:

Apresentar uma alternativa cirúrgica utilizando dispositivo laparoscópico de portal único na ressecção gástrica.

TÉCNICA:

O paciente é colocado em posição supina e em Trendelenburg reverso com o cirurgião entre as pernas. Auxiliar é posicionado ao lado direito do paciente com o monitor cranialmente situado. Sob anestesia geral, incisão transumbilical de 3 cm é realizada. Através dela, uma plataforma de portal único, com cobertura gelatinosa é introduzida. Três portais de trabalho de 5-12 mm são introduzidos através do dispositivo de portal único. Devido à cobertura gelatinosa, instrumentos articulados não são necessários. O pneumoperitônio é estabelecido em 12 mmHg. É utilizada ótica rígida de 30 graus com introdução de laparoscópio de 10 mm. A operação começa com abertura do omento maior ao longo da grande curvatura do estômago usando bisturi harmônico. Após exposição do estômago, pontos de reparos são colocados e gastrectomia parcial é realizada a cerca de 1 cm do tumor. O procedimento é completado pela sutura contínua da parede gástrica em dois planos. Não é necessária drenagem da cavidade e a incisão umbilical é suturada.

RESULTADOS:

Este procedimento foi usado em um paciente com a duplicação gástrica. O tempo operatório foi de 200 min. A perda de sangue foi mínima. A recuperação transcorreu sem intercorrências e o paciente recebeu alta no 2º dia do pós-operatório. O aspecto final da incisão umbilical foi excelente.

CONCLUSÃO:

A ressecção gástrica laparoscópica com o uso de portal único é factível e pode ser empregada com segurança em pacientes selecionados.

 

 
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