Biomedical subjects

Adolfo Jiménez Garrido

Publications and source records attributed to Adolfo Jiménez Garrido.

5 recordsLinked to original sources

PubMed2006

[Single trocar laparoscopic nephrectomy].

OBJECTIVES: The usual laparoscopic hand assisted nephrectomy procedure requires either two or three trocars and a small incision to extract the organ. Our experience reveals that surgical invasion is significantly less when we use only one trocar and a retroperitoneal approach. METHODS: We start with a small low oblique incision close to the pubis and insert a trocar over the iliac crest. When the kidney is free we grasp the undissected vascular pedicle between thumb and middle finger and without moving the inserted hand, we remove the telescope and introduce the stapler. The index finger is used blind to check that the stapler is correctly positioned before triggering. Finally, we divide the ureter in the same way We have carried out 74 nephrectomies with this procedure. RESULTS: The mean operative time was 67.12 minutes. A retroperitoneal haematoma occurred in one patient and was drained by the same approach without further incident. One patient had an intestinal occlusion that in the reoperation was found to be caused by a loop of intestine trapped in a peritoneal tear: the postoperative was satisfactory. We lost one patient: an 89-year-old lady with a pyonephrosis and a retroperitoneal abscess. The operation was uneventful, but the patient died after five days; possibly because of septic shock. The other patients had no significant complications. CONCLUSIONS: The use of only one trocar markedly reduced operative invasion. The blind division en-bloc of the pedicle saves valuable time and does not offer any additional risk. The possibility of an arterio-venous fistula is remote because the stapler leaves the artery close to the vein, but separated from it. Cost is minimal because the surgeon only needs one trocar and a stapler. Consequently, we believe that this procedure with only one trocar could also be safely adopted for living donor nephrectomy

Equipment Design↗

PubMed2005

[Finger assisted laparoscopic prostatectomy].

OBJECTIVES: Laparoscopic prostatectomy is the treatment of choice for localized prostate cancer. The learning curve for unexperienced teams is dauntingly steep because it is associated with high incidence of complications and such long operation times that the procedure becomes almost unacceptable. Therefore, we needed to seek an alternative for this operation that has been almost unmodified since first description in 1998. METHODS: The patient is placed in lithotomy position and draped with an urological apron similar to the one used for transurethral resection. A beniqué sound is introduced up to the bladder and a 12 mm incision is made in the perineum, through which we slowly introduce the index finger touching the posterior aspect of the prostate. We advance the finger further longitudinally and laterally separating the rectum all the way to the bladder neck and prostatic pedicles on each side. Having freed the prostate, generally the most hazardous manoeuvre, we can then carry out a conventional laparoscopic prostatectomy, safely and quickly because the most difficult step, rectum dissection, has been carried out. RESULTS: Digital separation of the prostate through a perineal incision facilitates the operation a lot and shortens operation times significantly, allowing us to avoid the use of one or two trocars. At this time, we can not present statistical analysis because our limited experience, but there are significant advantages making the procedure easier and operation time shorter. Furthermore, the technique may also be used for laparoscopic cystectomy. CONCLUSIONS: laparoscopic prostatectomy is considered a very difficult procedure, with an unacceptable high incidence of complications, being rectum perforation the most feared. Therefore, laparoscopic prostatectomy assisted by digital manipulation through a small perineal incision appears to be a most welcome development with benefits similar to those brought ten years ago by introduction of hand assisted laparoscopy.

Humans↗

PubMed2002

[Initiation of laparoscopic nephrectomy].

OBJECTIVE: This work is reported to encourage experienced urologists to take advantage of a laparoscopic nephrectomy technique that has evolved into a remarkably inexpensive, uncomplicated routine procedure almost comparable with the gallbladder operations of general surgery. METHODS: The patient is placed in the lumbotomy position. The unsleeved, uncuffed hand is introduced through a mini-McBurney incision in the iliac fossa. The first 12 mm trocar is introduced just above the posterior part of the iliac crest. The second is placed anteriorly some 10 to 12 cm from the first. The kidney is released by extraperitoneal manual dissection. The artery is clipped and sectioned and then, without dissecting the vein, the rest of the pedicle is sectioned en bloc with the endostapler. However, if the artery is not found, then the whole pedicle is sectioned en bloc. Lastly, the ureter is sectioned. The kidney is then introduced into a simple plastic bag (open urine bag) and digitally fragmented for easy removal through the incision. RESULTS/CONCLUSIONS: The oblique McBurney incision is also useful in the event reconversion to an open lumbotomy is necessary. As we described in 1994, manual manipulation significantly simplifies the procedure. Operators soon gain confidence when they appreciate in practice the surprising versatility of the technique. Because most of the procedure is done under visual control, operator precision soon increases and successive operation times shorten considerably. Operation costs are lower because an expensive inflatable cuff or sleeve is unnecessary, only two trocars are required and a standard urine bag serves to receive the kidney. We are sure that once urologists experienced in conventional surgery try the procedure, they will wonder why they did not adopt it earlier.

Humans↗

PubMed2002

[New master arm for transurethral resection with a robot].

OBJECTIVE: In 1998, we designed a robot for transurethral resection that consisted of a master arm and a slave arm that reproduced the movements of the master. We describe the innovative master arm developed in two university departments that supersedes the mere "joystick" concept to become a true, operative surgical instrument. METHODS: The new master arm was developed from a conventional resectoscope working element integrated into a robotic manipulative device and fitted with angular displacement sensors. Each sensor, part of a computer-controlled feed back system commands the position and movements of the slave arm which, in turn, move the resectoscope. The surgeon freely chooses and manages precisely within a three-dimensional surgical field four basic resectoscope maneuvers; horizontal and vertical displacement, penetration-withdrawal, and rotation; he also controls the movements and operation of the resectoscope cutting loop. Additional computer-programs provide the surgeon with an error-free, fail-safe surgical instrument that denies any movements outside the planned surgical field. RESULTS: The fact that the new easily used instrument is similar in shape and works like conventional resectoscopes greatly helps familiarization and training. Advanced technology reduces the number of errors usually associated with fatigue or inexperience of the surgeon. CONCLUSIONS: The new surgical instrument handles just like conventional instruments so surgeons do not need to change their usual operating procedures. In addition, an early-warning program detects instantly and denies inappropriate maneuvers. This facility confers peace of mind to the surgeon and ensures patient satisfaction.

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PubMedDate not supplied

Microlaparoscopic varicocelectomy.

OBJECTIVES: To review the development of laparoscopic varicocelectomy from our initial description in 1986 based in the first pioneering works of K. Semm and to describe our latest microlaparoscopic technique that uses 3 mm instruments. METHODS: We use 3 mm reusable trocars with a specially designed telescope and instruments. One port is in the umbilicus the others are in the flanks at this level. Spermatic vessels are identified by firm traction of the testicle. The peritoneum is incised transversally at this level to dissect and ligate the two or three veins usually found here. To shorten operation time and improve results the vascular bundle is ligated en-bloc and when it is bulky, we divide it into two smaller bundles before tying the knot. RESULTS: Field of vision and image brightness is adequate and allows the operator to suture with great precision and ease. Large angular movements of the 3 mm telescope should be made with its trocar. Image brightness depends on the proximity of the lens to the structure being inspected; it worsens when the lens is withdrawn even slightly. Reusable 3 mm instruments can be used hundreds of times and with care they have sufficient strength to permit tying tight even en-bloc ligatures of vascular bundles. Operating times are between 20 and 25 minutes, bilateral operations need about 10 minutes more. Wounds made by the 3 mm trocars are usually self-closing and rarely need to stitch. CONCLUSIONS: Many authors confirm that since we first described the technique 15 years ago laparoscopic varicocelectomy is a safe, quick and easy minimal invasive procedure, less expensive than open techniques or occlusion under radiological control. The Palomo retroperitoneal approach using en-bloc ligatures of the vascular pedicle laparoscopically shortens operative times, the percentage of failures is minimum and postoperative testicular volumes and sperm counts increase. The microlaparoscopic technique not only reduces surgical aggression, but also the risk of complications is less and it does not increase operative difficulty or operation time.

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