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Abstract(s)
A “era moderna” da cirurgia laparoscópica tem as suas bases no século XIX, quando Philipp Bozzini criou o primeiro endoscópio a que chamou Lichtleiter. Desde aí, verificou-se uma evolução gradual da mesma, enfrentando grande cepticismo e tendo o seu apogeu no final do século XX. As suas vantagens face à cirurgia aberta são inúmeras, não só em termos cosméticos, mas também relativamente a incidência de infecções, herniação, dor e estadia pós-operatória. Ultrapassou as técnicas clássicas enquanto “gold standard” para a maioria dos procedimentos e tornou-se sinónimo de cirurgia minimamente invasiva.
Sendo a medicina uma área em permanente revolução, seria expectável que, com o passar dos anos, novos desenvolvimentos ocorressem na cirurgia minimamente invasiva. Foi o que aconteceu, tendo resultado no nascimento de NOTES (Natural Orifice Transluminal Endoscopic Surgery). Esta técnica visa realizar procedimentos cirurgicos através das aberturas naturais do corpo humano, como a boca, o ânus, a vagina ou a uretra, eliminando, dessa forma, os traumas externos à parede abdominal. Foi o florescer do conceito de cirurgia sem cicatrizes.
Na mesma época duas outras técnicas de cirurgia minimamente invasiva começaram a ser desenvolvidas, a SILS (Single Incision Laparoscopic Surgery) e a Minilaparoscopia. A primeira procura realizar cirurgias através de uma incisão única na superfície externa do corpo, preferencialmente transumbilical – preservando desta forma a integridade da parede abdominal, ao utilizar uma cicatriz natural – e a última, tal como o nome indica, baseia-se nos mesmos princípios da laparoscopia convencional, mas através da utilização de instrumentos de pequeno diâmetro (3mm), minimizando assim a agressão à parede abdominal.
Com o desenvolvimento destas técnicas minimamente invasivas pretende-se melhores resultados cosméticos, redução da incidência de infecção da ferida cirúrgica e da herniação, menor tempo de internamento e de dor pós-operatória. Para tal, foram realizados inúmeros estudos e ensaios clínicos sobre cada uma das técnicas.
Actualmente, devido à falta de desenvolvimento tecnológico que permita criar novas plataformas e instrumentos adequados para a realização destes procedimentos e, consequentemente, validação dos mesmos, observa-se uma fusão destas técnicas, com predominância para a minilaparoscopia. Enquanto se assiste ao desenvolvimento tecnológico na área, continuar-se-á em busca do equilibrio perfeito entre instrumentação e técnica, aliado a aposta na formação e a novos ensaios clínicos.
The “modern age” of laparoscopic surgery begins in the XIX century, when Philipp Bozzini created the first endoscope, the Lichtleiter. Since then it has gradually evolved, despite having faced great controversy, having his highlight at the end of the XX century. When compared with open surgery, the advantages are countless, not only providing better cosmetic outcomes, but also lesser infections, reduced herniation, pain and post-operative stay. It has become the gold standard for most minimally invasive surgery procedures, overtaking the traditional techniques. Since medicine is in permanent revolution, we would expect that sooner or later new developments occur regarding minimally invasive surgery. That happened, with the birth of NOTES (Natural Orifice Transluminal Endoscopic Surgery). This technique aims to eliminate the external traumas to the abdominal wall by using the natural orifices in human body, while perform surgical procedures. That was the flourish of Scarless Surgery. By the same time, two other minimally invasive techniques begun development – SILS (Single Incision Laparoscopic Surgery) and Minilaparoscopy. The first aims to preserve the integrity of the abdominal wall by using just a single incision (usually being transumbilical and therefore through a natural scar). The other is lined by the same principles of traditional laparoscopy, using smaller instruments (3mm diameter), reducing the abdominal wall trauma. With the development of these techniques better cosmetic results are expected, as well as reduction of the surgical site infection and herniation, shorter hospital length of stay e post-operative pain. For that purpose clinical trials on each technique were conducted. Nowadays, due to the lack of proper instrumentation and multicentre platforms for these types of surgery, and as result uncertainty to their benefits, a fusion of these techniques occured, with primacy for minilaparoscopy. While surgeons sit back and watch technological developments in this area, the search for the perfect balance between instruments and technique goes on, and it will need new clinical trials and formation.
The “modern age” of laparoscopic surgery begins in the XIX century, when Philipp Bozzini created the first endoscope, the Lichtleiter. Since then it has gradually evolved, despite having faced great controversy, having his highlight at the end of the XX century. When compared with open surgery, the advantages are countless, not only providing better cosmetic outcomes, but also lesser infections, reduced herniation, pain and post-operative stay. It has become the gold standard for most minimally invasive surgery procedures, overtaking the traditional techniques. Since medicine is in permanent revolution, we would expect that sooner or later new developments occur regarding minimally invasive surgery. That happened, with the birth of NOTES (Natural Orifice Transluminal Endoscopic Surgery). This technique aims to eliminate the external traumas to the abdominal wall by using the natural orifices in human body, while perform surgical procedures. That was the flourish of Scarless Surgery. By the same time, two other minimally invasive techniques begun development – SILS (Single Incision Laparoscopic Surgery) and Minilaparoscopy. The first aims to preserve the integrity of the abdominal wall by using just a single incision (usually being transumbilical and therefore through a natural scar). The other is lined by the same principles of traditional laparoscopy, using smaller instruments (3mm diameter), reducing the abdominal wall trauma. With the development of these techniques better cosmetic results are expected, as well as reduction of the surgical site infection and herniation, shorter hospital length of stay e post-operative pain. For that purpose clinical trials on each technique were conducted. Nowadays, due to the lack of proper instrumentation and multicentre platforms for these types of surgery, and as result uncertainty to their benefits, a fusion of these techniques occured, with primacy for minilaparoscopy. While surgeons sit back and watch technological developments in this area, the search for the perfect balance between instruments and technique goes on, and it will need new clinical trials and formation.
Description
Keywords
Cirurgia Minimamente Invasiva Laparoscopia Minilaparoscopia Notes Robótica Sils