SILVIA YUKARI TOGORO
Projetos de Pesquisa
Unidades Organizacionais
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina
3 resultados
Resultados de Busca
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- Back to the future: a case series of minimally invasive repair of pectus excavatum with regular instruments(2019) TEDDE, Miguel Lia; TOGORO, Silvia Yukari; EISINGER, Robert Stephen; OKUMURA, Erica Mie; FERNANDES, Angelo; PEGO-FERNANDES, Paulo Manuel; CAMPOS, Jose Ribas Milanez deObjective: Minimally invasive repair of pectus excavatum (MIRPE) is a surgical treatment for PE. During the procedure, a specialized introducer is used to tunnel across the mediastinum for thoracoscopic insertion of a metal bar. There have been reported cases of cardiac perforation during this risky step. The large introducer can be a dangerous lever in unskilled hands. We set out to determine the safety and feasibility of using regular instruments (i.e., not relying on special devices or tools) to create the retrosternal tunnel during MIRPE. Methods: This was a preliminary study of MIRPE with regular instruments (MIRPERI), involving 28 patients with PE. We recorded basic patient demographics, chest measurements, and surgical details, as well as intraoperative and postoperative complications. Results: Patients undergoing MIRPERI had Haller index values ranging from 2.58 to 5.56. No intraoperative complications occurred. Postoperative complications included nausea/vomiting in 8 patients, pruritus in 2, and dizziness in 2, as well as atelectasis, pneumothorax with thoracic drainage, pleural effusion, and dyspnea in 1 patient each. Conclusions: In this preliminary study, the rate of complications associated with MIRPERI was comparable to that reported in the literature for MIRPE. The MIRPERI approach has the potential to improve the safety of PE repair, particularly for surgeons that do not have access to certain special instruments or have not been trained in their use.
- The Vacuum Bell device as a sternal lifter: An immediate effect even with a short time use(2018) TOGORO, Silvia Yukari; TEDDE, Miguel Lia; EISINGER, Robert S.; OKUMURA, Erica Mie; CAMPOS, Jose Ribas Milanez de; PEGO-FERNANDES, Paulo ManuelBackground: To minimize cardiac perforation during the minimally invasive repair of pectus excavatum(MIRPE), several surgeons have suggested using a suction device to intraoperatively lift the sternum. Whether or not this technique is effective for all PE patients is not yet known. As such, our aim was to quantify the extent to which a suction device is capable of lifting the sternum with a short duration of use. Methods: 30 PE patients received a low-dose CT scan as part of standard PE evaluation. A Vacuum Bell suction was then applied for only two minutes, and a repeat CT scan was obtained only at the deepest point of the chest wall deformity. We compared chest dimensions before and after Vacuum Bell suction. Results: The Vacuum Bell lifted the sternum in all 29 patients included in the analysis. The absolute change in depth ranged from 0.29 to 23.67 mm (M = 11.02, SD = 6.05). The average improvement in Haller index was 0.76. The suction was most effective for individuals with low BMI and smaller chest depths. Efficacy was not associated with gender, age, or chest morphology. Conclusions: The Vacuum Bell device effectively lifted the sternumin PE patients with different demographics and chest morphologies. Future research is needed to address whether or not the device reduces risk of cardiac perforation during MIRPE.
- General thoracic surgery workforce: training, migration and practice profile in Brazil(2015) TEDDE, Miguel Lia; PETRERE JR., Oleno; PINTO FILHO, Darcy Ribeiro; PEREIRA, Sergio Tadeu L. Fortunato; MONTEIRO, Rosangela; SASSAKI, Ana Maria; TOGORO, Silvia Yukari; TRINDADE, Evelinda; SAAD JR., Roberto; JATENE, Fabio BiscegliOBJECTIVES: This study is aimed at drawing the profile of the Brazilian general thoracic surgeon. This experience has been fruitful in other areas, helping attract manpower and to better serve the interests of other Societies. This is the first survey of this kind in Brazil and in Latin America. METHODS: An electronic invitation was sent to the members of the Brazilian Society of Thoracic Surgery to answer a web-based questionnaire and physicians potentially practising thoracic surgery, with 82 questions including demographic data, medical education, training in general and thoracic surgery, continued professional education, practice profile, research activities and certifications, participation in medical societies, income/compensation and career satisfaction. Quantitative and qualitative analyses are presented. RESULTS: The estimated level of participation was 82% (468). The mean age of the active general thoracic surgeon is 43.2 (range 45.3 +/- 11.4) years. Women comprised 8% (37) of respondents, and 60% (277) of the participants had graduated from public medical schools. Four states nationwide trained 88% (391) of the thoracic surgeons. Only 32% (149) of the surgeons work exclusively with thoracic surgery. The public health system is the main provider of income for thoracic surgeons. Only 11 of 27 states have an adequate, although poorly distributed, number of thoracic surgeons. CONCLUSIONS: Although Brazil has a reasonable number of general thoracic surgeons, inequalities in their distribution through the country arise as one of the most concerning problems of the speciality. The results of this study show that leadership actions and consistent government policies are required to improve work conditions and provide efficient workforce planning.