SERGIO EDUARDO ALONSO ARAUJO
Projetos de Pesquisa
Unidades Organizacionais
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina
5 resultados
Resultados de Busca
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- Transanal total mesorectal excision: a systematic review of the experimental and clinical evidence(2015) ARAUJO, S. E.; CRAWSHAW, B.; MENDES, C. R.; DELANEY, C. P.Achieving a clear distal or circumferential resection margins with laparoscopic total mesorectal excision (TME) may be laborious, especially in obese males and when operating on advanced distal rectal tumors with a poor response to neoadjuvant treatment. Transanal (TaTME) is a new natural orifice translumenal endoscopic surgery modality in which the rectum is mobilized transanally using endoscopic techniques with or without laparoscopic assistance. We conducted a comprehensive systematic review of publications on this new technique in PubMed and Embase databases from January, 2008, to July, 2014. Experimental and clinical studies written in English were included. Experimental research with TaTME was done on pigs with and without survival models and on human cadavers. In these studies, laparoscopic or transgastric assistance was frequently used resulting in an easier upper rectal dissection and in a longer rectal specimen. To date, 150 patients in 16 clinical studies have undergone TaTME. In all but 15 cases, transabdominal assistance was used. A rigid transanal endoscopic operations/transanal endoscopic microsurgery (TEO/TEM) platform was used in 37 patients. Rectal adenocarcinoma was the indication in all except for nine cases of benign diseases. Operative times ranged from 90 to 460 min. TME quality was deemed intact, satisfactory, or complete. Involvement in circumferential resection margins was detected in 16 (11.8 %) patients. The mean lymph node harvest was equal or greater than 12 in all studies. Regarding morbidity, pneumoretroperitoneum, damage to the urethra, and air embolism were reported intraoperatively. Mean hospital stay varied from 4 to 14 days. Postoperative complications occurred in 34 (22.7 %) patients. TaTME with TEM is feasible in selected cases. Oncologic safety parameters seem to be adequate although the evidence relies on small retrospective series conducted by highly trained surgeons. Further studies are expected.
- Metachronous rectal cancer after surgery for familial adenomatous polyposis: what should we expect?(2015) ARAUJO, Sergio Eduardo Alonso; CAMPOS, Fábio Guilherme Caserta Marysael de
- Surgeons' perceptions of transanal endoscopic microsurgery using minilaparoscopic instruments in a simulator: the thinner the better(2015) ARAUJO, Sergio Eduardo Alonso; MENDES, Carlos Ramon Silveira; CARVALHO, Gustavo Lopes; LYRA, MarcosSeveral issues have limited the widespread adoption of transanal endoscopic microsurgery (TEM). The need for specialized equipment and the steep learning curve represent one of them. To operate on within a 4-cm diameter, rectoscope represents a major technical challenge. However, minilaparoscopic surgery has been introduced to reduce invasiveness and abdominal wall trauma. In TEM, instrument miniaturization may lead to technique optimization. We hypothesized that visualization and maneuverability during TEM performed with 3-mm minilaparoscopic instruments would be superior to TEM performed with conventional 5-mm instruments. Eighteen general and colorectal surgeons with experience with TEM under ten cases were recruited. Two tasks should be accomplished using the TEOA (R)-Neoderma simulator. First, using conventional 5-mm TEOA (R) curved-tip instruments, a ""polypoid lesion"" should be excised. Next, closure of the ""rectal"" defect should be undertaken. In the second part, the same participants repeated the same excision/closure tasks using 3-mm minilaparoscopic instruments. After tasks conclusion, participants fulfilled an evaluation questionnaire with seven questions regarding visualization and maneuverability when using 3-mm compared to 5-mm instruments. For each one of the seven questions in the questionnaire, the score results were significantly higher for the 3-mm instruments indicating that performance with the 3-mm minilaparoscopic instruments in the TEO simulator was in all cases between ""better than expected"" and ""much better than expected."" Appropriateness of the diameter of the minilaparoscopic instruments was the best evaluated parameter. The question addressing the ease of performing the tasks in the simulator presented the lowest mean score. The perceptions of participating surgeons indicated that there is better visualization and maneuverability during basic transanal endoscopic microsurgery tasks conducted in a simulator using 3-mm minilaparoscopic instruments when compared to conventional 5-mm instruments.
- Transanal Endoscopic Proctectomy: a new approach to the total excision of the mesorectum(2015) MENDES, Carlos Ramon Silveira; FERREIRA, Luciano Santana de Miranda; SAPUCAIA, Ricardo Aguiar; LIMA, Meyline Andrade; COBAS, Eduardo Costa; ARAUJO, Sergio Eduardo AlonsoIntroduction: Colorectal cancer is a serious public health problem. In 1982, Heald managed to reduce mortality by standardizing the total excision of mesorectum. The use of transanal endoscopic microsurgery has emerged to allow resection of rectal tumors as a minimally invasive method. With the association of Transanal Endoscopic Operation with total excision of mesorectum, it was possible to develop a new approach for total excision of mesorectum.Surgical technique:The procedure is started by the perineal time with Transanal Endoscopic Operation device; introduction of Transanal Endoscopic Operation system follows, with exposure of the lesion with a circumferential incision at a distance between 2 and 4 cm from distal tumor margin after making a purse string suture to close the rectal stump. Then, dissection is carried out by the posterior portion until reaching the presacral avascular fascia, completing the mesorectal circumferential dissection until the peritoneal reflection. After this step, a laparoscopic procedure is performed with the use of three trocars, with mobilization of splenic flexure and ligation of the inferior mesenteric artery, as well as confection of a protective ileostomy. Then, transanal removal of the surgical specimen is performed, and the procedure goes on with a coloanal anastomosis.
- Functional outcome of autologous anorectal transplantation in an experimental model(2015) SEID, V. E.; GALVAO, F. H. F.; VAIDYA, A.; WAISBERG, D. R.; CRUZ JR., R. J.; CHAIB, E.; NAHAS, S. C.; ARAUJO, S. E. A.; D'ALBUQUERQUE, L. A. C.; ARAKI, J.Background: Although anorectal transplantation is a challenging procedure, it is a promising option for patients who have completely lost anorectal function or in whom it failed to develop, as in congenital malformations. The paucity of animal models with which to test functional outcomes was addressed in this study of anorectal manometry in rats. Methods: Wistar rats were assigned randomly to four groups: orthotopic anorectal transplantation, heterotopic transplantation, sham operation, or normal control. Bodyweight and anal pressure were measured immediately before and after operation, and on postoperative days 7 and 14. ANOVA and Tukey's test were used to compare results for bodyweight, anal manometry and length of procedure. Results: Immediately after the procedure, mean(s.d.) anal pressure in the orthotopic group (n=13) dropped from 31.4(13.1) to 1.6(13.1) cmH(2)O (P < 0.001 versus both sham operation (n=13) and normal control (n=15)), with partial recovery on postoperative day 7 (14.9(13.9) cmH(2)O) (P=0.009 versus normal control) and complete recovery on day 14 (23.7(12.2) cmH(2)O). Heterotopic rats (n=14) demonstrated partial functional recovery: mean(s. d.) anal pressure was 26.9(10.9) cmH(2)O before operation and 8.6(6.8) cmH(2)O on postoperative day 14 (P < 0.001 versus both sham and normal control). Conclusion: Orthotopic anorectal transplantation may result in better functional outcomes than heterotopic procedures.