Tapia JJ, León MB, Baños GC, García LJ

Language: Spanish
References: 13
Page: 232-235
PDF size: 82.34 Kb.

ABSTRACT

Objective: To develop a surgical educational model for technical laparoscopic for appendectomy in the rabbit. Method: Twenty male rabbits were used, healthy, New Zealand breed, around 2.500 - 3.500 kg of weight. In the surgery room with the complete laparoscopic equipment (camera, source of light, insufflator, monitor, instrumental, suture), the rabbits, under general anesthesia, were submitted to an orotracheal intubation. Then, the abdominal cavity was insufflated with CO₂, at a pressure lower than 6 mmHg and with flow of 1.5 L/min. Four trocars were placed in the abdominal cavity. The transverse colon was elevated to identify the appendix, which had a length of 10 cm. The appendix was moved to the right superior quadrant, its mesoapendicular identified. The hemostasis was through electrocautery or a simple knot. Later on, a double knot in the base of the appendix, cutting it between both. Finally, the appendix was extracted with the trocar of 10 mm. Results: Of the 20 operated rabbits, 8 died in the transoperatory, some for anesthetic problems and others for an abrupt and high increase of the intra-abdominal pressure. The appendix vessels have a higher calibration in the proximal third of the appendix; for ligation absorbable material was used. Because the appendix contains abundant lymphoid tissue, it is was sectioned in 6 of the cases easily torn. Three rabbits stayed alive for 3 weeks; the rest died in the early postoperative time, by a surgical trauma and ventilatory problems. Conclusions: The appendectomy through laparoscopy is technically achievable. It is simple and safe. It also requires few instruments, which reduces the costs when using this species. For all these reasons, this procedure turns out to be useful, while teaching abilities and skills for an appendectomy with laparoscopic technique.

REFERENCES

1. Attwood SE, Hill AD, Murphy PG et al. A prospective randomized trial of laparoscopic versus open appendectomy. Surgery 1992; 112: 497.

2. Apelgren KN, Cowan BD, Metcalf AM, Scout-Conner CE. Apendicectomía laparoscópica y tratamiento de los trastornos patológicos ginecológicos que se encuentran durante la laparoscopia por sospecha de apendicitis. Clin Quirur Nort Am 1996; 76(3): 461-474.

3. Chousleb KA, Shuchleib ChS. Enseñanza y aprendizaje en cirugía laparoscópica. Cir Gen 1992; 14(4): 153-156.

4. Norma Oficial Mexicana. Especificaciones Técnicas para la producción, cuidado y uso de los animales de laboratorio. NOM-062-ZOO-1999.

5. León MB, Villegas FA. Manual, manejo y anestesia en el conejo como modelo quirúrgico en docencia. Facultad de Medicina, UNAM. México D.F. 2004.

6. Hawk CT, Leary SL. Formulary for laboratory. 2nd ed. Iowa State University Press/AMES. Iowa: 1995.

7. Hubert J, Neff U, Keleman M. Appendicitis diagnosis today: clinical and ultrasonic deductions. World J Surg 1993; 17: 243-249.

8. Barr D, van Heerden JA, Mucha P. The diagnostic challenge of postoperative acute appendicitis. World J Surg 1991; 15: 526-529.

9. Temple CL, Huchcroft SA, Temple WJ. The natural history of appendicitis in adults. Ann Surg 1995; 221: 41-51.

10. Golub R, Siddiqui F, Pohl D. Laparoscopic versus appendectomy: A meta-analysis. J Am Coll Surg 1998; 186(5): 545-553.

11. Garbutt J, Soper NJ, Shannon W, Botero A, Littenberg B. Meta-analysis od randomized controlled trails comparing laparoscopic and open appendectomy. Surgical and Laparoscopic & Endoscopy 1999; 9(1): 17-26.

12. Cheng RS, Rowland DY, Li P, Diaz J. A meta-analysis of randomized controlled trails of laparoscopic versus conventional appendectomy. 1999; 177: 250-256.

13. Pérez CJ. Manual de cirugía laparoscópica. McGraw-Hill Interamericana: México, D.F. 1995.