Hélder Ferreira

Continuous zoom calibration by tracking salient points in endoscopic video.

Many image-based systems for aiding the surgeon during minimally invasive surgery require the endoscopic camera to be calibrated at all times. This article proposes a method for accomplishing this goal whenever the camera has optical zoom and the focal length changes during the procedure. Our solution for online calibration builds on recent developments in tracking salient points using differential image alignment, is well suited for continuous operation, and makes no assumptions about the camera motion or scene rigidity. Experimental validation using both a phantom model and in vivo data shows that the method enables accurate estimation of focal length when the zoom varies, avoiding the need to explicitly recalibrate during surgery. To the best of our knowledge this the first work proposing a practical solution for online zoom calibration in the operation room.

Resection of Sentinel Lymph Nodes by an Extraperitoneal Minilaparoscopic Approach Using Indocyanine Green for Uterine Malignancies: A Preclinical Comparative Study.

Background. The sentinel lymph node (SLN) concept might minimize surgical aggressiveness in cervical and endometrial malignancies. The aim of the study was to test the feasibility and reliability of minilaparoscopic extraperitoneal SLN excision after indocyanine green (ICG) cervical injection using a high-definition near infrared (NIR) imaging system in an in vivo porcine model. The same procedure was performed using conventional laparoscopic instruments and both outcomes were compared. Methods. Twenty-four animals were equally and randomly divided into a minilaparoscopic group (group A) and a 5-mm conventional laparoscopic group (group B). A high-definition NIR imaging system and a 30° ICG endoscope were used. First, ICG (0.5 mL) was injected in the paracervical region. The SLN coloring time was recorded. An extraperitoneal approach to the SLN was executed with the same CO2 retropneumoperitoneum pressures (10 mm Hg). In both groups, the times for SLN localization and excision, as well as complications, were registered. Finally, a laparotomy was then done to evaluate whether any stained SLN still remained. The same surgical team performed all experiments. Results. SLNs were identified and extraperitoneally excised in all animals without major complications. The SLN localization varied between animals from external iliac to preaortic regions. The surgical times were shorter with minilaparoscopy (39.3 ± 13 minutes) than with conventional 5-mm instruments (51.3 ± 14.17 minutes; P = .042). In group B, one stained SLN remained and was only detected by laparotomy. Conclusions. We confirmed the feasibility and reliability of extraperitoneal minilaparoscopic approach for identification, dissection, and excision of SLN using an NIR imaging system and ICG.

Minilaparoscopic Versus Conventional Laparoscopic Sacrocolpopexy: A Comparative Study

INTRODUCTION AND AIMS We aim to compare clinical and surgical outcomes between minilaparoscopic sacrocolpopexy (MLSC) and conventional laparoscopic sacrocolpopexy (LSC). As far as we know, no comparative study exists between these two minimal invasive procedures to correct vaginal prolapse. DESIGN AND SETTING An observational and comparative study with 20 individuals submitted to vaginal vault prolapse correction between June and December of 2014 in our tertiary referral unit. Nine women were submitted to 3-mm MLSC and the others were approached by a standard 5-mm laparoscopic technique. MATERIALS AND METHODS Womens demographic data and prolapse grade were evaluated preoperatively using the Pelvic Organ Prolapse Quantification score. Operative parameters (surgical time, blood loss, and complications under Satava and Clavien-Dindo classification) and length of hospitalization were also compared. Postoperative pain and surgical scar satisfaction were measured using Visual Analog Pain Scale and Patient and Observer Scar Assessment Questionnaire, respectively. RESULTS MLSC took approximately the same time as LSC (P > .05). No significant differences in operative time, blood loss, length of hospitalization, and complications (Satava, Clavien-Dindo) were observed between both groups. Pain score after surgery was similar in MLSC and LSC (P > .05). Surgical scar monitoring at 3 months established that MLSC produced better overall results than LSC (P < .05). Anatomic cure rate was 100%. CONCLUSION Minilaparoscopy is a feasible and attractive approach for sacrocolpopexy as it enhances cosmetics, keeping the low morbidity associated with the classical laparoscopic approaches.

Indications and Contraindications for Laparoscopic Hysterectomy

Hysterectomy, the “queen” of gynecological surgical procedures, has been described since many years ago. Nowadays, the uterus removal is one of the most common performed surgeries in the gynecological field. The trend goes in a minimally invasive approach, decreasing the morbidity associated with surgical trauma caused by a laparotomic way. Total laparoscopic hysterectomy is associated with less blood loss, fewer transfusions, less post-operative pain, shorter hospital stay, decreased risk of wound infection, better quality of life and lower levels of disability in comparison with classic abdominal hysterectomy.

Laparoscopic Surgical Treatment of Pelvic Endometriosis – The Experience of a Portuguese Hospital Centre

To compare changes in Health State Questionnaire (HSQ) between patients treated with monopolar vs bipolar diathermy at 4 and 8months post-surgery. To compare the frequency and timing of pain-related admissions to gynaecology during 8 months of follow-up. To compare patient reported sick days fromwork with monopolar vs bipolar diathermy at 4 and 8 months post-surgery. To compare type, frequency and severity of adverse events, including surgical complications. Design: Single-blind (participant) parallel group randomised controlled trial of monopolar diathermy versus bipolar diathermy. Setting: UK endometriosis centre. Patients: Women aged 18 and above with clinical suspicion of endometriosis, found to have superficial endometriosis on diagnostic laparoscopy. Intervention: 1. Monopolar diathermy. 2. Bipolar diathermy. Measurements and Main Results: Awaiting. Conclusion: The study is in progress currently in our unit and we look forward to sharing it with you.