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To describe the perioperative and oncology outcomes in a series of laparoscopic or robotic partial nephrectomies (PN) for renal tumors treated in diverse institutions of Hispanic America from the beginning of their minimally invasive (MI) PN experience through December 2014. Seventeen institutions participated in the CAU generated a MI PN database. We estimated proportions, medians, 95 % confidence intervals, Kaplan-Meier curves, multivariate logistic and Cox regression analyses. Clavien-Dindo classification was used. We evaluated 1501 laparoscopic (98 %) or robotic (2 %) PNs. Median age: 58 years. Median surgical time, warm ischemia and intraoperative bleeding were 150, 20 min and 200 cc. 81 % of the lesions were malignant, with clear cell histology being 65 % of the total. Median maximum tumor diameter is 2.7 cm, positive margin is 8.2 %, and median hospitalization is 3 days. One or more postoperative complication was recorded in 19.8 % of the patients: Clavien 1: 5.6 %; Clavien 2: 8.4 %; Clavien 3A: 1.5 %; Clavien 3B: 3.2 %; Clavien 4A: 1 %; Clavien 4B: 0.1 %; Clavien 5: 0 %. Bleeding was the main cause of a reoperation (5.5 %), conversion to radical nephrectomy (3 %) or open partial nephrectomy (6 %). Transfusion rate is 10 %. In multivariate analysis, RENAL nephrometry score was the only variable associated with complications (OR 1.1; 95 % CI 1.02-1.2; p = 0.02). Nineteen patients presented disease progression or died of disease in a median follow-up of 1.37 years. The 5-year progression or kidney cancer mortality-free rate was 94 % (95 % CI 90, 97). Positive margins (HR 4.98; 95 % CI 1.3-19; p = 0.02) and females (HR 5.6; 95 % CI 1.7-19; p = 0.005) were associated with disease progression or kidney cancer mortality after adjusting for maximum tumor diameter. Laparoscopic PN in these centers of Hispanic America seem to have acceptable perioperative complications and short-term oncologic outcomes.

There is no information about the evolution of robotic programs in public hospitals of Latin-America. To describe the current status and functioning of robotic programs in Latin-American public hospitals since their beginning to date. We conducted a survey among leading urologists working at public hospitals of Latin-America who had acquired the Da Vinci laparoscopic-assisted robotic system. Questions included: date the program started, its utilization by other services, number and kind of surgeries, surgery paying system, surgery related deaths, occurrence and reasons of robotic program interruptions and its use for training purposes. Medians and 25–75 centiles (IQR) were estimated. Since 2009, there are ten public hospitals of four Latin-American countries that acquired the Da Vinci robotic system. The median number of months robotic programs has been functioning without considering transitory interruption: 43 (IQR 35, 55). Median number of urologic and total surgeries performed: 140 (IQR 94, 168) and 336 (IQR 292, 621), respectively. The corresponding median number of urologic and total surgeries performed per month: 3 (IQR 2, 5) and 8 (IQR 5, 11). Median number of total surgeries performed per year per institution was 94 (IQR 68,123). The median proportion of urologic cases was 40% (IQR 31, 48), ranging from 24 to 66%. Five of ten institutions had their urology programs transitory or definitively closed due to the high burden costs. Adoption and development of robotic surgery in some public hospitals of Latin-America have been hindered by high costs.

La descripcion clasica del arco palmar superficial de la mano se basa en la anastomosis entre las arterias ulnar y radiopalmar, rama de la arteria radial. Igualmente, la formacion del arco es altamente variable desde el punto de vista del tamano de las arterias que lo conforman y a la existencia de ramas provenientes de otras arterias y que se suman a las anteriores como tributarias del arco. El objetivo de este trabajo fue clasificar estas posibles variaciones, para definir la formacion del arco, las razones de su composicion variable y la importancia de sus aplicaciones clinicas y quirurgicas. Fueron disecadas 86 manos, formolizadas al 40%. Existia prevalencia de la arteria ulnar respecto a su tamano, con o sin la formacion de arco. El conocimiento anatomico de la variabilidad de la formacion del arco palmar superficial es de fundamental importancia en la aplicacion de tecnicas quirurgicas que pueden ayudar en el tratamiento de diversas patologias de la mano.

El recorrido del nervio radial a traves del codo constituye, para este elemento nervioso, un camino con riesgo de lesiones intrinsecas o extrinsecas. Cambios de la morfologia de las estructuras osteomusculares que constituyen el desfiladero del nervio radial, tanto patologicos como traumaticos, pueden determinar el atrapamiento y compresion del mismo, determinando el dano del nervio y/o la inflamacion localizada a nivel de las estructuras circundantes. Mediante la diseccion de 30 preparados, formolizados al 10%, y el analisis subsecuente de la disposicion de las estructuras musculares e insercion de las mismas, se determinaron los posibles puntos de riesgo anatomico que pudiesen alterar al nervio radial o a sus ramos en la canal bicipital lateral o en su ingreso y distribucion en el parte proximal del antebrazo (relacion con el musculo supinador y los musculos extensores radial largo y corto). Definimos 4 zonas de posible atrapamiento y compresion del nervio radial y sus ramos: 1. Septo intermuscular lateral. 2. Musculo extensor radial corto. 3. Musculo supinator, a nivel de la Arcada de Frohse. 4. Musculo supinator, a la salida de la masa muscular, en el dorso del antebrazo. La compresion del nervio radial a nivel del codo es una de las neuropatias del miembro superior, mas frecuentes. El objetivo de este trabajo fue analizar las implicancias anatomicas del recorrido del nervio radial en su pasaje desde el brazo al antebrazo, especialmente las relaciones con las estructuras osteomusculares, cuyas alteraciones pueden ser las responsables de patologias compresivas del nervio radial que puedan llevar a dolor, parestesias, con o sin perdida sensorial y/o impotencia funcional.