Videos of Surgical Procedures in Dermatology
Axillary Sentinel Lymph Node Biopsy: Video of the Surgical Procedure
Biopsia selectiva del ganglio centinela de localización axilar. Video quirúrgico
Leído
5244
Vecesse ha leído el artículo
1690
Total PDF
3554
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219016300245" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.03.010" "estado" => "S300" "fechaPublicacion" => "2016-06-01" "aid" => "1363" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:425-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 778 "formatos" => array:3 [ "EPUB" => 69 "HTML" => 551 "PDF" => 158 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731016000776" "issn" => "00017310" "doi" => "10.1016/j.ad.2016.02.002" "estado" => "S300" "fechaPublicacion" => "2016-06-01" "aid" => "1363" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:425-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 203 "formatos" => array:3 [ "EPUB" => 3 "HTML" => 183 "PDF" => 17 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Videos de cirugía dermatológica</span>" "titulo" => "Biopsia selectiva del ganglio centinela de localización axilar. Video quirúrgico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "425" "paginaFinal" => "426" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Axillary Sentinel Lymph Node Biopsy: Video of the Surgical Procedure" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Moreno-Ramírez, L. Ferrándiz, T. Ojeda-Vila, F.M.I. Mendonça, P. de la Riva" "autores" => array:5 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Moreno-Ramírez" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Ferrándiz" ] 2 => array:2 [ "nombre" => "T." "apellidos" => "Ojeda-Vila" ] 3 => array:2 [ "nombre" => "F.M.I." "apellidos" => "Mendonça" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "de la Riva" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219016300245" "doi" => "10.1016/j.adengl.2016.03.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016300245?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731016000776?idApp=UINPBA000044" "url" => "/00017310/0000010700000005/v1_201605260143/S0001731016000776/v1_201605260143/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219016300257" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.03.011" "estado" => "S300" "fechaPublicacion" => "2016-06-01" "aid" => "1296" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2016;107:427-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1209 "formatos" => array:3 [ "EPUB" => 53 "HTML" => 682 "PDF" => 474 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Resident's Forum</span>" "titulo" => "Verrucous Hemangioma or Verrucous Venous Malformation? Towards a Classification Based on Genetic Analysis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "427" "paginaFinal" => "428" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR - Hemangioma verrucoso o malformación venosa verrucosa? Hacia una clasificación asentada en el estudio genético" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "N. Knöpfel, P.H. Hoeger" "autores" => array:2 [ 0 => array:2 [ "nombre" => "N." "apellidos" => "Knöpfel" ] 1 => array:2 [ "nombre" => "P.H." "apellidos" => "Hoeger" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015004925" "doi" => "10.1016/j.ad.2015.07.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015004925?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016300257?idApp=UINPBA000044" "url" => "/15782190/0000010700000005/v2_201703310310/S1578219016300257/v2_201703310310/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219016300233" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.03.009" "estado" => "S300" "fechaPublicacion" => "2016-06-01" "aid" => "1302" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:423-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 933 "formatos" => array:3 [ "EPUB" => 57 "HTML" => 739 "PDF" => 137 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Nodules and Erythematous Papules on the Lower Legs and Knees" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "423" "paginaFinal" => "424" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nódulos y pápulas eritematosas en piernas y rodillas" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 475 "Ancho" => 600 "Tamanyo" => 48132 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. Lozano-Masdemont, L. Gómez-Recuero-Muñoz, O. Baniandrés-Rodríguez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Lozano-Masdemont" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Gómez-Recuero-Muñoz" ] 2 => array:2 [ "nombre" => "O." "apellidos" => "Baniandrés-Rodríguez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015004986" "doi" => "10.1016/j.ad.2015.10.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015004986?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016300233?idApp=UINPBA000044" "url" => "/15782190/0000010700000005/v2_201703310310/S1578219016300233/v2_201703310310/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Videos of Surgical Procedures in Dermatology</span>" "titulo" => "Axillary Sentinel Lymph Node Biopsy: Video of the Surgical Procedure" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "425" "paginaFinal" => "426" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D. Moreno-Ramírez, L. Ferrándiz, T. Ojeda-Vila, F.M.I. Mendonça, P. de la Riva" "autores" => array:5 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Moreno-Ramírez" "email" => array:1 [ 0 => "dmoreno@e-derma.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Ferrándiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "T." "apellidos" => "Ojeda-Vila" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "F.M.I." "apellidos" => "Mendonça" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "P." "apellidos" => "de la Riva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Medicina Nuclear, Hospital Universitario Virgen Macarena, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Biopsia selectiva del ganglio centinela de localización axilar. Video quirúrgico" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Selective sentinel lymph node biopsy (SLNB) is the gold-standard technique for lymph node staging in patients with primary cutaneous melanoma. However, over the last 2 decades, the debate about SLNB has focused on the absence of any direct benefit on patient survival.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> SLNB was developed as an alternative technique for lymph node staging with a lower surgical morbidity than prophylactic lymphadenectomy, which was performed on all patients with primary melanoma up to the 1990s. SLNB is now a surgical technique that, thanks to marking using nuclear medicine, can be highly selective. Marking also enables targeted dissection to be performed; this is associated with a lower surgical morbidity.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The video is a step-by-step presentation of the standard surgical technique for axillary SLNB. We show the whole procedure in a 48-year-old man with an ulcerated primary melanoma in the left scapular region with a Breslow thickness of 1.60<span class="elsevierStyleHsp" style=""></span>mm (stage T2b), with scintigraphic identification of 3 sentinel lymph nodes (SLN) in the left axillary region.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Description of the Technique</span><p id="par0015" class="elsevierStylePara elsevierViewall">The day before the operation, in the nuclear medicine department, the patient receives intradermal injections of 2<span class="elsevierStyleHsp" style=""></span>mCi of Nanocoll divided between 4 points around the scar of the primary melanoma. Dynamic study (60 images/20<span class="elsevierStyleHsp" style=""></span>s) is performed immediately, and static images (300<span class="elsevierStyleHsp" style=""></span>s) and multimodality single-photon emission computed tomography associated with x-ray computed tomography images are also obtained. The area of projection of the SLN is marked on the skin with permanent ink. The day of the operation, 20 to 30<span class="elsevierStyleHsp" style=""></span>min before anesthetic induction, Linfazurin patent blue dye, 2<span class="elsevierStyleHsp" style=""></span>ml, is injected (0.5<span class="elsevierStyleHsp" style=""></span>ml at each of 4 points around the scar of the primary tumor).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Under general anesthesia, in the supine position and with abduction of the ipsilateral upper limb to 90° to 100°, the site of the SLN is determined percutaneously by portable gamma camera (Sentinella Oncovision). Using a gadolinium probe, the exact site of the surgical field is marked at the point of maximum uptake, and an incision of 4 to 6<span class="elsevierStyleHsp" style=""></span>cm is made. Subcutaneous dissection is continued until the clavipectoral fascia is identified. The manual probe is used as often as necessary to guide dissection until blue-green stained structures, corresponding to the SLNs to be excised, are identified in deeper planes. After excision, uptake by the SLN is checked ex vivo using the manual probe in association with the portable gamma camera; this must be performed away from the surgical field to avoid detecting the uptake in the area of the primary tumor<span class="elsevierStyleItalic">.</span> Similarly, uptake in the surgical field is checked using the portable gamma camera directly over the surgical wound; this must be done to exclude persistent foci of uptake corresponding to additional SLNs. If a positive reading is obtained, the identified structures must be excised. After confirming an absence of uptake in the surgical field, hemostasis is checked and the wound is closed by tissue planes. The SLNs are sent to the pathology department in containers with formol, and histopathology is performed with hematoxylin and eosin and immunohistochemistry with HMB-45, S-100, and Melan-A stains.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Finally, in the same operation, after excision of the SLNs, the surgical margins are enlarged. When enlarging the margins, the radioactivity emitted by the area of the primary tumor may be found to overlap that from the lymph node region, as occurred in the case presented. In this situation, the gamma camera allows us to perform anteroposterior, lateral, and oblique projections and, together with the use of lead plates over the area of the primary tumor, this helps to differentiate the 2 zones.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The video presented was recorded using a GoPro<span class="elsevierStyleSup">®</span> Hero4 (GoPro Inc, USA) handheld camera fixed to a headset worn by the surgeon, with a resolution of 720<span class="elsevierStyleHsp" style=""></span>p, 60<span class="elsevierStyleHsp" style=""></span>fps and narrow field.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications/Contraindications</span><p id="par0030" class="elsevierStylePara elsevierViewall">SLNB is indicated in patients with primary cutaneous melanoma with tumor stage T1b or higher (Breslow thickness<span class="elsevierStyleHsp" style=""></span>≥1<span class="elsevierStyleHsp" style=""></span>mm or with ulceration and/or a mitotic index<span class="elsevierStyleHsp" style=""></span>≥1<span class="elsevierStyleHsp" style=""></span>mitoses/mm<span class="elsevierStyleSup">2</span>). In those cases of primary melanoma with Breslow thickness less than 1<span class="elsevierStyleHsp" style=""></span>mm, and with mitoses, SLNB can be considered with a Breslow thickness above 0.75<span class="elsevierStyleHsp" style=""></span>mm.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The contraindications of SLNB are determined by the general state of health of the patient, severe comorbid conditions, and anesthetic risk established using scales such as the Karnofsky and American Society of Anesthesiologists indices.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Complications</span><p id="par0040" class="elsevierStylePara elsevierViewall">The complication rate of SLNB is less than 5%.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> In a series by the Melanoma Unit of Hospital Universitario Virgen Macarena, the only complication observed was localized seroma, which developed in 3.64% of patients who underwent the operation.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> However, possible complications of the procedure include seroma-lymphorrhea, hemorrhage, hematoma, infection, wound dehiscence, and complications associated with general anesthesia or spinal anesthesia (in the case of inguinal SLNB).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="par0045" class="elsevierStylePara elsevierViewall">Instruments now available for the intraoperative identification and mapping of SLNs have changed SLNB into a technique with a low morbidity. For the surgical dermatologist, accustomed to complex reconstructions, the technique may be considered of intermediate complexity. However, as with all surgical techniques, SLNB requires appropriate training (><span class="elsevierStyleHsp" style=""></span>20 cases), and routine practice with a minimum monthly number of operations (><span class="elsevierStyleHsp" style=""></span>3 cases/month),<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> in order to perform the operation with greatest safety and the lowest possible rate of error.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5,6</span></a> In those centers in which these conditions are satisfied, knowledge of the natural history of melanoma and the surgical ability of the dermatologist will possibly make this specialist the most appropriate professional to indicate and perform SLNB.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Description of the Technique" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Indications/Contraindications" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Complications" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of Interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Moreno-Ramírez D. Biopsia selectiva del ganglio centinela de localización axilar. Video quirúrgico. Actas Dermosifiliogr. 2016;107:425–426.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0060" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0040" ] ] ] ] "multimedia" => array:1 [ 0 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 98660503 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estado actual del ganglio centinela en el melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Botella-Estrada" 1 => "E. Nagore" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2011.04.003" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2011" "volumen" => "102" "paginaInicial" => "749" "paginaFinal" => "753" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21640960" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sentinel lymph node biopsy in patients with primary cutaneous melanoma: Study of 455 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Landi" 1 => "M. Polverelli" 2 => "G. Moscatelli" 3 => "R. Morelli" 4 => "C. Landi" 5 => "O. Fiscelli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2000" "volumen" => "14" "paginaInicial" => "35" "paginaFinal" => "45" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10877250" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Biopsia selectiva del ganglio centinela radioguiada mediante gammacámara portátil. Estudio observacional" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Peral-Rubio" 1 => "P. de la Riva" 2 => "D. Moreno-Ramírez" 3 => "L. Ferrándiz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2014.11.013" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2015" "volumen" => "106" "paginaInicial" => "408" "paginaFinal" => "414" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25765503" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "NCCN Melanoma Guidelines 2015 [consultado 3 Sep 2015]. Disponible en: <a href="http://www.nccn.org/professionals/physician_gls/PDF/melanoma.pdf">http://www.nccn.org/professionals/physician_gls/PDF/melanoma.pdf</a>" ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Learning curves for breast cancer sentinel lymph node mapping based on surgical volume analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.E. Cox" 1 => "C.J. Salud" 2 => "A. Cantor" 3 => "S.S. Bass" 4 => "E.S. Peltz" 5 => "M.D. Ebert" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Coll Surg" "fecha" => "2001" "volumen" => "193" "paginaInicial" => "593" "paginaFinal" => "600" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11768674" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The learning curve and sentinel node biopsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Tafra" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Surg" "fecha" => "2001" "volumen" => "182" "paginaInicial" => "347" "paginaFinal" => "350" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11720668" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000005/v2_201703310310/S1578219016300245/v2_201703310310/en/main.assets" "Apartado" => array:4 [ "identificador" => "6209" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Videos of Surgical Procedures in Dermatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010700000005/v2_201703310310/S1578219016300245/v2_201703310310/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016300245?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 4 | 6 | 10 |
| 2024 Octubre | 89 | 43 | 132 |
| 2024 Septiembre | 97 | 28 | 125 |
| 2024 Agosto | 105 | 49 | 154 |
| 2024 Julio | 119 | 32 | 151 |
| 2024 Junio | 103 | 38 | 141 |
| 2024 Mayo | 102 | 26 | 128 |
| 2024 Abril | 94 | 21 | 115 |
| 2024 Marzo | 99 | 40 | 139 |
| 2024 Febrero | 72 | 36 | 108 |
| 2024 Enero | 67 | 32 | 99 |
| 2023 Diciembre | 82 | 17 | 99 |
| 2023 Noviembre | 92 | 33 | 125 |
| 2023 Octubre | 100 | 28 | 128 |
| 2023 Septiembre | 69 | 28 | 97 |
| 2023 Agosto | 69 | 15 | 84 |
| 2023 Julio | 94 | 35 | 129 |
| 2023 Junio | 53 | 24 | 77 |
| 2023 Mayo | 70 | 20 | 90 |
| 2023 Abril | 33 | 13 | 46 |
| 2023 Marzo | 47 | 23 | 70 |
| 2023 Febrero | 63 | 24 | 87 |
| 2023 Enero | 46 | 17 | 63 |
| 2022 Diciembre | 56 | 31 | 87 |
| 2022 Noviembre | 50 | 25 | 75 |
| 2022 Octubre | 29 | 20 | 49 |
| 2022 Septiembre | 36 | 36 | 72 |
| 2022 Agosto | 28 | 26 | 54 |
| 2022 Julio | 29 | 37 | 66 |
| 2022 Junio | 27 | 20 | 47 |
| 2022 Mayo | 50 | 33 | 83 |
| 2022 Abril | 52 | 32 | 84 |
| 2022 Marzo | 36 | 42 | 78 |
| 2022 Febrero | 31 | 27 | 58 |
| 2022 Enero | 52 | 31 | 83 |
| 2021 Diciembre | 39 | 32 | 71 |
| 2021 Noviembre | 38 | 41 | 79 |
| 2021 Octubre | 38 | 39 | 77 |
| 2021 Septiembre | 27 | 39 | 66 |
| 2021 Agosto | 38 | 31 | 69 |
| 2021 Julio | 22 | 22 | 44 |
| 2021 Junio | 33 | 30 | 63 |
| 2021 Mayo | 34 | 28 | 62 |
| 2021 Abril | 67 | 52 | 119 |
| 2021 Marzo | 56 | 20 | 76 |
| 2021 Febrero | 53 | 33 | 86 |
| 2021 Enero | 33 | 14 | 47 |
| 2020 Diciembre | 25 | 15 | 40 |
| 2020 Noviembre | 22 | 20 | 42 |
| 2020 Octubre | 26 | 12 | 38 |
| 2020 Septiembre | 24 | 8 | 32 |
| 2020 Agosto | 21 | 16 | 37 |
| 2020 Julio | 33 | 16 | 49 |
| 2020 Junio | 36 | 20 | 56 |
| 2020 Mayo | 30 | 22 | 52 |
| 2020 Abril | 30 | 18 | 48 |
| 2020 Marzo | 32 | 16 | 48 |
| 2020 Febrero | 2 | 0 | 2 |
| 2020 Enero | 6 | 0 | 6 |
| 2019 Diciembre | 8 | 0 | 8 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 6 | 0 | 6 |
| 2019 Abril | 2 | 1 | 3 |
| 2019 Marzo | 4 | 6 | 10 |
| 2019 Febrero | 4 | 0 | 4 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 4 | 0 | 4 |
| 2018 Noviembre | 5 | 0 | 5 |
| 2018 Octubre | 5 | 0 | 5 |
| 2018 Septiembre | 7 | 0 | 7 |
| 2018 Mayo | 1 | 1 | 2 |
| 2018 Febrero | 21 | 4 | 25 |
| 2018 Enero | 38 | 8 | 46 |
| 2017 Diciembre | 60 | 8 | 68 |
| 2017 Noviembre | 32 | 10 | 42 |
| 2017 Octubre | 27 | 8 | 35 |
| 2017 Septiembre | 44 | 5 | 49 |
| 2017 Agosto | 32 | 7 | 39 |
| 2017 Julio | 21 | 7 | 28 |
| 2017 Junio | 33 | 7 | 40 |
| 2017 Mayo | 18 | 7 | 25 |
| 2017 Abril | 24 | 4 | 28 |
| 2017 Marzo | 14 | 5 | 19 |
| 2017 Febrero | 15 | 13 | 28 |
| 2017 Enero | 12 | 6 | 18 |
| 2016 Diciembre | 31 | 12 | 43 |
| 2016 Noviembre | 31 | 10 | 41 |
| 2016 Octubre | 23 | 25 | 48 |
| 2016 Mayo | 0 | 4 | 4 |
Mostrar todo
