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Documents published in Scipedia

• Endovascular Therapy Versus Surgical Clipping for Intracranial Aneurysms: A Systematic Review and Meta-Analysis

  C. Vanegas-Mondragon, O. Tellez-Tellez

  Collection of Articles on Medicine (2025). 10

  
  

  Abstract

  Intracranial aneurysms are a leading cause of subarachnoid hemorrhage (SAH), associated with high morbidity and mortality. Traditionally, microsurgical clipping was the gold standard, but endovascular coiling has emerged as a less invasive alternative. This review synthesizes current evidence comparing endovascular and surgical approaches. A systematic search was conducted across PubMed, Scopus, and the Cochrane Library, including randomized controlled trials (RCTs) and cohort studies published between 2000 and 2025. Outcomes assessed were mortality, functional independence, perioperative complications, recurrence, and retreatment rates. Twenty-seven studies encompassing 18,560 patients were analyzed. Endovascular therapy demonstrated reduced short-term mortality and higher rates of functional independence, particularly in elderly patients and those with posterior circulation aneurysms. Conversely, surgical clipping ensured greater long-term durability with fewer retreatments, especially among younger patients. Both techniques carry unique benefits and limitations; thus, treatment should be individualized, taking into account aneurysm morphology, patient age, comorbidities, and surgical risk. Risk of bias assessment was performed using Cochrane RoB2 for RCTs and the Newcastle-Ottawa Scale for observational studies, with most studies showing moderate risk. This review highlights the importance of a multidisciplinary, patient-centered approach, while emphasizing the need for future long-term RCTs and device innovations. In conclusion, endovascular therapy provides superior early safety, while surgical clipping ensures durable occlusion; an evidence-based, personalized strategy remains essential to optimize patient outcomes.

  Abstract
  Intracranial aneurysms are a leading cause of subarachnoid hemorrhage (SAH), associated with high morbidity and mortality. Traditionally, microsurgical clipping was the gold [...]

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• The Role of Robotic Surgery in General Surgery: Advances, Limitations, and Future Perspectives

  C. Vanegas-Mondragon

  Collection of Articles on Medicine (2025). 9

  
  

  Abstract

  Background: Robotic surgery is an important advancement in minimally invasive surgery, providing enhanced precision, ergonomics, and visualization compared to laparoscopy. Its increasing adoption in general surgery reflects both its potential and its limitations. Objective: To review the current role of robotic surgery in general surgery, emphasizing advances, limitations, and future perspectives. Methods: A narrative review was performed using PubMed, Scopus, and Web of Science (2020-2023). Search terms included “robotic surgery,” “general surgery,” “da Vinci system,” and “cost-effectiveness.” Priority was given to guidelines, randomized controlled trials, systematic reviews, and meta-analyses. Results: Robotic surgery shows advantages in ergonomics, dexterity, visualization, and conversion rates, particularly in colorectal, hernia, and hepatopancreatobiliary procedures. Limitations include high cost, limited access, absence of haptic feedback, and the need for structured training. Emerging technologies such as novel robotic platforms, artificial intelligence, and augmented reality suggest promising directions. Conclusions: Robotic surgery improves outcomes but requires addressing cost, access, and training challenges.

  Abstract
  Background: Robotic surgery is an important advancement in minimally invasive surgery, providing enhanced precision, ergonomics, and visualization compared to laparoscopy. [...]

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• Alcohol Intoxication as Just Cause for Employment Termination: A Comparative Medical–Legal Perspective in Argentina, Peru, Costa Rica, and Mexico

  C. Vanegas-Mondragon, E. Vanegas-Lopez

  International Journal of Multidisciplinary Educational Research and Innovation (2025). 2

  
  

  Abstract

  Objective: To analyze the medical–legal framework regarding drunkenness as grounds for termination of the employment relationship in Argentina, Peru, Costa Rica, and Mexico, considering alcoholism as a disease and its implications for occupational health. Methods: A documentary and comparative review of labor legislation, jurisprudence, and doctrine was conducted in the four countries. Additionally, medical literature on alcoholism published between 2000 and 2023 was reviewed, using PubMed, Scopus, Web of Science, WHO, and ILO sources [1–3,5,9,13]. Results: Although labor laws in Latin America recognize drunkenness as just cause for dismissal [4–7], judicial practice has progressively incorporated principles of proportionality, human dignity, and the right to health [13,14]. National jurisprudence shows variability: while some courts uphold dismissal, others consider alcoholism a disease requiring treatment and rehabilitation [16–21]. The medical literature highlights the health burden of alcohol use and the need for workplace interventions focused on prevention and reintegration [9–12,22]. Conclusion: Dismissal due solely to drunkenness is insufficient without evidence of recurrence, direct harm to productivity, or risk to third-party integrity. A balanced approach integrating occupational health policies, rehabilitation measures, and proportional sanctions is recommended.

  Abstract
  Objective: To analyze the medical–legal framework regarding drunkenness as grounds for termination of the employment relationship in Argentina, Peru, Costa Rica, and [...]

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• Alcohol Intoxication as Just Cause for Employment Termination: A Comparative Medical–Legal Perspective in Argentina, Peru, Costa Rica, and Mexico

  C. Vanegas-Mondragon, E. Vanegas-Lopez

  International Journal of Multidisciplinary Educational Research and Innovation (2025). 1

  
  

  Abstract

  Drunkenness as grounds for termination of the employment relationship without employer liability has been widely debated in Latin America. Although contemplated in the labor laws of Argentina, Peru, Costa Rica, and Mexico, recent case law questions its strict application. From a medical perspective, alcoholism is recognized as a chronic, progressive disease, creating tension between workers' right to health and employers' authority to terminate contracts[1–3]. This article provides a medical-legal comparative analysis of legal and health criteria regarding workplace drunkenness. The study highlights the principle of proportionality, recognition of alcoholism as a disease, and the need to align labor regulations with occupational health[4–6]. We conclude that mere drunkenness should not suffice to justify dismissal, except when workplace safety, productivity, or third-party integrity is compromised, emphasizing preventive and rehabilitative measures[7,8].

  Abstract
  Drunkenness as grounds for termination of the employment relationship without employer liability has been widely debated in Latin America. Although contemplated in the labor [...]

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• The Role of Robotic Surgery in General Surgery: Advances, Limitations, and Future Perspectives

  C. Vanegas-Mondragon

  Collection of Articles on Medicine (2025). 8

  
  

  Abstract

  Background: Robotic surgery is an important advancement in minimally invasive surgery, providing enhanced precision, ergonomics, and visualization compared to laparoscopy. Its increasing adoption in general surgery reflects both its potential and its limitations. Objective: To review the current role of robotic surgery in general surgery, emphasizing advances, limitations, and future perspectives. Methods: A narrative review was performed using PubMed, Scopus, and Web of Science (2020–2023). Search terms included “robotic surgery,” “general surgery,” “da Vinci system,” and “cost-effectiveness.” Priority was given to guidelines, randomized controlled trials, systematic reviews, and meta-analyses. Results: Robotic surgery shows advantages in ergonomics, dexterity, visualization, and conversion rates, particularly in colorectal, hernia, and hepatopancreatobiliary procedures. Limitations include high cost, limited access, absence of haptic feedback, and the need for structured training. Emerging technologies such as novel robotic platforms, artificial intelligence, and augmented reality suggest promising directions. Conclusions: Robotic surgery improves outcomes but requires addressing cost, access, and training challenges. Keywords: robotic surgery; general surgery; minimally invasive surgery; da Vinci system; cost-effectiveness; surgical training; future perspectives

  Abstract
  Background: Robotic surgery is an important advancement in minimally invasive surgery, providing enhanced precision, ergonomics, and visualization compared to laparoscopy. [...]

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• ''Appendicitis during Pregnancy: A Narrative Review Comparing Laparoscopic and Open Approaches''

  C. Vanegas-Mondragon, E. Perera-Escalante, X. Lozano-Cancino

  Collection of Articles on Medicine (2025). 5

  
  

  Abstract

  '''Background:''' Acute appendicitis is the most common non-obstetric surgical emergency during pregnancy. The choice between laparoscopic appendectomy (LA) and open appendectomy (OA) remains controversial due to maternal and fetal safety concerns. '''Objective:''' To analyze current evidence comparing laparoscopic and open appendectomy in pregnant women. '''Methods:''' A narrative review was conducted using PubMed, Elsevier, and ClinicalKey. Systematic reviews, meta-analyses, and observational studies published between 2000 and 2023 were included. '''Results:''' LA was associated with shorter hospital stay, fewer wound infections, and faster recovery compared to OA. Earlier meta-analyses suggested a slightly higher risk of fetal loss with LA (OR ~1.7), but more recent studies and sensitivity analyses demonstrated no significant differences. LA is increasingly considered safe throughout all trimesters when performed with appropriate surgical technique and intraoperative monitoring. '''Conclusions:''' Laparoscopic appendectomy provides maternal benefits and comparable fetal safety to open surgery. The choice of surgical approach should be guided by surgeon expertise and institutional resources.

  Abstract
  '''Background:''' Acute appendicitis is the most common non-obstetric surgical emergency during pregnancy. The choice between laparoscopic appendectomy [...]

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