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   Table of Contents - Current issue
January-March 2019
Volume 15 | Issue 1
Page Nos. 1-91

Online since Tuesday, December 4, 2018

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Perioperative complications of sleeve gastrectomy: Review of the literature p. 1
Antonio Iannelli, Patrick Treacy, Lionel Sebastianelli, Luigi Schiavo, Francesco Martini
DOI:10.4103/jmas.JMAS_271_17  PMID:29737316
Sleeve gastrectomy (SG) has known a spectacular rise worldwide during the last decade. The absence of digestive anastomosis simplifies the surgical technique, reducing anastomosis-related complications such as fistula, stricture and marginal ulcer. Furthermore, the respect for digestive continuity preserves the functions of pylorus, that regulates gastric emptying, and duodenum, where calcium, B vitamins and iron are absorbed. Despite the multiple advantages, SG also has specific complications such as bleeding, stenosis, portal thrombosis and leak. The staple line leak at the oesophagogastric junction is the most feared complication and its prevention remains difficult, as the involved mechanisms have been only partially elucidated. Its management is long and requires a multidisciplinary technical platform including Intensive Care Unit, digestive endoscopy and interventional radiology as well as a specialised surgeon. The aim of this review is to explain in detail the perioperative complications of SG, their prevention and treatment, referring to the most recent available literature.
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Laparoscopic hysterectomy for large uteri: Outcomes and techniques Highly accessed article p. 8
Rooma Sinha, G Swarnasree, B Rupa, S Madhumathi
DOI:10.4103/jmas.JMAS_205_17  PMID:29582799
Aim: The aim of this study was to analyse our data of laparoscopic hysterectomy for large uteri (>16 weeks size) regarding their perioperative outcomes and possible factors for conversions to open surgery over 5 years. It also describes our techniques for the feasibility of performing such hysterectomies by the minimally invasive way. Materials and Methods: A five-year retrospective chart review was performed at the Minimal Access and Robotic Surgery Unit of the Department of Gynecology at Apollo Hospital, Hyderabad. Demographic and pre-operative and post-operative data were recorded. Clinical assessment including bimanual examination and surgery was made by a single senior surgeon. Intra-operative conversions, complications and post-operative complications were recorded. Results: A total of 128 women were included in this study, 5 patients underwent robotic-assisted hysterectomy. The average age was 44.4, body mass index - was 27.6 and size of the uterus was 17.5 weeks. The most common diagnosis was leiomyoma. The median Operating room (OR) time was 107 min. There was a need for myomectomy in 39.8%, extensive adhesiolysis in 33.6% and dense bladder adhesion in 26.6%. The average drop in haemoglobin was 1.72 g%, and hospital stay was 2 days. The specimen was removed by vaginal morcellation (2 cases via an umbilical port). Conversion to open surgery was required in 10.9% of cases. The conversion was significantly correlated with excessive haemorrhage and bladder injury but not with difficult hysterectomy, difficult bladder dissection or adhesions. There were 3 cases of bladder injury detected and managed intraoperatively. Conclusion: Laparoscopic hysterectomy is technically feasible and safe procedure for large uteri. The learning curve is about 50 cases and can be performed by experienced surgeons regardless of the size, number or location of the myomas without much morbidity.
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Prospective analysis of laparoscopic versus open radical nephrectomy for renal tumours more than 7 cm Highly accessed article p. 14
Mohd Mubashir Ali Khan, Rajkumar Ashokkumar Patel, Nitesh Jain, Arunkumar Balakrishnan, Murali Venkataraman
DOI:10.4103/jmas.JMAS_158_17  PMID:29582796
Aims: To analyse the feasibility of laparoscopic radical nephrectomy (LRN) for renal tumours >7 cm and to compare the operative and oncologic outcomes with open radical nephrectomy (ORN). Settings and Design: This was a prospective, observational, comparative study. Subjects and Methods: The study was conducted at a tertiary care super-speciality hospital. All the patients who underwent radical nephrectomy for >7 cm renal tumours during a period of 2 years (April 2012 to May 2014) were included in the study. Thirty patients were included in each ORN and LRN group. Pre-operative, intra-operative and post-operative data for all these patients were collected and analysed. Statistical Analysis Used: Statistical Package for the Social Sciences (SPSS, version 11.0 for Windows, Chicago, IL). Results: Mean age of patients in ORN and LRN groups was 57.3 ± 6.1 years and 54.9 ± 5.7 years, respectively (P = 0.220). As compared to ORN, LRN had less drop in post-operative haemoglobin (1.39 ± 0.55 g/dl vs. 4.07 ± 1.023 g/dl, P < 0.05), less drop in haematocrit value (4.7 ± 3.25% vs. 9.5 ± 5.13%, P < 0.05), less analgesic requirement for tramadol hydrochloride (165 ± 74.5 mg vs. 260 ± 181.66 mg) and less mean hospital stay (4.2 days vs. 6.1 days, P < 0.05). There was no statistically significant difference in post-operative complication rate and recurrence-free survival over a median follow-up of 17 months (93.9% – LRN vs. 90% – ORN) Conclusions: LRN for large renal tumours is feasible and achieves oncologic outcomes similar to that obtained with ORN.
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Minimally invasive surgery for salvage of malfunctioning peritoneal dialysis catheters p. 19
Hrishikesh P Salgaonkar, Ramya Ranjan Behera, Pradeep Chandra Sharma, Avinash Katara, Deepraj S Bhandarkar
DOI:10.4103/jmas.JMAS_184_17  PMID:29483375
Background: Malfunction of continuous ambulatory peritoneal dialysis (CAPD) catheters is a frequent complication and has traditionally been treated with a laparotomy. We present our experience with minimally invasive surgical (laparoscopic and thoracoscopic) salvage of CAPD catheters. Materials and Methods: Between October 2003 and June 2013, 19 patients (13 males and 6 females with a mean age of 37 years [range 28–64]) underwent minimally invasive laparoscopic salvage of malfunctioning CAPD catheters. These catheters had been placed with either a percutaneous or open technique and had been in place for a mean of 4.5 months (range 2–18 months). All the salvage procedures were performed under general anaesthesia using one 10 mm and two or three 5 mm ports. The various manoeuvres undertaken to re-establish catheter function included correct positioning the catheter and anchoring it to the pelvic peritoneum, clearing the fibrin clot/sheath, freeing up the omentum/bowel/taenia coli. In addition, all patients underwent an omentopexy. Results: Laparoscopic salvage could be completed in 18 patients with good catheter inflow and outflow established at the end of the surgery and one patient underwent thoracoscopic salvage. The median operative time was 63 min (range 45–96 min) and median post-operative hospital stay was 2 days (range 2–5 days). Low volume dialysis was commenced the day after surgery and full volume dialysis by the 10th day. There were no intra- or post-operative complications. All the catheters were functioning at the end of 6-month follow-up. Conclusions: Minimally invasive surgery is a valid, safe and efficacious way of salvaging malfunctioning CAPD catheters. This modality reduces the chances of re-formation of adhesions, ensures rapid recovery, reduced wound-related complications and allows for early institution of peritoneal dialysis.
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Laparoscopic management of retroperitoneal injuries from penetrating abdominal trauma in haemodynamically stable patients p. 25
Modise Zacharia Koto, Oleh Y Matsevych, Fusi Mosai, Moses Balabyeki, Colleen Aldous
DOI:10.4103/jmas.JMAS_199_17  PMID:29483377
Background: Laparoscopy is increasingly utilised in the trauma setting. However, its safety and reliability in evaluating and managing retroperitoneal injuries are not known. Aim: The aim of this study was to analyse our experience with laparoscopic management of retroperitoneal injuries due to penetrating abdominal trauma (PAT) and to investigate its feasibility, safety and accuracy in haemodynamically stable patients. Methods: Over a 4-year period, patients approached laparoscopically with retroperitoneal injuries were analysed. Mechanism, location and severity of injuries were recorded. Surgical procedures, conversion rate and reasons for conversion and outcomes were described. Results: Of the 284 patients with PAT, 56 patients had involvement of retroperitoneum. Stab wounds accounted 62.5% of patients. The mean Injury Severity Score was 7.4 (4–20). Among retroperitoneal injuries, the colon (27%) was the most commonly involved hollow viscera followed by duodenum (5%). The kidney (5%) and the pancreas (4%) were the injured solid organs. The conversion rate was 19.6% and was mainly due to active bleeding (73%). Significantly more patients with gunshot wound were converted to laparotomy (38% vs. 9%). Therapeutic laparoscopy was performed in 36% of patients. There were no recorded missed injuries or mortality. Five (9%) patients developed the Clavien-Dindo Grade 3 complications, three were managed with reoperation, one with drainage/debridement and one with endovascular technique. Conclusion: Laparoscopic management of retroperitoneal injuries is safe and feasible in haemodynamically stable patients with PAT. However, a high conversion rate indicates difficulties in managing these injuries. The requirements are the dexterity in laparoscopy and readiness to convert in the event of bleeding.
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Outcomes in morbidly obese adolescent patients undergoing laparoscopic sleeve gastrectomy in the Indian subcontinent: A retrospective review p. 31
Kirit Arumalla, Vitish Singla, Sandeep Aggarwal, Harshit Garg, Ritesh Goel, Varidh Katiyar
DOI:10.4103/jmas.JMAS_143_17  PMID:29483370
Introduction: There is a worldwide increase in the prevalence of obesity among the adolescent population in India from 16.3% in 2001 to 19.3% in 2010. Recent evidence suggests that bariatric surgery leads to resolution of comorbidities and associated long-term complications in adolescent patients with morbid obesity. Aim: The aim of this study is to determine the impact of bariatric surgery on the weight loss and comorbidities of morbidly obese adolescents. Materials and Methods: A retrospective review of the data of 10 adolescent patients, who underwent Laparoscopic Sleeve Gastrectomy at our institute (tertiary care hospital), from July 2009 to July 2016 was carried out. Results: Of the 10 patients, 4 patients had syndromic forms of obesity. The median age was 16.54 years. The median pre-operative weight and height were 112 kg and 154 cm, respectively, with a body mass index of 47.2 kg/m2. There was no intra-operative or post-operative complication except for suspected methylene blue toxicity in one patient which was treated conservatively. Median follow-up period was 1 year (0–5 years). The patients had an increase in excess weight loss (EWL) of 54.5% until the end of 1 year. There was a regain of weight between the 1st and 2nd year, followed by a sustained weight loss achieving 44.8% EWL at 3 years and 60% at the end of 5 years (only two patients followed up at 5 years). Similar results were found in syndromic patients. Among the four diabetic patients, three had complete resolution and one had improvement in diabetes status. Among the three patients with obstructive sleep apnoea, two patients had complete resolution, while one patient had improvement in symptoms. One patient with hypocortisolism improved after surgery with a decrease in the steroid requirement. Among the hypothyroid patients, one patient had a complete resolution, one patient had improvement in hypothyroid status while two patients had no change. Conclusion: Bariatric surgery is effective for morbidly obese adolescents, leading to significant resolutions of comorbid illness.
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Laparoscopic versus conventional open surgery in T4 rectal cancer: A case–control study p. 37
Xubing Zhang, Qingbin Wu, Tao Hu, Chaoyang Gu, Liang Bi, Ziqiang Wang
DOI:10.4103/jmas.JMAS_67_18  PMID:30416145
Background: Laparoscopic surgery (LAS) for T4 rectal cancer (RC) is still controversial. This study aims to compare LAS with conventional open surgery in patients with T4 RC. Patients and Methods: Patients undergoing laparoscopic or open curative resection for T4 RC from January 2010 to September 2014 in our hospital were enrolled. Patients' clinicopathological characteristics and survival outcomes were collected and compared. All statistical analysis was performed using SPSS 22.0. Results: A total of 125 patients (39 open, 86 LAS) were included in this study finally. The baseline information between the two groups were comparable except that LAS group had a more anterior resection (P = 0.012) and less combined resection (P = 0.003). The results demonstrated that patients in LAS group had less blood loss (P < 0.001), smaller incision length (P < 0.001), faster time to first soft diet (P = 0.010) and less incidence of post-operative complications, although it was not significantly different (P = 0.063). In addition, the operative time was also comparable (P = 0.140) and the conversion rate was low (2/86). The 3-year overall survival (OS) was 71.8%, 79.1% in open, LAS group respectively and the 3-year disease-free survival (DFS) was 66.7%, 68.6% in open, laparoscopic group, respectively. The Kaplan curves demonstrated that there was no significant difference between the two groups in OS (P = 0.981) or DFS (P = 0.900). Conclusions: LAS is safe and feasible in selected patients with T4 RC. It can achieve a better perioperative outcomes, and the long-time survival is not inferior to open surgery. Prospective studies should be conducted in the future to reduce the selection bias.
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Single-incision laparoscopic approach for linea alba hernia in children p. 42
Zhang Jun, Jia Na, Chen Zhen, Yang Xuan, Wei Yan-Dong, Liu Shu-Li, Li Long
DOI:10.4103/jmas.JMAS_211_17  PMID:29483378
Objective: The aim of this study is to describe the technique and to evaluate the outcome of single-incision laparoscopic (SILC) approach for linea alba hernia in children. Materials and Methods: A 2 cm vertical umbilical incision was made and stretched horizontally. A 5-mm trocar was inserted through middle port for the telescope. Another extra-long 5-mm 30° trocar was inserted through the lateral port, 5 mm beside the middle port. The extraperitoneal fat was removed, and the defect of linea alba was repaired after hernial sac was excised. The peritoneum was reconstructed with interrupted suture. Results: From May 2014 to May 2015, eight children with linea alba hernia underwent SILC. Pre-operative abdominal ultrasound showed the average diameter of hernia ring was 3.2 ± 0.7 cm. Mean operation time was 32.5 min (range = 30–45 min). Oral intake was resumed during anaesthesia recovery period. All could endure pain and discharge on the post-operative 12 h. There was no post-operative wound infection. The follow-up period was 1–12 months, no recurrence and other complications occurred. Conclusions: SILC approach for linea alba hernia is a safe and effective, minimally invasive new technology. The linea alba hernia could be repaired with a cosmetic outcome.
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C-reactive protein as predictor of anastomotic complications after minimally invasive oesophagectomy Highly accessed article p. 46
Vladimir Prochazka, Filip Marek, Lumir Kunovsky, Roman Svaton, Martina Farkasova, Martin Potrusil, Petr Moravcik, Zdenek Kala
DOI:10.4103/jmas.JMAS_254_17  PMID:29595182
Background: Anastomotic leaks after oesophagectomy with tabularised stomach replacement are a significant factor in post-operative mortality and morbidity. Early detection and treatment of this complication allow for improving operative and oncological results. When assessing laboratory values – elevation of inflammatory parameters – complicated interpretation is an issue (systemic inflammatory response syndrome, surgical versus non-surgical complication). Results studying the relationship between C-reactive protein (CRP) and complications following oesophagectomies are inconsistent. The aim of our work was to find relationships between the development of post-operative CRP values and the occurrence of anastomotic complications following minimally invasive oesophagectomy (MIE). Materials and Methods: Analysis of the relationship between CRP values and the occurrence of anastomotic complications or the necessity of reoperation following oesophagectomy with tabularised stomach replacement and cervical anastomosis performed using thoracoscopy and laparoscopy in a group of patients operated on for malignancies at our department between 2012 and 2015. Results: A significant difference was found in average CRP values on the 5th day and 7th day following operation between patients with and without leaks (233 mg/l vs. 122.8 mg/l P = 0.003, respectively 208.9 mg/l vs. 121.3 mg/l P = 0.014). However, on the 5th day, the leak was clinically apparent only in one case out of 11 leaks. A significant difference in CRP values on the 5th day was found between patients who needed revision surgery and patients without revision surgery (294 mg/l vs. 133.5 mg/l P = 0.01). Conclusions: Patients after MIE with tabularised stomach replacement and cervical anastomosis complicated by anastomotic leaks or with the necessity for reoperation had a significantly higher CRP values on the 5th day following operation than patients without complications, regardless of the presence of clinical signs of leaks.
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Our experience of laparoscopic pyloromyotomy with ultrasound-guided parameters Highly accessed article p. 51
Aboli Hukeri, Abhaya Gupta, Paras Kothari, Vishesh Dikshit, Geeta Kekre, Prashant Patil, Apoorva Kulkarni, Arjun Pawar
DOI:10.4103/jmas.JMAS_193_17  PMID:29582798
Traditional management of infantile Hypertrophic Pyloric Stenosis is open pyloromyotomy after initial adequate resuscitation of the patient. From 1991, laparoscopic approach is considered feasible and safe. Today, diagnosis of hypertrophic pyloric stenosis is made most often made by ultrasound. With use of ultrasound-guided parameters (length of pyloric tumour and thickness of pyloric tumour), we could avoid ‘incomplete pyloromyotomy’ and ‘mucosal perforation’ (most common complications in laparoscopic approach) to achieve 100% adequacy and safety in laparoscopic pyloromyotomy.
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Bedside diagnostic laparoscopy for critically ill patients in the Intensive Care Unit: Retrospective study and review of literature p. 56
Giovanni Alemanno, Paolo Prosperi, Annamaria Di Bella, Filippo Socci, Stefano Batacchi, Adriano Peris, Matteo Pieri, Giuseppe Olivo, Pietro Quilghini, Paolo Fontanari, Pierluigi Stefàno, Alessio Giordano, Veronica Iacopini, Carlo Bergamini, Andrea Valeri
DOI:10.4103/jmas.JMAS_232_17  PMID:29483381
Background: Bedside diagnostic laparoscopy could be helpful in extremely critically ill patients. The aim of this retrospective study is to evaluate the safety and diagnostic accuracy of bedside diagnostic laparoscopy in the identification of intra-abdominal pathology in critically ill patients and to compare its accuracy and outcomes with the ones of laparotomy. Patients and Methods: A retrospective review was conducted on the medical records of patients admitted to the Intensive Care Unit (ICU) of Careggi University Hospital and submitted to bedside diagnostic laparoscopy between January 2006 and May 2017. This group of patients was compared with a group of patients that were admitted to the ICU and submitted directly to explorative laparotomy for suspected intra-abdominal pathologies. Results: One hundred and twenty-nine patients (M/F = 81/48, mean age = 71.64 years) underwent bedside diagnostic laparoscopy in ICU. 154 patients instead were submitted directly to explorative laparotomy in operatory room (mean age 75.70 years, M/F = 94/60). Among the 129 patients submitted to bedside laparoscopy, 53.49% were positive for intra-abdominal pathologies whereas 46.51% were negative, while among the 154 patients submitted directly to laparotomy, 76.62% were positive for intra-abdominal pathologies whereas 23.38% were negative. In 55.03% of all patients submitted to bedside laparoscopy, a non-therapeutic laparotomy was avoided, while the 33.76% of patients submitted directly to laparotomy had a non-therapeutic laparotomy that could be avoidable. Conclusions: Our results pinpoint the advantages of performing bedside diagnostic laparoscopy in the ICU setting, which can be considered an option every time there is the suspicion of an intra-abdominal pathology.
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Preduodenal portal vein: A recipe for disaster during laparoscopic cholecystectomy p. 63
Rohit Bansal, Kanwarjit Singh Dhillon, Gourav Kaushal
DOI:10.4103/jmas.JMAS_73_18  PMID:29737323
We had encountered a very rare congenital anomaly of a preduodenal portal vein while doing laparoscopic cholecystectomy. More significant in our case is that this preduodenal vein is hiding behind omental adhesions with the gallbladder. We want to raise awareness about this very rare anomaly. Recognition and knowledge of this anomaly will prevent the potential of a serious operative misadventure.
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Posterior mediastinal myelolipoma resected by video-assisted thoracic surgery p. 65
Luigi Ventura, Eugenia Marta Martella, Michele Rusca, Luca Ampollini
DOI:10.4103/jmas.JMAS_44_18  PMID:29737320
Myelolipoma (ML) is a benign tumour composed of haematopoietic and mature adipose tissue commonly found in adrenal glands. Prognosis is usually good with an indolent clinical course. The occurrence of an ML in the extra-adrenal site is very rare. Herein, we report a very interesting and unusual case of ML located in the posterior mediastinum successfully resected by video-assisted thoracic surgery. The clinical and histological features are largely discussed.
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Laparoscopic colon resection in patients with situs inversus totalis: Is it the same operation as in patients without situs inversus totalis? p. 68
Onder Karabay, Bulent Gurbuz, Serkan Zenger, Emre Balik, Dursun Bugra
DOI:10.4103/jmas.JMAS_13_18  PMID:29737309
Situs inversus totalis (SIT) is a rare condition. In this case, a patient who underwent laparoscopic anterior resection for repeated sigmoid colon diverticulitis with SIT was presented. Laparoscopy surgery in patients with this condition has some important technical differences than standard laparoscopic procedures. Therefore, it may be more appropriate to request surgical experience to perform safe laparoscopic surgery in patients with SIT.
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Resection of a giant nonparasitic splenic cyst by minilaparoscopy p. 71
Gustavo Lopes de Carvalho, Gustavo Henrique Belarmino de Góes, Raimundo Hugo Matias Furtado, Raquel Nogueira Cordeiro, Marianna de Castro Araújo Lessa
DOI:10.4103/jmas.JMAS_55_18  PMID:29737321
A female patient, 20 years old, with a history of a progressive increase in abdominal volume on the left side, starting 3 years ago, with no associated symptoms and no history of trauma. Ultrasonography and a computed tomography scan of the abdomen were performed, which revealed a large splenomegaly, and a partial minilaparoscopic splenectomy was indicated. We opted for unroofing of the cyst, and the procedure was uneventful, with a total surgical time of 47 min. The patient progressed clinically well, without abdominal pain, being discharged on the 2nd post-operative day.
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Early recurrence after laparoscopic radical cholecystectomy in a patient with gallbladder cancer p. 74
Kunal Parasar, Sundeep Singh Saluja, Vaibhav Kumar Varshney, B Deepak, Pramod Kumar Mishra
DOI:10.4103/jmas.JMAS_97_18  PMID:29794366
Laparoscopic radical cholecystectomy for gallbladder cancer (GBC) has been performed at various oncology centres reporting its technical feasibility. Considering GBC an aggressive malignancy, laparoscopic radical cholecystectomy should be dealt with caution. We recently encountered a case of carcinoma gallbladder who underwent laparoscopic radical cholecystectomy elsewhere and presented with early recurrence. The patient's records were evaluated and he underwent re-resection. Hereby, we discuss the factors that could lead to early recurrence after laparoscopic radical cholecystectomy and measures that can be taken to prevent it.
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Laparoscopic splenectomy for large splenic pseudocyst: A rare case report and review of literature p. 77
Ankush Sarwal, Anil Sharma, Rajesh Khullar, Vandana Soni, Manish Baijal, Pradeep Chowbey
DOI:10.4103/jmas.JMAS_82_18  PMID:29794364
Laparoscopic splenectomy is gaining popularity due to less morbidity and minimal operative complications. Nowadays, laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen. Splenic pseudocyst due to non-traumatic cause has been very rarely reported in literature. We report an interesting case of a rare large splenic pseudocyst without a history of previous abdominal trauma, treated successfully by laparoscopic technique and discuss literature for the same.
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Laparoscopically assisted insertion of peritoneal dialysis catheter p. 80
Jurij Janez
DOI:10.4103/jmas.JMAS_196_17  PMID:29319017
Peritoneal dialysis (PD) is a generally accepted method for treatment of patients with the end-stage renal disease. A larger proportion of PD patients transfer to haemodialysis every year than the converse. Many of the underlying causes of transfer to haemodialysis are preventable. Infectious complications still remain the most common reason for transfer of PD patients to haemodialysis, catheter-related problems are the second most common cause. For PD to be effective it is very important to provide a quality peritoneal access with the insertion of PD catheter with minimum complications. With the development of minimally invasive and laparoscopic surgery, laparoscopic insertion of PD catheter is becoming widely accepted method, which showed to be effective with minor complications. In our institution, laparoscopic insertion of PD catheter in adult patients is a standard method for providing peritoneal access for chronic peritoneal dialysis.
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Rescue stitch: A minimal access surgeon's lifeboat in life-threatening intraoperative bleeding Highly accessed article p. 84
Abhishek Singh, Arvind Ganpule
DOI:10.4103/jmas.JMAS_186_17  PMID:29582797
Bleeding in a minimal access surgery can be very intimidating for a laparoscopic surgeon. Open conversion becomes an imminent option in these situations. Although open conversion is not a surgical defeat, in certain situations, bleeding can be salvaged using a ‘rescue stitch.’ We, herein, describe rescue stitch along with a rescue tray and its application during intraoperative bleeding in minimal access surgery.
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Laparoscopy for continuous ambulatory peritoneal dialysis catheter placement and management of malfunctioning peritoneal dialysis catheter p. 88
Pankaj N Maheshwari
DOI:10.4103/jmas.JMAS_251_17  PMID:29319023
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The use of double CO2 insufflators in transanal total mesorectal excision: An alternative possibility p. 90
Claudio Lazzara, Giuseppe Navarra, Giuseppe Currò
DOI:10.4103/jmas.JMAS_26_18  PMID:29737314
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2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04