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   2005| April-June  | Volume 1 | Issue 2  
 
 
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CME ARTICLE
Anatomy relevant to cholecystectomy
Sanjay Nagral
April-June 2005, 1(2):53-58
DOI:10.4103/0972-9941.16527  PMID:21206646
This review discusses anatomical facts that are of relevance to the performance of a safe cholecystectomy. Misinterpretation of normal anatomy and anatomical variations contribute to the occurrence of major postoperative complications like biliary injuries following a cholecystectomy, the incidence being higher with laparoscopic cholecystectomy. A look at the basic anatomy is therefore important for biliary and minimally invasive surgeons. This includes normal anatomy and variations of the biliary apparatus as well as the arterial supply to the gallbladder. Specific anatomical distortions due to the laparoscopic technique, their contribution in producing injury and a preventive strategy based on this understanding are discussed. Investigative modalities that may help in assessing anatomy are considered. Newer insights into the role of anatomic illusions as well as the role of a system-based approach to preventing injuries is also discussed.
  12 53,557 1,943
HOW I DO IT DIFFERENTLY?
Laparoscopic transabdominal extraperitoneal repair of lumbar hernia
A Sharma, R Panse, R Khullar, V Soni, M Baijal, PK Chowbey
April-June 2005, 1(2):70-73
DOI:10.4103/0972-9941.16530  PMID:21206649
Lumbar hernias need to be repaired due to the risk of incarceration and strangulation. A laparoscopic intraperitoneal approach in the modified flank position causes the intraperitoneal viscera to be displaced medially away from the hernia. The creation of a wide peritoneal flap around the hernial defect helps in mobilization of the colon, increased length of margin is available for coverage of mesh and more importantly for secure fixation of the mesh under vision to the underlying fascia. Laparoscopic lumbar hernia repair by this technique is a tensionless repair that diffuses total intra-abdominal pressure on each square inch of implanted mesh. The technique follows current principles of hernia repair and appears to confer all benefits of a minimal access approach.
  7 13,235 355
ORIGINAL ARTICLE
Laparoscopic cholecystectomy - Is there a need to convert?
Kuldip Singh, Ashish Ohri
April-June 2005, 1(2):59-62
DOI:10.4103/0972-9941.16528  PMID:21206647
INTRODUCTION: The difficult gallbladder is the most common 'difficult' laparoscopic surgery being performed by general surgeons all over the world and the potential one that places the patient at significant risk. We present our experience of 6147 cases since January 1993 in a single center with respect to conversion to open cholecystectomy. METHODS: Patients who underwent laparoscopic cholecystectomy (LC) from January 1993 to December 2004 were analyzed. The cases were analyzed in relation to conversion rate to open surgery, factors affecting the conversion, and completion rate of LC. Patients having absolute contraindications to LC like cardiovascular and pulmonary disease were not included in the study. RESULTS: Out of 6147 cases, 1518 patients (21.5%) were identified as difficult cases. Laparoscopic cholecystectomy was successfully completed in 6125 patients with a completion rate of 99.6%. Laparoscopic procedure had to be converted to the open procedure in 22 patients with a conversion rate of 0.36% of the total LCs performed and 1.66% of the difficult cases. Conversion had to be done due to several reasons. CONCLUSION: It can be reliably concluded that LC is the preferred method even in the difficult cases. Our study emphasizes that although the rate of conversion to open surgery and complication rate are low in experienced hands the surgeon should keep a low threshold for conversion to open surgery and it should be taken as a step in the interest of the patient rather than be looked upon as an insult to the surgeon.
  7 10,412 437
UNUSUAL CASE
Laparoscopic repair of a Morgagni hernia
JM Sherigar, AD Dalal, JR Patel
April-June 2005, 1(2):76-78
DOI:10.4103/0972-9941.16532  PMID:21206651
We report a case of laparoscopic repair of symptomatic Morgagni hernia (MH) in an adult. A tension-free closure of the defect was carried out using a polypropylene mesh. The recovery was quick and uneventful. Two years after surgery, the patient is doing well. A search of the English-language surgical literature revealed a total of 55 cases of laparoscopic repair of MH reported: 40 in adults and 15 in children. The various modalities of diagnosis, operative techniques, and disease presentation are discussed.
  5 7,320 236
EDITORIAL
Laparoscopy in India - A personal perspective
Tehemton E Udwadia
April-June 2005, 1(2):51-52
DOI:10.4103/0972-9941.16526  PMID:21206645
  3 8,271 254
ORIGINAL ARTICLE
Laparoscopic splenectomy using conventional instruments
AN Dalvi, PM Thapar, AA Deshpande, SA Rege, RY Prabhu, AN Supe, RS Kamble
April-June 2005, 1(2):63-69
DOI:10.4103/0972-9941.16529  PMID:21206648
INTRODUCTION : Laparoscopic splenectomy (LS) is an accepted procedure for elective splenectomy. Advancement in technology has extended the possibility of LS in massive splenomegaly [Choy et al., J Laparoendosc Adv Surg Tech A 14(4), 197-200 (2004)], trauma [Ren et al., Surg Endosc 15(3), 324 (2001); Mostafa et al., Surg Laparosc Endosc Percutan Tech 12(4), 283-286 (2002)], and cirrhosis with portal hypertension [Hashizume et al., Hepatogastroenterology 49(45), 847-852 (2002)]. In a developing country, these advanced gadgets may not be always available. We performed LS using conventional and reusable instruments in a public teaching the hospital without the use of the advanced technology. The technique of LS and the outcome in these patients is reported. MATERIALS AND METHODS : Patients undergoing LS for various hematological disorders from 1998 to 2004 were included. Electrocoagulation, clips, and intracorporeal knotting were the techniques used for tackling short-gastric vessels and splenic pedicle. Specimen was delivered through a Pfannensteil incision. RESULTS : A total of 26 patients underwent LS. Twenty-two (85%) of patients had spleen size more than 500 g (average weight being 942.55 g). Mean operative time was 214 min (45-390 min). The conversion rate was 11.5% ( n = 3). Average duration of stay was 5.65 days (3-30 days). Accessory spleen was detected and successfully removed in two patients. One patient developed subphrenic abscess. There was no mortality. There was no recurrence of hematological disease. CONCLUSION : Laparoscopic splenectomy using conventional equipment and instruments is safe and effective. Advanced technology has a definite advantage but is not a deterrent to the practice of LS.
  3 9,892 298
IMAGES IN SURGERY
Cholecystomegaly: Laparoscopic treatment
DJ Tessier, L McMahon, KL Harold
April-June 2005, 1(2):82-83
DOI:10.4103/0972-9941.16534  PMID:21206653
  - 6,227 192
LETTER TO EDITOR
Minimally invasive technique cuts costs in veterinary surgery
VM Chariar, DN Shirodkar, YB Khare
April-June 2005, 1(2):84-85
DOI:10.4103/0972-9941.16535  PMID:21206654
  - 5,258 196
PERSONAL VIEWPOINT
Surgical packages for laparoscopic surgery
K Bhattacharya
April-June 2005, 1(2):74-75
DOI:10.4103/0972-9941.16531  PMID:21206650
'Packages' are in fashion today for most surgical procedures in various corporate hospitals and this has included laparoscopic procedures too. A package system enables the hospitals to get cost settlements done more easily. Also, it is more convenient for the patients who are aware upfront of the charges. The principal disadvantages seems to be for the surgeon, who may face displeasure of the patient, hospital or insurance agencies apart from forfeiting his personal charges if (a) he is a novice in laparoscopic surgery and takes extra time to complete a procedure, (b) unforeseen problems occur during surgery, or (c) new pathologies are discovered on exploration.
  - 6,279 209
UNUSUAL CASE
Breakage of fascial closure device during laparoscopic surgery
AN Katara, Deepraj S Bhandarkar, RS Shah, TE Udwadia
April-June 2005, 1(2):79-81
DOI:10.4103/0972-9941.16533  PMID:21206652
Breakage of instruments during laparoscopic surgery is rare. However, when it does occur, locating and retrieving the broken part of the instrument can be cumbersome. Moreover, inability to do so may carry serious medicolegal implications. We report a patient in whom the tip of a fascial closure device broke during laparoscopic surgery. This was located by intraoperative fluoroscopy and retrieved from the extraperitoneal plane via a small incision. The paper discusses the probable factors responsible for breakage of the fascial closure device in our patient and reviews the previously reported cases of the rare complication of breakage of instruments during laparoscopic surgery.
  - 5,645 203
2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04