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   2012| October-December  | Volume 8 | Issue 4  
    Online since November 2, 2012

 
 
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ORIGINAL ARTICLES
Laparoscopic adrenalectomy for large tumours: Single team experience
Abhay N Dalvi, Pinky M Thapar, Vinaykumar B Thapar, Sameer A Rege, Aparna A Deshpande
October-December 2012, 8(4):125-128
DOI:10.4103/0972-9941.103110  PMID:23248438
Background: Laparoscopic adrenalectomy (LA) has become the procedure of choice to treat benign functioning and non-functioning adrenal tumours. With improving experience, large adrenal tumours (> 5 cm) are being successfully tackled by laparoscopy. This study aims to present our single unit experience of LA performed for large adrenal masses. Materials and Methods: Forty-six laparoscopic adrenalectomies performed for large adrenal lesions more than 5 cm during the period 2001 to 2010 were reviewed. Results: A total of 46 adrenalectomies were done in 42 patients. The mean tumour size was 7.03 cm (5-15 cm). Fourteen patients had tumour size more than 8 cm. The lesions were localised on the right side in 17 patients and on the left side in 21 patients with bilateral tumours in 4 patients. Functioning tumours were present in 32 of the 46 patients. The average blood loss was 112 ml (range 20-400 ml) with the mean operating time being 144 min (range 45 to 270 min). Five patients required conversion to open procedure. Three of the 46 patients (6.52%) on final histology had malignant tumours. Conclusion: LA is safe and feasible for large adrenal lesions. Mere size should not be considered as a contraindication to laparoscopic approach in large adrenal masses. Graded approach, good preoperative assessment, team work and adherence to anatomical and surgical principles are the key to success.
  3 1,830 185
REVIEW ARTICLE
Analysing the benefits of laparoscopic hernia repair compared to open repair: A meta-analysis of observational studies
Sarah A Salvilla, Sundeep Thusu, Sukhmeet S Panesar
October-December 2012, 8(4):111-117
DOI:10.4103/0972-9941.103107  PMID:23248436
Background: The purpose of this study is to compare the difference of incidence of post-operative complications, operative time, length of stay and recurrence of patients undergoing laparoscopic or open repair of their ventral/incisional hernia a meta-analytic technique for observational studies. Materials and Methods: A literature search was performed using Medline, PubMed, Embase and Cochrane databases for studies reported between 1998 and 2009 comparing laparoscopic and open surgery for the treatment of ventral (incisional) hernia. This meta-analysis of all the observational studies compared the post-operative complications recurrence rate and length of stay. The random effects model was used. Sensitivity and heterogeneity were analysed. Results: Analysis of 15 observational studies comprising 2452 patients qualified for meta-analysis according to the study's inclusion criteria. Laparoscopic surgery was attempted in 1067 out of 2452. The results showed that the length of stay (odds ratio [OR], − 1.00; 95% confidence interval [CI], − 1.09 to − 0.91; P < 0.00001) and operative time (OR, 59.33; 95% CI, 58.55 to 60.11; P < 0.00001) was significantly lower in the laparoscopic group. The results also showed that there was a significant reduction in the formation of abscesses (OR, 0.38; 95% CI, 0.16 to 0.92; P = 0.03) and wound infections (OR, 0.49; 95% CI, 0.29 to 0.82; P = 0.007) post-operatively. There is a trend which indicates that the recurrence of the hernia using laparoscopic repair versus open repair was overall lower with the laparoscopic repair (OR, 0.48; 95% CI, 0.22 to 1.04; P = 0.06), however, this was not significant. Conclusion: Laparoscopic incisional hernia repair was associated with a reduced length of stay, operative time and lower incidence of abscess and wound infection post-operatively. This study also highlights the benefit of using observational studies as a form of research and its value as a tool in answering questions where large sample sizes of patient groups would be impossible to accumulate in a reasonable length of time.
  3 2,771 288
ORIGINAL ARTICLES
Endoscopic placement of fully covered self expanding metal stents for management of post-operative foregut leaks
Gianfranco Donatelli, Parag Dhumane, Silvana Perretta, Bernard Dallemagne, Michele Vix, Didier Mutter, Stavros Dritsas, Michel Doffoel, Jacques Marescaux
October-December 2012, 8(4):118-124
DOI:10.4103/0972-9941.103109  PMID:23248437
Background: Fully covered self-expanding metal stent (SEMS) placement has been successfully described for the treatment of malignant and benign conditions. The aim of this study is to evaluate our experience of fully covered SEMS placement for post-operative foregut leaks. Materials and Methods: Retrospective analysis was done for indications, outcomes and complications of SEMS placed in homogeneous population of 15 patients with post-operative foregut leaks in our tertiary-care centre from December 2008 to December 2010. Stent placement and removal, clinical and radiological evidence of leak healing, migration and other complications were the main outcomes analyzed. Results: Twenty-three HANAROSTENT® SEMS were successfully placed in 14/15 patients (93%) with post-operative foregut leaks for an average duration of 28.73 days (range=1-42 days) per patient and 18.73 days per SEMS. Three (20%) patients needed to be re-stented for persistent leaks ultimately resulting in leak closure. Total 5/15 (33.33%) patients and 7/23 (30.43%) stents showed migration; 5/7 (71.42%) migrated stents could be retrieved endoscopically. There were mucosal ulceration in 2/15 (13.33%) and pain in 1/15 (6.66%) patients. Conclusions: Stenting with SEMS seems to be a feasible option as a primary care modality for patients with post-operative foregut leaks.
  2 3,656 181
Management of choledochal cyst: Evolution with antenatal diagnosis and laparoscopic approach
Abdelmounim Cherqaoui, Mirna Haddad, Celine Roman, Guillaume Gorincour, Jean Yves Marti, Arnaud Bonnard, Jean-Michel Guys, Pascal de Lagausie
October-December 2012, 8(4):129-133
DOI:10.4103/0972-9941.103113  PMID:23248439
Background/Aim: Laparoscopic excision of a choledochal cyst (CC) with hepaticojejunostomy gained a wide acceptance in the treatment of children even in neonatal period. Although, the use of prenatal diagnostic techniques causes a significant increase in antenatal diagnosis of CC, the time of surgical intervention during infancy is still controversial. A retrospective study was performed to evaluate the results of laparoscopic management of CC with special emphasis on antenatal diagnosis and treatment, and to compare the results with open procedure. Materials and Methods: The patients who were diagnosed with choledochal cyst and underwent either open or laparoscopic hepaticojejunostomy in two centres, hopital d'enfant de La Timone from Marseille and hopital Robert Debre from Paris between November 2000 and December 2009 were included in the study. The data obtained from medical reports were evaluated for sex, time of antenatal diagnosis, age at time of operation, operative time, time of postoperation. Results: A total of 19 hepaticojejunostomy were performed, including 10 open procedures (group A), and 9 laparoscopic procedures (group B, 4 were diagnosed prenatally, without conversion to open procedure). There were 3 boys and 16 girls, ranging in age from 2 weeks to 16 years. Patients in the group A were older than patients in the group B. The mean hospital stay and time to return of bowel fuction was longer in the group B. there were 60% of pre-operative complications in group A versus 22% in group B. There was one postoperative complications in group B (biliary leakage nedeed redo surgery). No significant differences were found between different parameters except for operative time (288.56 min in the group B versus 206 min in the group A. (p = 0.041)). Conclusions: Our initial experience indicates that the laparoscopic approach in infancy is technically feasible, safe, and effective, with a low morbidity and a comparable outcome to the open approach. Therefore, we propose a laparoscopic approach for antenatally diagnosed CC as early as possible, before the onset of complications.
  2 2,168 154
Single incision laparoscopic colorectal resection: Our experience
Chinnusamy Palanivelu, Anirudh Vij, Subbiya Rajapandian, Praveenraj Palanivelu, Ramakrishnan Parthasarathi, Velyoudam Vaithiswaran, Senthilnathan Palanisamy
October-December 2012, 8(4):134-139
DOI:10.4103/0972-9941.103118  PMID:23248440
Background: A prospective case series of single incision multiport laparoscopic colorectal resections for malignancy using conventional laparoscopic trocars and instruments is described. Materials and Methods: Eleven patients (seven men and four women) with colonic or rectal pathology underwent single incision multiport laparoscopic colectomy/rectal resection from July till December 2010. Four trocars were placed in a single transumblical incision. The bowel was mobilized laparoscopically and vessels controlled intracorporeally with either intra or extracorporeal anastomosis. Results: Three patients had carcinoma in the caecum, one in the hepatic flexure, two in the rectosigmoid, one in the descending colon, two in the rectum and two had ulcerative pancolitis (one with high grade dysplasia and another with carcinoma rectum). There was no conversion to standard multiport laparoscopy or open surgery. The median age was 52 years (range 24-78 years). The average operating time was 130 min (range 90-210 min). The average incision length was 3.2 cm (2.5-4.0 cm). There were no postoperative complications. The average length of stay was 4.5 days (range 3-8 days). Histopathology showed adequate proximal and distal resection margins with an average lymph node yield of 25 nodes (range 16-30 nodes). Conclusion: Single incision multiport laparoscopic colorectal surgery for malignancy is feasible without extra cost or specialized ports/instrumentation. It does not compromise the oncological radicality of resection. Short-term results are encouraging. Long-term results are awaited.
  2 3,725 180
UNUSUAL CASES
Single port robotic hysterectomy technique improving on multiport procedure
John R Lue, Brian Murray, Stephen Bush
October-December 2012, 8(4):156-157
DOI:10.4103/0972-9941.103130  PMID:23248446
The benefits of laparoscopic surgery over conventional abdominal surgery have been well documented. Reducing postoperative pain, decreasing postoperative morbidity, hospital stay duration, and postoperative recovery time have all been demonstrated in recent peer-review literature. Robotic laparoscopy provides the added dimension of increased fine mobility and surgical control. With new single port surgical techniques, we have the added benefit of minimally invasive surgery and greater patient aesthetic satisfaction, as well as all the other benefits laparoscopic surgery offers. In this paper, we report a successful single port robotic hysterectomy and the simple process by which this technique is performed.
  2 1,434 113
LETTERS TO THE EDITOR
Single incision laparoscopic cholecystectomy: Great start and a long way to go
Pankaj K Garg
October-December 2012, 8(4):163-163
DOI:10.4103/0972-9941.103133  PMID:23248449
  1 973 102
Single port access sleeve is reasonable if done without any violation of basic principles
P Praveen Raj, P Senthilnathan, C Palanivelu
October-December 2012, 8(4):163-164
DOI:10.4103/0972-9941.103134  PMID:23248450
  1 1,122 94
ORIGINAL ARTICLES
Adrenal cysts: Our laparoscopic experience
Rajendra B Nerli, Ajay Guntaka, Shishir Devaraju, Shivagouda Patil, Murigendra B Hiremath
October-December 2012, 8(4):145-148
DOI:10.4103/0972-9941.103123  PMID:23248442
Introduction: Cystic lesions of the adrenals are rare with an incidence of 0.06% in autopsies, and the most frequently found are either the endothelial cysts or the pseudocysts. We report our series of patients presenting with adrenal cysts. Materials and Methods: The case records of patients presenting with adrenal cysts were reviewed and analyzed. Age, gender, presenting symptoms, physical examination findings, laboratory investigations and imaging records were all noted and analysed. Results: During the 10-year study period, 14 patients, with a mean age of 41.36 ± 5.57 years, were diagnosed to have adrenal cysts. Laparoscopic excision of cysts was performed in three and laparoscopic adrenalectomy in the remaining eleven. Conclusions: Adrenal cysts are rare, and intervention is indicated whenever they are large (>5 cm), symptomatic, functional, and potentially malignant. Laparoscopic management of these cysts in the form of either decortication/excision is safe, effective, minimally invasive, with minimal blood loss and shorter duration of hospitalization.
  1 2,395 127
UNUSUAL CASES
Reduced port laparoscopic repair of Bochdalek hernia in an adult: A first report
Pravin Hector John, John Thanakumar, Arunkumar Krishnan
October-December 2012, 8(4):158-160
DOI:10.4103/0972-9941.103131  PMID:23248447
Bochdalek hernia is a congenital defect of the diaphragm that usually presents in the neonatal period with life-threatening cardiorespiratory distress. It is rare for Bochdalek hernias to remain silent until adulthood. A 57-year-old woman presented with history of difficulty in swallowing, as well as retching. There was no history of abdominal or thoracic trauma. A chest x-ray showed the herniated stomach clearly. Computed tomography (CT) of the abdomen showed a herniated volvulus of the stomach, along with left posterolateral diaphragmatic hernia. The defect was repaired by a single incision laparoscopic technique. We present the first case of a posterolateral diaphragmatic hernia repaired by a reduced port laparoscopic technique in an adult, after an extensive literature search yielded no precedents. This report validates the feasibility of reduced port laparoscopic repair of Bochdalek hernia in an adult, and should be within the remit of the advanced laparoscopic surgeon.
  1 1,958 131
INSTRUMENTS AND EQUIPMENTS
Efficacy of the modified anvil grasper for laparoscopic intra-corporeal circular stapled anastomosis
Yuen Nakase, Tsuyoshi Takagi, Kanehisa Fukumoto, Takuya Miyagaki
October-December 2012, 8(4):161-162
DOI:10.4103/0972-9941.103132  PMID:23248448
The traditional anvil grasper may be difficult to use for connecting the stem of an anvil with the centre rod of a circular stapler because the grasper holds the anvil completely still. In addition, the head angle is fixed and cannot handle the anvil head delicately in a tight pelvic space. Many surgeons use a grasper designed for holding the bowel or a dissector for holding the anvil during intra-corporeal circular stapled anastomosis during low anterior resection, sigmoidectomy, left hemi colectomy and know that it is difficult to connect segments with these instruments due to slipping. A new modified anvil grasper was developed with curved blades that can easily grasp the stem of an anvil and smoothly connect it with the centre rod of the circular stapler. This grasper should be useful for surgeons performing laparoscopic intra-corporeal circular stapled anastomoses, which are the most challenging part of laparoscopic colorectal surgery.
  - 1,669 111
LETTERS TO THE EDITOR
Laparoscopic cholecystectomy and appendicectomy in situs inversus totalis
Sugunakara Rao Kodi
October-December 2012, 8(4):164-165
DOI:10.4103/0972-9941.103135  PMID:23248451
  - 1,142 105
Response to comment on "Laparoscopic cholecystectomy and appendicectomy in situs inversus totalis"
Vijay Borgaonkar, Sushil Deshpande, Vidyadhar Kulkarni
October-December 2012, 8(4):165-165
DOI:10.4103/0972-9941.103136  PMID:23248452
  - 967 89
The operating laparoscope: Time for a revival?
Philip Ng
October-December 2012, 8(4):165-166
DOI:10.4103/0972-9941.103137  PMID:23248453
  - 826 91
Authors' reply
Rajaraman Durai, Philip Cheng Hin Ng
October-December 2012, 8(4):166-166
  - 713 73
ORIGINAL ARTICLES
Two-port vs. three-port laparoscopic appendicectomy: A bridge to least invasive surgery
Ashwin Rammohan, Paramaguru Jothishankar, AB Manimaran, RM Naidu
October-December 2012, 8(4):140-144
DOI:10.4103/0972-9941.103121  PMID:23248441
Introduction: The conventional three-port technique for laparoscopic appendicectomy has proven its worth in the management of appendicular pathologies. From a cosmetic viewpoint, the umbilical and suprapubic port-sites are hidden by natural camouflages, the right Iliac fossa (RIF) port is the only visible external sign of surgery. The two-port technique avoids even this marker of abdominal invasion. In this study, we describe the technique of two-port laparoscopic appendicectomy (TPA) and compare it with conventional laparoscopic appendicectomy (CLA). Materials and Methods: All patients studied underwent operation for acute appendicitis during a 6-month period. Data were collected prospectively for the TPA and retrospectively for the CLA. The TPA was performed with one 10 mm umbilical working port and one 5 mm suprapubic camera port. A hypodermic needle was introduced in the RIF to retract the appendix. The appendicular artery was controlled with diathermy or ultrasonic shears. The base was ligated with a loop knotted extracorporeally. CLA was performed via the conventional 10 mm umbilical, 5 mm suprapubic and 5 mm RIF ports. The appendicular stump was ligated with an endoloop or an intracorporeal knot. Results: A total of 146 patients underwent surgery over the 6-month period for appendicitis. Out of 62 cases attempted, the TPA was successful in 51 cases, with conversion to the three-port technique in 11. The operative time, complication rates, return to work were comparable between the two groups. Patients who had TPA had a shorter postoperative stay. Conclusion: This is an initial experience with TPA. There is little difference in the operative time, postoperative stay and complications rates between this technique and the conventional three-port one. There is hence little to be lost and a likely benefit to be gained by performing the TPA although a randomised study is necessary.
  - 5,765 185
UNUSUAL CASES
Management of intestinal obstruction following laparoscopic donor nephrectomy
Randeep Wadhawan, Subrat Raul, Muneendra Gupta, Sanjay Verma
October-December 2012, 8(4):149-151
DOI:10.4103/0972-9941.103126  PMID:23248443
Internal hernias are a rare cause of small bowel obstruction. Following laparoscopic bariatric surgery, specifically gastric bypass and laparoscopic colonic resections, there has been an increase in the incidence of internal hernias. This has been due to either a mesenteric or mesocolic defect being not closed or completely missed. Small bowel loops usually herniate through these defects and present as intestinal obstruction. Internal hernia following laparoscopic donor nephrectomy is a rare complication. The need for presenting this case is the rarity of its occurrence, to stress the fact that following major abdominal laparoscopic surgery the mesenteric or mesocolic defects should be closed, and that this complication was managed laparoscopically, through the same port sites as used earlier for the donor nephrectomy.
  - 1,714 98
Two-stage laparoscopic resection of colon cancer and metastatic liver tumour
Yukio Iwashita, Atsushi Sasaki, Toshifumi Matsumoto, Kohei Shibata, Masafumi Inomata, Masayuki Ohta, Seigo Kitano
October-December 2012, 8(4):152-153
DOI:10.4103/0972-9941.103128  PMID:23248444
We report herein the case of 70-year-old woman in whom colon cancer and a synchronous metastatic liver tumour were successfully resected laparoscopically. The tumours were treated in two stages. Both post-operative courses were uneventful, and there has been no recurrence during the 8 months since the second procedure.
  - 1,610 101
A simple gastropexy for the loop-gastrostomy tube
Pang Ah-San, Ho Soon-Teck, Iruru Maetani
October-December 2012, 8(4):154-155
DOI:10.4103/0972-9941.103129  PMID:23248445
The percutaneous endoscopic gastrostomy has been in clinical use for more than three decades. A recent innovation, the loop-gastrostomy, is more suitable for developing countries because the tube cannot be dislodged and is easy to change. Gastropexy and gastrostomy are separate but related moieties. We describe a novel technique to add a gastropexy to the loop-gastrostomy, using it successfully in a man with permanent dysphagia. It involved creating a secondary loop at the mid-portion of the LOOPPEG® 3G tube with absorbable ligatures.
  - 1,652 103
2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04