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   2017| July-September  | Volume 13 | Issue 3  
    Online since June 12, 2017

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Three-dimensional laparoscopy: Principles and practice
Rakesh Y Sinha, Shweta R Raje, Gayatri A Rao
July-September 2017, 13(3):165-169
DOI:10.4103/0972-9941.181761  PMID:27143695
The largest challenge for laparoscopic surgeons is the eye–hand coordination within a three-dimensional (3D) scene observed on a 2D display. The 2D view on flat screen laparoscopy is cerebrally intensive. The loss of binocular vision on a 2D display causes visual misperceptions, mainly loss of depth perception and adds to the surgeon's fatigue. This compromises the safety of laparoscopy. The 3D high-definition view with great depth perception and tactile feedback makes laparoscopic surgery more acceptable, safe and cost-effective. It improves surgical precision and hand–eye coordination, conventional and all straight stick instruments can be used, capital expenditure is less and recurring cost and annual maintenance cost are less. In this article, we have discussed the physics of 3D laparoscopy, principles of depth perception, and the different kinds of 3D systems available for laparoscopy. We have also discussed our experience of using 3D laparoscopy in over 2000 surgeries in the last 4 years.
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Laparoscopic retrieval of impacted Dormia basket
Manash Ranjan Sahoo, Saurabh Kumar, P Shameel Ahammed
July-September 2017, 13(3):237-239
DOI:10.4103/0972-9941.169975  PMID:27251803
For choledocholithiasis, endoscopic management is the first line of treatment. Both Dormia basket and balloon catheter are used to retrieve common bile duct (CBD) stones. Here we present a case of impaction of the Dormia basket during an endoscopic procedure. The patient was managed through laparoscopic choledochotomy, and the basket was found to be impacted with a common bile stone of size 18 mm. The stone was disengaged from the basket and, by holding the tip of the basket, was removed through one of the laparoscopic ports.
  1,725 68 -
Morbidity analysis in minimally invasive esophagectomy for oesophageal cancer versus conventional over the last 10 years, a single institution experience
Misbah Khan, Muhammad Ijaz Ashraf, Aamir Ali Syed, Shahid Khattak, Namra Urooj, Anam Muzaffar
July-September 2017, 13(3):192-199
DOI:10.4103/0972-9941.199606  PMID:28607286
Background: There has been an increasing inclination towards minimally invasive esophagectomies (MIEs) at our institute recently for resectable oesophageal cancer. Objectives: The purpose of the present study is to report peri-operative and long-term procedure specific outcomes of the two groups and analyse their changing pattern at our institute. Methods: All adult patients with a diagnosis of oesophageal cancer managed at our institute from 2005 to 2015 were included in this retrospective study. Patients' demographic and clinical characteristics were recorded through our hospital information system. The cohort of esophagectomies was allocated into two groups, conventional open esophagectomy (OE) or total laparoscopic MIE; hybrid esophagectomies were taken as a separate group. The short-term outcome measures are an operative time in minutes, length of hospital and Intensive Care Unit (ICU) stay in days, post-operative complications and 30 days in-hospital mortality. Complications are graded according to the Clavien-Dindo classification system. Long-term outcomes are long-term procedure related complications over a minimum follow-up of 1 year. Trends were analysed by visually inspecting the graphic plots for mean number of events in each group each year. Results: Our results showed no difference in mortality, length of hospital and ICU stays and incidence of major complications between three groups on uni- and multi-variate analysis (P > 0.05). The operative time was significantly longer in MIE group (odds ratio [OR]: 1.66, confidence interval [CI]: 2.4–11.5). The incidence of long-term complication was low for MIE (OR: 1.0, CI: 133–1.017). However, all post-operative surgical outcomes trended to improve in both groups over the course of this study and stayed better for MIE group except for the operative time. Conclusion: MIE has overall comparable surgical outcomes to its conventional counterpart. Furthermore, the peri-operative outcomes tend to improve in our centre with the maturation of program and experience.
  1,410 41 -
Natural orifice transluminal endoscopic surgery (hybrid) cholecystectomy: The Dhillon technique
Kanwarjit Singh Dhillon, Divya Awasthi, Arshbir Singh Dhillon
July-September 2017, 13(3):176-181
DOI:10.4103/0972-9941.207838  PMID:28607283
Introduction: This study presents a novel technique to perform cholecystectomy and assess its outcome and feasibility. Patients and Methods: This study presents the novel Dhillon technique and experience of hybrid natural orifice transluminal endoscopic surgery (NOTES) technique, that is, laparoscopic-assisted transvaginal cholecystectomy. We have evaluated the outcomes in terms of cosmesis, post-operative recovery and analgesic requirement. The study included 257 patients who underwent hybrid NOTES cholecystectomy at single tertiary hospital. The biographical data, surgical time, pain score on day 1 and 2, need of analgesia, intra- and post-operative complication and aesthetic assessment on day 7 were recorded. Results: Out of a total of 1100 cases of laparoscopic cholecystectomy 257 had hybrid NOTES cholecystectomy. Only two of these cases were converted to standard laparoscopic cholecystectomy. The mean operative time was 31.5 ± 5.1 (25–40) min. None of the patients had any complication or biliary leakage. The mean pain score on day 1 and 2 was 3.6 ± 0.4 (3–4) and 1.0 ± 0.06 (1–2), respectively. The mean paracetamol (analgesic) dose requirement was 6.1 ± 0.6 (4–6.9) g. The aesthetic score was excellent in all the cases. Conclusions: Using the present technique of hybrid NOTES is beneficial in terms of cosmetic results, lesser need of analgesic and shorter hospital stay.
  1,322 98 -
Rationalisation of the surgical technique for minimally invasive laparoscopic ileal pouch-anal anastomosis after previous total colectomy for ulcerative colitis
Francesco Giudici, Stefano Scaringi, Carmela Di Martino, Ferdinando Ficari, Paolo Bechi
July-September 2017, 13(3):188-191
DOI:10.4103/0972-9941.199607  PMID:28607285
Introduction: No previous study clearly focuses on laparoscopic technique to perform the second stage surgery (proctectomy with ileal pouch-anal anastomosis [IPAA]) after total colectomy for acute/severe ulcerative colitis (UC). We describe the procedural steps for a simple and rational minimally invasive second stage surgery, reporting intra- and short-term post-operative results. Patients and Methods: During the period December 2014–December 2015, 10 consecutive patients (8 males and 2 females) with mean age of 48 years underwent laparoscopic proctectomy and IPAA adopting our novel approach. They were operated 3 months after the previous total colectomy which has been performed, respectively, for acute (three patients) or severe (seven patients) UC. Intraoperative data and post-operative complications, divided as minor and major, were recorded and analysed. A body image questionnaire was administered to all patients to evaluate the cosmetic results of the procedure. Results: Overall mean surgical time was 235 ± 49 min. During the post-operative course, three patients required morphine for >48 h, no patient needed blood transfusion and bowel movements recovery happened as mean during the 2nd day. No early major complications happened. Two patients (20%) developed peri-ileostomic wound infection at the right flank. Only one patient (10%) suffered from ileal-anal anastomotic dehiscence, conservatively treated till resolution. The average length of hospital stay was 8 ± 2 days. The body image questionnaire showed in all patients an extreme satisfaction about the results obtained (mean value = 59/64 points). Conclusions: Through three standardised surgical steps easily reproducible, we describe an almost scar-less procedure able to optimise the intraoperative time with good post-operative results in terms of complications and cosmesis.
  1,255 49 -
Laparoscopic management of 'Y-shaped' gallbladder duplication with review of literature
S Rajapandian, Samrat V Jankar, Darshan S Nayak, Bhushan Chittawadgi, Sandeep C Sabnis, R Sathyamoorthy, R Parthasarathi, P Senthilnathan, P Praveen Raj, C Palanivelu
July-September 2017, 13(3):231-233
DOI:10.4103/0972-9941.199611  PMID:28607295
Gallbladder duplication is a rare congenital malformation that occurs in about 1:4000 cases. Congenital anomalies of the gallbladder and anatomical variations of their position are associated with an increased risk of complications during laparoscopic cholecystectomy. We report a case of gallbladder duplication with symptomatic cholelithiasis, who presented with recurrent episodes of biliary colic and subsequently underwent laparoscopic cholecystectomy with intraoperative cholangiography. We also discussed in brief about the available literature support in relation to incidence of this disorder, imaging modalities used, intraoperative strategies and recommended measures for safe outcomes.
  1,218 64 -
Transperitoneal laparoscopic nephrectomy in acute Grade 4 renal trauma with literature review and a note on some unusual complications
Rohan Satish Valsangkar, Syed J Rizvi, Syed J. F Quadri, Pranjal R Modi
July-September 2017, 13(3):225-227
DOI:10.4103/0972-9941.199609  PMID:28607293
Most renal traumas are successfully managed conservatively. Grade 4 and 5 trauma, however, can require nephrectomy which is almost always by laparotomy and laparoscopic nephrectomy (LN) is still considered contraindicated in acute trauma setting. We report successful transperitoneal LN in an acute grade 4 renal trauma with retroperitoneal haematoma, extensive parenchymal devascularisation and urinary extravasation though retroperitoneoscopic nephrectomy in trauma has been reported recently. However, we believe transperitoneal approach is more logical and replicates all the principles of open renal trauma surgery more accurately. A review of LN in renal trauma and some unusual problems to be anticipated during laparoscopic procedures in acute trauma setting is presented.
  1,199 58 -
Laparoscopic total colectomy for ulcerative colitis after liver transplantation is feasible
Benjamin Darnis, Gilles Poncet, Maud Robert
July-September 2017, 13(3):222-224
DOI:10.4103/0972-9941.199211  PMID:28607292
Ulcero-haemorrhagic rectocolitis can occur after liver transplantation for sclerosing cholangitis. Total colectomy with or without proctectomy may be indicated in case of chronic drug-resistant colitis, dysplasia or cancer. Today, laparoscopic approach is the standard for such procedure in non-operated patients. We performed a completely laparoscopic total colectomy 5 years after a liver transplantation. There were a few peritoneal adherences, and we could safely perform the procedure almost as usual. It provided all the advantages of the laparoscopic approach in the post-operative course.
  1,184 37 -
Technique of totally robotic delta-shaped anastomosis in distal gastrectomy
Hidehiko Kitagami, Keisuke Nonoyama, Akira Yasuda, Yo Kurashima, Kaori Watanabe, Shiro Fujihata, Minoru Yamamoto, Yasunobu Shimizu, Moritsugu Tanaka
July-September 2017, 13(3):215-218
DOI:10.4103/jmas.JMAS_109_16  PMID:28607290
Background: We aimed to clarify the utility of delta-shaped anastomosis (Delta), an intracorporeal Billroth-I anastomosis-based reconstruction technique used after laparoscopy-assisted distal gastrectomy (LADG), in robot-assisted distal gastrectomy (RADG). Methods: RADG was performed in patients with clinical Stage I gastric cancer, and reconstruction was performed using Delta. The Delta procedure was the same as that performed after LADG, and the operator practiced the procedure in simulated settings with surgical assistants before the operation. After gastrectomy, the scope and robotic first arm were reinserted from separate ports on the right side of the patient. Then, a port on the left side of the abdomen was used as the assistant port from which a stapler was inserted, with the robotic arm in a coaxial mode. The surgical assistant performed functional end-to-end anastomosis of the remnant stomach and duodenal stump using a powered stapler. Results: The mean anastomotic time in four patients who underwent Delta after RADG was 16.5 min. All patients were discharged on the post-operative day 7 without any post-operative complications or need for readmission. Conclusions: Pre-operative simulation, changes in ports for insertion of the scope and robotic first arm, continuation of the coaxial operation, and use of a powered stapler made Delta applicable for RADG. Delta can be considered as a useful reconstruction method.
  1,116 44 -
Incidence of incisional hernia after single-incision laparoscopic surgery in children
Mahdi Ben Dhaou, Mohamed Zouari, Rahma Chtourou, Hayet Zitouni, Mohamed Jallouli, Riadh Mhiri
July-September 2017, 13(3):240-241
DOI:10.4103/0972-9941.199214  PMID:28607297
  1,109 47 -
A long-term evaluation of the quality of life after laparoscopic Nissen-Rossetti anti-reflux surgery
Giovanni Alemanno, Carlo Bergamini, Paolo Prosperi, Alessandro Bruscino, Ancuta Leahu, Riccardo Somigli, Jacopo Martellucci, Andrea Valeri
July-September 2017, 13(3):208-214
DOI:10.4103/0972-9941.205872  PMID:28607289
Background: The quality of life (QoL) has been suggested to be the most relevant parameter to assess and monitor the long-term outcome in patients who underwent surgery for gastroesophageal reflux disease (GERD). Patients and Methods: A retrospective evaluation was conducted on patients who underwent Laparoscopic Nissen-Rossetti Fundoplication for GERD between January 1998 and December 2010. To evaluate the long-term results a telephone interview was made using the VISICK score and the GERD-health-related QoL (HRQL) questionnaire at 1, 3, 5 years and at the end of the study. If the questionnaires resulted unsatisfactory, a complete diagnostic revaluation was performed. Results: A total of 168 patients underwent laparoscopic surgery for GERD. When evaluated at the end of the study, the number of unsatisfied patients according to the VISICK score was significantly higher than the one obtained with the GERD-HRQL questionnaire. Conclusions: Many data suggest a possible recurrence of the symptoms after surgery in a long follow-up period. Our data seem to demonstrate a slight but significant trend in symptoms relapse after surgery. Considering the non-specific and specific nature of the two scores, VISICK and GERD HRQL, our result showed a significantly more relevant trend of symptoms relapse only for the non-specific ones. Such QoL scores seem to be important in selecting patients who need to be instrumentally examined. Consequently, our work proves that only a few patients out of the total number of followed up patients, are to be recalled to undergo instrumental examination.
  1,060 56 -
Laparoendoscopic single-site adnexal surgery: Preliminary Indian experience
Smitha Balusamy, Hrishikesh P Salgaonkar, Ramya Ranjan Behera, Ashwini Bhalerao-Gandhi, Deepraj S Bhandarkar
July-September 2017, 13(3):170-175
DOI:10.4103/jmas.JMAS_206_16  PMID:28607282
Introduction: Laparoendoscopic single-site surgery (LESS) is an emerging technique in gynaecology. The proposed advantages of the LESS include better cosmesis and reduction in pain. We report our preliminary experience with LESS in the treatment of adnexal pathology. Materials and Methods: After a preoperative workup, LESS was offered to 37 patients between July 2009 and April 2015. All the procedures were carried out through a 2–2.5 cm transumbilical incision using conventional laparoscopic instruments. A single-incision, multiport (SIMP) approach (utilising one 7 mm and two 5 mm ports) was used in 27 patients and a homemade glove port (HMGP) was utilised in ten patients. All the specimens were extracted after placement in a plastic bag or inside the glove port avoiding contact with the wound. Umbilical fascial incisions were meticulously closed with non-absorbable sutures. Results: Two patients with a history of previous abdominal surgery required omental adhesiolysis. Seventeen patients with breast cancer underwent bilateral salpingo-oophorectomy, ten had ovarian cystectomy (6 had cystadenoma, 2 had endometriotic cysts and 2 had dermoid cyst), six had excision of paraovarian cysts (one along with partial salpingectomy) and four with ruptured ectopic pregnancy underwent salpingectomy. LESS was completed in all but one patient, who required insertion of an additional 5 mm port. There were no intra- or post-operative complications. Conclusions: Our experience confirms the feasibility and safety of LESS in a variety of benign adnexal pathology. Both the SIMP and HMGP approaches seem comparable. Performing LESS without the use of specialised access ports or instruments makes it cost effective and suitable for wider application.
  989 82 -
Does carbon dioxide pneumoperitoneum affect the renal function in donors following laparoscopic donor nephrectomy? A prospective study
Murali Vinodh, Vijaykumar Mohankumar, Arvind Ganpule, Banibrata Mukhopadhyay, Ravindra Sabnis, Mahesh Desai
July-September 2017, 13(3):200-204
DOI:10.4103/jmas.JMAS_117_16  PMID:28607287
Context: Although the technical feasibility of laparoscopic donor nephrectomy (LDN) has been established, concerns have been raised about the impaired renal function resulting from pneumoperitoneum and its short- and long-term effects. Aims: We used urinary biomarkers of acute kidney injury including urinary neutrophil gelatinase-associated lipocalin (uNGAL) and urinary N-acetyl-beta-D-glucosaminidase (uNAG) to study the injury caused to the donor's retained kidney by pneumoperitoneum. Settings and Design: This was a prospective cohort study of thirty consecutive patients who underwent LDN at our hospital. Subjects and Methods: We measured urinary creatinine, uNAG and uNGAL at the time of induction of anaesthesia, at 1 h after starting surgery, at 5 min after clamping the ureter, at the time of skin closure and then at 4, 8 and 24 h after the surgery. Results: The uNAG level showed a gradual increase from the start of the surgery and reached the peak at the time of the closure. Thereafter, there was a gradual fall in the level and reached to pre-operative level at 24 h post-surgery. Similarly, the uNGAL also showed a similar trend although it did not reach pre-operative value by 24 h. Conclusions: We objectively confirm that although there is acute injury to the retained kidney in the donor after LDN due to the CO2pneumoperitoneum, the renal function improves and reaches close to the pre-operative level within 24 h after surgery.
  989 49 -
'Natural orifice' transcolostomy full-thickness excision of colonic tumour
Victor E Pricolo
July-September 2017, 13(3):219-221
DOI:10.4103/0972-9941.199608  PMID:28607291
This technical note describes a novel technique, not previously found in the surgical or endoscopic literature: A combined endoscopic and surgical approach to perform a full-thickness excision of a colonic tumour. At the time of colonoscopy via stoma, a large sessile polyp in the descending colon was detected but could not be safely resected endoscopically. The lesion was exteriorised by prolapsing the distal colon through the colostomy, then excised surgically with adequate margins in a full-thickness fashion. This approach was more complete than an endoscopic approach and less invasive than a segmental colectomy and redo colostomy. It may prove useful to surgical endoscopists facing a similar clinical situation in their practice.
  993 41 -
Role of routine pre-operative screening venous duplex ultrasound in morbidly obese patients undergoing bariatric surgery
P Praveen Raj, Rachel M Gomes, Saravana Kumar, Palanisamy Senthilnathan, Ramakrishnan Parathasarathi, Subbiah Rajapandian, Chinnusamy Palanivelu
July-September 2017, 13(3):205-207
DOI:10.4103/jmas.JMAS_199_15  PMID:28607288
Background/Aims: It is well established that obesity is a strongly associated risk factor for post-operative deep vein thrombosis (DVT). Physical effects and pro-thrombotic, pro-inflammatory and hypofibrinolytic effects of severe obesity may predispose to idiopathic DVT (pre-operatively) because of which bariatric patients are routinely screened before surgery. The aim of this study was to audit the use of routine screening venous duplex ultrasound in morbidly obese patients before undergoing bariatric surgery. Methods: We retrospectively reviewed 180 patients who underwent bariatric surgery from August 2013 to August 2014 who had undergone pre-operative screening bilateral lower-extremity venous duplex ultrasound for DVT. Data were collected on patient's demographics, history of venous thromboembolism, prior surgeries and duplex ultrasound details of the status of the deep veins and superficial veins of the lower limbs. Results: No patients had symptoms or signs of DVT pre-operatively. No patient gave history of DVT. No patient was found to have iliac, femoral or popliteal vein thrombosis. Superficial venous disease was found in 17 (8%). One patient had a right lower limb venous ulcer. Conclusion: Thromboembolic problems in the morbidly obese before bariatric surgery are infrequent, and screening venous duplex ultrasound can be done in high-risk patients only.
  890 45 -
A case report of oesophageal schwannoma with thoracoscopic surgery
Zhiliang Hu, Zhun He, Xianfeng Li, Chuanliang Peng, Zhen Li
July-September 2017, 13(3):234-236
DOI:10.4103/jmas.JMAS_271_16  PMID:28607296
Oesophageal schwannomas is a rare tumour and most commonly found incidentally or from diagnostic workup of dysphagia or dyspnoea. Most oesophageal schwannomas are benign and more frequently occurs in female than in the male. To date, <40 cases have been described in the English literature. In this study, we reported the case of a 57-year-old woman visited our hospital with the symptom of long-time dysphagia. A thoracic computed tomography demonstrated an upper oesophageal well marginated and homogeneous mass that adhered to the right wall of the oesophagus. Oesophageal endoscopy showed an extrinsic bulge 21 cm distal to the incisors with normal overlying mucosa. Strictly on a clinical and radiologic basis, this entity is impossible to definitively diagnose, the final diagnosis was based on histopathology and immunohistochemistry. Tumour cells stain positive for S100, a characteristic marker of Schwann cell. A minimally invasive thoracoscopic surgery was performed. The post-operative period was uneventful.
  876 40 -
The use of over-the-scope clip in the treatment of persistent staple line leak after re-sleeve gastrectomy: Review of the literature
Dimitrios Zacharoulis, Konstantinos Perivoliotis, Eleni Sioka, Eleni Zachari, Andreas Kapsoritakis, Anastassios Manolakis, George Tzovaras
July-September 2017, 13(3):228-230
DOI:10.4103/jmas.JMAS_245_16  PMID:28607294
Staple line leak after sleeve gastrectomy (SG) is a severe complication associated with increased mortality rates and the potential need for reoperation. We report the successful management of a re-SG staple line leak with the use of an endoscopic over-the-scope clip.
  846 47 -
A comparison of clinical outcomes between endoscopic and open surgery to repair neonatal diaphragmatic hernia
Ma Lishuang, Wei Yandong, Liu Shuli, Feng Cuiru, Zhang Yue, Wang Ying, Zhang Yanxia, Sun Bin, Li Jingna, Li Long
July-September 2017, 13(3):182-187
DOI:10.4103/jmas.JMAS_208_16  PMID:28607284
Objective: The objective of this study is to evaluate the clinical efficacies of open versus endoscopic surgery in the treatment of congenital diaphragmatic hernia (CDH) and investigate the feasibility and safety of endoscopic surgery as an alternative to open surgery in these cases. Patients and Methods: A retrospective analysis was performed from June 2002 to February 2014. A total of 59 cases were attempted. The neonates were divided into either an endoscopic or open surgery group. The pre-, intra- and post-operative data on the neonates were analysed, and the surgery-related complications, survival rates and recurrence rates were compared between the two groups. Results: Demographic characteristics were not significantly different between the two groups. Compared with open group, the hospital stay and post-operative mechanical ventilation time were significantly shorter, while surgery duration was significantly longer in the endoscopic surgery group. The recurrence rate was higher and the survival rate was lower in the endoscopic surgery group with no statistically significant and the recurrence rate has decreased over the past 5 years. Conclusions: We have demonstrated that the endoscopic surgery is safe and effective for repairing CDH. The endoscopic surgery is a minimally invasive procedure with fast post-operative recovery and a good cosmetic outcome.
  790 63 -
2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04