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   2019| April-June  | Volume 15 | Issue 2  
    Online since March 12, 2019

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Gastrointestinal stromal tumours of stomach: Robot-assisted excision with the da Vinci Surgical System regardless of size and location site
Niccolò Furbetta, Matteo Palmeri, Simone Guadagni, Gregorio Di Franco, Desirée Gianardi, Saverio Latteri, Emanuele Marciano, Andrea Moglia, Alfred Cuschieri, Giulio Di Candio, Franco Mosca, Luca Morelli
April-June 2019, 15(2):142-147
DOI:10.4103/jmas.JMAS_260_17  PMID:29595183
Aims: The role of minimally invasive surgery of gastrointestinal stromal tumours (GISTs) of the stomach remains uncertain especially for large and/or difficult located tumours. We are hereby presenting a single-centre series of robot-assisted resections using the da Vinci Surgical System (Si or Xi). Subjects and Methods: Data of patients undergoing robot-assisted treatment of gastric GIST were retrieved from the prospectively collected institutional database and a retrospective analysis was performed. Patients were stratified according to size and location of the tumour. Difficult cases (DCs) were considered for size if tumour was >50 mm and/or for location if the tumour was Type II, III or IV sec. Privette/Al-Thani classification. Results: Between May 2010 and February 2017, 12 consecutive patients underwent robot-assisted treatment of GIST at our institution. DCs were 10/12 cases (83.3%), of which 6/10 (50%) for location, 2/10 (25%) for size and 2/10 (25%) for both. The da Vinci Si was used in 8 patients, of which 6 (75%) were DC, and the da Vinci Xi in 4, all of which (100%) were DC. In all patients, excision was by wedge resection. All lesions had microscopically negative resection margins. There was no conversion to open surgery, no tumour ruptures or spillage and no intraoperative complications. Conclusion: Our experience suggests a positive role of the robot da Vinci in getting gastric GIST removal with a conservative approach, regardless of size and location site. Comparative studies with a greater number of patients are necessary for a more robust assessment.
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Laparoscopic repair for parastomal hernia with ongoing barbed suture followed by sandwich-technique: 'Sandwich-plus-technique'
Reiko Wiessner, Thomas Vorwerk, Alexander Gehring
April-June 2019, 15(2):148-153
DOI:10.4103/jmas.JMAS_236_17  PMID:29582804
The incidence of parastomal hernias after a permanent stoma is between 50% and 80% depending on the type of stoma, the definition of the hernia (clinical or radiological), and the length of the follow-up. Surgical therapy is complex and involves several techniques with different recurrence rates. We present three cases where we have closed the hernia gap with continuous, non-resorbable, self-retaining sutures with subsequent use of the sandwich technique ('Sandwich-plus-technique'). There were pronounced parastomal hernias in three female patients (mean age was 72 years and the range was 63–78 years) with permanent colostomata. After laparoscopic adhesiolysis, the closure of the hernia defect was completed with ongoing, barbed non-resorbable 1-0 sutures (polybutester) followed by the sandwich technique. There were no intraoperative complications and currently no clinical or radiological evidence for recurrences of the parastomal hernia. Closure of the hernia gap leads to the additional reconstruction of the lateral abdominal wall, resulting in a larger contact surface for integration of the keyhole mesh and thus prior to implantation of the Sugarbaker mesh. The laparoscopic augmentation of large parastomal hernias using the 'Sandwich-plus-technique' is technically complex but achieves very good results in our case series. Further studies and long-term results should prove that the low recurrence rate of the sandwich technique can be further reduced.
  1,564 2,030 -
The surgical outcome of minimally invasive pharyngo-laryngo-oesophagectomy in prone position
Mariko Ogino, Yuma Ebihara, Akihiro Homma, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Yo Kurashima, Soichi Murakami, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano
April-June 2019, 15(2):98-102
DOI:10.4103/jmas.JMAS_230_17  PMID:29582802
Purpose: Pharyngo-laryngo-oesophagectomy (PLE) which is mainly indicated for cervical oesophageal cancer or synchronous double cancer of the thoracic oesophagus and the pharynx or larynx, is extremely invasive. Since minimally invasive oesophagectomy (MIE) using video-assisted thoracic surgery has become popular recently, the procedure can be adopted to PLE. Moreover, the use of the prone position (PP) in MIEs has been increasing recently because technical advantages and fewer post-operative complications were reported. To assess the validity of PP, this study compared surgical outcomes of minimally invasive PLE (MIPLE) in PP with that in the left lateral decubitus position (LLDP). Patients and Methods: This study enrolled consecutive 15 patients that underwent MIPLE with LLDP (n = 7) or PP (n = 8) between January 1996 and October 2016. The patients' background characteristics, operative findings and post-operative complications were examined. Results: Eligible diseases are 5 cases of cervical oesophageal cancer, 9 cases of synchronous double cancer of the thoracic oesophagus and head and neck and 1 case of cervical oesophageal recurrence of the head-and-neck cancer. The patients' background characteristics were not significantly different. During surgery, thoracic blood loss was significantly lower in PP than in LLDP (P = 0.0487). Other operative findings and post-operative complications were not significantly different between the two groups. Conclusions: In MIPLE, the PP could reduce blood loss due to the two-lung ventilation under artificial pneumothorax and was associated with lower surgical stress than LLDP.
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Short-term outcomes of minimally invasive surgery for patients presenting with suspected gallbladder cancer: Report of 8 cases
Gerald Zeng, Nan Zun Teo, Brian K. P. Goh
April-June 2019, 15(2):109-114
DOI:10.4103/jmas.JMAS_229_17  PMID:29582801
Introduction: Minimally invasive surgery (MIS) for gallbladder cancer (GBCa) has traditionally been discouraged, with limited studies reporting on its outcomes. The aim of this study was to evaluate the short-term outcomes of MIS for patients with GBCa or suspected GBCa. Methods: A retrospective study of 8 consecutive patients who underwent MIS for GBCa by a single surgeon over a 22-month period between 2015 and 2017. Results: Three patients underwent robotic surgery, while five underwent conventional laparoscopic surgery. Four patients presented with histologically proven GbCa detected incidentally after cholecystectomy. All 4 patients underwent resection of Segment 4b/5. Of these, 3 underwent hilar lymphadenectomy and 1 underwent hilar lymph node sampling. Four patients presenting with suspected GBCa underwent upfront extended cholecystectomy. Two patients who had malignancy on frozen section underwent hilar lymphadenectomy. The median operation time was 242.5 (range, 165–530) min, and the median blood loss was 175 (range, 50–700) ml. The median post-operative hospital stay was 3.5 (range, 2–8) days. There were no open conversion, post-operative morbidities and mortalities. Six had histologically proven GBCa. Five were T3 and one had T2 cancers. Conclusions: The results of the present study confirm the short-term safety and feasibility of MIS for patients with GBCa, as all eight patients underwent successful MIS with no major morbidity or mortality. Further studies with larger patient cohorts with long-term follow-up are needed to determine the oncologic outcomes and the definitive role of MIS in treating GBCa.
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'Little old lady's hernia' (obturator hernia): A deceptive encounter
Vijay Waman Dhakre, Pravin Agrawal
April-June 2019, 15(2):180-181
DOI:10.4103/jmas.JMAS_21_18  PMID:29794358
Obturator hernia (OH) is rare which not only carries high mortality amongst all abdominal hernia, but also known for the difficulty in diagnosing it. Howship–Romberg sign is a clinical sign to diagnose OH, but due to the lower-limb muscle contractures, it was not possible in our case. Computed tomography scan becomes the investigation of choice in this situation. A laparoscopic approach can be used safely.
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Application of a newly designed microfork probe for robotic-guided pelvic intraoperative neuromapping
Jonas F Schiemer, Yen-Yi Y Juo, Yas Sanaiha, Anne Y Lin, Kevork Kazanjian, Hauke Lang, Werner Kneist
April-June 2019, 15(2):182-183
DOI:10.4103/jmas.JMAS_12_18  PMID:29582794
Introduction: Robotic-assisted total mesorectal excision (TME) with pelvic intraoperative neuromapping was recently accomplished. However, neuromapping is conventionally conducted by a hand-guided laparoscopic probe. We introduce a prototype microfork probe to make robotic-guided neuromapping feasible. Experiments and Technical Setup: Two porcine experiments with nerve-sparing TME surgery were performed. A newly designed prototype bipolar microfork probe was inserted intraabdominally and guided with the robotic forceps. Intermittent neuromapping was then conducted and neuromonitoring data integrated in the surgeon console viewer. Conclusion: Robotic-guided neuromapping is shown to be feasible and fully controllable from the surgeon console.
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Easy and effective way to evaluate the urological complication during laparoscopic gynaecologic surgery
Tanitra Tantitamit, Kuan-Gen Huang
April-June 2019, 15(2):177-178
DOI:10.4103/jmas.JMAS_242_17  PMID:29794360
  2,959 46 -
The debate between use and cost of technology is on-going!
Jaydeep H Palep
April-June 2019, 15(2):179-179
DOI:10.4103/jmas.JMAS_59_18  PMID:29794363
  2,837 42 -
Is laparoscopic approach for wandering spleen in children an option?
Gratiana Oana Alqadi, Amulya K Saxena
April-June 2019, 15(2):93-97
DOI:10.4103/jmas.JMAS_14_18  PMID:29737310
Aim: Wandering spleen present generally as an acute abdomen after twisting of the splenic vascular pedicle. This study aimed to review the literature with regard to the management and outcomes of the laparoscopy in children with wandering spleen. Methods: The literature was reviewed for articles on PubMed with regard to the following search terms 'laparoscopy', 'wandering', 'spleen' and 'children'. The inclusion criteria included article only in the paediatric age group of 0–16. Articles that did not meet the inclusion criteria were excluded from the study. Results: The PubMed search from 1998 to 2016 identified 15 articles. There were 20 children with an age range from 2 to 16 years who underwent the laparoscopic procedure for wandering spleen. The median age was 8 years. Associated conditions were present in 45% of patients: gastric volvulus (n = 3), torsion of the distal pancreas (n = 3), splenic cyst (n = 2), mental retardation and myotonic dystrophy (n = 1). In two cases, the spleen was twisted around the pedicle and was non-viable, and therefore, a splenectomy was performed. Other 18 cases were managed by splenopexy using a 3–5-port technique. An extraperitoneal pocket was created using a balloon device in five patients. Fixation of the spleen was performed using a mesh in 10 cases and omentum in three cases. In one case, additional support was created by plicating the phrenicocolic ligament. Simultaneous gastropexy was performed in four patients. There were no post-operative complications. Conclusions: Wandering spleen is a rare entity and in the paediatric age group 10% cannot be salvaged for which splenectomy is the only option. Of the 90% that can be pexied, the literature has favoured the application of meshes followed by the extraperitoneal pockets and omental pouch. Laparoscopic splenopexy is feasible, with no reported conversions or complications.
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Laparoscopic ureterolithotomy: Experience of 60 cases from a developing world hospital
Mudassir Maqbool Wani, Abdul Munnan Durrani
April-June 2019, 15(2):103-108
DOI:10.4103/jmas.JMAS_203_17  PMID:29737311
Objective: Laparoscopic ureterolithotomy, which has been quoted to have a success rate equivalent to open ureterolithotomy for uretric stones, can be performed transperitoneally and retroperitoneally. The aim of the present study is to report our experience with laparoscopic retroperitoneal ureterolithotomy, its results and advantages in the current era of minimally invasive surgery in a developing country. Patients and Methods: It was a prospective study carried from May 2010 to December 2012. 60 patients diagnosed with upper and middle uretric calculi, with sizes more than 1 cm and with value of more than 1500 hu on CT Urography ,underwent laparoscopic retroperitoneal ureterolithotomy. Results: All patients underwent retroperitoneal laparoscopic ureterolithotomy successfully. The mean operative time was 64.53 min. The mean blood loss was 39.83 ml. 3 patients had minor intra-operative complications which were tackled on table. Post-operative complications developed in 3 patients, all minor. There were no major complications. The removal of drain was at (2.7 days). Mean hospital stay was of 3.3 days. Patients reported to their routine activities in 1.78 weeks. During follow-up 3 months later, CT urography revealed normal ureter in all cases. Conclusion: Laparoscopic retroperitoneal ureterolithotomy has low rate of conversion to open surgery and an acceptable overall complication rates. In selected patients with impacted, hard, large ureteral stones, which are likely to cause diffi-culty in endo-urological procedures, laparoscopic ureterolithotomy is a reason-able treatment option.
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Applicability of transoral endoscopic parathyroidectomy through vestibular route for primary sporadic hyperparathyroidism: A South Indian experience
P R K Bhargav, M Sabaretnam, V Amar, N Vimala Devi
April-June 2019, 15(2):119-123
DOI:10.4103/jmas.JMAS_264_17  PMID:29737315
Introduction: Primary hyperparathyroidism is one of the most common endocrine disorders requiring surgical parathyroidectomy for its definitive treatment. Surgical exploration is traditionally performed through conventional open neck approach. A wide range of minimal access and minimally invasive endoscopic techniques (gas less and with gas) have been attempted in the past two decades. In this context, we evaluated the feasibility and safety of an innovative transoral endoscopic parathyroidectomy (EP) technique, which represents a paradigm shift in transluminal endocrine surgery. Materials and Methods: This is a prospective study conducted at a tertiary care Endocrine Surgery Department in South India between May 2016 and August 2017. We employed a novel transoral, lower vestibular route for EP. All the clinical, investigative, operative, pathological and post-operative data were collected from our prospectively filled database. Statistical analysis was performed with SPSS 20.0 version. Operative Technique: Under inhalational general anaesthesia, access to the neck was obtained with 3 ports (central frenulotomy and two lateral port sites), dissected in subplatysmal plane and insufflated with 6 mm Hg CO2 for working space. Rest of surgical steps is similar to conventional open parathyroidectomy. Results: Out of the 38 hyperparathyroidism cases operated during the study, 12 (32%) were operated by this technique. Mean operative time was 112 ± 15 min (95–160). The post-operative course was uneventful with no major morbidity, hypocalcemia or recurrent laryngeal nerve palsy. Cure and diagnosis were confirmed by >50% fall in intraoperative parathyroid hormone levels and histopathology (all were benign solitary adenomas). Conclusions: Through this study, we opine that this novel transoral vestibular route parathyroidectomy is a feasibly applicable approach for primary sporadic hyperparathyroidism, especially with solitary benign adenomas.
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Who profits from three-dimensional optics in endoscopic surgery? Analysis of manual tasks under two-dimensional/three-dimensional optic vision using a pelvic trainer model
Cornelius Jacobs, Frank Alexander Schildberg, Dieter Christian Wirtz, Philip Peter Roessler
April-June 2019, 15(2):124-129
DOI:10.4103/jmas.JMAS_274_17  PMID:29737319
Background: In endoscopic operations, direct binocular view, tissue sensation and depth perception get lost. It is still unclear whether the novel three-dimensional (3D) high-definition (HD) cameras are able to compensate the limited senses and how this affects the skill set of users with different endoscopic experience. This study aimed first to evaluate if the 3D technology improves depth perception, precision and space orientation as compared to conventional two-dimensional (2D) HD technology. The second aim was to determine the 3D influence on participants with different endoscopic experience. Methods: A total of 24 participants of different experience levels performed three different tasks on a pelvic trainer using the same thoracoscopic unit in 2D and 3D modes. Results were statistically analysed using Student's t-test and Pearson's product–moment correlation. Results: Across all the participants, we found that 3D optic vision significantly reduced the needed time to perform a defined difficult task in comparison to 2D. This difference was less pronounced in participants with higher experience level. Participants with eyeglasses performed slower in both 2D and 3D in comparison to participants with normal vision. Only participants with normal vision could significantly improve their completion times with 3D optic vision. Conclusions: By testing the novel generation of 3D HD cameras, we could demonstrate that the 3D optic of these systems improves depth perception and space orientation for novices and experienced users and especially inexperienced users benefit from 3D optic.
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Changes of serum and peritoneal inflammatory mediators in laparoscopic radical resection for right colon carcinoma
Pengcheng Zhu, Wenzhong Miao, Feng Gu, Chungen Xing
April-June 2019, 15(2):115-118
DOI:10.4103/jmas.JMAS_217_17  PMID:29483379
Objective: The objective of this study is to investigate the effects of laparoscopic and open operation on serum and peritoneal inflammatory mediators in patients with right colon carcinoma. Patients and Methods: A total of 100 patients were randomly divided into laparoscopic group (n = 50) and open group (n = 50). The age, sex, operation time, operation blood loss, post-operative Dukes stage, time to first passage of flatus and post-operative hospital stay were recorded. The levels of hypersensitive C reactive protein (hsCRP) and tumour necrosis factor-α (TNF-α) in serum and abdominal exudate were measured by ELISA at the time of pre-operative 2 h and post-operative 6 h and 24 h. Results: There was no significant difference in age, sex, Dukes stage and pre-operative inflammatory mediators between the two groups (P > 0.05). The operation time, intraoperative blood loss, time to first passage of flatus and post-operative hospital stay were significantly better in laparoscopic group than those in open operation group. At 6 h and 24 h after operation, the levels of hsCRP and TNF-α in serum and abdominal exudate in laparoscopic group were significantly lower than those in open operation group. Conclusions: Laparoscopic surgery for the treatment of right colon carcinoma has the advantages of fewer traumas, less systemic and local inflammatory response, rapider post-operative recovery and shorter hospital stay. It is worthy of clinical application.
  1,353 103 -
Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose?
Oleh Yevhenovych Matsevych, Modise Zacharia Koto, Moses Balabyeki, Lehlogonolo David Mashego, Colleen Aldous
April-June 2019, 15(2):130-136
DOI:10.4103/jmas.JMAS_72_18  PMID:30178773
Background: Selective non-operative management (NOM) and diagnostic laparoscopy (DL) are well-accepted approaches in the management of stable patients with penetrating abdominal trauma (PAT). The aim of this pilot study was to investigate the advantages and disadvantages of early DL in stable asymptomatic or minimally symptomatic patients with PAT as opposed to NOM, a standard of care in this scenario. The secondary aim was to suggest possible indications for DL. Methods: Patients managed with DL or NOM over a 12-month period were included in this study. The age, gender, mechanism and location of injuries, trauma scores, haemodynamic and metabolic parameters, intraoperative findings and length of hospital stay (LOS) were recorded and correlated with outcomes. Results: Thirty-six patients were in the NOM group and 35 in the DL group. Stab wounds were more common. The most common location of injury was the anterior abdominal wall in the NOM group and the lower chest in the DL group. Computed tomography (CT) scan was performed more often in the NOM group (75% vs. 17.1%). The injury severity score (ISS), New ISS and PAT Index were higher in the DL group. Nearly 23 (66%) patients in the DL group had a penetration of the peritoneum, but no significant abdominal injuries. LOS in the NOM group was 2 days versus 3.1 days in the DL group. There were no missed injuries, complications or mortality. Conclusion: NOM is a preferred modality for minimally symptomatic stable patients. However, there is a risk of missed injuries and delayed treatment. DL accurately visualizes injuries, decreases unnecessary CT scans and avoids nontherapeutic laparotomies.
  1,301 67 -
End-stage renal disease is a risk factor for complex laparoscopic cholecystectomy in patients waiting for renal transplantation
Sara Colozzi, Samuele Iesari, Giovanni Cianca, Quirino Lai, Luigi Bonanni, Francesco Pisani, Gianfranco Amicucci
April-June 2019, 15(2):137-141
DOI:10.4103/jmas.JMAS_145_17  PMID:29483371
Introduction: To date, there are no studies investigating whether laparoscopic cholecystectomy (LC) is technically more complex in patients waiting for kidney transplant. The aim of this study is to create a user-friendly score to identify high-risk cases for complex LC integrating end-stage renal disease (ESRD). Materials and Methods: We retrospectively analysed 321 patients undergoing LC during the period 2014–2016. Two groups were compared: ESRD group (n = 25) versus control group (n = 296). Concerning statistical analysis, continuous variables were compared using Kruskal–Wallis' test, dummy variables with Chi-square test or Fisher's exact test when appropriate. A multivariable logistic regression analysis was performed to identify risk factors for complex LC. A backward conditional method was used to design the final model. Results: Seventy out of 321 (21.8%) cases were considered as complex, with a higher prevalence in the ESRD group (32.0 vs. 20.9%; P = 0.2). Using a multivariable logistic regression analysis, we formulated a score based on the independent risk factors for complex LC: 4×(previous cholecystitis) +5 × (previous ESRD) +1 × (age per decade) +2 × (previous open abdominal surgery). High-risk cases (score ≥ 10) were more commonly reported in the ESRD group (72.0 vs. 24.7%; P < 0.0001). Conclusion: Although several scores investigating the risk for complex LC have been proposed, none of them has focused on ESRD. This is the first series demonstrating that ESRD is an independent risk factor for technical complexity in LC. We developed a score to offer surgeons an extra tool for pre-operative evaluation of patients requiring LC.
  1,283 70 -
Exploring minimally invasive options: Laparoscopic transabdominal levator transection for low rectal cancers
Fadl H Veerankutty, Sidharth Chacko, Vipin I Sreekumar, Prasad Krishnan, Deepak Varma, Prakash Kurumboor
April-June 2019, 15(2):174-176
DOI:10.4103/jmas.JMAS_130_18  PMID:30106021
Extralevator abdominoperineal excision (ELAPE) of the rectum offers wider circumferential margin and decreased rate of intraoperative tumour perforation. However, the need to change the position of the patient in between abdominal and perineal stages of the procedure and extended perineal resection result in increased morbidity and operative time. Evolving technique of laparoscopic transabdominal controlled division of levator ani muscles under direct vision could address these issues while providing all benefits of ELAPE for patients with low rectal cancers.
  1,276 66 -
Laparoscopic donor hepatectomy: First experience from Indian sub-continent
Natesan Anand Vijai, Palanisamy Senthilnathan, Vikram Annamaneni, Sandeep C Sabnis, Arvinder Singh Soin, Chinnusamy Palanivelu
April-June 2019, 15(2):170-173
DOI:10.4103/jmas.JMAS_134_18  PMID:30106023
Liver transplantation is a ray of hope for thousands of patients with end-stage liver disease but is currently challenged by the scarcity of donor organs worldwide. Unlike kidney transplantation where minimally invasive donor organ procurement has almost become a norm, laparoscopic procurement of hemi-liver from a living donor is still in the infancy of development, at least in the Indian sub-continent. Minimally invasive surgery has made its way into different procedures of hepatobiliary and pancreatic surgery, but only a few centres in the world are performing pure laparoscopic donor hepatectomy. We report two cases of total laparoscopic donor hepatectomy, and to the best of our knowledge, this is the first report from Indian sub-continent.
  1,227 59 -
Laparoscopic two-stage procedure for gallstone ileus
Koichi Inukai, Eri Tsuji, Nobuhiro Takashima, Minoru Yamamoto
April-June 2019, 15(2):164-166
DOI:10.4103/jmas.JMAS_88_18  PMID:29974881
Gallstone is a rare cause of bowel obstruction and is associated with high rates of morbidity and mortality. Here, we report a case of gallstone ileus treated by laparoscopic two-stage procedure. A 65-year-old man, without a history of any surgery, presented to our hospital with abdominal pain and vomiting. His abdominal computed tomography revealed gallstone ileus with cholecystoduodenal fistula. Then, enterolithotomy was performed as an emergency laparoscopic surgery. After 1 year of the surgery, a second laparoscopic procedure was performed for cholecystectomy and fistula closure. The patient was discharged on the 7th postoperative day. Laparoscopic two-stage procedure is a safe and an efficient approach for the management of gallstone ileus. This definitive treatment is minimally invasive, thereby suitable for treating elderly patients.
  1,182 60 -
Total laparoscopic Billroth-I gastrectomy for corrosive-induced antropyloric stricture
Kapil Nagaraj, Raja Kalayarasan, Senthil Gnanasekaran, Biju Pottakkat
April-June 2019, 15(2):161-163
DOI:10.4103/jmas.JMAS_132_18  PMID:29974876
Antro-pyloric stricture with gastric outlet obstruction is a common manifestation of corrosive-induced gastric injury. Surgical management is the only curative option as endoscopic dilatation usually fails in the long term. Billroth I gastrectomy with gastroduodenostomy is the preferred surgery as it restores normal alimentary pathway, reduces dumping and does not complicate colon mobilisation for the future oesophageal bypass. Conventionally, it is performed by the open approach. The present report is the first technical description of total laparoscopic Billroth-I gastrectomy using the laparoscopic linear cutter for corrosive-induced antropyloric stricture. The two patients who underwent this procedure had patent gastroduodenal anastomosis on the post-operative contrast study and tolerating normal diet at 9 and 6 months follow-up, respectively.
  1,032 56 -
Laparoscopic splenic pseudocyst management using indocyanine green dye: An adjunct tool for better surgical outcome
Ramesh Kumar Aggarwal, Bishal Badal Mohanty, Arun Prasad
April-June 2019, 15(2):154-157
DOI:10.4103/jmas.JMAS_156_18  PMID:30416137
Splenic cysts are not so common in incidence. Only 800–850 cases have been reported till now in the literature. Splenic cysts can be further classified into parasitic and non-parasitic cysts. Non-parasitic cyst is further subdivided into true and false or pseudocyst. Pseudocysts are those who are lacking any epithelial lining. Splenic pseudocysts are usually a result of trauma, infection or infarction. We present a case of splenic pseudocyst that was diagnosed incidentally on routine check-up, and we managed this case with minimally invasive approach with complete preservation of spleen and only removal of pseudocyst. We used indocyanine green dye that helped us in complete delineation of splenic parenchyma and vascular structure adjacent to it. In our view, as in this study also, adopting a new technique that can be helpful in better treatment of the patient and if it can change the surgical outcome of the disease in favour of the patient, it should be encouraged.
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Laparoscopic evaluation and resection of type-II choledochal cyst arising from right hepatic duct mimicking gall bladder duplication
Rajesh Bhojwani, Nikhil Jain, Subhash Mishra
April-June 2019, 15(2):158-160
DOI:10.4103/jmas.JMAS_101_18  PMID:30178764
A Type II choledochal cyst arising from the right hepatic duct may mimic a gall bladder duplication. Both are rare and may not get differentiated before operative exploration. While a magnetic resonance cholangiopancreatography (MRCP) may be helpful, laparoscopy may be the final tool for evaluation and effective surgical treatment. We report such a case of a 22-year-old male whose MRCP was suggestive of a cystic lesion in the gall bladder fossa and was taken up for surgery with a pre-operative diagnosis of gall bladder duplication with a single cystic duct. He underwent elective laparoscopic evaluation, mobilisation, discerning of anatomy and diagnosis, excision of cyst and concomitant cholecystectomy. This case highlights that these two rare entities can mimic each other on imaging; however, a laparoscopic approach serves the dual purpose of diagnosing and treating this unique pathoanatomical entity.
  946 55 -
Resection of giant hepatic cyst by hybrid minilaparoscopy
Gustavo Lopes Carvalho, Gustavo Henrique Belarmino Góes, Raimundo Hugo Matias Furtado, Raquel Nogueira Cordeiro, Eduarda Migueis Quintas Calheiros
April-June 2019, 15(2):167-169
DOI:10.4103/jmas.JMAS_68_18  PMID:30416146
A female patient, 59-year-old, was complaining of abdominal pain in the right hypochondrium and mesogastrium for 6 months. Ultrasonography and abdominal computed tomography were performed, both confirming a large hepatic cyst (10.6 cm × 7.6 cm × 7.3 cm) on the left lobe. A hybrid minilaparoscopic resection was proposed. We opted for unroofing the cyst, and the procedure was uneventfully performed, with a total surgical time of 60 min. In the post-operative the patient did well, with minimal abdominal pain, being discharged on the 5th post-operative day, after drain removal due to the use of intravenous antibiotic therapy.
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2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04