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   2005| July-September  | Volume 1 | Issue 3  
 
 
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ORIGINAL ARTICLE
Role of laparoscopy in evaluation of chronic pelvic pain
Shripad Hebbar, Chander Chawla
July-September 2005, 1(3):116-120
DOI:10.4103/0972-9941.18995  PMID:21188008
Introduction: Chronic pelvic pain (CPP) is a common medical problem affecting women. Too often the physical signs are not specific. This study aims at determining the accuracy of diagnostic laparoscopy over clinical pelvic examination. Settings and Design: A retrospective study of patients who underwent diagnostic laparoscopy for CPP. Materials and Methods: The medical records of 86 women who underwent laparoscopic evaluation for CPP of at least 6-month duration were reviewed for presentation of symptoms, pelvic examination findings at the admission, operative findings and follow up when available. Statistical analysis used: McNemar Chi-square test for frequencies in a 2 x 2 table. Results: The most common presentation was acyclic lower abdominal pain (79.1%), followed by congestive dysmenorrhoea (26.7%). 61.6% of women did not reveal any significant signs on pelvic examination. Pelvic tenderness was elicited in 27.9%. Diagnostic laparoscopy revealed significant pelvic pathology in 58% of those who essentially had normal pervaginal findings. The most common pelvic pathology by laparoscopy was pelvic adhesions (20.9%), followed by pelvic congestion (18.6%). Laparoscopic adhesiolyis achieved pain relief only in one-third of the women. Conclusion: The study revealed very low incidence of endometriosis (4.7%). Overall clinical examination could detect abnormality in only 38% of women, where as laparoscopy could detect significant pathology in 66% of women with CPP. This shows superiority of diagnostic laparoscopy over clinical examination in detection of aetiology in women with CPP (P < 0.001). Adhesiolysis helps only small proportion of women in achieving pain control.
  13,033 375 3
Hand-assisted laparoscopic surgery using Gelport
Puneet Gupta, VK Bhartia
July-September 2005, 1(3):110-115
DOI:10.4103/0972-9941.18994  PMID:21188007
Introduction: Minimally invasive surgery has revolutionized general surgery during the past 10 years. However, for more advanced surgical procedures, the acceptance of the minimally invasive approach has been slower than expected. Advanced laparoscopic surgery is complex and time-consuming. The major drawbacks of laparoscopic surgery are two-dimensional view, lack of depth perception and loss of tactile sensation. This has led to the innovation of hand-assisted laparoscopic surgery (HALS). The objective of the present study was to determine that safety of HALS. Materials and Methods: We preformed 18 HALS procedures in our department between July 2003 and January 2005 on patients who had given their informed consent for the use of Gelport. Out of these, 15 were colectomy, 2 nephrectomy and 1 splenectomy. Out of the 18 patients, 13 were males and 5 were females with the age group ranging from 44 to 72 years. Results: Hand-assisted laparoscopic surgery could be completed in 17 patients maintaining all the oncological principals of surgery. The mean operating times were 120 min for right haemicolectomy, 135 min for left colectomy, 150 min for splenectomy, and 150 min for nephrectomy. The patient undergoing radical nephrectomy by HALS had to be converted to open surgery. As the tumour was large and adherent to the spleen and posterior peritoneal wall. Postoperative recovery was excellent with an average hospital stay of 5 days. Histopathology report showed wide clearance and till date we have a good follow up of 30-380 days. Conclusion: Hand-assisted laparoscopic surgery allows tactile sensation and depth perception thereby may simplify the complex procedures. This may result in reduction of operating time and conversion rates at the same time maintaining all the oncological principles. Hand-assisted laparoscopic surgery strikes a perfect balance between an extended open laparotomy incision and an excessively tedious laparoscopic exercise. Hand assistance is an initial tool for the trainee laparoscopic surgeon or a last resort for the experienced laparoscopic surgeon.
  10,070 251 3
Minimal access surgery in children - 5 years institutional experience
SN Oak, SV Parelkar, T Akhtar, M Joshi, R Pathak, N Viswanath, KV Satish Kumar, K Ravikiran, L Manjunath, A Ahmed
July-September 2005, 1(3):121-128
DOI:10.4103/0972-9941.18996  PMID:21188009
Context: Minimal access surgery (MAS) in children are common place and performed worldwide with gratifying results as the learning curve of the surgeon attains plateau. We share our experience of this technically evolving modality of surgery, performed at our setup over a period of 5 years. We also review and individually compare the data for commonly performed procedures with other available series. Author also briefly discuss potential advantages of MAS in certain debatable conditions performed quickly and with cosmesis as open procedure. Materials and methods: We performed 677 MAS in children aged between 7 days and 12 years. Five hundred and sixty-eight of these were Laparoscopic procedures and 109 were Video assisted thoracoscopic surgeries (VATS). In all laparoscopic procedures, the primary port placement was by the Hasson's open technique. We have used 5, 3 and 2 mm instruments. Our study include 259 inguinal hernia, 161 Appendectomies, 95 VATS for empyema, 51 orchiopexies, 49 diagnostic laparoscopy, 29 cholecystectomies, 22 adhesionlysis and other uncommonly performed procedures. Results: The ultimate outcome of all the performed procedures showed gratifying trend, the data of which are discussed in detail in the article. Conclusion: As we gained experience the operating time showed a decreasing trend, the complication rates and conversion rate also reduced. The advantages we came across were better postoperative appearances, less pain and early return to unrestricted activities.
  9,701 269 5
UNUSUAL CASE
Laparoscopic gastric partitioning gastrojejunostomy for an unresectable duodenal malignant tumor
Toshifumi Matsumoto, Koichi Izumi, Akio Shiromizu, Kohei Shibata, Masayuki Ohta, Seigo Kitano
July-September 2005, 1(3):129-132
DOI:10.4103/0972-9941.18997  PMID:21188010
As a palliative bypass for unresectable gastric or periampullary cancer, gastrojejunostomy (GJ) is sometimes associated with postoperative delayed gastric emptying. We report the successful laparoscopic application of this procedure in a 78-year-old man with duodenal obstruction. Computed tomography revealed a mass in the duodenum along with multiple masses in the liver. A radiological image showed an ulcerative tumour in the third portion of the duodenum occluding the lumen. He was diagnosed as having an unresectable duodenal cancer with multiple liver metastases. He needed palliative bypass surgery. Laparoscopically, the stomach was partially divided using an endoscopic autosuture device, and end-to-side GJ was performed successfully. He was given a normal diet on the fourth postoperative day, and there was no delayed gastric emptying. Laparoscopic gastric partitioning GJ is a feasible and safe procedure to prevent postoperative delayed gastric emptying in case of malignant duodenal obstruction.
  9,157 229 5
REVIEW ARTICLE
Laparoscopic liver resections
Alfred Cuschieri
July-September 2005, 1(3):99-109
DOI:10.4103/0972-9941.18993  PMID:21188006
Though still practiced in only a few centres worldwide, laparoscopic liver resections, particularly left hepatectomy offer advantages over the conventional open approach in two important respects: reduced operative blood loss and lower major postoperative morbidity. Two approaches are used: the totally laparoscopic and the hand-assisted technique, which in the author's opinion facilitates both the execution and safety of these procedures, especially major resection of the right liver (right hepatectomy and pluri-segmentectomies). Technologies, which have enabled hepatic resections include: laparoscopic contact ultrasound, linear cutting staplers, ultrasonic dissection, LigaSure and TissueLink. The components operative steps necessary for these resections as practised by the author are described in this review.
  8,066 314 -
UNUSUAL CASE
Solitary pelvic kidney encountered during laparoscopic colectomy
Kazuhiro Sakamoto, Yutaka Kojima, Ryohei Takeda, Kiyoshi Terai, Mitsuhiro Matsuda
July-September 2005, 1(3):133-135
DOI:10.4103/0972-9941.18998  PMID:21188011
We report a case of solitary pelvic kidney encountered during laparoscopic colectomy. A 55-year-old man was admitted to undergo laparoscopic colectomy for an early sigmoid colon cancer, which had been detected after a polypectomy. The kidneys were not clearly visualized in their normal position by ultrasonography. During the operation, anomalous vessels in the presacral space and a mass covered with fatty tissue were identified. We converted the operation to a mini-laparotomy, and on performing intraoperative ultrasonography a solitary pelvic kidney was detected. An anterior resection was performed without operative complications. Laparoscopic ultrasonography (LUS) and hand-assisted laparoscopic surgery (HALS) should be considered as feasible adjuvants, when difficult situations arise during laparoscopic colectomy. In case of uncertainty about anatomical orientation or identification, it is prudent to convert to open surgery thereby preventing intraoperative complications such as injury to anomalous vessels or the ureter.
  5,700 172 -
IMAGES IN SURGERY
Menetrier's disease with gastrointestinal bleed
Kaushik Bhattacharya
July-September 2005, 1(3):136-136
DOI:10.4103/0972-9941.18999  PMID:21188012
  3,550 156 -
LETTER TO EDITOR
Laparoscopic splenectomy using conventional instruments
HG Doctor
July-September 2005, 1(3):137-137
DOI:10.4103/0972-9941.19000  PMID:21188013
  3,336 163 -
2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04