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   2006| April-June  | Volume 2 | Issue 2  
 
 
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REVIEW ARTICLE
Twenty years after Erich Muhe: Persisting controversies with the gold standard of laparoscopic cholecystectomy
Kalpesh Jani, PS Rajan, K Sendhilkumar, C Palanivelu
April-June 2006, 2(2):49-58
DOI:10.4103/0972-9941.26646  PMID:21170235
This review article is a tribute to the genius of Professor Erich Muhe, a man ahead of his times. We trace the development of laparoscopic cholecystectomy and detail the tribulations faced by Muhe. On the occasion of the twentieth anniversary of the first laparoscopic cholecystectomy, we take another look at some of the controversies surrounding this gold standard in the management of gallbladder disease
  14,133 515 10
UNUSUAL CASE
Pseudo-aneurysm of the hepatic artery after laparoscopic cholecystectomy: A case report
G Roche-Nagle, MacEneaney , P Harte
April-June 2006, 2(2):73-75
DOI:10.4103/0972-9941.26652  PMID:21170238
Iatrogenic injuries to hepatic artery system may evolve to pseudoaneurysms in the late postoperative period. Although rare, pseudoaneurysms after laparoscopic cholecystectomy can occur, are a serious clinical entity and very difficult to detect. We present a case of iatrogenic pseudoaneurysm after laparoscopic cholecystectomy. The onset of symptoms occurred 5 days after an uneventful operation. Endovascular coil embolization for a large pseudoaneurysm was unsuccessful and open surgery was conducted. Review of the literature reveals fifty-four more cholecystectomy-related pseudoaneurysms. The site of injury was the right hepatic artery in 61% of the cases and the presenting symptom was hemobilia in two-third of the patients. Embolization was performed in 82% of the cases and surgery undertaken in the remaining 18%. Knowledge of the condition should result in early diagnosis and thus limit the resultant morbidity. Embolization is the first line of treatment and surgery is reserved for more complex injuries and cases with life-threatening rupture of the aneurysm.
  7,115 276 5
ORIGINAL ARTICLE
Laparoscopic adrenalectomy: Gaining experience by graded approach
Abhay N Dalvi, Pinky M Thapar, K Vijay Kumar, Ranjeet S Kamble, Sameer A Rege, Aparna A Deshpande, Nalini S Shah, Padma S Menon
April-June 2006, 2(2):59-66
DOI:10.4103/0972-9941.26649  PMID:21170236
INTRODUCTION: Laparoscopic adrenalectomy (LA) has become a gold standard in management of most of the adrenal disorders. Though report on the first laparoscopic adrenalectomy dates back to 1992, there is no series of LA reported from India. Starting Feb 2001, a graded approach to LA was undertaken in our center. Till March 2006, a total of 34 laparoscopic adrenalectomies were performed with success. MATERIALS AND METHODS: The endocrinology department primarily evaluated all patients. Patients were divided into Group A - unilateral LA and Group B - bilateral LA (BLA). The indications in Group A were pheochromocytoma (n=7), Conn's syndrome (n=3), Cushing's adenoma (n=2), incidentaloma (n=2); and in Group B, Cushing's disease (CD) following failed trans-sphenoid pituitary surgery (n = 8); ectopic ACTH- producing Cushing's syndrome (n=1) and congenital adrenal hyperplasia (CAH) (n=1). The lateral transabdominal route was used. RESULTS: The age group varied from 12-54 years, with mean age of 28.21 years. Average duration of surgery in Group A was 166.43 min (40-270 min) and 190 min (150- 310 min) in Group B. Average blood loss was 136.93 cc (20-400 cc) in Group A and 92.5 cc (40-260 cc) in Group B. There was one conversion in each group. Mean duration of surgical stay was 1.8 days (1-3 days) in Group A and 2.6 days (2-4 days) in Group B. All the patients in both groups were cured of their illness. Three patients in Group B developed Nelson's syndrome. The mean follow up was of 24.16 months (4-61 months). CONCLUSION: LA though technically demanding, is feasible and safe. Graded approach to LA is the key to success.
  6,721 293 5
Changes in cerebral oximetry during peritoneal insufflation for laparoscopic procedures
CL Gipson, GA Johnson, R Fisher, A Stewart, G Giles, JO Johnson, JD Tobias
April-June 2006, 2(2):67-72
DOI:10.4103/0972-9941.26651  PMID:21170237
BACKGROUND: Changes in cardiac output may occur during insufflation for laparoscopic procedures. However, there are limited data regarding its potential effects on cerebral oxygenation. MATERIALS AND METHODS: Cerebral oxygenation (ScO2), end tidal CO2, heart rate, blood pressure and oxygen saturation by pulse oximetry were recorded every 5 minutes prior to insufflation, during insufflation and after desufflation. Minute ventilation was increased to maintain normocapnia and the depth of anesthesia was adjusted or fluids/phenylephrine administered to maintain the blood pressure within 20% of the baseline. RESULTS: The cohort for the study included 70 adults for laparoscopic herniorrhaphy, gastric bypass or cholecystectomy. A total of 1004 ScO2 values were obtained during laparoscopy. The ScO2 decreased from the baseline in 758 of the1004 data points. The ScO2 was 0-9 less than the baseline in 47.8% of the values, 10-19 less than the baseline in 24.9% of the values and 20-29 less than the baseline in 26 values (2.6%). Eighty-two (8.2%) of the values were less than 80% of the baseline value, while 25 values (2.5%) were less than 75% of the baseline value. Twelve patients had at least one ScO2 value that was less than 80% of the baseline and 6 had at least one ScO2 value that was less than 75% of the baseline. Four patients of the cohort had ScO2 values less than 80% of the baseline for more than 50% of the laparoscopic procedure. CONCLUSIONS: Although relatively uncommon, significant changes in cerebral oxygenation do occur in some patients during insufflation for laparoscopic surgery.
  6,734 276 5
UNUSUAL CASE
Laparoscopic reduction of acute intrathoracic herniation of colon, omentum and gastric volvulus
Vishwanath Golash
April-June 2006, 2(2):76-78
DOI:10.4103/0972-9941.26650  PMID:21170239
Intrathoracic gastric volvulus with herniation of colon and omentum in a paraesophageal hernia is a rare occurrence. It may present as an acute surgical emergency with life-threatening complications. The diagnosis is usually made by imaging studies and endoscopy. Definite treatment is surgery. We present the laparoscopic management of this case.
  6,534 191 2
Transperitoneal laparoscopic approach for retrocaval ureter
HK Nagraj, TA Kishore, S Nagalakshmi
April-June 2006, 2(2):81-82
DOI:10.4103/0972-9941.26647  PMID:21170241
We had a 14 year old boy, who presented with recurrent attacks of right loin pain. Investigations revealed a retrocaval ureter. A transperitoneal three port laparoscopic approach was undertaken. The retrocaval portion of ureter was excised. A double J stent was placed laparoscopically and ureteroureterostomy was done with intracorporeal suturing. The patient was discharged after 72 hours and the stent was removed on the 15th day. Follow up showed regression of hydronephrosis. We recommend this approach compared to open surgery, as it offers several advantages compared to conventional open surgery like decreased postoperative pain, decreased hospital stay and a cosmetically more acceptable surgical scar.
  5,149 206 5
Vesicovaginal fistula: An unusual complication of laparoscopic assisted nephroureterectomy
Rajiv G Pillai, Ameet S Patel, Anant Kumar
April-June 2006, 2(2):79-80
DOI:10.4103/0972-9941.26648  PMID:21170240
We report a case of vesicovaginal fistula in 71-year-old lady who had previously undergone a lapascopic assisted nephroureterectomy for transitional cell carcinoma in her right ureter and kidney. The surgery was uncomplicated with no post-operative problems and was discharged on day on seven. She later presented five weeks following the initial operation with signs and symptoms suggestive of a vesicovaginal fistula, which was confirmed on cystogram and flexible cystosopy. She proceeded to have an abdominal (O'Connor's) repair of the fistula together with cystodiathermy for a few superficial bladder recurrences. The area of the fistula (within the bladder) was noted to be tumour free. She had an uneventful post-operative recovery and was discharged from hospital on day 11. At six month follow-up, there was another superficial recurrence in the bladder that was resected, with no sign of fistula.
  4,716 175 -
EDITORIAL
Cerebral oximetry and laparoscopic surgery
Eleni Moka
April-June 2006, 2(2):47-48
DOI:10.4103/0972-9941.26644  PMID:21170234
  4,272 191 -
LETTER TO EDITOR
Are you a "laparoscopic surgeon"?
KP Balsara
April-June 2006, 2(2):83-84
DOI:10.4103/0972-9941.26645  PMID:21170242
  3,960 177 -
2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04