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   2009| October-December  | Volume 5 | Issue 4  
    Online since January 22, 2010

 
 
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ORIGINAL ARTICLES
Minimally invasive video-assisted thyroidectomy versus conventional thyroidectomy: A single-blinded, randomized controlled clinical trial
Gouda M El-Labban
October-December 2009, 5(4):97-102
DOI:10.4103/0972-9941.59307  PMID:20407568
We aimed to test the hypothesis that Minimally Invasive Video-assisted Thyroidectomy (MIVAT) affords comparable safety and efficacy as to the open conventional surgery, when dealing with patients with unilateral thyroid nodules or follicular lesions, in terms of cosmetic results, intraoperative and postoperative complications, postoperative pain and hospital stay. Materials And Methods: This was a single-blinded randomised controlled trial comparing the MIVAT with conventional thyroidectomy. The primary endpoints of the study were measurement of postoperative pain after 24 and 48 hours from operation and self-rated patient satisfaction with cosmetic outcome three months postoperatively. The secondary outcome measures were operative time, incidence of temporary and permanent recurrent laryngeal nerve injury, postoperative haematoma formation, length of incision, and duration of hospital stay. Results: Operative time was significantly less with open thyroidectomy than with MIVAT, while MIVAT was associated with less pain 24 hours postoperatively. Blood loss did not reach significance between procedures. Comparisons between the two procedures with regard to pain scores after 24 and 48 hours, respectively, depicted statistically significant differences in favour of the MIVAT after 24 hours. MIVAT was associated with less scarring and more satisfactory cosmetic results. There were statistically no significant differences between both procedures for the presence of transient recurrent laryngeal nerve palsy and hypoparathyroidism. Conclusions: MIVAT is a safe procedure that produces outcomes, in view of short-term adverse events, similar to those of open thyroidectomy, and is superior in terms of immediate postoperative pain and cosmetic results.
  21 4,659 333
REVIEW ARTICLE
Robot-assisted laparoscopic partial nephrectomy: Current review of the technique and literature
Iqbal Singh
October-December 2009, 5(4):87-92
DOI:10.4103/0972-9941.59305  PMID:20407566
Aim: To visit the operative technique and to review the current published English literature on the technique, and outcomes following robot-assisted laparoscopic partial nephrectomy (RPN). Materials and Methods: We searched the published English literature and the PubMed (TM) for published series of 'robotic partial nephrectomy' (RPN) using the keywords; robot, robot-assisted laparoscopic partial nephrectomy, laparoscopic partial nephrectomy, partial nephrectomy and laparoscopic surgery. Results: The search yielded 15 major selected series of 'robotic partial nephrectomy'; these were reviewed, tracked and analysed in order to determine the current status and role of RPN in the management of early renal neoplasm(s), as a minimally invasive surgical alternative to open partial nephrectomy. A review of the initial peri-operative outcome of the 350 cases of select series of RPN reported in published English literature revealed a mean operating time, warm ischemia time, estimated blood loss and hospital stay, of 191 minutes, 25 minutes, 162 ml and 2.95 days, respectively. The overall computed mean complication rate of RPN in the present select series was about 7.4%. Conclusions: RPN is a safe, feasible and effective minimally invasive surgical alternative to laparoscopic partial nephrectomy for early stage (T 1 ) renal neoplasm(s). It has acceptable initial renal functional outcomes without the increased risk of major complications in experienced hands. Prospective randomised, controlled, comparative clinical trials with laparoscopic partial nephrectomy (LPN) are the need of the day. While the initial oncological outcomes of RPN appear to be favourable, long-term data is awaited.
  13 5,117 283
UNUSUAL CASES
Total laparoscopic management of large complicated jejunal diverticulum
Niraj Garg, Rajesh Khullar, Anil Sharma, Vandana Soni, Manish Baijal, Pradeep Chowbey
October-December 2009, 5(4):115-117
DOI:10.4103/0972-9941.59311  PMID:20407572
Jejunoileal diverticulae, also referred to as non-Meckelian diverticulae, are very uncommon. These diverticulae are considered to be acquired pulsion diverticulae and they mostly occur in older people. Their prevalence increases with age. About 80% of these diverticulae occur in jejunum and are usually multiple. Patients with jejunoileal diverticulae present with nonspecific symptoms. The clinical picture of a complicated jejunoileal diverticulae can be confused with other intra-abdominal acute conditions such as appendicitis, cholecystitis, perforated ulcer, etc. Nonmechanical or pseudoobstruction is related to the dyskinesia associated with this condition. The diagnosis is made by a small bowel contrast study, enteroclysis, endoscopy or computed tomography. A surgical approach is the best form of treatment for complicated jejunoileal diverticulae. Laparoscopy is very useful in diagnosing and treating this condition. The current report is about a patient who presented with recurrent subacute intestinal obstruction and was managed by laparoscopy.
  8 3,750 138
Adrenal myelolipoma a rare benign tumour managed laparoscopically: Report of two cases
Bandar Al Harthi, Muhammad M Riaz, Amal H Al Khalaf, Mohammad Al Zoum, Wafa Al Shakweer
October-December 2009, 5(4):118-120
DOI:10.4103/0972-9941.59312  PMID:20407573
Adrenal Myelolipoma is a rare benign neoplasm composed of mature adipose tissue and a variable amount of haemopoietic elements. Most lesions are small and asymptomatic, discovered incidentally during autopsy or on imaging studies performed for other reasons. Two cases of myelolipoma are presented here, where the tumours were hormonally inactive, but presented with abdominal symptoms and were managed by laparoscopic adrenalectomy.
  8 5,343 148
ORIGINAL ARTICLES
Minimal access mediastinal surgery: One or two lung ventilation?
Karamollah Toolabi, Ali Aminian, Mihan J Javid, Rasoul Mirsharifi, Abbas Rabani
October-December 2009, 5(4):103-107
DOI:10.4103/0972-9941.59308  PMID:20407569
Background : Minimal access mediastinal surgery (MAMS) is usually performed under general anaesthesia with double lumen tubes (DLT). The aim of this study is to evaluate two lung ventilation through single lumen tubes (SLT) during thoracoscopic sympathectomy for hyperhidrosis and thoracoscopic thymectomy for myasthenia gravis. Methods : In this prospective non-randomized study, MAMS was performed in 58 patients with hyperhidrosis and 42 patients with myasthenia gravis, from January 2002 to December 2008. Patients were intubated with a DLT or SLT, 50 patients in each group. In the DLT group, endobronchial tubes were placed using the traditional blind approach and one lung ventilation was confirmed clinically. In the SLT group, the hemithorax was insufflated with CO2 in conjunction with two-lung anaesthesia. All the patients were evaluated for haemodynamic stability, oxygen saturation of haemoglobin (Spo2), end-tidal Pco2 (ETPco2), times required for intubation and surgery, satisfaction of surgeon with regard to exposure and postoperative complications. Results : In the SLT group, all the patients had stable haemodynamic and ventilation parameters. In the DLT group, haemodynamic instability occurred in two, decrease in Spo2 in four and increase in ETPco2 in three patients. One patient in the DLT group developed vocal cord granuloma two months later. Time required for surgery and the surgeon's opinion with regard to exposure were similar for both groups. Conclusion : Thoracoscopic surgery when used in cases where a well-collapsed lung may not be essential, since surgery is not performed on the lung itself, does not require DLT. SLT is safe in MAMS. It provides good surgical exposure and decreases the cost, time and undesirable complications of DLT.
  5 2,856 167
UNUSUAL CASES
Laparoscopic salvage total pelvic exenteration: Is it possible post-chemo-radiotherapy?
H Patel, JV Joseph, A Amodeo, K Kothari
October-December 2009, 5(4):111-114
DOI:10.4103/0972-9941.59310  PMID:20407571
Indications for total pelvic exenteration in a male (removal of the bladder, prostate and rectum) and in a woman (removal bladder, uterus, vagina, ovaries and rectum) are rare. The advanced stage generally dictates that the patient has some form of chemotherapy or radiotherapy, or a combination of two to shrink/debulk the tumour. We report the first two cases of a salvage laparoscopic total pelvic exenteration in a male for rectal adenocarcinoma invading into the bladder and prostate, post-chemo-radiotherapy and in a woman for squamous cell carcinoma of cervix invading the bladder and rectum post-chemo-radiotherapy. Salvage surgery is often difficult and has been noted to have high morbidity. Applying a laparoscopic approach to this group may have advantages for the patient and the surgeon, i.e. less pain, early recovery and magnified views. As we have technically shown it to be possible, perhaps laparoscopic approaches should be discussed if the teams in these centres are of advanced laparoscopic surgeons working in multi-skilled groups.
  4 3,710 145
Laparoscopic repair of a right para duodenal hernia
Vishnu Bhartia, Anil Kumar, Indira Khedkar, KS Savita, N Goel
October-December 2009, 5(4):121-123
DOI:10.4103/0972-9941.59313  PMID:20407574
Para duodenal hernia is among the uncommon and rare causes of intestinal obstruction, but it is the most common type of internal hernia in abdomen and accounts for more than half of cases that do occur. Here, we are reporting a case of right Para duodenal hernia, reduced and repaired laparoscopically. This thirteen year old girl presented to us with features of small bowel obstruction of two days duration. Plain abdominal X-ray showed multiple fluid levels confined to right side of abdomen. A diagnostic laparoscopy was done under General Anaesthesia. Right Para duodenal hernia was found with small bowel confined to the right side between the ascending colon and hepatic flexure of colon. Laparoscopic reduction of contents of the hernia was done starting from the Ileocaecal junction. Hernial opening was closed laparoscopically with nonabsorbable suture. Patient is quite well till date and has had no recurrence of symptoms
  3 3,940 162
ORIGINAL ARTICLES
Pediatric cholelithiasis and laparoscopic management: A review of twenty two cases
J Deepak, Prakash Agarwal, RK Bagdi, S Balagopal, R Madhu, P Balamourougane
October-December 2009, 5(4):93-96
DOI:10.4103/0972-9941.59306  PMID:20407567
Aim: To evaluate the role of laparoscopic cholecystectomy (LC) in the management of cholelithiasis in children. Materials and Methods: A retrospective review of our experience with LC for cholelithiasis at our institution, between April 2006 and March 2009 was done. Data points reviewed included patient demographics, clinical history, haematological investigations, imaging studies, operative techniques, postoperative complications, postoperative recovery and final histopathological diagnosis. Results: During the study period of 36 months, 22 children (10 males and 12 females) with cholelithiasis were treated by LC. The mean age was 9.4 years (range 3 to 18 years). Twenty-one children had symptoms of biliary tract disease and one child was incidentally detected with cholelithiasis during an ultrasonogram of the abdomen for an unrelated cause. Only five (22.7%) children had definitive etiological risk factors for cholelithiasis and the remaining 13(77.3%) cases were idiopathic. Twenty cases had pigmented gallstones and two had cholesterol gallstones. All the 22 patients underwent LC, 21 elective and one emergency LC. The mean operative duration was 74.2 minutes (range 50-180 minutes). Postoperative complications occurred in two (9.1%) patients. The average duration of hospital stay was 4.1 days (range 3-6 days). Conclusion: Laparoscopic chloecystectomy is confirmed to be a safe and efficacious treatment for pediatric cholelithiasis. The cause for an increased incidence of pediatric gallstones and their natural history need to be further evaluated.
  2 4,431 126
UNUSUAL CASES
Self-insertion of needles: An unusual cause of empyema thoracis and its thoracoscopic management
Vinod Jain, Sandeep Tiwari, Samir Misra, Debashish Chaudhary
October-December 2009, 5(4):108-110
DOI:10.4103/0972-9941.59309  PMID:20407570
Intrapulmonary aberrant needles are rare in clinical practice. Most common cause till date is the intra-thoracic migration of pins and wires commonly used in treatment of fractures and dislocations of upper extremity. Some cases of traumatic intra-thoracic insertion of needles have also been reported. We report a patient of empyema thoracis due to unusual habit of self-insertion of needles in his body because of some myth. The patient was successfully managed by video-assisted thoracoscopic surgery.
  - 2,885 120
2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04