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   2010| October-December  | Volume 6 | Issue 4  
    Online since November 23, 2010

 
 
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REVIEW ARTICLE
Secrets of safe laparoscopic surgery: Anaesthetic and surgical considerations
Arati Srivastava, Ashutosh Niranjan
October-December 2010, 6(4):91-94
DOI:10.4103/0972-9941.72593  PMID:21120064
In recent years, laparoscopic surgery has gained popularity in clinical practice. The key element in laparoscopic surgery is creation of pneumoperitoneum and carbon dioxide is commonly used for insufflation. This pneumoperitoneum perils the normal cardiopulmonary system to a considerable extent. Every laparoscopic surgeon should understand the consequences of pneumoperitoneum; so that its untoward effects can be averted. Pneumoperitoneum increases pressure on diaphragm, leading to its cephalic displacement and thereby decreasing venous return, which can be aggravated by the position of patient during surgery. There is no absolute contraindication of laparoscopic surgery, though we can anticipate some problems in conditions like obesity, pregnancy and previous abdominal surgery. This review discusses some aspects of the pathophysiology of carbon dioxide induced pneumoperitoneum, its consequences as well as strategies to counteract them. Also, we propose certain guidelines for safe laparoscopic surgery.
  6,893 513 4
UNUSUAL CASES
Laparoscopic Nissen fundoplication in situs inversus totalis: Technical and ergonomic issues
Radha Govind Khandelwal, S Karthikeayan, TG Balachandar, Prasanna K Reddy
October-December 2010, 6(4):116-118
DOI:10.4103/0972-9941.72599  PMID:21120070
We report a laparoscopic Nissen fundoplication for gastroesophageal reflux disease (GERD) in a patient with situs inversus totalis (SIT). A 34-year-old man was diagnosed with SIT on performing chest X-ray and abdominal sonography as a routine preoperative investigations. He presented with chronic gastro-esophageal reflux disease (GERD) inadequately controlled by medications. The laparoscopic procedure was performed using five ports placed in a mirror-image configuration and with the patient in the modified lithotomy position. Few technical difficulties were encountered during the operation. The position of the primary surgeon, working between the lower limbs of the patient as in case of standard fundoplication, was considered most prudent position to the success of this case. In SIT, this position provides the least visual disorientation from the reversed abdominal organs. We recommend that preoperative detection of SIT is essential to understand the symptomatology of the patient and for planning of any upper abdominal laparoscopic procedure.
  5,579 91 3
Laparoscopic management of left paraduodenal hernia
B P S Parmar, RS Parmar
October-December 2010, 6(4):122-124
DOI:10.4103/0972-9941.72601  PMID:21120072
Internal herniation of small bowel accounts for about 1% of all the patients with intestinal obstruction. Fifty percent of the patients with paraduodenal hernia will have bowel obstruction. Left paraduodenal hernia resulting from abnormal rotation of the midgut during embryonic development is the most common form of congenital internal hernia. A case of a young male presenting with chronic abdominal pain due to left paraduodenal hernia is being reported. A correct preoperative diagnosis of left paraduodenal hernia was made on computerised tomography (CT), and the patient was managed by laparoscopic surgery. The role of imaging in preoperative diagnosis is being highlighted with a brief review of literature.
  4,463 134 10
ORIGINAL ARTICLES
Laparoscopic adrenalectomy: A single center experience
Suresh Kumar, Moley K Bera, Mukesh K Vijay, Arindam Dutt, Punit Tiwari, Anup K Kundu
October-December 2010, 6(4):100-105
DOI:10.4103/0972-9941.72595  PMID:21120066
Aims : To evaluate the efficacy and safety of laparoscopic adrenalectomy in benign adrenal disorders. Methods and Material: Since July 2007, twenty patients have undergone laparoscopic adrenalectomy for various benign adrenal disorders at our institution. Every patient underwent contrast enhanced CT-abdomen. Serum corticosteroid levels were conducted in all, and urinary metanephrines, normetanephrines and VMA levels were performed in suspected pheochromocytoma. All the patients underwent laparoscopic adrenalectomy via the transperitoneal approach. Results : The patients were in the age range of 18-57 years, eleven males and nine females, seven right, eleven left, two bilateral. The mean operative time was 150 minutes (120-180), mean hospital stay four days (3-5), mean intraoperative blood loss 150 ml and mean post-operative analgesic need was for 36 (24-72) hours. One out of twenty-two laparoscopic operations had to be converted into open adrenalectomy due to intra-operative complications. Conclusions : Laparoscopic adrenalectomy is a safe, effective and useful procedure without any major post-operative complication and is the gold standard for all benign adrenal disorders.
  3,831 122 2
The efficacy of laparoscopy in the diagnosis and management of chronic abdominal pain
Gouda M El-labban, Emad N Hokkam
October-December 2010, 6(4):95-99
DOI:10.4103/0972-9941.72594  PMID:21120065
Background : Chronic abdominal pain is a difficult complaint. It leads to evident suffering and disability, both physically and psychologically. Many diagnostic and therapeutic procedures have been described in literature, but with little proof or evidence of success. Laparoscopy is one of the modalities that could be of benefit in such cases. We aim to evaluate the diagnostic and therapeutic value of laparoscopy in cases with chronic abdominal pain. Materials and Methods : Thirty patients with chronic abdominal pain were included in this prospective descriptive cross-sectional study. The pain in all patients was of unclear etiology despite all the investigative procedures. All patients were subjected to laparoscopic evaluation for their conditions. The findings and outcomes of the laparoscopy were recorded and analyzed. Results : The most common site of pain was the periumbilical region (30%). A definitive diagnosis was made in 25 patients (83.3%), while five patients (16.7%) had no obvious pathology. Adhesions were the most common laparoscopic findings (63.3%) followed by appendiceal pathology (10%), hernia (3.3%), gall bladder pathology (3.3%), and mesenteric lymphadenopathy (3.3%). Postoperatively, pain relief was achieved in 24 patients (80%) after two months. Conclusion : Laparoscopy is an effective diagnostic and therapeutic modality in the management of patients with chronic abdominal pain.
  3,502 199 1
INSTRUMENTS AND EQUIPMENTS
Use of uterine manipulator in laparoscopic colorectal surgery
PR Shah, J Rogers, S Chawathe, PN Haray
October-December 2010, 6(4):125-125
DOI:10.4103/0972-9941.72602  PMID:21120073
Laparoscopic colorectal surgery has become more common with the increase in the number of trained surgeons. We have used a disposable uterine manipulator to retract the uterus. This technique has been found to be very useful for laparoscopic low anterior resection and abdomino-perineal resection in females.
  3,490 100 -
ORIGINAL ARTICLES
Laparoscopic staging in gastric cancer: An essential step in its management
D Mahadevan, A Sudirman, P Kandasami, G Ramesh
October-December 2010, 6(4):111-113
DOI:10.4103/0972-9941.72597  PMID:21120068
Aim: The role of laparoscopy in staging of gastric cancer is widely accepted; however, in Malaysia its usage has been limited. Patients can be classified as resectable or unresectable, which helps in avoiding an unwanted laparotomy and the morbidities associated with it. The aim of this study was to assess the value of laparoscopy in staging of gastric cancer in comparison with CT scan. Materials and Methods: Patients with carcinoma of the stomach after a complete preoperative work-up underwent laparoscopy prior to surgical exploration. TNM staging was used to compare laparoscopy with CT, with the histopathological report used as the gold standard. Results: Forty cases were included in this study. The sensitivity of laparoscopy for T3 tumours appears to be significant when compared to that of CT. Laparoscopy detected 90.3% of the cases as against the 58% detected with CT. There was not much difference in the N factor. With regard to M factor, the sensitivity was 100% for laparoscopy in comparison with CT. Conclusions: Laparoscopy has been shown to be sensitive in detecting metastasis in gastric cancer in comparison to CT, thus helping in avoiding unwanted laparotomy and thus providing a more systemic approach in managing gastric cancers.
  3,331 135 4
UNUSUAL CASES
Membranous variety of rectal atresia - primary management in a neonate
Shalika Jayaswal, Hemanshi Shah, Keshav Murthy, Kailash Bhandarkar, Om Prakash Makhija
October-December 2010, 6(4):114-115
DOI:10.4103/0972-9941.72598  PMID:21120069
Rectal atresia is a rare form of anorectal malformation, with reported incidence of 1 to 2% and membranous variety of rectal atresia is even rarer. Most reported cases have been dealt with a staged procedure which includes sigmoid colostomy. We diagnosed and classified the variety of rectal atresia by performing an X-Ray (invertogram along with the red rubber catheter in situ.). In lesser developed geographies where MRI is not readily available or not affordable, this simple test could be used to confirm the variety of rectal atresia. However, the usual fallacies of invertogram should be considered. Here we report a neonate with membranous variety of rectal atresia managed by transanal endoscopic fulguration using bugbee passed through the cystourethroscope, without a covering sigmoid stoma.
  3,253 106 2
ORIGINAL ARTICLES
Retroperitoneal laparoscopic pyelolithotomy versus extra corporeal shock-wave lithotripsy for management of renal stones
Jagdish Chander, Nikhil Gupta, Pawanindra Lal, Pawan Lal, Vinod K Ramteke
October-December 2010, 6(4):106-110
DOI:10.4103/0972-9941.72596  PMID:21120067
Aim: The purpose of this study was to evaluate the role of retroperitoneal laparoscopic pyelolithotomy (RPPL) and its comparison with extra corporeal shock wave lithotripsy in the management of renal calculi. Materials and Methods: The study was carried out in the Department of surgery, Maulana Azad Medical College, New Delhi, India. The study included 86 cases of solitary renal calculi in the retroperitoneoscopic (RPPL) group and 82 cases in the shock wave lithotripsy (SWL) group. The parameters compared were stone clearance, hospital stay, number of postoperative visits, mean time to resume normal activities, number of man days lost, and analgesic requirement. Results : The RPPL group showed better stone clearance, fewer hospital visits, low analgesic requirement, fewer number of man days lost, and early resumption of normal activities, as compared to the SWL group. Conclusions : Shock wave lithotripsy, being a noninvasive modality, is an established procedure all over the world. However RPPL achieves comparable or better results in high volume centers.
  3,070 134 4
UNUSUAL CASES
Thoracoscopic removal of impacted denture: Report of a case with review of literature
Abhay N Dalvi, Vinay K Thapar, Sachin Jagtap, Devyani J Barve, Dattaraj P Savarkar, Mahadev N Garle, Akash P Shukla
October-December 2010, 6(4):119-121
DOI:10.4103/0972-9941.72600  PMID:21120071
Impacted foreign bodies in the oesophagus are common. Because of their large size, rigidity and pointed edges, dentures get frequently impacted in the oesophagus and are difficult for endoscopic retrieval. Traditional thoracotomy for retrieval of impacted foreign bodies in the thoracic oesophagus is associated with significant morbidity. We present a case of impacted denture in the mid-oesophagus successfully removed using minimal access thoracoscopic procedure.
  2,386 85 2
LETTERS TO EDITOR
Systemic inflammatory response syndrome following laparoscopic repair of diaphragmatic injury
Philip Umman
October-December 2010, 6(4):126-127
DOI:10.4103/0972-9941.72604  PMID:21120075
  1,617 72 -
Missed injury and complication after laparoscopy in trauma: Is the procedure still preferable?
Viroj Wiwanitkit
October-December 2010, 6(4):126-126
DOI:10.4103/0972-9941.72603  PMID:21120074
  1,544 85 -
2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04