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   2011| October-December  | Volume 7 | Issue 4  
    Online since October 3, 2011

 
 
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UNUSUAL CASES
Laparoscopic cholecystectomy and appendicectomy in situs inversus totalis: A case report and review of literature
Vijay D Borgaonkar, Sushil S Deshpande, Vidyadhar V Kulkarni
October-December 2011, 7(4):242-245
DOI:10.4103/0972-9941.85649  PMID:22022115
Situs nversus totalis is a rare condition which presents difficulty in clinical diagnosis as well as laparoscopic surgery for cholelithiasis. The mirror image anatomy makes the laparoscopic intervention difficult even for an experienced surgeon. Presenting here is a case report and review of literature.
  7 3,549 161
Single incision laparoscopic surgery ovarian cystectomy in large benign ovarian cysts using conventional instruments
Pankaj Garg, Swapna Misra, Jai Deep Thakur, Jeremy Song
October-December 2011, 7(4):232-235
DOI:10.4103/0972-9941.85646  PMID:22022112
We describe a technique for the management of large benign ovarian cysts by single incision laparoscopic surgery (SILS) through the umbilicus. The paucity of intra-abdominal working space in large ovarian cysts poses a technical challenge. Moreover, difficult convergence of operating instruments and competition for operating space outside the abdomen during the SILS makes the procedure quite demanding, especially with the conventional instruments. The concept of providing traction by taking sutures from the abdominal wall, as done in SILS laparoscopic cholecystectomy, was applied for SILS cystectomy in large ovarian cysts. Two sutures taken through the abdominal wall and then through the cyst wall provide excellent traction and "hang" the cyst from the abdominal wall, making it convenient to dissect and operate. This technique demonstrates that SILS ovarian cystectomy is feasible, safe and technically unchallenging even in large benign ovarian cysts.
  6 6,083 151
HOW I DO IT
Video-assisted thoracoscopic resection of a bronchogenic esophageal cyst
Nikolaos Barbetakis, Christos Asteriou, Athanassios Kleontas, Fani Papadopoulou, Christodoulos Tsilikas
October-December 2011, 7(4):249-252
DOI:10.4103/0972-9941.85651  PMID:22022117
Bronchogenic cysts are lesions of congenital origin derived from the primitive foregut. The usual presentation of bronchogenic cyst in the mediastinum is related to cyst infection or adjacent organs compression. A case of a bronchogenic esophageal cyst presenting with progressive dysphagia in a 46-year-old man is described. A video-assisted thoracoscopic excision was performed successfully. Details of the procedure are discussed.
  5 3,926 129
ORIGINAL ARTICLES
Effects of dexmedetomidine on oxygenation during one-lung ventilation for thoracic surgery in adults
Scott Kernan, Saif Rehman, Thomas Meyer, Joan Bourbeau, Norm Caron, Joseph D Tobias
October-December 2011, 7(4):227-231
DOI:10.4103/0972-9941.85645  PMID:22022111
Study Objective : To evaluate the effects of dexmedetomidine on hypoxic pulmonary vasoconstriction (HPV) and oxygenation during one-lung ventilation (OLV) in adults undergoing thoracic surgery. Design : Prospective, randomized, double-blinded trial. Setting : Tertiary care, University-based hospital. Patients : Nineteen adult patients undergoing thoracic surgery requiring OLV. Interventions : During inhalational anesthesia with desflurane, patients were randomized to receive either dexmedetomidine (bolus dose of 0.3 μg/kg followed by an infusion of 0.3 μg/kg/hr) or saline placebo. Measurements : Three arterial blood gas samples (ABG) were obtained to evaluate the effects of dexmedetomidine on oxygenation. Secondary outcomes included differences in hemodynamic parameters (heart rate and mean arterial pressure), end-tidal desflurane concentration required to maintain the bispectral index (BIS) at 40-60, supplemental fentanyl to maintain hemodynamic stability, and phenylephrine to keep the mean arterial pressure (MAP) within 10% of baseline values. Main Results : Oxygenation during OLV did not change following the administration of dexmedetomidine (PaO2/FiO2 ratio of 188 ± 115 in dexmedetomidine patients versus 135 ± 70 mmHg in placebo patients). There were no differences in hemodynamic variables or depth of anaesthesia between the two groups. With the administration of dexmedetomidine, there was a decrease in the expired concentration of desflurane required to maintain the BIS at 40-60 when compared with the control group (4.5 ± 0.8% versus 5.1 ± 0.8%). In patients receiving dexmedetomidine, fentanyl requirements were decreased when compared to placebo (2.7 μg/kg/patient versus 3.1 μg/kg/patient). However, more patients receiving dexmedetomidine required phenylephrine to maintain hemodynamic stability (6 of 9 patients versus 3 of 10 patients) and the total dose of phenylephrine was greater in patients receiving dexmedetomidine when compared with placebo 10.3 μg/kg/patient versus 1.1 μg/kg/patient). Conclusion : Dexmedetomidine does not adversely affect oxygenation during OLV in adults undergoing thoracic surgical procedures. The improvement in oxygenation in the dexmedetomidine patients may be related to a decrease in the requirements for inhalational anaesthetic agents thereby limiting its effects on HPV.
  4 4,313 237
Laparoscopic liver resection for hepatocellular carcinoma in cirrhotic patients. Feasibility of nonanatomic resection in difficult tumor locations
Marco Casaccia, Enzo Andorno, Stefano Di Domenico, Ilaria Nardi, Giuliano Bottino, Maximiliano Gelli, Umberto Valente
October-December 2011, 7(4):222-226
DOI:10.4103/0972-9941.85644  PMID:22022110
Background: Surgical resection for hepatocellular carcinoma (HCC) in cirrhotic patients remains controversial because of high morbidity and recurrence rates. Laparoscopic resection of liver tumors has recently been developed and could reduce morbidity. The aim of this study was to evaluate retrospectively our results for laparoscopic liver resection (LLR) for HCC including lesions in the posterosuperior segments of the liver in terms of feasibility, outcome, recurrence and survival. Materials and Methods: Between June 2005 and February 2009, we performed 20 LLR for HCC. Median age of the patients was 66 years. The underlying cirrhosis was staged as Child A in 17 cases and Child B in 3. Results: LLR included anatomic resection in six cases and nonanatomic resection in 14. Eleven procedures were associated in nine (45%) patients. Median tumor size and surgical margins were 3.1 cm and 15 mm, respectively. A conversion to laparotomy occurred in one (5%) patient for hemorrhage. Mortality and morbidity rates were 0% and 15% (3/20). Median hospital stay was 8 days (range: 5-16 days). Over a mean follow-up period of 26 months (range: 19-62 months), 10 (50%) patients presented recurrence, mainly at distance from the surgical site. Treatment of recurrence was possible in all the patients, including orthotopic liver transplantation in three cases. Conclusions: LLR for HCC in selected patients is a safe procedure with good short-term results. It can also be proposed in tumor locations with a difficult surgical access maintaining a low morbidity rate and good oncological adequacy. This approach could have an impact on the therapeutic strategy of HCC complicating cirrhosis as a treatment with curative intent or as a bridge to liver transplantation.
  3 7,226 217
REVIEW ARTICLES
Obturator hernias: A review of the laparoscopic approach
Samer Deeba, Sanjay Purkayastha, Ara Darzi, Emmanouil Zacharakis
October-December 2011, 7(4):201-204
DOI:10.4103/0972-9941.85642  PMID:22022108
Background : Obturator hernias (OH) account for a rare presentation to the surgical unit usually associated with bowel obstruction and strangulation. The treatment of this condition is classical laparotomy with repair of the hernia and bowel resection, if deemed necessary; recently, the laparoscopic approach has been reported in literature. This review examines the existing evidence of the safety and effectiveness of the laparoscopic approach for the management of OH. Materials and Methods: We have conducted a systematic review of the cases reported in the literature between 1991 and 2009, using Medline with PubMed as the search engine, as well as Ovid, Embase, Cochrane Collaboration and Google Scholar databases to identify articles in English language reporting on laparoscopic management for the treatment of this condition. Results: A total of 17 articles reporting on 28 cases were found. We describe the pooled data for demographics, operative time, hospital stay, morbidities and method of repair. We also compare to the results of the laparoscopic repair of other types of hernias in the literature. Conclusion: This approach was found to be a safe and effective approach for the repair of OH as compared to the classical open approach; however, its adoption as the gold standard needs further multicenter trials.
  3 4,090 237
HOW I DO IT
Videoendoscopic single-port axillary dissection
Cihan Uras, Erman Aytac, Fatih Aydogan
October-December 2011, 7(4):246-248
DOI:10.4103/0972-9941.85650  PMID:22022116
Videoendoscopy is newly used in breast and axillary surgery. Single-port surgery is one of the newest methods of minimally invasive surgery. This report describes the first case of videoendoscopic single-port axillary dissection. In histopathological evaluation, 24 lymph nodes were identified and one node was infiltrated by the cancer cells. Videoendoscopic single-port axillary dissection is a precise and improvable technique. Single-port videoendoscopic axillary dissection could be more feasible with individual tools that will be designed for minimally invasive breast surgery.
  2 3,124 115
REVIEW ARTICLES
Laparoscopic partial nephrectomy: Technical considerations and an update
Jose L Dominguez-Escrig, Nikhil Vasdev, Anna O'Riordon, Naeem Soomro
October-December 2011, 7(4):205-221
DOI:10.4103/0972-9941.85643  PMID:22022109
The widespread use of radiological imaging (ultrasound, computed tomography and magnetic resonance imaging) has resulted in a steady increase in the incidental diagnosis of small renal masses. While open partial nephrectomy (OPN) remains the reference standard for the management of small renal masses, laparoscopic partial nephrectomy (LPN) continues to evolve. LPN is currently advocated to be at par with OPN oncologically. The steep learning curve and technical demand of LPN make it challenging to establish this as a new procedure. We present a detailed up-to-date review on the previous, current and planned technical considerations for the use of LPN, highlighting important surgical techniques, including single-port and robotic surgery, techniques on improving intra-operative haemostasis and the management of complications specific to LPN.
  2 4,891 214
UNUSUAL CASES
Laparoscopic management of small bowel obstruction caused by a Sigmoid Mesocolic hernia
John Jimmy, Sachin V Wani, Vishwanath V Shetty, Roy V Patankar
October-December 2011, 7(4):236-238
DOI:10.4103/0972-9941.85647  PMID:22022113
Internal hernias involve protrusion of viscera through the peritoneum or mesentery into a compartment in the abdominal cavity. Hernias occurring through the meso-sigmoid are rare and the most common presentation of this entity is an acute small intestinal obstruction. Pre-operative diagnosis is often difficult and the diagnosis is usually made at surgery. Traditionally, open surgery is used to manage a meso-sigmoid hernia. We report a patient with meso-sigmoid hernia causing intestinal obstruction managed successfully by the laparoscopic approach.
  2 2,847 124
LETTERS TO THE EDITOR
SMILS: Single-site, multi-Incision, laparoscopic surgery, the way forward?
Saurabh Misra
October-December 2011, 7(4):253-254
DOI:10.4103/0972-9941.85653  PMID:22022119
  1 2,108 120
Single port access sleeve gastrectomy is reasonable!
Reinhard Mittermair
October-December 2011, 7(4):254-254
DOI:10.4103/0972-9941.85654  PMID:22022120
  1 1,961 104
UNUSUAL CASES
Laparoscopic perforostomy for treating a delayed colonoscopic perforation: Novel approach
Rajaraman Durai, Philip CH Ng
October-December 2011, 7(4):239-241
DOI:10.4103/0972-9941.85648  PMID:22022114
Introduction: With the implementation of bowel cancer screening programmes, more and more colonic polyps are detected, requiring hot biopsies or resections with an attendant risk of perforation. Laparoscopy is increasingly performed for assessing colonoscopic perforations, usually repaired by stitching or stapling, which is associated with a risk of a leak from the suture line. Case Report: We describe a novel approach of laparoscopic exteriorisation of a delayed colonoscopic perforation which resolved without any further intervention. Discussion: Laparoscopic perforostomy is an alternative minimally invasive laparoscopic approach which respects all the rules by allowing a single-stage procedure including thorough toilet with defunctioning and diversion.
  1 3,178 111
ERRATUM
Erratum

October-December 2011, 7(4):252-252
PMID:22022118
  - 1,556 105
2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04