Journal of Minimal Access Surgery最新文献

Introduction: Laparoscopy has increasingly become a preferred method for repairing inguinal hernias in children. However, there is ongoing debate about the necessity of closing the contralateral open internal ring during laparoscopic repair of symptomatic unilateral hernias. This study aimed to determine the incidence of contralateral patent processus vaginalis (PPV) in children undergoing laparoscopic inguinal hernia repair and to evaluate whether closure of the contralateral ring is warranted in asymptomatic patients.

Patients and methods: This study included all children who presented to us with unilateral inguinal hernia. The parameters examined comprised age, gender, side of hernia, the incidence of contralateral PPV and complications. The study was conducted in two phases, each lasting 5 years. In the first phase, if the contralateral processus vaginalis was patent, it was closed following the repair of the symptomatic side. In the second phase, only the symptomatic side was repaired, and the contralateral processus vaginalis was left untreated if patent. All repairs were performed laparoscopically by a single surgeon. The results were analysed to assess the rationale for laparoscopic closure of asymptomatic contralateral PPV.

Results: A total of 1300 patients with unilateral inguinal hernia without any associated pathologies were included in this 10-year study. Six hundred and fifty cases were analysed in each of the two 5-year phases. The mean age of the patients was 34 months (1 month-13 years). Of the participants, 73% were male and 27% were female. The surgical procedure involved ligating the hernia sac (PPV) at the internal ring without division. Follow-up durations varied from 6 months to 5 years, with a mean of 4.2 years. In phase 1, 247 children (38%) had a contralateral PPV (asymptomatic side), which was subsequently closed. In phase 2, 260 children (40%) had a contralateral PPV (asymptomatic side) which was left untreated. Development of a metachronous hernia was seen in only 10% of these cases where the PPV was not closed.

Conclusion: Our results show that upfront closure of the contralateral open ring in children with unilateral inguinal hernia is unnecessary. These patients can be monitored, and the contralateral side should only be repaired if a clinically significant hernia develops.

Abstract: Intestinal perforation due to an ingested foreign body is a serious complication; although it is often misdiagnosed, while treatment gets delayed due to non-specific symptoms. The present case report describes the case of small bowel perforation due to an ingested chicken bone wherein a 35-year-old female patient presented to the emergency department with a complaint of lower abdominal pain for 2 days. Based on history and symptom review, initially, a working diagnosis of a case of the ruptured haemorrhagic cyst was given, while the ultrasonography findings of the abdomen and pelvis, also, pointed towards a similar diagnosis. As the symptoms worsened, a computed tomography (CT) scan of the abdomen was advised to rule-out acute appendicitis, although, the CT findings revealed a foreign body perforating the small bowel. The patient was subsequently advised laparoscopy-assisted foreign body removal with segmental jejunal resection and an end-to-end anastomosis. The patient had an uneventful post-operative recovery, and was eventually, discharged on the 2nd post-operative day.

Introduction: Navigation skills for controlling the camera in the surgical field are critical for many minimally invasive surgery (MIS) procedures. Currently, endoscopes lack integrated navigation aids, making camera control a challenging task. This experimental study aims to investigate the effect of navigation guidance on the performance of beginners.

Patients and methods: A custom computer-based simulation environment was developed for this study, featuring two conditions - one with navigation guidance and one without - focussed on a camera-cleaning task. Participants (64 beginners) were randomly assigned to one of these groups and used two haptic devices to simulate the endoscope and surgical tools.

Results: Participants in the guided condition performed significantly better than those in the unguided condition. Notably, female participants completed the task in significantly less time under the guided condition compared to the unguided one.

Conclusion: These findings suggest that incorporating navigation aids into endoscope interfaces could improve user performance, especially for beginners. Medical device manufacturers should consider adding navigation features to enhance usability. In addition, simulation-based instructional systems should integrate navigation aids to better support surgical training.

Introduction: Colorectal polyps evolve into colorectal cancer with genetic mutations. Helicobacter pylori (HP) infection, which is classified as carcinogen, is thought to affect 50% of the world population.

Patients and methods: Retrospectively, demographic data, HP positivity status, the size, location and number of polyps in patients over 18 years of age who underwent simultaneous sedated oesophagogastroduodenoscopy and colonoscopy procedures between January 2023 and December 2023 were analysed and documented through file records.

Results: One hundred and sixteen patients with polyps in the colon and who underwent polypectomy were analysed. HP histology was positive in 50% of cases with colon polyps. No difference was observed in age, gender, number of polyps, polyp size, polyp type and polyp localisation between patients with HP and patients without HP. Colon polyps in patients with tubular adenoma were more common in the transverse colon (P = 0.035). However, no difference was observed regarding HP histology. In patients with hyperplastic polyps, the proportion of patients with a polyp size above 1 cm was higher and those with a polyp size below 0.5 cm was lower (P = 0.029). However, no difference was observed regarding polyp localisation and HP.

Conclusion: Although HP may be effective on colon polyps due to its effect on virulence factors and gastrointestinal hormones, current literature cannot clearly address this question and the relationship between HP histology and colon polyps is still controversial. In the present study, no significant results were found between demographic data and subtypes of polyps.

Introduction: With the ever-increasing demand for laparoscopic hernia repair, it is important to scrutinise the benefit in terms of recurrence, pain and cosmesis with the open technique for small ventral hernias. The objective is to compare the outcomes of open and laparoscopic intraperitoneal onlay mesh (IPOM) repair for small ventral hernias (defect size <3 cm).

Patients and methods: A prospective analysis of patients who underwent surgical mesh repair for ventral hernias with defects smaller than 3 cm between January 2021 and September 2022. Ventral patch composite mesh (VentralexTM) and composite Prolene-cellulose mesh (ProceedTM) were utilised. We collected and analysed patient characteristics, operative findings and post-operative data, including recurrence rates, pain scores and cosmetic satisfaction over a 12-month follow-up period.

Results: Among the 116 patients included in the study, 54 underwent laparoscopic IPOM repair, while 62 underwent open IPOM repair. The laparoscopic group had an average hernia defect size of 2.7 cm (±0.3), while for the open repair group, it was 2.4 cm (±0.4). The duration of open repair was notably shorter than that of laparoscopic repair (54 min [±16] vs. 94 min [±27]; P = 0.001). Postoperatively, there were significant differences between the groups in terms of VAS scale pain score on post-operative day 1 ([7 ± 2 vs. 4 ± 2]; P = 0.008). Eight cases developed surgical site infections requiring oral antibiotics in the open group, whereas the laparoscopic group had 3 cases (P = 0.6).

Conclusion: Open IPOM repair can be considered as a favourable option for ventral hernias <3 cm when compared to laparoscopic IPOM repair, primarily due to its shorter operative time, ease of spinal anaesthesia, single incision, shorter learning curve and absence of risks associated with port-site hernias. Higher initial pain in the laparoscopic group can be attributed to the use of absorbable tacks and transfascial sutures. No discernible disparities were observed in terms of chronic pain or recurrence rates between these surgical approaches.

Abstract: The increasing prevalence of obesity has made managing metabolic-dysfunction-associated steatotic liver disease and metabolic-dysfunction-associated steatohepatitis (MASH) with cirrhosis a significant challenge. This report details the case of a 53-year-old woman with class-V obesity (body mass index: 63.9 kg/m2) and MASH-associated decompensated cirrhosis with portal hypertension who underwent robotic sleeve gastrectomy (SG) after preoperative optimisation. Initial management involved stabilisation of variceal bleeding, a very-low-calorie diet, beta-blockers and continuous positive airway pressure, leading to improved liver function and Child-Turcotte-Pugh class improvement from B to A. The robotic SG, performed with meticulous intraoperative techniques to minimise bleeding and good post-operative care, resulted in favourable outcomes, including significant weight loss (44.8% total body weight loss) and improved liver parameters at 18-months. This case highlights the feasibility of metabolic and bariatric surgery in carefully selected cirrhotic patients following comprehensive optimisation and multidisciplinary care.

Introduction: Single port robotic assisted retroperitoneal partial nephrectomy (SPRA-PN) represents a novel minimally invasive approach in urology. This study aims to present the first European case series of SPRA-PN, describing the initial experience, patient outcomes and potential benefits of this technique.

Patients and methods: This prospective study included patients scheduled for retroperitoneoscopic surgery between 22nd February 2022 and 6th June 2023. All procedures were performed using the da Vinci Xi® surgical system with a single-port access technique. Patient demographics, operative details, complications and post-operative outcomes were recorded. Cosmetic satisfaction was assessed using the Patient Scar Assessment Questionnaire.

Results: Ten patients underwent SPRA-PN. Technical success was achieved in all cases, with no conversions to open surgery or additional ports required. The mean console time was 84.2 min, and the mean ischaemia time was 19.5 min. Post-operative pain remained low, with a mean visual analogue scale (VAS) of 2.5 at 48 h post-surgery. Positive margins were found in one case. Cosmetic satisfaction was reported to be high among patients.

Conclusion: This initial case series demonstrates the feasibility and potential benefits of SPRA-PN using the da Vinci Xi platform in Europe. Further research is warranted to evaluate long-term outcomes and the widespread applicability of SPRA-PN.

Abstract: A rare long-term complication of transabdominal preperitoneal (TAPP) repair is mesh-induced appendicitis, of which only five cases have been described in the literature. We aimed to present our case of mesh-induced acute appendicitis after TAPP hernia repair. A 25-year-old male presented with a 2-day history of right iliac fossa pain, nausea and appetite loss. He had undergone TAPP repair for a right inguinal hernia 2 years earlier. Imaging revealed an inflamed appendix adhered to the TAPP mesh. Diagnostic laparoscopy confirmed the entrapment and inflammation of the appendix. The patient underwent a successful laparoscopic appendectomy and recovered without complications. Histopathology showed chronic inflammation. To prevent the development of appendicitis after TAPP operation, surgical repair of peritoneal openings is important to prevent such rare complications.

Introduction: Liver retraction is an important aspect when performing minimal access surgeries, especially bariatric and upper gastrointestinal (GI) surgeries. Various liver retraction methods are available and have been tried. Here, we present our experience with our indigenous hiatal sling technique for liver retraction and compare it with Nathanson liver retractor which is a popular and commonly used liver retraction method.

Patients and methods: This is a retrospective observational study of 1874 patients who underwent bariatric and upper GI surgeries over the last 15 years since September 2009. A secondary study was conducted amongst the two groups of patients who underwent upper GI and bariatric surgeries using hiatal sling technique and Nathanson retractor system for liver retraction between January 2023 and October 2023. End points measured were time taken, conversions and complication along with liver function tests (LFTs) such as aspartate aminotransferase (AST) and alanine transaminase measured between the two groups pre- and postoperatively day 0, day 1, day 3 and day 7.

Results: In our series of 1874 patients, hiatal sling liver traction was possible without any difficulties in all except 2 patients with no associated liver injury and with adequate exposure. In the comparative study, patients in the hiatal sling group (Group B) had significantly lesser elevation in LFTs as compared to the patients in the Nathanson liver retraction group (Group A), with no adverse events in both the groups.

Conclusion: Hiatal sling technique for liver retraction is an effective technique which provides adequate exposure of the hiatus and causes lesser liver insult compared to rigid liver retraction system like Nathanson liver retraction system. Hiatal sling does not interfere with surgeons' field causing less errors during surgery and thus making it more ergonomic friendly.

Abstract: A duplicated gall bladder is a rare congenital biliary anomaly, with an incidence rate estimated between 1 in 4000-1 in 5000. It may present with no apparent symptoms or can manifest as biliary colic or symptoms related to pancreatitis. The Harlaftis classification system is widely used for categorising duplicated gall bladders: type I is the split primordial gallbladder, which includes the septated, V-shaped and Y-shaped varieties; type II is the accessory gall bladder type, encompassing the H-shaped or tubular and trabecular types and type III is the triplicated gall bladder type. Prophylactic surgical treatment is not recommended for asymptomatic duplicated gall bladders. However, for symptomatic cases, surgical resection remains the treatment of choice, and intraoperative cholangiography can help reduce the risk of bile duct injury. This article reports a case of a 59-year-old female patient in whom a duplicated gall bladder anomaly was not detected preoperatively but was found intraoperatively. The patient successfully underwent laparoscopic cholecystectomy, and the post-operative pathological examination confirmed the diagnosis of duplicated gall bladder anomaly.