Journal of Minimal Access Surgery最新文献

Introduction: This study investigates the effect of a 4-point transversus abdominis plane (TAP) block on diaphragm thickness (DT) and post-operative recovery following laparoscopic cholecystectomy (LC). This study aims to evaluate whether the 4-point TAP block preserves DT closer to baseline values and enhances post-operative pain control and recovery quality.

Patients and methods: This prospective randomised controlled trial was conducted at a tertiary care hospital. A total of 86 American Society of Anesthesiologists I-II patients aged 18-65 years undergoing elective LC were randomly assigned into two groups. Group B received a 4-point TAP block postoperatively, whereas Group C received no interventional analgesia. In Group B, 10 mL of 0.25% bupivacaine was administered bilaterally under ultrasound guidance to the upper abdominal (Th6-Th9) and typical TAP (T10-T12) regions. DT, the primary outcome, was measured by ultrasonography preoperatively and at 5 and 30 min post-extubation. Secondary outcomes included Visual Analogue Scale pain scores and Quality of Recovery-15 (QoR-15) scores. Statistical analysis was performed using SPSS v22.0. The Shapiro-Wilk test, Chi-square, independent samples t-test, Mann-Whitney U-test and repeated-measures ANOVA were used. P < 0.05 was considered statistically significant. Based on power analysis, 86 patients were sufficient.

Results: Group B demonstrated significantly better preservation of inspiratory DT, lower post-operative pain scores and higher QoR-15 scores compared to Group C (P < 0.05).

Conclusions: The 4-point TAP block improves DT preservation and enhances post-operative pain control and recovery following LC. Further large-scale studies are warranted to support these findings.

Introduction: Shoulder tip pain (STP) is a post-operative complication seen in up to 60% of patients after LC. It occurs because of diaphragmatic irritation from residual carbon dioxide from pneumoperitoneum. This study evaluated the effect of intraperitoneal normal saline irrigation in relieving STP.

Patients and methods: This randomised trial was conducted at Department of General Surgery, Government Medical College and Hospital, Chandigarh of North India between August 2024 and February 2025. A total of 158 patients underwent randomisation, and after exclusion, 63 participants were enrolled in Group A (intervention) and Group B (control). The Visual Analogue Scale (VAS) scores were measured at 6th, 12th, 24th and 48th h.

Results: The mean age of the patients in Group A was 42.57 ± 13.93 years and in Group B was 42.15 ± 15.15 years (P = 0.75). A female predominance was noted in both groups. The mean duration of surgery was slightly higher in Group A (36.19 ± 11.82 min) compared to Group B (33.28 ± 10.56 min) (P = 0.860). The primary outcome was STP, evaluated using the VAS. At 6 h, mean VAS score was 1.31 in Group A versus 2.96 in Group B (P = 0.000); at 12 h, 1.09 versus 2.84 (P = 0.000); at 24 h, 0.53 versus 1.73 (P = 0.0004) and at 48 h, 0.12 versus 0.76 (P = 0.0006), highlighting the effectiveness of the intervention in reducing post-operative STP.

Conclusion: This study demonstrates that intraperitoneal normal saline instillation is an effective and safe intervention for reducing STP after laparoscopic cholecystectomy.

Abstract: Internal hernias are a rare cause of small-bowel obstruction (SBO), particularly in patients without prior abdominal surgery. This case report describes a 70-year-old male presenting with acute intestinal obstruction in a virgin abdomen. Initial imaging suggested SBO but failed to identify a clear transition point. Diagnostic laparoscopy revealed a rare internal hernia caused by a ring formed by the inflamed epiploic appendages of the sigmoid colon. The entrapped bowel was successfully released, and histopathological examination confirmed epiploic appendagitis. This case highlights the diagnostic challenges of SBO due to internal hernias and underscores the importance of surgical exploration in unclear cases. Early identification and intervention are crucial to prevent complications such as bowel ischaemia. This report contributes to the limited literature on epiploic appendage-induced internal hernias, emphasising the need for multidisciplinary collaboration in managing rare abdominal pathologies.

Introduction: The enhanced-view totally extraperitoneal (eTEP) technique has emerged as a promising minimally invasive option for ventral hernia repair. Despite the global uptake, data from East Asian populations remain limited. This study presents the first Korean experience with laparoscopic eTEP, underscoring its real-world feasibility, safety and technical versatility.

Patients and methods: We retrospectively analysed 39 patients who underwent eTEP repair for primary or incisional ventral hernias at a Korean tertiary centre between October 2018 and December 2023. Port placement strategies - conventional multi-port, reduced-port, single-port and hybrid approaches - were tailored to hernia characteristics. Patient demographics, operative details and short-term outcomes were evaluated.

Results: Of the 39 patients, 32 (82.1%) were initially approached laparoscopically and seven (17.9%) underwent preplanned hybrid repair. Transversus abdominis release was conducted in seven patients. The mean operative time was 186 ± 35.9 min, and the mean hospital stay was 7.05 ± 4.10 days. The overall postoperative complication rate was 20.4%, including a 5.1% recurrence rate and 10.2% wound complications. No surgical site infections were observed. Five conversions to open surgery occurred in the early learning phase. Diverse port placement techniques improve access and ergonomics, particularly in complex cases.

Conclusion: Our initial experience in Korea supports the feasibility and safety of laparoscopic eTEP for ventral hernia repair. The technique's adaptability to various hernia types and compatibility with the Korean healthcare environment indicate a strong potential for broader adoption. These findings may help guide implementation in similar surgical settings.

Introduction: Uniportal video-assisted thoracoscopic surgery (Uni-VATS) is an effective minimally invasive technique for pericardial drainage, biopsy and window creation in cases of pericardial effusion (PE).

Patients and methods: This retrospective study evaluated 73 patients with PE who underwent pericardial window procedures between 2012 and 2024. Intraoperative and post-operative data related to Uni-VATS were assessed.

Results: The mean age of the patients was 53.79 ± 17.79 years (10-82 years), with 34 (46.6%) females and 39 (53.4%) males. The mean volume of pericardial fluid drained after window creation was 446.23 ± 199.81 cc (75-1100 cc). The mean operation time was 42.87 ± 12.79 min, and chest drain removal occurred after an average of 1.8 ± 1.2 days. The mean duration until discharge or referral to the follow-up clinic was 5.98 ± 2.14 days. In addition to the pericardial window procedure, pleural biopsy was performed in 12 patients, mediastinal mass biopsy in eight patients and wedge resection for parenchymal nodules in six patients. Microbiologic and virologic cultures of the fluids were negative in all cases. Among the 41 patients with benign cytology, pericardial biopsy results indicated tuberculosis in four patients (5.4%), amyloidosis in one patient (1.3%) and chronic or subacute nonspecific pericarditis in the remaining patients.

Conclusion: Uni-VATS is a novel and safe technique that may be the preferred choice for pericardial window due to its diagnostic and therapeutic efficacy, ability to perform simultaneous procedures, favourable impact on operation duration/hospital stay, low complication rates and superiority compared to traditional methods.

Introduction: This study aimed to compare the outcomes of Versius Robotic System-assisted cholecystectomy with conventional laparoscopic cholecystectomy for benign gall bladder pathologies, focusing on the perioperative and post-operative parameters.

Patients and methods: A retrospective study was conducted on patients with Versius Robotic System-assisted (Group VRS) or conventional laparoscopic cholecystectomy (Group LAP) between September 2021 and June 2023. Patient demographics, perioperative (operative time, conversion and intraoperative complications) details, post-operative pain management and complications were analysed.

Results: The study included 44 and 58 patients in Groups VRS and LAP. In Group VRS, we detected significantly reduced post-operative pain ( P = 0.009), lower opioid use ( P = 0.009) and shorter hospital stays ( P = 0.029) than in Group LAP. Total operative time was longer in Group VRS ( P < 0.001). No intraoperative complications or conversions occurred in either group.

Conclusion: Versius Robotic System-assisted cholecystectomy is a safe and feasible approach for benign gall bladder pathologies, offering benefits such as reduced post-operative pain and shorter hospital stays.

Abstract: Glanzmann's thrombasthenia is a rare inherited disorder affecting one in one million. It is characterised by a lack of platelet aggregation due to a defect in the platelet membrane receptor complex (αIIb/βIIIa), which mediates the aggregation of platelets at the site of vessel injury. We report here the first case of successful perioperative haemostatic management of a male patient with Glanzmann's thrombasthenia, who underwent an elective laparoscopic hernia repair. The patient was posted for elective surgery considering the availability of expertise in minimally invasive surgery and accessibility to recombinant activated factor VII. The patient was operated using the extended-view totally extraperitoneal technique for inguinal hernia repair. The patient recovered successfully and reported no complication during follow-up. We conclude that with proper perioperative haematological consultation, and careful coordination between anaesthetists and surgeons, elective laparoscopic procedure can be done in patients with Glanzmann's thrombasthenia, with only recombinant factor VIIa support.

Introduction: One of the critical steps involved is the distal transection of the rectum in rectal cancer surgeries. Multiple staple firings have been proven to increase the rate of anastomotic leakage. In this study, we intended to learn the effectiveness of the robotic SureForm SmartFire (SS) stapling system and its application in robotic sigmoid colon and rectal procedures performed at our institution.

Patients and methods: Prospective study of patients who underwent surgeries for sigmoid/rectal cancer at our centre was considered. During the surgery, SS staplers were used, and its internal data log with regard to reload selection by the colour, reloads, clamp attempts and staple fires was considered along with intra- and post-operative outcomes.

Results: 246 firings were done in 147 cases with mean body mass index of 26.3 ± 4.3 kg/m 2 ; mean blood loss was 53.6 ± 21.8 ml. None of our patients had stapler-related complications, and the mean length of stay was 7.18 ± 1.5 days. Average reloads used in robotic-low anterior resection (LAR) were 1.73 with the fire attempts beyond lap angle occurring only in robotic-assisted LAR (RA-LAR)/abdominoperineal resection in 87 fires (41%) with 120 instances of controlled and sequential pauses occurred in 246 fires once fire pedal was activated.

Conclusion: Apart from oncological nodal and margin clearance in the carcinoma rectum surgery, obtaining adequate distal margin, sphincter preserving approach and distal transection of the rectum forms one of the key steps in the low anterior resection. Robotic SS staplers have 120° angulation in both axes with EndoWrist technology that has better manoeuvrability within the confines of the pelvis.

Introduction: The significant rise in bariatric procedures (BPs) reflects the global increase in obesity. In Saudi Arabia, obesity prevalence is notably high at 35.6%, surpassing the global average. This retrospective cohort study primarily aims to identify demographic and clinical predictors influencing BP uptake among individuals at a single healthcare centre in Jeddah, Saudi Arabia. Secondarily, it evaluates the effectiveness of BPs, particularly laparoscopic sleeve gastrectomy (LSG), in reducing body mass index (BMI) and obesity-related comorbidities.

Patients and methods: Data were extracted from the hospital's registry between October 2023 and June 2024. The study population included obese adults of varying ages, genders and comorbidities who underwent bariatric surgery. However, the single-centre design limited generalisability, long-term outcome data were unavailable and contextual factors, such as socioeconomic status and health literacy, were not captured.

Results: A cohort of 208 patients was analysed, 64.9% females and 34.2% males, with a mean age of 36 ± 11.2 years. The pre-operative BMI was 44.10 ± 6.2 kg/m² ( P = 0.462), which decreased to 35.1 ± 6.5 kg/m² ( P = 0.577) postoperatively, reflecting a mean reduction of 9.03 ± 4.9 kg/m² (20.5%) ( P = 0.255). LSG was the most performed BP at 93.3%. The most prevalent obesity-related comorbidities identified were hypertension, diabetes and GIT disease including gall bladder disorders (15.9%, 13.9% and 13.5%, respectively).

Conclusions: This study highlights the increasing prevalence of BP, particularly among young, predominantly female patients. LSG demonstrated substantial effectiveness, achieving a 20.5% reduction in BMI and improvement in obesity-related comorbidities. Future research could explore more patient demographics that could not be analysed in this study.