Journal of Minimal Access Surgery最新文献

Abstract: While performing an intracorporeal intestinal anastomosis in minimally invasive procedures, surgeons may be encountered with many limitations which made many of them go back to doing extracorporeal anastomosis. In this article, we describe a simple but efficient technique using the Endoclose which improves the surgeon's ability to enhance the anastomosis' exposure while suturing, without having to add extra trocars.

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 22 nd February 2022 and 6 th 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: Spontaneous diaphragmatic hernias (DHs) are uncommon, yet potentially hazardous. To prevent consequences, timely diagnosis and treatment are necessary. A 54-year-old male presented to the emergency room with dyspnoea, cough and tachycardia; he had no history of trauma. Diagnostic imaging revealed a substantial left DH, indicating the need for surgical intervention. The intraoperative examination identified a transverse colon and omentum herniation. Dissection, reduction of the contents, primary sutures of the defect and dual mesh reinforcement accomplished the laparoscopic and thoracoscopic DH repair. This case underscores the importance of timely detection, precise surgical intervention and comprehensive post-operative monitoring when utilising a multidisciplinary approach to manage DHs. It serves as a reminder to exercise caution regarding DHs, particularly in circumstances devoid of traumatic aetiology and the benefits of combined laparoscopic and thoracoscopic approaches.

Introduction: Inguinal hernia surgery, a common procedure worldwide, continues to develop to achieve minimal access and tension-free repairs. However, a universally accepted technique has yet to be developed. Our study introduces a new approach, a modified tumescent transabdominal pre-peritoneal (TAPP), to a low-cost setting. We then compare its safety and efficacy with the conventional TAPP, providing a new perspective on hernia repair methods.

Patients and methods: The study was conducted between April 2016 and September 2017 at the department of surgery in a medical college in Jammu. Sixty patients were randomly assigned to either the conventional TAPP group or the tumescent TAPP group using computer-generated randomisation. In the tumescent group, we carefully administered a tumescent solution into the pre-peritoneal space after creating pneumoperitoneum and then compared the effectiveness and safety of the two procedures.

Results: Our study revealed significant differences in various aspects between the two groups. In the conventional group, 16.7% of patients experienced challenging peritoneal flap dissection, while none in the tumescent group faced this issue. In addition, none of the patients in the tumescent group had an intraoperative haemorrhage. The conventional group had a mean operating time of 100.4 ± 11.21 min. On the other hand, the tumescent group had a significantly shorter mean operating time of 84 ± 13.47 min. The complication rates were 16.7% in the tumescent group and 30% in the conventional group. After the surgery, 13.3% of patients in the conventional group reported persistent pain, compared to only one patient in the tumescent group, which was statistically significant.

Conclusion: Our study demonstrates that tumescent TAPP can overcome the challenges of conventional TAPP surgery, offering practical benefits such as reduced bleeding, easier dissection, decreased post-operative pain and shorter operating time. Administering tumescent solution before TAPP repair of inguinal hernia provides technical and clinical advantages, suggesting the potential for shorter surgeries and a quicker learning curve.

Abstract: Technical difficulties are often encountered in a laparoscopic cholecystectomy where a tense/distended/ turgid gall bladder prevents the surgeon from grasping the gall bladder properly which therefore necessitates the decompression of the turgid gall bladder. However, even if intraoperative decompression is done, the spillage of remnant stones, bile or fluid from the gall bladder is a possibility which can lead to undue complications. This is where following the simple technique of using a gauze piece with a radio-opaque marker to occlude the decompression puncture site helps in performing a safe decompression thereby preventing bile, fluid or stone spillage.

Introduction: Recently, there has been a growing emphasis on assessing the functional outcomes of hernia repair, particularly focusing on the quality of life (QOL). The aim of this study was to assess and compare the QOL amongst Nepalese patients undergoing laparoscopic ventral hernia repair (LVHR) and open ventral hernia repair (OVHR) during the initial 3 months following surgery.

Patients and methods: This was a hospital-based prospective study where 70 patients were divided into two groups: 35 underwent LVHR and 35 underwent OVHR. QOL was assessed using the Carolina's Comfort Scale at 2 weeks, 1 month and 3 months following surgery, which evaluated post-operative pain, sensation of mesh and limitations in the movement across eight positions.

Results: The study groups had comparable demographics, comorbidities and disease characteristics. Patients undergoing LVHR experienced significantly longer mean operative times. Wound infection and the use of drains were notably higher in OVHR. Mesh sensation was not significantly different between the two groups during the follow-up. Post-operative pain was more in OVHR compared to LVHR during bending over and exercising positions, at 2 weeks and a month post-surgery. Movement limitation was more in the OVHR group, especially during bending over positions, compared to the LVHR group.

Conclusion: This study highlights the laparoscopic repair of ventral hernias as an effective alternative to open techniques, reducing early post-operative pain.

Abstract: Spigelian hernia is a rare type of ventral abdominal wall hernia, and urinary bladder herniation into the inguinal canal is an uncommon complication typically seen in elderly males. The simultaneous occurrence of multiple abdominal wall hernias with bladder involvement is exceedingly rare and diagnostically challenging. We present the case of a 62-year-old male who underwent abdominal computed tomography (CT) due to chronic lower abdominal discomfort and right groin swelling. Imaging revealed a small midline umbilical hernia, a right-sided Spigelian hernia, bilateral inguinal hernias and partial urinary bladder herniation into the right inguinal canal. All hernias were clearly visualised on contrast-enhanced CT with multiplanar reconstructions. While individual hernias are common, the coexistence of four different types - particularly with bladder involvement - has not been previously reported in the radiological literature. Accurate CT imaging was instrumental in detecting the defects and guiding referral for surgical management. This case highlights the importance of comprehensive cross-sectional imaging in elderly patients with nonspecific abdominal or groin symptoms. This rare case underscores the diagnostic value of CT in identifying multiple synchronous abdominal wall hernias and emphasises the need to consider urinary bladder herniation in the differential diagnosis, especially in older male patients.

Introduction: This retrospective cohort study evaluated the efficacy of laparoscopic common bile duct exploration (LCBDE) for managing difficult common bile duct stones (CBDSs) in patients with failed endoscopic retrograde cholangiopancreatography (ERCP).

Patients and methods: Forty-two patients underwent LCBDE between 2019 and 2024, after unsuccessful ERCP. The causes of ERCP failure include cannulation failure, large stones, impacted stones and multiple stones. The surgical technique involved a standard 4-port laparoscopic cholecystectomy with an additional port for manipulation of the Fogarty catheter or choledochoscope. Stones were extracted by milking the CBD, using a Fogarty balloon catheter or with the aid of a choledochoscope. The choledochotomy was closed primarily or over the stent using interrupted or continuous sutures.

Results: The mean CBD diameter was 14.8 mm (range: 12-33 mm), with 31 patients having single stones and 11 having multiple stones. Two patients were suspected to have CBD strictures. CBD clearance was achieved in 38 (90.5%) patients. In four patients, the procedure was converted to open because of an impacted stone. Post-operative complications included bile leak (n = 2) and residual stones (n = 2). It was also observed that primary closure of the choledochotomy without drainage does not affect the outcome.

Conclusion: This study demonstrated that LCBDE is a safe and effective minimally invasive option for managing difficult CBDS when ERCP fails.

Abstract: Bile leakage is a serious complication that can lead to life-threatening conditions if not promptly addressed. We present a rare case of a 38-year-old male patient who sustained a liver laceration due to a gunshot injury, resulting in a multisegmental bile leak. Despite percutaneous transhepatic biliary drainage (PTBD), a persistent bile leak was observed. Selective embolisation was performed by interventional radiology via microcatheterisation of the affected peripheral biliary branches, using a mixture of Lipiodol and Histoacryl. The patient showed complete clinical recovery, and the bile leak resolved during follow-up. This case highlights a minimally invasive and effective treatment alternative for refractory bile leaks unresponsive to PTBD, potentially reducing the need for surgical intervention and its associated risks.

Introduction: Robotic-assisted cholecystectomy enhances precision and visualisation compared to traditional laparoscopy. This study compares single-incision robotic cholecystectomy (SIRC) with multi-port robotic cholecystectomy (MPRC) in elective settings.

Materials and methods: A retrospective cohort study analysed 188 patients (63 SIRC, 125 MPRC) at a tertiary centre from 2018 to 2023, assessing operative time, length of stay (LOS) and complications.

Results: SIRC had longer mean operative time (66 vs. 55 min, P < 0.001) and LOS (1.4 vs. 1.2 days, P = 0.02) than MPRC, with comparable wound infection (3.2% vs. 0.8%, P = 0.25) and hernia rates (1.6% vs. 0%, P = 0.33).

Conclusion: SIRC is a safe, cosmetically appealing alternative to MPRC despite longer operative times, suitable for lower-body mass index patients prioritising aesthetics.