[Year:2020] [Month:May-August] [Volume:13] [Number:2] [Pages:1] [Pages No:00 - 00]
DOI: 10.5005/wjols-13-2-v | Open Access | How to cite |
Ten-point Strategy for Safe Laparoscopic Cholecystectomy: A Prospective Study
[Year:2020] [Month:May-August] [Volume:13] [Number:2] [Pages:6] [Pages No:55 - 60]
DOI: 10.5005/jp-journals-10033-1402 | Open Access | How to cite |
Aims/objectives: To devise a 10-point strategy for performing safe laparoscopic cholecystectomy (LC), share experience of 8,000 patients without any conversion to open procedure by adopting the strategy, and assess its effectiveness. Materials and methods: A total of 8,000 patients were prospectively analyzed during 2007 to 2017. A point was assigned to a specific finding intraoperatively. Patients were divided into three groups based on the points. Anatomical variations, time of surgery, intraoperative/postoperative complications were plotted for three groups, and statistical significance was calculated. Results: In this study, 63.5% of patients were female. No case of conversion to open cholecystectomy (OC) was found. The youngest and oldest patients were 2 and 109 years old, respectively. Mortality, negligible morbidity, or significant complications were not observed. Group I (1–4 points) had high-risk patients, and lowest safety, and group III (8–10 points) had low-risk patients, and highest safety, and group II (5–7 points) had with equivocal numbers. Conclusion: Laparoscopic cholecystectomy was performed keeping these 10 points in mind with patience and precautions. Chances of conversion to open surgery can be reduced to zero, with minimal complications. The study suggests that in case of difficult anatomy, go gentle and slow to safeguard from injuries.
Retroperitoneal Single-port Donor Nephrectomy through Lumbotomy Incision: An Experience of 30 Cases
[Year:2020] [Month:May-August] [Volume:13] [Number:2] [Pages:4] [Pages No:61 - 64]
DOI: 10.5005/jp-journals-10033-1399 | Open Access | How to cite |
Introduction: Over the years, laparoscopic donor nephrectomy (LDN) has evolved as a preferred alternative to open-donor nephrectomy (ODN). Laparoscopic donor nephrectomy can be performed either by transperitoneal or retroperitoneal route. Retroperitoneoscopic live donor nephrectomy (RPLDN) results in less analgesic requirement, decreased hospital stay, and better cosmetic acceptance by the donors. Lumbotomy incision has been thought to be an ideal approach without any muscle being cut but is limited by the amount of space in open surgery. Materials and methods: Between November 2014 and September 2016, 350 donor nephrectomies were performed at our department. All the surgeries were performed by a single surgeon. Thirty patients consented for translumbar RPLDN out of the 82 donor nephrectomies assigned to that particular surgeon. Visual analog scale (VAS) was used to evaluate the severity of pain on postoperative day (POD)0 and POD1. Results: Mean age of donors was 44.7 ± 11.4 years, M:F ratio 9:21. Average duration of surgery was 170.33 ± 52 minutes. Four patients (13.3%) had double renal arteries and one patient had double renal vein. In one patient, retrieval was performed by an open approach. No patient had surgical site infection. Most patients (28/30) had a VAS score of <4, and did not require any additional analgesics beyond POD0. Conclusion: Single-site translumbar RPLDN is a feasible alternative approach to the donor surgery.
Laparoscopy-assisted Approach for Meckel's Diverticulum in Pediatric Age
[Year:2020] [Month:May-August] [Volume:13] [Number:2] [Pages:4] [Pages No:65 - 68]
DOI: 10.5005/jp-journals-10033-1408 | Open Access | How to cite |
Background: Meckel's diverticulum (MD) is the most common congenital gastrointestinal tract (GIT) anomaly, with incidence approximately 2–4%. It is usually asymptomatic and it is usually discovered accidentally during laparotomy or presenting with complication as perforation, bleeding, and bowel obstruction. The surgical treatment of MD includes exploratory laparotomy with either diverticulectomy or segmental small bowel resection. Materials and methods: A retrospective review performed for the cases of MD operated by laparoscopy-assistedexcision of the diverticulum in Zagazig University Hospital and International Medical Center Jeddah, during the period from November 2012 to October 2018, all data regarding patients’ demographics, clinical features, diagnostic tests performed, histopathology reports, operative time, conversion to laparotomy, hospital stay, and complications were analyzed. Results: This study includes 17 patients with MD who underwent laparoscopy-assisted excision of MD. The median age of the patients was 8.3 years. The male to female ratio was 11:6. Lower GIT bleeding was the most common presenting symptom. All patients were subjected to a laparoscopy-assisted excision. Four patients underwent wedge excision and 13 patients underwent segmental bowel resection. Conclusion: Laparoscopy-assisted resection of MD is safe, simple, and inexpensive. Moreover, it avoids the risk of intra-abdominal contamination.
Comparison Objective Structured Assessment of Camera Navigation Skills Score—Pre- and Post-training Intervention
[Year:2020] [Month:May-August] [Volume:13] [Number:2] [Pages:5] [Pages No:69 - 73]
DOI: 10.5005/jp-journals-10033-1405 | Open Access | How to cite |
Aim: Inexperienced operating assistants are often tasked with the important role of handling camera navigation during laparoscopic surgery. Incorrect handling can lead to poor visualization and increased operating time. The objective of this research was to examine benefit of camera navigation training in laparoscopic used pelvic box based on Objective Structured Assessment of Camera Navigation Skills (OSA CNS) assessment and explore factors correlated to difference skill after training. Materials and methods: An experimental study (pre–post interventional study) was conducted at the training room of Indonesia Clinical Training and Education Centre (ICTEC) Faculty of Medicine Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital (CMH), on December 2018 to January 2019. Participants were Obstetrics and Gynecology resident Medical Faculty of Universitas Indonesia. We did evaluation before training and 1, 2, 3 weeks after training used OSA CNS. Data analysis used paired-t test. Results: There were significant increasing OSA CNS score after camera navigation training used pelvic box. Average OSA CNS score before training and 1, 2, 3 weeks after training were 15.00 ± 2.03, 17.60 ± 2.69, 16.36 ± 1.84, 17.80 ± 2.26, respectively. Optimum duration of OSA CNS evaluation was 3 weeks after the training. Female gender and low experience were two factors influence camera navigation skill after the training. Conclusion: Laparoscopy camera navigation training used pelvic box could be applied to support residency program curriculum and there were increasing camera navigation skills after training used pelvic box. Female gender and low experience were factors significant correlate to training outcome of camera navigation skill used pelvic box. Clinical significance: Camera navigation training used pelvic box is a critical component for teaching safe endoscopic practices in our Ob/Gyn residency training program.
Predictors for Conversion to Open Appendectomy in Patients Undergoing Laparoscopic Appendectomy Based on Clinical Presentations on Ultrasonography Findings and Tzanaki's Scoring
[Year:2020] [Month:May-August] [Volume:13] [Number:2] [Pages:3] [Pages No:74 - 76]
DOI: 10.5005/jp-journals-10033-1401 | Open Access | How to cite |
Background: Laparoscopic appendectomy (LA) may need to be converted to open appendectomy (OA) if intraoperative complications or severity of the disease hinders with a safe laparoscopic intervention. This may be in the form of abnormal position of appendix, adhesion due to previous inflammations, appendix mass, abscess, perforated appendix and diffuse peritonitis or other pelvic or right iliac fossa pathologies or technical problems, and lack of space for dissection. Even though these pathologies can be dealt with minimal access surgery, conversion to open surgery may become mandatory in a small number of cases. The presence of comorbidities is the independent factor related to conversion during laparoscopic appendicectomy.1 Materials and methods: The study was carried out in PG Department of Surgery, SRN Hospital associated with MLN Medical College, Prayagraj from September 2018 to September 2019 after approval from the ethical committee and after obtaining written and informed consent either from patient or their legal heir. The study was conducted on the patients admitted in the Department of Surgery, SRN Hospital, MLN. Medical College between September 2018 and September 2019 who underwent conversion appendicectomy. Patients were evaluated and their complete biodata were recorded after taking detailed history. Based on history, clinical examination, laboratory investigations, and ultrasound of abdomen and pelvis, appendicitis diagnosed. The parameters studied include age, sex, previous history of acute appendicitis any lower abdominal surgeries in the past, symptoms, duration of symptoms, sign, white blood cell (WBC) count, ultrasound abdomen and pelvis findings, American Society of Anesthesiologists (ASA) grading, and intraoperative findings including reasons for conversion. Results: Multivariable analysis incorporating these factors available to the surgeon preoperatively identified advanced age, ASA score >2 points, severity of adhesion in ultrasonography (USG), significantly associated with conversion. These results highlight the complex nature of the decision to convert, in as much as baseline patient characteristics, disease severity, and surgeon factor each independently impact the probability of the successful laparoscopic procedure. Conversion in our study was significantly associated with comorbidities as out of 11 patients with comorbidities [6 hypertension (HTN), 4 diabetes mellitus (DM), 1 asthma], 10 (90.90%) were converted to OA with significant p value (p = 0.00001). Among nine patients with ASA grade >2 points, eight were converted to OA. Total leukocyte count was >12,000 in 25 patients (41.67%) out of which 9 patients (36%) were converted to OA. In this study, 21 patients (35%) had score ≤9, while 39 patients (65%) had score ≥10. Eleven patients (52.38%) were converted to OA out of 21 having score ≤9 in comparison to 1 patient (2.56%) out of 39 patients having score ≥10. Conclusion: We identified preoperatively, predictors for conversion of LA to OA consisting of age ≥40, comorbidity, ASA grade >2 point, leukocytosis, right iliac fossa lump and Tzanaki's score <9 point. By using this, we proceed directly to OA under these circumstances may reduce operative time and expenses by conversion to OA.
Single-incision Laparoscopy-assisted Appendectomy in the Pediatric Age Group: Our Experience
[Year:2020] [Month:May-August] [Volume:13] [Number:2] [Pages:3] [Pages No:77 - 79]
DOI: 10.5005/jp-journals-10033-1406 | Open Access | How to cite |
Background: Various methods of laparoscopic appendectomy have been described in children. We present the data of 50 children who underwent interval appendectomy at our institution by transumbilical single-incision laparoscopy-assisted appendectomy (SILAA). Materials and methods: Fifty patients <12 years from June 2011 to June 2017 with inclusion criteria <12 years of age who were admitted with clinical features of acute appendicitis of >24–48 hours’ duration; had abdominal ultrasound (USG) with appendicular diameter of >10 mm and good clinical response to initial management by intravenous antibiotics within 24–48 hours of admission were retrospectively analyzed. They underwent SILAA after 6 weeks. Under general anesthesia, an infraumbilical incision was made and umbilical tube was identified. A 5 mm camera port was inserted by open Hassan's technique. After visualizing the appendix, another incision was made adjacent to the port site on the left and a 5 mm instrument was introduced through this. The appendix was freed, mobilized, and delivered through the incision. Appendectomy was completed extracorporeally. Results: The average age at presentation was 9.3 years. There were 18 females and 32 males. Two patients required conversion to open procedure in view of extensive adhesions and a short retrocecal appendix which was difficult to mobilize and exteriorize through umbilicus. The mean operating time was 30 minutes. There were no complications. Conclusion: Single-incision laparoscopy-assisted appendectomy combines the advantages of both laparoscopic and open appendectomy and offers reduced operative time and less complications and reduced surgical costs in pediatric age group.
Laparoscopic Heminephroureterectomy in Infants Weighing Less Than 10 Kilograms: The Two Peculiar Cases
[Year:2020] [Month:May-August] [Volume:13] [Number:2] [Pages:4] [Pages No:80 - 83]
DOI: 10.5005/jp-journals-10033-1410 | Open Access | How to cite |
Aim: We report two peculiar cases of laparoscopic heminephrectomy in infants weighing less than 10 kg with megaureter of nonfunctioning renal upper pole. Cases description: A 6-month-old boy, with history of upper pole pyo-hydroureteronephrosis managed by percutaneous nephrostomy, was affected in the left side; while a 17-month-old girl, with history of abdominal mass then proved to be a giant megaureter of nonfunctioning renal upper pole, was affected in the right side and she was previously treated for primitive obstructive megaureter (in the lower pole). Laparoscopic heminephroureterectomy with a transperitoneal approach was performed. Mean length of surgery was 160 minutes. We reported no conversion to open surgery neither intraoperative bleeding/urine leakage. Mean hospitalization duration was 5 days. The reoperation rate was 0%. In both cases at preliminary follow-up, we reported a good outcome. Conclusion: Laparoscopic heminephrectomy is considered a technically challenging procedure, especially for small infant but, according to our experience, it is safe and effective if performed in pediatric centers with high experience in minimally invasive surgery.
Laparoscopic Retrieval of a Migrated Intrauterine Contraceptive Device
[Year:2020] [Month:May-August] [Volume:13] [Number:2] [Pages:3] [Pages No:84 - 86]
DOI: 10.5005/jp-journals-10033-1409 | Open Access | How to cite |
Introduction: Intrauterine contraceptive device (IUCD) migration consequent to perforation of the uterus is not very common, but is one of the more serious complications. Case descriptions: We described two cases of migrated IUCD, at two distinct sites in the pelvic cavity, one was located in the pouch of Douglas embedded behind the left ovary and tube which was adherent to the posterior uterine wall and another was in the left mesovarium between the ovary and the tube. Both IUCDs were successfully removed laparoscopically without any complication. Conclusion: Migrated IUCDs should always be removed once the diagnosis is made to prevent serious complications. Laparoscopic approach is a successful and preferred choice of treatment in selected cases.
Laparoscopic Retrieval of a Displaced Intrauterine Device Presenting as Umbilicus Sinus
[Year:2020] [Month:May-August] [Volume:13] [Number:2] [Pages:3] [Pages No:87 - 89]
DOI: 10.5005/jp-journals-10033-1404 | Open Access | How to cite |
Aim: To report a case of displaced intrauterine device (IUD), having unusual presentation, and signify the role of laparoscopy in the surgical management of migrated IUD. Background: The IUD is a popular family planning method worldwide. Intrauterine device migration into the peritoneal cavity is a serious complication and requires surgical removal in the majority of cases. In most of the reported cases, retrieval was performed through laparotomy. Moreover, cases which were attempted laparoscopically, many of them later converted to open. Also, previously published articles have mentioned migration of IUD into rectosigmoid, urinary bladder, small intestine, iliac vessels, and other sites. Ours is a probably first reported case of displaced IUD presenting as discharging umbilical sinus and surgical retrieval performed via laparoscopic approach. Case description: A 28-year-old woman presented with pain and discharge from umbilicus. Investigations revealed displaced IUD at the level of umbilicus. Patient underwent laparoscopy surgery and found to have displaced IUD, embedded in-between omental adhesion to umbilicus. Entire surgery was carried out laparoscopically and IUD removed. Patient had uneventful recovery after surgery. Conclusion: Uterine perforation following IUD insertion is a rare but potentially serious complication. Accurate preoperative localization of displaced IUD is obligatory and helpful. Current practice is to surgically remove all displaced IUDs. Laparoscopic approach appears to be safe with advantage of faster recovery and good cosmesis. Clinical significance: Our article will provide insight in erratic presentation of displaced IUD and further augment the role of laparoscopy in the management of such cases.
Total Laparoscopic Pancreaticoduodenectomy: A Single-center Experience of 33 Cases in Patients with Periampullary Tumor—Lessons Learnt
[Year:2020] [Month:May-August] [Volume:13] [Number:2] [Pages:4] [Pages No:90 - 93]
DOI: 10.5005/jp-journals-10033-1403 | Open Access | How to cite |
Introduction: The introduction of minimally invasive procedures has revolutionized surgical practice worldwide. However, its application to total pancreaticoduodenectomy since its inception in 1994 by Gagner and Pomp has elicited reluctance and skepticism due to the need for expertise, advanced laparoscopy skills, long operative time, difficulty in adhering to oncological principles of resection, and high rates of conversion to open surgery. Materials and methods: A retrospective review of 33 patients who underwent total laparoscopic pancreaticoduodenectomy at a tertiary care center in Mumbai from May 2015 to December 2019 was performed. All cases were operated by the principal investigator. Patients with malignancy on final histopathology report were included in the study. Patients with involvement of major vessels on preoperative contrast-enhanced computed tomography scan, distant metastasis, and contraindication to general anesthesia were excluded from the study. Perioperative data were collected and analyzed. Results: Thirty-three patients were operated for total laparoscopic pancreaticoduodenectomy. The average operative time was 330 minutes. Only one patient required conversion to open surgery and postoperative blood transfusion. The resection margins were negative in all the patients with an average lymph node retrieval rate of 12 nodes. There was no postoperative mortality. Conclusion and clinical significance: Total laparoscopic pancreaticoduodenectomy is a safe and feasible procedure with standard laparoscopic setup in patients with malignant periampullary disease.
A Surgery on Deep Infiltrating Endometriosis Involving the Rectum: A Debate Started 100 Years Ago between Cullen and Sampson
[Year:2020] [Month:May-August] [Volume:13] [Number:2] [Pages:3] [Pages No:94 - 96]
DOI: 10.5005/jp-journals-10033-1400 | Open Access | How to cite |
A recent randomized control trial reports at the 5 years postoperative stage for limited vs extended surgery involving the rectovaginal septum. For those gynecologists with advanced laparoscopy skills who have been reluctant to embrace the idea of complete bowel resections with reanastomosis, the study provides comfort in showing no difference in long-term outcomes between nodule excision and rectal resection. However, the study perpetuates the idea that all medical procedures have to be subjected to this type of statistical analysis, without any reference to the pioneers whose ideas formed the basis of current procedures as well as providing an understanding of the pathogenesis of the underlying disorder. The two gynecologists who first reported on the surgical management of this condition 100 years ago projected different ideas on pathogenesis as well as the appropriate surgical method to apply. Thomas Cullen and John Sampson should be acknowledged in any consideration of determining the appropriate procedure for this challenging disorder.