Context: This study was undertaken to reduce the incidence of port site infection (PSI). Aim: The study aimed to evaluate the impact of povidone iodine (PI)-dipped ports on PSI and compare it to non-PI-dipped ports. Materials and methods: A total of 164 patients undergoing elective laparoscopic surgery were enrolled in the study. All patients underwent routine preoperative workup. They were randomized into control and intervention groups. For patients in the intervention group, ports were dipped in 10% PI solution 5 minutes prior to usage. In the control group, conventional techniques were used. Patients were evaluated for infections on days 1, 3, 7, and 30. Statistical analysis: Data was compiled in Microsoft Excel and processed using Statistical Package for the Social Sciences (SPSS) software. Quantitative parameters were compared using the t-test while qualitative were compared using the Chi-square test. Results: The two groups were equally matched with respect to demographic and laboratory factors with no statistically significant difference between the two. Port sites were evaluated on days 1, 3, 7, and 30 using the Southampton scoring system. In the intervention group, infection was found to be 3.6% on day 1; 6.1% on day 3; and 1.2% on days 7–30. No statistically significant difference was found when compared to the infection rate in the control group (3.6, 2.4, and 1.2%). Conclusion: Ports dipped in PI have no significant impact on the incidence of PSI in elective laparoscopic surgeries.

Background: Total mesorectal excision (TME) by conventional laparotomy has been considered the standard of care for patients with rectal cancer. Over the past two decades, numerous prospective randomized studies have reported the feasibility, safety, and advantages of laparoscopic colorectal surgery. The benefits of laparoscopic surgery are advantageous only when the quality of the TME, as demonstrated by standardized pathological measures, is at least similar, if not superior, to that of open TME. However, in most of the studies, the impact of laparoscopic TME on pathological outcomes has been inconsistently reported. Therefore, we aimed to assess the quality of TME in laparoscopic resection of rectal cancer. Materials and methods: We reviewed retrospectively the medical records of patients who underwent laparoscopic resection for rectal cancer post-chemoradiation during the period from 2017 to 2021 at our institute. Patient data were collected from the cancer registry. The quality of pathological outcomes was analyzed by the completeness of TME, circumferential margins, lymph node harvest, and distal resection margins. Data analysis was done using MS Excel, and SPSS 28.0 (Trail version). Using this software, frequencies, percentage, range, mean, and standard deviation. Chi-square test, t-test, and p-values were calculated. Results: A total of 64 patients were included in the study. And 35 patients underwent low anterior resection (55%), 22 patients underwent abdominal perineal resection (34%), and 7 patients underwent anterior resection (11%). The mesorectum excision was complete in 58 patients (90.48%) and near complete in 6 patients (9.52%). The average number of lymph nodes harvested was 10. The multivariable analysis between patients with lymph nodes retrieved less than 12 and greater than 12 shows that the lymph node retrieved is less than 12 if the interval between radiotherapy and surgery is less than 6 weeks which is statistically significant (p-value –0.04). And there was no statistically significant association between the number of nodes retrieved and survival rate. Positive circumferential margins were seen in 2 patients (4%) and the rest 62 patients (96%) showed negative margins. In all the patients, distal resected margins were free of tumors. In a follow-up of 2 years, distant metastasis was seen in 5 patients. No one had local recurrence. Conclusions: Our study has shown that optimal pathological outcomes can be achieved with laparoscopic mesorectal excision in rectal cancer patients. Among patients who received preoperative chemoradiation, the number of lymph nodes retrieved was not associated with overall survival.

Aim and background: Over the past few decades, laparoscopic hysterectomies have dramatically increased and even exceed vaginal hysterectomies (VHs). This study aimed to determine which approach offers the greatest benefits based on the results of a total laparoscopic hysterectomy (TLH) and a laparoscopic-assisted vaginal hysterectomy (LAVH). Materials and methods: We performed a prospective study on patients posted for hysterectomy in the Department of Obstetrics and Gynecology from January 2021 to December 2021. An equal number of patients were posted for TLH and LAVH, according to the selection criteria, randomly, after getting written consent. The average age of the TLH group was 44 years and LAVH group was 46 years. Results: Among 100 patients, 50 patients were included in the LAVH group and 50 were included in the TLH group. A total of 30 patients were presented with previous lower abdominal pelvic surgery such as tubal ligation and appendectomy LSCS. The majority of patients who underwent TLH and LAVH were pathologically confirmed uterine fibroids (n = 36) and adenomyosis (n = 36). The LAVH required longer surgery duration (122.5 ± 25.37) than TLH (114.2 ± 18.93) with p = 0.066. In both groups, the average hospital stay was almost the same (4.26 vs 4) days. Conclusion: Total laparoscopic hysterectomy has an advantage over LAVH in terms of duration of surgery, blood loss, hospital stay, and postepisode recovery. Moreover, the decision to perform either LAVH or TLH should be based on the healthcare expertise in the field of laparoscopic and vaginal operative procedures. Also, patients’ satisfaction and mental health is a hallmark of surgeries. Clinical significance: Based on the present study, we recommended that TLH be an effective operative procedure as compared to LAVH. Because it requires a short duration for surgery, there is minimum blood loss, it does not require a prolonged hospital stay, and the patient's recovery time is also effective.

Background: Routine performance of a prophylactic postoperative drainage after abdominal surgeries was done to prevent and manage postoperative intra-abdominal complications. Sure evidence to avoid routine performance of prophylactic drainage after surgery in gastric cancer (GC) patients and its role in reducing postoperative morbidity was not reached yet. Aim: The aim of the present study was to compare between patients who underwent prophylactic drainage and patients who did not undergo prophylactic drainage following total laparoscopic gastrectomy in patients diagnosed with distal GC. Patients and methods: We included 150 patients who underwent totally laparoscopic distal gastrectomy for surgical management of histopathologically confirmed GCs. We divided patients into two groups, the first group included 100 patients and underwent totally laparoscopic gastrectomy with prophylactic drainage, and the other group included 50 patients underwent totally laparoscopic gastrectomy without performing drainage. We compare between both included groups regarding short-term and long-term outcomes. Results: Operative times in the group of patients who have drain group were longer than that in those with no drain. We showed that in the group of patients with drain, the number of days from time of surgery to time of soft diet initiation and time to first flatus was more than that in the no drain group. Conclusion: Avoiding prophylactic drain insertion in some patients after performing totally laparoscopic gastrectomy for management of gastric cancer could be feasible. It increases patients comfort without increasing the risk of postoperative complications.

Background: Nephrectomy is the cardinal treatment option for patients with non-functioning kidneys due to malignant and benign causes. Both laparoscopic and open nephrectomy is preferred but the laparoscopy has less complication and improved surgical outcome when compared over open procedure. In this backdrop, the present study was conducted to compare the surgical outcomes and complications of open and laparoscopic nephrectomy procedures. Materials and methods: This was a retrospective study conducted on 50 patients admitted with non-functioning kidneys. They were divided into two groups—laparoscopic nephrectomy (n = 25) and open simple nephrectomy (n = 25). The duration of hospital stay, surgery, postoperative catheter drain removal and surgical complications were analyzed and compared between laparoscopic and open methods. Results: Laparoscopic nephrectomy showed less operative time (90.60 ± 15.99 vs 133.64 ± 10.57 minutes; p = 0.001), shorter hospital stay (3.40 ± 0.12 vs 5.48 ± 0.16 days; p = 0.001) and early postoperative catheter removal (3.20 ± 1.08 vs 2.56 ± 1.04; p = 0.03) when compared with open nephrectomy and it was significant. The complication rate was lower in laparoscopic nephrectomy when compared with simple open nephrectomy (12 vs 36%). Conclusion: Laparoscopic nephrectomy for non-functioning is an effective alternative to open nephrectomy, leading to reduced operative time, quicker recovery and fewer complications as indicated by our findings.

Aims: The aims of this study are to evaluate the effectiveness, feasibility, and safety of laparoscopy for managing complicated appendicitis and to look for postoperative complications as well as morbidity, in a Tertiary Care Hospital. Objectives: To study the laparoscopic appendicectomy in cases of complicated appendicitis with respect to: • Mean duration of the surgical procedure. • Number of days of antibiotics given, postoperatively. • Postoperative day-start of oral feeds. • The incidence of postoperative morbidity. • Analgesics required. Materials and methods: This prospective study was conducted in a Tertiary Care Hospital in Ahmedabad on 50 patients who underwent laparoscopic appendicectomy between June 2022 and March 2023. Conclusion: • Our study has shown results encouraging the use of laparoscopic appendicectomy in cases of complicated appendicitis, having found less postoperative morbidity along with early start of postoperative oral feeds and decreased requirement of postoperative antibiotics. • Although the laparoscopic method can be technically challenging, but the results have demonstrated its feasibility and safety. • Although the number of patients enrolled in this study is far too small, preliminary results show that our experiences with laparoscopic appendicectomy in complicated appendicitis have been encouraging, although technically demanding, with proper surgical technique, it can be done without much postoperative complication. • As the laparoscopic approach has less morbidity in our study, we recommend the use of laparoscopy even with complicated appendicitis.

In modern times, surgical site infections (SSIs) are defined as infections occurring within 30 days after surgery (or 1 year in patients with implants) at the incision or deep tissue level. Purulent drainage should be observed and organisms from the site should be isolated for epidemiological purposes. Most of the factors contributing to SSIs are patient-related, as the majority of infections are caused by endogenous flora. It has also been suggested that unclean operating hands due to glove contamination do not affect rates of postoperative infections. While the traditional surgical scrub has so far stood the test of time, it is important to consider its environmental impact. There have been multiple attempts to reduce the carbon footprint of the surgical hand scrub, including usage of a different model of tap but there is an easier option available to us: hand rubbing. It takes up significantly less water, as reported by some of the studies given above. It is also particularly beneficial in resource-limited settings. All studies except one reported that hand rub solutions are also more affordable, making them accessible in poorer countries and hospitals. Our study results similarly suggest that waterless hand rubbing is at least as effective as hand scrubbing in preventing SSIs, and is a viable solution to address water scarcity concerns.

This review addresses gastroesophageal reflux disease (GERD), a prevalent and challenging condition worldwide, focusing on the role of 24-hour pH monitoring in assessing pre- and post-laparoscopic fundoplication. Laparoscopic fundoplication reinforces the lower esophageal sphincter (LES) in GERD. The review analyzes 35 relevant studies, exploring pH monitoring's significance in patient selection, tailored surgical intervention, and postoperative evaluation. Pre-fundoplication pH monitoring establishes baseline acid exposure, aiding surgical decision-making. Post-fundoplication monitoring evaluates procedure effectiveness, revealing reduced acid exposure time (AET) and improved De Meester Score (DMS), indicating symptom relief. The review draws from diverse databases, emphasizing pH monitoring's clinical importance in GERD management. Despite various diagnostic tools, 24-hour pH monitoring remains the gold standard, enhancing personalized patient care. The review identifies gaps, emphasizing the need for further research in wireless pH monitoring and laparoscopic or robotic antireflux surgery. Overall, integrating 24-hour pH monitoring with laparoscopic fundoplication shows promise for improving outcomes, warranting future research for methodological refinements and technological advancements in GERD management.

Background: Achalasia cardia (AC) is an esophageal motility disorder which, if left untreated, may progress to end-stage sigmoid achalasia characterized by mega-esophagus. It occurs with equal frequency in men and women and there is no racial predilection. Peak incidence has been reported between 30 and 60 years of age. Case presentation: We herein report a case of a 48-year-old male with progressive dysphagia due to Sigmoid Achalasia, who was treated successfully with laparoscopy. Clinical significance: Several treatment options exist for the surgical management of a sigmoid esophagus with achalasia, but there is no clear gold standard. In our case, Heller's cardiomyotomy with Dorr's fundoplication provided favorable results.

Internal hernia through a defect in the broad ligament of the uterus is a very rare condition. We review a case of a 55-years-old female with small bowel obstruction due to herniation of a small bowel loop through a defect in the broad ligament of the uterus on the right side. Computed tomography of the abdomen reported finding of small bowel obstruction, a small bowel loop seen between the uterus and urinary bladder in the right lower pelvis with surrounding inflammatory changes, possibility of an Internal hernia through a defect in the broad ligament. This was managed laparoscopically.

Aim: To elucidate the findings in a rare yet potentially morbid complication in a case of uncomplicated Cholecystitis. Background: Chyle leak after laparoscopic cholecystectomy (LC) is rarely reported. However, it must be recognized promptly and managed as it can lead to further metabolic and infectious complications. Case description: We present the case of a 40-year-old lady who was admitted with ultrasound-proven cholelithiasis with no signs of cholecystitis. Her Total leukocytic count and liver function tests were within normal limits. She underwent an uneventful standard LC. Postoperatively there was a cumulative collection of 150 mL of white fluid in his drain. The fluid triglyceride was 1620 mg/dL, confirming it to be chyle. She was clinically asymptomatic. She was managed conservatively as a low-volume chyle leak with a fat-free diet. The drain was removed on postoperative day (POD) 11 after nil collection for 3 consecutive days. Conclusion: Chyle leak, though a rare complication, after LC timely response and active intervention help in managing rare complications of LC like chylous leak for better outcomes. Significance: The ‘take home’ message is that although rare, chyle leaks should be considered even in uncomplicated LC.

Introduction: When performed by a skilled provider appropriately, induced abortion is a very safe medical procedure. However, a series of complications such as uterine perforation can still occur rarely. Case presentation: We present a case of tinea coli evisceration through a uterine perforation that occurred during a manual vacuum aspiration (MVA) procedure for uterine evacuation. The case presented with crampy lower abdominal pain 2 days after she had an MVA procedure for an incomplete abortion. The diagnosis of uterine perforation was considered on ultrasonography (USG) examination. Explorative laparoscopy was subsequently done and a posterior uterine wall perforation of ~2 cm was identified. A tinea coli of the sigmoid colon was seen sucked into the uterus through the perforation but no wall of the colon was lacerated or sucked in. The tinea coli was pulled out and the uterine defect was repaired laparoscopically. Conclusion: This unique case, the first of its kind to be reported to our knowledge, could be a reminder to consider tinea coli evisceration in suspected uterine perforation but without typical manifestations of bowel injury.

Background: Complications during colonoscopy such as perforation or bleeding may occur. Colonic perforation must be detected early in order to manage and reduce morbidity and mortality. Conservative, endoscopic, or surgical (laparoscopy or laparotomy) management techniques are available. The objective of this case report is to describe the management of a patient with post-colonoscopy polypectomy colonic perforation using a robotic platform approach. Case presentation: A 59-year-old male presented with a medical history significant for hypertension and hyperlipidemia, and he had several polyps removed with colonoscopy the day before admission. He started to have some left-sided abdominal pain which worsened and then moved to the right side. The primary diagnoses, interventions, and outcomes: CT scan was performed and revealed a small volume pneumoperitoneum, consistent with hollow viscus perforation and peritoneal signs on physical exam. He was taken to the OR for emergency robotic diagnostic laparoscopy, and proximal transverse colon repair with peritoneal lavage was successfully completed. There were no intraoperative complications or need for open conversion. The patient was discharged after 2 days and he did not suffer postoperative complications and did not need readmission. Conclusion: The robotic platform offers advantages that overcome the limitations of the laparoscopic approach including visualization, stability, dexterity, and precision. We believe that these advantages are maximized in the acute surgery setting. This case report proves that in experienced hands, the robotic platform is safe and effective for acute complex surgery cases. Further studies are recommended to determine the specific benefits of robotic laparoscopy in colonic emergency procedures.

Background: Wandering accessory spleen (WAS) is a very rare but dangerous condition. Patients are often asymptomatic and the diagnosis can be accidental. An early diagnosis and a correct treatment are fundamental. Case presentation: A young woman with renal disorders underwent laparoscopic surgery after sudden abdominal pain. Radiological exams show a wandering abdominal mass located in different abdominal areas. Discussion: Wandering accessory spleen is often asymptomatic. A torsion on its vascular axis leads to emergency surgery. Laparoscopy is the gold standard treatment in the correct management of this rare condition. Definitive diagnosis is based on histological exams.