To show that laparoscopic lymph node dissection and harvesting is equal to laparotomic lymph node dissection in patients undergoing total gastrectomy for gastric carcinoma.

Retrospective data was collected from 36 patients who underwent total gastrectomy for carcinoma stomach. Fifteen patients underwent open total gastrectomy (OG) and other 21 laparoscopic assisted total gastrectomy (LAG) over a period of 4 years from March 2009 to June 2012. In the laparoscopic group, dissection of lymph nodes and division of ligaments and omentum was done laparoscopically using harmonic scalpel. Both groups were compared for operative blood loss, operative time, blood transfusion, morbidity, mortality, the number of harvested lymph nodes (HLNs) with emphasis on harvested lymph nodes.

There were no significant differences in morbidity or mortality in both groups. Tumor free margins were obtained in all cases. Compared with OG group, the LAG group had significantly less blood loss, but a longer operation time. The mean harvested lymph nodes (HLN's) is 24.7 in LAG group as compared 23.3 in OG group.

Laparoscopic dissection and harvested lymph nodes is equivalent to OG with no other significant differences except for decreased blood loss and increased operative time. Thus, this procedure can achieve the same result as OG.

Kumar TA, Gowda M, Sahoo MR. Laparoscopy: A Procedure no less than Laparotomy for Lymph Node Dissection in Total Gastrectomy for Gastric Carcinoma. World J Lap Surg 2013;6(3):111-115.

To compare results of laparoscopic treatment of perforated peptic ulcer (PPU) in early and late presentation.

Fifty-eight patients of age ranging from 18 to 55 years underwent laparoscopic closure of PPU over a period of 4 years between 2008 and 2011 of which 43 were male, 15 were female. In our study we took early presentation as 3 days and late presentation as 3 to 7 days (time taken for seeking treatment from the onset of symptoms). Thirty-seven presented early whereas other 21 presented late. All patients were compared for variables like operating time, intraoperative complications, risk of anesthesia, rate of conversion to open surgery, postoperative pain and the opiate analgesic requirements, postoperative morbidity and mortality, hospital stay.

Mean operating time for patients with early presentation was 60 vs 90 minutes for delayed presentation. Conversion rate was 0 in early presentation 47.6% (10 cases) in late presentation. Thorough abdominal toileting was possible in all cases of early presentation. In late presentation it was possible only in 6 out of 11 cases after excluding conversion rate because of intestinal matting. No patients had any anesthesia problem in early presentation but 3 out of 11 cases had delayed recovery from anesthesia requiring treatment in intensive care unit. Postoperatively Opioid analgesia was required for mean of 3 days in early presentation vs mean of 4 days in late presentation. Nasogastric tube was removed on 3rd day in early presentation vs 4th day in late presentation which coincided with return of bowel sounds. Port site infection was seen in 5 out of 37 cases in early presentation and 2 out of 11 in late presentation. Intraperitoneal localized abscess was seen in 2 out of 11 cases in delayed presentation and none in early presentation which was then managed by aspiration. Mean hospital stay was 5 days in early presentation and 7 days in late presentation.

Laparoscopic treatment of PPU is safe, feasible done with ease in patients presenting less than 3 days and also in some cases of late presentation, with anesthetic complication, postoperative complications and conversion rate increasing with delayed presentation.

Kumar TA, Gowda M, Sahoo MR. Laparoscopic Management of Perforated Peptic Ulcer in Early and Late Presentation: A Comparative Study. World J Lap Surg 2013;6(3):116-120.

About 1 to 2% of boys at age of 1 year have an undescended testis (UDT); almost 20% of UDT are nonpalpable. Several surgical procedures have been described but there are no formal guidelines for the management of boys with nonpalpable testis. We report our experience with laparoscopic orchiopexy performed without dividing the spermatic vessels in this case series over a period of 4 years stating that the Fowler-Stephens technique is no longer indicated for the treatment of the intra-abdominal testis.

Over a period of 7 years from 2005 to 2012, we carried out diagnostic laparoscopy on 50 nonpalpable intra-abdominal testis in 45 boys followed by laparoscopic orchiopexy without sectioning the spermatic vessels even in cases where testis was higher up (30 cases). The technique consisted in sectioning the gubernaculum, opening the peritoneum laterally to the spermatic vessels, and mobilizing the testicular vessels and the vas deferens in a retroperitoneal position for 8 to 10 cm. The testis was then brought down into the scrotum through a neo-inguinal ring created just lateral to medial umbilical ligament.

Out of 45 cases with 50 undescended testis, 30 testes were abdominal, away from the internal ring out of which we were able to bring 28 testis in the scrotum without dividing the spermatic vessels, using a neo-inguinal ring. The other two patients had to undergo orchidectomy because of atretic testis. In the remaining 20 cases, the testis was at the inguinal ring or close to it and mobilized easily through the neo-inguinal ring to scrotum. The mean follow-up period has been 14 months (6 months to 2 years) and all the testes were found to be in scrotum with no atrophy.

On the basis of our experience, we believe that laparoscopic orchiopexy without division of the spermatic vessels should be the treatment of choice in the management of nonpalpable testes because it does not compromise the normal testicular vascularization. Creation of neo-inguinal canal lateral to the medial umbilical ligament has the advantage of gaining more length on the vessels and vas to bring the testis to scrotum and hence Fowler-Stephens procedure is no longer routinely indicated in management of high abdominal testis.

Bhaskar V, Sahoo MR. Laparoscopic Orchidopexy without Division of Spermatic Vessels using a Neoinguinal Canal Approach: A Single Center Experience. World J Lap Surg 2013;6(3):121-126.

To assess feasibility, advantages, oncological safety, cost-effectiveness and short-term results of laparoscopic vs open total mesorectal excision (TME) for rectal cancer in a government sector hospital.

This comparative nonrandomized retrospective study analyzes the data of 70 patients with rectal cancer treated with low anterior resection (LAR) or abdominoperineal resection (APR) from May 2007 to June 2012. Of these 40 patients underwent laparoscopic TME and 30 underwent open TME. Both the groups were comparable.

Laparoscopic surgery took longer to perform (200 vs 150 min), but was accompanied by less blood loss (200 vs 800 ml) and fewer postoperative complications. Enteric function recovered sooner after laparoscopy than open surgery. Hospital stay was shorter for patients who underwent a laparoscopic surgery (7 vs 10 days). The mean number of harvested lymph nodes was greater in the laparoscopic group than in the open group (12 ± 3 vs 9 ± 2). Mean follow-up time was 30 months (range: 28-32 months). No local recurrence was found.

This study shows that laparoscopic TME for rectal cancer is a safe and feasible technique with some short-term benefits over open TME.

Sahoo MR, Kumar TA, Jaiswal S. Laparoscopic vs Open Total Mesorectal Excision for Rectal Cancer: A Clinical Comparative Study in a Government Sector Hospital. World J Lap Surg 2013;6(3):127-131.

Alhomoud H. Ethical Issues and Training in Laparoscopic Surgery. World J Lap Surg 2013;6(3): 132-133.

Singh S, Lavania S. Laparoscopic Cholecystectomy: What is Appropriate Position of Epigastric Port? World J Lap Surg 2013;6(3):134-137.

Laparoscopic adrenalectomy is considered the standard surgical approach for adrenal tumors and is replacing the open technique in the majority of centers. The aim of the present study was to review the authors experience with laparoscopic adrenalectomy.

A retrospective review of laparoscopic adrenalectomies performed by an endocrine surgeon over a period of 4 years at King Fahad Medical City was conducted perioperative and postoperative records were studied.

Total of 10 patients underwent laparoscopic adrenalectomy. Mean operative time was 3 hours and 30 minutes; length of hospital stay was significantly low. Complications were few, with one patient developing a port site hernia.

Laparoscopic adrenalectomy can be performed safely and has the advantages of minimally invasive surgery. With experience the technical aspects show marked improvement as there is a learning curve.

Alharthi BN, Zadie SZ, Iqbal J. Retrospective Review of Laparoscopic Adrenalectomy: An Experience at King Fahad Medical City, Riyadh. World J Lap Surg 2013;6(3):138-140.

Two methods have been used for peritoneal access to create pnemoperitoneum–the open and the closed technique. We are describing here an open technique of creating pneumoperitoneum through the umbilical cicatrix. We have been using this technique routinely in view of its safety, rapidity and technical ease.

This method was used in 156 patients serially to create pneumoperitoneum. Patients were followed at 10 days, 3 months and 1 year interval.

The time range was 22 to 540 seconds. The mean time taken was 85 seconds. More than 70% of the patients (n = 110) fell in the range of 22 to 80 seconds where as 36 were in the range of 80 to 100 seconds. Ten patients had the range of 100 to 540 seconds. There were no incidences of vessel or viscus injury even in reoperative cases. There were no cases of any major bleeding or hematoma. Two cases had wound infection which subsided with antibiotic and wound drainage. Out of 42 patients who have completed 3 months follow-up and 11 patients who have completed 1 year followup, none showed any port site hernia.

The open technique of creating pneumoperitoneum through the umbilical cicatrix is a safe and rapid technique.

Misro AK, Sapkota P, Misro R. Our Experience of Open Technique of Creating Pneumoperitoneum through Umbilical Cicatrix from a Remote Health Facility at Nepal. World J Lap Surg 2013;6(3):141-143.

A review article to assess the impact of obesity on laparoscopic colorectal resection.

Relevant papers were searched using Medline, Embase, the Cochrane Central Register of Controlled Trials Clinical Trial. Government, National Research Register, by using the search terms ‘laparoscopic colorectal surgery, obese, laparoscopy’.

Laparoscopic colorectal resection are feasible in obese patients. However, increased rates of conversion to laparotomy should be anticipated with increased length of hospitalization when compared to nonobese patients.

Alhomoud H. The Impact of Obesity on Laparoscopic Colorectal Resection. World J Lap Surg 2013; 6(3):144-148.

Worldwide about 782,000 people are diagnosed with colorectal cancer each year. Colorectal cancer is the third leading diagnosed cancer in the United States and the second leading cause of cancer-related deaths in Western countries. Surgery is the primary treatment modality in colorectal cancer. The laparoscopic approach to colectomy is slowly gaining acceptance for the management of colorectal pathology. The cost-effectiveness and long-term outcomes with laparoscopic colectomy (LAC) for malignancy are less well accepted. This review article was aimed to compare laparoscopic with open anterior resection and ascertain the therapeutic benefit, if any, in the overall management rectal cancer.

Ingle SS. Laparoscopic vs Open Anterior Resection. World J Lap Surg 2013;6(3):149-155.

To provide a review in the available literature in robotic gynecological surgery, focusing on history of robotic surgery, basic setup, advantages and disadvantages of the robotic surgery, uses of surgical robots, the future of the robotic surgery and finally laparoendoscopic single site robotic surgery.

Literature survey.

Although it is not evident that robotic surgery is superior to conventional laparoscopic surgery in surgical outcomes, many studies demonstrate the positive feasibility of robotic assisted laparoscopic surgery in many gynecological fields including cancer. Robotic surgery is considered as a solution for the technical problems of minimal invasive surgery. However, the economic feasibility of robotic surgery still remains as an obstacle which should be overcomed. It is expected with further development of robotic technology that the concept of high cost will be resolved.

Ali MK, Abdelbadee AY, Shazly SA, Abbas AM. Robotic Gynecological Surgery: A Clinical Approach. World J Lap Surg 2013;6(3):156-162.

This involved the review of related articles to robotic vs laparoscopic hysterectomy. The scope of this review covered Medline, UpToDate, PubMed, Highwire press, Da Vinci community, Google search engine.^12,13

Recent comparative studies have found that robotic and conventional laparoscopic hysterectomy are essentially equivalent regarding surgical and clinical outcome. Operating times are slightly higher and costs are significantly higher for the robotic hysterectomy.

Mohosho MM. Robotic vs Laparoscopic Hysterectomy: Is Robot Superior? World J Lap Surg 2013;6(3): 163-166.

We analyzed 9 published articles to critically look at the effectiveness of self-retaining barbed suture in laparoscopic myomectomy. A literature research was performed using internet.

Barbed suture seems to be a reasonably good option for intracorporeal suturing in laparoscopic myomectomy. The time required for intracorporeal suturing was significantly less with barbed suturing (11.5 min/9.9 min/126s) when compared to the conventional suturing (17.4 min/15.8 min/272.6s). The total operative time required with barbed sutures (118 min/51 min) was found to be significantly reduced in comparison with conventional sutures (162 min/ 58 min). The intraoperative blood loss was found to be significantly reduced in 2 of the 3 studies with the use of barbed sutures. Fall in hemoglobin and duration of hospital stay also seems to be reduced with the self-retaining sutures.

The self-retaining barbed suture seems to be an effective option for intracorporeal suturing in laparoscopic myomectomy with numerous benefits.

Puliyathinkal S. Barbed Sutures in Laparoscopic Myomectomy—Realistic Expectations: A Critical Review. World J Lap Surg 2013;6(3):167-169.

Misro AK, Sapkota P, Misro R. A Costeffective Way of Performing Laparoscopic Radical Nephrectomy in a Remote Health Facility in Nepal. World J Lap Surg 2013;6(3):170-172.

Gupta S, Agrawal P, Arumugam AK. CO₂ Inducer, Indicator (EtCO₂) and venting it, is the Healer of Subcutaneous Emphysema. World J Lap Surg 2013;6(3): 173-175.