To compare the acute inflammatory responses of CL and SA, considering only the trauma caused by the placement of the access port, at first time without pneumoperitoneum or other surgical manipulation. The variations of serum interleukin (IL)-4, -6, -8 and -10, tumor necrosis factor-alpha (TNF-α) and C-reactive protein (CRP) were evaluated.

Twenty pigs were randomly divided into two groups: a SA group and a CL group. In the SA group, the procedure began with a 2.5 cm skin incision, aponeurosis and peritoneum, and then the single-access device (Gelport®) was placed without pneumoperitoneum. In the CL group, the incision was performed on the skin, aponeurosis and peritoneum, and the four trocars were placed only with the traction of the abdominal wall. Once the access points were placed, blood samples were collected to measure the cytokines and CRP at: time zero (T0), immediately after anesthesia (including intubation); T1, immediately after the access point(s) was placed; T2, 120 minutes after the access point(s) was placed; and T3, 240 minutes after the access point(s) was placed.

The concentrations of IL-4 and TNF-α decreased between T0 and T3. IL-10 and CRP also decreased, but not significantly. IL-6 and IL-8 increased, but not significantly.

During the study, there was no significant difference between the inflammatory response triggered exclusively by placing the SA and CL without pneumoperitoneum.

Duarte RJ, Bandeira RAST, Vattimo A, dos Reis ST, Leite KRM, Cristofani LM, Srougi M. Difference between the Inflammatory Reaction Caused by the Placement of a Conventional Laparoscopic Access and a Single Access (Single Port) in Pigs. World J Lap Surg 2015;8(1):1-6.

The aim of our study was to evaluate and establish the role of diagnostic laparoscopy (DL) in unexplained/nonspecific abdominal pain (NSAP) in this era of therapeutic laparoscopy, and thus to analyze and support the theory of minimal access surgery in diagnosing and treating abdominal conditions.

In this prospective study included patients with abdominal pain of (i) more than 6 hours and less than 6 days duration (acute) and (ii) more than or equal to 6 months duration (chronic) were included whether presenting as a surgical emergency or coming to surgical outpatient department (OPD) in whom a DL was performed after failure to achieve a diagnosis with conventional methods. The study included a total of 168 consecutive patients who fulfilled our inclusion criteria and underwent DL for NSAP. Their demographic and clinical data, admission dates and dates of surgery were noted. Outcome of surgery was recorded and the data were analyzed to ascertain the role and diagnostic yield of laparoscopy in our department, both in acute and chronic abdominal pain of nonspecific nature. Patients were followed postoperative for 3 months for any recurrence of symptoms.

Laparoscopy yielded diagnoses in 161 of these patients giving a diagnostic yield of 95.8%. Appendicitis (39.2%), gynecological pathology (16%) and abdominal tuberculosis (8.9%) were the major findings. Therapeutic procedures were performed in 112 cases (66.6%) where peroperative pathology was identified. In 38 cases (22.6%) where there was strong clinical suspicion of appendicitis and no pathology could be identified peroperative, an appendectomy was performed. Twenty-eight (73.6%) of these appendix specimens were found inflamed on subsequent histologic examination. There were no complications in this series.

This study establishes the role of early DL as a safe procedure with high efficacy. Hence, it is an effective investigative tool in undiagnosed abdominal pain of both acute and chronic nature.

Rubbia A, Faryal GA, Javeria I, Roohul M. Role of Diagnostic Laparoscopy in Patients with Acute or Chronic Nonspecific Abdominal Pain. World J Lap Surg 2015;8(1):7-12.

Abdominal pain and shoulder tip pain after laparoscopic cholecystectomy are distressing for the patient. Various causes of this pain are peritoneal stretching and diaphragmatic irritation by high intra-abdominal pressure caused by pneumoperitoneum. We designed a study to compare the postoperative pain after laparoscopic cholecystectomy at low pressure (7-8 mm Hg) and standard pressure technique (12-14 mm Hg).

To compare the effect of low pressure and standard pressure pneumoperitoneum in post-laparoscopic cholecystectomy pain. Further to study, the safety of low pressure pneumoperitoneum in laparoscopic cholecystectomy.

A prospective randomized double blind study.

A prospective randomized double blind study was done in 50 ASA grade I and II patients. They were divided into two groups—25 each. Group A, patients underwent laparoscopic cholecystectomy with low pressure pneumoperitoneum (7-8 mm Hg) while group B, underwent laparoscopic cholecystectomy with standard pressure pneumoperitoneum (12-14 mm Hg). Both the groups were compared for pain intensity, analgesic requirement and complications. Shoulder tip pain was recorded on a visual analog pain scale 1, 6, 12, 24 and 48 hours after operation.

Demographic data and intraoperative complications were analyzed using Chi-square test. Frequency of pain, intensity of pain, analgesics consumption and other pneumoperitoneum related complications were compared by applying ANOVA test.

Postoperative pain score was significantly less in low pressure group as compared to standard pressure group. Number of patients requiring rescue analgesic doses was more in standard pressure group. This was statistically significant. Also total analgesic consumption was more in standard pressure group. There was no difference in intraoperative complications.

This study demonstrates the use of simple expedient of reducing the pressure of pneumoperitoneum to 8 mm results in reduction in both intensity and frequency of postoperative pain, and hence early recovery and better outcome. This study also shows that low pressure technique is safe with comparable rate of intraoperative complications.

Zaman M, Chowdhary K, Goyal P. Prospective Randomized Trial of Low Pressure Pneumoperitoneum for Reduction of Shoulder Tip Pain following Laparoscopic Cholecystectomy: A Comparative Study. World J Lap Surg 2015;8(1):13-15.

To assess the usefulness of practicing preoperative coagulations tests in preparation of laparoscopic surgical procedures.

Retrospective observational study.

king fahad medical city a tertiary-care referral center in Saudi Arabia.

Five hundred and fifty adult patients scheduled for elective laparoscopic surgery were studied to determine whether plan of management was influenced by routinely done bleeding time (BT), platelet count (PC), prothrombin time (PT), activated partial thromboplastin time (APTT) and international normalization ratio (INR).

No intervention or change of management was identified in 463 patients whom coagulation profiles were done routinely as part of preoperative preparation. However, management plan was changed in 5 (5.75%) of 87 patients having indications for coagulation profile test (p < 0.01).

The study shows that preoperative screening tests for coagulopathies not suspected on the basis of detailed clinical information are unnecessary and should not be done.

Riyad M, Uddin S, Alsaied G, Alshareef A, Muhaimeed K, Abdulkarim Y. Coagulation Profile is Randomly done but never Helps in Preparation of Laparoscopic Surgery. World J Lap Surg 2015;8(1):16-20.

Several recent studies have produced conflicting results of warming up prior to laparoscopic surgery and surgical performance. The purpose of this study was to investigate whether warming up prior to a laparoscopic task improves a subsequent task performed on a laparoscopic trainer.

A prospective randomized controlled trial was conducted to compare warm-up modalities to no warm-up. The study was conducted at a single site, with 44 participants, including surgeons, medical students and surgical trainees. Randomization done within each group.

Control group was asked to do a designated task without a warm-up. Warm-up groups were asked to perform a warmup exercise prior to the designated task. Performances were recorded and analyzed with a computerized software different performance parameters were compared.

Warm-up was a significant predictor of smoothness of the operator's hand movement at the 5% significance level (p = 0.0358).

While there were some improvement of performances between control groups was demonstrated, they were not clinically significant.

This study shows that warming up prior to a task has a positive influence in the subsequent performance in smoothness of instrument movement in surgeons group. The major limitation of the study was the number of participants.

Navaneethan N, Hewett P. Effect of Warm-up Exercises on Laparoscopic Trainer: Improvement of Operator Smoothness. World J Lap Surg 2015;8(1):21-25.

Busmar B. Comparison between Robotic Radical Hysterectomy with Laparoscopic and Open Abdominal Radical Hysterectomy in the Treatment of Early Stage Cervical Cancer. World J Lap Surg 2015;8(1):26-31.

Sułkowski L, Pasternak A, Szura M, Matyja M, Solecki R, Matyja A. Single-incision Laparoscopic Cholecystectomy. How can we Reduce the Costs? Presentation of a Technique using Straight Non-articulating Instruments and One Conventional Trocar, without Commercially Available Single Port Devices. World J Lap Surg 2015;8(1):32-34.