Journal of Minimal Access Surgery最新文献

{"title":"Opioid-free anaesthesia with loco-regional block enhances safety and recovery in patients with obesity undergoing non-bariatric surgery: A randomised controlled trial.","authors":"Aparna Sinha, Dinesh Punhani, Abhishek Sharma, Sangeetha Patro, Neha Gupta, Misha Katyal","doi":"10.4103/jmas.jmas_35_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_35_26","url":null,"abstract":"<p><strong>Introduction: </strong>Opioid-free anaesthesia (OFA), when incorporated into enhanced recovery after surgery (ERAS) pathways, may improve peri-operative safety and recovery in patients with obesity. We evaluated the efficacy and safety of a multimodal OFA regimen incorporating loco-regional anaesthesia in this population undergoing general anaesthesia.</p><p><strong>Patients and methods: </strong>In this prospective randomised study with participant and outcome-assessor blinding, 380 adults (body mass index >35 kg/m 2 ) undergoing elective laparoscopic cholecystectomy were randomised to receive OFA or non-OFA (N-OFA). The OFA group received dexmedetomidine (0.3-0.5 μg/kg/h), low-dose ketamine (0.2 mg/kg) and an ultrasound-guided subcostal transversus abdominis plane block with 30 ml of 0.25% bupivacaine. The N-OFA group received fentanyl (1-2 μg/kg ideal body weight). All patients received total intravenous anaesthesia. The primary outcome was time to discharge readiness (DR). Secondary outcomes included pain scores, opioid requirement, quality of recovery-40 (QoR-40) and airway-related adverse events (ARAEs).</p><p><strong>Results: </strong>Baseline characteristics were comparable, and pain scores were significantly lower in the OFA group at 3 and 24 h ( P < 0.001). At 24 h, 61.1% of patients in the OFA group reported no pain compared with 42.6% in the N-OFA group. Rescue opioid requirement was markedly reduced (2.1% vs. 95.5%, P < 0.001). Time to DR was shorter (9.7 ± 1.6 h vs. 11.6 ± 2.7 h, P < 0.001), and QoR-40 scores were higher in the OFA group. ARAEs were not statistically significant.</p><p><strong>Conclusion: </strong>OFA using loco-regional block, dexmedetomidine and ketamine improves recovery, reduces opioid use and accelerates DR in patients with obesity undergoing laparoscopic surgery.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical clip migration in the biliary tract.","authors":"Haoyu Song, Lei Yang, Zhipeng Sun","doi":"10.4103/jmas.jmas_298_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_298_25","url":null,"abstract":"<p><strong>Abstract: </strong>Surgical clip migration in the biliary tract is uncommon and the diagnosis is still challenging, which may affect the treatment of these scenarios. We report three cases of surgical clip migration in the biliary tract that occurred in our clinical practice. Three female adults were diagnosed with dilation of the common bile duct (CBD), surgical clip migration in the biliary tract and the tumour of CBD, respectively. All of them had a history of hepatobiliary surgery. All of them were diagnosed with surgical clip migration in the biliary tract before surgery and underwent surgery and the migration surgical clips were removed successfully. The cause of surgical clip migration in the bile duct, whether it is non-absorbable Hem-o-lok or absorbable clip, is the foreign body reactions leading to bile duct wrapping the surgical clips and cause their migration. It may also be caused by continuous compression between the surgical clip and the CBD.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic cholecystectomy during pregnancy: A five-year single-centre experience.","authors":"Mubashir A Shah, Bilal A Wagay, Syed Mohsin Aijaz","doi":"10.4103/jmas.jmas_437_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_437_25","url":null,"abstract":"<p><strong>Introduction: </strong>Symptomatic gallstone disease is amongst the most common non-obstetric surgical conditions encountered during pregnancy. Historically, conservative management was favoured due to concerns regarding foetal safety during anaesthesia and laparoscopy. However, advances in minimally invasive surgery, anaesthetic techniques, and perioperative monitoring have led to increasing acceptance of laparoscopic cholecystectomy (LC) as a safe and effective treatment option during pregnancy. To evaluate perioperative outcomes, operative feasibility and maternal-fetal safety in pregnant patients undergoing LC in a tertiary care centre.</p><p><strong>Patients and methods: </strong>A hybrid retrospective-prospective observational study was conducted, including pregnant patients who underwent LC between January 2021 and December 2025. The study comprised a retrospective analysis (2021-2023) and a prospective cohort (2024-2025). Data collected included demographic characteristics, gestational age, surgical indication, operative details, maternal complications and neonatal outcomes. Descriptive statistics were used for the analysis.</p><p><strong>Results: </strong>Thirteen pregnant patients underwent LC during the study period. The mean maternal age was 28.5 ± 4.2 years, and the mean gestational age at surgery was 18.5 ± 3.1 weeks (range 14-28 weeks). Ten procedures were performed during the second trimester and three during the third trimester. All surgeries were completed laparoscopically without conversion to open surgery. Mean operative time was 45 min (range 35-65 min). One patient developed transient post-operative uterine contractions, which resolved with tocolytic therapy. No foetal distress, congenital anomalies or maternal surgical complications were observed.</p><p><strong>Conclusion: </strong>LC during pregnancy is a safe and feasible procedure when performed with multidisciplinary planning, pregnancy-specific technical modifications and appropriate foetal monitoring. Our findings support the growing body of evidence that minimally invasive surgery can be safely performed in selected pregnant patients requiring definitive treatment for symptomatic gallstone disease.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary hepatic neuroendocrine tumour in a child.","authors":"Sanjay Kumar, Akanksha, Khushi, Pooja Rathee, Sant Prakash Kataria, Sunita Singh","doi":"10.4103/jmas.jmas_587_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_587_25","url":null,"abstract":"<p><strong>Abstract: </strong>Primary hepatic neuroendocrine tumour (PHNET) is an exceptionally rare neoplasm, accounting for approximately 0.3% of all neuroendocrine tumours. It presents with non specific clinical and radiological features, making pre operative diagnosis difficult. Differentiation from other paediatric liver lesions, such as hepatoblastoma, haemangioma and hepatocellular carcinoma, is challenging. We report the rare case of PHNET in a 9 year old boy who presented with abdominal pain and vomiting. Routine laboratory investigations, including liver function tests and serum alpha fetoprotein levels, were within the normal limits. Radiological evaluation suggested a diagnosis of sclerosed hepatic haemangioma. Definitive diagnosis was established by histopathological examination and immunohistochemistry. Surgical resection was performed, which remains the mainstay of treatment. The post operative course was uneventful and regular follow up. This case highlights the diagnostic difficulty of PHNET and underscores the importance of histopathological evaluation for accurate diagnosis and appropriate management.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the effects of isoflurane and desflurane on the optic nerve sheath diameter in elderly patients undergoing robotic-assisted laparoscopic radical prostatectomies in steep Trendelenburg position - A randomised controlled trial.","authors":"Nisha Rajmohan, Fara Suhana, Sangeeth Perath Srinivasan, Shilpa Omkarappa, Suresh Gangadharan Nair, Shemeema Mundekkat","doi":"10.4103/jmas.jmas_511_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_511_25","url":null,"abstract":"<p><strong>Introduction: </strong>Optic nerve sheath diameter (ONSD) serves as a reliable surrogate marker for intracranial pressure (ICP) during robotic assisted laparoscopic radical prostatectomies (RARP). ICP elevation is greater in patients above 60 years due to impaired cerebral autoregulation and compliance. While total intravenous anaesthesia with propofol has demonstrated better control over ONSD compared to inhalational anaesthetics, the latter's dose-dependent vasodilatory effects on cerebral vessels remain understudied. This trial is aimed to compare the effects of isoflurane and desflurane on ONSD in elderly patients undergoing RARP. Secondary goals include incidence of neurological complications, delayed recovery and duration of hospital stay.</p><p><strong>Patients and methods: </strong>A prospective randomised controlled study was conducted on 54 elderly patients aged 60 years and above, undergoing RARP. These patients were randomised to receive isoflurane or desflurane for maintenance of anaesthesia. ONSD measurements and hemodynamic parameters were obtained at baseline, during pneumoperitoneum and postoperatively. Recovery profiles, complications and duration of hospital stay were recorded. Data were analysed using the Pearson Chi-square test, independent sample t -test and Mann-Whitney test.</p><p><strong>Results: </strong>A total of 50 patients were analysed. While mean ONSD values were raised from baseline intraoperatively in both groups, values remained within normal limits without significant intergroup differences. ONSD values returned to baseline in all patients at the end of surgery. Neither group exhibited post-operative complications nor delayed recovery.</p><p><strong>Conclusion: </strong>Isoflurane and desflurane exhibit comparable and safe profiles in terms of ICP elevation during RARP. Both agents are effective for maintenance of anaesthesia in elderly patients requiring steep Trendelenburg positioning for RARP.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomised trial validating the efficacy of standardised pain management regimen developed through a quality improvement study in laparoscopic surgery.","authors":"Jasmine Dhal, Krishna Asuri, Rashmi Ramachandran, Ashok Deorari, Omprakash Prajapati, Virinder Kumar Bansal","doi":"10.4103/jmas.jmas_532_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_532_25","url":null,"abstract":"<p><strong>Background: </strong>Post-operative pain mainly determines patient satisfaction but largely remains unaddressed owing to a lack of a uniform standardised perioperative pain management regimen, despite several existing recommendations on multimodal analgesic regimens.</p><p><strong>Patients and methods: </strong>This study included patients undergoing laparoscopic cholecystectomy or inguinal hernia repair between 31 May 2019 and 31 December 2021. Phase 1 comprised an observational study for assessment of baseline post-operative pain and a root cause analysis for development of a standardised pain management regimen, followed by Plan-Do-Study-Act (PDSA) cycle(s) until the aim was achieved, i.e. post-operative pain scores on Visual Analogue Scale (VAS) ≤3 at 0 h, 1 h, 2 h, 4 h, 6 h, 12 h, at discharge, 1 week, 6 weeks and 3 months, in at least 70% of patients. Phase 2 included a randomised trial to test the standardised pain management regimen.</p><p><strong>Results: </strong>In Phase 1 ( n = 20), suboptimal pain control was noted till 6 h postoperatively in the majority. The first PDSA cycle ( n = 20) achieved the aim of the quality improvement (QI) study, and the regimen was standardised. Interim analysis revealed significantly lower median pain scores ( P < 0.05) at all-time intervals. In Phase 2, sixty patients were randomised, 30 in each arm. The number of patients with acceptable pain (VAS ≤3) at 1 h was significantly ( P = 0.038) higher in the QI arm, correlating with significantly lower median pain scores ( P = 0.01). However, pain scores at other intervals were comparable.</p><p><strong>Conclusion: </strong>A standardised pain management regimen may significantly benefit early post-operative pain following laparoscopic surgery.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomised controlled study to compare the extended view totally extraperitoneal and transabdominal pre-peritoneal in terms of early post-operative complications in groin hernias.","authors":"Srishti Bishnoi, Priyam Sharma, Shardool Vikram Gupta, Atul Jain, Md Abu Masud Ansari, Neeti Kapur","doi":"10.4103/jmas.jmas_572_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_572_25","url":null,"abstract":"<p><strong>Introduction: </strong>The extended-view totally extraperitoneal (eTEP) technique is designed to overcome the limited working space and fixed port constraints of conventional totally extraperitoneal (TEP) hernia repair. This study aimed to provide a direct, randomised comparison of early outcomes between the eTEP approach and the transabdominal pre-peritoneal (TAPP) technique for groin hernias.</p><p><strong>Patients and methods: </strong>A prospective, randomised, single-blind, parallel-group trial was conducted at a tertiary care centre. Seventy patients were allocated to either eTEP or TAPP repair (35 per group). Early post-operative complications - defined as post-operative pain, seroma and scrotal hematoma - were assessed as the primary composite endpoint. Key secondary endpoints included operative time, intraoperative complications, blood loss, hospital stay and early recurrence.</p><p><strong>Results: </strong>Demographic and hernia characteristics were comparable at baseline. While Visual Analogue Scale pain scores decreased significantly over time in both groups ( P < 0.001), there was no statistically significant difference between the groups at any assessed interval. Seroma was clinically detected in three patients (8.6%) in the eTEP group at 1 week, all of which resolved spontaneously; no seromas occurred in the TAPP group ( P = 0.239). The median operative time was significantly shorter for eTEP (85 min, interquartile range [IQR]: 76-103) compared to TAPP (94 min, IQR: 87-110; P = 0.011). Rates of intraoperative complications, blood loss and mean hospital stay were similar between groups.</p><p><strong>Conclusion: </strong>Both eTEP and TAPP are safe and effective for groin hernia repair, demonstrating comparable early post-operative pain and morbidity. The eTEP technique was associated with a statistically significant reduction in operative time, positioning it as a valuable surgical alternative to TAPP.</p><p><strong>Trial registration: </strong>Clinical Trials Registry-India (CTRI/2023/09/057520).</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic distal gastrectomy gastric cancer in a patient with severe kyphosis: A case report and literature review.","authors":"Hiep Van Pham, Hoai To Nguyen, Thang Manh Tran, Phuong Nguyen Nhu Pham","doi":"10.4103/jmas.jmas_294_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_294_25","url":null,"abstract":"<p><strong>Abstract: </strong>Severe kyphosis poses significant challenges to gastric cancer surgery due to anatomical constraints. This case report details a successful laparoscopic distal gastrectomy in a 71-year-old female with advanced pyloric gastric cancer (cT3N1M0) and severe kyphosis from a prior spinal injury. The patient's spinal deformity, with a 60° Cobb angle, restricted abdominal space, rendering open surgery unfeasible. A laparoscopic approach with modified trocar placement and intraoperative adjustments, including low camera positioning and strategic organ retraction, enabled safe resection and Billroth II anastomosis. The procedure was completed without complications, with oral intake resumed on post-operative day 2 and discharge on day 5. This case demonstrates the feasibility of laparoscopic gastrectomy in patients with complex anatomical variations, highlighting the importance of customised surgical planning to achieve minimally invasive outcomes in challenging scenarios.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic management of splenic infarct in polysplenia with situs inversus - Case report and review literature.","authors":"Gutha Raajitha, Katikela Sai Tejaswi Reddy, Tehniyath Mariyam, Samir Ranjan Nayak","doi":"10.4103/jmas.jmas_559_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_559_25","url":null,"abstract":"<p><strong>Abstract: </strong>Situs inversus totalis (SIT) is a rare congenital abnormality, characterised by mirror imaging of visceral organs. Polysplenia is a subset of this, where multiple splenules are present. Splenic infarcts, in such conditions, can cause diagnostic uncertainty and significant surgical challenge. We report a case of a 35-year-old male with SIT and polysplenia who presented with right upper abdominal pain, fever and vomiting. Imaging showed multiple splenules in the right hypochondrium, with a peripheral splenic infarction. Laparoscopic splenectomy was done with modified port placement to accommodate the reversed anatomy. Laparoscopic splenectomy in patients with SIT and polysplenia is technically challenging due to altered anatomy and the need for a reversed surgical approach. Although technically demanding, it can offer better visualisation over an open approach. To the best of our knowledge, this is the first reported case of laparoscopic management for splenic infarction in polysplenia with SIT. The laparoscopic approach, though quite challenging, can be made feasible in such cases with effective planning but only under the expertise who can adapt to intra-operative challenges.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gangrenous Meckel's diverticulum due to axial torsion around a mesodiverticular band: A rare cause of acute abdomen in adults.","authors":"Rahul Ashok Mishra, Pichaimuthu Anbalagan, Dinesh Ramaswamy","doi":"10.4103/jmas.jmas_37_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_37_26","url":null,"abstract":"<p><strong>Abstract: </strong>Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, though it rarely presents with complications in adulthood. Axial torsion leading to gangrene, especially due to a mesodiverticular band, is an uncommon presentation and may pose a diagnostic challenge. We report a case of a 58-year-old female who presented with acute intestinal obstruction. Diagnostic laparoscopy revealed a gangrenous MD caused by axial rotation around a mesodiverticular band, without involvement of the adjacent ileum. Laparoscopic diverticulectomy was successfully performed. Isolated torsion of the MD is rare, particularly in adults. A mesodiverticular band can predispose to isolated volvulus, ischaemia and gangrene. Early surgical intervention is essential to prevent morbidity, and complicated MD in adults is often misdiagnosed. A high index of suspicion should be maintained in cases of intestinal obstruction with atypical features. This case highlights the importance of early laparoscopic evaluation in adults presenting with unexplained obstruction.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}