Journal of Minimal Access Surgery最新文献

{"title":"Did scarless thyroidectomy meet expectations? An evaluation in the aspect of cosmesis: A single-centre prospective study.","authors":"Mehmet Taner Unlu, Ozan Caliskan, Isik Cetinoglu, Yasin Cakir, Nurcihan Aygun, Mehmet Uludag","doi":"10.4103/jmas.jmas_27_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_27_25","url":null,"abstract":"<p><strong>Objective: </strong>Thyroidectomy is among the most commonly performed endocrine surgeries. Concerns regarding cosmetic outcomes and pain management have led to various surgical innovations. This study compares post-operative patient satisfaction based on cosmesis and expectations between open thyroidectomy (conventional open thyroidectomy [COT]) and transoral endoscopic thyroidectomy vestibular approach (TOETVA).</p><p><strong>Patients and methods: </strong>Female patients aged 18-65 years who underwent thyroidectomy for benign conditions were included. Patients were divided into two groups: COT and TOETVA, with 20 patients in each. Post-operative evaluations were conducted on days 15 and 30 using the Vancouver Scar Scale, the modified Stony Brook Scar Evaluation Scale and general/visual satisfaction questionnaires.</p><p><strong>Results: </strong>Participants rated their surgeries on a scale of 1 (poor) to 4 (excellent) on days 15 and 30. No significant difference in visual scores was observed between groups. However, overall satisfaction scores were higher in the COT group on day 15 (3.5 ± 0.5 vs. 2.7 ± 0.9, P = 0.004) and day 30 (3.7 ± 0.5 vs. 3.1 ± 0.8, P = 0.021). Satisfaction scores and incision site oedema showed no significant differences between groups, but hyperaemia was significantly lower in the TOETVA group on day 30. Scar length was also significantly shorter in the TOETVA group.</p><p><strong>Conclusion: </strong>Higher satisfaction in the COT group may result from post-operative pain and transient chin numbness in the TOETVA group, alongside short follow-up period. Longer-term studies could better evaluate these differences. The lack of a significant difference in satisfaction suggests that patients' expectations-shaped by the surgical approach they independently choose-may significantly influence their overall satisfaction. While satisfaction scores were similar, TOETVA provides a notable cosmetic advantage due to hidden incisions, making it particularly appealing for patients with aesthetic concerns. This technique represents a significant advancement in achieving patient-centred outcomes.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053555","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":"Is the Mayo adhesive probability score predictive of post-operative Clavien-Dindo complication grade in laparoscopic adrenalectomy?","authors":"Burhan Baylan, Yasin Sarıkaya","doi":"10.4103/jmas.jmas_257_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_257_24","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic adrenalectomy (LA) continues to be considered the optimum approach to the surgical treatment of small benign adrenal tumours. The present study explores the correlation between the Mayo adhesive probability (MAP) score, derived from computed tomography images and delineating such perinephric fat characteristics as thickness and adhesiveness, and post-operative complications in patients undergoing LA.</p><p><strong>Patients and methods: </strong>Data of patients who underwent LA between 2013 and 2023 were subjected to a retrospective analysis, and MAP scores were calculated for all patients. Intraoperative and post-operative surgical outcomes, as well as any complications, were categorised using Modified Clavien-Dindo grading, and the relationship between their MAP scores and outcomes was analysed.</p><p><strong>Results: </strong>The mean body mass index, rate of overweight patients, Clavien-Dindo scores of II, III or IV, surgical time, hospitalisation duration, transfusion requirement and post-operative blood loss of the group of patients with MAP scores of 2-3 were significantly higher than those in the group with MAP scores in the 0-1 range (P < 0.05). Each one-point increase in MAP score led to a 2.559-times greater probability of a Clavien-Dindo Grade > I (95% confidence interval: 1.391-4.708, P < 0.05).</p><p><strong>Conclusion: </strong>A high MAP score is associated with Grade II and higher Clavien-Dindo complications in LA.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036051","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":"Outcomes of ventral hernia repair in patients of severe obesity: An experience from a tertiary care centre.","authors":"Sonali Mittal, Arun Kumar, Jagadeep Ajmera, Surabhi Vyas, Sandeep Aggarwal","doi":"10.4103/jmas.jmas_292_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_292_24","url":null,"abstract":"<p><strong>Introduction: </strong>Ventral hernia (VH) in patients with severe obesity poses a surgical challenge during bariatric surgery (BS). There is conflicting evidence regarding the optimal timing to perform a definitive VH repair (VHR). We present our experience in managing severely obese patients with VH.</p><p><strong>Patients and methods: </strong>Sixty-seven severely obese patients with VH underwent a cross-sectional analysis of outcomes after BS and VHR. Outcomes were presented in terms of patients' demographics, BS performed, timing of VHR and recurrence rates.</p><p><strong>Results: </strong>Sixty-seven patients were included in the study. Seven patients who presented with complicated hernia underwent a concomitant BS and VHR (Group 1) and the rest with uncomplicated hernia underwent a staged VHR (Group 2). The mean age of presentation was 45.2 (±11.5) years, with a female preponderance (male:female = 17.9:82.1). The mean defect size was 3.4 (1.6) cm. Majority of Group 1 patients underwent an anatomical repair while Group 2 patients underwent a mesh hernioplasty. The patients in Group 1 had a higher body mass index at the time of VHR (47.4 ± 12.7 vs. 33.7 ± 4.21 kg/m2). The rate of recurrence was also higher in Group 1 compared to Group 2 (42.9% vs. 3.3%) at a mean duration of 10.3 and 12 months, respectively.</p><p><strong>Conclusion: </strong>VHR in patients with severe obesity is challenging. The staged approach appears to be a safer option with acceptable recurrence rates compared to the concomitant approach. However, an individualised approach based on patient presentation should be followed for VHR in such patients.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056518","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":"Early outcomes of robotic transabdominal preperitoneal repair of inguinal hernias: A single surgeon's experience.","authors":"Ramkaran Chaudhary, Akshat Dutt, Indra Singh Choudhary, Anupam Singh Chauhan, Aditya Baksi, Naveen Sharma","doi":"10.4103/jmas.jmas_221_23","DOIUrl":"https://doi.org/10.4103/jmas.jmas_221_23","url":null,"abstract":"<p><strong>Introduction: </strong>Minimally invasive techniques for inguinal hernia repair are becoming more popular due to their advantages over open surgery. These techniques aim to strengthen weakened tissue and result in reduced complications, shorter hospital stays and faster recovery. Robotic surgery provides better visualisation and ergonomics for surgeons and less post-operative pain for patients. This study evaluates the early outcomes of robotic transabdominal preperitoneal repair (rTAPP) for inguinal hernia.</p><p><strong>Patients and methods: </strong>The study included patients who underwent rTAPP for inguinal hernias. Patients with ventral or umbilical hernias were excluded. Data on patient and hernia characteristics, surgical details and outcomes were collected and analysed. The procedure was performed under general anaesthesia, with specific port placements. A mesh was used to cover the hernia defect the patients were followed up after discharge telephonically as well as through scheduled visits to the clinics.</p><p><strong>Results: </strong>Forty-five patients underwent rTAPP for inguinal hernias between November 2019 and March 2023. The majority of patients were males (97.78%). The average age was 48.2 years. Most of the patients (80%) had unilateral defects. Only one patient had a recurrent hernia. The average operative time was 140 min. The complications were minimal. Three patients had post-operative seroma, and one had a repaired vas deferens injury with no adverse symptoms or fertility issues post-surgery.</p><p><strong>Conclusion: </strong>rTAPP is a safe and feasible modality for treating inguinal hernias. It also offers a better three-dimensional visualisation of anatomy, thereby reducing complications due to faulty technique. It may serve as the procedure of choice for young surgeons seeking to learn robotic skills.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047761","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":"Comment on: Laparoscopic transperitoneal adrenalectomy for adrenal tumours of 6 cm or greater: A single-centre experience.","authors":"Emre Hepsen","doi":"10.4103/jmas.jmas_129_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_129_25","url":null,"abstract":"","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017608","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":"Single-port laparoscopic cholecystectomy with indocyanine green: A propensity score study.","authors":"Feng Zhan, Lixia Yang, Yun Zhang, Yu Zhang, Kai Zhang, Chao Jiang","doi":"10.4103/jmas.jmas_287_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_287_24","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to compare the clinical efficacy of single-incision laparoscopic cholecystectomy (SILC) with indocyanine green (ICG) fluorescence imaging and traditional multi-port laparoscopic cholecystectomy (MPLC) in the treatment of benign gall bladder diseases.</p><p><strong>Patients and methods: </strong>A retrospective analysis was performed on the clinical data of 345 patients who underwent laparoscopic cholecystectomy from June 2023 to June 2024. Forty-two patients underwent SILC, and 303 underwent MPLC. After propensity score matching, 37 matched pairs were identified. Parameters compared included critical view of safety (CVS) exposure rate, bile duct injury rate, operative time, blood loss, post-operative hospitalisation, costs, pain visual analogue scale (VAS) scores, Global Aesthetic Improvement Scale questionnaire scores, complication rates and the learning curve evaluated by cumulative sum analysis (CUSUM).</p><p><strong>Results: </strong>No conversions or bile duct injuries occurred. The SILC group had shorter hospital stay (2.6 ± 0.7 days vs. 4.2 ± 0.9 days) and lower pain VAS scores at 48 h (1.1 ± 0.5 vs. 1.9 ± 0.4), but higher blood loss (19.4 ± 9.5 mL vs. 10.1 ± 4.2 mL) (P < 0.05). No significant differences were observed in CVS exposure, operative time, costs, pain scores at 24 h, complication rates or 30-day post-operative incisional satisfaction (P > 0.05). The CUSUM analysis showed the learning curve stabilised after 25 cases.</p><p><strong>Conclusions: </strong>ICG-assisted SILC demonstrates comparable safety and cost-effectiveness to MPLC, without increasing perioperative risks. With appropriate patient selection, it may be a viable option for broader implementation in primary healthcare settings.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051406","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":"Simple and cost-effective liver retraction technique for laparoscopic right adrenalectomy - An initial experience from a tertiary care centre.","authors":"Saarim Bari, Kushagra Gaurav, Akshay Anand, Abhinav Arun Sonkar","doi":"10.4103/jmas.jmas_49_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_49_25","url":null,"abstract":"<p><strong>Abstract: </strong>Liver retraction is a critical step for optimal surgical exposure and preventing liver injury during right laparoscopic adrenalectomy (LA), due to the complex relationship of the suprarenal gland with the inferior vena cava and liver. Current retraction methods require specialised instruments like Nathanson and robotic retractors, which are challenging to procure in developing countries due to limited funding and resources. To overcome these challenges, we propose a technique for liver retraction using locally available basic laparoscopic tools, making LA more feasible in resource-limited settings. The patient was laid in the reverse Trendelenburg position and then laterally rotated to the left. Port 1, port 2 and port 3 were placed in a triangular configuration with the camera lying in situ in port 2, while ports 1 and 3 serve as working ports. Port 4 was made in the epigastrium, and a Maryland forceps or laparoscopic needle holder was introduced beneath the right liver lobe, supporting the liver uniformly. This surgical technique is characterised by its simplicity, feasibility and cost-effectiveness. It ensures reliable liver retraction while providing ergonomic benefits for surgeons and upholding both surgical safety and operational efficiency.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004147","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":"Mayer-Rokitansky-Kuster-Hauser syndrome with bilateral inguinal hernia of the adnexa - A rare coexisting anomaly.","authors":"Srikar Yedlapalli, Vishnukant Pandey, Thirugnanasambandam Nelson, Kamal Kataria, Uttam Kumar Thakur, Anita Dhar, Reeta Mahey, Kanika Sachdeva","doi":"10.4103/jmas.jmas_37_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_37_25","url":null,"abstract":"<p><strong>Abstract: </strong>Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare congenital disorder characterised by the absence of the uterus and upper vagina. It typically presents in adolescent females with primary amenorrhoea despite normal secondary sexual characteristics and a 46 XX karyotype, with an incidence of 1 in 4500 female births. A 20-year-old married female presented with a chief complaint of bilateral inguinal swelling persisting for the past 5-6 months. She had primary amenorrhoea and was sexually active without dyspareunia or coital difficulties. A general examination was normal. Bilateral reducible inguinal hernias, measuring 4 cm × 5 cm (left) and 2 cm × 2 cm (right), with a positive cough impulse, were noted. Hormonal parameters were normal. Karyotyping showed a normal 46 XX in all cells. Magnetic resonance imaging revealed the absence of the uterus, with both ovaries present in the inguinal canals. Diagnostic laparoscopy confirmed the absence of the uterus, a wide left deep inguinal ring with herniating ovary and Müllerian structures, and an open right deep inguinal ring with a herniating ovary and Müllerian nodule. Hernia reduction followed by pre-peritoneal space dissection was performed. A 10 cm × 15 cm non-absorbable polypropylene mesh (Ethicon) was placed and fixed with tackers. The left round ligament was divided to prevent future recurrence of the hernia. Early diagnosis and management of such cases are essential to prevent complications like ovarian torsion. This case underscores the importance of recognising MRKH syndrome presentations for timely and effective treatment.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041421","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":"Comment on: Is the self-adhesive mesh a solution for chronic postoperative inguinal pain after TAPP: A single centre preliminary experience?","authors":"Christopher Robert Smith, Guillaume B R C Lafaurie, Amir H Razvi","doi":"10.4103/jmas.jmas_246_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_246_24","url":null,"abstract":"","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804615","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":"Strategy of reduced port gastrostomy as a safe procedure for paediatric patients.","authors":"Yousuke Gohda, Hiroo Uchida, Takahisa Tainaka, Wataru Sumida, Chiyoe Shirota, Satoshi Makita, Miwa Satomi, Akihiro Yasui, Daiki Kato, Takuya Maeda, Hiroki Ishii, Kazuki Ota, Yaohui Guo, Jiahui Liu, Akinari Hinoki","doi":"10.4103/jmas.jmas_218_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_218_24","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic gastrostomy has improved surgical and cosmetic outcomes. Our approach involves a strategy of reduced port surgery, wherein only the umbilicus and tube insertion site were incised, with an additional port inserted if manipulation is difficult. This study aimed to investigate the outcomes of our reduced port gastrostomy strategy.</p><p><strong>Patients and methods: </strong>The paediatric patients who underwent gastrostomy at our institution from July 2013 to March 2023 were reviewed retrospectively. Surgical outcomes were compared between patients who underwent reduced port gastrostomy and those who underwent multiport gastrostomy with or without fundoplication.</p><p><strong>Results: </strong>Of the 78 patients who underwent gastrostomy, 25 and 39 patients who underwent reduced port gastrostomy and multiport gastrostomy with or without fundoplication, respectively, were included. Five patients who underwent reduced port gastrostomy required an additional port. The operative time during gastrostomy was shorter in the multiport gastrostomy group (21.3 min vs. 17.2 min, P = 0.00). One splenic injury in the reduced port gastrostomy group and one split of the stomach in the multiport gastrostomy group occurred and were completely repaired intraoperatively. No patient required reoperation within 30 days after gastrostomy. Post-operative complications, such as infection with pus (1 vs. 2, P = 1.00), external leakage requiring nutritional management change or tube replacement (2 vs. 2, P = 0.64) and tube dislodgement (1 vs. 0, P = 0.39), were similar between the two groups.</p><p><strong>Conclusions: </strong>The strategy of reduced port gastrostomy was safe and cosmetically favourable compared with multiport gastrostomy.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804623","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}