Journal of Minimal Access Surgery最新文献

{"title":"The clinical advantages of endoscopic submucosal dissection compared with endoscopic mucosal resection for early oesophageal cancer and pre-cancer lesions.","authors":"Xiaoting Hou, Tingting Ding, Gai Zhou, Guanqi Liu, Rui Yin, Jing Ying, Jianxin Ge, Yongjian Lv","doi":"10.4103/jmas.jmas_72_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_72_24","url":null,"abstract":"<p><strong>Objective: </strong>The objective of the study was to compare the effects of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of early oesophageal cancer.</p><p><strong>Subjects and methods: </strong>Eighty-six patients with early oesophageal cancer and precancerous lesions admitted to our hospital from November 2021 to December 2023 were randomly divided into a treatment group (ESD: 43 cases) and control group (EMR: 43 cases). The efficacy and safety of the two methods were compared.</p><p><strong>Results: </strong>The operation time of ESD was 117.65 ± 19.98, which was longer than that of EMR group (P < 0.05). The hospitalization time of patients in the ESD group was shorter than that in the EMR group (7.51 ± 1.30 vs. 9.16 ± 2.01 days, P < 0.05). Comparable en bloc resection rate, complete resection rate, and curative resection rate of patients in the ESD group (100.0%, 95.35%, and 93.02%) and EMR group (100.0%, 93.02%, and 90.70%) were observed (P > 0.05). The incidence of postoperative complications in the ESD group was 4.65%, which was lower than 13.95% in the EMR group (P > 0.05). No recurrence or metastasis of the primary lesions occurred in both groups. Both groups were displaying better postoperative life quality comparing to that of pre-operation. The quality of life in the ESD group was significantly better than that of the EMR group (P < 0.05).</p><p><strong>Conclusion: </strong>Compared with EMR, ESD showed better clinical effects, fewer postoperative complications and higher safety in treating early oesophageal cancer and precancerous lesions. However, the diameter of the lesion should be considered for an optimal surgical plan.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692174","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":"Comparing laparoscopic and robotic splenectomy: A systematic review of the outcomes.","authors":"K Madan, Ramya B Sriram, Siddharth Davuluri","doi":"10.4103/jmas.jmas_330_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_330_24","url":null,"abstract":"<p><strong>Abstract: </strong>Splenectomy can be performed using various surgical approaches, including open, laparoscopic (LS), and robotic splenectomy (RS). While LS has been the mainstay for many years, it is associated with a steep learning curve and increased rates of morbidity and conversion to open surgery in complex cases such as splenomegaly, obesity, haematological malignancies, and patients with prior laparotomies. RS has emerged as a technique that facilitates a spleen-focused dissection, potentially reducing anatomical disruption and operative risk. This systematic review aimed to compare the peri-operative outcomes of LS and RS in non-traumatic indications for splenectomy. A comprehensive search was conducted in MEDLINE, Embase, CINAHL, and CENTRAL databases, along with searches for unpublished and ongoing studies through the World Health Organization platform. Data extraction was standardized using a pre-tested collection form, and statistical methods were employed to derive mean values where only medians and interquartile ranges were reported. The results demonstrated that the mean operative time was longer in the RS group, although the difference was not statistically significant. Conversion to open surgery occurred in 12 LS cases compared to 2 RS cases. Post-operative complications were more frequent in the LS group (9 patients) compared to the RS group (1 patient), with most complications observed after 24 hours. The mean length of hospital stay was similar between groups (6.0 days for RS vs. 6.5 days for LS; P = 0.89). RS was associated with lower mean intraoperative blood loss compared to LS. In conclusion, RS may offer advantages over LS in terms of reduced blood loss, lower conversion rates, and fewer postoperative complications, although it does not significantly impact hospital stay duration or cost-effectiveness and is associated with longer operative time.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692158","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":"Evaluating the feasibility of two-port laparoscopic cholecystectomy: A minimally invasive approach.","authors":"Xiufeng Chu, Fengfeng Chen, Yichen Yu, Guoping Ding, Liping Cao","doi":"10.4103/jmas.jmas_13_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_13_25","url":null,"abstract":"<p><strong>Objective: </strong>To establish a two-port minimally invasive laparoscopic cholecystectomy (LC) technique that minimises surgical scarring and alleviates post-operative pain.</p><p><strong>Methods: </strong>A cohort study was conducted, enrolling patients meeting the inclusion criteria to undergo two-port minimally invasive LC. The outcomes were compared with those of patients who underwent conventional LC performed by other medical teams. The clinical and pathological data were collected. Visual Analogue Scale scores were used to assess incision pain on post-operative days 1 and 15. Statistical analyses were performed to compare pain scores between the groups.</p><p><strong>Results: </strong>Between November 2020 and June 2021, 56 patients met the screening criteria and were enrolled in the study group. Of these, 42 patients successfully underwent two-port LC, while 14 cases were converted to conventional three-port LC. No post-operative complications, such as bleeding or bile leakage, occurred, and all patients were discharged without incident. On day 1 post-surgery, the average incision pain score in the two-port LC group was 1.4 ± 0.95, significantly lower than 1.8 ± 1.32 in the conventional LC group (P = 0.02). On day 15 post-surgery, 13 patients (23.2%) in the two-port LC group reported subxiphoid incision pain, compared to 63 patients (41.4%) in the conventional LC group.</p><p><strong>Conclusion: </strong>For patients meeting indications for conventional LC, early implementation of two-port minimally invasive LC achieved a success rate of 75%. Compared to conventional LC, this technique did not significantly shorten operative time or reduce the complication rates. However, it decreased the number of incisions to two, reduced scar size from 10 mm to 3 mm and significantly alleviated post-operative pain. It is worthy of clinical application and promotion.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692163","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 various bailout strategies for managing different categories of difficult laparoscopic cholecystectomy - An experience of over two decades from a single surgical unit at a tertiary care teaching hospital.","authors":"Asuri Krishna, Sanjeet Kumar Rai, Mayank Jain, Om Prakash, Mahesh C Misra, Subodh Kumar, Virinder Kumar Bansal","doi":"10.4103/jmas.jmas_163_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_163_25","url":null,"abstract":"<p><strong>Introduction: </strong>A difficult laparoscopic cholecystectomy (LC), if not handled appropriately, can lead to devastating complications. We hereby describe our experience and outcomes of patients with difficult LC over the last two decades, with various bailout strategies to achieve a very low conversion rate and bile duct injury rate.</p><p><strong>Patients and methods: </strong>This study was a retrospective analysis of patients labelled as difficult LC in a single surgical unit at a tertiary care teaching hospital from January 2004 to December 2020. The pre-operative, peri-operative and follow-up data of all these patients were obtained from a prospectively maintained electronic database.</p><p><strong>Results: </strong>Between January 2004 and December 2020, 3726 patients underwent elective LC, of which 649 (17.4%) cholecystectomies were deemed difficult. Using the various bailout strategies, we were able to achieve a conversion rate of 4.9% and bile duct injury rate of 0.1% with an overall morbidity of 8%.</p><p><strong>Conclusion: </strong>When a difficult situation occurs, the benefit of removing the complete gall bladder is outweighed by the risk of a major injury, so a bailout strategy needs to be used. The present series reiterates the use of bailout strategies to not only decrease conversion but also achieve a minimal BDI rate.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692169","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 extended view totally extraperitoneal with intraperitoneal onlay mesh for primary ventral hernia surgery: A randomised controlled study from a tertiary university hospital.","authors":"Pawanindra Lal, Jony Kumar, Tusharindra Lal, Anubhav Vindal","doi":"10.4103/jmas.jmas_52_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_52_25","url":null,"abstract":"<p><strong>Introduction: </strong>Primary ventral hernia remains a common presentation in surgical clinics with reported recurrence rates of 10%-20%. Intraperitoneal onlay mesh (IPOM) repair has been the widely accepted technique for laparoscopic management of ventral hernia. More recently, extended view totally extraperitoneal (eTEP) repair has emerged as a safe procedure in terms of reduced post-operative pain and faster recovery. Studies comparing IPOM with eTEP are limited. The present study was conducted to compare the two surgical techniques in terms of early outcomes in patients presenting with primary ventral hernia.</p><p><strong>Patients and methods: </strong>A total of 30 patients with primary ventral hernias with defect size > 2 and up to 6 cm were randomised using computer-generated sequences into two groups. Operative time was used as the primary endpoint. Patients were followed up at 6 months, 1 year and 2 years postoperatively to look for recurrence, chronic pain and any other complications.</p><p><strong>Results: </strong>Mean operative time in the IPOM group was significantly less than eTEP repair (P < 0.001). Mean pain scores in the eTEP group at discharge, on day 1 and 1 week were significantly lower than corresponding scores in the IPOM group. The mean hospital stay (2.09 ± 0.30 days) in the eTEP group was less than the IPOM group (3.64 ± 1.56 days) (P < 0.001). Return to work was also significantly earlier in eTEP (10.18 ± 1.07 days vs. 13.55 ± 2.16 [P < 0.001]). No recurrence was recorded in 23 of 30 patients followed up till 2 years.</p><p><strong>Conclusions: </strong>Operative time was significantly longer in the eTEP group, reaffirming the published data. Post-operative pain was significantly lower in patients undergoing the eTEP procedure up to 1 week. Consequently, hospital stay was also reduced and return to work was faster in these patients. Both procedures fared equally in terms of no recurrence with a 77% follow-up at 24 months.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692160","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":"Factors leading to post-cholecystectomy bleeding requiring reoperation: A case series.","authors":"Mena Louis, Nathaniel Grabill, Baraa Mohamed, Emily Murdoch, Morgan A Krause, Bradley Kuhn","doi":"10.4103/jmas.jmas_366_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_366_24","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic cholecystectomy is widely regarded as the standard treatment for symptomatic gall bladder diseases due to its minimally invasive nature and favorable recovery profile. However, hemorrhagic complications pose significant risks to patient safety and outcomes.</p><p><strong>Patients and methods: </strong>This retrospective case series aimed to evaluate the incidence, risk factors and outcomes associated with intraoperative and post-operative hemorrhagic complications in patients undergoing cholecystectomy. Eighteen patients who experienced significant bleeding necessitating unplanned reoperations were included in the analysis. Data were collected encompassing demographic information, comorbidities, surgical details and post-operative outcomes.</p><p><strong>Results: </strong>The study found that older age and higher body mass index (BMI) were strongly correlated with increased estimated blood loss, with each additional year of age increasing the odds of severe hemorrhage by 7% and each unit increase in BMI raising the odds by 15%. Patients with the American Society of Anesthesiologists classifications of 3-4 were 3.5 times more likely to experience severe bleeding. In addition, the use of anticoagulant or antiplatelet therapy was associated with a nearly six-fold increase in the risk of significant hemorrhage. The presence of adhesions or severe inflammation further doubled the risk of substantial blood loss. Hemorrhagic complications were associated with prolonged hospital stays, higher rates of blood transfusions and increased mortality.</p><p><strong>Conclusion: </strong>These findings highlight the importance of pre-operative risk assessment and tailored surgical strategies to mitigate bleeding risks. Enhancing patient evaluation and optimizing surgical techniques are crucial for improving outcomes and ensuring patient safety in cholecystectomy procedures.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692164","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":"What does it take to become a hernia specialist?","authors":"Easwaramoorthy Sundaram","doi":"10.4103/jmas.jmas_35_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_35_25","url":null,"abstract":"<p><strong>Abstract: </strong>Hernia surgery is the most common procedure done by surgeons. The author describes the various pathways to becoming a hernia specialist, considering the strengths, weaknesses, opportunities and threats as in a business model.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692175","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":"Gastric tumour causing gastroduodenal intussusception - Laparoscopic management.","authors":"Pranav Wadhokar, Guhan Venkatakrishnan, Sudheer Othiyil Vayoth, Vinaya Chandra","doi":"10.4103/jmas.jmas_84_25","DOIUrl":"10.4103/jmas.jmas_84_25","url":null,"abstract":"<p><strong>Abstract: </strong>Adult gastroduodenal intussusceptions are very rare. Presentation of gastric gastrointestinal stromal tumours (GISTs) as gastroduodenal intussusception is atypical and clinically difficult to diagnose due to non-specific symptoms. We report the rare case of an elderly male who presented with clinical features of gastric outlet obstruction. Diagnostic imaging and endoscopy revealed a gastric antral GIST leading to gastroduodenal intussusception. Due to the irreducibility of the intussusception, the patient underwent laparoscopic distal gastrectomy as definitive management. Laparoscopic management in such cases is feasible with equally good oncological outcomes as compared to open surgery, with better cosmetic outcome and faster recovery.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692166","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 sleeve gastrectomy and nutritional deficiency: A comprehensive longitudinal analysis.","authors":"Shahbaz Bashir, Zubair Gul Lone, Yawar Nazir, Bilal Ahmad Wagay, Gowhar Aziz Bhat, Mubashir Ahmad Shah","doi":"10.4103/jmas.jmas_91_25","DOIUrl":"10.4103/jmas.jmas_91_25","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic sleeve gastrectomy (LSG) represents a cornerstone in the surgical management of morbid obesity. While the procedure effectively reduces weight and improves obesity-related comorbidities, the anatomical alterations inherent to LSG can lead to significant nutritional challenges. These modifications in gastrointestinal physiology may result in various micronutrient deficiencies, particularly affecting iron, Vitamin B12 and folate status.</p><p><strong>Patients and methods: </strong>We conducted a prospective cohort study of 70 patients undergoing LSG at our tertiary care centre. Participants underwent comprehensive nutritional assessment at baseline and regular intervals postoperatively (6, 12 and 24 months). We measured serum levels of key micronutrients, including iron, Vitamin B12 and folate, while simultaneously tracking supplement adherence. Statistical analysis incorporated both univariate and multivariate approaches to identify patterns and risk factors for nutritional deficiencies.</p><p><strong>Results: </strong>Our analysis revealed distinct gender-specific patterns in nutritional deficiencies. Female patients demonstrated significantly higher rates of iron deficiency throughout the study period, with prevalence rates of 58%, 50% and 36% at 6, 12 and 24 months, respectively. Vitamin B12 deficiency showed a progressive increase in both genders, while supplement adherence declined markedly from 96% at 6 months to 42% at 24 months. Multivariate analysis identified female gender, younger age and poor supplement adherence as significant risk factors for nutritional deficiencies.</p><p><strong>Conclusion: </strong>Post-LSG nutritional deficiencies present a significant clinical challenge, particularly for female patients. Our findings emphasise the critical importance of long-term nutritional monitoring and the need for targeted supplementation and adherence-enhancing intervention strategies to improve supplement adherence.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692167","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":"Comparing laparoscopic transversus abdominis plane block and port-site infiltration in laparoscopic ventral hernia repair: A randomised controlled trial.","authors":"Sourabh Singh, Himanshu Agrawal, Nikhil Gupta, Nitin Agarwal, Aditya Kumar, Shailesh Kumar","doi":"10.4103/jmas.jmas_382_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_382_24","url":null,"abstract":"<p><strong>Introduction: </strong>Adequate analgesia is of utmost importance for apposite in patients undergoing laparoscopic ventral hernia repair (LVHR) for smooth recovery. TAP block and port-site infiltration (PSI) are two most commonly employed methods for pain relief. Therefore, this study was done to compare laparoscopic-guided TAP block versus PSI for post-operative analgesia, hospital stay and rescue dose of analgesic in LVHR.</p><p><strong>Patients and methods: </strong>This single-blinded randomised controlled trial was done in a tertiary hospital of Delhi from 1 April 2023, to 1 August 2024. A total of 60 patients were enrolled. Randomisation was done using computer-generated random number table, and allotment was done using sequentially numbered opaque sealed envelopes. All patients >18 years of age with anterior abdominal wall hernia undergoing LVHR were included in the study. Patients with a history of opioid usage, patients with alcohol abuse within the past 6 months, patients with hernia size >6 cm were excluded from the study. Two groups included: test group (Group A) - laparoscopic-assisted TAP block (LTAP) and control Group (Group B) - port-site local anaesthesia infiltration (PSLAI).</p><p><strong>Results: </strong>In LVHR, the use of TAP blocks showed superior pain management compared to PSLAI (significantly lower VAS scores at 6, 12 and 24-h post-surgery in the LTAP group [P = 0.0031, 0.0037 and 0.00012, respectively]). LTAP was associated with a shorter hospital stay (P = 0.016) and less need for rescue analgesia (P = 0.031).</p><p><strong>Conclusion: </strong>Laparoscopic transverse abdominis plane block is superior to port-site local anaesthesia infiltration in providing effective post-operative analgesia.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692159","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}