Journal of Minimal Access Surgery最新文献

{"title":"Optimising pneumoperitoneum pressure to minimise post-operative shoulder tip pain: A randomised controlled trial of 10 versus 14 mmHg CO 2 in laparoscopic cholecystectomy.","authors":"K R P Viknesh, Sailesh I S Kumar, Raja Vel Shantharam, Ashfaq Sulaiman Arif Abdul Rahuman, Ashok Nimmakanty Ramadas, Peranbu Loganathan","doi":"10.4103/jmas.jmas_219_25","DOIUrl":"10.4103/jmas.jmas_219_25","url":null,"abstract":"<p><strong>Background: </strong>Post-operative shoulder tip pain (STP) is an established side effect of laparoscopic cholecystectomy, primarily attributed to diaphragmatic irritation from residual carbon dioxide (CO₂) insufflation during surgery. The purpose of this trial was to evaluate the severity of STP and the day of discharge after surgery between patients undergoing laparoscopic cholecystectomy who had low-pressure (10 mmHg, CO 2 ) and standard-pressure (14 mmHg, CO 2 ) pneumoperitoneum.</p><p><strong>Patients and methods: </strong>In this single-centre, double-blind, randomised controlled experiment, 100 patients scheduled for laparoscopic cholecystectomy were randomly allocated to one of two groups of 50 patients each, receiving either standard-pressure or low-pressure pneumoperitoneum. The primary outcomes included post-operative STP scores measured using a validated 10-point numerical rating scale at 3, 6, 12, 24, 48 and 72 h postoperatively. The secondary outcome was duration of hospitalisation. P < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>Study participants comprised 69% of females with a mean age of 44.2 ± 12.8 years. Despite observed demographic variations, there were no statistically significant differences in baseline characteristics between the groups ( P > 0.05 for all comparisons). The standard-pressure group had significantly higher mean pain scores than the low-pressure group at 3 h (2.3 ± 2.4 vs. 0.9 ± 1.3), 6 h (1.5 ± 1.8 vs. 0.5 ± 0.9), 12 h (1.0 ± 1.4 vs. 0.4 ± 0.8) and 24 h (0.4 ± 0.8 vs. 0.1 ± 0.5) after surgery, with P = 0.006, 0.007, 0.018 and 0.049, respectively. From the 2 nd day onwards, pain scores became minimal and showed no significant difference between the groups ( P = 0.662). The mean hospital stay was 2.04 ± 0.198 days versus 2.00 ± 0.000 days ( P = 0.159), with no clinically meaningful difference.</p><p><strong>Conclusion: </strong>This study provides Level 1 evidence that low-pressure pneumoperitoneum during laparoscopic cholecystectomy significantly reduces STP for the first 24 h postoperatively, though this effect does not persist beyond 48 h. Hospital length of stay remained equivalent between the groups, suggesting that early pain reduction alone does not translate to accelerated discharge. This suggests the need for larger, multicentre trials to validate these findings and assess the effect of low-pressure pneumoperitoneum on additional patient-reported outcomes and healthcare economics.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"389-396"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488038","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":"Comments on 'preliminary comparative outcomes of Versius robotic-assisted versus conventional laparoscopic cholecystectomy'.","authors":"Ayesha Rizwan, Ayesha Qayyum, Hira Naz","doi":"10.4103/jmas.jmas_55_26","DOIUrl":"10.4103/jmas.jmas_55_26","url":null,"abstract":"","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"456-457"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678035","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":"Don't repeat the cardiovascular and thoracic surgery - Cardiology shift: Surgeons should lead endoscopic ultrasonography-guided gastroenterostomy.","authors":"Kumar Vineet, Mayank Tripathi","doi":"10.4103/jmas.jmas_509_25","DOIUrl":"10.4103/jmas.jmas_509_25","url":null,"abstract":"","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"450-451"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147291696","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":"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":"371-377"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","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":"Laparoscopic repair of iatrogenic splenic artery injury during total gastrectomy: Tips for troubleshooting.","authors":"K Ganesh Shenoy, Marina Thomas, Amol S Jeur","doi":"10.4103/jmas.jmas_473_25","DOIUrl":"10.4103/jmas.jmas_473_25","url":null,"abstract":"<p><strong>Abstract: </strong>Iatrogenic splenic artery (SA) injury during laparoscopic total gastrectomy (LTG) is rare but a potentially catastrophic event and remains one of the major causes of conversion to open procedure. Prompt recognition and control are vital to avoid splenectomy. A 70-year-old man underwent LTG with D2 lymphadenectomy for proximal gastric adenocarcinoma. During dissection along the superior border of the pancreas, a 4-mm rent in the SA occurred near the distal pancreas, 3 cm from the hilum. Bleeding was controlled laparoscopically by intracorporeal interrupted 4-0 polypropylene suturing of the rent. After release of graspers, haemostasis and preserved splenic perfusion were confirmed. Post-operative computed tomography angiography on day 10 showed normal splenic flow. This case demonstrates the feasibility and safety of primary laparoscopic repair of iatrogenic SA injury during total gastrectomy, avoiding conversion or splenectomy. To the best of our knowledge, such cases are exceedingly rare, with no prior detailed technical descriptions available.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"452-455"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786498","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":"Outcome after flexible endoscopy structured training of surgeons in a novel hybrid format.","authors":"Sundaram Easwaramoorthy, Sakthivel Chandrasekar, Satyapriya DeSarkar, Kanagavel Manickavasakam, Vijay Borgoankar, Senthil Manickavasakam","doi":"10.4103/jmas.jmas_15_25","DOIUrl":"10.4103/jmas.jmas_15_25","url":null,"abstract":"<p><strong>Introduction: </strong>A flexible endoscopy skillset is essential in this era of laparoscopy. However, there are fewer avenues for endoscopy training in India. A short-structured endoscopy training course is the need of the hour for general surgeons. The study aims to find the impact of a 3-month hybrid basic level 1 diagnostic upper gastrointestinal (GI) endoscopy training course on skill transfer.</p><p><strong>Patients and methods: </strong>One hundred and ten trainees who completed the hybrid endoscopy training course in this prospective multicentre observational study from January 2023 to August 2024 were sent feedback forms to find the impact of the training course. The following outcome measures were analysed namely.• Quality of online endoscopy lecture modules and onsite simulation and live demonstration of basic upper GI endoscopy skills• Impact of the training course in improving the quality of endoscopy procedure• The volume of endoscopy cases done before and after the course.</p><p><strong>Results: </strong>One hundred and ten trainees had completed the 3-month endoscopy training course. A total of 74 trainees submitted the survey form. Eighty-two per cent of trainees were happy with the quality and delivery of online lecture modules. Ninety-three per cent of trainees were pleased with the on-site live endoscopy demonstration and hands-on training. Pearson Chi-squared test showed significant improvement in the competency of upper GI endoscopy after the flexible endoscopy structured training (FEST) course, with P < 0.005 and also noted an increase in the number of upper GI endoscopy workload for the surgeons following the FEST course with P < 0001.</p><p><strong>Conclusions: </strong>Endoscopy training of surgeons is the need of the hour. With the necessity to train an increasing number of surgeons in the skillset, any short-duration robust endoscopy training programme with proven efficacy in skill transfer would be a much sought-after training programme. The outcome of this hybrid pilot endoscopy training course is very encouraging.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"352-357"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267687","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":"Anatomical and clinical significance of lumbar veins in left laparoscopic donor nephrectomy: A novel classification based on intraoperative findings.","authors":"Arvind P Ganpule, Liju Mathew, Arun Chawla, S Nishanth, Saket Dipakkumar Patel, Harshit Tayal, Ravindra B Sabnis, Yogesh L Rathi, Abhijit Patil, Abhishek Singh, Mahesh R Desai, Sneha Guruprasad Kalthur","doi":"10.4103/jmas.jmas_200_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_200_26","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic donor nephrectomy (LDN) is the gold standard, but lumbar veins on the left side are highly variable and may cause bleeding or difficulty during dissection if not anticipated. This study examines lumbar vein drainage patterns using preoperative computed tomography (CT) and intraoperative findings, proposes a new classification and evaluates their clinical relevance.</p><p><strong>Patients and methods: </strong>This prospective observational study assessed the incidence and intraoperative anatomy of lumbar veins in consecutive LDN cases, correlated findings with preoperative CT angiography, classified lumbar veins by anatomical pattern and measured the time needed to secure them.</p><p><strong>Results: </strong>One hundred consecutive LDN procedures were analysed. Lumbar veins were identified in 81 donors. Two anatomical types were defined: Type 1, a single vein draining directly into the left renal vein; and Type 2, two or more branches forming a single trunk before entering the renal vein. Type 1 veins were found in 56 donors and Type 2 in 25. Nineteen donors showed no intraoperative lumbar veins. Concordance between CT angiography and intraoperative findings was 97% (Discordance in n = 2). The mean lumbar vein dissection time was 13.22 ± 5.89 min, with nearly identical times for both types.</p><p><strong>Conclusions: </strong>This study shows the importance of preoperative CT imaging in identifying and classifying lumbar veins during LDN. There was excellent concordance between preoperative CT imaging and intraoperative findings. Recognising the type of lumbar vein preoperatively using CT enables surgeons to anticipate technical challenges, if any. This classification potentially can enable case triage for resident training, which requires further multicentric study.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184858","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 Lichtenstein technique and transabdominal pre-peritoneal hernia repair in geriatric patients.","authors":"Onur Ağ, Mehmet Bugra Bozan, Nizamettin Kutluer, Ayşe Azak Bozan, Bekir Saricik, Mehmet Zeki Ogut, Serdar Erdogan","doi":"10.4103/jmas.jmas_228_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_228_26","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to compare the Lichtenstein technique and the transabdominal pre-peritoneal (TAPP) approach regarding safety and patient comfort in geriatric patients with inguinal hernia, and to evaluate the safety of laparoscopic surgery in this population.</p><p><strong>Patients and methods: </strong>This prospective study included patients aged ≥65 years who were hospitalised with an inguinal hernia and underwent surgical repair. Pre-operative complete blood count and biochemical parameters, operation and anaesthesia durations, and length of hospital stay were recorded through retrospective chart review. Post-operative patient satisfaction was assessed using the ODOMS questionnaire during outpatient follow-up. Patients were divided into two groups according to surgical technique: Lichtenstein repair and TAPP procedure.</p><p><strong>Results: </strong>A total of 125 patients developed complications. Among these, 110 cases (25.3%) occurred in the Lichtenstein group and 15 cases (3.4%) in the TAPP group, indicating a significantly lower complication rate with the laparoscopic approach ( P < 0.001). There were no statistically significant differences between groups in terms of ASA scores, anaesthesia duration or operative time ( P = 0.196 and P = 0.082, P = 0.147). However, the length of hospital stay was significantly shorter in the TAPP group ( P = 0.014). In addition, patient satisfaction scores measured by the ODOMS questionnaire were significantly higher in the TAPP group ( P = 0.003).</p><p><strong>Conclusion: </strong>Laparoscopic TAPP repair appears to be a safe and effective alternative to open Lichtenstein repair in geriatric patients. It is associated with fewer complications, shorter hospitalisation, and higher patient satisfaction, without increasing operative or anaesthesia duration.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185158","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":"Effect of preperitoneal negative-pressure drainage in laparoscopic transabdominal preperitoneal inguinal hernia repair: A propensity score-matched study.","authors":"Zhiwei Wang, Cuizhong Wang, Chuanzhuo Zhang, Chenhua Sun, Yuanying Li, Chunlin Gu","doi":"10.4103/jmas.jmas_269_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_269_26","url":null,"abstract":"<p><strong>Background: </strong>This study aims to investigate the effect of preperitoneal drainage on complications after transabdominal preperitoneal (TAPP) inguinal hernia repair.</p><p><strong>Patients and methods: </strong>Patients undergoing TAPP repair between August 2022 and June 2025 were included, and baseline characteristics were collected retrospectively. Outcomes included post-operative hospital stays, post-operative pain and post-operative complications. Patients were divided into two groups based on whether a drain tube was placed or not. The propensity score matching (PSM) method was used to obtain homogeneous comparison groups. Univariate and multivariate logistic regression models were used to analyse the risk factors of post-operative complications.</p><p><strong>Results: </strong>Seven hundred and seventy-two patients were enrolled and divided into drainage group of 133 patients and non-drainage group of 639 patients. The first 2 days after TAPP repair were the peak period for drainage volume, with a mean volume of 48.4 ml on post-operative day 1 and 37.6 ml on post-operative day 2. After PSM, drainage group had significantly longer post-operative hospital stay (3.4 ± 0.9 vs. 1.5 ± 0.8 days, P < 0.001), less pain after post-operative 6 h (0% vs. 1.7%, P = 0.041), fewer seroma (0.8% vs. 6.6%, P = 0.007) and more incisional infection (4.5% vs. 1.1%, P = 0.005). Multivariate logistic regression models exhibited that the placement of a drain tube significantly reduced the incidence of seroma (odds ratio [OR] =0.101, P = 0.029) and, however, increased the incidence of incisional infection (OR = 9.663, P = 0.014).</p><p><strong>Conclusion: </strong>The placement of drain tube after TAPP inguinal hernia repair effectively reduces the risk of seroma formation. However, the timing of removing the drain tube should be evaluated carefully to prevent the occurrence of incisional infection.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185146","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":"Subcutaneous emphysema beyond conventional grading following uncomplicated totally extraperitoneal inguinal hernia repair: A case report.","authors":"Abdullah Gürhan Duyan, Muhammed Nezih Koç","doi":"10.4103/jmas.jmas_273_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_273_26","url":null,"abstract":"<p><strong>Abstract: </strong>Subcutaneous emphysema (SE) is a rare and usually self-limiting complication of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. We report a 74-year-old man who developed massive SE after a short, technically uncomplicated 32-min TEP repair, despite the absence of major modifiable technical risk factors - working pressure ≤12 mmHg, open (Hasson) entry, single absorbable tack and no peritoneal breach. An abrupt rise in end-tidal carbon dioxide (EtCO 2 ) from a stable baseline (34-36 mmHg) to 60 mmHg was the earliest warning sign and preceded clinical detection. Post-operative computed tomography revealed SE extending to the neck, thorax, abdominal wall, back and both upper and lower extremities, surpassing all categories of the Aghajanzadeh classification. The patient was managed conservatively with manual decompression and an intentionally open trocar site, with complete resolution. This case illustrates an anatomical distribution extending beyond the territories included in conventional SE grading and underscores EtCO 2 monitoring as a valuable early warning tool.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907709","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}