Journal of Minimal Access Surgery最新文献

{"title":"Impact of lung ultrasound-guided fluid management and vasoactive medication use on anaesthetic outcomes in thoracic surgery for tuberculous empyema: A retrospective study.","authors":"Dan Wang, Tao Liu, Wei Liu","doi":"10.4103/jmas.jmas_44_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_44_26","url":null,"abstract":"<p><strong>Introduction: </strong>Anaesthetic management of thoracic surgery for tuberculous empyema is complex, with traditional fluid strategies often causing intraoperative hypotension or volume overload. Lung ultrasound (LUS) provides real-time assessment of pulmonary fluid status, but its combined effect with prophylactic vasopressor support on anaesthetic outcomes in this population is unclear. This study aimed to evaluate the impact of an integrated strategy combining LUS-guided goal-directed fluid therapy and prophylactic vasopressor support on intraoperative haemodynamics and early post-operative recovery in patients undergoing thoracic surgery for tuberculous empyema.</p><p><strong>Patients and methods: </strong>This retrospective cohort study included patients who underwent elective decortication for tuberculous empyema between January 2022 and June 2025. Patients were categorised into the LUS-guided group (LGG) and conventional management group. After 1:1 propensity score matching, 40 patients per group were analysed. Primary outcomes included intraoperative hypotension (mean arterial pressure <65 mmHg for >5 min), while secondary outcomes assessed fluid balance, norepinephrine use, recovery time, pain and post-operative complications.</p><p><strong>Results: </strong>The LGG had a significantly lower incidence and shorter duration of intraoperative hypotension ( P < 0.05). Intraoperative management showed reduced fluid balance, norepinephrine use and fewer vasopressor interventions in the LGG ( P < 0.01). Post-operative recovery was faster, with earlier ambulation and shorter hospital stays ( P < 0.001). The LGG also had lower pain scores and fewer pulmonary complications ( P < 0.05). Multivariable analysis confirmed that the LUS-guided strategy was independently associated with earlier ambulation (β = 6.798, P < 0.001), lower pain scores at rest (β = 0.589, P = 0.018) and reduced pulmonary complications (odds ratio = 3.713, P = 0.049) after adjusting for confounders. Multivariable analysis confirmed the LUS-guided strategy as an independent protective factor against intraoperative hypotension. Diabetes and thoracotomy approach were identified as independent risk factors ( P < 0.05), while fibrous stage empyema showed a trend toward significance ( P = 0.050).</p><p><strong>Conclusion: </strong>LUS-guided fluid management with prophylactic vasopressor support enhances intraoperative stability, optimises fluid and vasopressor use and accelerates recovery in thoracic surgery for tuberculous empyema.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851831","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 management of rectal cancer: Analysis of procedural patterns and perioperative outcomes in 510 patients.","authors":"Amir Zaffar Lone, Mehraj Ul Islam Teeli, Fazl-Ul-Qadir Parray, Anna Batool, Imran Salam Teeli, Qadar Un Nisaa, Zubair Gani","doi":"10.4103/jmas.jmas_91_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_91_26","url":null,"abstract":"<p><strong>Introduction: </strong>Effective surgical therapy of rectal cancer necessitates meticulous selection of suitable surgical procedures contingent upon tumour location, stage and patient characteristics. This research examines surgical procedural trends and results in a tertiary care facility in Kashmir.</p><p><strong>Patients and methods: </strong>A 7-year retrospective-prospective research examined 510 rectal cancer patients who had surgical treatment at SKIMS. Surgical interventions were classified as local excision, low anterior resection (LAR), abdominoperineal resection (APR), Hartmann's technique and palliative operations. Data about surgical approaches (open, laparoscopic and robotic), perioperative parameters and complications were gathered and analysed.</p><p><strong>Results: </strong>Out of 510 patients, 36 (7.05%) had transanal excision, 280 (54.9%) underwent LAR, 145 (28.4%) received APR, 35 (6.9%) were treated with Hartmann's surgery and 14 (2.7%) had unresectable disease necessitating palliative interventions. In the cohort undergoing neoadjuvant treatment, the rates of sphincter-preserving surgery were significantly elevated (62.5% compared to 45.1%, P < 0.05). A laparoscopic technique was employed in 178 individuals (34.9%). Conversion to open surgery was performed in 18 instances (10.1%).</p><p><strong>Conclusion: </strong>This institutional experience illustrates the progression of surgical practices, highlighting the growing implementation of sphincter-preserving techniques and less invasive methods. Neoadjuvant treatment profoundly impacts surgical decision-making, facilitating an increased number of sphincter-preserving surgeries. Persistent focus on entire mesorectal excision principles and judicious application of sophisticated surgical methods can enhance oncological and functional results.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850795","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":"Utility of enhanced liver fibrosis and other non-invasive tests in detecting liver fibrosis in patients undergoing bariatric surgery.","authors":"Ritvik Chekuri, Saksham Gagal, Vitish Singla, Washim Firoz Khan, Sandeep Aggarwal, Shalimar, Archna Singh, Rajni Yadav","doi":"10.4103/jmas.jmas_242_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_242_26","url":null,"abstract":"<p><strong>Background: </strong>The presence of metabolic dysfunction-associated steatotic liver disease and liver fibrosis in patients with obesity is associated with poor long-term liver-related outcomes. Liver biopsy is the gold standard. The enhanced liver fibrosis (ELF) panel is a non-invasive test (NIT) with an excellent correlation with liver fibrosis in various liver disorders. The diagnostic utility of this test in the obese population is not yet established. This study aims to assess the diagnostic accuracy of ELF and other NITs in predicting significant and advanced liver fibrosis in obese patients undergoing bariatric surgery.</p><p><strong>Patients and methods: </strong>This prospective cohort study was performed in a tertiary care academic institute in India. All patients underwent standard pre-operative workup according to the institute protocol. Pre-operative NIT values were determined, which included ELF, liver stiffness measurement (LSM) by FibroScan, aspartate aminotransferase-to-platelet ratio index and fibrosis-4 index. The fibrosis stage was graded based on findings of the liver biopsy performed intraoperatively.</p><p><strong>Results: </strong>On liver biopsy, significant fibrosis was present in 13 (33.3%) patients, while advanced fibrosis was present in 7 (17.9%) patients. ELF accuracy improved with fibrosis severity (area under the receiver operating characteristic curve: 0.7-0.9), with best performance for ≥F3 (85.7% - sensitivity, 82.8% - specificity and negative predictive value [NPV] - 96%). LSM demonstrated high sensitivity (83%-95%) but lower specificity, with consistently high NPV (88.9%-95.6%).</p><p><strong>Conclusion: </strong>ELF score and LSM demonstrated good diagnostic accuracy to identify liver fibrosis in obese patients undergoing bariatric surgery. Multi-centre studies involving larger sample sizes are needed for optimisation of ELF cut-off values to predict liver fibrosis.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851096","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":"Robotic-assisted segmental duodenectomy for giant Brunner's gland hamartoma.","authors":"Bijit Saha","doi":"10.4103/jmas.jmas_133_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_133_26","url":null,"abstract":"<p><strong>Abstract: </strong>Brunner's gland hamartoma (BGH) is an extremely rare benign duodenal tumour (<0.01% incidence), often asymptomatic but occasionally presenting with dyspepsia, bleeding or obstruction. Small lesions can be managed endoscopically, whereas broad-based masses require surgical resection. We report the first video article describing robotic-assisted segmental duodenectomy for a giant BGH. A male in his early 40s presented with dyspepsia and intermittent melena with anaemia. Endoscopy and contrast-enhanced computed tomography revealed a 7-cm broad-based lesion arising from the first part of the duodenum, provisionally diagnosed with gastrointestinal stromal tumours. Robotic segmental duodenectomy with stapled antecolic loop gastrojejunostomy was performed using the da Vinci Xi system. Operative time was 156 min with negligible blood loss. Histopathology confirmed BGH. Recovery was uneventful and the patient remained symptom-free at 2 months. Robotic segmental duodenectomy is safe, feasible and ensures adequate margins with enhanced recovery.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833766","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":"Evaluation of an artificial intelligence model in assessing the severity of gastritis during gastroscopy: A pilot study.","authors":"Krishnamoorthy Rajaram, Palaniappan Sakthivel, Sundaram Easwaramoorthy, Chandrasekar Sakthivel","doi":"10.4103/jmas.jmas_224_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_224_26","url":null,"abstract":"<p><strong>Background: </strong>Gastritis diagnosis via endoscopy remains highly subjective, often leading to inter-observer variability and the misdiagnosis of early inflammatory changes as congestive portal gastropathy. While Computer-Aided Diagnosis (CAD) shows promise, the \"paucity of labelled data\" remains a significant barrier to clinical implementation.</p><p><strong>Aim and objectives: </strong>This study aimed to develop and validate a scalable deep-learning solution using a hybrid CNN-Vision Transformer (ViT) architecture to assist endoscopists in the real-time severity stratification of gastritis (Normal, Mild, Moderate, and Severe).</p><p><strong>Materials and methods: </strong>We utilized 4,462 high-definition, anonymised endoscopic images annotated by expert gastroenterologists using the Kyoto Classification as a benchmark. A multi-branch parallel processing architecture was developed, combining a CNN-based branch for local feature extraction (texture and erythema) and a Vision Transformer (ViT) for global context learning. Data augmentation expanded the training set to over 68,000 images to prevent overfitting. Performance was evaluated using Accuracy, Precision, Recall, and the Matthews Correlation Coefficient (MCC).</p><p><strong>Results: </strong>The hybrid model achieved an Overall Classification Accuracy of 91.4% and a Matthews Correlation Coefficient (MCC) of 0.90, indicating a near-perfect correlation with clinical ground truth. The system demonstrated exceptional performance in the \"Normal\" category with 99% specificity, providing a highly dependable negative result. Precision (0.8892) and Recall (0.8481) remained robust across all categories, significantly reducing the risk of over-diagnosing gastropathy as gastritis.</p><p><strong>Conclusion: </strong>The proposed hybrid AI architecture provides a robust, real-time \"second opinion\" tool for endoscopists. By integrating local and global mucosal patterns, the system achieves high-precision severity stratification, potentially reducing unnecessary biopsies and minimizing diagnostic errors caused by inter-observer variability in the endoscopy suite.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229103","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":"Robotic excision of an ectopic thymoma in the cardiophrenic angle presenting as a cystic mediastinal mass.","authors":"Abhinav Deshpande, Kawadu Shivdas Jawade, Nitin Wadaskar, Ketan Chaturvedi, Amol Dongre, Mahesh Deshmukh, Kapilnath Muralimanohar, Nimish Ganvir","doi":"10.4103/jmas.jmas_36_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_36_26","url":null,"abstract":"<p><strong>Abstract: </strong>Thymomas most commonly arise in the anterior mediastinum, whereas ectopic thymomas occurring outside the normal thymic bed are rare. Lesions arising in the cardiophrenic angle can pose a diagnostic challenge, as they may mimic other mediastinal cystic lesions on imaging. We report the case of a 43-year-old male who was incidentally found to have a well-defined lesion in the right cardiophrenic angle on contrast-enhanced computed tomography. The mass appeared as a heterogeneously enhancing solid-cystic lesion closely abutting the pericardium, raising suspicion for a cystic mediastinal lesion. The patient underwent robotic-assisted thoracoscopic excision of the mass. Intraoperatively, the lesion was well encapsulated and separable from surrounding structures. Complete excision was achieved without the need for pericardial resection. Histopathological examination confirmed the diagnosis of a thymoma. This case highlights the diagnostic challenges associated with unusual mediastinal masses and demonstrates the feasibility and effectiveness of robotic-assisted minimally invasive resection.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799881","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":"Second-side efficiency advantage in robotic-assisted video-endoscopic inguinal lymphadenectomy for penile cancer.","authors":"Tarun Jindal, Monika Meena","doi":"10.4103/jmas.jmas_316_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_316_26","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic-assisted video-endoscopic inguinal lymphadenectomy (RAVEIL) reduces wound morbidity in penile cancer while maintaining oncological adequacy. During synchronous bilateral RAVEIL, we consistently observed that contralateral groin dissection was completed more rapidly than the first side with similar nodal yield. We term this phenomenon the 'second-side advantage' and report the first systematic quantification of this efficiency gain.</p><p><strong>Patients and methods: </strong>A retrospective analysis of 38-consecutive RAVEIL (21 patients) performed between 2019 and 2026 by a single surgeon was conducted. Seventeen patients underwent synchronous bilateral RAVEIL. Operative time and nodal yield were compared between first and second groins using paired t -tests. Cases were analysed according to actual operative sequence. Subgroup analysis by operative sequence and chronological learning curve analysis were performed to address potential confounders.</p><p><strong>Results: </strong>Corrected for actual operative sequence, the mean operative time decreased from 88.8 ± 25.7 min on the first side to 73.2 ± 25.7 min on the second (mean reduction: 15.6 min, 95% confidence interval: 8.3-22.9 min; P = 0.0004). Lymph node yield was comparable (13.1 ± 7.0 vs. 12.6 ± 5.2 nodes; P = 0.59). The advantage was significant in both the right-to-left ( P = 0.0025) and left-to-right ( P = 0.034) subgroups, excluding a laterality effect. The size of the advantage did not correlate with chronological case rank ( r = 0.43, P = 0.088), excluding a learning curve artefact.</p><p><strong>Conclusions: </strong>Synchronous bilateral RAVEIL demonstrates a consistent, highly significant and large-effect intraoperative efficiency gain on the second side, independent of laterality and operative experience.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799910","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":"Critical appraisal of 'enhanced-view totally extraperitoneal repair for ventral hernia: A prospective analysis of peri-operative outcomes, functional recovery and cost-effectiveness'.","authors":"N Karthik, M Swathi","doi":"10.4103/jmas.jmas_447_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_447_26","url":null,"abstract":"","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800317","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":"Minimal access surgery for the combined management of oesophageal duplication cyst and congenital pulmonary airway malformation in a 4-year-old boy.","authors":"Nikola Kostadinov Kartulev","doi":"10.4103/jmas.jmas_496_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_496_25","url":null,"abstract":"<p><strong>Abstract: </strong>Oesophageal duplication cyst (ODC) and congenital pulmonary airway malformation (CPAM) are rare congenital anomalies, and their coexistence has been documented only in isolated case reports. Both malformations necessitate surgical intervention, with timing dependent on clinical presentation. Surgical resection is recommended even for asymptomatic patients with incidentally discovered lesions, given the risk of subsequent complications or malignant transformation. We present a rare case of a 4-year-old boy with combined ODC and CPAM malformations. The patient underwent successful surgical treatment via video-assisted thoracoscopic surgery. At follow-up, the child remains asymptomatic with normal growth and development.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800390","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":"Port-guided port placement: An innovative technique in endoscopic thyroidectomy.","authors":"Brijesh Kumar Singh, R Sachin, Ramita Mukherjee, Sushant Soren, Aditya Baksi, Asuri Krishna","doi":"10.4103/jmas.jmas_88_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_88_26","url":null,"abstract":"<p><strong>Abstract: </strong>Endoscopic thyroidectomy using the bilateral axillo-breast approach (BABA) provides excellent cosmetic outcomes and surgical completeness. Conventional techniques often require hydro-dissection and, in some modifications, specialized tunnelling instruments for flap creation. Hydro-dissection may impair visualization due to camera fogging and tissue charring, while custom instruments increase procedural cost and limit accessibility in resource-constrained settings. We describe a novel port-guided port placement technique for BABA endoscopic thyroidectomy that eliminates the need for hydro-dissection and specialized tunnelling devices, named by us as P3 modification (P- Port P- guided Port P - Placement) Following standard patient positioning and surface marking, a 10-mm port is introduced through an anterior axillary incision after limited blind subcutaneous dissection with a haemostatic artery forceps. This initial port serves as a guide for the sequential placement of additional working ports in the appropriate plane. Subsequent flap elevation and thyroid dissection are performed under direct endoscopic visualization. The technique is applicable to both hemi- and total thyroidectomy while preserving key structures, including the recurrent laryngeal nerves and parathyroid glands. The proposed modification minimizes blind dissection, avoids complications associated with excessive hydro-dissection, and obviates the need for custom-made instruments. Improved visualization, reduced risk of inadvertent deep or superficial dissection, decreased bleeding, and potentially shorter operative time are additional benefits. The technique also reduces procedural costs and enhances the feasibility of remote-access thyroidectomy in low-resource settings. Port-guided port placement is a simple, safe, and cost-effective modification of BABA endoscopic thyroidectomy that improves accessibility while maintaining the principles of minimally invasive thyroid surgery.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800344","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}