Journal of Minimal Access Surgery最新文献

{"title":"Polymeric clip versus endoscopic stapler for securing the base of the appendix during laparoscopic appendectomy: An exploratory randomised controlled trial.","authors":"Ratnakar Namdeo, Manjunath Maruti Pol, Manav Manohar, Venu Madhav Jarapala, Raghav Garg","doi":"10.4103/jmas.jmas_410_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_410_25","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic appendectomy (LA) is the standard of care for acute appendicitis, but the optimal method for appendiceal stump closure remains debated. Endoscopic staplers (ESs) are widely used but expensive, whereas polymeric clips (PCs) offer a cheaper alternative.</p><p><strong>Patients and methods: </strong>We conducted a single-centre, open-label, exploratory randomised controlled trial (September 2021-August 2023) comparing PC (Group A, n = 30) versus ES (Group B, n = 30) for stump closure during LA. Primary outcomes included safety and cost-effectiveness; secondary outcomes included ease and time of application, operative time, hospital stay and complications. Learning curve analysis was performed for a trained surgical resident.</p><p><strong>Results: </strong>Sixty patients (mean age: 30.7 ± 11.6 years) were randomised. Demographics and appendicitis severity were comparable between groups. No stump dehiscence occurred in either group. Operative time was similar (55.1 ± 12.8 vs. 54.5 ± 15.4 min, P = 0.86), although application time was longer with PC (80.1 ± 10.0 vs. 68.3 ± 10.9 s, P < 0.0001). Post-operative complication rates were comparable. Total cost was significantly lower with PC (₹79,815 ± 4,072) versus ES (₹1,19,732 ± 16,061; P < 0.0001). Learning curve analysis showed residents required ~20 cases to achieve operative efficiency.</p><p><strong>Conclusions: </strong>PCs are a safe, technically simple and cost-effective alternative to staplers for appendiceal stump closure in LA, with comparable outcomes and a short learning curve. Larger multicentre RCTs are warranted.</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":"148800408","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":"Effectiveness of chest tube placement via the utility incision in uniportal video-assisted thoracoscopic surgery lobectomy on residual pleural effusion.","authors":"Nicola Rotolo, Elena Asteggiano, Davide Di Natale, Luca Filipponi, Alberto Colombo, Elisa Nardecchia","doi":"10.4103/jmas.jmas_76_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_76_26","url":null,"abstract":"<p><strong>Introduction: </strong>The optimal placement of chest drains after uniportal lobectomy remains a subject of debate, despite the widespread adoption of this minimally invasive approach. This study aimed to compare post-operative pleural effusion between two different chest drain placements: through the utility incision (uniportal video-assisted thoracoscopic surgery [U-VATS]) and through a separate port (triportal VATS [T-VATS]) in patients undergoing pulmonary lobectomy.</p><p><strong>Patients and methods: </strong>We conducted a retrospective, single-center study including 214 consecutive patients who underwent lobectomy for NSCLC (January 2019-December 2024). Patients were divided into two groups: U-VATS group ( n = 107), with a 24-Fr drain placed through the utility incision; T-VATS group ( n = 107), with a 28-Fr drain inserted through the camera port. Demographic data, tumor characteristics and perioperative details were collected. The primary outcome was the residual pleural effusion evaluated on chest X-ray (CXR) before discharge, using the Blackmore scoring system. Secondary outcomes included chest tube duration, hospital stay and post-operative complications.</p><p><strong>Results: </strong>Baseline characteristics were comparable between groups. The U-VATS group exhibited significantly less pleural effusion on immediate post-operative and 3 rd -day chest radiographs ( P < 0.001 for both), while no difference was observed at discharge ( P = 0.45). Chest tube duration was significantly shorter in the U-VATS group (mean 3 vs. 5 days, P = 0.004) despite the use of smaller-diameter drains. There were no differences in complications or post-operative length of stay.</p><p><strong>Conclusions: </strong>Chest tube placement through the utility incision in U-VATS lobectomy ensures effective post-operative pleural fluid management without requiring alternative or additional drainage strategies.</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":"148800336","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":"Eight-year evolution of quality of life after sleeve gastrectomy: A prospective cohort study.","authors":"Ghassan Chakhtoura, Farid Abi Habib, Christian Mouawad, Richard Saade, Roger Noun","doi":"10.4103/jmas.jmas_71_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_71_26","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic sleeve gastrectomy (LSG) yields strong short- and mid-term outcomes, but long-term quality-of-life (QoL) trends remain less defined. Our objectives were to assess 8-year changes in weight, obesity-related medical problems (ORMPs) and QoL after LSG.</p><p><strong>Patients and methods: </strong>This prospective cohort included 106 adults who underwent LSG (2016-2017). Assessments were performed preoperatively and at 1, 5 and 8 years using anthropometric data, ORMPs' status and the Moorehead-Ardelt II QoL questionnaire. Fifty-four patients completed 8-year follow-up. Linear mixed-effects and non-parametric tests were used for paired comparisons.</p><p><strong>Results: </strong>The mean percentage of excess weight loss declined from 73.2% at 1 year to 63.4% at 8 years, with excellent weight loss outcomes decreasing from 92.6% to 81.5% and failure rates rising to 16.7%. QoL improved from - 0.44 preoperatively to 1.80 at 1 year, peaked at 1.99 at 5 years and then declined to 1.41 at 8 years. Weight loss independently predicted higher QoL (β = +0.019 per kg lost, P < 0.001). Most ORMPs remained improved long term, while gastroesophageal reflux disease and smoking increased.</p><p><strong>Conclusions: </strong>LSG provides durable long-term benefits; however, attenuation after 5 years and rising behavioural and reflux-related risks highlight the importance of structured, multidisciplinary, lifelong follow-up to preserve outcomes and QoL.</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":"148800423","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 outcomes of laparoscopic sigmoidectomy in patients with diverticular colovesical fistula.","authors":"María Agustina Casas, Jose Mariano Piatti, Cristian Agustin Angeramo, Francisco Schlottmann, Maximiliano Enrique Bun, Nicolás Agustin Rotholtz","doi":"10.4103/jmas.jmas_57_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_57_26","url":null,"abstract":"<p><strong>Introduction: </strong>Colovesical fistula (CVF) is the most common diverticular fistula. We aimed to determine the safety and feasibility of laparoscopic sigmoidectomy (LS) in patients with CVF.</p><p><strong>Patients and methods: </strong>We performed a retrospective analysis of a prospectively collected database of patients undergoing elective LS for diverticular disease between 2010 and 2023. The sample was divided into two groups: patients with diverticular CVF (CVF group) and patients with recurrent diverticulitis (No-CVF group). Demographics, operative and post-operative variables were analysed and compared between groups. A propensity score matching (2:1) with a control population undergoing elective colorectal resection for recurrent diverticulitis was performed. A cumulative sum analysis was also performed to determine the learning curve for LS in patients with CVF.</p><p><strong>Results: </strong>After propensity score matching, a total of 123 patients were included; 42 patients belonged to the CVF group and 81 to the No-CVF group. No significant differences were found regarding mean operative time, conversion rate, anastomotic leakage rate, overall post-operative morbidity, length of hospital stay, major morbidity and/or mortality. For patients with CVF, a significant decrease in operative time was observed after 13 procedures.</p><p><strong>Conclusion: </strong>LS is feasible and safe for patients with diverticular CVF and has similar morbidity and mortality rates as LS for patients with recurrent diverticulitis. Minimally invasive surgery should be advocated for patients with diverticular CVF in centres with vast experience in laparoscopic colorectal 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":"148799841","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":"Double tract reconstruction for the management of small intestinal bacterial overgrowth after Roux-en-Y gastric bypass.","authors":"Paul Rat, Robin Grellet, Olivier Facy, Nicolas Santucci","doi":"10.4103/jmas.jmas_299_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_299_26","url":null,"abstract":"<p><strong>Introduction: </strong>Small intestinal bacterial overgrowth (SIBO) after Roux-en-Y gastric bypass (RYGB) is underdiagnosed and its management is challenging. Double tract after RYGB may decrease malabsorption and intestinal stagnation. We report our experience, as an innovative approach by using double tract reconstruction for the management of SIBO after RYGB.</p><p><strong>Patients and methods: </strong>All patients included underwent a double tract reconstruction after RYGB for obesity between January 2020 and December 2023. Double tract reconstruction was only indicated after a documented positive breath test, failure of conservative treatment and exclusion of a candy-cane effect or a very long biliopancreatic limb. Body mass index, reflux and SIBO symptoms were recorded.</p><p><strong>Results: </strong>Five patients were included. All patients had an uneventful post-operative course. Median length of hospital stay was 2 days. All patients had a significant improvement in their symptoms at the first post-operative appointment. At the end of follow-up, two patients had no improvement in symptoms, while three patients had significant improvement. Among them, two patients were completely cured from chronic diarrhoea. No patient reported weight regain or reflux symptoms.</p><p><strong>Conclusion: </strong>Double tract reconstruction might be a safe and reproductive procedure, which should be considered in patients with SIBO after RYGB whose medical treatment has failed.</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":"148800254","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":"Minimally invasive management of patent vitello-intestinal duct in an adult.","authors":"Rahul Kumar Jaiswal, Devender Singh, Piyush Ranjan, Sunil Chumber","doi":"10.4103/jmas.jmas_266_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_266_26","url":null,"abstract":"<p><strong>Abstract: </strong>The patent vitello-intestinal duct (PVID) is a persistent embryological remnant of the omphalomesenteric duct, which normally connects the yolk sac to the primitive midgut, and it is obliterated between the 8 th and 9 th weeks of gestation. Failure of this involution results in a spectrum of anomalies, including Meckel's diverticulum, umbilical sinus, fistula, and cyst. Although such remnants are present in approximately 2% of the population, symptomatic presentation in adulthood is exceedingly rare. We report the case of a 30-year-old male who presented with foul-smelling umbilical discharge from a 0.3 cm × 0.3 cm opening for 24 months. He was successfully treated with laparoscopic resection of the PVID using an endoscopic linear stapler. Adult presentation of PVID with bilio-feculent discharge is exceptionally uncommon and not reported in the literature.</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":"148800398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A prospective randomised controlled trial comparing tissue adhesive and sutures for laparoscopic port-site skin closure.","authors":"M Praveen Kumar, P Niranjan, H R Ravishankar","doi":"10.4103/jmas.jmas_323_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_323_26","url":null,"abstract":"<p><strong>Introduction: </strong>The cosmetic outcome of surgical scars plays an important role in overall patient satisfaction, particularly in minimally invasive procedures. Various skin closure techniques, including sutures and cyanoacrylate-based tissue adhesives, are used to optimise efficiency, patient comfort and aesthetic outcomes. This study compares sutures and adhesive skin glue for laparoscopic port-site skin closure.</p><p><strong>Patients and methods: </strong>A prospective randomised controlled trial was conducted on 100 patients undergoing laparoscopic surgeries at Sagar Hospitals, Bangalore. Patients were randomised into suture and adhesive glue groups. Outcomes assessed included wound closure time (primary outcome), post-operative pain, cosmetic outcome and complications. Patients were followed up for a period of 1 month.</p><p><strong>Results: </strong>The mean wound closure time was significantly lower in the glue group (20.3 s) compared to the suture group (165.1 s) ( P < 0.0001). Post-operative pain scores were significantly lower in the glue group in the immediate post-operative period (3 and 12 h), but were comparable between groups at later time points. The Modified Hollander Score, assessing objective cosmesis at 1 month, showed no significant difference between the suture (5.52) and glue groups (5.67) ( P = 0.4256). However, patient-reported cosmetic outcomes were higher in the glue group, with excellent ratings in 80% versus 48% of patients ( P = 0.0009). Descriptive cosmetic scores also favoured the glue group ( P = 0.0051). No significant difference in wound complications was observed between the two groups.</p><p><strong>Conclusion: </strong>Tissue adhesive significantly reduces wound closure time and is associated with lower immediate post-operative pain, although this benefit is short lived. Objective cosmetic outcomes are comparable between techniques, whereas improved patient-reported cosmesis may be influenced by lack of blinding. Both methods are safe and effective, and the choice of closure technique should be guided by clinical context and resource considerations.</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":"148800312","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":"Long-term outcomes of endoscopic pilonidal sinus treatment: A single tertiary centre experience.","authors":"Syeda Yusra Sabir, F N U Tooba, Muhammad Hassan Saeed","doi":"10.4103/jmas.jmas_348_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_348_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":"148800369","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":"Ergonomic impact of open- versus closed-console robotic systems on surgeon fatigue and musculoskeletal strain: A prospective, experimental, wet-lab comparative study.","authors":"Bhavneet Singh Bhalla, Amrita Soni, Pavit Singh","doi":"10.4103/jmas.jmas_265_26","DOIUrl":"https://doi.org/10.4103/jmas.jmas_265_26","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic-assisted surgery has transformed minimally invasive surgery by enhancing dexterity, visualisation and surgeon ergonomics. However, significant variations exist in robotic console architecture, primarily between open-console and closed-console systems. Although robotic surgery is generally considered to offer ergonomic benefits over laparoscopic surgery, evidence comparing ergonomic outcomes between console designs remains limited. To compare the ergonomic impact of open- versus closed-console robotic systems on surgeon fatigue, musculoskeletal strain and workload.</p><p><strong>Patients and methods: </strong>A prospective, randomised, crossover wet-lab study was conducted involving surgeons performing standardised robotic surgical tasks on both open-console and closed-console robotic systems. Ergonomic outcomes were assessed using Rapid Upper Limb Assessment (RULA), NASA Task Load Index (NASA-TLX) and subjective fatigue scales.</p><p><strong>Results: </strong>Open-console systems demonstrated significantly lower RULA scores and improved ergonomic posture compared with closed-console systems ( P < 0.05). Surgeons reported reduced neck, shoulder and upper back discomfort after open-console use. NASA-TLX scores revealed lower physical demand, effort and frustration with open-console systems. No statistically significant difference in surgical precision or error rates was observed between the systems.</p><p><strong>Conclusion: </strong>Open-console robotic systems provide superior ergonomic advantages compared with closed-console robotic systems, reducing surgeon fatigue and musculoskeletal strain without compromising technical performance. Console architecture should be recognised as a major determinant of surgeon occupational health and future robotic platform design.</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":"148800414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic distal gastrectomy and intra-operative reduction of gastroduodenal intussusception for gastric cancer with ball valve syndrome: A case report with video.","authors":"Hitoshi Hara, Yasuhide Muto, Tomoki Kido, Kazutsugu Iwamoto, Michio Itabashi","doi":"10.4103/jmas.jmas_555_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_555_25","url":null,"abstract":"<p><strong>Abstract: </strong>Gastroduodenal intussusception due to gastric tumours, including gastric cancer, is called ball valve syndrome. Transection of the duodenum is challenging when laparoscopic gastrectomy is performed in patients with ball valve syndrome. An 80-year-old woman with appetite loss was diagnosed with anaemia and gastric cancer and referred to our hospital. Pre-operative examination revealed two gastric cancer lesions in the antrum: one was a 20-mm elevated lesion intussuscepting into the duodenum. Laparoscopic distal gastrectomy with regional lymph node dissection was performed following the clinical diagnosis of early gastric cancer with ball valve syndrome. The prolapsed tumour was moved into the stomach using a pair of laparoscopic forceps and after confirming that the two tumours were present within the stomach using intra-operative endoscopy, the duodenum was transected and Billroth I reconstruction was performed. Gastroduodenal intussusception of small gastric cancers can be managed laparoscopically; however, intra-operative endoscopic confirmation is required to enable duodenal transection.</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":"148800387","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}