Journal of Minimal Access Surgery最新文献

{"title":"Comment on: Is the self-adhesive mesh a solution for chronic postoperative inguinal pain after TAPP: A single centre preliminary experience?","authors":"Christopher Robert Smith, Guillaume B R C Lafaurie, Amir H Razvi","doi":"10.4103/jmas.jmas_246_24","DOIUrl":"10.4103/jmas.jmas_246_24","url":null,"abstract":"","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"329-330"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of uterine weight on surgical outcomes in robotic hysterectomy: An ambispective analysis.","authors":"Anupama Bahadur, Shloka Sharma, Ayush Heda, Latika Chawla, Rajlaxmi Mundhra","doi":"10.4103/jmas.jmas_125_24","DOIUrl":"10.4103/jmas.jmas_125_24","url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted surgeries are increasingly used for the treatment of benign gynaecological conditions. However, their impact in cases of significantly enlarged uteruses remains uncertain. This study aims to investigate whether the weight of the uterus influences the surgical results of robotic hysterectomy.</p><p><strong>Patients and methods: </strong>Ambispective analysis of 306 cases was performed, of which 265 cases were analysed retrospectively. The outcome measures included total operative time, including docking time, console time and vault closure time, complication rates and quality of life (World Health Organization Quality of Life Brief questionnaire) stratified based on uterine sizes into three groups by every 250 g.</p><p><strong>Results: </strong>Of the 306 cases, 76.47% of cases ( n = 234) had uterine weight <250 g, 18.30% of cases ( n = 56) had uterine weight between 250 and 500 g, while 5.23% of cases ( n = 16) had a weight of uterine specimen >500 g. The total operative time was significantly lower in the <250 g group compared to >500 g (81.92 ± 22.81 vs. 111.88 ± 40.27 min; P = 0.003), contributed primarily by the console time. Although the need for post-operative blood transfusion was higher in the >500 g group, the overall complication rate between the three groups was similar. The three groups had comparable QOL through all four domains.</p><p><strong>Conclusion: </strong>The present study underscores the influence of uterine weight on robotic hysterectomy outcomes, revealing increased operative times and post-operative haemoglobin drop for uteri over 500 g. Despite these challenges, complications were not significantly affected by uterine size.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"276-281"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the application value of the modified Billroth-II with Braun anastomosis in laparoscopic distal gastric cancer radical surgery.","authors":"Yubing Zhong, Yi Qian, Tao Wang","doi":"10.4103/jmas.jmas_306_23","DOIUrl":"10.4103/jmas.jmas_306_23","url":null,"abstract":"<p><strong>Introduction: </strong>This retrospective study aims to compare the feasibility and efficacy of the modified Billroth-II with Braun (B-II Braun) reconstruction with the Roux-en-Y (R-Y) reconstruction following laparoscopic distal gastrectomy.</p><p><strong>Patients and methods: </strong>Between January 2020 and December 2022, 213 patients underwent total laparoscopic distal gastrectomy (TLDG). Of these, 125 patients underwent B-II Braun reconstruction and 8 underwent R-Y reconstruction. Patient data were prospectively collected and retrospectively analysed.</p><p><strong>Results: </strong>The modified B-II Braun reconstruction required shorter operative times compared to the R-Y approach (151.60 ± 12.50 vs. 182.50 ± 10.60; P = 0.0037), including anastomosis time (32.46 ± 1.55 vs. 48.80 ± 2.84; P = 0.016). At a 6-month short-term follow-up, endoscopic examination in the B-II Braun group revealed 27 cases of bile reflux and 15 cases (10.3%) of Grade 2 gastritis, with no cases of Grade 2 food residue. However, there was no statistically significant difference between the two groups in terms of food residue remaining in the residual stomach at 6 months ( P = 0.29), gastritis at 6 months ( P = 0.126) or bile reflux at 6 months ( P = 0.209).</p><p><strong>Conclusion: </strong>For gastric cancer patients, TLDG with modified B-II Braun reconstruction is technically feasible. It offers an acceptable post-operative complication profile, shortens operative time, facilitates early post-operative recovery and effectively prevents bile reflux into the remnant stomach.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"245-250"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of ventral hernia repair in patients of severe obesity: An experience from a tertiary care centre.","authors":"Sonali Mittal, Arun Kumar, Jagadeep Ajmera, Surabhi Vyas, Sandeep Aggarwal","doi":"10.4103/jmas.jmas_292_24","DOIUrl":"10.4103/jmas.jmas_292_24","url":null,"abstract":"<p><strong>Introduction: </strong>Ventral hernia (VH) in patients with severe obesity poses a surgical challenge during bariatric surgery (BS). There is conflicting evidence regarding the optimal timing to perform a definitive VH repair (VHR). We present our experience in managing severely obese patients with VH.</p><p><strong>Patients and methods: </strong>Sixty-seven severely obese patients with VH underwent a cross-sectional analysis of outcomes after BS and VHR. Outcomes were presented in terms of patients' demographics, BS performed, timing of VHR and recurrence rates.</p><p><strong>Results: </strong>Sixty-seven patients were included in the study. Seven patients who presented with complicated hernia underwent a concomitant BS and VHR (Group 1) and the rest with uncomplicated hernia underwent a staged VHR (Group 2). The mean age of presentation was 45.2 (±11.5) years, with a female preponderance (male:female = 17.9:82.1). The mean defect size was 3.4 (1.6) cm. Majority of Group 1 patients underwent an anatomical repair while Group 2 patients underwent a mesh hernioplasty. The patients in Group 1 had a higher body mass index at the time of VHR (47.4 ± 12.7 vs. 33.7 ± 4.21 kg/m 2 ). The rate of recurrence was also higher in Group 1 compared to Group 2 (42.9% vs. 3.3%) at a mean duration of 10.3 and 12 months, respectively.</p><p><strong>Conclusion: </strong>VHR in patients with severe obesity is challenging. The staged approach appears to be a safer option with acceptable recurrence rates compared to the concomitant approach. However, an individualised approach based on patient presentation should be followed for VHR in such patients.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"270-275"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning curve in robotic rectal cancer surgery: A national two-centre study.","authors":"Anislav Ventsislavov Gabarski, Paulina T Vladova, Martin P Karamanliev, Nikolai Ramadanov, Aleksandar K Zlatarov, Turgay T Kalinov","doi":"10.4103/jmas.jmas_179_23","DOIUrl":"10.4103/jmas.jmas_179_23","url":null,"abstract":"<p><strong>Introduction: </strong>Colon and rectal surgery was amongst the earliest specialities to adopt robotic surgery, with Weber and Hashizume reporting the first operations for benign and malignant colorectal disease, respectively, in 2002. Although robotic-assisted surgery benefits from technical advantages that shorten the learning curve, it nonetheless presents a steep and extended learning curve.</p><p><strong>Patients and methods: </strong>A prospective study was performed by a surgical team formed from two different departments in Bulgaria, using the da Vinci Si HD robotic system. The patients were divided into two groups: group I - the first 28 patients without indocyanine green (ICG) use and group II - the next 17 patients with ICG fluorescence imaging to assess bowel perfusion. Correlations between patient characteristics, operation duration, conversions, hospitalisation duration, complications, bleeding, reoperation, type of operation and ICG usage were assessed using multivariate analysis. This research aims to evaluate our learning curve, oncological safety and technical proficiency using the cumulative summation (CUSUM) method. To determine the CUSUM scores for each procedure index, the average console and docking time were taken into account. Subsequently, CUSUM plots were generated for the initial 45 cases.</p><p><strong>Results: </strong>Forty-five patients were included: 32 men (71.1%) and 13 women (28.9%). The procedures performed included 37 anterior resections (82.2%) and 8 (17.8%) abdominoperineal excisions. The operative time was shorter in group II for both the docking and console times. The docking time in group I was 10 min (range, 4-30 min) compared with 9 min (ranging 5-20 min) in group II ( P = 0.691). The console time was 166 min in group I (ranging 45-300 min) and 147 min in group II (ranging 60-235 min) ( P = 0.020).</p><p><strong>Conclusion: </strong>A significant reduction in console time was observed after the 28 th case. Anastomotic leaks were not observed in the ICG group. Despite our small patient cohort, we believe our institution contributes to the literature by describing our experience and the learning curve associated with robotic rectal resections.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"239-244"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case report on the loss of an Iglesias resectoscope beak during hysteroscopic myomectomy.","authors":"Ugo Indraccolo","doi":"10.4103/jmas.jmas_376_23","DOIUrl":"10.4103/jmas.jmas_376_23","url":null,"abstract":"<p><strong>Abstract: </strong>This case report describes the dynamics of the detachment of the ceramic beak of an Iglesias resectoscope that was lost in the uterine cavity during 'cold loop' hysteroscopic myomectomy. Our aim is to increase awareness of this issue and caution our colleagues against using Iglesias resectoscopes for hysteroscopies. The ceramic beak of an Iglesias resectoscope can detach itself if hard tissue is encountered during operative hysteroscopy.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"303-305"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unusual case of small-bowel obstruction: Broad ligament hernia.","authors":"Anmol Ahuja, Shyam Sundar Rengan, Ashish Dey, Vinod K Malik, Tarun Mittal","doi":"10.4103/jmas.jmas_280_23","DOIUrl":"10.4103/jmas.jmas_280_23","url":null,"abstract":"<p><strong>Abstract: </strong>Broad ligament hernias (BLHs) are rare internal hernias that can lead to serious complications if left untreated. In this case report, we present the case of a BLH in a female patient and discuss its clinical presentation, diagnosis and management. A 40-year-old woman presented with subacute intestinal obstruction symptoms, including the inability to pass flatus and faeces and recurrent bilious vomiting. A computed tomography (CT) scan confirmed small-bowel obstruction adjacent to the uterus within the left broad ligament. Diagnostic laparoscopy revealed a loop of obstructed small intestine within the broad ligament, which was released and found to be healthy. The defect between the broad and infundibulopelvic ligaments was closed with sutures. The patient had an uneventful recovery and was asymptomatic at a 6-month follow-up. BLHs can be congenital or acquired, with acquired defects often resulting from previous surgeries or pregnancy-related causes. The clinical presentation typically involves the symptoms of bowel obstruction, and a CT scan is the diagnostic modality of choice, showing characteristic findings such as closed-loop obstruction and bowel dilation. Laparoscopic management offers the advantages of faster recovery and less morbidity. Closure of the defect using nonabsorbable sutures is the standard surgical approach, although a wide opening of the defect has also been described. Recurrence is a possibility, particularly if absorbable sutures are used for closure. This case report highlights the importance of early diagnosis and intervention in BLHs to prevent the complications and emphasises the role of laparoscopy in their management.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"315-317"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic nephrectomy in crossed-fused inferior ectopic kidneys - Defusing complexities: A case series.","authors":"Zain Tamboli, Alok Srivastava, Ishwar Ram Dhayal, Sanjeet Singh","doi":"10.4103/jmas.jmas_14_24","DOIUrl":"10.4103/jmas.jmas_14_24","url":null,"abstract":"<p><strong>Background: </strong>Crossed fused renal ectopia manifests as an operative challenge to the minimally invasive urologist. Provided that certain preset steps are meticulously followed and the anatomy is understood, it is not a difficult task to operate on these cases.</p><p><strong>Patients and methods: </strong>This is a retrospective study of 15 cases at our Dr. RMLIMS, Lucknow over a period of 5 years.</p><p><strong>Results: </strong>The mean operative time was 117.3 minutes and the mean blood loss was 99.3 ml. Two arteries were encountered in 53.3 % of cases, but they can vary in number from a single artery to even six, as found in our series. Two veins were found in 46.6 % of cases, and even up to four veins can be found.</p><p><strong>Conclusions: </strong>Tackling a case of crossed fused inferior renal ectopia by laparoscopic simple nephrectomy is possible with ease and confidence, provided that certain steps are carefully followed to minimize the possibility of complications and conversion to open surgery.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"251-255"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic cholecystectomy in elderly patients: Avoid or expedite? - A comparative cohort study.","authors":"Maria Mondragon, Ali Yasen Mohamedahmed, Shafquat Zaman, Ja'quay Farquharson, Usman Raja, Arhum Ijaz, Deepak Singh-Ranger","doi":"10.4103/jmas.jmas_138_24","DOIUrl":"10.4103/jmas.jmas_138_24","url":null,"abstract":"<p><strong>Introduction: </strong>Although laparoscopic cholecystectomy (LC) has become the gold standard for treating gall bladder stones (GBS), its safety in elderly patients is still questioned. This study aimed to assess the outcome of LC in patients 70 and older compared to younger patients.</p><p><strong>Patients and methods: </strong>The medical records of 548 patients undergoing LC were evaluated retrospectively. Patients' demographics and post-operative complications were recorded. Furthermore, patients were divided according to the CEPOD into emergency and elective patients, and complications were recorded according to Clavien-Dindo (CD) classifications. Data analysis was performed with SPSS software version 27.</p><p><strong>Results: </strong>Patients were divided into the elderly patients group (≥70 years of age, n = 185) and the young patients group (<70 years of age, n = 363). The ≥70-year-old group showed a significantly higher number of patients who required emergency admission with GBS symptoms (P = 0.001), emergency LC (P = 0.01) and conversion to open (P = 0.02). The two groups showed comparable post-operative complications: bile leak (P = 0.26), collection (P = 0.11) and re-operation (P = 0.60), post-operative endoscopic retrograde cholangiopancreatography (P = 1.0), GBS pancreatitis (P = 0.33) and death (0.30). CD I-II complications were higher in the ≥ 70-year-old group compared to the <70-year-old group in elective (P = 0.01) and emergency (P = 0.03) LC. However, CD ≥3 complications were higher in the ≥70-year-old group than the <70-year-old group in the emergency LC (P = 0.01) and comparable in the elective LC (P = 0.12).</p><p><strong>Conclusion: </strong>LC is safe and efficient in elderly patients. Elective LC should be expedited in elderly patients to avoid emergency admissions and emergency LC, which are associated with higher complication rates.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":"21 3","pages":"265-269"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic management of variant ductal and vascular anatomy in children with choledochal cysts.","authors":"Ankur Mandelia, Rohit Kapoor, Anju Verma, Pujana Kanneganti, Rajanikant R Yadav, Moinak Sen Sarma, Nishant Agarwal, Tarun Kumar, Biju Nair, Amit Buan","doi":"10.4103/jmas.jmas_255_24","DOIUrl":"10.4103/jmas.jmas_255_24","url":null,"abstract":"<p><strong>Introduction: </strong>Variations in biliary ductal and hepatic vascular anatomy increase the complexity of surgery for choledochal cysts (CDC). The laparoscopic approach for the management of paediatric CDCs with variant anatomy is underreported. This study aimed to describe anatomical variations, operative techniques and early outcomes of laparoscopic hepaticojejunostomy (HJ) in children with CDCs and variant anatomy.</p><p><strong>Patients and methods: </strong>We conducted a retrospective review of 40 children who underwent laparoscopic CDC excision with HJ between 2019 and 2024 in a single surgical unit. Patients were divided into Group I (with anatomical variations, n = 20) and Group II (without variations, n = 20). Data on demographic details, clinical presentation, imaging findings, pre-operative interventions, ductal and vascular anatomical variations, surgical techniques, intraoperative variables, post-operative complications and outcomes were collected and analysed.</p><p><strong>Results: </strong>Ductal variations were found in 10 patients, with aberrant right posterior sectoral duct being the most common. Vascular variations were identified in 12 patients, with anteriorly crossing the right hepatic artery (RHA) being the most frequent. Group I had a higher mean age (7.32 vs. 3.57 years, P = 0.014) and longer operative times (415 vs. 364 min, P < 0.0001). Conversion to laparotomy was necessary in 10% of Group I and 15% of Group II patients ( P = 0.634). Post-operative complications, primarily minor (Clavien-Dindo Grade I or II), occurred in 40% of Group I and 30% of Group II ( P = 0.495). Group I had a significantly shorter time to full feeds (72 vs. 80 h, P = 0.015). Both groups had similar post-operative hospital stays and follow-up durations. At the last follow-up, all patients, except one with liver failure in Group II, were asymptomatic with no significant biliary dilatation or liver function abnormalities.</p><p><strong>Conclusion: </strong>Laparoscopic management of CDCs with variant ductal and vascular anatomy in children is feasible, safe and effective. Detailed pre-operative imaging, meticulous intraoperative assessment and tailored surgical techniques are crucial for successful outcomes.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"282-291"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}