Journal Of Minimal Access Surgery[JOURNAL]
Sun
200 papers
The Swiss-cheese paradox: An unusual cluster of primary ventral hernia defects managed by robotic TAPP.
Karthik N, Chaudhary R
J Minim Access Surg · 2026 May · PMID 42241362 · Publisher ↗
Primary ventral hernias are common surgical conditions; yet, their fascial morphology rarely deviates from the typical solitary pattern. We report a rare presentation of a primary ventral hernia with multiple umbilical a...
Primary ventral hernias are common surgical conditions; yet, their fascial morphology rarely deviates from the typical solitary pattern. We report a rare presentation of a primary ventral hernia with multiple umbilical and multiple supraumbilical fascial defects - forming a 'Swiss cheese' configuration - in a patient without prior surgery, trauma or connective tissue disorders. Robotic exploration unexpectedly revealed multiple occult fascial defects that were not fully appreciated on pre-operative imaging, underscoring both the diagnostic and therapeutic value of the robotic transabdominal pre-peritoneal approach.
Balancing relief and reflux: A prospective comparative study on gastric myotomy length and post-operative outcomes in laparoscopic Heller's myotomy for achalasia.
Yadav S, Kiran SP, Gurjar SK … +2 more , Buddha SDV, Aher MA
J Minim Access Surg · 2026 May · PMID 42241360 · Publisher ↗
INTRODUCTION: Laparoscopic Heller's myotomy (LHM) with a partial fundoplication is the standard surgical therapy for achalasia cardia. However, the ideal gastric extension of the myotomy remains controversial, as it may...
INTRODUCTION: Laparoscopic Heller's myotomy (LHM) with a partial fundoplication is the standard surgical therapy for achalasia cardia. However, the ideal gastric extension of the myotomy remains controversial, as it may influence both symptom relief and post-operative gastro-oesophageal reflux disease (GORD). This study prospectively assessed the impact of gastric myotomy length on clinical outcomes after LHM with Dor fundoplication. PATIENTS AND METHODS: In this prospective non-randomised comparative interventional study, patients undergoing LHM with Dor fundoplication were divided into three groups according to gastric myotomy length: Group A (<1.5 cm), Group B (1.5-2.5 cm) and Group C (>2.5 cm). The primary outcome was improvement in the Eckardt score at 1, 3 and 6 months postoperatively. The secondary outcomes included GORD incidence (Gastro-Oesophageal Reflux Disease Questionnaire [GORD-Q]), complications and re-intervention rates. RESULTS: Sixty-three patients were included ( n = 21 per group). All groups showed significant symptom improvement post-surgery. At 3 and 6 months, Groups B and C demonstrated greater Eckardt score improvement than Group A ( P = 0.012 and P < 0.01, respectively). Median GORD-Q scores were similar at 1 and 3 months but higher in Group C at 6 months ( P = 0.01). Re-intervention was most frequent in Group A (23.8%) due to persistent dysphagia ( P = 0.047). Operative time, hospital stay and complications did not differ significantly among the groups. CONCLUSION: Gastric myotomy beyond 1.5 cm improves symptom control after LHM with Dor fundoplication, but extension beyond 2.5 cm increases reflux risk. A length of 1.5-2.5 cm appears optimal for balancing dysphagia relief and reflux prevention.
Laparoscopic cholecystectomy simulation training: A comprehensive review of models, assessment tools and training curricula.
Brown IG, Cronin M, Lone M
J Minim Access Surg · 2026 May · PMID 42241353 · Publisher ↗
Laparoscopic cholecystectomy (LC) is one of the most frequently performed surgical procedures worldwide and serves as a fundamental training operation in general surgery. As surgical education evolves, simulation-based t...
Laparoscopic cholecystectomy (LC) is one of the most frequently performed surgical procedures worldwide and serves as a fundamental training operation in general surgery. As surgical education evolves, simulation-based training (SBT) has become an essential component for developing laparoscopic skills outside the operating room. Multiple simulation modalities, such as box trainers, virtual reality (VR), animal models and cadaveric models, are now available to replicate components of LC, each offering distinct benefits and limitations. This narrative review explores the state of LC training with a focus on simulation models, assessment strategies and curriculum structure. We outline the procedural foundations of LC to contextualise key learning objectives. A detailed review of available simulation models follows, highlighting technical features, realism, procedural fidelity and limitations. We also discuss recent advances in model design, including three-dimensional printing and hybrid simulators. Assessment tools used to evaluate LC skills are examined, including global rating scales, procedure-based assessments and hierarchical task analysis-based systems. The shift from traditional case-number-based training to performance-based or proficiency-based curricula is also reviewed, along with the challenges this transition poses. Despite growing evidence supporting SBT, direct comparisons of available LC training models remain limited. Variations exist in fidelity, cost, accessibility and assessment capability across synthetic, VR, animal and cadaveric modalities. This review provides a structured comparison of these training platforms, highlighting their respective strengths, limitations and implications for curriculum design. Understanding of these modalities is essential for optimising training pathways, aligning institutional investment with educational value and ultimately enhancing surgical competency and patient safety.
Laparoscopic splenopexy for splenic torsion in a patient with heterotaxy and single ventricle physiology: A rare case report.
Malik MA, Shashikiran B
J Minim Access Surg · 2026 Apr · PMID 42241351 · Publisher ↗
Splenic torsion in a wandering spleen with heterotaxy syndrome (HS) with single ventricle physiology is a rare and challenging clinical situation. Single-ventricle physiology poses a challenge in performing laparoscopy i...
Splenic torsion in a wandering spleen with heterotaxy syndrome (HS) with single ventricle physiology is a rare and challenging clinical situation. Single-ventricle physiology poses a challenge in performing laparoscopy in these patients. We report safe laparoscopic splenopexy performed in a 10-year-old boy with heterotaxy and single ventricle physiology post-bidirectional Glenn Shunt.
Fluorescence-guided autonomic nerve preservation during total mesorectal excision: A prospective pilot study.
Nishtha, Sugoor P, Daima M
J Minim Access Surg · 2026 May · PMID 42241138 · Publisher ↗
INTRODUCTION: Total mesorectal excision has significantly improved oncologic outcomes in rectal cancer; however, post-operative urinary and sexual dysfunction remain important concerns due to inadvertent pelvic autonomic...
INTRODUCTION: Total mesorectal excision has significantly improved oncologic outcomes in rectal cancer; however, post-operative urinary and sexual dysfunction remain important concerns due to inadvertent pelvic autonomic nerve injury. Intraoperative identification of these nerves is particularly challenging following neoadjuvant chemoradiotherapy. This study evaluated the feasibility of indocyanine green (ICG)-guided fluorescence imaging for the selective visualisation of pelvic autonomic nerves during minimally invasive TME. PATIENTS AND METHODS: In this prospective pilot feasibility study, 24 patients undergoing minimally invasive TME for rectal adenocarcinoma were included. Twelve patients underwent conventional nerve-preserving TME guided by anatomical landmarks, whereas twelve received intravenous ICG (0.5 mg/kg) 12 h preoperatively. Near-infrared imaging was used intraoperatively. Short-term post-operative outcomes assessed included the day of urinary catheter removal, need for recatheterisation and incidence of urinary tract infection. RESULTS: The median age was 57 years, and baseline characteristics were comparable between groups. In the fluorescence-guided group, autonomic nerves appeared as distinct non-fluorescent structures against a fluorescent background. Earlier catheter removal was observed in the ICG group (predominantly post-operative day 2 vs. day 3). Recatheterisation was required in one patient in the fluorescence-guided group compared with three in the conventional group. One UTI occurred in the conventional group, whereas none were observed in the fluorescence-guided group. No adverse reactions to ICG were recorded. CONCLUSION: Pre-operative low-dose ICG administration is feasible and safe for real-time intraoperative visualisation of pelvic autonomic nerves during minimally invasive TME and may improve early post-operative urinary outcomes. Larger prospective studies are warranted.
Next-generation mesh materials, beyond polypropylene and biologics: A scoping review.
Singh K, Arunkumar V, Maheshwari P … +5 more , Jha A, Karn A, Mishra A, Ammapalem S, Gupta A
J Minim Access Surg · 2026 May · PMID 42241136 · Publisher ↗
Hernia repair remains one of the most frequent surgical procedures worldwide, with more than 20 million cases performed annually. Although polypropylene has served as the clinical workhorse since the mid-20 th century du...
Hernia repair remains one of the most frequent surgical procedures worldwide, with more than 20 million cases performed annually. Although polypropylene has served as the clinical workhorse since the mid-20 th century due to its mechanical strength and accessibility, it is often limited by complications such as infection, fibrosis, and chronic pain. This scoping review synthesizes the evolution of mesh technology, evaluating the transition from traditional synthetics and biologics toward next-generation biomaterials. While biologic and biosynthetic meshes were developed to offer improved biocompatibility, they are frequently hindered by high recurrence rates, prohibitive costs, and uncertain long-term durability under physiological stress. Emerging innovations-including composite designs, antimicrobial coatings (such as benzalkonium chloride), and nanotechnology-enhanced nanofiber scaffolds-aim to bridge these gaps by fostering regenerative healing rather than mere structural reinforcement. Furthermore, the integration of 3D printing and artificial intelligence (AI) heralds a new era of personalized medicine, allowing for bespoke mesh design, predictive outcome modeling, and intraoperative guidance. Ultimately, hernia mesh innovation is shifting from passive, inert barriers toward intelligent, adaptive scaffolds that harmonize with human biology. While regulatory and manufacturing hurdles remain, these advancements signal a transformative shift in the future of abdominal wall reconstruction.
Surgical clip migration in the biliary tract.
Song H, Yang L, Sun Z
J Minim Access Surg · 2026 Apr · PMID 42085076 · Publisher ↗
Surgical clip migration in the biliary tract is uncommon and the diagnosis is still challenging, which may affect the treatment of these scenarios. We report three cases of surgical clip migration in the biliary tract th...
Surgical clip migration in the biliary tract is uncommon and the diagnosis is still challenging, which may affect the treatment of these scenarios. We report three cases of surgical clip migration in the biliary tract that occurred in our clinical practice. Three female adults were diagnosed with dilation of the common bile duct (CBD), surgical clip migration in the biliary tract and the tumour of CBD, respectively. All of them had a history of hepatobiliary surgery. All of them were diagnosed with surgical clip migration in the biliary tract before surgery and underwent surgery and the migration surgical clips were removed successfully. The cause of surgical clip migration in the bile duct, whether it is non-absorbable Hem-o-lok or absorbable clip, is the foreign body reactions leading to bile duct wrapping the surgical clips and cause their migration. It may also be caused by continuous compression between the surgical clip and the CBD.
Comparison of the effects of isoflurane and desflurane on the optic nerve sheath diameter in elderly patients undergoing robotic-assisted laparoscopic radical prostatectomies in steep Trendelenburg position - A randomised controlled trial.
Rajmohan N, Suhana F, Srinivasan SP … +3 more , Omkarappa S, Nair SG, Mundekkat S
J Minim Access Surg · 2026 Apr · PMID 42085065 · Publisher ↗
INTRODUCTION: Optic nerve sheath diameter (ONSD) serves as a reliable surrogate marker for intracranial pressure (ICP) during robotic assisted laparoscopic radical prostatectomies (RARP). ICP elevation is greater in pati...
INTRODUCTION: Optic nerve sheath diameter (ONSD) serves as a reliable surrogate marker for intracranial pressure (ICP) during robotic assisted laparoscopic radical prostatectomies (RARP). ICP elevation is greater in patients above 60 years due to impaired cerebral autoregulation and compliance. While total intravenous anaesthesia with propofol has demonstrated better control over ONSD compared to inhalational anaesthetics, the latter's dose-dependent vasodilatory effects on cerebral vessels remain understudied. This trial is aimed to compare the effects of isoflurane and desflurane on ONSD in elderly patients undergoing RARP. Secondary goals include incidence of neurological complications, delayed recovery and duration of hospital stay. PATIENTS AND METHODS: A prospective randomised controlled study was conducted on 54 elderly patients aged 60 years and above, undergoing RARP. These patients were randomised to receive isoflurane or desflurane for maintenance of anaesthesia. ONSD measurements and hemodynamic parameters were obtained at baseline, during pneumoperitoneum and postoperatively. Recovery profiles, complications and duration of hospital stay were recorded. Data were analysed using the Pearson Chi-square test, independent sample t -test and Mann-Whitney test. RESULTS: A total of 50 patients were analysed. While mean ONSD values were raised from baseline intraoperatively in both groups, values remained within normal limits without significant intergroup differences. ONSD values returned to baseline in all patients at the end of surgery. Neither group exhibited post-operative complications nor delayed recovery. CONCLUSION: Isoflurane and desflurane exhibit comparable and safe profiles in terms of ICP elevation during RARP. Both agents are effective for maintenance of anaesthesia in elderly patients requiring steep Trendelenburg positioning for RARP.
Primary hepatic neuroendocrine tumour in a child.
Kumar S, Akanksha, Khushi … +3 more , Rathee P, Kataria SP, Singh S
J Minim Access Surg · 2026 Apr · PMID 42085064 · Publisher ↗
Primary hepatic neuroendocrine tumour (PHNET) is an exceptionally rare neoplasm, accounting for approximately 0.3% of all neuroendocrine tumours. It presents with non specific clinical and radiological features, making p...
Primary hepatic neuroendocrine tumour (PHNET) is an exceptionally rare neoplasm, accounting for approximately 0.3% of all neuroendocrine tumours. It presents with non specific clinical and radiological features, making pre operative diagnosis difficult. Differentiation from other paediatric liver lesions, such as hepatoblastoma, haemangioma and hepatocellular carcinoma, is challenging. We report the rare case of PHNET in a 9 year old boy who presented with abdominal pain and vomiting. Routine laboratory investigations, including liver function tests and serum alpha fetoprotein levels, were within the normal limits. Radiological evaluation suggested a diagnosis of sclerosed hepatic haemangioma. Definitive diagnosis was established by histopathological examination and immunohistochemistry. Surgical resection was performed, which remains the mainstay of treatment. The post operative course was uneventful and regular follow up. This case highlights the diagnostic difficulty of PHNET and underscores the importance of histopathological evaluation for accurate diagnosis and appropriate management.
Opioid-free anaesthesia with loco-regional block enhances safety and recovery in patients with obesity undergoing non-bariatric surgery: A randomised controlled trial.
Sinha A, Punhani D, Sharma A … +3 more , Patro S, Gupta N, Katyal M
J Minim Access Surg · 2026 Apr · PMID 42085048 · Publisher ↗
INTRODUCTION: Opioid-free anaesthesia (OFA), when incorporated into enhanced recovery after surgery (ERAS) pathways, may improve peri-operative safety and recovery in patients with obesity. We evaluated the efficacy and...
INTRODUCTION: Opioid-free anaesthesia (OFA), when incorporated into enhanced recovery after surgery (ERAS) pathways, may improve peri-operative safety and recovery in patients with obesity. We evaluated the efficacy and safety of a multimodal OFA regimen incorporating loco-regional anaesthesia in this population undergoing general anaesthesia. PATIENTS AND METHODS: In this prospective randomised study with participant and outcome-assessor blinding, 380 adults (body mass index >35 kg/m 2 ) undergoing elective laparoscopic cholecystectomy were randomised to receive OFA or non-OFA (N-OFA). The OFA group received dexmedetomidine (0.3-0.5 μg/kg/h), low-dose ketamine (0.2 mg/kg) and an ultrasound-guided subcostal transversus abdominis plane block with 30 ml of 0.25% bupivacaine. The N-OFA group received fentanyl (1-2 μg/kg ideal body weight). All patients received total intravenous anaesthesia. The primary outcome was time to discharge readiness (DR). Secondary outcomes included pain scores, opioid requirement, quality of recovery-40 (QoR-40) and airway-related adverse events (ARAEs). RESULTS: Baseline characteristics were comparable, and pain scores were significantly lower in the OFA group at 3 and 24 h ( P < 0.001). At 24 h, 61.1% of patients in the OFA group reported no pain compared with 42.6% in the N-OFA group. Rescue opioid requirement was markedly reduced (2.1% vs. 95.5%, P < 0.001). Time to DR was shorter (9.7 ± 1.6 h vs. 11.6 ± 2.7 h, P < 0.001), and QoR-40 scores were higher in the OFA group. ARAEs were not statistically significant. CONCLUSION: OFA using loco-regional block, dexmedetomidine and ketamine improves recovery, reduces opioid use and accelerates DR in patients with obesity undergoing laparoscopic surgery.
Laparoscopic management of splenic infarct in polysplenia with situs inversus - Case report and review literature.
Raajitha G, Reddy KST, Mariyam T … +1 more , Nayak SR
J Minim Access Surg · 2026 Apr · PMID 42085035 · Publisher ↗
Situs inversus totalis (SIT) is a rare congenital abnormality, characterised by mirror imaging of visceral organs. Polysplenia is a subset of this, where multiple splenules are present. Splenic infarcts, in such conditio...
Situs inversus totalis (SIT) is a rare congenital abnormality, characterised by mirror imaging of visceral organs. Polysplenia is a subset of this, where multiple splenules are present. Splenic infarcts, in such conditions, can cause diagnostic uncertainty and significant surgical challenge. We report a case of a 35-year-old male with SIT and polysplenia who presented with right upper abdominal pain, fever and vomiting. Imaging showed multiple splenules in the right hypochondrium, with a peripheral splenic infarction. Laparoscopic splenectomy was done with modified port placement to accommodate the reversed anatomy. Laparoscopic splenectomy in patients with SIT and polysplenia is technically challenging due to altered anatomy and the need for a reversed surgical approach. Although technically demanding, it can offer better visualisation over an open approach. To the best of our knowledge, this is the first reported case of laparoscopic management for splenic infarction in polysplenia with SIT. The laparoscopic approach, though quite challenging, can be made feasible in such cases with effective planning but only under the expertise who can adapt to intra-operative challenges.
Laparoscopic cholecystectomy during pregnancy: A five-year single-centre experience.
Shah MA, Wagay BA, Aijaz SM
J Minim Access Surg · 2026 Apr · PMID 42085018 · Publisher ↗
INTRODUCTION: Symptomatic gallstone disease is amongst the most common non-obstetric surgical conditions encountered during pregnancy. Historically, conservative management was favoured due to concerns regarding foetal s...
INTRODUCTION: Symptomatic gallstone disease is amongst the most common non-obstetric surgical conditions encountered during pregnancy. Historically, conservative management was favoured due to concerns regarding foetal safety during anaesthesia and laparoscopy. However, advances in minimally invasive surgery, anaesthetic techniques, and perioperative monitoring have led to increasing acceptance of laparoscopic cholecystectomy (LC) as a safe and effective treatment option during pregnancy. To evaluate perioperative outcomes, operative feasibility and maternal-fetal safety in pregnant patients undergoing LC in a tertiary care centre. PATIENTS AND METHODS: A hybrid retrospective-prospective observational study was conducted, including pregnant patients who underwent LC between January 2021 and December 2025. The study comprised a retrospective analysis (2021-2023) and a prospective cohort (2024-2025). Data collected included demographic characteristics, gestational age, surgical indication, operative details, maternal complications and neonatal outcomes. Descriptive statistics were used for the analysis. RESULTS: Thirteen pregnant patients underwent LC during the study period. The mean maternal age was 28.5 ± 4.2 years, and the mean gestational age at surgery was 18.5 ± 3.1 weeks (range 14-28 weeks). Ten procedures were performed during the second trimester and three during the third trimester. All surgeries were completed laparoscopically without conversion to open surgery. Mean operative time was 45 min (range 35-65 min). One patient developed transient post-operative uterine contractions, which resolved with tocolytic therapy. No foetal distress, congenital anomalies or maternal surgical complications were observed. CONCLUSION: LC during pregnancy is a safe and feasible procedure when performed with multidisciplinary planning, pregnancy-specific technical modifications and appropriate foetal monitoring. Our findings support the growing body of evidence that minimally invasive surgery can be safely performed in selected pregnant patients requiring definitive treatment for symptomatic gallstone disease.
Gangrenous Meckel's diverticulum due to axial torsion around a mesodiverticular band: A rare cause of acute abdomen in adults.
Mishra RA, Anbalagan P, Ramaswamy D
J Minim Access Surg · 2026 Apr · PMID 42041400 · Publisher ↗
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, though it rarely presents with complications in adulthood. Axial torsion leading to gangrene, especially due to a mesodivert...
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, though it rarely presents with complications in adulthood. Axial torsion leading to gangrene, especially due to a mesodiverticular band, is an uncommon presentation and may pose a diagnostic challenge. We report a case of a 58-year-old female who presented with acute intestinal obstruction. Diagnostic laparoscopy revealed a gangrenous MD caused by axial rotation around a mesodiverticular band, without involvement of the adjacent ileum. Laparoscopic diverticulectomy was successfully performed. Isolated torsion of the MD is rare, particularly in adults. A mesodiverticular band can predispose to isolated volvulus, ischaemia and gangrene. Early surgical intervention is essential to prevent morbidity, and complicated MD in adults is often misdiagnosed. A high index of suspicion should be maintained in cases of intestinal obstruction with atypical features. This case highlights the importance of early laparoscopic evaluation in adults presenting with unexplained obstruction.
Laparoscopic repair of iatrogenic splenic artery injury during total gastrectomy: Tips for troubleshooting.
Shenoy KG, Thomas M, Jeur AS
J Minim Access Surg · 2026 Apr · PMID 42041267 · Publisher ↗
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 c...
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.
A randomised controlled study to compare the extended view totally extraperitoneal and transabdominal pre-peritoneal in terms of early post-operative complications in groin hernias.
Bishnoi S, Sharma P, Gupta SV … +3 more , Jain A, Ansari MAM, Kapur N
J Minim Access Surg · 2026 Apr · PMID 42041241 · Publisher ↗
INTRODUCTION: The extended-view totally extraperitoneal (eTEP) technique is designed to overcome the limited working space and fixed port constraints of conventional totally extraperitoneal (TEP) hernia repair. This stud...
INTRODUCTION: The extended-view totally extraperitoneal (eTEP) technique is designed to overcome the limited working space and fixed port constraints of conventional totally extraperitoneal (TEP) hernia repair. This study aimed to provide a direct, randomised comparison of early outcomes between the eTEP approach and the transabdominal pre-peritoneal (TAPP) technique for groin hernias. PATIENTS AND METHODS: A prospective, randomised, single-blind, parallel-group trial was conducted at a tertiary care centre. Seventy patients were allocated to either eTEP or TAPP repair (35 per group). Early post-operative complications - defined as post-operative pain, seroma and scrotal hematoma - were assessed as the primary composite endpoint. Key secondary endpoints included operative time, intraoperative complications, blood loss, hospital stay and early recurrence. RESULTS: Demographic and hernia characteristics were comparable at baseline. While Visual Analogue Scale pain scores decreased significantly over time in both groups ( P < 0.001), there was no statistically significant difference between the groups at any assessed interval. Seroma was clinically detected in three patients (8.6%) in the eTEP group at 1 week, all of which resolved spontaneously; no seromas occurred in the TAPP group ( P = 0.239). The median operative time was significantly shorter for eTEP (85 min, interquartile range [IQR]: 76-103) compared to TAPP (94 min, IQR: 87-110; P = 0.011). Rates of intraoperative complications, blood loss and mean hospital stay were similar between groups. CONCLUSION: Both eTEP and TAPP are safe and effective for groin hernia repair, demonstrating comparable early post-operative pain and morbidity. The eTEP technique was associated with a statistically significant reduction in operative time, positioning it as a valuable surgical alternative to TAPP. TRIAL REGISTRATION: Clinical Trials Registry-India (CTRI/2023/09/057520).
A randomised trial validating the efficacy of standardised pain management regimen developed through a quality improvement study in laparoscopic surgery.
Dhal J, Asuri K, Ramachandran R … +3 more , Deorari A, Prajapati O, Bansal VK
J Minim Access Surg · 2026 Apr · PMID 42041240 · Publisher ↗
BACKGROUND: Post-operative pain mainly determines patient satisfaction but largely remains unaddressed owing to a lack of a uniform standardised perioperative pain management regimen, despite several existing recommendat...
BACKGROUND: Post-operative pain mainly determines patient satisfaction but largely remains unaddressed owing to a lack of a uniform standardised perioperative pain management regimen, despite several existing recommendations on multimodal analgesic regimens. PATIENTS AND METHODS: This study included patients undergoing laparoscopic cholecystectomy or inguinal hernia repair between 31 May 2019 and 31 December 2021. Phase 1 comprised an observational study for assessment of baseline post-operative pain and a root cause analysis for development of a standardised pain management regimen, followed by Plan-Do-Study-Act (PDSA) cycle(s) until the aim was achieved, i.e. post-operative pain scores on Visual Analogue Scale (VAS) ≤3 at 0 h, 1 h, 2 h, 4 h, 6 h, 12 h, at discharge, 1 week, 6 weeks and 3 months, in at least 70% of patients. Phase 2 included a randomised trial to test the standardised pain management regimen. RESULTS: In Phase 1 ( n = 20), suboptimal pain control was noted till 6 h postoperatively in the majority. The first PDSA cycle ( n = 20) achieved the aim of the quality improvement (QI) study, and the regimen was standardised. Interim analysis revealed significantly lower median pain scores ( P < 0.05) at all-time intervals. In Phase 2, sixty patients were randomised, 30 in each arm. The number of patients with acceptable pain (VAS ≤3) at 1 h was significantly ( P = 0.038) higher in the QI arm, correlating with significantly lower median pain scores ( P = 0.01). However, pain scores at other intervals were comparable. CONCLUSION: A standardised pain management regimen may significantly benefit early post-operative pain following laparoscopic surgery.
Laparoscopic distal gastrectomy gastric cancer in a patient with severe kyphosis: A case report and literature review.
Pham HV, Nguyen HT, Tran TM … +1 more , Pham PNN
J Minim Access Surg · 2026 Apr · PMID 42041239 · Publisher ↗
Severe kyphosis poses significant challenges to gastric cancer surgery due to anatomical constraints. This case report details a successful laparoscopic distal gastrectomy in a 71-year-old female with advanced pyloric ga...
Severe kyphosis poses significant challenges to gastric cancer surgery due to anatomical constraints. This case report details a successful laparoscopic distal gastrectomy in a 71-year-old female with advanced pyloric gastric cancer (cT3N1M0) and severe kyphosis from a prior spinal injury. The patient's spinal deformity, with a 60° Cobb angle, restricted abdominal space, rendering open surgery unfeasible. A laparoscopic approach with modified trocar placement and intraoperative adjustments, including low camera positioning and strategic organ retraction, enabled safe resection and Billroth II anastomosis. The procedure was completed without complications, with oral intake resumed on post-operative day 2 and discharge on day 5. This case demonstrates the feasibility of laparoscopic gastrectomy in patients with complex anatomical variations, highlighting the importance of customised surgical planning to achieve minimally invasive outcomes in challenging scenarios.
Prospective comparative analysis of operative variables after transabdominal pre-peritoneal and eTEP techniques for unilateral inguinal hernia with respect to hernia sac volume based on computer tomography in male patients.
Akre AH, Thorat S, Changdeo AM
J Minim Access Surg · 2026 Apr · PMID 42013092 · Publisher ↗
BACKGROUND: The impact of hernia sac volume on post-operative pain and operative time in laparoscopic transabdominal pre-peritoneal (TAPP) and enhanced-view totally extraperitoneal (eTEP) repair of unilateral inguinal he...
BACKGROUND: The impact of hernia sac volume on post-operative pain and operative time in laparoscopic transabdominal pre-peritoneal (TAPP) and enhanced-view totally extraperitoneal (eTEP) repair of unilateral inguinal hernia remains unexplored. This study aimed to evaluate differences in post-operative pain between TAPP and eTEP techniques based on hernia sac volume quantified by computed tomography (CT), with operative time as a secondary outcome. PATIENTS AND METHODS: This prospective randomised study was conducted at a single centre in Pune, Maharashtra, India, from September 2022 to August 2023. Seventy-two male patients with unilateral inguinal hernia were randomised equally into TAPP (n = 36) and eTEP (n = 36) groups. Hernia sac volume was calculated preoperatively using an ellipsoidal formula applied to diameters derived from Computed Tomography scan and expressed as a volume ratio (volume of hernia sac to volume of abdominal cavity). Post-operative pain was assessed using the Visual Analogue Scale (VAS) at 24 hrs and 36 hrs. Operative time was recorded for all procedures. Statistical analysis employed the Mann-Whitney U-test for pain scores and independent samples t-test for operative time. RESULTS: At 24 hrs, the mean VAS score was significantly lower in the eTEP group (3.06 ± 1.09) than in the TAPP group (3.97 ± 1.18; P = 0.0011). Both groups exhibited a non-linear pain response relative to sac volume, with higher pain in smaller sacs, a decrease in mid-sized sacs and a drop in larger sacs. At 36 hrs, VAS scores converged between TAPP (2.51 ± 0.74) and eTEP (2.45 ± 0.71; P = 0.73). The mean operative time was significantly shorter for eTEP (41.61 ± 5.43 min) compared to TAPP (54.83 ± 5.93 min; P = 7.19 × 10-15). CONCLUSIONS: The eTEP technique demonstrated significantly lower post-operative pain at 24 hrs and shorter operative time compared to TAPP for unilateral inguinal hernia repair. Hernia sac volume influenced pain patterns in both groups, with smaller sacs associated with higher pain scores. These findings support the consideration of hernia sac volume as a clinical parameter for planning surgical technique.
Unusual case of an ectopic pre-uterine spleen.
Schumacher G, Gebert U, Costa S … +1 more , Prader S
J Minim Access Surg · 2026 Apr · PMID 41972881 · Publisher ↗
Ectopic spleens are rare and most commonly occur congenitally, but also after trauma or pregnancy. They may be asymptomatic or cause pain due to pressure or torsion of the vascular pedicle. They may even extend into the...
Ectopic spleens are rare and most commonly occur congenitally, but also after trauma or pregnancy. They may be asymptomatic or cause pain due to pressure or torsion of the vascular pedicle. They may even extend into the small pelvis. We report on a 30-year-old patient with lower abdominal pain and the desire to have children. The spleen was located in front of the uterus in the lower abdomen. In case of pregnancy, the growing uterus could cause vascular torsion with recurrent pain, or complications could occur during a caesarean section. Thus, the indication for surgery was made in cooperation between surgeons, gynecologists and the patient. We preferred the laparoscopic splenectomy as the simplest operation rather than the splenopexy. The operation and post-operative course were uneventful, so she was able to be discharged on the 4th post-operative day. Ultimately, the decision of treatment modality remains individually.
Retrospective study comparing robotic versus open approaches for genitourinary fistula repair.
Patel P, Coelho V, Patel SD … +4 more , Ganpule A, Singh AG, Sabnis R, Desai M
J Minim Access Surg · 2026 Apr · PMID 41972880 · Publisher ↗
INTRODUCTION: Genitourinary fistulas are abnormal communications between the urinary or genital tract and adjacent structures, often requiring surgical repair to restore function and quality of life. Robotic-assisted sur...
INTRODUCTION: Genitourinary fistulas are abnormal communications between the urinary or genital tract and adjacent structures, often requiring surgical repair to restore function and quality of life. Robotic-assisted surgery has gained acceptance due to improved visualisation and surgical precision. This study compares the outcomes of robotic-assisted and open genitourinary fistula repair. PATIENTS AND METHODS: A retrospective review of patients undergoing genitourinary fistula repair between 2010 and 2020 was performed. Patients were divided into robotic (n = 26) and open (n = 24) groups. Surgical success was defined as the absence of recurrence, with post-operative complications and length of hospital stay also analysed. RESULTS: Fifty patients underwent genitourinary fistula repair, with 26 in the robotic group and 24 in the open group. Surgical success was 96.15% in the robotic group (1/26 recurrence) and 95.83% in the open group (1/24 recurrence), with no statistically significant difference between groups (P > 0.05). The robotic group had a greater haemoglobin drop than the open group (1.9 vs. 1.1 g/dL, P = 0.024), and interposition flaps were used more frequently in robotic cases (17/26 vs. 3/24, P < 0.001). Length of hospital stay was similar in both groups despite greater case complexity in the robotic arm. CONCLUSION: Both robotic-assisted and open approaches provide high and comparable success rates for genitourinary fistula repair. The robotic approach was used more often in complex cases, with higher flap utilisation and slightly greater blood loss, but without compromising overall outcomes. The choice of approach should be guided by patient factors, fistula complexity and available surgical expertise, and larger prospective studies are needed to confirm these findings.
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