Journal Of Minimal Access Surgery[JOURNAL]
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200 papers
Comparison of post-operative pain and complications in patients undergoing suture fixation versus tacker fixation of mesh in transabdominal preperitoneal inguinal hernia repair.
Gnanaprakash S, Dewangan M
J Minim Access Surg · 2026 Mar · PMID 41860099 · Publisher ↗
INTRODUCTION: Hernias, particularly inguinal hernias, represent a common clinical issue, with a marked prevalence in adult males. Laparoscopic inguinal hernia repair becomes a frequently performed surgical intervention....
INTRODUCTION: Hernias, particularly inguinal hernias, represent a common clinical issue, with a marked prevalence in adult males. Laparoscopic inguinal hernia repair becomes a frequently performed surgical intervention. This study compares two prevalent surgical techniques in laparoscopic transabdominal preperitoneal (TAPP) repair - tack fixation and suture fixation of mesh. AIMS AND OBJECTIVES: The primary aim is to compare early postoperative outcomes such as pain, seroma, hematoma, urinary retention, and neuralgia between suture and tack fixation methods in TAPP repair. Objectives include assessing cost-effectiveness of mesh fixation, comparing postoperative pain, and evaluating early postoperative recovery and discharge rates. METHODOLOGY: Conducted at J.L.N. Hospital and Research Centre, this prospective experimental study involved 60 patients who underwent TAPP repair for inguinal hernia, randomized into two groups for either suture or tack fixation. Data on pain scores and postoperative complications were collected and analyzed statistically to evaluate the outcomes. RESULTS: The study found significant differences in early postoperative pain, with the suture fixation group experiencing lower pain scores at 6 hours (P = 0.001) and 24 hours (P = 0.03) post-surgery compared to the tack fixation group. Other parameters such as seroma, hematoma, and urinary retention showed no significant differences between the groups. The suture fixation group also required fewer postoperative analgesic doses and had a shorter hospital stay. CONCLUSION: Suture fixation in TAPP repair is associated with lower early postoperative pain and reduced analgesic requirements compared to tack fixation, highlighting its potential benefits in enhancing patient recovery and reducing hospital resources. No significant differences were observed in other early postoperative complications, suggesting both techniques are viable with respect to safety.
Suture grasper (Endo Close) versus simple closure of the umbilical port site in laparoscopic appendectomy in children.
AlSinan T, Altokhais T, AlFraih Y … +11 more , Alshehri A, Fawzy AN, Mohamed I, AlSinan N, Almosallam O, AlNafisah T, Alqahtani KJ, Ghanem BZ, Aljbawi DY, El Hassan M, Al Ali KK
J Minim Access Surg · 2026 Mar · PMID 41860079 · Publisher ↗
INTRODUCTION: This prospective randomised study compared two umbilical port-site closure techniques in paediatric laparoscopic appendectomy: The suture grasper (Endo Close) and simple closure. The primary outcome was pos...
INTRODUCTION: This prospective randomised study compared two umbilical port-site closure techniques in paediatric laparoscopic appendectomy: The suture grasper (Endo Close) and simple closure. The primary outcome was post-operative pain at the umbilical port site over the first five post-operative days, and the secondary outcome was the incidence of port-site hernia at 2 weeks, 2 months and 6 months postoperatively. PATIENTS AND METHODS: One hundred children (mean age 10.5 years) undergoing laparoscopic appendectomy for acute non-complicated appendicitis were randomised into two groups: Endo Close (n = 50) and simple closure (n = 50). Pain scores (1-10 scale) were recorded daily for 5 days postoperatively, and port-site hernias were assessed during the follow-up visits. Statistical analysis included repeated-measures ANOVA and Chi-square tests. RESULTS: No significant differences were observed in post-operative pain scores between the Endo Close and simple closure groups (P > 0.05). Pain scores declined similarly in both groups from day 1 (Endo Close: 6.8 ± 2.1; simple closure: 6.2 ± 2.3) to day 5 (Endo Close: 1.8 ± 1.6; simple closure: 1.2 ± 1.6). No port-site hernias were detected in either group during the 6-month follow-up period. CONCLUSION: The Endo Close device is comparable to simple closure in terms of post-operative pain and port-site hernia incidence in paediatric laparoscopic appendectomy. Larger multicentre studies with a longer follow-up are needed to confirm the long-term outcomes and further define its role in paediatric laparoscopic surgery.
Assessing surgical residents' knowledge of totally extraperitoneal hernia repair: Anatomical landmarks and technical proficiency.
Tokgöz S, Süer MS, Demir S … +4 more , Dogan EG, Chousein B, Güzel H, Yavuz A
J Minim Access Surg · 2026 Mar · PMID 41860067 · Publisher ↗
INTRODUCTION: Totally extraperitoneal (TEP) inguinal hernia repair is widely favoured for its minimally invasive nature and favourable clinical outcomes. However, it presents a steep learning curve due to its reliance on...
INTRODUCTION: Totally extraperitoneal (TEP) inguinal hernia repair is widely favoured for its minimally invasive nature and favourable clinical outcomes. However, it presents a steep learning curve due to its reliance on in-depth knowledge of complex posterior inguinal anatomy and advanced laparoscopic skills. This study aimed to assess surgical residents' understanding of the anatomical and technical components essential for safe and effective TEP repair. PATIENTS AND METHODS: A cross-sectional study was conducted at the Etlik City Hospital, Ankara, in June-July 2025, involving 73 general surgery residents. Participants completed a 25-item multiple-choice questionnaire assessing the knowledge of TEP-specific anatomical landmarks (17 questions) and operative technique (8 questions). Demographic data, surgical experience (TEP cases performed and assisted) and post-graduate year were recorded. Each correct answer was awarded four points (total: 100). Receiver operating characteristic curve analysis identified 29 performed cases as the threshold for satisfactory performance (area under the curve = 0.82, 95% confidence interval [CI] 0.71-0.91). Residents were grouped into novice (≤29 cases) and experienced (>29 cases) cohorts. Statistical comparisons were performed using t-tests, ANOVA and Spearman correlation. RESULTS: The mean age of the participants was 28.8 ± 2.2 years; 76.7% were male. The mean number of TEP procedures performed was 17.2 ± 34.2 and assisted was 30.8 ± 40.4. Experienced residents scored significantly higher than novices in anatomy (61.3 vs. 40.1, P < 0.001), technique (29.5 vs. 19.7, P < 0.001) and total score (90.8 vs. 59.8, P < 0.001, Cohen's d = 1.96, 95% CI 1.3-2.6). Anatomy question performance differed significantly on 13 of 17 items, particularly in identifying the triangle of doom and inferior epigastric vessels. Technical performance differed significantly on 6 of 8 items. A positive correlation was found between the number of assisted cases and total score (R² =0.386), with each three assisted cases associated with a 1-point increase. CONCLUSION: Significant knowledge differences in TEP hernia repair exist between novice and experienced residents, strongly associated with procedural volume. TEP represents a valuable educational opportunity for posterior groin anatomy and technical skill development. Structured training programmes emphasising real-time exposure, simulation and anatomy-based feedback may accelerate the learning curve.
Laparoscopic 'G'-shaped mesh repair for hiatal hernia: A retrospective study on efficacy and safety.
Li S, Niu Q, Liu K … +2 more , Nie P, Hou K
J Minim Access Surg · 2026 Mar · PMID 41860065 · Publisher ↗
INTRODUCTION: To evaluate the clinical outcomes of a novel 'G'- shaped mesh in the laparoscopic repair of hiatal hernia (HH). PATIENTS AND METHODS: A retrospective analysis was performed on 40 patients undergoing laparos...
INTRODUCTION: To evaluate the clinical outcomes of a novel 'G'- shaped mesh in the laparoscopic repair of hiatal hernia (HH). PATIENTS AND METHODS: A retrospective analysis was performed on 40 patients undergoing laparoscopic transabdominal HH repair with the 'G'-shaped mesh between March and July 2023. Surgical feasibility, operative time, recurrence rates and complications were analysed. RESULTS: All procedures were completed laparoscopically (no conversions). Biological meshes were used in 35 patients (87.5%) and synthetic meshes in 5 (12.5%). Mean operative time was 103.62 ± 30.75 min. Post-operative dysphagia occurred in 2 patients (5%), resolved without intervention. At a 1-year follow-up (2 lost), recurrence was observed in 1 case (2.6%). No severe complications (e.g. mesh erosion and visceral injury) occurred. CONCLUSION: The 'G'- shaped mesh demonstrates safety and efficacy in HH repair, with low recurrence and manageable complications. Comparative studies are needed to validate the long-term benefits.
Thoracic duct visualisation with subcutaneous administration of indocyanine green dye during minimally invasive oesophagectomy.
Jones AS, Paul N, Surendran S … +3 more , Yacob M, Chandran S, Samarasam I
J Minim Access Surg · 2026 Mar · PMID 41860064 · Publisher ↗
INTRODUCTION: Chylothorax is a rare complication of oesophagectomy with an incidence of 2%-12%, resulting in high mortality. Accurate identification of the course of the thoracic duct (TD) intraoperatively may help preve...
INTRODUCTION: Chylothorax is a rare complication of oesophagectomy with an incidence of 2%-12%, resulting in high mortality. Accurate identification of the course of the thoracic duct (TD) intraoperatively may help prevent injury to this vital structure. Techniques to visualise the TD during oesophagectomy have evolved over the years. The various routes of indocyanine green (ICG) administration to visualise TD include superficial inguinal lymph nodal injection, injection into the toe web space and small bowel mesentery. Of these, the image-guided injection into the inguinal nodes is the most popular technique. In this study, we introduce a novel and simpler technique of pre-operative subcutaneous administration of ICG in the inguinal region (without image guidance). PATIENTS AND METHODS: This is a single-arm clinical trial amongst patients undergoing thoracolaparoscopic and robotic oesophagectomy for oesophageal cancer. ICG was injected subcutaneously into the bilateral inguinal regions, 10-12 hours, before the surgery. Intraoperatively, visualisation of the TD under near-infrared spectroscopy, and any anatomical variation was noted. RESULTS: Amongst the 38 patients included in the study, TD was visualised in 35 patients (92%). Five patients had anatomical variations, and 3 had intraoperative injury, which was identified and dealt with by clipping. CONCLUSION: Visualisation of the TD during oesophagectomy using subcutaneous administration of ICG is a simplified, non-demanding technique with comparable results to those of image-guided groin node injection. This simple technique of ICG administration, which has been standardised in this study, can be safely incorporated into routine practice for oesophageal resections.
Chronic epigastric pain revealing a left-sided Morgagni hernia in a young adult female: A case report from Central India.
Chhetri K, Verma M, Kumar A
J Minim Access Surg · 2026 Mar · PMID 41860063 · Publisher ↗
BACKGROUND: Diaphragmatic hernias in adults are rare and often present with non-specific gastrointestinal or respiratory symptoms, leading to delayed diagnosis. Morgagni hernias (MHs), in particular, may remain asymptoma...
BACKGROUND: Diaphragmatic hernias in adults are rare and often present with non-specific gastrointestinal or respiratory symptoms, leading to delayed diagnosis. Morgagni hernias (MHs), in particular, may remain asymptomatic for years. CASE PRESENTATION: A 24-year-old female from a rural area presented with a 3-year history of intermittent dull aching epigastric and left hypochondrial pain. Chest X-ray suggested a left-sided diaphragmatic hernia, confirmed on contrast-enhanced computed tomography (CT) as herniation of the transverse colon into the thoracic cavity, consistent with a left-sided MH. MANAGEMENT: The patient was referred for elective surgical repair. CONCLUSION: Adult diaphragmatic hernias can present with chronic, non-specific gastrointestinal and respiratory symptoms, often leading to misdiagnosis. Imaging modalities, particularly CT scans, are critical for accurate diagnosis. Early surgical intervention is recommended to avoid potentially serious complications.
Beyond representation: Reframing women in surgery through evidence and accountability.
Priya P, Khandelwal N
J Minim Access Surg · 2026 Mar · PMID 41860012 · Publisher ↗
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Robotic-assisted versus laparoscopic transabdominal preperitoneal inguinal hernia repair: A cross-sectional comparison of surgical outcomes.
Chougala BS, Mittal O, Gupta S … +3 more , Gopalakrishnappa R, Gupta T, Patil V
J Minim Access Surg · 2026 Mar · PMID 41860007 · Publisher ↗
INTRODUCTION: Inguinal hernias are the most common type of abdominal wall hernias, comprising approximately 75% of cases. Surgical management has advanced from traditional open repair to minimally invasive techniques suc...
INTRODUCTION: Inguinal hernias are the most common type of abdominal wall hernias, comprising approximately 75% of cases. Surgical management has advanced from traditional open repair to minimally invasive techniques such as laparoscopic transabdominal preperitoneal (TAPP) repair. Robotic-assisted TAPP represents a newer evolution in hernia surgery. This study compares robotic-assisted and laparoscopic TAPP in terms of post-operative pain, intraoperative visualisation and procedural feasibility. PATIENTS AND METHODS: A descriptive, observational study was conducted at SMS Hospital, Jaipur, involving 72 patients (36 in each group) undergoing unilateral or bilateral uncomplicated inguinal hernia repair. Post-operative pain was assessed using the Visual Analogue Scale (VAS) at 8, 16 and 24 h. Intraoperative ergonomics and feasibility were measured using standard fatigue and visualisation scores. RESULTS: The robotic-assisted TAPP group demonstrated significantly lower pain scores at all post-operative time points (P < 0.001). Mean VAS scores at 8, 16 and 24 h were 5.03, 3.22 and 1.94, respectively, in the robotic-assisted group, compared to 5.83, 4.28 and 2.83 in the laparoscopic group. The overall mean VAS score was 3.38 for robotic-assisted and 4.31 for laparoscopic TAPP (P < 0.01). Visualisation was rated as 'very good' in 100% of robotic-assisted cases versus only 'good' or 'average' in laparoscopic cases (P < 0.001). CONCLUSION: Robotic-assisted TAPP is associated with significantly reduced post-operative pain, superior surgical field visualisation and improved ergonomic feasibility compared to laparoscopic TAPP. These findings support the use of robotic-assisted TAPP as a preferred approach for inguinal hernia repair.
Awake giant bullectomy with uniportal video-assisted thoracoscopic surgery.
Karamustafaoglu YA, Celebi N, Uzan SA
J Minim Access Surg · 2026 Mar · PMID 41859975 · Publisher ↗
Giant bullous lung disease presents unique challenges in thoracic surgery due to the large size of bullae and compromised respiratory function. This case report highlights the successful use of awake uniportal video-assi...
Giant bullous lung disease presents unique challenges in thoracic surgery due to the large size of bullae and compromised respiratory function. This case report highlights the successful use of awake uniportal video-assisted thoracoscopic surgery (A-UVATS) in a high-risk patient with severe chronic obstructive pulmonary disease and a giant multiseptated bulla occupying the entire left lower lobe. Instead of traditional general anaesthesia, regional techniques, including thoracic paravertebral block and dexmedetomidine sedation, were employed to ensure safety and comfort. The procedure resulted in significant clinical improvement, with minimal complications, aside from a transient air leak. Post-operative recovery was uneventful, and lung re-expansion was confirmed via imaging. This case highlights the feasibility and safety of A-UVATS bullectomy in carefully selected patients, offering improved recovery and reduced perioperative risks. More research is needed to develop standardised protocols and evaluate long-term outcomes of awake thoracic surgical approaches.
Laparoscopic transabdominal pre-peritoneal hernia repair with bilateral orchidectomy in partial androgen insensitivity syndrome.
Shrivastav RR, Shrivastava RKP, Shrivastava RR
J Minim Access Surg · 2026 Mar · PMID 41859946 · Publisher ↗
Partial androgen insensitivity syndrome (PAIS) is a rare X-linked recessive disorder in which individuals with a 46,XY karyotype exhibit a phenotypically female appearance due to end-organ resistance to androgens. We pre...
Partial androgen insensitivity syndrome (PAIS) is a rare X-linked recessive disorder in which individuals with a 46,XY karyotype exhibit a phenotypically female appearance due to end-organ resistance to androgens. We present a 21-year-old phenotypic female with left groin pain and a palpable right labial mass. Clinical findings included normal breast development, scant pubic and axillary hair, primary amenorrhea, clitoromegaly resembling a microphallus and bifid scrotum-like labia. Imaging revealed a left inguinal undescended testis with hernia and a right testis in the right labia majora, with absent uterus and ovaries. Karyotyping confirmed a 46,XY genotype. After multidisciplinary counselling, the patient chose to retain female gender identity and initiate lifelong oestrogen therapy. Laparoscopic transabdominal pre-peritoneal (TAPP) hernia repair with synchronous bilateral orchidectomy was performed. Recovery was uneventful with excellent cosmesis. This is the first reported case of PAIS managed with combined laparoscopic TAPP hernia repair and bilateral orchidectomy, underscoring the importance of individualised gender-affirming management and the versatility of minimally invasive surgery.
Hyper-diluted indocyanine green fluorescence cholangiography: The way to prevent bile leak from the duct of Luschka.
Lai KM
J Minim Access Surg · 2026 Mar · PMID 41821424 · Publisher ↗
The duct of Luschka is the most common anatomical variation of the biliary tree. It is the second most common cause for bile leak in laparoscopic cholecystectomy. Many times, it is not identified until bile leak occurs a...
The duct of Luschka is the most common anatomical variation of the biliary tree. It is the second most common cause for bile leak in laparoscopic cholecystectomy. Many times, it is not identified until bile leak occurs after the operation. We routinely use hyper-diluted indocyanine green (ICG) with 0.025 mg injection on induction for overlay ICG-fluorescence cholangiography for difficult laparoscopic cholecystectomy. A 78-year-old male underwent an elective laparoscopic cholecystectomy and open left inguinal hernia repair. After resection of the gall bladder, a duct of Luschka with bile leak was identified under ICG-fluorescence cholangiography. Leakage was controlled with metal clips under real-time cholangiography.
Laparoscopic extended-view totally extraperitoneal repair for sliding inguinal hernia with ovary and fallopian tube as content: A rare case.
Shirodkar A, Lal T, Joon H … +1 more , Lal P
J Minim Access Surg · 2026 Mar · PMID 41821415 · Publisher ↗
Female reproductive organs such as the ovaries and fallopian tubes are rarely encountered in the hernia sac, with only a few cases reported in the literature. Herniation of these structures may pose a significant risk of...
Female reproductive organs such as the ovaries and fallopian tubes are rarely encountered in the hernia sac, with only a few cases reported in the literature. Herniation of these structures may pose a significant risk of strangulation, torsion and infertility. Preserving fertility in such cases is of utmost importance, especially in women of reproductive age. In this report, we describe the case of a 31-year-old female who presented with an irreducible left inguinal hernia with ovary and fallopian tube as content, which was managed using the laparoscopic extended-view totally extraperitoneal repair.
Deliberate pleurotomy in the surgical management of large hiatal hernias: Case series with 5-year follow-up.
Mgandi L, Harris B, Bhatt K … +1 more , Mangukiya D
J Minim Access Surg · 2026 Mar · PMID 41821413 · Publisher ↗
INTRODUCTION: The objective of this study was to demonstrate outcomes of cooperating with deliberate capnothorax in large hiatal hernia (LHH) surgery. Tension-free crural repair is one of the key tenets of hiatal hernia...
INTRODUCTION: The objective of this study was to demonstrate outcomes of cooperating with deliberate capnothorax in large hiatal hernia (LHH) surgery. Tension-free crural repair is one of the key tenets of hiatal hernia surgery. Achieving a tension-free crural repair in LHHs presents a technical challenge. Tension repairs are associated with anatomical failure of repair, hernia recurrence, higher symptom scores and poor quality of life (QoL). We present our outcomes with the use of a novel technique of incorporating a deliberate left pleurotomy to reduce crural tension in large hiatal defects. PATIENTS AND METHODS: Single-centre mixed cross-sectional review of pre-operative, surgical and 5-year follow-up data. Primary outcomes were gastro-oesophageal reflux disease health-related quality of life scores (GERD-HRQL) and gastro-oesophageal reflux symptom scores (GER-SS). Secondary outcomes were recurrence, post-operative respiratory complications and medication use. RESULTS: Eighty-six patients had hiatal hernia surgery, 48 patients had LHH. 68% of cases had deliberate pleurotomy as part of their surgical technique. QoL scores using the GERD-HRQL were 43.2, 2.7 and 4.3 in the pre-operative, early and late post-operative periods, respectively. The symptom scores using the GER SS were 36, 1.2, and 3.0 in the pre-operative, early and late post-operative periods, respectively. Only one recurrence that required reoperation was reported, but no respiratory complications were reported. CONCLUSIONS: Deliberate left pleurotomy to create capnothorax can be safely incorporated in the surgical technique of LHH repair to reduce crural tension for a tension-free crural repair.
Emergency involving four intra-abdominal pathologies.
Vittori A, Arru GG, Agaj J … +2 more , Gebert U, Schumacher G
J Minim Access Surg · 2026 Mar · PMID 41821406 · Publisher ↗
Patients in the emergency department usually present with a defined condition that can be treated. More often than not, a cause leads to a pathology that is the leading symptom, such as sigmoid carcinoma with caecal perf...
Patients in the emergency department usually present with a defined condition that can be treated. More often than not, a cause leads to a pathology that is the leading symptom, such as sigmoid carcinoma with caecal perforation. However, we very rarely see three different conditions that lead to another and require emergency treatment. We report the case of a 70-year-old male who presented with ileus, peritonitis and an incarcerated inguinal hernia. We found a gastric perforation and a desmoid tumour of the small intestine in the incarcerated inguinal hernia. An ileocecal resection, gastric suturing and a Shouldice hernioplasty were performed. The correlation between the pathologies was presumably a gastric perforation with paralytic ileus and subsequent incarceration of the existing hernia. It is important to carefully examine the abdomen for incidental findings during every operation. In cases of multiple pathologies, the connection must be explainable to ultimately resolve all problems.
Short-term results of robot-assisted transabdominal pre-peritoneal repair for primary midline ventral hernias.
Mehrotra M, Kumar CG
J Minim Access Surg · 2026 Mar · PMID 41821404 · Publisher ↗
INTRODUCTION: Minimally invasive approaches are considered best for the repair of primary midline ventral hernia (PMVH). Mesh placement in the pre-peritoneal plane appears to be optimal with minimal disruption of normal...
INTRODUCTION: Minimally invasive approaches are considered best for the repair of primary midline ventral hernia (PMVH). Mesh placement in the pre-peritoneal plane appears to be optimal with minimal disruption of normal anatomy. Robot-assisted surgery for the placement of mesh in the pre-peritoneal plane helps in overcoming the technical difficulties of the laparoscopic approach. We present our experience of robotic-assisted transabdominal pre-peritoneal (R-TAPP) approach for the repair of PMVHs and evaluate its feasibility and perioperative results. PATIENTS AND METHODS: We performed R-TAPP for PMVHs between November 2023 and March 2025. Demographic data and hernia characteristics were noted. Operative data and post-operative complications were collected and analysed. RESULTS: A total of 67 patients underwent R-TAPP for PMVHs. Their average age was 45.85 years, body mass index (BMI) was 28.87 kg/m2, operating time was 81.19 min, defect size was 9.55 cm2 and five patients needed conversion to a robotic transabdominal retromuscular (R-TARM) repair. There were no conversions to laparoscopy or open procedure. Post-operative day 1 mean pain score was 1.78. CONCLUSION: R-TAPP is safe and feasible in most cases of PMVHs with a short learning curve of approximately 20 cases. Conversion to R-TARM, through the same port positions, may be required in lower BMI patients. R-TAPP affords a good mesh-to-defect area ratio with mild post-operative pain. It has an acceptable perioperative and early post-operative complication profile.
Laparoscopic posterior component separation (transabdominal retromuscular + transversus abdominis release) for obstructed incisional hernia with ventriculoperitoneal shunt entrapment.
Dey S, Agrawal A, Banerjee K … +4 more , Singh RK, Bhattacharya S, Karmakar S, Sarwar M
J Minim Access Surg · 2026 Mar · PMID 41821402 · Publisher ↗
Ventriculoperitoneal (VP) shunt placement is the most common treatment for hydrocephalus. Abdominal complications occur in up to a third of the patients, but incisional hernia at the site of catheter entry and presenting...
Ventriculoperitoneal (VP) shunt placement is the most common treatment for hydrocephalus. Abdominal complications occur in up to a third of the patients, but incisional hernia at the site of catheter entry and presenting as acute intestinal obstruction is a rare occurrence. A 47-year-old female presented with an acute abdomen and on examination was found to have an irreducible L2W1 incisional hernia. Radiology revealed herniation of a loop of small bowel along with the intraperitoneal part of the VP shunt. Emergency diagnostic laparoscopy confirmed the findings. The bowel loop was reduced; the VP shunt was repositioned using a percutaneous suture passer. Hernia was repaired by performing a laparoscopic transabdominal retromuscular mesh repair with right transversus abdominis release. A minimally invasive approach, along with posterior component separation, allowed for a durable hernia repair, eliminated mesh-shunt contact, minimised complications and enhanced recovery.
Observational study of airway changes in robotic-assisted laparoscopic surgeries in the steep Trendelenburg position after a short period of post-operative ventilation.
Rajmohan N, Panikkaparambil S, Ramkumar P … +3 more , Nair SG, Shaji A, Menon LP
J Minim Access Surg · 2026 Mar · PMID 41821389 · Publisher ↗
INTRODUCTION: Upper airway oedema seen in robotic-assisted laparoscopic surgeries (RAS) in steep Trendelenburg position (STP) can lead to airway complications. In this study, we evaluated airway changes in RAS after a sh...
INTRODUCTION: Upper airway oedema seen in robotic-assisted laparoscopic surgeries (RAS) in steep Trendelenburg position (STP) can lead to airway complications. In this study, we evaluated airway changes in RAS after a short period of post-operative ventilation and analysed intraoperative factors contributing to these changes. PATIENTS AND METHODS: This prospective observational cohort study was conducted on 70 patients undergoing RAS in STP. Our primary aim was to assess changes in Samsoon and Young modification of Mallampati classification (MMS) and neck circumference (NC) at 30 min and 4 h post extubation after 30-45 min of ventilation in head up position in the intensive care unit. We studied the association between airway changes and intravenous fluids, duration of surgery and STP. The statistical analysis was performed by the Shapiro-Wilk test, Friedman test, Nemenyi test, Stuart-Maxwell test and Spearman correlation test. P < 0.05 was considered statistically significant. RESULTS: There was a significant change in post-operative MMS (Stuart-Maxwell test: χ2 = 29.000, P < 0.001) and NC (P < 0.001) (Friedman test) at 30 min post-extubation. Four hours later, the changes were not significant. There was a statistically significant weak positive correlation between intake (mL) and change in NC (30 min post-operative) (rho = 0.29, P = 0.015) (Spearman correlation test). CONCLUSION: In robotic-assisted laparoscopic surgeries, there was a significant increase in MMS and NC at 30 min despite post-operative ventilation for at least 30 min. Intraoperative fluids had a positive correlation with NC changes.
Robotic credentialing and simulation-based training: An institutional perspective.
Singh S
J Minim Access Surg · 2026 Mar · PMID 41821385 · Publisher ↗
INTRODUCTION: Simulation-based training has emerged as a critical tool in the acquisition of robotic surgical skills, especially in urology, where procedures are highly complex and technology-intensive. My article evalua...
INTRODUCTION: Simulation-based training has emerged as a critical tool in the acquisition of robotic surgical skills, especially in urology, where procedures are highly complex and technology-intensive. My article evaluates current simulation modalities, training curricula and institutional credentialing frameworks to establish safe, reproducible and standardised pathways for robotic surgery competency. Emphasis is placed on structured simulation, mentorship and validated assessment tools. PATIENTS AND METHODS: Literature on robotic surgical education, simulation platforms (virtual reality [VR], augmented reality [AR] and high-fidelity) and credentialing practices was reviewed (2001-2025). Institutional data from an internal credentialing framework, including simulation-based training hours, structured assessments (Global Evaluative Assessment of Robotic Skills, Robotic Objective Structured Assessment of Technical Skills) and mentored case logs, were incorporated. Intuitive's training certification pathway was described as implemented in our setting. RESULTS: Institutional adoption of structured simulation (20 h on da Vinci Skills Simulator, validated assessments and 30 mentored cases) resulted in measurable improvements in surgeon performance. Trainees credentialed through simulation-based pathways demonstrated 45% fewer console-related errors in their early independent cases and a 30% reduction in operative time compared to non-simulation-trained counterparts (unpublished data). Simulation enhanced confidence, standardisation and reproducibility in skill acquisition. Challenges identified included high costs, limited access in resource-constrained settings, variability in validation across simulators and incomplete assessment of non-technical skills. CONCLUSION: Simulation-based training is a cornerstone for robotic credentialing in urology, enabling safe skill acquisition and reducing early learning curve-related complications. Institutional credentialing frameworks integrating structured curricula, validated assessment tools and supervised operative exposure provide a reproducible model for competency. Future directions should emphasise artificial intelligence-driven adaptive feedback, integration of VR/AR 'digital twins', cloud-based training ecosystems and harmonised global standards for credentialing.
A novel technique created for parastomal hernia repair from a hybridisation model of published evidence: The SSIMPLE approach.
Venkateswaran R, Hammond TM, Kulkarni GV
J Minim Access Surg · 2026 Apr · PMID 41821379 · Full text
The treatment of parastomal hernias (PSH) represents a major challenge in hernia surgery. Various techniques have been reported with different outcomes in terms of complication and recurrence rates. Most of the technique...
The treatment of parastomal hernias (PSH) represents a major challenge in hernia surgery. Various techniques have been reported with different outcomes in terms of complication and recurrence rates. Most of the techniques have certain advantages and disadvantages. The aim of this manuscript is to describe our novel approach to have created a new technique for repair of PSH associated with end stomas. This is an "existing orifice" least invasive surgery that combines the advantages of most of the recognised procedures while minimizing the drawbacks of each and at the same time making it reproducible in safe hands, using the DynaMesh- IPST 3D funnel mesh made of polyvinylidene fluoride (PVDF). With these points in mind, we present the SSIMPLE approach (Stomal access Sublay IPST Mesh repair of ParastomaL hErnia). This is a technique-oriented paper where we offer feasibility, proof of concept in 2 cases with images and illustrations prior to adopting this in a wider cohort. This includes one PSH associated with end ileostomy and one with end colostomy. This also utilises the sac of the parastomal hernia with no other incisions apart from the existing stoma orifice.
Laparoscopic deroofing of a recurrent non-parasitic splenic cyst in a paediatric patient: A case report and review of literature.
Patil VL, Chavan D, Madagond S … +5 more , Sindagikar V, Nyamannawar B, Goudar A, Reddy MH, Mathias L
J Minim Access Surg · 2026 Mar · PMID 41821376 · Publisher ↗
Splenic cysts are uncommon lesions, often discovered incidentally during imaging studies. Recurrent splenic cysts pose a clinical challenge due to their potential for complications such as rupture, haemorrhage or infecti...
Splenic cysts are uncommon lesions, often discovered incidentally during imaging studies. Recurrent splenic cysts pose a clinical challenge due to their potential for complications such as rupture, haemorrhage or infection. Management options range from observation and percutaneous drainage to partial or total splenectomy. Laparoscopic deroofing has emerged as a minimally invasive, spleen-preserving approach with favourable outcomes, although recurrence remains a concern, particularly in incompletely excised cysts. This report presents a rare case of recurrent non-parasitic splenic cyst that was successfully managed by laparoscopic deroofing. This case highlights the clinical utility of laparoscopic deroofing as a safe, spleen-conserving minimal invasive surgical option for recurrent splenic cysts. It offers reduced morbidity, faster recovery and lower risk of post-splenectomy complications. While the risk of recurrence persists, meticulous surgical technique and careful patient selection can optimise the outcomes. A literature review supports laparoscopic deroofing as an effective strategy in managing selected cases of recurrent splenic cysts with low complication and recurrence rates.
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