Journal Of Minimal Access Surgery[JOURNAL]
Sun
200 papers
Feasibility and safety of video-assisted thoracic surgery after neoadjuvant chemoimmunotherapy in non-small cell lung cancer: A single-centre experience.
Çetinkaya Ç, Keskin S, Öztürk MA … +4 more , Saglam EK, Yaman M, Yildizeli B, Batirel HF
J Minim Access Surg · 2026 Apr · PMID 41059782 · Full text
INTRODUCTION: Neoadjuvant chemoimmunotherapy has emerged as a promising strategy in the multimodal treatment of locally advanced non-small cell lung cancer (NSCLC). However, concerns remain regarding its impact on surgic...
INTRODUCTION: Neoadjuvant chemoimmunotherapy has emerged as a promising strategy in the multimodal treatment of locally advanced non-small cell lung cancer (NSCLC). However, concerns remain regarding its impact on surgical complexity and the feasibility of video-assisted thoracic surgery (VATS) in this setting. PATIENTS AND METHODS: Between April 2021 and August 2024, 17 patients who received neoadjuvant chemoimmunotherapy (PD-1 inhibitor plus chemotherapy) underwent lung resection. A significant proportion of cases (58.8%) were managed through VATS (primarily biportal approach), with no conversions to open surgery. The remaining patients underwent thoracotomy or Dartavelle incision due to anatomical complexity. RESULTS: The mean operative time was 135 ± 25 min for VATS and 172.9 ± 30 min for open surgery ( P = 0.068). While hospital stay was similar between VATS (5.9 days) and open surgery (6.4 days) ( P = 0.449), intensive care unit stay was significantly shorter in the VATS group (0.5 vs. 1.3 days, P = 0.007). Significant tumour downstaging was observed in 88.2% of patients, with four achieving complete pathological response and three demonstrating a major pathological response ( P < 0.05). Post-operative complications were observed in 41.2% of patients, but no 90-day mortality occurred. CONCLUSION: VATS appears to be a feasible and safe approach for selected NSCLC patients after neoadjuvant chemoimmunotherapy, demonstrating favourable short-term outcomes. These findings contribute to the growing evidence supporting minimally invasive surgery as a viable option in complex, locally advanced cases following immunotherapy.
Effectiveness of intraperitoneal instillation of normal saline in reducing shoulder tip pain following laparoscopic cholecystectomy - A randomised controlled trial from North India.
Kumar A, Bansiwal RK, Khemchand AK … +3 more , Singh M, Palta S, Sharma R
J Minim Access Surg · 2025 Oct · PMID 41059748 · Publisher ↗
INTRODUCTION: Shoulder tip pain (STP) is a post-operative complication seen in up to 60% of patients after LC. It occurs because of diaphragmatic irritation from residual carbon dioxide from pneumoperitoneum. This study...
INTRODUCTION: Shoulder tip pain (STP) is a post-operative complication seen in up to 60% of patients after LC. It occurs because of diaphragmatic irritation from residual carbon dioxide from pneumoperitoneum. This study evaluated the effect of intraperitoneal normal saline irrigation in relieving STP. PATIENTS AND METHODS: This randomised trial was conducted at Department of General Surgery, Government Medical College and Hospital, Chandigarh of North India between August 2024 and February 2025. A total of 158 patients underwent randomisation, and after exclusion, 63 participants were enrolled in Group A (intervention) and Group B (control). The Visual Analogue Scale (VAS) scores were measured at 6th, 12th, 24th and 48th h. RESULTS: The mean age of the patients in Group A was 42.57 ± 13.93 years and in Group B was 42.15 ± 15.15 years (P = 0.75). A female predominance was noted in both groups. The mean duration of surgery was slightly higher in Group A (36.19 ± 11.82 min) compared to Group B (33.28 ± 10.56 min) (P = 0.860). The primary outcome was STP, evaluated using the VAS. At 6 h, mean VAS score was 1.31 in Group A versus 2.96 in Group B (P = 0.000); at 12 h, 1.09 versus 2.84 (P = 0.000); at 24 h, 0.53 versus 1.73 (P = 0.0004) and at 48 h, 0.12 versus 0.76 (P = 0.0006), highlighting the effectiveness of the intervention in reducing post-operative STP. CONCLUSION: This study demonstrates that intraperitoneal normal saline instillation is an effective and safe intervention for reducing STP after laparoscopic cholecystectomy.
Laparoscopic common bile duct exploration for managing difficult common bile duct stones after failed endoscopic retrograde cholangiopancreatography.
Gupta S, Aggarwal A, Bansal I … +1 more , Attri AK
J Minim Access Surg · 2025 Sep · PMID 40965094 · Publisher ↗
INTRODUCTION: This retrospective cohort study evaluated the efficacy of laparoscopic common bile duct exploration (LCBDE) for managing difficult common bile duct stones (CBDSs) in patients with failed endoscopic retrogra...
INTRODUCTION: This retrospective cohort study evaluated the efficacy of laparoscopic common bile duct exploration (LCBDE) for managing difficult common bile duct stones (CBDSs) in patients with failed endoscopic retrograde cholangiopancreatography (ERCP). PATIENTS AND METHODS: Forty-two patients underwent LCBDE between 2019 and 2024, after unsuccessful ERCP. The causes of ERCP failure include cannulation failure, large stones, impacted stones and multiple stones. The surgical technique involved a standard 4-port laparoscopic cholecystectomy with an additional port for manipulation of the Fogarty catheter or choledochoscope. Stones were extracted by milking the CBD, using a Fogarty balloon catheter or with the aid of a choledochoscope. The choledochotomy was closed primarily or over the stent using interrupted or continuous sutures. RESULTS: The mean CBD diameter was 14.8 mm (range: 12-33 mm), with 31 patients having single stones and 11 having multiple stones. Two patients were suspected to have CBD strictures. CBD clearance was achieved in 38 (90.5%) patients. In four patients, the procedure was converted to open because of an impacted stone. Post-operative complications included bile leak (n = 2) and residual stones (n = 2). It was also observed that primary closure of the choledochotomy without drainage does not affect the outcome. CONCLUSION: This study demonstrated that LCBDE is a safe and effective minimally invasive option for managing difficult CBDS when ERCP fails.
Single-incision versus multi-port robotic cholecystectomy: A retrospective comparison in 188 patients.
Abulfaraj M
J Minim Access Surg · 2025 Sep · PMID 40965090 · Publisher ↗
INTRODUCTION: Robotic-assisted cholecystectomy enhances precision and visualisation compared to traditional laparoscopy. This study compares single-incision robotic cholecystectomy (SIRC) with multi-port robotic cholecys...
INTRODUCTION: Robotic-assisted cholecystectomy enhances precision and visualisation compared to traditional laparoscopy. This study compares single-incision robotic cholecystectomy (SIRC) with multi-port robotic cholecystectomy (MPRC) in elective settings. MATERIALS AND METHODS: A retrospective cohort study analysed 188 patients (63 SIRC, 125 MPRC) at a tertiary centre from 2018 to 2023, assessing operative time, length of stay (LOS) and complications. RESULTS: SIRC had longer mean operative time (66 vs. 55 min, P < 0.001) and LOS (1.4 vs. 1.2 days, P = 0.02) than MPRC, with comparable wound infection (3.2% vs. 0.8%, P = 0.25) and hernia rates (1.6% vs. 0%, P = 0.33). CONCLUSION: SIRC is a safe, cosmetically appealing alternative to MPRC despite longer operative times, suitable for lower-body mass index patients prioritising aesthetics.
Simultaneous umbilical, Spigelian and bilateral inguinal hernias with partial urinary bladder herniation: A rare radiological presentation.
Azizi F, Karatay E, Eren A
J Minim Access Surg · 2025 Sep · PMID 40965085 · Publisher ↗
Spigelian hernia is a rare type of ventral abdominal wall hernia, and urinary bladder herniation into the inguinal canal is an uncommon complication typically seen in elderly males. The simultaneous occurrence of multipl...
Spigelian hernia is a rare type of ventral abdominal wall hernia, and urinary bladder herniation into the inguinal canal is an uncommon complication typically seen in elderly males. The simultaneous occurrence of multiple abdominal wall hernias with bladder involvement is exceedingly rare and diagnostically challenging. We present the case of a 62-year-old male who underwent abdominal computed tomography (CT) due to chronic lower abdominal discomfort and right groin swelling. Imaging revealed a small midline umbilical hernia, a right-sided Spigelian hernia, bilateral inguinal hernias and partial urinary bladder herniation into the right inguinal canal. All hernias were clearly visualised on contrast-enhanced CT with multiplanar reconstructions. While individual hernias are common, the coexistence of four different types - particularly with bladder involvement - has not been previously reported in the radiological literature. Accurate CT imaging was instrumental in detecting the defects and guiding referral for surgical management. This case highlights the importance of comprehensive cross-sectional imaging in elderly patients with nonspecific abdominal or groin symptoms. This rare case underscores the diagnostic value of CT in identifying multiple synchronous abdominal wall hernias and emphasises the need to consider urinary bladder herniation in the differential diagnosis, especially in older male patients.
Percutaneous transhepatic embolisation of multisegmental bile leak using a combined Histoacryl-Lipiodol mixture.
Akyüz B
J Minim Access Surg · 2025 Sep · PMID 40965084 · Publisher ↗
Bile leakage is a serious complication that can lead to life-threatening conditions if not promptly addressed. We present a rare case of a 38-year-old male patient who sustained a liver laceration due to a gunshot injury...
Bile leakage is a serious complication that can lead to life-threatening conditions if not promptly addressed. We present a rare case of a 38-year-old male patient who sustained a liver laceration due to a gunshot injury, resulting in a multisegmental bile leak. Despite percutaneous transhepatic biliary drainage (PTBD), a persistent bile leak was observed. Selective embolisation was performed by interventional radiology via microcatheterisation of the affected peripheral biliary branches, using a mixture of Lipiodol and Histoacryl. The patient showed complete clinical recovery, and the bile leak resolved during follow-up. This case highlights a minimally invasive and effective treatment alternative for refractory bile leaks unresponsive to PTBD, potentially reducing the need for surgical intervention and its associated risks.
Quality of life following laparoscopic vs. open ventral hernia repair: A prospective comparative cohort study.
Mandal LK, Upadhya PS, Luitel P … +6 more , Paudel S, Shah BK, Thapaliya I, Sah SP, Gupta RK, Adhikary S
J Minim Access Surg · 2026 Apr · PMID 40965083 · Full text
INTRODUCTION: Recently, there has been a growing emphasis on assessing the functional outcomes of hernia repair, particularly focusing on the quality of life (QOL). The aim of this study was to assess and compare the QOL...
INTRODUCTION: Recently, there has been a growing emphasis on assessing the functional outcomes of hernia repair, particularly focusing on the quality of life (QOL). The aim of this study was to assess and compare the QOL amongst Nepalese patients undergoing laparoscopic ventral hernia repair (LVHR) and open ventral hernia repair (OVHR) during the initial 3 months following surgery. PATIENTS AND METHODS: This was a hospital-based prospective study where 70 patients were divided into two groups: 35 underwent LVHR and 35 underwent OVHR. QOL was assessed using the Carolina's Comfort Scale at 2 weeks, 1 month and 3 months following surgery, which evaluated post-operative pain, sensation of mesh and limitations in the movement across eight positions. RESULTS: The study groups had comparable demographics, comorbidities and disease characteristics. Patients undergoing LVHR experienced significantly longer mean operative times. Wound infection and the use of drains were notably higher in OVHR. Mesh sensation was not significantly different between the two groups during the follow-up. Post-operative pain was more in OVHR compared to LVHR during bending over and exercising positions, at 2 weeks and a month post-surgery. Movement limitation was more in the OVHR group, especially during bending over positions, compared to the LVHR group. CONCLUSION: This study highlights the laparoscopic repair of ventral hernias as an effective alternative to open techniques, reducing early post-operative pain.
Laparoscopic sleeve gastrectomy and nutritional deficiency: A comprehensive longitudinal analysis.
Bashir S, Lone ZG, Nazir Y … +3 more , Wagay BA, Bhat GA, Shah MA
J Minim Access Surg · 2026 Apr · PMID 40694028 · Full text
INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) represents a cornerstone in the surgical management of morbid obesity. While the procedure effectively reduces weight and improves obesity-related comorbidities, the an...
INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) represents a cornerstone in the surgical management of morbid obesity. While the procedure effectively reduces weight and improves obesity-related comorbidities, the anatomical alterations inherent to LSG can lead to significant nutritional challenges. These modifications in gastrointestinal physiology may result in various micronutrient deficiencies, particularly affecting iron, Vitamin B12 and folate status. PATIENTS AND METHODS: We conducted a prospective cohort study of 70 patients undergoing LSG at our tertiary care centre. Participants underwent comprehensive nutritional assessment at baseline and regular intervals postoperatively (6, 12 and 24 months). We measured serum levels of key micronutrients, including iron, Vitamin B12 and folate, while simultaneously tracking supplement adherence. Statistical analysis incorporated both univariate and multivariate approaches to identify patterns and risk factors for nutritional deficiencies. RESULTS: Our analysis revealed distinct gender-specific patterns in nutritional deficiencies. Female patients demonstrated significantly higher rates of iron deficiency throughout the study period, with prevalence rates of 58%, 50% and 36% at 6, 12 and 24 months, respectively. Vitamin B12 deficiency showed a progressive increase in both genders, while supplement adherence declined markedly from 96% at 6 months to 42% at 24 months. Multivariate analysis identified female gender, younger age and poor supplement adherence as significant risk factors for nutritional deficiencies. CONCLUSION: Post-LSG nutritional deficiencies present a significant clinical challenge, particularly for female patients. Our findings emphasise the critical importance of long-term nutritional monitoring and the need for targeted supplementation and adherence-enhancing intervention strategies to improve supplement adherence.
Gastric tumour causing gastroduodenal intussusception - Laparoscopic management.
Wadhokar P, Venkatakrishnan G, Vayoth SO … +1 more , Chandra V
J Minim Access Surg · 2025 Jul · PMID 40694014 · Publisher ↗
Adult gastroduodenal intussusceptions are very rare. Presentation of gastric gastrointestinal stromal tumours (GISTs) as gastroduodenal intussusception is atypical and clinically difficult to diagnose due to non-specific...
Adult gastroduodenal intussusceptions are very rare. Presentation of gastric gastrointestinal stromal tumours (GISTs) as gastroduodenal intussusception is atypical and clinically difficult to diagnose due to non-specific symptoms. We report the rare case of an elderly male who presented with clinical features of gastric outlet obstruction. Diagnostic imaging and endoscopy revealed a gastric antral GIST leading to gastroduodenal intussusception. Due to the irreducibility of the intussusception, the patient underwent laparoscopic distal gastrectomy as definitive management. Laparoscopic management in such cases is feasible with equally good oncological outcomes as compared to open surgery, with better cosmetic outcome and faster recovery.
An experimental investigation of the split-attention effect on endoscopic surgical performance.
Ozcelik E, Topalli D, Cagiltay NE
J Minim Access Surg · 2025 Jul · PMID 40694011 · Publisher ↗
INTRODUCTION: Surgeons in the operating theatre frequently need to split their attention, such as when switching between the monitor and radiological images during endoscopic surgery. This split attention can lead to cog...
INTRODUCTION: Surgeons in the operating theatre frequently need to split their attention, such as when switching between the monitor and radiological images during endoscopic surgery. This split attention can lead to cognitive overload, potentially impacting performance. Despite this, limited research has been conducted on how split attention affects surgical outcomes. PATIENTS AND METHODS: This study examines the impact of split attention on surgical performance in a simulation-based training environment with two conditions: A far-condition (where information sources were spaced farther apart) and a near-condition (where sources were positioned closer together). A total of 53 participants (13 experienced surgical residents and 40 beginners) completed ten trials in each condition. RESULTS: The results indicated that split attention led to diminished performance in beginners but not in residents. These findings suggest that expertise plays a crucial role in managing cognitive load for surgeons. CONCLUSION: The study highlights the need to develop training curricula that promote the automation of surgical skills through practice, allowing surgeons to allocate more cognitive resources effectively.
Comparison of extended view totally extraperitoneal with intraperitoneal onlay mesh for primary ventral hernia surgery: A randomised controlled study from a tertiary university hospital.
Lal P, Kumar J, Lal T … +1 more , Vindal A
J Minim Access Surg · 2026 Jan · PMID 40694009 · Full text
INTRODUCTION: Primary ventral hernia remains a common presentation in surgical clinics with reported recurrence rates of 10%-20%. Intraperitoneal onlay mesh (IPOM) repair has been the widely accepted technique for laparo...
INTRODUCTION: Primary ventral hernia remains a common presentation in surgical clinics with reported recurrence rates of 10%-20%. Intraperitoneal onlay mesh (IPOM) repair has been the widely accepted technique for laparoscopic management of ventral hernia. More recently, extended view totally extraperitoneal (eTEP) repair has emerged as a safe procedure in terms of reduced post-operative pain and faster recovery. Studies comparing IPOM with eTEP are limited. The present study was conducted to compare the two surgical techniques in terms of early outcomes in patients presenting with primary ventral hernia. PATIENTS AND METHODS: A total of 30 patients with primary ventral hernias with defect size > 2 and up to 6 cm were randomised using computer-generated sequences into two groups. Operative time was used as the primary endpoint. Patients were followed up at 6 months, 1 year and 2 years postoperatively to look for recurrence, chronic pain and any other complications. RESULTS: Mean operative time in the IPOM group was significantly less than eTEP repair ( P < 0.001). Mean pain scores in the eTEP group at discharge, on day 1 and 1 week were significantly lower than corresponding scores in the IPOM group. The mean hospital stay (2.09 ± 0.30 days) in the eTEP group was less than the IPOM group (3.64 ± 1.56 days) ( P < 0.001). Return to work was also significantly earlier in eTEP (10.18 ± 1.07 days vs. 13.55 ± 2.16 [ P < 0.001]). No recurrence was recorded in 23 of 30 patients followed up till 2 years. CONCLUSIONS: Operative time was significantly longer in the eTEP group, reaffirming the published data. Post-operative pain was significantly lower in patients undergoing the eTEP procedure up to 1 week. Consequently, hospital stay was also reduced and return to work was faster in these patients. Both procedures fared equally in terms of no recurrence with a 77% follow-up at 24 months.
The clinical advantages of endoscopic submucosal dissection compared with endoscopic mucosal resection for early oesophageal cancer and pre-cancer lesions.
Hou X, Ding T, Zhou G … +5 more , Liu G, Yin R, Ying J, Ge J, Lv Y
J Minim Access Surg · 2025 Jul · PMID 40694006 · Publisher ↗
OBJECTIVE: The objective of the study was to compare the effects of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of early oesophageal cancer. SUBJECTS AND METHODS: Eighty...
OBJECTIVE: The objective of the study was to compare the effects of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of early oesophageal cancer. SUBJECTS AND METHODS: Eighty-six patients with early oesophageal cancer and precancerous lesions admitted to our hospital from November 2021 to December 2023 were randomly divided into a treatment group (ESD: 43 cases) and control group (EMR: 43 cases). The efficacy and safety of the two methods were compared. RESULTS: The operation time of ESD was 117.65 ± 19.98, which was longer than that of EMR group (P < 0.05). The hospitalization time of patients in the ESD group was shorter than that in the EMR group (7.51 ± 1.30 vs. 9.16 ± 2.01 days, P < 0.05). Comparable en bloc resection rate, complete resection rate, and curative resection rate of patients in the ESD group (100.0%, 95.35%, and 93.02%) and EMR group (100.0%, 93.02%, and 90.70%) were observed (P > 0.05). The incidence of postoperative complications in the ESD group was 4.65%, which was lower than 13.95% in the EMR group (P > 0.05). No recurrence or metastasis of the primary lesions occurred in both groups. Both groups were displaying better postoperative life quality comparing to that of pre-operation. The quality of life in the ESD group was significantly better than that of the EMR group (P < 0.05). CONCLUSION: Compared with EMR, ESD showed better clinical effects, fewer postoperative complications and higher safety in treating early oesophageal cancer and precancerous lesions. However, the diameter of the lesion should be considered for an optimal surgical plan.
Factors leading to post-cholecystectomy bleeding requiring reoperation: A case series.
Louis M, Grabill N, Mohamed B … +3 more , Murdoch E, Krause MA, Kuhn B
J Minim Access Surg · 2025 Jul · PMID 40694005 · Publisher ↗
INTRODUCTION: Laparoscopic cholecystectomy is widely regarded as the standard treatment for symptomatic gall bladder diseases due to its minimally invasive nature and favorable recovery profile. However, hemorrhagic comp...
INTRODUCTION: Laparoscopic cholecystectomy is widely regarded as the standard treatment for symptomatic gall bladder diseases due to its minimally invasive nature and favorable recovery profile. However, hemorrhagic complications pose significant risks to patient safety and outcomes. PATIENTS AND METHODS: This retrospective case series aimed to evaluate the incidence, risk factors and outcomes associated with intraoperative and post-operative hemorrhagic complications in patients undergoing cholecystectomy. Eighteen patients who experienced significant bleeding necessitating unplanned reoperations were included in the analysis. Data were collected encompassing demographic information, comorbidities, surgical details and post-operative outcomes. RESULTS: The study found that older age and higher body mass index (BMI) were strongly correlated with increased estimated blood loss, with each additional year of age increasing the odds of severe hemorrhage by 7% and each unit increase in BMI raising the odds by 15%. Patients with the American Society of Anesthesiologists classifications of 3-4 were 3.5 times more likely to experience severe bleeding. In addition, the use of anticoagulant or antiplatelet therapy was associated with a nearly six-fold increase in the risk of significant hemorrhage. The presence of adhesions or severe inflammation further doubled the risk of substantial blood loss. Hemorrhagic complications were associated with prolonged hospital stays, higher rates of blood transfusions and increased mortality. CONCLUSION: These findings highlight the importance of pre-operative risk assessment and tailored surgical strategies to mitigate bleeding risks. Enhancing patient evaluation and optimizing surgical techniques are crucial for improving outcomes and ensuring patient safety in cholecystectomy procedures.
Quality-based assessment of laparoscopic camera navigation for resident surgeons - A randomised control study.
Kavuluri RB, Biswal JK, Mohanty SK … +1 more , Nayak DR
J Minim Access Surg · 2025 Jul · PMID 40693998 · Publisher ↗
INTRODUCTION: The introduction of laparoscopy has revolutionised the field of surgery. Camera navigation is a pivotal factor for a successful laparoscopic surgery. Good camera assistance guides the operating surgeon towa...
INTRODUCTION: The introduction of laparoscopy has revolutionised the field of surgery. Camera navigation is a pivotal factor for a successful laparoscopic surgery. Good camera assistance guides the operating surgeon towards a safe and successful surgery. Laparoscopic camera navigation is a complicated task, requiring specific psychomotor and visuospatial skills. This study aimed to find out whether the objective structured assessment of camera navigation skills (OSA-CNS) is an effective tool for assessment and feedback to the residents. PATIENTS AND METHODS: This was a single-centre randomised study with a test group and a control group having surgical residents as participants. The sample size is 24, with 12 in each group. Residents were assessed based on the five key parameters of camera navigation skills by an expert surgeon and the operating surgeon. The test and control group scores were analysed along with the progress of the groups after each assessment. Each participant assisted in five laparoscopic cholecystectomies. Statistical tests were conducted using SSPN and R-code. RESULTS: After the assessment, the test group had improved scores compared to the control group, which was statistically significant (P < 0.001). The analysis of variance test of the groups revealed that the test group participant scores improved after each assessment (F = 23.45, P < 0.001). The residents opined that the objective assessment helped improve their navigation skills. CONCLUSION: The data from our study showed that the OSA-CNS is a viable and reliable tool. This structured assessment helps to improve camera navigation and has great scope in the future with regard to surgical training.
Comparing laparoscopic transversus abdominis plane block and port-site infiltration in laparoscopic ventral hernia repair: A randomised controlled trial.
Singh S, Agrawal H, Gupta N … +3 more , Agarwal N, Kumar A, Kumar S
J Minim Access Surg · 2025 Jul · PMID 40693977 · Publisher ↗
INTRODUCTION: Adequate analgesia is of utmost importance for apposite in patients undergoing laparoscopic ventral hernia repair (LVHR) for smooth recovery. TAP block and port-site infiltration (PSI) are two most commonly...
INTRODUCTION: Adequate analgesia is of utmost importance for apposite in patients undergoing laparoscopic ventral hernia repair (LVHR) for smooth recovery. TAP block and port-site infiltration (PSI) are two most commonly employed methods for pain relief. Therefore, this study was done to compare laparoscopic-guided TAP block versus PSI for post-operative analgesia, hospital stay and rescue dose of analgesic in LVHR. PATIENTS AND METHODS: This single-blinded randomised controlled trial was done in a tertiary hospital of Delhi from 1 April 2023, to 1 August 2024. A total of 60 patients were enrolled. Randomisation was done using computer-generated random number table, and allotment was done using sequentially numbered opaque sealed envelopes. All patients >18 years of age with anterior abdominal wall hernia undergoing LVHR were included in the study. Patients with a history of opioid usage, patients with alcohol abuse within the past 6 months, patients with hernia size >6 cm were excluded from the study. Two groups included: test group (Group A) - laparoscopic-assisted TAP block (LTAP) and control Group (Group B) - port-site local anaesthesia infiltration (PSLAI). RESULTS: In LVHR, the use of TAP blocks showed superior pain management compared to PSLAI (significantly lower VAS scores at 6, 12 and 24-h post-surgery in the LTAP group [P = 0.0031, 0.0037 and 0.00012, respectively]). LTAP was associated with a shorter hospital stay (P = 0.016) and less need for rescue analgesia (P = 0.031). CONCLUSION: Laparoscopic transverse abdominis plane block is superior to port-site local anaesthesia infiltration in providing effective post-operative analgesia.
Robotic transabdominal preperitoneal repair of the left-sided secondary lumbar hernia.
Chundru KVRV, Abhinaya PR, Shamrao KU
J Minim Access Surg · 2025 Jul · PMID 40693966 · Publisher ↗
Lumbar hernias (LHs) are exceedingly rare, with definite management being surgery immediately upon diagnosis when the patient is medically fit. Herein, we report the case of a male patient in his mid-40s who presented wi...
Lumbar hernias (LHs) are exceedingly rare, with definite management being surgery immediately upon diagnosis when the patient is medically fit. Herein, we report the case of a male patient in his mid-40s who presented with acquired left LH secondary to transabdominal percutaneous drainage of necrotic collection in a case of necrotising pancreatitis as a part of a step-up approach. He underwent robotic transabdominal preperitoneal repair using 15 cm × 12 cm polypropylene mesh. He was discharged on the second post-operative day. The patient returned to regular activity within 10 days, and at 2-month follow-up, he continued with routine daily activities. Robotic repair of the LH is feasible and safe with the advantage of having a three-dimensional high-definition vision, better ergonomics, intuitive motion, higher precision, tremor filtration and self-camera control.
Demographics, complications and outcomes of laparoscopic appendectomy in paediatric patients: A 15-year study from Western India.
Choudhury P, Shah A, Sharma R … +1 more , Shah A
J Minim Access Surg · 2026 Apr · PMID 40693953 · Full text
INTRODUCTION: Acute appendicitis is one of the most common causes of abdominal pain in children and is considered the most frequent paediatric surgical emergency. The incidence progresses from extremely low in the neonat...
INTRODUCTION: Acute appendicitis is one of the most common causes of abdominal pain in children and is considered the most frequent paediatric surgical emergency. The incidence progresses from extremely low in the neonatal period to a peak incidence between ages 12 and 18 years. Prompt diagnosis and management are imperative to prevent serious complications such as perforation, peritonitis, intra-abdominal abscess formation and bowel obstruction. Laparoscopy has improved intra- and post-operative outcomes for children with appendicitis. This study was conducted to evaluate demographics and complications of laparoscopic appendicectomy in Indian children. PATIENTS AND METHODS: This is a retrospective cohort study encompassing 714 consecutive patients of appendicitis operated over 15 years (2006-2021) by a single surgeon at a high-volume private paediatric surgical centre in Western India. Data collected included age and gender, duration of surgery and post-operative variables such as length of stay and early or delayed interventions, if any. The patients were categorised into two groups: complicated appendicitis and non-complicated appendicitis, depending on the operative findings. Patients with acutely inflamed appendix without perforation, peritonitis or collection and patients with chronically inflamed appendix were categorised as non-complicated appendicitis. Patients with perforated or gangrenous appendicitis, appendicular lump and appendicitis with intraperitoneal collection were categorised as complicated appendicitis. Additional pathologies found and treated during the surgery were also documented. The statistical analysis was performed using IBM SPSS Statistics 28.0.0.0. RESULTS: The total cohort of patients who underwent laparoscopic appendectomy in the study was 714. The number of male patients was significantly greater than the female population ( P < 0.001). The total number of cases of non-complicated appendicitis was 580 (81.23%). Patients with uncomplicated appendicitis had a mean age of 9.12 ± 3.65 years, while those with complicated appendicitis had a mean age of 7.49 ± 3.58 years. Additional pathologies such as simple ovarian cyst, Meckel's diverticulum and Enterobius vermicularis were found in 11.55% of uncomplicated cases. Post-operative complications were observed to be higher in the complicated group (27.6%) compared to the uncomplicated group (1.72%). CONCLUSION: This study shows that acute appendicitis affects our study population at a mean age of 8.84 years, with a majority of males (64.14%). It also shows that complicated appendicitis has a higher incidence of post-operative complications of 27.6% and prolonged hospital stay. A multicentre research across various states in India can help establish a clear outlook regarding the demographics of complicated and uncomplicated paediatric appendicitis in the country.
A simplified technique for laparoscopic feeding jejunostomy and its outcomes.
Manohar M, Pol MM, Fawaz M … +3 more , Kumar RR, Jarapala VM, Saheer M
J Minim Access Surg · 2025 Oct · PMID 40693949 · Full text
Feeding jejunostomy (FJ) is essential for patients with absolute dysphagia, providing a critical means of nutrition. Despite various techniques being described in the literature, there is no standardized, cost-effective...
Feeding jejunostomy (FJ) is essential for patients with absolute dysphagia, providing a critical means of nutrition. Despite various techniques being described in the literature, there is no standardized, cost-effective approach for laparoscopic FJ. This study aims to describe a modified, simplified laparoscopic FJ technique and assess its safety, feasibility, and cost-effectiveness. A case series of 30 patients who underwent laparoscopic FJ between June and December 2022 was evaluated. The mean age of the patients was 29 ± 1.2 years, with an average operating time of 46.5 ± 9 minutes. Intraoperative blood loss was minimal, and there were no major complications during the hospital stay. Only one minor complication, catheter displacement, occurred during the 1-month follow-up. The average hospital stay was 2 ± 0.66 days. The cost of the procedure was compared to existing commercial kits in India, demonstrating significant savings. The findings suggest that the modified laparoscopic FJ technique is a safe, feasible, and cost-effective alternative, offering a simplified approach with minimal complications and a short hospital stay. Further studies with larger sample sizes and longer follow-up are needed to validate these results.
Comparing laparoscopic and robotic splenectomy: A systematic review of the outcomes.
Madan K, Sriram RB, Davuluri S
J Minim Access Surg · 2026 Jan · PMID 40693947 · Full text
Splenectomy can be performed using various surgical approaches, including open, laparoscopic (LS), and robotic splenectomy (RS). While LS has been the mainstay for many years, it is associated with a steep learning curve...
Splenectomy can be performed using various surgical approaches, including open, laparoscopic (LS), and robotic splenectomy (RS). While LS has been the mainstay for many years, it is associated with a steep learning curve and increased rates of morbidity and conversion to open surgery in complex cases such as splenomegaly, obesity, haematological malignancies, and patients with prior laparotomies. RS has emerged as a technique that facilitates a spleen-focused dissection, potentially reducing anatomical disruption and operative risk. This systematic review aimed to compare the peri-operative outcomes of LS and RS in non-traumatic indications for splenectomy. A comprehensive search was conducted in MEDLINE, Embase, CINAHL, and CENTRAL databases, along with searches for unpublished and ongoing studies through the World Health Organization platform. Data extraction was standardized using a pre-tested collection form, and statistical methods were employed to derive mean values where only medians and interquartile ranges were reported. The results demonstrated that the mean operative time was longer in the RS group, although the difference was not statistically significant. Conversion to open surgery occurred in 12 LS cases compared to 2 RS cases. Post-operative complications were more frequent in the LS group (9 patients) compared to the RS group (1 patient), with most complications observed after 24 hours. The mean length of hospital stay was similar between groups (6.0 days for RS vs. 6.5 days for LS; P = 0.89). RS was associated with lower mean intraoperative blood loss compared to LS. In conclusion, RS may offer advantages over LS in terms of reduced blood loss, lower conversion rates, and fewer postoperative complications, although it does not significantly impact hospital stay duration or cost-effectiveness and is associated with longer operative time.
What does it take to become a hernia specialist?
Sundaram E
J Minim Access Surg · 2026 Apr · PMID 40693946 · Full text
Hernia surgery is the most common procedure done by surgeons. The author describes the various pathways to becoming a hernia specialist, considering the strengths, weaknesses, opportunities and threats as in a business m...
Hernia surgery is the most common procedure done by surgeons. The author describes the various pathways to becoming a hernia specialist, considering the strengths, weaknesses, opportunities and threats as in a business model.
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