Journal Of Minimal Access Surgery[JOURNAL]
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200 papers
Robotic reconstruction in genitourinary tuberculosis: Surmounting technical challenges.
Bharath R, Kalra S, Ghorai RP … +7 more , Sreenivasan SK, Dorairajan LN, Bolar S, Mudhol R, Priyan G, Gupta P, Bharath NL
J Minim Access Surg · 2026 Jun · PMID 42377183 · Publisher ↗
INTRODUCTION: Genitourinary tuberculosis (GUTB) causes long ureteric strictures, bladder contracture and renal function impairment. While open reconstruction has been traditional, it entails considerable morbidity. Robot...
INTRODUCTION: Genitourinary tuberculosis (GUTB) causes long ureteric strictures, bladder contracture and renal function impairment. While open reconstruction has been traditional, it entails considerable morbidity. Robotic-assisted reconstructive surgery provides three-dimensional visualisation, greater precision and expedited recovery. This study evaluates the complexities of reconstructive robotic surgery and explores strategies to mitigate them, aiming for optimal outcomes. The primary objective was to discern the surgical and technical challenges, intraoperative difficulties and perioperative complications associated with robotic intracorporeal reconstructive surgeries for GUTB. PATIENTS AND METHODS: This retrospective study was conducted at a single tertiary centre. Thirteen patients were diagnosed with GUTB who underwent robotic urological procedures from January 2018 to May 2025. All patients received antitubercular treatment. RESULTS: Thirteen patients (11 males and 2 females) with GUTB underwent robotic surgery during the study period. The mean age of the study population was 42.3 ± 13.2 years. The mean robotic console time was 236.5 ± 40.07 min, and the intra-operative mean blood loss was 122.3 ± 14.23 ml. The average follow-up period was 13.3 ± 10.01 months. This study encompassed robotic procedures, such as ileal ureter substitution, augmentation cystoplasty, Boari flap reconstruction, combined ileal ureter and augmentation cystoplasty and Studer neobladder reconstruction. CONCLUSIONS: Robotic reconstruction in GUTB is a feasible and safe procedure, even in the presence of anatomical distortion and fibrosis. Robotic platforms facilitate meticulous dissection and boost anastomosis accuracy, resulting in better outcomes and decreased morbidity.
Minimally invasive adrenalectomy for the treatment of large pheochromocytoma: A single-centre experience.
Iqbal M, Tooba F, Saeed MH
J Minim Access Surg · 2026 Jun · PMID 42377181 · Publisher ↗
Abstract loading — click title to view on PubMed.
Enhanced view totally extraperitoneal (eTEP) repair for ventral hernia: A prospective analysis of peri-operative outcomes, functional recovery, and cost effectiveness.
Singh J, Anand A, Singh VP … +5 more , Kumar A, Kumar P, Karnik A, Pahwa HS, Sonkar AA
J Minim Access Surg · 2026 Jun · PMID 42377179 · Publisher ↗
INTRODUCTION: Minimally invasive ventral hernia repair has traditionally been performed using intraperitoneal onlay mesh (IPOM). Although effective, IPOM places mesh within the peritoneal cavity, with potential risks rel...
INTRODUCTION: Minimally invasive ventral hernia repair has traditionally been performed using intraperitoneal onlay mesh (IPOM). Although effective, IPOM places mesh within the peritoneal cavity, with potential risks related to adhesions and mesh-bowel interaction. Enhanced-view totally extraperitoneal (eTEP) repair recreates the retromuscular (Rives-Stoppa) plane using a laparoscopic approach and may reduce these concerns. PATIENTS AND METHODS: A prospective, observational study was conducted on n = 24 adult patients undergoing eTEP retrorectus ventral hernia repair. Perioperative outcomes, post-operative pain (Visual Analogue Scale), complications, quality of life (Carolinas Comfort Scale; HerQLes) and abdominal wall function (double-leg lowering and trunk-raising tests) were assessed at 7 days, 1 month and 3 months. RESULTS: The mean age was 45.6 ± 13.7 years; 54.2% were women. Mean operative time was 167.0 ± 28.7 min; no intraoperative visceral or vascular injury occurred. Surgical-site infection and seroma occurred in one patient each (4.2%) at 7 days and resolved by 1 month. Pain peaked in the early post-operative period and declined significantly over the follow-up (repeated-measures analysis of variance P < 0.001). Both CCS and HerQLes scores improved significantly at 1 and 3 months ( P < 0.001), with parallel improvement in abdominal wall function tests ( P < 0.001). CONCLUSION: In this early experience, eTEP retrorectus repair was feasible and safe with low early morbidity, significant improvement in patient-reported outcomes and improved abdominal wall function over 3 months. Larger comparative studies with longer follow-up are warranted.
Pyloric botulinum toxin injection and single-port laparoscopic intragastric surgery for bulbus hamartoma.
Tikici D, Basceken SI
J Minim Access Surg · 2026 Jun · PMID 42377178 · Publisher ↗
Gastrointestinal polyps are associated with risks such as bleeding, intussusception, obstruction and malignancy, necessitating removal. Technological advancements in endoscopic and laparoscopic surgery have introduced mi...
Gastrointestinal polyps are associated with risks such as bleeding, intussusception, obstruction and malignancy, necessitating removal. Technological advancements in endoscopic and laparoscopic surgery have introduced minimally invasive options like laparoscopic intragastric surgery (LIGS), especially beneficial for polyps that cannot be resected endoscopically. This report presents a 37-year-old male patient with Peutz-Jeghers Syndrome who exhibited symptoms of nausea, vomiting and weight loss. Endoscopy and computed tomography imaging revealed obstructive polyps in the bulbus and gastric cardia. The patient underwent single-port LIGS with preoperative botulinum toxin injection to facilitate pyloric opening. This combined approach allowed effective lesion resection without requiring extensive gastric resection. Pathology confirmed a hamartomatous polyp in the bulbus and high-grade dysplasia with negative margin in the gastric cardia. LIGS, particularly with botulinum toxin assistance, appears to be a safe and effective method for excising intraluminal lesions in complex anatomical areas, such as the duodenal bulbus and cardia.
A new technical approach in sleeve gastrectomy: The SA-FAS (fundic anchor sleeve).
Ahmad SJS
J Minim Access Surg · 2026 Jun · PMID 42377137 · Publisher ↗
Sleeve gastrectomy is the most commonly performed bariatric procedure but remains limited by high proximal staple-line leak rates and post-operative reflux, largely due to disruption of the angle of His and loss of fundi...
Sleeve gastrectomy is the most commonly performed bariatric procedure but remains limited by high proximal staple-line leak rates and post-operative reflux, largely due to disruption of the angle of His and loss of fundic support. This study describes a technical modification designed to strengthen the proximal sleeve, preserve key anti-reflux anatomy and optimise gastric flow. The procedure uses a 40 Fr bougie and preserves a small, well-vascularised fundic remnant by positioning the final staple firing 2 cm lateral to the native angle of His. The proximal staple line is reinforced with oversewn sutures, and the fundic remnant is anchored to the left diaphragmatic crus to restore the physiological flap-valve mechanism. In patients with a 2-5 cm hiatal hernia, posterior or anterior cruroplasty is performed prior to anchoring. This modification aims to reduce leak risk, enhance sleeve geometry and improve post-operative reflux control by re-establishing a more competent gastro-oesophageal junction.
Laparoscopic cholecystectomy in the paediatric population: A quality-of-life study.
Singhai P, Malik MA, Peters NJ … +1 more , Mahajan JK
J Minim Access Surg · 2026 Jun · PMID 42262829 · Publisher ↗
INTRODUCTION: Cholelithiasis is uncommon in childhood but is more likely to present with symptoms that adversely affect the quality of life (QoL). This study assessed patient-reported outcomes after laparoscopic cholecys...
INTRODUCTION: Cholelithiasis is uncommon in childhood but is more likely to present with symptoms that adversely affect the quality of life (QoL). This study assessed patient-reported outcomes after laparoscopic cholecystectomy (LC) using a paediatric-specific gastrointestinal (GI) health-related quality-of-life tool at a tertiary care centre in northern India. PATIENTS AND METHODS: A retrospective study of a cohort of children aged <12 years who underwent LC between 2016 and 2022 was performed. The PedsQL™ GI module questionnaire was administered to the patients or their parents, and the change in the QoL after surgery was evaluated across 14 GI symptom-related domains. RESULTS: Thirty-five children (23 males: 12 females) with a mean age of 7.24 years (standard deviation [SD]: 3.27) were recruited. The most common indication for surgery was biliary colic (70.3%). The mean post-operative hospital stay was 1.7 days. At a mean follow-up of 52.6 months (SD: 29.7), there was a significant improvement in the mean PedsQL™ GI score after surgery (93.37 [±5.2] vs. 99.65 [±1.35], P < 0.0001). The domains of stomach pain, stomach discomfort, nausea and vomiting and worry about stomach aches showed significant improvement after LC. CONCLUSIONS: LC for paediatric cholelithiasis results in a significant improvement in QoL following surgery.
Laparoscopic enhanced view totally extraperitoneal repair for recurrent incisional hernias following previous laparoscopic intraperitoneal onlay mesh plus repairs: Challenges, technical aspects and short-term results.
Shenoy KG, Thomas M, Jeur AS
J Minim Access Surg · 2026 May · PMID 42262827 · Publisher ↗
INTRODUCTION: Following previous intraperitoneal onlay mesh (IPOM) plus repairs, laparoscopic enhanced view totally extraperitoneal (ETEP) repair for recurrent incisional hernias (RIH) presents difficulties due to fused...
INTRODUCTION: Following previous intraperitoneal onlay mesh (IPOM) plus repairs, laparoscopic enhanced view totally extraperitoneal (ETEP) repair for recurrent incisional hernias (RIH) presents difficulties due to fused planes from the previous mesh, transfascial sutures and tacks. The literature on ETEP in this setting, particularly with retro rectus mesh implantation, is limited. This study details our experience of performing ETEP for RIH following prior laparoscopic IPOM plus repairs. PATIENTS AND METHODS: This was a retrospective study from a prospective database of 28 patients who underwent Laparoscopic ETEP-Rives Stoppas (RS)/transversus abdominis release (TAR) from January 2022 to June 2025. The operative details, challenges faced and tips to overcome the difficulties are explained. RESULTS: Out of 28 patients (mean age 64 years, 19 women and 9 men), 20 patients required ETEP-TAR and 8 underwent ETEP-RS. The mean operating time was 125 min for ETEP-RS, 155 min for ETEP-right TAR and 185 min for ETEP-bilateral TAR. There was no conversion to open/hybrid procedure. The duration of stay was 2-3 days. There were no recurrences during the follow-up period, which ranged from 2 months to 3.5 years, with a mean follow-up of 2 years. CONCLUSION: Based on our short-term experience, laparoscopic ETEP for the management of recurrent incisional hernia following previous IPOM plus repairs is technically demanding but can be performed safely and effectively in experienced hands, representing a valuable treatment option.
An unexpected encounter in Calot's triangle: Cystic duct duplication with cholelithiasis in a young male.
Sharma S, Krishnanand
J Minim Access Surg · 2026 Jun · PMID 42262826 · Publisher ↗
A duplicated cystic duct draining a single gall bladder is an exceedingly rare congenital biliary anomaly. Fewer than 25 cases have been described in published literature, and the condition is almost never diagnosed befo...
A duplicated cystic duct draining a single gall bladder is an exceedingly rare congenital biliary anomaly. Fewer than 25 cases have been described in published literature, and the condition is almost never diagnosed before surgery. We report a 19-year-old male who presented with recurrent right upper quadrant pain. Abdominal ultrasonography confirmed cholelithiasis but revealed no biliary ductal abnormality. During elective laparoscopic cholecystectomy, meticulous dissection of Calot's triangle unexpectedly identified two separate cystic ducts, both draining a single gall bladder. Each duct was individually traced to confirm its distal course, then clipped and divided under direct vision after establishing the critical view of safety. The procedure was completed laparoscopically without complication. The patient was discharged on the post-operative day 2 and remained well at the follow-up. This case underscores that standard pre-operative imaging does not guarantee normal biliary anatomy and that systematic, unhurried dissection with a critical view of safety remains the only reliable safeguard against inadvertent bile duct injury.
Comment on: Investigation of the relationship between Helicobacter pylori positivity and colon polyps in simultaneous oesophagogastroduodenoscopy and colonoscopy procedures.
Liu Y
J Minim Access Surg · 2026 Jun · PMID 42262817 · Publisher ↗
Abstract loading — click title to view on PubMed.
National Aeronautics and Space Administration-Task Load Index for minimally invasive surgeries from multiple departments in a tertiary health care centre - A prospective study.
Sivakumar AJ, Nair KP, Vaishnavi C
J Minim Access Surg · 2026 Jun · PMID 42262815 · Publisher ↗
BACKGROUND: Minimally invasive surgery (MIS) has become an essential component of modern surgical practice due to improved patient outcomes. However, these procedures impose significant cognitive and physical demands on...
BACKGROUND: Minimally invasive surgery (MIS) has become an essential component of modern surgical practice due to improved patient outcomes. However, these procedures impose significant cognitive and physical demands on surgeons, which remain inadequately quantified. The National Aeronautics and Space Administration-Task Load Index (NASA-TLX) is a validated subjective tool used to assess workload during complex tasks, including surgery. AIM: The aim of this study was to evaluate intra-operative surgeon workload during minimally invasive procedures across multiple surgical departments in a tertiary healthcare centre using NASA-TLX. PATIENTS AND METHODS: This prospective observational study included surgeons performing elective minimally invasive procedures over a 3-month period at a tertiary care hospital. A total of 200 procedures performed by 27 surgeons across multiple departments were analysed. Emergency procedures, conversions to open surgery, combined procedures and abandoned surgeries were excluded. Surgeons completed the NASA-TLX questionnaire immediately after each procedure, assessing mental demand, physical demand, temporal demand, performance, effort and frustration. Workload scores were compared across procedure types and surgeon experience levels using appropriate statistical analyses, and effect sizes (η²) were calculated. RESULTS: NASA-TLX scores demonstrated a moderate overall workload, with higher mental and physical demand. Significant differences were observed across procedures in mental demand ( P = 0.013, η² =0.07), physical demand ( P = 0.022, η² =0.06), temporal demand ( P < 0.001, η² =0.11) and frustration ( P < 0.001, η² =0.21). The mean global NASA-TLX score was 5.77 ± 1.3. Laparoscopic gastrointestinal and cholecystectomy procedures demonstrated higher workload scores. Surgeons with < 5 years' experience reported greater temporal demand, while senior surgeons demonstrated higher mental demand, effort and frustration. CONCLUSION: Surgeon workload during MIS varies with procedure type and experience level. NASA-TLX is a practical and effective tool for assessing intra-operative workload and may help optimise surgical training, ergonomics and operative planning.
Thoracoscopic treatment of recurrent pleural effusions with and without implantation of a small-lumen indwelling pleural catheter - A bicentric retrospective study.
Redwan B, Al Masri E, Kösek V … +4 more , Krüger M, Khalil A, Greve T, Biancosino C
J Minim Access Surg · 2026 Jun · PMID 42262813 · Publisher ↗
INTRODUCTION: Recurrent pleural effusions (RPEs) significantly impair the quality of life and remain a therapeutic challenge. Video-assisted thoracoscopic surgery (VATS) pleurodesis is an established treatment, while the...
INTRODUCTION: Recurrent pleural effusions (RPEs) significantly impair the quality of life and remain a therapeutic challenge. Video-assisted thoracoscopic surgery (VATS) pleurodesis is an established treatment, while the role of primary indwelling pleural catheter (IPC) implantation during surgery is not yet clearly defined. This study compared the outcomes of thoracoscopic treatment of RPEs with and without primary IPC implantation. PATIENTS AND METHODS: In this retrospective bicentric study, 115 adult patients undergoing VATS for RPEs between January 2022 and December 2023 were analysed. Patients were treated at either Knappschaft Kliniken Lünen (KKL), where VATS pleurodesis without IPC was standard, or Helios University Hospital Wuppertal (WUP), where routine primary IPC implantation was performed. Demographic data, operative characteristics, post-operative chest drainage duration and length of hospital stay (LOS) were evaluated. Statistical analysis was performed using unpaired t -tests. RESULTS: Operative duration did not differ significantly between groups. However, patients in the WUP group demonstrated a significantly shorter duration of post-operative chest drainage (3.4 ± 1.5 vs. 5.2 ± 2.1 days) and reduced LOS (5.8 ± 1.6 vs. 7.4 ± 2.4 days) compared with the KKL group. Post-operative complications were minor and comparable between groups, with no major complications observed. CONCLUSION: Simultaneous IPC implantation during VATS pleurodesis for RPEs is associated with shorter chest drainage duration and hospital stay without increasing operative time or morbidity. This combined approach represents a safe and effective treatment option for selected patients. Prospective studies are warranted to confirm long-term benefits.
Perioperative complications of laparoscopic mesh repair for inguinal hernia: A prospective observational study from a tertiary centre in Kashmir.
Nasir M, Naikoo GM, Wani HN … +2 more , Nazir I, Attri MR
J Minim Access Surg · 2026 Jun · PMID 42262809 · Publisher ↗
BACKGROUND: Laparoscopic mesh repair for inguinal hernia offers faster recovery and less post-operative pain than open repair, though concerns persist regarding perioperative and mesh-related complications. This prospect...
BACKGROUND: Laparoscopic mesh repair for inguinal hernia offers faster recovery and less post-operative pain than open repair, though concerns persist regarding perioperative and mesh-related complications. This prospective observational study evaluated the incidence and pattern of complications following laparoscopic inguinal hernia repair in a high-volume tertiary care centre in Kashmir. PATIENTS AND METHODS: Adults ≥18 years with primary, uncomplicated inguinal hernia undergoing elective laparoscopic mesh repair (transabdominal preperitoneal [TAPP], totally extraperitoneal [TEP] or extended TEP [e-TEP]) were included, while obstructed, strangulated, irreducible, recurrent and paediatric hernias were excluded. Demographic, clinical, operative and outcome data were analysed. RESULTS: Fifty-six male patients (mean age 56.25 ± 13.56 years) were studied. Hypertension (32.1%) and hypothyroidism (19.6%) were common comorbidities; smoking (46.4%) was the predominant risk factor. Most hernias were unilateral (75%), right-sided (42.8%) and indirect (71.4%). TAPP was performed in 57.1%, e-TEP in 30.3% and TEP in 12.6% of cases. Mean operative time was 65.7 ± 3.9 min for unilateral and 88 ± 7.4 min for bilateral repairs. No intraoperative complications occurred. Early post-operative complications included pain (7.1%) and urinary retention (1.8%), mainly after TAPP. Intermediate complications comprised port-site infection (1.8%) and seroma (5.4%), more frequent after e-TEP. Mesh infection occurred in 2 patients (3.6%), requiring explantation in one. Mean hospital stay was 1.6 ± 0.62 days (96.4% discharged within 2 days). No mortality or recurrence occurred at 6 months. CONCLUSION: Laparoscopic mesh repair using TAPP, TEP or e-TEP is safe, with minimal pain, short hospitalisation and low complication rates. Optimisation of comorbidities and mesh selection may further enhance outcomes.
Early radiologic diagnosis and laparoscopic transabdominal pre-peritoneal repair of a rare adnexal sciatic hernia: A case report.
Yao T, Wu M, Xie W … +2 more , Wu X, Shen M
J Minim Access Surg · 2026 Jun · PMID 42262805 · Publisher ↗
Sciatic hernias containing adnexa are exceedingly rare and prone to misdiagnosis. This study reports the case of an 84-year-old multiparous female (body mass index: 18 kg/m 2 ) who presented with acute right lower abdomi...
Sciatic hernias containing adnexa are exceedingly rare and prone to misdiagnosis. This study reports the case of an 84-year-old multiparous female (body mass index: 18 kg/m 2 ) who presented with acute right lower abdominal pain. Initially, the patient was misdiagnosed clinically with an obturator hernia; however, rigorous multidisciplinary computed tomography re-evaluation confirmed a right-sided adnexal sciatic hernia. Laparoscopic exploration revealed the adnexa and a mesosalpingeal cyst herniating through a 2.0-cm suprapiriform defect. Given her advanced age and the mechanical risk posed by the cyst, a right salpingo-oophorectomy was justified. The defect was concurrently repaired using a transabdominal pre-peritoneal approach, with the mesh secured solely by continuous peritoneal suturing. Prior to mesh placement, the ureter was mobilised medially to maintain a safe distance from the repair site. The post-operative course was uneventful, and she was discharged on day seven. This case highlights the crucial role of accurate radiological differential diagnosis in high-risk women and demonstrates a safe, minimally invasive management strategy.
Laparoscopic resection of recurrent hepatic biliary cystadenoma in a patient with both accessory right and left hepatic arteries.
Shenoy G, Thomas M, Jeur AS
J Minim Access Surg · 2026 May · PMID 42262804 · Publisher ↗
Biliary cystadenoma (BC) of the liver is a rare benign cystic lesion. Recurrence following excision is uncommon, and aberrant hepatic arterial anatomy adds further surgical complexity. A 25-year-old female underwent lapa...
Biliary cystadenoma (BC) of the liver is a rare benign cystic lesion. Recurrence following excision is uncommon, and aberrant hepatic arterial anatomy adds further surgical complexity. A 25-year-old female underwent laparotomy 3 years earlier for a presumed hydatid cyst; histopathology revealed mucinous BC. She presented with abdominal pain. Computed tomography (CT) showed an 8 cm × 8 cm × 7 cm multiloculated cystic lesion in segments 4a/4b/5 and another in segments 5/8 compressing the porta hepatis structures. CT angiography demonstrated both accessory right and left hepatic arteries. After pre-operative endoscopic retrograde cholangiopancreatography with common bile duct stenting, laparoscopic resection was performed with careful preservation of the portal vein and all hepatic arteries. A minor left hepatic duct injury was repaired primarily. Operative time was 210 min; blood loss was 250 ml. Recovery was uneventful. Histopathology confirmed biliary mucinous cystadenoma without malignancy. This case illustrates a rare combination of vascular anatomy encountered during laparoscopic resection of recurrent hepatic BC, and to our knowledge, it is the first published report describing this precise surgical scenario. Laparoscopic resection of recurrent BC with dual accessory hepatic arteries is feasible and safe in expert hands following detailed vascular mapping and meticulous dissection.
Delayed posterior rectus sheath rupture presenting as intestinal obstruction: A case report and review.
Rege SA, Vyas DB
J Minim Access Surg · 2026 Jun · PMID 42262803 · Publisher ↗
Extended-view totally extraperitoneal repair (eTEP) is one of the recently introduced, advanced minimal access approaches for the repair of ventral hernias. Posterior sheath rupture (PRSR), though rare, is a lethal compl...
Extended-view totally extraperitoneal repair (eTEP) is one of the recently introduced, advanced minimal access approaches for the repair of ventral hernias. Posterior sheath rupture (PRSR), though rare, is a lethal complication of eTEP, exposing the polypropylene mesh to the viscera. Few cases of PRSR have been reported following eTEP ventral hernia; however, delayed presentations as acute small bowel obstruction, has not been reported so far. We present the case of acute intestinal obstruction following eTEP ventral hernia repair after 10 months following the primary surgery. A 67-year-old female underwent laparoscopic eTEP repair for an incisional hernia using a polypropylene mesh of 20 cm × 15 cm without mesh fixation, along with anterior and posterior rectus sheath re-approximation 10 months ago. She presented in emergency with abdominal pain and constipation and obstipation for 2 days. Contrast-enhanced computed tomography of the abdomen and pelvis revealed interstitial hernia with dilated small bowel herniating till anterior rectus sheath with adhesions to the mesh through the posterior rectus sheath dehiscence. She was subjected for an emergency laparoscopic surgery. She had an uneventful recovery. Ventral hernia repair with mesh reinforcement in retrorectus plane is considered safer with maintained peritoneal integrity, reducing the risk of bowel obstruction and fistula formation as with an intraperitoneal mesh. There are few documented cases of posterior rectus sheath rupture as an early complication of eTEP, which exposes to similar risks of bowel obstructions. However, PRS rupture as delayed complication with bowel obstructions has not been documented. A high degree of clinical suspicion of PRS rupture must be kept post-ventral hernia repair in patients presenting with obstructive symptoms. We consider that poor muscle tone, strenuous activity and deep bending may cause PRS rupture.
Safety, efficacy and scope of telerobotic surgery with the SS Innovations MantraSync: A case report with workflow and outcomes.
Khanna S, Barua A, Khanna S … +3 more , Das PK, Choudhury S, Das K
J Minim Access Surg · 2026 Jun · PMID 42262798 · Publisher ↗
BACKGROUND: Telerobotic surgery allows expert surgical care delivery across large distances using robotic systems and high-speed, low-latency networks. However, concerns regarding technical safety, clinical workflow and...
BACKGROUND: Telerobotic surgery allows expert surgical care delivery across large distances using robotic systems and high-speed, low-latency networks. However, concerns regarding technical safety, clinical workflow and outcomes - particularly in settings without on-site surgical expertise - limit its global adoption. OBJECTIVE: To evaluate the feasibility, safety, efficacy, workflow and technical requirements of long-distance telerobotic cholecystectomy in India using the indigenous SS Innovations (SSI) MantraSync robotic system and Multiprotocol Label Switching (MPLS)-based dedicated connectivity. PATIENTS AND METHODS: Two female patients underwent an elective telerobotic cholecystectomy with the surgeon located at Gurugram and the patient at Guwahati, separated by ~ 1950 km. A pre-established surgical workflow with a modified surgical safety checklist was followed. A strict contingency protocol, multilayered network security and backup conversion plans were implemented. Technical requirements included a dedicated 40 Mbps MPLS line, ultra-low latency video and control data paths and the RASCOW2 protocol for stable streaming. Perioperative and network parameters were prospectively recorded. RESULTS: Both surgeries were completed successfully without intraoperative complications, conversions or technical failures. Console times were 51 and 30 mins, blood loss was minimal (10-15 mL), Visual Analogue Scale pain score at 24 h was 1-2 and uneventful discharge occurred on day 2. Network transmission latency was 35-40 ms, round-trip latency 250-260 ms, with jitter <10 ms and packet loss <0.1%. All values were within recommended global benchmarks for telerobotic safety (<320 ms round-trip). Functional handover to local control was verified and could be achieved in 2-3 min if needed. CONCLUSION: Telerobotic cholecystectomy using the SSI MantraSync platform and a robust network infrastructure is safe, feasible and effective, with technical and clinical outcomes comparable to in-person robotic surgery. Adherence to multidisciplinary workflow, safety checklists and redundancy protocols is critical. These results support expanded adoption of telerobotic surgery in resource-limited and remote environments, enabling broader access to advanced surgical care.
Critical appraisal of 'skin stapler versus subcuticular suture for port-site skin closure in laparoscopic sleeve gastrectomy'.
Gupta N, Agrawal H
J Minim Access Surg · 2026 Jun · PMID 42262797 · Publisher ↗
Abstract loading — click title to view on PubMed.
Surgical strategy in pulmonary hydatid cysts: Procedure type outweighs surgical approach in determining post-operative outcomes - A retrospective study.
Yildiran H, Altintas K, Can A … +2 more , Sahinoglu T, Sen H
J Minim Access Surg · 2026 Jun · PMID 42262782 · Publisher ↗
INTRODUCTION: While minimally invasive techniques such as video-assisted thoracoscopic surgery (VATS) are applied, the relative impact of surgical approach versus procedure type on outcomes remains controversial in pulmo...
INTRODUCTION: While minimally invasive techniques such as video-assisted thoracoscopic surgery (VATS) are applied, the relative impact of surgical approach versus procedure type on outcomes remains controversial in pulmonary hydatid cyst treatment. PATIENTS AND METHODS: This retrospective study analysed 192 operations performed in 157 patients with pulmonary hydatid cysts between 2010 and 2023. Patients were stratified by surgical approach (VATS, video-assisted mini-thoracotomy and thoracotomy) and by procedure type (cystotomy, cystotomy + capitonnage, cystotomy + wedge and wedge). Demographic data, cyst characteristics, rupture status, concomitant hepatic hydatidosis, post-operative complications, length of stay and recurrence were evaluated. Statistical comparisons were made as appropriate. RESULTS: The mean patient age was 38.9 ± 20.2 years; 94 were female (59.5%) and 63 were male (40.5%). Cysts treated with VATS were significantly smaller, likely reflecting selection bias towards thoracoscopic suitability, whereas larger cysts were more often managed with cystotomy + capitonnage. Surgical approach did not significantly affect post-operative complication rates or hospital stay ( P > 0.05). In contrast, procedure type strongly influenced outcomes: cystotomy was associated with prolonged air leak and longer hospitalisation, capitonnage reduced complications but slightly extended recovery, and wedge resections achieved the shortest stays with low morbidity. Overall morbidity, recurrence and hospitalisation duration were comparable between paediatric and adult groups. CONCLUSIONS: In pulmonary hydatid cyst surgery, prognosis depends primarily on the procedure performed rather than the surgical approach. Parenchyma-preserving techniques - particularly capitonnage and appropriately selected wedge resections - reduce morbidity and accelerate recovery. Surgical planning should therefore prioritise the choice of procedure over the approach to optimise outcomes in pulmonary hydatid disease.
Robotic single-site cholecystectomy with indocyanine green fluorescence for duplicated gallbladder.
Yoo D
J Minim Access Surg · 2026 Jun · PMID 42262778 · Publisher ↗
Symptomatic gallbladder (GB) duplication is a rare congenital anomaly that poses a significant surgical challenge due to anatomical variability, increasing the risk of bile duct injury or retained GB syndrome. We present...
Symptomatic gallbladder (GB) duplication is a rare congenital anomaly that poses a significant surgical challenge due to anatomical variability, increasing the risk of bile duct injury or retained GB syndrome. We present the case of a 58-year-old woman with symptomatic cholelithiasis in a duplicated GB, who underwent a robotic single-site cholecystectomy using the da Vinci SP ® system. Intraoperative indocyanine green (ICG) fluorescence imaging was instrumental in delineating the biliary tree, enabling the successful resection of both GBs and their respective cystic ducts and arteries without complications. The articulated instruments of the robotic platform provided the dexterity required for precise dissection, particularly as one GB was partially embedded in the liver parenchyma. This case demonstrates that robotic single-site cholecystectomy with ICG fluorescence imaging is a safe, feasible and effective approach for managing GB duplication, enhancing anatomical identification to minimise surgical risks in aberrant biliary anatomy.
Laparoscopic versus open pancreaticoduodenectomy in patients with periampullary carcinoma: A randomised clinical trial.
Chauhan V, Sharma A, Nag HH … +5 more , Shetty A, Saluja SS, Sachdeva S, Chandra S, Sakhuja P
J Minim Access Surg · 2026 Jun · PMID 42262773 · Publisher ↗
INTRODUCTION: Pancreaticoduodenectomy (PD) is the standard curative surgery for periampullary carcinoma. Laparoscopic PD (LPD) offers minimally invasive advantages, but concerns remain regarding safety, oncological adequ...
INTRODUCTION: Pancreaticoduodenectomy (PD) is the standard curative surgery for periampullary carcinoma. Laparoscopic PD (LPD) offers minimally invasive advantages, but concerns remain regarding safety, oncological adequacy and perioperative outcomes compared with open PD (OPD). Intraoperative blood loss, a key predictor, is underexplored in randomised controlled trials (RCTs). PATIENTS AND METHODS: We conducted a single-centre, prospective, and single-blind RCT (January 2018-December 2021). Patients with resectable periampullary carcinoma were randomised to LPD or OPD after staging laparoscopy. The primary endpoint was intra-operative blood loss (Nadler's and Gross's equations). The secondary endpoints included operative time, hospital stay, transfusion need, complications, margin status, lymph node, overall survival (OS) and recurrence-free survival (RFS). RESULTS: Thirty-six patients were randomised (18 LPD and 18 OPD). Groups were comparable at baseline. Mean blood loss was significantly lower in LPD ( P = 0.046). Operative time was longer, and hospital stay shorter in LPD, both nonsignificant. Rates of pancreatic fistula, delayed gastric emptying and reoperation were similar. One LPD patient had an R1 resection; all others achieved R0. Lymph node yield was comparable. At the follow-up, 3-year OS and 2-year RFS were similar. CONCLUSION: LPD significantly reduced intra-operative blood loss with comparable oncological and survival outcomes. It is safe and feasible in patients, although larger multicentre trials are warranted to confirm long-term benefits.
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