World Journal of Laparoscopic Surgery

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2011 | May-August | Volume 4 | Issue 2

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EDITORIAL

Editorial

[Year:2011] [Month:May-August] [Volume:4] [Number:2] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/wjols-4-2-v  |  Open Access |  How to cite  | 

1,072

RESEARCH ARTICLE

Henry Atawurah

Role of Laparoscopy in Diagnosis and Management of Nonpalpable Testes

[Year:2011] [Month:May-August] [Volume:4] [Number:2] [Pages:3] [Pages No:73 - 75]

   DOI: 10.5005/jp-journals-10007-1119  |  Open Access |  How to cite  | 

Abstract

Methods

For a span of 5 years, orchidopexy was performed for 64 patients between the ages of 1 to 15 years (mean age of 4.6 years) with nonpalpable (intra-abdominal) testes. In all, 75 testes were involved in the study during which some had laparoscopic and open Fowler-Stephens orchidopexy while others had laparoscopic orchidectomy.

One stage Fowler-Stephens orchidopexy was performed laparoscopically for 28 testes; 17 had two stage Fowler-Stephens orchidopexy. Laparoscopic orchidectomy was done for five testes. Postoperative follow-up consisted of clinical and color Doppler utrasonography. This was done for all who underwent orchidopexy.

Results

The diagnostic convergence of US and laparoscopy was 16 out of 75 testes (21.3%). Laparoscopically 20 testes were located low intra-abdominally (26.6%), 17 were in the category of high intra-abdominal testes (22.7%). 18 testes had entered the inguinal canal (24%). Four of the patients had associated hernia. Mean follow-up period was 26 months (1 month to 5 years) during which the testes where found in their respective hemiscrotums except for two testes which had atrophied and three which were retracted up the scrotum.

Conclusion

Laparoscopy can provide accurate diagnosis of nonpalpable testes and thereby enabling a simultaneous, comparable definitive treatment.

1,974

REVIEW ARTICLE

Paul A Kisanga

Laparoscopic Splenectomy using a Single Incision Access

[Year:2011] [Month:May-August] [Volume:4] [Number:2] [Pages:4] [Pages No:77 - 80]

   DOI: 10.5005/jp-journals-10007-1120  |  Open Access |  How to cite  | 

Abstract

Conclusion

Single incision splenectomy can be performed safely in patients of all ages. Immediate indicators show superior cosmetic outcome compared to conventional laparoscopic splenectomy, however, bigger series with long-term follow-up are required.

3,989

REVIEW ARTICLE

Haile M Mezghebe

Does Timing of Laparoscopic Bile Duct Injury Repair affect Long-term Outcome?

[Year:2011] [Month:May-August] [Volume:4] [Number:2] [Pages:3] [Pages No:81 - 83]

   DOI: 10.5005/jp-journals-10007-1121  |  Open Access |  How to cite  | 

Abstract

Objective

This article will review the controversies and prevailing views that deal with the vexing questions of “what is the optimal time of repair” that delivers the best long-term outcome following laparoscopic surgery injury of bile duct system.

Materials and methods

Literature review conducted using Google search engine and HighWire press, using keywords, like bile duct injuries, timing of repair, outcome and laparoscopic cholecystectomy.

Results

The reported incidence of bile duct injury after laparoscopic cholecystectomy varies widely due to the inclusion or exclusion of minor or self-limited events, such as bile leak from intrahepatic radicles or leak from a cystic stump. Once a major bile duct injury occurs, early recognition is paramount to minimize morbidity and potential mortality. Once recognized, appropriate measures are instituted to address the damage. However, controversy surrounds as to the optimal time for repair of the injury. The literature gives conflicting assessment and interpretation of when such injuries should be repaired. Patients cared for in facilities that lack the expertise to perform immediate repair may inherently end up at a tertiary referral center in a delayed manner. Some recognized institutions and individual surgeons with the expertise and resources to perform immediate repair opt for repair without delay claiming good outcomes while others delay the repair to intermediate and late repairs with claims of equally good outcomes reported.

Conclusion

While immediate recognition of any injury is mandatory for improved patient outcome, the timing of repair remains controversial with convincing arguments on both sides of the issue. However, there seems to be more evidence to support either immediate repair in experienced hands or delayed repair beyond six weeks. Intermediate repair (within 3 to 14 days) is more likely to lead to failures and long-term complications.

3,820

REVIEW ARTICLE

E Ray-Offor

Immunological Response of Postcholecystectomy: Single Incision Laparoscopic Surgery (SILS) vs Natural Orifice Transluminal Endoscopic Surgery (NOTES)

[Year:2011] [Month:May-August] [Volume:4] [Number:2] [Pages:4] [Pages No:85 - 88]

   DOI: 10.5005/jp-journals-10007-1122  |  Open Access |  How to cite  | 

Abstract

Introduction

Surgery evokes complex metabolic, neuroendocrine and immunological responses. These are reparatory but when exaggerated may cause immunosuppression with morbidity and mortality. It is well-known that these responses are attenuated in laparoscopic cholecystectomy, which is the gold standard for treatment of cholelithiasis. Current novel minimal access techniques of natural orifice transluminal endoscopic surgery (NOTES) and single incision laparoscopic surgery (SILS) consolidate on the gains of better cosmesis, reduced postoperative pain and rapid recovery; however, they are yet to be fully evaluated in terms of comparative advantage on immunological basis.

Aims

This study aims to compare the immunological changes following the techniques of NOTES and SILS in cholecystectomy with a view to ascribe relative advantage.

Methods

Literature review of immunological changes following NOTES and SILS from Medline, Cochrane Database, Google and SpringerLink. Cross references from list of major articles on subject were read with other relevant journals from a laparoscopic research institute library.

Results

Pneumoperitoneum affects the local peritoneal immune environment resulting in alterations in cytokine production and phagocytic function. Interleukin-1 (IL-1), tumor necrosis factor and particularly IL-6 are potent systemic mediators of the immune and acute phase response following surgery. Various animal model studies have shown that NOTES and SILS evoke similar levels of inflammatory cytokine profiles but for a late-phase tissue necrosis factor-alpha (TNF-alpha) depression with NOTES.

Conclusion

Minimal access techniques of cholecystectomy have reduced immune response compared to open surgery. There is limited immunological data available comparing NOTES and SILS postcholecystectomy. Large randomized studies are needed to ascribe immunological advantage between these two techniques of cholecystectomy.

2,107

REVIEW ARTICLE

Pranay Ghosh, Puneet K Kochhar

A Comparative Study of the use of Different Energy Sources in Laparoscopic Management of Endometriosis-Associated Infertility

[Year:2011] [Month:May-August] [Volume:4] [Number:2] [Pages:7] [Pages No:89 - 95]

   DOI: 10.5005/jp-journals-10007-1123  |  Open Access |  How to cite  | 

Abstract

Background

Although there is controversy about the mechanism by which endometriosis causes infertility, laparoscopic treatment for endometriosis-associated infertility is becoming popular. However, the optimal modality of energy sources used for dissection and ablation in infertile women remains unexplored.

Objective

To study the best available evidence exploring the use of laparoscopic surgery in infertile women with endometriosis, compare various available energy sources, and their effect on surgical outcome and probability of pregnancy.

Methods

A retrospective review of literature was done to explore the role of laparoscopic surgery and various energy sources in managing endometriosis-associated infertility, using keywords—endometriosis, laparoscopy, infertility, electrosurgery and ultrasonic energy.

Results

Laparoscopic treatment of endometriosis using mechanical or electrical technologies was proposed in the 1980s. Later, use of lasers to vaporize endometriosis and to excise adhesions became popular. The invention of ultrasonic generator and tissue response electrosurgical generator has revolutionized laparoscopic surgery for endometriosis.

Conclusion

No prospective randomized double-blind controlled trial has been conducted to date in this area. Current evidence suggests that laparoscopic excision or ablation, either by electrocautery or laser, improves pregnancy rates. However, the impact of newer energy sources and tissue dissection techniques in this field is yet to be explored.

2,208

REVIEW ARTICLE

Anaam Majeed Hasson

Risk of Pneumoperitoneum in Obese: Old Myths and New Realities

[Year:2011] [Month:May-August] [Volume:4] [Number:2] [Pages:6] [Pages No:97 - 102]

   DOI: 10.5005/jp-journals-10007-1124  |  Open Access |  How to cite  | 

Abstract

Objective

To provide an overview of difficulties encountered during laparoscopic entries in obese patients and the contemporary methods used to establish the safest possible laparoscopic entry in obese.

Methods

Twenty-six articles related to laparoscopy procedures, in general, and associated difficulties in obese patient, in particular, were examined.

Results

Obesity imposes a challenge for the minimal access surgery procedures; particularly those related to the primary access of peritoneal cavity. However, closed and open peritoneal entry using blunt or optical instruments, through different sites, have been used to prevent entry failures or possible complications if difficulties are encountered whenever the surgeon cannot safely use his/her preferred entry procedure.

Conclusion

Induction of pneumoperitoneum can be a difficult, time-consuming and occasionally hazardous task in a morbidly obese patient. Different alternatives are possible according to differences in the method of entry, the site or the instruments used. The riskbenefit and the alternative options must be examined individually by the healthcare provider.

3,544

REVIEW ARTICLE

Sagar Basanale

Laparoscopic Surgery for Colorectal Cancers: Current Status

[Year:2011] [Month:May-August] [Volume:4] [Number:2] [Pages:6] [Pages No:103 - 108]

   DOI: 10.5005/jp-journals-10007-1125  |  Open Access |  How to cite  | 

Abstract

Background

Minimal access surgery short-term benefits of laparoscopy for colorectal cancer, such as faster bowel function recovery, less postoperative pain and shorter hospitalization based on data organized according to levels of evidence.

Purpose

To understand the long-term benefits of laparoscopy for colon cancer with regard to recurrence and survival based on data organized according to levels of evidence. To review the literature of laparoscopic surgery for colorectal cancers and its current status in purely laparoscopic, laparoscopic assisted, hand-assisted laparoscopic surgery (HALS).

Materials and methods

A literature search was performed using search engine Google, HighWire Press and Online Springer Library facility available at World Laparoscopy Hospital. The following search terms were used: Laparoscopic surgery for colorectal cancer current status. Selected papers were screened for further references, operative procedure were selected, only if they are universally accepted procedures, and the institution where the study was done is specialized institution for laparoscopic surgery.

Conclusions

In selected patients, a laparoscopic resection for colorectal cancer produces acceptable intermediate to long-term oncologic outcomes and a low long-term complication rate.

513

REVIEW ARTICLE

CR Praveen

Transanal Endoscopic Microsurgery: Where it Stands as of Today?

[Year:2011] [Month:May-August] [Volume:4] [Number:2] [Pages:7] [Pages No:109 - 115]

   DOI: 10.5005/jp-journals-10007-1126  |  Open Access |  How to cite  | 

Abstract

Objective

To review the present role of transanal endoscopic microsurgery (TEM) in the treatment of rectal neoplasms.

Methods

Literature search was conducted with restriction to english language and only published material was considered. Search was performed at Medline, Google, Cochrane library and SpringerLink. Search terms were: transanal endoscopic microsurgery, TEM, rectal cancer, rectal adenoma and carcinoid tumor.

Results and conclusion

The review of the present literature is confirming the increasing acceptance of TEM, as a primary modality, over conventional surgery in the management of early rectal cancers, especially pT1 lesions. As far as pT2 is considered, it has to be combined with either adjuvant chemoradiation or salvage surgery. For locally advanced pT3, lesions, it is not preferred unless neoadjuvant therapy is successful in downstaging the tumor or in patients who refuse or are unfit for major surgery. However, the cost of equipment and steep learning curve are restricting this therapy to few specialized centers around the world.

1,841

REVIEW ARTICLE

S Ravikumar

Subfascial Endoscopic Perforator Surgery in Perforator Vein Insufficiency

[Year:2011] [Month:May-August] [Volume:4] [Number:2] [Pages:6] [Pages No:117 - 122]

   DOI: 10.5005/jp-journals-10007-1127  |  Open Access |  How to cite  | 

Abstract

Surgical treatment of incompetent perforating veins of the lower leg performed by open method carries considerable morbidity and also associated with poor wound healing. Subfascial endoscopic perforator surgery (SEPS) is a new, minimally invasive endoscopic technique performed in patients with advanced chronic venous insufficiency. This technique offers an effective treatment alternative which avoids the lengthy incisions of the classical open Linton subfascial ligation techniques. The favorable ulcer healing rate and improvement in clinical symptoms suggest that SEPS is a feasible, safe and effective treatment of the incompetent perforator veins in patients with advanced chronic venous insufficiency.

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CASE REPORT

Meha Jabeen

Mayer-Rokitansky-Kuster-Hauser Syndrome

[Year:2011] [Month:May-August] [Volume:4] [Number:2] [Pages:6] [Pages No:123 - 128]

   DOI: 10.5005/jp-journals-10007-1128  |  Open Access |  How to cite  | 

Abstract

The Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by congenital aplasia of the uterus and the upper part (2/3) of the vagina in women showing normal development of secondary sexual characteristics and a normal 46, XX karyotype. It affects at least one out of 4,500 women. MRKH may be isolated (type I) but it is more frequently associated with renal, vertebral and, to a lesser extent, auditory and cardiac defects (MRKH type II or MURCS association). The first sign of MRKH syndrome is a primary amenorrhea in young women presenting otherwise with normal development of secondary sexual characteristics and normal external genitalia, with normal and functional ovaries, and karyotype 46, XX without visible chromosomal anomaly. The phenotypic manifestations of MRKH syndrome overlap with various other syndromes or associations and thus require accurate delineation. For a long time, the syndrome has been considered as a sporadic anomaly, but increasing number of familial cases now supports the hypothesis of a genetic cause. In familial cases, the syndrome appears to be transmitted as an autosomal dominant trait with incomplete penetrance and variable expressivity. This suggests that the involvement of either mutations in a major developmental gene or a limited chromosomal imbalance. However, the etiology of MRKH syndrome still remains unclear. Treatment of vaginal aplasia, which consists in creation of a neovagina, can be offered to allow sexual intercourse. As psychological distress is very important in young women with MRKH, it is essential for the patients and their families to attend counseling before and throughout treatment.

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