Prospective analytical study to evaluate the Veress needle technique for creating pneumoperitoneum in terms of safety profile.

A total of 4,014 patients undergoing laparoscopic surgery for different reasons in which Veress needle was the technique to create pneumoperitoneum were included in the study during the period of January 2008 to September 2012.

Results were evaluated by analysing the data through SPSS version 16.

Total 27 patients developed complications in terms of abdominal wall emphysema 12 (44%), omental injury 11 (40.7%), small bowel injury 2 (7.4%) and mesenteric vascular injury 2 (7.4%).

Among these complications majority of patients were having BMI > 30 (78%).

All the complications were managed by simple measures laparoscopically.

Veress needle technique for creating pneumoperitoneum is comparable with open technique, particularly in patients with BMI < 30.

Kumar S, Bhaduri S, Ansari AM, Tripathi S, Dikshit P. Veress Needle: A Safe Technique in Modern Laparoscopic Era. World J Lap Surg 2013;6(1):1-5.

Over the past 5 years, minimal access surgery has been moved toward a new less invasive single port access surgery. Like any new technique, there is a need to ensure that basic tenets of safety and efficacy are maintained. In this study, we demonstrate the efficacy and safety of single port laparoscopic surgery for cholecystectomy in 22 consecutive cases in single institution.

It is a case series of 22 patients (20 females/2 males) who underwent single port laparoscopic cholecystectomy (SPLC) a single laparoscopic surgeon at Barts and the Royal London NHS Trust performed all surgeries using straight conventional instruments from July 2009 to May 2011.

In our series, the operations were performed by SPLC successful in 21 patients. In one case an extra-port was added due to inadequate exposure. The mean age was 37.27 years (24-70). The mean BMI was 25.25 kg/m² (21.1-35). The mean operative time was 69.21 minutes (30-90). Gallbladder perforations were recorded in three cases. Minor bleeding was found in one case. The mean hospital stay was <24 (10.05) hours. Visual analog scale was used to record pain severity and the mean was less than one. All patients had uneventful recovery.

The results from current series show SPLC to be a promising technique. We established in this series that SPLC is a safe, efficacious and feasible technique, but it took longer to perform than standard surgery. It can be performed using straight instruments. However, routine application of this novel technique requires evaluation of its safety and effectiveness in large randomized studies.

SILS: Single incision laparoscopic surgery; SIMPLS: Single incision multiport laparoscopic surgery; OPUS: One port umbilical surgery; TUES: Transumbilical endoscopic surgery; SPAS: Single port access surgery, are acronyms of LESS: Laparoendoscopic single site surgery.

Abdullah K, Sarker SJ, Patel H, Patel B. Efficacy and Safety of Single Port Laparoscopic Cholecystectomy: A Single Institute Experience. World J Lap Surg 2013; 6(1):6-10.

Sreeramulu PN, Venkatachalapathy TS, Supreet CS, Prathima S. A Comparative Study of Laparoscopic vs Open Surgery for the Management of Duodenal Ulcer Perforation. World J Lap Surg 2013;6(1):11-14.

Mukhopadhyay BK. Dilip-Sarbani Knot (New Extracorporeal Knot). World J Lap Surg 2013;6(1):15-18.

Gastroesophageal reflux disease (GERD) has been the main health concern in the last few years, both in term of quality of life and symptomatology and also causing longterm health concern like cancer. In our current practice laparoscopic Nissen fundoplication is the most commonly performed operative procedure for reflux disease.

We performed our review to predict the future of robot-assisted laparoscopic fundoplication (RALF) by looking at this new technology from different angles namely, comparison with conventional laparoscopic Nissen fundoplication (CLF), in term of operative complications and postoperative outcome, training aspect of RALF, application in complicated cases and difficult tasks, and also in pediatric population.

We are in the opinion that there is a promising future for RALF, despite the increased cost and longer operation time. It has been found that RALF can function better in smaller spaces and more capable in finer dissection and it has shorter and steeper learning curve. The time and the cost issue is expected to reduce with further development and upgrades of the robotic surgery, and increase in surgeons experience in RALF. Therefore, we think the trend should be more toward RALF as a future of antireflux surgery.

Pushdary KH. Is there a Future for Robot-assisted Laparoscopic Nissen Fundoplication (RALF)...? World J Lap Surg 2013;6(1):19-22.

The aim of this study is to review available treatment options and to review current opinions in the management of patients with chronic gastroesophageal reflux disease (GERD).

This is a review article. Articles for the literature review were collected by using Google Search Scholar Engine. Literature search included relevant original and review articles addressing issues like medical treatment for GERD, surgical treatment for GERD, studies comparing surgical and medical treatment for GERD.

GERD is a common and chronic syndrome. Patients affected with syndrome experience symptoms which affect their quality of life.

The goals of treatment in this condition is to control symptoms, heal injured esophageal mucosa and to prevent complications. Both proton pump inhibitor (PPI) therapy and antireflux surgery are equally effective in controlling symptoms and in healing esophageal mucosal injury. In the recent years, laparoscopic surgery is increasingly been offered to patients with GERD. However, there is still controversy over best approach to management of GERD. This study attempted to review current opinions of this issue.

PPIs is an option for initial management of GERD. However, this condition been a chronic condition, relapse is common while on therapy with medications or following discontinuation of therapy. Hence, a treatment option which provides effective control of symptoms and prevents or minimizes complications has to be offered to patients. Medical therapy with PPI and laparoscopic antireflux surgery, both can achieve these therapeutic goals. Hence, in the light of this literature review it is recommended to individualize the treatment offered to the patient with GERD, in consultation with the patient himself or herself.

Solih M. What Should be the Approach in the Long-term Management of Patients with Gastroesophageal Reflux Disease? World J Lap Surg 2013;6(1): 23-28.

Kumar SP. Comparing Laparoscopic and Laparotomy for the Surgical Management of Ectopic Pregnancy. World J Lap Surg 2013;6(1):29-32.

Bodie SS. A Review of Medical Education in Minimally Invasive Surgery. World J Lap Surg 2013;6(1):33-36.

Is minimal access surgery of esophageal atresia with tracheoesophageal fistula by thoracotomy better than conventional thoracotomy? A multi-institutional review of literature.

Minimal access surgical technique has been one of the most important surgical advances in the last few decades; we have reached now in such era that complex neonate surgical issue can be addressed safely by minimal access surgery without significant morbidity. Esophageal atresia (EA) with distal tracheoesophageal fistula (TEF) has been successfully treated by traditional thoracotomy, but now the trend has been shifted toward minimal access surgery via thoracoscopic repair of EA with distal EA. The quest of this multi-institutional review is to get the answer that is minimal access surgery is better than the traditional open approach.

A literature view was performed from 2005 to 2012 using the PubMed, science direct, OVID search EBSCOhost and search engines Google and Yahoo. The following search terms were used, thoracoscopic repair or thoracoscopic surgery, thoracotomy and EA.

Inclusion criterion is EA with distal esophageal fistula with comparative study by open thoracotomy or by historical data. Exclusion criteria were other esophageal anomalies.

In 182 patients operated by minimal access surgery by thoracoscopy, the mean gestational age, weight, associated congenital anomalies, mechanical ventilation, perioperative pCO₂, postoperative early and late complication are comparable with historical open thoracotomy. However MAS has a superadded advantage in markedly reduction in scar tissue, postoperative pain and no chest wall deformity.

This multi-institutional review provides a recent comparison of the approached to EA with TEF without any worse effect of thoracoscopy and competes well with traditional open thoracotomy approach. There is dramatic advancement of pediatric MAS over the last decade and the result are comparable with open thoracotomy in perioperative, postoperative and long-term outcome with potential advantages of less scar tissue, less postoperative pain, less disruption of anatomy and function and better cosmoses with markedly reduced musculoskeletal complication. Thoracoscopic repair is a promising adjunct, but there are difficulties for setting it as the open thoracotomy and it still needs more subjective studies with the consideration of learning curve and long surgical time. However, thoracoscopic repair of EA with TEF is a favorable and effective procedure with good prognosis.

Javaid U. Is Minimal Access Surgery of Esophageal Atresia with Distal Esophageal Atresia by 10.5005/jp-journals-10033-1179 Thoracoscopy is better than Conventional Thoracotomy? A Multi-institutional Review of Literature to get the Answer. World J Lap Surg 2013;6(1):37-41.

Laparoscopic sacrocolpopexy has been in vogue since 1993. Robotic technique has started only since 2004.¹ In this article both the techniques are reviewed and an attempt is made to discuss the advantages of each.

Initially, a description of the procedure is given. Then, the article will review the recent published studies on the procedure, patient selection, intraoperative complications, postoperative complications, recovery, postoperative pain, quality of life and economic aspect of sacrocolpopexy performed laparoscopically and robotic assisted and discuss the merits of each.

Literature review conducted from Google, PubMed, Springer Link, Highwire Press, da Vinci surgery community.

The minimal access approach offers reduced morbidity, shorter hospitalization, and decreased postoperative pain. The disadvantages of the laparoscopic approach compared to open include longer operating time and need for advanced laparoscopic surgical skills including suturing. Robotassisted laparoscopic procedure allows the performance of complex laparoscopic maneuvers with less ergonomic difficulty, and thereby simplifies the complex procedure but is currently expensive.

Lavanya B. Laparoscopic vs Roboticassisted Sacrocolpopexy. World J Lap Surg 2013;6(1):42-46.

Morgagni hernia (MH) is a rare entity that accounts for less than 6% of all surgically treated diaphragmatic hernias in pediatric age group. They are mostly asymptomatic and discovered incidentally. Open surgical repair has been the gold standard in all cases. However, since the introduction of minimal access surgery, different laparoscopic techniques of MH repair have been reported. Most of them are reporting on few cases and the immediate outcomes. I report one of the largest experiences to date assessing the safety and efficacy two trocars laparoscopic repair of MH in children with more emphasis on the short-term outcomes, such as the recurrence, conversion rate, operative, postoperative complications and the fate of the hernia sac.

Fifteen children with MHs underwent primary laparoscopic repair by placement of U-shaped, nonabsorbable sutures through the full thickness of the anterior abdominal wall incorporating, the posterior rim of the defect, and returning back out through the anterior abdominal wall with the sutures tied in the subcutaneous tissue using the Storz port closure needle and without hernia sac excision, no insertion of chest tube or drain.

A total of 15 patients with MH were operated upon. There were 10 males and 5 females. Left-sided MH was present in five cases (33%), right-sided MH was present in seven cases (47%) and three bilateral MH (20%). Male-female ratio was 2:1. Intraoperative and postoperative analgesia requirement was minimal. All operations were completed laparoscopically. None of the patients developed intraoperative or postoperative complications. The maximum follow-up was 48 months (mean, 20 months). All patients are in good health without recurrence or significant sac residual.

This easy save technique of MH repair is reducing the operative time and postoperative hospital stay. Also it is minims the need of postoperative analgesia. The hernia sac excision or not is not affecting the outcome.

Ibrahim MM. Two Trocar Laparoscopic Repair of Morgagni Hernia in Infant and Childhood: Simplified Technique. World J Lap Surg 2013;6(1):47-51.