Laparoscopic Surgery

We present the case of a 70-year-old male patient, a tennis player, with recurrence of a right inguinal hernia openly repaired 40 years before, who also had an umbilical and left inguinoscrotal hernia for more than 30 years, complaining of 8 months of progressive groin pain that made it difficult to play tennis. We performed a laparoscopic TAAP repair of the left side. On the right side, the peritoneal sac covered completely an incarcerated bladder hernia of approximately eighty percent of it, which was completely reduced from the defect. The peritoneal flap was extended and joined with the one on the left side to obtain a complete view of the pelvis and two 15x15cm polypropylene meshes tailored to fit the area completely as described by Stoppa for giant and complex bilateral hernias. The patient was discharged 48 hours after surgery without complications. This report presents a case of modified Stoppa transabdominal preperitoneal (TAPP) laparoscopic approach, to repair a large direct inguinal bladder hernia and a big inguinoscrotal contralateral bowel hernia as the better method to repair these defects.

The coexistence of multiple hernias in different anatomical zones, such as the abdominal wall and bilateral inguinal region, is an uncommon condition scarcely documented in the literature. Most reports focus on individual hernia repair in specific locations, making the true incidence of simultaneous multiple hernia repair uncertain. This clinical case represents a significant contribution, as it demonstrates the feasibility of performing multiple laparoscopic repairs in a single surgical session for various hernias. We present the case of an octogenarian patient with a history of right nephrectomy due to benign pathology, with no additional risk factors. He presented with mild abdominal pain and a large bulge in the right abdominal flank and bilateral inguinal regions. Physical examination revealed a right lateral incisional hernia, an umbilical hernia, and bilateral inguinal hernias. A single-stage laparoscopic repair was performed, placing a mesh at each site and combining different approaches for each defect. The postoperative course was satisfactory, with no complications and rapid functional recovery. This case exemplifies that synchronous laparoscopic repair of multiple hernias is a viable, safe, and potentially beneficial option in selected patients, allowing adequate visualization, minimal postoperative pain, and shortened recovery time.

Minimal access surgery is a routine surgical practice due
to its minimal invasive and associated advantages. It has a
lot of advantages but not devoid of complication, one of the
major concerned complication is the trocar site herniation
(TSH). TSH is a serious complication often requiring
emergency repair. If unattended, TSH can lead to small
bowel strangulation and incarceration.

BACKGROUND: Subfertile women with endometriosis have been reported to demonstrate impaired follicular growth, ovulatory dysfunction and disturbed LH patterns. In addition, abnormal LH and/or LH receptors have been linked with endometriosis-associated infertility. Carriers of a variant of the β-subunit of luteinizing hormone (V-LH) are largely healthy; however, differences in their gonadal function such as alterations in gonadal steroidogenesis, ovarian reserve, pubertal development and predisposition to diseases such as infertility and polycystic ovarian disease have been found. METHODS AND RESULTS: To explore the possible relationship between endometriosis and V-LH, we examined its frequency in 230 women undergoing laparoscopic surgery for the investigation of infertility. For the entire study population, 185 (80.4%) were wild type; 42 (18.3%) were heterozygous; and three (1.3%) were homozygous for V-LH. No difference was found between women with (n ϭ 85) and without (n ϭ 145) endometriosis concerning the frequency of the type of LH. CONCLUSION: Our results do not support the hypothesis that the variant form of LH is associated with an altered risk of endometriosis in the population tested.

This paper presents the details of a combined hardware/software system, which has been developed to provide haptic feedback for teleoperated laparoscopic surgical robots. Surgical instruments incorporating quantum tunnelling composite (QTC) force measuring sensors have been developed and mounted on a pair of Mitsubishi PA-10 industrial robots. Feedback forces are rendered on pseudo-surgical instruments based on a pair of PHANTOM Omni devices, which are also used to remotely manipulate the robotic arms. Measurements of the behaviour of the QTC sensors during a simulated teleoperated procedure are given. In addition, a method is proposed that can compensate for their non-linear characteristics in order to provide a ‘realistic feel’ to the surgeon through the haptic feedback channel. The paper concludes by explaining how the force feedback channel is combined with a visual feedback channel to enable a surgeon to perform a two-handed surgical procedure better on a remote patient by more...

Diaphragmatic hernia is usually congenital or follows thoracoabdominal injury. Diaphragmatic hernia combined with pneumothorax is a rare combination in the clinical setting, where pneumothorax is usually secondary to hollow viscera perforation in the long-term complications of diaphragmatic herniation or rupture of ectopic endometrium over the diaphragm during menstruation. Unlike the aforementioned conditions, we describe a 67-year-old man with chronic diaphragmatic hernia who suffered from pneumothorax and pneumoperitoneum secondary to pulmonary bulla by barotrauma during mechanical ventilation. Computed tomography showed scattered free gas in the thoracic and abdominal cavities, while there was no tenderness and rebound tenderness. The patient was managed conservatively with low PEEP and a lung-protective mechanical ventilation strategy. Finally, the oxygenation index gradually rose from 58 to 107. Unfortunately, in light of the patient’s poor clinical status and significant comorbidities, the patient passed away peacefully 3 weeks after hospital admission. Diaphragmatic hernia combined with pneumothorax should be differentiated from tension pneumothorax. Whether to intubate chest drainage depends on the cause of pneumothorax and pneumoperitoneum, as well as the risks and benefits of chest drainage. Additionally, mechanical ventilation should be applied cautiously, and respiratory parameters should be adjusted reasonably in patients at high risk of pneumothorax.

Opioid anaesthesia remains a cornerstone of perioperative medicine, despite global efforts to mitigate opioid misuse and dependence. These agents, administered via diverse routes-including intravenous, neuraxial, transdermal, and oral pathways-provide unmatched analgesia and adjunctive sedation across all phases of surgery. Common opioids such as fentanyl, morphine, and hydromorphone are complemented by ultra-potent synthetic opioids, including sufentanil, alfentanil, and remifentanil, which are reserved for complex intraoperative scenarios requiring rapid titration. Neuraxial approaches, combining opioids with local anesthetics, offer prolonged and synergistic analgesia, particularly in obstetric and major abdominal procedures. Recent years have seen a paradigm shift toward multimodal analgesia, as embodied in Enhanced Recovery After Surgery (ERAS) protocols, which integrate non-opioid pharmacologic agents, regional techniques, and nonpharmacologic modalities such as cryotherapy, physical therapy, and cognitive interventions. In parallel, opioid-free anesthesia (OFA) has emerged as a provocative approach, demonstrating improvements in recovery metrics, though its applicability remains limited to selected surgical populations. The use of opioids is not without risks. Adverse effects range from common complications such as respiratory depression, hypotension, and nausea, to rarer phenomena such as opioid-induced hyperalgesia and chest wall rigidity. Monitoring strategies-including electrocardiography, capnography, and advanced ventilatory monitoring-are crucial to preventing life-threatening toxicity. Special attention is required for vulnerable populations, including children, older adults, and patients with sleep apnea, organ dysfunction, or substance use disorders. Effective opioid anesthesia management demands interprofessional collaboration, leveraging the expertise of anesthesiologists, pharmacists, nurses, and advanced practitioners. Such teamwork ensures not only safe perioperative care but also contributes to broader public health strategies aimed at addressing the opioid crisis. This review highlights the enduring importance of opioids in anesthesia while emphasizing the need for responsible, evidence-based, and team-driven approaches to maximize patient benefit and minimize harm.

Minimally invasive surgery is increasingly being used in veterinary medicine. Laparoscopic procedures have several advantages compared with open surgery. These include the magnification of the field of surgery, reduced post-surgical pain and associated stress, reduced post-operative infection rates, and decreased hospitalization time. The establishment of a pneumoperitoneum is a critical step; however, this procedure can prolong the operation time, and most of the complications associated with laparoscopic surgery have been attributed to the insertion of devices into the abdominal cavity. Two main techniques have been employed to create pneumoperitoneum: the closed-entry method using the Veress needle and the open Hasson technique. The first portal is necessary to start insufflation and, subsequently, to realize the operative channel to insert the laparoscopic instruments into the abdomen. Many authors have compared the time necessary to create the first portal using different techn...

Background: The purpose of this study was to introduce a technique to extract the remaining peritoneal gas in order to improve the post-laparoscopic shoulder pain. Methods: This study included 12 patients undergoing laparoscopic gynecologic procedures between February and March 2016 in Minimally Invasive Techniques Research Center, Pars Hospital, Tehran, Iran. For complete suction of the air from abdominal cavity, the air was first vacuumed from the pelvic cavity in Trendelenburg position and then the patients were put in anti-Trendelenburg position. In this position, as the remaining gas was shifting toward subdiaphragmatic area, the suction tube was shifted to a position next to the camera canal and the remaining air was suctioned. A 10 point visual analogue scale was used to measure the severity of patients' post-operative shoulder pain. Results: The mean VAS for shoulder pain was 0.8±1.7 4 hr post-surgery. At 12 hr post-surgery, the mean VAS was 0.8±1.5. At 24 hr post-surgery, the mean VAS for shoulder pain was 0.3±0.8. Finally, 48 hr post-surgery, the VAS score for all patients was zero. Conclusion: Our approach for emptying the abdominal cavity from residual gas after laparoscopic procedures seems to be useful in preventing post-operative shoulder pain among patients undergoing gynecological laparoscopic surgeries. Further studies are suggested to compare the effect of our proposed method with other methods.

Background: Adnexal mass is one of the most common gynecologic diseases among women of all ages. Methods: In this cross-sectional study, we enrolled 126 patients with large adnexal masses (≥ 10 cm) managed by laparoscopic surgery during 2013 - 2020. The rates of intraoperative complications, conversion to open surgery, and incidence of cancer were assessed. Results: Mean mass size was 15.08 ± 5.03 in all participants without significant difference based on the tumor type (P = 0.624). Mean age and operation time were higher in the malignant type compared to the benign type (P < 0.001). Type of surgery and frequency of intraoperative complications were also different among patients with different tumor types (P < 0.001 and P = 0.816, respectively). Conclusions: Our study showed that large adnexal tumors can be operated by laparoscopic approach, while the most important factor for increased surgical complications and duration was malignancy.

The purpose of this study was to introduce a technique to extract the remaining peritoneal gas in order to improve the post-laparoscopic shoulder pain. This study included 12 patients undergoing laparoscopic gynecologic procedures between February and March 2016 in Minimally Invasive Techniques Research Center, Pars Hospital, Tehran, Iran. For complete suction of the air from abdominal cavity, the air was first vacuumed from the pelvic cavity in Trendelenburg position and then the patients were put in anti-Trendelenburg position. In this position, as the remaining gas was shifting toward subdiaphragmatic area, the suction tube was shifted to a position next to the camera canal and the remaining air was suctioned. A 10 point visual analogue scale was used to measure the severity of patients' post-operative shoulder pain. The mean VAS for shoulder pain was 0.8±1.7 4 post-surgery. At 12 post-surgery, the mean VAS was 0.8±1.5. At 24 post-surgery, the mean VAS for shoulder pain was 0...

O izboru između otvorene i laparoskopske apendektomije postoje kontroverzni stavovi. Dobro su poznate prednosti i nedostatci laparoskopije. Tijekom 3 godine proveli smo prospektivnu studiju (1. sijecnja 2008.- 31. prosinca 2010.) 123 bolesnika operiranih zbog akutne upale crvuljka. Bolesnici su slucajno odabrani, a podijeljeni su u dvije skupine: (LA) - laparoskopska apendektomija sa 42 i (OA) – otvorena apendektomija sa 81 zapisom. Proucavali smo: dob, spol ; vrijednosti broja leukocita prije operacije, CRP, nalaz ultrazvuka (UZ), prepisanu analgeziju i poslijeoperacijski PHD nalaz, te usporedili duljinu trajanja kirurskog zahvata, duljinu hospitalizacije i komplikacije. Provedena je telefonska anketa s pitanjima o osobnom zadovoljstvu nakon operacije. U 90% bolesnika PHD nalaz bio je pozitivan na upalu. CRP je u 42 bolesnika preoperacijski (34%) bio sa srednjom vrijednosti 59 ; u 31 (74%) bolesnika s povisenim preoperacijskim vrijednostima CRP PHD nalaz bio je pozitivan. UZV je uc...

Laparoscopic surgery for hepatic echinococcosis is a technically difficult and demanding surgical procedure even for the most experienced abdominal surgeon. Surgery is performed after the conservative treatment with albendazole for 28 days. We report a case of laparoscopic partial pericystectomy with biliostasis and omentoplasty in a patient with two previously open surgeries (laparotomies)--right subcostal laparotomy for acute inflammation of the gallbladder and right pararectal laparotomy for perforated gangrenous appendix. The patient underwent extensive laparoscopic adhesiolysis due to pronounced intra-abdominal adhesions to gain access to a large hydatid cyst with the diameter of 11 cm. Laparoscopic surgery is much less traumatic to the patient with a better cosmetic effect.

In the cases of incarcerated Richter hernia the diagnosis is difficult especially for obese patients. Laparoscopic diagnostics and desincarceration, can be combined with mini laparotomy in lieu of bowel resection and open hernioplasty, or conversion to classic laparotomy and open hernioplasty. Here is presented a case of incarcerated Richter inguinal hernia managed through the combination of laparoscopy, mini laparotomy for segmental bowel resection and open hernioplasty.

Operative treatment of hepatic hydatid cyst is technically demanding procedure. The method of choice is conservative treatment with Albendazolum followed by surgery. Open laparotomy or laparoscopic operation can be performed. We prefere laparoscopic exploration followed by laparoscopic total pericystectomy or laparoscopic partial pericystectomy. If laparoscopic operation is not possible due to technical reasons and patient safety, conversion to an open operation should be done, followed by total or partial pericystectomy. The case and our detailed technique of laparoscopic partial pericystectomy with biliostasis and omentoplasty is described. Laparoscopic operation is equally safe for the patient, yet with minor trauma and better aesthetic effect.

Hepatic hydatid cysts are a serious medical problem in some regions like Mediterranean region. In Croatia 25-30 new cases of hepatic hydatid cysts are recorded each year In University Hospital Dubrava 7 patients with hepatic hydatid cysts were operated in 2008. Surgical approach recognizes open laparotomy and laparoscopy. The case and technique of laparoscopic operation of hepatic hydatid cyst in seventh segment and three disseminated intraabdominal cysts is described. Laparoscopy should be attempted even in complex cases with dissemination.

A new algorithm for collision handling between 3D agents in a laparoscopic surgery simulator is proposed in this paper. Simulation in minimally invasive surgery pursues a trade off between real-time execution and fidelity in the virtual scene. In order to achieve visual realism, accurate deformations of graphical models are required when interactions between tools and organs occur. Specifically, during the simulation step, vertices of the organ detected as collided must be accurately shifted out of the tool to elude the interpenetration. Techniques reported in the literature usually resort to approaches grounded on physical properties that entail significant computational load. Consequently, it reverts on non-desirable simplifications in which the 3D character of tool models is typically avoided. Hence, the aim of this paper is to present an algorithm for collision handling between 3D deformable (organ) and non-deformable (surgical tool) objects involved in a non-structured interaction scene. The proposed approach obtains the new position of each collided vertex of the organ taking into account two key concepts. First, a parameter which embodies the ongoing state of the scene is obtained making use of both kinematic information of the surgical tool and geometric information of the organ surface that surrounds the vertex under analysis. Second, three parameters inferred from a feedback fuzzy logic system ponderate the nature of the tool motion with respect to the organ, modeled as penetration/extraction and sliding. Preliminary experimental results show that this solution is able to avoid the interpenetration among the multiple colliding points detected in each simulation step in an efficient, physically and spatially coherent manner.

INA« Zagreb, Klinička bolnica Osijek, Bolnica za plućne bolesti i tbc pluća Klenovnik Autori iznose rezultate ispitivanja kojim je bila obuh vaćena populacija bolesnika s KOPB u svrhu da se pokuša utvrditi na koji način i u kojoj mjeri ova bolest oštećuje kvalitetu života oboljelih. Uzorak je sačinjavao 50 bolesnika koji su bolovali od KOPB. Rezultati upućuju na to da je kvaliteta života tih bolesnika umanjena u gotovo svakom pogledu. Osnovni emocionalni poremećaj u tih bolesnika jest depresivnost, generalizirano nezadovoljstvo sa svo jim životom i somatske preokupacije? Drže da ti bolesnici u većini slučajeva nisu u mo gućnosti zadržati svoju bazičnu socijalnu ulogu i na staviti sudjelovati u aktivnostima koje bi im pričinjavale zadovoljstvo. Daju i smjernice koje bi trebalo slijediti u liječenju bolesnika s KOPB.

Introduction: Laparoscopic Cholecystectomy is now the gold standard treatment of symptomatic gallstones. Post-surgery, patients suffer visceral and shoulder pain secondary to peritoneal insufflation. This study evaluates the analgesic effectiveness of 0.25% bupivacaine instillation in gall bladder fossa after laparoscopic cholecystectomy. Methods: A prospective, double-blind study was conducted in 60 patients aged 20-60 years, ASA I and II, weighing 40-80 kgs, undergoing laparoscopic cholecystectomy under general anaesthesia. Patients were divided into two groups: Group A (30 patients) received 10 ml of 0.25% Bupivacaine, and Group B (30 patients) received 10ml Normal Saline in gall bladder fossa post-surgery. Postoperative pain was accessed using the visual analogue scale at 6, 12 and 24 hours postoperatively. Data were applied with appropriate statistical tests, results with p value <0.05 were considered significant. Results: Demographic data were comparable in both groups (p>0.05). VAS score was significantly lower in group A(1.10± 0.76) compared to group B(2.73± 1.62)(p=0.00) at 6 hours postoperatively. VAS scores were comparable at 12 and 24 hours postoperatively. Rescue analgesic use was significantly less in group A (0%) compared to group B (20%) in the first 6 hours postoperatively (p=0.01). Rescue analgesia requirements were comparable and statistically insignificant for the rest of the study duration (p=0.79; p=0.64). Conclusions: Postoperative pain was lower in patients receiving bupivacaine instillation in gall bladder fossa compared to those receiving normal saline during first six postoperative hours. VAS scores and rescue analgesic requirements were comparable on rest of the study duration.

A three-dimensional ultrasound (3D-US) system suitable for laparoscopic surgery that uses a novel magneto-optic hybrid tracker configuration. Our aim is to integrate 3D-US into a laparoscopic AR system. A 5D miniature magnetic tracker is combined with a 6D optical tracker outside the body to perform 6D tracking of a flexible US probe tip in the abdominal cavity. 6D tracking parameters at the tip are obtained by combining the 5D parameters at the tip inside the body, the 6D parameters at the US probe handle outside the body, and the restriction of the tip motion relative to the handle. The system was evaluated in comparison with a conventional 3D ultrasound system. Although the accuracy of the proposed system was somewhat inferior to that of the conventional one, both the accuracy and sweet spot area were found to be acceptable for clinical use.

The present paper describes a method for intraoperative recovery of respiratory motion and deformation of the liver by using a laparoscopic freehand 3D ultrasound (US) system. The proposed method can extend 3D US data of the liver to 4D by acquiring additional several sequences of time-varying 2D US images during a couple of respiration cycles. 2D US images are acquired on several sagittal image planes and their time-varying 3D positions and orientations are measured using a miniature magnetic 3D position sensor attached to a laparoscopic US (LUS) probe. During the acquisition, the LUS probe is assumed to move together with hepatic surface. Respiratory phases and in-plane 2D deformation fields are estimated from time-varying 2D US images, and then time-varying 3D deformation fields on sagittal image planes are obtained by combining 3D positions and orientations of the image planes. Time-varying 3D deformation field of the volume, that is, 4D deformation field, is obtained by interpolating the 3D deformation fields estimated on several planes. In vivo experiments using a pig liver showed that the proposed method could perform accurate estimation of respiratory cycle and in-plane 2D deformation fields. Furthermore, evaluation for the effects of sagittal plane interval indicated that 4D deformation fields could be stably recovered.

Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but...

A RARE CASE OF HEMOPERITONEUM- EOSINOPHILIC COLITIS



BACKGROUND: Eosinophilic colitis (EC) is a rare clinical entity. Severe cases may develop severe abdominal pain and distension, malabsorption, intestinal obstruction, and even gastrointestinal hemorrhage . Once diagnosed early, EC responds to steroid therapy.

Methods: We are reporting a case of a 46year old male who presented with acute onset left upper abdominal pain, enlargement of right scrotal sac and hemoperitoneum. A CECT scan abdomen revealed irregular hypoechoic lesion measuring approx. 6.5*4.8cm (?). Transverse Mesocolon hematoma in epigastric region with hemoperitoneum and Right sided hematocoele with persistent processus vaginalis. USG guided ascitic tap yielded bloody tap. Ascitic fluid analysis showed sheets of eosinophils (60%) with hemorrhagic background. Complete blood count showed Eosinophilia 38%. He underwent diagnostic laparoscopy and Laparoscopic left hemicolectomy; histopathological examination of the resected colon revealed Eosinophilic Colitis (Transmural type). He was given oral corticosteroids for 2 weeks after discharge.
CONCLUSION:
Eosinophilic colitis is a rare condition. It may present acutely and give rise to potentially severe and fatal complications like haemorrhage and perforation. With early diagnosis and appropriate treatment, we may be able to avoid serious complications in such patients

Aim: To compare the conventional Open herniotomy with the Laparoscopic surgery in children with Unilateral Inguinal hernia over a period of one year pospectively from June2014 to June 2015 at SVRRGG Hospital, a tertiary care hospital attached to S.V.Medical College at Tirupati.parameters include duration of surgery,recovery ,post operative pain,post operative complications,discharge,recurrence and cosmesis. Patients and methods: Total of132 cases attended to opd during June 2014 to June2015.but only 40 cases of Unilateral inguinal hernias [20 open surgery+20 lapararoscopic surgery] ,age group between 2years to 12 years were taken into consideration,average hospital stay was 37 hrs. Results: Of the 40 children with unilateral inguinal hernias Male were=36 and female were 4 ratio being 9:1, hernias were clinically right-sided in 29 (72.5%) patients and left sided in 11 (27.5%) .post operative pain is almost similar in both procedures,recurrence noted in 1 case of lap surgery.cosmeis i...

The debate regarding the safety of smoke evacuation and aerosol diffusion during laparoscopy has resurfaced with the COVID 19 outbreak. We suggest using a simple, readily available low-cost filtration system for immediate implementation. We solicit the responsibility of surgeons to take the necessary precautions to reduce the risk of viral diffusion in the operating room and ensure that our patients continue to benefit from the advantages of laparoscopic surgery.

Single-port laparoscopic surgery has evolved from an effort to minimize tissue trauma, limit morbidity, and maximize cosmesis. Limited data exist comparing single-port with conventional laparoscopy for right colectomy. Our aim is to compare single-port with laparoscopic colectomy with regard to safety and feasibility. We assert that this approach can be adopted in a safe and efficacious manner while using standard laparoscopic instrumentation. METHODS: This is a retrospective analysis of prospectively gathered data regarding 16 single-port and 27 conventional laparoscopic right hemicolectomies performed by a single surgeon between January 2008 and February 2009. Demographics, operative outcomes, and morbidity were included and analyzed using either Student t test or Fisher exact probability test. RESULTS: Single-port and conventional laparoscopic groups were similar with regard to age, gender, body mass index, prior abdominal surgery, and co-morbidity. Seventy-five percent and 70% of the operations were performed for malignancy in the single-port and the conventional laparoscopy group, respectively (P ϭ .69). Operative duration was 106 minutes in the single-port group vs 100 minutes in the conventional group (P ϭ .64). Blood loss was 54 mL and 90 mL, respectively (P ϭ .07). No conversions or additions of ports occurred. Hospital stay was 5.3 days in the single-port group vs 6 days in the conventional group (P ϭ .53). Margins were negative in both groups. Mean lymph node number was 18 and 16 nodes (P ϭ .92). There was one death in the conventional group (P ϭ .44). Morbidity including wound infection was 18.8% and 14.9%, respectively (P ϭ .73). These findings support single-port right colectomy as a safe and efficacious approach to right colon resections in patients eligible for laparoscopy with minimal additional equipment or learning curve for experienced laparoscopic colorectal surgeons. The single port was undertaken without an increase in morbidity or mortality. There was no increase in operative time with use of the single-port approach. Finally, adequate lymph node harvest and margin clearance was maintained.

Objective: To evaluate the efficacy and safety of Adept (4% icodextrin solution) in reducing adhesions after laparoscopic gynecological surgery involving adhesiolysis. Design: Multicenter, prospective, randomized, double-blind study comparing Adept with lactated Ringer's solution (LRS). Patient(s): Four hundred two patients randomized intraoperatively to Adept (n ¼ 203) or LRS (n ¼ 199) returned for second laparoscopy within 4-8 weeks. Incidence, severity, and extent of adhesions were determined on both occasions. Main Outcome Measure(s): The primary efficacy measure defined by the Food and Drug Administration was the number of patients achieving clinical success with adhesion treatment. Other measures included incidence and American Fertility Society (AFS) scores. Result(s): Significantly more Adept patients achieved clinical success than did LRS patients (49% vs. 38%). In infertility patients, Adept demonstrated particular clinical success compared with LRS (55% vs. 33%). This was reflected in the number of patients with a reduced AFS score (53% vs. 30%) and in fewer patients with a moderate/severe AFS category score (43% vs. 14%). Safety was comparable in both groups. Most events were related to the surgery, with an increase in transient labial edema in the Adept group. Conclusion(s): This is the first randomized, double-blind trial of an adhesion reduction agent. It demonstrated that Adept is a safe and effective adhesion reduction agent in laparoscopy. (

Introducción: La incidencia real de la enfermedad tromboembólica venosa (ETV) es difícil de precisar. La mayoría de los casos son asintomáticos y generalmente no se diagnostican, pero se sabe que el tromboembolismo pulmonar (TEP) es la tercera causa de muerte en el medio hospitalario. El subdiagnóstico de la patología complica el conocimiento exacto de la incidencia y no hay demasiados trabajos que evalúen la calidad de la prevención que se aplica.Objetivos: El principal fue determinar la frecuencia de la utilización de profilaxis de la ETV en los pacientes sometidos a cirugías de alto y/o mediano riesgo para la presentación de dicha patología en diferentes instituciones médicas de nuestro país. Se establecieron como objetivos secundarios evaluar la calidad de la prevención empleada y la variabilidad de la misma de acuerdo a la especialidad médica del profesional que la indica, su relación con el número de camas de la institución como criterio de complejidad de la misma y las difere...

Robotizing laparoscopic surgery not only allows achieving better accuracy to operate when a scale factor is applied between master and slave or thanks to the use of tools with 3 DoF, which cannot be used in conventional manual surgery, but also due to additional informatic support. Relying on computer assistance different strategies that facilitate the task of the surgeon can be incorporated, either in the form of autonomous navigation or cooperative guidance, providing sensory or visual feedback, or introducing certain limitations of movements. This paper describes different ways of assistance aimed at improving the work capacity of the surgeon and achieving more safety for the patient, and the results obtained with the prototype developed at UPC.

Purpose: Minimally invasive surgical techniques have been shown to reduce the inflammatory response related to a surgical procedure. The main objective of our study was to measure the inflammatory response in patients undergoing a totally laparoscopic versus open aortobifemoral bypass surgery. This is the first randomized trial on subjects in this population. Patients and methods: This is a substudy of a larger randomized controlled multicenter trial (Norwegian Laparoscopic Aortic Surgery Trial). Thirty consecutive patients with severe aortoiliac occlusive disease eligible for aortobifemoral bypass surgery were randomized to either a totally laparoscopic ( ) or an open surgical procedure (n=16). The inflammatory response was measured by perioperative monitoring of serum interleukin-6 (IL-6), IL-8, and C-reactive protein (CRP) at six different time points. The inflammatory reaction caused by the laparoscopic procedure was reduced compared with open surgery. IL-6 was significantly lower after the laparoscopic procedure, measured by comparing area under the curve (AUC), and after adjusting for the confounding effect of coronary heart disease (P=0.010). The differences in serum levels of IL-8 and CRP did not reach statistical significance. In this substudy of a randomized controlled trial comparing laparoscopic and open aortobifemoral bypass surgeries, we found a decreased perioperative inflammatory response after the laparoscopic procedure measured by comparing AUC for serum IL-6.

Under general anesthesia, a 1 cm supra-umbilical skin incision was done followed by Veress needle insertion for carbon dioxide insufflation up to 10-12 millimeter mercury (mmHg). Mesocolic excision was performed for colon tumors and total mesorectal excision was performed for rectal cancers. To avoid seeding and surgical site infection, a wound protector was used in all operations (Alexis® O™ Retrac-

Fibroids or leiomyomas are a very commonly occurring
uterine tumor affecting up to 20–25% of women. Fibroid
develops from benign transformation of a single smooth
muscle cell. The growth of myoma is dependent on many
factors. Increased estrogen stimulation alone or together
with growth hormone or human placental lactogen
appears to be the major growth regulator of fibroid.

Sažetak. Ateroskleroza je sustavna bolest koja dovodi do bolesti koronarnih, karotidnih i perifernih arterija. Vodeći je uzrok smrti u razvijenim zemljama. Patofiziologija ateroskleroze ovisi o brojnim urođenim i stečenim čimbenicima. Ključno uporište za nastanak ateroskleroze je gubitak normalne funkcije endotela. Klinička istraživanja dala su brojne dokaze da snižavanje koncentracije lipida može dovesti do korisnih kvalitativnih promjena u atarosklerotskom plaku i povoljno utjecati na kliničko očitovanje bolesti. U aterosklerotskim promijenjenim krvnim žilama česti su kalcifikati koje je moguće radiološki dijagnosticirati, a služe kao pokazatelj težine i ishoda ishemijske bolesti srca. U bolesnika s kroničnim zatajenjem srca, a posebno onih koji su na dijalizi, kalcifikati u koronarnim arterijama čest su nalaz. Najčešće se dovode u vezu s dobi, trajanjem dijalize i dislipidemijom. Liječenjem bolesnika sa zatajenjem bubrega uz pomoć statina i sevelamera moguće je usporiti godišnju progresiju kalcificiranja koronarnih arterija s 30 % na 6 %. Prema podacima iz nekih istraživanja smanjenje koncentracije LDL kolesterola < 2,59 mmol/l može zaustaviti proces odlaganja kalcija ili čak dovesti do njegove regresije. Dodatna istraživanja pokazala su da smanjenje koncentracije LDL kolesterola uz istovremeno povećanje koncentracije HDL kolesterola mogu povoljno utjecati na smanjenje debljine intime i medije karotidnih arterija, kao i na smanjenje veličine plaka u koronarnim arterijama.

Minimally invasive surgeries are widely applied due to the advantages of small surgical wound, short postoperative recovery period, and low surgical infection rate. In minimally invasive surgery, vascular clips play a significant role in hemostasis and managing the direction of blood flow, ensuring the success of surgical procedures. The mechanical structure and manufacturing materials of vascular clips have an important influence on its clinical application effect. In this paper, we classify and summarize the mechanical structure and manufacturing materials of the currently available vascular clips worldwide, and then analyze the hemostatic coating materials of vascular clips. Besides, we also summarize the shortcomings of the existing vascular clips and propose a coat-absorbable vascular clip with future research potential.

Translocation of an intrauterine device (IUD), is slightly frequent, affecting neighboring organs like the rectal sigmoid, bladder and ovaries. After uterine perforation, because of IUD migration, immediate removal of the abdominal cavity is justified. We present a case of a 38 year-old woman who had a partial perforation by an intrauterine device causing pelvic pain.

Introduction: Even though the development of the recent anti-parasitic drugs has led to a high degree of efficiency, surgical treatment still remains the gold standard for a number of conditions. Material and method. The authors discuss a series of 90 cases in a multicenter and retrospective analysis that stretches over 20 years. Results and discussions. These cases have been diagnosed and treated – through different surgical methods, both classical and laparoscopic – for hepatic hydatid cysts. The paper also presents a short review of the major types of surgical procedures cited in the international literature, with a specific focus on the advantages brought by Romanian innovations in this field. Conclusions. Even though the classical open approach still assumes the first place among surgical procedures, modern laparoscopic techniques have earned a much appreciated place in providing positive results based on long-term assessment, with virtually no or only minor complications. In t...

This case report outlines the effective management and outcome of a 26 years old male patient with lumbar scoliosis and multiple large left ureteric calculi with moderate hydronephrosis. The patient visited the outpatient urology department with a complaint of left flank pain persisting for four months. Imaging revealed multiple large stones in the left proximal ureter, with the largest measuring over 3 cm. Because of the anatomical complexities associated with severe lumbar scoliosis and the significant stone burden, the patient was not an ideal candidate for extracorporeal shock wave lithotripsy (ESWL) or ureteroscopic lithotripsy (URSL). Instead, laparoscopic ureterolithotomy was successfully performed, yielding favorable results. This report examines the surgical approach, challenges, and benefits of laparoscopic ureterolithotomy in comparison to other treatment options, including percutaneous nephrolithotomy, open ureterolithotomy, extracorporeal shock wave lithotripsy, and laser lithotripsy.

The indications and preparation for laparoscopic liver
surgery remain the same as in open hepatic surgery.
Visualization is excellent with the laparoscope, and the
addition of laparoscopic ultrasound has been shown to
help intraoperative plans in 66% of cases when compared
to laparoscopic exploration alone. The ability of visual
inspection laparoscopy to assess resectability as opposed to
inoperability remains relatively low. It can be improved by
extended laparoscopy combined with laparoscopic contact
ultrasonography.

In the evolving world latest contemporary surgical operation, laparoscopic methods have emerge as a cornerstone ultra-modern affected person care. Minimally invasive strategies not handiest make sure quicker recovery and reduced pain but additionally enhance surgical effects notably. For surgeons, gynecologists, urologists, and pediatric surgeons, today's laparoscopic capabilities is no longer non-obligatory-it is a professional necessity. some of the most fulfilling establishments devoted to laparoscopic schooling, global Laparoscopy health facility (WLH) has installed itself as a depended on center for laparoscopic schooling in India and throughout the globe. With world-class school, infrastructure, and a recognition for excellence, WLH has emerge as a beacon trendy contemporary for medical professionals aiming to excel in minimum get entry to surgery.

Introducción: los cuadros agudos de abdomen inferior (CAAI) en la mujer son una causa frecuente de consulta en puerta de emergencia. El rol de la laparoscopía como herramienta diagnóstica y terapéutica, más aun en la mujer, se encuentra bien establecido. Permite arribar a un diagnóstico de certeza en todos los casos al visualizar la totalidad de la cavidad abdominal mediante un abordaje mínimamente invasivo, evita retrasos diagnósticos y sus consiguientes complicaciones evolutivas.

The aim of this systematic review and meta-analysis is to compare robotic colectomy (RC) with laparoscopic colectomy (LC) in terms of intraoperative and postoperative outcomes. A systematic literature search was performed to retrieve comparative studies of robotic and laparoscopic colectomy. The databases searched were PubMed, Embase and the Cochrane Central Register of Controlled Trials from January 2000 to October 2014. The Odds ratio, Risk difference and Mean difference were used as the summary statistics. A total of 12 studies, which included a total of 4,148 patients who had undergone robotic or laparoscopic colectomy, were included and analyzed. RC demonstrated a longer operative time (MD 41.52, P<0.00001) and higher cost (MD 2.42, P<0.00001) than did LC. The time to first flatus passage (MD -0.51, P = 0.003) and the length of hospital stay (MD -0.68, P = 0.01) were significantly shorter after RC. Additionally, the intraoperative blood loss (MD -16.82, P<0.00001) was significantly less in RC. There was also a significantly lower incidence of overall postoperative complications (OR 0.74, P = 0.02) and wound infections (RD -0.02, P = 0.03) after RC. No differences in the postoperative ileus, in the anastomotic leak, or in the conversion to open surgery rate and in the number of harvested lymph nodes outcomes were found between the approaches.

Obesity has emerged as one of the most pressing global health challenges, strongly associated with cardiometabolic diseases, reduced quality of life, and premature mortality. In the United States alone, nearly 40% of adults are classified as obese, with annual healthcare expenditures exceeding $147 billion. Despite advances in dietary, behavioral, and pharmacological interventions, no medical therapy has consistently demonstrated durable weight loss in patients with severe obesity. Bariatric surgery, therefore, represents the most effective and evidence-based treatment, producing sustained weight loss, reversal of metabolic syndrome, and significant reductions in long-term morbidity and mortality.
Nevertheless, obesity is frequently accompanied by multiple comorbidities—including type 2 diabetes, hypertension, obstructive sleep apnea, and psychiatric disorders—that heighten perioperative risks. For this reason, a thorough preoperative evaluation is indispensable. This process should be comprehensive and interprofessional, involving surgeons, anesthesiologists, endocrinologists, cardiologists, dietitians, psychologists, and nursing staff. The preoperative assessment addresses medical optimization, nutritional counseling, psychosocial evaluation, and anesthetic planning, while simultaneously preparing the patient for lifelong postoperative adherence.
This review explores the essential elements of preoperative workup in bariatric surgery, highlighting the interplay between patient selection, comorbidity management, and interdisciplinary collaboration. Emphasis is placed on evidence-based practices for psychological readiness, nutritional assessment, weight loss planning, laboratory and imaging investigations, and anesthetic considerations. Ultimately, the success of bariatric surgery extends beyond operative technique and relies heavily on meticulous preparation and coordinated care by a multidisciplinary team.

The endometriotic lesions are typically located in the
pelvis but can occur at multiple sites, including the bowel,
diaphragm, and pleural cavity. While endometriosis is a
common and nonmalignant process, ectopic endometrial
tissue and resultant inflammation can cause dysmenorrhea,
dyspareunia, chronic pain, and infertility.

Magnetic resonance imaging (MRI) is a noninvasive diagnostic modality renowned for its exceptional soft tissue resolution and expanding physiological and functional applications. Since its clinical introduction in the 1980s, MRI has become a cornerstone of medical imaging, providing detailed anatomical and functional information without exposure to ionizing radiation. MRI employs three primary types of magnetic fields—static, radiofrequency, and time-varying gradient fields—each associated with unique safety considerations. The static magnetic field can convert ferromagnetic objects into dangerous projectiles and interfere with electronic implants, while radiofrequency fields may induce tissue heating, particularly in metallic implants. Gradient magnetic fields, responsible for spatial encoding, can stimulate nerves and produce significant acoustic noise, risking hearing damage. MRI safety is particularly critical in patients with metallic foreign bodies, implanted devices, or other relative contraindications. Comprehensive pre-scan screening, staff training, and adherence to established safety protocols are essential to mitigate risks and optimize diagnostic outcomes. This review emphasizes the principles of MRI physics, potential hazards, and current safety practices, highlighting the importance of interprofessional collaboration to ensure patient and staff safety.

It is well-known that laparoscopy is the consequence of
advances made in the field of medical engineering. Each
surgical specialty has different requirement of instruments.
Laparoscopy was initially criticized owing to the cost of
specialized instruments and possible complications due
to these sharp long instruments. Also, it necessitated
difficult hand-eye coordination.