Minimal Access Surgery Research Articles

Minimally Invasive Liver Transplantation: The Recipient Operation.

Minimally Invasive Liver Transplantation: The Recipient Operation.

The Avian Model as a Versatile and Cost-Effective Tool for Surgical Training Across Specialties

Abstract Background Five years after its 2019 validation, the avian tissue model for neonatal minimal access surgery (MAS) training was reassessed to evaluate its sustained effectiveness and realism. Unlike the original study, this evaluation included participants from pediatric and other surgical specialties. Aims The study aimed to reassess the model’s realism and effectiveness for neonatal MAS training and explore its potential for broader applications in surgical training. Methods The study occurred during two events: an international MAS Skills Lab in August 2024 and a national MAS Skills Lab in September 2024. Twenty-six participants (16 females, 10 males) took part, including 17 pediatric surgeons and 9 from other specialties. Using 3 mm MAS instruments on fresh chicken cadavers with balloon trocars, participants performed laparoscopic exercises such as adhesiolysis, cholecystectomy, and intestinal anastomosis. Feedback on the model was gathered via a 5-point Likert scale (MiSSES). Results Participants had varied experience levels: 23% had performed over 100 MAS cases, 15.4% between 50–100 cases, and 61.5% fewer than 50 cases. The model’s perceived realism averaged 4.05 ± 0.10. Scores for specific features included 3.66 ± 0.09 for the abdominal wall, 3.85 ± 0.10 for the abdominal cavity, and 4.86 ± 0.09 for tissue dissection. Participants rated the model highly for improving laparoscopic knowledge (4.3 ± 0.90) and skills development (4.77 ± 0.07). Satisfaction scores highlighted its effectiveness in addressing challenges like trocar placement (3.64 ± 0.12), pneumoperitoneum (3.5 ± 0.10), and confined-space suturing (4.99 ± 0.08). Overall satisfaction with the model was rated at 4.9 ± 0.09. Conclusion The avian tissue model remains an effective and realistic tool for neonatal MAS training, reaffirming the findings of the 2019 study. Positive outcomes across multiple disciplines demonstrate its versatility, highlighting its potential as a valuable training tool extending beyond pediatric surgery to other specialties.

Use of 3D in paediatric minimal access surgery: our experience of 209 cases.

In the last three decades, the field of surgery has evolved from open surgery to an era of minimal access surgery (MAS) which is conventionally 2 dimensional (2D). When the vision is 3 dimensional (3D), which is natural, the accuracy and safety of procedures can be improved and complex reconstructive MAS procedures can be performed with depth perception. The aim was to assess feasibility, safety and efficacy of 3D MAS in the paediatric age group. Retrospective analysis of 209 3D MAS procedures in the department of Paediatric Surgery over a period of five years. Subjective rating of image quality and difficulty score was done immediately after each procedure by operating and assistant surgeons. Likert scale was used. All data recorded was analysed and are represented as mean, median or percentage. The average score for subjective rating of image quality was 9.71 for surgeon and 9.74 for assistant surgeon with some parameters having higher subjective scores for the procedures on infants. It explains advantage of 3 D vision in every aspect of imaging. Mean difficulty scores for surgeon (0.12) and assistant surgeon (0.10) were very low, suggesting encouraging vision for the surgeons. The use of 3D in paediatric minimal access surgery is feasible and safe. Advantage of excellent vision with depth perception is unequivocal, which along with the use of conventional hand instruments can be a good alternative to more expensive robotic surgical systems.

Patient-reported outcomes by individuals with differentiated thyroid cancer who underwent minimal-access versus conventional open thyroidectomy: a real-world propensity score-matching study

Background:Minimal-access surgery has been widely used in differentiated thyroid cancer (DTC) management and its therapeutic effectiveness is well-proven. However, little is known about how minimal-access thyroidectomy affects patient-reported outcomes (PRO).Materials and methods:In this real-world cross-sectional study, 6221 patients with DTC who underwent minimal-access or conventional open thyroidectomy were included and required to fill out PRO questionnaires, including the Thyroid Cancer-Specific Quality of Life, the European Organisation for Research and Treatment of Cancer’s Core Quality of Life Questionnaire, and Fear of Progression Questionnaire-Short Form. Of the 3586 patients who completed the questionnaires entirely, 915 and 2671 belonged to the minimal-access and open groups, respectively. To reduce bias and balance confounding factors, propensity score matching was performed, after which 1818 patients were equally divided between the two groups.Results:Compared with the open group, the minimal-access group reported better PRO in terms of the THYCA-QOL summary score (P < 0.001), neuromuscular (P = 0.038), voice (P < 0.001), concentration (P = 0.044), sympathetic (P = 0.002), throat/mouth (P < 0.001), and scar (P < 0.001), feeling chilly (P < 0.001), and tingling hands/feet (P = 0.002). Subgroup analysis demonstrated that minimal-access thyroidectomy can be optimal for most patients from the PRO perspective. Moreover, longitudinal PRO comparisons indicated that at ≤6 months postoperatively, the open group experienced more problems in neuromuscular, voice, sympathetic, throat/mouth, scar, feeling chilly, tingling hands/feet, headache, and lower global health status scores (all P < 0.05). However, except for voice, scar and tingling hands/feet, nearly all the differences disappeared after 7 months postoperatively. Intergroup comparisons suggested that the minimal-access group required less time to recover to a stable state.Conclusions:The minimal-access group exhibited significantly superior postoperative PRO compared to the open group. Furthermore, the PRO trajectories of the two groups differed, with the minimal-access group demonstrating a considerably shorter recovery time. If better PRO is desired, minimal-access thyroidectomy may be preferred.

Emergency Minimally Invasive Surgery for Obturator Hernias: A Systematic Review.

Despite their rarity, obturator hernias pose significant clinical challenges due to their high complication rate and frequent emergency presentation. While minimally invasive surgery has proven effective and safe for elective groin hernia repair, its application in emergency settings, particularly for obturator hernias, lacks robust evidence, highlighting a critical knowledge gap in this area. This systematic review aims to evaluate the feasibility of a minimally invasive approach for the repair of obturator hernias in emergency settings. A systematic review was conducted searching PubMed, OVID, MEDLINE, Embase, and Cochrane reviews for ((obturator hernia) AND (laparoscop* OR minimal access OR robotic)) AND (strangulat* OR obstruct* OR incarcerat*). The time of the literature is from the establishment of each database to 1 September 2023. Critical appraisal used the Joanna Briggs Institute (JBI) appraisal checklist. A systematic review of 337 manuscripts identified 47 relevant studies, including 39 case reports, 4 case series, and 4 retrospective studies. Minimally invasive approaches, particularly totally extraperitoneal (TEP), transabdominal preperitoneal (TAPP), and the Kugel procedure, demonstrated favourable outcomes for obturator hernias, including shorter operative times, reduced hospital stays, low recurrence rates, effective management of complications, and improved diagnostics, with success dependent on timely intervention, bowel viability, and patient selection. The findings suggest that minimal access surgery can effectively avoid unnecessary laparotomy for hernial content assessment, particularly when employing the TAPP approach. While emergency repair of obturator hernias using minimal access techniques appears feasible and safe, achieving outcomes comparable to open surgery requires further high-quality evidence. PROSPERO: CRD42024503724.

Surgeons' Preference Regarding Port Site Closure and Incidence of Port Site Hernias in Bariatric Surgery: A Retrospective Multicentre Study Across Peshawar, Pakistan

IntroductionLaparoscopic bariatric surgery is gaining popularity among the people of Pakistan because of increasing obesity and awareness about minimal access surgery. However, bariatric surgery is associated with certain potential complications. Port site hernias (PSHs) are one such complication and can be symptomatic or asymptomatic. The purpose of our study was to find the incidence of PSHs in our patients and the preference of operating surgeons regarding port site closure techniques.Materials and methodsThis study was conducted retrospectively by reviewing patients' records, history and examination with imaging, if necessary. Six hundred and fifty patients were included in the study who were operated between 2019 and 2024 across different centres in Peshawar. Data was collected about patients' age, gender, any comorbidities, type of surgery, surgeon preference for the closure technique and incidence of PSHs. Data was analysed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States).ResultsThe incidence of PSHs in our patients was 1.5% (10 cases in 650). Three of the hernias occurred at a 10mm camera port site while others occurred at a 12mm left-side port site. Six of the patients were hypertensive and two were diabetic. Of the procedures performed, 202 were laparoscopic sleeve gastrectomy, 185 were laparoscopic roux-en-y gastric bypass and 263 were laparoscopic one anastomosis gastric bypass. All the port sites were closed using simple closure of skin incision only.ConclusionThe incidence of symptomatic PSHs is low in our patients. The incidence of PSHs increases with the increase in the size of the port and comorbidities of patients. Simple skin closure was preferred by surgeons as it can reduce operative time, postop pain, surgical site infection and financial burden. However, further studies are needed for an ideal closing technique for port sites and to assess whether such closure decreases the incidence of PSHs.

A Decade-Long Review of Outpatient Hysteroscopic Procedures in Southwestern Nigeria: 2012–2023

Abstract Background: Hysteroscopy is a widely used diagnostic and treatment technique for assessing and correcting uterine pathologies and their associated symptoms. The aim of this study is to assess the types and prevalence of hysteroscopy findings among women seen in our healthcare facility over a ten-year period. Materials and Methods: This was a retrospective study conducted at a secondary healthcare facility in Lagos State, between 2012 and 2023. The records of 888 women with primary or secondary infertility who underwent hysteroscopy were included in this study. Information, including body mass index (BMI), parity, age, surgical histories, the type of hysteroscopy procedure undergone, and findings, was retrieved from their records. The retrieved data were analyzed using SPSS version 21. Results: The mean age and body mass index (BMI) of the women were 38.91 years and 28.31, respectively, with 518 (75.7%) being either overweight or obese. More than half (447; 51.7%) of the women had primary infertility. In all, 827 (93.2%) of the women had abnormal hysteroscopy presentations, with 780 (87.9%) having single pathologies. The commonest pathological findings were adhesions 289 (34.9%), polyps 209 (25.2%), and fibroids 202 (24.4%). The commonest operative hysteroscopies performed were adhesiolysis (300; 40.7%), polypectomy (207; 28.0%), and myomectomy (187; 25.3%). Conclusions: Findings from this study demonstrate the need to widen the use of minimal access surgery in Nigeria, including hysteroscopy in routine evaluation and correction of uterine lesions.

A comparison of surgical outcomes of endoscopic versus microscopic myringoplasty

A comparison of surgical outcomes of endoscopic versus microscopic myringoplasty

Hiatal sling liver retraction technique in bariatric and upper gastrointestinal surgeries - Our 15 year experience with 1874 surgeries.

Liver retraction is an important aspect when performing minimal access surgeries, especially bariatric and upper gastrointestinal (GI) surgeries. Various liver retraction methods are available and have been tried. Here, we present our experience with our indigenous hiatal sling technique for liver retraction and compare it with Nathanson liver retractor which is a popular and commonly used liver retraction method. This is a retrospective observational study of 1874 patients who underwent bariatric and upper GI surgeries over the last 15 years since September 2009. A secondary study was conducted amongst the two groups of patients who underwent upper GI and bariatric surgeries using hiatal sling technique and Nathanson retractor system for liver retraction between January 2023 and October 2023. End points measured were time taken, conversions and complication along with liver function tests (LFTs) such as aspartate aminotransferase (AST) and alanine transaminase measured between the two groups pre- and postoperatively day 0, day 1, day 3 and day 7. In our series of 1874 patients, hiatal sling liver traction was possible without any difficulties in all except 2 patients with no associated liver injury and with adequate exposure. In the comparative study, patients in the hiatal sling group (Group B) had significantly lesser elevation in LFTs as compared to the patients in the Nathanson liver retraction group (Group A), with no adverse events in both the groups. Hiatal sling technique for liver retraction is an effective technique which provides adequate exposure of the hiatus and causes lesser liver insult compared to rigid liver retraction system like Nathanson liver retraction system. Hiatal sling does not interfere with surgeons' field causing less errors during surgery and thus making it more ergonomic friendly.

Video Compilation Of The Use Of Inexpensive Materials To Simplify Minimal Access Surgery In Gynecological Cancer

Video Compilation Of The Use Of Inexpensive Materials To Simplify Minimal Access Surgery In Gynecological Cancer

Surgical outcomes in mediastinal mature teratoma.

This study was aimed at reporting the clinical characteristics and perioperative surgical outcomes of mediastinal mature teratoma managed in a single surgical unit. This is a retrospective analysis of 35 cases of mediastinal mature teratoma cases managed in a tertiary level thoracic surgery center over 10years. A comprehensive analysis of perioperative surgical outcomes including complications was performed. Males (n = 22, 62.8%) were predominant in the study group. Mean age of the cohort was 31.2 ± 13.3years. The diagnosis was unruptured mature teratoma in 17(48.6%), ruptured mature teratoma in 8 (22.8%) and mature cystic teratoma in 10 (28.6%) patients. The mean duration from symptoms was 5.5months (range: 1 - 84months). Open surgery was done in 22 patients (62.8%) followed by video-assisted thoracoscopic surgery in 4 (11.4%) and robotic surgery in 9 patients (25.7%). Conversion from minimal access surgery to open surgery was in 2 patients (5.7%). The mean duration of intercostal chest drainage (ICD) was 6.3 ± 1.3days, and mean hospital stay averaged 5.8 ± 2.7days. Most common postoperative complication was prolonged post-operative air leak (> 7days) in 5 patients (14.3%). The peri-operative mortality was in 1 (2.8%) patient. Ruptured teratoma was a strong predictor of postoperative complications (p = 0.008). Complete surgical resection is primary and effective treatment modality for mediastinal mature teratoma. A tailored approach is needed, considering the factors like tumor size, location, and relation with surrounding structures. The online version contains supplementary material available at 10.1007/s12055-024-01882-8.

EP39 Emergency Minimally Invasive Surgery for Obturator Hernias: A Systematic Review of the Literature

Abstract Background Despite their rarity, obturator hernias pose significant clinical challenges due to their high complication rate and frequent emergency presentation. While minimally invasive surgery has proven effective and safe for elective groin hernia repair, its application in emergency settings, particularly for obturator hernias, lacks robust evidence, highlighting a critical knowledge gap in this area. Methods A systematic review was conducted searching PubMed, OVID, Embase, and Cochrane reviews for ((Obturator hernia) AND (laparoscop* OR minimal access OR robotic)) AND (strangulat* OR obstruct* OR incarcerat*). Results A systematic review of 337 manuscripts identified 47 relevant studies, including 39 case reports, 3 case series, and 5 retrospective studies. Conclusion The findings suggest that minimal access surgery can effectively avoid unnecessary laparotomy for hernial content assessment, particularly when employing the TAPP approach. While emergency repair of obturator hernias using minimal access techniques appears feasible and safe, achieving outcomes comparable to open surgery requires further high-quality evidence.

Robotic Surgery from a Gynaecological Oncology Perspective: A Global Gynaecological Oncology Surgical Outcomes Collaborative Led Study (GO SOAR3).

For healthcare institutions developing a robotic programme, delivering value for patients, clinicians, and payers is key. However, the impact on the surgeon, training pathways, and logistics are often overlooked. We conducted a study on the impact of robotic surgery on surgeons, access to robotic surgical training, and factors associated with developing a successful robotic programme. In our international mixed-methods study, a customised web-based survey was circulated to gynaecological oncologists. The Wilcoxon rank-sum test and Fisher's exact test, tested the hypothesis of the differences in continuous and categorical variables. Multiple linear regression was used to model the effect of variables on outcomes adjusting for gender, age, and postgraduate experience. Outcomes included situational awareness, surgeon fatigue/stress, and the surgical learning curve. Qualitative data were collected via in-depth semi-structured interviews using an inductive theoretical framework to explore access to surgical training and logistical considerations in the development of a successful robotic programme. In total, 94%, 45%, and 48% of survey respondents (n = 152) stated that robotic surgery was less physically tiring/mentally tiring/stressful in comparison to laparoscopic surgery. Our data suggest gender differences in the robotics learning curve with men six times more likely to state robotic surgery had negatively impacted their situational awareness in the operating theatre (OR = 6.35, p ≤ 0.001) and 2.5 times more likely to state it had negatively impacted their surgical ability due to lack of haptic feedback in comparison to women (OR = 2.62, p = 0.046). Women were more risk-averse in case selection, but there were no self-reported differences in the intra-operative complication rates between male and female surgeons (OR = 1, p = 0.1). In total, 22/25 robotically trained surgeons interviewed did not follow a structured curriculum of learning. Low and middle income country centres had less access to robotic surgery. The success of robotic programmes was measured by the number of cases performed per annum, with 74% of survey respondents stating that introducing robotics increased the proportion of surgeries performed by minimal access surgery. There was a distinct lack of knowledge on the environmental impact of robotic surgery. Whilst robotic surgery is considered a landmark innovation in surgery, it must be responsibly implemented through effective training and waste minimisation, which must be a key metric in measuring the success of robotic programmes.

Assessing the Knowledge Base and Impact of Training on Minimal Access Surgery among Healthcare Providers in a Poor Resource Setting

Assessing the Knowledge Base and Impact of Training on Minimal Access Surgery among Healthcare Providers in a Poor Resource Setting

Training in Minimally Invasive Surgery: A Resident’s Perspective

Abstract In the era of evidence-based medicine, minimal access surgery is a key component in patient care in elective as well as emergency procedures. Currently, surgical training programs are deficient in various aspects and not uniform across the country. Uniform training of surgical residents across the country is crucial in building a strong surgical community in the near future.

Morbidity at discharge in the Urology Department of the Peltier University Hospital Center in Djibouti

Introduction: Morbidity at discharge after admission for urological diseases has been scarcely described in the literature. Methodology: A quantitative, observational, descriptive, longitudinal study was conducted at the Peltier University Hospital Center in Djibouti, from January to July 2024. The population was 131 patients hospitalized in the urology service and the sample was 129 discharged patients. Objective: to describe morbidity at discharge from the Urology service. Results: The largest number of patients admitted were patients diagnosed with prostatic hypertrophy and hydronephrosis. Adenomectomy and minimal access surgeries were performed relatively frequently and the predominant complication was infection of the surgical wound. Conclusions: The patients who were admitted and treated had diagnoses that reveal the impact of sociodemographic factors on the population of Djibouti, advanced age and desert climate

Looking Ahead: A Vision for Annals of Minimal Access Surgery and Allied Sciences

Looking Ahead: A Vision for Annals of Minimal Access Surgery and Allied Sciences

Computed tomography hydroenema as a diagnostic alternative for colon tumors

Introduction: colorectal cancer is one of the most common causes of death worldwide. The first-line detection method is colonoscopy; however, colon examination by computed tomography with hydroenema and intravenous contrast technique is a useful method for detecting the disease. Objective: to assess the usefulness of computed tomography with water enema and intravenous contrast for the diagnosis of colon tumors. Method: an observational, descriptive study was carried out, which included all patients operated on for colon cancer, diagnosed by computed axial tomography with water enema and intravenous contrast at the National Center for Minimal Access Surgery, between March 2022 and February 2025. Results: of the 21 patients included, eleven had tumor location in the rectum, with predominance over the other segments studied. Lesions measuring 2 to 4 cm predominated, in accordance with the results of colonoscopies, pathological anatomy and surgery. Regarding the degree of infiltration, the results of pathological anatomy and hydroenema behaved in a similar way, with the highest number of infiltrations up to fat (T4) and in relation to metastatic lymph nodes, both studies coincided with eleven patients who presented lymph node metastasis. Conclusions: the application of the study of computed axial tomography with water enema and intravenous contrast is a useful method for the diagnosis of tumor lesions, through which it is possible to determine the stage of the disease.

Effect of scrotal support application on seroma formation following minimal access surgery for inguinal hernia: A randomised controlled trial.

The incidence of seroma formation is high following laparoscopic surgery for an inguinal hernia. Literature has shown many intraoperative techniques to reduce post-operative seroma formation. The hypothesis was made that scrotal support may reduce seroma formation following laparoscopic or robotic hernia surgery. This study aimed to compare the post-operative outcome of uncomplicated inguinal hernia patients with or without scrotal support application. A randomised controlled trial was conducted on 266 male patients with inguinal hernias. A block randomisation was done, and accordingly, a scrotal support was applied after mobilisation of study patients following laparoscopic or robotic surgery. After discharge, all patients were followed up for 30 days and their outcomes were compared. Post-operative numbness after hernia surgery was significantly reduced with the application of scrotal support ( P = 0.03). However, there were no significant differences in the early post-operative period for seroma formation, scrotal oedema, scrotal haematoma, surgical site infections, epididymo-orchitis or groin pain between the groups. A scrotal support application is not effective at reducing the formation of seroma after laparoscopic or robotic inguinal hernia repairs. Early post-operative groin numbness may be reduced by including scrotal support in post-operative care protocols.

An emerging, less explored Subcutaneous onlay laparoscopic approach for ventral hernias with concomitant diastasis recti

Ventral Hernia (VH) is a common issue in patients with Diastasis Recti (DR). VH with concomitant DR presents a challenging scenario for surgical repair due to complexity of abdominal wall defects. Traditional open surgical procedure is associated with prolonged discomfort and poor cosmesis and resultant patients’ unacceptability. Minimal access surgery such as Sub Cutaneous Onlay Laparoscopic Approach (SCOLA), offers innovative solution in addressing both hernia defects and DR comprehensively and circumvent drawbacks of open surgery. In this prospective observational study, 33 patients with VH and DR underwent SCOLA in a tertiary care hospital in Jamnagar, India over a period of 15 months. Reconstruction of abdominal wall was done by suturing hernia defect, plication of DR and onlay polypropylene mesh augmentation by using this technique. No recurrence was detected at follow up from 4 to 18 month. Overall patient satisfaction rate was 90.9%. We conclude that, the SCOLA is a promising advancement in the treatment of patients of VH with DR with many benefits.