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Nalankilli VP, Christopher PJ, Motati H, Balasubramanian S, Ganapathi SK, Natesan AV, Chinnusamy P. A randomized controlled trial on the effectiveness of laparoscopic-guided transversus abdominis plane block in patients undergoing laparoscopic IPOM plus. Hernia 2024:10.1007/s10029-024-03016-w. [PMID: 38520615 DOI: 10.1007/s10029-024-03016-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/06/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Ventral hernia repairs, particularly laparoscopic ventral hernia repair (LVHR), have become common procedures among general surgeons worldwide. Despite the benefits of LVHR, acute postoperative pain remains a significant concern. Transversus abdominis plane (TAP) blocks have been employed to alleviate postoperative pain in various laparoscopic procedures. This study aimed to assess the effectiveness of laparoscopic-guided TAP block in laparoscopic IPOM plus and its impact on postoperative pain and analgesic requirements. MATERIALS AND METHODS A randomized controlled trial was conducted at a tertiary care center in India involving 72 patients undergoing laparoscopic IPOM plus. Patients were randomized into two groups: Group I received laparoscopic-guided TAP block, while Group II received standard general anesthesia without TAP block. Pain scores were assessed at 6, 12, and 24 h postoperatively using the numerical rating scale. Postoperative analgesic requirements were also recorded. RESULTS Group I demonstrated significantly lower pain scores at 6 and 24 h postoperatively compared to Group II. The need for additional analgesics was significantly lower in Group I (13.8%) compared to Group II (72.2%). There were no significant differences in age, BMI, duration of surgery, or other demographic characteristics between the two groups. CONCLUSION The findings of this randomized controlled trial demonstrate the effectiveness of laparoscopic-guided TAP blocks in reducing postoperative pain and analgesic requirements after laparoscopic IPOM plus.
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Affiliation(s)
- V P Nalankilli
- Department of Surgical Gastroenterology, Gem Hospital and Research Institute, Coimbatore, Tamil Nadu, India
| | - P J Christopher
- Department of Surgical Gastroenterology, Gem Hospital and Research Institute, Coimbatore, Tamil Nadu, India.
| | - H Motati
- Department of Surgical Gastroenterology, Gem Hospital and Research Institute, Coimbatore, Tamil Nadu, India
| | - S Balasubramanian
- Department of Surgical Gastroenterology, Gem Hospital and Research Institute, Coimbatore, Tamil Nadu, India
| | - S K Ganapathi
- Department of Surgical Gastroenterology, Gem Hospital and Research Institute, Coimbatore, Tamil Nadu, India
| | - A V Natesan
- Department of Surgical Gastroenterology and Liver Transplant, Gem Hospital and Research Institute, Coimbatore, Tamil Nadu, India
| | - P Chinnusamy
- Gem Hospital and Research Institute, Coimbatore, Tamil Nadu, India
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Kakkilaya HB, Ganapathi SK, Christopher PJ, Pawar J, Maharaj R, Subbiah R, Rudhramoorthy S, Chinnusamy P. Robotic Totally Extraperitoneal Hernia Repair: An Initial Experience with Cambridge Medical Robotics Versius. J Laparoendosc Adv Surg Tech A 2023; 33:1167-1175. [PMID: 37906106 DOI: 10.1089/lap.2023.0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Background: Total extraperitoneal approach for laparoscopic inguinal hernia repair (L-TEP) allows for better dissection, lesser chance of bowel injury, and quicker operating time. However robotic groin hernia repair is currently performed only through transabdominal route as it allows for more mobility of the arms. This study is aimed at studying the feasibility and outcomes of robotic totally extraperitoneal (R-TEP). Methods: A prospective nonrandomized comparative study was conducted to compare R-TEP with L-TEP. Out of a total of 88 patients with inguinal hernia, 44 patients underwent R-TEP and other 44 patients underwent L-TEP over a period of 15 months. All R-TEP were performed with Cambridge Medical Robotics (CMR) Versius. The outcomes were analyzed over a minimum follow-up period of 6 months. Results: All patients were males with a mean age of 45.9 years. Average body mass index was 28.7. Mean docking time for R-TEP was 12.7 minutes. Overall time taken for R-TEP (mean 60.47 minutes) was significantly higher (P < .001) than L-TEP (mean 38.45 minutes). When the console time of R-TEP and overall time of L-TEP were compared, there was no significant difference (P = .053). A RCT (RIVAL Trial) conducted by Prabhu et al. showed their robotic transabdominal preperitoneal (R-TAPP) time of median 75.5 (59.0-93.8) minutes. Kimberly et al. had their overall time of 77.5 minutes and Andre Luiz et al. had a console time of 58 minutes. When we compared the data, the overall time of R-TEP is lesser compared with R-TAPP. Postoperative pain on POD-1 showed that the robotic group had significantly lower pain. There were no recurrences noted in the study period. Conclusion: With our study, we have shown that R-TEP performed using the principle of laparoscopic triangulation technique with CMR Versius is feasible and reproducible. Although the overall time is significantly more in R-TEP when compared with L-TEP, console times of R-TEP and overall times of L-TEP were very similar. Console times of R-TEP are much lesser compared with other studies on R-TAPP. R-TEP can be a better alternative to R-TAPP and can be considered at par with L-TEP. A systematic RCT would provide a better picture.
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Affiliation(s)
| | - Senthil Kumar Ganapathi
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India
| | | | - Jayadatt Pawar
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India
| | - Rajiv Maharaj
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India
| | - Rajapandian Subbiah
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India
| | | | - Palanivelu Chinnusamy
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India
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Uijterwijk BA, Kasai M, Lemmers DHL, Chinnusamy P, van Hilst J, Ielpo B, Wei K, Song KB, Kim SC, Klompmaker S, Jang JY, Herremans KM, Bencini L, Coratti A, Mazzola M, Menon KV, Goh BKP, Qin R, Besselink MG, Abu Hilal M. The clinical implication of minimally invasive versus open pancreatoduodenectomy for non-pancreatic periampullary cancer: a systematic review and individual patient data meta-analysis. Langenbecks Arch Surg 2023; 408:311. [PMID: 37581763 PMCID: PMC10427526 DOI: 10.1007/s00423-023-03047-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Most studies on minimally invasive pancreatoduodenectomy (MIPD) combine patients with pancreatic and periampullary cancers even though there is substantial heterogeneity between these tumors. Therefore, this study aimed to evaluate the role of MIPD compared to open pancreatoduodenectomy (OPD) in patients with non-pancreatic periampullary cancer (NPPC). METHODS A systematic review of Pubmed, Embase, and Cochrane databases was performed by two independent reviewers to identify studies comparing MIPD and OPD for NPPC (ampullary, distal cholangio, and duodenal adenocarcinoma) (01/2015-12/2021). Individual patient data were required from all identified studies. Primary outcomes were (90-day) mortality, and major morbidity (Clavien-Dindo 3a-5). Secondary outcomes were postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), blood-loss, length of hospital stay (LOS), and overall survival (OS). RESULTS Overall, 16 studies with 1949 patients were included, combining 928 patients with ampullary, 526 with distal cholangio, and 461 with duodenal cancer. In total, 902 (46.3%) patients underwent MIPD, and 1047 (53.7%) patients underwent OPD. The rates of 90-day mortality, major morbidity, POPF, DGE, PPH, blood-loss, and length of hospital stay did not differ between MIPD and OPD. Operation time was 67 min longer in the MIPD group (P = 0.009). A decrease in DFS for ampullary (HR 2.27, P = 0.019) and distal cholangio (HR 1.84, P = 0.025) cancer, as well as a decrease in OS for distal cholangio (HR 1.71, P = 0.045) and duodenal cancer (HR 4.59, P < 0.001) was found in the MIPD group. CONCLUSIONS This individual patient data meta-analysis of MIPD versus OPD in patients with NPPC suggests that MIPD is not inferior in terms of short-term morbidity and mortality. Several major limitations in long-term data highlight a research gap that should be studied in prospective maintained international registries or randomized studies for ampullary, distal cholangio, and duodenum cancer separately. PROTOCOL REGISTRATION PROSPERO (CRD42021277495) on the 25th of October 2021.
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Affiliation(s)
- Bas A Uijterwijk
- Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.
| | - Meidai Kasai
- Department of Surgery, Meiwa Hospital, Hyogo, Japan
| | - Daniel H L Lemmers
- Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Palanivelu Chinnusamy
- Department of Surgical Gastroenterology and Hepatopancreatobiliary Surgery, GEM Hospital and Research Center, Ramanathapuram, Coimbatore, Tamil Nadu, India
| | - Jony van Hilst
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Department of Surgery, OLVG, Amsterdam, the Netherlands
| | - Benedetto Ielpo
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar. Universitat Pompeu Fabra, Barcelona, Spain
| | - Kongyuan Wei
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Song C Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Sjors Klompmaker
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Kelly M Herremans
- Division of Surgical Oncology, General Surgery, University of Florida, Gainesville, USA
| | - Lapo Bencini
- Department of Surgery, Careggi University Hospital, Florence, Italy
| | - Andrea Coratti
- Department of Surgery, Misericordia Hospital of Grosseto, Grosseto, Italy
| | - Michele Mazzola
- Division of Oncologic and Mini-Invasive General Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Krishna V Menon
- Department of Liver Transplant and HPB Unit, King's College Hospital, London, UK
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
| | - Renyi Qin
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Mohammed Abu Hilal
- Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
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Uijterwijk BA, Wei K, Kasai M, Ielpo B, Hilst JV, Chinnusamy P, Lemmers DHL, Burdio F, Senthilnathan P, Besselink MG, Abu Hilal M, Qin R. Minimally invasive versus open pancreatoduodenectomy for pancreatic ductal adenocarcinoma: Individual patient data meta-analysis of randomized trials. Eur J Surg Oncol 2023; 49:1351-1361. [PMID: 37076411 DOI: 10.1016/j.ejso.2023.03.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/31/2023] [Accepted: 03/24/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE Assessment of minimally invasive pancreatoduodenectomy (MIPD) in patients with pancreatic ductal adenocarcinoma (PDAC) is scarce and limited to non-randomized studies. This study aimed to compare oncological and surgical outcomes after MIPD compared to open pancreatoduodenectomy (OPD) for patients after resectable PDAC from published randomized controlled trials (RCTs). METHODS A systematic review was performed to identify RCTs comparing MIPD and OPD including PDAC (Jan 2015-July 2021). Individual data of patients with PDAC were requested. Primary outcomes were R0 rate and lymph node yield. Secondary outcomes were blood-loss, operation time, major complications, hospital stay and 90-day mortality. RESULTS Overall, 4 RCTs (all addressed laparoscopic MIPD) with 275 patients with PDAC were included. In total, 128 patients underwent laparoscopic MIPD and 147 patients underwent OPD. The R0 rate (risk difference(RD) -1%, P = 0.740) and lymph node yield (mean difference(MD) +1.55, P = 0.305) were comparable between laparoscopic MIPD and OPD. Laparoscopic MIPD was associated with less perioperative blood-loss (MD -91ml, P = 0.026), shorter length of hospital stay (MD -3.8 days, P = 0.044), while operation time was longer (MD +98.5 min, P = 0.003). Major complications (RD -11%, P = 0.302) and 90-day mortality (RD -2%, P = 0.328) were comparable between laparoscopic MIPD and OPD. CONCLUSIONS This individual patient data meta-analysis of MIPD versus OPD in patients with resectable PDAC suggests that laparoscopic MIPD is non-inferior regarding radicality, lymph node yield, major complications and 90-day mortality and is associated with less blood loss, shorter hospital stay, and longer operation time. The impact on long-term survival and recurrence should be studied in RCTs including robotic MIPD.
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Affiliation(s)
- Bas A Uijterwijk
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy; Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands.
| | - Kongyuan Wei
- Faculty of Hepato-Biliary-Pancreatic Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China; Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Meidai Kasai
- Department of Surgery, Meiwa Hospital, Hyogo, Japan
| | - Benedetto Ielpo
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Jony van Hilst
- Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - Palanivelu Chinnusamy
- Department of Surgical Gastroenterology and Hepatopancreatobiliary Surgery, GEM Hospital and Research Center, Ramanathapuram, Coimbatore, Tamil Nadu, India
| | - Daniel H L Lemmers
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy; Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands
| | - Fernando Burdio
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Palanisamy Senthilnathan
- Department of Surgical Gastroenterology and Hepatopancreatobiliary Surgery, GEM Hospital and Research Center, Ramanathapuram, Coimbatore, Tamil Nadu, India
| | - Marc G Besselink
- Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands
| | | | - Renyi Qin
- Faculty of Hepato-Biliary-Pancreatic Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
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Ganapathi SK, Subbiah R, Rudramurthy S, Kakkilaya H, Ramakrishnan P, Chinnusamy P. Laparoscopic posterior rectopexy for complete rectal prolapse: Is it the ideal procedure for males? J Minim Access Surg 2022; 18:295-301. [PMID: 35313438 PMCID: PMC8973478 DOI: 10.4103/jmas.jmas_323_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/20/2021] [Accepted: 02/02/2021] [Indexed: 11/04/2022] Open
Abstract
Background Rectal prolapse is more common in elderly women worldwide, but in India, it predominantly occurs in young- and middle-aged males. While ventral mesh rectopexy is proposed as the preferred procedure in females, the debate on the best procedure in men is still wide open. Methods A retrospective review of all adult male patients operated for external rectal prolapse (ERP) between January 2005 and December 2019 was performed. Patients either underwent modified laparoscopic posterior mesh rectopexy (LPMR) or laparoscopic resection rectopexy (LRR). The outcome was analysed in terms of recurrence, post-operative constipation, sexual dysfunction and other complications. Results A total of 118 male patients were included (LPMR: 106, LRR: 12). The mean age was 46.2 years (standard deviation [SD] 11.8, range: 21-88). The mean operating time was 108 min (SD: 24). The mean length of hospital stay was 4.8 days (SD: 1.4, range: 3-11 days). There was no anastomotic leak in the LRR group. Other complications included wound infection (n = 2), mesh infection with sigmoid colon perforation (n = 1), constipation (n = 4), sexual dysfunction (n = 2), urinary urgency (n = 3) and retention of urine (n = 4). There was no mortality in both the groups. During a mean follow-up of 5.2 years, recurrent ERP was noted in one patient and partial mucosal prolapse was seen in three patients. Conclusion LPMR/LRR is a safe and effective treatment for ERP in men with very low recurrence rates. Randomised trials comparing modified LPMR with LVMR are needed to establish the better procedure in males.
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Affiliation(s)
- Senthil Kumar Ganapathi
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Rajapandian Subbiah
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Sathiyamoorthy Rudramurthy
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Harish Kakkilaya
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Parthasarathi Ramakrishnan
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Palanivelu Chinnusamy
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
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Uijterwijk BA, Kasai M, Lemmers D, Ielpo B, Van Hilst J, Song KB, Chinnusamy P, Jang JY, Besselink M, Hilal MA. Minimally invasive vs. open pancreatoduodenectomy in selected patients with peri-ampullary, non-pancreatic cancer: A systematic review and individual patient data meta-analysis. Int J Surg 2022. [DOI: 10.1016/j.ijsu.2022.106545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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7
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Mamaniya U, Dasgupta P, Senthilnathan P, Chinnusamy P. Giant lumbar incisional hernia with loss of domain. J Minim Access Surg 2022; 18:606-608. [PMID: 36204942 PMCID: PMC9632718 DOI: 10.4103/jmas.jmas_274_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Giant lumbar hernia, with loss of domain, is a complex scenario to treat. Abdominal compartment syndrome is a dreaded post-operative complication. This can gravely impair the patient's respiratory function and also cause insufficient perfusion of the viscera. Pre-operative progressive pneumoperitoneum can facilitate bowel repositioning and can reduce impairment of the post-surgery lung function, essential for a favourable post-operative outcome. Here, we describe the treatment of a case of giant lumbar incisional hernia by the creation of progressive pneumoperitoneum and hybrid repair of incisional hernia with left posterior component separation and placement of giant prosthetic reinforcement of the defect.
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Chittawadagi B, Nayak SK, Ramakrishnan P, Kumar S, Cumar B, Natarajan R, Palanivelu PR, Chinnusamy P. Laparoscopic D2 gastrectomy in advanced gastric cancer: Postoperative outcomes and long-term survival analysis. Asian J Endosc Surg 2021; 14:707-716. [PMID: 33605064 DOI: 10.1111/ases.12926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/29/2020] [Accepted: 01/31/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Data on laparoscopic treatment of operable gastric cancer from India is sparse. This study aims to document outcomes of laparoscopic D2 gastrectomy in an Indian population. MATERIALS AND METHODS Data of patients who underwent laparoscopic D2 gastrectomy for operable advanced gastric cancer between February 2012 and January 2017 were collected from electronic hospital records supplemented by telephonic interviews and analyzed. Survival was evaluated using Kaplan-Meier survival analysis curves. RESULTS In total 121 patients were included. Conversion to open gastrectomy was 5.7%. One hundred and fourteen patients (73 laparoscopic subtotal gastrectomy and 41 laparoscopic total gastrectomy) were included for analysis. D2 lymphadenectomy was done in all cases; mean number of dissected lymph nodes was 23.12 ± 9.14 (12-45). Major complications (Clavien-Dindo Grade III and IV) was seen in 6.1% of cases with reoperation rate of 3.5% (4/114). Stage 3 disease was seen in 60.6% cases and stage 2 disease in 32.5%. Follow-up data were available for 76.3% of patients with mean follow-up of 29.5 months. Overall survival across all stages was 38.7 months. Five-year disease-free survival and overall survival were 36.7% and 55.9% respectively, across all stages. CONCLUSION Laparoscopic D2 gastrectomy is safe, feasible with similar postoperative complications and comparable survival outcomes across all stages when compared to available literature on open gastrectomy cases.
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Affiliation(s)
- Bhushan Chittawadagi
- Division of Esophago-Gastric Surgery, GEM Hospital and Research Center, Coimbatore, India
| | - Sunil K Nayak
- Division of Esophago-Gastric Surgery, GEM Hospital and Research Center, Coimbatore, India
| | | | - Saravana Kumar
- Division of Esophago-Gastric Surgery, GEM Hospital and Research Center, Coimbatore, India
| | - Bharath Cumar
- Division of Esophago-Gastric Surgery, GEM Hospital and Research Center, Coimbatore, India
| | - Ramesh Natarajan
- Division of Esophago-Gastric Surgery, GEM Hospital and Research Center, Coimbatore, India
| | - Praveen R Palanivelu
- Division of Esophago-Gastric Surgery, GEM Hospital and Research Center, Coimbatore, India
| | - Palanivelu Chinnusamy
- Division of Esophago-Gastric Surgery, GEM Hospital and Research Center, Coimbatore, India
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Subramaniam A, Gnanasekaran D, Suruliraj S, Chinnusamy P. Anaplastic Lymphoma Kinase positive large B cell lymphoma of ileocaecal mesentery: A case report. INDIAN J PATHOL MICR 2021; 63:615-617. [PMID: 33154317 DOI: 10.4103/ijpm.ijpm_296_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ALK+ large B cell lymphoma (LBCL) is a very rare aggressive neoplasm. It accounts for less than 1% of diffuse large B cell lymphoma (DLBCL). This is a case report of ALK+ DLBCL in a 34-year-old woman with an ileocaecal mesenteric mass. Microscopically, the neoplastic cells were of high grade along with a spindle cell component. Immunohistochemistry revealed ALK+, MUM-1+, LCA+, Vimentin+, EMA+ and negative for CK 20, CK 7, neuroendocrine, melanocytic, muscle specific, and GIST panel markers. This case report, hence, presents the rarity of this tumor.
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Affiliation(s)
- Aravinth Subramaniam
- Department of Pathology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Divya Gnanasekaran
- Department of Pathology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | | | - Palanivelu Chinnusamy
- Department of Pathology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
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10
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Balasubramanian S, Chittawadagi B, Misra S, Ramakrishnan P, Chinnusamy P. Propensity matched analysis of short term oncological and perioperative outcomes following robotic and thoracolaparoscopic esophagectomy for carcinoma esophagus- the first Indian experience. J Robot Surg 2021; 16:97-105. [PMID: 33609251 PMCID: PMC7896161 DOI: 10.1007/s11701-021-01211-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/03/2021] [Indexed: 12/26/2022]
Abstract
Thoracolaparoscopic esophagectomy (TLE) for carcinoma esophagus has better short-term outcomes compared to open esophagectomy. The precise role of robot-assisted laparoscopic esophagectomy (RALE) is still evolving. Single center retrospective analysis of TLE and RALE performed for carcinoma esophagus between January 2015 and September 2018. Propensity score matching was done between the groups for age, gender, BMI, ASA grade, tumor location, neoadjuvant therapy, the extent of surgical resection (Ivor Lewis or McKeown’s), histopathological type (squamous cell carcinoma or adenocarcinoma), clinical T and N stages. The primary outcome parameter was lymph node yield. Secondary outcome parameters were resection margin status, duration of surgery, blood loss, conversion to open procedure, length of hospital stay, length of ICU stay, complications, 90-day mortality and cost. There were 90 patients in TLE and 25 patients in RALE group. After propensity matching, there were 22 patients in each group. The lymph node yield was similar in both the groups (23.95 ± 8.23 vs 22.73 ± 11.63; p = 0.688). There were no conversions or positive resection margins in either group. RALE was associated with longer operating duration (513.18 ± 91.23 min vs 444.77 ± 64.91 min; p = 0.006) and higher cost ($5271.75 ± 456.46 vs $4243.01 ± 474.64; p < 0.001) than TLE. Both were comparable in terms of blood loss (138.86 ± 31.20 ml vs 133.18 ± 34.80 ml; p = 0.572), Clavien-Dindo grade IIIa and above complications (13.64% vs 9.09%; p = 0.634), hospital stay (12.18 ± 6.35 days vs 12.73 ± 7.83 days; p = 0.801), ICU stay (4.91 ± 5.22 days vs 4.77 ± 4.81 days; p = 0.929) and mortality (0 vs 4.55%; p = 0.235). RALE is comparable to TLE in terms of short-term oncological and perioperative outcomes except for longer operating duration when performed for carcinoma esophagus. RALE is costlier than TLE.
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Affiliation(s)
- Shankar Balasubramanian
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India.
| | - Bhushan Chittawadagi
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India
| | - Shivanshu Misra
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India
| | | | - Palanivelu Chinnusamy
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India
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Ganapathi SK, Subbiah R, Rudramurthy S, Kakkilaya H, Ramakrishnan P, Chinnusamy P. Laparoscopic anterior resection: Analysis of technique over 1000 cases. J Minim Access Surg 2021; 17:356-362. [PMID: 33605924 PMCID: PMC8270051 DOI: 10.4103/jmas.jmas_132_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: Laparoscopic rectal surgery has moved from being experimental to getting established as a mainstream procedure. We aimed at analysing how rectal cancer surgery has evolved at our institute. Methods: A retrospective review of 1000 consecutive patients who underwent laparoscopic anterior resection for rectal adenocarcinoma over a period of 15 years (January 2005 to December 2019) was performed. Technical modifications were made with splenic flexure mobilisation, intersphincteric dissection and anastomotic technique. The data collected included type of surgery, duration of surgery, conversion to open, anastomotic leak, defunctioning stoma and duration of hospital stay. The first 500 and the next 500 cases were compared. Results: The study patients were predominantly males comprising 68% (n = 680). The mean age of the patients was 58.3 years (range: 28–92 years). Majority of the procedures performed were high anterior resection (n = 402) and low anterior resection (LAR) (n = 341) followed by ultra-LAR (ULAR) (n = 208) and ULAR + colo-anal anastomosis (n = 49). A total of 42 patients who were planned for laparoscopic surgery needed conversion to open procedure. Forty-one patients (4.1%) had an anastomotic leak. The mean duration of stay was 5.3 + 2.8 days. The rate of conversion to open procedure had reduced from 5.4% to 3.0%. The rate of defunctioning stoma had reduced by >50% in the recent group. The anastomotic leak rate had reduced from 5.0% to 3.2%. The average duration of stay had reduced from 5.8 days to 4.9 days. Conclusion: This is one of the largest single-centre experiences of laparoscopic anterior resection. We have shown the progressive benefits of an evolving approach to laparoscopic anterior resection.
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Affiliation(s)
- Senthil Kumar Ganapathi
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Rajapandian Subbiah
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Sathiyamoorthy Rudramurthy
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Harish Kakkilaya
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Parthasarathi Ramakrishnan
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Palanivelu Chinnusamy
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
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Balasubramaniam D, Duraisamy KY, Chinnusamy P, Nethaji S, Karunanithi S. Feasibility of Laparoscopic Hysterectomy in Stage IV Pelvic Endometriosis: Our Technique and Outcomes. J Midlife Health 2020; 11:27-33. [PMID: 32684724 PMCID: PMC7362979 DOI: 10.4103/jmh.jmh_69_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 02/28/2020] [Indexed: 11/24/2022] Open
Abstract
Context: The definitive surgical treatment of severe endometriosis remains to be hysterectomy whether done by laparoscopy or laparotomy. Aim: The aim of this study was to assess the feasibility and outcome of laparoscopic hysterectomy in severe pelvic endometriosis. Settings and Design: This retrospective study was carried out in a tertiary center over a period of 5 years (January 2013–December 2017). Subjects and Methods: A total of 70 patients who underwent laparoscopic hysterectomy for severe pelvic endometriosis with a score of more than 40, which was defined by the revised American Fertility Society classification, were included in the study. Feasibility of laparoscopic hysterectomy and other clinical parameters such as operative time, blood loss, recurrence of the disease, and need for postoperative medical treatment was analyzed. Results: The mean age of the patients was 43.2 ± 4.56. Majority of the women (62.8%) had dysmenorrhea as the primary complaint, followed by menorrhagia (21.4%). Intraoperatively rectovaginal septum was involved in 95% of the cases with complete obliteration of the pouch of Douglas in 80% of the cases. The ureter was involved in 34% of the cases. The bladder was densely adherent in 71.4% of the patients. There was no conversion to laparotomy in any of these patients and no visceral injuries. The mean duration of surgery was 3 h. The estimated blood loss ranged from 100 to 500 ml. The duration of hospital stay was 2–5 days. There was no recurrence during follow-up in any of these patients. Conclusions: Laparoscopy in experienced hands is feasible and safe even in difficult cases of Stage IV pelvic endometriosis apart from offering superior results.
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Affiliation(s)
| | | | | | - Swathi Nethaji
- Department of Endogynaecology, GEM Hospital, Coimbatore, Tamil Nadu, India
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Duraisamy KY, Balasubramaniam D, Ezhilmani M, Chinnusamy P. Laparoscopic Approach for Recurrent Huge Vulval Mass. J Obstet Gynaecol India 2020; 70:240-242. [PMID: 32476774 DOI: 10.1007/s13224-019-01266-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Kavitha Yogini Duraisamy
- 1Department of Endogynecology, GEM Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
| | - Devi Balasubramaniam
- 1Department of Endogynecology, GEM Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
| | - Malathi Ezhilmani
- 1Department of Endogynecology, GEM Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
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Palanisamy S, Chittawadagi B, Dey S, Sabnis SC, Nalankilli V.P, Subbiah R, Chinnusamy P. Inflammatory Myofibroblastic Tumor of Colon Mimicking Advanced Malignancy: Report of Two Cases with Review of Literature. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02215-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Rajapandian S, Jankar SV, Kakkilaya H, Sabnis S, Ramkrishana P, Palanivelu P, Chinnusamy P. Modified laparoscopic keyhole plus repair to manage a parastomal hernia: A single-center experience. Asian J Endosc Surg 2020; 13:77-82. [PMID: 30675994 DOI: 10.1111/ases.12686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Parastomal hernia (PH) is a common late complication of stoma formation for which laparoscopic repair is a well-accepted modality of treatment. Keyhole repair has been frequently reported with recurrence, but our modification in surgical technique have lesser and acceptable recurrence rates. The present study aimed to assess the results of modified laparoscopic keyhole plus repair in the treatment of symptomatic PH. METHODS We reviewed our prospectively maintained database to search for patients who had undergone laparoscopic modified keyhole repair between January 2008 and April 2018. All 23 symptomatic patients who had undergone this procedure were included in the present study. RESULTS A total of 23 patients were studied. The median age was 37 years (range, 22-54 years). Two patients with large PHs underwent open excision of the redundant skin and then laparoscopic modified keyhole repair. There was one conversion to open repair because of dense adhesions. The mean operative time was 112 ± 37 minutes. The mean postoperative hospital stay was 3 ± 2 days. There were no significant intraoperative or postoperative complications. During follow-up, three patients had a seroma, which was managed conservatively. One morbidly obese patient who had an ileal conduit-related stomal hernia had a symptomatic recurrence 3 years after surgery. CONCLUSION The modified laparoscopic keyhole plus repair is a safe, feasible, and effective technique for PH repair; it has an acceptable recurrence rate and offers good cosmesis and functional outcomes.
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Affiliation(s)
- Subbiah Rajapandian
- Department of Gastrointestinal Surgery, GEM Hospital Coimbatore, Coimbatore, India
| | - Samrat V Jankar
- Department of Gastrointestinal Surgery, GEM Hospital Coimbatore, Coimbatore, India
| | - Harish Kakkilaya
- Department of Gastrointestinal Surgery, GEM Hospital Coimbatore, Coimbatore, India
| | - Sandeep Sabnis
- Department of Gastrointestinal Surgery, GEM Hospital Coimbatore, Coimbatore, India
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Rajapandian S, Dey S, Jain M, Sabnis S, Palanisamy S, Palanivelu P, Ramakrishnan P, Chinnusamy P. Evaluation of Single-Incision Multiport Laparoscopic Appendectomy (SIMPLA) Performed with Conventional Equipment. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1782-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Duraisamy KY, Balasubramaniam D, Kakollu A, Chinnusamy P, Periyasamy K. A Prospective Study of Minimally Invasive Paravaginal Repair of Cystocele and Associated Pelvic Floor Defects: Our Experience. J Obstet Gynaecol India 2019; 69:82-88. [PMID: 30814815 DOI: 10.1007/s13224-018-1137-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/15/2018] [Indexed: 11/28/2022] Open
Abstract
Aims and objectives To assess the outcome of minimally invasive paravaginal repair of symptomatic cystocele and to correlate postoperative outcome with preoperative presentation. The primary outcome was the anatomical outcome measured by postoperative physical examination and the functional outcome was assessed by subjective symptoms and questionnaires. The secondary outcomes were perioperative and postoperative complications. Materials and methods In this longitudinal prospective observational study, 44 women underwent laparoscopic or robotic paravaginal cystocele repair from January 2016 to July 2016 and they were followed up to 1 year after surgery in a tertiary advanced laparoscopic center. All patients had a symptomatic lateral cystocele ≥ grade 2 according to Baden-Walker classification. Other coexisting defects like apical cystocele or combined defects were corrected concomitantly. The anatomical outcome was measured by physical examination and functional outcome was assessed by questionnaires-Pelvic Organ Prolapse Distress Inventory 6 and Urinary Distress Inventory 6 preoperatively and during postoperative follow-up. Results All 44 patients were followed up to 12 months after surgery. The anatomical cure rate for cystocele was 97.7%. There were no major complications. All subjective symptoms and quality of life scores improved significantly during postoperative follow-up. The anatomical recurrence rate in our study was 2.3%. Conclusion Minimally invasive paravaginal repair of cystocele is an effective advanced laparoscopic procedure. It can be concomitantly performed with other surgical procedures to correct coexisting defects. The anatomical and functional results were outstanding with minimum perioperative morbidity and encouraging long-term outcome.
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Affiliation(s)
- Kavitha Yogini Duraisamy
- Department of Endogynecology, Gem Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
| | - Devi Balasubramaniam
- Department of Endogynecology, Gem Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
| | - Amrutha Kakollu
- Department of Endogynecology, Gem Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
| | - Palanivelu Chinnusamy
- Department of Endogynecology, Gem Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
| | - Kodeeswari Periyasamy
- Department of Endogynecology, Gem Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
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Nakata K, Shikata S, Ohtsuka T, Ukai T, Miyasaka Y, Mori Y, Velasquez VVDM, Gotoh Y, Ban D, Nakamura Y, Nagakawa Y, Tanabe M, Sahara Y, Takaori K, Honda G, Misawa T, Kawai M, Yamaue H, Morikawa T, Kuroki T, Mou Y, Lee WJ, Shrikhande SV, Tang CN, Conrad C, Han HS, Chinnusamy P, Asbun HJ, Kooby DA, Wakabayashi G, Takada T, Yamamoto M, Nakamura M. Minimally invasive preservation versus splenectomy during distal pancreatectomy: a systematic review and meta-analysis. J Hepatobiliary Pancreat Sci 2018; 25:476-488. [DOI: 10.1002/jhbp.569] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kohei Nakata
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | | | - Takao Ohtsuka
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Tomohiko Ukai
- Department of Community Medicine; Mie University School of Medicine; Tsu Mie Japan
| | - Yoshihiro Miyasaka
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Yasuhisa Mori
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | | | - Yoshitaka Gotoh
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Daisuke Ban
- Department of Hepatobiliary and Pancreatic Surgery; Graduate School of Medicine; Tokyo Medical and Dental University; Tokyo Japan
| | - Yoshiharu Nakamura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery; Nippon Medical School; Tokyo Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery; Tokyo Medical University; Tokyo Japan
| | - Minoru Tanabe
- Department of Hepatobiliary and Pancreatic Surgery; Graduate School of Medicine; Tokyo Medical and Dental University; Tokyo Japan
| | - Yatsuka Sahara
- Department of Gastrointestinal and Pediatric Surgery; Tokyo Medical University; Tokyo Japan
| | - Kyoichi Takaori
- Division of Hepatobiliary-Pancreatic Surgery and Transplantation; Department of Surgery; Kyoto University; Kyoto Japan
| | - Goro Honda
- Department of Surgery; Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital; Tokyo Japan
| | - Takeyuki Misawa
- Department of Surgery; Tokyo Jikei University School of Medicine; Tokyo Japan
| | - Manabu Kawai
- Second Department of Surgery; School of Medicine; Wakayama Medical University; Wakayama Japan
| | - Hiroki Yamaue
- Second Department of Surgery; School of Medicine; Wakayama Medical University; Wakayama Japan
| | | | - Tamotsu Kuroki
- Department of Surgery; National Hospital Nagasaki Medical Center; Nagasaki Japan
| | - Yiping Mou
- Department of Gastrointestinal and Pancreatic Surgery; Zhejiang Provincial People's Hospital; People's Hospital of Hangzhou Medical College; Zhejiang China
| | - Woo-Jung Lee
- Department of Hepatobiliary and Pancreatic Surgery; Yonsei University College of Medicine; Seoul Korea
| | - Shailesh V. Shrikhande
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology; Tata Memorial Hospital; Mumbai India
| | - Chung Ngai Tang
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong China
| | - Claudius Conrad
- Department of Surgical Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Ho-Seong Han
- Department of Surgery; Seoul National University College of Medicine; Seoul National University Bundang Hospital; Seoul Korea
| | - Palanivelu Chinnusamy
- Division of Gastrointestinal Surgery and Minimal Access Surgery; GEM Hospital and Research Centre; Coimbatore India
| | | | - David A. Kooby
- Department of Surgery; Emory University School of Medicine; Atlanta GA USA
| | - Go Wakabayashi
- Department of Surgery; Ageo Central General Hospital; Ageo Japan
| | - Tadahiro Takada
- Department of Surgery; Teikyo University School of Medicine; Tokyo Japan
| | - Masakazu Yamamoto
- Department of Surgery; Institute of Gastroenterology; Tokyo Women's Medical University; Tokyo Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
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Chinnusamy P, Dey S, Chittawadagi B, Gurumurthy S, Sabnis S, Palanisamy S. First robotic pylorus preserving pancreaticoduodenectomy for Frantz's tumour in an adolescent girl. J Minim Access Surg 2018; 14:349-353. [PMID: 29737317 PMCID: PMC6130189 DOI: 10.4103/jmas.jmas_272_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Solid pseudopapillary tumour (SPT) is one of the uncommon benign cystic neoplasms of pancreas occurring predominantly in young females. Being benign in nature, surgical resection is the treatment of choice with excellent 5-year survival. A 14-year-old girl presented with pain abdomen for 1 week. On evaluation, she was found to have a large SPT involving head and uncinate process of Pancreas She underwent robotic pylorus preserving pancreaticoduodenectomy (R-PPPD) with da Vinci® Si Robotic System (Intuitive Surgical, Sunnyvale, CA, USA). The total operating time was 480 min. Her postoperative recovery was uneventful and she was discharged on postoperative day 6. In the era of minimally invasive surgery, robotic pancreatic resection and reconstruction are becoming more acceptable. Although the operating domain is small in younger age group, the precise movement of robotic arm and high quality magnified three-dimensional view allows the surgeons to perform PPPD on younger patients also. Young female patients suffering from SPTs can electively undergo R-PPPD with minimal morbidity and mortality. R-PPPD can become the treatment of choice for SPTs involving pancreatic head region even in paediatric and adolescent age group.
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Affiliation(s)
- Palanivelu Chinnusamy
- Deapartment of HPB and Minimal Access Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Sumanta Dey
- Deapartment of HPB and Minimal Access Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Bhushan Chittawadagi
- Deapartment of HPB and Minimal Access Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Srivatsan Gurumurthy
- Deapartment of HPB and Minimal Access Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Sandeep Sabnis
- Deapartment of HPB and Minimal Access Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Senthilnathan Palanisamy
- Deapartment of HPB and Minimal Access Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
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Palanisamy S, Deuri B, Naidu SB, Palanisamy NV, Natesan VA, Chinnusamy P. Hepatic artery reconstruction following iatrogenic injury during laparoscopic distal pancreatectomy: Minimal access surgery is new horizon. J Minim Access Surg 2016; 12:382-4. [PMID: 27251821 PMCID: PMC5022525 DOI: 10.4103/0972-9941.181330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Although minimally invasive surgery has evolved in every field of surgery, its use in vascular surgery is limited to major vessel diseases only. A 23-year-old female presented with a cystic lesion in the distal body and the tail of the pancreas. Triphasic computed tomography (CT) abdomen revealed a 4.5 cm × 3.2 cm-sized mass with calcifications. A diagnosis of the mucinous cystic neoplasm in the distal body and the tail of the pancreas was made and the patient was planned for laparoscopic distal pancreatectomy. During the procedure, hepatic artery was accidentally injured due to its anomalous course. The artery was then reconstructed laparoscopically using left gastric artery as conduit. The time duration of the procedure was 45 min and blood loss was approximately 75 mL. The patient recovered well and the postoperative Doppler study revealed normal blood flow. Medium-vessel surgery through laparoscopic approach is feasible and safe in select cases, while availing benefits of laparoscopy.
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Affiliation(s)
- Senthilnathan Palanisamy
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Biswajit Deuri
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Subrahmaneswara Babu Naidu
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | | | - Vijay Anand Natesan
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Palanivelu Chinnusamy
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
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Ramakrishnan P, Deuri B, Keerthi MSS, Naidu SB, Subbaiah R, Raj P, Palanisamy S, Chinnusamy P. Laparoscopic Division of Median Arcuate Ligament for the Celiac Axis Compression Syndrome-Two Case Reports with Review of Literature. Indian J Surg 2016; 78:163-5. [PMID: 27303132 DOI: 10.1007/s12262-016-1448-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022] Open
Abstract
Median arcuate ligament (MAL) syndrome is an uncommon condition caused by the external compression of the celiac trunk by the median arcuate ligament. In the current era of technological advancement, this syndrome may be corrected through the laparoscopic approach. We report two patients who were diagnosed as MAL syndrome and underwent laparoscopic division of MAL fibers at our institute. Both the patients improved symptomatically following the procedure and were discharged on the fourth post-operative day. Also, they remained symptom free during subsequent follow-up period of 1 year and 8 months, respectively. Laparoscopic approach to correct the MAL syndrome is feasible and safe. It may be the preferred modality of treatment in view of its superior visualization and lack of morbidity. However, adequate experience in advanced laparoscopic surgery is required before attempting this procedure.
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Affiliation(s)
- Parthasarathy Ramakrishnan
- GEM Hospital and Research Center, 45, Pankaja Mill Road, Ramanathapuram Coimbatore, 641045 Tamil Nadu India
| | - Biswajit Deuri
- GEM Hospital and Research Center, 45, Pankaja Mill Road, Ramanathapuram Coimbatore, 641045 Tamil Nadu India
| | - M S S Keerthi
- GEM Hospital and Research Center, 45, Pankaja Mill Road, Ramanathapuram Coimbatore, 641045 Tamil Nadu India
| | - Subrahmaneswara Babu Naidu
- GEM Hospital and Research Center, 45, Pankaja Mill Road, Ramanathapuram Coimbatore, 641045 Tamil Nadu India
| | - Rajapandian Subbaiah
- GEM Hospital and Research Center, 45, Pankaja Mill Road, Ramanathapuram Coimbatore, 641045 Tamil Nadu India
| | - Praveen Raj
- GEM Hospital and Research Center, 45, Pankaja Mill Road, Ramanathapuram Coimbatore, 641045 Tamil Nadu India
| | - Senthilnathan Palanisamy
- GEM Hospital and Research Center, 45, Pankaja Mill Road, Ramanathapuram Coimbatore, 641045 Tamil Nadu India
| | - Palanivelu Chinnusamy
- GEM Hospital and Research Center, 45, Pankaja Mill Road, Ramanathapuram Coimbatore, 641045 Tamil Nadu India
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Palanisamy S, Patel ND, Sabnis SC, Palanisamy N, Vijay A, Chinnusamy P. Laparoscopic hysterectomy with bilateral orchidectomy for Persistent Mullerian duct syndrome with seminoma testes: Case report. J Minim Access Surg 2015; 11:273-5. [PMID: 26622120 PMCID: PMC4640029 DOI: 10.4103/0972-9941.158160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Persistent Mullerian duct syndrome (PMDS) is one of the three rare intersex disorders caused by defective anti-mullerian hormone or its receptor, characterized by undescended testes with presence of underdeveloped derivatives of mullerian duct in genetically male infant or adult with normal external genitals and virilization. This population will essentially have normal, 46(XY), phenotype. We hereby present a case of PMDS, presented with incarcerated left inguinal hernia associated with cryptorchidism and seminoma of right testes. Patient underwent laparoscopic hernia repair with bilateral orchidectomy and hysterectomy with uneventful postoperative recovery. Here we highlight the importance of minimal access approach for this scenario in terms of better visualization, less blood loss, combining multiple procedures along with early return to work and excellent cosmetic outcome.
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Affiliation(s)
- Senthilnathan Palanisamy
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Nikunj D Patel
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Sandeep C Sabnis
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Nalankilli Palanisamy
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Anand Vijay
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Palanivelu Chinnusamy
- Department of Minimal Access Surgery, Gem Hospital and Research Centre, Coimbatore, Tamil Nadu, India
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Palanisamy S, Patel N, Sabnis S, Palanisamy N, Vijay A, Palanivelu P, Parthasarthi R, Chinnusamy P. Laparoscopic radical cholecystectomy for suspected early gall bladder carcinoma: thinking beyond convention. Surg Endosc 2015; 30:2442-8. [PMID: 26416372 DOI: 10.1007/s00464-015-4495-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/03/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Gall bladder cancer (GBC) is the most common and aggressive malignancy of the biliary tract with extremely poor prognosis. Radical resection remains the only potential curative treatment for operable lesions. Although laparoscopic approach is now considered as standard of care for many gastrointestinal malignancies, surgical community is still reluctant to use this approach for GBC probably because of fear of tumor dissemination, inadequate lymphadenectomy and overall nihilistic approach. Aim of this study was to share our initial experience of laparoscopic radical cholecystectomy (LRC) for suspected early GBC. METHODS From 2008 to 2013, 91 patients were evaluated for suspected GBC, of which, 14 patients had early disease and underwent LRC. RESULTS Mean age of the cohort was 61.14 ± 4.20 years with male/female ratio of 1:1.33. Mean operating time was 212.9 ± 26.73 min with mean blood loss of 196.4 ± 63.44 ml. Mean hospital stay was 5.14 ± 0.86 days without any 30-day mortality. Bile leak occurred in two patients. Out of 14 patients, 12 had adenocarcinoma, one had xanthogranulomatous cholecystitis and another had adenomyomatosis of gall bladder as final pathology. Resected margins were free in all (>1 cm). Median number of lymph nodes resected was 8 (4-14). Pathological stage of disease was pT2N0 in eight, pT2N1 in three and pT3N0 in one patient. Median follow-up was 51 (14-70) months with 5-year survival 68.75 %. CONCLUSIONS Laparoscopic radical cholecystectomy with lymphadenectomy can be a viable alternative for management of early GBC in terms of technical feasibility and oncological clearance along with offering the conventional advantages of minimal access approach.
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Affiliation(s)
- Senthilnathan Palanisamy
- Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India.
| | - Nikunj Patel
- Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India
| | - Sandeep Sabnis
- Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India
| | - Nalankilli Palanisamy
- Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India
| | - Anand Vijay
- Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India
| | - Praveenraj Palanivelu
- Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India
| | - R Parthasarthi
- Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India
| | - Palanivelu Chinnusamy
- Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India
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Pidigue RS, Chinnusamy P, Jategaonkar PA, Ramakrishnan P, Subbiah R, Palanisamy S, Natesan AVS, Palanivelu PR. Laparoendoscopic approach for refractory Roux-en-Y hepaticojejunostomy stricture in an acute setting: a unique case and technique. Asian J Endosc Surg 2014; 7:67-70. [PMID: 24450348 DOI: 10.1111/ases.12065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 12/22/2022]
Abstract
Roux-en-Y hepaticojejunostomy stricture is a substantial problem that develops in 10%-30% of patients and requires frequent intervention. Although endoscopic/percutaneous approaches are preferred, especially for refractory stricture, open surgical reconstruction remains the gold standard. However, such an operation may be highly challenging. The recently developed covered, self-expanding metallic stent is a useful option for such difficult cases. We present a case of recurrent Roux-en-Y hepaticojejunostomy stricture complicated by densely packed intrahepatic stones and suppurative cholangitis with failed percutaneous biliary draining. Enteroscopic manipulations were unfeasible, and the case was successfully managed by the laparoendoscopic approach. If treating surgeons have the necessary expertise, this technique may be considered in such difficult scenarios.
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Affiliation(s)
- Rajan Seshiyer Pidigue
- Department of Surgical Gastroenterology, GEM Hospital and Postgraduate Institute, Coimbatore, India
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25
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Chinnusamy P, Ahluwalia JS, Palanisamy S, Seshiyer RP. Single incision multi-trocar hepatic cyst excision with partial splenectomy. J Minim Access Surg 2013; 9:91-4. [PMID: 23741118 PMCID: PMC3673583 DOI: 10.4103/0972-9941.110972] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 03/02/2012] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION: Surgery has the potential to remove the entire hydatid cyst and can lead to complete cure. Presence of hydatid cysts in multiple abdominal organs imposes special challenges for laparoscopic management. The patient position and port placement for one organ may not be adequate for other and proper exposure in hydatid cyst is of paramount importance to prevent spillage and complete removal of the cyst. Single incision multi-trocar technique has a unique advantage of allowing surgeon to work in different quadrants of abdomen using the same incision and ports. We report in this paper the first Laparo-endoscopic single-site hepatic cyst excision with partial splenectomy for hydatid cyst in liver and spleen using conventional laparoscopic instruments. PATIENT AND TECHNIQUE: The procedure was performed on a 64 year old female diagnosed to have Hydatid cyst in segment VIII of liver and another cyst in lower pole of spleen a transverse 3 cm incision was made 6 cm above umbilicus and was deepened up to fascia. Two 10mm and one 5mm ports were inserted. Procedure was completed in 160 minutes without any intra-operative complication. There were no post-operative complication and patient was discharged on day 5. CONCLUSION: Single incision multi-trocar surgery has cosmetic advantage over standard laparoscopic approach. It is even more marked when two procedures are combined in different quadrants of abdomen. As this is a rare combination procedure so it remains to be determined if this technique offers additional advantages of decreased analgesia, decreased hospital stay or cost effectiveness.
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Affiliation(s)
- Palanivelu Chinnusamy
- Gastrointestinal and Laparoscopic Surgery, GEM Hospital, Coimbatore, Tamil Nadu, India
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