Single-incision laparoscopic appendectomy seeks to further reduce the trauma of parietal access to abdomen. The challenge of this surgery lies in the compromised ergonomics of instrument movement and triangulation. In this context, a feasibility study of an operative technique of singleincision laparoscopic appendectomy with technical modifications was conducted. This prospective study was carried out in tertiary care teaching institute of a semi-urban area in South India over a period of 1 year from June 2010 to May 2011. Thirty-two patients of acute appendicitis were included in this study. Mean operative time was 56.7 min (40-85 min). Mean age of subjects was 41±15 years. M/F ratio was 2:1. There was no significant peri-operative morbidity or mortality. Mean follow-up period was 8 months. We propose that this technique of single-incision laparoscopic appendectomy using conventional multiport laparoscopic instruments (SILACI) is feasible, safe, and cost-effective.
We report the surgical management of a case of Zenker's diverticulum in a 64 year old man, complicated by metallic nail penetration and surgical scarring due to previous surgery for cervical vertebral trauma.
Laparoscopic and Minimally invasive techniques have become a routine practice for various surgical disorders in present times. Though, advanced laparoscopic procedures are feasible they are largely restricted to fewer centers due to lack of advanced instrumentation, finances and expertise at most of them. In this context, we conducted a feasibility study to evolve definite criteria for performing advanced laparoscopic surgeries in resource restricted setups. We present our experience with 25 cases of advanced laparoscopic procedures using conventional laparoscopic instruments. We evaluated the clinico-investigative profile and operative details of all the patients. We classified the surgical expertise, laparoscopic instrumentation, surgical set ups and patient factors systematically to evolve the criteria for feasibility of advanced laparoscopicsurgery. Out of the 22 eligible patients for the study, various laparoscopic surgeries performed were -Fundoplication (4), Cystogastrostomy (3), Endoscopic thyroidectomy (7), Thoracoscopic Thyroidectomy (2), Adrenalectomy (5) and Retroperitoneal paraganglioma excision (1). There was no mortality and two morbidities in the form of hypercarbia and a tracheocutaneous fistula in 2 cases of endoscopic thyroidectomy. According to the criteria, we propose our surgical set up falls in to Grade 3, for which this criteria fits in. This study demonstrates the feasibility of advanced laparoscopic procedures in semi-equipped set-up, preferably by employing institute specific criteria of CLASS.
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