Journal of Minimal Access Surgery

Publisher: Medknow Publications

Journal description

Journal of Minimal Access Surgery (JMAS), the official publication of Indian Association of Gastrointestinal Endo Surgeons, is scheduled to be launched in early 2005. The JMAS, a quarterly publication, will be the first English-language journal from India, as also from this part of the world, dedicated to Minimal Access Surgery. The JMAS boasts an outstanding editorial board comprising of Indian and international experts in the field. The mission of the JMAS is to publish peer-reviewed articles in the fields of laparoscopic and thoracoscopic surgery, laparoscopic urology and gastrointestinal endoscopy. Although the Journal strives to publish quality articles submitted from around the world, there will be a strong emphasis on showcasing Minimal Access Surgery as practiced in the developing world. The JMAS looks forward to receiving the best of the material from centres around India and Asia

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Additional details

5-year impact 0.00
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Website Journal of Minimal Access Surgery website
Other titles JMAS
ISSN 1998-3921
OCLC 60352635
Material type Periodical, Internet resource
Document type Internet Resource, Journal / Magazine / Newspaper

Publisher details

Medknow Publications

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Non-commercial
    • Publisher's version/PDF may be used
    • Creative Commons Attribution Non-Commercial Share Alike License
    • Published source must be acknowledged
    • All titles are open access journals
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Robotics is the science. In scientific words a "Robot" is an electromechanical arm device with a computer interface, a combination of electrical, mechanical, and computer engineering. It is a mechanical arm that performs tasks in Industries, space exploration, and science. One such idea was to make an automated arm - A robot - In laparoscopy to control the telescope-camera unit electromechanically and then with a computer interface using voice control. It took us 5 long years from 2004 to bring it to the level of obtaining a patent. That was the birth of the Swarup Robotic Arm (SWARM) which is the first and the only Indian contribution in the field of robotics in laparoscopy as a total voice controlled camera holding robotic arm developed without any support by industry or research institutes.
    Journal of Minimal Access Surgery 01/2015; 11(1):106-10. DOI:10.4103/0972-9941.147724
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    ABSTRACT: Currently, benefits of robotic surgery in patients with benign gynecological conditions remain unclear. In this study, we compared the surgical outcome of robotic and laparoscopic total hysterectomies and evaluated the feasibility of robotic surgery in cases with pelvic adhesions or large uterus. A total of 216 patients receiving total hysterectomy via robotic or laparoscopic approach were included in this study. Of all 216 patients, 88 underwent robotic total hysterectomy and 128 underwent laparoscopic total hysterectomy. All cases were grouped by surgical type, adhesion score, and uterine weight to evaluate the interaction or individual effect to the surgical outcomes. The perioperative parameters, including operation time, blood loss, postoperative pain score, time to full diet resumption, length of hospital stay, conversion rate, and surgery-related complications were compared between the groups. Operation time and blood loss were affected by both surgical type and adhesion score. For cases with severe adhesions (adhesion score greater than 4), robotic surgery was associated with a shortened operation time (113.9 ± 38.4 min versus 164.3 ± 81.4 min, P = 0.007) and reduced blood loss (187.5 ± 148.7 mL versus 385.7 ± 482.6, P=0.044) compared with laparoscopy. Moreover, robotic group showed a lower postoperative pain score than laparoscopic group, as the effect was found to be independent of adhesion score or uterine weight. The grade-II complication rate was also found to be lower in the robotic group. Comparing to laparoscopic approach, robotic surgery is a feasible and potential alternative for performing total hysterectomy with severe adhesions.
    Journal of Minimal Access Surgery 01/2015; 11(1):87-93. DOI:10.4103/0972-9941.147718
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    ABSTRACT: Robotic surgery was initially developed to overcome problems faced during conventional laparoscopic surgeries and to perform telesurgery at distant locations. It has now established itself as the epitome of minimally invasive surgery (MIS). It is one of the most significant advances in MIS in recent years and is considered by many as a revolutionary technology, capable of influencing the future of surgery. After its introduction to urology, robotic surgery has redefined the management of urological malignancies. It promises to make difficult urological surgeries easier, safer and more acceptable to both the surgeon and the patient. Robotic surgery is slowly, but surely establishing itself in India. In this article, we provide an overview of the advantages, disadvantages, current status, and future applications of robotic surgery for urologic cancers in the context of the Indian scenario.
    Journal of Minimal Access Surgery 01/2015; 11(1):40-4. DOI:10.4103/0972-9941.147687
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    ABSTRACT: Laparoscopic adrenalectomy (LA) is now considered the standard for treatment of surgically correctable adrenal disorders. Robotic adrenalectomy has been performed worldwide and has established itself as safe, feasible and effective approach. We hereby present the first study in robotic transperitoneal LA from Indian subcontinent. We conducted a retrospective evaluation of 25 patients who had undergone robotic assisted LA at a tertiary health centre by a single surgeon. Demographic, clinical, histopathological and perioperative outcome data were collected and analysed. Mean age of the patients was 45 years (range: 27-65 years). Eleven male and 14 female patients were operated. Mean operative time was 139 min ± 30 min (range: 110-232 min) and mean blood loss was 85 ml ± 12 ml (range: 34-313 ml). Mean hospital stay was 2.5 ± 1.05 days (range: 2-6 days). Mean visual analogue scale score was 3.2 (range: 1-6) mean analgesic requirement was 50 mg diclofenac daily (range: 0-150 mg). Histopathological evaluation revealed 11 adenomas, eight phaeochromocytomas, two adrenocortical carcinomas, and four myelolipomas. According to Clavien-Dindo classification, three patients developed Grade I post-operative complications namely hypotension and pleural effusion. Robotic adrenalectomy is safe, technically feasible and comfortable to the surgeon. It is easier to perform with a short learning curve.
    Journal of Minimal Access Surgery 01/2015; 11(1):83-6. DOI:10.4103/0972-9941.147704
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    ABSTRACT: The use of Robotic Surgery as a purported adjunct and aid to Minimal Access Surgery (MAS) is growing in several areas. The acknowledged advantages as also the obvious and hidden disadvantages of Robotic Surgery are highlighted. Survey of literature shows that while Robotic Surgery is "feasible" and the results are "comparable" there is no convincing evidence that it is any better than MAS or even open surgery in most areas. To move "Robotic Surgery is ready for prime time in India" with no less than two dozen robots, many sub-optimally utilized for a population of 1.2 billion seems untenable.
    Journal of Minimal Access Surgery 01/2015; 11(1):5-9. DOI:10.4103/0972-9941.147655
  • Journal of Minimal Access Surgery 01/2015; 11(1):1. DOI:10.4103/0972-9941.147648
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    ABSTRACT: Pre-coccygeal ganglioneuroma is a rare clinical entity that presents incidentally or with non-specific symptoms. We present a case of a 25 year old housewife who was incidentally diagnosed with pre-coccygeal ganglioneuroma while getting investigated for primary infertility. The patient had no specific complaints except for irregular menstruation which had started 8 months back. Magnetic resonance imaging (MRI) was suggestive of a presacral and pre-coccygeal lesion. Resection of the tumor was done through the anterior approach using the da Vinci Si robotic system. Two robotic arms and one assistant port were used to completely excise the tumor. Robotic excision of such a tumor mass located at a relatively inaccessible area allows enhanced precision and 3-dimentional (3D) view avoiding damage to important surrounding structures.
    Journal of Minimal Access Surgery 01/2015; 11(1):103-5. DOI:10.4103/0972-9941.147722
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    ABSTRACT: FDA approved Da Vinci Surgical System in 2005 for gynecological surgery. It has been rapidly adopted and it has already assumed an important position at various centers where this is available. It comprises of three components: A surgeon's console, a patient-side cart with four robotic arms and a high-definition three-dimensional (3D) vision system. In this review we have discussed various robotic-assisted laparoscopic benign gynecological procedures like myomectomy, hysterectomy, endometriosis, tubal anastomosis and sacrocolpopexy. A PubMed search was done and relevant published studies were reviewed. Surgeries that can have future applications are also mentioned. At present most studies do not give significant advantage over conventional laparoscopic surgery in benign gynecological disease. However robotics do give an edge in more complex surgeries. The conversion rate to open surgery is lesser with robotic assistance when compared to laparoscopy. For myomectomy surgery, Endo wrist movement of robotic instrument allows better and precise suturing than conventional straight stick laparoscopy. The robotic platform is a logical step forward to laparoscopy and if cost considerations are addressed may become popular among gynecological surgeons world over.
    Journal of Minimal Access Surgery 01/2015; 11(1):50-9. DOI:10.4103/0972-9941.147690
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    ABSTRACT: Different skills are required for robotic surgery and laparoscopic surgery. We hypothesized that the laparoscopic experience would not affect the performance with the da Vinci(®) system. A virtual robotic simulator was used to estimate the operator's robotic dexterity. The performance of 11 surgical fellows with laparoscopic experience and 14 medical students were compared using the dV-trainer(®). Each subject completed three virtual endo-wrist modules ("Pick and Place," "Peg Board," and "Match Board"). Performance was recorded using a built-in scoring algorithm. In the Peg Board module, the performance of surgical fellows was better in terms of the number of instrument collisions and number of drops (P < 0.05). However, no significant differences were found in the percentage scores of the three endo-wrist modules between the groups. Robotic dexterity was not significantly affected by laparoscopic experience in this study. Laparoscopic experience is not an important factor for learning robotic skills.
    Journal of Minimal Access Surgery 01/2015; 11(1):68-71. DOI:10.4103/0972-9941.147696
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    ABSTRACT: We aimed to compare the surgical, oncological, and functional outcomes of robot-assisted partial nephrectomy (RAPN) with open partial nephrectomy (OPN) in the management of small renal masses. Between 2009 and 2013, a total of 46 RAPN patients and 20 OPN patients was included in this study. Patients' demographics, mean operative time, estimated blood loss (EBL), warm ischemia time (WIT), length of hospital stay, pre- and post-operative renal functions, complications and oncological outcomes were recorded, prospectively. Mean tumor size was 4.04 cm in OPN group and 3.56 cm in RAPN group (P = 0.27). Mean R.E.N.A.L nephrometry score was 6.35 in OPN group and 5.35 in RAPN group (P = 0.02). The mean operative time was 152 min in OPN group and 225 min in RAPN group (P = 0.006). The mean EBL in OPN and RAPN groups were 417 ml and 268 ml, respectively (P = 0.001). WIT in OPN group was significantly shorter than RAPN group (18.02 min vs. 23.33 min, P = 0.003). The mean drain removal time and the length of hospital stay were longer in OPN group. There were no significant differences in terms of renal functional outcomes and postoperative complications between groups. Minimally invasive surgical management of renal masses with RAPN offers better outcomes in terms of EBL and length of stay. However, the mean operative time and WIT were significantly shorter in OPN group. RAPN is a safe and effective minimally invasive alternative to OPN in terms of oncological and functional outcomes.
    Journal of Minimal Access Surgery 01/2015; 11(1):72-7. DOI:10.4103/0972-9941.147699
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    ABSTRACT: Minimally invasive surgery for rectal cancer is now widely performed via the laparoscopic approach and has been validated in randomized controlled trials to be oncologically safe with better perioperative outcomes than open surgery including shorter length of stay, earlier return of bowel function, better cosmesis, and less analgesic requirement. Laparoscopic surgery, however, has inherent limitations due to two-dimensional vision, restricted instrument motion and a very long learning curve. Robotic surgery with its superb three-dimensional magnified optics, stable retraction platform and 7 degrees of freedom of instrument movement offers significant benefits during Total Mesorectal Excision (TME) including ease of operation, markedly lower conversion rates and better quality of the specimen in addition to shorter (steeper) learning curves. This review summarizes the current evidence for the adoption of robotic TME for rectal cancer with supporting data from the literature and from the authors' own experience. All relevant articles from PubMed using the search terms listed below and published between 2000 and 2014 including randomized trials, meta-analyses, prospective studies, and retrospective reviews with substantial numbers were included.
    Journal of Minimal Access Surgery 01/2015; 11(1):29-34. DOI:10.4103/0972-9941.147682
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    ABSTRACT: The well-known advantages of robotic surgery include improved dexterity, three-dimensional operating view and an improved degree of freedom. Robotic surgery is performed for a wide range of surgeries in urology, which include radical prostatectomy, radical cystectomy, and ureteric reimplantation. Robotic paediatric urology is evolving. The major hindrance in the development of paediatric robotics is, first, the differences in practice patterns in paediatric urology compared with adult urology thereby making development of expertise difficult and secondly it is challenging to conduct proper studies in the paediatric population because of the paucity of cases. The difficulties in conducting these studies include difficulty in designing a proper randomised study, difficulties with blinding, and finally, the ethical issues involved, finally the instruments although in the phase of evolution require a lot of improvement. In this article, we review the relevant articles for paediatric robotic surgery. We emphasise on the technical aspects and results in contemporary paediatric robotic case series.
    Journal of Minimal Access Surgery 01/2015; 11(1):45-9. DOI:10.4103/0972-9941.147689
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    ABSTRACT: Robotic surgery with its bundled advantages is still in its burgeoning phase, the best of which is yet to come. The unrivalled suturing ease and motion scaling features, transforming into greater precision, has led to its widespread application in different surgical ramifications. These, coupled with the aforementioned advantages, has led to an increasing number of procedures being performed and that too with improved patient outcomes. It seems that the progressing India is readily accepting this robotic surgical innovation, the use of which is on a continuous rise, with the number of robotic platforms coming up in increasing numbers in many tertiary care Indian centres and a corresponding increase in demand of the same by the patients as well; thereby aptly fulfilling the economics of 'demand and supply'.
    Journal of Minimal Access Surgery 01/2015; 11(1):2-4. DOI:10.4103/0972-9941.147649
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    ABSTRACT: We summarise our experience with RPN emphasising on learning curve, techniques and outcomes. A retrospective chart review of 57 patients was done. The preoperative workup included a triple phase CT angiography. The parameters analyzed were demographics, tumor characteristics, operative details, postoperative outcome, histopathology and follow-up. The data were compared with historical cohort of the laparoscopic partial nephrectomy (LPN). 58 renal units in 57 patients (45 males and 12 females) underwent RPN. The mean age was 53.08 ± 13.6 (30-71) years. The mean tumor size was 4.96 ± 2.33 (2-15.5) cm. Average operative time was 129.4 ± 29.9 (70-200) min.; mean warm ischemia time was 20.9 ± 7.34 (9-39) min. 8 renal units in 7 patients were operated with the zero ischemia technique. The average follow-up was 5.15 months (1-18). There was no recurrence. 15 patients underwent LPN. The mean tumor size was 4.3 ± 1.6 (1.6-8) cm. operative time was 230.7 ± 114.8 (150-300) min.; mean warm ischemia time was 31.8 ± 9 min. The nephromerty score in the LPN group was 7.1 ± 0.89, in the RPN group was 8.75 ± 1.21. Our results suggest that prior experience of LPN shortens the learning curve for RPN as seen by shorter warm ischemia time and operative time in our series. The nephrometry score in RPN were higher suggesting that complex tumour can be managed with robotic approach.
    Journal of Minimal Access Surgery 01/2015; 11(1):78-82. DOI:10.4103/0972-9941.147701
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    ABSTRACT: Even today, open lobectomy involves significant morbidity. Video-assisted thoracic surgery (VATS) lobectomy results in lesser blood loss, pain, and hospital stay compared to lobectomy by thoracotomy. Despite being an excellent procedure in expert hands, VATS lobectomy is associated with a longer learning curve because of its inherent basic limitations. The da Vinci surgical system was developed essentially to overcome these limitations. In this study, we report our initial experience with robotic pulmonary resections using the Completely Portal approach with four arms. To the best of our knowledge this is the first series of robotic lobectomy reported from India. Data on patient characteristics, operative details, complications, and postoperative recovery were collected in a prospective manner for patients who underwent Robotic Lung resection at our institution between March 2012 and April 2014 for various indications including both benign and malignant cases. Between March 2012 to April 2014, a total of 13 patients were taken up for Robotic Lobectomy with a median age of 57 years. The median operative time was 210 min with a blood loss of 33 ml. R0 clearance was achieved in all patients with malignant disease. The median lymph node yield in nine patients with malignant disease was 19 (range 11-40). There was one intra-operative complication and two postoperative complications. The median hospital stay was 7 days with median duration to chest tube removal being 3 days. Robotic lobectomy is feasible and safe. It appears to be oncologically sound surgical treatment for early-stage lung cancer. Comparable benefits over VATS needs to be further evaluated by long-term studies.
    Journal of Minimal Access Surgery 01/2015; 11(1):94-8. DOI:10.4103/0972-9941.147758
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    ABSTRACT: Isolated ovarian metastases from colorectal cancer (CRC) are rare disease presenting in approximately 3% of all patients undergoing colorectal resection. Most reports describe an open approach to the disease, but we report a case isolated ovarian metastases from CRC managed completely by robotic technique. A 54-year-old female, with a family history of CRC, was admitted for rectosigmoid junction cancer. Computed tomography scan demonstrated in rectosigmoid tumor and pelvic mass, presumed as teratoma. Robotic surgery discovered a 10-cm encapsulated tumor, attached to the left ovary, with no macroscopic peritoneal involvement. The pathologic diagnosis of the resected pelvic mass, ovarian metastases from CRC. Robotic anterior resection was performed. Operative time was lasted 165 min, considering 25 min for robotic system set up. This is the first report to describe robot-assisted anterior resection and oophorectomy in patient with isolated ovarian metastases from rectosigmoid junction cancer.
    Journal of Minimal Access Surgery 01/2015; 11(1):99-102. DOI:10.4103/0972-9941.147720
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    ABSTRACT: Minimally invasive thoracic surgery has come a long way. It has rapidly progressed to complex procedures such as lobectomy, pneumonectomy, esophagectomy, and resection of mediastinal tumors. Video-assisted thoracic surgery (VATS) offered perceptible benefits over thoracotomy in terms of less postoperative pain and narcotic utilization, shorter ICU and hospital stay, decreased incidence of postoperative complications combined with quicker return to work, and better cosmesis. However, despite its obvious advantages, the General Thoracic Surgical Community has been relatively slow in adapting VATS more widely. The introduction of da Vinci surgical system has helped overcome certain inherent limitations of VATS such as two-dimensional (2D) vision and counter intuitive movement using long rigid instruments allowing thoracic surgeons to perform a plethora of minimally invasive thoracic procedures more efficiently. Although the cumulative experience worldwide is still limited and evolving, Robotic Thoracic Surgery is an evolution over VATS. There is however a lot of concern among established high-volume VATS centers regarding the superiority of the robotic technique. We have over 7 years experience and believe that any new technology designed to make minimal invasive surgery easier and more comfortable for the surgeon is most likely to have better and safer outcomes in the long run. Our only concern is its cost effectiveness and we believe that if the cost factor is removed more and more surgeons will use the technology and it will increase the spectrum and the reach of minimally invasive thoracic surgery. This article reviews worldwide experience with robotic thoracic surgery and addresses the potential benefits and limitations of using the robotic platform for the performance of thoracic surgical procedures.
    Journal of Minimal Access Surgery 01/2015; 11(1):60-7. DOI:10.4103/0972-9941.147693
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    ABSTRACT: With the rise in a number of bariatric procedures, surgeons are facing more complex and technically demanding surgical situations. Robotic digital platforms potentially provide a solution to better address these challenges. This review examines the published literature on the outcomes and complications of bariatric surgery using a robotic platform. Use of robotics to perform adjustable gastric banding, sleeve gastrectomy, roux-en-y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch and revisional bariatric procedures (RBP) is assessed. A search on PubMed was performed for the most relevant articles in robotic bariatric surgery. A total of 23 articles was selected and reviewed in this article. The review showed that the use of robotics led to similar or lower complication rate in bariatric surgery when compared with laparoscopy. Two studies found a significantly lower leak rate for robotic gastric bypass when compared to laparoscopic method. The learning curve for RYGB seems to be shorter for robotic technique. Three studies revealed a significantly shorter operative time, while four studies found a longer operative time for robotic technique of gastric bypass. As for the outcomes of RBP, one study found a lower complication rate in robotic arm versus laparoscopic and open arms. Most authors stated that the use of robotics provides superior visualisation, more degrees of freedom and better ergonomics. The application of robotics in bariatric surgery seems to be a safe and feasible option. Use of robotics may provide specific advantages in some situations, and overcome limitations of laparoscopic surgery. Large and well-designed randomised clinical trials with long follow-up are needed to further define the role of digital platforms in bariatric surgery.
    Journal of Minimal Access Surgery 01/2015; 11(1):16-21. DOI:10.4103/0972-9941.147673