SM Journal of Minimally Invasive Surgery

Archive Articles

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Prophylactic Use of Mesh during Laparoscopic Surgery to Prevent Parastomal Hernia: A Literature Review

Background: Different surgical techniques and types of mesh have been used in the prevention of parastomal hernia. However, the evidence in laparoscopic abdominoperineal resection with end colostomy has been analysed in few randomized clinical trials. The aim of this review article was to outline use of prophylactic mesh in laparoscopic surgery.

Methods: A literature search using electronic databases was performed to find articles that analysed prophylactic placement of mesh to prevent parastomal hernia. The search was limited to English-language, randomised controlled trials and laparoscopic abdominoperineal resection with a permanent colostomy for rectal cancer patients.

Results: Three randomized controlled trials were found and analyzed in our study. A total of 158 patients were included, with no significant difference in general characteristics and stoma-related complications across their study groups. A significant reduction in radiologically-defined parastomal hernia was demonstrated in two trials (P=0.008, P=0.005), whilst prophylactic mesh reduced clinically-diagnosed parastomal hernia in one trial (P=0.049).

Conclusion: The use of prophylactic mesh to prevent parastomal hernia during laparoscopic surgery is safe and appears to be effective. Further trials to clarify the effectiveness of prophylactic parastomal hernia mesh are required with tighter definition of what constitutes a parastomal hernia.

Mohammed Al-Hijaji¹*, Ali Khabaza² and Ali AlGhazzawi³


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Endoscopic assisted Occipital Ventriculo-Peritoneal Shunt for Pagetoid Hydrocephalus

Hydrocephalus secondary to bone remodeling of cranial base in Paget’s disease is rare with few cases reported in the post TC era. There were not previous reports of endoscopic assisted ventriculo peritoneal shunts in these cases. We describe an elderly lady, diagnosed to have Paget’s disease who suffered dementia, gait disturbances and urinary incontinence. Obstructive hydrocephalus secondary to cranial base crowding was present. Fibreoptic intubation was doing and an endoscopic assisted occipital ventriculo-peritoneal shunt was inserted. She improved immediately following CSF diversion. Hydrocephalus in Paget’s disease is an uncommon and challenging complication. Timely surgery yields good results. There are some anesthetic and surgical precautions that we need to take account in order to ensure good results. Endoscopic visualization ensures an optimal colocation of ventricular catheter far too choroid plexus minimizing the risk of shunt failure and a subsequent reintervention in these difficult cases.

Joel Caballero García¹*, Adolfo Michel Giol Álvarez², Iosmill Morales Pérez¹ and Carlos Aparicio-García¹


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Hybrid Navigation Information System for Minimally Invasive Surgery -Phase I: Offline Sensors Registration

Current minimally invasive surgery (MIS) technology, although advantageous compared to open cavity surgery in many aspects, has limitations that prevents its use for general purpose MIS. This is due to reduced dexterity, cost, and required complex training of the currently practiced technology. The main challenges in reducing cost and amount of training is to have an accurate inner body navigation advisory system to help guide the surgeon to reach the surgery location. As a first step in making minimally invasive surgery affordable and more users friendly, quality images inside the patient as well as the surgical tool location should be provided automatically and accurately in real time in a common reference frame. The objective of this paper is to build a platform to accomplish this goal. It is shown that a set of three heterogeneous asynchronous sensors is a minimum requirement for navigation inside the human body. The sensors have different data rate, different reference frames, and independent time clocks. A prerequisite for successful information fusion is to represent all the sensors data in a common reference frame. The focus of this paper is on off line calibration of the three sensors, i.e. before the surgical device is inserted in the human body. This is a pre-requisite for real time navigation inside the human body. The proposed off-line sensor registration technique was tested using experimental laboratory data. The result of calibration was promising with an average error of 0.1081mm and 0.0872mm along the x and y directions, respectively, in the 2D camera image.

Uddhav Bhattarai and Ali T Alouani¹*