Clipless Laparoscopic Cholecystectomy: Our Experience

Background:Laparoscopic cholecystectomy (LC) is acceptedas the gold standart treatment of gallstones. Various methodshave been developed to close the cystic duct (CD) and cysticartery (CA), but titanium clip application is currently themost frequently used technique. High-tech electrosurgicalinstruments, such as Harmonic Scalpel (HS), have been usedboth for dissection of the cystic artery and Cystic duct. Thepresent study was conducted to observe and establish efficacyof clipless cholecystectomy, by use of harmonic scalpel as analternative, for division and sealing of cystic artery and cysticduct.Methods: This study was a hospital based, retrospectivestudy, conducted in Govt. Medical College, Srinagar, usingmedical records. A total of 114 patients included in the study,having been operated by a single surgeon over time period of5 years from February 2014 to january 2019.Results: In our study of 114 patients 82 (71.92%) werefemales and 32 (28.07%) were males with average age of41.4years (16-72 yr). No patient was converted to open withaverage operating time of 24.2 minutes (18-46 minutes). Meanhospital study was 1.42 days (1-8 days) with no mortality.Postoperative complications were found in 6 (5.2%) patientswith bile leak from duct of Lushka in 1 (0.8%) patient, portsite infection in 2 (1.7%) patients and fever in 3 (2.6%)patients.Gallbladder perforation intraoperatively was seen in7 (6.2%) patients.Conclusions:Use of harmonic scalpel is an excellent optionfor the cystic duct closure with less time consumption and lesscomplications

Laparoscopic Spleenectomy.

Spleen is the largest reticuloendothelial organ in the body consisting of an encapsulated mass of vascular and lymphoid tissue and responsible for defensive actions and hence the name defense organ for it. Like any other organ in the body it is also afflicted by a number of disorders among which are splenic cysts. Herein we report a case of large primary splenic cyst that was treated successfully by laparoscopic Spleenectomy.

Laparoscopic Adrenalectomy-Our Experience.

Adrenal glands are known to be central to homeostasis and consequently their afflictions are responsible for majorhuman ailments. Laparoscopic adrenalectomy has become the procedure of choice for handling these benign functioning and non-functional afflictions. Recently, literature has documented the feasibility of laparoscopic procedure for even the larger (>5cm) tumors. We present our first-hand experience with ten laparoscopic adrenalectomies done at our center for adrenal masses upto 6cm in diameter.Ten patients with adrenal masses upto 6cm in diameter underwent laparoscopic adrenalectomy at our department between Jan 2010 and Jan 2013. There were 7 males and 3female patients. There were six left sided tumors and four right side tumors with an average tumor size of 4.5cm. Seven out of ten cases had functional tumors. All of the procedures were completed successfully without any major intraoperative complication. The mean (range) operating time was 130 (100-210) min. There was an average (range) blood loss of 200 (150-400) ml. A drain was kept in all the patients and removed mostly on 1st postoperative day. The patients were strictly followed up after the surgery and none of them developed any complication. From our favorable results, we can safely conclude that laparoscopic adrenalectomy is safe and feasible procedure especially for smaller tumors. More experience is needed to tackle the larger size tumors.

Cholecystoduodenal Fistula: An Intraoperative Diagnosis.

We report a case of chronic cholecystitis that had no preoperative diagnosis of cholecystoduodenal fistula but was found during laparoscopic cholecystectomy and was managed successfully. I

Pregnancy and Labour in a Case of Uterus Pseudodidelphys.

Mullerian Duct abnormalities cause various congenital malformations in the female genital tract. These abnormalities have variable effects on pregnancy and its out come. Uterus didelphys and uterus pseudodidelphys are two extreme forms of these abnormalities which are rarely encountered in obstetrical practice. A young primigravida reported in labour and because of duplication of genital tract there was difficulty in the determination of stage of labour as well as diagnosis of labour. There was also problem associated with progress of labour and operative delivery. Same patient on a subsequent pregnancy reported with complications associated with presentation of foetus as well as preterm labour. This poses a diagnostic dialemma during labour. The insight into such an event can make us alert in diagnosis during such rare obstetrical encounters.

Pleomorphic Xanthoastrocytoma (PXA)

PXA is a rare form of supratentorial astrocytoma which occurs in the young individuals and involves the leptomeninges. Microscopically the tumour shows pleomorphism without any evidence of necrosis and vascular endothelial proliferation. Tumour cells contain intracytoplasmic fat. The present case is a 20 years old male who presented with history of Grand Mal seizures and the CT scan showed a tumour in the supratentorial region. Histopathologically tumour turned out to be a PXA.