"Stealth" retro-auricular endoscopic surgery for a submandibular mass.

INTRODUCTION: With the need for increased cosmesis, it is the desire of patients all over the world to avoid an unsightly scar over the neck, face, or any of the exposed areas. This popularised the concept of "stealth" surgery. CASE DETAILS: A 42 year-old gentleman underwent a stealth surgery for a painless progressively growing mass in the left submandibular triangle, which was provisionally diagnosed as a Lymphoma. As he desired a scarless procedure, a linear incision in the neck was avoided, and the surgical team opted for a Retro-Auricular HairLine (RAHL) approach, with a combination of balloon spacing and ultrasonic shears dissection. DISCUSSION: The procedure was performed with perfect hemostasis, and is being reported as the first case of stealth RAHL (scarless) surgery in the United Arab Emirates for a submandibular mass. This article has been reported in line with the SCARE criteria [1]. "Stealth" surgery is becoming increasingly popular as it helps to avoid unsightly incisions in exposed areas of the body. The term was first used by by the paediatric surgical department of John Hopkins hospital, and it caught the fancy of the public as well as the surgeons. CONCLUSION: A retro-auricular endoscopic excision of a submandibular mass is being reported in this article for its feasibility and cosmesis. Following the principles of "stealth" surgery, invisible port site incisions were used to complete the surgery successfully. The purpose of this case report was to illustrate the feasibility and safety of the endoscopic resection using the retro-auricular approach for submandibular mass excision.

Single site laparoscopic simultaneous cholecystectomy, sleeve gastrectomy, and paraumbilical hernia - First case report.

INTRODUCTION: Single site surgery is rapidly gaining popularity for its cosmetic benefits. However it requires immense technical skill due to its challenging ergonomics.We have reported here a case where multiple surgeries have been performed through the same single site,without the usage of special devices.This article has been reported in line with the SCARE criteria [1]. PRESENTATION OF CASE: A 45-year-old obese lady presented with symptomatic cholelithiasis and a para umbilical hernia. She underwent uneventful trans umbilical, single site laparoscopic cholecystectomy, sleeve gastrectomy and paraumbilical hernia repair. DISCUSSION: This article is being published as it is the first reported from the Middle East. Recent development of laparoscopy was represented with introduction of the concept of scarless surgery using Natural Orifice Transluminal Endoscopic Surgery (NOTES), or its Transumbilical counterpart (NOTUS). Unfortunately,these two approaches have not been widely reported, probably due to the need for specialized instruments, learning curve, and prolonged surgery time [2]. CONCLUSION: This single case report is to indicate that it is technically possible and cosmetically appealing to perform such a complex surgery.