OTHERS_CITABLE http://annbsurg.iums.ac.ir/article-1-272-en.pdf 2013-05-15 0 0 10.5812/jmiss.9291 Congresses Needs Assessment Heshmatollah Kalbasi 1 1 Past president of MMESA, Iranian Association of Endoscopic Surgeons, Tehran, IR Iran AUTHOR Mohsen Pazouki 2 Minimally Invasive Surgery Research Center, Tehran University of Medical Sciences, Tehran, IR Iran AUTHOR

OTHERS_CITABLE http://annbsurg.iums.ac.ir/article-1-269-en.pdf 2013-05-15 0 0 10.5812/jmiss.7185 Appendectomy Laparoscopy Single Incision Laparoscopic Appendectomy Nereo Vettoretto 1 1 Laparoscopic Surgical Unit, M. Mellini Hospital, Chiari, Italy AUTHOR Ayman Ismail 2 Surgical Clinic, University of Brescia, Brescia, Italy AUTHOR Giovanetti Maurizio 3 General and Vascular Surgery Department, M. Mellini Hospital, Chiari, Italy AUTHOR

OTHERS_CITABLE Background: Myasthenia gravis is a neurological disorder characterized by muscle weakness. The role of thoracoscopic thymectomy in the treatment of this disease is controversial, but has some advantages that include less pain, shorter hospital stays, and better cosmetic results. Objectives: After the introduction of video-assisted thoracoscopic surgery (VATS) thymectomy, there has been increased interest in the use of this technique for myasthenia gravis. We conducted a retrospective study to assess the safety and efficacy of VATS thymectomy in treatment of myasthenia gravis. Patients and Methods: The medical records of 50 patients who underwent VATS thymectomy for the treatment of myasthenia gravis between May 2005 and June 2010 in Afzalipour Hospital, (affiliated to Kerman Medical University of Sciences, Iran) were reviewed. The patients were examined for response to treatment; for patients who were not available for examination, data was obtained through telephone conversations. Results: Forty-three of 50 patients were accessible. Of these, 34 were female and 16 were male, with a mean age of 34.8 years. The treatment responses were remission, 6 (16%); improvement, 30 (70%); and without change, 7 (16%). The total positive response to treatment was 84 percent. Conclusions: VATS thymectomy has been considered as a safe and effective treatment in myasthenia gravis and was associated with low mortality and morbidity. VATS thymectomy is recommended for the treatment of myasthenia gravis. http://annbsurg.iums.ac.ir/article-1-268-en.pdf 2013-05-15 0 0 10.5812/jmiss.7868 Myasthenia Gravis Thoracic Surgery Video-Assisted Thymectomy Mohammad Reza Lashkarizadeh 1 1 Department of Surgery, Clinical Research Unit of Afzalipour Hospital, School of Medicine, Kerman University of Medical Sciences, Kerman, IR Iran AUTHOR Rasoul Ajami 2 1 Department of Surgery, Clinical Research Unit of Afzalipour Hospital, School of Medicine, Kerman University of Medical Sciences, Kerman, IR Iran AUTHOR Mehrdad Vahedian 3 1 Department of Surgery, Clinical Research Unit of Afzalipour Hospital, School of Medicine, Kerman University of Medical Sciences, Kerman, IR Iran AUTHOR Bahram Pourseyedi 4 1 Department of Surgery, Clinical Research Unit of Afzalipour Hospital, School of Medicine, Kerman University of Medical Sciences, Kerman, IR Iran AUTHOR Hamid Zeynali 5 1 Department of Surgery, Clinical Research Unit of Afzalipour Hospital, School of Medicine, Kerman University of Medical Sciences, Kerman, IR Iran AUTHOR Mitra Samareh Fekri 6 Departments of Internal Medicine, Clinical Research Unit of Afzalipour Hospital, School of Medicine, Kerman University of Medical Sciences, Kerman, IR Iran AUTHOR Massoud Baghai Wadji 7 Department of Surgery, Firouzgar Hospital, School of Medicine, Tehran University of Medical Sciences, Kerman, IR Iran AUTHOR

CASE_STUDY Background: Large ovarian cysts are rarely seen in the paediatric population and can now be managed by a variety of surgical approaches. Case Presentation: We report a case where a substantial right ovarian cyst in a 13 year old was removed through a single incision in the superior umbilical fold leaving no discernable scar. The placement of a purse string facilitated safe decompression of the cyst allowing delivery into the wound where the lining was stripped before being returned to the abdomen. Conclusions: Subsequent single incision laparoscopic surgery (SILS) port placement through the same wound allowed for a full inspection of the pelvis and abdomen. This approach represents an advance on conventional surgery and is a tenable alternative to an exclusive laparoscopic technique. http://annbsurg.iums.ac.ir/article-1-267-en.pdf 2013-05-15 0 0 10.5812/jmiss.6240 Ovarian Cysts Child Laparoscopy Surgery Nadine Hughes 1 1 Department of Paediatric Surgery, Royal Alexandra Children’s Hospital, Brighton, UK AUTHOR Costa Healy 2 1 Department of Paediatric Surgery, Royal Alexandra Children’s Hospital, Brighton, UK AUTHOR Anies Mahomed 3 1 Department of Paediatric Surgery, Royal Alexandra Children’s Hospital, Brighton, UK AUTHOR

OTHERS_CITABLE Background: Post-operative nausea and vomiting (PONV) are the most common unpleasant experiences following laparoscopic surgeries. Objectives: In the current research, compared the effect of dexamethasone and ondansetrone combined and separately on preventing nausea and vomiting in the patients undergone elective surgery with general anesthetic using laparoscopic cholecystectomy procedure. Patients and Methods: One hundred fifty patients with ASA class I and II aged between 20-65 years voluntarily participated in this double-blind randomized prospective study. The patients were randomly divided into three groups of 50. All the participants faced general anesthetic procedure whereas each group received different treatment regimen as follow: the O-group, 4 mg ondansetrone, the D-group, 8 mg dexamethasone, and the OD –group, combination of 4 mg of ondansetrone plus 8 mg dexamethasone. Every episode of PONV and the need for antiemetic drug were evaluated 6 hours following the operation and then every 6 hours up to 24 hours after the operation. The complete response was defined as the case with no episode of PONV within the 24 hours and the need for anti-vomiting cases was defined as the failure in prophylaxis. Results: The complete response was observed in 62.2, 68.2 and 89.6 percent of O, D, and OD groups, respectively. The frequency of complete response was significantly lower in OD-group (P = 0.011 vs. the D and P = 0.005 vs. the O group). The need for the antiemetic drug in groups O, D, and OD was 28.3, 22.8, and 6.2, respectively. The incidence of vomiting and failure in prophylaxis was observed in D-group during the first six hrs. The highest need for the anti-vomiting drug within the 6 to 24 hours of post operation was observed in group O compared to the group OD (P = 0.012). Conclusions: Combination of dexamethasone and ondansetrone is more effective than the treatment of PONV by each of these drugs separately following the laparoscopic cholecystectomy .The application of dexamethasone alone in preventing premature PONV is less effective than the application of ondansetrone or the combination of these two drugs. In addition, ondansetrone alone is less effective than the combination of these two drugs in preventing PONV. http://annbsurg.iums.ac.ir/article-1-266-en.pdf 2013-05-15 0 0 10.5812/jmiss.8450 Ondansetrone Dexametasone PONV Laparoscopic Cholecystectomy Mohammad Eidy 1 1 Trauma Research Center, Kashan University of Medical Sciences, IR Iran AUTHOR Hamid Reza Vafaei 2 Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran AUTHOR Mehdi Rajabi 3 Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran AUTHOR Mahdi Mohammadzadeh 4 Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran AUTHOR Abdolreza Pazouki 5 Minimally Invasive Surgery Research Center, Tehran University of Medical Sciences, Tehran, IR Iran AUTHOR

OTHERS_CITABLE Background: Operating room (OR) planning involves the creation of a “master surgical schedule” in which surgeons are assigned to specific operating rooms (ORs) on specific days of a week. The master schedule is typically one or two weeks long repeatable for several months. Objectives: The purpose of this study was to recommend using a mathematical program to generate a rotation in a way that the limited operating room capacity could be distributed based on smoothing expected demand for in-patient beds. Patients and Methods: This study concentrated on the service-level scheduling at Sunnybrook Health Sciences Centre in Toronto, Canada, to build such a model. We assumed that the number of blocks (days) for each surgeon was given, and that the expected casemix for each surgeon was chosen by random sampling based on historical data. The goal was to assign surgeons to the blocks so tat bed occupancy in the wards would become as stable as possible during the week. The planning problem was first formulated as a stochastic integer programming. Then, an approach with combination of Monte Carlo simulation and Premium Solver provided an approximate solution. Results: The integer program provided scheduled OR number and day of the week for each surgeon, corresponding to the sample. The final result of model, approximated by the proposed method, was the maximum number of beds for each surgical service throughout the week. These were the required bed capacities to handle demands for surgeries. Conclusions: An Integer Programming was presented to schedule OR and day of surgery for each surgeon with restrictions on the available ORs and required number of blocks. The problem was quickly solved using Premium Solver. The reliability of the results was highly dependent on the data. Another fundamental restriction for implementation of the results was to convince surgeons to accept changes in the schedules. The surgeon preferences might be included in the model constraints for more acceptable results. http://annbsurg.iums.ac.ir/article-1-265-en.pdf 2013-05-15 0 0 10.5812/jmiss.8084 Operating Room Master Surgical Schedule Block Scheduling Stochastic Integer- Programming Michael W Carter 1 1 Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada AUTHOR Saeedeh Ketabi 2 Faculty of Administrative Sciences and Economics, Department of Management, University of Isfahan, Isfahan, IR Iran AUTHOR

OTHERS_CITABLE Background: Laparoscopic tension-free repair of inguinal hernia was presented in 1990s, promising less pain and shorter recovery period. Objectives: We have presented our experience on laparoscopic inguinal hernia tensionfree repair and comparing it with the open one. Patients and Methods: This is a retrospective study of cases undergone tension-free mesh inguinal hernia repair between July 2008 and October 2011. Cases were divided into two groups. Group I included cases that were repaired by the laparoscopic transabdominal preperitoneal (TAPP) approach and II by the open. Cases were compared regarding the operation time, the postoperative pain (early and long-term), the postoperative scrotal-related and wound complications and the recurrence as well as the cost. Results: The study included 217 cases; 114 in the group I and 103 in the group II. The operation time was significantly longer in the TAPP group (76.5 ± 18 vs. 67.6 ± 20 minutes). However, the overall hospital stay was less (2.6 ±0.79 vs. 2.9 ±0.87 days.) Early postoperative pain scores in the groups I and II were 0.95 ± 1.36 and 1.48 ± 1.47 and long-term pain and numbness were9% and 7.5% respectively, which were not significantly different between the two groups. The postoperative scrotal-related complications occurred more in the laparoscopic group (15% vs. 7.5%). Local wound complications were significantly more in the open technique (1.8% vs. 12%, groups I and II, respectively). Twelve (11%) cases in the group I undergone treatment of an incidentally discovered pathology during laparoscopy including; other side inguinal hernia (7), adhesions (4) and abdominal testis (1). The recurrence rates were 4.3% and 2.4% in the group I and II correspondingly. Conclusions: Laparoscopic TAPP inguinal hernia repair has longer operation time and more cost than the open technique. Local wound complications were more prevalent in the open repair. The postoperative pain, the hospital stay, the scrotal-related complications as well as the recurrence rates were the same in the both groups. The laparoscopy can detect and treat other intra-abdominal pathologies which have not been diagnosed preoperatively. http://annbsurg.iums.ac.ir/article-1-264-en.pdf 2013-05-15 0 0 10.5812/jmiss.7633 Hernia Inguinal Laparoscopy Herniorrhaphy Mostafa Tolba 1 1 Department of Surgery, Dallah Hospital, Riyadh, Kingdom of Saudi Arabia AUTHOR Ahmed Khairi 2 1 Department of Surgery, Dallah Hospital, Riyadh, Kingdom of Saudi Arabia Department of Surgery, Alexandria University, Cairo, Egypt AUTHOR Osman Nour-Eldin 3 1 Department of Surgery, Dallah Hospital, Riyadh, Kingdom of Saudi Arabia AUTHOR Maher Salem 4 1 Department of Surgery, Dallah Hospital, Riyadh, Kingdom of Saudi Arabia AUTHOR Ahmed Awad 5 1 Department of Surgery, Dallah Hospital, Riyadh, Kingdom of Saudi Arabia Department of Surgery, Ain-Shams University, Cairo, Egypt AUTHOR

OTHERS_CITABLE Context: Correct timing of diagnostic laparoscopy for unexplained infertility management remains as a debate for clinicians. A cost-effective strategy of diagnostic laparoscopy utilization for unexplained infertile patients is much needed. Evidence Acquisition: Detailed evaluation of the articles extracted from a “Pubmed” and “Cochrane database” search using “unexplained infertility and diagnostic laparoscopy” word group between 1993 and 2012 was the preparation style of this review. Results: Diagnostic laparoscopy should be considered when there are abnormal hysterosalpingography results, a past history of pelvic infection, pelvic surgery and/or unexplained secondary infertility during management of an unexplained infertile couple. Currently, omitting diagnostic laparoscopy following a normal hysterosalpingography in couples suspected to have unexplained infertility and proceeding with ovulation induction for several cycles before referring to assisted reproductive techniques are recommended. The additional value of diagnostic laparoscopy after a normal hysterosalpingography was found to be very low prior several attempts of intrauterine insemination. In the absence of pathological findings precluding fertility during an unexplained infertility evaluation, routine diagnostic laparoscopy for infertility evaluation is not necessary because 77% of these patients become pregnant following ovulation induction and/or assisted reproductive techniques treatment. Conclusions: Omitting diagnostic laparoscopy after a normal hysterosalpingography in infertile patients with unexplained infertility and without risk factors for pelvic pathologies related to infertility is reasonable because the majority became pregnant after several cycles of ovulation induction, and/or assisted reproductive techniques treatment while diagnostic laparoscopy is indicated when pelvic endometriosis and/ or tubal pathology is strongly suspected. http://annbsurg.iums.ac.ir/article-1-263-en.pdf 2013-05-15 0 0 10.5812/jmiss.6367 Laparoscopy Infertility Treatment Serkan Kahyaoglu 1 1 Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey AUTHOR

CASE_STUDY Background: Hydatid cyst, a zoonosis caused by Echinococcus granulosus, is the only recognized parasitic cysts of the spleen and is known to be at least twice as common as the non-parasitic variety. Case Presentation: A 35 year old woman presented with a one-year history of dull pain and a dragging sensation in her left hypochondrium. Ultrasonography revealed a hydatid cyst in the lower part of the spleen. Laparoscopic splenectomy along with hydatid cyst was done. Her post-operative phase was uneventful. Conclusions: Here, we discuss the pathogenesis of the rare entity of splenic hydatid cysts and the various treatment options available. http://annbsurg.iums.ac.ir/article-1-262-en.pdf 2013-05-15 0 0 10.5812/jmiss.5371 Spleen Echinococcosis Laparoscopy Ritesh Pathak 1 1 Department of Surgery, Lady Hardinge and Associated Dr. Ram Manohar Lohia Hospital, New Delhi, India AUTHOR Deborshi Sharma 2 1 Department of Surgery, Lady Hardinge and Associated Dr. Ram Manohar Lohia Hospital, New Delhi, India AUTHOR Kamal Yadav 3 1 Department of Surgery, Lady Hardinge and Associated Dr. Ram Manohar Lohia Hospital, New Delhi, India AUTHOR Atul Goel 4 Department of Medicine, Lady Hardinge and Associated Dr. Ram Manohar Lohia Hospital, New Delhi, India AUTHOR Romesh Lal 5 1 Department of Surgery, Lady Hardinge and Associated Dr. Ram Manohar Lohia Hospital, New Delhi, India AUTHOR

OTHERS_CITABLE http://annbsurg.iums.ac.ir/article-1-108-fa.pdf 2013-05-15 100 110 Dear Editor, We read with great interest the article "Changes in Lipid Profile and Insulin Resistance in Obese Patients Following Laparoscopic morbidly Total Gastric Vertical Plication" of Atefeh Golpaie et al. (1). The authors developed a prospective study that included 15 morbidly obese patients who underwent Laparoscopic Gastric Total Vertical plication (LTGVP) with the technique described by Talebpour and Amoli in 2007 (2), and evaluated the evolution of lipid profile; total cholesterol (TC), triglycerides (TG), LDL-C and HDL-C, fasting glucose, insulin, and insulin resistance (HOMA insulin sensitivity and the quantitative check index (QUIKI), before and six weeks after surgery. They found a significant decrease in body weight and BMI, blood level of TG, LDL-C and HOMA at six weeks, but changes in TC, HDL-C, fasting glucose, insulin Levels and QUICKI were not significant. The LTGVP is a new technique with scarce data, which just few patients with short-term follow-up have been investigated. However, initial results reported in terms of decrease in excess weight (EBW) are promising. In the study published by Talebpour et al., EBW loss was 61% at 12 months in patients with a preoperative average body mass index (BMI) of 47 Kg/m2 (2). Brethauer et al. reported an EBW loss of 53.4% in six patients with a mean BMI of 43.3 Kg/m2 at 12 months follow-up (3). Ramos-Cardoso et al. published a series of 15 patients with a mean preoperative BMI of 41 Kg/m2 with EBW loss of 60% at 12 months (4). These short-term results are comparable to those obtained after Sleeve Gastrectomy (SG) (5). The main advantages of this new technique are the low cost, since no mechanical sutures are used, and the possible low incidence of complications. However, after increasing reports, by employing this technique, some complications especially gastric outlet obstruction, vomiting, and gastric perforation, leaks, esophagitis and re-operation will probably be observed. Until now, no late complications have been reported, but follow-up is still limited. Regarding resolution of co-morbidities, it has been widely shown that the significant drop in weight experienced by patients undergoing any bariatric surgery have an impact on the increased insulin sensitivity (6). With regard to dyslipidemia, there are no other reports to assess the evolution of this disease in LTGVP. The postoperative evolution after LTGVP is probably similar to the results observed after SG. Chowbey et al. (7) reported 62 patients with dyslipidemia and 80.6% remission was reported at six months and 85% per year (32/40 patients). Omana et al. reported 87% (13/15 patients) improvement after SG and 50% after LAGB, one year after surgery (8). Wong et al. (9) showed, a significant reduction of hypertriglyceridemia (33%), total cholesterol (6%) in 37 morbidly obese patients. LDL-Cholesterol decreased 6%, but was not significant and HDL-Cholestrol increased 11% during one year follow up. In our experience, among 116 patients with dyslipidemia who underwent SG, 47.6% remission achieved for total cholesterol (TC), 48.8% for LDL-cholesterol, 75.4% for Triglycerides while HDL-cholesterol increased among 21% of patients. These findings are very similar to the results published by Benaiges et al. (10), which reported a 75% remission of dyslipidemia in patients undergoing SG at 12 months, whereas analyzing the lipid profile separately, didn’t show any significant changes in TC or LDL-C, but a significant decrease in TG and increase in HDL-C were seen. These finding are very important to decide which technique to be used in our obese patients with dyslipidemia, because patients with hypertriglyceridemia would benefit from a restrictive technique, but patients with hypercholesterolemia (TC and/or LDL-C), probably would benefit more with a technique involving malabsorption as the gastric bypass. Another important point to discuss is the follow-up time in order to evaluate the lipid profile. We believe that six weeks is insufficient to measure the effects of surgery. The changes probably would be determined by diet restriction during the early postoperative months. In addition, it is still controversial whether the lipid profile changes are due to the surgery (SG or LTGVP) or to the changes in eating habits (11-13). http://annbsurg.iums.ac.ir/article-1-108-en.pdf 2013-05-15 100 110 Insulin Laparoscopy Italo Braghetto 1 Department of Surgery, Hospital J. J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile AUTHOR Enrique Lanzarini 2 Department of Surgery, Hospital J. J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile AUTHOR

OTHERS_CITABLE http://annbsurg.iums.ac.ir/article-1-107-fa.pdf 2013-05-15 100 110 Dear Editor, In parallel with “epidemic of obesity”, the number of bariatric surgical procedures is increasing worldwide. Several different procedures are now available; each procedure has specific advantages and shortcomings. Mainly due to the latter, new procedures are being developed continuously. One of the most recently described techniques is Laparoscopic Total Gastric Vertical Plication (LTGVP). LTGVP has been reported to be associated with promising short-time (18 months) results in terms of weight loss and complication rates (1). Also, due to the limited need of expensive disposable equipment, LTGVP is an attractive alternative economically. However, data on effects of LTGVP on obesity-associated co-morbidity as well as long-term weight development are insufficient so far. In one of the issues of “J Minim Surg Sci”, Golpaie et al. reported data on changes in blood lipid profile and insulin sensitivity in 15 patients with a preoperative BMI of 44 kg/m2, 6 weeks after LTGVP (2). Although not much data on surgical technique used, nutritional intake or postoperative course was given, this represents the first information regarding changes in important biochemical parameters after LTGVP. As such, the report adds information regarding post- process effects. However, lack of the proper control group with the same degree of weight loss during this short term period makes the specific metabolic mechanisms of the procedure difficult to evaluate. We are looking forward to more data regarding the long-term effects in order to define the indication of this procedure for treatment of patients with morbid obesity. http://annbsurg.iums.ac.ir/article-1-107-en.pdf 2013-05-15 100 110 Obesity Laparoscopy Mikael Wiren 1 Deptartment of Surgery, Karolinska University Hospital, Stockholm, Sweden AUTHOR Anders Thorell 2 Deptartment of Surgery, Karolinska University Hospital, Stockholm, Sweden AUTHOR