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Byline: Debesh. Bhoi, Dhruv. Jain, Anjolie. Chhabra, Virender. Mohan, Praveen. Talawar, Kamal. Kataria Background and Aims: Serratus anterior plane (SAP) blocks can be given either superficial or deep to the [...]

The incidence of adrenal cysts is 0.06% and only 9% of these are true mesothelial cysts. Here, we present a case of a true mesothelial cyst together with a review of the literature. A female in her 30s presented to the surgical outpatient department complaining of right flank pain. Her contrast-enhanced CT scan revealed a 7.5×6.5×4.5 cm right adrenal gland cyst. The patient underwent a laparoscopic right adrenalectomy. Immunohistopathology revealed the cyst to be mesothelial in nature. The majority of true mesothelial adrenal cysts are benign, unilateral and more common in women. Any adrenal cyst diagnosed as a functional lesion or one that may be malignant or with a diameter of 5 cm or greater requires surgical care whereas smaller lesions can be managed conservatively. Laparoscopic adrenalectomy for an adrenal cyst of diameter greater than 6 cm is a safe and feasible procedure in expert hands if there is no invasion of surrounding tissue. [ABSTRACT FROM AUTHOR]

Byline: Chitresh. Kumar, Kush. Lohani, Kamal. Kataria, Piyush. Ranjan, Anita. Dhar, Anurag. Srivastava Introduction: Endoscopic thyroidectomy is an advanced procedure and has a long learning curve. Most commonly employed approach [...]

Purpose: Evaluation of fluorescein along with blue dye as an affordable tracer for sentinel node biopsy in comparison with technetium + methylene blue. A randomized trial was conducted with the following objectives: (1) to demonstrate that the identification of sentinel lymph node by fluorescein + methylene blue is not inferior to the identification by Tc-99 m sulfur colloid + methylene blue and (2) to evaluate the cost-effectiveness of sentinel node biopsy by above two tracers. Subjects and Methods: One-thirty patients above age 18 years presenting with early breast cancer T1, T2, N0 breast carcinoma were randomized to undergo sentinel node biopsy by either fluorescein + methylene blue or Tc-99 m sulfur colloid + methylene blue. Results: The sentinel lymph nodes were identified in 89% in Fluorescein + methylene blue group and 90.9% with Tc-99 m sulfur colloid + methylene blue group. The trial demonstrated noninferiority of fluorescein + methylene blue as compared to isotope + methylene blue with effect size = 1; 95% confidence interval-9.54 to + 11.54. The fluorescein + methylene blue was more cost-effective than isotope guided sentinel node biopsy. Conclusion: Fluorescein-guided sentinel node biopsy is noninferior and more cost-effective than isotope-guided sentinel node biopsy. [ABSTRACT FROM AUTHOR]

Angiolipomas are uncommon benign vascular adipocytic mesenchymal tumors and generally present as painful subcutaneous nodules in the extremities and trunk. Chest wall is a rare site for angiolipoma. We describe a case of a giant retromammary angiolipoma that presented clinically as an apparent large breast lump. This tumor was surgically excised after preoperative angioembolization. Latter was carried out to reduce intraoperative bleeding and facilitate the excision. We recommend keeping benign tumors such as angiolipomas in differential when dealing with apparent breast/chest wall lumps. We also advocate preoperative angioembolization in select cases while excising large angiolipomas to decrease perioperative blood loss. [ABSTRACT FROM AUTHOR]

Myofibroblastomas are soft-tissue neoplasms that are thought to arise from myofibroblasts. They are mostly observed in males 41-85 years of age; however, this lesion also occurs in women. The usual clinical presentation is a unilateral painless lump that is not adherent to overlying or underlying structures. Microscopically, myofibroblastomas can be divided into 5 subtypes: classical, epithelioid, collagenised, cellular, and infiltrative. Mammary ducts and lobules are absent in the typical histological subtypes and the adjacent breast parenchyma may form a pseudocapsule. The majority of myofibroblastomas are immunoreactive for CD34, desmin, smooth muscle actin, and vimentin and are negative for cytokeratin and S-100 protein. We present a case of a giant myofibroblastoma arising in the background of gynecomastia in an adult male. [ABSTRACT FROM AUTHOR]

Abstract: Endoscopic thyroidectomy is a minimally invasive surgical approach that has become popular due to its cosmetic advantages and reduced post-operative discomfort. Central to the success of this procedure is the accurate identification of the midline, which becomes a challenge in endoscopic surgeries. We propose a novel method of using methylene blue, a Food and Drug Administration-approved dye, which offers the ability to clearly mark the midline, enhancing orientation and reducing the potential for injury to critical anatomical structures. Although using methylene blue has many benefits, there are drawbacks, including the requirement for intraoperative ultrasonography. Continued research and clinical experience will be critical in improving and extending its use in the field of thyroid surgery., (Copyright © 2024 Copyright: © 2024 Journal of Minimal Access Surgery.)

Purpose: These days laparoscopic inguinal hernia surgery, both totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP), is a commonly performed procedure due to advancements in laparoscopic instruments and the availability of skilled laparoscopic surgeons. The purpose of this study was to compare the perioperative complications of these two procedures., Methods: This was a prospective observational study between July 2019 and December 2020. Perioperative complications were compared with a 6-month follow-up. It included 144 patients, of whom 71 underwent TAPP repair and 73 underwent TEP repair. The selection was based on the surgeon's choice., Results: Early postoperative complications were scrotal edema (12 cases in TEP and 16 in TAPP), urinary retention (one case in TEP), ecchymosis (six cases in TEP and two in TAPP), and scrotal subcutaneous emphysema (two cases in TEP). On follow-up, seroma was found in a total of 22 cases, of which 12 were TEP and 10 were TAPP. While only one case of TAPP developed surgical site infection. There was no statistically significant difference in hospital stay between the two groups ( p = 0.58). The pain scores significantly decreased throughout recovery and were comparable between the groups. Neither group experienced a recurrence during the 6-month follow-up. Fifty-eight patients developed Clavien-Dindo grade I complications, one had grade II, and three had grade IIIa complications., Conclusion: With the increasing experience of the surgical fraternity in laparoscopic surgery, TEP and TAPP were proven to be comparable in terms of duration of surgery, postoperative complications, hospital stay, pain scores, and recurrence during the 6-month follow-up.

Objectives: This is a diagnostic test research study to evaluate the various existing methods of thyroid examination and their comparison with the novel modified Rose method. It also aims to measure inter-examiner variation in clinical findings based on the level of education and training, as compared to ultrasonography., Methodology: This cross-sectional study was conducted at a tertiary care hospital with 83 patients presenting to surgery OPD with neck swelling. Each patient was examined by one trained Junior Resident and a Surgery Consultant with all the four methods and with ultrasonography. Data was analysed by Stata-14, agreement between the two categorical variables was assessed by Kappa. In case of continuous variable agreement was assessed by Intra class correlation and Bland-Altman plot., Results: Modified Rose method by the consultant has the highest sensitivity (98%) and diagnostic odds (210) as compared to others but its specificity ranges from 46.7-91.1% to diagnose retro-sternal extension of a goiter. It has 93.98% agreement for identification of nodules. It has a high specificity (Consultant - 100%, Resident - 95.5%) with relatively lower sensitivity (Consultant - 94%, Resident - 86.8%) to diagnose solitary thyroid nodule (STN) but the sensitivity and specificity for diagnosing a multinodular goitre (MNG) was high. However, the highest sensitivity to diagnose STN was highest with Crile's method, but specificity was low. Lahey's method was a better clinical method to palpate lymph nodes compared to the other three., Conclusion: Examination in modified Rose's position is a better method of clinical examination of thyroid especially in patients with occult substernal extension. Lahey's method is a better method to examine cervical lymph nodes., Competing Interests: The authors declared no conflict of interest., (© 2022 Journal of the ASEAN Federation of Endocrine Societies.)