Abdominal cavity will be closed by a single layer of 2 continuous sutures beginning on the opposite ends of the wound towards the median line and involving peritoneum, transversalis fascia, posterior and anterior layer of rectus abdominis muscle fascia and, in case of incisions beyond the lateral border of rectus abdominis muscle, also the oblique abdominal muscles fascia.

Abdominal cavity will be closed with two separate layers of continuous sutures. The first layer will include peritoneum, transversalis fascia and posterior layer of the rectus abdominis muscle fascia. In case of incisions not exceeding the lateral border of rectus abdominis muscle, the second layer will involve only the anterior layer of the rectus abdominis muscle fascia. In case of incisions exceeding the lateral border of rectus abdominis muscle, the second layer will include internal oblique abdominal muscle fascia, external oblique abdominal muscle fascia and anterior layer of the rectus abdominis muscle fascia.

Incisional Hernia

Malignancy

Mass closure technique

he first layer will include peritoneum, transversalis fascia and posterior layer of the rectus abdominis muscle fascia closed with 2 continuous sutures beginning at both ends of the wound. In case of incisions exceeding the lateral border of rectus abdominis muscle, the second layer of the continuous suture will start at the lateral border of rectus abdominis muscle, process laterally to the lateral end of the wound involving internal oblique abdominal muscle fascia. Subsequently, the suture will be led out on the anterior surface of the external oblique abdominal muscle, put through by the created loop in the medial direction and processed medially to close the external oblique abdominal muscle fascia and anterior layer of the rectus abdominis muscle fascia.

Layered closure technique

Department of General, Transplant and Liver Surgery

Risk Factors for Development of Incisional Hernia in Transverse Incisions

Study on the Risk of Incisional Hernia Development Following Transverse Epigastric Incisions in Patients Operated for Malignant Tumors

Development of burst abdomen in the immediate postoperative period (until discharge from hospital) or incisional hernia over a 2-year follow-up period (combined end-point). The follow-up protocol used for the assessment of incisional hernias at discharge from hospital and two control visits at 1 and 2 years postoperatively.

Quality of life assessed in EORTC QLQ-C30 questionnaire

surgical site infections, defined and classified according to the CDC (Centers for Disease Control) recommendations

Complications of grade III or higher according to Clavien-Dindo classification

Duration of postoperative hospitalization in days

Medical University of Warsaw

National Science Centre, Poland

The technique comprising continuous suture and mass closure will be compared to the technique 2 separate layers of continuous sutures.
Patients will be randomly assigned to one of the two techniques of abdominal closure during the operative procedure and after its main part has been completed, just before the beginning of closure of the abdominal cavity. Randomization will be performed in a 1:1 ratio and in blocks of 20 patients.

Neither the patients included in the study nor the investigators assessing the presence of incisional hernia during follow-up visits will be aware of the type of surgical technique used for abdominal closure (double-blinded study). Only the professionals present in the operating room during surgical procedure, including operator, assistants, anesthesiologist, and nurses, will be aware of the type of assigned intervention.

Preoperative application of a Bluetooth enabled headphones with standard music played for atleast 2 hours preoperatively.

Preoperative application of a Bluetooth enabled headphones with no music played and headphones will just mask the surrounding noise.

Music Therapy

Cholecystitis/Cholelithiasis

Inflammatory Response

Surgical Injury

A Bluetooth enabled Headphones device which is worn overhead and music can be played through it.

Preoperative application of a bluetooth enabled Headphones.

Prof. Brij Bushan Agarwal

Effect of Preoperative Music on Sterile Inflammation Induced by Laparoscopic Surgery

Effect of Preoperative Music on "Sterile Inflammation" Induced by Laparoscopic Surgery-A Randomized Study

Visual Analogue Scale (VAS) will be used to measure the pain on a numeric scale of 0-100 at 6 Hours, Day 1, Day 3, Day 10 and Week 3 postoperatively respectively with a total of 5 readings. Higher values on the VAS will represent a worse outcome.
Minimum value on VAS = 0 Maximum value on VAS= 100

Visual Analogue Scale (VAS) will be used to measure the PONV on a numeric scale of 0-100 at 6 Hours, Day 1, Day 3, Day 10 and Week 3 postoperatively respectively with a total of 5 readings. Higher values on the VAS will represent a worse outcome.
Minimum value on VAS = 0 Maximum value on VAS= 100

Gastrointestinal Quality Of Life Index (GIQoL) 30 Days Min=0 (Best) Max=144 (Worst) GIQoL will be assessed on 30th postoperative day and any difference in the measurement will be assessed for analysis in between the two study arms.

Tests will be done for 4 times (Preoperatively, Intraoperatively, 6 hours postoperatively, 24 hours postoperatively)

Tests will be done for 4 times (Preoperatively, Intraoperatively, 6 hours postoperatively, 24 hours postoperatively)
The difference in the values will be assessed as follows for all the testes:
Preop-Intraop, Intraop-6H, 6H-24H

Recording of EEg will be done at 3 separate occasions. Preoperatively, Intraoperatively and 24 hours postoperatively. EEG will be interpreted by a an independent evaluator for any changes who will be unaware of the timing of record of the EEG. The changes in the brain wave form will be seen and recorded for evaluation.

PROF. BRIJ B AGARWAL

Vice Chairman Department of General and Laparoscopic Surgery

Sir Ganga Ram Hospital

50 patients meeting the inclusion criteria will be included in the study after written and informed consent. They will be randomized and divided into 2 groups. Group 1 will be labelled as intervention group (recieving pre-operative music intervention), The group 2 will be labelled as controlled group (Not receiving pre-operative music intervention). Clinico-biochemical, Bio-cellular & Neurohumoral data evaluation will be done in both the groups.The results will be analyzed using standard SPSS software.

The Participants will be randomized to be part of the study groups. The Care providers will not be aware of the grouping of the participants as the intervention is done in the pre-operative holding area. All patients will undergo Laparoscopic Cholecystectomy under standard operative and anesthesia protocol. The Investigator (Nurse and the doctor staff) will also be unaware of the grouping of the patients. The recorded data will be analyzed by an individual outcome asser unaware of the grouping or identity of the patient.

Participants randomized to TV NOTES cholecystectomy

Participants randomized to laparoscopic cholecystectomy

Cholecystolithiasis

Surgery

Pain

TV NOTES cholecystectomy

Departement of Surgical Gastroenterology, Gentofte Hospital

The Effect of Transvaginal vs. Conventional Laparoscopic Cholecystectomy on the Postoperative Course

Postoperative pain will be measured with VAS, 3 hours after the operation as well as on the first, second and third postoperative day. Pain score will be assessed at rest and during mobilization from supine to erect posture. Based on these assesments a cumulated overall pain score for the first 72 postoperative hours will be calculated by adding the respective scores for each participant.

Postoperative fatigue will be measured on a scale from 0 (no fatigue) to 10 (severe fatigue) 3 hours post surgery and on postoperative day 1, 2 and 3.

Well-being will be measured with VAS 3 hours post surgery and on postoperative day 1, 2 and 3.

Nausea will be measured with VRS 3 hours post surgery and on postoperative day 1, 2 and 3.

Total number of times the participant have been vomiting 3 hours post surgery and on postoperative day 1, 2 and 3.

All participants will be given oral Paracetamol 1g four times a day and Ibuprofen 400 mg three times a day for the first 72 postoperative hours. Any need for additional analgesics besides this will be registered. Consumption of antiemetics will be registered.

Any postoperative complications will be registered during the participants admission and on follow-up 28 days (+/- 2 days) and 12 months (+/- 14 days) after surgery

Participants will be requested to score their satisfaction with the cosmetic result on a scale from 0 (no scarring) to 10 (severe scarring)28 days (+/- 2 days) and 12 months (+/- 14 days) after surgery.

Participants are requested to fill in the questionnaire Female Sexual Function Index (FSFI) on sexual function and dyspareunia 28 days (+/- 2 days) and 12 months (+/- 14 days) after surgery.

The time from admission to discharge from the hospital is recorded.

Details about the technical aspects of performing TV NOTES cholecystectomy is recorded during and immediate after surgery.

Early overall postoperative pain measured with VAS, 3 hours after the operation as well as on the first postoperative day. Pain score will be assessed at rest and during mobilization from supine to erect posture.

Late postoperative pain measured with VRS on the second and third postoperative day. Pain score will be assessed at rest and during mobilization from supine to erect posture.

Pain localization (abdominal wall, intra-abdominal or shoulder pain) will be measured with VRS, 3 hours postoperatively as well as on the first postoperative day.

Pain localization (abdominal wall, intra-abdominal or shoulder pain) will be measured with VRS, on the second and third postoperative day.

incisional hernia/fatigue

Risk Factors for Development of Incisional Hernia in Transverse Incisions

Effect of Preoperative Music on Sterile Inflammation Induced by Laparoscopic Surgery

The Effect of Transvaginal vs. Conventional Laparoscopic Cholecystectomy on the Postoperative Course

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