Use of robotic technology is of benefit in performing minimally invasive retroperitoneal surgery.

Preoperative and perioperative findings were discordant in quite a few cases. Preperitoneal dissection discovered coincidental occult hernias in 6.25% of patients.

Spigelian hernias, also known as spontaneous lateral ventral hernias, are rare primary ventral hernias arising in the Spigelian, or semilunar, line located at the lateral border of recti. Because of its varied presentation, clinical examination is often inconclusive. Traditional repair of such hernias use the open approach. Herein we report on three cases of Spigelian hernias. All were diagnosed and treated laparoscopically at our institution between March 2011 and June 2012. Multiple surgeons performed the repairs using the laparoscopic transabdominal preperitoneal technique of mesh reinforcement and reperitonization. There were no perioperative or postoperative complications. All three were discharged 1 day postoperatively. A complete resolution of preoperative symptoms was observed at follow-up at 1 week, 1 month and 6 months. Laparoscopic transabdominal preperitoneal repair of Spigelian hernia is safe, easy, and feasible for experienced laparoscopic surgeons.

Among the atypical manifestations of dengue fever, comprising 15.8% of all cases, acalculous cholecystitis forms a small subset. Acalculous cholecystitis is managed conservatively in majority of cases and a chance of gall bladder perforation is low (2-18%). Management of gall bladder perforation in the scenario of Dengue is sometimes complicated by presence of thrombocytopenia and its complications thereof. Mortality associated with gall bladder perforation is relatively high. Gallbladder usually perforates at the fundus and is to be dealt with surgically if it doesn’t localize. Laparoscopic management of gall bladder perforation is feasible as calot’s is relatively virgin (as there is no calculous disease). Thorough peritoneal toileting is possible and a chance of intra-abdominal abscess in post-operative period is a mere speculation. Laparoscopic management results in early recovery and fewer wound complications and lesser hospital stay.

Metastatic lesions in the small bowel are more common than primary lesions and account for 0.5% of all small intestinal malignancies. Most common is malignant melanoma followed by adenocarcinoma from pancreas, colon or stomach; and squamous cell carcinoma from lung, cervix, esophagus, skin, penis, ovary, pancreas and gallbladder. Gastrointestinal involvement as a manifestation of metastatic squamous cell carcinoma with unknown primary is relatively uncommon with very few being reported in the literature. The most common presenting symptom of small bowel lesions is subacute or acute obstruction and less commonly, bowel perforation, abdominal pain or hemorrhage. It is a diagnosis which dawns upon after the surgery when histopathology proves the same and therefore a thorough workup to establish the primary starts after the bailout procedure. Its clinical course is aggressive, characterized by a short preclinical history, resistance to chemotherapy, and overall dismal prognosis with a median life expectancy of 6 to 9 months as it represents a disseminated disease.