These are inter-society guidelines for performance of laparoscopic surgery during COVID-19 pandemic that has affected the way of surgical practice. The safety of healthcare workers and patients is being challenged. It is prudent that our surgical practice should adapt to this rapidly changing health environment. The guidance issued is based on global practices and national governmental directives. The Inter-Society Group urges you to be updated with the developing situation and evolving changes.

Single port laparoscopic cholecystectomy (SPLC) was introduced to minimize postoperative morbidity and improve cosmesis. We performed a comparative study to assess feasibility, safety and perceived benefits of SPLC. Two groups of patients (40 each) with comparable demographic characteristics were selected for SPLC and multiport laparoscopic cholecystectomy (MPLC) between November 2010 to October 2011. SPLC was performed using X-cone with 5 and 10 mm extra-long (50 cm) telescope and 3 ports for hand instruments. MPLC was performed with traditional 4 port technique. A large window was always created during dissection to obtain the critical view of safety. Data collection was prospective. The primary end points were postoperative pain and surgical complications. Secondary end points were patient assessed cosmesis and satisfaction with body image and operating time. The mean VAS scores for pain at rest in MPLC group were higher on day 0 (SPLC 3.38 versus MPLC 4.80, p0.0001). VAS on coughing/straining was also significantly higher in MPLC group on day 0(SPLC 3.98 versus MPLC 6.48, p0.0001).VAS on postoperative day 1 was significantly higher in MPLC group (SPLC 2.25 versus MPLC 3.80, p0.000). Number and nature of surgical complications was statistically insignificant. Post-operative resumption of normal activity was earlier in SPLC group (SPLC 7.08, MPLC 10.83, p0.0001). Patient assessed cosmesis and satisfaction with body image scores on likert index (SPLC 5 in 100% versus MPLC 3 in 82.5% and 3 in 7.50%) indicating better cosmesis and greater patient satisfaction in SPLC. SPLC took longer to perform (87.63min versus 58 min in MPLC). Additional laparoscopic device (Alligator, 2.3 mm grasper) was used for retraction of gall bladder in 6 patients and 5mm right subcostal port in SPLC. SPLC appears to be feasible and safe with cosmetic benefits in selected patients. However, challenges remain to improve operative ergonomics. SPLC needs to be proven efficacious with a high safety profile to be accepted as standard laparoscopic technique.

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BACKGROUND Despite the developments in laparoscopic repair of ventral hernia, some problems in this repair still persist. In addition to recurrence and postoperative pain, the problem of seroma with persistent postoperative bulge and loss of body image render the procedure unacceptable to patients. This was the basis on which our study was conducted. We studied and compared the safety, efficacy and postoperative morbidity of laparoscopic ventral hernia repair with and without closure of hernial defect. MATERIALS AND METHODS We compared 30 patients in Group A (where the defect was closed before mesh was placed) and 30 patients in Group B (where the defect was not closed and mesh was placed directly over the defect). RESULTS In this study, the average defect size was 43.66 cm 2 in Group A and 44.53 cm² in Group B. In our study the incidence of postoperative seroma in the closure group was 6.6%, whereas it was 53% in the non-closure group. There was one recurrence in our mean follow-up of 10 months, in closure group and 3 in non-closure. 80% of patients in the closure group were very satisfied with their body image, whereas only 20% of patients in the non-closure group were very satisfied with their body image. CONCLUSION The advantage of closure of the hernial defect before mesh reinforcement in laparoscopic ventral hernia repair has been established. A drastic decrease in the incidence of seroma has occurred. Quality of life in the postoperative period is better, because there is no bulge and patients are satisfied. The correlation with reduction in the incidence of recurrence needs further follow-up.

BACKGROUND As we progressed from operations involving multiple ports to single access through umbilicus, there is empirical evidence that postoperative pain can be reduced as a result of single incision, in addition to accomplishing the laparoscopic procedure effectively and safely. This study was conducted to evaluate safety, efficacy and postoperative morbidity with this method. MATERIALS AND METHODSThis case series was conducted on forty patients suffering from cholelithiasis, who met the inclusion criteria were selected for single port laparoscopic cholecystectomy (SPLC) over a period of one year. SPLC was performed using X-cone device in twenty patients and multiport through a single periumbilical incision in twenty patients. RESULTSThe perception of pain was very less in immediate postoperative period and no patient required analgesics beyond one week. Early ambulation and early return to normal activity was observed. CONCLUSIONSPLC is going to develop a platform of its own or lead us down the path we have not yet realised and will certainly become apparent over the next decade. It has become patient-demanding procedure, because of excellent cosmetics and satisfaction with body image with decreased postoperative pain, early ambulation and return to day-to-day activity. Whichever direction we go in, the driving force needs to be patient's safety and patient care about which we have concluded in our study. KEY WORDSSingle Port Laparoscopic Cholecystectomy, Single Incision Laparoscopic Surgery, X-Cone, Single-Incision Cosmesis. HOW TO CITE THIS ARTICLE: Pathania BS, Raina AW. Our experience with single-incision laparoscopic cholecystectomy.