Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

View Point
Year : 2007 | Month : October | Volume : 1 | Issue : 5 | Page : 437 - 439

Modified Open Method of First Port Insertion in Laparoscopic Surgery

BHATTACHARJEE P K

Department of Surgery, I.P.G.M.E & R/S.S.K.M Hospital, Kolkata, India.

Correspondence Address :
Dr Prosanta Kr. Bhattacharjee. Flat No 10-C, 9, Mandeville Gardens, Kolkata 19, India.Tel.: 0332565-0403; Mob: 09434194957; e-mail: prosantabh@rediffmail.com

How to cite this article :

BHATTACHARJEE P K . MODIFIED OPEN METHOD OF FIRST PORT INSERTION IN LAPAROSCOPIC SURGERY . Journal of Clinical and Diagnostic Research [serial online] 2007 October [cited: 2018 Nov 15 ]; 1:437-439. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2007&month=October&volume=1&issue=5&page=437-439&id=113

Introduction Various techniques, both the open and the closed, have been described for insertion of the first trocar during laparoscopic surgery. The conventional closed technique with blind insertion of Veress needle is associated with some of the serious complications of laparoscopic surgery (1),(2). In 1971, Hasson first described the open method of port insertion using a cannula designed by him (3). It affords peritoneal access under direct vision and is supposed to be a far safer method of establishing pneumoperitoneum, though one cannot claim it to be totally safe. The latter technique has the limitations of being more time consuming and having occasional gas leakage from around the trocar. Increasingly, the open method of first trocar placement is replacing the closed technique in view of the lower morbidity associated with the former (4). Though the choice of a particular technique is a matter of surgeon’s preference, its safety, ease, rapidity, and cost effectiveness are points that need to be considered. Described herein is a modified method of open placement of first port using the readily available, common instruments. It was found to afford an easy, safe, rapid, and cheap method of establishing pneumoperitoneum even in patients who had undergone previous abdominal surgery. Operative Technique/Method As a routine, all patients are initially catheterised, and the stomach is decompressed by placing a Ryle’s tube. As in the standard procedure for Veress needle insertion, the surgeon stands at the patient’s left side. The umbilicus is stretched transversely with the left hand, and a 1 cm long incision is made on superior umbilical fold using a No. 11 scalpel blade. The upper margin of the umbilicus is lifted up with an Allis tissue forceps, and using the back of the B.P handle or the right index finger, the underlying tissue is bluntly dissected to identify the junction of the umbilical stalk and the linea alba (Table/Fig 1). The correct identification of this point is the key to the rapid and smooth access. At this point, the abdominal wall is the thinnest and the peritoneum is intimately adherent (5). With the umbilical scar stretched and the abdominal wall elevated by the retraction on upper margin of the umbilicus with the Allis forceps, a vertical cut, <5 mm in length, is made on the umbilical stalk and the adjoining linea alba (Table/Fig 2). The peritoneum is entered carefully, using the tip of a medium-sized closed haemostat, and opened up to stretch the opening enough to introduce the tip of the little finger. Exploration with the finger tip, probing with the tip of a haemostat, and direct visualisation of the peritoneal cavity with the blades of the haemostat being open(Table/Fig 3) exclude any adhesions around the incision. The assistant keeps the blades of the haemostat open and guides the surgeon to gently introduce the tip of the 10 mm cannula (without the trocar) directly into the incision line. The haemostat and the Allis forceps are removed, and the trocar is gently pushed, against minimal resistance, into the peritoneal cavity with the right hand while keeping the abdominal wall elevated with the left hand. Subsequent establishment of pneumoperitoneum is rapid and uniform. The port site incision being small is sutured easily with a figure of eight sutures with port closure (Vicryl®). There is no need to fix the cannula to the abdominal wall nor is there any gas leakage, as the fascial opening, being slightly smaller than the diameter of the cannula, grips the later tightly.

Discussion

The most important and potentially dangerous first step in laparoscopy is safe and successful insertion of the first port. There are four basic techniques of peritoneal access in laparoscopic surgery: blind Veress insertion, direct trocar insertion without previous pnuemoperitoneum, optical trocar insertion, and open laparoscopy.

The first two are blind techniques and have been associated with various complications such as subcutaneous emphysema, gas embolism, injury to intra-abdominal structures (hollow viscus, solid organs, and vessels), etc. Chances of serious injuries are less in the open procedure, though a complication like direct entry into a loop of small gut has been reported (6). The technique described above is a modified open laparoscopic technique. We combine the advantages of open procedure of visualising peritoneal cavity (though limited) and exploring the same with the finger tip, before introduction of the trocar, with that of the closed technique of avoiding gas leak, by keeping the incision on the umbilical cicatrix and adjoining linea alba small. Unlike Hasson technique, there is no need of any special instrument. Access into the peritoneal cavity and establishment of subsequent pneumoperitoneum are completed rapidly, average time taken being 3 minutes (range 2–5 minutes). There was no incidence of any intraoperative injury in over 300 cases (including 24 cases with previous abdominal surgical scars) in which the procedure was practised, though there were two instances where the peritoneum got pushed down from the parietes and it was not possible to gain access into the peritoneal cavity initially. Subsequent establishment of pneumoperitoneum with Veress needle introduced on the Palmer’s point pushed the peritoneum up and enabled the trocar to be introduced. One of these two cases also developed a periumbilical haematoma that resolved spontaneously. Cases have been followed up over last 6 years, and there has been no incidence of umbilical hernia so far.

Though similar procedures have been described by Lal et al. (4) in 2002 and Jared et al. (7) in 2005, there are some basic differences between them. Jared et al. made a skin incision to the left of the umbilicus, while standing on the patient’s right side , and used a pair of suture scissors to cut the umbilical stalk directly down to the peritoneum instead of just incising the sheath. Lal et al. had preferred an incision on the inferior umbilical fold. They had to use silk thread to fix the cannula to the abdominal wall and to place the paraffin gauze around the cannula to minimise gas leak.

The technique described herein is accomplished while standing to the patent’s left side, and hence there is no need to change sides during the commonly performed laparoscopic cholecystectomy. Limiting the incision up to the sheath and subsequent entry into the peritoneal cavity with a haemostat minimise the risk of inadvertent injuries. Moreover, as the cannula fits in snugly into the incision on the sheath, which is smaller than its diameter, there is no chance of gas leak and the cannula may remain fixed at a desired length; thus, there is no need of the fixation stitch and the paraffin gauze, as described by Lal et al.

Conclusion

This simple technique of first trocar insertion is safe and easily to learn. The controlled, effortless insertion minimises the penetration force at the instrument–tissue interface and reduces chances of trocar-induced injuries. Avoiding the sharp pointed trocar minimises the chances further. It may be safely practised even in patients with previous laparotomy scars. Rapid establishment of pneumoperitoneum is an additional advantage.

References

1.
Yuzpe AA. Pneumoperitonem needle and trocar injuries in laparoscopy. A survey on possible contributing factors and prevention. J Reprod Med 1990;35:485–90.
2.
Gunenc MZ, Yesildaqlar N, Binqol B, Onalan G, tabak S, et al. The safety and efficacy of direct trocar insertion with elevation of the rectus sheath instead of the skin for pneumoperitoneum. Surg Laparosc Endosc Percutan Tech 2005;15:80–1.
3.
Hasson HM. A modified instrument and method for laparoscopy. Am J Obstet Gynecol 1971;110:886–7.
4.
Lal P, Sharma R, Chander R, Ramteke VK. A technique of open trocar placement in laparoscopic surgery using the umbilical cicatrix tube. Surg Endosc 2002;16:1366–70.
5.
Mochado MA, da Rocha JR, Machado MC. An alternative of open laparoscopy. Rey Hosp Clin Fac Med Sao Paulo 1998;53:174.
6.
Sadeghi-Nejad H, Kavoussi LR, Peters CA. Bowel injury in open technique laparoscopy cannula placement. Urology 1994;43:559–60.
7.
Jared LA, Sunil B, Mathew EB, Mark AV, Nayan DS. Safe and rapid laparoscopic access – a new approach. World J Surg 2005;29:800–3.

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