scholarly journals DURATION OF SURGERY OF LAPAROSCOPIC NEPHRECTOMY -AN INITIAL EXPERIENCE IN IGMC, SHIMLA

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Bhartendu Nagesh ◽  
D.K Verma ◽  
R S Jhobta ◽  
Sanjiv Sharma ◽  
Mehar Chand
Keyword(s):  
Operating Time ◽  
Standard Of Care ◽  
Laparoscopic Nephrectomy ◽  
P Value ◽  
Dense Adhesion ◽  
Medical College ◽  
Duration Of Surgery ◽  
The Mean ◽  
Gandhi Medical College ◽  
Hydronephrotic Kidney

Background: Laparoscopic nephrectomy has been established as the standard of care for the management of benign non-functioning kidneys and has gained worldwide popularity over the past decade. Methods- This study was conducted in the Department of General surgery, Indira Gandhi medical college, Shimla on 20 selected patients of benign non functional kidney admitted for elective Laparoscopic Nephrectomy between July 2018 to June 2019 Results: In this study, the mean operating time in success full laparoscopic nephrectomies was 103.7 + 20.6 min in lap converted to open it was    165 .7 +26.99 min and in hand-assisted tame taken was 150 min which is statically not significant with p value =0.1317. Conclusion: The mean time taken for completion of laparoscopic nephrectomy in first 4 cases was 105 min and in next 4 cases was 108 min and in last 4 cases it was 97 min there was definitive learning curve as in last 4 cases operating time was less as compared to initial cases but operating time also depends on other factors like in hydronephrotic kidney due to well maintained plane dissection take less time ,but in  pyonephrotic kidney ,tubercular kidney,previously intervension like PCN, there were dense adhesion resulting in more time for disection. Keywords: Laparoscopy, Nephrectomy, Duration of surgery

scholarly journals BLOOD LOSS IN LAPAROSCOPIC NEPHRECTOMY -AN INITIAL EXPERIENCE IN IGMC, SHIMLA

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Bhartendu Nagesh ◽  
D.K Verma ◽  
R S Jhobta ◽  
Sanjiv Sharma ◽  
Mehar Chand
Keyword(s):  
Blood Loss ◽  
Standard Of Care ◽  
Laparoscopic Nephrectomy ◽  
P Value ◽  
Dense Adhesion ◽  
Medical College ◽  
The Mean ◽  
Gandhi Medical College ◽  
End Stage ◽  
Hydronephrotic Kidney

Background: Laparoscopic nephrectomy has been established as the standard of care for the management of benign non-functioning kidneys and has gained worldwide popularity over the past decade. Methods: This study was conducted in the Department of General surgery, Indira Gandhi medical college, Shimla on 20 selected patients of benign non functional kidney admitted for elective Laparoscopic Nephrectomy between July 2018 to June 2019 Results: Less than 100 ml of blood was lost in 3(15%) of the patient. 100 to 200 ml was lost in 9(45%) and in 3(15%) patients 200 to 300 ml blood was lost and 5 (25%) had blood loss more than 300 ml. The mean blood loss in successful laparoscopic nephrectomy was 129 +123 ml and in lap converted to open was 435.7 + 174.9 ml. which is significantly less in successful lap nephrectomy which is statistically significant with a p-value of o.oo3 Conclusion: Mean blood loss in laparoscopic nephrectomy was 145 +144 ml and in converted cases, it was 350+200 ml.  mean blood loss in hydronephrotic kidney was 145+ 144.2 ml in pyonephrotic kidney 325+ 318 in end stage nephrolithiasis  350+ 200  ml .There was more  blood loss in ESRD and pyonephrotic  kidney due   to dense adhesion whereas blood loss is less in hydronephrotic kidney due to well maintained plane for dissection . Keywords: Laparoscopy, Nephrectomy, Blood loss

scholarly journals Hemilaminectomy approach for intradural extramedullary spinal tumors: an analysis of 164 patients

2015 ◽  
Vol 39 (2) ◽  
pp. E9 ◽  
Author(s):  
Mazda Keki Turel ◽  
Wilson Prashanth D’Souza ◽  
Vedantam Rajshekhar
Keyword(s):  
Spinal Cord ◽  
Operating Time ◽  
Spinal Tumors ◽  
Duration Of Symptoms ◽  
Medical College ◽  
Intraoperative Fluoroscopy ◽  
Duration Of Surgery ◽  
Intradural Extramedullary ◽  
The Mean ◽  
Improved Accuracy

OBJECT The authors report their experience with the use of a minimally invasive hemilaminectomy approach for the excision of intradural extramedullary (IDEM) tumors of the spinal cord. METHODS Included were 164 consecutive patients (167 tumors in total), treated between January 2004 and December 2014, in whom the hemilaminectomy approach for IDEM spinal cord tumors was planned. The clinicoradiological data of patients presenting to Christian Medical College were analyzed retrospectively using a computerized chart-review method. Preoperative MRI localization was used in 51 cases. RESULTS The mean age (± SD) of the patients was 42.6 ± 16.6 years, and the mean duration of symptoms was 20.8 ± 27.8 months. The average tumor size was 2.4 ± 1.7 cm. Forty-four tumors were cervical, 5 were cervicothoracic, 72 were thoracic, 7 were thoracolumbar, and 39 were lumbar. Forty-two tumors were ventrally located, whereas 11 were ventrolateral; the rest were either dorsal or dorsolateral. The most common pathologies were schwannoma (110 cases) and meningioma (31 cases). Total excision was achieved for 93% of the tumors. The average duration of surgery was 1.6 ± 0.6 hours. CONCLUSIONS The hemilaminectomy approach to the removal of intradural tumors was quick and safe and resulted in minimal morbidity and no mortality. Preoperative MRI localization improved accuracy and reduced operating time by eliminating the need for intraoperative fluoroscopy.

scholarly journals Validity of the Diabetes, Hypertension and Hyperlipidaemia (DHL) Knowledge Instrument among Medical Students of Karachi

2016 ◽  
Vol 9 (1) ◽  
pp. 265
Author(s):  
Muhammad Bilal ◽  
Abdul Haseeb ◽  
Aleena Zehra Merchant ◽  
Muhammad Ahad Sher Khan ◽  
Arsalan Majeed Adam ◽  
...  
Keyword(s):  
Medical Education ◽  
Medical Students ◽  
Knowledge Score ◽  
Educational Status ◽  
Educational Programs ◽  
P Value ◽  
Medical College ◽  
Knowledge Based ◽  
The Mean ◽  
Knowledge Levels

BACKGROUND: While there have been a number of studies on DM, hypertension and hyperlipidaemia, an instrument which assesses knowledge based on all three conditions has neither been established nor authorized in Pakistan. Hence, the focus of this study was to establish a pre- tested extensive questionnaire to evaluate medical students’ understanding of DM, hypertension, hyperlipidaemia and their medications for use.METHODS: A pre-validated and pre-tested DHL instrument was employed on 250 students of Dow Medical and Sindh Medical College and on 45 physicians working in a leading teaching hospital of Karachi. The DHL knowledge instrument was then distributed a second time to the very same set of students, after a period of 2 months, at the end of the foundation module, once they had received some basic formal medical education including diabetes and CVS diseases.RESULTS: The overall internal consistency for the DHL instrument failed to comply with the set standard of more than or equal to 0.7 as our results yielded Cronbach’s α of 0.6. Overall the average difficulty factor of 28 questions is 0.41, which highlighted that the instrument was moderately tough. The mean scores for all domains were substantially lower in the students section in comparison to that of the professional section, which had remarkable impact on the overall mean(SD) knowledge score (40.58 ± 14.63 vs. 63.49 ± 06.67 ; p value = 0.00).CONCLUSION: The instrument can be used to recognize people who require educational programs and keep an account of the changes with the passage of time as it could help in differentiating the knowledge levels among its participants based on their educational status.

An Evaluation of the Effect of Catheter-Directed Continuous Infusion of Local Anesthetic by Elastomeric Pump on Opioid Usage Following Donor Kidney Nephrectomy

2021 ◽  
pp. 106002802110178
Author(s):  
Jessica Goldsby ◽  
Kerry Schwarz ◽  
Ike Kim ◽  
Victor Lewis ◽  
Clark Lyda
Keyword(s):  
Continuous Infusion ◽  
Oral Morphine ◽  
Standard Of Care ◽  
Postoperative Pain Management ◽  
Bowel Function ◽  
Laparoscopic Nephrectomy ◽  
Kidney Donors ◽  
Pain Scores ◽  
The Mean ◽  
Postoperative Administration

Background Postoperative pain management following donor nephrectomy can prove challenging for immediate discharge on postoperative day 1 or 2. Although the standard for pain control is utilization of opioids, this increases the risk of postoperative ileus and, if continued inappropriately, increases excess opioids circulating in the community. One strategy that proposes to limit postoperative opioids in kidney donors is the continuous infusion of local anesthetics (CILA), though the effect on patient outcomes is unclear. Objective The purpose of this study was to evaluate the effectiveness of postoperative CILA to decrease opioid usage in kidney donors who undergo laparoscopic nephrectomy. Methods A retrospective analysis was conducted of kidney donors who underwent laparoscopic nephrectomy and received CILA (CILA group) compared with kidney donors who received standard-of-care (SOC) postoperative analgesia. The primary outcome was the mean total oral morphine equivalents (OMEs) administered following surgery. Results A total of 176 kidney donors were evaluated, 88 in each group. The mean OME administered in the CILA group was significantly higher than in the SOC group: 194.8 versus 133.5 mg ( P = 0.003). Mean total postoperative administration of acetaminophen was also increased in the CILA group: 3736.9 versus 2611.6 mg ( P = 0.0041). Mean length of stay following surgery was higher in the kidney donors who received CILA, whereas return to bowel function, time to ambulation, and pain scores were not significantly different. Conclusion and Relevance This report demonstrated that CILA is not an effective modality to reduce opioid utilization or improve recovery in kidney donors following laparoscopic nephrectomy.

scholarly journals Outcome analysis of surgical management of comminuted quadrilateral plate acetabulum fractures

2019 ◽  
Vol 5 (5) ◽  
pp. 883
Author(s):  
Chandan Uday Kulkarni ◽  
Abhijit Sen ◽  
Jimi Jose
Keyword(s):  
Surgical Management ◽  
Operating Time ◽  
Clinical Score ◽  
Outcome Analysis ◽  
Medical College ◽  
Quadrilateral Plate ◽  
Spring Plate ◽  
Acetabulum Fractures ◽  
Clinical And Radiological Outcome ◽  
The Mean

<p class="abstract"><strong>Background:</strong> The acetabular quadrilateral fractures are difficult to treat and ORIF using a spring plate buttressing the quadrilateral surface underneath an iliopectenial plate in a 90-90 construct. The aim of the study was to assess the clinical and radiological outcome, success rate and proportion of the post-operative complications of surgical management of comminuted quadrilateral plate acetabulum fractures after ORIF.</p><p class="abstract"><strong>Methods:</strong> It was a hospital based descriptive type of observational study conducted in the Department of Orthopedics, SMS Medical College. The data collection was done from May 2016 up to June 2018. The sample size was 31 for the study purpose, at 95% confidence limits and 20% relative allowable error.<strong></strong></p><p class="abstract"><strong>Results: </strong>We studied 31 patients of communited quadrilateral plate fractures, who were evaluated preoperatively and optimized. ORIF was performed. The mean blood loss was 450 ml and the mean operating time was 130 minutes. The patients were followed up at 1 year postoperatively where 24 patients had an excellent to good Harris Hip clinical score and 24 patients had an excellent to good Matta radiological score, and both were found to be statistically significant.</p><p><strong>Conclusions:</strong> Comminuted quadrilateral plate fractures of the acetabulum are managed surgically by ORIF using a spring buttressing plate beneath the infrapectenial plate. The clinical and radiological follow up for one year duration scores showed good scores which were statistically significant, indicating the success of quadrilateral fixation using this technique. </p>

scholarly journals Application of platysma muscle suture after thyroidectomy

2020 ◽  
pp. 147-150
Keyword(s):  
Postoperative Pain ◽  
Wound Infection ◽  
Intervention Group ◽  
Control Group ◽  
P Value ◽  
Platysma Muscle ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
The Mean ◽  
Length Of Hospitalization

Introduction: Thyroidectomy is a common surgery in the neck area, in which the application of platysma muscle suture after thyroidectomy is still being discussed. This study was conducted to compare the application (currently common) or non-application of suture for platysma muscle. Methods: In this retrospective cross-sectional study, 117 patients underwent thyroidectomy, among which 63 cases without suturing platysma (control group) and 54 subjects with suturing platysma (Intervention group ) were examined in terms of postoperative pain based on visual analogue scale score measured 24 h post-operation. The samples were also investigated regarding hematoma and seroma, wound infection, length of hospitalization, scarring (1 year after surgery), duration of surgery, and the number of cases using opioids during the hospitalization. Patients with diabetes, previous neck surgery, coagulopathy, and radiation history were excluded from the study. The gathered data were analyzed statistically in SPSS software (version 18) using the Chi-square test and the Mann–Whitney U test. A p-value of less than (0.05) was considered significant. Results: Based on the findings, the mean age of the patients in the Intervention group was calculated at 51 years, of which 41 and 13 cases were females and males, respectively. In the Intervention group, 34 patients underwent complete thyroidectomy and 20 patients had hemithyroidectomy. The mean age score of subjects in the control group was calculated at 50 years, of which 44 and 19 patients were respectively female and male. No significant difference was revealed considering wound infection, length of hospitalization, created scarring, the amount of opioid use (opioids), and postoperative pain. However, only the length of surgery was different between the groups (P-value<0.05). Conclusions: There was no difference between wound and surgical complications and cosmetic results between both groups; nevertheless, due to the duration of the surgery and other benefits, such as consuming less thread, not suturing the platysma is recommended.

scholarly journals TO STUDY THE FUNCTIONAL AND THE RADIOLOGICAL OUTCOME OF TUBERCULOSIS OF SPINE OPERATED BY POSTERIOR APPROACH.

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Anil Kumar ◽  
Manoj Kumar Thakur ◽  
Rahul Kumar Singh
Keyword(s):  
Lumbar Spine ◽  
Posterior Approach ◽  
P Value ◽  
Radiological Outcome ◽  
Skeletal System ◽  
Kyphotic Angle ◽  
Medical College ◽  
Significant Difference ◽  
Gandhi Medical College ◽  
Tuberculosis Of Spine

Background: Tuberculosis is ubiquitous in distribution. Globally, nearly 30 million people suffer from tuberculosis. 3 million deaths occur due to tuberculosis per year. India has burden of 6 million cases. Of these 1-3% constitutes skeletal system involvement. Methods: The present study included prospective cases of tuberculosis of dorsal and lumbar spine admitted and operated at Indira Gandhi Medical College, Shimla between May 2017 to May 2018 and retrospective patients who have been operated before May 2017. Results: There was improvement from preoperative kyphotic angle to postoperative kyphotic angle and improvement in kyphotic angle as a significant difference less than 0.05 (p value is 0.01). Conclusion: At the end of our study, we concluded that good sagittal balance along with good fusion of the vertebrae leads to better functional outcome in patients. Keywords: Spine, TB, Kyphotic angle.

Uterine Isthmus Tourniquet during Abdominal Myomectomy: Support or Hazard? A Randomized Double-Blind Trial

2020 ◽  
Vol 85 (5) ◽  
pp. 396-404
Author(s):  
Abolfazl Mehdizadehkashi ◽  
Kobra Tahermanesh ◽  
Samaneh Rokhgireh ◽  
Vahideh Astaraei ◽  
Zahra Najmi ◽  
...  
Keyword(s):  
Blood Loss ◽  
Ovarian Reserve ◽  
Operating Time ◽  
Serum Levels ◽  
Massive Hemorrhage ◽  
Control Group ◽  
Double Blind ◽  
Abdominal Myomectomy ◽  
Duration Of Surgery ◽  
The Mean

<b><i>Background and Objectives:</i></b> A tourniquet has been suggested as a useful means of reducing massive hemorrhage during myomectomy. However, it is not clear whether the restricted perfusion affects the ovaries. In the present study, we examined the effect of a tourniquet on ovarian reserve and blood loss during myomectomy. <b><i>Materials and Methods:</i></b> In a randomized double-blind clinical trial, fertile nonobese patients scheduled for abdominal myomectomy at Rasool-e-Akram Hospital from February 2018 to June 2019 were randomized to a tourniquet (<i>n</i> = 46) or a non-tourniquet group (<i>n</i> = 35). Serum levels of anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) were measured before and 3 months after surgery, blood loss was recorded during surgery, and serum levels of hemoglobin (Hb) were recorded before surgery, 6 h and 3 days after surgery. SPSS version 21 was used for statistical analysis. <b><i>Results:</i></b> Demographic, obstetric, and myoma characteristics were similar in the 2 groups (<i>p</i> &#x3e; 0.05). The mean baseline values of AMH and FSH did not differ between groups (<i>p</i> &#x3e; 0.05). After surgery, only FSH was higher in the control group (<i>p</i> = 0.043). Despite the time taken to fasten and open the tourniquet, the mean operating time was shorter in the tourniquet group (<i>p</i> &#x3c; 0.001). Blood loss was higher in the control group (<i>p</i> = 0.005). The drop in Hb levels at 6 h after surgery was higher in the non-tourniquet group (<i>p</i> = 0.002). Blood loss was significantly associated with the duration of surgery (<i>r</i> = 0.523, <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> The use of a tourniquet during abdominal myomectomy significantly reduced the mean volume of blood loss compared to the non-tourniquet group, while it did not prolong the duration of surgery, nor reduced the ovarian reserve. A tourniquet is a safe and efficient measure during abdominal myomectomy.

Factors predicting the occurrence of syringomyelia in patients with Chiari I malformations

2019 ◽  
Vol 7 (8) ◽  
pp. 2967
Author(s):  
Vijayan Peettakkandy ◽  
Bijukrishnan Rajagopalawarrier ◽  
Sreenath Kuniyil ◽  
Jithin Veliyath Thankaraj
Keyword(s):  
Foramen Magnum ◽  
P Value ◽  
Tonsillar Herniation ◽  
Duration Of Symptoms ◽  
Medical College ◽  
Chiari I ◽  
The Mean ◽  
Time Of Presentation ◽  
Common Association ◽  
Cerebellar Tonsils

Background: Chiari I malformations are defined as the downward herniation of cerebellar tonsils more than 5 mm through the foramen magnum. Syringomyelia is a common association of Chiari I malformation.Methods: This purpose of this study was to determine the various factors predicting the occurrence of syringomyelia in patients with Chiari I malformations. This retrospective study was conducted in Government medical college, Thrissur, Kerala, India. 27 patients admitted with diagnosis of symptomatic Chiari I malformations during the period of January 2015 to January 2019 were selected for the study.Results: The mean age was 22.8 years and syringomyelia was more common in patients older than 10 years (p value0.005). Females were 17(63%) and males were 10(37%) but there no difference in occurrence of syringomyelia among both sexes(p value is 0.16). Syringomyelia was present in 17(63%) cases. Association between various factors and syringomyelia measured by calculating P value which was 0.005 for age >10 years, 0.16 for sex, 0.093 for duration of symptoms >12 months, 0.05 for tonsillar descend >10mm and 0.097 for hypertension. The p value for the association of duration of symptoms >12months and extend of tonsillar descend is 0.001 Mean duration of symptoms (onset of first symptom to the time of presentation) was 16.3 months and syringomyelia was more common in patients with duration of symptoms more than 12 months but this difference was statistically not significant (p value 0.093). Mean tonsillar descend from the level of foramen magnum was 11.3 mms and syringomyelia was more common in patients with tonsillar herniation more than 10mm (p value 0.05). There is a statistically significant relationship between duration of symptoms more than 12 months and tonsillar descend more than 10mm(p value 0.001).There is no significant association between hypertension and occurrence of syringomyelia in patients with Chiari I malformation.Conclusions: Incidence of Chiari I Malformations is more among adults and it is slightly higher in females. Syringomyelia is a common association of Chiari I Malformations. The occurrence of syringomyelia in patients with Chiari I Malformations associated with increasing age of patients and extend of tonsillar herniation. There is no statistically significant association between syringomyelia and duration of symptoms or hypertension.

scholarly journals Comparison of the surgical and post-operative outcomes between single incision laparoscopic appendicectomy (cross triangulation method) with normal conventional laparoscopic appendicectomy

2021 ◽  
Author(s):  
Pratheep Samraj Rajendran Paulraj ◽  
Kiran Kailas Chirayil ◽  
Renuka Jayakumar Bellasindhi ◽  
Punitha Thetraravu Oli ◽  
Mohith Mathew ◽  
...  
Keyword(s):  
Recovery Time ◽  
Single Incision ◽  
Operating Time ◽  
Laparoscopic Appendicectomy ◽  
Conventional Laparoscopic ◽  
Post Operative Pain ◽  
Conversion Rates ◽  
Duration Of Surgery ◽  
The Mean ◽  
Operative Recovery

Background: The usual multiport conventional laparoscopic surgeries (appendicectomy) are now being replaced by single incision laparoscopic surgeries (appendicectomy).In our study various aspects of SILS in comparison with the multiport conventional laparoscopic appendicectomy such as incision site pain, duration of surgery, morbidity and instruments used are discussed, duration of surgery, morbidity and instruments used are discussed.Methods: A single blinded randomized control trial was done on patients presenting with acute appendicitis. Pain numerical scale, use of analgesics, time to return to routine activities, hospital re-admission, complication like port site infection, hernia, intra operative complications rates, conversion rates and duration of surgery were evaluated. Various statistics of pain and other parameters are studied and evaluated. The mean operation time, mean recovery time, post-operative pain were statistically analysed using unpaired t-test. Results: Mean operating time was 44.16 minutes for SILS and 26.88 minutes for laparoscopic appendicectomy. The mean operative pain in scale of 1 to 4 was 1.40 and 0.40 for SILS and for laparoscopic appendicenctomy respectively making SILS more pain free and comfortable for the patient. The mean post-operative recovery time was 3.12 days for SILS and 7.88 days for laparoscopic appendicenctomy giving SILS patients more rapid recovery and resumption of work.  Conclusions: SILS offers better cosmetic outcome, lesser post-operative pain and shorter duration of hospital stay compared to classical 3 port conventional laparoscopic surgery but at the expense of time. Operative difficulties along with time constraint need to be overcome by the surgeon.

Sign in / Sign up

Export Citation Format

Share Document