Rise of robots in surgical territory

Robotic surgery is a rapid advancement in the scientific strata of artificial intelligence and has evolved into a refined tool for the surgeons. Over the last 30 years, this field has evolved in leaps and bounds with wide applications in the field of surgery by improving the dexterity and accessibility for the surgeons in various array of major complicated cases. The surgical armamentarium has been strengthened by evolution of robotic surgery to an extent that man may be replaced by artificial intelligence-based robots in the operation theatre, thereby eliminating the possibility of human errors and limitations.

Can I Be Pregnant? – Diagnostic Challenges in Ruptured Chronic Ectopic Pregnancy

Ectopic pregnancy is an obstetric emergency which accounts for 4% of all pregnancy-related deaths. All women of child bearing age with abdominal pain or vaginal bleeding presenting to the Emergency Department should be evaluated for ectopic pregnancy. However, there have been many reported cases of diagnostic challenges of ectopic pregnancy. One rare variant of ectopic pregnancy that can be easily overlooked is chronic ectopic pregnancy. We present this case of a 39-yearold female, who presented with acute abdomen and free fluid in her abdomen. Urine pregnancy test indicated she was not pregnant. However, intraoperative findings confirmed left tubular pregnancy. We would like to highlight three major diagnostic challenges we faced in this case i.e.; (i) women of child bearing age with abdominal pain should always be evaluated for ectopic pregnancy; (ii) diagnosis of ectopic pregnancy should not be dismissed even though the pregnancy test is negative; and (iii) the role of computed tomography (CT) scan in acute abdomen of unclear aetiology. As a rule, all haemodynamically unstable acute abdomen should be sent to the operation theatre. Haemodynamically stable patients should be carefully evaluated to facilitate surgical management.

A comparison of Lidocaine and Ketamine for prevention withdrawal from injection of Rocuronium.

Aim : To make comparison of the effects of lidocaine and ketamine in preventing withdrawal moments linked with IV injection of rocuronium . Methods: About sixty candidates (ASA I & II) were chosen for this case research and categorized into two groups via aid of random number table in such a manner that each group contained 30 individuals. Candidates belonging to group A were administered ketamine in the dosage of 0.5mg/kg that was diluted in 2ml whereas group B candidates were administered 2ml of 1% lidocaine. On the dorsum of the hand, 20 gauge cannula will be inserted intravenously and candidate will be administered midazolamin doage of 0.02mg/kg intravenously for five minutes before coming into in the Operation theatre. After arrival of candidate , non-invasive routine monitoring of the candidates will be carried out and free fluid flow fluid via cannula will be assured by gravity with aid of IV fluid as normal saline. At room temperature, the syringes will be placed. Administration of drugs will be carried out via the injection port of intravenously cannula with a free fluid flow intravenously. Results: In case of ketamine , the prevalence withdrawal movements was recorded as 43.3% and lidocaine as 40%. In case of both research groups, the mean withdrawal scores were similar (P value two tailed = 1.0 (>0.05). Two candidates among these individuals i-e one from each groups depicted generalized response (3.3%). No noteworthy difference was recorded in case of lidocaine and ketamine for preventing withdrawal moments after administration of injection of rocuronium. Conclusion: Equal effectiveness of lidocaine 1% and Ketamine 0.5mg/kg 2ml (20mg) was recorded in deducing withdrawal moments after administration of injection of rocuronium intravenously . Keywords: Lidocaine, ketamine, withdrawal movements

A critical Review of Dhoopan Karma in Ayurveda and Dhoopana of an Ayurvedic Herbomineral formulation Yavasarshapadi churna in context of Sterilization.

Dhoopana Karma is classical remedy mentioned in various Ayurvedic scriptures to maintain disease free and hygienic environment in the world. As per Ayurvedic scriptures Dhoopana is indicated for Rakshoghna Karma which means killing of disease producing microorganisms. Hence, it plays key role in prevention and cure of various infectious diseases.A similar process called fumigation is one of best and fastest method to maintain asepsis, antisepsis in wards and operation theatres of hospitals.Additionally, this study comprises critical literary review of herbomineral formulation named Yavasarshapadi Choorna which is indicated in form of incense for Dhoopana karma. It is indicated in Ayurvedic scripture Charaka Samhita in chapter Jatisutriya Sharir Adhyaya of Sharir Sthana. It was reviewed in context of sterilization activity to maintain asepsis and antisepsis. Specifically, it is indicated for fumigation of cloths and belongings of post-natal period of Women and that of the New born, Drug preparation room, New born care room, Surgical Procedure room modern surgery, traditional operation theatre sterilization was done by formalin gas fumigation over many decades which is found to have carcinogenic effect over human lives. Ayurvedic modality named Dhoopana was undertaken in current study as it is a safe and healthy alternative for sterilization.It overcomes harmful effects caused by modern sterilization method i.e. Formalin gas fumigation which is need of an hour. The Analytical study of antimicrobial and antifungal effect of various Ayurvedic Dhoopana Dravyas is the need of the hour along with preclinical and clinical study to verify Sterilization activity of various Ayurvedic Dhoopana Dravyas.

Impacted vesicouretric stone a quagmire settled with holmium laser

A 38 years female presented with left flank pain, nausea, and vomiting. Ultrasound and Noncontrast CT scan were suggestive of left hydronephrosis with left Vesicoureteral stone (Figure 1). Conservative medical treatment previously was not successful. Blood investigations were Hb 11.5 gm%, TLC 11500/mm3 , urea 22, creatinine 0.6, urine was full of RBCs. She was taken to the operation theatre for emergency double j stenting. Cystoscopy showed impacted left vesicoureteral stone (Figure 2,3).

LMA PROSEAL: AN ALTERNATIVE TO ENDOTRACHEAL IN- TUBATION IN OPEN APPENDECTOMY OPERATION.' IN THE DEPARTMENT OF ANESTHESIOLOGY, MEDICAL COLLEGE, KOLKATA

INTRODUCTION One of the important responsibilities of an Anaesthesiologist is to maintain a patent airway during any surgical procedure. Since the early days of Anaesthesia, various efforts have been made to dispel the problem of airway maintenance. AIMS AND OBJECTIVES The study entitled “LMAProSeal: An alternative to endotracheal intubation in open appendicectomy operation” was conducted with the aims to compare the efcacy of LMA ProSeal and Endotracheal Tube in patients undergoing Open Appendectomy under General Anaesthesia. MATERIALAND METHODS Study Area: This study was conducted in Medical College, Kolkata (West Bengal), under the department of Anaesthesiology in General Surgery Operation Theatre (C. B. Top OT/ Green OTComplex), after clearance from the Hospital ethical committee, during the period from 1st may 2013 to 31st January 2014. Awritten informed consent was taken from all patients included in the study. StudyPopulation:Patients postedforopenAppendicectomyoperationwithBMIbetween18.50–24.99kg/m2andbodyweightbetween30—60kg. Sample Size: 100 RESULTS AND OBSERVATIONS The effects were observed by monitoring heart rate, blood pressure and SPO2 preoperatively (as baseline), after intubation or placement of LMAProSeal at 1 min, 3 mins, 5mins and every 5 mins thereafter till the reading at removal of the device. For both the groups baseline ETCO2 was taken from connection of ETCO2 cable following placement of airway devices. SUMMARY AND CONCLUSION The study revealed that both the airway devices (ET tube and LMA ProSeal) were successful in operative procedure (open appendicectomy) in all the patients without any signicant complication. In experienced hands and following a strict protocol of insertion, the LMA ProSeal can prove to be an efcient and safe alternative to endotracheal tube for airway management of elective patients undergoing laparotomy procedure like open appendicectomy.

Sewing machine spool in cervical canal: Case report

Background: Intentional placement or forgotten foreign bodies in the lower female genital tract have been reported. Patients may selfreport or may present with an array of symptoms including pelvic pain, vaginal discharge and vaginal bleeding. Case: Ms X, 23 years old, presented to antenatal clinic at two months pregnancy with complaints of excessive discharge per vaginum. There was no bleeding or foul smell. She did not reveal any other significant history. On internal examination, uterus was 8 weeks size, and a nodular lesion was felt in the cervical canal. Transvaginal USG confirmed intra-uterine pregnancy but also aroused the suspicion of a foreign body in the cervix. At examination in the operation theatre, the spool of sewing machine was found imbedded in cervical canal. It was gently dislodged and removed. Procedure and post-operative period were uneventful. The history was then reviewed. It came to light that the spool had been inserted in the cervical canal to expedite conception, without her knowledge when the patient was examined by an untrained birth attendant. Conclusion: Fear of infertility drives women to seek treatment from any source, as illustrated in this report. The spool inserted into the cervix was possibly to function as a “conduit” for the sperms Keywords: foreign body; cervix; pregnancy; discharge.

396 A 6-Month Audit of Initial Diabetic Foot Assessment and Documentation for Patients Undergoing Major Lower Limb Amputations in An Orthopaedics Ward

Aim To determine if adequate diabetic foot assessment and documentation were done at the Orthopaedics ward for patients undergoing a below-knee amputation (BKA) or above-knee amputation (AKA). Method Retrospective data from August 2019 to January 2020 were taken from paper documentation and e-records from the Orthopaedics ward and operation theatre. Diabetic foot assessments were based on the ASEANPlus guidelines for diabetic foot wounds which included foot inspection (for dermatological or musculoskeletal abnormalities), vascular (palpation of dorsalis pedis and posterior tibial pulses, ABSI measurement) and neurological assessments (testing of sensation and ankle reflexes). The assessments were deemed “adequate” or “inadequate” based on the information found on documentation. Results Only 67/81 data pieces were available for analysis (AKA=26, BKA=41), with an average age of 60 years. Inspection of the foot was most adequately assessed and documented (100%), followed by vascular and neurological assessment. For vascular assessment, palpation of pulses was done in 94% cases, and ABSI was performed in 76%. For neurological assessment, assessment of sensation was performed in 55%, while ankle reflexes were only assessed and documented in 25% cases. Conclusions Overall, the local practice had poor documentation of diabetic foot assessment, especially in vascular and neurological assessments. Possible reasons for poor practice include lack of guidance for incoming junior doctors starting their Orthopaedics rotation, and subsequently, the lack of skills and confidence in performing said assessments. Measures that could be done to improve the quality of practice include teaching key examinations to junior staff and having closer monitoring of notes documentation during ward rounds.

Comparison of endometrial sampling with pipelle versus conventional dilatation and curettage in abnormal uterine bleeding.

Objective: To compare the adequacy of endometrial sampling with pipelle versus conventional dilatation and curettage in patients with abnormal uterine bleeding. Study Design: Randomized Control Trial. Settings: Department of Obstetrics and Gynecology Madina Teaching Hospital affiliated with University Medical and Dental College Faisalabad. Period: July 2019 to June 2020. Material & Methods: A total of 90 patients with abnormal uterine bleeding were included in the study. Patients in Group A underwent endometrial sampling in OPD without anesthesia using pipelle. Patients in Group B were admitted, dilatation and curettage was done in operation theatre under anesthesia, endometrial tissue sent for histopathology. Patients were called in OPD on follow up visit with histopathology report. Results: Comparison of adequacy of endometrial sampling with pipelle versus conventional dilatation and curettage in abnormal uterine bleeding shows that 84.44% (n=38) in Group A and 91.11% (n=41) in Group B have adequate sample. P value was 0.33, showing insignificant difference. Conclusion: Pipelle has acceptable adequacy for endometrial sampling as compare to dilatation and curettage. It is an outpatient procedure, no need of anesthesia and cervical dilatation. Pipelle can be safely used as an alternative to conventional dilatation and curettage.