Transcanal Endoscopic Antrostomy Hole : Its Utility in Restoring Ventilation Pathway to Epitympanum and Mastoid Antrum During Tympanoplasty

Aim: To evaluate the role of newly created transcanal endoscopic antrostomy hole as a passage in restoring the aeration of epitympanum and mastoid antrum.Materials & Methods: Study design: Retrospective case series study. Study duration: From January 2013 to January 2014. Study place: Private tertiary care hospital. Patients: 27 ears of 23 adult patients (age ranging from 15years to 54years) underwent transcanal endoscopic tympanoplasty for their chronic middle ear diseases in presence of inflamed middle ear mucosa along with radiological shadows of stagnant fluid in their epitympanum and mastoid antrum. Structured three months follow-up was ensured in every case. Intervention: A hole was created at a selected site of posterior meatal wall purely through transcanal endoscopic approach that established direct communication between mastoid antrum and external auditory canal. Thereafter this newly created passage was used for three purposes- assessment of the condition of mastoid antrum, performing the water test for checking epitympanic patency and in few cases placement of temporary tube for postoperative ventilation and drainage of middle ear. Main out come measures: The feasibility, performance and management of transcanal endoscopic antrostomy hole as passage for reestablishing the aeration of epitympanum and mastoid antrum.Results: The chosen site for antrostomy hole was found effective and safe in providing convenient entrance into the mastoid antrum in every case in this study with out facing technical complexity and failure. Postoperative healing of skin over antrostomy hole was found complete in all ears without any inward growth of skin in to mastoid antrum. Available post operative CT scan imaging of temporal bones showed improved aeration in their epitympanum and mastoid antrum.Conclusions: The role of transcanal antrostomy hole has been proved worthy in restoring ventilation pathway to epitympanum and mastoid antrum during tympanoplasty. This antrostomy hole has the potentiality to be considered in future for placement of long term mastoid ventilation tube in order to treat persistent atelectatic middle ear.

Posterior Urethral Obstruction: COPUM

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Laparoscopic Excision of A Rare Retroperitoneal Non-Pancreatic Pseudocyst

Retroperitoneal cysts (RCs) are rare. They are composed of both epithelial and mesothelial tissues, and those without an epithelial lining in the wall are called pseudocysts. Most retroperitoneal pseudocysts are pancreatic in origin, and nonpancreatic pseudocysts are very rarely reported.We report a case of large cystic lesion adjacent to the left kidney in a 25 years old man. He presented with 2 and half years history of gradual swelling of left upper abdomen. Abdominal ultrasonography and CT scan showed a large unilocular cystic mass in left side of the abdomen, which was attached with the lower pole of the left kidney. The cystic mass was excised laparoscopically. Histology showed a fibrous wall without epithelial lining thus confirming the diagnosis of a nonpancreatic pseudocyst.

Laparoscopic Assisted Orchidectomy Eases Future Insertion of Testicular Prosthesis in Paediatric Patients

High ligation orchidectomy in paediatric patients is performed for testicular tumours. This is carried out via open surgery at the inguinal or groin region. In these boys, elective insertion of testicular prostheses is carried out later to improve the external genitalia appearance. In most cases, insertion of testicular prosthesis or implant is carried out via the previous scar, to avoid prosthesis extrusion; however this is usually difficult due to scarring and may cause haematoma and possible infection. We report a novel technique of laparoscopic assisted orchidectomy in an adolescent boy with disorder of sexual development (DSD) whom was suspected of having bilateral gonadal (testicular) malignant change, he successfully underwent bilateral ligation of testicular vessels laparoscopically and removal of both testes via a midline scrotal raphe incision; hence avoiding bilateral groin incisions. With this method, future insertion of testicular prostheses can be carried out via virgin inguinal incisions.

Laparoscopic vs Open Appendectomy : A Comparative Study

Backgraound: Open appendectomy (OA) has been the treatment of choice for acute appendicitis since its introduction by Mc-burney in 1884. Laparoscopic appendectomy(LA) though widely practiced, has not gained universal approval. LA was first described in 1983. Some early studies showed equivocal results about benefit of LA. Recent studies showed overall benefit in favour of LA. So far no such a large study was done in any Bangladeshi hospital. So, we decided to do this study with a view to evaluate the therapeutic benefit of LA by comparing with conventional OA.Materials and methods: We collected data of 763 appendectomies done in Jahurul Islam medical college hospital from July 2007 to June 2012 for a period of 5 years. Out of them 448 had conventional OA and 315 had LA. We compared the mean operation time, time of first oral feeding, narcotic analgesic requirement, duration of post operative hospital stay.Results: We found that mean operation time was 33±5.8 minute and 37± 7.5 minute in LA and OA respectively. Duration of post operative hospital stay was 1.2 days shorter in Laparoscopic group. LA required 1.1 shots of less analgesic than OA. Oral feeding was resumed 21 hours earlier following LA compared to OA. Laparoscpic appendectomy was safely performed in paediatric patient without any adverse effect. We also found that, in female patient, concurrent ovarian cysts, tubal pregnancy and endometriosis can be diagnosed and managed laparoscopically in the same sitting.Conclusion: Our study found that laparoscopic appendectomy is an effective and safe procedure irrespective of age and sex of the patient. LA has added advantage of early return of bowel movement, less post-op hospital stay and less requirement of narcotic analgesic.

Current Trends in Pediatric Robotic Surgery

Not available.

A Comparative Study Between Laparoscopic Management of Ectopic Pregnancy and Laparotomy: Experience in Tertiary Care Hospital in Bangladesh: A Prospective Trial

Objectives: To compare the efficiency and surgical morbidity associated with laparoscopic management of tubal ectopic pregnancy (EP) compared with that of open laparotomy. Materials and methods: During November 2008 to October 2012, there were 89 with a confirmed ectopic pregnancy These patients were admitted through emergency or outpatient department and managed by laparoscopy (number 70) and by laparotomy (number 19). The diagnosis of ectopic pregnancy was based on history, clinical symptoms, physical examination, a positive serum B-human chorionic gonadotropin (B-HCG), transvaginal ultrasonography. Patients were informed pre-operatively about the surgical procedures. The main outcome measured included operative time, blood loss, and complications.Results: Laparoscopic surgery gives an overall success rate of 98.9%. Linear salpingostomy was the main procedure performed in both groups. Estimated blood loss was significantly lower in the laparoscopy group compared with laparotomy group (p<0.001). Only 3 (3.81%) patients in the laparoscopy group required blood transfusion, whereas 16 (74.94%) in the laparotomy group needed transfusion (P<0.0001). The duration of operation in laparoscopy group was 53.2 ± 16.8 minutes and 84.5 ± 30.3 minutes in the laparotomy group. The duration of hospitalization was significantly shorter in the laparoscopy group 1.12±0.5 days compared to 5.25±0.1days in the laparotomy group (p<0.0001). ). In the laparoscopy group 57(72.4%) patients did not need analgesia after surgery compared with laparotomy group where all the patients needed analgesia.Conclusion: Laparoscopic treatment (Salpingostomy or Salpingectomy) of EPs offers major benefits superior to laparotomy in terms of less blood loss, less need for blood transfusion and postoperative analgesia, a shorter duration of hospital stay. Laparoscopic management of ectopic pregnancy might be the most beneficial procedure with maximal safety and efficacy.