ABSTRACT
Introduction: With the advent of laparoscopic surgery,urologists once again found it necessary to traverse theperitoneal cavity in order to provide their patients with thebenefit of this less invasive type of surgery. In this study westudied the prevalence of laparoscopic urological surgeries,ergonomics involved, difficulties faced and complicationsrelated to laparoscopic procedures.Material and methods: It was a prospective hospitalbased non-randomised study carried out among 36 indoorcases operated using various laparoscopic procedures vizlaparoscopic pyeloplasty, laparoscopic pyelolithotomy,laparoscopic nephrectomy, laparoscopic ureterolithotomy etc.admitted under department of general surgery in a tertiaryhealthcare teaching instituteResults: In the present study, out of 31 cases, 20 casespresented with diagnosis of renal stone disease (Renal pelviccalculi, staghorn renal calculi and ureteric calculi). Total 5cases i.e 16.12% cases were having diagnosis of chronic nonfunctioning kidney while 3 cases (9.67%) were presented withrenal cell carcinoma. 3 cases (9.67%) presented with pelviureteric junction obstruction.Conclusion: Laparoscopic pyelolithotomy in extrarenal pelvisis a good procedure as pelvis can be reached easily especiallyif pelvis is dilated and Laparoscopic ureterolithotomy inabdominal ureter is a promising surgery as entire ureter canbe visualized so stones are easily detected and surgeon has abetter control of proximal ureter in case of slippage of calculas
ABSTRACT
Thyroidectomy is one of the most common operations performed throughout the world, with solitary thyroid nodules being one of the more common indications for surgery. Though conventional open thyroidectomy is considered extremely safe and remains the treatment of choice, it is associated with an undesirable scar. Endoscopic thyroidectomy has the distinct advantage of limiting external scarring and having better cosmetic results. It moreover is associated with reduced post-operative pain, and enhanced postoperative recovery. Methods: It was a hospital based non randomized prospective descriptive study carried out in department of general surgery at tertiary hospital in which 39 patients with benign thyroid lesions were included on the basis of a predefined inclusion and exclusion criteria. Detailed history, clinical and local examination was done in all the cases. Thyroid function tests, FNAC under ultrasound guidance, indirect laryngoscopy and imaging of thyroid gland was done in all the cases. All patients underwent endoscopic thyroid surgery (Total, near total, subtotal or hemithyroidectomy). Patients were followed up for 6 months after surgery. P value less than 0.05 was taken as statistically significant. Results: Out of 39 studied cases there were 35 males and 4 females with a M:F ratio of 1:8.75. Most common age group was found to be 30-40 years with a mean age of 32 yrs. Average size of thyroid nodule was 3.20 cms and right lobe was predominantly involved (69.23%). Predominant Pathology on FNAC was found to be colloid goiter (71.79%). All patients underwent endoscopic thyroidectomy. Mean duration of surgery was 55 minutes. Most common surgery undertaken was hemithyroidectomy (84.62%) followed by total thyroidectomy (10.16%) and completion total thyroidectomy (5.13%). Average total blood loss was significantly less (36 ml). Mean visual analogue score at 24 and 48 hours post-operatively were 4.14 and 2.85. Mean duration of hospital stay was 3.3 days. Majority of the patients (89.75%) were extremely satisfied with the cosmetic results. Conclusion: Endoscopic thyroidectomy for Benign thyroid lesion is associated with less blood loss during surgery, comparatively less severe pain, decreased mean duration of hospital stay and satisfactory cosmetic results.
ABSTRACT
A 50 year old female patient presented with history of regurgitation of food, heart burn, dyspepsia. Patient was investigated and presence of large hiatus hernia was confirmed on endoscopy, computed tomogram chest and barium swallow. Patient had severe symptoms even with maximum medical management, therefore surgical intervention was planned. Left posterolateral thoracotomy was done through sixth intercostal space. Mobilization of esophagus, reduction of stomach and Belsey Mark IV 270 degree anterolateral fundoplication was done. Patient was discharged on 7th postoperative day. First follow up was I month after the discharge and patient had significant relief from the preoperative problems.