ABSTRACT
Purpose@#Laparoscopic approach to colonic tumor requires skill set and resources to be established as routine standard of care in most centers around the world. It presents particular challenge in country like Pakistan due to economic constrain and lack of teaching and training opportunities available for surgeons to be trained to deliver such service. The aim of this study is to look into changing practice of our institution from conventional approach of open to laparoscopic surgery for right colon cancer. @*Methods@#Consecutive patients between January 2010 to December 2018 who presented to Shaukat Khanum Memorial Cancer Hospital and Research Centre with diagnosis of right colon (cecum, ascending and transverse colon) adenocarcinoma and underwent surgical resections were included in this study. @*Results@#A total of 230 patients with adenocarcinoma of the right colon underwent curative resections during the study period. Of these, 141 patients (61.3%) underwent laparoscopic surgery while open resection was performed in 89 patients (38.7%). Five-year disease-free survival (DFS) of patients with American Joint Committee on Cancer (AJCC) stage III (80.9% vs. 54.8%, P = 0.021) was significantly better if these patients underwent laparoscopic surgery while a trend toward better DFS (96.7% vs. 84.1%, P = 0.111) was also observed in AJCC stage II patients, although this difference was not significant. @*Conclusion@#This study demonstrates the adoption of a laparoscopic approach for right colon cancer over 10 years. With a standardized approach and using the principle of oncological surgery, we incorporated this in our minimally invasive surgery practice at our institution.
ABSTRACT
To compare the improvement of intraoperative laparoscopic skills by measuring GOALS score between residents who have undergone simulator training with those who have not received any simulator training. A randomized controlled trial. Department of Surgery, Services Hospital, Lahore, from August 2013 to February 2014. Thirty residents belonging to year 1, 2 and 3 were included in the study. They were randomly divided into 2 groups. Both groups had a baseline evaluation with GOALS score while performing dissection of gallbladder from liver bed during laparoscopic cholecystectomy. Group-A underwent formal training on simulators whereas group-B did not receive any formal training on simulators. After 6 months, a repeat evaluation was done again by measuring GOALS score while performing gallbladder dissection. Baseline GOALS scores of both the groups were similar. Group-A baseline score was 7.66 +/- 0.93 and group-B score was 7.46 +/- 1.04 [p = 0.585]. However repeat scores for group-A showed a significant improvement [an increase of 7.16 +/- 1.48 to 14.76 +/- 1.67, p < 0.001] from baseline scores. Residents in group-B improved their scores by 2.30 +/- 0.99 to 9.76 +/- 0.79 [p < 0.001]. When inter group comparison was done the second score of group-A was significantly higher than that of group-B [14.76 +/- 1.67 vs. 9.76 +/- 0.79, p < 0.001]. Inter-rater reliability was moderately significant [Kappa 0.540]. Training on laparoscopic simulators results in significant improvement of intraoperative laparoscopic skills
Subject(s)
Humans , Male , Female , Laparoscopy/standards , Clinical Competence , Laparoscopy/education , Surgeons/education , Cholecystectomy, Laparoscopic , Education, Medical , Internship and ResidencyABSTRACT
Objectives: To determine the frequency of the metabolic syndrome in patients with type 2 diabetes mellitus who attended the diabetes clinic of Nishtar Medical College and Hospital, Multan
Methods: A cross sectional descriptive study was conducted at the diabetes clinic of Nishtar Medical College and Hospital, Multan from June 2010 to August 2010. 187 patients with type 2 diabetes were enrolled in the study. Frequency of metabolic syndrome was estimated according to the criteria proposed by American Heart Association/ National Heart, Lung and Blood Institute
Results: Total number of patients enrolled was 187 out of which, there were 67 male patients and 120 female patients. The mean age of the patients was 48 years and the range was 28 to 80 years. By applying American Heart Association criteria, metabolic syndrome was found in 65.2% type 2 diabetics, [43.31% women and 21.92% men]
Conclusion: The frequency of the metabolic syndrome was found very high in our study. This was especially high in type 2 diabetic women at a frequency of 43.31%
ABSTRACT
Disseminated peritoneal leiomyomatosis [DPL] is a very rare condition. It occurs in females of reproductive age, initiated or promoted by hormonal factors. During operation, it may appear as metastases. This entity should be kept in mind whenever multiple peritoneal nodules are encountered especially in young pregnant females. Here, we present a case report of a 30 year old woman with DPL found incidentally during caesarean section