Hollow abdominal visceral injuries following minimally invasive gynecological procedure: a 16 year experience

To study the pattern of hollow abdominal visceral injuries during minimally invasive gynecological procedures. Retrospective, Descriptive Study. This study was conducted at Fauji Foundation Hospital Karachi, Gulshan General Hospital Karachi, Star General Hospital Karachi and Al-Tibri Medical College Hospital from July 1997 to December 2013. All patients admitted to above mentioned hospitals for minimally invasive gynecological procedures electively or in emergency were included in the study. Total 3050 minimally invasive gynecological procedures were carried out in the above mentioned hospitals and 77 [2.5 %] patients had complications following the procedures. Mean age was 28 years ranged from 20-55 years. 40 % patients had history of previous gynaecological surgery.Abdominal visceral injuries included small bowel perforation 30 [38.96 %] patients, sigmoid colon perforation 20 [25.97%] patients. Both small bowel and sigmoid colonic perforation 08 [10.38%] patients, Caecal perforation 01 [1.29 %] patient and Urinary Bladder 01 [1.29%] patient. 52 % cases were diagnosed within two days of primary surgery and rest within 10 days. All gynecologists must be skilled, vigilant and careful while doing minimally invasive gynecological procedures that visceral injury should not happen or ready to deal if it happens accidentally

impact of renal lower pole radiographic anatomy on the clearance of stone fragments after extracorporeal shock wave lithotripsy

1. To determine the frequency of clearance of stone fragments after extracorporeal shock wave lithotripsy [ESWL] for isolated lower pole renal calculi. 2. To compare the average Lower Infundibular diameter and lower infundibulo-pelvic angle [L-IPA] between patients with residual stone fragments and those who become stone free after extracorporeal lithotripsy [ESWL] for isolated lower pole renal calculi. Descriptive Study. This study was conducted at Department of Urology, Liaquat National Postgraduate Medical Centre, Karachi from June 2006 to June 2010. One Hundred patients of either sex, aged > 14 years with isolated lower pole calculi [LPC] of <20mm undergoing ESWL were included in the study, while patients with lower pole calculi > 20mm, multiple renal calculi, congenitally distorted pelvi-calyceal anatomy, with concomitant Ureteric calculi, with decreased urine output due to renal insufficiency, with Hydronephrosis, with previous pyelo-uretral surgery, who required ancillary procedures e.g. Ureteroscopy, DJ Stent insertion were excluded from the study. The confirmation of stone in lower pole and LPC anatomy [width of the infundibulum and lower infundibulo-pelvic angle] were viewed on the IVU. The Infundibular width was measured as the narrowest point of the infundibulum. The L-IPA was determined in two axes, the ureteropelvic axis and the infundibulo-pelvic axis. Frequency of clearance of stone fragments after ESWL for lower pole renal calculi was 82%. Average L-IPA was significantly higher in those who become stone free after ESWL than patients with residual stone fragments [79.34 +/- 8.33 vs. 64.56 +/- 5.53, p<0.001]. Average Lower Infundibular diameter was slightly higher in stone free patients after ESWL but not statistically significant [5.02 +/- 0.76 vs. 4.89 +/- 0.78, p=0.631]. Successful ESWL is sensitive to lower pole anatomical variables especially lower Infundibulo-pelvic angle and preferably first line treatment in patient with a lower pole stone has L-IPA >80 degrees and lower infundibular diameter of >5mm

Veress needle versus direct trocar insertion techniques for inducing pneumoperitoneum in laparoscopic procedures

To compare the safety and complications of veress needle [VN] versus direct trocar insertion [DTI] techniques in laparoscopic procedures. Comparative study. The study was conducted at three different hospitals in Karachi from October 2005 to May 2011. A total of 1050 consecutive laparoscopic surgeries were done during the study period. Female to male ratio was 2.5:1. In 73% of the cases direct trocar placement was done while in 27% pneumoperitoneum was achieved with Veress needle. Variables noted included technique, complications, and duration of surgery. Data was analyzed statistically using SPSS version 16. Female to male ratio was 2.5:1.Complications were more in direct trocar insertion method. Overall total complications were 3.4%. One percent in group I [VN technique] and 4% in group II [DTI technique] had complications [p=0.017]. No visceral injuries were noted in either group, but pre-peritoneal insufflations found in 2 patients [0.25%] in group II. Late complications were more in group II. This include wound infection [1.5%], late wound bleeding [0.9%], port site hernia formation [0.9%] and chronic sinus formation [0.38%].All these were statistically insignificant except wound infection [p 0.036]. Veress needle method is as safe as direct trocar insertion method in expert hands