The New Gold Standard In Laparoscopic Imaging: 3d Vs 4k Laparoscopic Nephrectomy- A Single Centered Randomized Controlled Trial.

BACKGROUND: Thanks to progressive technology and modern innovations, laparoscopic procedures, being minimally invasive, have now supervened upon most open surgical procedures. Laparoscopic procedures have proven advantages over open procedures. The study was designed to compare the outcomes of laparoscopic nephrectomy between 3D and 4K camera resolutions. METHODS: This randomized control trial carried out at Tabba Kidney institute, Karachi, Pakistan from July 2020 to April 2021, to our knowledge was the first of its kind comparative study in Pakistan and internationally. All patients diagnosed to have symptomatic non-functioning kidney on the basis of both renal scintigraphy and CT- KUB were divided through blocked randomization in to two different camera resolution groups, i.e., 3D vs 4K and outcomes in terms of operative time, haemoglobin fall, post procedure complications and in patient stay were recorded. RESULTS: It was observed that the 3D group had a significantly shorter mean total operative time 172.1±36.9 vs 272.5±14.1 respectively (p<0.005). A significant difference was also observed in mean operative time for task 2 was 53.1±21.1 & 101±30.9 mins (p<0.005), and for task 3 was 67.18±18.3 & 112.5±37 mins (p=0.005) for 3D and 4K groups respectively. The mean haemoglobin drops in 3D and 4K groups was 0.51±1.6 & 0.73±1.1 respectively (p=0.7). Moreover, the mean hospital stay was 2.5±0.6 for 3D group & 2.7±0.9 for 4K group (p-value 0.8). Post-operative wound infection was observed in one patient in each group. No case had to be converted to surgery by an open approach. CONCLUSIONS: We concluded that despite being the latest technological advancement with a greater zooming capability, when used for performing laparoscopic nephrectomy, 4K imaging system couldn't show any superiority over 3D imaging system, in different operative tasks and in terms of total operative time.

Effects and outcome of Tamsulosin more than just stone clearance after extracorporeal shock wave lithotripsy for renal calculi.

OBJECTIVE: To determine the effect of Tamsulosin, as adjunctive medical therapy after Extracorporeal Shock Wave Lithotripsy for renal stones on rate of stone clearance, clearance time, pain intensity during stone clearance, steinstrasse formation and auxiliary surgical intervention required. METHOD: A prospective randomized controlled study was carried out in 120 patients who undeiwent ESWL for renal stones of 0.5-2.0 cm. They were randomized into study and control group in which Tamsulosin 0.4 mg/day was given in former as an adjunctive medical therapy. All patients underwent ESWL every 2 weeks until complete stone clearance for 8 weeks. The parameters assessed were stone clearance, clearance time, pain intensity and effect on steinstrasse. RESULTS: Of the 120 patients 60 were in each group. The stone clearance rate was greater in study than in control group, 58 (96.7%) vs. 48 (80%) respectively, (p < 0.004). The mean stone clearance time was observed earlier in study group as compared to control group with significant statistical difference in stone size between 0.6-1.Scm.The mean intensity of pain patients experienced according to Visual analogue scale (VAS) was significantly less in study group (p < 0.002). The rate of steinstrasse formation was observed to be higher in control than in study group 15 (25%) vs 6 (10%) respectively (p < 0.003), while its spontaneous clearance was higher in study group than in control group 83.3% vs 33.3% (p < 0.03). CONCLUSION: Tamsulosin significantly increases stone clearance after shock wave lithotripsy for renal stones. It also appeared to facilitate earlier stone clearance, reduces severity of pain, reduces the incidence of steinstrasse formation and tends to facilitate its spontaneous clearance.