Laparoscopic nephrectomy: initial experience with 120 cases.

Laparoscopic nephrectomy for both benign and malignant diseases of kidney is increasingly being performed. We report our experience with the first 120 consecutive laparoscopic nephrectomy performed in our hospital. It is the retrospective analysis of a prospectively maintained database of 4 years period. The parameters examined included age, gender, indications, operative time, blood loss, intraoperative and post operative complications. Mean age of surgery was 59 years (rang 19-84years). The indications for surgery included solid renal masses (71 patients), non-functioning kidneys (43), and collecting system tumours (6). The mean operating time was 132 minutes (range 75-270), average blood loss was 209 ml (range 0-1090) and average hospital stay was 4.7days (range 2-20). Bleeding, bowel injury and poor progression of laparoscopic procedure were the reasons in 7 (5.8%) cases converted to open surgery. There was 1 (0.8%) perioperative mortality. Eight (6.6%) patients developed post operative complications. Laparoscopic nephrectomy has inherent benefits and may be considered an alternate therapeutic option for kidney diseases with acceptable morbidity

Laparoscopic pyeloplasty.

We report our results and short term follow up of transperitoneal laparoscopic pyeloplasty for pelvi-ureteric junction (PUJ) obstruction. We have prospectively maintained a database to document our initial experience of 54 laparoscopic pyeloplasty. All procedures were carried out by one surgeon through a transperitoneal approach. The data extends from April 2005 to September 2008 and reports operative time, blood loss, complications, hospital stay, short term follow-up on symptomatic and radiological outcome. Fifty-four procedures were performed during the study period. Mean patient age was 29 years. Mean operating time was 133 minutes (range 65-300 minutes), and mean blood loss was 45 ml (range 20-300 ml). No intra operative complication occurred. Neither blood transfusion nor conversion to open surgery was required. Postoperative mean hospital stay was 3.4 days (range 3-14 days). There were 3 anastomotic leakages; 2 in the immediate postoperative period and 1 following removal of stent. They all required percutaneous drainage and prolonged stenting. Overall 47 (87%) patients have symptomatic relief and resolution of obstruction on renogram. Four (7%) patients developed recurrence. Three (5.5%) patients had symptomatic relief but have a persistent obstructive renogram. Laparoscopic pyeloplasty is an effective alternative treatment for symptomatic pelvi-ureteric junction obstruction. The results appear comparable to open pyeloplasty with decreased postoperative morbidity.

Evaluation of liver function after thioacetamide treatment of partially hepatectomized rabbits.

A group of male rabbits was partially hepatectomized, while another group was administered intraperitoneally with aqueous thioacetamide (TAA) solution (2 mg/kg body weight/alternate day) after partial hepatectomy (PH). The blood samples of animals of both groups were collected on day 10, 15, 20, 30, 60 and 90 following PH and used for various haematological and biochemical analyses. The haemoglobin content decreased significantly within 10 days of PH and gained significant increase 3 months after. An abrupt increase was, however, recorded after TAA treatment. All the enzymatic activities remained unchanged except for that of lactate dehydrogenase (LDH), which was elevated 87% during the first 10 days of PH. The serum glutamate pyruvate transaminase (SGPT) activity was raised 2.8 times. It was only two months after the operation that the alkaline phosphatase (AP) and LDH activities showed signs of inhibition. The only enzyme affected by TAA treatment after the PH was AP activity, which was inhibited drastically within 15 days after operation. It was concluded that, except for the AP activity and bilirubin and urea content, that essentially decreased in the presence of TAA during the first 15-20 days of experimental period, all the other haematological and biochemical parameters got normalized more quickly in the presence of TAA.

Evaluation of liver function after thioacetamide treatment of partially hepatectomized rabbits.

A group of male rabbits was partially hepatectomized, while another group was administered intraperitoneally with aqueous thioacetamide (TAA) solution (2 mg/kg body weight/alternate day) after partial hepatectomy (PH). The blood samples of animals of both groups were collected on day 10, 15, 20, 30, 60 and 90 following PH and used for various haematological and biochemical analyses. The haemoglobin content decreased significantly within 10 days of PH and gained significant increase 3 months after. An abrupt increase was, however, recorded after TAA treatment. All the enzymatic activities remained unchanged except for that of lactate dehydrogenase (LDH), which was elevated 87

during the first 10 days of PH. The serum glutamate pyruvate transaminase (SGPT) activity was raised 2.8 times. It was only two months after the operation that the alkaline phosphatase (AP) and LDH activities showed signs of inhibition. The only enzyme affected by TAA treatment after the PH was AP activity, which was inhibited drastically within 15 days after operation. It was concluded that, except for the AP activity and bilirubin and urea content, that essentially decreased in the presence of TAA during the first 15-20 days of experimental period, all the other haematological and biochemical parameters got normalized more quickly in the presence of TAA.