Laparoscopy training status in India and a review of the current resident skill standards.

CONTEXT: The aim was to identify the current training standard of laparoscopy skills among the urology residents. AIMS: This paper presents the residents' subjective perception of their laparoscopy skills and evidence of an objective assessment of their actual skills. SETTINGS AND DESIGN: An online survey was mailed, and completed by urology residents in training. The residents' perception of laparoscopy training received, exposure to laparoscopy procedures, and training facilities were queried. The assessment was done on the skill levels of the residents presenting at an annual training program. SUBJECTS AND METHODS: 103 residents responded to the online survey and 115 residents were assessed at the training program. STATISTICAL ANALYSIS USED: Discrete data were compared using the t-test to test for significance of the means; P < 0.05 was considered significant. Pearson's correlation coefficient was used to obtain the relationship between variables. RESULTS: An overwhelming 91% rated their laparoscopy skill as just "satisfactory" or worse, and 60% did not have any training facilities in their department. 66% continue to be "assistants only" in conventional laparoscopy surgeries. Assessment of basic laparoscopy skills in the dry lab revealed 92% of residents having poor laparoscopy skills; similar to the subjective opinion in the survey. Only 6% (n = 5) of the residents showed a good or better skill score in the dry lab; similar to the survey. CONCLUSIONS: Based on the survey, a large number of residents have a poor opinion of their own laparoscopy skills, and the training facilities available to them. The data objectively prove the self-assessment of the residents on their laparoscopy skill level.

A Case of Primary Amenorrhea with Swyer Syndrome.

Swyer syndrome with complete gonadal dysgenesis is associated with an absence of testicular differentiation in a phenotypic female with a 46, XY karyotype. A 14-year-old unmarried girl was referred with complaints of primary amenorrhea and nondevelopment of breast. Her built was normal. Examination of her secondary sexual characteristics revealed no breast development, absent axillary hairs, and sparse pubic hairs. External genitalia was of female type. Karyotype showed genotype of 46, XY. Magnetic resonance imaging revealed hypoplastic uterus with absent fallopian tubes and ovaries. A diagnosis of Swyer syndrome was made. Laparoscopy showed infantile uterus, normal fallopian tubes, and streak gonads. Laparoscopic removal of streak gonads was done as there is a risk of gonadoblastoma in such cases. The patient was started on hormonal replacement therapy. Swyer syndrome results mainly due to mutation in certain genes such as SRY gene, which leads to failure of development of testis.

Comparison of kidney paired donation transplantations with living related donor kidney transplantation: implications for national kidney paired donation program.

BACKGROUND: Kidney Paired Donation (KPD) is a rapidly growing modality for facilitating living related donor kidney transplantation (LRDKTx) for patients who are incompatible with their healthy, willing, and living donors. Data scarcity on the outcome of KPD versus LRDKTx prompted us to review our experience. MATERIALS AND METHODS: This was a single-center study of 224 patients on regular follow-up, who underwent LRDRTx from January 2010 to June 2012 at our institute. The aim of this study was to compare short-term graft survival, patient survival and rejection rates of KPD (group 1, n = 34) with those of LRDKTx (group 2, n = 190). All the recipients received triple immunosuppression and thymoglobulin induction in KPD group. Kaplan-Meier curves were used for survival analysis. In group 1, mean recipient age was 35.5 ± 13.2 years, 29 were men and mean donor age was 44.4 ± 8.17 years, 10 were men. In group 2, mean recipient age was 29.1 ± 10 years, 155 were men and mean donor age was 47.5 ± 9.69 years, 74 were men. Mean human leukocyte antigen (HLA) matching in group 1 and 2 was 1 versus 3.2 (p < 0.05). RESULTS: One- and two-year patient survival showed no significant difference between the two groups (97.1%, 97.1% vs. 96.2%, 94.8%, respectively, p = 0.81). Death-censored graft survival also showed no significant difference between the two groups (97.1%, 97.1%, vs. 97.6%, 97.6%, p = 0.73). Acute rejection incidence was also similar (8.7% vs. 9.9%, p > 0.62). CONCLUSIONS: Our study showed similar graft survival, patient survival and rejection rates of KPD versus LRDKTx over 2 years post-transplantation, encouraging the use of this approach for national KPD program.

Retroperitoneoscopic living-donor nephrectomy and laparoscopic kidney transplantation: experience of initial 72 cases.

BACKGROUND: To evaluate the feasibility, safety, and outcome of laparoscopic kidney transplantation (LKT) after retroperitoneoscopic living-donor nephrectomy. METHODS: Between February 2010 and January 2012, a total of 217 renal transplantations were performed from living donors by a single surgical unit. All living-donor nephrectomies were performed by retroperitoneoscopic approach. Recipient surgery was performed either laparoscopically (n=72) or by conventional open approach (n=145). In the LKT group, a 5 to 6 cm Pfannenstiel incision was placed and the kidney was dropped into abdomen. Renal vessels were anastomosed by freehand suturing technique. Calcineurin inhibitor-based immunosuppressants were given. RESULTS: The mean operative time was 223.8 and 175.7 min (P=0.07) and the rewarming time was 60.3 and 30.3 min (P=0.03) in the LKT and open kidney transplantation (OKT) groups, respectively. The estimated glomerular filtration rate value on days 7 and 30 was significantly less in the LKT group, but no difference was found at 3, 6, 12, and 18 months. The mean wound length was 5.5 and 17.8 cm (P=0.0001) and the analgesic requirement was 1.4 and 3.2 mg morphine equivalent in first 24 hr (P=0.005) in the LKT and OKT groups, respectively. In the LKT group, four cases required conversion to open surgery due to vascular complications and one for urinary leak. Kaplan-Meier curve shows 86.5% and 94.6% (P=0.086) and patient survival is 94.1% and 94.7% (P=0.745) at 22.3 months of follow-up. CONCLUSIONS: LKT after living-donor nephrectomy is feasible, but it has steep learning curve. Graft fixation with peritoneal fold is necessary to avoid torsion and related graft loss. Pain after LKT is significantly less compared with conventional OKT.

Breast carcinoma metastasizing to the urinary bladder and retroperitoneum presenting as acute renal failure.

Breast carcinoma is the most common nondermatologic cancer diagnosis in women. Common metastatic sites include lymph nodes, lung, liver, and bone. Breast carcinoma metastatic to the bladder has been reported only sporadically. Most patients were symptomatic breast cancer with evidence of disseminated disease at the time of diagnosis. Metastasis usually occurred many years after diagnosis, and the prognosis was poor. We report a case of breast caricinoma metastasizing to the urinary bladder and retroperitoneum, which presented initially with acute renal failure. Patient was treated with bilateral per cuteneous nephrostomies and chemotherapy. Starting from this clinical case we review the available literature on this issue. Patients with breast cancer presenting with urinary symptoms should be examined for possible bladder metastasis.

Dual kidney transplantation from expanded criteria deceased donors: Initial experience from single center.

AIM: To evaluate results of dual kidney transplantation from expanded criteria deceased donors. MATERIALS AND METHODS: Between January 2000 and December 2009, 23 dual kidney transplantations were performed from expanded criteria deceased donors; 11 were from non-heart-beating donors and 12 from brain-dead heart-beating donors. All transplantations were performed in monolateral iliac fossa. RESULTS: Two perioperative deaths occurred due to sepsis and multiorgan failure in non-heart-beating group, and one in brain dead group. One- and five-year graft and patient survival in recipients having organs from brain-death heart-beating group were 91.67%. In non-heart-beating group, 1- and 5-year graft survival was 65.45% and 81.82%, and 1- and 5-year patient survival was 43.64% and 61.36%, respectively. CONCLUSION: Dual kidney transplantation from expanded criteria brain dead donors has better graft and patient survival than from non-heart-beating donors.