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   2005| October-December  | Volume 1 | Issue 4  
 
 
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REVIEW ARTICLE
Emerging role of robotics in urology
Rajeev Kumar, Ashok K Hemal
October-December 2005, 1(4):202-210
DOI:10.4103/0972-9941.19268  PMID:21206664
Robotic assistance is one of the latest additions to the field of laparoscopic surgery. The most commonly used robotic device in Urology is the da Vinci ® system of which over 200 devices are installed worldwide including 3 in India. This robot consists of three or four arms, one of which is used to hold and manipulate the laparoscopic camera while the others are used to manipulate specialized laparoscopic instruments with endowrist ® technology that allows 7 degrees of freedom. The robot is currently used primarily for radical prostatectomies where complex dissection and reconstruction can be performed in less than 2 hours with excellent outcomes. There is a progressive increase in the number of surgeries being performed by this device which allows laparoscopy naοve surgeons to offer the benefits of minimally invasive surgery to their patients. The other surgeries where this device has been used to benefit are pyeloplasty, cystectomy with urinary diversion, nephrectomy and ureteric re-implant. The principal drawbacks of the device are the steep cost of machine and disposables. However, the benefits achieved in terms of improved surgical precision, magnified 3 dimensional vision, scaling of movements, remote surgery and as a teaching tools will help the robot establish a definitive place in the urologic armamentarium.
  10 10,056 392
Laparoscopic reconstructive urology
Declan Murphy, Ben Challacombe, Abhay Rane
October-December 2005, 1(4):181-187
DOI:10.4103/0972-9941.19265  PMID:21206661
Objective: Laparoscopic reconstructive urology is undergoing rapid change. We review the current status of laparoscopic reconstructive urology, with particular respect to pyeloplasty and reconstructive ureteric surgery. Methods: An extensive Medline search of reconstructive laparoscopic procedures was undertaken. The initial reports and large series reports of a range of procedures was examined and summarised. The most commonly practised procedure within this remit is laparoscopic pyeloplasty. Several series of over 100 patients have been published. Success rates average over 90% for laparoscopic pyeloplasty with a low complication rate. Much less common laparoscopic reconstructive urological procedures include ureteric re-implantation, Boari flap, urinary diversion and transuretero-ureterostomy. The results of these are encouraging. Conclusions: Laparoscopic pyeloplasty may be safely performed by either the transperitoneal or retroperitoneal routes with excellent results. It should be considered the "gold standard" for the management of UPJ obstruction, especially in those patients with significant hydronephrosis, renal impairment or a crossing vessel. Laparoscopic ureteric reimplantation, Boari flap, urinary diversion and transuretero-ureterostomy have been performed by experienced laparoscopic urologists with encouraging results.
  5 10,910 340
Laparoscopic radical and partial cystectomy
Ben J Challacombe, Kirsten Rose, Prokar Dasgupta
October-December 2005, 1(4):188-195
DOI:10.4103/0972-9941.19266  PMID:21206662
Radical cystectomy remains the standard treatment for muscle invasive organ confined bladder carcinoma. Laparoscopic radical cystoprostatectomy (LRC) is an advanced laparoscopic procedure that places significant demands on the patient and the surgeon alike. It is a prolonged procedure which includes several technical steps and requires highly developed laparoscopic skills including intra-corporeal suturing. Here we review the development of the technique, the indications, complications and outcomes. We also examine the potential benefits of robotic-assisted LRC and explore the indications and technique of laparoscopic partial cystectomy.
  2 10,573 318
Laparoscopic adrenalectomy
Nobuo Tsuru, Kazuo Suzuki
October-December 2005, 1(4):165-172
DOI:10.4103/0972-9941.19263  PMID:21206659
Laparoscopic adrenalectomy is currently recognized as the gold standard for the treatment of adrenal tumors. In order to assess the current status of laparoscopic adrenalectomy, we reviewed the literature focusing on the indications and contraindications, surgical techniques, complications and new methods. We also reviewed the results separately for aldosteronoma, pheochromocytoma, Cushing's syndrome, and primary or metastatic adrenal cancer. Laparoscopic adrenalectomy is a safe and effective treatment for adrenal disorders, excluding primary adrenal cancer. There are no differences of the various operative parameters between the transperitoneal and retroperitoneal approaches, so the choice of approach should depend on the surgeon's preference or the patient's circumstances. It is important for the surgeon to remove the tumor and the surrounding fat en bloc, especially in the case of large or irregular tumors because of the potential for malignancy. The surgeon must also immediately switch to an open procedure if the laparoscopic operation becomes difficult. We conclude that use of laparoscopic adrenalectomy allows the performance of minimally invasive surgery with the advantages of more rapid recovery and a shorter hospital stay than open adrenalectomy.
  2 11,747 382
Laparoscopy in the management of stone disease of urinary tract
Rajiv Yadav, Rajeev Kumar, Ashok K Hemal
October-December 2005, 1(4):173-180
DOI:10.4103/0972-9941.19264  PMID:21206660
As in other fields of urology, the use of minimally invasive techniques has helped decrease the morbidity and convalescence associated with the management of urolithiasis. Laparoscopy has also been used as one of the minimally invasive techniques. This has developed particularly with the increasing experience and use of intracorporeal suturing techniques. However, in comparison with other surgeries, laparoscopy for stone removal is relatively uncommon and we review the current indications, technical limitation and results.
  2 23,591 454
Laparoscopic nephrectomy for benign non functioning kidneys
Narmada P Gupta, Gagan Gautam
October-December 2005, 1(4):149-154
DOI:10.4103/0972-9941.19261  PMID:21206657
Laparoscopic nephrectomy has been established as the standard of care for the management of benign non-functioning kidneys and has gained worldwide popularity over the past decade. In this article, we have reviewed the current literature to elucidate the indications, contraindications, surgical techniques, results and complications of laparoscopic nephrectomy.
  2 9,125 294
EDITORIAL
Laparoscopy in urology
Ashok K Hemal, Rajeev Kumar
October-December 2005, 1(4):147-147
DOI:10.4103/0972-9941.19260  PMID:21206655
  - 7,042 473
EDITORIAL COMMENTS
This special issue
TE Udwadia
October-December 2005, 1(4):148-148
DOI:10.4103/0972-9941.19269  PMID:21206656
  - 3,512 187
REVIEW ARTICLE
Laparoscopic donor nephrectomy
Nitin Gupta, Pamposh Raina, Anant Kumar
October-December 2005, 1(4):155-164
DOI:10.4103/0972-9941.19262  PMID:21206658
Of the various options for patients with end stage renal disease, kidney transplantation is the treatment of choice for a suitable patient. The kidney for transplantation is retrieved from either a cadaver or a live donor. Living donor nephrectomy has been developed as a method to address the shortfall in cadaveric kidneys available for transplantation. Laparoscopic living donor nephrectomy (LLDN), by reducing postoperative pain, shortening convalescence, and improving the cosmetic outcome of the donor nephrectomy, has shown the potential to increase the number of living kidney donations further by removing some of the disincentives inherent to donation itself. The technique of LLDN has undergone evolution at different transplant centers and many modifications have been done to improve donor safety and recipient outcome. Virtually all donors eligible for an open surgical procedure may also undergo the laparoscopic operation. Various earlier contraindications to LDN, such as right donor kidney, multiple vessels, anomalous vasculature and obesity have been overcome with increasing experience. Laparoscopic live donor nephrectomy can be done transperitoneally or retroperitoneally on either side. The approach is most commonly transperitoneal, which allows adequate working space and easy dissection. A review of literature and our experience with regards to standard approach and the modifications is presented including a cost saving model for the developing countries. An assessment has been made, of the impact of LDN on the outcome of donor and the recipient.
  - 8,764 342
Laparoscopic radical prostatectomy
Michael Lipke, Chandru P Sundaram
October-December 2005, 1(4):196-201
DOI:10.4103/0972-9941.19267  PMID:21206663
Millions of men are diagnosed annually with prostate cancer worldwide. With the advent of PSA screening, there has been a shift in the detection of early prostate cancer, and there are increased numbers of men with asymptomatic, organ confined disease. Laparoscopic radical prostatectomy is the latest, well accepted treatment that patients can select. We review the surgical technique, and oncologic and functional outcomes of the most current, large series of laparoscopic radical prostatectomy published in English. Positive margin rates range from 2.1-6.9% for pT2a, 9.9-20.6% for pT2b, 24.5-42.3% for pT3a, and 22.6-54.5% for pT3b. Potency rates after bilateral nerve sparing laparoscopic radical prostatectomy range from 47.1 to 67%. Continence rates at 12 months range from 83.6 to 92%.
  - 8,204 278
2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04