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2009| January-March | Volume 5 | Issue 1
May 14, 2009
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Robotic assisted minimally invasive surgery
Jaydeep H Palep
January-March 2009, 5(1):1-7
The term "robot" was coined by the Czech playright Karel Capek in 1921 in his play Rossom's Universal Robots. The word "robot" is from the check word robota which means forced labor.The era of robots in surgery commenced in 1994 when the first AESOP (voice controlled camera holder) prototype robot was used clinically in 1993 and then marketed as the first surgical robot ever in 1994 by the US FDA. Since then many robot prototypes like the Endoassist (Armstrong Healthcare Ltd., High Wycombe, Buck, UK), FIPS endoarm (Karlsruhe Research Center, Karlsruhe, Germany) have been developed to add to the functions of the robot and try and increase its utility. Integrated Surgical Systems (now Intuitive Surgery, Inc.) redesigned the SRI Green Telepresence Surgery system and created the daVinci Surgical System
classified as a master-slave surgical system. It uses true 3-D visualization and EndoWrist
. It was approved by FDA in July 2000 for general laparoscopic surgery, in November 2002 for mitral valve repair surgery. The da Vinci robot is currently being used in various fields such as urology, general surgery, gynecology, cardio-thoracic, pediatric and ENT surgery. It provides several advantages to conventional laparoscopy such as 3D vision, motion scaling, intuitive movements, visual immersion and tremor filtration. The advent of robotics has increased the use of minimally invasive surgery among laparoscopically naοve surgeons and expanded the repertoire of experienced surgeons to include more advanced and complex reconstructions.
Ambulatory laparoscopic cholecystectomy: Is it safe and cost effective?
Athar Ali, Tabish Chawla, Abid Jamal
January-March 2009, 5(1):8-13
Laparoscopic cholecystectomy (LC) is the most commonly performed minimal invasive surgery. However, practice of its use as an ambulatory surgery in our hospital settings is uncommon.
To evaluate safety and cost effectiveness of LC as an ambulatory day care surgery.
Study Design :
Department of surgery, Aga Khan University Hospital, Karachi, Pakistan.
Materials and Methods :
Patients with uncomplicated symptomatic gallstones were selected for Ambulatory LC. They were admitted electively on the same day and operated on in the morning hours and discharged after a check by the surgeon 6-8 hrs later.
Of fifty (
= 50) patients selected for ambulatory LC, 92% were discharged successfully after 6-8 hrs observation. No significant perioperative complications were noted. Unplanned admission and readmission rate was 8 and 2%, respectively. Cost saving for the daycare surgery was Rs. 6,200, Rs. 13,300, and Rs.22,800 per patient as compared to in patient general, semiprivate, and private ward package, respectively.
Practice ambulatory LC is safe and cost-effective in selected patients with uncomplicated symptomatic gallstones.
Large primary splenic cyst: A laparoscopic technique
M Geraghty, IZ Khan, KC Conlon
January-March 2009, 5(1):14-16
Splenic cysts are rare lesions with around 800 cases reported in the world literature. Traditionally splenectomy was the treatment of choice. However, with the recognition of the important immunological function of the spleen, new techniques to preserve splenic function have been developed. This case emphasizes that in selected cases splenic preservation is appropriate.
Laparoscopic treatment of renal hydatid cyst
Suraj C Prabhudessai, Roy V Patankar, Anil Bradoo
January-March 2009, 5(1):20-21
A 30-year-old woman was treated successfully for renal hydatid cyst disease by using the Transperitoneal Laparoscopic Technique. The peritoneal cavity was protected with the use of betadine-soaked gauze pieces, to avoid spillage. Hypertonic saline was used as the scolicidal solution to sterilize the cyst. The endocyst was removed completely and retrieved in an endobag. There were no intraoperative or early postoperative complications. This appears to be only the second reported case of renal hydatid cyst disease treated with the help of laparoscopy.
Melanoma metastasis to the spleen: Laparoscopic approach
Manoel Roberto Maciel Trindade, Rodrigo Blaya, Eduardo Neubarth Trindade
January-March 2009, 5(1):17-19
We report a case of minimally invasive surgery in the management of metastasis to the spleen. A 67-year-old male patient with possible splenic soft tissue melanoma metastasis was referred to our hospital. He had a history of an excised soft tissue melanoma from his back eight months earlier, and the control abdominal computer tomography (CT) scan revealed a hypodense spleen lesion. The patient underwent laparoscopic surgery to diagnose and treat the splenic lesion. The splenectomy was performed and the histological examination revealed a melanoma. The patient had a good postoperative course and was discharged on the second postoperative day. On his 12-month follow-up there was no sign of recurrence. The laparoscopic approach is a safe and effective alternative for treatment of splenic metastases.
LETTER TO EDITOR
Regarding diagnosis and management of
James G Bittner IV
January-March 2009, 5(1):25-25
INSTRUMENTS AND EQUIPMENTS
A new balloon dissector for totally extraperitoeneal hernia repair
January-March 2009, 5(1):22-24
Balloon dissectors (BD) find their use in totally extraperitoneal (TEP) and retroperitoneoscopic procedures. Commercial BD is prohibitively expensive. The author uses an indigenously assembled BD and describes the same.
Material and Methods:
The author assembles the BD by tying glove-fingers on an NG tube and then tying this assembly in the concavity of a Kelly's clamp, premounted with peanut gauze (KC-BD).
The author has used it in the last 75 cases of TEP. A large working space is created, without any iatrogenic injuries or balloon rupture. This cheap indigenous BD can be assembled easily and in no time at all.
KC-BD offers several advantages because of its unique design. It is effective, totally nontraumatic, inexpensive, and easy to assemble.
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