No abstract

Single port laparoscopic cholecystectomy (SPLC) was introduced to minimize postoperative morbidity and improve cosmesis. We performed a comparative study to assess feasibility, safety and perceived benefits of SPLC. Two groups of patients (40 each) with comparable demographic characteristics were selected for SPLC and multiport laparoscopic cholecystectomy (MPLC) between November 2010 to October 2011. SPLC was performed using X-cone with 5 and 10 mm extra-long (50 cm) telescope and 3 ports for hand instruments. MPLC was performed with traditional 4 port technique. A large window was always created during dissection to obtain the critical view of safety. Data collection was prospective. The primary end points were postoperative pain and surgical complications. Secondary end points were patient assessed cosmesis and satisfaction with body image and operating time. The mean VAS scores for pain at rest in MPLC group were higher on day 0 (SPLC 3.38 versus MPLC 4.80, p0.0001). VAS on coughing/straining was also significantly higher in MPLC group on day 0(SPLC 3.98 versus MPLC 6.48, p0.0001).VAS on postoperative day 1 was significantly higher in MPLC group (SPLC 2.25 versus MPLC 3.80, p0.000). Number and nature of surgical complications was statistically insignificant. Post-operative resumption of normal activity was earlier in SPLC group (SPLC 7.08, MPLC 10.83, p0.0001). Patient assessed cosmesis and satisfaction with body image scores on likert index (SPLC 5 in 100% versus MPLC 3 in 82.5% and 3 in 7.50%) indicating better cosmesis and greater patient satisfaction in SPLC. SPLC took longer to perform (87.63min versus 58 min in MPLC). Additional laparoscopic device (Alligator, 2.3 mm grasper) was used for retraction of gall bladder in 6 patients and 5mm right subcostal port in SPLC. SPLC appears to be feasible and safe with cosmetic benefits in selected patients. However, challenges remain to improve operative ergonomics. SPLC needs to be proven efficacious with a high safety profile to be accepted as standard laparoscopic technique.

for a period of one year. Aim of the study was to see the effects of surgeries of benign prostatic hyperplasia (TURP and open prostatectomy) on the urodynamic parameters and to statistically analyze and compare the urodynamic outcome of two surgeries. Patients selected for study were those undergoing either transurethral resection of prostate (TURP) or open prostatectomy for benign prostatic hyperplasia (BPH), whereas those excluded from the study were patients with nervous system disorders, unstable/overactive bladder, obstructive symptoms due to causes other than BPH and those who were not fit for general anaesthesia. Forty patients with prostate >50 grams, who fulfilled the inclusion criteria, were randomly and equally selected to undergo either transurethral resection of prostate (TURP) or open prostatectomy. Preoperative urodynamic study of the patients was done. Repeat urodynamic study of the patients was done at 3 weeks and 3 months after surgery. Then the differences in the preoperative and postoperative urodynamics were evaluated in two groups of patients. The mean maximum flow rate (in ml/sec) was more in TURP group at 3 weeks postoperatively but the difference was statistically non-significant. However, it was more in open prostatectomy group at 3 months postoperatively and the difference was statistically significant (p = 0.01).The mean average flow rate (in ml/sec) was more in TURP group at 3 weeks postoperatively but the difference was statistically non-significant. However, it was more in open prostatectomy group at 3 months postoperatively and the difference was statistically significant (p = 0.008). The mean maximum detrusor pressure (in cm H2O) was more in open prostatectomy group at 3 weeks postoperatively but the difference was statistically non-significant. However, it was more in TURP group at 3 months postoperatively and the difference was statistically significant (p = 0.0001). Open prostatectomy is an acceptable operation for the prostate size >50 grams. Higher peak flow rate improvement, average flow rate improvement and less detrusor pressure was evident in patients treated with open prostatectomy group. Open prostatectomy is a better procedure than transurethral resection of prostate as per as the udoynamic outcome is taken into consideration.