Objectives: For renal cell cancer, the hand-assisted laparoscopic approach provides several advan... more Objectives: For renal cell cancer, the hand-assisted laparoscopic approach provides several advantages while maintaining equal advantages with regards to patient recovery. We offer our experience with laparoscopic handassisted radical nephrectomy and the incidence of ventral wall hernia. Methods: Between February 1999 and July 2002, we performed 50 laparoscopic hand-assisted radical nephrectomies. A midline or a muscle splitting right lower quadrant incision was used depending on the side of the tumor. Hand-port incisions were all between 7 cm and 8 cm and closed with #1 polydioxanone sulfate suture in a running fashion. Three (6%) patients developed handport incisional hernias. All hernias occurred in midline hand-port sites. The average body weight of those who developed an incisional hernia was 137 kg. Although the cause of incisional hernia is multifactorial, we believe that obesity plays a significant role. The technical limitations involved in closing a short, deep ventral incision combined with the earlier return to activity of laparoscopy patients put this patient population at significant risk. Conclusion: We now perform an interrupted closure with nonabsorbable suture for the hand-assist incision and limited activity for 4 weeks to 6 weeks post procedure in high-risk patients. We have had no further wound hernias since adopting these changes.
Anterior urethral valves are rare anomalies which cause obstructive uropathy in the lower urinary... more Anterior urethral valves are rare anomalies which cause obstructive uropathy in the lower urinary tract of young men. We discuss our illustrative case and review the English medical literature in order to analyze the clinicopathologic spectrum. We propose a hypothesis of ...
Purpose: Susruta, a pioneer surgeon of antiquity, practiced around 1000 BC in India. We review hi... more Purpose: Susruta, a pioneer surgeon of antiquity, practiced around 1000 BC in India. We review his many contributions with special reference to the management of urological ailments. Materials and Methods: Information gleaned from the available English translation of 3 volumes of Susruta's treatise in surgery is analyzed with commentaries and historical perspectives chronicled by Oriental and Occidental historians. Results: Susruta belonged to the period between 600 and 1000 BC. His conceptions of anatomy, physiopathology and therapeutic strategies were of unparalleled brilliance, considering the early age in the history of mankind with no supportive knowledge base preceding his era. His discussions of many aspects of urological diseases are often reaffirmed in the principles of urology today. Conclusions: Through his rational understanding, elaborate teachings and practice of the art of surgery, and many urological ailments in particular Susruta has earned the glory of being the pioneer urologist of antiquity.
Objectives. Significant obesity is considered to be a relative contraindication to laparoscopic s... more Objectives. Significant obesity is considered to be a relative contraindication to laparoscopic surgery. This study reviews the complications encountered in massively obese patients undergoing urologic laparoscopic surgery. Methods. Body mass index (BMI) was used as an objective index to indicate massive obesity. Eleven institutions compiled retrospective data on 125 patients having a BMI greater than 30. Procedures performed included 76 pelvic lymph node dissections, 14 nephrectomies, 7 bladder neck suspensions, and 28 miscellaneous procedures. Results. For the group as a whole, the mean BMI was 35.1 (range 30.1 to 57.2). Mean operative time was 202 m{nutes (range 60 to 480). Conversion to open surgery occurred in 15 of the 125 patients (12%), Complication rates (minor and major) were 22% (27 occurrences in 125 patients) intraoperatively and 26% (33 occurrences in 125 patients) postoperatively. The major complications included 2 trocar injuries to abdominal wall vessels, 1 bladder injury, 3 peripheral nerve iniuries, I dysrhythmia, 1 deep vein thrombosis, 1 wound seroma, 1 nephrocutaneous fistula, 1 incisional hernia, and I death. Conclusions. In this review, complication rates for urologic laparoscopic surgery on massively obese patients were higher than in the general population undergoing laparoscopic surgery (0.3% to 21%). UROLOGY 48: 562-567, 1 996. T he use of laparoscopy in urologic surgery over the past 6 years has gained increasing attention. The potential benefits of rapid recovery, decreased postoperative pain, and reduction in pulmonary dysfunction make it an attractive alternative for many patients. ~ However, massive obesity has been regarded as a relative contrain
1. J Urol. 1980 Dec;124(6):818-9. Peyronie's disease: excision and autografting with tunica ... more 1. J Urol. 1980 Dec;124(6):818-9. Peyronie's disease: excision and autografting with tunica vaginalis. ... The parietal layer of tunica vaginalis has proved to be an ideal substitute of tunica albuginea of the penis and has caused neither shrinkage nor bulging at the graft site. ...
Treatment of urolithiasis within a pelvic kidney presents a technical challenge. We report an ext... more Treatment of urolithiasis within a pelvic kidney presents a technical challenge. We report an extraperitoneal laparoscopy-assisted percutaneous approach to access the lower-pole calix of a pelvic kidney for percutaneous nephrolithotomy.
Traumatic dislocation of the testicle is characterized by an ectopically displaced testis as the ... more Traumatic dislocation of the testicle is characterized by an ectopically displaced testis as the result of closed injury. We report on 1 patient with subcutaneous inguinal dislocation of the testis that was successfully treated by immediate dosed reduction. Forty-...
PURPOSE: The feasibility of using minimally invasive laparoscopic techniques adhering to the surg... more PURPOSE: The feasibility of using minimally invasive laparoscopic techniques adhering to the surgical principles of management of anatomical stress incontinence was evaluated in 10 women. MATERIALS AND METHODS: Postoperative performances and early surgical ...
The Raman spectroscopic technology can be utilized for the detection of changes occurring at the ... more The Raman spectroscopic technology can be utilized for the detection of changes occurring at the molecular level during the pathological transformation of the tissue. The potential of its use in urology is still in its infancy and increasing utility of this technology will transform noninvasive tissue diagnosis. The Nobel laureate, Sir C.V. Raman is credited for the discovery of the principles of Raman spectroscopy. Applications of Raman spectroscopy in the bladder, renal, prostate, and other urological disorders were gathered from Medline and abstracts from recent international urological meetings. Current status and future directions of Raman spectroscopy in urology were also reviewed. Raman spectroscopic technology is used to interrogate biological tissues. The potential use of this technology in urology has shown encouraging results in the in vitro diagnosis and grading of cancers of the bladder and the prostate. Raman microprobes have been used for the characterization and identification of renal lithiasis. Technology may be available for the urologists to determine the margin status intraoperatively during partial nephrectomy and radical prostatectomy. The future would see the development of optical fiber probes to incorporate them into catheters, endoscopes, and laparoscopes that will enable the urologist to obtain information during the operation. Raman spectroscopy is an exciting tool for real-time diagnosis and in vivo evaluation of living tissue. The potential applications of Raman spectroscopy may herald a new future in the management of various malignant, premalignant, and other benign conditions in urology.
Objectives: For renal cell cancer, the hand-assisted laparoscopic approach provides several advan... more Objectives: For renal cell cancer, the hand-assisted laparoscopic approach provides several advantages while maintaining equal advantages with regards to patient recovery. We offer our experience with laparoscopic handassisted radical nephrectomy and the incidence of ventral wall hernia. Methods: Between February 1999 and July 2002, we performed 50 laparoscopic hand-assisted radical nephrectomies. A midline or a muscle splitting right lower quadrant incision was used depending on the side of the tumor. Hand-port incisions were all between 7 cm and 8 cm and closed with #1 polydioxanone sulfate suture in a running fashion. Three (6%) patients developed handport incisional hernias. All hernias occurred in midline hand-port sites. The average body weight of those who developed an incisional hernia was 137 kg. Although the cause of incisional hernia is multifactorial, we believe that obesity plays a significant role. The technical limitations involved in closing a short, deep ventral incision combined with the earlier return to activity of laparoscopy patients put this patient population at significant risk. Conclusion: We now perform an interrupted closure with nonabsorbable suture for the hand-assist incision and limited activity for 4 weeks to 6 weeks post procedure in high-risk patients. We have had no further wound hernias since adopting these changes.
Anterior urethral valves are rare anomalies which cause obstructive uropathy in the lower urinary... more Anterior urethral valves are rare anomalies which cause obstructive uropathy in the lower urinary tract of young men. We discuss our illustrative case and review the English medical literature in order to analyze the clinicopathologic spectrum. We propose a hypothesis of ...
Purpose: Susruta, a pioneer surgeon of antiquity, practiced around 1000 BC in India. We review hi... more Purpose: Susruta, a pioneer surgeon of antiquity, practiced around 1000 BC in India. We review his many contributions with special reference to the management of urological ailments. Materials and Methods: Information gleaned from the available English translation of 3 volumes of Susruta's treatise in surgery is analyzed with commentaries and historical perspectives chronicled by Oriental and Occidental historians. Results: Susruta belonged to the period between 600 and 1000 BC. His conceptions of anatomy, physiopathology and therapeutic strategies were of unparalleled brilliance, considering the early age in the history of mankind with no supportive knowledge base preceding his era. His discussions of many aspects of urological diseases are often reaffirmed in the principles of urology today. Conclusions: Through his rational understanding, elaborate teachings and practice of the art of surgery, and many urological ailments in particular Susruta has earned the glory of being the pioneer urologist of antiquity.
Objectives. Significant obesity is considered to be a relative contraindication to laparoscopic s... more Objectives. Significant obesity is considered to be a relative contraindication to laparoscopic surgery. This study reviews the complications encountered in massively obese patients undergoing urologic laparoscopic surgery. Methods. Body mass index (BMI) was used as an objective index to indicate massive obesity. Eleven institutions compiled retrospective data on 125 patients having a BMI greater than 30. Procedures performed included 76 pelvic lymph node dissections, 14 nephrectomies, 7 bladder neck suspensions, and 28 miscellaneous procedures. Results. For the group as a whole, the mean BMI was 35.1 (range 30.1 to 57.2). Mean operative time was 202 m{nutes (range 60 to 480). Conversion to open surgery occurred in 15 of the 125 patients (12%), Complication rates (minor and major) were 22% (27 occurrences in 125 patients) intraoperatively and 26% (33 occurrences in 125 patients) postoperatively. The major complications included 2 trocar injuries to abdominal wall vessels, 1 bladder injury, 3 peripheral nerve iniuries, I dysrhythmia, 1 deep vein thrombosis, 1 wound seroma, 1 nephrocutaneous fistula, 1 incisional hernia, and I death. Conclusions. In this review, complication rates for urologic laparoscopic surgery on massively obese patients were higher than in the general population undergoing laparoscopic surgery (0.3% to 21%). UROLOGY 48: 562-567, 1 996. T he use of laparoscopy in urologic surgery over the past 6 years has gained increasing attention. The potential benefits of rapid recovery, decreased postoperative pain, and reduction in pulmonary dysfunction make it an attractive alternative for many patients. ~ However, massive obesity has been regarded as a relative contrain
1. J Urol. 1980 Dec;124(6):818-9. Peyronie's disease: excision and autografting with tunica ... more 1. J Urol. 1980 Dec;124(6):818-9. Peyronie's disease: excision and autografting with tunica vaginalis. ... The parietal layer of tunica vaginalis has proved to be an ideal substitute of tunica albuginea of the penis and has caused neither shrinkage nor bulging at the graft site. ...
Treatment of urolithiasis within a pelvic kidney presents a technical challenge. We report an ext... more Treatment of urolithiasis within a pelvic kidney presents a technical challenge. We report an extraperitoneal laparoscopy-assisted percutaneous approach to access the lower-pole calix of a pelvic kidney for percutaneous nephrolithotomy.
Traumatic dislocation of the testicle is characterized by an ectopically displaced testis as the ... more Traumatic dislocation of the testicle is characterized by an ectopically displaced testis as the result of closed injury. We report on 1 patient with subcutaneous inguinal dislocation of the testis that was successfully treated by immediate dosed reduction. Forty-...
PURPOSE: The feasibility of using minimally invasive laparoscopic techniques adhering to the surg... more PURPOSE: The feasibility of using minimally invasive laparoscopic techniques adhering to the surgical principles of management of anatomical stress incontinence was evaluated in 10 women. MATERIALS AND METHODS: Postoperative performances and early surgical ...
The Raman spectroscopic technology can be utilized for the detection of changes occurring at the ... more The Raman spectroscopic technology can be utilized for the detection of changes occurring at the molecular level during the pathological transformation of the tissue. The potential of its use in urology is still in its infancy and increasing utility of this technology will transform noninvasive tissue diagnosis. The Nobel laureate, Sir C.V. Raman is credited for the discovery of the principles of Raman spectroscopy. Applications of Raman spectroscopy in the bladder, renal, prostate, and other urological disorders were gathered from Medline and abstracts from recent international urological meetings. Current status and future directions of Raman spectroscopy in urology were also reviewed. Raman spectroscopic technology is used to interrogate biological tissues. The potential use of this technology in urology has shown encouraging results in the in vitro diagnosis and grading of cancers of the bladder and the prostate. Raman microprobes have been used for the characterization and identification of renal lithiasis. Technology may be available for the urologists to determine the margin status intraoperatively during partial nephrectomy and radical prostatectomy. The future would see the development of optical fiber probes to incorporate them into catheters, endoscopes, and laparoscopes that will enable the urologist to obtain information during the operation. Raman spectroscopy is an exciting tool for real-time diagnosis and in vivo evaluation of living tissue. The potential applications of Raman spectroscopy may herald a new future in the management of various malignant, premalignant, and other benign conditions in urology.
Uploads
Papers by Sakti Das