ABSTRACT
STUDY OBJECTIVE: The present study aimed to evaluate the impact of the implementation of the enhanced recovery after surgery (ERAS) program in patients undergoing robotic hysterectomy for benign indications in comparison with conventional management. DESIGN: Randomized controlled trial. SETTING: North Indian tertiary care hospital. PARTICIPANTS: Patients aged 40 to 60 years willing to sign the informed written consent were included, whereas cases with contraindications for neuraxial anesthesia were excluded. A total of 130 subjects undergoing robotic hysterectomy were divided into ERAS (n = 65) and conventional (non-ERAS) (n = 65) groups. INTERVENTIONS: Components of the ERAS protocol included preoperative counseling, carbohydrate loading, early removal of catheter, and early ambulation. Both groups underwent optimization of medical conditions, standardized anesthesia, and venous thromboembolism prophylaxis. MEASUREMENTS AND MAIN RESULTS: Outcome measures included length of hospital stay (LOHS), time to tolerance of diet, postoperative complications, readmission rates, and quality of life assessed by WHO-QOL BREF. Baseline characteristics were comparable between groups. ERAS group showed significantly lower docking time (4.82 ± 0.73 vs 5.31 ± 0.92 minutes), faster tolerance of diet (0.14 ± 0.35 vs 1.14 ± 0.35 days), and earlier resumption of ambulation (0.42 ± 0.5 vs 1.26 ± 0.44 days). Time for "fit for discharge" (1.43 ± 0.61 vs 2.97 ± 1.1 days) and LOHS (2.85 ± 1.09 vs 3.78 ± 1.29 days) were significantly lower in the ERAS group. Postoperative complications and readmission rates were comparable. Quality-of-life scores favored the ERAS group at postoperative days 1 and 30. CONCLUSION: The combination of ERAS and robotic surgery improves patient outcomes, shortens hospital stays, and enhances postoperative recovery without increasing complications. This research serves as a pioneering effort in assessing the impact of ERAS on robotic hysterectomy for benign indications, providing valuable insights for future multicentric studies and supporting the integration of ERAS protocols to enhance patient outcomes and quality of life.
ABSTRACT
Ureteric leiomyosarcoma is a rare but aggressive tumor among other sarcomas. There is no established epidemiological data due to the scarcity of literature on this uncommon disorder. The present literature comprises about 20 case reports mostly of women above 40 years of age. The presenting complaint is mostly pain in the abdomen with only a few reporting urological symptoms like hematuria. Understandably, this tumor is diagnosed by histopathological examination with immunohistochemistry. We report one such case of a 32-year-old female who underwent an exploratory laparotomy with preoperative suspicion of adnexal neoplastic mass only to find normal ovaries and left ureteric tumor intraoperatively. She was managed with excision of the tumor with partial resection of the involved ureter and end-to-end anastomosis of the ureter followed by chemotherapy and radiation.
ABSTRACT
Context: Reproductive tract infections/sexual tract infections (RTI/STIs) have a huge economic impact in terms of costs of healthcare, loss of productivity and the long-term sequelae. Aims: This study was aimed at documenting the pattern of RTI/STIs and clinico-epidemiological profiles of patients attending an STI clinic. Settings and Design: Seventy-six female patients attending the STI clinic at the Department of Obstetrics and Gynaecology, AIIMS Rishikesh between November 2017 and March 2018 were recruited after taking informed verbal consent in this cross-sectional study. Methods and Materials: All patients were evaluated and managed according to the syndromic approach (NACO). Patients were interviewed and data were entered into a semi-structured questionnaire. Statistical Analysis Used: The data were analysed using Microsoft Excel 2016 (Microsoft Corporation, released September 22, 2015). Results: The average age of the patients was 34.46 ± 8.77 years, with a maximum of patients (41%) in the age group 25-35 years. The majority of patients were from an urban background (62%), Hindu (91%), married (95%) and housewives (74%). Most had some level of formal education (97%) and belonged to the lower middle class (43%). The most common diagnosis was lower abdominal pain (LAP) (68%) followed by vaginal/cervical discharge (VD/CD) (30%). Only one patient out of 76 had genital ulcer disease - herpetic (GUD-H). Conclusions: There is a need for focussed community-based interventions targeting the young, urban, lower-middle-class population to reduce the burden of STIs, particularly LAP.
