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CONTEXT: The aim was to identify the current training standard of laparoscopy skills among the urology residents. AIMS: This paper presents the residents' subjective perception of their laparoscopy skills and evidence of an objective assessment of their actual skills. SETTINGS AND DESIGN: An online survey was mailed, and completed by urology residents in training. The residents' perception of laparoscopy training received, exposure to laparoscopy procedures, and training facilities were queried. The assessment was done on the skill levels of the residents presenting at an annual training program. SUBJECTS AND METHODS: 103 residents responded to the online survey and 115 residents were assessed at the training program. STATISTICAL ANALYSIS USED: Discrete data were compared using the t-test to test for significance of the means; P < 0.05 was considered significant. Pearson's correlation coefficient was used to obtain the relationship between variables. RESULTS: An overwhelming 91% rated their laparoscopy skill as just "satisfactory" or worse, and 60% did not have any training facilities in their department. 66% continue to be "assistants only" in conventional laparoscopy surgeries. Assessment of basic laparoscopy skills in the dry lab revealed 92% of residents having poor laparoscopy skills; similar to the subjective opinion in the survey. Only 6% (n = 5) of the residents showed a good or better skill score in the dry lab; similar to the survey. CONCLUSIONS: Based on the survey, a large number of residents have a poor opinion of their own laparoscopy skills, and the training facilities available to them. The data objectively prove the self-assessment of the residents on their laparoscopy skill level.
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BACKGROUND AND AIMS: Modern anesthetic practice utilizes low-flow anesthesia with evolving evidence on its pulmonary effects. Studies comparing measurement of vital capacity and inspiratory reserve volume using respirometer in both low-flow and high-flow anesthesia are sparse. We evaluated the effects of low-flow and high-flow anesthesia on postoperative pulmonary functions using respirometer. MATERIAL AND METHODS: This was a prospective randomized double blind study wherein One hundred and ten patients undergoing peripheral surgeries under general anesthesia were allocated into two groups Group I- Low-flow anesthesia with O2 + N2O + Sevoflurane (0.5L + 0.5L + 3.5%) and Group II- High-flow anesthesia with O2 + N2O + Sevoflurane (2L + 2L + 2%). The difference in vital capacity (VC), inspiratory reserve volume (IRV), and peak expiratory flow rates (PEFR) from the preoperative period were compared in both the groups postoperatively. RESULTS: The difference in VC, IRV, and PEFR measured in both the groups between the preoperative and postoperative period were found to be similar and statistically insignificant (P - 0.173, 1.00 and 0.213 respectively). The difference in single breath count (SBC), breath holding time (BHT), and respiratory rates (RR) were also similar in both the groups (P - 0.101, 0.698, and 0.467) respectively. CONCLUSIONS: The pulmonary effects of low-flow anesthesia are comparable with the high-flow ones in patients undergoing elective surgeries under general anesthesia.
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CONTEXT: Traditional truncal blocks are devoid of visceral analgesia. Quadratus lumborum (QL) block has shown greater efficacy in providing the same. AIMS: This study was done to compare the efficacy of transversus abdominal plane (TAP) block versus QL block in providing postoperative analgesia for lower abdominal surgeries. SETTINGS AND DESIGN: This was a prospective, randomized, double-blinded study. SUBJECTS AND METHODS: Seventy adult patients were randomly allocated into two groups, where Group A received TAP block with 20 ml of 0.25% ropivacaine on each side (n = 35) and Group B received QL block with 20 ml of 0.25% ropivacaine on each side (n = 35). The time of block, duration of surgery, Numerical Pain Intensity Scale (NPIS) score at the 1st, 2nd, 4th, 8th, 12th, 16th, and 24th postoperative hours, and the total analgesic drug requirements were noted and compared between the two groups. STATISTICAL ANALYSIS USED: Data were analyzed with SPSS version 23 (IBM corporation, Armonk, NY, USA) with independent t-test and Chi-square test as appropriate. P < 0.05 was considered statistically significant. RESULTS: The time for first analgesic requirement was 243.00 ± 97.36 min and 447.00 ± 62.52 min and the total analgesic consumption (morphine in mg) was 5.65 ± 1.55 and 3.25 ± 0.78 in Group A and Group B, respectively, both of which were statistically significant (P < 0.01). There was a significant difference in postoperative pain scores (NPIS scale 0-10) at rest, between the two groups, up to 16 h. CONCLUSIONS: Patients who received QL block had a significant improvement in postoperative pain relief with reduced consumption of opioids.
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CONTEXT: Dexamethasone as an adjunct to ropivacaine has shown promising results in prolonging the duration of analgesia in transverse abdominis plane (TAP) block. Only limited studies evaluated the effects of dexamethasone with ropivacaine in TAP block in specific population. AIMS: The effects of adding dexamethasone to ropivacaine on the quality and duration of TAP block in lower abdominal surgeries in multiple specialties were studied. SETTINGS AND DESIGN: This was a prospective, randomized, double-blinded study. SUBJECTS AND METHODS: Seventy adult patients undergoing lower abdominal surgeries were allocated into two groups to receive general anesthesia with TAP block with 20 ml 0.25% ropivacaine with 8 mg dexamethasone (2 ml) (Group A, n = 35) or 20 mL 0.25% ropivacaine with 2 ml saline (Group B, n = 35) each side. The analgesic efficacy in terms of pain scores, morphine consumption, and occurrence of nausea and vomiting was compared between two groups. STATISTICAL ANALYSIS USED: Data were analyzed with SPSS 23 with independent t-test and Chi-square test as applicable. P < 0.05 was considered statistically significant. RESULTS: The duration of analgesia was significantly prolonged in Group A (P = 0.000). The total morphine consumption was significantly lesser in Group A (P = 0.000). The pain scores (numerical pain intensity scale) were significantly lesser in Group A till the 8th postoperative hours. The occurrence of nausea and vomiting was comparable between the groups (P = 0.3821). CONCLUSIONS: Addition of dexamethasone to ropivacaine significantly improved the quality of analgesia with reduced consumption of opioids as compared to plain ropivacaine in TAP block.
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BACKGROUND: Oxygen supplementation through Hudson type face mask is frequently used in perioperative settings. Hudson mask is a variable rate performance device with the risk of rebreathing. Studies using capnography to find out an actual fraction of rebreathing in spontaneously breathing patients are not available. AIMS: In this study, we analyzed the effects of different flow rates through Hudson mask with capnography on fractional inspired carbon dioxide (FiCO2). SETTING AND DESIGNS: Forty patients posted for minor surgeries under monitored anesthesia care were divided into four groups. They received oxygen flow rate of 3 L/min, 4 L/min, 5 L/min, and 6 L/min as per group division, through Hudson mask. MATERIALS AND METHODS: Parameters such as pulse rate, noninvasive blood pressure, oxygen saturation, respiratory rate (RR), end-tidal carbon dioxide (EtCO2), and FiCO2 were noted at baseline. After starting oxygen supplementation, these parameters were monitored every minute for ten minutes. Statistical analysis was done using analysis of variance and Kruskal-Wallis test. Pearson correlation was used to establish a relation between RR and FiCO2. RESULTS AND CONCLUSIONS: EtCO2 and FiCO2 were comparable in all four groups with no statistical significance. There was strong positive correlation seen between RR and FiCO2 at a flow rate of 3 L/min while negative correlation in other groups. We conclude that FiCO2 is similar at all flow rates while breathing through Hudson mask. Increase in RR can cause increase in FiCO2 at lower flow rate, which is within physiological tolerance limits.
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Vascular anomalies increase the difficulty during live donor nephrectomy. We herein report a left-sided retroperitoneoscopic living donor nephrectomy performed in a donor with a duplicated inferior vena cava (IVC). Computed tomography angiography provided accurate delineation of the venous anatomy and allowed preoperative planning. The duplicated IVC was clipped and divided just below its confluence with the left renal vein. The length of the left renal vein was sufficient for anastomosis in the recipient, and the recipient's serum creatinine was 1.21% on day 7. The donor made an uneventful recovery. Duplicated IVC is not a contraindication for left retroperitoneoscopic donor nephrectomy.
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Percutaneous nephrolithotripsy is the treatment of choice for large renal calculi. Total stone clearance as the treatment goal remains elusive, despite staged procedures and multiple tracks. There is also the morbidity of multiple sittings and tracks. We investigated the feasibility of a synchronized approach to clearing these difficult stones with two teams operating through two or more tracks in tandem and also the ergonomic and logistic issues involved.
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STONE MANAGEMENT IN HORSESHOE KIDNEYS IS CHALLENGING: percutaneous nephrolithotripsy is a safe and effective procedure in the treatment of large stones within horseshoe kidneys. Simultaneous bilateral PCNL has been described with a single surgeon operating sequentially on one renal unit following the other under the same anesthetic. We describe synchronized bilateral PCNL by two operating teams in tandem for a patient with bilateral stag horn calculi associated with a horseshoe kidney.