Lumbotomy is an open surgical procedure performed to access the kidney and proximal ureter through an extraperitoneal flank incision. It provides direct visualization and is indicated for large or impacted proximal ureteral stones when less invasive options have failed. The procedure involves making a flank incision through the skin, muscles and opening the peritoneum to expose the ureter. Once accessed, the ureteral stone is removed by incising the ureter and extracting the stone. Post-operatively, urethral catheters are removed after 1-2 days while drains may stay for 2 days if producing less than 20cc every 24 hours. Complications include bleeding, injury to internal
MRM adalah pembedahan onkologi untuk mengangkat seluruh jaringan payudara, areola, puting susu, dan kulit di atas tumor disertai diseksi kelenjar getah bening aksila level I, II/III secara en bloc tanpa mengangkat otot pektoralis.
Chest tube placement digunakan untuk mengeluarkan udara/cairan dari rongga pleura pasca bedah toraks. Tujuan utama pemasangan water sealed drainage adalah membuat tekanan intra pleura yang positif menjadi negatif kembali. Ada beberapa teknik pemasangan chest tube dan sistem drainase pleura yang digunakan.
Dokumen tersebut membahas beberapa jenis insisi yang umum digunakan pada operasi abdomen pada anak, termasuk insisi transversal, median, subkosta, subkosta bilateral, grid-iron, pfannenstiel, dan lanz. Dokumen tersebut juga menjelaskan prinsip-prinsip umum dalam melakukan insisi pada abdomen anak serta cara penutupan luka setelah insisi.
MRM adalah pembedahan onkologi untuk mengangkat seluruh jaringan payudara, areola, puting susu, dan kulit di atas tumor disertai diseksi kelenjar getah bening aksila level I, II/III secara en bloc tanpa mengangkat otot pektoralis.
Chest tube placement digunakan untuk mengeluarkan udara/cairan dari rongga pleura pasca bedah toraks. Tujuan utama pemasangan water sealed drainage adalah membuat tekanan intra pleura yang positif menjadi negatif kembali. Ada beberapa teknik pemasangan chest tube dan sistem drainase pleura yang digunakan.
Dokumen tersebut membahas beberapa jenis insisi yang umum digunakan pada operasi abdomen pada anak, termasuk insisi transversal, median, subkosta, subkosta bilateral, grid-iron, pfannenstiel, dan lanz. Dokumen tersebut juga menjelaskan prinsip-prinsip umum dalam melakukan insisi pada abdomen anak serta cara penutupan luka setelah insisi.
FAST (Focused Assessment with Sonography for Trauma) adalah pemeriksaan USG serial untuk mendeteksi cairan atau udara di area anatomis tertentu seperti perikardium, ruang pleura, dan kantung Morisson untuk mendiagnosis keadaan pasien trauma. Lokasi yang diperiksa meliputi subkostal, kanan atas kuadran, kiri atas kuadran, suprapubik, dan dada kanan-kiri. Temuan abnormal seperti efusi pericardium, hemoperitoneum, dan hemothoraks
Presus ileus obstruktif dr. gunawan siswadi, sp. bWoro Nugroho
Pasien laki-laki berusia 29 tahun datang dengan keluhan muntah dan nyeri perut sejak 2 hari. Didiagnosis dengan ileus obstruksi letak tinggi berdasarkan riwayat operasi sebelumnya dan hasil pemeriksaan fisik serta laboratorium. Dilakukan laparotomi eksplorasi dan penatalaksanaan.
Dokumen tersebut membahas kasus peritonitis difus akibat appendisitis perforasi pada pasien laki-laki berusia 14 tahun. Pasien mengeluh nyeri perut selama seminggu dan demam. Pemeriksaan fisik menunjukkan tanda-tanda peritonitis. Hasil pemeriksaan laboratorium dan diagnostik mendukung diagnosis appendisitis perforasi. Pasien dioperasi dan didiagnosis dengan peritonitis difus akibat appendisitis perforasi.
Tindakan bedah untuk membentuk anus pada pasien malformasi anorektal meliputi berbagai pendekatan seperti abdominoperineal pullthrough, posteriorsagital anorectoplasty (PSARP), limited PSARP, anoplasti perineal, dan anoplasti laparoskopik. Tatalaksana pasca operasi meliputi pemberian antibiotik, dilatasi anus secara bertahap, serta penurunan frekuensi dilatasi secara bertahap pula untuk mencegah terjadinya komplikasi sepert
Apendisitis adalah peradangan pada apendiks yang disebabkan oleh hambatan aliran lendir di dalamnya, yang dapat menyebabkan infeksi bakteri. Apendiks berada di ujung sekum dengan vaskularisasi dari arteri apendikularis. Gejala apendisitis tergantung lokasi apendiks dan umumnya berupa nyeri di perut bagian bawah kanan. Diagnosis didukung dengan pemerikahan darah dan gambaran klinis, sementara CT scan
Dokumen tersebut memberikan ringkasan tentang appendisitis. Appendisitis adalah peradangan pada appendix vermiformis yang dapat menyebabkan nyeri perut dan komplikasi seperti peritonitis. Diagnosa appendisitis didasarkan pada gejala klinis dan pemeriksaan penunjang seperti USG atau CT scan. Penatalaksanaannya adalah appendiktomi untuk kasus akut dan komplikasinya, sedangkan kasus kronis dapat ditangani secara elektif.
Efloresensi (modul kulit dan jaringan penunjang)fikri asyura
Dokumen tersebut membahas berbagai jenis morfologi penyakit kulit primer dan sekunder beserta contoh-contohnya, seperti makula, papula, plak, urtika, nodul, vesikel, pustula, dan komedo. Jenis-jenis morfologi tersebut dibedakan berdasarkan karakteristik fisiknya seperti ukuran, konsistensi, dan isiannya. Dokumen ini berguna bagi diagnosis penyakit kulit secara
Hidrokel adalah penumpukan cairan berlebih di antara lapisan tunika vaginalis testis yang dapat terjadi pada bayi akibat belum menutupnya prosesus vaginalis. Pada bayi, hidrokel cenderung sembuh sendiri pada usia 2 tahun, namun jika tidak sembuh atau semakin membesar diperlukan operasi. Tindakan operasi hidrokel pada anak meliputi insisi kantung prosesus vaginalis dan ligasi untuk mencegah ak
1. Degloving adalah trauma yang menyebabkan kulit dan jaringan lunak terlepas dari dasarnya. Penyebab utama adalah kecelakaan lalu lintas.
2. Ada dua jenis degloving, yaitu tertutup dan terbuka. Degloving tertutup kulitnya masih utuh sedangkan terbuka kulitnya terputus.
3. Penilaian vitalitas jaringan sangat penting untuk menentukan penanganan selanjutnya, seperti eksisi atau pen
Kasus pria berusia 55 tahun dengan keluhan sulit buang air kecil. Pemeriksaan fisik menunjukkan prostat membesar. Diagnosis beninga hiperplasia prostat. Pasien diobati dengan open prostatektomi.
Pasien wanita berusia 51 tahun menjalani hystero-salphingo-oophorectomy bilateral karena mioma uteri dengan status ASA II dan hipertensi. Anestesi spinal dilakukan dengan bupivakain 0,5% 15 mg dan fentanil 25 mcg. Operasi berjalan lancar selama 2 jam 30 menit dengan pemantauan tanda vital dan pemberian cairan sesuai perhitungan.
Amputasi ekstremitas adalah penghilangan sebagian atau seluruh ekstremitas karena trauma atau pembedahan untuk menyelamatkan hidup. Teknik amputasi telah berkembang dari yang kasar tanpa anestesi menjadi lebih maju dengan teknik bedah dan perawatan luka yang lebih baik. Amputasi dapat dilakukan di berbagai level ekstremitas tergantung lokasi dan kondisi medis pasien.
Anatomi hepar, lien, pankreas, vaskularisasi abdomen dan kelainan kongenitaldr. Bobby Ahmad
Dokumen tersebut membahas anatomi organ-organ pencernaan seperti hati, limpa, pankreas, vaskularisasi abdomen, dan kelainan kongenital yang dapat terjadi pada sistem pencernaan. Organ-organ tersebut dijelaskan fungsi dan strukturnya, serta bagaimana perdarahannya. Kelainan yang disebutkan antara lain atresia esofagus, stenosis duodenum, fibrosis kistik, divertikula, hernia, dan kelainan kongenital lainnya seperti at
Laporan kasus mengenai Ny. AY usia 46 tahun yang mengalami nyeri dan kesulitan bergerak pada tungkai kiri akibat jatuh 2 bulan lalu. Pemeriksaan menunjukkan fraktur femur dextra yang terlantar. Diagnosis negelcted fraktur femur dextra 1/3 tengah yang perlu ditangani dengan refrakturisasi, skeletal traksi, dan rencana operasi.
Invaginasi atau intususepsi adalah kondisi darurat akut dimana bagian usus masuk ke dalam lumen usus bagian distal yang menyebabkan obstruksi dan strangulasi usus. Gejalanya berupa nyeri perut kolik, muntah, dan berak lendir darah. Diagnosis didukung dengan pemeriksaan fisik, radiologi, dan ultrasonografi. Pengobatannya meliputi reposisi manual atau bedah, tergantung tingkat obstruksinya.
This document provides information about lumbotomy and proximal ureterolithotomy surgical procedures. It defines lumbotomy as a surgical approach using an extraperitoneal access to the kidney and proximal ureter. Proximal ureterolithotomy is described as an open surgery to remove stones in the proximal ureter. The document discusses the anatomy, indications, contraindications, preparation, procedure and postoperative care for these surgeries. Potential complications are also outlined.
FAST (Focused Assessment with Sonography for Trauma) adalah pemeriksaan USG serial untuk mendeteksi cairan atau udara di area anatomis tertentu seperti perikardium, ruang pleura, dan kantung Morisson untuk mendiagnosis keadaan pasien trauma. Lokasi yang diperiksa meliputi subkostal, kanan atas kuadran, kiri atas kuadran, suprapubik, dan dada kanan-kiri. Temuan abnormal seperti efusi pericardium, hemoperitoneum, dan hemothoraks
Presus ileus obstruktif dr. gunawan siswadi, sp. bWoro Nugroho
Pasien laki-laki berusia 29 tahun datang dengan keluhan muntah dan nyeri perut sejak 2 hari. Didiagnosis dengan ileus obstruksi letak tinggi berdasarkan riwayat operasi sebelumnya dan hasil pemeriksaan fisik serta laboratorium. Dilakukan laparotomi eksplorasi dan penatalaksanaan.
Dokumen tersebut membahas kasus peritonitis difus akibat appendisitis perforasi pada pasien laki-laki berusia 14 tahun. Pasien mengeluh nyeri perut selama seminggu dan demam. Pemeriksaan fisik menunjukkan tanda-tanda peritonitis. Hasil pemeriksaan laboratorium dan diagnostik mendukung diagnosis appendisitis perforasi. Pasien dioperasi dan didiagnosis dengan peritonitis difus akibat appendisitis perforasi.
Tindakan bedah untuk membentuk anus pada pasien malformasi anorektal meliputi berbagai pendekatan seperti abdominoperineal pullthrough, posteriorsagital anorectoplasty (PSARP), limited PSARP, anoplasti perineal, dan anoplasti laparoskopik. Tatalaksana pasca operasi meliputi pemberian antibiotik, dilatasi anus secara bertahap, serta penurunan frekuensi dilatasi secara bertahap pula untuk mencegah terjadinya komplikasi sepert
Apendisitis adalah peradangan pada apendiks yang disebabkan oleh hambatan aliran lendir di dalamnya, yang dapat menyebabkan infeksi bakteri. Apendiks berada di ujung sekum dengan vaskularisasi dari arteri apendikularis. Gejala apendisitis tergantung lokasi apendiks dan umumnya berupa nyeri di perut bagian bawah kanan. Diagnosis didukung dengan pemerikahan darah dan gambaran klinis, sementara CT scan
Dokumen tersebut memberikan ringkasan tentang appendisitis. Appendisitis adalah peradangan pada appendix vermiformis yang dapat menyebabkan nyeri perut dan komplikasi seperti peritonitis. Diagnosa appendisitis didasarkan pada gejala klinis dan pemeriksaan penunjang seperti USG atau CT scan. Penatalaksanaannya adalah appendiktomi untuk kasus akut dan komplikasinya, sedangkan kasus kronis dapat ditangani secara elektif.
Efloresensi (modul kulit dan jaringan penunjang)fikri asyura
Dokumen tersebut membahas berbagai jenis morfologi penyakit kulit primer dan sekunder beserta contoh-contohnya, seperti makula, papula, plak, urtika, nodul, vesikel, pustula, dan komedo. Jenis-jenis morfologi tersebut dibedakan berdasarkan karakteristik fisiknya seperti ukuran, konsistensi, dan isiannya. Dokumen ini berguna bagi diagnosis penyakit kulit secara
Hidrokel adalah penumpukan cairan berlebih di antara lapisan tunika vaginalis testis yang dapat terjadi pada bayi akibat belum menutupnya prosesus vaginalis. Pada bayi, hidrokel cenderung sembuh sendiri pada usia 2 tahun, namun jika tidak sembuh atau semakin membesar diperlukan operasi. Tindakan operasi hidrokel pada anak meliputi insisi kantung prosesus vaginalis dan ligasi untuk mencegah ak
1. Degloving adalah trauma yang menyebabkan kulit dan jaringan lunak terlepas dari dasarnya. Penyebab utama adalah kecelakaan lalu lintas.
2. Ada dua jenis degloving, yaitu tertutup dan terbuka. Degloving tertutup kulitnya masih utuh sedangkan terbuka kulitnya terputus.
3. Penilaian vitalitas jaringan sangat penting untuk menentukan penanganan selanjutnya, seperti eksisi atau pen
Kasus pria berusia 55 tahun dengan keluhan sulit buang air kecil. Pemeriksaan fisik menunjukkan prostat membesar. Diagnosis beninga hiperplasia prostat. Pasien diobati dengan open prostatektomi.
Pasien wanita berusia 51 tahun menjalani hystero-salphingo-oophorectomy bilateral karena mioma uteri dengan status ASA II dan hipertensi. Anestesi spinal dilakukan dengan bupivakain 0,5% 15 mg dan fentanil 25 mcg. Operasi berjalan lancar selama 2 jam 30 menit dengan pemantauan tanda vital dan pemberian cairan sesuai perhitungan.
Amputasi ekstremitas adalah penghilangan sebagian atau seluruh ekstremitas karena trauma atau pembedahan untuk menyelamatkan hidup. Teknik amputasi telah berkembang dari yang kasar tanpa anestesi menjadi lebih maju dengan teknik bedah dan perawatan luka yang lebih baik. Amputasi dapat dilakukan di berbagai level ekstremitas tergantung lokasi dan kondisi medis pasien.
Anatomi hepar, lien, pankreas, vaskularisasi abdomen dan kelainan kongenitaldr. Bobby Ahmad
Dokumen tersebut membahas anatomi organ-organ pencernaan seperti hati, limpa, pankreas, vaskularisasi abdomen, dan kelainan kongenital yang dapat terjadi pada sistem pencernaan. Organ-organ tersebut dijelaskan fungsi dan strukturnya, serta bagaimana perdarahannya. Kelainan yang disebutkan antara lain atresia esofagus, stenosis duodenum, fibrosis kistik, divertikula, hernia, dan kelainan kongenital lainnya seperti at
Laporan kasus mengenai Ny. AY usia 46 tahun yang mengalami nyeri dan kesulitan bergerak pada tungkai kiri akibat jatuh 2 bulan lalu. Pemeriksaan menunjukkan fraktur femur dextra yang terlantar. Diagnosis negelcted fraktur femur dextra 1/3 tengah yang perlu ditangani dengan refrakturisasi, skeletal traksi, dan rencana operasi.
Invaginasi atau intususepsi adalah kondisi darurat akut dimana bagian usus masuk ke dalam lumen usus bagian distal yang menyebabkan obstruksi dan strangulasi usus. Gejalanya berupa nyeri perut kolik, muntah, dan berak lendir darah. Diagnosis didukung dengan pemeriksaan fisik, radiologi, dan ultrasonografi. Pengobatannya meliputi reposisi manual atau bedah, tergantung tingkat obstruksinya.
This document provides information about lumbotomy and proximal ureterolithotomy surgical procedures. It defines lumbotomy as a surgical approach using an extraperitoneal access to the kidney and proximal ureter. Proximal ureterolithotomy is described as an open surgery to remove stones in the proximal ureter. The document discusses the anatomy, indications, contraindications, preparation, procedure and postoperative care for these surgeries. Potential complications are also outlined.
NOTES (Natural Orifice Transluminal Endoscopic Surgery)- By Dr. Onkardronkarsingh
Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an experimental surgical technique that performs abdominal operations through natural orifices like the mouth, urethra, anus or vagina without external incisions. NOTES aims to reduce surgical trauma and pain for patients by avoiding incisions. It also shortens recovery time and eliminates risks of complications from external incisions like infections and hernias. While still in development, NOTES shows promise as a less invasive future of surgery.
Incidental appendectomy is the removal of the appendix during another operation when there is no evidence of appendicitis. It may be performed during operations for malrotation to prevent future diagnostic confusion, as well as during hernia repairs and gynecologic or trauma surgeries. While it prevents future appendicitis, it increases operative time and risk of contamination. The appendix can also be useful for urologic reconstruction like ureteral repairs or the Mitrofanoff procedure to create a continent urinary stoma. It is also used in some cases of biliary reconstruction or for a Malone antegrade continence enema procedure to allow bowel evacuation through an abdominal stoma. The decision to remove the appendix
NOTES (Natural Orifice Transluminal Endoscopic Surgery) is an experimental surgical technique that performs operations through natural openings in the body without external incisions. This avoids scarring and reduces recovery time. NOTES procedures first began in the 1980s and have included cholecystectomies, appendectomies, and other abdominal surgeries. While still being developed, NOTES may eventually allow many operations to be done as outpatient procedures with even faster recovery times compared to laparoscopic surgery.
ERCP is an endoscopic procedure that combines endoscopy and fluoroscopy to diagnose and treat issues in the duodenum, bile ducts, pancreatic duct, and gallbladder. During ERCP, an endoscope is inserted and a catheter is used to inject radiocontrast dye to identify any blockages. If needed, a wire can enlarge the opening to the bile duct to remove gallstones or perform other procedures like stent placement. Potential but rare complications include infection, pancreatitis, bleeding, and perforation of the GI tract. ERCP requires an experienced physician due to its risks.
1. Midurethral slings are now the gold standard treatment for stress urinary incontinence, replacing pubovaginal slings.
2. Pubovaginal slings are placed at the bladder neck and can be effective for various types of SUI but have higher risks than midurethral slings.
3. Midurethral slings are typically placed at the midurethra using either a retropubic or transobturator approach and have better subjective cure rates than pubovaginal slings.
This document describes a technique for performing a single layer continuous hand-sewn esophagogastric anastomosis during a thoracolaparoscopic Ivor Lewis esophagectomy. The technique was performed on 5 patients with lower esophageal adenocarcinoma. No intraoperative complications or postoperative anastomotic leaks occurred. The mean operative time was 338 minutes and mean hospital stay was 8 days. This preliminary study suggests the technique of a thoracoscopic single layer continuous hand-sewn anastomosis is a feasible and safe method for esophagogastric anastomosis during minimally invasive Ivor Lewis esophagectomy. However, larger comparative studies are still needed to fully validate this technique.
Laparoscopic surgery is the mainstay of surgical management for gynaecological procedures but can be associated with complications in 0.2-10.3% of cases. Common complications include injuries to the gastrointestinal tract and urinary tract. Urinary tract injuries like bladder trauma can occur in 0.02-8.3% of advanced laparoscopy cases from mechanical or electro-thermal trauma. Risk factors include previous pelvic surgery or endometriosis. Ureteric injuries have a reported incidence of 0.06-21% and most commonly occur near the pelvic brim or lateral to the cervix. Gastrointestinal tract injuries have an incidence of 0.13% and most injuries are to the
Successful Urology surgery in India by team of expert and international surgeons with advance micro surgical instruments for complex surgery in your budget.
This document discusses surgical procedures for stress urinary incontinence (SUI), specifically mid-urethral slings (MUS). It provides a timeline of significant SUI procedures, from anterior repairs in the 1800s to tension-free tapes in the 1990s. The transobturator tape (TOT) procedure is described, which places a synthetic sling under the mid-urethra via the obturator foramen to support the urethra without entering the retropubic space. Complications of MUS procedures are generally low but can include bladder perforation, urethral injury, and voiding dysfunction. Long-term success rates of over 90% are reported with MUS.
This document discusses Natural Orifice Transluminal Endoscopic Surgery (NOTES), a new surgical technique. NOTES involves performing surgery using an endoscope inserted through natural openings like the mouth, vagina, or anus without external incisions. The document provides a brief history of NOTES, describes some procedures that have been performed, and discusses potential advantages as well as challenges to further development and acceptance of the technique.
This document outlines principles of trauma laparotomy and damage control surgery. It discusses relevant anatomy, indications for laparotomy following penetrating or blunt trauma, and the operative sequence including access, exploration, hemorrhage control, and damage control or definitive repair. It provides details on approaches and management of injuries to various abdominal organs. The goal is to control hemorrhage and contamination while optimizing the patient's physiology for subsequent definitive care.
ABSTRACT- Urinary tracts stone diseases are one of the most common afflictions of modern society and it has
witnessed much advancement in its management. Keeping in view various aspects of management we carried out a
comparatively newer study called Transperitoneal Ureterolithotomy. This study was carried out to evaluate Laparoscopic
Transperitoneal Ureterolithotomy (TPUL) as a viable option to open surgical ureterolithotomy, Laparoscopic
Retroperitoneal Ureterolithotomy (RPUL) & endoscopic urology and to assess its place in the spectrum of various surgical
interventions for ureteric calculi in a tertiary care center. This study was conducted on 25 selected patients of a single large
impacted calculus of size more than 10mm in upper and middle ureter. It was observed that conversion to open
ureterolithotomy was observed in 4 cases and excessive bleeding in one case. No major perioperative complications were
seen. The procedure has definitely shown decreased post-operative discomfort, decreased requirement of post-operative
analgesia, better cosmesis, early return to work and less morbidity.
Key-words- Transperitoneal ureterolithotomy (TPUL), Retroperitoneal ureterolithotomy (RPUL), Extracorporeal
shockwave lithotripsy (ESWL), Open surgical ureterolithotomy
Laparoscopic cholecystectomy has been the standard procedure for gallbladder removal since the 1990s. Recently, single incision laparoscopic cholecystectomy (SILC) has been developed to further reduce invasiveness. While technically challenging, SILC offers benefits like less pain, faster recovery, and better cosmetic outcomes compared to standard laparoscopic cholecystectomy. The document presents a study protocol to evaluate the benefits of SILC with intraoperative cholangiography, including safety, reduced invasiveness, and ability to manage unexpected bile duct issues. The prospective randomized study will compare outcomes of SILC with cholangiography to standard techniques in 100 patients. Results will help determine if S
Dr Pawan Sharma1*, Dr D K Verma2, Dr Raj Kumar3
1General Surgeon Incharge, Civil Hospital Rohru, Shimla (HP), India
2Professor of Surgery, IGMC Shimla (HP), India
3General Surgeon Incharge, Distt Hospital Bilaspur (HP), India
*Address for Correspondence: Dr. Pawan Sharma, General Surgeon Incharge, Department of Surgery, Civil Hospital,
Rohru, Shimla, HP, India
Received: 17 September 2016/Revised: 11 October 2016/Accepted: 25 October 2016
ABSTRACT- This study was carried out to evaluate laparoscopic retroperitoneal ureterolithotomy (RPUL) as a viable
option to open surgical ureterolithotomy, laparoscopic transperitoneal ureterolithotomy (TPUL) & endoscopic urology and
to assess its place in the spectrum of alternatives for the surgical treatment of ureteric calculi in a tertiary care centre. This
study was conducted on 20 selected patients of single large impacted calculus of size more than 8mm in upper & middle
ureter. It was observed that excessive bleeding was present in only one (5%) of the patients, while need for conversion to
open ureterolithotomy was seen in 8 (40%) cases. No major peri-operative complications were encountered. From our
experience, it can be concluded that this procedure has definitely shown decreased post-operative discomfort, decreased
requirement of post-operative analgesia, better cosmesis, early return to work and less morbidity. RPUL can be considered
as another well-established armamentarium in the armour of laparoscopic surgeons and is recommended as an effective
minimally invasive primary treatment in large, impacted difficult stones in the upper & mid ureter.
Key-words- Retroperitoneal ureterolithotomy (RPUL), Transperitoneal ureterolithotomy (TPUL), Extracorporeal
shockwave lithotripsy (ESWL)
Management of enterocutaneous fistulas involves several phases:
1) Recognition and stabilization including resuscitation, controlling sepsis and drainage, nutrition support, and skin care.
2) Investigation using fistulograms and CT scans to define the fistula anatomy and underlying pathology.
3) Decision on management which depends on factors predicting spontaneous closure like output, nutrition status and bowel health.
4) Definitive surgery including bowel resection and anastomosis if needed, otherwise a staged approach with bypass.
5) Post-surgical recovery focusing on preventing recurrent fistula and hernia.
The document discusses ureteric injuries during gynecologic surgery. It notes that ureteric injuries can lead to serious complications like ureterovaginal fistulas and renal impairment. The document outlines risk factors for injury including surgical complexity, patient anatomy, and surgeon experience. It provides details on injury prevention, identification, and various surgical and nonsurgical management strategies depending on injury characteristics and timing of detection. The key message is that most ureteric injuries can be prevented through anatomical knowledge and early detection improves prognosis.
Laparoscopic Urologic surgery, is a part of the curriculum of Minimal Access Surgery, and requires lot of skills and patience. All new surgeons carrying out Basic Laparoscopic surgery should aim at also doing Lap. Urological surgeries, which has a steep learning curve, but with with excellent outcomes.
Similar to Lumbotomy- Proximal Ureterolithotomy.pptx (20)
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
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Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
2. Definition
• Manual of urologic surgery, Jackson E. Fowler. 2012
Flank Incision : Surgical approach to
provide direct extraperitoneal access to
the kidney, proximal ureter
• Hinmann Atlas of Urologic Surgery. 2012
Proximal ureterolithotomy : Open surgery
procedure performed for the removal of
proximal ureteral stones
4. Indication
• Ureterolithotomy proximal
• Nephrolithotomy
• Pyelolithotomy- extended
pyelolithotomy
• Bivalve nephrolithotomy
• Pyeloplasty
• Nephrectomy-partial nephrectomy
Lumbotomy :
all procedure to
access kidney
and proximal
ureter by
extraperitoneal
approach by
open surgery
such as
(Manual of Urologic Surgery, Jackson E. Fowler. 2012)
5. Indication for open surgery in ureteral stone
Large impacted stones
Multiple ureteral stones
When other non-invasive or low-invasive procedures have
failed
For proximal ureteral calculi, ureterolithotomy has the
highest stone free rate compared to URS and SWL
EL-HUSSEINY, Tamer; BUCHHOLZ, Noor. The role of open stone surgery. Arab journal of urology, 2012, 10.3: 284-288.
Moufid K, Abbaka N, Touiti D, Adermouch L, Amine M, Lezrek M. Large impacted upper ureteral calculi: A comparative study between retrograde ureterolithotripsy and percutaneous antegrade ureterolithotripsy in the modified lateralposition. Urol Ann. 2013;5(3):140-
146. doi:10.4103/0974-7796.115729
6. Contraindications
Malrotation and malposition of kidney
Bleeding disorder
Patients who are medically unfit for an open
surgery
Manual of Urologic Surgery, Jackson E. Fowler. 2012
Muslumanoglu, Ahmet Yaser, et al. When is open ureterolithotomy indicated for the treatment of ureteral stones?. International journal of urology, 2006, 13.11: 1385-1388.
13. • Incise skin starting from
Subcostae towards the
umbilicus approximately 15
cm.
• Structures are incised: skin,
subcutaneous fat, External
oblique m., Internal oblique
m., Transverse abdominis m.
until internal abdomen fascia
• Open the lumbodorsal muscle
fascia slightly to the posterior
in the posterior axillary line.
(Hinmann Atlas of Urologic Surgery, 2012)
14. • Separate the
peritoneum with steel
deppers toward the
medial
• After the peritoneum
clearly separated, the
incision widened.
• Attach spreader
(Hinmann Atlas of Urologic Surgery, 2012)
15. Insert a self-retaining
retractor.
Enter Gerota's fascia
bluntly to displace part of
the perirenal fat
posteriorly, and expose
the ureter.
(Hinmann Atlas of Urologic Surgery, 2012)
16. Procedure
• Find the ureter by opening
the fascia gerota , infront
of M. ileopsoas
• Use nelathon catheter
(no.8 fr) to teugel the
ureter
• Identify the ureteral stone
• Incise the ureter with
blade no.11, upon the
ureteral stone.
• Remove the ureteral stone
(Hinmann Atlas of Urologic Surgery, 2012)
17. Procedure
• Evaluate fluid/urine that
coming out from the ureter
• Sondage to the distal and
proximal of ureter
• If sondage can be done well,
do spoeling, and also DJ
stent insertion if needed
• Stitch the ureter with
polyglactin 4-0
• Wash operation field with PZ
• Lower the kidney rest, and
partially flatten the table
top
(Hinmann Atlas of Urologic Surgery, 2012)
18. Procedure
• Evaluate bleeding
• Put redon drain in
retroperitoneal
• Closure the wound
▫ Muscle and fascia with polyglactin
1-0 continous or interrupted
▫ Sub cutan fat with plain cat-gut
3-0 interrupted
▫ Skin with polypropylen 3-0
interrupted
• Close the wound by tulle and
gauze
(Hinmann Atlas of Urologic Surgery, 2012)
19. • Bleeding (2-6%) ; injured peritoneal
cavity and intra abdominal organ (2%)
; axillary nerve palsy (1%)
During
operation
• Wound infection (10-15%) ; urosepsis
(10%) ; hematuria (9-15%) ; leakage of
urine-urinoma (1-5%)
Early
postoperative
• Ureteral stricture (15-20%) ; Fistule
(5%)
Late post
operative
Complication
Borofsky, Michael S.; Lingeman, James E. The role of open and laparoscopic stone surgery in the modern era of endourology. Nature Reviews Urology, 2015, 12.7: 392.
Chen, Ding-Yuan; Chen, Wen-Chi. Complications due to surgical treatment of ureteral calculi. Urological Science, 2010, 21.2: 81-87.
El-husseiny, Tamer; BUCHHOLZ, Noor. The role of open stone surgery. Arab journal of urology, 2012, 10.3: 284-288.
20. Post operative care
KUB post
operatively
Remove urethral
catheter 1 or 2 day
post operatively
Remove drain if
production is <20 cc
2x24 hours
Release the stitches
10-14 days
postoperatively
Borofsky, Michael S.; Lingeman, James E. The role of open and laparoscopic stone surgery in the modern era of endourology. Nature Reviews Urology, 2015, 12.7: 392.
HU, Qingfeng, et al. Retroperitoneal laparoscopic ureterolithotomy for proximal ureteral calculi in selected patients. The Scientific World Journal, 2014, 2014.
Muslumanoglu, Ahmet Yaser, et al. When is open ureterolithotomy indicated for the treatment of ureteral stones?. International journal of urology, 2006, 13.11: 1385-1388.
Insisi Flank adalah prosedur bedah untuk memberikan akses ekstraperitoneal langsung ke ginjal, ureter proksimal
Proksimal Ureterolitotomi adalah Prosedur operasi terbuka yang dilakukan untuk mengangkat batu ureter proksimal
Anatomi ureter, penyempitan fisiologis ureter yakni (UVJ, UPJ, Iliac Vessel)
segmentasi ureter radiografi dan suplai darah ureter (Campbell-Walsh Urology, 2015)
Diameter normal dari ureter adalah 8mm.
Kemudian pada daerah tertentu mengalami penyempitan dan memiliki ukuran yang berbeda, yaitu pada bagian
Ureteropelvis junction (UPJ) sebesar 2-4 mm,
Pada abdomen (persilangan vasa iliaca) sebesar 5-6 mm
Intramural (UVJ) sebesar 1,5-3 mm.
Lumbotomi adalah prosedur operasi untuk mengakses ginjal dan ureter proksimal dengan pendekatan ekstraperitoneal melalui operasi terbuka seperti pada kasus
SFR of 84% (URS)
SFR of 89% (ESWL)
Batu-batu besar
Batu ureter multipel
Dalam kondisi bersamaan yang membutuhkan pembedahan
Ketika prosedur non-invasif atau minimal invasif lainnya gagal
Jika diindikasikan, untuk batu ureter bagian atas, proximal ureterolithomy memiliki free rate stone lebih tinggi dibandingkan dengan URS dan SWL.
Malrotasi dan malposisi ginjal
Gangguan perdarahan
Pasien yang secara medis tidak layak untuk menjalani operasi terbuka
Cevoperazone 50mg/kgbb pada dewasa diambil dosis max 2 gr
Gentamicin 5mg/kgbb pada dewasa diambil dosis max 160mg
Disinfeksi bidang operasi menggunakan Povidone Iodine 10%
Mempersempit bidang operasi dengan linen steril
INCISI SUBCOSTAE, TIP COSTAE, INTERCOSTAE
Sayatan kulit mulai dari ICS XI menuju umbilikus kurang lebih 15 cm.
Struktur yang diinsisi: kulit, lemak subkutan, m. Oblik eksternal, m. Oblik internal, m. Transversal abdominis. sampai fasia internal
Buka sedikit fasia otot lumbodorsal ke posterior di garis aksila posterior.
Apabila memperlebar ke arah posterior karena untuk mencegah merobek peritoneum
Pisahkan peritoneum dengan steel deppers ke arah medial
Setelah peritoneum terpisah dengan jelas, sayatan diperlebar.
Masukkan spreader
Masukkan retraktor
Kemudian saya telusuri ke dalam fasia Gerota secara gentle untuk memindahkan sebagian dari lemak perirenal ke posterior, dan expose ureter.
NELATON CATETER, UNTUK TEGEL
URETER : PGA 4.0
Impacted stone, HN berat, mencederai periureter banyak curiga edema pada ureter, jika ada batu di renal
Setelah batu dikeluarkan, 1. Mapping Batu, 2. apa ada tanda obstruksi di proximal aliran urin dari proximal setelah desobstruksi aliran urin + paten
Cari ureter dengan membuka fascia gerota, di depan M. ileopsoas
Gunakan kateter nelathon (no.8 fr) untuk teugel ureter
kemudian Identifikasi batu ureter
insisi ureter dengan blade no. 11, di atas batu ureter.
singkirkan batu ureter
Sondase untuk memastikan patensi ureter distal
DJ Stent dipasang jika ditemukan cedera ureter, obstruksi dikeluarkan batu/batu impacted
BOF dilakukan hanya pada saat stenting
Sebelum operasi, menentukan posisi batu ada di mana tujuannya untuk menentukan letak batu (proximal distal beda insisi)Proximal Subcostae, Tipcostae, IntercostaeDistal Gibson, Pfanenstiel, Midline.
Evaluasi cairan / urine yang keluar dari ureter
Dilakukan Sondage ke distal dan proksimal ureter
Jika sondage bisa dilakukan dengan baik, lakukan spoeling, dan juga pemasangan stent DJ jika diperlukan
Jahit ureter dengan poliglaktin 4-0
Cuci bidang operasi dengan PZ
Kembalikan ginjal, dan ratakan sebagian bagian atas meja.
Evaluasi perdarahan
Letakkan redon drain di retroperitoneal
Tutup lukanya
Otot dan fasia dengan poliglaktin 1-0 terus menerus atau terputus
Lemak sub kutan dengan cat gut 3-0 interuptus
Kulit dengan polypropylen 3-0 interuptus
Tutup luka dengan kain tule dan kassa steril
Sondage distal dan proksimal
Pemasangan stent rutin setelah ureterolitotomi tanpa komplikasi (pengangkatan batu lengkap) tidak lagi diperlukan
Stent harus dipasang pada pasien yang berisiko tinggi mengalami komplikasi (misalnya fragmen sisa, perdarahan, perforasi, infeksi saluran kemih atau kehamilan), dan dalam semua kasus yang meragukan, untuk menghindari keadaan darurat yang membuat stres.
Pleura : PGA 3.0, Catgut 3.0
Peritoneum : PGA 3.0, catgut 3.0Pleura robek Beritahu Anestesi Inspirasi max dari pasien Jahit pleura, terakhir menyimpul juga inspirasi maximal
cedera rongga peritoneum dan organ intra abdominal (2%); Perdarahan (2-6%), kelumpuhan saraf axilla (1%)
Infeksi luka (10-15%); urosepsis (10%); hematuria (9-15%); kebocoran urin-urinoma (1-5%)
fistula (5%), striktur ureter (15-20%)