This document discusses the advantages and technique of robotic radical prostatectomy. It notes that robotic surgery results in less bleeding, less pain and scarring, shorter hospital stays, lower risk of incontinence and impotence compared to open surgery. The da Vinci robotic system is used, with precise 3D visualization enabling preservation of nerves for potency. The procedure involves developing the space around the prostate, ligating blood vessels, and precisely excising the prostate before reconstructing the bladder neck. With experience, robotic surgery achieves similar oncologic outcomes to open surgery with improved recovery of urinary control and sexual function.
Every upcoming surgeon practising minimal access surgery should know the basics of urology , so that he or she can put his or her,s capabilities as a surgeon
Indocyanine green (ICG) in liver surgery.pptxGian Luca Grazi
The use of indocyanine green has now become common practice during liver and biliary tract surgery. This dye helps in defining the anatomy of the liver segments and is able to provide data on the course of the biliary tract. Furthermore, it can detect the presence of small superficial tumors, increasing the cure potential of liver resections in the treatment of liver tumors.
This reading reviews the main uses of indocyanine green in liver surgery, in particular for laparoscopic and robotic surgery, and opens a window on the future clinical developments of indocyanine green in the treatment of liver tumors.
Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore
What is New In Minimally Invasive Surgery for UrologySiewhong Ho
Dr Ho Siew Hong gave a series of Continous Medical Education lectures to doctors of Gleneagles, Mount Elizabeth and East Shore Hospitals on the latest in Urology surgery
Robotic assisted radical prostatectomy (RARP) has become the commonest minimally invasive surgical procedure for the treatment of localized prostate cancer. Despite limited data supporting the excellence of RARP over laparoscopic radical prostatectomy (LRP) or open radical prostatectomy (ORP), it has gained wide acceptance among the patients and surgeons.
Minimal invasive Surgery in Management of colorectal cancerpiyushpatwa
Laparoscopic Anterior resection. After insertion of ports with patient in steep trendelenburg position Inferior mesenteric artery was identified and high ligation done with division of left colic artery and then medial to lateral dissection was done. Subsequently inferior mesenteric vein was dissected and clipped and divided. Distal dissection proceeded just behind the superior rectal artery and after identification and preservation of the hypogastric nerves, upper rectum was mobilised. Division of bowel was done at upper rectum after giving adequate distal margin and end to end anastomosis was done using circular stapler.
Every upcoming surgeon practising minimal access surgery should know the basics of urology , so that he or she can put his or her,s capabilities as a surgeon
Indocyanine green (ICG) in liver surgery.pptxGian Luca Grazi
The use of indocyanine green has now become common practice during liver and biliary tract surgery. This dye helps in defining the anatomy of the liver segments and is able to provide data on the course of the biliary tract. Furthermore, it can detect the presence of small superficial tumors, increasing the cure potential of liver resections in the treatment of liver tumors.
This reading reviews the main uses of indocyanine green in liver surgery, in particular for laparoscopic and robotic surgery, and opens a window on the future clinical developments of indocyanine green in the treatment of liver tumors.
Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore
What is New In Minimally Invasive Surgery for UrologySiewhong Ho
Dr Ho Siew Hong gave a series of Continous Medical Education lectures to doctors of Gleneagles, Mount Elizabeth and East Shore Hospitals on the latest in Urology surgery
Robotic assisted radical prostatectomy (RARP) has become the commonest minimally invasive surgical procedure for the treatment of localized prostate cancer. Despite limited data supporting the excellence of RARP over laparoscopic radical prostatectomy (LRP) or open radical prostatectomy (ORP), it has gained wide acceptance among the patients and surgeons.
Minimal invasive Surgery in Management of colorectal cancerpiyushpatwa
Laparoscopic Anterior resection. After insertion of ports with patient in steep trendelenburg position Inferior mesenteric artery was identified and high ligation done with division of left colic artery and then medial to lateral dissection was done. Subsequently inferior mesenteric vein was dissected and clipped and divided. Distal dissection proceeded just behind the superior rectal artery and after identification and preservation of the hypogastric nerves, upper rectum was mobilised. Division of bowel was done at upper rectum after giving adequate distal margin and end to end anastomosis was done using circular stapler.
The indications and preparation for laparoscopic liver surgery remain the same as in open hepatic surgery. Visualization is excellent with the laparoscope, and the addition of laparoscopic ultrasound has been shown to help intraoperative plans in 66% of cases when compared to laparoscopic exploration alone.
Laparoscopic Partial Nephrectomy of Hilar Tumors with Cold Ischemiaguestd58ac53
Laparoscopic Partial Nephrectomy of Hilar Tumors with Cold Ischemia
Juza Chen and Avi Bery
Director of Sexual Dysfunction Clinic
Department of Urology
Tel-Aviv Sourasky Medical Center
Sackler Faculty of Medicine Tel-Aviv University
Moscow 2010
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
2. ADVANTAGE OF ROBOTIC
PROSTATECTOMTY
Minimal Bleeding Faster return to normal daily activities.
Reduced hospital stay Significantly less pain and scarring.
Lower blood transfusion rates.
Improved preservation of physical appearance.
Three (3) D vision enables surgeon to perform Prostate excision with
cancer.
Reduced risk of Post Surgery incontinence (control over urinary and fecal
discharge) and Impotency.
3. Patient selection
Patients should have a pathologically confirmed
cancer clinically confined within the prostate (stage T1 or T2) or
a cancer that extends beyond the margins of the prostate (T3) but still
seems amenable to surgical extirpation with a wide resection.
Based on the 2013 American Urological Association (AUA), radiographic
staging with CT and bone scan is recommended only for patients with:
suspected locally advanced disease, Gleason score of 8 or greater
or prostate-specific antigen (PSA) level greater than 20 ng/mL.
5. Relative contraindication
who have a history of prior complex lower abdominal and pelvic surgery
prior transurethral resection of the prostate(TURP)
6. INSTRUMENTATION
ROBOTIC-ASSISTED LAPAROSCOPIC PROSTATECTOMY
• da Vinci Si or Xi HD Surgical System
• Endowrist Maryland bipolar forceps or PK dissector
• Endowrist curved monopolar scissors
• Endowrist ProGrasp forceps
• Endowrist large needle drivers (two)
• InSite Vision System with 0-degree and 30-degree lens
• 12-mm trocars (two)
• 8-mm metal robotic trocars (three if using a fourth robotic arm)
• 18-Fr urethral catheter
• Small and medium-large Hem-o-lok clips (Teleflex Medical)
• 0 polydioxanone suture for dorsal venous complex
• 2-0 polydioxanone suture for posterior reconstruction
• 3-0 Monocryl double-armed suture for anastomosis
10. PREOPERATIVE PREPARATION
Bowel Preparation
Informed Consent
Pre anaesthetic work up
Patient positioning
Operative room equipment
11. Patient Positioning
o supine position in steep
Trendelenburg
o arms and hands carefully tucked
and padded at the sides
o Sequential compression stocking
devices are placed on both legs
and activated
o patient’s legs may be placed in
stirrups in the low lithotomy
position
o secured firmly to the table using
heavy cloth tape and egg-crate
padding across the chest
14. Abdominal Access, Insufflation, and
Trocar Placement
o 5mm ports x 1 in RHC
o 12mm camera port supraumbilical,
12mm RLQ
o 8mm robotic ports x 2 in R and L
midclav lines, about 17cm from pubic
symphysis
o 8mm robotic port in LLQ
16. Developing the Space of Retzius
initial step is entry and development of the space of Retzius.
The bladder is dissected from the anterior abdominal wall by
dividing the urachus high above the bladder and incising the
peritoneum bilaterally immediately lateral to the medial
umbilical ligaments
Lateral dissection upto
crossing of the medial umbilical ligaments and vas deferens to
ensure optimal mobilityof the bladder
17.
18. Ligation of the deep dorsal venous
complex
Securing the deep DVC as far distal
from the prostatic apex as possible
can help minimize iatrogenic entry
into the prostatic apex during later
division of the DVC.
profuse bleeding, is less apparent
because of the tamponade effect on
venous bleeding offered by the
pneumoperitoneum even when the
DVC is inadvertently entered.
19. Bladder Neck Identification and
Transection
Several maneuvers for
identification
1. point of transition of the prevesical fat to
the anterior prostate.
2. caudal retraction of an inflated urethral
catheter balloon
3. retract the dome of the bladder in a
cephalad direction
4. bimanual palpation or pinch of the
bladder neck using the tips of two robotic
or laparoscopic instruments.
20. Dissection of seminal vesicles and vasa
deferentia
After bladder neck transection, the
seminal vesicles and vasa
deferentia are individually
identified, dissected, and divided,
minimizing electrocautery if
possible to prevent damage to the
nearby NVBs
21. Development of the plane between
the prostate and rectum.
The Denonvilliers fascia is an inferior extension
of the peritoneal cul-de-sac that lies between
the prostate and rectum.
With an intrafascial or interfascial dissection,
Denonvilliers fascia can be separated from the
posterior prostate by careful blunt and sharp
dissection.
The separation can be carried all the way to the
prostatic apex and laterally to the medial aspect
of the prostatic pedicle
23. Entering into the interfascial plane of dissection for neurovascular bundle
(NVB) preservation. The levator fascia is first incised along the anteromedial
aspect of the midprostate, allowing entry into the interfascial plane of
dissection
24. Apical Dissection
common location for tumor involvement
and the most common site of positive
margins
avoid entry into the anterior prostate
during division of the deep DVC
limited use of electrocautery is preferred
during the prostatic apical dissection and
division of the urethra
25. Pelvic Lymphadenectomy and
Entrapment of Specimens
prior mobilization of the bladder allows for excellent
exposure of the obturator lymph node region and iliac
vessels
26. Bladder Neck Reconstruction
Running vesicourethral anastomosis. The posterior anastomosis
is reapproximated after preplacing two or three suture throws
on either side starting at the 6 o’clock position and cinching the
sutures by lifting anteriorly.
27. POSTOPERATIVE MANAGEMENT
drain may be placed through one of the 8-mm robotic trocar sites
o drain typically can be removed on the first or second postoperative day
Parenteral narcotic medications may be required for the first 24 hours
With 1 week or more of an indwelling urethral catheter, the vast majority of
patients are able to void adequately with minimal risk for urinary retention
and need for catheter replacement.
o Need for urethrogram on surgeons preference.and if wants to removed before 1
week.
Most patients can tolerate a regular diet within 24 hours of surgery return to
their preoperative activities shortly after catheter removal but must avoid
strenuous activity up to 3 to 4 weeks after surgery.
28. PERIOPERATIVE OUTCOMES
OPERATIVE TIME:
typically longer with LRP or RALP compared with open surgery, especially early in a
surgeon’s experience
At experienced centers of excellence with LRP, operative times less than 3 to 4
hours
Postoperative Pain:
minimally invasive nature resulting in less postoperative pain than comparative
open approaches
Intraoperative Blood Loss:
antegrade approach used during LRP and RALP allows earlier control of the
prostatic pedicles and late division of the deep DVC compared with RRP
29. Hospital Stay:
shorter length of hospital stay and lower probability of prolong hospitalization
30. Functional Outcomes
URINARY INCONTINENCE:
o With LRP and RALP, visualization of the prostatic apex is typically superb.
o allow precise dissection of the prostatic apex with limited trauma to the
periurethral striated sphincter and genitourinary diaphragm.
o tension-free, watertight anastomosis under the superior and direct
visualization
o urinary incontinence improves substantially within the first 3 to 6 months
31. ERECTILE DYSFUNCTION:
o depends on precise and meticulous separation of the cavernous nerves within the
NVB from the prostate gland
o Thompson and colleagues (2014) reported higher sexual function scores after
transition to RALP compared to RRP
Critical to post operative recovery of potency
o avoidance of traction,
o direct manipulation,
o hemostatic energy sources, and
o performance of a meticulous interfascial dissection during NVB preservation
32. ONCOLOGIC OUTCOMES
Surgical Margins:
o adhering to specific surgical principles can help reduce site-specific positive
margins at the apex, bladder neck, and posterolateral regions of the prostate
Biochemical Recurrence:
o provide a more accurate assessment of oncologic control than margin status
o RALP and RRP offer similar disease control when performed by experienced
surgeons, even in high-risk settings.
33. COMPLICATION
Complications Related to Patient Positioning
Vascular and Bowel Injury
Rectal Injury
Thromboembolic Complications
Anastomotic Complications
Bleeding and Transfusion
Equipment Malfunction