ISWANTO SUCANDY, MD, FACS’ Post

A Real life journey of a patient with a rare presentation of a #neuroendocrine neoplasm managed with Dr.Prasad K. Wagle sir. Highlights the importance of having experienced teams for #cancertreatment for good outcomes and a need for long term follow up in #cancer cases. Key features to learn - Pre-op scan reading with the expert radiologists Dr. Manoj Deshmukh sir and kaustubh lokhande , excellent images by the radiology team to map the tumors - Intraoperative sonography a must - Adherance to the ten commandments of safe liver surgery - https://lnkd.in/dmTP3q_i - Experienced anesthesia team for such complex cases and post-op support system in place All these together help in achieving good outcomes for the patients. https://lnkd.in/dRy9R8pk To get epaper daily on your whatsapp click here: https://lnkd.in/drnzeKeV

Transcatheter aortic valve replacement (TAVR) can be performed safely in adults with congenital heart disease (CHD) if done by a multidisciplinary team of specialists at a high-volume center, so concludes a Cleveland Clinic case series. TAVR can be an effective intervention in CHD in select clinical scenarios, proving both feasible & safe with good short-term outcomes. In high surgical risk, it can be used as a bridge to recovery, future surgery, transplantation, or palliation. Joanna Ghobrial Tara Karamlou Grant Reed https://lnkd.in/gMXUfMdj

📃Scientific paper: Is endourological intervention a suitable treatment option in the management of iatrogenic thermal ureteral injury? A contemporary case series Abstract: Background Iatrogenic ureteral injury (IUI) is relatively rare, however, can cause sepsis, kidney failure, and death. Most cases of IUI are not recognized until the patient presents with symptoms following pelvic surgery or radiotherapy. Recently, minimally invasive approaches have been used more frequently in the treatment of IUI. This study evaluates urological intervention success rates and long-term clinical outcomes according to the type of IUI following hysterectomy. Methods Twenty-seven patients who underwent surgery due to IUI in our clinic following hysterectomy were evaluated between January 2011 and April 2018. Patients were classified according to the time of diagnosis of IUI. The IUI cases diagnosed within the first 24 h following hysterectomy were designated as "immediate" IUI, while that diagnosed late period was considered 'delayed' IUI. The type of IUI was categorized as "cold transection" if it was due to surgical dissection or ligation without any thermal energy, and "thermal injury" if it was related to any energy-based surgical device. Patient information, laboratory and perioperative data, imaging studies, and complications were assessed retrospectively. Results All cases of delayed diagnosis IUI were secondary to laparoscopic hysterectomy ( P  = 0.041). Patients with thermal injury to the ureter were mostly diagnosed late (delayed) ( P  = 0.029). While 31% of the patients who underwent endourological intervention were diagnosed immediately,... Continued on ES/IODE ➡️ https://etcse.fr/Uxu ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

🚨 Breakthrough in EBTB Treatment! 🚨 A recent study published in Updates Surgery reveals that cryorecanalisation significantly outperforms cryoablation for patients with tumor-like endobronchial tuberculosis (EBTB). 🔍 Key Findings: - Efficacy Rates: - Cryorecanalisation: 81.5% - Cryoablation: 48.0% - For patients with severe airway obstruction (>50%), cryorecanalisation shows a remarkable efficacy of 77.5%, compared to just 25.0% for cryoablation. ⚠️ However, this promising treatment comes with a notable increase in bleeding complications (96.2% incidence rate). Healthcare providers must carefully weigh the benefits of higher efficacy against the risks involved, tailoring treatment plans to individual patient needs. This study emphasizes the importance of personalized care in EBTB management, potentially revolutionizing patient outcomes and quality of life. 👉 Click the link to learn more about this significant advancement! #ClinicalResearches #Cryorecanalisation #EBTB #HealthcareInnovation #MedicalResearch #PatientCare #MarketAccess #MarketAccessToday

📃Scientific paper: Is endourological intervention a suitable treatment option in the management of iatrogenic thermal ureteral injury? A contemporary case series Abstract: Background Iatrogenic ureteral injury (IUI) is relatively rare, however, can cause sepsis, kidney failure, and death. Most cases of IUI are not recognized until the patient presents with symptoms following pelvic surgery or radiotherapy. Recently, minimally invasive approaches have been used more frequently in the treatment of IUI. This study evaluates urological intervention success rates and long-term clinical outcomes according to the type of IUI following hysterectomy. Methods Twenty-seven patients who underwent surgery due to IUI in our clinic following hysterectomy were evaluated between January 2011 and April 2018. Patients were classified according to the time of diagnosis of IUI. The IUI cases diagnosed within the first 24 h following hysterectomy were designated as "immediate" IUI, while that diagnosed late period was considered 'delayed' IUI. The type of IUI was categorized as "cold transection" if it was due to surgical dissection or ligation without any thermal energy, and "thermal injury" if it was related to any energy-based surgical device. Patient information, laboratory and perioperative data, imaging studies, and complications were assessed retrospectively. Results All cases of delayed diagnosis IUI were secondary to laparoscopic hysterectomy ( P  = 0.041). Patients with thermal injury to the ureter were mostly diagnosed late (delayed) ( P  = 0.029). While 31% of the patients who underwent endourological intervention were diagnosed immediately,... Continued on ES/IODE ➡️ https://etcse.fr/Uxu ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

Aim: To investigate the association between early postoperative anastomotic leakage or pelvic abscess (AL/PA) and symptomatic anastomotic stenosis (SAS) in patients after surgery for left colonic diverticulitis. Methodology: Retrospective study of 7053 patients who underwent surgery for colonic diverticulitis. Patients with right-sided diverticulitis, no anastomosis, or missing data were excluded, giving 4441 patients in the final analysis. Path analyses were used. Results: AL/PA occurred in 4.6%, and SAS in 1.8%. AL/PA was associated with an ↑ risk of SAS (OR = 3.41), as was a diverting stoma for ≥100 days (OR = 2.77). Central vessel ligation proximal to the IMA was associated with a ↓ risk of SAS (OR = 0.41). Diverting stoma, whether kept for <100 days (OR = 3.08) or ≥100 days (OR = 12.95), was associated with an ↑ risk of AL/PA. No significant association was found between radiological or surgical management of AL/PA and SAS. Conclusion: AL/PA is associated with ↑ risk of SAS. The management of AL/PA does not influence the occurrence of anastomotic stenosis. Diverting stoma is associated with ↑ risk of both AL/PA and SAS, especially if left for ≥100 days. Limitations: 1. Retrospective methodology - limits ability to investigate causality 2. Definition of SAS - retrospective and limited by symptomatic characteristic 3. Survival analysis - lacking, only occurrence recorded, not the date 4. Elective surgery - many patients underwent it contrary to new guidelines, introducing possible bias 5. Anastomosis details - type, height, and extent of resection not collected, potential risk factors for AL/PA or SAS 6. Stapled anastomosis recommendations - adherence not verified by study design 7. SAS management - data on consequences and management not collected https://lnkd.in/gEvukTZa

📃Scientific paper: Hospital rating websites play a minor role for uro-oncologic patients when choosing a hospital for major surgery: results of the German multicenter NAVIGATOR-study Abstract: Purpose Hospital rating websites (HRW) offer decision support in hospital choice for patients. To investigate the impact of HRWs of uro-oncological patients undergoing elective surgery in Germany. Methods From 01/2020 to 04/2021, patients admitted for radical prostatectomy, radical cystectomy, or renal tumor surgery received a questionnaire on decision-making in hospital choice and the use of HRWs at 10 German urologic clinics. Results Our study includes n  = 812 completed questionnaires (response rate 81.2%). The mean age was 65.2 ± 10.2 years; 16.5% were women. Patients were scheduled for prostatectomy in 49.1%, renal tumor surgery in 20.3%, and cystectomy in 13.5% (other 17.1%). Following sources of information influenced the decision process of hospital choice: urologists’ recommendation (52.6%), previous experience in the hospital (20.3%), recommendations from social environment (17.6%), the hospital's website (10.8%) and 8.2% used other sources. Only 4.3% ( n  = 35) used a HRW for decision making. However, 29% changed their hospital choice due to the information provided HRW. The most frequently used platforms were Weisse-Liste.de (32%), the AOK-Krankenhausnavigator (13%) and Qualitaetskliniken.de (8%). On average, patients rated positively concerning satisfaction with the respective HRW on the Acceptability E-Scale (mean values of the individual items: 1.8–2.1). Conclusion In Germany, HRWs play a minor role for uro-oncologic patients undergoing elective su... Continued on ES/IODE ➡️ https://etcse.fr/ikuCd ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

We are proud to share our latest publication on an innovative approach to managing left-sided valve thrombosis: The Lausanne Novel Procedure. Left-sided valve thrombosis (LSVT) presents a significant clinical challenge, frequently requiring invasive interventions such as redo surgery or fibrinolysis. In this study, we introduce the Lausanne Novel Procedure, a groundbreaking minimally invasive approach designed to reduce the need for these extensive procedures. This technique provides a less invasive alternative that minimizes patient risk and recovery time. Our innovative method utilizes a novel cannula connected to an extracorporeal circuit, offering a safer and more effective means of thrombus aspiration compared to traditional systems like the AngioVac System. Its design enhances precision and control during the aspiration process, reducing potential complications and improving patient outcomes. This publication details our procedure's development, technical specifications, and clinical outcomes, highlighting its efficacy in managing LSVT. We also present a comparative analysis of our approach against existing methods, demonstrating significant advantages in safety and effectiveness. Our findings underscore the potential of the Lausanne Novel Procedure to transform the treatment paradigm for LSVT, offering a promising alternative to more invasive interventions. This advancement not only reduces the burden on patients but also represents a significant leap forward in the field of cardiac surgery. #leftsidedthrombosis #thromboaspiration #Lausannenovelprocedure #structuralcardiacintervention #cardiacsurgery #innovation CHUV / Centre hospitalier universitaire vaudois

Partial nephrectomy is now considered the standard of care for small renal tumors and benign kidney neoplasms, even when the other kidney is normal. The treatment of renal tumors is advancing, with less invasive approaches gaining importance in our field. Laparoscopy has become a crucial part of our surgical techniques. Several studies have shown positive results with laparoscopic partial nephrectomy, including reduced post-operative pain, shorter hospital stays, and satisfactory oncologic outcomes. However, as more complex laparoscopic procedures are performed, the reported warm ischemia times seem to be longer compared to partial nephrectomy done via an open approach, even in skilled laparoscopic hands. The duration of ischemia time, or the amount of time during which renal blood flow is interrupted, remains the most important factor governing the return of renal function. It is commonly believed, based on animal models, that a warm ischemia time of over 25 minutes results in significant immediate functional loss with either incomplete or absent late recovery. Therefore, the discussion around ischemia times and their limits has become an intriguing topic in urologic literature. A 55-year-old female patient underwent an ultrasound examination as part of a routine health check-up, revealing the presence of two hyperechoic masses, each approximately 10 cm in size, in the right kidney. Subsequent computed tomography (CT) examination showed a large mass with mixed density measuring approximately 8x7.5x6 cm, accompanied by a 1-cm aneurysm and a smaller mass measuring about 2.5x3x3.5 cm. There were no symptoms or radiological findings suggestive of tuberous sclerosis complex (TSC). The adrenal glands bilaterally and the right kidney appeared normal, and the results of blood biochemistry tests fell within the normal range. The patient needs the removal of all tumors through minimally invasive surgery. As mentioned above, what should I do?"

Adnexal lesions can be classified as benign or malignant accurately with imaging modalities. Between these two ends of the spectrum are the cysts that cannot be characterized, and are considered as INDETERMINATE. Frequencies of ovarian cancer ranges from 5 to 40% within this indeterminate spectrum. These indeterminate cysts can be classified as benign or malignant only through surgery, hence these may lead to overtreatment to a benign or undertreatment/staged for a malignant cyst. Recently French National College of Obstetricians and Gynecologists (CNGOF) introduced the term PBOT (Presumed benign ovarian tumor) for such indeterminate lesions. Since there is very little data on these Indeterminate cysts, we have done an Audit in our institute (Department of Gynecology and Surgical Oncology both in Cantonment and Tennur) for 3 years. Methods and Materials : Study Method: Retrospective (collected from electronic Database). Study Period: 3 years (From August 2020 to August 2023). Those patients who were indeterminate on ultrasonogram were further imaged with contrast-enhanced CT or MRI scan and tumour markers were taken to further characterize the lesion and offered surgery, either Pfannenstiel, midline laparotomy or laparoscopy. Inclusion criteria: All the patients who underwent surgery for indeterminate cysts either laparoscopy/ laparotomy/Pfannenstiel. Exclusion criteria: Those patients who were operated for simple cysts, malignant ovarian mass, and those with inadequate documents. What we consider as Indeterminate Cyst: Unilocular cyst 10 cm in size, or with irregular walls, Multilocular cyst, Multilocular cyst with solid component. Unilocular cyst with 1to3 papillary projections or solid components Solid lesion with smooth outer contour. https://lnkd.in/gYAMmXQW