MULJIBHAI PATEL UROLOGICAL HOSPITAL, NADIAD


JAYARAMDAS PATEL ACADEMIC CENTRE

Retrograde Intra Renal Surgery

Jayaramdas Patel Academic Centre (JPAC) at the Muljibhai Patel Urological Hospital (MPUH), Nadiad is organizing a two-day programme on ‘Retrograde Intra Renal Surgery (RIRS)’ on 16th & 17th September, 2010. Who will be in the driving seat? PCNL, RIRS, ESWL?

RIRS is a procedure for doing surgery within the kidney using a viewing tube called a fiberoptic endoscope. The scope is placed through the urethra (the urinary opening) into the bladder and then through the ureter into the urine-collecting part of the kidney. The scope thus is moved retrograde (up the urinary tract system) to a position within the kidney (intrarenal).

RIRS may be done to remove a stone. The stone is seen through the scope and can then be manipulated or crushed by a pneumatic probe or evaporated by a laser probe or grabbed by small forceps, etc.

The advantages of RIRS over open surgery are that it is a minimally invasive surgery with the elimination of prolonged pain after surgery, and much faster recovery.

Muljibhai Patel Urological Hospital has handled more than 23000 stone cases so far.

The two-day programme will cover all aspects of RIRS. The participants will also be able to see LIVE surgeries of Flexible URS for Lower Calyceal Stone, Calyceal Diverticular Stone, Ectopic Kidney and Mini/Micro perc for Kidney Stone and Ectopic kidney stone.

Faculty from abroad and India will be participating. They include Drs Olivier Traxer (France), M Prabhakar, Pawan Gupta, Anil Bradoo, PP Rao, and Abhay Khandekar. Medical Director and Managing Trustee of MPUH, Dr. Mahesh Desai; and Chairman of Dept of Urology, Dr. R B Sabnis will also be participating in the programme.

P A JOSEPH



P A JOSEPH

Stress urinary incontinence in men after prostate surgery is usually a result of intrinsic sphincter deficiency. Active conservative management with fluid restriction, medication management and pelvic floor exercises is indicated for the first 12 mths. If bothersome incontinence persists, urodynamic evaluation is indicated to assess detrusor storage function, contractility and sphincteric integrity. Standard surgical options include urethral bulking agents, artificial urinary sphincter (AUS) and male sling. Periurethral injection of bulking agent is satisfactory in only a minority of patients but AUS and male sling are the most common surgical treatment. AUS seems to have a higher success rate than male sling. AUS is indicated in men with hypocontactility of the detrusor as adequate detrusor contractility is needed to overcome the fixed resistance of the sling. However, infection, erosion, and revision rate for the male sling seem to be somewhat lower than that for the AUS .

BUSINESS_STANDARD
Sohini Das | 2010-03-16 01:50:00

Robot surgeons: Coming soon at Nadiad

Kidney patients have a reason to cheer as Nadiad - a sleepy town lying between Ahmedabad and Vadodara, would soon have a robot conducting urology surgeries on them that will not only have superfine precision, but will also less than halve the post operation recovery time.

A non-profit 170-bed charitable hospital run by the Muljibhai Patel Society for Research in Nephro-Urology, the Muljibhai Patel Urological Hospital (MPUH), popularly known as Nadiad Kidney Hospital, is planning to buy the Rs 10 crore da Vinci robot, a four-armed US made model for intricate prostate and kidney surgeries. "We have always tried to adopt new technology, and would not like to deprive our patients of the new-age surgical experience that definitely comes with numerous advantages," said Mahesh Desai, managing trustee and chairman, department of urology at the Nadiad Kidney Hospital.

So, what are the advantages? As Desai points out: "In a computer assisted surgery, a doctor can sit at a remote place and conduct live surgery. Only recently, a doctor in New York did a surgery on a patient in Paris. In a hospital set up, an experienced doctor can preside over two or three simultaneous operations from his chamber while young doctors could man the operation table together with the robot".

On top of it, while it takes around two months to recover from an open surgery, a patient will up on his feet in 10 days after a robotic surgery as the scars and incisions are restricted to minimal extents. However, he will have to shell out around 25 times more for a robotic surgery that can cost around Rs 5 lakh per surgery.

Nadiad Kideny hospital is planning to extend the services of the robot to other surgical fields apart from urology, like paediatrics, gynaecology and oncology to make the service cost-effective.

"We already conduct uro-oncological paediatric urological surgeries, we can now think of offering the service to some gynaecological clinics, or can start a uro-gynaeocology department ourselves", Desai said. He also pointed out that by 2012, similar systems on the lines of the da Vinci surgical systems would be open for other equipment makers to manufacture as the system goes off-patent. Intuitive Surgical has the monopoly over da Vinci robots now.

When asked, if the hospital would consider waiting till the robotic surgery set up was available at more competitive prices, Desai said that they wanted to acquire it much sooner than 2012. "We will take up this issue at the next budgetary meeting. The management or promoters are likely to make the capital expenditure while the cost of running and maintaining the system will lie with the hospital", he explained.

Being a charitable hospital, around 68 per cent of all operative cases at the Muljibhai Patel Urological Hospital are free or subsidised, the remaining are either paid or partly paid cases.

While the cost of acquiring the system is around Rs 10 crore which comes with the basic machine and around 100 robotic arms, one has to later on incur a recurring cost of replenishing the robotic arms that come for $6000 each and last 10 operations. The hospital is considering attracting patients from neighbouring states who will pay for availing the technology that will not only ensure 100 per cent accuracy and precision but also reduce recovery time. This could take care of the recurring cost of maintenance that runs into Rs10-12 lakh per annum and the service could come free for the needy patients.

MPUH had organised a live transmission of a surgery from the USC Institute of Urology, US at the hospital auditorium recently for 70 people and is upbeat on training personnel to equip them for conducting such surgeries. Nadiad Kidney hospital was one of the five international locations along with Venezuela, UK, China and Kuwait which saw a live demonstration of the da Vinci Robot at work.

Robotic surgeries, particularly in urology and gynecologic-oncology, are increasingly being promoted as the new standard of care. Hospitals are marketing it, patients are asking for it, and young physicians are expecting to be trained on it. The number of da Vinci robotic surgical systems installed worldwide has ballooned from 210 in 2003 to 1,395 last year, with 1,028 of those in the United States, according to records from Intuitive Surgical, which makes the da Vinci robot.

In India only the All India Institute of Medical Sciences (AIIMS) owns a da Vinci robot.

ORGAN SPECIFIC STEP-BY-STEP ROBOTIC SYMPOSIA, ON KIDNEY AND PROSTATE

LIVE TRANSMISSION FROM
USC INSTITUTE OF UROLOGY, USA
AT JPAC, NADIAD KIDNEY HOSPITAL

USC Institute of Urology, USA organised a concept series of organ-specific ‘step-by-step’ Robotic Symposia focused on live surgical demonstrations of various urologic procedures. The Part-I during March 12-13, 2010 was focused on Kidney & Prostate. The dominant feature of this unique symposium series was an emphasis on the ‘nuts & bolts’ of the practical technical aspects of robotic technique, both for the beginner and the expert. World-class faculty provided in-depth discussions on each step of the actual operative procedure, with live transmission to 5 international locations, including JPAC (Jayaramdas Patel Academic Centre) at Nadiad Kidney Hospital. These was Intense audience participation with audience response systems.

Dr. Inderbir S Gill was the Course Chairman whereas the Course Directors were Drs Mihir M Desai and Monish Aron, of USC Institute of Urology, USA. The international faculty included Dr. Mahesh Desai, Chairman, Department of Urology & President-Elect of Society Internationale d’Urologie, MPUH, Nadiad.

The symposium covered introduction to Robotic-assisted kidney surgery and introduction to Robotic-assisted Radical Prostatectomy, followed by moderated panel discussions and live transmission from operation theatre.

There were instructional video session as well.

P A JOSEPH
OSD, MPUH NADIAD

MULJIBHAI PATEL UROLOGICAL HOSPITAL, NADIAD

JAYARAMDAS PATEL ACADEMIC CENTRE

2nd International Live Operative workshop
On Laparo-Endoscopic Single Site (LESS) Surgery


Jayaramdas Patel Academic Centre (JPAC) at the Muljibhai Patel Urological Hospital (MPUH), Nadiad is organizing the 2nd International Multi-disciplinary Summit on Laparo-Endoscopic single Site (LESS) Surgery during December 10th to 12th, 2009. This Course will feature leading international faculty and will cover the entire field of LESS surgery including state-of-the-art lectures, live operative surgery and ‘hands-on’ workshop wherein delegates will be able to practice with the entire gamut of LESS instrumentation. Around 140 delegates will be participating in the Live Operative Workshop.

With the LESS surgery, the minimally invasive surgery has just got further minimal. Experts will be demonstrating removal of large organs and growths through the navel. Unlike in laparoscopy, where four cuts are made on the abdomen, in LESS just one small incision is made on the navel. Pain and recovery period for the patient will be much less.

JPAC had organized the first successful Single Port Surgery Instruction Course in August last year. Since then the field, now called ‘LESS’ surgery has progressed exponentially and more than 1000 LESS procedures have been performed world-wide. Stimulated by increased interest in LESS technology by surgeons and patients, there has been an ongoing improvement and refinements in new technology in access devices and instrumentation.

The International faculty who will be participating in the 3-day Workshop includes Drs Mihir Desai (USA), who is also the Course Director, Lee Richstone (USA), Michael Kia (USA), Abhay Rane (UK) and Rene Sotelo (Venezuela). The prominent national faculty includes Drs Prashanth P Rao, Pradeep P Rao, G.V. Rao and Jyotsna Kulkarni. From MPUH, Dr. Mahesh Desai, Chairman, Department of Urology & Director of JPAC and Dr. R B Sabnis, Vice-Chairman, Department of Urology will also be participating alongwith other Urologists.


P.A. Joseph
Officer on Special Duty
MPUH, Nadiad 387001
Mobile 9327941331

www.mpuh.org