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BACKGROUND: Ureteric reimplantation is the treatment of choice for pelvic lipomatosis with ureteric obstruction. Pelvic adherent fat poses a technical challenge during this surgery. DESCRIPTION OF TECHNIQUE: We describe the robotic approach to facilitate the precise dissection of the ureter and bladder in adherent fat. After creating pneumoperitoneum and port placement, the ureter is exposed at the iliac crossing and dissected distally. Perivesical fat at the intended site of ureteric reimplantation is excised and cystotomy is done. Ureterovesical anastomosis is performed over a stent. PATIENTS AND METHODS: Two patients with pelvic lipomatosis causing ureteric obstruction and renal function impairment underwent robotic ureteric reimplantation at our institute. Technical aspects and outcomes are discussed here. RESULTS: Blood loss was minimal. No intra-operative or post-operative complication was noted. Renal function improved for both patients. CONCLUSION: Robotic approach helps to overcome the technical difficulties posed by adherent fat during ureteric reimplantation in pelvic lipomatosis.

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Centrally located completely endophytic renal hilar tumors pose a technical challenge, especially during a minimally invasive surgery. Relation of the tumor to the renal vasculature decides the approach. Tumors placed anterior to the vasculature can be approached in the anterior trans-hilar manner. However, tumors placed posterior to the vasculature need a posterior approach, which is quite a difficult maneuver during transperitoneal laparoscopy. Adequate exposure to access the resection plane is the key principle. We describe a laparoscopic technique for enucleation of such tumors, applying the surgical principle of radial nephrotomy in the intersegmental plane which is usually performed to remove renal stones.

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INTRODUCTION: Renal cell carcinoma (RCC) is known to invoke both immunological and inflammatory responses. While the neutrophils mediate the tumor-induced inflammatory response, the lymphocytes bring about the various immunological events associated with it. The neutrophil-to-lymphocyte ratio (NLR) is a simple indicator of this dual response. We investigated the association between preoperative NLR and histopathological prognostic variables of RCC intending to find out whether it can be of value as a red flag capable of alerting the clinician as to the biological character of the tumor under consideration. METHODS: Preoperative NLR and clinicopathological variables, namely histological subtype, nuclear grade, staging, lymphovascular invasion, capsular invasion, tumor necrosis, renal sinus invasion, and sarcomatoid differentiation of 60 patients who underwent radical or partial nephrectomy, were analyzed to detect the association between the two. RESULTS: We found that mean preoperative NLR was significantly higher in clear-cell carcinomas (3.25 ± 0.29) when compared with nonclear-cell carcinomas (2.25 ± 0.63). There was a linear trend of NLR rise as the stage of the disease advanced. A significant rise in preoperative NLR was noted in tumors with various high-risk histopathological features such as tumor size, capsular invasion, tumor necrosis, and sarcomatoid differentiation. CONCLUSION: Preoperative measurement of NLR is a simple test which may provide an early clue of high-risk pathological features of renal cell cancer.

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INTRODUCTION: Various nephrolithometric scoring systems have recently emerged to predict the outcomes of percutaneous nephrolithotomy (PCNL). However, there is no consensus upon an ideal tool. The current study aimed to assess the correlation between Guy's stone score (GSS) and PCNL outcomes. METHOD: This was a hospital-based observational study of 2-year duration. All patients electively undergoing PCNL for renal stones during the study period were included. Based on the imaging findings, the stones were categorized as simple (GSS I & II) and complex (GSS III & IV). The association between GSS and duration of the procedure, the number of percutaneous tracts needed, stone-free rate (SFR), and the severity of complications based on modified Clavien classification and postoperative stay were assessed. RESULTS: Total number of the patients studied were 100 (n = 100), and most of the patients were in the category of GSS II (51%). Post-extrapolation of χ2 to Pearson's test, GSS demonstrated a significant association with duration of surgery, the number of percutaneous tracts needed, the severity of complications, and SFR. CONCLUSIONS: Preoperative assessment of stone complexity by using GSS effectively correlated with SFR as well as other PCNL outcomes. Hence, we recommend utilizing this predictive tool for standardized documentation, preoperative planning, and better patient counseling.

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Cálculos Renales/diagnóstico , Cálculos Renales/cirugía , Nefrolitotomía Percutánea , Adulto , Correlación de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Preoperatorio , Resultado del Tratamiento

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Jejunostomy is usually indicated as an additional procedure during major surgery of upper digestive tract to administer enteral nutrition in post-operative period. Complications associated with it can be mechanical, infectious, gastrointestinal or metabolic. The aim of the study was to evaluate safety of post-operative feeding jejunostomy in different types of major upper gastrointestinal surgeries. It was a prospective study conducted during the period between August 2009 and September 2011. Post-operative cases of major upper gastrointestinal surgeries who receive jejunostomy feeds were included in the study. Sampling was done by convenient method with sample size of 50 cases. Post-operatively, patients were monitored according to standard orders of enteral nutrition. Total calorie and protein intake through feeding jejunostomy was calculated regularly, and complications were assessed in terms of frequency, type, duration, management, and final outcome in different types of upper gastro intestinal surgeries. Analysis was done using chi square test with the help of statistical package SPSS vers.13. P < 0.05 was considered as significant. Complications observed were gastrointestinal -8 (16 %), mechanical -6 (12 %), infectious -4 (8 %) and metabolic -4 (8 %). Duration of complications ranged from 1 to 7 days (mean, 4 days). All types of complications observed during study were less severe and could be managed by simple measurements. Haemoglobin, serum albumin and weight of the patient at the time of discharge were improved for all patients when compared to pre-operative values. All patients received target calories and proteins through feeding jejunostomy. Considering benefits of enteral feeding via jejunostomy tube with minor and acceptable complications, we conclude that feeding jejunostomy is a preferred route of nutritional administration in those who undergo major upper gastro intestinal surgeries.