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Biomedical subjects

Prokar Dasgupta

Publications and source records attributed to Prokar Dasgupta.

28 records · Page 2Linked to original sources
PubMed2005

A randomized controlled trial of human versus robotic and telerobotic access to the kidney as the first step in percutaneous nephrolithotomy.

OBJECTIVE: We present results from the first randomized controlled trial of human vs. telerobotic access to the kidney during percutaneous nephrolithotomy. METHODS: To compare (a) human with robotic percutaneous needle access and (b) local robotic with trans-Atlantic robotic percutaneous needle access, we used a validated kidney model into which a needle was inserted 304 times. Half the insertions were performed by a robotic arm and the other half by urological surgeons. Order was decided randomly except for a sub-group of 30 trans-Atlantic robotic procedures that were controlled by a team at Johns Hopkins, Baltimore, via four ISDN lines. RESULTS: All attempts were successful within three passes with a median time of 35 s for human attempts compared with a median of 57 s for robotic attempts. The robot was slower than the human to complete insertions (p < 0.001, Mann-Whitney U test), but was more accurate when compared with human operators as it made fewer attempts (88% robotic vs. 79% human first attempt success; p = 0.046, chi-squared test). Times for trans-Atlantic robotic needle insertion (median = 59 s) were comparable to times taken for local robotic needle insertion (median = 56 s) with no difference in accuracy. CONCLUSION: Telerobotics is an accurate and feasible tool for future minimally invasive surgery.

Clinical Competence↗
PubMed2004

Laparoscopic nephroureterectomy for adult incontinence caused by functioning ectopic pelvic kidney draining into vagina.

A 29-year-old woman had been continent of the majority of her urine for her entire life but had constant, uncontrollable dribbling. A contrast CT scan showed a solitary functioning left kidney and a dysplastic right pelvic kidney with a tortuous dilated ureter running close to the vaginal vault. The kidney was removed whole at transperitoneal laparoscopy, rendering the patient continent. This is the first such case reported in an adult.

Abnormalities, Multiple↗
PubMed2004

Treatment of urolithiasis in the morbidly obese.

BACKGROUND: Morbidly obese patients with urolithiasis present a therapeutic and diagnostic challenge to the Urologist. Management is reported and potential difficulties discussed. METHODS: Morbidly obese patients (body mass index > or = 40kg/m2) with stone disease were identified by retrospective review. Stone load was calculated and treatment modalities noted. RESULTS: 18 renal units (kidneys) were treated in 17 patients. Of these, 2 required no treatment, 2 had open procedures, and 15 were treated with flexible ureteroscopy. Mean stone burden in patients treated with flexible ureteroscopy was 18 mm, but 8 patients had stone loads >15 mm and in these patients mean stone burden was 23 mm. All were successfully treated or rendered asymptomatic. There were no major complications. CONCLUSION: Obesity is increasingly prevalent and associated with a high incidence of co-morbidity and complications. Imaging can be difficult and treatment options are limited. Flexible ureteroscopy has proven to be the most successful treatment option, and can avoid the need for more invasive procedures. Furthermore, stone loads greater than normally acceptable can be successfully undertaken in these patients, and should be attempted due to problems associated with other techniques.

Adult↗
PubMed2003

Management of encrusted ureteral stents impacted in upper tract.

OBJECTIVES: To present our series of patients with ureteral stent encrustation and give indwelling times and management. Encrustation is one of the most serious complications of ureteral stents. METHODS: A retrospective review was undertaken of all encrusted stents during a 4-year period. The inclusion criterion was a stent that required some form of intervention above the ureteral orifice to remove it. Combinations of extracorporeal shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, and open surgery were used to achieve stent removal. RESULTS: Forty-nine impacted encrusted stents were treated in 41 patients. Of these, 75.5% had become encrusted within 6 months and 42.8% within 4 months. The mean indwelling time was 5.6 months. Forty-seven stents were removed by endourologic techniques, with 4 requiring extracorporeal shock wave lithotripsy alone, 28 ureteroscopy, and 10 a combination of both. Five patients underwent successful percutaneous nephrolithotomy. One patient underwent open surgery, and in one removal failed. The mean number of procedures per patient was 1.94. CONCLUSIONS: Stent encrustation can pose a serious challenge to the endourologist, and indwelling times should be minimized to avoid problems. Patients often require multiple treatments and a combination of extracorporeal shock wave lithotripsy and ureteroscopy offers highly successful outcomes and often avoids the need for more invasive techniques.

Adult↗
PubMed2003

Prospective experience with a second-generation hand-assisted laparoscopic device and comparison with first-generation devices.

BACKGROUND AND PURPOSE: The GelPort Hand-Assisted Laparoscopy (HAL) device was licensed for use in the U.K. in September 2001. We compared our experience with this second-generation device with that of first-generation devices; i.e., the Handport, launched in 1999, and the Intromit, first marketed in 1998. MATERIALS AND METHODS: We prospectively compared a number of parameters for operations performed using the GelPort (13 radical nephrectomies, 4 nephroureterectomies) with those performed using the Handport (3 radical nephrectomies, 2 nephroureterectomies, 2 simple nephrectomies) and the Intromit (2 radical nephrectomies, 1 nephroureterectomy, 2 simple nephrectomies). The main outcome measures were ease of application, time required to place the device, and perioperative complications specific to the device. RESULTS: The device requiring the longest time to place was the Intromit (average 15 minutes) followed by the HandPort (average 10 minutes) and then the GelPort (average 5 minutes). There were two leaks with the Intromit (one major and one minor). Pop-outs were a frequent issue with the HandPort, necessitating repeated replacement and resufflation. There was also a need to resufflate every time the hand was removed for a change of swab. None of these problems was noted with the GelPort, which was also found to be the easiest to use. The major disadvantage of the GelPort was its price, which was about a third more than that of the first-generation devices. CONCLUSION: The GelPort is currently a more user-friendly and robust HAL device. It is, however, more expensive than first-generation devices.

Cohort Studies↗
PubMed2002

The ultrastructure of bladder lamina propria nerves in healthy subjects and patients with detrusor hyperreflexia.

PURPOSE: Detrusor hyperreflexia is a common finding in patients with neurological disease involving the spinal cord. In animal models it has been attributed to an emergent reflex mediated mostly by unmyelinated C-fibers. We describe and measure ultrastructural features of these nerves in the lamina propria in healthy subjects and patients with detrusor hyperreflexia. MATERIALS AND METHODS: Flexible cystoscopic bladder biopsies were obtained from 51 patients (8 controls, 8 with tropical spastic paraparesis, 23 with multiple sclerosis and 12 with spinal cord disease). Electron micrographs were obtained of every nerve profile seen in the midpoint of the biopsy specimen, and in each nerve profile a number of variables were measured and recorded. RESULTS: The mean nerve profile diameter was greater in patients with tropical spastic paraparesis (mean 2.19 microm.) compared to controls (1.59 microm.) and patients with multiple sclerosis (1.55 microm.) (p <0.001). We observed a sparse urothelial innervation by naked axonal varicosities but similar bare varicosities were more frequent in the superficial layer of the lamina propria. In deeper layers close membrane contacts between axonal varicosities and cells with cytological characteristics of myofibroblasts were seen. CONCLUSIONS: We described and measured ultrastructural characteristics of human bladder lamina propria nerves. The mean profile diameter is larger in patients with tropical spastic paraparesis compared to controls and patients with multiple sclerosis. This study provides a baseline to which other bladder disorders can be compared and may allow the effect of intravesical treatments on these nerves to be assessed. Some possible functional aspects of observed structural interrelationships are presented.

Adult↗
PubMedDate not supplied

Embolization of a bleeding renal angiomyolipoma in pregnancy: case report and review.

A case is described of a woman 10 weeks pregnant who had severe bleeding, secondary to a renal angiomyolipoma (AML), that was treated with embolization. Subsequent pregnancy was uneventful and she delivered a normal female infant 28 weeks after the procedure. One month after delivery, liquefaction of the AML occurred, which eventually required surgical drainage. We review and discuss AML during pregnancy, its management and post-embolization complications.

Adult↗
PubMedDate not supplied

Video consent: a pilot study of informed consent in laparoscopic urology and its impact on patient satisfaction.

OBJECTIVES: In the current climate of increasing awareness, patients are demanding more knowledge of the operative process. We report a new protocol for consenting patients. In addition to the normal consent process, patients are invited to watch a video of the operation to gain a perspective of what is involved. We applied this novel method of consent and assessed its impact on patient satisfaction. METHODS: As part of postoperative follow-up, prospective data from 43 consecutive laparoscopic patients was obtained in the form of a self-constructed, patient-directed questionnaire regarding the consenting process. Patients were also invited to complete the Client Satisfaction Questionnaire (CSQ-8) 4 weeks after their operation. Laparoscopic workload included nephrectomy (n = 27), deroofing of cysts (n = 2), pyeloplasty (n = 6), exploration for undescended testis (n = 6), lymph node dissection (n = 1), and nephropexy (n = 1). To reduce bias, an individual independent of the team treating the patient conducted these surveys. RESULTS: All study participants read the information leaflet before laparoscopic surgery, and 81% thought we should give patients the option to watch a video before their surgery. The leaflet information was understood by 92% of patients. All patients who opted to watch a video found it helpful to their understanding, and 75% requested a copy of the video of their own operation. The mean patient satisfaction (CSQ-8) score was 29.8 of a possible maximum score of 32. CONCLUSIONS: This novel approach to informed consent has had a positive impact on the patient journey as is evident from high satisfaction scores. Additional randomized, controlled trials need to be conducted to evaluate video consenting methods in laparoscopic urology.

Adult↗