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Golebiewski A, Anzelewicz S, Wiejek A, Lubacka D, Czauderna P. A Prospective Randomized Controlled Trial of Single-Port and Three-Port Laparoscopic Appendectomy in Children. J Laparoendosc Adv Surg Tech A 2019; 29:703-709. [PMID: 30945979 DOI: 10.1089/lap.2018.0560] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: This study aimed to evaluate single-port laparoscopic appendectomy (SPLA) in comparison with three-port laparoscopic appendectomy (3PLA) in children about the extent of surgical trauma after SPLA and 3PLA measured by serum interleukin-6 (IL-6) and C-reactive protein (CRP) concentrations. Materials and Methods: A total of 50 patients with a median age of 11.5 were randomized to two groups. Experts in both methods performed the surgeries. The decision on the type of planned surgery was randomly determined. Serum IL-6 and CRP levels were measured using an enzyme-linked immunosorbent assay before, and at 12 and 36 hours after surgery. Furthermore, we compared operating time, hospital stay, postoperative pain, and complication rates. Results: The operative time in the 3PLA group was shorter than that in the SPLA group (P < .05). Preoperative IL-6 levels were not different between the two groups, but the rise (pre- versus postoperative) of IL-6 in the SPLA group was remarkably higher when compared with the 3PLA group (P < .05). Similar results were obtained for CRP; basal serum CRP levels were not different between the two groups, but the rise of CRP in the 3PLA group was significantly lower compared with that in the SPLA group. During the first 12 hours postoperative, the SPLA patients reported more severe postoperative pain and longer inpatient opiate usage was noted that after 3-PLA. Only one SPLA case was converted to 3PLA. There were no conversions to open surgery. The length of hospital stay and complication rate were not different between the two groups. Conclusions: SPLA in children is associated with longer operative times, increased pain level, and more severe surgical trauma as measured by postoperative CRP and IL-6 levels in comparison with a 3PLA. The two approaches were comparable regarding the length of hospital stay and complication rate.
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Affiliation(s)
- Andrzej Golebiewski
- Department of Surgery and Urology for Children and Adolescents, Medical University in Gdansk, Gdansk, Poland
| | - Stefan Anzelewicz
- Department of Surgery and Urology for Children and Adolescents, Medical University in Gdansk, Gdansk, Poland
| | - Agnieszka Wiejek
- Department of Surgery and Urology for Children and Adolescents, Medical University in Gdansk, Gdansk, Poland
| | - Dominika Lubacka
- Department of Surgery and Urology for Children and Adolescents, Medical University in Gdansk, Gdansk, Poland
| | - Piotr Czauderna
- Department of Surgery and Urology for Children and Adolescents, Medical University in Gdansk, Gdansk, Poland
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Agarwal BB, Dhamija N, Agarwal S, Chintamani. Practice of Surgery-Decision, Precision, Incision. Indian J Surg 2017; 79:483-485. [PMID: 29217896 DOI: 10.1007/s12262-017-1711-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Brij B Agarwal
- Department of General and Laparoscopic Surgery, Ganga Ram Institute of Postgraduate Medical Education and Research (GRIPMER), New Delhi, India
| | - Neeraj Dhamija
- Department of General and Laparoscopic Surgery, Ganga Ram Institute of Postgraduate Medical Education and Research (GRIPMER), New Delhi, India
| | | | - Chintamani
- Department of Surgery, VMMC & Safdarjung Hospital, New Delhi, India
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Agarwal BB, Agarwal N, Dhamija N, Chintamani. Mentoring in Surgery-Mentor, Parshuram, Dronacharya, Krishan. Indian J Surg 2017; 80:81-83. [PMID: 29581690 DOI: 10.1007/s12262-017-1689-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022] Open
Abstract
Success in any profession has no well-defined predictors. Knowledge, skills, training, and talent come in plenty but fail at times to achieve the universal goal of success. Some attribute it to luck. Apart from the tangible ingredients of a successful career, the intangibles like luck or something ill-defined is a real challenge. The intangibles seem like a chasm, an abyss, or a phantom obstacle. Presence of a guiding spirit who can handhold you to overcome these is essential for success. The aim of a professional is to learn, earn, and yearn for creativity. Practice of surgery is an ideal career to pursue the learning, earning, and yearning. More than any other profession, the guiding handholding spirit is required in surgical profession, the concept of mentoring. Originating from the Greco-Roman times when kind Odysseus left his son Telemachus under the care of his friend, mentor, it has become a universal defining necessity for a successful career in surgery. Indian history replete with such examples of mentorship, good as in the case of Dronacharya to Kaurvas but bad as denied by an able, competent, aspiring student like Eklavya. In the medical profession, there are very few Indian role models of mentorship. One name that comes to our mind is Dr. Krishan Mahajan. The more said is less revealed about him. "Knife before wife" was his commonly spoken advice to all who sought his mentorship. "Hard work is not easy but it is fair" so said a famous boxer, Larry Holmes. It is more than true for our profession as it is better to prepare and prevent, rather than repair and repent.
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Affiliation(s)
- Brij B Agarwal
- Department of General and Laparoscopic Surgery, Ganga Ram Institute of Post Graduate Medical Education and Research (GRIPMER), New Delhi, India
| | - Nayan Agarwal
- 2University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Neeraj Dhamija
- Department of General and Laparoscopic Surgery, Ganga Ram Institute of Post Graduate Medical Education and Research (GRIPMER), New Delhi, India
| | - Chintamani
- 3Department of Surgery, VMMC and Safdarjung Hospital, New Delhi, India
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Agarwal BB, Chintamani, Dhamija N, Sharma S, Agarwal S. Why the Resistance: Minimally Invasive Pancreaticoduodenectomy-Saving the Patient from Tigers. Indian J Surg 2017; 78:431-434. [PMID: 28100937 DOI: 10.1007/s12262-016-1568-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 12/10/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- Brij B Agarwal
- Department of General and Laparoscopic Surgery, Ganga Ram Institute of Post Graduate Medical Education and Research (GRIPMER), New Delhi, India
| | - Chintamani
- Department of Surgery VMMC, Safdarjang Hospital, New Delhi, India
| | - Neeraj Dhamija
- Department of General and Laparoscopic Surgery, Ganga Ram Institute of Post Graduate Medical Education and Research (GRIPMER), New Delhi, India
| | - Shruti Sharma
- Department Of Surgery, Harlem Hospital Center, New York, NY USA
| | - Sneh Agarwal
- Department of Anatomy, Lady Hardinge Medical College, New Delhi, India
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Affiliation(s)
| | - Chintamani
- VMMC and Safdarjung Hospital, New Delhi, India
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Agarwal N. Even Handed Future of Surgery-Ambidextrous, Serious Gamers with Innate Left Hand Laterality. Indian J Surg 2016; 78:509-510. [PMID: 28100954 DOI: 10.1007/s12262-016-1514-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/17/2016] [Indexed: 02/07/2023] Open
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Agarwal BB, Chintamani, Agarwal S. Fast Track Surgery-Minimizing Side Effects of Surgery. Indian J Surg 2016; 77:753-8. [PMID: 27011451 DOI: 10.1007/s12262-016-1451-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 12/30/2022] Open
Affiliation(s)
- Brij B Agarwal
- Department of Surgery Ganga Ram Institute, Post Graduate Medical Education Research, New Delhi, India
| | - Chintamani
- Department of Anatomy, Lady Hardinge Medical College, New Delhi, India ; VMMC Safdarjang Hospital, New Delhi, India
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Agarwal BB, Nanavati JD, Agarwal N, Sharma N, Agarwal KA, Manish K, Saluja S, Agarwal S. Biomolecular inflammatory response to surgical energy usage in laparoscopic surgery: results of a randomized study. Surg Endosc 2015; 30:1733-41. [PMID: 26194253 DOI: 10.1007/s00464-015-4408-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 07/02/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Use of surgical energy is integral to laparoscopic surgery (LS). Energized dissection (ED) has a potential to impact the biomolecular expression of inflammation due to ED-induced collateral inflammation. We did this triple-blind randomized controlled (RCT) study to assess this biomolecular footprint in an index LS, i.e., laparoscopic cholecystectomy (LC). METHODS AND PROCEDURES This RCT was conducted in collaboration with tertiary-level institutions, from January 2014 to December 2014 with institutional review board clearance. Consecutive, unselected, consenting candidates for LC were randomized (after anesthesia induction) into group I (ED) and group II (non-ED). They were managed with compliance to universal protocols for ethics, informed consent, anesthesia, drug usage and clinical pathway with blinded observers. Biomolecular inflammatory markers, i.e., interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α) and highly sensitive CRP (HS-CRP), were measured with blood drawn juxta-preoperatively (H0), at 4 h (H4) and at 24 h (H24). The quantitative changes induced by ED on IL-6, TNF-α and HS-CRP at H0, H4 and H24 with their kinetic behavior were the study endpoint. Prospective data were analyzed statistically with a p value of <0.05 being significant. RESULTS Two cases from the ED group had biliary injury and hence were withdrawn from analysis. The ED (n = 49) and non-ED (n = 51) groups had similar demographic, clinical and H0 biomolecular variables. There was a significant increase in IL-6, TNF-α and HS-CRP from H0 to H4 in both the groups (p values <0.001). From H4 to H24, all three cytokines showed significant increase in ED group (p < 0.05), whereas in the non-ED group, IL-6 showed significant fall (p = 0.004) and TNF-α showed no significant change (p = 0.063). Both the groups showed H4-H24 elevation of HS-CRP (p = 0.000). CONCLUSION Energized dissection adds to the cytokine-mediated postoperative inflammation. The additional ED-induced inflammation can be measured objectively by IL-6 and TNF-α levels. CLINICAL TRIALS REGISTRY Clinical Trials Registry, India (REF/2014/06/007153).
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Affiliation(s)
- Brij B Agarwal
- Department of General and Laparoscopic Surgery, Ganga Ram Institute of Post Graduate Medical Education and Research (GRIPMER), New Delhi, India.
| | - Juhil D Nanavati
- Department of General and Laparoscopic Surgery, Ganga Ram Institute of Post Graduate Medical Education and Research (GRIPMER), New Delhi, India
| | - Nayan Agarwal
- University College of Medical Sciences, New Delhi, India
| | - Naveen Sharma
- University College of Medical Sciences, New Delhi, India
| | | | - Kumar Manish
- Department of General and Laparoscopic Surgery, Ganga Ram Institute of Post Graduate Medical Education and Research (GRIPMER), New Delhi, India
| | - Satish Saluja
- Department of Academics, Ganga Ram Institute of Post Graduate Medical Education and Research (GRIPMER), New Delhi, India
| | - Sneh Agarwal
- Department of Anatomy, Lady Hardinge Medical College, New Delhi, India
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Outcomes of laparoscopic cholecystectomy done with surgical energy versus done without surgical energy: a prospective-randomized control study. Surg Endosc 2014; 28:3059-67. [PMID: 24879143 DOI: 10.1007/s00464-014-3579-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/18/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Laparoscopic cholecystectomy (LC), a gold standard procedure can be done without energized dissection (ED). We did a randomized study for the outcomes of LC done with ED or without ED, i.e., with cold dissection (CD). METHODS AND PROCEDURES At a tertiary level institution, open-ended prospective-randomized control study was conducted between September 2008 and June 2013. Consecutive, unselected, consenting candidates for LC were enrolled following standard ethics, informed consent, anesthesia, and clinical pathway protocol. They were allocated to control group (LC with ED) or study group (LC with CD, as per our published technique with the option for rescue ED). The study points were based upon Clavien-Dindo grading of postoperative complications. They were either, peri-operative events potentially affecting, hospital stay (Grade I) or Grade II-V, e.g., peri-operative hemodynamic instability, needing intervention/blood transfusion, injury to biliary ducts/hollow viscous, postoperative biliary leak, postoperative re-intervention, re-hospitalization, mortality, and any adverse event during a 90-day follow-up period. The data were prospectively collected in an integrated "hospital information system" that could be retrieved only by independent external coordinators. RESULTS Demographics, co-morbidities, and gallbladder inflammation profile of the control group (n = 361) and study group (n = 384) were comparable. There was no rescue ED usage in the study group. Hospital stay (Grade I adverse outcome dependent) was longer, i.e., 1.6 ± 1.03 in the control versus 1.35 ± 1.2 days in the study group (p < 0.001). Grade II-IV complications were significantly more (p < 0.009) in control group. There was one common bile duct (CBD) injury in each group. The index bilio-enteric anastomosis for CBD injury in control group failed and needed a revision with multiple interventions. There was one grade V adverse outcome, i.e., mortality in the control group. CONCLUSION Avoiding the use of ED in LC is associated with better outcomes.
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Agarwal BB, Jha SK, Agarwal S, Goyal K, Chintamani. Esophagectomy: anastomotic leak, stent the rent! Saudi J Gastroenterol 2014; 20:1-4. [PMID: 24496153 PMCID: PMC3952416 DOI: 10.4103/1319-3767.126304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Brij B. Agarwal
- Department of Surgical Disciplines, Ganga Ram Institute of Post-graduate Medical Education and Research, Sir Ganga Ram Hospital, New Delhi, India
| | - Sandeep K. Jha
- Department of Surgical Gastroenterology and Liver Transplant, Ganga Ram Institute of Post-graduate Medical Education and Research, Sir Ganga Ram Hospital, New Delhi, India
| | - Sneh Agarwal
- Department of Anatomy, Lady Hardinge Medical College, New Delhi, India
| | - Karan Goyal
- Department of General Surgery, Ganga Ram Institute of Post-graduate Medical Education and Research, Sir Ganga Ram Hospital, New Delhi, India
| | - Chintamani
- Department of Surgery, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India E-mail:
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