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Aim: With advancement in minimal access surgery two laparoscopic procedures can be combined together shortening the total hospital stay, decreasing morbidity and overall reduced cost. Combining two laparoscopic procedures in a single session has been reported in general surgery. Very few articles are available in literature with regard to combined urological laparoscopic surgeries. This article retrospectively analyses the outcomes of multiple laparoscopic procedures performed in a single stage at our centre. Materials and Methods: Patients undergoing simultaneous procedures from May 2003 to Jan 2009 were included in the study. Patients were categorised into three groups according to the primary urological organ involved, for better comparison with the control group. Diseases involving the adrenals gland were grouped in (group 1), kidney (group 2) and renal collecting system/ureter (group 3). All patients had one urological procedure for either of the above-mentioned organs combined with another surgical procedure. Similarly three control groups were chosen according to the primary urological organ involved (group 1c- unilateral laparoscopic adrenalectomy, group 2c- unilateral laparoscopic radical nephrectomy and group 3c- unilateral laparoscopic ureterolithotomy) for comparative study. The operative details, hospital stay and complications were analysed. Results: Thirty-two patients underwent 64 laparoscopic procedures under single anaesthesia. The most common procedure in this series was laparoscopic adrenalectomy (n=34) followed by laparoscopic nephrectomy (n=13). Group 1 patients had a prolonged operative time ( P=0.012) and hospital stay ( P=0.025) when compared with group 1c. However, blood loss was comparable in both the groups. Patients in groups 2 and 3 had comparable operative times, blood loss and recovery period with respect to their controls. Intraoperatively, the end tidal carbon dioxide levels were within permissible limits. All procedures were completed using the laparoscopic approach, without any conversion. Conclusions: Simultaneous laparoscopic procedures can be done for urological diseases in selected patients with the advantages of single anaesthesia and hospital admission without increasing the morbidity.

Byline: Sudhir. Sukumar, Santosh. Jadhav, Balagopal. Nair, Sanjay. Bhat, Ginil. Kumar, Georgie. Mathew Purpose: Although commonly performed in adults, laparoscopic adrenalectomy in children is performed only in centres with advanced [...]

Byline: Santosh. Jadhav, Sudhir. Sukumar, Ginil. Kumar, Sanjay. Bhat Objectives : To determine the level and prevalence of anxiety and depression in men being investigated for prostate cancer (CaP) and [...]

Byline: Sudhir. Sukumar, P. Kumar, Appu. Thomas Isolated herniation of ureter into thoracic cavity due to a defect in the diaphragm is a very rare entity. We present clinical details [...]

Introduction: Renal artery embolisation has gained popularity as a minimally invasive tool for various urological emergencies or as a preoperative therapy in case of renal tumours. Our objective is to review the indications of embolisation for various causes and its outcome. Materials and Methods: We retrospectively analysed our database in our institution who underwent renal artery embolisation for various causes during the period of Jan 2001 to Jan 2007. All patients underwent selective renal angiogram using technique with 5fr angiocathter in radiology department followed by embolisation with either gel foam or coils as per indications. Different groups were identified and the indications, pre and post procedure hemogram, blood loss, transfusion requirements and complications of these groups were analysed. Results: In all 29 cases 20 were male and 9 were female. Four group of patients were identified who underwent angioembolsation i.e. Post PCNL bleeding (6), Renal cell carcinoma (16), Angiomyolipoma (5), Renal artery aneurysm, (1). The most common (elective) indication was to achieve infarction before radical nephrectomy or partial nephrectomy for carcinoma with IVC thrombus and partial nephrectomy in angiomyolipomas. Gel foam was most often used followed by metallic coils. The mean size of the tumours was 10.8 cm. The commonest pathology was conventional renal cell carcinoma with stage III presentation. The median range of time interval between embolisation and nephrectomy was 6 hrs. The mean preoperative Hb was 10.9 gms and the blood transfusion requirements after procedure was 350 ml. In case of post PCNL bleeding the pre procedure hemogram was 11.2 and post procedure was 13.9gm%. The commonest puncture in such cases were supra costal. Regarding the symptoms of post infarction syndrome pain was the major symptom followed by vomiting, fever and hematoma at the site of cannulation. Conclusion: Renal artery embolisation is a safe and effective therapeutic tool for many urological conditions. Due to improved interventional skills and techniques, renal artery embolisation proves a neo adjuvant therapy for renal tumours and as minimal access tool to combat unexpected bleeding after trauma or PCNL. It proves to have potential advantages with minimal morbidity in centres were such facilities are available. [ABSTRACT FROM AUTHOR]