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I have started getting trained in Robotic surgery.

At Nanavati hospital, we have Da Vinci XI system of surgical robot which is the finest amongst all.

Advantage that the Robotic surgery offers to the patient is precision of dissection, clear 3D vision and movements of Robotic arms to almost 270degress so that surgery can be done in the most difficult sites in the body, which otherwise would have required an open surgery. These reduce the complication rates during surgery.

Though a gold standard in Uro-Oncology,  robotic surgery is also useful in routine Minimal access abdominal surgeries like… Surgery for Recurrent or Difficult Hernia, Bowel resection and anastomosis for benign or malignant conditions,  and even for difficult Gall Bladder surgery.

Facebook Live on 26th June 2020

37 yrs, Male patient came with upper abdominal discomfort.  Had a surgery done in 2015 for Pseudocyst of Pancrease. ( CystoJejunostomy).

On examination there was a palpable lump in the upper abdomen which was non tender.

Palpable Abdominal Lump

CT scan of the abdomen confirmed the diagnosis of Recurrent Pseudocyst of Pancrease

Exploratory Laparatomy with Cysto-Gastrostomy was done.

Patient recovered well.

75 yrs old Male, chronic smoker presented with Gangrene of Left 2nd toe. All pulsations below the knee joints were absent.

Amputation of 2nd toe done.

Angiography of Left lower limb by an Interventional radiologist revealed tight blockage of all main arteries supplying left leg and foot.

Complete cut off noted in left leg main artery

Angioplasty done and stents are placed past the arterial blocks

65 year old male, presented with –

Pain in Abdomen since, 4 days, which became severe since, one day.

Vomiting several times since, one day.

Constipation since, one day.

On Examination – Patient had Tachycardia, Blood Pressure was within normal limits

Per Abdominal examination – The whole abdomen had guarding and severe tenderness all over.

Distention was present.

Cinical diagnosis of Peritonitis was made,

CT scan of whole Abdomen showed Pneumatosis intestinalis i.e. Free air in the bowel wall, which is suggestive of Ischaemia of Intestine with imminenet Gangrene.

Also, it showed free air in the abdomen.

After stabilizing the patient, Emergency Exploratory Laparatomy was performed.

Gangrenous Small Bowel ( Jejunum )

Gangrenous part resected and End to End anastamosis of Small bowel Done.

Patient recovered completely after the surgery.

Acute Abdominal wall ( Ventral ) Hernia with Intestinal Obstruction… An Unusual presentation-

Bull Horn Penetrating Injury to Abdomen

Close Up Look at the Penetrating Injury

Patient Presented with a history of Bull Horn Injury to right lower abdomen, 4 days back, followed by Acute onset symptoms of Intestinal Obstruction like Abdominal Pain, Vomiting, Distention and Constipation.

CT scan of the Abdomen was suggestive of Obstructed Hernia in Right Lower Abdomen.

CT scan showing Obstructed Hernia in Right Lower Quadrant

Emergency exploration in right lower quadrant of Abdomen revealed Obstructed Small Bowel loop which was Dusky in colour herniating through a Small defect in the Anterior Rectus sheath and Peritoneum.

Dusky looking small bowel loop herniating through a small defect in Rectus Sheath.

On incising the rectus sheath, colour of the obstructed loop returned back to normal.

Normal Healthy Bowel loop after Incising the sheath

Contents were reduced and the Defect was closed Anatomically with Non Absorbable Sutures

Contents reduced back in the abdomen revealing the defect in the sheath

Patient tolerated the procedure well and was discharged after 4 days, tolerating full diet and relieved completely of his symptoms.

© Copyright 2019 Dr. Amol Joshi

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