Laparoscopic Surgeon

I want to speak about an illness known as Fistula in Ano today.

Occasionally the side of the a**s gets a tiny wound, and pus drips from it. We call it a Fistula. It has a root. We can find it if we examine it closely, touching it. It must be heading to our a**l ca**l's interior.

Fistula may be dry, or ripe. We can't sit while it's ripe. The pain will be unbearable. The discomfort goes away after it bursts and all of the pus goes out. This will continue on for a while. Thus gradually the Fistula progresses.

The Fistula is categorized in a number of ways.

Secondary Fistula- Fistula can occasionally be brought on by cancer, Crohn's disease, TB, etc.

Primary Fistula is the one that is most commonly called a fistula. A primary fistula has no underlying illness. Primary fistula is caused by a low-fiber diet, less water intake, constipation, and straining for stools.

After the underlying illness is addressed, the secondary fistula goes away. But surgery is necessary to eliminate the primary fistula.

Fistula, high and low

The levator ani muscle holds the stool in place. If the root passes through that muscle is termed as a high fistula. Those that do not pass through that muscle are classified as low fistulas.

When the fistula is surgically removed, cutting the muscle that holds stool can lead to permanent problems as the stool passes without control. This is a concern for high fistulas. Removal of a low fistula through surgery should not pose any such difficulties.

Why is surgery necessary for treating a Fistula?

As previously mentioned, pus formation and intermittent pain occur. With each occurrence of pain, the root extends. Gradually a low fistula converts into a high fistula, requiring a completely different mode of treatment. Therefore, it is crucial to treat it at an early stage.

What surgical procedure does this require?

1. Removal of the fistula is known as Fistulectomy.

2. Incising the fistula is referred to as Fistulotomy.

Both methods are open procedures.

Keyhole surgeries include LIFT, TROPIS, LASER, and VAAFT. In LIFT and TROPIS, after outlining, only the fistula tract is removed through a small incision and the muscle hole is closed with sutures. The fistula tract can also be destroyed by LASER, similar to video assistance in VAAFT. There are also combined operations that increase efficiency and reduce pain and discomfort for the patient. Part of the fistula is destroyed by LASER and another part with open surgery to achieve an even better result. This is especially true for high fistulas, because we can't cut the muscle. So we burn the course with a LASER and close it with stitches on the inside. In the case of a High Fistula that does not heal using such a procedure, it may be necessary to place a colostomy bag and divert the stools. Therefore, it is important to ask the surgeon for advice as soon as a fistula develops.

To determine whether it is a high or low fistula, tests such as an MRI scan can provide the necessary information. A colonoscopy can help differentiate between a primary or secondary condition. In the case of a primary low fistula, it is advisable to undergo surgical removal at the earliest opportunity. For a high fistula, it is essential to seek treatment from a capable surgeon who can perform the necessary surgery to cure the condition. If you have any queries, feel free to reach out using the contact number provided in the comment section or by leaving a comment.

ഫിസ്റ്റുല എങ്ങനെ പൂർണമായി മാറ്റാം | What is Fistula | Best Treatment for fistula in ano ഫിസ്റ്റുല എങ്ങനെ പൂർണമായി മാറ്റാം | What is Fistula | Best Treatment for fistula in anoKeyhole Clinic,Metro Pillar No. 448, Edappally, Kochi,https://www.keyh...

May you all be blessed with knowledge and flourish by Godess Saraswati.
Happy Vijaya Dasami to all of you.
Dr Madhukar Pai
Organizing Chairman
Worldcon 2025 Kochi

ROBOTIC SURGERY- THE NEWEST ADVANCEMENT IN LAPAROSCOPIC SURGERY

Laparoscopic surgery or Keyhole surgery has reached its peak. Any surgeries in the abdomen can be performed laparoscopically. The advantages of laparoscopic surgery are
1. Less pain
2. Less medication
3. Avoidance of unsightly scar
4. Early discharge of the patient
5. Early return to work
6. Less chance for incisional hernia
7. Less chances for postoperative pneumonia and deep vein thrombosis,
8. Better visibility especially in the lowermost and uppermost portions of the abdomen. Even for appendectomy, we can view entire abdomen (diagnostic laparoscopy is the first step of any laparoscopy)
9. Multiple surgeries can be combined
10. Precision of instruments is enhanced

Because of all the advantages of laparoscopic surgery, now it has surpassed open surgery not only in the abdomen but in thorax, joints, and even in brain, spine, and heart. Now, minimally invasive surgery has incorporated the advantages of LASER and stapler. Even in anorectal surgery and varicose vein surgery, the concept of minimally invasive surgery has penetrated.

Now, laparoscopic surgery has reached its saturation. Then robotic surgery is introduced. In robotic surgery there is a console on which the surgeon is seated. Looking into the console there is a virtual reconstruction (3D vision) of what is there in the abdomen. With his hand movements the surgeon can fully control the Robot, which is placed on the side of the patient. Patient is under General Anesthesia and through laparoscopic ports, instruments are introduced and are connected to the Robo. Now the instruments get into the control of the surgeon and as his hand moves the Robot also moves like a puppet.

ADVANTAGES OF ROBOTIC SURGERY
1. It is the most updated version of laparoscopy. All the instruments including the camera system, hand instruments, energy sources are all updated and the safest versions. This brings down the instrumental errors to the minimum and precision to the maximum.
2. 3D vision gives a virtual view of the inside of the abdomen to the surgeon. In that field of virtual reality, he can perform the procedure and the same will be replicated in the abdomen by the Robot.
3. In laparoscopic surgery, the surgeon looks on the screen and performs surgery in the abdomen. So, there should be hand and eye coordination i.e, looking on the screen and performing the procedure down. That is why it is not handy for all the surgeons. Also, there is a mirror image effect in laparoscopy. On moving our hands up, the Laparoscopic instruments move down. These effects are nullified in the Robot. So it is easy to learn. Even elderly surgeons can perform laparoscopic surgery with the help of the Robot.
4. Surgeons are seated on the console comfortably. His head rests, unlike in laparoscopy. In very long laparoscopic surgery, surgeons can develop neck as well as shoulder issues which are not there with robotic surgery. So it is ergonomic and the comfort of the surgeon gets transformed as the betterment in surgery. When a driver is comfortable, the passenger is safe.
5. Elderly surgeons can have minor tremors. These can be masked by the Robot. This helps elderly surgeons in surgery. Those surgeons have the vast treasure of experience and knowledge, but because of tremor they have difficulty operating. The Robot masks their tremor. Thus, they can be fruitful to society with the vast treasure of knowledge that they acquired during their entire life.
6. Our hands have a definite range of movement. Robotic hands move more and rotate more than our natural hands. They twist and turn into the crevices, especially in the depth of the pelvis and upper most aspects of the abdominal cavity. The hands of the Robot can do what our natural hands can’t. That makes Robot a wonderful tool for urology, gynecology as well as upper abdominal surgeries.

THE FUTURE
As of now, laparoscopic surgery has reached its saturation. Robots are promising tools for further advancement. Sometimes, during surgery the surgeon faces some unexpected difficulty. Expert opinion about surgery and helping hands can be gotten from anywhere across the globe. This is our dream, but in years to come, these will transform to reality.
The patient is in the operation theater with no other human beings there, and the rest of the people are sitting outside the theater. Before taking the patient into the OT, we can sterilize the OT completely so that the chances of infection are very very less.
Third, artificial intelligence (AI) can be linked to the Robot during surgery. During rare situations, this can help to understand the Anatomy. With the help of artificial intelligence, the structures can be demarcated. This gives the best result to the patient.
Thank you…..

Thank you.

Really felt sad. Most of the people there, lived an equally vibrant life as we do now. God only knows, what he has for us.

We everyone do waste a lot of time on futile works like 'Whatsap'. The amount we spend for a dinner for four, is more than enough for giving a 'feast' for those eighteen inmates.

Felt good about the members of the trust for their selfless efforts in helping the destitutes.
Together we will try our little, that may bring happiness on their faces.

Thank you Dr Padmakumar sir, and keyhole clinic team for your physical and mental support in this regard.

Thankful for the opportunity to be a part of IHSCON 2022, organized by the Indian Hernia Society. It was a well conducted conference, though all the arrangements were made at a very short span of time. Thanks to organizing team, especially Dr. Sandeep Gupta.

All type of hernia cases were demonstrated by reputed faculties all across India from Srinagar to Kochi. Junior surgeons to senior surgeons were benefitted from the conference. Hospitality was excellent. Thank once again for giving me opportunity to be a part of the conference, to be a part of the faculty team and to perform a surgery.

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