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General Surgery includes surgeries related to colon and rectum,
bowel, bile ducts, gallbladder, liver, stomach and esophagus.
General Surgery also includes surgery of the adrenal glands and
thyroid and pituitary.
Under general surgery common
services that our network hospitals are capable to offer are ;
++
Laparoscopic Procedures: Both Diagnostic and Therapeutic
procedures include Cholecystectomy, Appendicectomy, Splenectomy,
Adrenalectomy, Anti Reflux Procedures, Colectomies, etc.
++
Surgical Gastroenterology: Operations on the Stomach,
Duodenum, Hepato- Biliary tract, Pancreas, Colorectal, Anal
canal, for Benign and Malignant diseases.
++ Oncology:
Operations for cancer of gastrointestinal tract.
++
Hernias: All types of Hernias, including Inguinal, Femoral
and Incisional Hernia.
++
Thyroid: All operations on Thyroid.
++
Portal Hypertension: Shunt and De-vascularization procedures.
++
Vascular Surgery: All types of Vascular Surgeries including
Vascular Bypass, Varicose Veins Operation, Endovascular Stenting and
IVC Filter.
++
Whipples, Choecytecomy & Exploration of CBD, Circumsion, Fem Pop
Bypass, Laprotomy Emergency.
++ Lymp Node Biopsy, Thyroidectomy
etc.
Frequently asked questions About Keyhole Surgery
Q. What is
Keyhole Surgery?
A. In keyhole Surgery a scope is introduced into the body cavity
through a 0.5cm opening. The area is viewed through a CCD video
camera attached to the monitor. Surgeons can perform any type of
surgery by viewing the monitor. Because of the smallness of the
opening, this kind of surgery is called Keyhole surgery, Minimal
Access Surgery, or based on the equipment used, Laparoscopic or
Endoscopic Surgery.
Q. Why keyhole
Surgery?
A. Small incision, minimal pain, no large exposure so chances of
infection are almost nil. This surgery is cosmetically acceptable
and allows quick recovery – You’re back in the gym after a major
Laparoscopic Surgery in 24 hrs.
Q. Is it more
expensive than conventional open surgery?
A. The use of sophisticated equipment, instruments and consumables
and special training required for surgeons makes the cost of keyhole
surgery more expensive. But reducing the use of medicines,
especially antibiotics and length of hospital stay, brings down the
costs considerably.
Q. Can Children
undergo Keyhole Surgery?
A. Anybody can undergo keyhole surgery including children. Since
most keyhole surgeries are taken up on an outpatient basis (the
patient can leave on the same day), children will be spared a long
hospital stay and loss of school.
Q. Can cardiac
Patients undergo Keyhole Surgery?
A. Keyhole surgery is the safest option for the elderly with
hypertension and other cardiac problem.
Q. How do
surgeons benefit?
A. This method allows surgeons to have a magnified and very close
view of the organs that are lying at a depth. The Cameras can be
used to view, not only the operative field, but other organs and
spaces as well. More than one surgery can be simultaneously tackled
through the same surgical opening.
Q. What surgeries
can be performed using this method?
A. It’s said about keyhole surgery that you can do any surgery
except deliver a live baby!
+ Surgeries for Peptic ulcer, Gastro-esophageal reflux disease
+ Appendicectomy
+ Gall bladder stones (Cholecystectomy)
+ Hernias
+ Surgeries of the liver, pancreas, spleen and kidney
+ Hysterectomy (uterus removal), Tubo-ovarian tumours, Ectopic
pregnancy,
Polycystic ovarian disease
+ Removal of tumours from the abdomen
+ Endoscopic surgery of the heart (bypass surgery)
+ Arthroscopic surgery of the knee and shoulder
+ Minimally invasive total hip replacement surgery
+ Minimally invasive total knee replacement surgery
+ Endoscopic spinal surgery including microdiscectomy
+ Cataract surgery
Q. What is
Endoscopy?
A. The word “Endo” means “inside”, “Scope” means “to view”.
Endoscopy is an investigative procedure that is most commonly done
to view the esophagus (food pipe), stomach and intestines, windpipe,
its branches and lungs. Done as an outpatient procedure, endoscopy
takes just 10 minutes to perform and does not require any
anaesthesia. After the procedure patients can resume their normal
diet and medication and return to work.
Q. Can any
hospital perform Keyhole Surgery?
A. Keyhole surgery requires sophisticated dedicated equipment and
instruments for each procedure and specially trained skilled
personnel.
Minimally Invasive
Surgery in Urology
About 40% of the outpatients seeking medical
advice at any clinic present symptoms relating to the urinary
system.
What brings the patient to the Urologist?
Frequent urination especially during nights, inability to pass
urine freely, bloodstained urination, burning urination, severe
colicky pain at the flank or lower abdomen, pain and swelling of the
testes are all symptoms which prompt the patients to consult the
urologist.
What are the tests required to diagnose
urologic problems?
A detailed medical history, clinical examination, urine and
blood tests for sugar and urea, X-ray and ultrasound scan of the
kidneys, may all be required.
What are the common urologic conditions?
Kidney stones, ureteric and bladder stones, urinary tract
infection, enlarged prostate with urinary obstruction, cancer of the
kidney, bladder. Also, prostate, stricture urethra and
hydronephrosis and phimosis are common diseases.
What is the role of minimally invasive
surgery?
Open surgery was the mainstay of treatment until the year 1990,
after which a breakthrough occurred with the advent of Endo Urology
and extra corporeal shockwave lithotripsy. Most Urologic conditions
could be treated effectively and non-invasively, with shorter
operating hours, shorter hospital stay and early return to work.
Cystoscopy : This involves direct
inspection of the lower urinary passage, urinary bladder and
enlarged prostate gland using fiber optic telescopes. It is an
outpatient procedure not requiring anesthesia. It is useful for
diagnosing the cause of bleeding from the urinary tract.
Ureteroscopy : A very useful tool to
diagnose and treat urinary stones, strictures and tumours of the
ureter and pelvis. Usually done under regional anesthesia, it is
very useful in relieving blocks in the kidneys due to stoes, tumours
or strictures.
Trans urethral Resection of Prostate (TURP)
This permits removal of enlarged prostate in multiple chips
without any skin incision, using under water electrocautery and
cutting electrodes. The procedure is performed generally under local
anesthesia without the need for massive blood transfusions. It
requires only 3-4 days of hospitalization, and eliminates the need
for lifelong medication and frequent catheterizations.
Internal urethrotomy (OIU)
Endoscopic incision of urethral strictures under regional
anesthesia to relieve blocks along the lower urinary passage.
Vesicolithotripsy: Endoscopic crushing
and fragmentation of stones in the bladder and removal through
cystoscope sheaths.
Trans urethral Resection of Bladder Cancers
(TURBT)
Endoscopic resection of growths involving the bladder, without
open surgery, under regional anesthesia.
Percutaneous Nephrolithotomy (PCNL)
Enables fragmentation and removal of large stones in the kidney,
multiple stones and Staghorn stones. The procedure is performed
under general anesthesia, with the patient lying prone on the OT
table. Using X-ray control, a track is created to the kidney from
the overlying skin. Special endo urologic instruments are used to
widen the track and fragment the stones using energy sources like
air under pressure (pneumatic), ultrasonic sources etc.
What is the MIOT experience?
The Urologists at MIOT are well experienced in both Open Surgery
and Endo urology. We have performed over a 100 minimally invasive
procedures in the past two years, on patients from Oman, Maldives,
Seychelles, Srilanka, Canada, Singapore, and from all parts of
India.
Urology Consultant India
DR. N. SUBRAMANIAN
MBBS MS FRCS D. UROL FIMSA
SR. CONSULTANT UROLOGIST
PREVIOUS POSITION: CONSULTANT UROLOGIST, ROYAL VICTORIA INFIRMARY,
BLACKPOLL, U. K.
EDUCATIONAL QUALIFICATIONS
M.B.B.S, University of Delhi, New Delhi, India.
Distinction in Physiology and Pharmacology (1980)
M.S (Surgery), University of Delhi, New Delhi, India (1983)
F.R.C.S Royal College of Physicians and Surgeons ,Glasgow,
U.K.(1989)
Diploma Urology University College London, U.K.(1993)
TRAINING IN THE UNITED KINGDOM :
Locum Consultant Urologist,01/05/1995 – 30/06/1995
Blackpool Victoria Infirmary, Blackpool
Clinical Observer,01/10/1994 – 30/04/1995
Royal National Orthopaedic Hospital, Stanmore. Consultant:
Mr.P.J.R.Shah
Royal Liverpool Children’s Hospital, Alder Hey, Liverpool.
Consultant: Mr.A.M.K.Rickwood.
Guy’s Hospital, London. Consultant:Mr.A.R.Mundy.
BroadGreen Hospital ,NHS Trust,01/10/1992 – 30/09/1994
Liverpool, Merseyside.
Consultants :Mr.A.D.Desmond,Urology.
Mr.M.V.P.Fordham, Urology.
Registrar in Surgery and Urology, Merseyside Health Authority,
Arrow Park and Clatterbridge Hospitals 01/10/1991 – 30/09/1992
Consultants: Mr.R.B.Crosbie, Urology.
Ms.C.A.Makin, GI Surgery.
Registrar Surgical Rotation,01/02/1990 –31/07/1991
North East Regional Health Authority, Shotley Bridge General
Hospital. Consett, CO, Durham.
Consultants: Mr. D. Gatehouse, GI Surgery.
Mr. K.B.Queen, Urology.
Mr. J.R.Mason, Vascular
Senior House Officer, Surgical Rotation,01/08/1988 – 31/01/1990
Worcester Royal Infirmary, Worcester.
Consultants: Mr.J.H.Eckersley, Orthopaedics.
Mr. H.T.W. Williams, Urology.
Mr. C.W.O. Windsor, General Surgery.
Senior House Officer, Accident and emergency,01/02/1988 - 31/07/1988
Cuckfield Hospital, Haywards Health, West Sussex.
Consultant: Mr. M.S.Islam.
I obtained my basic medical degree (MBBS) and postgraduate degree
(MS) in surgery from the university of Delhi. This was followed by a
senior residency in a 1600 bedded teaching hospital in Delhi and 3
years as a senior surgeon in the Caribbean. Between 1988 and 1995 I
Obtained Higher surgical training in general surgery and then in
urology in the United Kingdom .I obtained the FRCS diploma in 1989
and the Diploma in Urology from the Institute of Urology and the
University college in London. Between 1991 and 1994, I worked as a
registrar in Urology in Liverpool.
Following this period of training, I visited some of the centres to
observe work in specialised areas of Urology. These included
Mr.A.M.K.Rickwood’s Paediatric Urology unit at the the Alder Hey
Children’s hospital, Prof.A.R.Mundy’s firm at the Guy’s hospital
where I saw complicated Reconstructive Urology, Mr.P.J.R.Shah’s firm
at the Spinal injuries unit at the Royal National Orthopaedics
Hospital in Stanmore and at the Middlesex hospital where I learnt
the ideal management of Neurogenic bladders and other problems like
infertility and erectile dysfunction in this special group.
As a locum Consultant Urologist at the Blackpool Victoria Infirmary,
Blackpool, UK,.I managed a large urological workload including all
forms and levels of Endourology, urological cancers, reconstructive
urology, male infertility and erectile dysfunction along with a well
established urodynamic laboratory. All the above appointments
involved clinical teaching of medical students from the universities
of Birmingham, Newcastle-upon-Tyne and Liverpool.
I have been working as a full time Senior consultant Urologist at
the Indraprashta Apollo hospital since October 1995.This is a large
corporate hospital with 695 beds and offers all specialised services
including Cardiac, transplant and Neurosurgical services all of
which are supported by over 80 Intensive Care beds. The department
of Urology with facilities for all types of endourology,
Urodynamics, Lithotripsy, imaging facilities for Uro- Oncology and a
dedicated IVF laboratory is suitably staffed to deal with all kinds
of emergency and elective urological problems. We are well supported
by nephrology division who have helped to successfully run the Renal
transplantation program. We are recognised for post Graduate
training in Urology and have a DNB program in Urology.
My special areas of interest in Urology include Male Infertility and
Impotence, urodynamics in neurogenic bladders, URO Gynaecology and
Newer approaches to benign prostate diseases and Prostate cancer.
MEMBERSHIP AND REGISTRATION:
FELLOW OF INTERNATIONAL MEDICAL SCIENCES ACADEMY
UROLOGICAL SOCIETY OF INDIA.
UROLOGICAL SOCIETY OF INDIA (NORTH ZONE).
INDIAN MENOPAUSE SOCIETY
INDIAN MEDICAL ASSOCIATION
DELHI MEDICAL ASSOCIATION
ANDROLOGY SOCIETY OF INDIA.
MEDICAL COUNCIL OF INDIA:MCI 1379 (JAN.1980)
GENERAL MEDICAL COUNCIL (UK):3528419 (JAN.1991)
DELHI MEDICAL COUNCIL:1796
CLINICAL RESEARCH AND PRESENTATIONS:
THESIS: Evaluation of feeding jejunostomy in postoperative
nutrition. Accepted by the University of Delhi in 1982.
DISSERTATION: Can changes in the PSA levels after treatment
predict the outcome in prostate cancer?. Accepted by the Institute
of Urology and University college, London in 1992.
Prevalence of Malnutrition in surgical patients Paper presented at
the Annual conference of the Association of Surgeons of India in
1983.
Bleeding Jejunal Diverticulum:Case report in the Indian Journal of
Surgery 1984.
Bilateral orchidectomy for Metastatic prostate cancer under local
anesthesia. Presented at the USI-NZ annual conference1995.
Urinary tract infections in the post-menopausal women. Article in
the journal of the Menopause society of India.
PSA current concepts. Presented at the Annual meeting of the
Andrology society of India.
-Predictive Value of PSA in Prostate cancer:Urological society of
India (North
zone)Dec.1996.
-Voiding Disorders: Annual symposium IMA,Muzaffarnagar.Apr.1997.
-Role of urodynamics in Stress urinary incontinence: Annual
conference on
Indian Menopause Society. Dec. 1998.
-Obstructive uropathy in Adults: Nephro-urology
update,Kathmandu,1999.
-Nephrolithiasis – Surgical Aspects: Nephro-urology Update,1999.
-Sexual dysfunction in Cancer survivors : Biennial National
conference of Indian
Society of Oncology, March 1999.
-PSA: It’s significance in Prostate cancer : National congress of
Andrology and
reproductive medicine.Dec.1999.
-Advance Urology Workshop, Bassi Hospital,Ludhiana.Feb.2000
-Update on management of Prostate cancer: Nephro-urology update,
Kathmandu, Aug. 2000.
-Management of Impotence: Current Approaches: Nephro-urology
Update,Kathmandu,Aug.2000.
-Current Approach to Haematuria: Annual CME,IMA.Aligarh,Mar.2001.
-Genito-urinary injury FEM (RCGP) Sept.2001.
-Erectile dysfunction; V Anniversary CME Apollo Hospitals, July
2001.
-Management of Male infertility in 2001:New Life Infertility
Centre,Ludhiana. July
2001.
-Primary Nocturnal Eneuresis : Indian Academy of Paediatrics,
Ludhiana. July
2001.
-Urinary Incontinence in the Elderly:Delhi Medical Association
CME.Oct.2001.
-Interpretation of Bacteriuria:Panel Discusion. ACADIMA Indian
Medical
Association CME.Dec.2001.
-Interpretation of Cancer Markers: Role of Free and total PSA:
ACADIMA Indian
Medical Association CME.Dec.2001.
-Management of testicular pain FEM(RCGP) lecture.Dec.2001.
-Current Approach to Male Infertility:Gynae Update 2002, Delhi
Medical
Association,Feb.2002.
-Advances in Prostate Cancer Management Apollo CME. Sept. 2002.
-Basics of Cancer Management: Winter CME for GPs and
specialists.Dec.2002.
-Menopause-Role of HRT in Indian Women. Second National Revised
consensus
and policy development Experts meeting. Preparation of Consensus
document. June 2002.
-Advances in Prostate Cancer management Apollo CME September 2002
-Overactive Bladder : A symposium, Annual conference, North Zone
Urological
Society of India.Oct.2002.
-Extended release ofloxacin in complicated UTI and Acute
Pyelonephritis- An
Indian experience; The Indian Practioner:Vol 56 No.11,Nov 2002
-Organised an update on Early diagnosis and treatment of prostate
cancer.
06.Sept.2003
i) Early Diagnosis: NCCN guidelines
ii) Role of Bicalutamide monotherapy in Prostate cancer.
-Indications and surgical procedures for GSI : Indian Menopause
Society.18th.Oct.2003
-Role of varicocoele surgery in treating Male infertility:
Obstetrics and
Gynaecology CME.July.2003
-Role of fluroquinolones in the management of Complicated UTI: An
update.15th.Sept.2003
-Male Infertility and its Management 30.Nov. 2003
-HIV today and challenges for tomorrow: Surgeon’s viewpoint 1St
Dec.2003
-Basic techniques of PCNL: Chairperson. Symposium at Holy Family
Hospital.21-
23 May 2004
-AICC-RCOG-NORTH ZONE: INTENSIVE POSTGRADE REVISION COURSE June
2004Four lectures:Urodynamics in gynecology / Urge incontinence /
Surgery in
Stress incontinence / Urological injuries in Gynecology and
obstetrics
-Current trends in Male infertility: FOGSI June 2004
-Dutasteride: A dual 5 alpha reductase inhibitor in the management
of BHP:07th
August 2004 Indian Medical Association, Hissar
-Finasteride vs Dutasteride in the management of BHP:14th August
2004;Delhi
Urological Society
-Andropause: The ageing male in focus Rotary club Delhi:09th August
2004
-Erectile Dysfunction: Current approach. XXI Surgical update Maulana
Azad
Medical College, New Delhi 16th –23rd September 2004
-RGCON 4th International Conference: Chairperson 12th –13th March
2005
-High Risk Prostate cancer: Role of monotherapy: Current concepts:
Oncology
Seminar. October 2005
-MRCS II Revision course of Royal College of Surgeons of Edinburgh
17th-21st
October 2005:convenor.
-Early versus delayed hormonal treatment of locally advanced
Prostate cancer;
Mini symposium on prostate cancer.12th November 2005
-Role of Bicalutamide in Localised and Locally advanced Prostate
cancer: A mini
symposium:10th December 2005 |
