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“I found out that I needed an operation for a back problem which was causing severe pain to my left leg from the sciatic nerve. After speaking to my GP and realizing I was getting nowhere I decided to take the matter into my own hands as I could hardly walk. After speaking to private consultants and realizing that without private medical insurance I was not going to be seen to in this country without shelling out around £20,000 I decided to look elsewhere. I decided to look into having the operation privately in India and was fortunate to come across Mediescapes India. From my initial enquiry when I e-mailed my MRI results to Mediescapes India I was amazed ..more.”
- A Patient from UK

General Surgery in India
Suggested Hospitals / Clinics
Our Medical Consultant’s Panel

Under general surgery Clinical Services that we are capable to offer are as follows;

++ 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

Mediescapes India

                         Take Advantage of Laparoscopy

What is Laparascopy?
In Greek (Laparo means abdomen – ‘skopein’ – to view). Here, a telescope is introduced into the abdominal cavity through small holes of 1 cm. Images from the scope are projected onto a monitor. Surgery is performed by viewing the monitor. Additional openings of 0.5 cm are made as required. Because of the small point of entry, laparoscopy is also called “Keyhole/ Minimal Access Surgery/Endoscopic Surgery/Band Aid Surgery/Belly Button Surgery.” Let’s take a look at some Laparoscopic procedures. 

Laparoscopic Appendicectomy
The appendix is a small worm-like dead tissue at the junction between the small and large intestine which serves no purpose. Appendicitis means infection and inflammation of the appendix. It occurs when faeces or undigested food gets trapped in the dead space by the appendix, setting off infection. As with any dead infected tissue, the appendix has to be removed. The best and simplest way is through surgical removal – Appendicectomy. 

Compare the treatment
In conventional open surgical Appendicectomy, an 8-10 cm long cut is made in the lower abdominal wall and the appendix is removed. After this surgery you will have to stay in the hospital for 4 days, (2-3 days before food is allowed) and you will be recommended complete rest for another 2 weeks and no heavy work for another 4 months.

Compare this to Laparoscopic Appendicectomy. Only three 0.5 cm holes are made. You will be back to normal activity within 24 hrs and can return to work in 2 days. There is no pain and no need for attendants. Two months after the Laparoscopy the scar is gone – while in open surgery it remains as a life long reminder. 

Laparoscopic Cholecystectomy

The gall bladder is a globular bag located on the undersurface of the liver. Its function is to store and concentrate the bile secreted from the liver. During the process the bile sometimes transforms into a salt called gall stones. Once a stone is formed it can obstruct the bile flow causing digestive problems, pain and fever – and in some cases jaundice. If a stone migrates down it can cause pancreatitis (destruction of the pancreas).

If you suffer from gall stones, the only option is to remove the gall bladder completely. Using the conventional method a 12-15cm long cut will be made in your upper abdomen to perform the surgery. Following this you will need to rest for 10days before resuming routine work. In the Laparoscopic procedure only 3 holes of 0.5 cm are required and you will be back on your feet the next day itself!  

Laparoscopic Assisted Vaginal Hysterectomy
No woman is immune to fear of hysterectomy. It brings images of pain, big surgical scar, prolonged bed rest, the possibility of wound infection, weight gain, post surgical back pain and surgical hernias. Even after hysterectomy you may continue to experience pain.

All these were side effects of conventional surgery which involves making a long incision of 15cms, in the lower abdomen. Laparoscopic Hysterectomy, on the other hand calls for just 3 holes of 0.5 cms. You can return to normal routine in 2 days. Since no prolonged bed rest is required you won’t gain weight. 

Laparoscopic Ovarian Surgeries
Usually young females have a problem in their ovaries. The cause? Either multiple small cysts or large cysts containing fluid or a tumour. By open method a 8-10 cm cut is made in the lower abdomen to do surgery in the ovaries. But in Laparoscopy 3 holes of 0.5 cm holes is enough. They are immediately discharged and back to normal in a day.

For Detailed Dossier on General Surgery, please write to us at
 
mktg@mediescapes.com

Mediescapes India
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