Indian Surgeons Research Articles

Indian Perspectives on Graft Materials Used for Repair of Tympanic Membrane.

Repair of Tympanic Membrane (TM) is one of the most common surgeries performed by the otologists. Literature reveals that Indian surgeons have contributed substantially in the research on techniques and graft materials used for the repair of tympanic membrane, though no review has been written so far highlighting their contributions. To summarize and analyse the contributions of Indian authors who have used different graft materials for repair of TM and their studies listed in Medline search. A literature review was conducted using a Medline search using keywords of 'myringoplasty' and 'tympanoplasty' with 'India' on 30th June 2016. A total of 243 articles were found listed onwards from year 1998. Out of these 50 articles in which type 1 tympanoplasty or myringoplasty was performed using different graft materials were selected. The content of each abstract was studied in order to identify studies related to topic. Authors have experimented with a variety of tissues as graft materials. Temporalis Fascia (TF) has been most widely used in 58.6% studies as graft material. The next popular graft is tragal perichondrium. The graft take up rates varied from 68.5% to 100%, while method of reporting of hearing gain in most studies was inconsistent amongst studies, though most studies have reported achievement of serviceable hearing of < 25 dB in most patients. TF was the most prefered material due to anatomic proximity, light material and strength. It was followed in popularity by tragal perichondrium and tragal cartilage. All graft materials have given satisfactory hearing results.

Indian Orthopaedic surgeons are less burned out than their Western colleagues

BackgroundBurnout is a tridimensional psychological syndrome, the consequences of which in surgeons can be devastating. A preliminary review of the literature has demonstrated a paucity of validated studies measuring the levels of surgeon burnout throughout Asia. The purpose of this paper was to assess the prevalence and factors associated with burn out in Indian orthopedic surgeons and compare them to their western colleagues. Materials & methodsThis nationwide cross-sectional study was conducted at the Indian Orthopaedic Association Annual Meeting, via a validated burnout assessment instrument. Variables were compared using the chi-square, Mantel-Haenszel and Mann-Whitney-U tests. Variables associated with burnout subscales and overall burnout were explored using multiple linear and logistic regression. ResultsThere were 299 responses to the survey, 23.1% of the surgeons were allocated burnout status. There was a significant (p<0.001) association between burnout, all measures of satisfaction and health. This association also existed for half-days in public practice (p=0.03) and marital status (p<0.001). ConclusionThis is the first study to assess burnout among orthopedic surgeons in Asia. The use of a validated instrument facilitates future cross study comparisons. There were low levels of burnout in the Indian orthopedic profession, when compared to western countries, albeit a variety of sociocultural factors may play a role. There was evidence to suggest that the number of half-day sessions per week in public practice was associated with burnout, possibly attributed to longer hours and less flexibility. Satisfaction with training pathway was consistently significantly associated with all burnout subscales, a focus for future interventions. A strongly significant association persisted with our previous Australian study between burnout and marital status, emotional support and family stability critical for burnout minimization.

Controversy and consensus for primary repair of cleft lip nose deformity

Introduction: Correction of Cleft lip nose deformity is a difficult challenge for cleft surgeons. Though, Primary repair of cleft lip nose deformity has been accepted worldwide, there are many variations amongst surgeons involved in cleft care. To demystifying the controversy of primary correction of cleft lip nose repair, we have done an internet based survey to define consensus among surgeons. Methodology: A 15 items questionnaire was framed and sent to the all plastic surgeons of India as well as oral & maxillofacial surgeons, Head & neck, ENT & Pediatric surgeons of the country involved in cleft lip surgery. The questionnaire was categorised in the form of repairing the nose deformity with cleft lip, approach to address such deformity, secondary complications & residual deformity present and satisfactory outcome in order to make a common consensus among surgeons involved in cleft surgery. Results: Of total respondents, 91.8% were plastic surgeons and 9.3 % Oral & maxillofacial surgeons. Almost all of them(100%) felt that nose deformity is a part of cleft lip, but only 81.3% agreed for nose deformity correction at the same time of cleft lip repair. Those who performed nose correction were about 58.1%, who always addressed nose deformity whereas 38.7% performed it sometimes.68.8 % address mostly flaring of ala whereas 52.1% address depressed nasal dome also while 24% address all the deformities. The maximum group, 45.3% prefer semi-open approach; whereas almost equal group 42.1% feel closed approach is sufficient enough to address all deformities. As per age of primary correction of nose deformity, 43% do it at the age of 3-4 months along with cleft lip repair whereas 33 % wait for 6 months. Regarding extent of dissection, 31.2% believe in minimum dissection, whereas for 62.7% it varies according to deformity. 89.7% feel primary correction reduces the deformities and 54.1% people feel only 25% patients may require revision before 7 years of age. However 59.6% prefer to revise the nose correction secondarily at adolescent age. About 29.3% surgeons were satisfied with their result in almost 50-75% of their patients and equal group in their 25-50% of patients' .The main complication they encounter was residual nose deformity in about 75.8%. About 87.8% believe there is no maxillary growth disturbances following nose repair and 87.52% are in favour of doing nose correction at the time of cleft lip repair. Conclusion: To conclude, nose deformity is a part of cleft lip and should be repaired at the time of cleft lip repair. The optimum age of repair is same as for cleft lip. The approach may be “semi-open” to “closed” depending on the surgeon's expertise and experiences and extent of dissection may vary according to deformities. However, a small group of patients may require secondary correction, but it is evident that primary nasal correction reduces the deformities and it should be an integral part of cleft lip repair.

Current State of Training and Evaluation of Laparoscopic Surgical Skills

__Objective:__ The aim of this study is to understand the current state of training practices and evaluation in laparoscopic surgery in a global context. __Design:__ An open-ended three part questionnaire was designed to gather the opinions about the current state of, adequacy of, and the need for a standard in laparoscopic surgical training. __Participants:__ Members of the European Association for Endoscopic Surgery (EAES), Endoscopic and Laparoscopic Surgeons of Asia (ELSA) and Association of Surgeons of India (ASI) were asked to participate in the survey. __Results:__ Of the 663 responses received, 83.6% were surgeons (64.6% in a teaching position) and 12.6% were surgical residents in training. Most respondents (75.4%) had performed over 200 laparoscopic procedures. Most (72.1%) training programs were approved/endorsed by local surgical associations or government health authorities and of the courses taught by surgical associations the majority had certified trainers (71.1%). In lower Human Development Index (HDI) countries significantly less courses are taught by certified trainers (68.2% versus 54.6%, p<0.001). Only 26.8% stated that their respective government health authorities participated in the certification of laparoscopic surgery; certification was considered important by 63.6%. However, only 17.8% of government health authorities contributed to ensure the quality of laparoscopic training, mostly in very high HDI. Only 3.3% of respondents considered the laparoscopic training and education in their country to be optimal and 51.9% rated it insufficient. Most respondents (86.3%) stated that there is a need for the standardization of laparoscopic training and 88.3% stated that standardization of laparoscopic training is important. __Conclusion:__ Regardless of demographic and experience factors, there was a general consensus that that there is a need for standardisation in mandatory training of laparoscopic surgical skills, although currently not obligatory in most countries.

Indian Survey on Practice Patterns of Lacrimal and Eyelid Disorders (iSUPPLE) Report 2: Mitomycin-C and Lacrimal Stents in Dacryocystorhinostomy.

The aim of the study was to assess practice patterns on the use of intraoperative Mitomycin-C (MMC) and lacrimal stents (intubation) in dacryocystorhinostomy (DCR) for nasolacrimal duct obstruction (NLDO) among oculoplastic surgeons in India. The survey was aimed at obtaining data on the duration of stent placement and specifics regarding MMC usage namely, concentration and duration of application. A survey that included questions on the management of lacrimal disorders was sent in April 2015 to members of the Oculoplastic Association of India, through an email communication. The results were tabulated and analyzed. External DCR is the preferred surgery of choice to treat NLDO for most oculoplastic surgeons (86%) surveyed. A majority (58%) of the respondents do not place stents during DCR routinely in their practice. Lesser experienced oculoplastic surgeons (<10 years of experience) when compared with more experienced surgeons were more likely to place stents routinely in their DCRs (59% versus 19%; P = 0.0002). Of the special situations that the respondents would consider stent placement, the most common scenarios were the presence of coexisting canalicular pathology followed by cases of previously failed DCRs. The preferred duration for stent removal was 3 months (48%). Intraoperative MMC was used routinely by only 36% of the respondents. The most common condition where they would consider intraoperative MMC was previously failed DCRs. Three minutes (25%) and 0.2 mg/mL (30%) were the preferred duration of application and concentration of MMC, respectively. External DCR is the most preferred surgery for NLDO; in comparison, endoscopic DCR enjoys less popularity as the surgical procedure of choice in NLDO. Adjunctive procedures, namely intraoperative MMC and stenting of the lacrimal passages, are not routinely performed; however, previously failed DCRs are common indications when the respondents may use MMC and/or lacrimal stents. Three months is the preferred duration for stent removal. The trends regarding the concentration of MMC and the application show considerable variation, underscoring the need for evidence-based guidelines to assist oculoplastic surgeons.

Indian survey on practice patterns of lacrimal and eyelid disorders (iSUPPLE) report 1: Congenital nasolacrimal duct obstruction

BackgroundTo assess the preferred practice patterns in the management of congenital nasolacrimal duct obstruction (CNLDO) among oculoplastic surgeons in India. The survey was aimed at obtaining data on the timing of intervention, procedure of choice, and the use of adjunctive techniques such as silicone intubation and nasal endoscopy. MethodsAn anonymized survey that included questions on the management of lacrimal disorders was sent in April 2015 to members of the Oculoplastic Association of India (OPAI), through an e-mail communication. The results were tabulated and analyzed. ResultsA large proportion (84%) of respondents indicated that they advise lacrimal sac compression up to 1 year of age. Fourteen percent (12/87) indicated 2 years as their upper age limit for advising sac compression. One year is the preferred minimum age for advising primary nasolacrimal duct (NLD) probing by majority (45%) of respondents and the upper age limit being 5 years for 62% of respondents. Based on experience, younger surgeons (<10 years experience) when compared to more experienced surgeons are more likely to offer a trial of primary probing in children between 8 and 12 years age (29% versus 8%). Nasal endoscope is used by 50% (44/88) respondents during primary NLD probing. Nearly a third of the respondents (29/88) use intubation in all cases of NLD probing. Eighty one percent (71/88) of the surgeons would rather repeat NLD probing with adjunctive procedures over dacryocystorhinostomy (17%). Balloon Dacryoplasty is rarely used for CNLDO amongst our respondents. ConclusionsThis study highlights the variation in practice pattern in the management of CNLDO across India. While there are certain trends that are global phenomena, such as the shift towards the use of a nasal endoscope; use of silicone intubation in repeated procedures and time of performing primary NLD probing; issues like the use of balloon dacryoplasty showed lesser degree of agreement.

Trends in scientific publications of Indian spine surgeons over 14 years (2000-2013).

Background:The number and quality of scientific publications reflects the standards of scientific research in a country. However, the contribution of Indian spine surgeons toward global publications is unknown. The goal is to study the publications of Indian spine surgeons between 2000 and 2013.Materials and Methods:A literature search of the publications by Indian spine surgeons was performed using MEDLINE. The search terms used were India and several spine-related terminologies. The main information of the selected papers including the year of publication, scientific journal, type of pathology studied, Neurosurgical or Orthopedic Department where the study was done, type of study, and the type of article was analyzed.Results:A total of 4459 articles were identified using MEDLINE and after exclusion, 507 articles were analyzed. A growth of 440% in the number of publications was observed in the period between 2009 and 2013, during which 60.15% of the articles were published. Clinical studies (n = 492; 97.04) were the most common types of articles, followed by experimental studies and other types. The Neurosurgery department published the majority of the articles (58.2%). The three most common pathologies studied were spinal tumors (17.35%), surgical technique (15.4%), and spinal infection (15.2%).Conclusion:The current study shows that publications in the field of spine surgery have been increasing in the last few years, although it is less. Further efforts such as research training of spine surgeons, inducing collaborations and formulation of multicenter projects and periodically allocating adequate funds are key factors to improve the scientific publications from India.

Spectrum of perforation peritonitis at a tertiary healthcare centre: A prospective cohort study of 1908 cases

Introduction Perforation peritonitis is one of the most common surgical emergencies encountered by general surgeons in India. The spectrum of aetiology of perforation differs from its western counterpart. This prospective study conducted at a tertiary healthcare centre was designed to highlight the spectrum of perforation in terms of aetiology, presentation site of perforation, surgical treatment and postoperative complications so as to improve its outcome in our region.

Spectrum of Perforation Peritonitis in a Rural Medical College

Aim: Perforation peritonitis is the most common surgical emergency encountered by surgeons in India. The etiology and sites of perforation shows wide geographical variation. The objective of the study was to find the spectrum of perforation peritonitis &amp; highlight its management at Maharishi Markendeshwar Institute of Medical Sciences &amp; Research, Mullana (MMIMSR).Methods: 93 Operated patients of perforation peritonitis were studied retrospectively in terms of clinical presentation, duration, operative findings and postoperative morbidity and mortality over a period of two years between 2011 to 2013 at MMIMSR Mullana. All the patients had undergone emergency laparatomy under general anesthesia and sites of perforation were identified &amp; managed.Results: The most common cause of perforation peritonititis noticed in our series was peptic ulcer perforation 43 cases (46%), followed by ileal perforation 30 cases (32%), appendicular perforation 6 cases (6.4%), gallbladder perforation 5 cases (5.3%) and all the jejunal perforation 6cases (6.4%) was post traumatic. Large bowel and malignant perforation were least common in our series. Highest no. of perforation noticed in upper part of Gastro intestinal tract as compared to western countries where perforations are seen in distal parts. Mortality was of 11 cases (11.8%) &amp; morbidity was noticed in 55 cases (59%).Conclusion: Peptic ulcer perforation peritonitis is the leading etiology. Mortality is comparable to that of best centre. Aggressive resuscitation and early minimum surgery are required to avoid the high morbidity and mortality. Major complication noticed was wound infection and dehiscence.Bangladesh Journal of Medical Science Vol.15(1) 2016 p.70-73

Development and validation of a Re-Modified Work-Style Short Form Questionnaire for assessment of stress in medical practitioners working in Indian hospitals

ABSTRACTMedical practitioners are unduly stressed, leading to ill health, loss of work efficiency, sometimes affecting decision-making capability. The present study was conducted with the aim to quantify the psychosocial factors that affect the medical practitioners working in Indian hospitals. This study constructed and validated Re-Modified Work-Style Short Form Questionnaire, an eight-item instrument based on work style of 108 medical practitioners comprising Indian physicians and surgeons. The re-modified tool had acceptable validity and internal consistency, which the modified one did not. Explorative factor analysis identified and labelled three factors: ‘Working through pain’, ‘Deadlines/pressure’ and ‘Self-imposed workload’. The findings of the study reveal that the mean total work style score exceeded the standardised limits ≥16, which suggests that the work style of medical practitioners working in Indian hospitals are at risk which may precipitate psychosocial stress. Factor weights was derived through Analytic Hierarchy Process to prioritise the relative importance of three potential work-style factors. The study may help to increase the preventive strategies to proactively reduce the effect of risk factors for the precipitation of stress, successfully leading to its attenuation.

Scientific Abstracts of 40th Annual Conference of Association of Oral and Maxillofacial Surgeons of India

Scientific Abstracts of 40th Annual Conference of Association of Oral and Maxillofacial Surgeons of India

The Initial Indian Experience with Cytoreductive Surgery and HIPEC in the Treatment of Peritoneal Metastases.

Worldwide, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been used for nearly 3 decades to treat peritoneal metastases (PM), improve quality of life, and prolong survival substantially in selected patients. In India, the use of the combined modality of treatment dates back a decade with majority of the efforts taking place within the last 5years. The first PSOGI workshop (India) held in April 2015, at Bangalore, India offered an opportunity for Indian surgeons performing CRS and HIPEC to share their experience. To study the methodologies of CRS and HIPEC (hospital set up, equipment, training and surgical background) as well as the outcomes in terms of perioperative morbidity and mortality and short and long term survival of patients treated in India, Indian surgeons who had treated at least 10 patients with this combined modality were invited to present their experience. Data collection was retrospective. Analysis of the pooled data was carried out. Eight surgeons treated 384 patients with CRS and HIPEC over a period of 10years. The commonest primary sites were ovary (as first line therapy n=124), followed by appendix, including pseudomyxoma peritonei (n=99), colorectum (n=77), recurrent ovary (as second line therapy, n=33), stomach (n=15), primary peritoneal cancer (n=10), peritoneal mesothelioma (n=9) and rare tumors in 17 patients. The weighted mean PCI for all 384 patients was 18.25. 349/384 patients (90.88%) had a complete cytoreduction (completeness of cytoreduction score of CC-0/1). Grade 3-5 complications developed in 108 patients (27.34%) and 30day mortality occurred in 28 (7.29%) patients. This study showed that CRS and HIPEC can be performed with an acceptable morbidity and mortality in Indian patients. Most of the surgeons are on the learning curve and further improvement in these outcomes is expected over a period of time. Pooling of data related to both common and rare peritoneal cancers would be useful in knowing the disease behavior, response to treatment and outcomes in Indian patients. The 2015 PSOGI meeting provided a unique platform for data presentation with feedback from international experts in the field of peritoneal surface oncology. Future meetings are planned to expand the evaluation of Indian data and progress.

Association of Spine Surgeons of India 2016

Association of Spine Surgeons of India 2016

The 38th annual meeting of the Association of Colon and Rectal Surgeons of India in New Delhi, India.

The 38th annual meeting of the Association of Colon and Rectal Surgeons of India in New Delhi, India.

Current trends of liposuction in India: Survey and Analysis.

Background:Liposuction is the commonest aesthetic procedure performed by Indian plastic surgeons. However, there exists substantial disparity amongst Indian surgeons about guidelines concerning liposuction. To address this disparity, a nationwide email survey (Association of Plastic Surgeons of India [APSI] database) was started in December 2013 and continued for 5 months.Material and Methods:The survey was developed with software from www.fluidsurveys.com. The study was designed to cover most aspects of patient selection, perioperative management, technical considerations, postoperative management and complications. This is the first survey to be conducted in India for an extremely popular procedure. It is also one of the most exhaustive surveys that have been conducted in terms of the topics covered.Results and Conclusions:One hundred and eighteen surgeons (including a majority of the cosmetic surgery stalwarts in the country) completed the survey. As expected, the results show a disparity in most parameters but also consolidation on some issues. Liposuction is considered extremely safe (86.1%). The majority of surgeons (70.3%) aspirated >5 L at onetime. The majority (80.2%) felt that the limits for liposuction should be relative and not absolute. The survey highlights lack of standardization with respect to infiltration solutions. The commonest complications observed were contour irregularities, followed by seroma and inadequate skin redrape. The amount of aspirate is the only factor, which achieves statistical significance with respect to major complications. A review of the current evidence and recommendations has been incorporated, along with an in depth analysis of the survey.

Message from the president association of surgeons of India.

Message from the president association of surgeons of India.

Occupational radiation exposure from C arm fluoroscopy during common orthopaedic surgical procedures and its prevention.

Image intensifiers have become popular due to the concept of minimally invasive surgeries leading to decreasing invasiveness, decreased operative time, and less morbidity. The drawback, however, is an increased risk of radiation exposure to surgeon, patient and theatre staff. These exposures have been of concern due to their potential ability to produce biological effects. The present study was embarked upon to analyse the amount of radiation received by orthopedic surgeons in India using standard precautionary measures and also to bring awareness about the use of image intensifier safety in everyday practice. Twelve right-handed male orthopedic surgeons (4 senior consultants, 5 junior consultants and 3 residents) were included in a three month prospective study for radiation exposure measurement with adequate protection measures in all procedures requiring C Arm fluoroscopy. Each surgeon was provided with 5 Thermo Luminescent Dosimeter (TLD) badges which were tagged at the level of neck, chest, gonads and both wrists. Operative time and exposure time of each procedure was recorded. Exposure dose of each badge at the end of the study was obtained and the results were analysed. Mean radiation exposure to all the parts were well within permissible limits. There was a significantly positive correlation between the exposure time and the exposure dose for the left wrist (r=0.735, p<0.01) and right wrist (r=0.58, p<0.05). The dominant hand had the maximum exposure overall. Orthopaedic surgeons are not classified radiation workers. The mean exposure doses to all parts of the body were well within permissible limits. Nothing conclusive, however, can be said about the stochastic effects (chance effects like cancers). Any amount of radiation taken is bound to pose an additional occupational hazard. It is thus desirable that radiation safety precautions should be taken and exposures regularly monitored with at least one dosimeter for monitoring the whole-body dose.

Knowledge and attitude of dental surgeons in India toward ocular complications of intra-oral local anesthesia.

Background:Ocular disturbances such as blurring of vision, mydriasis, palpebral ptosis, diplopia, ptosis, enophthalmos, miosis, and blindness (temporary or permanent) are rare complications due to intra-oral local anesthesia. Currently, the guidelines to dentists on preventing and caring for such ocular problems are lacking. Hence, we evaluated the knowledge and attitudes of dentists toward ocular complications of intra-oral anesthesia as a means to assess the need for such guidelines.Materials and Methods:A cross-sectional prospective survey targeting dentists was conducted using a self-administered questionnaire. Totally 500 standardized self-administered questionnaires were sent out by E-mail to practicing dentists or academicians. In total, 390 replies were received, and the data were analyzed.Results:About 39% of graduates and 14% postgraduate dentists knew about ocular complications. Journals were the leading source of information among both graduates and postgraduate dentists. 8.3% graduates and 17.6% postgraduate dentists encountered ocular complications. Interestingly most of the graduates and postgraduates responded that ocular complications are underreported in the literature. 90.5% graduates and 84.3% postgraduates are in the opinion that more research should be carried on ocular complications. 98.3% postgraduates and 97.3% graduates favored the prevention of ocular complications.Conclusion:The dentist's knowledge about ocular complications due to intra-oral anesthesia in our study group is not adequate and needs improvement. Although the awareness and practice of taking preventive measures are satisfactory, there is a need for specific guidelines to dentists in identifying and clinically managing ocular complications of intra-oral anesthesia.

Management Procedures Pain Used by Dental and Maxillofacial Surgeons: An Investigation With Special Regard To Odontalgia

ABSTRACT Background Little is known about the procedures used by indian dental and maxillofacial surgeons treating patients suffering from chronic orofacial pain (COP). This study aimed to evaluate the ambulatory management of COP. Methods Using a standardized questionnaire we collected data of dental and maxillofacial surgeons treating patients with COP. Therapists described variables as patients’ demographics, chronic pain disorders and their aetiologies, own diagnostic and treatment principles during a period of 3 months. Results Although only 14.5% of the 520 addressed therapists returned completely evaluable questionnaires, 985 patients with COP could be identified. An orofacial pain syndrome named atypical odontalgia (16.0 %) was frequent. Although those patients revealed signs of chronification, pain therapists were rarely involved (12.5%). For assessing pain the use of Analogue Scales (7%) orinterventional diagnostics (4.6%) was uncommon. Despite the fact that surgical procedures are cofactors of COP therapists preferred further surgery (41.9%) and neglected the prescription of analgesics (15.7%). However, most therapists self-evaluated the efficacy of their pain management as good (69.7 %). Conclusion Often ambulatory dental and maxillofacial surgeons do not follow guidelines for COP management despite a high prevalence of severe orofacial pain syndromes.

Global Standardization of Surgical Training.

Global Standardization of Surgical Training.