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Your search keyword '"Ramachandran Narayana Menon"' showing total 2 results
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2 results on '"Ramachandran Narayana Menon"'

1. Technique of robotic right donor hepatectomy

Author

Biju Chandran, Christi Titus Varghese, Dinesh Balakrishnan, Krishnanunni Nair, Shweta Mallick, Johns Shaji Mathew, Binoj Sivasankara Pillai Thankamony Amma, Ramachandran Narayana Menon, Unnikrishnan Gopalakrishnan, Othiyil Vayoth Sudheer, and S Sudhindran

Subjects
live donor, liver transplantation, minimally invasive surgery, right hepatectomy, robotic surgery, technique, Surgery, RD1-811, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background: Although minimally invasive right donor hepatectomy (RDH) has been reported, this innovation is yet to be widely accepted by transplant community. Bleeding during transection, division of right hepatic duct (RHD), suturing of donor duct as well as retrieval with minimal warm ischemia are the primary concerns of most donor surgeons. We describe our simplified technique of robotic RDH evolved over 144 cases. Patients and Methods: Right lobe mobilization is performed in a clockwise manner from right triangular ligament over inferior vena cavae up to hepatocaval ligament. Transection is initiated using a combination of bipolar diathermy and monopolar shears controlled by console surgeon working in tandem with lap CUSA operated by assistant surgeon. With the guidance of indocyanine green cholangiography, RHD is divided with robotic endowrist scissors (Potts), and remnant duct is sutured with 6-0 PDS. Final posterior liver transection is completed caudocranial without hanging manoeuvre. Right lobe with intact vascular pedicle is placed in a bag, vascular structures then divided, and retrieved through Pfannenstiel incision. Conclusion: Our technique may be easy to adapt with the available robotic instruments. Further innovation of robotic platform with liver friendly devices could make robotic RDH the standard of care in future.

Published
2022
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2. Open to robotic right donor hepatectomy: A tectonic shift in surgical technique

Author

Binoj Sivasankara Pillai Thankamony, Amma, Johns Shaji, Mathew, Christi Titus, Varghese, Krishnanunni, Nair, Shweta, Mallick, Biju, Chandran, Ramachandran Narayana, Menon, Unnikrishnan, Gopalakrishnan, Dinesh, Balakrishnan, Preethi Sara, George, Sudheer Othiyil, Vayoth, and Surendran, Sudhindran

Subjects
Transplantation, Postoperative Complications, Robotic Surgical Procedures, Living Donors, Hepatectomy, Humans, Laparoscopy, Length of Stay, Transaminases, Retrospective Studies
Abstract

Robotic right live donor hepatectomy (r-LDRH) has been reported with reduced morbidity compared to open donor right hepatectomy (o-LDRH) in few recent series. Nevertheless, its routine use is debated. We present a large series comparing pure r-LDRH with o-LDRH. Consecutive r-LDRH performed from June 2018 to June 2020 (n = 102) were compared with consecutive donors undergoing o-LDRH (n = 152) from February 2016 to February 2018, a period when r-LDRH was not available at this center. Propensity score matched (PSM) analysis of 89 case-control pairs was additionally performed. Primary endpoints were length of high dependency unit (HDU) and hospital stay and Clavien-Dindo graded complications among donors. Although r-LDRH took longer to perform (540 vs. 462 min, P .001), the postoperative peak transaminases levels (P .001), the length of HDU (3 vs. 4 days, P .001), and hospital stay (8 vs. 9 days, P .001) were lower in in donors undergoing r-LDRH. Clavien-Dindo graded complications were similar (16.67% in r-LDRH and 13.16% in o-LDRH). The rates of early allograft dysfunction (1.6% vs. 3.3%), bile leak (14.7% vs. 10.7%), and 1-year mortality (13.7% vs. 11.8%) were comparable between r-LDRH and o-LDRH recipients. PSM analysis yielded similar results between the groups. These data support the safety and feasibility of r-LDRH in select donors.

Published
2022
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