Dr Mahesh Desai
@DrMaheshDesai4
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Urologist, Muljibhai Patel Urology Hospital, Nadiad, India https://t.co/UZLGpJplxf
Nadiad, India
Joined November 2017
We calculate volume in 3 dimension and add it up
One question friends: How do you calculate the size of stone in patient with multiple calculi? 1. Take the largest dimension of the largest stone 2. Add the largest dimensions of all stones 3. Any other option? @DrMaheshDesai4 @so_uro @docsharadshah @jteoh_hk
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What We see as future of stone management- dusting with suction :“in pursuit of total stone clearance”@peepeeDoctor @abhisingh82
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Vascular supply to remaining kidney
@DrMaheshDesai4 Sir thank you for your reply, one more question if I may, please explain Hillary extension, what nephrometric score do you prefer to use, were you anticipating difficulty prior to surgery in this case so that you may have to convert, if so, what was the worrying point, thank You
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Dear Rahul final biopsy rt kidney Clear cell RCC WITH ADRENAL RCC metastasis on left
@DrMaheshDesai4 Sir, it looks like B/L adrenal tumour, right kidney seems to be separate from the tumour, could be done robotic but difficult, may need help from Vascular surgeons, I have seen @mallikuro7 presenting a similar case
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Rahul Hillary dissection rt renal artery exposed below IVC,Renal Vein isolates ,kidney exposed too big ,No space to maneuver ,medial margin irregular there fore open and under hypothermia tumor with Hillary extension removed ,is hair Mia time 24 mins 🙏
@DrMaheshDesai4 Sir, please explain, which part by robot and which part by open
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Robotic assisted open partial nephrectomy in a solitary functioning kidney. On POD 1, 1.9 lit output and egfr 40 ( pre op egfr 80) . In Covid era some serious work going on. Comments!!
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Looking forward👍
Please join us for #EDGEtalks on May 11 at 11 AM EST (8 am PST). @roger_sur @SSivalingamMD @MSourialMD @shah_ojas @OJWiseman @BodoKnudsen @MayoMitch @DrBenChew
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Further to our conversation. We had done two cases in 2004 and 2006 . Laparoscopic radical nephrectomy and opposite side adrenalectomy . 1st patient had a 4 year survival , second patient lost to follow up after 2 years. Both were RCC. This was pre TKI era.
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Met does not always depend upon size but location ,whether perinephreic or Hilar fat involved .@drniteshjain
RCC IN BOTH SPECIMEN ,rt kidney mass extended in to perinepheric fat adherent not infiltrating to liver .adrenal mass also RCC
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RCC IN BOTH SPECIMEN ,rt kidney mass extended in to perinepheric fat adherent not infiltrating to liver .adrenal mass also RCC
@DrMaheshDesai4 @DrMihirDesai @pprao @DrGaganGautam @abhisingh82 Sir, what’s the final Biospy ... kidney tumor looks very small ...sharing a similar case did a year back (Lap Left Nx and Lap Right Adrenalectomy... was started on TKI ...one year patient doing well
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Change position from rt to left kidney position
Standard kidney position after rt Radical change the position and put extra port ,use two port of rt side ,telescopic and liver retraction converted to upper left hand port ,one extra port for rt hand 4 th arm from assist port of rt side see picture,
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Standard kidney position after rt Radical change the position and put extra port ,use two port of rt side ,telescopic and liver retraction converted to upper left hand port ,one extra port for rt hand 4 th arm from assist port of rt side see picture,
@DrMaheshDesai4 @DrMihirDesai @pprao @DrGaganGautam @abhisingh82 In what position do u put the patient to make both side?
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41/2hrs no major problem
@DrMaheshDesai4 @DrMihirDesai @pprao @DrGaganGautam @abhisingh82 Nice work sir, i wonder how much time it would have taken? any difficulty encountered during surgery?
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I will decide after final histopathology
@DrMaheshDesai4 @DrMihirDesai @pprao @DrGaganGautam @abhisingh82 Why immediate TKI+IO and not active follow-up if single metastasis and low risk IMDC?
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For Nephrectomy I do not think to much advantage but for Adrenalectomy of this size I think Robot had advantage not that I can not do it laparoscopically total time 41/2 hrs
@DrMaheshDesai4 @DrMihirDesai @pprao @DrGaganGautam @abhisingh82 Do you find an benefit of using the robot over the lap approach. whats the total operative time for the lap approach?
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@DrMaheshDesai4 @DrMihirDesai @pprao @DrGaganGautam @abhisingh82 Nice work sir, i wonder how much time it would have taken? any difficulty encountered during surgery?
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Simultaneous right robotic nephrectomy and robotic left adrenalectomy (solitary metastasis) . IMDC -low risk . Plan to add TKI with PDL1 inhibitor. Have done two such cases lap- third one robotic.Any critic??@DrMihirDesai @pprao @DrGaganGautam @abhisingh82
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Mumbai Police regrets to inform about the untimely demise of Head Constable Chandrakant Ganapat Pendurkar (57) from Vakola PStn, who was battling Coronavirus for the past few days. May the departed soul rest in peace. Our thoughts and prayers are with the bereaved family.
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