Neeraj V Rayate

Abasaheb Garware College, Poona, Mahārāshtra, India

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Publications (20)16.46 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To retrospectively evaluate the complications of the laparoscopic pelvic surgeries and to formulate the guidelines to avoid them. Retrospective study (Canadian Classification). Advanced Laparoscopic Institute. Nine hundred and seven operated for gynecological malignancies. Laparoscopic surgeries. 567 women suffering from different pelvic conditions were studied in a period of 60 months. The median age of the patient was 35 (11-80). Complications occurred in 32 patients (32/567, 5.5 %). The overall incidence of urinary tract injury in all the advanced cases at our institute was 2.1 % (12/567). The incidence of bowel injury at our center was 1.76 %. The incidence of vascular injury at our institute was 1.76 % (10/567). Laparoscopic complications are different than those seen following open surgeries. Anticipation, early recognition, and timely intervention help to reduce morbidity. Laparoscopic management of complications is possible. Formulating standard guidelines can help to avoid many such complications.
    Journal of Obstetrics and Gynecology of India 02/2014; 64(1):36-40.
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    ABSTRACT: Minimal access surgery is an accepted modality for benign surgery. Despite the advantages of laparoscopy, its acceptance in oncology is slow. Robotic surgery is an emerging field with rapid acceptance because of the 3-dimensional image, dexterity of instruments and autonomy of camera control. We report here our experience of using the Da Vinci robot for various oncological procedures. We performed 164 oncological surgeries from November 2009 to June 2011. The surgeries performed included thoracic, colorectal, hepatobiliary, gynaecological and urological system. We could complete 163 cases robotically. We share our initial experience of robotic surgery in oncology with comparison with other series.
    Indian journal of surgical oncology. 06/2012; 3(2):96-100.
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    ABSTRACT: To study the feasibility of performing single-incision total laparoscopic hysterectomy using conventional ports and instruments. Patients undergoing laparoscopic surgery at Galaxy Care Laparoscopic Institute, Pune, India, between January 2007 and December 2010 were selected for participation. All procedures were performed using conventional laparoscopic instruments and trocars. Operative data-including operative time (from incision to port closure), blood loss, additional ports used, energy sources used, and intraoperative complications-were recorded. Twenty-three procedures were performed during the study period. All procedures were completed via single incision only. Operative time, blood loss, and hospital stay were comparable with those associated with conventional laparoscopy. It is debatable whether laparoscopic surgery via a single incision would threaten the position of the current gold standard of conventional laparoscopic procedures. The present study showed that single-incision laparoscopic surgery using conventional instruments is feasible and effective.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 01/2012; 117(1):37-9. · 1.41 Impact Factor
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    ABSTRACT: Minimally invasive surgery for diseases in the pelvic region is gaining popularity due to advances in technology and increased benefit to the patient. As indications for such surgeries increase, the known boundaries for minimal access are being extended by a few teams. We report a patient who underwent robotic-assisted transabdominal repair of a high rectovaginal fistula which developed following a vaginal hysterectomy. Vaginography revealed a communication between the vaginal vault and the upper rectum. After evaluation of the colon and the vagina, the patient was planned for a robotic-assisted rectovaginal fistula repair. The three-arm daVinci® surgical robot was used. A total of five ports were used to complete the entire procedure, which included adhesiolysis, re-creation of the vaginal vault, repair of the fistula and omental interposition. This is the first robotic-assisted rectovaginal fistula repair reported to date. Besides the advantages of minimally invasive surgery for the patient, the surgeon benefits from the ease of suturing deep in the pelvis afforded by the articulated robotic arms.
    Journal of Robotic Surgery 01/2012;
  • The Journal of thoracic and cardiovascular surgery 04/2011; 142(5):1283-4. · 3.41 Impact Factor
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    ABSTRACT: Hydatid disease is a zoonotic infection caused by larval stages of dog tapeworms belonging to the genus Echinococcus (family taeniidae) and is also referred to as echinococcosis. Human cystic echinococcosis caused by E. granulosus is the most common presentation and probably accounts for more than 95% of the estimated 2-3 million annual worldwide cases. The liver (70-80%) and lungs (15-25%) are the most frequent locations for echinococcal cysts. The diagnosis is made through the combined assessment of clinical, radiological, and laboratory findings. The treatment is mainly surgical, and, with appropriate diagnosis and treatment, prognosis is good. With advances and increasing experience in laparoscopic surgery, many more attempts have been made to offer the advantage of such a procedure to these patients (Chowbey et al. (2003)).
    Minimally invasive surgery. 01/2011; 2011:346828.
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    ABSTRACT: The aim of this study was to evaluate the feasibility, complications, margin status, and functional outcome (on urinary and sexual functions) of nerve-sparing radical hysterectomy (NSRH) performed laparoscopically. Patients with cervical carcinoma of stage Ia2 and Ib1 underwent laparoscopic NSRH along with pelvic lymphadenectomy. We performed the technique in simple comprehensible steps with anatomic delineation of the autonomic nerves and selective cutting of the uterine and cervical branches. Laparoscopic NSRH was feasible in 85.7% of patients. Mean operative time was 160 minutes and all 7 patients had clear surgical margins. There were no complications and no blood transfusions were required. The median hospital stay was 3 days. The median return time for normal bladder function was 2 days and none of them required catheterization beyond 2 weeks. The mean residual urine volume was <50 mL. Urodynamic studies performed at 3 weeks after the operation showed no impairment of maximum flow rate (maximal flow rate: 20 ± 2 mL). The postoperative results of sexual dysfunction were inconclusive. Understanding this technique and the knowledge of laparoscopic anatomy of pelvic autonomic nerves is important in both benign and malignant pelvic surgeries. These preliminary results indicate that nerve sparing is easier done laparoscopically and its results are comparable to that of conventional laparoscopic radical hysterectomy in terms of lateral margin status and lymph node yield. Whether quality of life can be benefited by L-NRSH technique and its long-term oncological sequelae need further evaluation.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 12/2010; 20(10):813-9. · 1.07 Impact Factor
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    ABSTRACT: To study the feasibility, morbidity, and oncologic outcome of laparoscopic posterior exenteration in patients with advanced gynecologic malignant diseases. Retrospective study based on clinical experience (Canadian Task Force classification III). Private hospital. The medical records for 10 patients who underwent laparoscopic posterior exenteration because of advanced gynecologic malignant disease were retrospectively reviewed. Laparoscopic posterior exenteration involving selective resection of the uterus, ovaries, vagina, and rectum was performed using a 6-port technique that included harmonic shears, the LigaSure device, and a circular endostapling instrument. Histopathologic diagnosis included carcinoma of the cervix in 5 patients, ovary in 4 patients, and vagina in 1 patient. Indication for surgery was primary disease in 7 patients and secondary disease in 3 patients. Complications included delayed bladder recovery in 4 patients, and anastomotic leak, wound infection, and prolonged ileus in 1 patient each. No conversions to open surgery were required. The extent of resection was supralevator in 8 patients and infralevator in 2. Median operative time was 210 minutes. Median length of hospital stay was 9 days. Median blood loss was 360 mL. Disease recurred in 1 patient. After a median follow-up of 26 months, 9 patients were alive, and 8 were free of disease. Laparoscopic posterior exenteration is feasible in advanced gynecologic malignant disease with rectal involvement. In addition to the known benefits of laparoscopic surgery, carefully selected patients could achieve a survival benefit following R0 resection.
    Journal of Minimally Invasive Gynecology 10/2010; 18(1):59-63. · 1.61 Impact Factor
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    ABSTRACT: Esophagectomy has been performed using a thoracoabdominal, transhiatal, or transthoracic approach. All these methods have an acknowledged high intra- and postoperative morbidity. The principle of minimally invasive esophagectomy is to perform the operation the same as by the open approach but through a smaller incision, thus reducing the operative trauma without compromising the principles of the operation. The authors report their experience with thoracoscopic esophagectomy performed for 112 patients in left lateral position. Patients with resectable thoracic or gastroesophageal junction cancer and medically fit for a three-stage esophagectomy underwent thoracoscopic esophagectomy in left lateral position. The procedure was converted to open surgery for 2 (1.79%) of the 112 patients. Since June 2005, 112 patients have undergone thoracoscopic esophagectomy in left lateral position. Of these patients, 80 patients had middle-third esophageal cancer. The pathology of 100 patients showed squamous cell carcinoma. The average thoracoscopic operating time was 85 min (range, 40-120 min). The average blood loss was 200 ml, and the average number of harvested mediastinal nodes was 20. Postoperative morbidity occurred for 16 patients, with 8 patients (7.27%) experiencing respiratory complications. Postoperative mortality was experienced by three patients. The median follow-up period was 18 months. Thoracoscopic esophagectomy is surgically safe and oncologically adequate. Thoracoscopy for patients in the left lateral position does not require prolonged single-lung ventilation. The anatomic orientation in the left lateral position is the same as that for open surgery, reducing the learning curve for thoracic surgeons. The potential advantages and the morbidity trend of prone instead of left lateral thoracoscopic esophagectomy needs to be evaluated.
    Surgical Endoscopy 03/2010; 24(10):2407-14. · 3.43 Impact Factor
  • Journal of Minimally Invasive Gynecology - J MINIM INVASIVE GYNECOL. 01/2010; 17(6).
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    ABSTRACT: Aim. To describe a new technique of uterine manipulation in laparoscopic management of pelvic cancers. Material and Methods. We used a novel uterine hitch technique in 23 patients from May 2008 to October 2008. These patients underwent pelvic oncologic surgery including laparoscopic radical hysterectomy (n = 7), laparoscopic anterior resection (n = 4), laparoscopic abdominoperineal resection (n = 3), laparoscopic posterior exenteration (n = 4), or laparoscopic anterior exenteration (n = 5). The uterus was hitched to the anterior abdominal.wall by either a single suture in the fundus or by sutures through the round ligaments. Results. The uterine hitch technique was successfully accomplished in all procedures. It was performed in less than 5 minutes in all cases. It obviated the need for vaginal manipulation. An extra port for retraction could be avoided. There were no intraoperative complications. Conclusion. A practical, cheap and reproducible method for uterine manipulation, during pelvic oncologic surgery is described. It improves the stability of the uterus and also obviates the need for keeping an additional assistant for vaginal manipulation in any of the procedures.
    Minimally invasive surgery. 01/2010; 2010:836027.
  • Journal of Minimally Invasive Gynecology - J MINIM INVASIVE GYNECOL. 01/2010; 17(6).
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    ABSTRACT: Minimal access surgery is an accepted treatment modality in cervical cancer. Despite the advantages of laparoscopy, the surgical technique of laparoscopic radical hysterectomy is not very commonly performed. Robotic surgery is an emerging field with rapid acceptance because of the 3-dimensional image, dexterity of instruments and autonomy of camera control. We report here our technique of performing robotic radical hysterectomy using the Da Vinci surgical system. Twenty patients with cervical cancer stage 1a1–1b2 underwent robotic radical hysterectomy since December 2009. The median duration of surgery was 122min, and the average blood loss was 100ml. Postoperative ureteric fistulas occurred in two patients and were managed by ureteric stenting. The median lymph node retrieval was 30 nodes (range 18–38). We compared our robotic results with our published data on laparoscopic radical hysterectomy (Pune technique). We were able to complete all 20 cases robotically with minimal morbidity, and could duplicate our laparoscopic steps in robotic radical hysterectomy. KeywordsRadical hysterectomy-Robot-Laparoscopy-Cervical cancer
    Journal of Robotic Surgery 01/2010; 4(4):259-264.
  • Journal of Minimally Invasive Gynecology - J MINIM INVASIVE GYNECOL. 01/2010; 17(6).
  • Journal of Minimally Invasive Gynecology - J MINIM INVASIVE GYNECOL. 01/2010; 17(6).
  • Journal of Minimally Invasive Gynecology - J MINIM INVASIVE GYNECOL. 01/2010; 17(6).
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    ABSTRACT: Minimally invasive surgery is widely employed for the treatment of thyroid diseases. Several minimal access approaches to the thyroid gland have been described. The commonly performed surgeries have been endoscopic lobectomies. We have performed endoscopic total thyroidectomy by the anterior chest wall approach. In this study, we have described our technique and evaluated the feasibility and efficacy of this procedure. From June 2005 to August 2006, 15 cases of endoscopic thyroidectomy were done at our institute. Five patients were male and 10 were female. Mean age was 45 years. (Range 23 to 71 years). Four patients had multinodular goiter and underwent near-total thyroidectomy; four patients had follicular adenoma and underwent hemithyroidectomy. Out of the seven patients of papillary carcinoma, four were low-risk and so a hemithyroidectomy was performed while three patients in the high risk group underwent total thyroidectomy. A detailed description of the surgical technique is provided. The mean nodule size was 48 mm (range 20-80 mm) and the mean operating time was 85 min (range 60-120 min). In all cases, the recurrent laryngeal nerve was identified and preserved intact, the superior and inferior parathyroids were also identified in all patients. No patients required conversion to an open cervicotomy. All patients were discharged the day after surgery. All thyroidectomies were completed successfully. No recurrent laryngeal nerve palsies or postoperative tetany occurred. The postoperative course was significantly less painful and all patients were satisfied with the cosmetic results. It is possible to remove large nodules and perform as well as total thyroidectomies using our endoscopic approach. It is a safe and effective technique in the hands of an appropriately trained surgeon. The patients get a cosmetic benefit without any morbidity.
    Journal of Minimal Access Surgery 07/2007; 3(3):91-7.
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    ABSTRACT: To describe our experience and technique of total laparoscopic radical hysterectomy with pelvic lymphadenectomy, which is the largest single- institution study. Retrospective, nonrandomized study (Canadian Task Force classification II-2). Private hospital. Two hundred forty-eight patients with International Federation of Gynecology and Obstetrics stage IA2 (n = 32) and IB1 (n = 216) of cancer of the cervix. Total laparoscopic type III radical hysterectomy with bilateral pelvic lymphadenectomy was done. Simple repetitive steps were used to perform this surgery and develop an easily replicable technique. Harmonic Shears, bipolar coagulation, and vascular clips were used. Resection of the cardinal and uterosacral ligaments was performed with LigaSure (LigaSure Vessel Sealing System; Valleylab, Tyco Healthcare, Boulder, CO) or the Harmonic Shears (Ethicon Endo-Surgery, Inc., Cincinnati, OH). Pelvic lymph node dissection was done. Histopathologically, there were 183 (73%) cases of squamous carcinoma, 52 (20%) adenocarcinomas, and 13 (5%) adenosquamous carcinomas. Four patients needing anterior exenteration because of bladder involvement were excluded from data analyses. The operation was performed entirely by laparoscopy in all patients and by the same surgical team. The patients' median age was 61 years. The median operative time was 92 minutes (range 65-120 minutes). The median number of resected pelvic nodes was 18. The median blood loss was 165 mL. The median length of stay was 3 days. All 15 intraoperative complications were tackled laparoscopically. No patients were converted to the open technique. There were no deaths in our series. Seventeen patients had complications within 2 months of surgery. Seven patients had recurrences after a median follow-up of 36 months. Our technique of total laparoscopic radical hysterectomy, developed over 248 cases, can be performed safely. It is an easily replicable technique. This procedure reduces the morbidity associated with abdominal radical hysterectomy. All of the complications can also be tackled laparoscopically, which does not further add to the morbidity.
    Journal of Minimally Invasive Gynecology 01/2007; 14(6):682-9. · 1.61 Impact Factor
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    ABSTRACT: The aim of this study was to retrospectively evaluate, in a series of 16 consecutive patients, the technique, feasibility and oncological safety of laparoscopic anterior exenteration for locally advanced pelvic cancers. Since August 2003, 16 patients with locally advanced pelvic cancer were considered. All patients were in a good general condition, in the age group of 50-60 years of which 12 had cervical carcinoma and 4 had bladder carcinoma. The median operative time was 180 min. The mean number of harvested pelvic iliac nodes was 14. All margins were tumor-free. The median postoperative hospital stay was 3 days. Three patients had postoperative complications; two had subacute intestinal obstruction and one had ureteric leak. The median follow-up was 15 months. Our results have demonstrated the feasibility and oncological safety of performing anterior exenteration laparoscopically in advanced pelvic cancer patients with acceptable morbidity. Intermediate-term follow-up validates the adequacy of this procedure.
    Gynecologic Oncology 10/2006; 102(3):513-6. · 3.93 Impact Factor
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    ABSTRACT: The objectives of surgical management in carcinoma esophagus are • A complete resection of the esophagus • Adequate lymph node clearance • Replacement of the esophagus by a suitable conduit • Minimum morbidity The salient features of the technique of combined thoracoscopic and laparoscopic esophagectomy with anastomosis in the neck described in this chapter are: 1. Thoracoscopic esophageal mobilization with lymphadenectomy, including the paratracheal, subcarinal, parabronchial and paraesophageal nodes. 2. Laparoscopic stomach mobilization with regional lymphadenectomy, including the lymph nodes along the lesser curvature of the stomach, the coeliac axis and the paraaortic nodes. 3. Specimen delivery through a small epigastric incision, and extracorporeal formation of stomach tube. 4. Intrathoracic placement of stomach tube and esophagogastric anastomosis in the neck. 5. Feeding jejunostomy in all patients.