Abhay Rane

Publications (35)86.79 Total impact

• Article: Contemporary Perspectives on LaparoEndoscopic Single-Site Surgery in Urologic Training and Practice.

  Soroush Rais-Bahrami, Daniel M Moreira, Joel H Hillelsohn, Arvin K George, Abhay Rane, Andreas J Gross, Lee Richstone
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  ABSTRACT: Introduction: The initial surge of interest in LaparoEndoscopic Single-Site (LESS) surgery is balanced by skepticism regarding its future. We sought to evaluate perspectives of practicing urologists on the role of LESS in urologic training and practice. Materials and Methods: An anonymous questionnaire was electronically-mailed to members of the Endourological Society and American Urological Association. Questions were grouped in three domains: training background and LESS experience, perspectives on LESS training, and perspectives on LESS in current urologic practice. Results: 422 surveys were completed. Respondents had a mean of 11.7 years in practice and 60.7% completed fellowship training. LESS was performed by 44.7% of respondents, however, of these respondents, 75% had only performed <10 LESS cases. For timing of LESS training, 50% believed LESS should be taught during residency and 39% during fellowship. Hands-on workshops and courses were thought to be insufficient by a majority (56%) for learning LESS techniques prior to use in practice, and 51% support a credentialing process for urologists performing LESS surgery. Assessing the role of LESS in urologic practice, in its current state, LESS was deemed to provide superior cosmesis (69%) more commonly believed by those with LESS experience 77vs63% (p=0.004), however, without yielding quicker recovery (75%) or less postoperative pain (73%). Conclusion: LESS is viewed as an area with potential growth with benefits of superior cosmesis. LESS training should be more integrated into residency and fellowship training and establishing a credentialing process for LESS should be strongly considered by accrediting bodies.
  Journal of endourology / Endourological Society 12/2012; · 1.75 Impact Factor
• Article: Urological laparoendoscopic single site surgery: multi-institutional analysis of risk factors for conversion and postoperative complications.

  Riccardo Autorino, Jihad H Kaouk, Rachid Yakoubi, Koon Ho Rha, Robert J Stein, Wesley M White, Jens-Uwe Stolzenburg, Luca Cindolo, Evangelos Liatsikos, Soroush Rais-Bahrami, [......], Paolo Fornara, Carlo Terrone, Camilo Giedelman, Joo Yong Lee, Sebastien Crouzet, Georges-Pascal Haber, Lee Richstone, Sun Yinghao, Fernando J Kim, Jeffrey A Cadeddu
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  ABSTRACT: We analyzed the incidence of and risk factors for complications and conversions in a large contemporary series of patients treated with urological laparoendoscopic single site surgery. The study cohort consisted of consecutive patients treated with laparoendoscopic single site surgery between August 2007 and December 2010 at a total of 21 institutions. A logistic regression model was used to analyze the risks of conversion, and of any grade and only high grade postoperative complications. Included in analysis were 1,163 cases. Intraoperatively complications occurred in 3.3% of cases. The overall conversion rate was 19.6% with 14.6%, 4% and 1.1% of procedures converted to reduced port laparoscopy, conventional laparoscopic/robotic surgery and open surgery, respectively. On multivariable analysis the factors significantly associated with the risk of conversion were oncological surgical indication (p=0.02), pelvic surgery (p<0.001), robotic approach (p<0.001), high difficulty score (p=0.004), extended operative time (p=0.03) and an intraoperative complication (p=0.001). A total of 120 postoperative complications occurred in 109 patients (9.4%) with major complications in only 2.4% of the entire cohort. Reconstructive procedure (p=0.03), high difficulty score (p=0.002) and extended operative time (p=0.02) predicted high grade complications. Urological laparoendoscopic single site surgery can be done with a low complication rate, resembling that in laparoscopic series. The conversion rate suggests that early adopters of the technique have adhered to the principles of careful patient selection and safety. Besides facilitating future comparisons across institutions, this analysis can be useful to counsel patients on the current risks of urological laparoendoscopic single site surgery.
  The Journal of urology 04/2012; 187(6):1989-94. · 4.02 Impact Factor
• Article: Patient selection for LESS urological surgery.

  Marco De Sio, Carmelo Quattrone, Rocco Damiano, Chandaran Tanabalan, Abhay Rane
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  ABSTRACT: Laparoendoscopic single-site surgery (LESS) should theoretically improve perioperative results and cosmesis minimizing skin incision. LESS surgery is technically demanding and the result of any procedure depends on the surgeon skill and experience, on the condition to be treated and finally on careful patient selection. As cosmesis is the main advantage over standard laparoscopy, LESS is particularly indicated in young patients with low BMI. While at the beginning LESS surgery was limited to demolitive procedures, increasing experience lead to widen indications to reconstructive and more challenging conditions. New technologies and robotics may increase LESS indications in the next future.
  Archivos españoles de urología 04/2012; 65(3):280-4.
• Article: Focal therapy for renal mass lesions: where do we stand in 2012?

  Abhay Rane, Robert Stein, Jeffrey Cadeddu
  BJU International 02/2012; 109(4):491-2. · 2.84 Impact Factor
• Article: Is robotics the future of laparoendoscopic single-site surgery (LESS)?

  Gregory Spana, Abhay Rane, Jihad H Kaouk
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  ABSTRACT: • Laparoendoscopic single-site surgery (LESS) is a term that covers a spectrum of surgical techniques that perform laparoscopic surgery by consolidating all ports into one surgical incision. • In recent years, there has been an expansion of LESS surgical techniques with a wide spectrum of urological procedures being performed using LESS surgery. • Paralleling the clinical expansion of LESS are efforts to improve the instrumentation and access devices as well as incorporation of robotic platforms to the LESS arena. • This expansion in technology has generated the essential question: is robotics the future of LESS?
  BJU International 09/2011; 108(6 Pt 2):1018-23. · 2.84 Impact Factor
• Article: LESS: 'Where's the meat'?

  Abhay Rane, Jeffrey A Cadeddu
  BJU International 07/2011; 108(2):157. · 2.84 Impact Factor
• Article: Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases.

  Jihad H Kaouk, Riccardo Autorino, Fernando J Kim, Deok Hyun Han, Seung Wook Lee, Sun Yinghao, Jeffrey A Cadeddu, Ithaar H Derweesh, Lee Richstone, Luca Cindolo, [......], Sara Best, Sean P Stroup, Soroush Rais-Bahrami, Luigi Schips, Paolo Fornara, Phillip Pierorazio, Camilo Giedelman, Jae Won Lee, Robert J Stein, Koon Ho Rha
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  ABSTRACT: Laparoendoscopic single-site surgery (LESS) has gained popularity in urology over the last few years. To report a large multi-institutional worldwide series of LESS in urology. Consecutive cases of LESS done between August 2007 and November 2010 at 18 participating institutions were included in this retrospective analysis. Each group performed a variety of LESS procedures according to its own protocols, entry criteria, and techniques. Demographic data, main perioperative outcome parameters, and information related to the surgical technique were gathered and analyzed. Conversions to reduced-port laparoscopy, conventional laparoscopy, or open surgery were evaluated, as were intraoperative and postoperative complications. Overall, 1076 patients were included in the analysis. The most common procedures were extirpative or ablative operations in the upper urinary tract. The da Vinci robot was used to operate on 143 patients (13%). A single-port technique was most commonly used and the umbilicus represented the most common access site. Overall, operative time was 160±93 min and estimated blood loss was 148±234 ml. Skin incision length at closure was 3.5±1.5 cm. Mean hospital stay was 3.6±2.7 d with a visual analog pain score at discharge of 1.5±1.4. An additional port was used in 23% of cases. The overall conversion rate was 20.8%; 15.8% of patients were converted to reduced-port laparoscopy, 4% to conventional laparoscopy/robotic surgery, and 1% to open surgery. The intraoperative complication rate was 3.3%. Postoperative complications, mostly low grade, were encountered in 9.5% of cases. This study provides a global view of the evolution of LESS in the field of minimally invasive urologic surgery. A broad range of procedures have been effectively performed, primarily in the academic setting, within diverse health care systems around the world. Since LESS is performed by experienced laparoscopic surgeons, the risk of complications remains low when stringent patient-selection criteria are applied.
  European urology 06/2011; 60(5):998-1005. · 7.67 Impact Factor
• Article: Laparoendoscopic single site (LESS) adrenalectomy: Technique and outcomes.

  Abhay Rane, Luca Cindolo, Luigi Schips, Marco De Sio, Riccardo Autorino
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  ABSTRACT: PURPOSE: To describe the surgical technique, to analyze outcomes and to provide an overview of the current status of laparoendoscopic single site (LESS) adrenalectomy. METHODS: A comprehensive PubMed search was performed for all relevant urological literature regarding LESS and adrenal surgery. In addition, experience gained at the authors' own institutions was considered. Clinical descriptive and comparative reports on LESS adrenal surgery procedures were analysed. RESULTS: LESS adrenal surgery has been effectively performed for a number of indications. A wide variety of approaches (transperitoneal versus retroperitoneal, multichannel trocar versus multiple ports, trans- or extraumbilical) have been described. LESS adrenalectomy seems to be safe, taking more time than the standard laparoscopic counterpart but appears to offer the patient less postoperative discomfort. Technical difficulties of the procedure include the requirement of more time for adjustment of articulating instruments, longer 'one-handed' manipulation time, and a high peroperative tissue re-grasping rate. CONCLUSIONS: The feasibility and safety of LESS adrenalectomy has been demonstrated. Only long-term follow-up outcomes will prove its benefits over conventional laparoscopy and define the role and the oncological safety of LESS adrenal surgery.
  World Journal of Urology 04/2011; · 2.41 Impact Factor
• Article: Complications and conversions of upper tract urological laparoendoscopic single-site surgery (LESS): multicentre experience: results from the NOTES Working Group.

  Brian H Irwin, Jeffrey A Cadeddu, Chad R Tracy, Fernando J Kim, Wilson R Molina, Abhay Rane, Chandru P Sundaram, James H Raybourn, Robert J Stein, Inderbir S Gill, Louis R Kavoussi, Lee Richstone, Mihir M Desai
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  ABSTRACT: Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Several studies have shown the feasibility of performing both complex and reconstructive laparoendoscopic single site (LESS) surgical procedures in urology. To date, no studies have evaluated the rates of conversion to conventional laparoscopy and complications at the time of LESS procedures in urology. This study, a compilation of results from members of the NOTES working group, is the first study to address the rates of complications and conversions to conventional laparoscopy at the time of LESS surgery in urology. • To present complications and rates of conversion from LESS to conventional laparoscopy (CL) at the time of upper tract LESS urologic procedures. • Patients undergoing LESS upper tract procedures between September, 2007 and November, 2008 (n = 125) were identified at six high-volume academic centers pioneering urologic LESS procedures. All LESS procedures were performed transperitoneally via a single umbilical incision using either adjacent conventional trocars or a dedicated single-site access device. Reconstructive procedures incorporating a single planned 2 mm accessory needle port were included as LESS procedures and were not considered conversions. • Patients, undergoing LESS procedures requiring conversion to CL with the placement of additional ports were identified. Conversion was defined as the placement of additional 5 or 10/12 mm ports beyond the primary incision. In each case the operative reports were reviewed, the reason for conversion was determined, and the number and types of additional ports and complications were noted. • Upper tract LESS procedures were performed in 125 patients comprising 13.3% of the total 937 laparoscopic procedures performed at the participating institutions during this time period. Conversion to CL was necessary in 7 patients (5.6%) undergoing LESS requiring the addition of 2-5 ports. • Reasons for conversion included: facilitate dissection in 3 (43%), facilitate reconstruction in 3 (43%), and control of bleeding in 1 (14%). All attempted LESS cases were completed laparoscopically without need for open conversion. • Complications occurred in 15.2% of patients undergoing LESS surgery. Three of the 7 patients that required conversion to CL developed postoperative complications (Clavien grade II in two and IIIa in one). • Limitations of this study included the inability to standardize LESS patient selection criteria, instrumentation and surgical technique as well as the lack of available complete data from a CL control group for comparison. • LESS surgery is technically feasible for a variety of upper urinary tract reconstructive and ablative procedures, although it appears to be associated with higher rates of complications than in mature CL series. Conversion to CL occurs infrequently and may be a reflection of stringent patient selection.
  BJU International 04/2011; 107(8):1284-9. · 2.84 Impact Factor
• Article: Low-cost reusable instrumentation for laparoendoscopic single-site nephrectomy: assessment in a porcine model.

  Riccardo Autorino, Fernando J Kim, Abhay Rane, Marco De Sio, Robert J Stein, Rocco Damiano, Salvatore Micali, Jorge Correia-Pinto, Jihad H Kaouk, Estevão Lima
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  ABSTRACT: To test different sets of prebent instruments and a new reusable access device for laparoendoscopic single-site (LESS) surgery. Three surgeons with previous experience in LESS performed 12 nephrectomies in six pigs. In all procedures, a multichannel access device (X-CONE) and a 5-mm extra-long telescope were used. Four sets of prebent instruments with different profiles (S-portal) were tested: Standard (one straight scissors and one curved grasper), Cuschieri, Carus, and Leroy set (each of them consisting of two curved instruments with different configurations). Assessment was performed based on both objective (procedure time; time to manage the pedicle; time to free kidney) and subjective parameters (entry/exit of instruments; triangulation; dissection up/down; dissection lateral; retraction; interdependence). The subjective assessment tool used was a Likert type scale (1 = easy to 5 = prohibitive). The access device was assessed by using objective (time to complete insertion of device after skin incision) and subjective (significant air leakage, movement constraint) parameters. Time to insertion of the X-CONE was <1 minute in all the cases. Surgeons reported significant insufflant leakage in 58% of cases. The procedure was completed in 10/12 (83%) cases. Mean operative time was 8.3 ± 4.2 minutes, being lower for the Carus group (4.5 min) and higher for the standard group (13 min). Among the different sets, the standard one obtained the best mean scores for all subjective parameters. X-CONE allows easy abdominal access, and its reusable properties represent cost savings for LESS compared with disposable devices. Prebent instruments might also represent attractive low-cost tools for LESS.
  Journal of endourology / Endourological Society 02/2011; 25(3):419-24. · 1.75 Impact Factor
• Article: Urological applications of single-site laparoscopic surgery.

  Andrew Symes, Abhay Rane
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  ABSTRACT: Single-port, single-incision laparoscopy is part of the natural development of minimally invasive surgery. Refinement and modification of laparoscopic instrumentation has resulted in a substantial increase in the use of laparoendoscopic single-site surgery (LESS) in urology over the past 2 years. Since the initial report of single-port nephrectomy in 2007, the majority of laparoscopic procedures in urology have been described with a single-site approach. This includes surgery on the adrenal, ureter, bladder, prostate, and testis, for both benign and malignant conditions. In this review, we describe the current clinical applications and results of LESS in Urological Surgery. To date this evidence comes from small case series in centres of excellence, with good results. Further well-designed prospective trials are awaited to validate these findings.
  Journal of Minimal Access Surgery 01/2011; 7(1):90-5.
• Article: Where do we really stand with LESS and NOTES?

  Matthew T Gettman, Wesley M White, Monish Aron, Riccardo Autorino, Tim Averch, Geoffrey Box, Jeffrey A Cadeddu, David Canes, Edward Cherullo, Mihir M Desai, [......], Abhay Rane, Maria Ribal, Robert Rabenhalt, Pradeep Rao, Lee Richstone, Mark D Sawyer, Rene Sotelo, Jens-Uwe Stolzenburg, Chad R Tracy, Robert J Stein
  European urology 11/2010; 59(2):231-4. · 7.67 Impact Factor
• Article: Robotic natural orifice translumenal endoscopic surgery and laparoendoscopic single-site surgery: current status.

  Abhay Rane, Riccardo Autorino
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  ABSTRACT: To analyse the evidence supporting current and future application of robotic technology in natural orifice translumenal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). Early clinical experience with the application of currently available da Vinci robotic system to LESS has been encouraging, as some of the constraints encountered during conventional LESS can be overcome. Robotic devices that are currently being developed for NOTES and LESS focus on improving either tissue manipulation capabilities for externally actuated robotic and flexible endoscopy systems or visualization for robots that are inserted completely into the peritoneal cavity. Robotic technology is rapidly evolving and is expected to drive several aspects of minimally invasive surgery forward in the near future with the ultimate goal of minimizing complications and improving outcomes.
  Current opinion in urology 10/2010; 21(1):71-7. · 2.50 Impact Factor
• Article: LESSons in minimally invasive urology.

  Harveer Dev, Prasanna Sooriakumaran, Ashutosh Tewari, Abhay Rane
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  ABSTRACT: Since the introduction of laparoscopic surgery, the promise of lower postoperative morbidity and improved cosmesis has been achieved. LaparoEndoscopic Single Site (LESS) surgery potentially takes this further. Following the first human urological LESS report in 2007, numerous case series have emerged, as well as comparative studies comparing LESS with standard laparoscopy. Technological developments in instrumentation, access and optics devices are overcoming some of the challenges that are raised when operating through a single site. Further advances in the technique have included the incorporation of robotics (R-LESS), which exploit the ergonomic benefits of ex vivo robotic platforms in an attempt to further improve the implementation of LESS procedures. In the future, urologists may be able to benefit from in vivo micro-robots that will allow the manipulation of tissue from internal repositionable platforms. The use of magnetic anchoring and guidance systems (MAGS) might allow the external manoeuvring of intra-corporeal instruments to reduce clashing and facilitate triangulation. However, the final promise in minimally invasive surgery is natural orifice transluminal endoscopic surgery (NOTES), with its scarless technique. It remains to be seen whether NOTES, LESS, or any of these future developments will prove their clinical utility over standard laparoscopic methods.
  BJU International 10/2010; 107(10):1555-9. · 2.84 Impact Factor
• Article: Laparoscopic training in urology: critical analysis of current evidence.

  Riccardo Autorino, Georges-Pascal Haber, Robert J Stein, Abhay Rane, Marco De Sio, Michael A White, Bo Yang, Jean J de la Rosette, Jihad H Kaouk, M Pilar Laguna
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  ABSTRACT: To provide an evidence-based analysis on the status and perspectives of laparoscopic training in urologic surgery. A thorough review of the current literature was performed as of January 31, 2009, using the Medline database through a PubMed search. The search protocol included a free-text query using the following terms: "training," "urologic laparoscopy," "urology," and "laparoscopy." Suitable articles were selected on the basis of the study content. The following issues were addressed: prediction of laparoscopic skills and transfer of training in clinical practice; homemade and commercially available laparoscopic trainers and simulators; training models for specific laparoscopic procedures; mentored training programs; formal training programs; and the impact of robotics in laparoscopic training. Currently available tools predicting laparoscopic skills lack adequate validation to justify their widespread adoption. There still is not enough evidence to show definite transfer of skills from currently available simulators to the operating theater. Learning opportunities continue to evolve. Specific models have been developed for complex procedures. Various informal training programs exist, yet most urologists will not be able to complete a formal fellowship. Postgraduate urologists may possibly be more rapidly and efficiently trained using a structured mentoring program. Robotics is likely to have an increasing role in teaching urological laparoscopy. Despite progress in recent years and an extensive amount of data from the urological literature, the ideal training program in urological laparoscopy remains a goal to be determined objectively.
  Journal of endourology / Endourological Society 09/2010; 24(9):1377-90. · 1.75 Impact Factor
• Article: Minimally invasive surgery in urology: is the winner natural-orifice translumenal endoscopic surgery or laparoendoscopic single-site surgery?

  Abhay Rane, Lee E Ponsky, Lee Richstone
  BJU International 07/2010; 106(1):1-2. · 2.84 Impact Factor
• Article: Evaluation of a hemostatic sponge (TachoSil) for sealing of the renal collecting system in a porcine laparoscopic partial nephrectomy survival model.

  Abhay Rane, Peter D Rimington, Chris F Heyns, Andre van der Merwe, Shaun Smit, Christopher Anderson
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  ABSTRACT: The objective of this study was to evaluate the efficacy of TachoSil (Nycomed UK, Oxford, Buckinghamshire, UK), a hemostatic sponge, to seal major collecting system injuries (in addition to providing an adjunct to hemostasis) after partial nephrectomy in a porcine chronic survival model. Laparoscopic upper-pole partial nephrectomies were performed in 10 farm pigs (>40 kg). After hilar clamping, an energyless incision was made at a point halfway between the hilum and the upper pole of the kidney and the collecting system was opened widely. TachoSil was applied to cover the defect; 15 to 20 minutes after the application of TachoSil, the hilar clamp was removed, hemostasis confirmed, and the pig survived. Assessment was made for hematoma and urinoma. Four weeks postoperatively, the pigs were euthanized. Ex-vivo retrograde studies were performed to assess collecting system leak. Weight, blood pressure, estimated blood loss, the weight of the partial and completion nephrectomy specimen, presence/absence of urinary leak on retrograde study, histopathologic findings, and complications were recorded. All pigs survived. Mean warm ischemia time was 18 minutes, mean blood loss was 90 mL, and mean resected weight was 13.7 g. There was no evidence of leak on retrograde study. Histologically, nonspecific changes were noted in all specimens, which included dystrophic calcification, scarring, and areas of fibrosis at the partial nephrectomy surgical margin. TachoSil seals the collecting system after partial nephrectomy on a porcine chronic survival model, in addition to providing an adjunct to hemostasis. More studies, including human trials, are warranted to evaluate this observation further.
  Journal of endourology / Endourological Society 03/2010; 24(4):599-603. · 1.75 Impact Factor
• Article: Laparoscopy extirpative renal surgery in the octogenarian population.

  Dan Magrill, Tet Yap, Jordan Durrant, Christopher Anderson, Peter Rimington, Abhay Rane
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  ABSTRACT: Laparoscopic extirpative surgery for cancer is usually safe and effective, even in the elderly. However, the risk to benefit ratio of laparoscopic nephrectomies in patients aged over 80 has not been quantified objectively. The purpose of this study is to analyze the outcomes of this technique in the octogenarian population. Between July 2001 and March 2008, 37 laparoscopic nephrectomies were performed for malignancy in patients over the age of 80. Patient demographics and perioperative and postoperative data were analyzed retrospectively. Population characteristics include a median age of 82, 65% female with a median American Society of Anesthesiologists score of 2. In all, 57% of the laparoscopic nephrectomies were left sided. Twenty-four laparoscopic nephrectomies were for renal cell carcinoma, with 13 nephroureterectomies for transitional cell carcinoma. A total of 32% had postoperative complications, three of which resulted in death. Average total length of hospital stay was 10.5 days. Stage of malignancy varied from pT(a) to pT(4), and the mean size of the specimen was 169 x 77 mm with a mean tumor size of 54 x 44 mm. At 1 year follow-up (n = 27), 85% were alive, and at 3 years (n = 21) 52% were alive and free of disease. Our small study suggests that laparoscopic nephrectomy in this age group is feasible, although the results are far from ideal. Cancer-specific survival rates are poor in this population, and therefore the risk to benefit ratio should be weighed up carefully prior to committing a patient in this age group to extirpative surgery.
  Journal of endourology / Endourological Society 09/2009; 23(9):1499-502. · 1.75 Impact Factor
• Article: Laparoendoscopic single-site surgery for nephrectomy as a feasible alternative to traditional laparoscopy.

  James H Raybourn, Abhay Rane, Chandru P Sundaram
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  ABSTRACT: To report an initial clinical urologic experience using single-port surgery compared to the traditional laparoscopic technique for nephrectomy. A total of 11 patients underwent laparoscopic nephrectomy using the laparoendoscopic single-site surgery (LESS) procedure, with 1 R-port used for each. A group of 10 patients who previously underwent simple nephrectomies by 1 of the 2 surgeons were selected for comparison. The intraoperative and postoperative narcotic analgesia requirements were compared between the 2 groups. The Student t test was used to compare the means. All complications, clinical data, and technical issues with performing the procedure were noted. All LESS simple nephrectomy procedures were completed uneventfully. There were no intraoperative complications in the LESS group. Postoperative complications included pyrexia and port site bruising with 2 patients. Operative time showed no significant difference in the LESS group compared to the traditional laparoscopic group (151 vs 165 minutes). Narcotic analgesia requirements showed no significant difference in both intraoperative and postoperative usage analyses (P = .15 and P = .55, respectively). The LESS technique can be performed safely compared to traditional laparoscopy. With no significant difference in operative time and relatively few complications, this is a feasible technique for simple nephrectomy. Even though there is no significant difference in intraoperative and immediate postoperative narcotic usage, the procedure has obvious cosmetic advantages.
  Urology 08/2009; 75(1):100-3. · 2.43 Impact Factor
• Article: Port-site metastasis after laparoscopic surgery: what causes them and what can be done to reduce their incidence?

  Prasanna Sooriakumaran, Sashi S Kommu, Christopher Anderson, Abhay Rane
  BJU International 03/2009; 103(9):1150-3. · 2.84 Impact Factor