Publications by authors named "Narasimhan Ragavan"

Objective: To compare the outcomes of vesicovaginal fistula (VVF) repair using two different robotic systems.

Design: This retrospective comparative study analysed the surgical outcomes of VVF repair utilizing two different robotic platforms: the Hugo RAS Medtronic robot and the da Vinci Xi robot.

Methods: VVF repair was performed with da Vinci Xi system (n = 15) and Hugo RAS Medtronic robot (n = 11) in a non-randomized fashion.

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Article Synopsis
  • Pelvic organ prolapse (POP) is prevalent among women over 50, with sacrocolpopexy being a common surgical treatment, though it can lead to complications like bowel dysfunction and urinary incontinence.
  • This study compares the outcomes of robotic sacrocolpopexy and ileopectopexy, analyzing data from 35 patients who underwent these procedures between 2021 and 2023.
  • Results indicated that ileopectopexy had no complications compared to sacrocolpopexy, which had some bowel issues, suggesting that ileopectopexy could be a safer alternative, although further research is necessary to confirm these results.
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Introduction: This study evaluates the safety and feasibility of the Medtronic Hugo robot-assisted surgery (RAS) system in gynecological and urogynecological procedures. Through a retrospective analysis of prospectively collected data from the first 100 surgeries performed at Apollo Hospitals Chennai, we aim to provide insights into the system's effectiveness, including outcomes, complications, and overall surgical efficiency in major gynecological and urogynecological operations.

Methods: A single experienced robotic surgeon conducted the surgeries, including hysterectomies (n=66).

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Primary Mullerian duct-type clear cell adenocarcinoma of the urethra is a rare clinical entity with a varied clinical presentation. This can be diagnosed only with a high index of suspicion. Clinical examination, biopsy, and immunohistochemistry are essential for diagnosis.

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Paraurethral leiomyoma is an exceptionally rare benign smooth muscle tumor adjacent to the female urethra, presenting diagnostic challenges due to nonspecific symptoms like urinary obstruction and dysuria. This case report details the clinical presentation, diagnostic workup, and surgical management of a 45-year-old woman with a paraurethral leiomyoma. Diagnosis involved clinical examination, imaging, and biopsy.

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Isolated testicular tuberculosis is rare, often diagnosed incidentally during histopathological examination due to its asymptomatic nature. We present a case of a 35-year-old male with a left testicular mass mimicking malignancy. Despite normal tumor markers and negative imaging for pulmonary tuberculosis, left inguinal orchiectomy revealed testicular tuberculosis.

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Introduction: There is an unmet need for high-quality data for Robot-assisted partial nephrectomy (RAPN) in the Indian population. Indian study group on partial nephrectomy (ISGPN) is a consortium of Indian centers contributing to the partial nephrectomy (PN) database. The current study is a descriptive analysis of perioperative and functional outcomes following RAPN.

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Purpose: Androgen deprivation therapy (ADT) is the mainstay approach for prostate cancer (PCa) management. However, the most commonly used ADT modality, gonadotropin-releasing hormone (GnRH) agonists, has been associated with an increased risk of cardiovascular disease (CVD).

Methods: The PCa Cardiovascular (PCCV) Expert Network, consisting of multinational urologists, cardiologists and oncologists with expertise in managing PCa, convened to discuss challenges to routine cardiovascular risk assessment in PCa management, as well as how to mitigate such risks in the current treatment landscape.

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Introduction: Prostate cancer usually affects older men and accounts for considerable cancer-associated mortality in men globally. In India, there is a rise in prostate cancer, and the published literature to determine age-specific prostate-specific antigen (PSA) is limited by a small sample size. The objective of our study was to determine age-specific PSA for Indian men based on a very large cohort of apparently healthy men undergoing health screening.

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Crossed fused renal ectopia (CFRE) is a rare congenital anomaly with both kidneys located on the same side of the retroperitoneal space. Due to complex anatomy, any renal tumours arising from this congenital anomaly will require careful pre-operative planning and intra-operating management to ensure oncological clearance while maximizing renal function. In this clinical case, a 57-year-old lady was referred to our center with a left to right CFRE and a 10cmx8cmx8cm mass arising from the interpolar region of left ectopic kidney on a background of multiple medical co-morbidities including stage 3a chronic kidney disease (CKD).

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Background Prostate cancer holds a substantial presence in the global cancer landscape, and a considerable proportion of diagnoses occur at late stages, particularly in India. Management of locally advanced prostate cancer necessitates a multimodal treatment strategy. A critical part of this strategy is neoadjuvant androgen deprivation therapy, typically administered via luteinizing hormone-releasing hormone (LHRH) analogs.

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The Hugo RAS™ is a newly launched robotic system for clinical use. This article provides the initial outcomes of patients undergoing radical prostatectomy with Hugo RAS. It also attempts to compare the outcomes with a similar set of patients undergoing the procedure with the DaVinci robotic systems.

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Objective: The objective of the study is to describe the perioperative outcomes, disease-specific, and overall survival status in patients diagnosed with renal cell carcinoma with inferior vena cava (IVC) tumor thrombus.

Patients And Methods: We did a retrospective analysis of all patients who underwent radical nephrectomy along with IVC thrombectomy from the year 2013 to 2020. Mayo's classification was used to stratify the level of IVC thrombus.

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Introduction: Minimal invasive surgeries (MIS) for large size adrenal tumors are still debatable. The objective is to evaluate the contemporary peri- and post-operative outcomes of patients undergoing (open = OA, laparoscopic = LA, and robotic = RA) adrenalectomies in three institutions.

Materials And Methods: Retrospectively gathered peri- and post-operative data of 235 patients, underwent adrenalectomy at three Institutions over a 7-year period (2013-2020) were analyzed.

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The Hugo RAS is a newly launched robotic system for clinical use. This article provides the initial experience of the authors using Hugo RAS in urologic procedures. Patients undergoing major urologic procedures, including nephrectomy and prostatectomy, were included in this prospective clinical trial.

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Introduction Tobacco use, especially cigarette smoking, is a well-documented risk factor for cancer; however, its specific effect on bladder cancer has not been clearly defined. This study aimed to determine the association between tobacco use and bladder cancer in a South Asian population. Materials and methods We conducted a retrospective review of the medical records of 64 patients diagnosed with bladder tumors from February 2018 to March 2020.

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Primary carcinosarcoma of the prostate is an extremely rare and aggressive malignancy. We report a patient who presented with obstructive symptoms and without a history of radiation, prior adenocarcinoma, or androgen deprivation therapy. Transurethral resection of the prostate was performed.

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Introduction The role of vitamin D in kidney stone disease is unclear. Current evidence and existing studies are inconsistent and inconclusive. The objective of this study is to assess the prevalence of vitamin D (VD) inadequacy (VDI) and metabolic abnormalities in urolithiasis patients presenting to a tertiary care center.

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Purpose: Large-size ports used for laparoscopic and robotic procedures will require appropriate closure to reduce the probability of trocar site complications including hematoma and hernia. Closure of these ports is done by various methods like the open method extending skin incisions, S-retractor, Carter Thomason method, and so on. Chennai port closure (CHC) method, a novel technique that had been in practice in our unit for more than 2 years, ensures direct visualization of the suture placement, and hence, the abdominal wall fascia and peritoneum are secured.

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Objective: The delivery of surgical services has undergone a shift in the past decade with increasing numbers of surgeries being performed in the daycare setting. Implementing a minimally invasive surgical approach with a robot with an enhanced recovery protocol permits robot-assisted laparoscopic surgeries (RALS) to be performed as a day-case (DC) procedure. This study aimed to assess the feasibility and safety of DC surgery according to our experience.

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Objective:  Open adrenalectomy (OA) is considered to be the standard care for large adrenal tumors. Minimally invasive surgery (MIS) using laparoscopic technique is considered for many patients in the modern era. Robot assisted laparoscopic adrenalectomy (RALA) can be an extremely useful tool which will negate the disadvantage of laparoscopic method.

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Robot-assisted laparoscopic radical prostatectomy (RRP) has traditionally been done using transperitoneal (TP) approach. This requires patients to be in the steep Trendelenburg position with antecedent risks of high intraoperative ventilatory pressure, post-operative confusion status, corneal and cerebral edema, deep vein thrombosis (DVT), predisposes risk of intestinal injury and slight delay in bowel recovery. Extraperitoneal (EP-RRP) approach circumvents the above given issues.

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Extragonadal germ cell tumors (EGGCTs) usually are not coexistent with a gonadal tumor, hence in a way, are primary and are rare. The origin of primary EGGCT is still a matter of debate. Herewith, we report a patient with primary intrarenal yolk sac tumor in a 43-year-old man.

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