Dr Masleh Uddin

04/03/2025

Laparoscopic cholecystectomy is a minimally invasive surgical procedure to remove the gallbladder, typically performed to treat gallstones and gallbladder disease. It is the gold standard for cholecystectomy due to its benefits over open surgery, including faster recovery, reduced pain, and fewer complications.Procedure Steps: 1. Anesthesia & Patient Positioning • The patient is placed under general anesthesia and positioned in the supine position, often with reverse Trendelenburg and slight left tilt to aid visualization. 2. Port Placement & Pneumoperitoneum • A Veress needle or Hasson technique is used to establish pneumoperitoneum (typically 12–15 mmHg CO₂). • Standard 4-port technique: • 10 mm umbilical port for the camera • 10 mm epigastric port for working instruments • Two 5 mm right subcostal ports for grasping and dissection 3. Gallbladder Mobilization • The gallbladder is retracted cephalad, exposing Calot’s triangle. • Dissection is done to identify the cystic duct and artery, ensuring Critical View of Safety (CVS). 4. Clip & Divide Structures • The cystic duct and cystic artery are clipped (usually with 2 proximal and 1 distal clip) and then divided. 5. Gallbladder Detachment • The gallbladder is separated from the liver bed using electrocautery or an energy device. 6. Specimen Extraction • The gallbladder is placed in an endobag and removed through the umbilical port. 7. Hemostasis & Closure • The liver bed is checked for bleeding. Ports are closed (fascial closure for ≥10 mm ports).Postoperative Care & Recovery • Same-day or next-day discharge in most cases. • Diet: Clear liquids initially, advancing as tolerated. • Pain Management: NSAIDs or mild opioids if needed. • Complications: Bile duct injury, bleeding, infection, retained stones. • Return to Work: Usually within 1–2

https://youtu.be/rEAJGilmDNE?si=S4Iicyzn5KwoQzsB

13/11/2024

https://www.facebook.com/share/r/1AnNyw15v2/?mibextid=YlDasU

03/11/2024

02/11/2024

28/10/2024

Basal cell carcinoma (BCC) is the most common type of skin cancer, accounting for about 80% of all cases. It typically develops in the basal cells, which are located in the lowest layer of the epidermis (the outer layer of the skin). BCC is most commonly found on areas of the skin exposed to the sun, such as the face, neck, and arms. It grows slowly and is rarely life-threatening, as it seldom spreads to other parts of the body (metastasizes), but it can cause significant damage to surrounding tissue if left untreated.Causes and Risk FactorsThe primary cause of BCC is long-term exposure to ultraviolet (UV) radiation from the sun or tanning beds. Other risk factors include: • Fair skin and light-colored eyes • Older age • History of frequent sunburns or cumulative sun exposure • Family history of skin cancer • Weakened immune systemSymptomsBCC often appears as a small, pearly or flesh-colored bump. Other signs may include: • A sore that doesn’t heal • A flat, reddish patch with a rough or scaly texture • A shiny, translucent bump or nodule, often pink or white • A scar-like area that is white, yellow, or waxyDiagnosisDiagnosis typically involves a skin examination by a dermatologist, followed by a biopsy to confirm the presence of cancer cells.Treatment OptionsTreatment depends on the size, location, and depth of the tumor: • Surgery (such as excisional surgery or Mohs surgery) • Topical treatments (like imiquimod or 5-fluorouracil for superficial BCC) • Radiation therapy (for cases where surgery isn’t an option) • Cryosurgery (freezing the tumor with liquid nitrogen) • Photodynamic therapy (using a drug activated by light to kill cancer cells)Prevention • Use broad-spectrum sunscreen daily, especially on sun-exposed areas. • Wear protective clothing (hats, sunglasses, long sleeves). • Avoid tanning beds and limit sun exposure, especially during peak hours. • Regular skin checks by a healthcare provider, especially if you have a history of skin cancer or are at high risk.While BCC generally has an excellent prognosis when treated early, prompt treatment is important to avoid more extensive procedures or potential complications.

08/10/2024

Chest tube insertion, also known as tube thoracostomy, is a medical procedure used to drain air, blood, or other fluids from the pleural space (the area between the lungs and the chest wall). It’s often performed in emergencies, such as after trauma, or for conditions like a pneumothorax (collapsed lung), hemothorax (blood accumulation), or pleural effusion (fluid accumulation).

Steps of Chest Tube Insertion:

1. Preparation:

The patient is positioned, usually lying on their back or side, with the affected side elevated.

The skin over the insertion site (typically the mid-axillary line between the 4th and 6th ribs) is cleaned with an antiseptic solution.

Local anesthetic is injected into the skin and deeper tissues, including the intercostal muscles and pleura.

2. Incision:

A small incision is made just above the rib to avoid damaging the neurovascular bundle that runs under each rib.

A blunt dissection is performed through the muscle layers to reach the pleural cavity.

3. Insertion of the Chest Tube:

The chest tube is inserted through the incision and directed into the pleural space.

The tube is advanced until its side holes are inside the chest cavity.

Proper positioning is confirmed, often with the help of imaging like a chest X-ray.

4. Securing the Tube:

The tube is connected to a drainage system, which may use suction to help evacuate air or fluid.

The tube is sutured in place to prevent displacement, and the insertion site is covered with a sterile dressing.

5. Post-Insertion Care:

The patient is monitored for complications, such as infection, tube dislodgement, or persistent air leaks.

The tube remains in place until the underlying problem (e.g., air leak or fluid drainage) is resolved.

∆ Indications for Chest Tube Insertion:

Pneumothorax (air in the pleural space causing lung collapse)

Hemothorax (blood in the pleural space)

Pleural effusion (fluid accumulation)

Empyema (pus in the pleural space)

Chylothorax (lymphatic fluid in the pleural space)

* Complications:

Infection

Bleeding

Injury to nearby organs (e.g., lungs, diaphragm)

Misplacement of the tube

Persistent air leak

~Chest tube insertion is a life-saving procedure, especially in trauma or emergency situations, but it requires skilled ex*****on to avoid complications.

05/10/2024

Liver abscess aspiration is a procedure used to drain a collection of pus (abscess) that forms within the liver. Liver abscesses are usually caused by bacterial or parasitic infections. The aspiration procedure involves using a needle or catheter to drain the abscess, and it is typically guided by imaging techniques like ultrasound or CT scan.

Here’s an overview of the process:

Indications:

The procedure is usually indicated when the abscess is large, symptomatic, or does not respond to antibiotic therapy.

It helps in relieving symptoms such as pain, fever, and discomfort and prevents complications like rupture of the abscess.

Procedure:

1. Pre-procedure imaging: Ultrasound or CT scans are used to locate the abscess and guide the needle to the correct position.

2. Sedation and anesthesia: The patient may receive local anesthesia to numb the area, and sometimes light sedation.

3. Aspiration:

A long, thin needle or catheter is inserted through the skin and into the liver abscess under imaging guidance.

The pus is aspirated (suctioned out) and may be sent to the lab for microbiological analysis to determine the causative organism.

4. Post-procedure care:

The catheter may be left in place to allow continuous drainage if the abscess is large or multiloculated (having several compartments).

Antibiotics are often continued after the procedure to clear the infection.

Risks:

Bleeding

Infection at the needle insertion site

Injury to nearby structures like the bile ducts or blood vessels

Recurrent abscess formation

Most patients recover well with the combination of aspiration and antibiotic therapy.
​ ​ ​ ​ ​ ​ ​ ​ ​

03/10/2024

Excision of Lipoma from Nape of Neck
Lipoma is a benign (non-cancerous) tumour composed of fatty tissue. When it occurs at the nape of the neck, it often appears as a soft, painless, and slow-growing lump beneath the skin. Lipomas are generally not harmful, but some people opt to have them removed if they cause discomfort, become too large, or for cosmetic reasons.
Here are some key points about lipomas:
Symptoms: Usually painless, soft, and mobile when touched.
Size: They can vary in size, from small (pea-sized) to larger lumps.
Treatment: While many lipomas do not require treatment, surgical removal is an option if they cause discomfort or grow too large. Other treatments like liposuction or steroid injections may also be considered.
Diagnosis: Usually diagnosed by physical examination, but imaging tests like ultrasound or MRI may be used to confirm.

02/10/2024

Laparoscopic Appendicectomy is indicated for Acute Appendicitis.
Appendix get inflammed due to infection, mostly due to fecolith.
Acute pain abdomen in right lower quadrant, nausea/ vomiting, fever, dyspepsia etc. are symptoms of acute Appendicitis. It is emergency condition need surgery as soon as possible. It may get perforated or ruptured, if delay in diagnosis or treatment and maybe a life threatening situation.


Dr Masleh Uddin
MS, MCh
Medaz Hospital, Patna
9117600600

02/10/2024

Dermabrasion & Ultra-thin skin graft is indicated for post Burn Hypopigmented patches. Post Burn Hypopigmented patches is replaced by normal colour skin. Ultra-thin skin graft is taken from the thigh of same patient by specialised instruments dermatome or humbey knife. Graft is covered with special boster dressing. Result is very satisfying.
​ ​ ​ ​ ​ ​

24/02/2023

https://www.youtube.com/live/ZfRVtHvLfXc?feature=share

Dr. Masleh Uddin is a well known General Surgeon in Patna having over 8 years of experience in the field. He has been associated with Medaz Hospital, Patna a...