Consultant Urological Surgeon & Head of the Department of Urology and Lead Urological Cancer Clinician in the Dudley Group of Hospitals NHSFT
Senior Clinical Lecturer in Urology, University of Birmingham, UK.
Laser surgery of the prostate, surgery for stone diseases, laparoscopic surgery (keyhole surgery) of the urinary tract, Prostate cancer diagnostics using MRI guided biopsies
Mr Aniruddha Chakravarti qualified as a medical graduate in 1990 and attained post graduate training in general surgery before embarking onto an extensive training in Urology. Amidst his twelve years of experience in General Urology, Mr Chakravarti has developed a special interest in laser surgery of the prostate, stone disease and laparoscopic management of upper urinary tract conditions. He has received intensive laparoscopy training from the European Institute of Telesurgery in Strasbourg, France, and has obtained a Diploma in Laparoscopic Surgery from the Institute and has had intensive training in laparoscopy during later part of his higher urological training.
He has also been through intensive training and has over four years of experience of using all kinds of lasers for prostatic surgery and is one of the few surgeons experienced in Holmium-YAG/Thulium laser enucleation and morcellation of prostate currently providing this service as a unique one in West Midlands.
The standard surgical treatment of Benign Prostatic enlargement causing bladder outflow obstruction leading to retention of urine or other urinary symptoms is transurethral resection of the prostate (TURP). However, relatively high morbidity associated with TURP has led to the development of a range of minimally invasive techniques, some of which use thermal energy. One such minimally invasive technique is the use of holmium: yttrium-aluminium-garnet (YAG) laser which is the only laser treatment approved by the National Institute for Health and Clinical Excellence.
Holmium laser resection of the prostate (HoLRP) utilises the holmium laser as a precise cutting instrument to resect large pieces of prostate. Initially a bilateral bladder neck incision is made to define the margins of resection. The median and lateral lobes are then individually undermined and peeled off the prostate capsule in a retrograde direction until only a bridge of tissue remains at the bladder neck.
HoLRP is performed with a modified continuous flow resectoscope that has a circular fibre guide in the tip of the scope. An end-firing laser fibre is used as a precise cutting instrument to resect large pieces of prostate. The laser is then used to cut the resected tissue into smaller pieces before their removal.
A further evolution of the HoLRP procedure is holmium laser enucleation of the prostate (HoLEP) in which the intact prostatic lobes are removed with the holmium laser and then passed into the bladder where they are cut into smaller pieces, before removal.
A primary advantage of HoLRP over other laser prostatectomy techniques is that it can rapidly create a large ‘TURP-like’ cavity by immediately removing obstructing tissue, rendering it suitable for large prostates of up to 100 grams. The coagulative ability of the holmium laser effectively seals tissue planes as the operation progresses, which makes HoLRP a relatively bloodless operation with a concomitant reduction in transfusion requirement, and also avoids the dangers of systemic fluid absorption.
Other postulated advantages include a reduced need for bladder irrigation, shorter postoperative catheterisation period and length of hospital stay, and the ability to retrieve tissue for histological examination...
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