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© 2001, HT Gangal, MH Gangal, PH Gangal
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors and the publisher.
First Edition : 2001
Publishing Director: RK Yadav
Typeset at JPBMP typesetting unit
Printed at Gopsons Papers Ltd., Sector 60, Noida
dedicate this contribution to
our beloved parents and
other members of the familyForeword
It is a proud privilege to write a Foreword for the prestigious book Percutaneous Endoscopy so well brought out by Dr HT Gangal assisted by Dr (Mrs) MH Gangal and Dr PH Gangal
Dr Gangal is a sensitive dexterous surgeon who has pioneered the cause of endoscopy as early as latter part of since 1970s.
It is worth noting all these have come from a small place and a private hospital. These works have been presented world over well ahead of time only to meet casual and skeptic reception.
The development of optics was a boon to the surgeons and this was gainfully utilised by Dr Gangal for the cause of humanity.
It is interesting to know the ever demand of the patients, i.e. the least injury to them clubbed with acceptable postoperative discomfort and quick recovery as against conventional concepts of large exposures and their equally all along practised by the surgeon had to be the background leading to the present innovations by him. He also advocated review of the many concepts on the background of his thinking as against practised by many others, and these innovations have been fairly clarified in the present book which itself is entirely new in its own background so as to be acceptable for practice by one and all in underprivileged situations.
The book has many illustrations from historical aspect to the recent technology. The technique of laparoscopic appendicectomy is very well described with coloured pictures. So also various other techniques. The use of endoscopy for thoracoscopy is also brought in extremely well.
Dr Gangal has a vision and while we enter 21st century we need such visionaries to make surgery more acceptable and patient friendly.
The high-tech equipment must be well understood and implanted to be properly utilised. Many of the surgical procedures can be much better performed by endoscopy which has an advantage of no incision, better vision and early postoperative recovery.
Dr (Mrs) Snehalata S Deshmukh ms frcs fams
University of Bombay
Although we have pioneered several new conceptions, perceptive operative procedures, and developed surgical instruments in our time, this book is our first effort to register our credentials in some detail, on just one such.
The aim of this book is to acquaint the medical/surgical fraternity about the new and epochal area of Laparoscopic Surgery; to stir up every one's imaginations, with regard to the vast uncharted scope of this new frontier. This is well expressed by Michel F Appel of Houston, USA in his article “Whither Laparoscopy?” Int Surg 79: 376–79, 1994 by stating laparoscopic surgery has romanced and captivated the surgeons of the world and the lay public as no other surgical event in the career lifetime of most of us. Donald W Weaver of Detroit, Michigan, USA feels laparoscopic surgery ranks with general anaesthesia, open heart surgery and modern transplantation surgery as one of the major advances in surgical techniques of the twentieth century.
Decio Blucher and Thome Lobe of Memphis, Tennesse, USA feels minimal access surgery is more than a new technique, it is a whole new approach to an old problem.
Pedro A Rubio in his article “Laparoscopic General Surgery”—State of Art in the United States” as a Guest editor for the subject of International Surgery 1994, 79, states, “A decade ago surgical world had no inkling (our first procedure in Gen Surg 1979) of laparoscopic revolution. Judging by the growth and scope of laparoscopic procedures in the past few years surgeons will be faced with many new techniques that are simply unimaginable today”.
So also William C Meyers in his article—What is New in Gastrointestinal and Hepatobiliary Surgery in JACS 182(2): 1996 states, “The excitement in Laparoscopy continues and is reflected by a large number of articles on the subject in established journals and by the subspeciality fields”. By the time this book has come for handy use, is already a well-known development to many. The publication is delayed due to non-appreciation of its importance in the early days, as that too such a subject is coming from unexpected quarters in terms of place, institution and individual. It had to overcome many hurdles and also meet many requirements and obligations while being processed through academic channel for having submitted for the award of Doctor of Science (D Sc) degree.
In one of our years of postgraduate study, and involvement in the experimental study of developing Open Heart Surgery and as a teacher for undergraduate and postgraduate students, we could manage to concentrate on some major problems in medical science and make appreciably rational contributions. We are now happy to note that those contributions are gaining firm ground with passing time, coupled with more and more information now generated, to support our views which have been published in reputed and indexed journals all along.
We are grateful for the benevolence and encouragement of our seniors, the late Dr BM Desai (then Dean, BJ Medical College, Poona); late Dr RG Talwalkar, Hon Professor of Surgery, Dr RJ Maneckshaw, then Hon Professor of Surgery; GT Hospital, Mumbai, Dr MN Gheewala, Chief of Surgery, Dr AD Dias; Dr SD Bapat; LTMG Hospital, Sion, Mumbai; late Dr PK Sen, Professor and Director of Surgery, Dr GB Parulkar, then Professor of Surgery, later Head and Director of Surgery and Dean KEM Hospital, Mumbai; Dr Dwight Magoon, Mayo Clinic, Minnesota, USA; Dr JF Howel, Assoc Professor of Surgery, Dr ME DeBakey, Chancellor, Texas Medical Center, Chairman Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA.
We humbly attribute the pioneering achievements made by us in this field to an accident in 1979—the rectification of which opened the route to the wondrous, hitherto unimagined expanse and benefits, of key-hole surgery. Their induction into this line was mainly due to the outlook and foresight of the (second author) Dr Mrs MH Gangal.
The works in this book are mainly the signal achievements of ours, long before anyone else, broke the capsuled barriers of surgical thoughts and deeds in general surgery. No such event had occurred earlier, nor did written and/or visual documentation existed. Our evolved concepts are our own, supported by allied works duly acknowledged/referred to.
We hope this work will stimulate greater worldwide thinking, and provide the essential spark to many of our fraternity, especially those with the right attributes of ability and resources; for, this book amply proves that the procedures are possible for even a single person with a small clinic in a small town affording limited facilities. It is heartening to note that these presented and published procedures have had good effect, and that many surgeons are active in this field across the world and have also developed many other procedures on their own.
As per the terms of permission to publish this thesis—submitted along with published work towards the requirement for award of Doctor of Science Degree—in the form of book Percutaneous Endoscopy: the first author on behalf of all authors takes pleasure in acknowledging their gratitude to the board of study in surgery, the academic council, the syndicate, the Registrar and the Vice-chancellor of the Karnataka University, Dharwad for their academic outlook and unanimous decisions in awarding the degree.
I am grateful to the referees for their unanimous decisions in recommending the award of D Sc Degree.
We are grateful to Dr (Mrs) Snehalata S Deshmukh, the Vice-chancellor of Bombay University, Mumbai for writing Foreword of the book.Main Developments (Yearwise)
- Tubectomy without the need of uterine manipulator—1978
- Use of Fundal view to avoid mistakes—1978
- Use of bands only even on bulky tubes—1979
- Introduced removal of IUD from the adnexa of the uterus by Endoscopy—1979
- Spot endoscopic dealing of bowel perforation, bleeding—1979
- Laparoscopic appendicectomy and dealing ectopic pregnancy 1980—1981.
- Release of adhesions, lumbar sympathectomy and trunkal vagotomy, cholecystectomy, hysterectomy, ventral suspensions of uterus, etc
- Could ligate the indirect inguinal hernial sac at internal ring, by band application, at Renugunta, only to feel not worth to continue the efforts—1982
- Could pursue and insist on developing the present widely used stapple applicator
- Retroperitoneoscopic approach to ureteric stones—1984.
- Thoracoscopy—for diagnostic and theapeutic use 1986.
- Developed a band applicator—now awarded a patent by USA—1997, usable at ease, and at low cost in various operative procedures. Even today we are the only one to adopt this technique by this instrument.
- Developed dissector, coagulator and realised the instrument to enable us to promote, precise, definite and quicker operations
- The third author (PHG) has developed independently air leak-proof self-retaining cannula, to avoid problems associated with it
- Developed a telescope holder thus enormously enhancing the co-ordinated use of operator's capabilities
- Developed a simple means of abdominal distension retainer. There are now quite a few of them based of varitude concepts near akin to our objective have come up and are in use
- Advocates use of air only and definitely not CO2 to cause abdominal/thoracic cavity to open up
- Use of Dextrose, 10% Dextrose in saline with insulin, and electrolytes in dextrose intra/postoperative period to avoid and prevent common problems associated with surgery
- Full relaxation with assisted ventilation to avoid associated problems
- Based on all these contributions the first Author (HTG) assisted by the second Author (MHG) had requested an award of Doctor of Science Degree on the subject of Percutaneous Endoscopy from Karnataka University, Dharwad. He is awarded the D Sc degree.
Unsatiable quest for better results led him to evolve:
- A method of Radical Cure Operation for Hydrocoele of the Tunica Vaginalis (1959–1961).
- A method of Measuring Residual Angulation and its Practical Application in Wedging (1959–1961). Now it forms the main background to calculate the wedging needed for correction of the bony deformities and the replacement of joints.
- A Safety Valve Shunt Procedure in the Management of Portal Hypertension due to liver pathology.
- Non-operative Procedure in Correction of the Developmental Retracted/Flat Nipple to gain almost normal nipple in all aspects.
- Nature-friendly Allopathic Holistic Approach to gain rejuvenation in various clinical conditions by use of dextrose and insulin.
- The present concept which has a better role to play than the conventional one.
Dr Gangal participated in the development of open-heart surgery, organ perfusion and transplants. He is a pioneer in Laparoscopic Surgery.
Has expertise in Laparoscopic Tubectomy.
Has been instrumental in improvement of technology.