Annexures

A Study of Laparoscopic Surgical Anatomy of Infraumbilical Posterior Rectus Sheath, Fascia Transversalis & Pre-Peritoneal Fat/ Fascia during TEPP Mesh Hernioplasty for Inguinal Hernia

A Thesis Submitted for the award of the Degree of DOCTOR OF PHILOSOPHY In SURGERY By DR. MAULANA MOHAMMED ANSARI MBBS, MS (Surgery) Department of Surgery Faculty of Medicine, Jawaharlal Nehru Medical College Aligarh Muslim University, Aligarh – 202002, UP, INDIA

May, 2016

Annexures

List of Annexures 1. Annexure I:

Ethical Clearance & CASR Approval

2. Annexure II:

Informed Consent Form

3. Annexure III:

Proforma For Data Collection

4. Annexure IV:

Working Papers (List)

5. Annexure V:

Published Papers (List & Full Texts)

6. Annexure VI:

Profile of the Candidate

7. Annexure VII: Soft/Digital Material (List, Videos, & PDFs) a) Video Clips (Eleven in Number) b) Complete Thesis (PDF) c) Publications (PDFs) d) Bio-Data of the Candidate (PDF)

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ANNEXURE I (A) Approval of the Institutional Ethics Committee (Item No. 2)

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ANNEXURE I (B)

Approval of the Committee of Advanced Studies & Research (Item No. 5)

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ANNEXURE - II PATIENT’S INFORMED CONSENT FOR SURGERY

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TEPP 1 DR. M. M. ANSARI

ANNEXURE – III THESIS PROFORMA FOR PhD (Surgery) For Candidate: Dr. Maulana M. Ansari Patient’s Name : Age / Sex : Marital Status : OPD/Casualty No. : Consultant Incharge : Date of Admission : Clinical Diagnosis :

Hospital Record Key No. Religion : Ward/ Bed No. : CADS No. : Dr. M. M. Ansari Date of Operation : Date of Discharge :

Name of Operation : Presenting features: a) Swelling in groin: Duration: b) Pain: Duration: c) Others General Examination: General Condition: Pulse: B.P.: R/R: Temp. Anaemia: Icterus: Clubbing: Koilonychia: Lymph Node Enlargement: Cervical / Axillary / Inguinal Pedal Oedema: Height: Weight: BMI: Any Other: Local Examination: Inguinal Hernia Yes / No a. Unilateral / Bilateral b. Direct / Indirect c. Fully Reducible / Partially Reducible / Irreducible Any history of previous Disease: a) Nervous system: b) Cardiovascular system: c) Respiratory systems: d) Gastro intestinal systems: e) Others : Treatment History: Previous Operation for groin hernia / Previous Abdominal Operation / Medications Addictions: Smoking: Alcoholism: Others: Pre-operative Investigations: Haemoglobin (Hb %): Blood sugar (R) (mg %): Blood urea (mg %): Serum Creatinine (mg %): X-ray Chest: ECG: USG Abdomen/ Groin: OPERATION: Date: Operator: Dr. M. M. Ansari 1 -----------------Page 8 of 16


PERI-OPERATIVE FINDINGS: Primary outcome measures: 1. Infra-umbilical Posterior Rectus Sheath (PRS):

2.

3.

4. 5. 6.

A. Extent of Posterior Rectus Sheath (PRS): a. Complete upto Symphysis Pubis: b. Incomplete (Ending before Symphysis Pubis) B. Nature of Posterior Rectus Sheath (PRS):: a. Whole tendinous b. Partly tendinous (tendinous above and attenuated below) c. Musculo-tendinous d. Thinned-out fascia-like e. Grossly attenuated with thickened tendinous Band(s) Arcuate Line (AL) Arcuate Line - Present / Absent A. Existence: B. Nature: Sharp Well-defined / Ill-defined C. Number: Single / Double / Multiple D. Level: i. Distance from Umbilicus: ............. cm ............. cm ii. Distance from Symphysis Pubis: iii. Distance from Xiphisternum: ............. cm iv. Distance from Interspinous Line (ASIS): ............. cm Fascia Transversalis in Supra-Inguinal Region(TF-SIR): A. Nature: Well-defined - Diaphanous/Membranous / Thin Flimsy B. Layers: Single / Double C. Transversalis Fascial Analogs: D. SLEXT Well-Defined/ Ill-Defined/ Absent E. ILEXT Well-Defined/ Ill-Defined/ Absent F. IFL Well-Defined/ Ill-Defined/ Absent Present /Absent G. MEXT H. PF Well-defined/ Thinned Out/ Absent I. IPT Well-Defined/ Thin Attenuated/ Absent J. TA-Arch Classical/High/Low/Very Low/Absent Tendinous/ Musculo-tendinous/ Fascia Transversalis in Inguinal Region (TF-IR) A. Nature: Well-defined - Diaphanous/Membranous / Thin Flimsy B. Layers: Single / Double Pre-Peritoneal Fascia (PPF): A. Nature: Well-Defined - Diaphanous/Membranous / Ill-defined B. Layers: Single / Double: Pre-Peritoneal Fat: ..................... Minimal / Moderate / Excessive

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Secondary outcome measures: 1. Endoscopic vision (measured on Visual Analogue Score of 1-10): ................ 2. Ease of the procedure (measured on visual analogue score of 1-10): ............. 3. Operating Time: .................... Hours 4. Surgical Emphysema: 5. Peritoneal Injury –

Yes / No Yes / No

Time:

Site:

6. Conversion - No / Yes - Open Anterior / Open Preperitoneal / TAPP Cause - Vascular Injury/ Peritoneal Injury/ Anaesthetic Problem/ Others 7. Postoperative Infection:

Yes / No

8. Chronic Groin Pain:

Yes / No

9. Recurrence of Hernia:

Yes / No

10. Mortality:

Yes / No

-

Time:

Additional Observations: 1. Nature and Layers of Rectusial Fascia (RF): a. Existence: Rectusial Fascia - Present / Absent b. Nature:

Well-Defined- Membranous or Diaphanous / Flimsy

c. Layer:

Single / Double

2. Measurements: a. Distance Between Umbilicus & Symphysis Pubis = b. Distance Between Xiphisternum & Symphysis Pubis = c. Distance Between Right & Left Anterior Superior Iliac Spines =

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ANNEXURE – IV

List of Working Papers/Invited Lecture Related To the PhD Thesis I.

Working Papers (Presented At National/International Conferences): 1. “Anatomical variations in Arcuate line: are they important for the TEPP surgeons” – presented at APHS 2013 – 9th International Congress of the Asia-Pacific Hernia Society held on 27th – 28th November, 2013 at AsiaWorld Expo, Hong Kong; and Pre-Congress Workshop with Handson Training held on 26th November, 2013 at HKEC Training Centre for Healthcare, Hong Kong. 2. “Anatomic Risk Factors For Seroma Formation After TEPP Hernioplasty” – presented at UPASICON 2013 – 39TH Annual Conference & Live Workshop of Association of Surgeons of India (UP & Uttrakhand Chapter) held on 22nd – 24th November, 2013 at Santosh Medical College & Hospital, Ghaziabad, UP, India. 3. “ Transversalis Fascia - Laparoscopic Live Surgical Anatomy During TEPP Hernioplasty”- presented at IHSCON 2013 – 6th National Conference-cum-CME & Live Operative Workshop of Indian Hernia Society (IHS), held on 26th – 27th October, 2013 at Department of General Surgery, IMS, BHU, Varanasi, UP, India. 4. “Pre-Peritoneal Fat & Fascia – A Laparoscopic Study of Live Surgical Anatomy During TEPP Hernioplasty” – presented at HERNIACON 2013 – 7th National Congress of Hernia Society of India (Indian Chapter of Asia-Pacific Society of Hernia (APHS) held on 13th – 15th, September, 2013 at Hotel Cambay Grand, Ahmedabad, Gujrat, India. 5. “Complete Posterior Rectus Sheath & TEPP Hernioplasty” - presented at AMASICON 2013 - 8th International Conference of AMASI (Association of Minimal Access Surgeons of India) held on 22nd – 25th August, 2013 at Brilliant Convention Centre, Indore (MP), India.

II.

Invited Lecture (Thesis Related) 1. “TEPP Anatomy: Anatomic Variations” – invited lecture delivered at UPASICON 2013 – 39TH Annual Conference & Live Workshop of Association of Surgeons of India (UP & Uttrakhand Chapter) held on 22nd – 24th November, 2013 at Santosh Medical College & Hospital, Ghaziabad, UP, India.

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ANNEXURE - V 1. List of Published Papers Related To PhD Thesis (Thesis-Related Papers Published In National/International Journals)

1.

Ansari (2013):

Ansari MM. Effective Rectus Sheath Canal: Does It Affect

TEP Approach for Inguinal Mesh Hernioplasty. Journal of Experimental and Integrative Medicine (Turkey) 2013; 3(1): 73-76. 2.

Ansari (2014):

Ansari MM. Complete posterior rectus sheath and total extra-

peritoneal hernioplasty. Saudi Surgical Journal 2014; 2: 80-83. 3.

Ansari (2015a):

Ansari MM. Arcuate Line Variations: Are they important for

TEP surgeons? Kuwait Medical Journal 2015; 47: 313-316. 4.

Ansari (2015b):

Ansari MM. Fascia Transversalis - A Study of Live Surgical

Anatomy during Laparoscopic Total Extra-Peritoneal Hernioplasty. International Journal of Science and Research (IJSR) 2015; 4(8): 1788-1796. 5.

Ansari (2015c):

Ansari MM. Pre-Peritoneal Fascia/Fat – Laparoscopic

Anatomy during Total Extra Peritoneal Hernioplasty. International Journal of Sciences and Applied Research (IJSAR), 2015; 2(10): 01-05. 6.

Ansari (2015d):

Ansari MM. Cord Lipoma - An Analogue of Preperitoneal Fat:

A Laparoscopic Study. International Journal of Science and Research (IJSR) 2015; 4(12): 2052-2055.

2. FULL TEXTS: (Soft /Digital Copy Attached Separately)

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ANNEXURE – VI CURRICULUM VITAE (Brief) _________________________________________________________

Name:

Maulana Mohammed Ansari

PROFESSIONAL QUALIFICATIONS: M.B.B.S Feb., 1979 Aggregate 60% (Passed All Professionals in 1st Attempt) M.S. (Surgery)

G.S.V.M. Medical College, Kanpur, UP, India

April, 1983(Passed in 1st Attempt)

G.S.V.M. Medical College, Kanpur, UP, India

Medical Registration No.: 1. M.B.B.S. - 24349 (Medical Council of India, U.P.) and 2. M.S. (Surgery) – 4944 (Medical Council of India, Delhi)

PROFESSIONAL EXPERIENCE: Designation Duration

From

To

Institution

17.06.2013

Till-Date

J.N. Medical College AMU, Aligarh

Associate Professor 7 ½ years (Gen. Surgery)

01.01.2006

16.06.2013

J.N. Medical College AMU, Aligarh

Reader (Gen. Surgery)

31.03.1997

31.12.2005

J.N. Medical College

Professor (Gen. Surgery)

1 ¾ year

8 ¾years

(Inclusive of EOL for Foreign Assignment as Specialist (General Surgery), Holy Makkah, Ministry of Health, K.S.A. w.e.f. 19.5.1999 to 15.4.2004)

Lecturer (Gen. Surgery)

8 years

22.02.89

30.03.97

J.N. Medical College, AMU, Aligarh

Clinical Registrar (Gen. Surgery)

1 2/3 years

19.06.87

21.02.89


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Profile of the Candidate, Dr. M. M. Ansari

C. M. O. 4 Months (Casualty Medical Officer)

21.02.87

18.06.87


Clinical Registrar (UHS)

7 ½ Months

01.07.86

20.02.87

University Hospital A.M.U., Aligarh

Senior Resident (Surgery)

2 2/3 Years

19.10.83

12.06.86

SKIMS, Srinagar Kashmir

Demonstrator (Anatomy)

3.5 Months

16.06.83

30.09.83

GSVM Medical College, Kanpur

Demonstrator (Surgery)

13 Months

01.05.82

31.05.83


Resident (Surgery)

11 ½ Months 01.05.81

19.04.81


House Officer (Surgery)

12 Months

01.05.80

30.04.81

L.L.R. & Associated Hospitals, Kanpur

Internship

One Year

02.04.79

23.04.80

L.L.R. & Associated Hospitals, Kanpur

ACADEMIC & PROFESSIONAL ACHIEVEMENTS: TOTAL PUBLICATIONS

:

124 (38*)

(*Indicates papers with Dr. M. M. Ansari as first author) : :

67

RESEARCH SCHOLARS

:

27

OTHER ACADEMIC ACTIVITIES: 1. BOOKS/ Book Chapters:

:

i. Published Book

:

WORKING PAPERS (Papers presented/ Received at Conferences)

01

“Management of Trauma” by Paras Medical Publisher, Hyderabad

2. ORGANIZED Conferences/Workshops

:

02 02 02

3. ATTENDED Conferences/Workshops

:

53

ii. Book (Under Process)

:

iii. Book Chapter (Under Process)

:

4. INVITED FACULTY/ CHAIRPERSON

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Profile of the Candidate, Dr. M. M. Ansari

AT CONFERENCES, ETC. 5. CONTRIBUTION OF KNOWLEDGE TO MEDICAL SCIENCE:

:

19

:

:

09 31 10 02 01 01

:

01

:

06

:

07

:

01

:

05

12. NATIONAL AWARDS

:

13. EXAMINER FOR MBBS/ MS / BDS EXAMS

:

14. EXPERT FOR THESIS EVALUATION

:

15. EXPERT FOR SELECTION BOARD

:

16. REVIEWER FOR MEDICAL JOURNALS

:

02 10 03 01 04

a. Coined New Medical Terms

:

b. Described Rare Lesions/ Conditions

:

c. Successful Atypical Treatment Used

:

a. New Treatments

:

b. Surgical Anatomy

:

6. NEW SURGICAL SKILL LEARNED 7. CONTRIBUTION TO THE UNIVERSITY ADMINISTRATION 8. CONTRIBUTIONS TO THE DEPARTMENT & HOSPITAL 9. MEMBERSHIP OF ACADEMIC BODIES (Appendix XI) 10. FELLOWSHIP OF ACADEMIC BODIES 11. PUBLIC HEALTH FIELD SERVICES IN INDIA/ ABROAD

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ANNEXURE – VII LIST OF DIGITAL MATERIAL (SOFT COPY) 1. Video Clips (JPG): 1) Video Clip 3.1: Telescopic Dissection in Posterior Rectus Canal & Placement of 1st Working Port 2) Video Clip 3.2: Telescopic Dissection in Posterior Rectus Canal followed by Single Hand Instrument Dissection 3) Video Clip 3.3: Sac Dissection & Parietalization 4) Video Clip 4.1: Incomplete Posterior Rectus Sheath with Single Sharp Well-defined Arcuate Line 5) Video Clip 4.2: Double Posterior Rectus Sheath (Partly Tendinous) & Double Preperitoneal Fascia; Creation of Artificial Arcuate Line & Further Dissection 6) Video Clip 4.3: Complete Posterior Rectus Sheath (Whole Tendinous) & Creation of Artificial Arcuate Line 7) Video Clip 4.4: Complete Posterior Rectus Sheath (Partly Tendinous) & Creation of Artificial Arcuate Line 8) Video Clip 4.5: Long Posterior Rectus Sheath & Cord Lipoma; Sac Dissection & Parietalization of Cord structures 9) Video Clip 4.6: Single & Double Layer Preperitoneal Fascias (Combined video of 4 Patients) 10)

Video Clip 5.1: Rectusial Fascia Taken Down & Long Posterior

Rectus Sheath with Double Arcuate Line 11)

Video Clip 5.2: Continuation of Video Clip 5.1

2. Complete Thesis_PhD_Dr. M. M. Ansari_May 2016 (PDF) 3. Publications (PDFs) 4. Complete Bio-Data of the Candidate_Dr. M. M. Ansari (PDF)

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