Harmonic scalpel is popular for use in a variety of surgical procedures including thyroid surgery. Proposed advantages of the harmonic scalpel include less lateral thermal tissue damage with no electrical energy transferred to the patient, no neuromuscular stimulation, less smoke formation as compared with electrocautery. Objectives: Our aim was to compare outcomes following thyroid surgery in terms of operative time, postoperative pain, drainage volume, recurrent laryngeal nerve and parathyroid gland injury with the use of the Harmonic Scalpel compared to conventional methods of hemostasis. Study Design: Randomized control trial. Setting: Surgical Department Lahore General Hospital. Period: Twelve Months June 2016 to June 2017. Material & Methods: 60 patients, 30 in each group. Patients were randomized in each group by balloting method. Operative time, postoperative pain and drainage volume was assessed during hospital stay. Recurrent laryngeal nerve and parathyroid gland injury was assessed during hospital stay and follow-up. Results: There was no significant difference in development of hoarseness of voice in both groups, p-value > 0.05. The mean operative time for group A was 69.47 ± 15.44 minutes and for group B it was 54.93 ± 11.56 minutes, p-value <0.05. The overall blood loss in group-A and group-B was 118.73 ± 50.72 ml and 44.60±10.70 ml, p-value<0.05. The mean post-op pain observed at 2nd day for group B was 2.93 ±3.57 and for group A it was 3.57±0.77, p-value < 0.05. Conclusion: Use of Harmonic Scalpel has better results in thyroid surgery in terms of less operative time, less postoperative pain, less drainage volume, while no RLN & parathyroid injury detected in either group.

Objectives: To compare the outcome of Vesicovaginal fistula repair by omental transposition and perivesical fat emplacement in terms of recurrence and maximum bladder capacity. Study Design: Randomized control trial. Setting: Urology department of Peoples University Hospital Nawabshah, Sindh, Pakistan. Period: From January 2018 to December 2018. Material & Method: Overall 40 patients with VVF were added in the research, split into two identical groups, each consisting of 20. In group 1, omental transposition and in group 2, perivesical fat emplacement was done. Adult female patients with Vesicovaginal fistula, resulting from obstetrical and as a complication of surgery was included. This was confirmed by physical examination, IVU, pelvic computerized tomography scan with contrast, retrograde uretherocystogram, ultrasound KUB and cystoscopy. Exclusion criteria were Patients with systemic illness like diabetes mellitus, chronic renal failure and chronic liver disease etc, immunosuppressant therapy like: steroids intake, patient’s undergone irradiation of the pelvis due to any malignant disease. Follow up after 6, 12 and 24 weeks, all the patients were assessed for recurrence. The complications like wound infections, urgency, urge incontinence and paralytic ileus were also noted. The data was collected in a specially designed proforma. Results: In this study 40 patients fulfilling the inclusion criteria were included, 20 patients in each group. The success rate was 95 %( 19 /20) in group 1, only one case had recurrence. While in group 2 all the cases were successful. Chi square analysis was employed for comparison of adequacy of both the techniques, the P value was found to be 0.311 which suggests that the difference between the efficacies was not statistically significant. Conclusion: It is concluded that both the techniques of Vesicovaginal fistula repair, either with omental transposition or perivesical fat emplacement are equally good in terms of recurrence and maximum bladder capacity.

Objective: To Ascertain the outcome of microsurgical resection of intracranial dermoid and epidermoid tumors.Materials and Methods: This prospective study was carried out in Neurosurgical Department, Lady Reading Hospital (LRH) Peshawar and followed for 3 years after microsurgical resection. All the patients with suspected intracranial Dermoid and epidermoid tumors (IDETs) on imaging study pre-operatively and later confirmedpostoperatively (after histopathology) were enrolled. Patients having recurrent tumor, opting for nonsurgical management and those deem unfit for surgery were not included in the study.Results: 27 patients were included in the study with 12 (44.4%) males and 15 (56.6%) female. Age of the patients rangefrom 11 to 58 years.Mean age was 38.6 years. Epidermoid tumors were 19 (70.3%) in number and dermoid 8 (29.7%) in number. The most common presentation was increased intracranial pressure (ICP) and cranialnerve deficit. The lesion was located in infratentorial location in 15 (56.6%) patients, 12(44.4%) were supratentorialy located. Gross total removal (GTR) was performed in 21 (77.8%) patients, while in six patients (22.2%) subtotal removal (STR) was attempted. 1 (3.7%) patient died while 2 (7.4%) patients had permanent morbidity post operatively, all other patients (89%) improved. Recurrence occurred in 9.5% of GTR patients while in STR patients, 33.3% patients were noted with increase in residual tumor on neuroimaging.Conclusion: Microsurgical resection with GTR is possible for most IDET and gives good results with minimalcomplications.

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