Gallery

Saw the Admitted Pt.Yesterday at BaroMa Hosp.Two days ago Sustained Accidental Sharp Cut Injury at ant.aspect of lt.Ankle Jnt.There was severe  bleeding. Locally Quack dared to ligate the Bleeding Vessel haphazardly. Thank God, he put support of BK POP Slab. Thus there was Suspicion of Soft Tissue Injury including Injury of Extensor Compartment, Retinaculum & Extensor Tendons

Dissecting out,the Distal & Proximal cut Ends after meticulous mobilization of Soft Tissue. Extensor Tendon Retinaculum has to be divided to Release the retracted Sharp Cut Tendon Ends

Procedure Completed. End to End Anastomosis done. Exposure, Mobilisation Required Rotational local Flaps

Closure of Operated Area balancing with Created Rotational Skin Flaps.I take the opportunity to mention that my friend Orthopedic Surgeon of Bhagalpur after seeing the Video on TA.Repair Suggested me to use Vicryl ( instead of Prolene )as he does to Avoid Incidence of Infection.

Several months old injury TA.Tackled today at Baro Ma Hospital

Another case of Necrotic lesion in the Gluteal Region. Neglected case. Extensive Slough ec tomy had to be done. Primary closure of Deep Cavity keeping a Drain had to be done

Necrotizing Fascitis Resulting in so much loss of Tissue, you can see the exposed Calf Muscle almost in its Entirety. Treated for a Prolonged Period at Midnapur Medical College, then Referred to SSKM Hospital. From there got Admitted at Paskura Baroma MultiSpeciality Hosp.Hb% was 7.6gm/dl.Preop Dressing in OT,Pre Op.Bl.Transfusions, AntiBiotics, Physiotherapy done. I attempted today; So much Muscular, Heavy Weight,it was a body aching hectic Exersise for me.Excellent Support, I did Recieve from my OT Staff.It was done with Spinal Anaesthesia.

As Narrated & Shown, how laborious are the procedures with one Assistant holding the leg & foot much above OT Table while I am taking up queer positions to fix the Split Skin Graft in Place.

Pt.got admitted yesterday, Monday 8p.m at Baroma HDU with Agonising Howling due to Acute Retention of Urine. Lots of Suprapubic puncture marks due to attempts at Suprapubic puncture s with Jelco to decompress UB.I had arrived from Kolkata, ;Before it was Referred to me by Kuntal, I managed to decompress the UB.He was 82 years, taking Ecosprin,with lots of Medical Co Morbidities. There was the person who came from Kolkata to perform Echo Cardio, detected E.F,38%.Today,Tuesday thanks to our Anaesthesist Dr Prakash who Administered Sp. Anaesthesia. First Circumcision was done; Ulcerated inner layer of Prepuce was sent for HP Examination. Then Urethral Dilatation broke through Gross BOO.In Dilator Guidance Suprapubic Cystostomy done.Unhealthy Congested Friable Mucosa detected. 3way Size 20 Foley kept Suprapubic. Per Urethral Suze 18 Foley was also passed .Irrigation Started,Urine colour’s got lighter from Reddish. Pt. Recovered View the next Video

Ghastly Challenging case encountered at Baroma Hospital. I just could not Escape

Further Steps illustrated

Actually this pic should have been shown in the beginning.Incision line marked,etched .

Start of the Surgical Procedure

Some Steps of MRM exposing Rt.Axilla after Axillary Clearance.I am hesitant to Submit,I did MRM,last in 2021.My Engagement in the Pattern of Surgeries changed (from the Period Mentioned )to GI,HPB,Head Neck&Gynae Surgery +Trauma Cases.

Steps of how I do it

Pt.Sarifun Bibi, had Investigations, Formalities at TMH.Clinically Stage 11,Rt.Ca,Breast, Operated today at Baro Ma, MultiSpeciality Hospital, Paskura. MR M+Axillary Clearance. No Blood in Hand, (ultimately recieved one unit,long after Surgery was Over

MRM,(Modified Radical Mastectomy).Specimen,with Axilarry l.Nodes,level1,2,3 as seen after Axillary Clearance
Tumour,cut s like an Unripe Pear(Traditional Text Book Teaching)

Beyond Infiltration area,Section done at Mid transverse Colon

Display or Ovarian Tumour+Extended Rt.Hemicolectomy Specimens

Lt.Sided Tense Cystic,Partly Solid Ovarian Tumour being Removed,Sent for HP Examination

After Extended Rt.Hemicolectomy, end to end Ileo Colic Anastomosis performed

A case of Ovarian Tumour with Suspicion of Malignancy and Metastatic Spread to Omentum,Ileo Caecal,Ascending Colon involving almost Rt.half of Transverse Colon.Clinical Evaluation by Gynae. Could highlight lt.sided Ovarian Tumour,but it’s for the Experience d Surgeon to Suspect the cause of Sub Acute Intestinal Obstruction.Explored today at BaroMa MultiSpeciality Hospital, Paskura.(Meanwhile,Conservative Measures, CECT W.A.PreOp.Bl.Transfusion,Chest PhysioTherapy etc,were offered to the Pt.
Extended Rt.Hemicolectomy being done .Cause of Sub Acute Intestinal Obstruction identified as Metastatic Infiltration,Engulfment by infiltrated Bands from Greater Omentum

Last part of Extended Rt.Hemicolectomy with Division of Terminal lleum

Diagnosed from history .RMO reported he admitted a Female middle aged pt with c/0 painful,burning sensation during defecation.,with bleeding per anum sometime.He reported Sir it s likely Fissure in
I did PR Ex.large Growth Lt.Anterolateral wall of Rectum,lower Anal Canal 2 c.m.from Anal verge with extension in Post.Direction.Today under Sp.An.after Vigorous Anal Stretching with helpful Retraction within AnoRectum I could Excise the Growth in piecemeal.Repairred the mucosa & muscular Gap after maintaining the lumen with tight Roller Gauge Pack.Tomorrow I shall Remove the pack in OT

Upper Sigmoid Colon held in Clamp before Constructing Lt Iliac End Colostomy.As low as possible Rectum divided&Stump closed–HARTMANN S procedure done

Upper Sigmoid Colon held in Clamp before Constructing Lt Iliac End Colostomy.As low as possible Rectum divided&Stump closed–HARTMANN S procedure done

During Exploration, Gross Adhesions,of Small Intestine with Omentum found with Friable Arreas on lleum with prolonged compression gave way.Thus Resection Anastomosis of Small Intestine made it a Compounded Problem.

Scar of Previous Surgery seen ;Surgery done on 2022,for Cervical SOL as was mentioned.likely this time a Recurrence of Malignancy with Resultant RVF.No VVF as was Suspected

From 5.7 gm/dl Hb%,correction could be done up to close 7.5.Party was Reluctant to procure AB+ve blood

Got Admitted at Baro Ma Hospital with offensive Stool escaping from Vagina.Catchectic,Anaemic,Toxic.Clinical Examination-Recto Vaginal Fistula with hard indurated edge of Fistula.Prepared with all measures including Blood Transfusion, FFP.

My Clinical note

A case of Acute Abdomen.Pt. was being treated for the last few days at Jharkhand with pain lower Abdomen&bleeding P.V..USG described,App.lump + Complex Rt.Adnexal Cyst.Pt was admitted yesterday with severe lower Abd. Rigidity Guarding,vague tender lump RIF. Rebound Tenderness++. Expl. Lap.done by me today.Haemoperitoneum, Ectopic Gestation,peeping product through Rent. In addition,inflamed twisted Retrocaecal Appendix. Rt.Salpingo Oophorectomy, Peritoneal Toilet+ Retrograde Appendectomy done.Specimen sent for HP.Exam. Gynae colleague did DC.,Endometrial Biopsy+ insertion of Cu-T.

They look happy so will be the New Year

Just completed OT.in my old Institution,Glocal Krishnanagar.A case of Necrotizing Colitis with Perforation,localized Faecal Peritonitis,ang Phlegmon near Splenic Flexure.Dangerously adherent with Spleen.Only Careful finger Dissection,delineation of Anatomy done. Extended lt.Hemicolectomy done. End to End Anastomosis,cover Ileostomy done. Blood was available after Surgery. Pt is in ICU, so far behaving well.Its a painful Nostalgia,my dear Friend Mukti, used to give Anaesthesia in all difficult cases till 2017 end, when I left the Institution. Inflammatory Fluid alongside descending colon.There was no free perforation.During mobilization of thin walled descending colon,Splenic Flexure,rent was revealed with faeculent material gushing out.

This Redo Gynaecologic Ovarian Malignancy Case ,previously attempted by one Gynae 6 months ago at Health Point N.Home. After 6 cycles Chemotherapy, on 13.12.2022,I did the Exploration (ReDo Surgery) at H.Point. Extremely Difficult Case with Dense Adhesions.

Yesterday I could Successfully remove this bulky,Infiltrating Ghastly Stage 111 Renal cell Carcinoma,likely Infiltrating not only Retroperitoneal structures,but also directly engulfing Rt.Renal Pedicle,with permeating along Rt.Renal vein to I.V.C.Preo Op.Investigations,like CECT,IVP.U.S.G all I certify were fully correct.It was exercise of Finger Dissection,Serial Application of Vascular Clamps&5-0 Prolene utilization.Even traditional policy of “GARAM MAP CHEPE PATIENCE” Helped me.Naturally,lumbar veins had slipped.I secured them with direct suture on IVC With 6-0 proline on IVC.Even one slipped aberrant Arterial Branch had to be secured in this way on Abd.Aorta.Pt.is well,post op.900ml.Urine passed(single kidney)and miraculously drain is almost Dry.Thank Almighty

Same Pt. as was operated at OHIO 8 days before.She had Adhesive Acute on Sub Acute Small Intestinal Obstruction.2 incisions if you recollect were in the Sub Umbilical region,shaped like inverted T. as an aftermath of two G&O procedures done elsewhere.She had Small intestinal(ileal) Resection Anastomosis with Concurrent side to side Anastomosis for multiple partly sealed Perforation s.Pt.was too sick to withstand extensive gut Resection.Pt had a Stormy post op.period.last 4 days I visited daily to that far away Centre.I did Dressing everyday self with competent sister,o.t.staff.She had developed Small Intestinal moderate Fistula,gradually shrinking.Today I had instructed how to make her Ambulant&as per my wish they sent this Video.She took smashed,boiled lunch today.Tomorrow Christmas ,yet I shall visit tomorrow early morning to supervise the result following full bathing &do the dressing myself.Encouraging,she is passing Stool following Dulcolax Suppository insertion.LOOK AT HER FACE&,COMFORTABLE GAIT

Inverted T.Two incisions used for two different G&O Surgeries.Pt now Presenting with Aggravating S&S of Acute on SubAcute Intestinal Obstruction

So much Friable were some Ileal portions,(paper thin,like wet blotting paper with perforations revealed while performing Extensive Adhesiolysis)three procedures were done1)Attempt at reinforcing exposed Mucous Membrane with SeroMuscular Stiches,2)On failure to contain the persistent leak of Intestinal contents,Segmental Resection Anastomosis done3)To avoid extensive Resection of Friable Sodden Intestine,SIDE TO SIDE ANASTOMOSIS WERE DONE IN ADDITION.As Appendix was found involved in the Adherent loop,Appendectomy was also Done.Its just 24 hours Post Op Period,Pt s Vital Parameter are Stable,CBC,l.F.T done today are within Normal limit s.RT.,Abd.Drain –Minimum Collection. Let’s Pray for the Pt.I have discussed the present Scenario with Dr.Rakshit and Requested him to Monitor the Pt. For 4 more days at least

I was called in Yesterday by Dr.Asis Rakshit,Cardiologist,Owner of OHIO To Attend & do the Needful on this Pt .,a lady of 52 yrs age with already fair trial of Conservative Treatment

Dr Bhaskar Ghoshal: This is Peripheral/Rural Surgery in its Constraints(No ICU,HDUetc.)Operated on O7.12.23 for Obstucted Incisiona Hernia,now today Early Morning Supported Walking accompanied by Sister,pt herself carrying the Catheter Urobag.Not only their Physical Strength but also Mental make up which helps me to tide over the Critical Situation so easily
[10:41 am, 10/12/2023] Dr Bhaskar Ghoshal: I believe almost all of my Surgeon Friends have spent Rural Career in their Early part of Career.But I am blessed,I am Still Carying on.God knows how long I shall be able.Bless Me

USG,Diagnosis-Ing.Hernia.Clinical Diagnosis,Incisional Hernia.See the PfannenStiel incision for TAH,4 Years before.Coming out through Rt.lateral end of Incision&burrowing & presenting near Umbelicus.App.was adherent to adhered Gut loops.Pt.party were Appraised of the situation.Sub Muscular Under lay Prolene Mesh Hernio Plasty done after Adhesiolysis + Appendectomy.Done on Thursday.On my Instruction the team at Kabita N.Home at Debogram had sent Video while dressing.Its my practice every where.Till discharge of Pt.i shall be Recieving such Feed Back s

That Pt. which was operated for Incisional Hernia.USG.Report

0perated yesterday at KNJ GLOCAL.Just could not Explain the Immense Vascularity.Bled ,a good ammount.Sonologist had informed me on the Evening before Surgery of the prevailing condition.That helped me to reserve one unit Blood and keep myself armed with Vascular Surgery instruments.Except 99mTc pertechnetate l131 Scan relevant Tests had been Done before Surgery

0perated yesterday at KNJ GLOCAL.Just could not Explain the Immense Vascularity.Bled ,a good ammount.Sonologist had informed me on the Evening before Surgery of the prevailing condition.That helped me to reserve one unit Blood and keep myself armed with Vascular Surgery instruments.Except 99mTc pertechnetate l131 Scan relevant Tests had been Done before Surgery

A young lady of 22years age ,mother of one child had Caesarian Section+ H/ O Appendectomy several years before.I examined her at Nadia, Karimpur, Swasti NH yesterday.She was Suffering from Acute on Chronic Cholecystitis.Investigations had been done.Surprisingly R.I.F was extremely Tender.I,even forwarded the diagnosis of left over Appendix with inflammation.With Kocher s Incision explored,Cholecystectomy done.Amazing–after lysis,division of Adherent Omental band,I could discover the Appendix in situ from base to fibrous tip lying Retrocaecal,Retro Ascending Colon.Removed it.Thus on display,G.B.,APPENDIX, Piece of Omentum.What a suffering for that young patient over years since stated so called Appendix Removal.

Yesterday I could Successfully remove this bulky,Infiltrating Ghastly Stage 111 Renal cell Carcinoma,likely Infiltrating not only Retroperitoneal structures,but also directly engulfing Rt.Renal Pedicle,with permeating along Rt.Renal vein to I.V.C.Preo Op.Investigations,like CECT,IVP.U.S.G all I certify were fully correct.It was exercise of Finger Dissection,Serial Application of Vascular Clamps&5-0 Prolene utilization.Even traditional policy of “GARAM MAP CHEPE PATIENCE” Helped me.Naturally,lumbar veins had slipped.I secured them with direct suture on IVC With 6-0 proline on IVC.Even one slipped aberrant Arterial Branch had to be secured in this way on Abd.Aorta.Pt.is well,post op.900ml.Urine passed(single kidney)and miraculously drain is almost Dry.Thank Almighty

Frey s,lateral Pancreato jejunostomy done with Roux en-Y jejuno jejunostomy

Head Coring,Unroofing of MPD,exposing opened up areas along course of MPD

Third Post Op day.Operation done at Glocal Krishnanagar. Pt.having liquid diet.Postponed day after day at Govt.Med.Coll, Kolkata.Till 2017 I was here.I was in Tears recalling such cases quite a Food number I did at KNJ GLOCAL When Every time Dear,Late Mukti Prosad Dey administered Anaesthesia.Getting very Sentimental quickly recently

Taking Practical Class for 2nd& Final year Students at ICare Institute of Health Science,Haldia

Suspected GIST Antrum.CECT Correlated.Exophytic,with pus discharge from within.Sent for C&S.From within the Sero Submuscular layers,tumor excised with BiPolar+layer Suturing with 2-0 Vicryl& Silk.Sent for HP ex.Peculiarly Sequelae of Previous LAP chole had resulted in Dense Adhesions.Calcareus material was recovered from within the necrotic Tumour(outside lumen) Extensive Adhesiolysis were done.

CECT Report of tis case.Operated today at GLOCAL KRISHNA NAGAR

This Redo Gynaecologic Ovarian Malignancy Case ,previously attempted by one Gynae
6 months ago at Health Point N.Home. After 6 cycles Chemotherapy, on 13.12.2022,I did the Exploration (ReDo Surgery) at H.Point. Extremely Difficult Case with Dense Adhesions.

I am going to explore this case tomorrow.Then let you appraise the outcome

Just completed OT.in my old Institution,Glocal Krishnanagar.A case of Necrotizing Colitis with Perforation,localized Faecal Peritonitis,ang Phlegmon near Splenic Flexure.Dangerously adherent with Spleen.Only Careful finger Dissection,delineation of Anatomy done.Extended lt.Hemicolectomy done.End to End Anastomosis,cover Ileostomy done.Blood was available after Surgery.Pt is in ICU,so far behaving well.Its a painful Nostalgia,my dear Friend Mukti,used to give Anaesthesia in all difficult cases till 2017 end,when I left the Institution

Acute Inflamed GB With Calculi adherent with inferior surface of cyst wall as seen after decompression of Hgic Cyst

Steps of Op.Procedures in that case of Abd.Cocoon.Bands Adhesions lysis,Resection of Ischaemic Terminal Ileum& End to side Ileo Transverse Anastomosis were done

Exploratory laparotomy in a case of Abdominal Cocoon with Sub Acute Int.Obstruction

After lumbo inguinal approach for Pyelolithotomy years ago,65 years lady developed an unusually large Incisional Hernia.There was Strangulated Omentocele.Omentectomy& Innovative Prolene Mesh HernioPlasty done.Performed at Basanti Sunderban in a NH.with Meagre Facilities.Pt recovered uneventfully

Tenosynovitis finger with gross cellulitis.Incision,,debridement done.Terminal phalanx along with nail removed

Lady of 76 years with Obstructive SigmoidoRectal jn.Schirrous Growth.After bowel preparation,Anterior Resection Done.During Exploration,liver Mets found.Wedge Resection Biopsy done

Same case depicting prolapsed Rectal Mucosa in Third degree CPT,along with Uterine Prolapse.Gross Ulceration ,Suspicious on Cervix discovered during V.H.

Second Degree Uterine Prolapse+ CPT

Its not Pressure Sore.Possibly initiated by Trauma.Superadded infection,Ischaemia,long Standing neglected management initiated the Gangrenous Change+ healing areas at places.

Discharging Pus over many months.Likely Persistent Embryological Vestige Sinus-Excision Biopsy done

After laparoscopic attempt to remove an Adnexal mass,pt developed a periumb.painfullump in the post op period.USG Couldnot describe clearly the cause.Explored today,Omentum with sealed perforated Ileum,16 inches from IC Valve,were stuck firmly in the PeriUmb.region.Lysis done.Adherent Strong Omental Bands divided.HM type repair done on the rent in Ileum.Peculiarly,this female pt.had Endoscopically proved bleeding Antral Ulcer.With a separate supra umb.incision,Truncal Vagotomy,GJ done simultaneously

Careful dissection of the infĺamed GB with Large faceted Calculi from the Hgic Cyst Wall.Retrograde Cholecystectomy safeguarding Adherent Duodenum,Colon& Obscure Frozen Callotts triangle.

Extremely hazardous adherence with Porta Hepatis

Acute Inflamed GB With Calculi adherent with inferior surface of cyst wall as seen after decompression of Hgic Cyst

Pt.83 yrs old,with comorbidities,treated carefully by qualified Physician,referred this case to Surgeon with provisional diagnosis of infected corn on plantar aspect of distal foot.Aghast operated under Sp.Anaes.Most likely,its Malignant Melanoma.XRay chest,bones of the foot were-NAD.Wide,Radical Excision Biopsy done.Tissue s sent to Roy Tribedi lab.,Kol.One unit Bl.Tr.given.

Charcoal like,very firm tissues infiltrating Plantar Aponeurosis

Not that Commonly discovered Case.CECT.+ USG,W.A.Diagnosed this case as arising out of Pelvis,Huge Swelling,Gross Ascites.Catchectic,features of S.A.Int.Obstr.Preop investigations including XRAY CHEST,Within Normal limits.Xray Abd,Diffuse Haziness+ Multiple fluid levels.OnExploration-ABDOMINAL COCOON.Could be,Tubercular/Malignancy as Etiology.Diffuse adhesions of Small Intestines interloop.Terminal Ileocaecal firmly stuck in Pelvis with last 10 inches of Ileum grossly Ischaemic.Rt.colon,lt.colon mobilised with difficulty from Paracolic Gutter.Ileum,10 inches Resected;Terminal end closed;end to side Ileo Tr.Anastomosis done.Infact,Ascending Colon had its post wall imperceptibly fused with cyst wall of Abd.Cocoon.Perop,on table,2 units Bl.Tr.given.

Tethering Bands being divided

Relatively Rare Familiarity with this type of Clinical Presentation. Lady, 60yrs age had undergone Surgery on lt. Kidney with lumbar Incision in one of the Med. Coll. in Kol. Yesterday, as an Obstructed lumbar Incisional Hernia it was presented to me in Basanti Sundarban, (Saswata NH owned by Dr.Risikesh Sardar). See the oblique lumbar scar & USG Report.

Operated at Balurghat, North Bengal, adjacent to Bangladesh Border. Ca Head Panceas with Serum Bilirubin, 16 mg%.T2/3, N1, M0. Non Resectable on Exploration, thus Triple Diversion/By Pass were done.2 days after, Ser. Bil.cane down to 5.47 mg with direct component, .85mg

Cholecysto jejunostomy in progress. Look at the gush of White Bile on opening the hugely distended GB.( Courvorsiers law). Here lower CBD found infiltrated with growth arising from Head Pancreas. Thus Choledocho jejunostomy was not a feasible choice

On exploration, distended GB+Grossly distended Stomach( Due to Antro Duodenal infiltration) seen

Better view on opening up the Abdomen, showinh popping out Hugely Distended GB +Distended Stomach (Gastric Outlet Obstr.due to craggy mass in Head of Pancreas)

Bilateral Roof Top Incision(Chevron) being fashioned in this case. Such incision,very commonly utilised for Pancreato Biliary Surgeries

Fashioning of Roux loop in Jejunum,30 cm distal to ligament of Treitz

Showing the infiltrated Porta, thus abandoning Choledocho Jejunostomy

Roux-en Y Cholecysto Jejunostomy in progress

Grossly bulging upper Abdomen due to Pseudo Cyst Pancreas. Serial CECT Done since 29.03.21.Now,intense backache, Pallor, respiratory distress points to Haemmorhagic Lesser Sac Collection. After Comservative measures, Blood Transfusion etc., Explored today.Gross adhesolysis, done. Cyst wall adherent to parietes gave way(see video) Contents evacuated. Side to side Cysto jejunostomy & side to side jejuno jejunostomy done. Multiple drains inserted in Abd. Pt is Young male, 24 yrs old

Pancreatolithiasis with Chronic Pancreatitis, lateral Pancratojejunostomy done

Renal Cell Carcinoma(Golden Yellow Tumour), Radical Nephrectomy done

CA G.B.Resected along with Segment4B,5 of liver

Tis case of Hydatid Cyst liver,refused surgery in Nearby Reputed Centres.Calcified Hydatid Cyst left lobe of liver (Segment3&part of 2).Treatment-Heparic lobectomy.In a remote Peripheral Centre like Dhuliyan, such Surg performed without blood.I had GA+BIPOLAR DIA.+My Personal Vascular Clamps&ofcourse the desire.I lament,in Med.Coll.settings P.G Studs would have flocked to enrich themselves.O.T done on09.08.Till now Fine.

Huge Hydatid Cyst Rt. Lobe liver (Seg.5678) operated just now at SUN HOSP. BURDWAN Look at 2 Kidney Trays full with Laminated Membranes.  Capitonage + Omentoplasty done.+ Cholecystectomy.

T2/3 N1 M0 Antro Pyloric Ca Stomach Operated today at SUN HOSP. BURDWAN. Fixed to Pancreas, Mesocolon; DISTAL 2/3 rd Radical Gastrectomy done with L. NODE CLEARANCE

Acute Haemmorhagic, Profuse Collection in Lesser Sac as an aftermath of Acute Pancreatitis. U can see the Shiny, Oedematous Skin of Abdominal wall. CECT,Conservative measures, PreOp, Albumin infusion, Bl. Transfusion & Expl. Lap. done yesterday at Raigunje. Multiple Drains kept in Abd.

Operated today at Basanti Sunderban. Staggering, Pathetic Condition of Prolonged Illness of Poor Rural Patient. Pt,in spite of repeated visits to a Private Med. Coll,had been suffering due to repeated deferred Admission. Almost Emergency Expl. Lap. revealed Ghastly Picture of Perforated Empyema G.B. with gross adhesions even to the deeper Parietes. So much stuck with Transverse Colon, Duodenum, there was suspicion of Cholecystocolc, Duodenal Fistula. GB stones, piecemeal removal of Necrotic GB+safety guard procedures of GJ+Ileo Transverse Anastomosis were done. We had no reserved Blood. Infact, investigations could not tune, preoperatively that such extensive procedures with blood loss would have to be done Excellent, GA.-Pending Blood Transfusion, Pt. Stable in the Post Op. Period

Obstructed(USG,Describing it as Strangulated) Para Umb. Hernia in an old lady of 81yrs of age. She had Aortic Stenosis. Returned, Refused in Malda Disari, which was fully equipped with gadgets to tackle such case. Came back to Raigunj. Emergency Exploration done yesterday with consent and Counselling with Pt.Parties. Quick Procedures removed Strangulated Omentocele. There was Ascites+palpabIe nodular liver. Its almost 24 hrs first Post Op.day. So far Vital Parameters OK

ReDo Surgery.Previously operated for T.O.Mass.Recurrence of Symptoms.Investigated-Complex SOL in Adnexa with Bulky Uterus.Re Explored today,at Basanti Sunderban.Pfannenstiel Scar Excision.Likely,Endometriotic origin with dangerously, precariously adherent to Rectum,U.B & Lat Pelvic Wall.Carefully dissected out safeguarding Vital Structures.See,Excised Scar,TAH BSO+Appendectomy Specimens.No blood transfusion was necessary.

Already 3 scars existing at infraumbelical region.Look at the USG Report.Very Painful large irregular mass in the Suprapubic Region.look at the dangerously adhesions with U.Bladder,Rectum & ofcourse with the Parietal layers.After careful and Painstaking dissection,TAH,BSO+Appendectomy was done today at Basanti,Sundarban.U wont believe,the Total Package was 20K

Huge,Tense,hard Calcified Hydatid Cyst lt.lobe liver(Seg.3,part of 2,part of1)Daughter Cysts with laminated membranes removed on 19.7.20 at Basanti Sundarban.I removed lt lobes in 3 such cases at Dhuliyan,Mursidabad.Here in Basanti,BiPolar Diathermy was not available

Extensive Split Skin Grafting done today at Raigunj

Not yet post op 24 hours.Pt,Bijaylaxmi 77yrs,operated with Revision Biliary Surgery on 04.05,at Balurghat NH Carrying out Exercises.She had lap.Chole several yrs ago at Malda.Now operated for multiple packed calculi in CBD.Astinishingly,i encountered ghastly intra abdominal adhesions although Minimally Invasive Surg.was done earlier.In the next pic i show u the lap clip on CBD,adjacent to the CBD Calculi

Specimen of Abdomino Perineal Resection,done today for Schirrous AnoRectal Growth.I was invited by NH Of a Neighbouring District.Extremely,needy & Poor Pt.My learned colleauges know,its a Synchronised Combined approach by two Surgeons.Budget not permitting.So i had to do it Singlehanded,changing positions from Abd.to Perineum.Since the days of my posting in Raig.Dist Hosp,i got used to do it Single handed.Situation,Budget dictates

Plethora of Complicated,Varieties of Major lifeSaving Surgeries performed by Dr.Bhaskar Ghoshal.They had been performed in the different Peripheral Centres of West Bengal over the last couple of months

Several Steps of Rt.Hepatic Lobectomy( in this case)

Young Male pt,aged 32yrs, had been suffering from Fever, pain abd.vague upper Abd.Swelling for quite some time.Treated at Liver Diseases Hosp,Sonarpur.Investigation reports attached.They had been planning Per Cutaneous drainage of liver abscess.I suspected otherwise.Explored today at Dr.Sardars Saswata NH.Huge fiery,very firm mass,( lump) Rt.lobe liver sparing little of Segment8,5.Intraparenchymal dissection and Securing of structures of Rt Porta done.Branches ofRt Hepatic Vein,Middle Hepatic Vein similarly secured with different types of Vascular Clamps.Removed Mass sent for HP Ex.Haemostasis secured with measures including approximation over Omental Flap.T incision closed after placing RomoAdk Drain.we had only one unit blood.3 more packets ordered stat.Excellent GA administered in this set up by Dr.Arpan

Previously Two Gynae.Op.done with Infraumbilical Vertical Incisions.Look at the Scars;Para Incisional Bulge.At Dissection see the Bulge of Incisional Hernia.Sac opened;lysis of Adhesions done.Appendectomy done.Opened Sac cloosed with continious O Maxon.Then “KEEL” operation done with continious No1,Vicryl

Pt had two units blood transfusion to correcy Anaemia.DUB With Moderately big Fibroid.TAH+ BSODone.Also,Appendectomy done.

Already 3 scars existing at infraumbelical region.Look at the USG Report.Very Painful large irregular mass in the Suprapubic Region.look at the dangerously adhesions with U.Bladder,Rectum & ofcourse with the Parietal layers.After careful and Painstaking dissection,TAH,BSO+Appendectomy was done today at Basanti,Sundarban.U wont believe,the Total Package was 20K

Bull Horn Injury resulting in laceration Rt.Lobe liver with Haemoperitoneum

Huge Myoma,just now operated at Dr.Sardar s NH,*(SASWATA)In Basanti,Sundarban

My Gynae Colleagues would have described this case as Bicornuate Uterus.Actually its moderately big Myoma.

Operated today at Basanti Sunderban.Staggering,Pathetic Condition of Prolonged Illness of Poor Rural Patient.Pt,in spite of repeated visits to a Private Med.Coll,had been suffering due to repeated deferred Admission.Almost Emergency Expl.Lap.revealed Ghastly Picture of Perforated Empyema G.B.with gross adhesions even to the deeper Parietes.So much stuck with Transverse Colon,Duodenum,there was suspicion of Cholecystocolc,Duodenal Fistula.GB stones,piecemeal removal of Necrotic GB+safety guard procedures of GJ+IleoTransverse Anastomosis were done.We had no reserved Blood.Infact,investigations could not tune,preoperatively that such extensive procedures with blood loss would have to be doneExcellent,GA.-Pending Blood Transfusion,Pt. Stable in the Post Op.Period

Huge,Tense,hard Calcified Hydatid Cyst lt.lobe liver(Seg.3,part of 2,part of1)Daughter Cysts with laminated membranes removed on 19.7.20 at Basanti Sundarban.I removed lt lobes in 3 such cases at Dhuliyan,Mursidabad.Here in Basanti,BiPolar Diathermy was not available.After this procedure of Capitonage,taking consent from party i also did Cholecystectomy+Adhesiolysis which was dense following previous ligation &Appendectomy.It was Bilat.RoofTop Incision
Pancreatic Calculi at Operation
Operated.Noncircumferentialulceroproliferated growth RectoSigmoid jn,prolapsing upto mid rectumPt.visited Manipal Hosp.Dignosed as TubuloVillous Adenoma?Malignant.Low Anterior Resection done,with ColoUpper Anal Anastomosis done.Pt.Diabetic,Hypertensive,65 yrs age
Pt.presented with symptoms of recurrent large Bowel Obstruction and Pallor.Investigations done at Manipal.Operated(Low Anterior Resection)by me at Kolkata.HP Report follows
Huge Hydatid Cyst lt.lobe Liver.Lt Hepatic Lobectomy done
Fungating CA Breast.Anae.refused GA.I had to remove with Xylocaine 2% infiltration anaes.Can u imagine,LOCAL!FIrst one Utpal,Nightmare.Case had Cholecystectomy,app.&TAH.Pt had Cx Twice,Chocolate Cysts(leaking).So immensely adherent UB,Rectum,SmallInt
On 27.05,at Raigunj,Emergency Exploratory Lap.done for Acute Abdomen.Cl.Ex,USG Favoured rupture Ectopic Gestation/Rupture Lt.Ov.Cyst with Fluid in lower Abd.Expl.Lap.-Gross Haemoperitoneum with rupture enlarged cystic Lt.Ovary.There was gross omental band adhesion with uterus and ovary.Pt was nulliparous even15 yrs after marriage,having recurrent lower abd.pain
Expl.Lap.done for GOO,In a catchectic female pt.CECT,described as adherent gut with enlarged perigastric l.nodesThorough Preop Preparation done..On Table extensive peri & retro duodenal l.nodes engulfing whole of Duo.upto DJFlexure.likely Caseating deposit in Tr.Mesocolon present.Pus,sent for ex.+lining of the cavity excised for H.P.Ex.Ant.GJ+JJ done.
Operated in 2010,pt.residing in Bansihari,Dakshin Dinajpur,shifted to CAMRI By Road.Pt.had Pancreatic Surg. In Katihar Med Coll,March 2010.Symptoms recurred.I did Revision Pancreatic Surg in Dec.2010.Pancreatic Surg.a highly specialised Surg.itself;Revision Panc.Surg.is a dream Surg.case even in Med.College or Specialised Centre.A Wonder,after 10 yrs he has arrived today in Raigunj for Consultation
Extreme Pallor.Hb%6gm/dl.Features of Chronic large Gut Obstruction.PR-almost immobile AnoRectal jn.UlceroProliferative Growth.Pt.cannot Afford,PetCt.Ideally this case needs NeoAdjuvant ChemoRadiation.Poor Rural patient.Preop one unit BlTr.given.Anaes.refused.Luckily one Anaes.offerred with Epidural Anaes.On Expl.Advanced Growth Extending to anorectal jn,fixed partially with Sacrum ,Base of U.Bladder.Careful separation done.Hartmanns Op.done with ligation of Bilat.Int.Iliac Artery.Thus,Anus closed&lt.Iliac end Colostomy done after maximal debulking
Toilet Mastectomy under 2%Xylocaine peripheral infiltration Anaesthesia.Even hard Axillary l.nodes could also be temoved.It was done on 13.07.20 at Basanti Sunderban.Amazing Pt is fine.Regular dressing being done,waiting for split Skin Grafting as soon as the bed is removed. Specimen,after removal Will need Skin Cover after generating satisfactory granulation Tissue
Post Op(drainage of App.Abscess)Int. Obstruction.Loop of Terminal Ileum adherent,fixed to the drainage site
Gritty Diffusely Enlarged Mutinodular Goitre-Total Thyroidectomy done at Basantil
  • Split Skin Grafting Long Strips of Skin harvested.Recipient area is an old injured area,extensive on leg.Suture fixation done+ POP,Below Knee

  • Emergency Surgery.for Acute Empyema G.B.

     

  • FREIS Operation of Lateral Pancreatojejunostomy

     

  • Large Ovarian Tumor with Torsion
  • Torsion Large Ovarian Cyst/Tumor with Torsion-Process of removal during Emergency Laparotomy
  • Traumatic rupture of Small Intestine
  • Difficult Pelvic Dissection with tape up of Both Ureters
  • Post Surgery same pt.with CECT demonstrating IntraThoracic Extension
  • Strangulated Necrotic Small Intestine
  • Prolene Mesh Repair of Incisional Hernia
  • Ca G.B with involvement of segment 4B,5.Process of Modified Radical Cholecystectomy
  • Stage 3 duct CA Breast-had incomplete Chemo.Almost fungating,much bleeding from nipple.Wide,as far as possible Salvage Total Mastectomy done removing involved Pectoral fasciae&muscle.Look at the ghastly ipsilateral Axillary Metastatic l.Nodes.Bilat.Oophorectomy done.Surprisingly Rotationalflaps secured Skin closure although we were ready to harvest split skin for grafting
  • Hospital,OT,Anesthesia,Octogenarian Pt,such Major Procedures (3 Rt.Hemicolectomies for Ca.Caecum,ileocaecal mass)+Meckels Diverticulitis(ileal segmental resection)+Total Parotidectomy etc,all done on Wed.,Thurs.Purpose is to Highlight how much Tension free the relatives of those Major cases-taking food on the ground close to the stair case with children,some preferred to have a sista but observing fast during ROJA-at DHULIYAN
 
  • Emergency life Saving Surgery in a case of Ruptured Ectopic Gestation with gross Haemoperitoneum
  • Combined Mirrizzi Syndrome(CholecystoCholedocal Fistula) associated with CholecystoDuodenal Fistula.After stone removal,the rent was utilised to create a CholedochoDuodenostomy
  • MPD Anastomosis side to side with a Roux loop Jej.+final closure of Bilat Roof Top Incision
  • Side to Side Lateral Pancreatojejunostomy with 3-0 PDS-Posterior through and through with beginning of Ant.through & through at the head of Pancreas
  • MPD Anastomosis side to side with a Roux loop Jej.+final closure of Bilat Roof Top Incision
  • Surgery on Calculous Chronic Pancreatitis First,Anterior surface of Body of Turgid,Very Firm Pancreas Aspirated to locate Dilated Main Duct.Direct lncision on needle guide& Progressive lay open of MPD done proximally & distally(Tail to Head)with stones extraction.This is followed by Lateral Side to side Roux-en-y Pancreato Jejunostomy.(Video to follow)
  • My dear MedicoSurgical Colleagues know its comparitively rare encounter with development of Incisional Hernia in Rt.Subcostal Incision(used for Open Chole.)I got it in Dhuliyan(Murshidabad) after many years.I operated on this lady aged 65 yrs.Gross adhesiolysis,Tricky dissection of fascial layers&Subapponeurotic placement of Prolene Mesh done successfullyExpert G.A.&Support provided by the owner Dr.R.Islam(ex Matia)
  • Chronic Calcific Pancreatitis with Gastric Outlet Obstruction.Head,Body Tail Coring with Roux en Y lat.PancreatoJejunostomy+Truncal Vago.+GJ +JejunoJejunostomy-at Dhuliyan,i took 3.5 hours to complete
  • A case of Ulcerative Colitis-After failed Conservative measures;Total Colectomy with IleoRectal Anastomosis done
  • Large Hydatid Cyst in Lt.Lobe liver.Segment 2+3 grossly replaced by the cyst which had also an Exophytic component.Lt.Hepatic Lobectomy done in Dhuliyan N.H on 13.03.19.No Blood Transfusion administered during & after Surg.We had this time Sufficient Vascular Clamps,Sutures.Excellent G.A.and per op.monitoring was done by Dr.R.Islam.I was well assisted by 3 assistants.
  • Pt.84 years old operated for obstructed left inguinal hernia.Firm Globular irregular Mass involving distal Ileum with additional intraluminal fleshy mass adjacent to the mass.Right Hemicolectomy done.Peculiarity-Rt.Colon with Ileocaecal region entering Lt ing.hernial sac &and presenting with features of obstruction
  • 2 wks ago i operated in Dr.Rafikul Islams Dhuliyan N.H-Disseminated Abd.Hydatidisosis;Main lesion in lt.Lobe liver removed by Seg.2+3 lt.Hepatic lobectomy.Today this case,anold lady previously had Cholecystectomy done(same quack rahaman of Basanti operated)Today Exp.lap.done for Acute Abd with USG Diag.of Cyst in Rt.lobe liver/Gut related Cystic lesion.It was same as the prev case with ascites,dense adhesions of liver Hydatid Cyst with colon,Omentum,Duodenum.Seg.5+6Rt.lobe liver removed(note how under pressure daughter cysts jumping out of the leaking Rt.lobe Hydatid)
  • What a Hell done by a Quack practicing as an accomplished surg.in Basanti(Sundarban).Reported operated-Appendectomy+Ov.Cyst removal 20 days ago Today i was rushed in on request to do the needful.Toxic,Distended Abd.,Obstipation.Expl.Lap.-Perforation Ileo Cecal,Gross Biliary with Pus alongwith old Serosanguinous fluid gushed out.Terminal Ileum with Duplex looped Small Bowel loops adherent almost inseparably eith Parietes ,Plastered Pelvis & Rt.Paracolic Gutter Delivered,with morose i had no way but to do an Extended Rt.Hemicolectomy.This was done in Hrisikesh Sardars N.H where i frequent since last 3 yrs.I move with M.D.Anaes.from Kol.Without blood in hand Nicely Managed (G.A.)After Surg.over-i had to be fast,one unit blood brought in from Canning
  • Large Abscess Lt. Lobe Liver-Sequentially the second case within 10 days.Last one was a boy aged 6 yrs.This one is Adult Male aged 30 yrs presnted with gross emaciation fever with chill & rigor.
  • Coringout segment 4 & 5 Royx en y Hepatico jejunostomy done to relieve jaundice(longmires operation)
  • 7 yr s ago pt.had some Surg.at Lalbag,Murshidabad.Yesterday pt.presented with Acute Abd.(s/s of Perf.Peritonitis)CECT at Illahabad diagnosed ?Hydatid Cyst lt.lobe liver+2 more in Pelvis.Lt.lobe liver,Hepatic Resection done at Dhuliyan.No blood available;well managed my Dr.Raficul Islam with Haemmaeccel,both hand drip+necessary drugs & measures.Sending u next the removed specimens
  • Lt.lobe liver Seg.3+2 resected alongwith Hydatid Cysts(laminated Membrane seen coming out.Also other Cysts in Pelvis +Paracolic Gutter removed & filled in Kidney Tray
  • Steps of Total Thyroidectomy for a FNAC Proved Papillary Carcinoma Rt.Lobe
Huge Hydatid Cyst Rt.Lobe liver-Operated-2Kidney Trays full of laminated Membranes.Large Cavity after extraction seen-Obliterated by Capitonage [ctu_ultimate_oxi id=”2″]
  • Torsion Rt.Ovarian Cyst-Gangrenous change with imminent rupture
  • Ruptured Ectopic Gestation.Lt.sided CORNUAL RUPTURE
Post ceaserian case- ceaserian section done again
Necrotic empyema gallbladder presenting as acute abdomen
7 days before this pt.was operated at Basanti,Sundarban by a Gynae.Ovarian Cystectomy,Appendectomy.Soon after that pt.dev.Abd.Distension,vomiting,Spiky Fever.USG revealed huge intraperitoneal collection.I explored today.It was a Charitable Hosp.U can see vicryl sutures tie onmidthird of rt.Ureter.Astonishing-lower third of rt.Ureter nonexistentHow could it be so extensive injury!I had to reconstruct &bridge that long gap with Boari Aucherbaldt flap tubed on a splint.I am priviledged to get an opportunity to participate in a case which Is Urogynecologist s delight.
Verry Firm Irregular lump ( Mobility Restricted) in Pelvis.CECT Describing proximity to U.B.Expl.Lap.-Hard irregular lump adherent to Colon & U.B.Bled profusely,yet with patience dissected out from Vital Structures.Done at Basanti ( 98 k.m from Kol).Good &able Support from Anaesthesist,Dr.Das.In fact she waited one week to arrange G.A.In that Rural Centre .No Bl.Tr.was given till Closure.Unedited Video yet patiently done by one OT Staff.O.K till now -O.T done on 11.o8.18 [ctu_ultimate_oxi id=”1″]
Interesting case.Lady had staged operation for Obstructing Sigmoid Colon Signet Ring Cell Adeno Ca.Had postop Chemo.Now presented with features of Small Gut Obstruction..Expl.Lap.-Metastatic Annular Stricture on Ileum 3 feet away from Ileo Caecal Jn.found infiltrating Uterus.10 inch segment of ileum Resection Anastomosis plus TAH BSO Done
T2/3N1M0 ANTROPYLORIC CA STOMACH.Fixed to Pancreas;dissected out,Retrograde Distal 2-3rd Radical Gastrectomy done.Adjuvant Chemothrapy given
Huge Hydatid Cyst Rt.Lobe Liver-CAPITONAGE Done.Two Kidney trays full with removed Laminated Membranes
Pt.was brought to us 4 days after Lap Chole which failed and same Surg.converted.Yet intestinal contents was pouring out from Umb.Port.Resuscitated,Exp.Lap.revealed 3 perforations on 10 inch seg.of jejunum 1 foot away from DJ flexure.Resection Anastomosis with Proximal Diverting Jejunostomy done.Tension Suture Closure of Abdomen done.Pt.survived after Stormy Post Op Period
Radical Total Glossectomy-T3N1M0 With MND After Mandibulotomy.Tongue Reconstruction done withAnteroLat Thigh Micro-vascular Free Flap
A case of graves disease (primary thyrotoxicosis) pt was having treatment (look at the facies of the pt) at Chennai Apollo with neomarcazole etc for 5yrs. I operated sub total thyrodectomy as it was normal sized thyroid. Surgery had to be extremely meticulous leaving thyroid remnant thumb size. Very satisfactory post-op result as proved clinically and with necessary investigations.
secondary thyrotoxicosis -autonomous toxic nodule clinical features and sophisticated investigations including scan confirmed the diagnosis excession of the nodule with the lobe of thyroid was removed
This old pt was respiratory cropped had advanced ca penis with sloughed out of entire penis with maggot infestation. Operations was done in semi reclining posn. Total amputation of penis and total orchidectomy was fone and reconstruction done
Case of ulceratic colitis with crippling symptoms. After investigation exploration was done. Sub total colectomy was done with primary ileocolic end to end anastomosis done
Revision biliiary surgery
Strangulated complete indirect inguinal hernia – late presentation resulting in extensive gangrenous Gut
Jaundice, CBD impacted stone – choledochoduodenostomy
Gross painful fibrocystic disease of breast- Partial Mastectomy
Excised Giant Fibroadenoma of breast
Huge adrenal tumor right Removed.At the same time cholecystectomy was also done. After these operation another patient had patey mastectomy done for Ca Breast Patey
Pt. Diagnosed with polyp and was advised lapchole. However pt. Had agonizing pain in lower abdomen and was admitted as an emergency case.
32-year-old Mr Kumar (name changed due to privacy protocols) was an engineer by profession, residing in Durgapur. He was soon to be the father a child, as his wife was expecting a baby. Even with the ever-increasing work pressure, life was good for him. However, his happy days were soon to be short-lived. Mr Kumar started developing abdominal pain along with occasional vomiting. Initially, he ignored the problem after taking some unprescribed medicines. The problem gradually worsened with the pain increasing to agonising levels followed by constant vomiting. Requiring immediate medical attention, Mr Kumar’s father in law admitted him to a reputed hospital in Durgapur where he was diagnosed with acute abdomen. Acute abdomen is a condition of severe abdominal pain, usually requiring emergency surgery, caused by acute disease of or injury to the internal organs. The doctors there performed an ileostomy, which is a surgical operation in which a damaged part is removed from the ileum and the cut end diverted to an artificial opening in the abdominal wall. Post surgery Mr Kumar was released after a few days but his problems persisted. The excruciating abdominal pain refused to abandon him and the vomiting continued. So his father-in-law decided to rehospitalize Mr Kumar. Having lost faith in the reputed Durgapur Hospital Mr Kumar’s father-in-law got him admitted in Krishnanagar Glocal Hospital. When admitted, Mr Kumar was abnormally thin or weak, especially because of illness and required immediate medical assistance. Dr Bhaskar Ghoshal (MS, Senior Surgery Consultant) took up the case, which was challenging even for someone as skilled and experienced as him as the patient was in a very bad shape. But desperate times call for desperate measures. Dr Ghosal took up the challenge of a redo surgery, even though the risks involved were critical. Knowing full well that Mr Kumar may breathe his last if anything went wrong, his father-in-law decided to sign a high-risk bond. With Mrs Kumar expecting a baby soon, the most tragic outcome of this situation would have been the baby not being able to see his/her father. Showing great strength of character and courage Dr Ghosal decided to perform a redo surgery, just 2 weeks after the initial one. Dr Ghosal performed an Extended Right Hemicolectomy which is an operation to remove the right side of the colon. The small and large gut gangrenous with pus was evacuated, something which evaded the attention of the previous surgeon. Gangrenous is a dead tissue caused by an infection or lack of blood flow, while pus is the thick yellowish or greenish opaque liquid produced in infected tissue, consisting of dead white blood cells and bacteria with tissue debris and serum. The operation was finally a successful one sans any complications. Dr Ghosal’s courage had paid off. Post operation after a few days of further care and management the patient was released. Mr Kumar had finally got relief from the agonising pain, something which seemed like a distant dream once. As the saying goes, there is always light at the end of the tunnel. Mrs Kumar gave birth to a baby boy days after, much to the delight of everyone in the family. With the happy days returning in the family, Mr Kumar is now looking forward to starting a new chapter of his life. Fatherhood.
Necrotic painful GB mass explored Ca GB empyema and sub hepatic collection Radical colechocystecttomy with segment 4B and 5 hepatic resection done.
Pt. With Fourniers gangrene scrotum with sloughing out of medial thigh. Radical orchido scrotectomy plus sloughectomy done. Pt had copd. Plastic reconstruction done with rotational flap uneventful recovery.

Surgery for thyroid neoplasms

Young male fnac colloid goitre on exploration, gritty irregular nodular thyroid with l. Nodes near total thyroidectomy and neck dissection done. H.p. Papillary Ca Aged female with large irregular nodular thyroid fnac colloid goitre. Exploration suspicious mass near total thyrodectomy done. Hp follicular Ca