Vattikuti Foundation
Vattikuti Foundation
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373 Orthotopic robot-assisted kidney transplantation Dr Alessio Pecoraro
This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Dr Alessio Pecoraro, Fundació Puigvert, Barcelona, Spain.
Abstract:
Orthotopic robot-assisted kidney transplantation: surgical technique and preliminary results
Alessio Pecoraro1,2, Begoña Etcheverry3, Josep Maria Gaya1, Angelo Territo1, Andrea Gallioli1, Camille Berquin1,4
,
Giuseppe Basile1,5, Pietro Diana1
, Thomas Prudhomme6, Nicolas Doumerc6, Francesc Vigués3 and Alberto Breda1
1Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain; 2Unit of Urological
Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence,
Italy; 3Department of Urology, Hospital Universitari de Bellvitge, Le'Hospitalet de Llobregat, Barcelona, Spain;
4Department of Urology, University Hospital Ghent, Belgium, ERN eUROGEN accredited centre; 5Department of
Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific
Institute, Milan, Italy; 6Department of Urology and Renal Transplantation, University Hospital of Rangueil, Toulouse,
France.
1. Introduction
Kidney transplant (KT) candidates are fragile and immunocompromised patients and they are more often older, with
several comorbidities. However, some of them present a retained iliac fossa from a previous KT or for severe
atherosclerotic calcification. In this challenging setting, KT recipients and particularly those patients who are
candidates for an orthotopic KT, could benefit the most from the implementation of minimally invasive approach,
potentially improving the recipient vessels dissection and the vascular anastomoses, as well as perioperative
outcomes. In this video, we report the largest experience about orthotopic robot-assisted KT (ORAKT), focusing on
technical nuances and perioperative outcomes.
2. Materials and methods
After ethical committee approval, we retrospectively collected data regarding patients who underwent ORAKT
between January 2020 and August 2023 at three European referral transplant centers.
All ORAKTs were performed by a highly experienced robotic and transplant surgeon. The primary aim was to assess
the technical feasibility and safety.
3. Results
Overall, 16 ORAKTs were included. Of these, 4 (25%) were from donors after cardiocirculatory death, 5 (31%) from
donors after brain death and 7 (44%) from living donors.
Notably, all KT were carried out in the left renal fossa. Severe calcification of the external iliac vessels (100%), often
with a previous iliac fossa KT (31%), drove ORAKT. The median recipient age was 66 (IQR 63-71) years and the median
BMI was 26 (23-29) kg/m2
.
Surgical open conversion occurred in 12.5% of cases with a median operative time of 295 (268-360) minutes. An end-
to-end anastomosis between graft artery and native left renal artery was performed in 75%, while 25% had an end-to-
end anastomosis with the splenic artery. Graft vein anastomosed with the native renal vein in all cases. A uretro-
ureteral anastomosis was reported in 81% of cases, while pyelo-ureteral anastomosis and ureteral reimplantation
were carried out in 2 and 1 case, respectively. During the first 30-days after ORAKT, any grade postoperative
complications were recorded in 11 (69%). Of these, 3 patients experienced high-grade complications (Clavien-Dindo
greater than 2).
4. Conclusion
This study presents the largest ORAKT series reported, suggesting the robotic approach offers a safe minimally
invasive alternative for select patients unsuitable for heterotopic KT in high-volume KT centers with robotic expertise
and prior heterotopic RAKT experience. Robotic surgery can reduce perioperative complications, postoperative pain,
and hospital stays while enabling precise dissection of the native renal vein and splenic artery and accurate vascular
anastomoses.
See more at: vattikutifoundation.com/
มุมมอง: 88

วีดีโอ

375 Robotic Intercostal Nerve Harvesting for Brachial Plexus Neurotisation Dr Philippe Liverneaux
มุมมอง 4221 วันที่ผ่านมา
This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Dr Philippe Liverneaux, Strasbourg University Hospitals, Strasbourg, France. Abstract: Microsurgery, developed in the 1960s from experimental work in animals, has not undergone technological evolution until today. Robotics could lead to a major technological leap ...
377 Uroverse for robotic partial nephrectomy Dr Francesco Porpiglia
มุมมอง 4721 วันที่ผ่านมา
This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Dr Francesco Porpiglia, Division of Urology, Department of Oncology, School of Medicine University of Turin - San Luigi Gonzaga Hospital and IRCCS Candiolo Cancer Institute, Turin, Italy. Abstract: Uroverse for robotic partial nephrectomy Enrico Checcucci, Gabriel...
383 Uniportal Robotic Assisted Mastectomy (U-RABS) Dr Jagdishwar Goud Gajagowni
มุมมอง 26921 วันที่ผ่านมา
This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Dr Jagdishwar Goud Gajagowni, Apollo Hospitals, Hyderabad, India. Abstract: Uniportal Robotic Assisted Mastectomy (U-RABS) INTRODUCTION We have designed an innovative minimally invasive robotic assisted uniportal mastectomy.We would like to describe our technique ...
392 ...Robotic Assisted Rectal Surgery for Rectal Cancer using Indian SSI Mantra Robot Dr. K Agrawal
มุมมอง 20921 วันที่ผ่านมา
This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Dr Kushal Agrawal, Aster International Institute of Oncology, Aster Hospital Bengaluru, India. Abstract: FULL title: Optimizing Surgical Precision: A Procedural Guide for Robotic Assisted Rectal Surgery for Rectal Cancer using Indian SSI Mantra Robot Background- M...
404 Robotic J-Pouch Creation Dr Jennifer Blake
มุมมอง 7721 วันที่ผ่านมา
This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Dr Jennifer Blake, Baylor Scott and White Health, Temple, Texas, USA. Abstract: Robotic J-Pouch Creation Jennifer Blake, MD Rahila Essani, MD FACS FASCRS Abstract Introduction and objectives This is a video of Intracorporeal J-pouch creation. We describe a technic...
406 Real time image fusion for augmented surgical navigation Dr MS Ansari
มุมมอง 4621 วันที่ผ่านมา
This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Dr MS Ansari, Sanjay Gandhi Postgraduate iIstitute of Medical Sciences, Lucknow, India. Abstract: Real time image fusion for augmented surgical navigation (A case of multiple vessels for nephron sparing surgery in a child) Introduction & objectives Image enhanceme...
407 Single Port Robot Assisted Transvesical Prostatectomy in Hostile Abdomen Dr Sij Hemal
มุมมอง 5221 วันที่ผ่านมา
This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Dr Sij Hemal, University of Southern California, Los Angeles, California, USA. Abstract: Abstract Introduction Robotic Radical Prostatectomy using the Da-Vinci Single-Port (SP) robot can provide comparable functional and oncological outcomes with potential advanta...
409 TRAINING COURSE FOR 3D-AUGMENTED REALITY IN ROBOTIC PARTIAL NEPHRECTOMY Dr Daniele Amparore
มุมมอง 5721 วันที่ผ่านมา
This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Dr Daniele Amparore, Division of Urology, Department of Oncology, University of Turin, Italy. Abstract: TRAINING COURSE FOR 3D-AUGMENTED REALITY IN ROBOTIC PARTIAL NEPHRECTOMY 1D. Amparore, 1A. Piana, 2R. Campi, 3S. Pulia4, 1F. Piramide, 4E. Checcucci, 1A. Bellin,...
411 Outcomes of Modified Robot-Assisted Thoracoscopic versus Open Tracheobronchoplasty Mathew Thomas
มุมมอง 2321 วันที่ผ่านมา
This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Dr Mathew Thomas, Mayo Clinic, Jacksonville, Florida, USA. Abstract: Outcomes of Modified Robot-Assisted Thoracoscopic versus Open Tracheobronchoplasty Introduction and Objective Tracheobronchoplasty for severe tracheobronchomalacia is commonly performed by open t...
414 T3b kidney tumors. Could robotics be new gold standard? Dr Nicola Frego
มุมมอง 9321 วันที่ผ่านมา
This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Dr Nicola Frego, Onze Lieve Vrouwziekenhuis hospital, ORSI Academy Aalst, Belgium. Abstract: T3b kidney tumors. Could robotics be new gold standard? Noya Mourullo, A.; Frego, N.; Pissavini,A.; Barletta, F.; Resca, S.; Lambert,E.; D’Hondt, F.; De Naeyer, G.; De Gro...
420 Validating automatic kinematics in proficiency based progression training Dr. Jente Simoens
มุมมอง 621 วันที่ผ่านมา
This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Drs Jente Simoens & Alexandre Mottrie, ORSI Academy, Melle, Belgium. Abstract: Validating automatic kinematics in proficiency-based progression training Introduction and objectives As robotic surgical systems become more prevalent, effective training and assessmen...
422 Micro-ultrasound: histological subtypes characterization in kidney cancer Dr Laura Zuluaga
มุมมอง 3221 วันที่ผ่านมา
This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Dr Laura Zuluaga, Mount Sinai Medical Center, New York, USA. Abstract: Micro-ultrasound: histological subtypes characterization in kidney cancer Authors: Laura Zuluaga1, Burak Ucpinar1, Shirin Razdan1, Indu Saini1, Kennedy Okhawere1 , Jenna Worth1, Jewel Bamby1, S...
423 Artificial intelligence to predict innate ability for surgery Dr Andrea Moglia
มุมมอง 1121 วันที่ผ่านมา
This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Dr Andrea Moglia, Department of Electronics, Information, and Bioengineering, Polytechnic University of Milan, Italy. Abstract:' Artificial intelligence to predict innate ability for surgery Andrea Moglia, PhD Department of Electronics, Information, and Bioenginee...
425 Robotic assisted tubal reanastomosis Dr Erica Stockwell
มุมมอง 1121 วันที่ผ่านมา
This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Dr Erica Stockwell, AdventHealth, Celebration, Florida, USA. Abstract: Title: Robotic assisted tubal reanastomosis Author: Introduction: Objectives: Methods: Results: Conclusions: Erica Stockwell, DO MBA FACOG, AdventHealth, Celebration, Florida, USA Indications f...
429 Robotic Distal Splenopancreotomy and Left Nefrectomy- Dr Carolina Gonzalez
มุมมอง 3521 วันที่ผ่านมา
429 Robotic Distal Splenopancreotomy and Left Nefrectomy- Dr Carolina Gonzalez
431 Parotidectomy by Robotic Infraclavicular Approach Dr Sandeep Nayak
มุมมอง 5721 วันที่ผ่านมา
431 Parotidectomy by Robotic Infraclavicular Approach Dr Sandeep Nayak
432 Utility of near infrared fluorescence imaging in robotic partial cystectomy- Karthik Thandapani
มุมมอง 2121 วันที่ผ่านมา
432 Utility of near infrared fluorescence imaging in robotic partial cystectomy- Karthik Thandapani
433 Robotic Central Pancreatectomy: Unique Pancreatic Parenchyma-conserving Procedure-Dr. A.Kulkarni
มุมมอง 3621 วันที่ผ่านมา
433 Robotic Central Pancreatectomy: Unique Pancreatic Parenchyma-conserving Procedure-Dr. A.Kulkarni
438 PSMA-Radioguided Surgery Detecting Nodal Metastases during RARP- Dr Simone Scuder
มุมมอง 4421 วันที่ผ่านมา
438 PSMA-Radioguided Surgery Detecting Nodal Metastases during RARP- Dr Simone Scuder
442 Robotic-assisted hysterectomy with novel uterine artery dividing technique, Dr Toshiya Itoh
มุมมอง 9221 วันที่ผ่านมา
442 Robotic-assisted hysterectomy with novel uterine artery dividing technique, Dr Toshiya Itoh
443 Robot-assisted nipple sparing mastectomy on SSI Mantra- Dr. Medha Sugera
มุมมอง 7421 วันที่ผ่านมา
443 Robot-assisted nipple sparing mastectomy on SSI Mantra- Dr. Medha Sugera
444 Robotic segmental resection of splenic flexure tumour- Dr Weerakkodige Mithun Alwis
มุมมอง 4221 วันที่ผ่านมา
444 Robotic segmental resection of splenic flexure tumour- Dr Weerakkodige Mithun Alwis
447 Robotic Surgery in Obstetrics: Tackling Uncharted Pregnancy Complications- Dr. Anupama Bahadur
มุมมอง 5121 วันที่ผ่านมา
447 Robotic Surgery in Obstetrics: Tackling Uncharted Pregnancy Complications- Dr. Anupama Bahadur
448 Novel technique of isoperistaltic bowel anastomosis in RARC- Dr Pankaj Panwar
มุมมอง 11421 วันที่ผ่านมา
448 Novel technique of isoperistaltic bowel anastomosis in RARC- Dr Pankaj Panwar
449 Robotic Esophagectomy Totally Robotic Intracorporeal Anastomosis Dr Manu Sancheti
มุมมอง 4021 วันที่ผ่านมา
449 Robotic Esophagectomy Totally Robotic Intracorporeal Anastomosis Dr Manu Sancheti
452 Living donor uterus transplantation- Dr Mireia Musquera
มุมมอง 5921 วันที่ผ่านมา
452 Living donor uterus transplantation- Dr Mireia Musquera
454 Completely intracorporeal and extraperitoneal single-port robot-assisted kidneyautotransplant...
มุมมอง 6321 วันที่ผ่านมา
454 Completely intracorporeal and extraperitoneal single-port robot-assisted kidneyautotransplant...
472 Modified Robotic axillo-breast insufflation thyroidectomy (m-RABIT) Dr Nandini N Menon
มุมมอง 8421 วันที่ผ่านมา
472 Modified Robotic axillo-breast insufflation thyroidectomy (m-RABIT) Dr Nandini N Menon
474 Robotic Total Pelvic Exenteration Dr Ankit Sharma
มุมมอง 15721 วันที่ผ่านมา
474 Robotic Total Pelvic Exenteration Dr Ankit Sharma

ความคิดเห็น

  • @shaileshyadav7804
    @shaileshyadav7804 4 วันที่ผ่านมา

    Surya prostate ki dava kis medical store per uplabdh hai Jara bataen

  • @rajeshmali7309
    @rajeshmali7309 6 วันที่ผ่านมา

    Technically challenging

  • @LindaMalá-s7i
    @LindaMalá-s7i 8 วันที่ผ่านมา

    is a uterus transplant possible even if I don't want children anymore? I had a hysterectomy 2 years ago and I miss this organ very much for sexual functions...life without a uterus is so sad...

  • @KLGynaecologist
    @KLGynaecologist 10 วันที่ผ่านมา

    Excellent 🌹

  • @جوايفون
    @جوايفون 17 วันที่ผ่านมา

    احسنت عملا❤

  • @siviwemadiya8004
    @siviwemadiya8004 18 วันที่ผ่านมา

    Is there a possibility of being paralyzed after a lumbar lymphadenectomy

  • @favourite1944
    @favourite1944 20 วันที่ผ่านมา

    Nice work.

  • @kewlanandbelwal2463
    @kewlanandbelwal2463 หลายเดือนก่อน

    डा, साहब मेरा प्रणाम स्वीकार करें आपने मुझे नयी जिन्दगी दी है वर्ष 2004/ 2005 में आपने मेरी यूरेथोप्लास्टी की थी मैं आपके चरण छूना चाहता हूँ अगर आपका पता मिल जाता तो 🙏🙏

  • @khaliddurrani6432
    @khaliddurrani6432 หลายเดือนก่อน

    Very good, clean and expertly executed D2 gastrectomy. Thanks-

  • @amitabhsingh1000
    @amitabhsingh1000 หลายเดือนก่อน

    Nice video

  • @MrDanbo_
    @MrDanbo_ 2 หลายเดือนก่อน

    Is this mahesh desai related to neem karoli baba?

  • @gopucol
    @gopucol 2 หลายเดือนก่อน

    AUM NAMAH Shivaya. Dr Manav, your robotic surgeries and preparation of OT and equipment were so educative, and the recession and ease of handling the complex delicate procedures were commendable.I am sure your services to Amrita Hospital will be a real asset. Our prayers are for many more of your professional milestones to emerge. Regards Col Gopalakrishnan

  • @anuarora3379
    @anuarora3379 2 หลายเดือนก่อน

    Nice lecture

  • @SylvaPálová
    @SylvaPálová 2 หลายเดือนก่อน

    Its geat but for living uterus donors it is a risk. Women who’ve had hysterectomies may enter menopause almost 4 years earlier. The blood supply to the ovaries may be compromised during surgery by ligation, spasm, or thrombosis. Early menopause is known to be associated with increased cardiovascular risk such as heart attacks and strokes, as well as osteoporosis. Premature menopause can also increase the risk of dementia.Hysterectomy weakens the supports for the upper and mid-vagina, and can cause stress urinary incontinence. Removal or cutting of the ligaments supporting the cervix and vagina may predispose women to the development of vaginal vault prolapse. Furthermore, the effectiveness of prolapse repair can be compromised by the removal of the cervix and ligaments, which are used to anchor an effective repair.Studies regarding the effect of hysterectomy on a woman’s sex life can be confusing. Essentially, it depends on whether her symptoms that led her to consider hysterectomy were affecting her sex life in the first place. Women whose sex life was ruined by menstrual symptoms might find hysterectomy “liberating”, improving the sex life that they didn’t previously have. On the other hand, women whose sex life was not affected by their menstrual symptoms need to be aware that studies have demonstrated decreased libido and altered orgasm sensation, especially after total hysterectomy. Nerve damage during surgery may be a cause.For some women, uterine contraction is essential for orgasm. This could be lost after hysterectomy, leading to failure to orgasm or changes in the nature of them. Surgery may also change the anatomy of the top of the vagina, resulting in an altered sensation for women and their partners. Constipation following hysterectomy has been reported, and this may be a result of nerve injury.A recent Mayo Clinic study has shown that hysterectomy, even without removal of the ovaries, is associated with a 33% increased risk of coronary heart disease. The risk is increased by 250% if the hysterectomy is performed on women younger than 35 years of age

  • @shwetasuryawanshi9274
    @shwetasuryawanshi9274 2 หลายเดือนก่อน

    Amazing

  • @sayedeltaweel2279
    @sayedeltaweel2279 2 หลายเดือนก่อน

    sir please we need more details about the program

  • @Pellija4321
    @Pellija4321 2 หลายเดือนก่อน

    My son 2 years old had Cohen surgery in Paris Necker He it a succes! Now 16 years old !

  • @subbubaratdwaj9525
    @subbubaratdwaj9525 3 หลายเดือนก่อน

    My sun 12 eyar old disease type one jaundice daw suggest liver transplant im indian bat my hand no mani us really great

  • @subbubaratdwaj9525
    @subbubaratdwaj9525 3 หลายเดือนก่อน

  • @bestpaediatricsurgeonmumbai
    @bestpaediatricsurgeonmumbai 4 หลายเดือนก่อน

    excelent sir

  • @shantanumeshram134
    @shantanumeshram134 4 หลายเดือนก่อน

    Cost

  • @carlosg7661
    @carlosg7661 4 หลายเดือนก่อน

    Congrats!

  • @basantkaul8122
    @basantkaul8122 5 หลายเดือนก่อน

    Fantastic Sir 👍

  • @ProfBLAhuja
    @ProfBLAhuja 5 หลายเดือนก่อน

    Dr. Khanna is the best doctor in Robotic surgery in NE states. I had underwent Robotic surgery performed by Dr Khanna, in remarkable way. Prof BL Ahuja

  • @c_m_p_1
    @c_m_p_1 5 หลายเดือนก่อน

    Dr. Khanna is one of God's gift.

  • @gouthamans9375
    @gouthamans9375 5 หลายเดือนก่อน

    Our Mentor and Guru

  • @vedanshchugh1753
    @vedanshchugh1753 5 หลายเดือนก่อน

    Loved it , thank you sir

  • @SindhuJacob-lf3ty
    @SindhuJacob-lf3ty 5 หลายเดือนก่อน

    Beautifully said 👌👌👏👏. Awesome. 👍👍

  • @appdata007
    @appdata007 5 หลายเดือนก่อน

    ❤thank you sir for inspiring us..u were once taken one online class and i was answering on urthetrhroplasty 🎉🙏🏻❤️

  • @pavement-hexagon-spew
    @pavement-hexagon-spew 6 หลายเดือนก่อน

    👏 Hare Krishna...

  • @omg23417
    @omg23417 6 หลายเดือนก่อน

    He did my kidney transplant

  • @arkhan8402
    @arkhan8402 6 หลายเดือนก่อน

    Excellent work Dr Deepak.

  • @pizzaburger8159
    @pizzaburger8159 7 หลายเดือนก่อน

    Is this safe for Donor?How is the Donor doing?

  • @drhannibal.lecter
    @drhannibal.lecter 7 หลายเดือนก่อน

    😮

  • @MsSweetsoumya
    @MsSweetsoumya 7 หลายเดือนก่อน

    Dr Ashok Johari - really hats off to you sir.. I being his patient remember him exactly for what he told... I still remember the smile he had in his face when we entered in his room.. Thank you sir😊

  • @nikunjpatel2110
    @nikunjpatel2110 8 หลายเดือนก่อน

    Nicely done

  • @tripletse
    @tripletse 8 หลายเดือนก่อน

    I just had this May 9th 2024. I Ty God I made it through

  • @nama5257
    @nama5257 8 หลายเดือนก่อน

    Thanks for such good tips

  • @shivaoutlook
    @shivaoutlook 8 หลายเดือนก่อน

    Sir, please do such videos on monthly basis.

  • @drsahilbassi2807
    @drsahilbassi2807 9 หลายเดือนก่อน

    Amazing work

  • @AMS9928
    @AMS9928 9 หลายเดือนก่อน

    Thanks Dilip sir, whom to contact for tele icu seevices?

  • @gabrielwood9345
    @gabrielwood9345 9 หลายเดือนก่อน

    Amazing job

  • @Captivated2
    @Captivated2 9 หลายเดือนก่อน

    Is it true that you did not compare CRS+ chemo and CRS/HIPEC + chemo with CRS+chemo+Avastin? Doesn't adding Avastin improve progression free survival to the same extent that HIPEC seems to?

  • @dr.ketamine4752
    @dr.ketamine4752 10 หลายเดือนก่อน

    Amazing 🎉

  • @KrishnaRao-i6y
    @KrishnaRao-i6y 10 หลายเดือนก่อน

    Very nice sir

  • @dr.monowarulislamurologist5848
    @dr.monowarulislamurologist5848 11 หลายเดือนก่อน

    Huge presentation

  • @victorpao7416
    @victorpao7416 11 หลายเดือนก่อน

    I just got discharged from Narayana cardiac science for double valve replacement and tricuspid valve repair within 5 days of surgery. So glad to view this

  • @sambathbojan4654
    @sambathbojan4654 11 หลายเดือนก่อน

    Hi Sir, what are the long term affects of this surgery? Such as will she has more frequent infections? Or will there be complications if she wants to have children later on? Thanks!

  • @khushbookr3125
    @khushbookr3125 11 หลายเดือนก่อน

    Yesterday my father went with heart bypass surgery, he has lot of trust on trehan sir so he decided to take this surgery from him, thank you so much trehan sir... You are god for us.