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- •Foreword
- •Foreword
- •Foreword
- •Foreword
- •Foreword
- •Preface
- •Acknowledgments
- •Contents
- •1.1 Introduction
- •1.4 Laser Light Characteristics
- •1.5 Thermal Relaxation Time
- •1.6 Delivery Systems
- •1.7.1 Photothermal Interactions
- •1.7.2 Photochemical Interactions
- •1.7.3 Photodisruption (Photoacoustic) Interactions
- •1.7.4 Photoablation Interactions
- •1.7.5 Plasma-Induced Ablation
- •1.8 Interaction Parameters
- •About the Author
- •1.13 Laser Safety
- •1.13.2 Precautions
- •1.14 Laser Versus Cautery
- •1.15 Your Queries! My Answers!
- •1.16 Discussion
- •1.17 Terminology
- •References
- •2.1 Introduction
- •2.3 Urogenital Triangle
- •2.5 Upper Columnar Zone: Contents
- •2.5.1 Morgagni Columns
- •2.5.2 Anal Valves
- •2.5.4 Dentate Line
- •2.5.5 Anal Papillae
- •2.5.6 Anal Cushions
- •2.5.7 Anal Transitional Zone (ATZ)
- •2.6 Intermediate Zone
- •2.7 Lower Cutaneous Zone
- •2.8 Internal Anal Sphincter (IAS)
- •2.8.2 Thickness
- •2.8.3 Importance
- •2.8.4 Innervation
- •2.8.5 Blood Supply
- •2.8.6 Functions
- •2.8.7 Features
- •2.9.1 Thickness
- •2.9.2 Functions
- •2.10 EAS (External Anal Sphincter)
- •2.10.1.1 Subcutaneous Part
- •2.10.1.3 Deep Part
- •2.10.2 Thickness
- •2.10.4 Innervation
- •2.10.5 Blood Supply
- •2.10.6 Functions
- •2.10.7 Features
- •2.11.1 Arterial Supply
- •2.11.2 Venous Supply
- •2.13 Anal Canal Lymphatic Drainage
- •2.14 Anal Canal Innervation
- •2.14.1 Above Dentate Line
- •2.14.2 Below Dentate Line
- •2.15 Anal Canal Histology
- •2.16 Pelvic Floor Muscles
- •2.16.1 Levator Ani
- •2.16.2 Blood Supply
- •2.16.3 Innervation
- •2.16.4 Functions
- •2.16.5 Features
- •2.17 Anorectal Ring
- •2.18 Anorectal Triangle
- •2.19 Anorectal Angle
- •References
- •3.1 Introduction
- •3.6.1 Sliding Anal Cushion Theory
- •3.6.2 Hypervascularization Theory
- •3.9.1 Internal Hemorrhoids
- •3.9.2 External Hemorrhoids
- •3.9.3 Mixed Hemorrhoids
- •References
- •4.1 Introduction
- •4.2 Clinical Features
- •4.2.1 Bleeding
- •4.2.2 Prolapse
- •4.2.3 Thrombosis
- •4.2.4 Mucus Discharge
- •4.2.5 Pain
- •4.2.6 Pruritus Ani
- •4.4 Physical Examination
- •4.4.1 Inspection
- •4.4.2 Palpation
- •4.4.3 Digital Rectal Examination (DRE)
- •4.4.4 Proctoscopy
- •4.5.1 Rectal Bleeding
- •4.5.2 Pain
- •4.5.3 Perianal/Rectal Mass
- •4.5.4 Mucus Discharge
- •4.6 Diagnostic Evaluations
- •4.6.1 Sigmoidoscopy
- •4.6.2 Colonoscopy
- •References
- •5.1 Introduction
- •5.2 History
- •5.3.2 Medical Management
- •5.3.2.1 Role of Flavonoids
- •5.3.2.3 Sitz Bath
- •5.3.3.1 Infra-Red Coagulation
- •5.3.3.2 Sclerotherapy
- •5.3.3.3 Rubber Band Ligation
- •5.4 A Word About Cryotherapy
- •5.5 Discussion
- •References
- •6.1 Introduction
- •6.2 Historical Background
- •6.6.1.1 Technique
- •6.6.3 Milligan-Morgan’s Hemorrhoidectomy
- •6.6.3.1 Technique
- •6.6.5 Whitehead Hemorrhoidectomy
- •6.6.7.1 Principle
- •6.6.7.2 Indications
- •6.6.7.3 Technique
- •6.7.1.1 Indication
- •6.7.1.2 Technique
- •6.7.1.3 Results
- •6.7.2.1 Indications
- •6.7.2.2 Technique
- •6.7.2.3 Results
- •6.8 Carbon Dioxide Laser Hemorrhoidectomy
- •6.8.1 Principle
- •6.8.2 Technique
- •6.8.3 Advantages
- •6.9 Radiofrequency Ablation
- •6.9.1 Principle
- •6.9.2 Technique
- •6.11.1 Bleeding
- •6.11.2 Postoperative Pain
- •6.11.3 Urinary Retention
- •6.11.5 Anal Tags
- •6.11.6 Anal Stenosis
- •6.13 Discussion
- •References
- •7.1 Introduction
- •7.2.1 Principle
- •7.2.2 Indication
- •7.2.3 Contraindication
- •7.2.4 Instrumentation
- •7.2.5 Technique
- •7.2.6 Advantages
- •7.2.7 Results
- •7.3.1 Principle
- •7.3.2 Indication
- •7.3.3 Contraindication
- •7.3.4 Instrumentation
- •7.3.5 Technique
- •7.3.6 Results
- •7.3.7 Complications
- •7.5.1 Principle
- •7.5.2 Indications
- •7.5.3 Technique
- •7.5.4 Results
- •7.6 Superior Hemorrhoidal Artery Embolization
- •7.6.1 Principle
- •7.6.2 Indications
- •7.6.3 Technique
- •7.6.4 Results
- •7.7 Discussion
- •References
- •8: Laser Hemorrhoidoplasty
- •8.1 Introduction
- •8.3 Laser Hemorrhoidoplasty
- •8.3.1 Indications
- •8.3.2 Contraindications
- •8.4.3.1 Technique
- •8.4.4 Laser Hemorrhoidoplasty
- •8.4.4.1 Energy! Dosage! Fiber! Mode
- •8.4.4.4 Postoperative Care
- •8.7 Recurrence After Laser Hemorrhoidoplasty
- •8.8.4 Postoperative Edema: (2.34%)
- •8.8.5 Thrombosis: (0.89%)
- •8.8.8 Skin Tags: (0.2%)
- •8.9 Your Queries, My Answers!
- •8.10 Discussion
- •8.11 Case Presentations
- •8.12 Bottom Line
- •References
- •9.1 Introduction
- •9.2 External Hemorrhoids
- •9.2.1 Thrombosed External Hemorrhoids
- •9.2.1.3 Clinical Evaluation
- •9.2.1.6 Postoperative Care
- •9.3 Thrombosed Internal Hemorrhoids
- •9.4 Strangulated Internal Hemorrhoids
- •9.5 Discussion
- •References
- •10.1 Introduction
- •10.2.1 Ischioanal/Ischiorectal Space
- •10.2.1.1 Boundaries
- •10.2.1.2 Contents
- •10.2.2 Perianal Space
- •10.2.2.1 Boundaries
- •10.2.2.2 Contents
- •10.2.3 Intersphincteric Space
- •10.2.3.1 Boundaries
- •10.2.3.2 Contents
- •10.2.4 Submucosal Space
- •10.2.4.1 Boundaries
- •10.2.4.2 Contents
- •10.2.6 Deep Postanal Space
- •10.2.6.1 Boundaries
- •10.2.7 Supralevator Space
- •10.2.7.1 Boundaries
- •10.2.8 Retrorectal Space
- •10.2.8.1 Boundaries
- •10.3 Anal Glands
- •10.6 A Word About Milligan’s Septum
- •10.8 A Word About Deep Intersphincteric Space
- •10.8.1 Boundaries
- •10.9 A Word About Deep Anterior Anal Space
- •10.9.1 Surgical Relevance
- •10.10 A Word About Infralevator Space
- •10.10.1 Surgical Importance
- •10.11 Discussion
- •References
- •11.1 Introduction
- •11.2 Epidemiology
- •11.8 Types of Abscesses
- •11.10 Clinical Evaluation
- •11.12 Perianal Abscess
- •11.12.1.1 Diagnosis
- •11.12.1.2 Managing Perianal Abscess
- •11.13 Ischiorectal Abscess
- •11.13.1 Managing Ischiorectal Abscess
- •11.14 Intersphincteric Abscess
- •11.14.2 Managing Intersphincteric Abscess
- •11.15 Supralevator Abscess
- •11.15.1 Managing Supralevator Abscess
- •11.16 Deep Postanal Abscess
- •11.16.1 Managing Deep Postanal Abscess (Hanley’s Technique)
- •11.16.3 Core Tip
- •11.17 Deep Anterior Anal Space Abscess
- •11.19 Horseshoe Abscess
- •11.19.1 Managing Horseshoe Abscess
- •11.20 A Word About Retrorectal Abscess
- •11.20.1 Management
- •11.23 Postoperative Care
- •11.24 Case Studies
- •11.25 Discussion
- •References
- •12.1 Introduction
- •12.2 Symptoms
- •12.3 History
- •12.4 Clinical Examination
- •12.4.1 Inspection
- •12.4.2 Palpation
- •12.4.3 Digital Rectal Examination (DRE)
- •12.4.3.1 The Internal Opening
- •12.4.3.2 The External Opening
- •12.4.4 Proctoscopy
- •12.4.5 Sigmoidoscopy
- •12.7.1 Intersphincteric Fistula
- •12.7.2 Trans-Sphincteric Fistula
- •12.7.2.1 B1: Uncomplicated
- •12.7.3 Suprasphincteric Fistula
- •12.7.4 Extrasphincteric Fistula
- •12.8.1 Simple Fistula
- •12.8.2 Complex Fistula
- •12.9.1 Anal Endosonography
- •12.9.2.1 Indications
- •12.9.2.2 Advantages
- •12.11 Evaluating Incontinence
- •12.11.1 Wexner’s Score
- •References
- •13.1 Introduction
- •13.2 Fistulotomy
- •13.2.1 Principle
- •13.2.2 Indications
- •13.2.3 Contraindications
- •13.3.1 Simple Intersphincteric Fistula (A1)
- •13.4.1 B1 Uncomplicated
- •13.4.2 B2 Complicated
- •13.7 Simple Fistulotomy Technique
- •13.7.2 Results
- •13.8 Discussion
- •13.8.1 Intersphincteric Fistula
- •13.8.2 Trans-sphincteric Fistulas
- •13.8.3 Suprasphincteric Fistula
- •13.8.4 Extrasphincteric Fistula
- •13.9 Points to Ponder
- •13.10 Core Tips
- •13.11 Fistulectomy
- •13.11.1 Indications
- •13.11.2 Technique
- •13.11.3 Advantages
- •13.11.4 Disadvantages
- •13.12 Fistulotomy Versus Fistulectomy: A Surgeon’s Dilemma!
- •13.13 Primary Sphincter Repair
- •13.13.1 Indications
- •13.13.2 Advantages
- •13.13.3 Technique
- •13.13.4 Postoperative Care
- •13.13.5 Core Tips
- •13.13.6 Discussion
- •13.13.7 Core Tips
- •13.14 Case Studies
- •References
- •14: Sphincter-Saving Techniques
- •14.1 Introduction
- •14.2 Principle
- •14.3.1 Principle
- •14.3.2 Indications
- •14.3.3 Contraindication
- •14.3.4.3 Flap Thickness
- •14.3.5 Technique
- •14.3.6 Core Tip
- •14.3.7 Advantage
- •14.3.8 Results
- •14.4 Fibrin Glue
- •14.4.1 Principle
- •14.4.3 Indications
- •14.4.4 Technique
- •14.4.5 Results
- •14.4.6 Advantages
- •14.5 Fistula Plugs
- •14.5.1 Principle
- •14.5.2 Indications
- •14.5.3 Contraindications
- •14.5.4 Technique
- •14.5.6 Complications
- •14.5.7 Results
- •14.6 Seton
- •14.6.1 Principle
- •14.6.4 Loose Setons
- •14.6.5 Tight Setons
- •14.6.6 Materials Used for Setons
- •14.6.7 Indications
- •14.6.8 Complications
- •14.6.9 Technique
- •14.6.11 Snug Seton Technique
- •14.6.12 Double Seton Technique
- •14.6.13 Kshar Sutra
- •14.6.14 Results
- •14.6.15 Core Tips
- •14.7.1 Principle
- •14.7.2 Indication
- •14.7.3 Technique
- •14.7.4 Results
- •14.7.7 Complications After LIFT
- •14.8 Video-Assisted Anal Fistula Treatment (VAAFT)
- •14.8.1 Principle
- •14.8.2 Indications
- •14.8.3 Contraindications
- •14.8.4 Equipment
- •14.8.5 Technique
- •14.8.5.1 Operative Phase
- •14.8.6 Advantages
- •14.8.7 Results
- •14.9 Stem Cells
- •14.9.1 Principle
- •14.9.2 Indications
- •14.9.3 Technique
- •14.9.4 Results
- •14.9.5 Core Tip
- •14.9.5.1 Choosing Stem Cells
- •14.10.1 Principle
- •14.10.2 Indications
- •14.10.3 Contraindications
- •14.10.4 Technique
- •14.10.5 Results
- •14.11 Discussion
- •References
- •15.1 Introduction
- •15.2 Principle
- •15.3 Indications
- •15.4 Contraindications
- •15.5 Technique
- •15.6 Pitfalls
- •15.7 Results
- •15.8 Discussion
- •15.9 Core Tips
- •15.10 Your Queries! My Answers!
- •References
- •16.1 Introduction
- •16.3 Indications
- •16.4 Contraindications
- •16.5 Hybrid Procedures
- •16.6.1 Principle
- •16.6.2 Indications
- •16.6.3 Advantages
- •16.6.4 Technique
- •16.6.5 Results
- •16.6.6 Discussion
- •16.7.1 Principle
- •16.7.2 Indications
- •16.7.3 Contraindications
- •16.7.4 FiXcision Instrument
- •16.7.5 Technique
- •16.7.6 Pitfalls
- •16.7.7 Discussion
- •16.8.1 Principle
- •16.8.2 Technique
- •16.8.3 Results
- •16.8.4 Discussion
- •16.9.1 Principle
- •16.9.2 Indications
- •16.9.3 Technique
- •16.9.4 Results
- •16.9.5 Discussion
- •16.10.1 Principle
- •16.10.2 Indications
- •16.10.3 Technique
- •16.10.4 Discussion
- •16.12.1.1 Intersphincteric Tract
- •16.12.1.2 Trans-sphincteric Tract
- •16.12.1.3 Suprasphincteric Fistulas
- •16.12.1.4 Extrasphincteric Fistula
- •16.12.1.5 Horseshoe Fistula
- •16.13 Core Tips While Performing Fistula Surgery
- •16.14 Your Queries! My Answers!
- •16.15 Case Presentations
- •16.16 Conclusion
- •References
- •17.1 Introduction
- •17.2 Epidemiology
- •17.3 Location
- •17.5 Etiology
- •17.5.1 Bascom Theory
- •17.5.2 Karydakis Theory
- •17.5.3 Stelzner Theory
- •17.6 Pathophysiology
- •17.7 Histopathology
- •17.9.1 History
- •17.9.2 Physical Examination
- •17.10 Navicular Area
- •17.12 Imaging
- •17.13 Differential Diagnosis
- •17.15.1 Principle
- •17.15.4 Energy! Dosage! Fiber!
- •17.15.5 Technique
- •17.15.6 Postoperative Care
- •17.16 Discussion
- •17.17 Case Presentation
- •17.17.1 Opinion
- •17.18 Your Queries, My Answers
- •References
- •18.1 Introduction
- •18.2 Historical Aspect
- •18.3 Epidemiology
- •18.5 Risk Factors
- •18.11 Anatomical Considerations: Why Anal Fissures Are Painful?
- •18.13.1 History
- •18.13.2 Physical Examination
- •18.13.3 Inspection
- •18.13.4 Palpation
- •18.13.5 Digital Rectal Examination (DRE)
- •18.13.6 Proctoscopy
- •18.18.2 Sitz Bath
- •18.18.3 Medical Management
- •18.18.3.1 Laxatives
- •18.18.3.3 Botulinum Toxin (Botox)
- •18.18.4 Surgical Management
- •18.18.4.1 Anal Dilatation
- •18.18.4.2 Fissurectomy
- •Open Lateral Internal Sphincterotomy
- •Closed Lateral Internal Sphincterotomy (CLIS)
- •18.18.4.4 Advancement Flap (Anoplasty)
- •18.19 Laser Lateral Internal Sphincterotomy
- •18.23.1 Management
- •18.26 Discussion
- •18.27 Case Presentation
- •18.27.1 Opinion
- •18.28 Your Query, My Answer
- •References
- •19.1 Introduction
- •19.5 Postoperative Wound Care After Anorectal Surgery
- •19.5.1 Ice Packs
- •19.5.2 Sitz Bath
- •Metronidazole
- •Sucralfate
- •Lidocaine
- •Commonest Uses
- •Commonest Uses
- •19.6 Wound Cleaning
- •19.7.1 Hemoglobin Spray
- •19.8 Discussion
- •References
- •Hemorrhoids
- •Pilonidal Sinus

Lasers in
Proctology
Kamal Gupta
123

Lasers in Proctology

KamalGupta
Lasers in Proctology

KamalGupta
Department of Surgery
Karan Hospital
Jalandhar, India
ISBN 978-981-19-5824-3 ISBN 978-981-19-5825-0 (eBook)
https://doi.org/10.1007/978-981-19-5825-0
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Singapore Pte Ltd. 2022
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher,
whether the whole or part of the material is concerned, specically the rights of translation,
reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any
other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specic statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, expressed or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore
189721, Singapore

Dedicated to
A few good women
My mother, Mrs. Ved Gupta; my wife, Dr. Ruby; and my
daughters Ankita and Nikita
and
A few good men
My father, Dr. Sat Paul Gupta; my mentor, Guru, and teacher,
Dr. Kushal Mital; and my friend and critic, Dr. Niranjan
Agarwal

Foreword
In the last decade, there has been a surge in publications on Lasers in
Proctology. Many surgeons own laser equipment, yet there is no in-depth nar-
rative on using lasers in proctology. A considerable variation in results, the
wavelength used, type of laser machines, and amount of energy used has been
mentioned in the literature, leaving a surgeon dazed. The missing piece is
how exactly the procedure is done, how to select patients, how much energy
is safe, and what steps are to be taken to avoid potential complications. The
book Lasers in Proctology arrives when there is a surge in patients opting for
lasers for anorectal diseases.
Lasers in Proctology is a comprehensive book with 19 chapters spread
over 200 pages with more than 200 professional illustrations, giving in-depth
knowledge of the “Art of Application of Laser Technology in Proctology.” If
a surgeon is practicing proctology, this book should be read cover to cover,
over and over again. After reading it, practice it. You would notice a difference in the outcome of the results.
The book came out on the demand of surgeons using LASERS in practice.
I met Dr. Kamal Gupta for the rst time in the Minimal Invasive Benign
Proctology course at CeMAST, Mumbai, in 2017. He was a student seeking
knowledge, and I was the Director and one of the course faculty. As a student,
he was seeking answers to never-ending questions. At the time, he was far
ahead of us in lasers but not quite getting the desired results. After thoroughly
understanding the anatomy taught in the course, he focused on improving
outcomes in patients undergoing laser surgery. After he proved that lasers
were safe and the techniques reproducible, he was offered a faculty position
to teach lasers in proctology at CeMAST.
Over the next 6 months, he sent me over 300 articles from PubMed on
lasers in proctology and videos of his procedures. Impressed, I invited him to
train me in lasers for all anorectal diseases. In three sessions, one each month,
I did 30 cases with him hovering over me. The next step was to promote safe
laser surgery among surgeons across India. Because of the repeatable techniques, safety, and good results, soon he was a guest speaker at all surgical
conferences in India. He started demonstrating live surgeries in the conferences, and surgeons started following his surgical techniques.
As the tale goes, he has been faculty at IMMAST (formerly known as
CEMAST), Mumbai, India, and MASST, Chennai, India, since 2018 and
2022, respectively. I was his strongest critic. Newer techniques were designed,
lower wattage was used, different sites of entry points were devised, and
vii

viii
safety points were created. Above all, everything was documented. Several
papers have been published on the laser in proctology in the past 4 years.
However, one issue was left, how do we train surgeons worldwide? It is
just not laser surgery; he needed surgeons to understand why a particular
method was used. The book Laser in Proctology answers all the queries.
Lasers in Proctology book has been built from the base up. The text is
written in a simple format as if the author is speaking to the reader. The
author offers time-tested techniques based on evidence-based practices to
improve patient management outcomes.
I wish the best for Dr. Kamal Gupta. The readers are in for a surgical feast.
KushalMital
Hon. Secretary
Association of Colon and Rectal
Surgeons of India
Medicare Hospital
Thane, Maharashtra, India
Foreword

Foreword
It is a proud privilege to write this foreword for this book authored by Dr.
Kamal Gupta. Having witnessed his journey in the eld of proctology for the
last 5–6 years, I have no reservations in acclaiming that I am yet to see a more
dedicated person in the eld. His yearning to know the minutest details of the
anal canal anatomy,the various principle behind each surgery, and the reasons for their failures based on anatomy physiology have made him a perfectionist, if I could call it so. He is never tired of learning, de-learning, relearning,
and readopting anything in proctology. His indent knowledge in the eld of
laser proctology is unmatched, and his desire to teach the intricacies of the
same to all has persuaded him to write this book.
Having him as aco-author for the chapter on hemorrhoids, I can tell he can
improvize on anything he writes within a day. This is because he reads and
studies the topic repeatedly and has something new to add every time.
Though he describes me as hisstrongest critic, I know how impressed I am
with this personality. His penchant for learning and teaching has resulted in
developing clear concepts in this eld.
This book of his on lasers in proctology reects his hard work. It will act
as a ready reckoner for the readers to understand the various aspects of anorectal disorders as well as their surgical management, especially the laserbased procedure. He has explained each aspect in simple language and helps
develop a clear understanding of the subject. The opinions of surgeons with
extensive training who, in some or other way, are experts in their respective
elds speak volumes about the book. His innovative ideas of hybridizing
minimally invasive procedures in proctology have shown great results. If
duplicated by others may lead to change in gold standard managements of
some of these disorders.
In addition to general surgeons, surgery residents, and medical students
interested in laser surgery, the book will hopefully be a source of helpful
knowledge and perhaps even a guide for surgeons who want to develop expertise in the eld of lasers in colorectal surgery. Kamal has put a lot of work into
the book, taking time out of his hectic schedule to put his frequently original
perspectives on paper.
I commend Kamal on his superb work in publishing this textbook. I'm
expecting that after reading this book, readers will have new insights into the
concept of employing lasers in anorectal surgery, especially in stula surgery,
where it’s crucial to know when to use lasers and when not to.
ix

x
To conclude, I must say everything may be accomplished by taking small
steps, one at a time: overcoming anxieties and apprehensions, realizing aspirations, or becoming someone you want to be different from the mass.
The journey of a thousand miles begins with one step.—Lao Tzu.
NiranjanAgarwal
Consultant Colorectal Surgeon
Bombay Hospital
Mumbai, India
Foreword

Foreword
My rst reaction to Kamal’s request for a foreword was a surprise mixed with
great satisfaction of his achievements in such a short time over a decade. I
vividly remember an inquisitive young surgeon asking me for a few minutes
to discuss various aspects of anorectal problems, predominantly DGHAL
AND RAR.I always enjoyed expressing tricks and tips for success in these
procedures. Shortly, I started seeing him as a faculty performing surgeries at
state, national, and international conferences. This was soul-satisfying to me
as he addressed me as his GURU.He focused more and more on Lasers in
Proctology, soon becoming famous as the LASER MAN OF INDIA.Now
was the turn of Guru, making students learn laser procedures in anorectal
surgeries. He has trained over 400 surgeons in laser in anorectal procedures
through regular workshops.
I saw an excellent teacher in him, inspiring, talented, precise, revealing
tricks and tips, and encouraging full audience participation. Thus, teacher in
him evolved to a level to research, study, get peers’ views, discuss, express,
and write a comprehensive book. Right from anatomy, physiology, physiopathology, and functional disturbances, he has written so well that with the academic experience of decades, I feel this book will be a boon in understanding,
practicing, managing complications, and improving their skills by practical
demonstrations and live operating workshops to young surgeons and experienced to refresh the standard to latest advances in knowledge. Kamal has
solicited a galaxy of authors of repute to contribute and share their less-known
secrets of success in this broad specialty.
It is a great pleasure to see a student and my teacher in laser proctology
progressing so fast and so well with a down-to-earth attitude and exemplary
humility.
I wish him all success in life.
NEVER MISTAKE KNOWLEDGE FOR WISDOM.ONE HELPS YOU MAKE A
LIVING, AND THE OTHER HELPS MAKE A LIFE.
Prof. (Dr.) RamaKant
Former Head of Department of Surgery
King George Medical University
Lucknow, India
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