current applications of laparoscopic in gi surgery
DESCRIPTION
Dr. Pradeep Jain, Fortis Healthcare Laparoscopic GI, GI Oncology Surgery Department Director, has an extensive and rich experience in gastroenterology surgery. He offers patients accurate diagnoses about their gastroenterology conditions, which might be overlooked by other doctors.TRANSCRIPT
Current Applications of Laparoscopy in advanced GI Surgery
Dr Pradeep jain M.ChDirector, Laparoscopic GI & GI Oncology and
Bariatric surgeryFortis Hospital, Shalimar bagh,
New Delhi
1901 George Kelling first laparoscopic procedure in animals 1910 Hans Christian Jacobaeus reported first laparoscopic procedures in
humans 1965 Berci introduces rode lens system 1982 video laparoscope introduced 1983 Semm performed first laparoscopic appendicectomy 1985 Muhe performed first laparoscopic cholecystectomy ( though Mouret is
often credited for first lap chole ) 1992 NIH consensus conference lap chole as preferred alternative to open
chole Decade of 90s almost every GI surgery done laparoscopically 1st decade of 2000s safety and efficacy of GI cancers established 2005 Rao and Reddy first transgastric appendicectomy
( NOTES) 2007 First NOTES in USA ( trans vaginal cholecystectomy )
History line of Laparoscopy
Introduction
General questions in the mind of a clinician before sending the patient to a Laparoscopic Gastrointestinal Surgeon
Which is superior, open or laparoscopic approach?
Is the laparoscopic approach safe?
Is the laparoscopic approach feasible?
Are the outcomes of laparoscopic approach acceptable?
YES
Laparoscopic approach is safe and feasible in the field of GI surgery
Laparoscopic method is largely accepted by medical fraternity as well as by aware general public
Laparoscopic Vs Open approach
On the basis of various randomized controlled trial laparoscopic approach is well accepted compared to open approach because it is—
Less invasive Associated with less pain and postoperative disability Require less analgesic requirement Early return of GI function Quicker improvement Better preserved pulmonary function Shorter hospital stay
Gagner M et al. Surg Clin North Am, 2004April; 84(2):451-62
Current application of laparoscopy in GI Surgery
Laparoscopy used in the diseases of –
Esophagus
Stomach
Hepato-biliary-pancreatic
Small bowel
Colo-rectal
Role of laparoscopy in GI Surgery
Diagnosis Staging Palliation Curative resections Postoperative problems- Adhesive obstruction -Incisional hernias - Leaks
Laparoscopic esophageal Surgery
Esophagectomy
Heller’s cardiomyotomy
Fundoplications
Paraesophageal hernia repair
Laparoscopic esophageal Surgery
Minimal invasive esophagectomy –
safe as complication rate is comparable to open
approach
Lymphnodes yield is comparable to open approach
Less requirement for Blood Tx, analgesics, post op
ventilation, ICU stay.
Thoraco laparoscopic esophagectomy For Ca Esophagus
Laparoscopic Gastric Surgery
Bariatric surgery
Various types of gastrectomies for malignancy
Perforated ulcers
Gastrostomy
Gastric outlet obstruction
Laparoscopic Gastric Surgery
Laparoscopic approach for bariatric surgery- GOLD STANDARD
Types of bariatric surgery done by laparoscopy- Gastric bypass Sleeve gastrectomy Adjustable gastric band BPD-DS
GASTRIC BYPASS FOR MORBID OBESITY
Laparoscopic Gastric Surgery
For gastric malignancy - LAP vs OPEN approach
No difference in tumor staging No difference in resection margins No difference in LN retrieval No difference in survival between groups
Weber KJ et al. Surg Endosc, 2003;17(6):968-71
LAP RADICAL GASTRECTOMY FOR CA STOMACH
Laparoscopic Colo-rectal Surgery
Resection of malignant tumors
Ulcerative colitis
FAP
Colonic diverticula
Laparoscopic Colo-rectal Surgery
Laparoscopic resection of colonic malignancies Overall and Disease free survival rate same No difference in carcinoma recurrences Early recovery of Bowel functions and shorter stay
Advance age, obesity, Bulky tumors or prior abdominal surgery – not absolute contraindication for LAP
LAP RADICAL RT HEMICOLECTOMY FOR CA CAECUM
LAP TOTAL PROCTOCOLECTOMY WITH “J POUCH” FOR POLYPOSIS COLI
Laparoscopic Hepato-biliary Surgery
Hepatic resections Hydatid cyst Fenestration and drainage of benign liver cysts CBD exploration CBD excision for choledochal cyst Roux-en-Y hepaticojejunostomy
LAP. LIVER RESECTION FOR HCC
Laparoscopic Pancreatic Surgery
Distal pancreatectomy Pancreatico duodenectomy Cystogastrostomy/cystojejunostomy Pancreatic necrosectomy Lateral pancreatojejunostomy Enucleation of insulinoma
LAP PANCREATIC NECROSECTOMY FOR INFECTED PANCREATIC NECROSIS
LAP DISTAL PANCREATECTOMY FOR SOLID PAPILLARY TUMOR PANCREAS
LAP CYSTOJEJUNOSTOMY FOR PANCREATIC PSEUDOCYST
Summary
Almost all Gastrointestinal surgery including Bariatric, Cancer and HepatoPancreatobiliary surgery are feasible and safe by Laparoscopy in a well structured GI Surgery Department
Thank You