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