LAPAROSCOPIC LIVER RESECTION
Laparoscopic liver resection is a minimally invasive approach to the liver resection procedure. It is performed under general anesthesia. During the laparoscopic liver resection procedure, very small incisions are made and a small fiber optic camera is used to remove tumors from the surface of the liver. For larger tumors or tumors located deeper within the liver, an open procedure is necessary.
The benefits of laparoscopic liver resection include minimal blood loss during the surgery, lessened pain and discomfort after the procedure, less scarring, both internally and externally, and a shorter hospital stay and recovery time. The risks associated with laparoscopic liver resection include post-operative bleeding and the risks associated with general anesthesia: heart attack, stroke, and death.
LAPAROSCOPIC CHOLEDOCHAL CYSTS EXCISION
A choledochal cyst is a congenital anomaly of the duct (tube) that transports bile from the liver to the gall bladder and small intestine. The liver produces bile to help digest food. When a patient has a choledochal cyst, a swelling of that duct, bile may back up in the liver. This can cause liver problems or inflammation of the pancreas (pancreatitis) because it blocks the main duct from the pancreas gland to the intestine. Patient with choledochal cysts have a higher rate of cancer of the bile duct in adulthood. Early treatment can reduce these risks.
There are four basic types of choledochal cysts based on where they appear:
Laparoscopic Choledochal Cysts Excision is done through small incisions using miniaturized surgical tools and cameras or telescopes. Laparoscopy usually results in less pain, less scarring and a quicker recovery time. The instruments are manipulated by the surgeon who controls their movements, while watching them on a video screen.
LAPAROSCOPIC SLEEVE GASTRECTOMY (LSG)
The sleeve gastrectomy originated as the restrictive part of the duodenal switch operation. In the last several years, it has also been used as a staging procedure prior to a gastric bypass or duodenal switch in very high risk patients. It has also been used as a primary, stand-alone procedure
Most sleeve gastrectomies performed today are performed laparoscopically. This involves making five or six small incisions in the abdomen and performing the procedure using a video camera (laparoscope) and long instruments that are placed through these small incisions.
Sleeve gastrectomy is a restrictive form of operation in which approximately 2/3rd of the left side of the stomach is removed laparoscopically using endoscopic staplers. The stomach thus takes the shape of a hockey stick or sleeve. It can be performed as either first stage of a two-stage procedure for super obese (BMI >60) where it can be followed with malabsorptive surgery or as a single stage procedure by itself.
The capacity of the stomach ranges between 60 - 100 cc. Unlike many other forms of bariatric surgery, the outlet valve and the nerves of the stomach remains intact while only the stomach size is drastically reduced. Though a non-reversible procedure, the part of the stomach that contains Ghrelin, the hormone for hunger is removed; it drastically reduces your appetite and hormones that controls diabetes.
The hour glass configuration only constricts the upper stomach thus acting as a pure restrictive operation. Since the outlet is small, food stays in the pouch longer and one also feels satiated for a longer time. Scheduled follow-up visits will be at 6 weeks, monthly for the first six months and yearly thereafter or as and when medically required.
LAPAROSCOPIC COLON RESECTION
A technique known as minimally invasive laparoscopic colon surgery allows surgeons to perform many common colon procedures through small incisions. Depending on the type of procedure, patients may leave the hospital in a few days and return to normal activities more quickly than patients recovering from open surgery.In most laparoscopic colon resections, surgeons operate through 4 or 5 small openings (each about a quarter inch) while watching an enlarged image of the patient’s internal organs on a television monitor. In some cases, one of the small openings may be lengthened to 2 or 3 inches to complete the procedure.
Advantages:
THORACOSCOPIC ESOPHAGECTOMY
Oesophagectomy is a high-risk surgical procedure which is associated with significant morbidity and mortality. Open oesophagectomy results in considerable trauma of access, generates a substantial systemic inflammatory response, and is associated with significant postoperative pain and reduced postoperative mobilization. Although oesophagectomy remains the primary treatment for patients with non-metastatic cancer of the oesophagus.there have been substantial advances in laparoscopic and thoracoscopic equipment, skills, and techniques over the last decade. Less traumatic techniques of surgery using minimally invasive techniques are now being adopted for more challenging and complex surgical procedures.
LAPAROSCOPIC PANCREATIC RESECTION
A laparoscopic distal pancreatectomy is a minimally invasive surgical procedure that is performed to remove benign or malignant (cancerous) tumors in the body or the tail of the pancreas. The surgeon most often will need to remove the spleen because it is located near the pancreas and shares some of the blood vessels.
LAPAROSCOPIC FUNDOPLICATION
The most commonly performed operation for GERD is called a fundoplication (usually a Nissen fundoplication, named for the surgeon who first described this procedure in the late 1950’s). A fundoplication involves fixing your hiatal hernia, if present, and wrapping the top part of the stomach around the end of the esophagus to reinforce the lower esophageal sphincter, and this recreate the “one-way valve” that is meant to prevent acid reflux. This can be done using a single long incision on the upper abdomen, or more commonly by minimally invasive techniques using several small incisions, called laparoscopic surgery.
Heartburn is often used to describe a variety of digestive problems, in medical terms, it is actually a symptom of gastroesophageal reflux disease. In this condition, stomach acids reflux or “back up” from the stomach into the esophagus. Heartburn is described as a harsh, burning sensation in the area in between your ribs or just below your neck. The feeling may radiate through the chest and into the throat and neck.
LAPAROSCOPIC HELLER MYOTOMY
Laparoscopic Heller myotomy is a minimally invasive procedure that opens the tight lower esophageal sphincter (the valve between the esophagus and the stomach) by performing a myotomy (cutting the thick muscle of the lower part of the esophagus and the upper part of the stomach) to relieve the dysphagia (difficulty swallowing). Further, a Dor fundoplication (a partial wrapping of the stomach around the esophagus to make a low-pressure valve) is performed to prevent reflux from the stomach into the esophagus following the myotomy. There is a very small chance that patients may develop reflux despite Dor fundoplication and may need to be treated with antacid medication. This procedure results in a great symptomatic relief.
Minimally Invasive Necrosectomy For Pancreatitis
Pancreatic necrosectomy is the surgical procedure used in the management of acute necrotising pancreatitis, a condition characterised by the inflammation of the pancreas.It is traditionally performed via an open surgery with an abdominal incision. However, concerns regarding additional morbidity, specifically related to organ dysfunction brought about by an abdominal incision, have resulted in the introduction of alternative techniques. These make use of laparoscopic equipment that are inserted in significantly smaller incisions.
After the incisions are made, the surgeon will access the abdominal cavity and the pancreas. This can be done via the transgastric, retrocolic or retroperitoneal routes. The pancreas should be thoroughly exposed, making sure that all necrotic areas and pockets are visualised.
The ultimate goal of necrosectomy is to remove all the areas of infection and necrosis. Using forceps, the necrotic pancreatic tissues and debris are removed. Dissection should be limited to areas with loose tissues, making sure that normal pancreatic tissue is preserved.
Following the procedure, drains are inserted from the pancreatic area to minimise the exposure of the abdominal contents to the pancreatic juice. A gastric tube is also placed to control secretions coming from the stomach. An appropriate access for feeding must also be inserted, typically a jejunal tube.
