Dr Pradeep Jain Reviews, Fortis Hospital - Laparoscopy Surgery New Horizones
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Transcript of Dr Pradeep Jain Reviews, Fortis Hospital - Laparoscopy Surgery New Horizones
LAPAROSCOPIC SURGERYLOOKING BEYOND EXISTING HORIZONS
Dr Pradeep Jain Director
Laparoscopic G I & GI Oncosurgery and Bariatric Surgery Fortis Hospital Shalimar Bagh
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
Advancement of technology Awareness Benefit to patients Competitiveness among surgeons
Why this “KOLAVERI DI”
Cholecystectomy Appendicectomy Hernia repair Fundoplication Rectopexy Hellers myotomy Bariatric surgery
Gold standard
Laparoscopy for cancers Pancreatic necrosis surgery Bariatric surgery SILS (single incision laparoscopic surgery ) NOTES (natural orifice transluminal
endoscopic surgery ) Robotic Surgery
Demanding surgery Dissection near vessels Oncological clearance Lymphadenectomy Port site recurrences Local recurrences
Cancer concerns
Colorectal cancers Esophagectomy Gastrectomy Distal pancreatectomy Whippels Hepatic resections
Disease Free Survival: ◦ Comparative Randomised Studies
Barcelona (Lacy 2002) USA (COST 2004) Hong Kong RCT (Leung 2004) New Mexico (Curet 2000) Los Angeles (Kaiser 2004)
Evidence to Support Laparoscopic Colorectal Surgery
Clinical Effectiveness◦ Shorter length of stay◦ Fewer complications◦ Less blood loss & use of blood products◦ Less pain & analgesia◦ Quicker return to normal activities◦ Better cosmesis◦ Incidence of port site metastases is 1%
Equivalent to open surgery
Evidence to Support Laparoscopic Colorectal Surgery
Laparoscopic surgery is recommended as an alternative to open surgery for colorectal cancer…..
The surgeon has been trained in laparoscopic surgery for colorectal cancer and performs the operation often enough to keep his skills up to date
NICE guidelines laparoscopic colorectal cancer - August 2006
Laparoscopic APR
Laparoscopic Ant Resection
Laparoscopic Hemicolectomy
Enough evidence for safety, oncological clearances, comparable morbidity and mortality.
No RCTs like colorectum suggesting equivalence to open surgery
Lap esophagectomy, gastrectomy,distal pancreatectomy
Thoracolaparoscopic Esophagectomy
Morbidity, mortality and overall outcome not dependent on incision
Feasibility and safety has been documented
Still can not be recommended as a routine
Lap Whippels , Hepatic Resection
Laparoscopic liver resection
Lap. Pancreatic Necrosectomy
Substantial decrease in mortality and
morbidity Improved surgical techniques Increased media attention Increased profitability
Bariatric Surgery
Laparoscopic Bariatric Surgery
SILS (Single incision laparoscopic surgery )
NOTES ( natural orifice transluminal endoscopic surgery )
ROBOTICS
New kids on the block
Safe No pain No scar No post operative complication No loss of activity Out patient Any body can have it Inexpensive All surgeon can do it
Goals of minimally invasive surgery
SILS
Hernias Less safe Wound complications No decrease in pain
Concerns of sils
Standard laparoscopy and hernia 0.08 to 0.14 % port hernia >400 articles in print - no reported data on
port site hernia
Hussain et al :J soc of lap surg 2009
SILS and Hernia
Oral
Rectal Vaginal
Uretheral
Natural orifice transluminal endoscopic surgery ( NOTES )
NOTES
SILS NOTES
Safe +/- +/-
No pain - +/-
No scar +/- +
No complication +/- -
No loss of activity
- +/-
Out patient +/- +/-
Every body can have it
+ -
inexpensive - -
All surgeon can do it
- -
SILS VS NOTES
Best example of man machine combination Advantages - Precision - 3 D magnification - Articulation beyond normal manipulation - Miniaturization Disadvantages - Cost - Advantage over routine laparoscopy not
established except urological and cardiac procedures
Robotic surgery
Robotic Surgical Cart
Robotic Endowrist
OT schema
Robotic OT layout
The end of the beginning
Thanks