Laparoscopic surgery an over view

with with few Interesting

Laparoscopic Cases:

Dr. Sandesh K Sharma

MS. MNAMS (GI SURGERY),FACS.
Senior Consultant GI
,HPB& Laparoscopic Surgery.
National Hospital Bhopal
E-mail:- sandys2001@rediffmail.com
Current status of Laparoscopic surgery
• Recent advances in minimally invasive
surgery include laparoscopic and robotic surgery.
These surgical techniques have changed the
paradigm of surgical treatment.
• Minimally invasive surgery has the advantages of
• Minimal wound extension for cosmetic effect,
• Early postoperative recovery,
• Few postoperative complications in patients.
• Early return to work.
• Ist lap chole was done was Phillip Mouhet in
1990.
• Since then it become the procedure of choice
without RCT.
• Over 1.6 million lapchole were done globally.
• Over 16 million Lap surgeries were done
globally.
Survival advantage No of procedure
• Lap surgery has expanded from lap chole to
lap hernia to lap nephrectomy to lap whipples
to Lap liver resection.
• Early Versus Delayed Cholecystectomy, A Multicenter Randomized Trial (ACDC Study,
NCT00447304)
• Annals of Surgery 258(3):p 385-393,
• Results:
• Morbidity rate was significantly lower in group ILC (304 patients) than in group DLC (314
patients): 11.8% versus 34.4%. Conversion rate to open surgery and mortality did not
differ significantly between groups. Mean length of hospital stay (5.4 days vs 10.0
days; P < 0.001) and total hospital costs (€2919 vs €4262; P < 0.001) were significantly
lower in group ILC.
• Conclusions:
• In this large, randomized trial, laparoscopic cholecystectomy within 24 hours of hospital
admission was shown to be superior to the conservative approach concerning
morbidity and costs. Therefore, we believe that immediate laparoscopic
cholecystectomy should become therapy of choice for acute cholecystitis in operable
patients. (NCT00447304)

•
National Hospital Bhopal offer variety
of Minimal access surgical option for
wide spectrum of disease
We are equipped with most modern
and updated Hybrid OT suite
FACILITIES @ National Hospital
• OUR HOSPITAL IS EQUIPPED WITH Two MOST ADVANCE
LAPAROSCOPIC MODULAR OT .
• WHICH INCLUDES-
• 2 HD Laparoscopic System from Olympus and Stryker (USA).
• ADVANCE ENERGERY SYSTEM- THUNDER BEAT FROM
OLYMPUS.
• CUSA FROM VALLEY LAB
• ERBE ELECTROCAUTERY WITH APC
• “125 watts Multiutility LASER for MIS”
• (one stop solution for stone disease and Laser prostatectomy(HOLEP)
MODULAR OT WITH LAMINAR FLOW
OUR TEAM
 OUR DATA

LAST 10 YRS, DONE over

1500 plus LAPAROSCOPIC CASE-
• Which includes wide variety.
• Lap chole
• Lap hystrectomy.
• Lap.nephrectomy.
• lap hernias
• Lap achlasia.
• Lap colorectal cancer surgery
• Lap fundoplication
Lap fundoplication Lap achlasia
Lap cbd exploration Lap diaphragmatic hernia
Laparoscopic Lt. Adrenelectomy
POST OP STATUS POST OP SPECIMEN
 MEDIAN ARCUTE LIGAMENT
SYNDROME
• 3o year old male patient presented with
abdominal pain around and 15 kgs
weight loss over a one year period
• Pain is worsens with food intake
Laparoscopic Correction of medial
Arcute ligament syndrome
 Lap CBD exploration
• Current indicated for failed ERCP due to any
reason.
Lap CBD Exploration
 DIAPHRGMATIC HERNIA.

• 32 YRS FEMALE VOMITING AFTER MEALS.

• WEIGHT LOSS
Laparoscopic Repair of Diaphragmatic
Hernia
 Conclusion
• Major GI benign and Cancer surgery can be
performed by laparoscopic method which
results in benefit of laparoscopies in general
for patient in terms of
• Less Morbidity.
• Better Cosmosis
• Better visualization,
• Early recovery.
 Take home message
• Laparoscopic or MIS is current standard of
care for most surgical procedure.
• It offers tremendous advantages in early
recovery and cosmoses.
• Facilities and expertise available in our
hospital should be offered to patients as far as
possible.
Seasons greetings and best wishes for
Upcoming Deepwali.
Median Arcute ligament syndrome
• The median arcuate ligament is a fibrous arch that unites the
diaphragmatic crura on either side of the aortic hiatus. The
ligament usually passes superior to the origin of the celiac axis.
However, in some people, the ligament inserts low and thus crosses
the proximal portion of the celiac axis, causing compression and
sometimes resulting in abdominal pain. The diagnosis of clinically
significant celiac axis compression, referred to as median arcuate
ligament syndrome, is traditionally made with conventional
angiography; however, the condition can now be diagnosed with
three-dimensional computed tomographic (CT) angiography. In
patients with median arcuate ligament syndrome, CT angiograms
demonstrate a characteristic focal narrowing in the proximal celiac
axis. The focal narrowing has a characteristic hooked appearance,
 CT angiograms demonstrate a characteristic focal narrowing in
the proximal celiac axis. The focal narrowing has a characteristic
hooked appearance
¨ Laparoscopic vs open celiac
ganglionectomy in patients with
median arcuate ligament
syndrome, a retrospective study
by Tulloch et Al. at UCLA, 2010
¨ Laparoscopic and open
techniques are comparable.
¨ Laparoscopic decompression
offer less hospital stay and
decreased time to feeding.
¨ Late but milder recurrence of
symptoms is frequently seen
after both approaches.
LAPAROSCOPIC ARCUTE LIGAMENT
DIVISION
 Post Operative Recovery

• PT DID VERY WELL STARTED EATING

NORMALLY NO POST PRANDIAL PAIN
• UPPER GI ENDOSCOPY- VOLVULUS OF
STOMACH
• XRAY ABDOMEN-
 POST OP COURSE
• DID VERY WELL HAD ICD REMOVAL AFTER 3
DAYS
 Hiatus Hernia
• We are the only centre in Bhopal where PH
Metry and Manometry is routinely performed
.
• All our pt before undergoing antireflux surgery
go through it.
• We have done more than 50 antireflux (mostly
Nissen fundoplication ) in last 10 yrs with good
out come.
Nissen fundoplication video
 Achlasia Cardia
• Achalasia is a primary esophageal motility
disorder characterized by the absence of
esophageal peristalsis and impaired relaxation
of the lower esophageal sphincter (LES) in
response to swallowing.
• Dysphagia (most common) symptom

• Lap Hellers is currently the procedure of

choice for type 2 achlasia.
 Achlasia Treatment
• Oesophageal Ballon dilatation.
• Lap.?open heller’s Mayotomy.
• POEM
video