Dr Pradeep Jain Reviews, Fortis Hospital - Laparoscopy Surgery New Horizones. High volume experience of Dr Pradeep Jain means better outcome for patients.

1. Dr Pradeep Jain
Director
Laparoscopic G I & GI Oncosurgery and Bariatric Surgery
Fortis Hospital Shalimar Bagh

2.  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 )

3.  Advancement of technology
 Awareness
 Benefit to patients
 Competitiveness among surgeons

4.  Cholecystectomy
 Appendicectomy
 Hernia repair
 Fundoplication
 Rectopexy
 Hellers myotomy
 Bariatric surgery

5.  Laparoscopy for cancers
 Pancreatic necrosis surgery
 Bariatric surgery
 SILS (single incision laparoscopic surgery )
 NOTES (natural orifice transluminal
endoscopic surgery )
 Robotic Surgery

6.  Demanding surgery
 Dissection near vessels
 Oncological clearance
 Lymphadenectomy
 Port site recurrences
 Local recurrences

7.  Colorectal cancers
 Esophagectomy
 Gastrectomy
 Distal pancreatectomy
 Whippels
 Hepatic resections

8.  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)

9.  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

10.  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

14.  Enough evidence for safety, oncological
clearances, comparable morbidity and
mortality.
 No RCTs like colorectum suggesting
equivalence to open surgery

16.  Morbidity, mortality and overall outcome not
dependent on incision
 Feasibility and safety has been documented
 Still can not be recommended as a routine

19.  Substantial decrease in mortality and
morbidity
 Improved surgical techniques
 Increased media attention
 Increased profitability

21.  SILS (Single incision laparoscopic surgery )
 NOTES ( natural orifice transluminal
endoscopic surgery )
 ROBOTICS

22.  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

24.  Hernias
 Less safe
 Wound complications
 No decrease in pain

25.  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

26.  Oral
 Rectal

 Vaginal
 Uretheral

28. 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

29.  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

35. 