Dr Pradeep Jain Reviews, Fortis Hospital - Laparoscopy Surgery New Horizones

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

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  • Great publication . Allow me some comments Regarding slide 2 and 21 : The first report of transvaginal cholecystectomy (TVC) performed on August 20, 1999 at Mount Sinai Hospital of Queens, New York, was published in 2003 under the name of Culdolaparoscopy ( before the acronym NOTES) . Since then, several groups have described different modifications of the vaginal port and by using rigid or flexible endoscopes with different levels of laparoscopic assistance and TVC without abdominal ports. Minilaparoscopy Assisted Natural Orifice surgery was presented at 15TH SLS ANNUAL MEETING AND ENDO EXPO 2006 SCIENTIFIC ABSTRACTS abstract # 6117 and later published in the JSLS.
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Dr Pradeep Jain Reviews, Fortis Hospital - Laparoscopy Surgery New Horizones

  1. 1. Dr Pradeep Jain Director Laparoscopic G I & GI Oncosurgery and Bariatric Surgery Fortis Hospital Shalimar Bagh
  2. 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. 3.  Advancement of technology  Awareness  Benefit to patients  Competitiveness among surgeons
  4. 4.  Cholecystectomy  Appendicectomy  Hernia repair  Fundoplication  Rectopexy  Hellers myotomy  Bariatric surgery
  5. 5.  Laparoscopy for cancers  Pancreatic necrosis surgery  Bariatric surgery  SILS (single incision laparoscopic surgery )  NOTES (natural orifice transluminal endoscopic surgery )  Robotic Surgery
  6. 6.  Demanding surgery  Dissection near vessels  Oncological clearance  Lymphadenectomy  Port site recurrences  Local recurrences
  7. 7.  Colorectal cancers  Esophagectomy  Gastrectomy  Distal pancreatectomy  Whippels  Hepatic resections
  8. 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. 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. 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
  11. 11.  Enough evidence for safety, oncological clearances, comparable morbidity and mortality.  No RCTs like colorectum suggesting equivalence to open surgery
  12. 12.  Morbidity, mortality and overall outcome not dependent on incision  Feasibility and safety has been documented  Still can not be recommended as a routine
  13. 13.  Substantial decrease in mortality and morbidity  Improved surgical techniques  Increased media attention  Increased profitability
  14. 14.  SILS (Single incision laparoscopic surgery )  NOTES ( natural orifice transluminal endoscopic surgery )  ROBOTICS
  15. 15.  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
  16. 16.  Hernias  Less safe  Wound complications  No decrease in pain
  17. 17.  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
  18. 18.  Oral  Rectal   Vaginal  Uretheral
  19. 19. 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
  20. 20.  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
  21. 21.

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