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Dr Pradeep Jain Reviews, Fortis Hospital - Laparoscopy Surgery New Horizones
The document outlines the historical development and advancements in laparoscopic surgery, highlighting key milestones and procedures from its inception in the early 20th century to contemporary techniques such as SILS and NOTES. It emphasizes the clinical effectiveness, safety, and patient benefits of laparoscopic methods for various surgeries, particularly in colorectal cancer treatment, while also noting challenges and considerations for routine adoption. Key advantages of robotic surgery and the precision associated with laparoscopic techniques are discussed, alongside concerns regarding costs and complications.
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Dr Pradeep Jain Reviews, Fortis Hospital - Laparoscopy Surgery New Horizones
- 1. Dr Pradeep Jain Director LaparoscopicG I & GI Oncosurgery and Bariatric Surgery Fortis Hospital Shalimar Bagh
- 2. 1901 GeorgeKelling 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 oftechnology Awareness Benefit to patients Competitiveness among surgeons
- 4. Cholecystectomy Appendicectomy Hernia repair Fundoplication Rectopexy Hellers myotomy Bariatric surgery
- 5. Laparoscopy forcancers 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 FreeSurvival: ◦ 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 surgeryis 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 evidencefor safety, oncological clearances, comparable morbidity and mortality. No RCTs like colorectum suggesting equivalence to open surgery
- 16. Morbidity, mortalityand overall outcome not dependent on incision Feasibility and safety has been documented Still can not be recommended as a routine
- 19. Substantial decreasein mortality and morbidity Improved surgical techniques Increased media attention Increased profitability
- 21. SILS (Singleincision laparoscopic surgery ) NOTES ( natural orifice transluminal endoscopic surgery ) ROBOTICS
- 22. Safe Nopain 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 Lesssafe Wound complications No decrease in pain
- 25. Standard laparoscopyand 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 exampleof 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.