Benefits of minimally invasive or laparoscopic procedures include less post operative discomfort since the incisions are much smaller, quicker recovery times, shorter hospital stays, earlier return to full activities and much smaller scars.
Furthermore, there may be less internal scarring when the procedures are performed in a minimally invasive fashion compared to standard open surgery.
The laparoscopic procedures performed on the pancreas are:
Diagnostic and exploratory laparoscopy in patients with cancer of the pancreas
It is estimated that 10 to 15% of all patients who are thought to have cancer confined to the pancreas on preoperative x-ray studies including CT scan are shown to have metastatic disease at the time of surgery. To avoid unnecessary open surgery we perform a diagnostic laparoscopic procedure before making a large open incision. A complete examination of the abdomen is performed to rule out the presence of metastatic disease. The patient will undergo open surgery for removal of the pancreatic cancer, if the diagnostic laparoscopic examination is normal. This is performed in a selected group of patients only.
Laparoscopic Distal Pancreatectomy
We offer laparoscopic distal pancreatectomy for endocrine and cystic tumors of the body and tail pancreas. Endocrine and cystic tumors of the pancreas are associated with an excellent outcome and are often benign or associated with a very low grade malignancy. The surgery is performed as either total laparoscopic surgery or hand assisted laparoscopic surgery.During this procedure two half inch incisions are made and a hand-access device is utilized to perform the surgery. The hand-access device incision is about 2.5 to 3 inches long.
The hand-access devices are a major advancement in laparoscopic surgery and allows the surgeon to place his/her hand into the abdomen during the surgical procedure. Patient who undergo laparoscopic distal pancreatectomy have less pain, rapid recovery and early discharge from the hospital compared to open distal pancreatectomy. Our average hospital stay for this procedure is about two days. Th
Laparoscopic central pancreatectomy
Central pancreatectomy is a complex operation performed on the pancreas by only a few surgeons in the USA for patients with a pancreatic tumor in the neck of the pancreas. The procedure provides localized removal of the tumor with preservation of the body and tail of the pancreas that would otherwise be removed as part of the distal pancreatectomy that is usually performed for these tumors. In selected patients we offer a laparoscopic approach for this procedure.
Enucleation of pancreatic islet cell tumors
Many functional pancreatic islet tumors such as insulinoma and gastrinoma are small tumors usually less than 1 to 2cm. Furthermore the tumors are often on the surface of the pancreas. The tumors have a lining around them that separates them from the pancreas.
An operation called enucleation is often performed for these tumors. In this operation the tumor is shelled out from the pancreas without removing any pancreatic tissue. This procedure avoids the operations described below which are longer associated with removal with of pancreatic tissue and require longer periods of recovery. This surgery is offered in a select group of patients.
Laparoscopic enucleation of a pancreatic islet cell tumor also allows rapid recovery, early discharge from hospital and early return to work.
Laparoscopic surgery for complication of pancreatitis
Some of the complications that patients with severe pancreatitis develop include pancreatic necrosis (dead pancreas) that requires removal, pancreatic abscesses and infections that often occur in areas of dead pancreas and pseudocysts which are localized collections of pancreatic enzymes due to an injury to the pancreatic duct from the pancreatitis.
Laparoscopic treatment of pancreatic pseudocysts
Pancreatic pseudocysts are localized collections of pancreatic fluid that has leaked out of the pancreatic duct and developed into a local swelling behind the stomach. The pseudocyst may give rise to pain, nausea and blockage of the stomach or the duodenum. The treatment is to drain the cyst into an attached organ structure such as the stomach or the intestine. For this group of patients we offer laparoscopic pancreatic pseudocystogastrostomy along with laparoscopic cholecystectomy at the same sitting.
Laparoscopic Gallbladder and Bileduct Surgery
Benefits of laparoscopic surgery
Laparoscopic procedures provide many advantages to the patient over conventional open surgery. Some of the benefits of laparoscopic surgery are less discomfort & pain after the surgery, quicker recovery times, shorter hospital stays, earlier return to full activities and much smaller scars. Furthermore, there may be less internal scarring when the procedures are performed with laparoscopic surgery compared to standard open surgery.
Laparoscopic surgery for the gallbladder and the bile duct
Laparoscopic gallbladder removal has been performed in thousands of patients throughout the world and is a very safe procedure. Gallbladder removal should be performed by laparoscopic surgery when possible.
In contrast to laparoscopic gallbladder surgery, laparoscopic procedures on the bile duct are rarely performed by biliary surgeons since they are technically very difficult. Since the bile duct is located deep in the abdomen the incisions for open bile duct surgery are long and large incisions. These incisions are usually associated with a lot of discomfort and require recovery period of 4 to 12 weeks. The majority of patients who undergo open surgery stay in hospital for 4 to 10 days after surgery compared to patients who undergo laparoscopic surgery and stay in hospital for 1 to 3 days after surgery.
The laparoscopic procedures performed on the biliary system are:
Laparoscopic cholecystectomy: In this procedure the gall bladder is removed by laparoscopic techniques. The usual indications for removal of the gall bladder for laparoscopic cholecystectomy include the presence of gallstones in the gall bladder and small benign tumors called gallbladder polyps.
Laparoscopic common bile duct exploration: In this procedure, stones in the bile duct are removed by laparoscopic techniques. In patients with gallstones small stones can pass from the gallbladder into the bile duct. Stones in the bile duct can cause obstruction leading to the development of jaundice and pancreatitis (inflammation of the pancreas). The treatment is removal of the gallbladder.
In many patients a stone that has passed into the bile duct is spontaneously excreted into the intestine. If a stone is found in the bile duct at the time of the gallbladder surgery then additional procedures are required to remove the stones. Stones in the bile duct can be removed at the time of the laparoscopic cholecystectomy by advanced laparoscopic techniques.
Resection of choledocal cysts: Choledocal cysts develop from abnormal dilatation of the bile duct that is usually congenital in origin. Choledocal cysts can lead to the development to of jaundice, pancreatitis and cancer in some patients if left untreated for many years.
The recommended treatment is removal of the choledochal cyst. The bile duct is then sutured to the intestine so that normal passage of bile is restored. In selected patients we offer a laparoscopic procedure for removal of the choledocal cyst.
Comparison of Laparoscopic Hepatectomy and Living Donor Hepatectomy
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