|Laparoscopic Hepatobiliary Surgery|
|Written by Dr Ravishankar|
Laparoscopic surgery, in the last 20 years has seen a rapid rise from laparoscopic cholecystectomy to encompass various other general surgeries like laparoscopic hernia repair, adrenalectomy and splenectomy. However because of the complex nature of surgical diseases of the liver and pancreas, the high morbidity and the risk of mortality associated with hepatectomy, pancreatectomy and pancreatic necrosectomy, the speciality has been right fully slow in adopting the laparoscopic surgery. However in the last few years laparoscopic hepatectomy, laparoscopic pseudocystogastrostomy, minimally invasive pancreatic necrosectomy, laparoscopic distal pancreatectomy are being performed.
Laparoscopic Hepatectomy is performed in a wide variety of indications like:
· Hepatic Adenomas
· Hepatocellular carcinomas in selected group of patients
· Intrahepatic bile duct cysts- liver cysts
· Cancer metastasis to liver from colon cancer and other cancers
· Indeterminate mass lesions of the liver
· Select group of Hepatitis B cirrhosis with HCC
· Symptomatic Haemangiomas and liver
Laparoscopic liver surgery offers advantages in terms of lesser blood loss, less post operative pain and early discharge from the hospital. Hence it should be considered in all patients and performed in well selected patients.
As one of the patients madam Chua put it to the news papers. “When I was told to remove the cyst (Choledochal cyst). I was quiet worried as it was my first operation. I also heard that a that a 20cm cut would be made on my abdomen. But the doctor assured me only a small cut was needed.” She was up and about in three days and her liver function tests had also normalised. “ Liver Operation..... and she’s on her feet again in three days” The New Paper Singapore 28th June 2006
Laparoscopic distal pancreatectomy is performed for a variety of lesions like:
· Mucinous tumours of Pancreas
· Cyst adenomas & Carcinomas of tail of Pancreas
· Glucaganomas and other neuroendocrine tumours of Pancreas
Laparoscopic Surgery for pancreas offers advantages in terms of less blood loss, less post operative pain and early discharge from hospital.
Dr Ravishankar K Diddapur
MBBS, MS(Gen-Surg), FRCS(Glasg), FRCS(GenSurg-Transplant), FAMS(Singapore)
Dr Ravishankar is a hepatobiliary surgeon based in Gleneagles Hospital, Singapore. He performed the first three(only three) liver transplants in patients with portal vein thrombosis at NUH. All of them were discharged well from the hospital. Performed the first living donor hepatectomy for liver transplant, Portal & Hepatic Vein anastomosis for the liver transplant in Semarang, Indonesia.