Minimally Invasive Surgery
Laparoscopy is a procedure that enables your surgeon to look inside the abdominal cavity and pelvis to diagnose and treat a variety of abnormal conditions. A laparoscope is a long, narrow telescope with a light source and video camera at the end. The scope is passed through a small incision in the abdomen (usually close to the bellybutton). Images from the camera are projected onto a large monitor for the surgeon to view the abdominal cavity.
Laparoscopes have channels inside the scope enabling the surgeon to pass gas in and out to expand the viewing area or to insert tiny surgical instruments for treatment purposes. The surgical instruments used in operative laparoscopy are very small but appear much larger when viewed through a laparoscope.
Laparoscopy may be diagnostic, operative, or both:
Diagnostic (or staging) Laparoscopy
A laparoscopy is diagnostic when the surgeon is viewing the abdominal cavity and pelvis to find what is wrong, with or without any treatment administered at that time. This is particularly useful when other tests such as X-rays, scans, or blood work are inconclusive. The laparoscope is usually smaller as no channel is needed for surgical instruments.
Many treatments can now be performed using keyhole surgery (Laparoscopic). Laparoscopic surgery has the advantages of smaller scars and can aid the earlier return to work or normal activities. If performed laparoscopically, some procedures may involve less pain and a shorter hospital stay.
Examples of commonly performed laparoscopic procedures are appendicectomy, cholecystectomy (gallbladder) and bile duct exploration, laparoscopic splenectomy (benign and cancer) and adrenalectomy (benign). Dr Gandy also commonly performs laparoscopic procedures for many benign (non-cancerous) liver and pancreatic diseases.
Laparoscopic assisted surgery for pancreatic, liver, biliary and gastro-oesophageal cancer
A proportion of patients may be suitable for keyhole surgery to treat upper gastrointestinal cancers. In most cases these are hybrid procedures whereby parts of the operation are performed with keyhole surgery. Removal of surgical specimens and critical parts of the procedure was performed through an open incision or ‘Hand port”. However, the primary aim of treating upper GI cancers should be the safe and complete removal of the entire tumour and all involved structures and lymph glands. This provides the best chance of disease free, long-term survival and in many cases this is most appropriately achieved by conventional open surgery.
Robotic surgery is similar to laparoscopy, the main difference is the surgeon does not stand at the operating table, but sits at a control station for the surgical robot. The surgical robot has 4 arms which control the laparoscope and operating instruments. Although robotic surgery has been used for over 10 years, particularly for prostate surgery, it is still in its infancy for upper GI and general surgery. Limitations to its use are the costs of the system (which are often passed on directly to the patient), the limited benefits over laparoscopic surgery and the safety in treating upper GI and HPB cancers. It is likely that in the future the operating costs of robotic surgery will decrease and that further evidence for its use will become available.