‘Laparoscopic Surgery for Gastrointestinal Cancer’

‘Laparoscopic Surgery for Gastrointestinal Cancer’

– Key Hole Surgery

 

What is laparoscopic surgery?

Laparoscopic or “minimally invasive” surgery is a specialized minimally invasive technique for performing surgery. Presently this technique is commonly used for gall bladder surgery. Over the last 10 years the use of this technique has expanded into gastrointestinal surgery.

Laparoscopic surgery uses several 0.5-1cm incisions. Each incision is called a “port.”  At each port a tubular instrument known as a trocar is inserted.  Specialized instruments and a special camera known as a laparoscope are passed through the trocars during the procedure.. The laparoscope transmits images from the abdominal cavity to high-resolution video monitors in the operating room. During the operation the surgeon watches detailed images of the abdomen on the monitor. This system allows the surgeon to perform the same operations as traditional surgery but with smaller incisions.

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What are the advantages of laparoscopic surgery?

Compared to traditional open surgery, patients often experience

• less pain,
• early recovery
• a shorter hospital stay, and
• Less scarring with laparoscopic surgery.

 

What kinds of cancer operations can be performed using laparoscopic surgery?

Most Gastro-intestinal surgeries can be performed using the laparoscopic technique. These include surgery for Colon & rectum, Bariatric surgery (weight loss surgery), Gastric bypass, Fundoplication, rectal prolapse etc.

However newer advances have made laparoscopic surgery feasible & safe for GI cancers like:

• Esophagus cancer:
  • Thoracoscopic & Laparoscopic Surgery
• Stomach cancer:
  • Staging Laparoscopy, Distal Gastrectomy, Palliative Bypass
• Pancreas cancer:
  • Staging Laparosocpy, Distal Pancreatectomy
• Spleen:
  • Laparoscopic Splenectomy
• Colon & rectum cancers:
  • Hemicolectomy, Anterior Resection, APER procedures
• Liver cancer:
  • Diagnostic & staging Laparoscopy, Left lateral segmentectomy
• Gall Bladder cancer:
  • Staging Laparoscopy & Biopsy, Palliative Cholecysto-jejunostomy for jaundice.

 

How safe is laparoscopic surgery ?

In the past there had been concern raised about the safety of laparoscopic surgery for ­cancer operations. Recently several studies involving hundreds of patients have shown that laparoscopic surgery is safe for certain ­ cancers highlighted above.

Laparoscopic surgery is as safe as traditional open surgery. At the beginning of a laparoscopic operation the laparoscope is inserted through a small incision near the belly button (umbilicus). The surgeon initially inspects the abdomen to determine whether laparoscopic surgery may be safely performed. 

Any Gastro-intestinal surgery is associated with ­certain risks such as complications related anesthesia and bleeding or infectious complications. The risk of any operation is determined in part by the nature of the specific operation. An individual’s general heath and other medical conditions are also factors that affect the risk of any operation. You should discuss with your surgeon your individual risk for any operation.

 

For any queries contact your GI Surgeon:

 

Dr Manish Joshi –  Bangalore

Email:  docjoshi@gmail.com

+91-8197910166

 

Dr Manish Joshi

MBBS, MS, MRCS (UK), DNB – GI SURGERY, FHPB

Consultant Surgical Gastroenterologist, HPB Surgeon

& Advanced Laparoscopic Surgeon

St John’s Medical College Hospital, Bangalore

Motto: ‘ Patient comes first’

GALLSTONES – ALL YOU NEED TO KNOW BEFORE SURGERY

Patient information from your GI Surgeon

Gallstones

Gallstones are common but cause no symptoms in two out of three people who have them. They sometimes cause problems such as pain, jaundice, pancreatitis, and gallbladder inflammation. Surgery is the usual treatment for gallstones that cause symptoms.

Understanding the gallbladder and bile

The gallbladder lies under the liver on the right side of the upper abdomen. It is like a pouch which comes off the main bile duct and fills with bile. It is a ‘reservoir’ which stores bile. The gallbladder contracts (squeezes) when we eat. This empties the stored bile back into the main bile duct. The bile passes along the remainder of the bile duct into the duodenum (the first part of the gut after the stomach).

Bile helps to digest food, particularly fatty foods.

What are gallstones?

Gallstones occur when bile, which is normally fluid, forms stones. Gallstones commonly contain lumps of cholesterol-like (fatty) material that has solidified and hardened. Sometimes bile pigments or calcium deposits form gallstones. Sometimes just a few small stones are formed; sometimes a great many. Occasionally, just one large stone is formed.

About one in three women, and one in six men, form gallstones at some stage in their life. Gallstones become more common with increasing age.

The risk of forming gallstones increases with pregnancy, obesity, rapid weight loss, having a close relative with gallstones, diabetes and if you take certain medicines such as the contraceptive pill.

What problems can gallstones cause?

Commonly they cause no problems

Most people with gallstones do not know they have them. It is common to have stones in the gallbladder that cause no symptoms. (Because gallstones are common, they are often found when the abdomen is scanned).

Possible problems

About one out of three people with gallstones develop symptoms or problems. Symptoms are more likely to develop in smokers and women who have had babies. Symptoms include:

• Biliary colic. This is a severe pain in the upper abdomen. The pain is usually worst to the right-hand side, just below the ribs. It is caused by a stone that gets stuck . The gallbladder then squeezes hard to dislodge the stone, and this causes pain. The pain eases and goes if the gallstone is pushed out into the bile duct (and then usually out into the gut), or if it falls back into the gallbladder.

  Pain from biliary colic can last just a few minutes but, more commonly, lasts several hours. A severe pain may flare up from time to time. Sometimes less severe but niggly pains occur now and then, particularly after a fatty meal when the gallbladder contracts most.

  

• Inflammation of the gallbladder. This is called cholecystitis. Symptoms usually develop quickly and include abdominal pain, fever etc. You will normally be admitted to hospital and have your gallbladder removed soon if you develop this problem.
• Jaundice. This is an uncommon complication of gallstones. It occurs if a gallstone comes out of the gallbladder, but gets stuck in the bile duct. It is common to need an operation to remove a gallstone which has become stuck in the bile duct. (Note: there are many other causes of jaundice apart from gallstones.)
• Pancreatitis. This is an inflammation of the pancreas. The pancreatic duct and bile duct join together just before opening into the duodenum. If a gallstone becomes stuck here it can cause pancreatitis which is a painful and serious condition.
• Other complications like Cholangitis (severe infection) are uncommon.

How are gallstones diagnosed?

In many cases your symptoms, combined with tenderness in the upper right side of your abdomen, will alert the doctor that this is likely to be gallstones. However, tests are sometimes needed to rule out other conditions such as stomach ulcers, irritable bowel syndrome and tumours. Scans and blood tests are the most common investigations done.

What are the treatments for gallstones?

No treatment is needed in most cases

It is often best to leave gallstones alone if they cause few or no symptoms.

Medication

Once gallstones start giving symptoms, surgery is the best treatment. However, you may be given painkillers and antibiotics through a drip if the gallbladder gets infected. Surgery is performed once the infection settles down – usually a week later.

Surgery

An operation to remove the gallbladder is the usual treatment if you have symptoms caused by gallstones.

• Keyhole surgery is now the most common way to remove a gallbladder. The medical term for this operation is laparoscopic cholecystectomy. It is called keyhole surgery as only small cuts are needed in the abdomen with small scars remaining afterwards. The operation is done with the aid of a special telescope that is pushed into the abdomen through one small cut. This allows the surgeon to see the gallbladder. Instruments pushed through another small cut are used to cut out and remove the gallbladder.
• Keyhole surgery is not suitable for all people.
• Some people with gallstones need a traditional operation to remove the gallbladder. This is called cholecystectomy. In this operation a larger cut is needed to get at the gallbladder.
• Other surgical procedures may be needed if a stone gets stuck in the bile duct.

After a gallbladder is removed

You do not need a gallbladder to digest food. Bile still flows from the liver to the gut once the gallbladder is removed. However, there is no longer any storage area for bile between meals. The flow of bile is therefore constant, without the surges of bile that occur from a gallbladder when you eat a meal.

You can usually eat a normal diet without any problems after your gallbladder is removed.

For any queries,

contact your surgeon : +91-8197910166

Dr Manish Joshi

MS, MRCS (UK), DNB – GI Surgery

Consultant Surgical Gastroenterologist,

Endoscopist & Advanced Laparoscopic Surgeon

For appointments and emergencies contact:

Why Laparoscopic (KEY-HOLE) Surgery ?

Surgical Gastroenterologist , endoscopist & Advanced Laparoscopic Surgeon

Dr Manish Joshi MBBS, MS, MRCS (UK), DNB – GI SURGERY Consultant Surgical Gastroenterologist, GI oncologist & Advanced Laparoscopic Surgeon

Motto: ‘ Patient comes first’

Speciality Interests:

Laparoscopic (Key-hole) Surgery

1. GI cancers:

a. Colorectal cancers : Laparoscopic (key-hole) surgery – anterior resection / APR/ Hemicolectomy

b. Stomach (Gastric) cancers: Laparoscopic Gastrectomies / palliative GJ

c. Pancreatic cancers: Whipple’s procedure

2. GI disorders:

a. Gallstone : Single incision / Laparoscopic Cholecystectomy

b. CBD stones: Laparoscopic CBD Exploration

c. Biliary Strictures: Hepatico-Jejunostomy

d. Oesophageal replacements for stricture, cancer

3. Bariatric Surgery(Obesity surgery) : Laparoscopic Sleeve Gastrectomy

 

Benefits of Laparoscopic (Key Hole) surgery:

Much evidence in medical literature (evidence based medicine) to show:

For the patient:

1. Early recovery

2. Less pain, less pain killers

3. Short hospital stay

4. Early return to work

5. Less wound problems

6. cosmetic

Any benefit for the Surgeon:

1. Satisfied patient

2. Newer advances to benefit patient are utilised

 

Is it Costly? :

nowadays, the cost is equal to open surgery with better short term benefits.

WHich procedures are suitable for Laparoscopic (keyhole) surgery ?

Almost all surgical procedures can be done by both laparoscopic (key-hole) or open surgery

Please consult your doctor

 

regards,

 

Dr Manish Joshi

+91-8197910166

docjoshi@gmail.com

Surgical Gastroenterologist , endoscopist & Advanced Laparoscopic Surgeon

Dr Manish Joshi

MBBS, MS, MRCS (UK), DNB – GI SURGERY

Consultant Surgical Gastroenterologist, GI oncologist & Advanced Laparoscopic Surgeon

Motto: ‘ Patient comes first’

Professional Qualifications

Dip N B – Surgical Gastroenterology, 2010

Hepatobiliary & Liver transplantation Fellowship, 2007

MRCS – Royal College of Surgeons, Edinburgh 2005

Dip N B – General Surgery 2004

MS – General Surgery – Bangalore Medical College, Bangalore, India 2003

MBBS – Gulbarga University, Gulbarga, India 2000

Speciality Interests: Laparoscopic (Key-hole) Surgery

1. GI cancers:

a. Colorectal cancers : Laparoscopic (key-hole) surgery

– anterior resection / APR/ Hemicolectomy

b. Stomach (Gastric) cancers: Laparoscopic Gastrectomies / palliative GJ

c. Pancreatic cancers: Whipple’s procedure

2. GI disorders:a. Gallstone : Single incision / Laparoscopic Cholecystectomy

   b. CBD stones: Laparoscopic CBD Exploration

   c. Biliary Strictures: Hepatico-Jejunostomy

   d. Oesophageal replacements for stricture, cancer

3. Bariatric Surgery(Obesity surgery) : Laparoscopic Sleeve Gastrectomy

Dr Manish Joshi has trained in various places of surgical excellence all across India and abroad from the best of the masters over the last 10 years.From Dr Ramesh Ardhanari in Madurai to Dr Adarsh Chaudhary & Dr Pradeep Chowbey in Delhi for Gastrointestinal surgery especially Laparoscopic (key-hole) surgeries. He has also trained in UK and USA for Laparoscopic and endoscopic procedures.

Dr Manish Joshi did his undergraduation from Mahadevappa Rampure Medical College, Gulbarga. His surgical training started from Bangalore Medical College where he completed with honours his masters degree in General surgery in 2003. Subsequently he consolidated his skills and overall patient management in the NHS Hospitals, United Kingdom and obtained the membership of prestigious Royal College of Surgerons, Edinburgh in 2005. Further he specialised in Hepatopancreatobiliary and Liver Transplant fellowship from Sir Gangaram Hospital in 2007, with mentors Dr Samiran Nundy, Dr Arvinder Soin and Dr Adarsh Chaudhary. He continued his academic zeal and successfully completed his superspeciality masters degree in Gastrointestinal surgery in 2010 from Meenakshi Mission Hospital and Research Centre, Madurai with the reknowned Laparoscopic master surgeon – Dr Ramesh Ardhanari.

Dr Manish Joshi has presented several papers and posters in National and international conferences. He has been awarded the Travel Bursary by the Indian Association of Surgical Gastroenterologist in 2009.His recent article ‘Single incision Laparoscopic splenectomy’ was published in the Journal of minimal access surgery – Oct 2010.

With gratitude to his surgical mentors and to his patients and with a penchant for newer technologies Dr Manish Joshi strives to enhance the laparoscopic approach to GI cancers and disorders as Laparoscopic surgery helps the patient recover early with less pain and short hospital stay.

Dr Manish Joshi strongly believes in integrating the individual patients values and beliefs with evidence based surgery to lessen the complexity of cancer and its treatment for the patient.

Motto: ‘Patient comes first’

Contact: Dr Manish Joshi

e: docjoshi@yahoo.com

Ph: +91-8197910166

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