- Diagnostic Endoscopy
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Upper GI Scopy is a procedure that allows the physician to examine the inside of the esophagus, stomach, and duodenum with the help of a thin, flexible, lighted tube, called gastroscope. It is done from the mouth. |
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Colonoscopy is a procedure that allows the physician to view the entire length of the large intensive with a long, flexible, lighted tube, called Colonoscope. It is done from anus.
The Diagnostic Endoscopy procedures can help identify abnormal growth, inflamed tissue, ulcers, and bleeding. |
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ERCP (Endoscopic Retrograde Cholangiopancreatography)
is used primarily to diagnose and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP combines the use of x rays and an endoscope, which is a long, flexible, lighted tube. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x rays. |
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Bronchoscopy is a procedure that allows your doctor to look at your airway through a thin viewing instrument called a bronchoscope. During a bronchoscopy, your doctor will examine your throat, larynx, trachea, and lower airways.
Bronchoscopy may be done to diagnose problems with the airway or to treat problems such as an object or growth in the airway |
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- EMERGENCY LAPAROSCOPY:
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EMERGENCY LAPAROSCOPY It gives us important information in a minimally traumatic way. They are indicated in acute abdominal abdominal pain like Right lower abdominal pain ( R/O Gynaecological pathology), Peritonitis, mesenteric ischaemia, draining intrabdominal abscess ( not amenable to image guided drainage), Acalculus cholecystitis, small bowel obstruction, fever of unknown origin, gastro intestinal hemorrhage of unexplained etiology. It is also useful in blunt abdominal trauma as well as penetrating trauma to exclude peritoneal penetration and to evaluate diaphragmatic injuries. |
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- Hernia procedures:
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- Laparoscopic inguinal hernia repair: repair of the groin hernias (including recurrent hernias).
- Laparoscopic ventral hernia repair: repair of the hernias in the middle or on the side of the abdomen (usually resulting from a congenital defect or prior surgeries.
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- Gallbladder stones and liver procedures:
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- Laparoscopic cholecystectomy: removal of the gallbladder for a variety of reasons, such as stones.
- Laparoscopic common bile duct exploration: removal of the stones that escaped the gallbladder and are now lodged in the bile ducts
- Laparoscopic liver resection: removal of the diseased part of the liver for an infection, growth or cancer
- Laparoscopic cholecystojejunostomy for carcinoma of the head of the pancreas and other obstructive lesions of the peri ampullary region where stenting is not possible
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- Procedures on esophagus/ myotomy/fundoplication:
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- Minimally invasive esophagectomy: removal of the entire esophagus for a variety of benign conditions or cancer
- Laparoscopic Heller myotomy: treatment for achalasia
- Laparoscopic fundoplication: treatment of heartburn (gastro-esophageal reflux disease).
- Laparoscopic hiatal hernia repair: repair of the hole in the diaphragm muscle usually causing heartburn.
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- Procedures on the stomach cancer:
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- Laparoscopic gastrectomy: removal of the part of the stomach for tumors (smooth muscle tumours, some gastric cancers, gastric lymphoma) or intractable peptic ulcer disease
- Laparoscopic gastrostomy when PEG cannot be performed or contraindicated
- Laparoscopic placation of perforated ulcer
- Laparoscopic gastrojejunostomy for byepass of distal gastric, pyloric or duodenal obstruction, generally when the patient is not considerd to be a candidate for a more definitive procedure
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- Procedures on the small intestine ( Crohns disease):
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- Laparoscopic small bowel resection: removal of the diseased portion of the small of the intestine for bleeding, tumors, diverticula,stricture or inflammatory bowel disease (Crohn’s disease)
- Laparoscopic small bowel bypass: bypass around the intestinal blockage
- Laparoscopic Meckel’s diverticulectomy: removal of a Meckel’s diverticulum
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- Procedures on pancreas
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- Laparoscopic distal pancreatectomy with spleenectomy for tumours of of the tail and distal body of the pancreas
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- Procedures on other organs:
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- Laparoscopic splenectomy: removal of the spleen for many hematological disease, and tumours
- Laparoscopic adrenalectomy: removal of the adrenal gland.
- Laparoscopic appendectomy: removal of the appendix for appendicitis or other conditions
- Laparoscopic pancreatectomy: removal of the diseased pancreas for cysts, tumors or inflammation
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- VIDEO ASSISTED THORACIC SURGERY:
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Diagnostic:
- Indeterminate Pleural Effusion( Benign – Malignant)
Tissue diagnosis:
- Pleural based masses ( Metastatic Adenocarcinoma vs Mesothelioma
- Diffuse interstitial lung disease
- Indeterminate peripheral lung nodules
- Mediastinal Lymph node biopsy
- Mediastinal Mass biopsy
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Therapeutic Pleuropulmonary :
- Pleural effusion/ Empyema
- Pleurodesis ( Thermal/ mechanical/ Chemical/ Talc
- Bullous disease ablation/ Resection
- Wedge resection of early – stage lung cancer in selected high risk patients
- Anatomical resection for lung cancer
Esophageal:
- Resection of leiomyoma
- Resection of enteric cysts
- Esophagomyotomy for Achalasia cardia
- Antireflux surgery for intractable gastroesophageal reflux disease
- Esophagectomy for canceres
Esophageal:
- Resection of leiomyoma
- Resection of enteric cysts
- Esophagomyotomy for Achalasia cardia
- Antireflux surgery for intractable gastroesophageal reflux disease
- Esophagectomy for canceres
Mediastinal:
- Thymectomy for myasthenia grevis
- Thymectomy for stage 1 Thymoma
- Resection of mediatinal tumours, neurogenic mass,cysts
- Drainage of pericardial effusion/ pericariectomy
Other miscellaneous/ Hyperhidrosis:
- Dorsal Sympathectomy/ Splanchnicectomy
- Drainage of paravertebral abscess
- Discectomy
- Internal mammary harvesting for bypass
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- Laparoscopic Colonic Cancer/Rectal Cancer Surgery/ Laparoscopic Rectopexy/ Diverticular Disease:
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Laparoscopic anterior resection, APR, sub total colectomy and right hemicolectomy for cancer, infection, inflammation (including Crohn’s disease and ulcerative colitis) and bleeding, Laparoscopic rectopexy for rectal prolapse ,Laparoscopic colostomy for unresectable pelvic cancers,recto veginal fistula, complex peri anal fistulas, peri anal sepsis, fecal incontinence
The treatment of colorectal cancer with the laparoscopic approach is slowly gaining acceptance throughout the world. A newly published research paper on laparoscopic total colectomy for colorectal cancers in Surgical Endoscopy clearly establishes the benefits of this approach over the open surgical approach. In fact, we recently performed a laparoscopic total colectomy in a colorectal cancer case in Bangalore and found that the advantages outweigh the shortcomings. |
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| Thorough Investigation: Though the incidence of colorectal cancer is not high in India, the occurrence of synchronous cancer makes its diagnosis and treatment complicated. Around five per cent of colonic cancers are synchronous in nature. The second cancerous growth can be easily missed and can be anywhere in the large intestine. A complete large bowel workup is essential for the diagnosis of synchronous cancer. Colonoscopy should be used vigilantly to look for the second tumour after the primary cancer has been detected. In the colorectal case in Bangalore, where laparoscopy was effectively used to treat the cancer, the patient had primary cancer in the sigmoid colon and a second one in the caecum. Using the laparoscopic colectomy approach, both the cancers can be dealt with easily and effectively in a single procedure. |
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- Laparoscopy vs Open Surgery:
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In a study conducted between June 1997 and January 2005, results of which have been published in Surgical Endoscopy, the short-term clinical outcome and oncologic results have been examined in six colorectal |
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cancer patients who underwent elective laparoscopic total colectomy or proctocolectomy at the Prince of Wales Hospital at the Chinese University of Hong Kong. The outcome and progress of these patients were compared with that of 12 patients who underwent open total colectomy or proctocolectomy during the same period. The study is probably the first of its kind that compares the results of laparoscopic and open total colectomy in the case of colorectal cancer, especially synchronous cancer.
In the laparoscopic group, the indications for surgery were synchronous colorectal surgery in three patients, single colorectal cancer arising out of polyposis in two patients and colorectal cancer associated with ulcerative colitis in one. In the open surgery group, besides synchronous colorectal cancer in eight patients and single colorectal cancer associated with synchronous polyps in two patients, there were two cases of single colorectal cancer with invasion into another segment of the colon. There was no significant difference in the age, gender or comorbidities in patients in the two groups, but the mean length of the tumour was shorter and its stage less advanced in the laparoscopic group. The median follow-up period was shorter for the laparoscopic group; it was 43.9 months compared with 48.2 months for the open surgery group.
A comparison in the clinical outcome of the two groups shows that parenteral analgesia was given for a significantly lesser duration for patients in the laparoscopic group. It was three days for laparoscopy patients and five for open surgery patients. There were no differences in the two groups as far as the following factors go: time to first bowel motion, time to resumption of diet, time to full ambulation, duration of hospital stay and peri-operative morbidity. There was no operative mortality in either of the groups. One case needed to be converted to open surgery due to bleeding. The oncologic results were also similar for the two groups. The parameters measured were the number of lymph nodes removed, recurrence rates and survival rates.
In the recent past, it had been established that laparoscopic partial colectomy had many benefits over open surgery, like reduced post-operative pain, faster return to bowel function, shorter hospital stay, lower morbidity and an earlier return to normal quality of life. It is also an oncologically safe procedure. In comparison, total colectomy has been considered a technically more complicated procedure to perform. Now, this study proves that this highly complex surgery also has many benefits. But where it did not compare well with open colectomy was the median operative time, which was 427.5 min for the laparoscopic and 172.5 min for open surgery. But with increased experience in this approach and the availability of more sophisticated energy sources, the operative time has come down. Undoubtedly, laparoscopic total colectomy has become not only a viable but also a highly effective surgical procedure for colorectal cancer.
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- Hepatic Resection for Malignant Liver:
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- Hepatic Resections for Benign & Malignant Liver Tumors
- Resection for Carcinoma of Bile Ducts & Gall Bladder
- Surgery fir Portal Hypertension Normally, blood is carried to the liver by a major blood vessel called the portal vein. If blood can’t flow easily through the liver because of cirrhosis or block in the portal vein, the pressure in the portal venous system increases. This higher pressure in the portal vein is called portal hypertension.
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When the pressure becomes too high blood backflows to the veins in the esophagus and stomach (esophageal & gastric varices). Beyond a critical pressure these varices rupture and gives rise to blood vomiting called Hematomasis. This requires management by a team of trained Gastroenterologist, Interventional Endoscopist & a Surgeon.
- Meso-artial shunt for Budd – Chiari Syndrome
Budd – Chiari Syndrome is a rare problem that results from blood clotting in the veins flowing out of the liver (hepatic veins). The high pressure of the blood in these veins leads to an enlarged liver, and to an accumulation of fluid in the abdomen, called ascites. This is managed either by surgical bypass shunt or Interventional Radiology (TIPS)
- Bilio-enteric anastomasis for Bile duct strictures
Bile duct which carries bile from liver to intestine can get narrowed due to various causes. This obstruction can be relieved by Endoscopic Stenting or Surgical Bilio-enteric anastomasis
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- Nissen fundoplication:
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When drug treatments are not satisfactory, GERD can also be treated with a form of surgery called Nissen Fundoplication. It takes the top portion of the stomach (the “fundus”) and wraps it around the lower end of the esophagus and the lower esophageal sphincter. This increases the pressure at the lower end of the esophagus and creates a one way valve, which allows food to pass into the stomach, but prevents stomach acid from flowing into the esophagus and causing GERD. |
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