Sunday, September 11, 2011

Case of Cancer of the lower end of the bile duct

This is a case of cholangio carcinoma i.e cancer of the lower end of the bile duct. The image shows an MRCP(MR cholangiopancreatography) with blockage of the lower end of the bile duct. The pancreatic duct is also dilated. The patient was operated and a whipple’s operation was done where we removed the tumour along with part of the stomach, head of pancreas, lower end bile duct and re anastomosed the remaining structures. The patient is doing well.

Wednesday, September 7, 2011

HALS ( Hand Assisted Laparoscopic Surgery) used for colorectal cancer surgery

  • Lot of surgeons doing open colorectal oncology surgery but only < 10 % doing laparoscopic colorectal surgery
  • Most of these laparoscopic colorectal procedures require an incision 5-6cm
  • Extracorporeal resection, anastomosis, purse string for anvil and Retrieval of specimen
  • Most of the surgeons are doing basic laparoscopic procedures and would like to venture into laparoscopic colorectal surgery but have basic inhibitions:
  • equipment, learning curve
  • Bleeding
  • Suturing
  • Apprehension of conversion
  • HALS( Hand assisted laparoscopic surgery) is a hybrid operation which allows the surgeon to introduce the non-dominant hand into the abdominal cavity through a special hand port while maintaining the pneumoperitoneum
  • Main advantages of HALS are
  • Adequate maneuverability
  • Tissue retraction
  • blunt dissection
  • control of vascular pedicle
  • Improved tactile feed back, Specimen removal easier
  • Results of patient recovery are similar to total laparoscopic procedures
  • HALS gives benefit of both open and minimal invasive surgery.
  • Effective alternative to total laparoscopic approach especially in complex advanced procedures and in those surgeries which require mini laparotomy to retrieve the sample.
  • Beneficial to those surgeons who has basic laparoscopic training and wants to venture into advanced colorectal procedures.

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