This document discusses the history and current applications of laparoscopy in gastrointestinal (GI) surgery. It traces laparoscopy from its earliest uses in 1901 to recent advancements. The document also addresses common clinician concerns regarding laparoscopy, finding it to be a safe and feasible alternative to open surgery that offers benefits like less pain, quicker recovery, and shorter hospital stays compared to open procedures. Finally, it outlines how various GI surgeries of the esophagus, stomach, hepato-biliary system, pancreas, small bowel and colon can now be performed laparoscopically.

1. Current Applications of Laparoscopy
in advanced GI Surgery
Dr Pradeep jain M.Ch
Director, Laparoscopic GI & GI Oncology
and Bariatric surgery
Fortis Hospital, Shalimar bagh,
New Delhi

2.  1901 George Kelling first laparoscopic procedure in animals
 1910 Hans Christian Jacobaeus reported first laparoscopic procedures in
humans
 1965 Berci introduces rode lens system
 1982 video laparoscope introduced
 1983 Semm performed first laparoscopic appendicectomy
 1985 Muhe performed first laparoscopic cholecystectomy ( though
Mouret is often credited for first lap chole )
 1992 NIH consensus conference lap chole as preferred alternative to
open chole
 Decade of 90s almost every GI surgery done laparoscopically
 1st decade of 2000s safety and efficacy of GI cancers established
 2005 Rao and Reddy first transgastric appendicectomy (
NOTES)
 2007 First NOTES in USA ( trans vaginal cholecystectomy )
History line of Laparoscopy

3. Introduction
General questions in the mind of a clinician before sending
the patient to a Laparoscopic Gastrointestinal Surgeon
 Which is superior, open or laparoscopic approach?
 Is the laparoscopic approach safe?
 Is the laparoscopic approach feasible?
 Are the outcomes of laparoscopic approach acceptable?

4. YES
 Laparoscopic approach is safe and feasible in the
field of GI surgery
 Laparoscopic method is largely accepted by medical
fraternity as well as by aware general public

5. Laparoscopic Vs Open approach
On the basis of various randomized controlled trial laparoscopic
approach is well accepted compared to open approach
because it is—
 Less invasive
 Associated with less pain and postoperative disability
 Require less analgesic requirement
 Early return of GI function
 Quicker improvement
 Better preserved pulmonary function
 Shorter hospital stay
Gagner M et al. Surg Clin North Am, 2004April; 84(2):451-62

6. Current application of laparoscopy
in GI Surgery
Laparoscopy used in the diseases of –
 Esophagus
 Stomach
 Hepato-biliary-pancreatic
 Small bowel
 Colo-rectal

7. Role of laparoscopy in GI Surgery
 Diagnosis
 Staging
 Palliation
 Curative resections
 Postoperative problems- Adhesive obstruction
-Incisional hernias
- Leaks

8. Laparoscopic esophageal Surgery
 Esophagectomy
 Heller’s cardiomyotomy
 Fundoplications
 Paraesophageal hernia repair

9. Laparoscopic esophageal Surgery
Minimal invasive esophagectomy –
 safe as complication rate is comparable to open
approach
 Lymphnodes yield is comparable to open approach
 Less requirement for Blood Tx, analgesics, post op
ventilation, ICU stay.

10. Thoraco laparoscopic esophagectomy
For Ca Esophagus

12. Laparoscopic Gastric Surgery
 Bariatric surgery
 Various types of gastrectomies for malignancy
 Perforated ulcers
 Gastrostomy
 Gastric outlet obstruction

13. Laparoscopic Gastric Surgery
Laparoscopic approach for bariatric surgery-
GOLD STANDARD
Types of bariatric surgery done by laparoscopy-
 Gastric bypass
 Sleeve gastrectomy
 Adjustable gastric band
 BPD-DS

14. GASTRIC BYPASS FOR MORBID OBESITY

16. Laparoscopic Gastric Surgery
For gastric malignancy - LAP vs OPEN approach
 No difference in tumor staging
 No difference in resection margins
 No difference in LN retrieval
 No difference in survival between groups
Weber KJ et al. Surg Endosc, 2003;17(6):968-71

17. LAP RADICAL GASTRECTOMY FOR CA STOMACH

19. Laparoscopic Colo-rectal Surgery
 Resection of malignant tumors
 Ulcerative colitis
 FAP
 Colonic diverticula

20. Laparoscopic Colo-rectal Surgery
Laparoscopic resection of colonic malignancies
 Overall and Disease free survival rate same
 No difference in carcinoma recurrences
 Early recovery of Bowel functions and shorter stay
Advance age, obesity, Bulky tumors or prior abdominal
surgery – not absolute contraindication for LAP

21. LAP RADICAL RT HEMICOLECTOMY FOR
CA CAECUM

23. LAP TOTAL PROCTOCOLECTOMY WITH “J POUCH”
FOR POLYPOSIS COLI

25. Laparoscopic Hepato-biliary Surgery
 Hepatic resections
 Hydatid cyst
 Fenestration and drainage of benign liver cysts
 CBD exploration
 CBD excision for choledochal cyst
 Roux-en-Y hepaticojejunostomy

26. LAP. LIVER RESECTION FOR HCC

28. Laparoscopic Pancreatic Surgery
 Distal pancreatectomy
 Pancreatico duodenectomy
 Cystogastrostomy/cystojejunostomy
 Pancreatic necrosectomy
 Lateral pancreatojejunostomy
 Enucleation of insulinoma

29. LAP PANCREATIC NECROSECTOMY
FOR INFECTED PANCREATIC NECROSIS

31. LAP DISTAL PANCREATECTOMY
FOR SOLID PAPILLARY TUMOR PANCREAS

33. LAP CYSTOJEJUNOSTOMY
FOR PANCREATIC PSEUDOCYST

35. Summary
Almost all Gastrointestinal surgery including
Bariatric, Cancer and HepatoPancreatobiliary
surgery are feasible and safe by Laparoscopy
in a well structured GI Surgery Department

36. Thank You