During the past fifteen years, minimally invasive general surgery has speedily expanded to incorporate laparoscopic and robotic techniques for cholecystectomy, colectomy, gastric weight loss, and different procedures. For instance, cholecystectomy, a procedure that earlier needed a 10-inch incision within the abdominal wall, nowadays routinely needs only multiple tiny incisions, all measuring one one inch.
In distinction, minimally invasive techniques for liver and pancreas surgery were adopted more slowly owing to the complexness of those procedures.
Laparoscopic Liver Surgery Technique initially, laparoscopic liver resections were performed for tiny malignant tumours or symptomatic benign tumours. As expertise grew and technology advanced, the utilization of laparoscopy expanded into all aspects of liver surgery.
One of the first issues was whether cancer outcomes, and local margins and local rates, would be identical with laparoscopic procedures as they're for open procedures.
Studies have shown that laparoscopy is related to significantly reduced blood loss, frequency of transfusion, frequency of Pringle manoeuvre, postoperative morbidity, recovery time, length of hospital stay, and incidence of incisional hernia.
Robotic Liver Surgery Technique:
More recently, robotic liver surgery techniques utilising the da Vinci Surgical System is being used. Robotic instrumentation can offer the operating surgeon with more flexibility in some minimally invasive settings because of the wristed motion that mimics the movements of the human hand. This instrumentation functions together with a high-definition 3D camera
Liver resection With Ablation:
As the indications for surgical operation of liver metastases have broadened, use of multimodal therapies has become frequently common. Ablation is a method that uses heat from radiofrequency or microwave generators to destroy or ablate a tumour. Ablation plays a key role in hepatic parenchymal preservation as it allows treatment of tumours in areas that don't seem to be amenable to resection, and since it may be combined with resection of another area of the liver.
In addition, ablations allow for the likelihood of recurrent treatments for recurrences with reduced morbidity. For treatment of tiny hepatocellular carcinomas, proof from retrospective studies has been accumulating in support of ablation rather than resection.
Studies show that intraoperative ablation seems to be an extremely effective treatment for colorectal cancer liver metastases of size up to or smaller than 1 cm.
Laparoscopic ablations are related to a lower local repeat rate compared with percutaneous ablations. This method additionally permits for staging of the whole abdomen and the remainder of the liver via laparoscopic ultrasound. In addition, any bleeding caused by the procedure is controlled under direct vision and therefore the ablation zone is monitored in real time.
An FDA-cleared image- guidance device, Explorer, is the latest image-guidance system that permits for a 3D model to guide minimally invasive liver surgery, together with ablations. This image-guidance system is probably very valuable for patients who have steatosis (often related to an extended course of chemotherapy), because it may be tough to see small (<1 cm) tumours deep within the liver using solely ultrasound within the operating room.
This system creates a 3D model from preoperative CT scanned images and the 3D model is updated in real time to guide the surgical instruments throughout the resection or ablation.
The future for minimally invasive liver surgery is highly exciting. both laparoscopic and robotic procedures for general surgery have steep learning curves. For liver surgery, the curve is even more extreme.
For more information:
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