LAPAROSCOPIC SOLID ORGAN SURGERY Dr Gowri Singh Dr S.P SINGH Authors declare no conflict of interest

Laparoscopic procedures are increasingly preferred by both surgeons and patients Laparoscopy for solid organ has been slower to evolve when compared to laparoscopic cholecystectomy With rapid acceptence of laparoscopic cholecystectomy few adventerous surgeons dared to boldly go where no one had gone before They sought to achieve the same reduction in morbidity while accomplishing same surgical goals As new techniques and equipment emerge and experience and data accumulate the status of solid organ surgery will become more established Some of the procedures are in their infancy while others are rapidly becoming the new “ GOLD STANDARD”

SURGERY FOR SOLID ORGANS INCLUDES 1- LIVER 2- SPLEEN 3- ADRENAL 4- PANCREAS 5- KIDNEY 6-PROSTATE GLANDS

The laparoscopic solid organ surgery involves the creation of pneumoperitoneum,use of small trocars and introduction of long instruments to achieve reduced access trauma The indications and principle of operation have not changed and remain same as open surgery

Several technical considerations need to be considered for solid organ surgery Proper instrumentation and experience are the recepie for success The difficulty of surgery is directly related to the size and malignant potential of the pathology

LAPAROSCOPIC LIVER SURGERY -Staging and therapeutic procedures -Liver cyst -Liver abscess -Liver resection -Liver trauma

Laparoscopic lymph node biopsy and liver biopsy

LAPAROSCOPIC SPLENIC SURGERY ITP SPLEEN HEREDITARY SPHEROCYTOSIS TRAUMA Anatomy of spleen is constant Size should be meassured preop Spleniculi should be looked for Widely being adopted as gold standard treatment

LAPAROSCOPIC ADRENAL SURGERY Aldosteroma Pheochromocytoma Cushing’s disease Nonfunctioning adenoma Cyst Myolipoma No consensus on maximum size to be operated laparoscopicaly Technical difficulty increase with size Feasibility depends on experiance and skill of surgeon

LAPAROSCOPIC NEPHRFECTOMY Renal cell carcinoma Non functioning kidney Congenitally small kidney Donor nephrectomy Trauma Can be performed with single incision or multiple incision Hand assisted can be performed Helps in retrival of specimen

Laparoscopic pancreatic surgery Has been reported very rarely Solid tumors Cystic lesions Chronic pancreatitis Cystogastrostomy Enucleation of insulinomas Staging and palliation of pancreatic malignancy Drainage of pancreatic abscess Safe and feasible for benign tumors and cystic lesion

SPECIMEN RETRIVAL IN SOLID ORGAN SURGERY Specimen retrival after laparoscopic solid organ surgery is trickey as many times complete intact specimen needs to be sent for HPE

Techniques used are 1. Morcellator 2. Endobag 3. In hand assisted cases same port site is used for specimen retrival 4. Pffenantial incision in lower abdomen

PROCEDURE DONE AT SSH LIVER BIOPSIES138 LIVER ABSCESS10 LIVER CYST4 LIVER TRAUMA15 ITP SPLEEN47 SPLENIC TRAUMA10 NONFUNTIONING ADENOMA ADRENAL5 PHEOCHROMOCYTOMA3 NEPHRECTOMY (RCC)6 NEPHRECTOMY NONFUNCTIONING KIDNEY4 NEPHRECTOMY TRAUMA0 CYSTOGASTROSTOMY3 DISTAL PANCREATECTOMY2

DISCUSSION Solid organ laparoscopy is fast getting established as a speciality Results improve with experience Proper instrumentation is mandatory for success All preperations for conversion should always be ready

Thank you