Splenectomy

Laparoscopic splenectomy has become a gold standard now. Majority of benign conditions needing splenectomy like :-

Laparoscopic splenectomy in malignant conditions like Lymphomas and Hodgkins disease are routinely done. Standard five-port and lateral position is required. Newer energy sources like Harmonic scalpel which we routinely use make this surgery safe and also reduces time. Larger spleens of more than thousand grams are managed by a hand assisted lap surgery(HAL) wherein a disc a used to put inside to assist laparoscopic surgery to handle large organs. It can also be combined with Cholecystectomy in congenital spherocytosis.

Liver Surgery

Laparoscopic liver surgery has been performed in last few years. Modern gadgets has made the liver surgery safe and less time consuming. Many conditions like hydatid cyst, congenital cysts, benign tumours are routinely being done laparoscopically. Now even hepatectomies for metastatic lesion and primary hepatoma are carried out at few centres. Diagnostic laparoscopy is routinely done to pick up lesion less than 1cm in size and stage malignancies. thus avoiding  non therapeutic explorations. Laparoscopic ultrasound probe facilitates in picking up these lesions. Endostapler are very helpful during segmental resection of liver.

Laparoscopic deroofing and fenestration has become the ‘gold standard’ for solitary non parasitic liver cyst.

Adrenalectomy

Aided by clarity of vision with three-chip endocamera and magnified view experienced surgeons have started doing Lap Adrenalectomy. Masses up to 6-8 cm can be tackled laparoscopically. We prefer adrenalectomy through transperitonenal approach for benign conditions. Retroperitoneal Endoscopic  approach (R.E.A.) is more demanding  and suitable forsmall lesions and is preferred by urologist. Even bilateral adrenalectomies are carried out.