Laparoscopic surgery or Minimally Invasive Surgery(MIS) also commonly known as Keyhole Surgery is a revolution in GI surgery. In 1987, first laparoscopic cholecystectomy was done by Philip Mouret. Since then there has been a rapid advancement in laparoscopic procedures for the past 20 years.

This Key Hole surgery is less invasive and more comfortable for the patient than the traditional open surgeries. Initially this procedure was used only for gall bladder and appendix surgeries. But nowadays due to its enormous advantages and growing expertise among GI surgeons this laparoscopic procedures are used even in major cases like cancer surgeries.

The technique of laparoscopic surgery involves creation of 3 to 4 small ports (Keyholes) in the abdominal wall and inflation of gas [CO2] into the abdominal (peritoneal) cavity to increase the working space. By introducing specialized instruments through the keyholes surgeries will be performed. In open surgeries the patients will have more stress and pain which is invoked by incisions and the retraction of tissues. The patients have longer hospital stay in open surgeries.

Advantages of Laparoscopy

• Less post operative pain
• Faster return to normal life
• Lesser hospital stay
• Early return to routine work
• Very small scar which will give a good cosmetic result when compared to longer open surgical scar

In spite of all advantages and improvements in Laparoscopic surgeries, it cannot completely replace open surgeries, which even today remains the best option for some of the procedures.

Above all this there is a chance that any Laparoscopic surgery can be converted into an open procedure in less than 5 % of patients due to technical limitations. That decision to convert into an open procedure will be taken by the operating surgeon if the situation demands.

Commonly performed Laparoscopic Procedures

• Laparoscopic cholecystectomy.
• Laparoscopic appendectomy.
• Laparoscopic ovarian cyst removal.
• Laparoscopic Hysterectomy.
• Laparoscopic APR ( For Carcinoma Rectum)
• Laparoscopic hemicolectomy ( For carcinoma colon)
• Laparoscopic Fundoplication ( For GERD, Hiatus Hernia)
• Laparoscopic adhesion release.
• Laparoscopic inguinal hernia repair.
• Diagnostic laparoscopy for undetected pain.
• Diagnostic laparoscopy for tumour staging.
• Laparoscopic procedures for morbid obesity.

Endoscopy is a device used to visualize the interior aspect of the Gastro Intestinal tract starting from the Pharynx to the Anus. After the invention of flexible endoscopes there is a marked improvement in the management of GI tract diseases. Now a day’s, endoscopy has almost replaced the Barium Contrast X-rays, which were being used in the past for detecting GI tract diseases.

The main advantage of endoscopy is that it can be used for both diagnostic and therapeutic (treatment) purposes. Hence endoscopy has become a mandatory investigation in Gastroenterology. Another major advantage of endoscopy is early detection of GI Cancers, so that we can attempt a curative treatment for GI Cancers.

The types of endoscopes used in Gastroenterology are Upper GI Endoscopy, Colonoscopy or Lower GI Endoscopy, side viewing Upper GI Scopy used for Pancreatic and biliary tract diseases. Apart from this the recent revolution is the invention of Capsule Endoscopy, which is exclusively done in our centre for the whole of South Tamil Nadu

Upper GI Endoscope

• This is used to visualize the interior aspect of Oesophagus, Stomach and Duodenum that is up to the upper part of the small intestine.
• The technique involves introduction of flexible scope through the oral cavity after giving local anesthetic solution

Diseases Diagnosed

Therapeutic Uses

Side Viewing Upper GI Scope

• This is mainly used to diagnose Biliary Tract and Pancreatic pathologies.
• Used for doing ERCP (Endoscopic Retrograde Cholangio Pancreatography)
• For treatment purpose this is use for Common Bile Duct stone removal, Common Bile Duct stenting and Pancreatic Duct stenting.

Colonoscope

• This is used to visualize the large intestine starting from Caecum, Ascending Colon, Transverse Colon, Descending Colon, Sigmoid Colon, Rectum and Anus.
• Colonoscopy is usually done after Bowel Preparation and Under Intravenous Sedation.

Diagnostic and Therapeutic Uses

Capsule Endoscopy

Capsule Endoscopy is certainly a revolution in the diagnosis of small intestinal diseases as well as in GI bleeding.Technique:The patient will be asked to swallow a capsule with an inbuilt micro camera. The images from the camera will be sensed by a sensor attached to the patient’s body. After 8 to 10 hours the sensor will be taken and the images can be displayed in the monitor. The capsule will be passed in motion.Uses:

For diagnosing small bowel diseases like Small Intestinal Cancer, Crohn’s Disease, etc., which is not possible by routine Upper GI and Lower GI Endoscopies.

This is also used in detecting the exact cause and site of GI bleeding when it is not diagnosed by routine investigations.

Allied Facilities

We have the following facilities in GI Department

• GI cancer detection clinic.
• 24 hours GI bleeding care unit.
• Liver and Pancreatic diseases intensive care unit.
• GI trauma centre.
• Hepatology division – patients suffering from Ac.Hepatitis, Ch.Hepatitis, liver tumors, liver cysts, portal hypertension, cirrhosis & liver failure are treated here.
• Pancreatic diseases centre – patients with Ac & Ch.pancreatitis, pancreatic malignancies & pancreatic pseudocysts are treated here.
• Biliary division – patients with biliary stones, biliary obstruction & biliary malignancies are managed here.
• Ostomy clinic & stoma care centre colostomy & ileostomy care is routinely done here.
• Hernia detection & treatment clinic.
• Colo-rectal centre
• Piles detection & management clinic.
• Therapeutic endoscopic centre.
• Advanced laparoscopic centre.

• HEMOGLOBIN / BLOOD GROUPING / HIV / HBsAg / SUGAR (RANDOM) UREA
• TC, DC, ESR, CREATININE, Total Bilirubin / Direct Bilirubin / indirect Bilirubin / SGOT / SGPT
• alkaline phospatase / total protein / albumin / globulin
• Ultrasound scan / Colonoscopy / UGI Scopy
• ECG / X-Ray chest
• Physician’s consultation
• Echocardiogram

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