Gastrointestinal Surgery Series MINIMAL INVASIVE HEPATOBILIARY AND PANCREAS SURGERY
Gastrointestinal Surgery Series MINIMAL INVASIVE HEPATOBILIARY AND PANCREAS SURGERY
Editors
Dhiresh Kumar Maharjan MRCS (Edin) FCPS
Associate Professor Department of General and GI Surgery Kathmandu Medical College and Teaching Hospital Sinamangal, Kathmandu, Nepal
Prabin Bikram Thapa MS
Professor Department of General and GI Surgery Kathmandu Medical College and Teaching Hospital Sinamangal, Kathmandu, Nepal
Foreword
Samiran Nundy
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Gastrointestinal Surgery Series: Minimal Invasive Hepatobiliary and Pancreas Surgery
First Edition: 2022
9789354655890
Printed at
all pioneers in minimal invasive hepato-pancreato-biliary (HPB) surgeons who have pushed their boundaries.
- Adarsh Chaudhary MS FRCS
- Chairman
- Division of GI Surgery, GI Oncology
- and Bariatric Surgery
- Medanta—The Medicity
- Gurugram, Haryana, India
- AK Khanna MS MNAMS DSc MBA FACS FICS FAIS FRSTMH FUWAI FUICC FFIM
- Professor
- Department of General Surgery
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi, Uttar Pradesh, India
- Arvinder Singh Soin MS FRCS (Edin) FRCS (Glasgow) FRCS (Transplant Surgery)
- Chairman
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta—The Medicity
- Gurugram, Haryana, India
- GV Rao MS MAMS FRCS
- Director and Chief of Surgical Gastroenterology and Minimally Invasive Surgery
- Asian Institute of Gastroenterology
- Hyderabad, Telangana, India
- Ian P Bissett MBChB MD FRACS
- Professor, Department of Surgery
- School of Medicine
- Faculty of Medical and Health Sciences
- University of Auckland
- Auckland, New Zealand
- Manohar Lal Shrestha
- MS (Cal) FRCSEd FICS FCPS (Pak) FAIS (Ind)
- Professor
- (Surgical Gastroenterology and Colorectal Surgeon)
- Department of Surgery
- Nepal Medical College and
- Teaching Hospital
- Attarkhel, Kathmandu, Nepal
- Peush Sahni MS PhD
- Professor
- Department of Gastrointestinal Surgery and Liver Transplantation
- All India Institute of Medical Sciences
- New Delhi, India
- Piet Pattyn MD PhD
- Professor
- Department of General and
- Digestive Surgery
- Ghent University Hospital
- Ghent, Belgium
- Rahul Khanna
- MBBS MS DNB MNAMS FAIS PhD
- Professor
- Department of General Surgery
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi, Uttar Pradesh, India
- Rajesh Bhojwani MS MCh FCLS
- Professor
- Department of GI Surgery
- Santokba Institute of Digestive Surgical Sciences (SIDSS)
- Jaipur, Rajasthan, India
- Roberto Troisi MSc MD PhD FEBS
- Full Professor of Surgery
- Director HPB, Minimally Invasive
- and Robotic Surgery Center
- Federico II University, Naples, Italy
- Samiran Nundy MCh MA FRCP FRCS
- Chairperson of Surgical Gastroenterology and Liver Transplantation
- Sir Ganga Ram Hospital
- New Delhi, India
- Sushil Bahadur Rawal MBBS MS
- Consultant GI Surgeon
- Medicity Hospital
- Kathmandu, Nepal
- Shailesh V Shrikhande MS MD
- Professor
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery
- Tata Memorial Hospital
- Mumbai, Maharashtra, India
- Vinay Kumaran MS MCh
- Professor, Surgical Director, Living Donor
- Liver Transplantation
- Department of Surgery
- Division of Transplant Surgery
- West Hospital, Richmond, Virginia, USA
- Vijay Kumar Shukla MS MCh FAMS
- Professor, Department of General Surgery
- Banaras Hindu University
- Varanasi, Uttar Pradesh, India
- Wim P Ceelen MD PhD FACS
- Professor
- Department of General
- and Digestive Surgery
- Ghent University Hospital
- Ghent, Belgium
- Yves Van Nieuwenhove MD PhD
- Professor
- Department of General
- and Digestive Surgery
- Ghent University Hospital
- Ghent, Belgium
- Ammiel Arra
- DM (General Surgery) Fellow
- Gastrointestinal and HPB Surgical Oncology, Department of Surgical Oncology, Tata Memorial Centre
- Mumbai, Maharashtra, India
- Babu Raja Shrestha MBBS MD
- Professor
- Department of Anesthesiology
- Kathmandu Medical College and
- Teaching Hospital
- Sinamangal, Kathmandu, Nepal
- Brice Gayet MD PhD
- Department of Digestive Oncologic
- and Metabolic Surgery
- Institut Mutualiste Montsouris Université Paris Descartes
- Paris, France
- Catherine SC Teh MD FPCS FRCS (Ed)
- Chief
- Department of Hepatobiliary Pancreatic Surgery
- Makati Medical Centre
- St Luke's Medical Centre and National Kidney and Transplant Institute
- Quezon City, Metro Manila, Philippines
- Christoph Berchtold MD
- Department of General
- Visceral and Transplantation
- Surgery
- University Hospital Heidelberg Heidelberg, Germany
- David Fuks MD PhD
- Department of Digestive Oncologic
- and Metabolic Surgery
- Institut Mutualiste Montsouris, Université Paris Descartes
- Paris, France
- Fumiaki Tokito MD
- Department of Surgery
- Institute of Gastroenterology
- Tokyo Women's Medical University
- Tokyo, Japan
- Giovanni M Garbarino MD
- Department of Medical Surgical
- Science and Translational Medicine
- Sapienza University of Rome
- Rome, Italy
- Giammauro Berardi MD PhD
- Medical Doctor, Department of Surgery
- San Camillo Forlanini Hospital of Rome
- Rome, Italy
- Goro Honda MD PhD FACS
- Professor and Chief
- Department of Surgery
- Institute of Gastroenterology
- Tokyo Women's Medical University
- Tokyo, Japan
- GV Rao MS MAMS FRCS
- Director and Chief
- Surgical Gastroenterology and Minimally Invasive Surgery
- Asian Institute of Gastroenterology
- Hyderabad, Telangana, India
- Ioannis Triantafyllidis MD
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes Paris, France
- Katherine M Panganiban
- MD FPSGS FPCS
- Division of Minimal Invasive and Robotic Surgery, Institute of Surgery
- St Luke's Medical Centre
- Quezon City, Metro Manila, Philippines
- Manish S Bhandare
- MS MCh PDF GI and HPB Surgical Oncology
- Associate Professor
- Department of Gastric
- and HPB surgery
- Tata Memorial Centre
- Mumbai, Maharashtra, India
- Marc Beaussier MD PhD
- Department of Digestive
- Oncologic and Metabolic Surgery
- Institut Mutualiste Montsouris Université Paris Descartes
- Paris, France
- Masakazu Yamamoto MD PhD
- Director
- Department of Surgery
- Institute of Gastroenterology
- Tokyo Women's Medical University
- Tokyo, Japan
- Maud Neuberg MD
- Department of Digestive
- Oncologic and Metabolic Surgery
- Institut Mutualiste Montsouris Université Paris Descartes
- Paris, France
- Naoto Senmaru MD
- Department of Gastroenterological Surgery
- Hokkaido University
- Graduate School of Medicine
- Sapporo, Japan
- Rajesh Bhojwani MS MCh FCLS
- Professor
- Department of GI Surgery
- Santokba Institute of Digestive
- Surgical Sciences (SIDSS)
- Santokba Durlabhji Memorial
- Hospital (SDMH)
- Jaipur, Rajasthan, India
- Roshan Ghimire MBBS MS
- Fellowship in HPB and Liver Transplantation
- Associate Professor
- Department of General and GI Surgery
- Kathmandu Medical College and
- Teaching Hospital
- Sinamangal, Kathmandu, Nepal
- Ruchit H Kansaria
- MS (General Surgery) MCh
- (Surgical Oncology) Fellow
- Gastrointestinal and HPB
- Surgical Oncology
- Tata Memorial Centre
- Mumbai, Maharashtra, India
- Saseem Poudel MD
- Department of Gastroenterological Surgery
- Hokkaido University
- Graduate School of Medicine
- Sapporo, Japan
- Satoshi Hirano MD PhD
- Professor
- Department of Gastroenterological Surgery, Hokkaido University
- Graduate School of Medicine
- Sapporo, Japan
- Savio George Barreto MBBS MS PhD
- Senior Lecturer in Medicine
- Division of Surgery and
- Perioperative Medicine
- College of Medicine and Public Health Flinders University, Australia
- Shailesh V Shrikhande
- MBBS MS MD FRCS (HON)
- Deputy Director
- Tata Memorial Hospital
- Professor of Surgical Oncology
- Chief, Hepato-Pancreato-Biliary
- Surgical Oncology, Tata Memorial
- Centre, Mumbai, Maharashtra, India
- Shreeyash Modak MS
- Consultant and Surgical Gastroenterologist
- Department of Surgical Gastroenterology and Minimally Invasive Surgery
- Asian Institute of Gastroenterology
- Hyderabad, Telangana, India
- Siddhartha Mishra MBBS MS
- Clinical Associate
- Santokba Institute of Digestive
- Surgical Sciences (SIDSS)
- Santokba Durlabhji Memorial
- Hospital (SDMH)
- Jaipur, Rajasthan, India
- Sujan Regmee MBBS MS
- Lecturer
- Department of General and GI Surgery
- Kathmandu Medical College and
- Teaching Hospital
- Sinamangal, Kathmandu, Nepal
- Sushila Lama Moktan MBBS MD
- Assistant Professor
- Department of Anesthesiology
- Kathmandu Medical College and
- Teaching Hospital
- Sinamangal, Kathmandu, Nepal
- Thilo Hackert MD
- Professor
- Department of General, Visceral and Transplantation Surgery
- University Hospital Heidelberg
- Heidelberg, Germany
- Vikram Chaudhari DNB (General Surgery)
- DNB (Surgical Gastroenterology)
- PDF (GI and HPB Surgical Oncology)
- Associate Professor
- Department of Surgical Oncology
- Tata Memorial Centre
- Mumbai, Maharashtra, India
- Yoshikuni Kawaguchi MD PhD
- Department of Digestive Oncologic
- and Metabolic Surgery
- Institute Mutualiste Montsouris Université Paris Descartes
- Paris, France
- Yugal Limbu MBBS MS
- Lecturer, Department of General and GI Surgery, Kathmandu Medical College and Teaching Hospital
- Sinamangal, Kathmandu, Nepal
- Yusuke Ome MD PhD FACS
- Department of Surgery
- Institute of Gastroenterology
- Tokyo Women's Medical University
- Tokyo, Japan
Who would have thought that such a book discussing the different aspects of such complex, innovative and the most contemporary surgical procedures would come out of a small country like Nepal. It is indeed a remarkable achievement, and I am proud to have been asked to write the foreword.
Drs Dhiresh Kumar Maharjan and Prabin Bikram Thapa have gathered 34 surgeons from eight countries (Australia, France, Germany, Japan, India, Italy and the Philippines as well as their own colleagues in Nepal) to describe not only how to perform major procedures on the gallbladder, liver, bile ducts and pancreas but also place them in our present context. Thus, not only, for instance, are the techniques for robotic pancreaticoduodenectomy discussed, but also there are chapters on anesthesia, how to control intraoperative bleeding, the use of indocyanine green and starting laparoscopic hepatectomy in a low volume center. The well-known advantages of minimally invasive procedures are their cosmetic result, the lower blood loss and shorter hospital stay, and faster recovery compared to open operations. There is also evidence that during operations for carcinoma the outcomes are similar to the open technique regarding margins and lymph node retrieval.
However, I, who only performs open operations, must add a word of caution here. Lord Cohen of Birkenhead, the distinguished British physician once said that the ‘Feasibility of an operation is not an indication for it’. Any new procedure should be carefully evaluated regarding whether it is safe, effective, and affordable and the decision to perform it should be based on hard evidence. In fact, there are very few prospective randomized studies comparing minimally invasive and open surgery (there have been some American and Dutch trials which were terminated because of the higher mortality of these procedures) and apart from cholecystectomy and distal pancreatectomy I cannot think of any other operation which has become firmly established. The results of any surgical operation not only depend on surgical expertise but also on patient selection. Thus, publications on minimally invasive surgery are usually authored by those very experienced in the field who have generally performed procedures on thin patients with early disease. There is also a publication bias because even these surgeons will tell the world about their results if they are good. Those who have had major morbidity and mortality are hardly likely to write or speak about them.
Thus, although I think that minimally invasive surgery is the future before it is more widely adopted, especially in developing countries, it should be carefully evaluated on whether it is safe (probably not), effective (yes in experienced hands) and affordable (no). We must remember that these complex procedures all have a very steep learning curve, and some have suggested that before embarking on them at least 30–50 procedures should have been performed under supervision. This is a rather tall order and not feasible for most surgeons in our countries.
Nevertheless, the Editors have done us a great service in producing a book which tells us what is possible using these techniques and should be congratulated for their efforts. Everyone interested in the future of hepatobiliary and pancreatic surgery should read this book.
Samiran Nundy mch ma frcp frcs
Chairperson of Surgical Gastroenterology and Liver Transplantation
Sir Ganga Ram Hospital
New Delhi, India
Preface
Means of acquisition of knowledge never fades, but changes with time, so do our perseverance for academic excellence. Since the conception of the handbook entitled “Gastrointestinal Surgery Series,” “Pancreas and Hepatobiliary Surgery” in 2018, we were lagging in widely accepted minimal invasive hepato-pancreato-biliary (HPB) surgery as there had been rapidly evolving surgical techniques.
This book provides recent advances in the minimal invasive surgery from laparoscopic to the robotic approach of liver resection and approaches of minimal invasive Whipple operation, both laparoscopic and robotic.
This book would be an armamentarium mainly for surgical residents and young laparoscopic surgeon trying to set up laparoscopic HPB surgery and troubleshooting problems tips while performing it.
Dhiresh Kumar Maharjan | Prabin Bikram Thapa |
We would like to acknowledge Prof Suman Kumar Shrestha, Dr Roshan Ghimire, Dr Anuj Parajuli, Dr Uttam Laudari, Dr Santosh Shrestha, Dr Yugal Limbu, Dr Sujan Regmi, and our junior faculties. We would like to thank Mr Drishant Maharjan for his assistance in illustration.