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    Biliary Procedures

    Diagnostic laparoscopy and laparoscopic ultrasound

    Diagnostic laparoscopy combined with laparoscopic ultrasound is used for staging various intra-abdominal tumors. Staging refers to the classification of the severity or development of the tumor. Laparoscopic ultrasound is a surgical imaging method that provides direct contact imaging of organs with high frequency ultrasound. This procedure improves selection of patients for tumor resection, thereby, avoiding unnecessary open surgery and is ideal for patients with tumors of the pancreas and liver. Approximately 2 out of 3 patients with these tumors can be treated laparoscopically.
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    Laparoscopic cholecystectomy

    Laparoscopic cholecystectomy, gallbladder removal, is one the most common operations performed using a laparoscope. The gallbladder stores the bile, which is produced by the liver to aid in the digestion of fatty foods. The bile flows from the gallbladder through the common bile duct into the duodenum to mix with food for digestion. Removal is due to gallstones, inflammation caused by the blockage of the common bile duct or tumors. Gallstones are made up of cholesterol that start in the form of small crystals and eventually develop into stones. The common bile duct can sometimes be cleared through laparoscopic surgery using the same laparoscopic procedures.

    What previously was a week-long hospital stay is now, through the use of laparoscopic procedures, a one-day hospital stay for most patients with most returning to their normal routine within a week. Nearly all patients requiring a cholecystectomy are candidates for the laparoscopic version. There are usually only 4 to 5 small incisions made in the abdomen using the laparoscopic surgical tools, the gallbladder ducts are located and separated and the gallbladder is cut away and removed.

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    Needlescopic cholecystectomy

    Read our Needlescopic Cholecystectomy Procedure Profile
    Postoperative view of needlescopic surgical "scars" (circled)

    This procedure requires a 1 cm incision at the belly button to remove the gallbladder and three 3 mm incisions along the right lower rib. After inserting narrow guide tubes into the three small incisions, the surgeon passes tiny instruments though the tubes and detaches the gallbladder and then remove it through the belly button. The incisions are so small there is virtually no scarring and very little pain, which can usually be relieved with an over the counter analgesic such as Tylenol or Motrin.

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    Ablation: cryoablation and radiofrequency

    Cyroablation tumor destruction is performed through the use of ultra-cold liquid argon gas applied with special laparoscopic probes directly into the tumor, resulting in freezing and death of the tumor cells.

    Ablation (local tumor destruction): cryoablation and radiofrequency ablation resection (removal of tumor).

    Laparoscopic ultrasound is used to identify and characterize the tumor, to guide the cryoprobe, and to monitor the progression of the iceball formed by the argon gas, which freezes the tumor. Once the tumor is located with ultrasound, the cryoprobe is inserted into it and the freezing process begins. The freezing is completed once the tumor tissue reaches a temperature of negative 165┬░ C and the iceball has obtained a 1cm margin beyond the tumor edge. Tumors up to 10 cm can be destroyed with this method.

    Indication for cryotherapy include:

    • Patients with unresectable secondary or primary lesions of the liver

    • Comorbid medical conditions precluding hepatic resection

    • Limited hepatic reserve and cirrhosis preventing a patient from having a portion of their liver removed

    • Recurrent metastatic or primary tumors of the liver

    • Patients with benign tumors such as focal nodular hyperplasia and adenomas
    Radiofrequency ablation destroys tumor tissue by heat destruction through the laparoscopic application of mild, almost painless high-frequency energy applied directly to the tumor. The cauterizing effect, associated with radiofrequency, substantially decreases post-procedure bleeding and blood loss.

    Using a thinner probe than with Cryoablation, Radiofrequency ablation destroys liver tumors by heating them to high temperatures, 80 - 100°C, without damaging other parts of the liver. Tumors up to 4 centimeters in diameter can be effectively destroyed with this technique. A thin needle is inserted into the tumor and electrical current is passed through the tip of the needle, which becomes very hot and destroys the tumor. The majority of patients do not experience side effects and resume normal activity the following day.

    Ultrasound or CT scan monitors the thermal destruction of the tumor. The ease of the procedure for the patient and the relative safety make radiofrequency ablation a realistic option for patients who are not candidates for liver resection.

    Indication for radiofrequency ablation include:
    • Patients with inoperable liver tumors who are not candidates for conventional surgery

    • Patients with significant health problems

    • Recurrent metastatic or primary tumors of the liver

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    Liver tumor resection

    Liver tumor resection, or the removal of a tumor can be performed via laparoscopic techniques in selected patients. Smaller tumors in the left side or anywhere on the edge of the liver are ideal.
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