Laparoscopic splenectomy has become the gold standard now for majority of benign conditions needing splenectomy like :-
- Idiopathic Thrombocytopenic Purpura (ITP)
- Cyst of Spleen
- Tropical Splenomegaly
Laparoscopic splenectomy in malignant conditions like Lymphomas and Hodgkins disease are routinely done. A standard five-port and lateral position is required. New energy sources like the Harmonic scalpel, which we routinely use, makes this surgery safe and also reduces time. Larger spleens of more than a thousand grams are managed by a hand assisted lap surgery (HAL) wherein a disc a used to assist laparoscopic surgery to handle large organs. It can also be combined with Cholecystectomy in congenital spherocytosis.
Laparoscopic liver surgery has been performed in the last few years. Modern gadgets have made the liver surgery safe and less time consuming. Many conditions like hydatid cyst, congenital cysts, and benign tumours are routinely being done laparoscopically. Now even hepatectomies for metastatic lesions and primary hepatoma are carried out at a few centres. Diagnostic laparoscopy is routinely done to pick up lesions less than 1cm in size and to stage malignancies thus avoiding non therapeutic explorations. Laparoscopic ultrasound probe facilitates in picking up these lesions. Endostaplers are very helpful during segmental resection of liver.
Laparoscopic de-roofing and fenestration has become the ‘gold standard’ for solitary non parasitic liver cysts.
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 the transperitoneal approach for benign conditions. Retroperitoneal Endoscopic approach (R.E.A.) is more demanding and suitable for small lesions and is preferred by urologists. Even bilateral adrenalectomies can be carried out.