Updated Minimally Invasive Surgery for Gastro-Intestinal Diseases

Abstract

The minimally invasive surgical technique, like innovative technology, continues to evolve and be refined. New concepts in the surgery of benign and malignant gastrointestinal diseases will stimulate GI surgeons to deliver effective treatment in more minimally invasive procedures. 1. Laparoscopic gastrectomy for malignancy: With growing experience, laparoscopic gastric resections have become common procedures in certain high-volume hospitals and have encouraged the use of laparoscopy in the resection of gastric malignancy. However, the long-term oncologic outcome has not been established in large series. 2. Laparoscopic resection of colorectal cancer: Laparoscopically assisted colon resection was first reported in 1991. Since then laparoscopic resection of both benign and malignant colorectal diseases has been systematically evaluated. The cornerstone in the treatment of colorectal cancer establishes in surgical colon resection with a laparoscopic approach. Whereas the short-term outcome of laparoscopic versus open resection of colorectal malignancy has been evaluated, the long-term outcome still needs further evidence. 3. Bariatric surgery: The increasing use of bariatric procedures in the treatment of morbidly obese patients has undergone common practice. In general, restrictive, mal-absorptive, or combined restrictive and mal-absorptive procedures are the domain for the surgical treatment of diseased obesity. Both methods are the most common procedures for weight reduction at present. 4. Laparoscopic liver resection; Laparoscopic hepatectomy could avoid the disadvantages of open hepatectomy and is beneficial for the patient's life quality as a minimally invasive procedure. The indications for the laparoscopic approach are the tumor of less than 5cm, and it's location at the left or anterior sector superficially. The clinical long-term follow-up, either for laparoscopic or traditional liver resection for hepatocellular carcinoma, has been evaluated, and has failed to show significant differences between the laparoscopic and traditional groups. 5. Laparoscopic surgery in liver-donor hepatectomy: The most controversial topic in liver surgery has been the performance of living donor hepatectomy. The mortality of this procedure has varied from 0.5 to 1.0% based on reporting andperformance of hepatectomy: left lateral section, left hepatectomy or right hepatectomy. 6. Role of minimally invasive surgery in pancreatic diseases: Laparoscopic pancreatico-duodenectomy or central pancreatectomy for pancreatic tumor have been performed in specialized centers of the world. Additionally, studies that specifically evaluate and compare the oncologic outcomes of laparoscopic and open pancreatic resections are needed. In addition, natural orifice transluminal endoscopic surgery (NOTES) has the potential to redefine minimally invasive surgery. Application in human subjects is seen in sporadic reports. Rapid development of laparoscopic minimally invasive surgery and robot surgery will in all probability provide the greatest benefit for surgical science in the near future.