All gastric, oesophageal, liver, gallbladder, bile duct, and pancreatic surgery, for both benign disease and (where appropriate) for cancer, and including advanced techniques such as single-incision laparoscopic surgery (SILS). Including surgery for reflux/GORD and for rolling hiatal hernia.
- for GORD or for a rolling hiatal hernia.
- most cases are suitable for the laparoscopic approach.
- for small/moderate-sized spleens.
- commonest indication today is probably idiopathic thrombocytopaenic purpura.
- Dr Mackay favours the totally extra-peritoneal (TEP) approach.
- This technique is particularly useful for re-do hernia surgery after previous open surgery, and for those with bilateral inguinal hernias.
- The TEP approach is not suitable for those with a large inguinoscrotal hernia.
- laparoscopic IOUS (intra-operative ultrasound) is a useful investigation in the workup of many patients with upper-GIT and hepatobiliary cancers.
- Direct contact ultrasound offers the opportunity to use a high-frequency ultrasound probe, which allows better definition than the lower-frequency trans-abdominal probes.