All liver, gallbladder, bile duct, and pancreatic surgery, for both benign disease and for cancer, and including advanced laparoscopic surgery such as single-incision laparoscopic surgery (SILS).
Liver resection for primary and secondary tumours:
- workup will often include laparoscopy with intra-operative ultrasound, and a biopsy of the non-tumour liver (to determine the degree of underlying liver impairment, if any).
- Dr Mackay performs the vast majority of liver resections as open surgery, but there are selected cases that are suitable for a laparoscopic/keyhole approach.
- resections may be classified as “local” whereby a localised lesion is resected with an appropriate margin, or “anatomical” where a larger resection is accomplished taking note of the distribution of major blood vessels and bile ducts within the liver.
Gallbladder surgery:
- most gallbladder surgery is carried out for the complications of gallstones – pain, infection, jaundice, and pancreatitis being the most common conditions.
- most of this surgery is carried out as a laparoscopic or keyhole operation.
- cancer of the gallbladder is not a common condition, but does occur – if operable, it requires resection of the gallbladder, the adjacent liver, and often of the bile duct as well.
Bile duct surgery:
- surgery to remove stones that had migrated from the gallbladder to the bile duct was reasonably common in the era of open gallbladder surgery, but these days most bile duct stones can be dealt with using the endoscopic technique known as ERCP.
- from time to time, ERCP is not possible and a laparoscopic approach to the bile duct might then be necessary – this mirrors the previous open surgery, but is accomplished as a keyhole approach – generally the use of a specialised telescope to examine the duct and confirm all stones have been removed will obviate the need for a “T tube“.
- cancer of the bile duct is not common, but does occur and may be amenable to surgical resection – if not, a stent will relieve jaundice and the patient can be treated with chemo and/or radiotherapy.
Pancreatic surgery:
- most pancreatic resections are performed for pancreatic cancer, with some being performed for the (potentially) cancerous condition of IPMN (intra-ductal papillary mucinous neoplasm).
- resection of the head of the pancreas is known as a pancreaticoduodenectomy, or a Whipple’s operation.
- resection of the body and/or tail of the pancreas is known as a distal pancreatectomy, and may also involve a splenectomy.
SILS – single incision laparoscopic surgery:
- this link will take you to a scientific paper co-authored by Dr Mackay, which was the first report of the use of routine operative cholangiography in single-incision laparoscopic cholecystectomy.