NEW ADVANCES IN LAPAROSCOPIC SURGERY

Limitations of traditional laparoscopic surgery

The major limitation of standard laparoscopic techniques have been the following:

• The human hand is a wonderful structure and provides multitude of different functions during open surgery. This function is absent during standard laparoscopic surgery since the abdomen is closed and the procedure is performed with long surgical instruments inserted from the outside into the abdomen.
• Two dimensional image of the laparoscope: The image transmitted by the laparoscopic camera that surgeon utilizes as his eyes is a two dimensional image. For some procedures this is a major limitation because of the poor depth perception that is associated with two dimensional images.
• Retraction of internal organs: During open surgery insertion of the hand into the abdomen allows the surgeon to move the intestine and other organs away from the site of the surgery. During standard laparoscopic surgery the hand is not introduced into the abdomen and introducing long thin instruments into the abdomen performs the surgery. Retraction of internal organs is often a major problem for some procedures.
• Limitation of instruments: the standard instruments in laparoscopic surgery are long thin instruments. These instruments are poorly suited for many complex laparoscopic procedures.

New technologies for advance laparoscopic surgery

Development of new instruments and innovation in technique is required for widespread use of advanced laparoscopy for the treatment of abdominal conditions. New technologies may overcome many of the limitations (noted above) of standard laparoscopic techniques. We have utilized the new technologies to develop laparoscopic operations for the pancreas, liver and the bile duct.

Two new technologies that are particularly promising are: hand access devices and robotic surgery.

Hand access devices

The human hand performs many functions during surgery that are difficult to reproduce with laparoscopic instruments. The loss of the ability to place the hand into the abdomen during traditional laparoscopic surgery has limited the use of laparoscopy for complex abdominal surgery on the pancreas, liver and bile duct.

New laparoscopic hand-access devices that allows the surgeon to place a hand into the abdomen during laparoscopic surgery and perform many of the different functions with the hand that were previously possible only during open surgery. We have utilized this new device to develop a variety of laparoscopic pancreatic, liver and biliary procedures such as the Whipple operation, distal pancreatectomy and liver resection that were not possible previously by standard laparoscopic techniques.

Robot-assisted surgery utilizing the Da Vinci computer robot system

Da Vinci™ is a computer-assisted robotic system that expands a surgeon's capability to operate within the abdomen in a less invasive way during laparoscopic surgery. Da Vinci™ system allows greater precision and better visualization compared to standard laparoscopic surgery.

The USC University Hospital is the first hospital in Southern California to perform robotically-assisted surgery using the da Vinci™ Surgical System.

The operations with the Da Vinci System are performed with no direct mechanical connection between the surgeon and the patient. The surgeon is remote from the patient, working a few feet from the operating table while seated at a computer console with a three-dimensional view of the operating field. The physician operates two masters (similar to joysticks) that control the two mechanical arms on the robot. The mechanical arms are armed with specialized instruments with hand-like movements which carry out the surgery through tiny holes in the patient’s abdomen. The arms eliminate any hand tremor by the surgeon and offer motion scaling – allowing extremely precise movements within the patient.

We are presently exploring the role of this new technology for complex operations on the pancreas, bile duct and the liver.

Contact information: USC Center for Pancreatic and Biliary Diseases
1510 San Pablo Street, Los Angeles, CA
Phone: 323-4425837 dde-mail:PancreasDiseases@surgery.usc.edu
Programs: pancreatic cancer, pancreatitis, laparoscopic surgery, endocrine surgery,
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This web site provides select information about pancreatic and biliary disorders and is updated twice monthly. This information is not intended as a substitute for professional medical consultation with your physician.It is important that you consult with your physician for detailed information about your medical condition and treatment.The center will make every effort to update the site, however, past performance is no guarantee of future medical outcomes.
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