It is estimated that 10 to 15% of all patients who are thought to have cancer confined to the pancreas on preoperative x-ray studies including CT scan are shown to have metastatic disease at the time of surgery. To avoid unnecessary open surgery, in some cases we perform a diagnostic laparoscopic procedure before making a large open incision. A complete examination of the abdomen is performed to rule out the presence of metastatic disease. The patient will undergo open surgery for removal of the pancreatic cancer, if the diagnostic laparoscopic examination is normal. This is performed in a selected group of patients only.
We offer laparoscopic distal pancreatectomy for endocrine and cystic tumors of the body and tail pancreas. Endocrine and cystic tumors of the pancreas are associated with an excellent outcome and are often benign or associated with a very low grade malignancy. Some of these tumours are benign at excision with the potential to turn malignant if left unresected and are called premalignant tumours. The surgery is performed as either total laparoscopic surgery or hand port assisted laparoscopic surgery. During this procedure two half inch incisions are made and a hand-access device is utilized to perform the surgery. The hand-access device incision is about 2 inches long. Personally I have a low conversion rate of less than 5% and seldom use hand port.
The hand-access devices are a major advancement in laparoscopic surgery and allows the surgeon to place his/her hand into the abdomen during the surgical procedure. Patient who undergo laparoscopic distal pancreatectomy have less pain, rapid recovery and early discharge from the hospital compared to open distal pancreatectomy. Our average hospital stay for this procedure is about 3 to 7 days.
Central pancreatectomy is a complex operation performed on the Neck/body of the pancreas by only a few surgeons for patients with a pancreatic tumor in the neck of the pancreas. The procedure provides localised removal of the tumor with preservation of the head and tail of the pancreas. Otherwise, in addition the tail of the pancreas would have to be removed with the body and neck as part of distal pancreatectomy. This increases the risk for diabetes. Hence we offer this procedure in selected patients, and where feasible a laparoscopic approach for this procedure.
Many functional pancreatic islet tumors such as insulinoma and gastrinoma are small tumors usually less than 1 to 2cm. Furthermore the tumors are often on the surface of the pancreas. The tumors have a lining around them that separates them from the pancreas.
An operation called enucleation is often performed for these tumors. In this operation the tumor is shelled out from the pancreas without removing any pancreatic tissue. This procedure avoids the operations described above which take longer time and are associated with removal of pancreatic tissue and require longer periods of recovery. This surgery is offered in a select group of patients.
Laparoscopic enucleation of a pancreatic islet cell tumor also allows rapid recovery, early discharge from hospital and early return to work.
Some of the complications that patients with severe pancreatitis develop include pancreatic necrosis (dead pancreas) that requires removal, pancreatic abscesses and infections that often occur in areas of dead pancreas and pseudocysts which are localized collections of pancreatic enzymes due to an injury to the pancreatic duct from the pancreatitis.
In patients with acute necrotising pancreatitis on a selected basis, based on the anatomy of necrotic material, a radiologically guided guide wire/drain is placed into the infected necrotic abscess material. This track is dilated up to 40F drain size when a portex drain tube is placed. Subsequently through this a laparoscope with operating channel/cystoscope is passed and gently all the necrotic material is removed over multiple sessions. During the intervening time an irrigation suction drain is maintained. Patients recover with much reduced morbidity and mortality by this technique compared to open surgery. I offer this procedure in my centre.
Pancreatic pseudocysts are localized collections of pancreatic fluid that has leaked out of the pancreatic duct and developed into a local swelling behind the stomach. The pseudocyst may give rise to pain, nausea and blockage of the stomach or the duodenum. The treatment is to drain the cyst into an attached organ structure such as the stomach or the intestine. For this group of patients we offer laparoscopic pancreatic pseudocystogastrostomy along with laparoscopic cholecystectomy at the same sitting.
Senior Consultant Single Keyhole Laparoscopic Surgeon
MBBS, M.S (Gen Surg – KEMH, Bombay), FAMS
Over 30 years of clinical experience in gastrointestinal and metabolic surgery
His clinical focus includes:
Dr. Ravi routinely performs laparoscopic (keyhole) and endoscopic procedures, which are associated with smaller incisions and faster recovery times compared to traditional open surgery.
(Based on standard clinical outcomes for minimally invasive techniques.)
He holds a university academic appointment and is actively involved in teaching medical students and surgical trainees in Singapore, reflecting his commitment to medical education and continuous learning.
Dr. Ravi is affiliated with various international and local professional bodies including:
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