Indications and General Oncologic Principles

Abstract

Before 1987, the laparoscope was considered an instrument that allowed only intraabdominal inspection and biopsy of lesions. With the introduction of laparoscopic cholecystectomy in the mid-1980s, the endoscopic technique has become an important method of performing minimal access surgical resection and lymph node staging, with application of other intraabdominal therapy such as thermal ablation of liver metastases. Laparoscopic staging has been applied to upper and lower gastrointestinal malignancies as well as tumors involving the pancreatobiliary tract. Although important in preoperative staging of abdominal cancer, the laparoscope has an even more important potential use in the identification of patients who will not benefit from open celiotomy for extirpation of tumor or bypass. Preoperative laparoscopic staging for esophageal and gastric cancer may identify patients with lymph node metastases whose disease would be understaged using traditional imaging techniques of computed tomography and percutaneous ultrasound.

The cleaner and gentler the act of operation, the less pain the patient suffers, the smoother and quicker the convalescence, the more exquisite his healed wound, the happier his memory of the whole incident. (Moynihan [ 1 ])