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‘No substitute to hard training in laparoscopy liver resection'

— Photo: S. Siva Saravanan

Brice Gayet


Laparoscopy is described a revolutionary advance in medical science, providing the benefits of better imaging and precision for the surgeons and quick recovery for the patient. Medical institutions also point out that the costs are less compared to the open surgery.

But, intensive training holds the key to its success. None of the intended benefits can be reaped both by the medical fraternity and the patient community in the absence of proper training, laparoscopy liver resection specialist from France Brice Gayet points out.

The Professor of Surgery in the Department of Digestive Diseases at the Institut Mutualiste Montsouris, University of Paris-Descartes, tells K.V. Prasad that India is doing well in the area of laparoscopy and China is providing immense thrust to training in this field.

“There is no room for trial and error. This is a technically difficult procedure to perform,” says the surgeon who won the gold medal for liver resection at the laparoscopy Olympics held last year by the Society of American Gastro Intestinal Endo Surgery and the Japanese Society of Endo Surgery. “Laparoscopy was first introduced in France for gall bladder surgery. It is called the second French Revolution,” he says. “When I first took it up for liver resection (removal of a portion), everyone said I was crazy. But, what we do at our centre now is gold standard,” he says.

“From the times when surgeons kept away from liver surgery because one wrong move could kill the patients, we have made a lot of progress. We are able to remove a tumour affected portion of the liver and provide a fresh lease of life for the patient. As much as 75 per cent of the liver can be removed as the organ can re-generate,” Dr. Gayet points out.

In between live demonstration sessions at a liver and pancreas surgery conference organised by the PSG Institute of Medical Sciences and Research, Dr. Gayet emphasised capacity building in surgeons in order to make this option available wider. At present, 20 teams in the world perform laparoscopic liver resection. As for laparoscopy in general, it has spread wide and fast. “India is, in fact, doing better than the U.S. in this area,” he says.

“There is a definite advantage in the procedure. You can put your head under the liver, in the sense that you can now get images of those portions of the liver that could not be obtained prior to laparoscopy,” he explains. As for the patients, a large incision is avoided.

Dr. Gayet's message to medical students is: go back to basic anatomy. “The younger generation is baffled by the multiple images (of the organs targeted for treatment). Latest imaging technology facilitates transparency of an organ: one can see through the liver. It has re-invented anatomy. But, thorough knowledge of anatomy provides the required foundation.”

What is the future? “Any research done now aims to avoid surgery. We want to be less invasive. For instance, we can cure most ulcer cases with drugs, but these required surgery earlier.”

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