Dr. Lokesh H M

Both laparoscopic and robotic surgery are minimally invasive and use small incisions to access the abdomen. Laparoscopic surgery is performed with a camera and long-handled instruments controlled directly by the surgeon. Robotic surgery adds a mechanical platform between the surgeon's hands and the instruments, offering greater instrument articulation, tremor filtering, and a magnified 3D image. For most standard GI procedures, high-volume expert laparoscopy achieves equivalent outcomes to robotic surgery. Robotic platforms offer the most benefit in confined operative spaces, such as deep pelvic rectal surgery or complex oesophageal work, where the enhanced instrument range of motion makes a genuine technical difference. The choice depends on the specific procedure and the surgeon's training and experience with each approach.

Recovery after laparoscopic colorectal cancer surgery follows a more gradual pathway than shorter GI procedures, because the bowel needs time to recover its function after resection and anastomosis. Most patients are eating soft food within two to three days, go home within three to five days, and can manage light activity including short walks within one to two weeks. Return to desk work is usually possible within two to three weeks for most patients. Strenuous physical activity and heavy lifting are deferred until six to eight weeks post-operatively. The exact timeline depends on the extent of resection, the specific bowel segment involved, and the individual patient's overall health, and is discussed in detail before and after surgery.

This is one of the most frequent questions in my outpatient clinic, and the honest answer is: it depends on several specific factors rather than on a universal rule. Truly asymptomatic gallstones in an otherwise healthy adult with a normally functioning gallbladder have a low annual rate of progression to symptomatic disease, and the majority of published evidence supports a watchful waiting approach for most such patients rather than prophylactic cholecystectomy. However, there are situations where surgery is recommended even without symptoms. A gallstone larger than three centimetres in diameter is associated with a higher long-term risk of gallbladder carcinoma and is generally an indication for cholecystectomy. A porcelain gallbladder, where the gallbladder wall is calcified, previously thought to uniformly require surgery, is now assessed more selectively, but selective calcification patterns do carry higher cancer risk. A patient who is diabetic and who develops acute cholecystitis has a higher risk of rapid progression to gangrenous gallbladder and is therefore a candidate for prophylactic cholecystectomy before a complication occurs. And any patient who lives far from a hospital or who will be undertaking prolonged travel to a location without surgical access may reasonably choose elective surgery rather than risk an emergency presentation under difficult circumstances.

At Narayana Multispeciality Hospital and RK Speciality Clinic, Mysuru, I assess each patient with incidental gallstones individually, reviewing the imaging carefully for any of the features that shift the recommendation from watchful waiting toward surgery.

Jaundice, the yellow discolouration of the skin and whites of the eyes caused by elevated bilirubin in the blood, is not always a surgical emergency, but it always requires urgent medical evaluation to establish its cause, because some of the conditions that produce jaundice are surgical emergencies and others are not. The most important clinical distinction is between medical jaundice and obstructive jaundice. Medical jaundice, from hepatitis, liver disease, or haemolysis, reflects a problem in the liver's ability to process bilirubin rather than a blockage in the outflow pathway, and is managed medically. Obstructive jaundice, from a blockage of the common bile duct by a gallstone, a pancreatic tumour, a bile duct tumour, or a stricture, produces the distinctive pattern of progressively deepening yellow discolouration with pale or clay-coloured stools and very dark urine. The pale stools reflect the absence of bile reaching the intestine; the dark urine reflects bilirubin being excreted by the kidneys instead. Obstructive jaundice becomes a surgical or endoscopic emergency when it is complicated by cholangitis, the bacterial infection of the obstructed biliary system, which produces the classical Charcot's triad of jaundice, fever with rigors, and right upper abdominal pain. Cholangitis can progress to septic shock and multi-organ failure within hours without prompt biliary drainage, usually by ERCP. If you have jaundice accompanied by fever, shaking chills, and abdominal pain, go directly to the emergency department without delay, as this combination requires same-day biliary assessment and treatment.

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The finding of a liver lesion on incidental imaging is one of the most anxiety-provoking results in clinical practice, and I want to be direct: the great majority of liver lesions found incidentally are benign and require no surgical intervention. A simple hepatic cyst, which appears as a smooth, thin-walled, fluid-filled structure on ultrasound or CT, requires no treatment in the vast majority of cases and no follow-up imaging beyond confirming the diagnosis. A haemangioma, the most common benign liver tumour, is a vascular lesion that is almost always managed conservatively regardless of size, because the natural history is stable and the risk of intervention outweighs any benefit. The lesions that require more careful specialist evaluation are those that cannot be confidently classified as benign on initial imaging. Focal nodular hyperplasia typically has a characteristic imaging appearance but may require contrast-enhanced MRI for confident diagnosis. Hepatocellular adenoma, particularly in women of reproductive age using oral contraceptives, carries a risk of haemorrhage and a small malignant transformation risk that influences management. Hepatocellular carcinoma, the most common primary liver cancer, typically arises in a background of chronic liver disease or cirrhosis and requires multidisciplinary assessment for resection, ablation, or transplantation candidacy. Colorectal liver metastases can in selected patients be resected with curative intent. "The first step after an incidental liver finding is specialist hepatobiliary assessment, which uses the imaging characteristics, the clinical context, and if necessary additional imaging or biopsy to determine whether the lesion is benign, requires monitoring, or warrants surgical treatment."