Laparoscopic or keyhole surgery has
now entered a new dimension.
Many of the traditional operations
originally requiring unsightly incisions
on the stomach can now be performed
without visible scars.
Traditional laparoscopic surgery has
improved the cosmetic appearance
and healing rate of surgical procedures,
which required substantial and painful
incisions.The introduction of a single
scar, concealed within the umbilicus, has
taken keyhole surgery to the next level.
Patients have been delighted with their
rapid return to function and minimised
discomforts afforded by keyhole surgery,
but were still looking to avoid the telltale
marks of surgery.Traditional laparoscopic
surgery requires multiple incisions across
the abdomen that can be unsightly and
painful whilst healing.
By placing the scar deep within the
umbilicus, it is virtually impossible to
identify the incision required to perform
Developments are continually being made
to facilitate the practice of surgery to
keep up with the requests of our patients.
Procedures such as gall bladder surgery,
hernia repairs, appendicectomies and
even removal of bowel tumours, are now
possible without leaving the patient with
There are currently only a handful of
surgeons in the country who are trained
to perform this surgery, but the results
are truly amazing.
Who would want scars when the
procedure can be performed without
Dr Kosh Agarwal
BMedSci (Hons) MD FRCP (UK & Ed)
T: 020 7234 2713
Dr Kosh Agarwal offers a FibroScan
service as part of a one stop consultation
to exclude significant liver disease.
is a radiological technique used
to assess Liver Fibrosis.The technology
measures the velocity of a sheer wave
through the liver. The wave is created
by a vibratory source from a modified
ultrasound probe. Estimates of the velocity
translate to a liver stiffness score, which
correlates with fibrosis stage.
Excluding the presence of fibrosis is
important, as many people who appear
well can have early liver disease. The
technique has been evaluated in various
liver pathologies and can be performed in
approximately 95% of patients, although
older patients and patients who are obese
can be more difficult to study.
Medical Insurance Cover
London Bridge Hospital works with
all major private insurance companies.
Patients are advised to contact their
insurance provider and advise them of
their planned consultation. FibroScan
may or may not be covered, depending
on individual policy.
Disadvantages of FibroScan
• May underestimate fibrosis in some
patients with advanced fibrosis or
• May overestimate fibrosis in patients
with extrahepatic cholestasis or acute
hepatocellular injury, due to the effects
of these conditions on liver stiffness.
• Non-invasive, risk-free and painless.
• No anaesthetic or injections.
• Changes to liver may be picked up in
just a few minutes during an outpatient
consultation, which means no hospital
• Patients are able to return home or to
work straight afterwards.
• Real time result print-out supports
treatment option decision making with
a specialist liver doctor.
• Easy to repeat regularly to assess the
effect of treatment or changes to
Foucher J, Chanteloup E,Vergniol J, et al. Diagnosis of cirrhosis by transient elastography (FibroScan
a prospective study. Gut. 2006;55:403-408.
Castera L, Forns X,Alberti A. Non-invasive evaluation of liver fibrosis using transient elastography. J Hepatol. 2008;48:835-847.
Lucidarme D, Foucher J, Le Bail B, et al. Factors of accuracy of transient elastography (FibroScan
) for the diagnosis of liver fibrosis
in chronic hepatitis C. Hepatology. 2009;49:1083-1089.
Mr Nick Marshall
and Upper GI Surgeon