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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

the surgery.

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

a scar.

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





in Assessing

Liver Fibrosis

Dr Kosh Agarwal

BMedSci (Hons) MD FRCP (UK & Ed)

Consultant Hepatologist

T: 020 7234 2713


[email protected]

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

macronodular cirrhosis.

• 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


Reference Sources:

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

Consultant Laparoscopic

and Upper GI Surgeon