Appendectomy: laparoscopy is not always the best option

December 29, 2010 by  
Filed under HEALTHCARE

I had my appendix taken out laparoscopically in 1998. What was expected to be a simple operation caused me a lot of pain that persisted for a long, long time. Four years later, I had my thyroids taken and shared a room with a lady who, too, had laparoscopic appendectomy and had similar problems as I did.

The laparoscopic surgical technique became popular in the 1990s and is now the “gold standard” for simple procedures inside the body cavity such appendectomy. Here is how it works:

The abdomen in inflated with air, and a very small camera is inserted through a tiny incision. This enables the surgeon to control the tiny surgical instruments also inserted through tiny holes in the body cavity.

Compared to open surgery, laparoscopy is minimally invasive, causes less scarring and minimizes the risk of infection since the body cavity is less exposed to the air. The surgical wound heals fast and the patient is up and running in no time.

However, researchers at the University of Rochester Medical Center (URMC) report that there are some patients wherein laparoscopy may actually not be the best option.

According to study author Dr. John Monson, head of the Division of Colorectal Surgery at URMC.

“Our study corroborates a common theme in medicine: one size does not fit all. While the data suggest that the laparoscopic approach is still best for most patients, it might not be best for all.”

A small number of laparoscopic patients suffer from what is called “deep infection” inside the body cavity and these patients take months to heal and get back on feet, incurring tremendous costs.

Monson continues to explain:

“We think it comes down to balance. It’s not just about how much a procedure exposes the body to potential infection – it’s also about how easily that procedure allows you to mitigate infection risk… Consider the open approach. Admittedly there’s more chance of exposure to microbes – the wound is wide open. But there’s also more opportunity to sterilize, since you can meticulously clean the operating space before closing it. [In laparoscopy], there’s less exposure to the outside environment, but there’s also less opportunity to disinfect the organ space.”

The researchers tried to identify the risk factors that make some patients suitable or unsuitable for having a laparoscopic procedure. They report that patients with a certain profile are more likely to suffer from deep infection than others. These “high-risk patients” are

  • Male
  • Of older age
  • Smoker
  • Diabetic

In this day and age of “personalized” medicine, doctors are advised to assessment their patients for suitability and risks for this seemingly simple procedure.
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Surgical wonders and innovations

July 28, 2010 by  
Filed under HEALTHCARE

Here are the latest advances in surgery and implantation.

Doctors perform brain surgery via eyelid
A brain tumor usually requires a very invasive surgery, a procedure that entails opening the skull. However, recent innovations in medicine enable a minimally invasive procedure that could be comparable to a “keyhole” surgery of the brain. Doctors at the Johns Hopkins Hospital were able to remove a female patient’s tumor through a small incision in her eyelid.

According to the 47-year old female patient:

“When you tell people you had brain surgery, the first thing people always do is look for a scar, and that’s what’s amazing, there isn’t one. Anyone who needs to go through this should know it’s not that big of a deal even if it sounds like it is.”

First US surgery to compare NOTES vs. laparoscopy
NOTES stands for natural orifice translumenal endoscopic surgery and if you think laparoscopy is minimally invasive, NOTES is even several incisions less. Instead, it uses as point of entry natural orifices. In a groundbreaking clinical trial, researchers compare the use of laparoscopy vs. NOTES in gall bladder removal. As point of entry in the NOTES, the researchers used the mouth and on through the abdominal wall or through the vagina to access the gall bladder. The surgery needs only 2 small incisions that do not require suturing. According to study leader Dr. Santiago Horgan of the University of California at San Diego

What is unique about this trial is that we will not only evaluate the safety and efficacy of NOTES compared to laparoscopy but will also assess and compare pain levels, cosmetic outcomes, operative costs and logistical outcomes.”

Eye telescope implant clears FDA hurdle
Ever thought of having a telescope in your eye? Apparently this procedure is now available, recently approved by the US FDA to treat patients with vision problems. Target patients are those suffering from end-stage age-related macular degeneration above the age of 60. The telescope replaces the natural lens of the eyes and provided images magnified by 2.2 to 2.7 times.

First full face transplant performed in Barcelona
It took 24 hours and 30 surgeons to accomplish the feat – implantation of new facial muscles, skin, nose, lips, jaw, teeth, palate and cheekbones. The operation took place in March but it was only recently that the young male patient braved the media to express his gratitude to the medical team who performed the surgery. Before the surgery, the patient could not breathe or swallow on his own.

Full Face Transplant Claimed by French Doctors
French doctors claim that theirs was the first “full” face transplant almost months after Spanish doctors claimed a similar feat. The operation was performed at the Henri Mondor hospital in the Paris suburb of Creteil last June 27. The operation not only involved full face transplant but also transplant of eyelids and tear ducts.

Operating room injuries: doctors get hurt, too

May 3, 2010 by  
Filed under HEALTHCARE

They play God in the operating rooms. After all, they are holding the scalpel and most often, the patient’s life in their hands. But what we probably don’t know is that surgeons get cut, too, and the operating table is not necessary the most comfortable of all working places. Although most of these are non-serious injuries, they can have some long-term consequences on the surgeon’s health and their ability to practice their profession.

Nowadays, it is standard to use the least invasive procedures when performing a surgery and one of the most commonly used is laparoscopy or popularly known as keyhole surgery. Laparoscopic surgery is used for a wide range of health problems from a simple appendectomy to a radical prostatectomy to remove localized prostate cancer. It has the benefits of increased safety, quicker recovery, shorter hospital stays and cosmetic advantages compared to open surgery techniques. However, these benefits are all on the side of the patient. A large survey of surgeons revealed that about 87% of laparoscopic surgeons are suffering from pain and discomfort when performing these operations, physical symptoms that amount to occupational hazard. It is because performing laparoscopic procedures is less ergonomic than performing an open surgery.

According to lead author Dr. Adrian Park

“In laparoscopic surgery, we are very limited in our degrees of movement, but in open surgery we have a big incision, we put our hands in, we’re directly connected with the target anatomy. With laparoscopic surgery, we operate by looking at a video screen, often keeping our neck and posture in an awkward position for hours. Also, we’re standing for extended periods of time with our shoulders up and our arms out, holding and maneuvering long instruments through tiny, fixed ports.”

Aside from the physical discomfort, laparoscopic surgeons tend to have higher case loads. The resulting physical symptoms include discomfort in the neck, hand, and legs that can result, in the long-term, shortened career longevity.

According to Dr. E. Albert Reece, dean of the University of Maryland School of Medicine.

“The patient has always been the main focus of medicine, as caregivers and researchers grapple with disease treatment and prevention, enhanced patient safety and comfort and the extension of care to more people. At a time when minimally invasive, laparoscopic techniques are expanding, Dr. Park’s research raises new questions that may affect patient care in the future. It is my hope that further research will provide answers, and will help stem what may indeed be an impending epidemic among surgeons.”

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NOTE: The contents in this blog are for informational purposes only, and should not be construed as medical advice, diagnosis, treatment or a substitute for professional care. Always seek the advice of your physician or other qualified health professional before making changes to any existing treatment or program. Some of the information presented in this blog may already be out of date.