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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Know your interventions: focal cryoablation for prostate cancer

April 20, 2009 by  
Filed under CANCER

freezeThe recent contradictory results of two large scale studies that investigated the risks and benefits of prostate cancer screening brought about the question of overdiagnosis and overtreatment. It also highlighted the need for less radical and minimally invasive treatment.

Men diagnosed with prostate cancer are usually recommended to undergo prostatectomy, which is the surgical removal of the prostate gland. No one can deny that this treatment is radical and highly invasive, and sadly, sometimes unnecessary. This is because it is extremely difficult to determine whether a prostate tumor is malignant or benign, slow-growing or aggressive and the only way to be sure is looking at the tumor in the lab, long after the organ ahs been removed.

Researchers presented a study at the Society of Interventional Radiology’s 34th Annual Scientific Meeting that may just have the answer. Instead of bombarding tumors with radiation or chemotherapeutic agents, this new technique uses freezing technology. In the treatment of prostate cancer, this method is called “male lumpectomy” or “focal cryoablation.” Instead of surgically removing the entire prostate gland or subject the whole gland to radiation, interventional radiologists can localize the tumor and destroy it by freezing.

With cryoablation, interventional radiologists insert a probe through the skin, using imaging to guide the needle to the tumor; the probe then circulates extremely cold gas to freeze and destroy the cancerous tissue. This minimally invasive treatment targets only the cancer itself, sparing healthy tissue in and around the prostate gland rather than destroying it, as traditional approaches do.

This treatment method has the following advantages over traditional treatments:

  • Minimally invasive
  • Less traumatic
  • More likely to preserve sexual function
  • Less likely to interfere with urinary function
  • No major complications
  • Fewer side effects

The technique has long been used in breast cancer treatment where instead of radical mastectomy, surgical breast lumpectomy is now the preferred method. Unlike breast tumors, however, surgical lumpectomy of prostate tumors is technically not feasible. But the use of cryoablation technique seems to solve this problem. “Cryoablation spares as much as possible of the prostate gland and its neurovascular bundles, limiting the side effects of bladder control problems (incontinence) and erectile dysfunction (impotence) that result from more radical prostate cancer treatments.”

Many health experts advocate the “watchful waiting” strategy over traditional but radical prostatectomy. Advocates of focal cryoablation claim it, too, presents an advantage over the “watchful waiting” approach because all other treatment options are preserved.

The researchers further recommend that focal ablation should be complemented by the 3-D transperineal biopsy. Using 3-D mapping technique, this biopsy can detect very small tumors that can then easily be destroyed by cryoablation.

Indeed, this new development gives hope to men. Current guidelines recommend that men should get screened for prostate cancer at age 50 and above.

Photo credit: stock.xchng

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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.