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Archive for Tuesday, February 23, 1993

LESS-INVASIVE SURGERY OPTIONS EXPAND LOCALLY

February 23, 1993

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Jodene Smith says more than a month passed before she got up enough courage to watch the video of her gallbladder surgery.

When Smith entered the hospital a little over two years ago to have her gallbladder removed, her physician performed the surgery and filmed it from a new angle inside her body.

"The video shows the whole procedure," said Smith, an education technician and information officer at Haskell Indian Junior College. "When you watch it, you realize why you're so sore. They literally flip your liver over to get to the gallbladder."

Smith had her gallbladder removed through laparoscopic surgery, a minimally invasive technique in which the surgeon operates with miniature instruments and the aid of a tiny camera, all inserted into the patient's abdominal cavity through several small incisions.

SMITH'S SURGEON gave her the videotape, much like dentists give patients their extracted teeth.

Minimal pain, shorter recovery time and a shorter hospital stay are all pluses with laparoscopic surgery, said Dr. Steve Myrick, a Lawrence general surgeon who uses the technique.

Myrick and his partner, Dr. Dale Denning, use laparoscopic surgery for gallbladder removal, appendectomies, hernia repairs and biopsies.

"We started doing the gallbladder removals about three years ago," Myrick said. "Then we began adding new techniques and surgeries as we became more proficient."

Last February they begin doing appendectomies, and about four months ago, hernia repair.

"We started with gallbladders because it's one of the most commonly done surgeries in the United States," Myrick said, "and anatomically it's one of the easiest organs to remove with instruments."

LAPAROSCOPIC procedures begin with the surgeon making a small incision in the patient's abdomen and piping carbon dioxide through the incision into the abdominal cavity, expanding it so there is more room to work.

Next, a thin tube carrying a miniature camera is inserted into the incision. Using a telescope and camera, the surgeon focuses on a section of tissue and projects the magnified image onto a 20-inch television screen positioned nearby.

Other small incisions are made for the insertion of such surgical instruments as scalpels and clamps, which the surgeon uses to do the surgery while watching the manipulations on the TV screen.

DR. STEPHEN Vierthaler, a local obstetrician and gynecologist, said laparoscopic techniques had been used for a long time in his field.

"This technique has been widespread for the last 20 years in this specialty," he said, "mostly with tubal ligations and diagnostic techniques."

Other ob/gyn conditions that may qualify for laparoscopic surgeries include tubal pregnancies, ovarian cysts and some hysterectomies.

"We do the same operation we would do normally," Vierthaler said, "just with different instruments and smaller incisions."

Physicians said laparoscopic techniques had some drawbacks as well as advantages.

"Just because something can be done laparoscopically doesn't mean it's the best way to do it," said Dr. Mark Praeger, a general surgeon in Lawrence. "There's a danger in pushing this too quickly on too many people."

Praeger, who practices with Dr. Marilee McGinness, said they removed gallbladders and appendixes with laparoscopic surgery and were in training to do hernia repair.

"IN ORDER FOR this to be accepted," he said, "the dangers and risks of this surgery have to be equal to or less than the dangers and risks of traditional surgery.

One potential risk is the necessity of using general anesthesia, said McGinness, noting some traditional surgeries could be done with only local anesthesia.

"You always have to be careful when you have to put someone to sleep," she said.

Praeger said he thought that eventually a balance would develop between surgeries best done with the laparoscopic technique and surgeries best done traditionally.

Tom Campbell, LMH director of operating room nursing, said in terms of equipment, laparoscopic instruments were much more fragile than traditional instruments a situation reflected in the surgery's cost.

"It's very delicate," he said of the miniature equipment, noting it lasts only two or three years while traditional equipment can last up to 15 years.

Campbell also said laparoscopic surgery required more training for nurses and support staff, and more time in the operating room.

"It takes 15 or 20 more minutes on both sides of the surgery, especially if we're following one right after another," he said. "It takes time to process the instruments because they are so delicate."

Vierthaler noted the future of laparoscopic surgery centered on instrument development.

"No one knows where it's going to stop at this point," he said. "I expect for right now there will be a pause in the movement as the ideas solidify. Then I expect a whole new generation of techniques and instruments."

PRAEGER SAID, "The major benefit is getting people back to their normal work situation sooner and shortening hospital stays. The criteria we need to look at is can you do the same operation laparoscopically with less risk to the patient and less recuperative time than with traditional techniques.

"If the answer is yes, then it makes sense to work laparoscopically, but if you have to do major modifications to what you would normally do, then you should look at it."

Gallbladder patient Smith remained in the hospital 24 hours after her surgery two years ago, but most laparoscopic patients today are released the same day as their surgery to recover at home.

Smith said she had almost no residual scars. "The two little ones on the side (of her stomach) are almost gone," she noted. "The other is deep inside the belly button so you almost don't notice it's there."

Smith said she was away from her job for only two weeks to recover from the operation.

"That's a pretty fast," she said. "Given a choice between surgical techniques, the recovery time was a big plus with this one. If they do it the old way, it's six weeks at home."

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