Growing Number of Specialties Tap into Minimally Invasive Surgery Techniques

Growing Number of Specialties Tap into Minimally Invasive Surgery Techniques

By Kelli M. Donley

The advancements in medical technology that have allowed surgeons to perform a vast array of complicated medical procedures through keyhole incisions seems more like science fiction than reality.

But at one time, so did the Internet. Today, these two technologies are being used in combination as a method of providing advanced care for patients and educating healthcare workers on the benefits of minimally invasive procedures.

SURGEON'S CUT

Physicians both in healthcare facilities and ambulatory surgical centers are embracing minimally invasive surgery as the preferred method of treating their patients because of reduced infection rates and improvements in recovery time and pain management.

Laparoscopic surgery has evolved rapidly during the past 30 years. Gynecological procedures via laparoscope were approved in the 1970s, cholecystectomies in 1988, kidney removal in 1992 and prostate removal in 1998.¹

Jeffrey Port, MD, is a thoracic surgeon at New York-Presbyterian in New York City. Port says improved technology, including using robots in the operating theater, have revolutionized his field.

"We've gone down to smaller cameras, once starting at 10 and 12 mm and now down to 5 mm," he says. "There are smaller ports to operate through. Also, we have a robot in the hospital that we have been using in the research setting and soon in the clinical setting. We are really pushing the envelope forward in both the thoracic and cardiac specialties."

Port says he performs between 325 and 350 procedures annually.

"Most of our patients in thoracic surgery have some sort of lung or esophageal problem," he says. "Lung cancer patients need a diagnosis and a biopsy. Instead of doing a big, open biopsy, we can do a video-assisted biopsy. Patients with benign lung disease and benign breathing problems often need lung biopsies. Patients may develop recurrent fluid that needs to be drained and taken care of. Now we've pushed the envelope even further by taking out the lung cancers themselves via lobectomies. This is the actual resection of the lung through a thoroscope."

Port says there are many opportunities to operate via minimally invasive technology and it is preferred.

"We can do a lot of things, from the cancer patient, to the patient with an infection or even progressive lung disease," he says. "We are seeing patients with better pain control post-operatively and shorter lengths of stay with equally good results."

Dennis Fowler, MD, a surgeon at Weill Cornell Medical Center and director of the minimal access surgery program at New York-Presbyterian Hospital, says he performs a variety of procedures via laparoscope.

"I am a general surgeon, so everything I would do surgically, I do laparoscopically," he says. "Specifically, that includes gall bladder surgery, anti-reflux surgery, several types of stomach surgery, colon surgery, appendectomy and hernia repairs of all types. I also perform solid organ surgery, such as splenectomy, adrenalectomy and nephrectomy, including donor nephrectomy for transplant."

Fowler says laparoscopy offers a magnitude of benefits.

"I don't have a choice (whether to operate via laparoscopy) because my job is to do the best thing for the patient, and clearly, this is the best option," he says. "The benefits of minimal access surgery are now well documented. They certainly include numerous recovery benefits, such as less pain, quicker resumption of diet, quicker return of intestinal function, less time in the hospital and a faster return to work or normal activities. Recovery benefits are the first thing everyone notices, but there are also other benefits. For most procedures, there is less blood loss, less suppression of the immune system, fewer wound infections and less embarrassment of pulmonary function."

CLINIC'S VIEW

Laurie Canala, clinical director of ambulatory surgery centers for The Cleveland Clinic Foundation, says matching the patient's needs with the instrumentation is necessary.

"In general, minimally invasive surgeries are usually preferred to open (procedures) because they are less invasive, patients recover more quickly and the post-op course is usually easier for the patient," she says. "However, as in any surgical procedure, the physician always considers what is the best treatment option for the patient. There are times when a minimally invasive technique might not meet that criteria."

Canala is responsible for three ambulatory surgery centers, in which an estimated 17,000 patients are treated annually. She says laparoscopic orthopedic cases are the most common, although the facilities use minimally invasive technology for many procedures.

"They types of minimally invasive surgery cases being done are fairly typical of this setting," she says. Orthopedics: joint arthroscopy; gynecology; laparoscopy; plastic surgery: endoscopic brows and breast implants; general surgery: inguinal hernia repairs and cholecystectomies.

TECH TOOLS

John Konsin, vice president of marketing for Smith & Nephew Endoscopy, Inc., helps match minimally invasive technologies facilities, including creating digital operating rooms in ambulatory surgery centers. He says communicating with healthcare workers and administrators about their ultimate surgical goals from the beginning is key to a successful relationship.

"We sit down with them and plan what they want to accomplish in their operating room," he says. "As a result of the discussion, we take our array of technologies and try to create a solution that is unique and is based on their needs. We try not to go into any operating room and just say, 'Here is our technology and you are going to love it. Trust us.'"

The company specializes in five areas of technology when working to update a facility: endoscopic capital equipment, centralized control of equipment, multimedia capabilities, mounting equipment and digital image management.

Konsin says the management of images, whether they are being stored for the patient's use or for redistribution, has become increasingly important within the industry.

"They want to be able to broadcast what is being done in the operating room to another area of the facility or they want to take what is being broadcast in their OR to a tradeshow where there are other surgeons," he says. "You will see smaller affiliated ambulatory surgery centers looking to connect what is going on in their OR to a major hospital that they are affiliated with so students, interns and fellows can observe the procedure from a remote location."

The company has worked increasingly with ambulatory surgery centers in the last ten years. Konsin says minimally invasive procedures are ideal for the outpatient setting.

"Arthroscopic procedures specifically have become more popular for surgeons to perform at surgicenters," he says. "Endoscopy in general lends itself very well to an ambulatory surgery center setting because of its less invasive nature. With small incisions, there is typically less trauma to the patient. As a result, surgeons who perform these procedures feel very comfortable operating at a surgicenter."

TECHNOLOGY IN USE

Vail Valley Surgical Center in Vail, Colo., is in the process of developing four Smith & Nephew custom-designed endoscopic digital operating rooms. The surgicenter is a joint venture between the Steadman Hawkins Clinic, Vail Valley Medical Center and other affiliated physicians.

"We were focused on developing an operating room solution that would enable us to harness the power of the digital age, the Internet and other emerging technologies for the benefit of our surgeons and their patients," says Jim Silliman, MD, CEO and president of Steadman Hawkins Clinic and Foundation.

The revolutionary facility will include digital image acquisition systems, integrated touch panel solutions, Web-based interactive medical imaging database applications, advanced, point-to-point telecommunication solutions and flat-panel displays.

Ambulatory surgery centers provide the perfect opportunity for patients looking to escape the anxiety-causing environment of traditional hospitals. Procedural advancements are racing to keep up with technological progress, allowing patients to have everything from breast implants to appendectomies via laparoscope within a surgicenter. Understanding and implementing these minimally invasive procedures could provide a plethora of additional clients.