Procedures
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Photo by Peter Silvia. | |
Minimally invasive techniques have been used in gynecological surgery for about three decades and the vast majority of GYN surgery is now performed this way. Orthopedic surgery, particularly on the knee using an arthroscope, has also been widely used for several decades.
More recently other specialties have adopted minimally invasive techniques with great results.
More than 90 percent of all gallbladder surgery is now performed laparoscopically and other procedures that have been adapted to this technique include appendectomies (removal of the appendix), surgery for hernia repair and surgery to treat intestinal problems like diverticulitis (a condition in which the large intestine forms painful pouches).
Surgery for colon cancer is also being performed this way more frequently and the American Cancer Society recently released a study which demonstrated that minimally invasive surgery was as effective in colon cancer treatment as open surgery.
Some kinds of lung and kidney surgery can also now be performed with minimally invasive methods.
Southcoast surgeons have extensive training and experience with minimally invasice surgery. To find a Southcoast surgeon, visit our online Physician Finder.
Not every surgery can be performed with minimally invasive techniques. Check with your surgeon about whether you may be a candidate for a minimally invasive approach.
- Gallbladder surgery, which was one of the first types of abdominal surgery to be performed with a laparoscope. Most people go home the same day of surgery and can often return to a desk job several days later.
- Hernia repair: An abdominal hernia occurs when the inside layers of the abdominal wall weaken and then bulge or tear. The inner lining of the abdomen, can push through the weakened area, resulting in a bulging sac that can usually be felt. Sometimes a piece of intestine can get tangled inside the sac, causing severe pain and other, serious problems. With minimally invasive techniques, instruments are inserted through tiny incisions and the hernia is repaired from behind the abdominal wall. A small piece of surgical mesh or screen is fixed over the hernia defect and held in place with small surgical staples.
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Most types of general surgery used to require a large incision, and weeks of recovery time. With some types of laparoscopic surgery, incisions are usually a half-inch, and recovery time lasts only days.
Some common procedures done with minimally invasive techniques include:
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Gastric bypass — or "bariatric" surgery — is the fastest growing general surgical procedure in the country.
Often referred to as "stomach stapling," surgeons rearrange the intestines and use tiny staples to create a small stomach pouch. This restricts the amount of food patients can eat, and the amount of calories they can absorb. As a result, they lose excess weight, with studies showing that the majority are able to keep this weight off on a long-term basis.
Much of the growth in bariatric surgery has been attributed to the fact that the procedure can now be done laparoscopically, making the hospital stay shorter and the recovery period faster for these patients. Postoperative pain and infection rate are also less with minimally invasive techniques.
- Diverticultis: Diverticular disease involves weakenings in the colon walls, which form small pouches that can get infected, inflamed and cause pain. There is also the risk that these pouches can rupture, resulting in a serious medical emergency. If patients have recurrent attacks, they're a candidate for surgery.
- Colon cancer: Open surgery has been traditionally used to remove cancerous tumors in the colon. However, a study reported in 2004 in the New England Journal of Medicine found that minimally invasive surgery, called laparoscopic colectomy, is as effective a treatment for many patients. The study, performed at the Mayo Clinic covered over 800 patients and found that cancer recurrence and survival rates were identical in the groups who had open and minimally invasive surgery.
- Crohn's disease and ulcerative colitis: Crohn's disease and ulcerative colitis have similar symptoms — both inflame the lining of the digestive tract and can cause severe diarrhea and abdominal pain. Minimally invasive surgery is used more and more frequently to remove and re-sect diseased parts of the intestines. Crohn's disease can re-occur and surgery is most frequently used to treat complications such as abscesses or blockages.
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Colon surgery involves removal of pieces of the colon, the long organ that helps digest food and pass nutrients into the blood. Until recently, this type of surgery involved a long abdominal incision, almost a week in the hospital, and then additional weeks of recovery time.
Now, minimally invasive techniques are used more and more in colon surgery, making recovery easier and less painful and helping patients return to their normal lives much more quickly. Other advantages for patients include decreased blood loss and quicker return to normal digestion.
Colon surgery is used to treat conditions such as:
- Uterine bleeding: Statistics show one in five women suffer from heavy uterine bleeding. A major treatment for this has been hysterectomy, but many women often opt to "live with" their condition leaving surgery only as a last resort. However, a new, minimally invasive technique called endometrial ablation or "Novasure," has become the number one alternative to hysterectomy.
The uterine lining, the endometrium, sometimes causes heavy bleeding. Endometrial ablation removes that lining using electrical energy.
The technique requires no abdominal incisions and women can return to work the next day. It's an outpatient procedure that takes an average of 90 seconds and has a significant success rate in improving bleeding. More than 150,000 women have been treated with "Novasure" to date with about 93 to 95 percent having significantly less bleeding and greater than half the women having no bleeding thereafter.
- Permanent sterilization without any incisions: Traditional means of surgical sterilization use laparoscopy with incisions in the abdomen. Recovery can be painful and there are a number of risks associated with this surgery which is often referred to as "tube tying," since the fallopian tubes are surgically closed to prevent pregnancy.
There's a fairly new technique, called "Essure," which involves tubal sterilization without either incisions or anesthesia. This technique is relatively painless and performed as an outpatient procedure.
With "Essure," a tiny camera is inserted into the uterus through the vagina and micro inserts are placed into the fallopian tubes. Over the course of several weeks or months, body tissue actually grows into the tubes and blocks them, preventing fertilization.
The technique takes about 10 minutes and recovery just takes about 24 hours, verses two weeks for a traditional tubal ligation. Studies of hundreds of women have shown the method to have close to a 100 percent effectiveness rate in preventing pregnancy.
- Laparoscopic hysterectomy: A hysterectomy can be performed in three ways — traditionally, through open abdominal incision, vaginally, where the uterus and cervix are taken out through the vagina with no incision in the abdomen, or laparoscopically through tiny incisions on the abdomen.
The advantage to a laparoscopic hysterectomy are significant and include quicker recovery, less blood loss and lower infection rates. Most patients can leave the hospital within 24 hours after a laparoscopic hysterectomy.
Click here for a list of Southcoast Gynecologists
Gynecologic surgeons pioneered minimally invasive surgery — starting back in the 1980s.
New innovative techniques now let surgeons do an entire hysterectomy (removal of the uterus) in a short period of time through tiny incisions.
Significant advantages to the patient include decreased blood loss, decreased operating time, less pain and a much quicker recovery.
Click here for a list of Southcoast Urologists
Surgeons have made great strides in developing minimally invasive techniques for problems that range from painful kidney stones to benign or malignant tumors of the kidney or adrenal glands. Pioneered in the 1990s, minimally invasive urologic surgery has great benefits for patients including less pain from surgery and quicker recovery times.
Kidney Stones
One in 10 people suffer from kidney stones at some time in their lives. Once a person has a kidney stone, there is almost a 50 percent chance he or she will develop another. There are a number of minimally invasive treatments for kidney stones and open surgery for this problem is now performed very rarely.
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Shock wave lithotripsy: This is the most common — and least invasive form — of treatment and is now the front line of kidney stone removal. The technology was developed several decades ago when pilots noticed that their jet planes had large pockmarks from ultrasonic waves while in flight. Scientists theorized these waves might be harnessed to break gallstones and kidney stones, which then required major surgery to remove. The technology did not work well on gallstones, but did break kidney stones into fine fragments that passed naturally out of the body during urination.
During lithotripsy, you lie on a table through which shock waves are directed from a machine called a lithotripter. The waves are targeted directly at the area of the kidney with the stones, and the urologist can continually monitor how well the procedure is working through X-ray or ultrasound pictures.
The whole process takes about an hour and patients can go home that day. Lithotripsy is available at both the Charlton and St. Luke's sites.
Endoscopic laser treatment: Sometimes kidney stones are too large to be dissolved with lithotripsy. In these cases, a relatively new endoscopic treatment can be successful. Using a long, flexible instrument called a "uteroscope," the urologist can guide a laser up through the urinary tube into the kidney. The laser is applied directly to the large stones to vaporize them.
Laser & Ultrasound: Another technique involves puncturing the kidney through a small incision in the abdomen, and breaking up stones with laser and ultrasound.
All of these minimally invasive methods mean quicker recovery and less pain for patients and are available at both the Charlton and St. Luke's sites.
Laparoscopic nephrectomy: Patients suffering from kidney tumors, either benign or cancerous, can now be helped with a new surgical technique called laparoscopic nephrectomy. If caught early, cancerous kidney tumors are highly treatable by surgery alone, which involves removal of the kidney where the tumor is located. Kidney removal is also used to treat benign, or non-cancerous tumors and when the kidney is severely damaged by disease or trauma. Kidney removal, or "nephrectomy," traditionally required a very large incision — about 10 inches — through the rib cage, an area with lots of muscle tissue. Recovery was often extremely painful.
With minimally invasive techniques, the surgeon makes several small incisions — about a half-inch wide — and inserts a scope with a camera, along with surgical instruments. A larger incision — about 4 inches wide — is also made for removal of the kidney. All of the incisions are made in the center of the abdomen, where there is less muscle tissue and therefore less trauma during the surgery.
Patients report much less pain with this technique and can resume eating and digestion quickly, reducing their hospital stay to just several days. Overall, recovery is also quicker and patients are often able to resume their normal activities within several weeks.
This type of surgery is not for everyone and its success depends on tumor size, whether or not the tumor has spread beyond the kidney and whether the patient has extensive scarring from previous surgeries.
Surgery for Undescended Testicles
Five percent of baby boys are born with a testicle that remains inside of the body. This often resolves itself during the first few months of life, but sometimes, the testicle does not descend and may need to be corrected surgically.
Undescended testicles pose an increased risk of testicular cancer later in life. Although the surgical repair does not decrease this risk, it makes it much easier to monitor and detect the cancer at an early stage, when it is about 95 percent curable.
New techniques, now available here at Southcoast, make it easier for urologists to both explore the location of the undescended testicle and repair it with one procedure. Using a laparoscope through small incisions, the surgeon is able to detect how high in the abdomen the testicle is located. The testicle is then re-located by performing laparoscopic surgery, or if it is fairly low in the abdomen, another, less invasive technique is used.
This type of surgery is best performed on children when they are between one and two years of age.
