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What's Minimally Invasive Surgery?

Guest column by Dr. Scannell

By DR. GIANNA SCANNELL

Skyline Hospital

John woke up with heartburn. He sat up in bed in pain and frustration, and reached for his TUMS. It was getting more frequent, this last month, and it was lasting longer, but he didn't want to go to the doctor. If he drank milk and avoided coffee, he thought, it wasn't as bad. Sometime ago, a doctor had told him that he had acid reflux, to take some expensive pills, but he couldn't afford them.

He remembered his father having the same problem. He had to have surgery, and stayed at the hospital for weeks, nurturing his sore belly, after the surgeon had cut it open. John didn't want to have the same thing. So he waited, and waited. Until one day, food got stuck in his throat, and it wouldn't go down. He had to go to the emergency room, and have it removed.

Why do we put up with problems which affect our life and health? A number of cases can be resolved today with minimally invasive surgery. It requires at most an overnight hospital stay, minimal pain, and tiny little scars. One of them is laparoscopic repair of gastric reflux, which causes chronic heartburn, and may lead to cancer of the esophagus, our swallowing pipe. But there are more.

Gallbladder problems, caused by stones blocking the drainage of bile, can be solved with four tiny incisions and same day surgery, for example.

But isn't it still surgery?

Yes, and it still requires anesthesia, but recovery time is quicker, and much less painful.

Hernias can be fixed this way too, and in some cases, the bowel can be removed without having to make a large opening in the abdomen.

How does it work?

There are three essential components to doing minimally invasive surgery.

First, there is the camera, mounted on a long, narrow fiber optic cable. It is introduced in the abdomen through what is called a port, a protected opening in the belly wall. Images collected by the camera appear on two screens, located in strategic positions around the patient.

Second, there are long, straight instruments designed to do everything a surgical instrument does, but these can be introduced through ports half or one centimeter in diameter.

Third, and most important, is the carbon dioxide insufflator. It is this device which allows laparoscopic surgery. It keeps the abdominal wall from contact with the rest of the abdomen, creating a space through which it is possible to see organs, and perform operations.

Today, minimally invasive surgery is done from inside knees, abdomens, blood vessels, hearts, bladders, areas around the kidneys, in the neck, and in the chest. It is the way surgery will be done, almost exclusively, in the future. High risk patients can tolerate it better, and healing time is quicker. It is the closest thing to Star Trek's triquarters there is today.

After the gastroenterologist removed John's food from his esophagus, he referred him to a surgeon, and he underwent minimally invasive surgery to protect it from stomach acid. He is feeling a lot better, and doesn't wake up with heartburn anymore.

Please email (denisgianna@yahoo.com) or call (509-493-1101) for questions.

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