Imagine a surgical procedure with an incision no bigger than a grain of rice.
It may sound futuristic, but it’s happening every day at Cabell Huntington Hospital.
The newly-developed Division of Minimally Invasive Surgery established by the Marshall University Joan C. Edwards School of Medicine is on the forefront of the latest advances in techniques and technologies to allow its patients to reap the benefits of minimally invasive procedures for nearly any operation. General surgeons as well as specialized surgeons, in fields such as surgical weight control and surgical oncology, are leading the charge in the Tri-State to bring these laparoscopic procedures to patients. And the benefits, such as faster recovery times, fewer wound complications, reduced pain and a quicker return to normal activities that come with it.
Origins and History
Some of the early minimally invasive surgeries performed were recorded in the early 1940’s, but it was not until the mid- to late-80’s that they started becoming the talk of the medical community.
“Laparoscopic procedures became widely accepted in 1986 or 1987, but it was the early 90’s before things really took off in general surgery,” said Dr. Gerald McKinney, head of Marshall’s Division of Minimally Invasive Surgery. “For malignancies, it started being considered not only safe, but potentially a better surgery than an open procedure.”
When McKinney, a general surgeon, arrived at Cabell Huntington Hospital in 2003, it marked a resurgence in laparoscopic procedures and a renewed interest in an area that McKinney said he is very passionate about. The prevalence of minimally invasive cases increased as more physicians, including surgical oncologist Dr. Wade Douglas and bariatric surgeon Dr. Blaine Nease, started turning to the techniques for everything from colon and liver resections and ablation of tumors to weight control procedures and trauma surgeries. Even removal of a patient’s prostate and kidneys can be performed laparoscopically at Cabell Huntington Hospital.
Benefits
Besides the obvious cosmetic benefits of miniscule incisions, there are numerous benefits for patients who undergo minimally invasive procedures.
“For me, in my practice, what minimally invasive techniques allow is the ability to operate on patients who wouldn’t necessarily entertain surgery because of post-operative concerns or patients who wouldn’t be a candidate at all to undergo these procedures,” said Nease, who has been offering minimally invasive bariatric procedures since 2001. Just in the past week, Nease placed the first REALIZE Adjustable Gastric Banding, an alternative to the popular Lap-Band, in
the state of West Virginia.
Nease said 99 percent of his patient base is treated laparoscopically, adding that even for the more complex surgeries, he tends to lean toward minimally invasive treatment.
“Where we would automatically do open surgery before, we realize the more we do things laparoscopically, the more adept we get at doing them,” he offered.
In Dr. Douglas’ practice, the first choice for surgery, he said, is always minimally invasive surgery – for the right patient.
“I consider it my first choice, but it’s all about patient selection,” said Douglas, who has used laparoscopic techniques to treat colon and rectal cancers and to perform liver resections, splenectomies and adrenalectomies.
Dr. McKinney stressed that all patients looking at undergoing a surgical procedure should push for minimally invasive techniques, where appropriate. The benefits, he said, are widely documented and of substantial benefit to a surgical candidate.
“You’re looking at a shorter recovery time, reduced pain for the individual, less narcotic requirements, easier wound care, potentially shorter hospital stays and better cosmetic results with incisions anywhere from 5 millimeters to just the width of two fingers,” McKinney said. “We had a patient go home one day after a colon resection. That’s certainly not the norm; generally, you’re looking at two to three days. But, that shows you the advantages of going this direction.”
Some contraindications have presented roadblocks for physicians performing laparoscopic procedures, but McKinney said many of those he has personally disproved.
“We used to be concerned about doing these in pregnant patients or in very morbidly obese patients, but I’ve worked on a patient in her thirty-third week of pregnancy and a patient of 600 pounds,” he explained. “The only reason I couldn’t do a procedure laparoscopically is if I don’t have enough room to see to complete the procedure. There are very few things that you can’t accomplish laparoscopically.”
From Douglas’ perspective, minimally invasive surgery has become a much more attractive choice for patients.
“The two biggest attractions I see for patients is the decreased length of hospitalization and the amount of pain post-operatively. They get home quicker and feel better sooner,” he said.
Instrumentation
With the development of the Division of Minimally Invasive Surgery, physicians hospital-wide are moving from a comfort zone of open procedures to the more patient-friendly laparoscopic approach. Some, McKinney offered, are slower to make the transition because they believe open surgery can be performed more quickly. According to Nease, the more frequently these new methods are implemented, the sooner physicians will be won over.
“You get to a point where you’ve performed laparoscopically so much, having to do an open surgery is a disappointment,” Nease said. “In minimally invasive surgeries, we utilize these nice video screens that are magnified and high definition, so you can actually better see what you’re doing – better than you could see in an open procedure with your own eyes.”
Laparoscopic surgeries utilize monitors, small, thin instruments and flexible fiber optic scopes. Some procedures are computer-driven, and the investment made by Cabell Huntington Hospital in the state-of-the-art da Vinci Surgical System – a robotic- and computer-assisted platform for minimally invasive surgery – is proof that laparoscopic technique is on the front burner for physicians as well as administration.
“Every specialty area in the hospital is looking for a way of doing their procedures with minimally-invasive techniques, and the hospital supports that 100 percent,” said Douglas. As physicians, we aren’t able to purchase the new instrumentation, devices and special equipment ourselves, and the hospital has stepped up in a big way, making the commitment, so we’re able to do as many things laparoscopically as we possibly can.”
Dr. Douglas said the push to provide minimally invasive technologies is what makes Cabell Huntington Hospital on par with centers in larger cities.
“A lot of times these procedures can’t be found in the smaller community centers,” he said. “The expertise to do these is right here. The majority of things that are done in larger centers can be done right here in Huntington.”
McKinney said his goal is to see increased physician and surgeon involvement as well as early education and experience for up-and-coming medical students and residents in the area of minimally invasive technique. He also advocates increased training through the Marshall University Joan C. Edwards School of Medicine in this field.
“There are courses that can be taken and fellowships that can provide additional training,” McKinney said. “If I have my way, these opportunities will be available at Marshall University in the not-too-distant future.”
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