Surgery on the Cutting Edge

“Well, Bones, do the new medical facilities meet with your approval?”
– Admiral James T. Kirk

“They do not. It’s like working in a damn computer center.”
– Dr. Leonard “Bones” McCoy

From “Star Trek: The Motion Picture”

Modern surgery might not yet feature Star Trekian techniques and equipment, but in some regards, they are on their way. Technological advances have radically changed how some types of surgery are performed in New Hampshire, and have hastened the healing process for many patients.

One of the prime surgical trends enabled by technology is minimally invasive surgery, in which surgery is performed through a much smaller incision than in the past, or sometimes, through no incision at all. For example, some cardiac procedures that previously required a surgeon to make a large incision and cut through breast bone can now be done without breaking skin. Instead, the surgeon refers to three-dimensional images while guiding a catheter through a patient’s groin and up to the patient’s heart.

Laparoscopy, requiring small incisions and relying upon tiny video cameras and mini flashlight-like fiber optics, is commonly performed minimally invasive surgery that is applied in a variety of cases, including gallbladder removal, heartburn treatment and brain, prostate, colon, knee and weight-loss surgery.

But cardiovascular surgery has been especially affected by technology, says Yvon R. Baribeau, MD, FACS, Cardiovascular and Thoracic Surgeon at Catholic Medical Center. “It has been a tremendously exciting time for us in the last 10-15 years,” he says. “Technology is allowing us to do things we never would have dreamed of doing a few years back,” including “beating heart surgery,” which is cardiac surgery that forgoes the traditional method of stopping the patient’s heart during the operation. Not stopping the heart eliminates the need for the patient to be hooked up to a heart-lung machine, resulting in less bleeding and a lower risk of stroke.

Although costly and not risk-free, high-tech surgery like laparoscopy usually leads to fewer complications than traditional “open” surgery. Less-invasive procedures often result in shorter operations, less bleeding, a shorter hospital stay and quicker healing and recovery, says Samuel R. G. Finlayson, MD, MPH, Associate Professor of Surgery at Dartmouth Medical School and a surgeon at Dartmouth-Hitchcock Medical Center.

Also making big waves on the local surgical scene is telerobotic surgery. Telerobotic surgery can refer to a surgeon in one location using a robot to operate on a patient who is in another location, possibly in another state or country. In New Hampshire hospitals, robotic surgery typically involves using robotic assistance to perform a procedure on a patient who is in the same room as the surgeon.

Whether telerobotic surgery is performed remotely or not, the surgeon makes the decisions and controls the surgery, not the robot. The robotic system commonly used in the Granite State consists of a mechanical unit with arms that are attached to instruments. The surgeon controls the robot’s movements from a console in the operating room while viewing a 3-D image of the surgical site. Entering the patient’s body through small incisions, the robot’s tiny hand-like instruments mimic the surgeon’s hand, and are capable of performing extremely detailed work in tight spaces. The robot replicates the surgeon’s motions, but can execute the movements at a different rate or on a different scale, Baribeau says. “The robot allows me to be extremely precise.”

If you’re technology-averse or simply worried about possible consequences of high-tech gadgetry failing during life-saving surgery, fear not, the doctors say. The surgeon can always go to plan B: doing surgery the old-fashioned way. If a 3-D image suddenly goes blank or the robot stops working, the surgeon can quickly change gears and do a traditional operation. “We’d be able to immediately convert without thinking about it – in a second,” Baribeau says, adding that rigorous FDA regulation makes chances of equipment failure pretty slim.

And if you think about it, there’s always been a risk related to properly working equipment, Finlayson points out. After all, he says, “We’ve always needed lights.” NH

Questions for Your Surgeon

The U.S. Department of Health and Human Services recommends you take this list of questions with you when you go to your doctor or surgeon to discuss your surgery.

What operation are you recommending?
Why do I need the operation?
Are there alternatives to surgery?
What are the benefits of having the operation?
What are the risks of having the operation?
What if I don’t have this operation?
Where can I get a second opinion?
What is your training and experience to do this kind of surgery?
Where will the operation be done?
Will I have to stay overnight in the hospital?
What kind of anesthesia will I need?
How long will it take me to recover?
How much will the operation cost?
Can you please mark the part of my body you will operate on?