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Akron hospitals work on evolving minimally invasive laparoscopy using single opening
By Cheryl Powell
Beacon Journal medical writer
Published on Monday, May 18, 2009
For patients who can't stomach the thought of multiple abdominal incisions during surgery, there's a new way to operate.
Minimally invasive surgery is getting even less invasive.
Both of Akron's adult hospital systems recently started offering some laparoscopic surgery with only a single incision through the patient's belly button.
Laparoscopic procedures — such as many gallbladder or appendix removals — typically require three or four small incisions in the abdomen to accommodate surgical instruments and a video camera to guide the surgeon.
New ports and flexible instruments now are enabling doctors to insert the camera and surgical tools through a single opening that's less than 2 centimeters long.
Just as with traditional laparoscopic procedures, the abdomen is inflated with carbon dioxide gas to give the surgeon room to perform the procedure.
But by entering the abdominal cavity through only the belly button, the result is a practically scar-free surgery, said Dr. Charudutt Paranjape, a surgeon at Akron General Medical Center.
''The patients love it,'' Paranjape said. ''They have no scar, basically. That is driving the surgeons' desire to be less invasive. . . . Whenever it's possible, it's definitely more satisfying for the patient.''
Barbara Dingess, 56, of Akron, recently had a hernia in her lower left abdomen repaired by Paranjape through a single incision.
A 4-centimeter-long scar from a previous hernia surgery was visible on her abdomen.
This time, however, the lone incision was tucked inside her navel and secured with two stitches.
Before her surgery, Dingess said she was pleased with the idea of a single cut.
''I like that very much,'' she said. ''You know, those old cuts were a lot.''
The benefits aren't simply cosmetic.
Studies still are being conducted to determine whether one incision is better than three or more when it comes to pain, risk of infection and other post-operative problems, Paranjape said.
There is evidence that a single incision results in less use of narcotic painkillers after the procedure, said Dr. Daniel Guyton, chairman of the Department of Surgery at Akron General.
Previous medical studies have shown that fewer incisions result in shorter operating time and faster recovery.
Single-incision surgery is the latest step in the evolution of minimally invasive procedures, said Dr. John Zografakis, director of advanced laparoscopic surgical services and the bariatric care center at Summa Health System in Akron.
Surgeons started using laparoscopic techniques to remove gallbladders in the late 1980s, he said. That advance moved many of these surgeries from inpatient to outpatient procedures.
But just as all patients don't qualify for traditional laparoscopic procedures, not everyone can get a single-incision surgery, Zografakis said.
People with acute inflammation, gallbladders that are fully distended with gallstones or those who are morbidly obese often aren't candidates for the single-incision approach, he said. These conditions can limit the surgeon's vision through the camera.
Prepared to convert
Surgeons also must be prepared to convert to a more invasive procedure if needed, he said.
''This is an emerging technology,'' he said. ''Our attempts are to be pioneers and move forward the progress of minimally invasive procedures. But at the same time, there's the chance that we could convert to the traditional minimally invasive surgery.''
Local surgeons are using the single-incision approach to repair hernias and remove gallbladders and appendixes. But the approach could expand to many other procedures.
''Single port offers access to just about every organ in the body,'' Guyton said.
For example, the Cleveland Clinic started using single-incision surgery in 2007 to kill cancerous tumors on kidneys.
The Cleveland hospital also has done single-incision surgery to remove kidneys from living donors, to remove bladders and prostates, to treat pelvic organ prolapse in women, to reconstruct the urinary tract, to treat enlarged veins within the scrotum and for other procedures.
More options will be available in the future, when surgeons use robots to assist with single-port procedures, said Dr. Jihad Kaouk, director of the Center for Laparoscopic and Robotic Surgery in the urology department at the Cleveland Clinic.
''This is an approach that is still evolving,'' he said. ''While we're excited that we may be able to provide patients with less pain and quicker recovery, we need to be careful in gathering and monitoring new approaches.''
No outside incisions
The next step for minimally invasive surgery is to move toward procedures that don't require any incisions on the outside of the body.
Some experimental procedures have taken place through natural orifices, such as through openings created in the stomach or the vagina, Kaouk said.
The stomach could be a good candidate be an internal entry point for operations because it lacks pain receptors, he said. Surgery through the vagina also appears to be a good option for female patients because the tissue has a rich blood supply and heals very quickly.
The Cleveland hospital is hosting a seminar later this month to share information with other doctors nationwide about advances in single-port surgery as well as procedures through natural orifices.
''We're trying to spread this technique as much as we can to benefit as many patients as we can,'' Kaouk said.
Cheryl Powell can be reached at 330-996-3902 or chpowell@thebeaconjournal.com.
For patients who can't stomach the thought of multiple abdominal incisions during surgery, there's a new way to operate.
Minimally invasive surgery is getting even less invasive.
Both of Akron's adult hospital systems recently started offering some laparoscopic surgery with only a single incision through the patient's belly button.
Laparoscopic procedures — such as many gallbladder or appendix removals — typically require three or four small incisions in the abdomen to accommodate surgical instruments and a video camera to guide the surgeon.
New ports and flexible instruments now are enabling doctors to insert the camera and surgical tools through a single opening that's less than 2 centimeters long.
Just as with traditional laparoscopic procedures, the abdomen is inflated with carbon dioxide gas to give the surgeon room to perform the procedure.
But by entering the abdominal cavity through only the belly button, the result is a practically scar-free surgery, said Dr. Charudutt Paranjape, a surgeon at Akron General Medical Center.
''The patients love it,'' Paranjape said. ''They have no scar, basically. That is driving the surgeons' desire to be less invasive. . . . Whenever it's possible, it's definitely more satisfying for the patient.''
Barbara Dingess, 56, of Akron, recently had a hernia in her lower left abdomen repaired by Paranjape through a single incision.
A 4-centimeter-long scar from a previous hernia surgery was visible on her abdomen.
This time, however, the lone incision was tucked inside her navel and secured with two stitches.
Before her surgery, Dingess said she was pleased with the idea of a single cut.
''I like that very much,'' she said. ''You know, those old cuts were a lot.''
The benefits aren't simply cosmetic.
Studies still are being conducted to determine whether one incision is better than three or more when it comes to pain, risk of infection and other post-operative problems, Paranjape said.
There is evidence that a single incision results in less use of narcotic painkillers after the procedure, said Dr. Daniel Guyton, chairman of the Department of Surgery at Akron General.
Previous medical studies have shown that fewer incisions result in shorter operating time and faster recovery.
Single-incision surgery is the latest step in the evolution of minimally invasive procedures, said Dr. John Zografakis, director of advanced laparoscopic surgical services and the bariatric care center at Summa Health System in Akron.
Surgeons started using laparoscopic techniques to remove gallbladders in the late 1980s, he said. That advance moved many of these surgeries from inpatient to outpatient procedures.
But just as all patients don't qualify for traditional laparoscopic procedures, not everyone can get a single-incision surgery, Zografakis said.
People with acute inflammation, gallbladders that are fully distended with gallstones or those who are morbidly obese often aren't candidates for the single-incision approach, he said. These conditions can limit the surgeon's vision through the camera.
Prepared to convert
Surgeons also must be prepared to convert to a more invasive procedure if needed, he said.
''This is an emerging technology,'' he said. ''Our attempts are to be pioneers and move forward the progress of minimally invasive procedures. But at the same time, there's the chance that we could convert to the traditional minimally invasive surgery.''
Local surgeons are using the single-incision approach to repair hernias and remove gallbladders and appendixes. But the approach could expand to many other procedures.
''Single port offers access to just about every organ in the body,'' Guyton said.
For example, the Cleveland Clinic started using single-incision surgery in 2007 to kill cancerous tumors on kidneys.
The Cleveland hospital also has done single-incision surgery to remove kidneys from living donors, to remove bladders and prostates, to treat pelvic organ prolapse in women, to reconstruct the urinary tract, to treat enlarged veins within the scrotum and for other procedures.
More options will be available in the future, when surgeons use robots to assist with single-port procedures, said Dr. Jihad Kaouk, director of the Center for Laparoscopic and Robotic Surgery in the urology department at the Cleveland Clinic.
''This is an approach that is still evolving,'' he said. ''While we're excited that we may be able to provide patients with less pain and quicker recovery, we need to be careful in gathering and monitoring new approaches.''
No outside incisions
The next step for minimally invasive surgery is to move toward procedures that don't require any incisions on the outside of the body.
Some experimental procedures have taken place through natural orifices, such as through openings created in the stomach or the vagina, Kaouk said.
The stomach could be a good candidate be an internal entry point for operations because it lacks pain receptors, he said. Surgery through the vagina also appears to be a good option for female patients because the tissue has a rich blood supply and heals very quickly.
The Cleveland hospital is hosting a seminar later this month to share information with other doctors nationwide about advances in single-port surgery as well as procedures through natural orifices.
''We're trying to spread this technique as much as we can to benefit as many patients as we can,'' Kaouk said.
Cheryl Powell can be reached at 330-996-3902 or chpowell@thebeaconjournal.com.
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