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 The Mark Ravitch/Leon C. Hirsh Center for Minimally Invasive Surgery |
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Expanding the Scope
Minimally invasive surgery center aims for painless, scarless outpatient treatment
Just over a decade ago, minimally invasive surgery (MIS) was being introduced into widespread use in general and thoracic surgery. Today, MIS has become the standard of care for many procedures and has become widely accepted in nearly all medical specialties, often replacing traditional, open surgery.
The Mark Ravitch/Leon C. Hirsch Center for Minimally Invasive Surgery was established in 1995 to centralize the clinical and research efforts of MIS at UPMC.
Advances in General Surgery
Surgeons at UPMC have helped to advance numerous laparoscopic techniques that allow patients to return home form the hospital soon after surgery. In many instances, such as surgery for stomach tumors and ulcers, laparoscopic procedures have replaced open surgery, resulting in a faster recovery time for patients. Other procedures that were routinely performed by the open approach have been replaced with laparoscopic techniques. These include gallbladder removal (cholecystectomy), removal of the spleen and adrenal glands, and abdominal wall and inguinal hernia repair. For patients who are considered morbidly obese and have tried dieting and weight management programs with limited results, surgeons at the MIS Center offer minimally invasive bariatric surgery. With this procedure, patients lose about 70 percent of excess body weight. Laparoscopic bariatric procedures lower the risk of wound complications, shorten hospital stays, and allow patients to return to normal activities more quickly.
A relatively new advance in general surgery is the development of small (2-to 3-mm diameter) laparoscopic instruments. Referred to as micro-laparoscopy, this type of surgery is almost scarless. General surgeons at UPMC are using this technique for laparoscopic cholecystectomy and inguinal hernia repair.
Advances in Thoracic Surgery
Thoracic surgeons at UPMC have made a number of surgical advances in the treatment of thoracic diseases. Since they first introduced photodynamic therapy for treatment of lung and esophagus disease in the Pittsburgh region in 1996, they have treated more esophageal cancer patients with this form of therapy than any other cancer center in the country. Traditionally, open esophagectomy has been the standard of care for resectable cancer of the esophagus. In 1996, UPMC thoracic and general surgeons performed one of the first minimally invasive removals of the esophagus in the United States. To date, more than 500 patients have undergone minimally invasive esophagectomy with a mortality rate of 1 percent. Surgeons are continuing to refine this technique and are leading a multi-center trial to assess clinical outcomes following minimally invasive esophagectomy. Surgeons are also performing total videoscopic procedures for pulmonary lobectomy that promise to decrease pain and hospital stay.
A cooperative effort to control GERD
Patients with gastroesophageal reflux disease (GERD) now have another option for treatment. Through a combined effort on behalf of general and thoracic surgeons in the MIS Center, patients can undergo a laparoscopic Nissen fundoplication to treat severe heartburn caused by GERD. This procedure may offer patients significant relief of symptoms when medications fail. Other benign esophageal disorders may be treated using MIS, including achalasia, giant paraesophageal hernias, leiomyomas, Zenker's diverticulum and other related disorders.
Exploring the Future
Perhaps one of the most modern advances in MIS at UPMC to date is the development of several new robotic operating rooms. A new generation of operative instruments is making possible new MIS procedures that promise even smaller scars, less pain and shorter hospital stays.
Hermes, a robotic speech recognition system, allows the surgeon to control many operating room devices using simple voice commands. Wearing a headset, the surgeon can tell Hermes to adjust the operating room bed and the lighting in the room or over the operating room table, take pictures or videos of the surgical field, print pictures for future reference and call up the patient's X-rays or MRI scans on a video monitor. The surgeon also can automatically visualize pathology results during surgery and is allowed instant access to medical information from the patient's digital medical records. In a traditional operating room, many of these tasks must be done by nurses, who can now concentrate on the patient instead of moving equipment around. A voice card inserted into the system assures that Hermes will obey verbal commands only from the surgeon. Additionally, operating room staff members can input manual commands through use of a touch-screen pendant. Hermes also can provide visual and voice feedback on the status of each device, such as if there is a problem with malfunction or disconnection.
Aesop is a robotic arm that moves a camera, which is used during MIS to view the surgical field. The camera, positioned at the end of a tube, is inserted into the patient through an inch-long incision. Similar to the voice activation capabilities of Hermes, Aesop moves the camera with precise and steady movements to provide the surgeon with an optimal view of the surgical field. Aesop is literally the third arm for the surgeon. Using simple commands such as 'Aesop, move up, turn left,' the surgeon tells the robot where to move the camera. Because it is not held by a human hand, there is no unwanted camera movement.
The MIS Center also introduced the Charles G. Watson Surgical Education Center in July of 2002. The center is used for Continuing Medical Educations courses as well as for training residents and other physicians on using robotic assistants that they may be required to use in the operating room.
Financial Factors
Previously, surgery was always thought of as a last resort option, when medications and other forms of treatment didn't work. Now, however, that train of thought is changing. The cost of the technology used to perform MIS is high, however, there is a decrease in hospital stays, which saves on labor and overhead costs in an expensive clinical setting. MIS continues to narrow the gap between medical and surgical therapy in terms of overall benefits and risk.
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