When it comes to surgery, less is more — particularly when it comes to the incision.
Case in point: City of Hope surgeon Joseph Kim, M.D., and his team recently removed a liver tumor using minimally invasive surgery, and the patient left the hospital only three days later, significantly faster than the five-to-eight-day hospital stay typical for a traditional procedure.
“She was able to go home off of prescription pain medications; we just provided ibuprofen,” Kim said.
|Surgeon and researcher Joseph Kim (Paula Myers)|
He noted that the laparoscopic procedures, which are often dubbed “keyhole surgery,” offer the benefits of smaller incisions and less pain, and usually mean less blood loss, as well.
As Kim explained, traditional liver surgery involves making a long opening in the skin — called a chevron incision — that runs from one side of the abdomen to the other, just below the rib cage. In the laparoscopic procedure, however, surgeons made four, small incisions.
One incision accommodated a tiny camera, which allows surgeons to see organs on a monitor as they operate. Another two incisions allowed instruments into the body.
The fourth incision — at 4 centimeters wide, the longest of the incisions — was held open using a special device, allowing Kim to use his hand directly in the surgical field. Called hand-access laparoscopy, the technique brings together the traditional art and honed skill of a surgeon with the modern advances of minimally invasive surgery.
During a laparoscopic liver tumor procedure, surgeons carefully resect the tumor and place the tissue in a special bag, called an endocatch, which allows them to remove it from the body without contaminating nearby healthy tissue. In the recent procedure, Kim said, the tumor was benign, but surgeons anticipate using laparoscopic techniques primarily for cancerous tumors.
The surgeons use a special ultrasound probe to make sure they “see” the tumor correctly within the body, he added.
Although the surgery to remove 30 percent of the liver had to be carefully planned, the procedure itself took only two hours, and the patient lost less than 50 milliliters of blood during the operation — a small amount.
At City of Hope, surgeons in the Gastrointestinal Cancer Program will evaluate each patient with liver cancer to see if laparoscopic surgery is appropriate, Kim said; they also will carefully follow recommendations from a special conference of surgeons in autumn that will set international guidelines on the use of these laparoscopic resections.
In the future, Kim will work with fellow surgeons to study whether a robotic surgical system can be integrated into the surgeries. For now, however, Kim and surgical colleagues are enthusiastic about the benefits of laparoscopy.
Said Kim: “We think this can significantly benefit our patients.”