Minimally Invasive Surgical Options
January 01, 2014
There’s a popular saying that “less is more.” With minimally invasive surgery, many patients would tell you it’s true. Less pain and less time needed for recovery often mean a more satisfied patient and a faster return to daily life.
At Providence Health & Services, Southern California, we offer sophisticated minimally invasive surgical procedures. From highly advanced daVinci® Si HD Robotic-assisted Surgical Systems at Providence Saint Joseph and Providence Little Company of Mary Torrance Medical Centers, to our surgery departments’ top-quality scores and rankings, Providence’s dedicated team of minimally invasive surgery specialists is on the leading edge of care.
This is good news for patients, who can trust that Providence’s board-certified surgeons, anesthesiologists and highly trained surgical nurses and technicians have expertise across a broad range of minimally invasive surgical techniques.
In fact, going “under the knife” shouldn’t be as scary—or as scarring— as it used to be. With Providence at the forefront of this new frontier, patients facing surgery have more choices than ever before.
High-tech minimally invasive methods might have seemed Star Trek-esque even a generation ago. Using highly specialized instruments, surgeons insert miniature cameras through small surgical incisions to “boldly go” where no traditional surgery has gone before. In most cases, patients experience shorter hospital stays, less pain, smaller scars, reduced chances of complications or infections, and a quicker return to home and work.
Additionally, the use of tiny cameras and high-definition monitors gives the surgeons much better visualization when performing minimally invasive, or “laparoscopic,” surgeries. This can lead to greater precision and less damage to tissue.
The approach represents a new frontier in medicine—one that all Providence hospitals are advancing as they enlist these methods to spare patients pain and complications, while improving their lives. Simply put, minimally invasive surgeries are designed for better visualization and precision while traditional “open” surgeries involve large incisions and greater risks of complications, infections and pain.
“With laparoscopic surgery, physicians are able to go in and look at specifics. There is less damage en route to the area that needs to be operated on. And once there, they see magnified images on a screen,” says Sunder Nambier, Providence Saint Joseph director of perioperative services.
“The optics in this day and age are really superb,” says Allen Hoffman, MD, FACS, a general surgeon at Providence Tarzana Medical Center. “We can see things very, very clearly.”
At all five Providence hospitals, minimally invasive techniques are used to treat a range of conditions. Here’s a sampling of some of the surgeries performed and the positive impact a minimally invasive approach can have on outcomes.
Minimally invasive techniques are used at all five Southern California Providence medical centers for general surgery, including gallbladder removal, hernia repair and appendectomy, which are among the top minimally invasive surgeries by volume. If you have no complications, you are often home the same day after a laparoscopic general surgery, compared to a two- or three-day hospital stay following an open procedure.
“With laparoscopic gallbladder removal, you can use three or four small incisions, which can lead to a much faster return to everyday activities for patients,” Hoffman says. This compares to an older, open technique that required a 4- to 8-inch-long incision on the right side under the rib cage and involved a much slower, more painful recovery.
Providence Saint Joseph and Providence Little Company of Mary Medical Center Torrance also use robotic-assisted technology for partial nephrectomy, or the removal of kidney masses and tumors. The precise nature and design of minimally invasive robotic techniques is to save more of the kidney, allowing patients to retain more kidney function.
Minimally invasive bariatric surgery is performed at Providence Saint Joseph Medical Center, which has earned Bariatric Surgery Center of Excellence distinction from the American Society for Metabolic and Bariatric Surgery and the Healthgrades bariatric surgery excellence award, three years in a row.
“We do Lap-Band [short for laparoscopic gastric banding] through a minimally invasive approach,” says Philip Quilici, MD, FACS, medical director of the Bariatric Wellness Center at Providence Saint Joseph. “As a Center of Excellence, we met a series of rigorous requirements. We have board-certified surgeons trained in bariatric techniques, extra training for nurses and special equipment designed to accommodate the specific needs of these patients.”
Not many women are able to take months away from family, work and life to recover from surgery. Now, they often don’t have to.
In the past, a woman needed an average of six to eight weeks to recover from open surgery. With minimally invasive surgery, recovery time can be as short as two weeks. In some cases, a same-day hospital stay is a possibility.
Minimally invasive have a range of gynecologic applications, including ovarian cysts, uterine fibroids, hysterectomy, early stage endometriosis, uterine prolapse and other diagnostic and benign uses.
Providence Saint Joseph and Providence Little Company of Mary Medical Centers use Single Incision Laparoscopic Surgery (SILS) for some gynecological procedures, replacing the standard three to four incisions required by laparoscopic surgeries with a single, nickel-sized incision in the belly button. The procedure has the potential for no visible scars—an incredible feat when contrasted with the 7-inch incision that typically accompanies open approaches— and recovery time can be as little as two weeks, compared with an average of six to eight weeks for traditional surgery.
For many men, the words “prostate cancer” can trigger apprehensions about incontinence and loss of sexual function. Their fears are not unfounded—delicate nerve fibers can be damaged during radiation or surgery to remove the prostate.
While further research is needed to gauge its precise impacts on these side effects, robotic technology is picking up steam due its nerve-sparing, precision capabilities.
“With robotic surgery, images are magnified 10 times on a video screen. This helps surgeons operate with tremendous accuracy, which is essential in tight spaces,” Philip Weintraub, MD, FACS, a urologist at Providence Saint Joseph and Providence Holy Cross says.
How do you improve on success? Total joint replacement procedures enjoy one of the highest patient satisfaction levels of any surgery, with more than 90% of patients experiencing a dramatic reduction in pain and a significant improvement in their performance of daily activities. Yet here, too, rapidly advancing techniques, including artificial joints and visualization, are making minimally invasive options the treatment of choice for hip and knee replacement, knee arthroscopy and sports injury repairs.
In fact, with minimally invasive knee replacements, for example, “surgeons can work through small incisions with advanced instruments and GPS-like mapping to accurately position knee implants,” notes Ramin Ganjianpour, MD, chief of the Orthopedic Surgery Division at Providence Holy Cross Medical Center. And abbreviated recovery periods and hospital stays are making a good thing even better.
Many spine procedures can also be performed minimally invasively, allowing many patients with spinal disorders such as degenerative disc diseases, herniated discs and fractures to experience smaller incisions, less tissue damage and a faster recovery.
Imagine an athlete who’s back on the field two weeks after heart surgery. A generation ago this would have been unthinkable, yet with today’s high-tech techniques, it’s happening.
“We’ve had football players go back on the field at two weeks after surgery, and professional cyclists getting back on the bike one week post-valvular surgery,” says Li Poa, MD, a cardiovascular and thoracic surgeon at Providence Little Company of Mary Torrance. This compares to a three-month activity restriction with open-heart surgery.
What makes it possible? Today, certain heart surgeries can be performed through two-inch incisions near the ribs and simple maneuvering of instruments or robotic “arms.” This compares to a traditional technique of a torso-long incision and breaking of the breastbone.
“The timeline for patients to go back to their full activity and exercise potential is very quick when you go through the side,” Dr. Poa says. The approach has a cosmetic advantage (a “hidden” scar) as well as a medical one: An incision between the ribs is preferable because the blood supply there is more abundant—and thus heals faster—than above the sternum.
Although advanced minimally invasive techniques often are applied to heart surgery, Dr. Poa cautions that any heart surgery is invasive. “Patients need to understand that any heart surgery is very serious surgery,” Dr. Poa says. In fact, he prefers to use the term “minimal-access surgery” with his heart patients.
Top minimal-access heart surgeries include aortic and mitral valve replacement and repair, tricuspid valve repair and coronary artery bypass surgery.
The Next Frontier
All five Providence hospitals already utilize the latest in imaging so that our surgeons can strategize procedures with tremendous precision and accuracy. With a picture archiving and communication system that allows physicians to share real-time viewing capabilities of PET scans, CT scans and MRI images, we are well-positioned for the next frontier of medicine.
As for that next frontier? Dr. Hoffman predicts that robotic surgery—which is already available at Providence Saint Joseph and Providence Little Company of Mary Torrance Medical Centers—is the future, although he notes that the “jury is still out” on its applications in general surgery.
Dr. Poa predicts that as medicine marches ever closer to precision-based, pain-sparing techniques, complicated procedures such as artificial heart implantation will be performed through minimal-access techniques. He also predicts that off-pump mitral valve repair may soon be possible, meaning that a cardiopulmonary bypass machine may not be needed for this surgery.
For our part, Providence Southern California will continue combining the strengths of our individual hospitals with the combined resources of a comprehensive healthcare system to remain a frontrunner in high-tech health. It’s an important mission, because—at least when it comes to offering our patients the latest in training, technology and expertise— less isn’t always more.