September 1995
LAPAROSCOPIC AORTIC BYPASS SURGERY PERFORMED FOR THE FIRST TIME IN U.S.
Surgeons in San Ramon, CA, recently achieved a major breakthrough in minimally invasive bypass surgery by successfully completing the first totally laparoscopic aortic bypass procedure in the United States.
Dr. Carlos Gracia of the California Laparoscopic Institute and Dr. Yves Dion of the University of Laval, Quebec City, replaced more than 6 inches of a 67-year-old patient's clogged aorta (the main vessel leading from the heart that supplies blood to other major vessels and organs through out the body). The bypass began below the renal artery (which feeds the kidneys) and ran to the femoral artery (which is near the groin and supplies blood to the legs). Instead of making the usual 12-to 13-inch incision, they operated through six half-inch incisions, sparing the patient considerable pain, a large scar, a long hospital stay and a difficult recovery.
Unlike previously reported laparoscopically-assisted aortic bypass procedures where surgeons have made a 2-to 4-inch incision in addition to several half-inch incisions, Dr. Gracia and Dr. Dion performed this procedure entirely through six small incisions.
The procedure was performed to correct a condition known as aorto-iliac occlusive disease, in which arteries become clogged and the amount of blood reaching the body's extremities is dramatically reduced. If left untreated, the condition can result in the amputation of a leg. Until recently, patients suffering from this condition could either endure open aortic bypass surgery or undergo a blockage removal process such as angioplasty. Open bypass surgery offers a more permanent solution, but requires 7 to 10 days in the hospital and several weeks of recovery. An angioplasty is not as debilitating as open surgery, but may need to be performed again within a few years to keep the vessel clear.
"The laparoscopic approach combines the shorter recovery period of a blockage removal procedure with the superior surgical results of open reconstruction," said Dr. Gracia. "This is a breakthrough in bypass surgery that can help thousands of patients with this condition."
The patient, Robert Kenney, a landscape contractor from LaFayette, CA, left the hospital 4 days after surgery, mowed his lawn 2 weeks later and was back at work part-time in 3 weeks.
LAPAROSCOPIC DISCECTOMY 'COULD CHANGE THE WAY HERNIATED DISCS ARE TREATED'
A spine surgeon and a general surgeon who have worked as a team to successfully complete 12 anterior laparoscopic discectomies have found that this new procedure to remove herniated discs is safe and effective and can significantly reduce pain, scarring, hospital stay and recovery time for many patients.
Dr. Merrill W. Reuter, a spine surgeon, and Dr. Clyde S. Meckstroth, a general surgeon, who performed the series of procedures at Wellington Regional Medical Center in West Palm Beach, FL, say the laparoscopic approach "could change the way herniated discs are treated."
Currently most discectomies are performed by making a 11/2-to 2-inch incision in the middle of the lower back. This results in a hospital stay of 1 to 2 days and a difficult 4-to 6-week recovery. In the laparoscopic procedure, Dr. Meckstroth makes 3 to 5 half-inch incisions in the abdomen to provide access for a scope and other specialized instruments. Dr. Reuter performs the discectomy by operating through the tiny openings while watching a magnified image of the spinal column and the herniated disc on a television monitor.
The surgeons reported that most patients stayed in the hospital just one night -- although some patients were able to go home the same day -- and most return to normal activities within 2 to 4 weeks.
"Not only is this procedure safe, early indications show it to be 80 to 90 percent effective and it allows most patients to avoid the difficult recovery associated with open surgery," Dr. Reuter said.
PATIENT INFORMATION ABOUT LAPAROSCOPY & URINARY STRESS INCONTINENCE AVAILABLE
Urinary incontinence--the involuntary loss of urine--affects the lives of 17 million American men and women of all ages. Incontinence is neither a disease nor a natural part of aging, but rather a sign that a problem exists in the urinary system. While there are four types of urinary incontinence, stress incontinence is the most common, affecting more than half of all sufferers.
Stress incontinence occurs when the urethral sphincter (circular band of muscles that controls the release of urine from the bladder) or pelvic muscles cannot adequately support the bladder. This allows the bladder to slip down into the pelvic cavity and cause pressure on the urethra (the duct that carries urine from the bladder to outside the body). As a result, body movements such as exercising, coughing, laughing or sneezing can place additional pressure on the bladder, causing it to leak.
Treatment typically includes lifestyle adjustments, exercises, medication or, in persistent cases, a surgical procedure known as bladder neck suspension, which reduces the pressure on the urethra. While 75-90% effective, traditional surgery involves a long incision, 3 to 6 days in the hospital and up to 6 weeks recovery. Using laparoscopic techniques, surgeons can now perform the same procedure through 3 to 5 tiny openings. Most patients leave the hospital 1 to 2 days after surgery and can return to normal activities within a week.
An informational brochure on the laparoscopic treatment of urinary stress incontinence in now available from United States Surgical Corporation. To order, call Susan Thiele at 203-845-1735.
For more information or copies of references cited, please call Steve Rose, Editor, at 203-845-1732. The Laparoscopy Report is a trademark of United States Surgical Corporation.
