LiveLongAgeWell

One goal of this blog is to encourage you to adopt good health practices so to minimize your chances of needing extensive medical care, including surgery; nevertheless, at some point in your life a doctor may recommend some sort of operation. So it’s good to keep up with what’s current in surgery to help you make intelligent choices in the future.

The biggest revolution in surgery over the past twenty years has been the explosion in “minimally invasive” techniques—procedures done through tiny incisions, assisted by miniature video cameras and endoscopes (internal telescopes).  Often the surgeon works by looking at a monitor rather than directly at the patient. This sort of surgery is now common, and the norm in many areas such as gall bladder removal, sinus surgery, and orthopedic joint procedures.
Surgeons—probably the specialists most likely to aggressively “push the envelope” in technological matters—have been attempting more and more procedures through smaller and smaller incisions, and so I noted with interest this recent report about stomach surgery for obesity control, done without any incisions at all….only by passing instruments through the mouth and into the stomach! While now offered only on a very limited basis, in another ten or fifteen years, depending on the results, this could become the “standard of care” for certain operations.

There are many advantages to minimally invasive approaches including smaller skin scars and less internal scarring. Endoscopic procedures also require much shorter hospitalizations, so that a minimally invasive procedure might mean a one-day hospitalization, whereas ten years ago, the traditional procedure required a one-week hospital stay. Further, minimally invasive procedures typically result in much less swelling and pain, and the results are often as good or better than the traditional, “open” approach.

Besides the amazing ability now to do some surgeries entirely through the mouth, vagina, or rectum (called NOTES for “natural orifice transluminal endoscopic surgery”), another amazing development—one that is already becoming common for some procedures—is surgery done by “robot”. Here, the surgeon sits at a computer console and, utilizing a joystick, controls a remote robot which does the actual cutting. Most major medical centers have robots, and the surgery may be offered for heart valve repair, hysterectomy, and a big push now is for robot prostatectomy (for prostate cancer), since it may offer a lower risk of nerve damage and post-operative impotence.

All these highly technical approaches still carry risk. Even more than in “open” surgeries, these latest approaches depend on the experience level of the surgeon and the medical center. So if your surgeon recommends some newly developed endoscopic or robot or particularly a “natural orifice” approach, you should consider asking:

1.    How many of these procedures have you done on patients? (many doctors learn the latest procedures at courses, in the lab, and by observing experts at medical centers).
2.    What has been your success and complication rate?
3.    Why do you think this newer approach is better for me than a more standard method?

Don’t be embarrassed to ask these basic questions, and if your doctor is not forthcoming or you aren’t comfortable with her answers or experience level, seek a second opinion. You might say: I’d like to talk to an expert at a university medical center where many of these operations have already been done. Who would you recommend? Then visit the medical center, compare, and go where you are most comfortable.