Winnipeg Free Press - PRINT EDITION

Revolution in the operating room

Keyhole technique changing surgery

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For 45-year-old computer programmer Nick Gloor, it was a no-brainer.

He desperately needed surgery to fix a painful ulcer that made it impossible to enjoy a meal bigger than a sandwich. It had been two years since Gloor had gorged on his favourite Chinese dinner.

His surgeon, Dr. Hugh Taylor, a rising hot shot in the operating room, offered to do a stomach bypass using the keyhole technique called laparoscopic surgery.

When he went into the operating room last week, it was the first time the keyhole technique had been used in the city for such a complicated procedure.

Ordinarily keyhole surgery is used for simpler things such as gall bladder removal, where the bladder and its painful stones are blasted apart and sucked out of a hole in the abdomen no bigger than a quarter.

It's a technique that is rapidly revolutionizing the operating room.

When Taylor returned to Winnipeg in 1994 after training for laparoscopic surgery, there were only five patients who'd had keyhole surgery in the entire province.

This year, 7,000 patients were keyholed. In a decade, there could be 10 times as many, health planners said last week.

Today, there is laparoscopic removal of kidneys, adrenal glands, spleens, cysts and stones inside spleens, pancreas, bile ducts and kidneys. It's used extensively in gynecological surgery, and in bypass resections of the colon, rectum and small intestines.

Next up is surgery for cancer.

Complex operations are now possible through keyhole surgery because of new telescopic cameras and miniature floodlights that have transformed the inside of the body into an open stage for surgeons.

For Gloor, conventional surgery meant a high risk of infection, his internal organs would be traumatized, he'd spend a week in hospital and another two months at home recovering.

After having the keyhole surgery, Gloor was told he'd be kept in hospital for a few extra days for observation because he was the first to have the bypass procedure. But he was assured he would be back at work within a few weeks and he could have Chinese takeout while he recovered.

"It was less invasive. It's easier on the body and you heal faster," Gloor said just a day after his surgery.

"I've already been roaming up and down the hall," he said from his hospital bed at St. Boniface General. "I won't have as much downtime."

Without a hitch

On Thursday, Taylor and his team, including anesthetist Dr. Ian White, did the procedure without a hitch. White couldn't get over the difference in the calm steady readings he was getting for Gloor's heart rate, blood pressure and oxygen levels. Gloor was calmer during the surgery than he was when he was rolled into the OR.

"This is a hell of a lot better than the old way of doing it," White said. "Because there is less disturbance, he'll be out of hospital earlier."

Taylor, meanwhile, was moving a pair of hollow tubes that looked like big chop sticks poking out of Gloor's abdomen. In slow, tiny movements, he manipulated the hollow, 33 centimetre-long tubes with tiny instruments attached at the ends to cut and stitch through the operation inside his patient's abdomen.

Senior surgery resident Dr. Mohammed Al-Assira was holding another long tube with a telescopic camera and lights that illuminated the inside of Gloor. A bizarre-looking plug stuck in his belly button had a valve attached to pump in carbon dioxide, a colourless, odorless gas that inflates the stage for the surgery.

Attention was fixed on the pictures of Gloor's insides on two screens in the darkened OR. Visiting surgeons came and went to watch the inaugural surgery.

"You have to have a lot of stamina to do that," said surgery nurse Pat Duder, who came to watch. "You have to hold that camera and those instruments steady and stand on your feet for hours at a time."

With no big incision and no need for a surgeon to handle the body directly, the odds of infection plummet and patients don't need as many painkillers as they do with conventional surgery.

"We really only touch the exact (body) parts we want. We don't put our hands inside," Taylor said. Patients get better faster and most operations are day procedures, meaning shorter hospital stays and more room for other patients.

"For every day you reduce hospital stays you reduce costs by $1,000 to $2,000 a bed," White said.

Surgeons like Taylor operate out of the body -- which makes another revolution on the horizon easier to understand -- laparoscopic surgery is leading to robotics surgery.

'It's amazing'

Not only can a surgeon operate outside the body, he doesn't have to be in the same room or same continent as the patient on the operating room table.

"You can be anywhere in the world as long as you have the communications link. It's amazing. It's astounding," Taylor said.

This spring, French medical researchers signed a training deal with St. Boniface General. The partnership is with Professor Jacques Marescaux's Institute for Research into Cancer of Digestive System and the European Institute for Telesurgery. Marescaux performed the first transatlantic robotics surgery in 2001 on a patient in Strasbourg while he was manning the controls in Manhattan.

"Laparoscopic is the place to develop robotics surgery," said Taylor's boss Dr. Luis Oppenheimer "As good as France is, we want to go beyond that," said Oppenheimer who is head of surgery for the Winnipeg Regional Health Authority.

About 35 surgeons like Taylor know how to do laparoscopic surgery in Winnipeg and all are candidates for the new technology, Oppenheimer said in an interview before Gloor's surgery.

The head of surgery for the region said laparoscopics is brightening Winnipeg's future as a training centre and it will be patients who will gain from the expert care.

alexandra.paul@freepress.mb.ca

Republished from the Winnipeg Free Press print edition August 11, 2003 $sourceSection$sourcePage

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