Laparoscopic GI Surgery
May / June 2006
An Update on Trends and Conditions Treated
Laparoscopic (or minimally invasive) surgery, for preoperative
staging and even for treatment, has long been an option for
esophageal, pancreatic and gastrointestinal cancer patients.
These cancers are typically diagnosed endoscopically and
can be staged laparoscopically, allowing for disease detection
without open surgical exploration. Laparoscopic surgery can
also be used in combination with adjuvant strategies for
advanced stage cancers.
Further, laparoscopic surgery can be beneficial in patients
who present with other gastrointestinal disorders. “There
is almost nothing that cannot be approached through minimally
invasive surgery,” says Jo
Buyske, MD, chief, Department
of Surgery; director, Minimally Invasive Surgery at Penn
Presbyterian Medical Center, and Associate Professor of Surgery
at the University of Pennsylvania School of Medicine. “There
is a common misconception that patients who have had previous
abdominal surgery are inappropriate candidates for laparoscopic
surgery. However, scar tissue is not a contraindication.
Our surgeons perform a high volume of these cases and are
familiar with how to achieve positive outcomes despite the
difficulties scar tissue can present.”
“Our experience in the field enables us to perform
these and other abdominal surgeries with superior results,” says
Jeffrey
Drebin, MD, chief, Division of Gastrointestinal
Surgery and Professor of Surgery at
the Hospital of the University of Pennsylvania. “Our
team includes physicians from multiple disciplines, who engage
in collaborative team meetings to review a case and provide
the best possible treatment.”
Penn surgeons are particularly skilled in achalasia and
other esophageal motility disorders; laparoscopic cholecystectomy;
laparoscopic splenectomy; gastric bypass; and surgery for
colonic, gastric, esophageal and pancreatic carcinomas (benign
and malignant). In fact, Penn offers the only laparoscopic
surgical fellowship in the Philadelphia area, training surgeons
in advanced laparoscopic techniques.
Patient Benefits
Faster recovery and return to daily
activities, shorter hospitalizations and reduced pain are
just some of the benefits of minimally invasive gastrointestinal
surgery. “Pain
begets other complications,” says Dr. Buyske. “By
controlling pain, we’re reducing the need for narcotics.
Ill-managed pain can also, for example, result in respiratory
complications in some patients. Pain management is a key
element to better and faster recoveries.”
Blood loss can also be better controlled. “In many
cases, blood loss is actually reduced by laparoscopic surgery,” says
David
Wernsing, MD, surgeon at Pennsylvania
Hospital and
Clinical Assistant Professor of Surgery at the University
of Pennsylvania School of Medicine. “These procedures
tend to lend themselves to less blood loss because of the
meticulous need to keep the operative field dry in order
to visualize the anatomy. We actually have a large bloodless
medicine patient population and the techniques we offer laparoscopically
are very beneficial to them.”
Esophageal and pancreatic cancer patients can be particularly
good candidates for minimally invasive surgeries. “It’s
not uncommon for an advanced stage cancer patient to not
be a good surgical candidate,” says Dr. Wernsing. “In
many cases though, we can offer laparoscopic surgery either
to stage the cancer or as a possible curative treatment.
Patients with advanced carcinoma may not be helped by major,
open surgery but laparoscopic procedures are still possible
and, oftentimes, beneficial.”
Considerations
In general, most patients are good
candidates for laparoscopic surgery. There are, however,
some exceptions. “Patients
who present with end-stage pulmonary disease tend to not
be good candidates for laparoscopic surgery,” says
Dr. Buyske. “We use carbon dioxide to inflate the abdomen
and patients who are unable to convert it fast enough, may
have a blood pressure drop. In these patients, the use of
pneumoperitoneum can also reduce venous return from the legs.”
Additional patient education may also be necessary in some
cases. “As physicians, we should be sure our patients
understand how laparoscopic surgery works. It’s not
uncommon for patients to come to me presuming that laparoscopic
surgery is minor surgery, which is not true. Regardless of
the procedure performed, laparoscopic surgery is still major
surgery, just through a smaller incision,” says Dr.
Buyske.
“We offer one of the broadest laparoscopic gastrointestinal
surgery programs,” says Dr. Drebin. “This experience
combined with the collaborative nature of our program enables
us to provide some of the best possible treatment options
for patients with benign and malignant diseases.”
For more information about gastrointestinal surgery or to
consult a physician, call the physician referral
line, PENNHealth, at 1-800-789-PENN.
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Referring Physicians: To speak with a Penn physician
or refer a patient, contact PennHealth through the secure online
referral form or by calling
1-800-789-PENN
(7366). |
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