Overseas Radio Follow-up


As a follow-up for all the overseasradio.com radio listeners (and all my loyal readers) I have posted some additional information on the topics covered during the radio program with Ilene Little from Traveling for Health.com including contact information for several of the physicians mentioned.

in the Operating Room at New Bocagrande Hospital

Thoracic Surgery

Esophageal cancer – during the segment we highlighted the importance of seeking surgical treatment for esophageal cancer at a high-volume center.  One of the centers we mentioned was the University of Pennsylvania Medical Center in Pittsburgh, PA – and the work of Dr. Benny Weksler, MD.

Dr. Benny Weksler*, MD

Hillman Cancer Center

5115 Centre Avenue

Pittsburgh, PA 15232

Phone: (412) 648-6271

He is an Associate Professor in Cardiothoracic Surgery and Chief of Thoracic Surgery at UPMC and the UPMC Cancer Center.  (For more information on Dr. Weksler, esophageal cancer, and issues in thoracic surgery – see my sister site, Cirugia de Torax.org)

(To schedule an appointment via UPMC on-line click here).

We also briefly mentioned Dr. Daniela Molena*, MD at John Hopkins in Baltimore, Maryland.

The Johns Hopkins Hospital

600 N. Wolfe Street

Baltimore, MD 21287

Phone: 410-614-3891

Appointment Phone: 410-933-1233

(The link above will take readers to the John Hopkins site where they can also make an appointment.)

* I would like to note that I have not observed either of these physicians (Weksler or Molena) in the operating room.

We also talked about several of the thoracic surgeons that I have interviewed and observed numerous times, including both Dr. Rafael Beltran, MD & Dr. Ricardo Buitrago, MD at the National Cancer Institute in Bogotá, Colombia.  These guys are doing some pretty amazing work, on a daily basis – including surgery and research on the treatment of some very aggressive cancers.

in the operating room with Dr. Rafael Beltran

Dr. Rafael Beltran is the Director of the Thoracic Surgery division, and has published several papers on tracheal surgery.   He’s an amazing surgeon, but primarily speaks Spanish, but his colleague Dr. Buitrago (equally excellent) is fully fluent in English.

Now the National Institute website is in Spanish, but Dr. Buitrago is happy to help, and both he and Dr. Beltran welcome overseas patients.

Dr. Buitrago recently introduced RATS (robot assisted thoracic surgery) to the city of Bogotá.

Now, I’ve written about these two surgeons several times (including two books) after spending a lot of time with both of them during the months I lived and researched surgery in Bogotá, so I have included some links here to the on-line journal I kept while researching the Bogotá book.  It’s not as precise, detailed or as lengthy as the book content (more like a diary of my schedule while working on the book), but I thought readers might enjoy it.

In the Operating Room with Dr. Beltran

There are a lot of other great surgeons on the Bogotá website, and in the Bogotá book – even if they didn’t get mentioned on the show, so take a look around, if you are interested.

in the operating room with Dr. Ricardo Buitrago

Contact information:

Dr. Ricardo Buitrago, MD 

Email: buitago77us@yahoo.com

please put “medical tourist” or “overseas patient for thoracic surgery” in the subject line.

We talked about Dr. Carlos Ochoa, MD – the thoracic surgeon I am currently studying with here in Mexicali, MX.  I’ve posted all sorts of interviews and stories about working with him – here at Cartagena Surgery under the “Mexicali tab” and over at Cirugia de Torax.org as well.  (Full disclosure – I assisted Dr. Ochoa in writing some of the English content of his site.)

out from behind the camera with Dr. Ayala (left) and Dr. Carlos Ochoa

He is easily reached – either through the website, www.drcarlosochoa.com or by email at drcarlosochoa@yahoo.com.mx

HIPEC / Treatment for Advanced Abdominal Cancers

I don’t think I even got to mention Dr. Fernando Arias’ name on the program, but we did talk about HIPEC or intra-operative chemotherapy, so I have posted some links to give everyone a little more information about both.

HIPEC archives at Bogotá Surgery.org – listing of articles about HIPEC, and Dr. Arias.  (I recommend starting from oldest to most recent.)

Dr. Fernando Arias

Oncologic Surgeon at the Fundacion Santa Fe de Bogotá in Bogotá, Colombia.  You can either email him directly at farias00@hotmail.com or contact the International Patient Center at the hospital.  (The international patient center will help you arrange all of your appointments, travel, etc.)

Fundacion Santa Fe de Bogota

   www.fsfb.org.co

Ms. Ana Maria Gonzalez Rojas, RN

Chief of the International Services Department

Calle 119 No 7- 75

Bogota, Colombia

Tele: 603 0303 ext. 5895

ana.gonzalez@fsfb.org.co  or info@fsfb.org.co

Now – one thing I would like to caution people is that email communications are treated very differently in Mexico and Colombia, meaning that you may not get a response for a day or two.  (They treat it more like we treat regular postal mail.  If something is really important, people tend to use the phone/ text.)

Of course, I should probably include a link to the books over on Amazon.com – and remind readers that while the Mexicali ‘mini-book’ isn’t finished yet – when it is – I’ll have it available on-line for free pdf downloads.

The latest HIPEC headlines


More ongoing research trials to validate HIPEC as a potential treatment for ovarian cancer.

The University Hospitals of Cleveland, Ohio recently started several new clinical trials to test the effectiveness of hyperthermic intra-peritoneal chemotherapy  in women with ovarian and endometrial cancer.  Unfortunately, the trials are small (around 60 woman) which means that even positive results will be far from definitive for researchers involved in the HIPEC debate.  It also offers only limited opportunities for patients with ovarian cancer to receive potentially life-saving treatment.

Medpage recently published a nice overview on ovarian cancer and the current treatment modalities – which can be seen here.

More on HIPEC: here at Bogota Surgery:

What is HIPEC? What’s it used for?

Who does HIPEC?

HIPEC updates:

Update #1

New article on HIPEC


There’s a new article on the HIPEC procedure that’s a nice read for people interested in this procedure.  The article is unrelated to medical tourism – it’s about the first application of hyperthermic intraperitoneal chemotherapy at a private facility in India.  (As you can imagine – I wouldn’t recommend that anyone have a procedure at a facility where doctors have just started trialling the technique.) That being said – the article gives a nice overview of the procedure itself.

More about Single incision laparoscopic surgery (SILS)


Since we’ve talked about single incision laparoscopic surgery (SILS) here at Bogotá Surgery after interviewing several of the surgeons performing this surgical technique in Bogotá, Colombia – I wanted to bring readers more information about the technique itself.

I have added some links to published articles discussing this technique and how it can be used as treatment for different surgical conditions. (all case reports are from 2011.)  This is just a limited selection – there are hundreds of articles on this technique, and it is now being for a wide variety of abdominal conditions.

Case report from Japan – treatment of giant liver cyst (with color photos and radiographic information.)

Single port laparoscopy for adnexal surgery – 22 cases:  this study has a photo that demonstrates the sterile glove technique that I’ve mentioned previously (that allows for a smaller peri-umbilical incision than when using a commercial instrument holder.)

an Indian study discussing this technique for kidney donors (for organ harvesting) – has a nice post-operative photo of kidney donor.

Note: while this Turkish study is descriptive and colorful – it’s not true single incision laparoscopic surgery – as observed in Bogotá, Colombia and other facilities.  (It’s only single incision surgery if there’s just one incision..)

Single incision laparoscopy revisited


A new abstract published [ and re-posted below] in advance of the article – confirms what Bogotá surgeons already know –

Uniport or single incision laparoscopy is a safe, effective surgical treatment which reduces post-operative pain, length of stay and recovery time for patients while providing better cosmetic outcomes.

Surprising to me, it seems there is still hesitation among surgeons in the United States to adopt this technique for routine procedures such as appendectomy, or cholecystectomy.  In fact, during a recent multi-day tour of Duke University – I was unable to find out information/ or confirm the use of this technique by a single surgeon in the facility.  [My methods were by no means definitive or scientific – I questioned surgeons and anesthesiologists but it’s possible that surgeons using this technique were not identified.  However, the majority of people I spoke to didn’t know what SIL was, and required a description of the procedure, which adds to my suspicions that this procedure is not being performed at Duke.   I will be back at Duke later this month, and will continue to investigate.]  if true, this is a significant finding, and failure in American surgery – Duke is one of the leaders in surgical innovation and emerging therapies.

Now the abtract below talks about increased surgical time – which is true, initially as surgeons learn the technique.  However, as surgeons become more experienced in this procedure, this is no longer the case. In the cases I observed in Colombia, there was no increase in surgery time – but the surgeon has been performing this technique for several years.

Correction:  Despite what I was initially informed – Duke general surgeons do use SILS, and use the single incision laparoscopy approach as part of their living donor kidney transplantation.    I apologize for the error. 

Abstract re-posted below:

 Single incision laparoscopic cholecystectomy (SILC) versus laparoscopic cholecystectomy (LC) – a matched pair analysis

Source

Department of Surgery, Krankenhaus der Elisabethinen, Fadingerstrasse 1, 4020, Linz, Austria, odogangl@yahoo.com.

Abstract

INTRODUCTION:

The aim of our study was to compare single incision laparoscopic cholecystectomy (SILC) and laparoscopic cholecystectomy (LC) with respect to complications, operating time, postoperative pain, use of analgesics, length of stay, return to work, rate of incisional hernia, and cosmetic outcome.

METHODS:

Sixty-seven patients underwent SILC. Of a cohort of 163 LC operated in the same time period, 67 patients were chosen for a matched pair analysis. Pairs were matched for age, gender, ASA, BMI, acuity, and previous abdominal surgery. In the SILC group, patient characteristics (gender, age, BMI, comorbidities, ASA, previous abdominal surgery, symptomatic cholecystolithiasis, cholecystitis) and perioperative data (surgeon, operation time, conversion rate and cause, intraoperative complications, postoperative complications, reoperation rate, VAS at 24 h, VAS at 48 h, use of analgesics according to WHO class, and length of stay) were collected prospectively.

RESULTS:

Follow-up in the SILC and LC group was completed with a minimum of 17 and a maximum of 26 months; data acquired were recovery time the patients needed until they were able to get back into the working process, long-term incidence of postoperative hernias, and satisfaction with cosmetic outcome. Operating time was longer for SILC (median 75 min, range 39-168 vs. 63, range 23-164, p = 0.039). There were no significant differences for SILC and LC with regard to postoperative pain measured by VAS at 24 h (median 3, range 0-8 vs. 2, range 0-8, p = 0.224), at 48 h (median 2, range 0-6 vs. 2, range 0-8, p = 0.571), use of analgesics, and length of stay (median 2 days, range 1-9 vs. 2, range 1-11, p = 0.098). There was no major complication in either group. The completion rate of SILC was 85.1% (57 of 67). Although there was a trend towards an earlier return to the working process in patients of the SILC group, this was not significant. The rate of incisional hernias was 1.9% (1/53) in the SILC and 2.1% (1/48) in the LC group indicating no significant difference. Self-assessment of satisfaction with the cosmetic outcome was not judged different by patients in both groups.

CONCLUSION:

SILC is associated with longer operating time, but equals LC with respect to safety, postoperative pain, use of analgesics, length of stay, return to work, rate of incisional hernia, and cosmetic outcome.

Langenbecks Arch Surg. 2011 Jun 22. [Epub ahead of print]

Bogota Surgery and the International Medical Travel Journal


Thanks to the eagle-eyed reader who notified me that portions of one of my articles “Bogotá hospital offers hope to abdominal cancer patients” (originally published on Colombia Reports.com) was featured in the article, “Agencies promote Central and Southern American medical tourism.”

I’ve asked them to provide a link to the original article so readers can get more information on the topic.

Update: 29 June 2011: Here’s a link to the new article on Treatment Abroad (which is an International Medical Travel Journal sister site) that gives their readers the information they really need. (The name of the doctor, of course!)  It’s a summary of the original Colombia Reports.com article. They still haven’t cited the ‘borrowed’ content on the original article, or provided the name of the physician doing the treatment (Dr. Fernando Arias) but I guess it’s an improvement.

The Future is Now – HIPEC in the news again..


Another article on the effectiveness of HIPEC (cytoreductive surgery with intraoperative hyperthermic chemotherapy) in the news.  This story comes out of India and highlights doctors there and the HIPEC procedure for treatment of abdominal cancers (intestinal and ovarian cancers.)

The Future is Now..  in an article on Medscape, dated December of 2010 and originally published in Future Oncology, Dr. Ze Lu et. al discusses the future of cancer treatment.  (The article is several pages in length – so I haven’t re-posted but reference information is provided below).  Dr. Ze Lu and his colleagues believe the future of oncology treatment is…. Intraperitoneal Hyperthermic Chemotherapy (HIPEC)..

In August, we’ll check back in with Bogotá’s resident expert on HIPEC, Dr. Fernando Arias.

Reference:

Lu, Z., Wang, J.,  Wientjes, G., & Au, J. (2010).  Intraperitoneal therapy for peritoneal cancer.  Future Oncology. 2010 (6) 10; 1625 -1641

Bogota surgeons stay ahead of the curve


As we’ve seen several times before, Bogotá surgeons stay ahead of the curve on cutting edge treatments.  In the last several weeks, HIPEC or Hyperthermic intraperitoneal chemotherapy (Sugarbaker procedure) has been dotting the news headlines in the United States, and across the globe.

But as my readers here at Bogotá Surgery know, not only have we talked about HIPEC in the past – Dr. Arias has been performing this procedure at Fundacion Santa Fe de Bogota since 2009.  He reports he did eight cases in May alone.  (This is considered fairly high volume if you review the amount of cases being done at other centers.)

Planning to catch up with Dr. Arias and check in later this summer..

Thoracics..


This will be a quick post this evening before I run back out to catch another case.

Spent most of the morning in the OR with Dr. Mario Andres Lopez Ordenez (Thoracic Surgery) over at Mederi.. Complex case but he handled it beautifully. (and I remembered to get photos, so I will post later when I have more time.)

Dr. Mario Andre Lopez

Dr. Mario Lopez, Thoracic Surgeon

Then I raced over to meet with Dr. Luis Jaime Tellez Rodriguez (Thoracic Surgery) over at Cardioinfantil.  He works with Dr. Garzon.   No surgery this afternoon, but just give me time!  To be fair – he’s a lot like Dr. Edgar Guiterrez, (Cartagena) and he sees patients at several facilities; Cardioinfantil, Clinica Colombia, Clinica Reina Sofia. 

Now I’m getting ready to head back over to see Dr. Fernando Arias at Santa Fe de Bogota.  I interviewed him this afternoon – he’s a real interesting guy so I’ll write more about him later – but now I am heading back to see him at work.

Dr. Fernando Arias

Dr. Fernando Arias, General & Oncology Surgeon