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]

New article at Colombia Reports.com


Bogota’s Hottest Young Surgeons is my latest article on Colombia Reports – talking about some of the great young surgeons here in the capital;

1. Dr. Juan Pablo Umana (cardiac surgeon)

2/3. Dr. Ivan Santos and Dr. Freddy Sanabria, (plastic surgeons)

4. Dr. Costanza Moreno (orthopedics)

5.  Dr. Juan Carlos Garzon (thoracic surgeon) and

6. Dr. Jose Felix Castro (general surgeon)

and some of the things they are doing (which all of my loyal readers already know all about!)

It was a different style of writing than I am used to – but I enjoyed it, and hope to do another article in the future.

Update: After getting a few requests – I’ve re-posted the article here.  (But, I’d appreciate it if you went to Colombia Reports anyway, so the editors can know how many people are reading the articles – and hope that they will publish more in the future!)

From Colombia Reports.com

Bogota’s Hottest Young Surgeons
Don’t let their youth fool you. These young Bogota surgeons are well versed in the latest technologies and the newest surgical techniques, and are changing the face of, and bringing new sophistication to the capital’s medical community.

Colombia news - docDr. Juan Pablo Umana, 46, Cardiac surgeon

A Bogota native, Dr. Juan Pablo Umana, with his Stanford education, quintessential rugged good looks and a refreshing outlook, brings a California flavor to Fundacion Cardioinfantil, where he has been the Chief of Adult Cardiac Surgery since 2004.  He, along with Dr. Nestor Sandoval have ushered in a new era of Cardiac Surgery in Bogota with a expanding and state-of-the-art cardiac surgery service line.  Notably, in 1997, Dr. Umana along with Dr. Memhet Oz invented the first mitral clip for percutaneous valve repair. During surgery, he is focused, meticulous and unflappable.  Despite being the most senior of the surgeons listed here, he is just hitting his stride.

Colombia news - doc

Dr. Ivan Adolfo Santos, 41, Plastic Surgeon

Dr. Ivan Santos operates at Clinica Shaio, and is one of a trio of celebrity plastic surgeons here in Bogota. Genetically blessed, he looks ten years younger than his 41 years. In spite of his boyish good looks and shy nature, Dr. Santos is a confident and talented surgeon; more importantly, he gets results. Watching Dr. Santos operate is similar to watching a symphony conductor orchestrate classic music composures with 160 musicians. He never misses a beat, and he is simultaneously aware of everything around him. With his precision in the operating room and aggressive post-operative therapies, patients recover faster, with less pain, and leave his office looking and feeling their best.

Colombia news - doc

Dra. Constanza Moreno Serrano, 40, Orthopedic Surgeon

Dra. Constanza Moreno is orthopedic surgeon specializing in hand and microsurgery such as digital reattachment after traumatic injury, reconstructive surgery and correction of congenital deformities. After training with the famed Dr. Harold Kleinert and Dr. Breidenbach III in Louisville, Kentucky, she returned to Bogota in 2005.  She is currently developing a hand transplant program for victims of landmines. Next week, she is presenting her proposal at the International Hand and Composite Tissue Allotransplantation Society in Atlanta, Georgia.

Colombia news - doc

Dr. Juan Carlos Garzon, 39, Thoracic Surgeon

Dr. Juan Carlos Garzon is a man of action; operating at several facilities across Bogota. Trained in Hong Kong, Dr. Garzon excels at the more difficult thoracic cases. As one of just a few board-certified thoracic surgeons in Colombia, he is using video-assisted thoracoscopy to able to treat complex disease with minimal incisions.  He is also teaching this technique to surgeons across Colombia. During cases, he is relaxed, controlled and ready for anything.

Colombia news - doc

Dr. Freddy Sanabria S., 38, Plastic Surgeon

Dr. Freddy Sanabria, a young Richard Gere look-a-like, makes his own pretty women as one-half of the Sanabria plastic surgery practice. Trained at the University of Pennsylvania and Stanford University, he brings skill, dedication and the latest cosmetic innovations to a well-established surgical clinic. While operating, he is confident, focused and detail oriented, and his surgical team anticipates his every need.

Colombia news - doc

Dr. Jose Felix Castro, 37, General Surgeon

Dr. Jose Felix Castro is a staff surgeon at Clinica del Country. This magna cum laude academic scholar is one of a few of the talented young general surgeons in Bogota who have embraced single port laparoscopy, which means abdominal surgery without a scar. While Dr. Castro is the youngest of our line up, he brings a wealth of experience to the operating room.

// //

A day of Passion!


Had a long, but exciting day, with some interesting doctors – who are strikingly passionate about their work, which is always wonderful to see.

This morning, I traveled out to Chia, to the University of Sabana to visit with Dr. Camilo Osorio Barker, MD who is the Dean of Medicine, (and a practicing thoracic surgeon.)  Like many thoracic surgeons here in Colombia, Dr. Osorio practices at several locations, (primarily out in Chia at the University-affiliated hospital) but he also sees patients at Cardioinfantil. (He is partnered with Dr. Tellez and Dr. Garzon, both of whom we’ve interviewed previously)

One three- day weekend a month, he sees patients in Medellin.  He primarily specializes in the treatment of hyperhidrosis (excess sweating of palms, facial flushing) by thorascopic sympathectomy.  He report that this makes up about 90% of his practice – with the remainder of cases as VATS lung resections, and other lung procedures.    There’s a lot more to tell – but it’s been a long day, and I have an early appointment tomorrow with Dr. Ramon (neurosurgery) at Hospital Centro de Policia..

Don’t worry – I will be seeing Dr. Osorio again soon.

Next stop was Dr. Fernando Hakim, a neurosurgeon at Santa Fe de Bogota.  He was a fantastic interview – while he does the whole spectrum of neurosurgical procedures for vascular malformations, tumors, spinal problems, etc, he is best known for his treatment of normal pressure hydrocephalus (NPH).

(As I mentioned in a previous post) It seems almost inevitable, or inescapable that the son of the famed Dr. Salomon Hakim (who developed the first treatment for normal pressure hydrocephalus) – has carried on his father’s legacy. But Dr. Fernando Hakim is passionate about neurosurgery, and has certainly made his mark..

He clearly loves his work – I could have interviewed him for hours, and hours (but he’s a busy neurosurgeon, so I didn’t).  I will be seeing him again soon – (next week) and I’ll bring more information then.

Lastly, I stopped in to see Dr. Jose Felix Castro, general surgeon for a quick visit to get some last minute information for another project I am working on..

Single port laparoscopy


Single port laparoscopy with Dr. Arias

Over at Medscape – everyone is excited about single port laparoscopy.. But as Dr. Arias and Dr. Castro can tell you, that’s nothing new in Bogota, Colombia – just standard operating procedure.

Single Port Laparoscopy article at Medscape

Youtube movie with Dr. Arias – filmed several years ago.

 

 

Dr. Santos, almost Dr. Hoyos and Dr. Castro


Full day today – met with Dr. Hernando Santos at Clinica Shaio – and I’ll be heading to the OR with him on Monday..

 Dr. Hoyos – he was in surgery when I arrived for our appointment, so I’ll try again soon..

Spent the evening with Dr. (Jose) Felix Castro, a very nice general surgeon, on staff at Clinica del Country.. Followed him to the OR for a case –