The new tools are cutting time and costs Surgical Precision

January 11, 1994|By Nick Gallo | Nick Gallo,Contributing Writer/Los Angeles Times Syndicate

If you've ever undergone major surgery, you haven't forgotten the ordeal: a week in a hospital, a month or longer recuperating at home, a miserable bout of pain or discomfort and an unsightly lifetime scar.

These days, surgeons are using video cameras and specialized instruments to operate through dime-size incisions. They're using lasers to zap more than 100 conditions that once called for the knife. High-pressure shock waves crumble kidney stones without leaving a scratch.

Patients spend less time in the hospital, suffer less post-operation pain and need less pain medication. They recover more quickly and return to normal activities within days instead of weeks. The traditional long gash is replaced by tiny scars.

The new procedures aren't suitable for everyone, however, and long-term results aren't in yet for many techniques.

"These techniques are revolutionary, but they need more scrutiny," cautions Dr. Mika Sinanan, assistant professor of surgery at the University of Washington. "Someday, they may become routine, but right now, most are still considered alternatives."

Here's a look at the most common conditions being treated with these techniques.

Although most of these procedures are covered by typical health insurance policies, you should check with your doctor and insurer before agreeing to any elective surgery.

Gynecological problems

Gynecologists are teaming the laparoscope and the hysteroscope (a similar instrument inserted through a woman's cervix) with the laser to revamp women's surgery.

The laser's powerful pinpoint light beam has proven effective at destroying painful growths of endometriosis, a condition in which the lining of the uterus grows outside the uterus. Surgeons are also routinely using video-guided laser surgery to treat ectopic pregnancy, fibroids, polyps and blocked Fallopian tubes.

The laser, as well as an electrified tool called a resectoscope, are used in a procedure called endometrial ablation to reduce heavy blood flow.

In addition, the techniques sometimes prevent the need for a hysterectomy and preserve a woman's fertility, notes Dr. Michael Baggish, chairman of the department of obstetrics/gynecology at Ravenswood Hospital in Chicago.

Kidney stones

Kidney stones, which hospitalize about 400,000 Americans yearly, rarely succumb to the scalpel today. Instead, physicians crush stones with a lithotripter, a machine that delivers high-pressure shock waves.

The shock waves pass harmlessly through the body and come into focus in the kidney where they crumble stones into small fragments that are then passed in the urine. The procedure takes less than an hour, requires only a few hours' stay in a hospital or clinic and has few side effects. Reports linking lithotripsy to higher blood pressure have been largely discounted, says Dr. Robert Gibbons, a urologist in Seattle.

Lithotripsy is an option for 90 percent of people with severe kidney stones, reports the American Kidney Fund.

Heart surgery

When clogged coronary arteries threaten to shut off the blood supply to the heart, the traditional option is coronary bypass surgery. The operation involves routing blood around the clot, using a transplanted leg vein or chest artery. Today, doctors consider bypass surgery to be the best choice for severe blockages affecting several blood vessels.

For less severe blockages, there is balloon angioplasty. Specialists thread a wirelike balloon-tipped catheter into a blocked artery. The doctors then inflate the balloon, which presses the plaques against the artery wall. Finally, the catheter and balloon are removed, leaving a wider channel for better blood flow.

Angioplasty has a success rate of more than 85 percent, says Dr. Beverly Lorell, director of the hemodynamic research laboratory at Boston's Beth Israel Hospital. About half of the patients who need surgery for blockages of heart arteries are candidates for the alternative method. Angioplasty costs less than surgery and carries fewer risks. Hospital stays and recuperation periods are shorter.

Angioplasty has its limitation. In about one-third of patients, arteries become narrow or blocked again within six months. The procedure sometimes must be repeated.

New approaches may help overcome the problem. Surgeons are using a coronary atherectomy catheter, a capsule with a tiny, high-speed cutting blade to shave off plaque deposits and remove them. Coronary stents -- short, expandable metal tubes that serve as scaffolds within an artery -- also may help keep inflated walls propped open.

Finally, some heart specialists are using lasers to blast away at hard or calcified plaque, though recent results are less promising than those seen in early studies.

Back pain

Ruptured disks drive more than 235,000 Americans to the operating table every year. Conventional back surgery (laminectomy) relieves pain in about 90 percent of sufferers, reports Dr. Stephen Hochschuler, a spine surgeon at the Texas Back Institute.

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