TidBits Of Info

Time to retire the scalpel? Once just for simple procedures, minimally invasive surgery is now tackling major ills such as brain cancer and heart disease.
By Shari Roan, LATimes Staff Writer
June 19, 2006

THE doctor sits in a darkened corner of an operating room about 10 feet from where his patient lies on a gurney. Members of his surgical team stand around the room's periphery, staring at several large, flat-screen video monitors hanging from the ceiling.

On screen is a colon, shiny and pink. The patient himself is barely visible, shrouded in surgical sheets and dwarfed by a refrigerator-sized, four-armed robot positioned over his body.

In reality, surgeon Alessio Pigazzi and his team at City of Hope are getting the best possible view and access. The robot's arms hold slender surgical instruments, a tiny camera and a light, all threaded through dime-sized openings in the abdomen. The monitors reveal a bright, nearly bloodless landscape, magnified 10 times.

Using hand controls and foot pedals, Pigazzi commands the robot from a console, sliding the instruments into the tight confines of the rectum where a cancerous tumor sits - a space nearly impossible to see without the technology at his disposal. "There it is," he announces.

This is 21st century surgery - with little blood loss, rapid healing and minimal scarring - and it's quickly replacing surgery in which scalpels (in, hopefully, steady hands) slice long, bloody incisions through the body. In this dynamic movement, doctors aim to fix the body without hurting it.

"People will soon look back at any large incision as barbaric and archaic," says Dr. Paul A. Wetter, chairman of the Society of Laparoendoscopic Surgeons and a professor emeritus of gynecology at the University of Miami.

In only the last few years, minimally invasive surgery has evolved from a popular technique used for the simplest of abdominal surgeries ? such as a gallbladder removal or hernia repair - to a method that can treat even life-threatening diseases such as cancer, heart problems and emphysema.

An increasing number of these surgeries are augmented with sophisticated computer and imaging technology - such as robots. Such techniques elevate ordinary doctor skills to the super-human level by providing magnified, high-definition images and by preventing mistakes, such as cutting into the wrong tissue.

Some doctors are even taking the first tentative steps toward operating without incisions, using the body's natural openings - the nose, mouth and anus - to gain access to its inner workings.

Think of it as surgery without scars.

"Anything you can think of is now fair game," says Dr. Gary H. Hoffman, a clinical attending surgeon at Cedars-Sinai Medical Center. "It's to the point now where surgeons know no boundaries and are boldly trying to do all kinds of things."

Evolving procedure

The first minimally invasive surgery, a gallbladder removal, was performed by surgeons in France in 1987. Today, as many as 90% of gallbladder surgeries are laparoscopic (minimally invasive surgery performed through the abdomen).

In these non-robot-assisted surgeries, several dime-sized openings are made in the abdomen for the insertion of a tiny camera, fiber-optic light and instruments for cutting and cauterizing tissue. The surgeon manipulates the instruments from outside the body while watching his or her movements on a monitor.

Most patients undergo the procedure as outpatients. They are back at work within a few days and can return to normal physical activities shortly thereafter. In contrast, traditional gallbladder removal involves several days in the hospital, much more pain and four to six weeks of recovery.

Now hernia repair, appendectomy, even gastric bypass are also routinely performed with only small incisions in the abdomen. These operations have proved to be but the first step in the evolution of minimally invasive surgery.

"This first stage is sort of like where the first automobiles were," Wetter says. "They were made with bicycle parts. Modern vehicles are nothing like that. We're moving into a new phase in which instruments are designed with minimally invasive surgery in mind instead of taking big instruments used in open surgery and just miniaturizing them."

Some physicians are using minimally invasive techniques in spinal fusion surgery (which traditionally requires a 6-inch incision in the back). Others are using the methods to reduce lung capacity in emphysema patients, to remove part of the bowel in people with Crohn's disease, to replace faulty heart valves and to repair aortic aneurisms. (Open cardiac surgery typically requires a lengthy incision through the chest and the splitting of the chest bone to expose the heart.)

LENA'S COMMENT: You can expect an increase in surgery since doctors new toy will let them do things they couldn't do before. Who suffers? You and your insurance company's pocket book. Remember surgery has risks no matter how sophisticated they make it and should be the last resort of treatment...
 

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Study Links Pesticides With Parkinson's
June 27, 2006

WASHINGTON - People with long-term, low-level exposure to pesticides have a 70 percent higher incidence of Parkinson's disease than people who have not been exposed much to bug sprays, US researchers reported on Monday.


Such workers include mostly farmers, ranchers and fishermen, the researchers report in the July issue of Annals of Neurology.

Their study supports previous research that suggests pesticides can be linked with Parkinson's, which is caused by the destruction of key brain cells, the team at the Harvard School of Public Health said.

"The findings support the hypothesis that exposure to pesticides is a risk factor for Parkinson's disease," they wrote.

Alberto Ascherio, an associate professor of nutrition and epidemiology and colleagues examined data from a 2001 American Cancer Society survey of 143,325 people.

The researchers contacted those people who reported they had been diagnosed with Parkinson's.

The American Cancer Society was studying factors for cancer risk and all the people had reported on eating and lifestyle habits and environmental exposures.

More than 5,200 men and 2,600 women reported exposure to pesticides. After adjusting for age, sex, and other risk factors for Parkinson's disease, the researchers found a 70 percent higher incidence of the disease among these nearly 8,000 people than among people who reported no exposure.

More men than women said they had been exposed to pesticides and those reporting exposure were more likely to report their occupation as farmer, rancher or fisherman, the researchers said.

People who had other jobs and who reported pesticide exposure most likely were using the chemicals at home or while gardening, the researchers speculated.

Exposure to asbestos, chemicals, acids, solvents, or coal or stone dust was not associated with a higher risk, the researchers said.

"Future studies should seek to identify the specific compounds associated with risk," the researchers said. A class of chemicals called organophosphates has been linked with Parkinson's risk in other studies.

There is no cure for Parkinson's, which starts off with tremors and ends up paralyzing and often killing patients. Globally, it is estimated 6.3 million people have Parkinson's, more than a million in the United States alone.


REUTERS NEWS SERVICE