Innovative technique gives new meaning to ‘minimally invasive’
By Malka Eisenberg
Issue of May 15, 2009 / 14 Iyar 5769
Two doctors at South Nassau Communities Hospital are pioneering a new surgical technique that enables gallbladder surgery via a single incision through the patient’s bellybutton.
This single incision, minimally invasive surgery, leaves a scar that is not
A new surgical technique at South Nassau Communities Hospital enables gallbladder surgery via a single incision through the patient’s bellybutton.
easily seen in the navel. Besides the cosmetic benefit, other advantages are minimal blood loss, less pain post-surgery and quicker healing and recovery.
Rajeev Vohra, MD, FACS, chief of minimally invasive surgery and bariatric surgery at South Nassau Communities Hospital, and Gregory Nishimura, MD, began using this technique about six months ago. So far, the doctors have performed 20 surgeries with this method, using “new articulating, or bendable at 90 degrees, instruments all in one incision,” noted Dr. Vohra. “One of the prerequisites of laparoscopic surgery is the principle of triangulation, or the need to have the camera and the instruments in a triangle format so they are spaced apart.”
The bend “overcomes the limitations of being in close proximity together,” he explained. The tool has three thin tubes with very small cutting and grabbing instruments and a camera that sends an image of the operating field to a high-definition video monitor.
The progression of surgery has been “from open to minimally invasive laparoscopic to single incision laparoscopic to what is termed, although not actually, incisionless or NOTES — natural orifice transluminal endoscopic surgery — via the mouth and or trans-vaginally,” Dr. Vohra said. “It’s not mainstream yet, it’s where things are eventually headed but we are not there yet.”
“We start with one incision if it is feasible and if it is not appropriate, we use three to four incisions,” Dr. Vohra pointed out. During the same six months, the doctors performed about 150 three to four incision minimally invasive surgeries. “We do this surgery on selective patients,” stressed Dr. Vohra. “It depends on the patient’s BMI [body mass index] and previous abdominal surgery.”
According to Dr. Vohra, the main advantage of the technique is cosmetic, and it is most commonly used on younger women, who are not “morbidly obese.”
The technique is used predominantly for gallbladder removal, hernia repair and adjustable gastric band for weight loss. The procedure is ambulatory surgery, either the same day or overnight. Though the technique is available in other institutions, SNCH is pioneering it on the South Shore of Long Island.
Other surgeries available at South Nassau’s Division of Minimally Invasive Surgery are for gastroesophageal reflux disease (GERD), severe heartburn, hernias and diseases of the intestine, colon, spleen, kidneys and adrenals.
“Safety comes first,” Dr. Vohra stressed. After discussing the options available to each patient and studying their needs, the doctors are able to use these new techniques and implements to provide the optimum short and long term result.
For more information call (516) 374-8631 or go to www.newyorkbariatrics.com.
