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Simplified Surgery: Read Marissa's Story
New, single-port approach to surgery takes "minimally invasive" to another level
Date: 6/1/2010

Named one of the Cleveland Clinic's Top Ten Medical Innovations for 2009, single-port laparoscopic surgery  is catching on throughout the country, including right here in Hamilton, NJ.

Surgery's Past, Surgery's Future
So, what is it? To best understand the benefits of the single-port approach, it helps to understand how surgery has evolved to become less invasive.

Long ago, when the practice began, most surgeries were performed through a single, large incision, or cut, to offer the surgeon a clear view of the area.  In more recent years, multiple-port laparascopic surgery has changed the face of surgery.

Multiple-port procedures require several small incisions. Typically, there is one incision made to the navel cavity (belly button) and an additional two, three or four incisions made in others areas of the abdomen depending on the surgery. The surgeon uses these multiple entry points to access the affected area.

Single-port laparascopic is a surgical approach in which the surgeon makes only one incision, located in the navel cavity. Through this single small incision, using specially modified instruments, an advanced laparascopic surgeon can successfully complete the procedure.

"Minimally invasive options are continually being improved to move toward a smaller incision. This is directly related to improved patient outcomes which are always the goal in medicine," explains Vijay Vaswani, MD, board certified in general surgery, chairman of surgical services at RWJ Hamilton and one of the first area surgeons to perform this innovative procedure.

"Advancements in surgical instruments in recent years have made this type of procedure more popular among patients seeking a minimally invasive surgical solution," says Robert Mayson, MD, FACOG, board certified obstetrician and gynecologist and advanced laparascopic surgeon.

At RWJ Hamilton, single-port laparascopic surgeries have been applied in a variety of ways. Vaswani has used this approach for the removal of organs, such as the gall bladder and the appendix, while Mayson has performed single-port gynecological surgeries, like hysterectomy and ovarian cyst removal.

Patient Satisfaction
There are several benefits to laparascopic surgery, including:

  • Shortened hospital stay.  Most patients go home within 24 hours.
  • Decreased post-operative pain. Patients report lower pain scores than traditional open surgery.
  • Fewer complications. Studies find patients experienced a lower rate of infection and less blood loss.
  • Quicker recovery. Patients are able to return to work and their daily routine at a much faster rate.

Single-port laparascopic surgery enhances these benefits for the patient. Post-operative pain levels reported by patients of the single-port approach are lower than with multi-port. "Patients experience less pain because the single incision is in the area least likely to cause pain.  When incisions are made on the side of the abdomen, patients report higher pain levels," explains Vaswani.

Patients also experience fewer complications with the single port, and many report they are back to enjoying their normal activities faster than those who have had a multi-port procedure.

Finally, the single-port approach offers one more benefit: minimal scarring. The patient leaves the procedure with a single incision, leaving a single scar. The location of that scar is basically the belly button, leaving the scar virtually undetectable after the patient has recovered.

Low Risk Approach
Although single-port surgery may pose a challenge to the surgeon because of limited access to the affected area, it's one that holds no added risk. "Even after single-port laparascopic surgery has begun, the surgeon has the option to increase the number of ports without increasing the risk of the surgery," Vaswani explains.

This approach is becoming more accessible for individuals needing minimally-invasive surgery every day.  There are, however, some who are not candidates, including people with:

  • Morbid obesity
  • Scar tissue from previous abdominal surgeries, like gastric bypass or colon resection
  • Severely inflamed gall bladder or appendix

Manufacturers are making strides in their efforts to reduce the number of patients who are not candidates.

"In the obese patient, for example," explains Mayson, "the problem with trying to do the single port lies in the depth of the anterior (front of body) abdominal wall.  Manufacturers are now producing ports that can accommodate these patients. The goal is to soon offer the procedure to a broader spectrum of patients."

  Meet Marissa of Ocean Township

With a long family history of gall bladder sugery, Marissa knew it was a matter of time before hers would start to act up. When a routine test indicated the presence of gall stones, Marissa wasn't surprised.  And when her pain began to worsen, she knew it was time to call a surgeon.

"I was having pain in the right side of my abdomen after I ate anything, especially heavy meals. This past Labor Day weekend the pain forced me to pull my car over. I knew what it was; I'd just been putting off making the call," says Marissa.

She contacted Vijay Vaswani, MD, after the holiday to set up an appointment. "Dr. Vaswani explained I was a candidate for the single-port surgery. Going into the consultation, I just assumed I would have a multi-port procedure. I didn't even know single-port was an option," says Marissa.

The surgery took place on a Tuesday and Marissa was released from the hospital five hours after surgery. "The whole process was very efficient.  I was pretty sore at first.  After a couple days I was able to walk around."

One week after the surgery, Marissa returned to work. "At that point, I was feeling much better. I couldn't do any abdominal exercise or heavy lifting, but for the most part, I was back to my regular routine."

She is happy to have the surgery behind her and reports total relief from her gall bladder discomfort. "It is nice to know I shouldn't expect pain from eating certain foods," she says.

Her advice to anyone experiencing abdominal pain? "If you know it is your gall bladder, do not put off the surgery. The sooner you go, the sooner you'll be back on your feet and back to your life . . .without the pain."

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