Saturday, January 2, 2010

The new age in women's surgery

When my mother needed a hysterectomy 25 years ago, she had her abdomen cut, her uterus removed and things stitched back.
My aunt got her uterus removed vaginally.
Both went through pain, prolonged recovery periods, bed rest, put on weight due to bed rest, had to stay home from work and were miserable.
A revolution in surgery started with a German gynaecologist Kurt Semm who did a hysterectomy using a telescope, thin instruments put in through fine metal tubes and coagulating protein in tissues using electrical energy and even stitching up through those tubes.
Endoscopy was adopted by all surgeons-general surgeons now remove appendices and gall bladders laparoscopically, gynaecologists remove uterii, fibroids, ovarian tumors and even repair hernias [prolapsed uterii]  and orthopaedic surgeons to repair joints and even neurosurgeons are reaching remote areas of the brain endoscopically.
When my son needed a major joint surgery, all he needed were 3 puncture wounds round his shoulder, was home in one day and doing everything himself in two days.
This is the new magical world of endoscopy. We look into the patient's abdomen with a telescope-the image magnified several times and coagulate and cut tissues precisely using excellent instruments and electrical power or ultrasound waves. The tissue to be removed is cut with a rotating blade and removed in strips through a small puncture wound. Essential suturing is done. The cavity is washed with saline and every fine bleeding point is taken care of. 
The patient recovery is amazing. She sits up and drinks on the same day and goes home the next.
A week later, her sutures are removed and the scars are invisible in a few months.
Like any surgery, these operations have their complications but in experienced hands with good instruments, the complications are negligible.
At my hospital, where two patients who underwent the same surgery but one with a cut on her abdomen and the other laparoscopically, were lying side by side and comparing notes.
The Laparoscopic one went home in a day and the one who had open surgery started crying and quarreling with the doctors for not doing a laparoscopic surgery on her. Yes. There is such a degree of difference in the two routes.
However, lack of good training, poor instruments, lack of experience and hurry and greed on part of doctors are giving this surgery a bad name.
Further, senior renowned doctors are not familiar with these techniques and in an attempt to keep their patients, malign laparoscopy.
No matter, this is the future and it is here to stay.
I wish my mother had had a laparoscopy and not suffered any pain, or been invalid.
I'm glad we now live in the age where no pain or disfigurement needs to be suffered even for a supramajor cancer surgery.
In future, with robots endoscopy will become even more accepted and done remotely.-Yes a surgeon in Bangalore will soon be able to operate on a patient in Bhatinda.


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