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Patrick Springer, Published December 29 2008

Methods shorten hospital stays

Stabbing pains in his abdomen sent James Weninger to the emergency room.

Doctors diagnosed the source of his pain as a gallbladder attack. That meant surgery.

Hours later, once an operating room became available, he had surgery.

Not so many years ago, that would have meant a long incision on his abdomen.

Instead, using a laparoscope equipped with a camera, his surgeon made four small cuts to remove the gallbladder and nearby tissue damaged by infection.

Now, what usually required a three-day hospital stay is an outpatient procedure that allows the patient to go home the same day.

It’s just one example of what’s called “minimally invasive surgery,” a term for techniques that use smaller incisions or other steps that translate into shorter or no hospital stays, faster recovery and less pain.

“I never had any pain,” says Weninger, a 72-year-old Fargo man, “except when I went in.”

Two weeks later, he was back on the road as a truck driver. He delivered a load of groceries to a food bank in Crookston, Minn.

Dr. Robert Sticca, his Fargo MeritCare surgeon, says minimally invasive surgery is common, especially for obstetrical-gynecological procedures, urological procedures, some heart surgery and as some orthopedic surgery.

“It’s completely transformed all of general surgery,” he says. “It’s a completely different field.”

A hysterectomy, which once meant three or four days in the hospital, now is an out-patient procedure.

Gastric bypass surgery, a weight-loss procedure, now means two days in the hospital instead of five.

Heart surgery that can be done with minimally invasive techniques allow patients to go home after three to five days, instead of five to seven.

Those shorter hospital stays save money. A lot of money, considering the typical cost of a day in the hospital for a surgical patient at MeritCare runs from $800 to $1,200, not counting the cost of the procedure or supplies.

Society benefits as well, Sticca says, because people can return to work and their normal routines much more quickly.

“It’s not a stretch of the imagination to say almost any procedure that can be done open can be done laparoscopically,” he says. Open is the term used for conventional surgery. “In the history of surgery, this is a pretty dramatic change.”

Still, certain procedures require traditional techniques, including those involving the chest.

Only some heart surgery, including some valve repairs, can be done with smaller incisions, typically between the ribs.

On the other hand, Dr. Roxanne Newman, a cardiac surgeon at MeritCare who has helped pioneer robot-assisted minimally invasive techniques, says it’s now common to do many heart operations without using a heart-lung machine.

That’s accomplished by operating on a beating heart, which preserves normal circulation.

“That has taken away a huge part of the trauma of open-heart surgery,” Newman says.

Keeping someone off the heart-lung machine spares the patient from risk of memory loss or other side effects, and therefore qualifies as minimally invasive.

“It’s become so routine that nobody really thinks of it as being minimally invasive,” Newman says. “It’s been the routine standard of care.”

The expansion of minimally invasive surgery techniques requires a balance of the pros and cons, Sticca says.

For instance, some procedures that can be done with scope instruments may not be beneficial if they require the patient to stay under anesthesia for much longer periods than normal surgery.

Since minimally invasive techniques first came into use, in the 1980s, the evolution has progressed to such a degree that it’s difficult for Sticca to see much room for new categories replacing conventional surgery.

But Sticca acknowledges that when he began his surgical residency training in 1984, all surgery was open, and minimally invasive techniques, which began in Europe, seemed like a novelty that wouldn’t prove practical.

“I’m not sure there’s a big advantage, but who knows?” he says. “Some people said that when laparoscopic surgery came out.”

Readers can reach Forum reporter Patrick Springer at (701) 241-5522