Medical science fiction now reality

Tue, Mar 3rd 2015, 12:10 AM

Medical science is continually making advances with the development and introduction of new medications and treatments. But the major surgical advancement that has taken place in the last 10 years is minimally invasive surgery, also known as laparoscopic surgery or keyhole surgery. In minimally invasive surgery, surgeons use a variety of techniques to operate, with less injury to the body than with open surgery as major operations are done through a tiny incision. The advantage to the patient is that there is less stress on the body, according to General Surgeon Dr. Ross Downes.
"You recover faster, you have less pain ... You do better. [Minimally invasive surgery] is something that's become widely adopted ... It's spread like wildfire," said Downes, who spoke at the recent Doctors Hospital Distinguished Lecture Series. "A lot of people have adopted these techniques because they see the value in them. And the reason they're being able to make such advancements is because of how society has advanced -- a lot of things that were once science fiction are now reality."
Case in point, the doctor who refers to himself as a "science geek" is looking forward to the first commercial flying car -- an idea he said people should not consider far-fetched.
"We remember 'Star Trek' [and] Captain Kirk's communicator, many people have an iPhone, very popular device. Captain Picard had his handheld computer -- the iPad is very commonplace to us. The same thing has happened to medicine -- there is no difference. Doc if you remember him with his tricorder, flashing that little silver device over the patient and getting all the information he could. Today we have similar devices, a handheld ultrasound called a Vscan that can give us a whole bunch of information -- so not only can I talk to you and get information, I can examine you, and then I can do an ultrasound by the bedside."
Advancements in minimally invasive surgery are in all different areas of surgery -- urology (operation of the kidneys, the bladder and the tubes that connect them); gynecology; orthopedics (operation of the bone); neurosurgery (operation of the brain and spine); and of course general surgery.

Medical versus surgical advances
According to Downes, one of the major medical advances has been the 2000 Human Genome Project, in which scientists looked at human DNA and were able to tell exactly what each piece of DNA could do.

"The aim of the project was to use it to create new drugs," said the doctor. "In the last 20 years there haven't been that many new drugs, but what they're trying to do is get a new angle by using your genes, your genetic material, your DNA and create a drug that is targeted so that so you get a better faster and more directed outcome. Diabetes is very common in our society. You can't really solve diabetes, but if you can treat it better, if you can diagnose it earlier, then patients do better.

"We're able to use a lot of materials to help fix bones. Back in the day we were very limited with what we could use, but now with us using the Human Genome Project, printing what the DNA is, we're able to produce materials that the body does not reject, so it doesn't have to be a foreign material. It's something that your body can accept. And because it's tailored to your body, your body accepts it and it forms new bone for you."

Medical science is also developing technology to enable patients to take their ECG and vital signs at home, and send the information to their doctors.

Biosensors, which Dr. Downes said are relatively new, have exploded in use around the world. The tiny, flat device that is the size of a postage stamp is placed on the body and monitors a patient's vital signs daily, hourly and minute-to-minute. The results can then be shared with physicians, and the patient can log on to a computer and see his or her results, said the general surgeon.

Printing organs
As the technology for imaging devices advances, the CT Scan and MRI machine have also progressed to the point at which they can hone in on a specific organ in the body. The doctor compared the technology to taking the organ out of the body and putting it on the table. Advances, he said, have also reduced the number of times insulin takers need to test their blood sugar levels on a daily basis.

"We put a little monitor on the belly and then you have a pump connected with a needle that goes into the skin of the abdomen, and what this monitor does is senses what your glucose levels are. It senses those glucose levels, and then tells the device how much insulin to give you," said the general surgeon.

Advances also include the Wello cellphone case, which gives vital signs --how fast a person's heart is beating, how fast he or she is breathing, temperature and seeing how well his or her organs are being oxygenated.

"Everybody has a cellphone, so you put this case on your cellphone and from anywhere you can get this information, this information not only you can use, but you can now sign up with services, connect with your doctor, and send that information to him," said Downes.

"So once you don't feel well, or you do this on a regular basis, you can have this information, send it to your doctor and your doctor can create trends."

The iWatch would do the same thing. The office visit of the future would involve patient portals, allowing patients to sit in front of a computer and connect with a physician. Limitations may include acute conditions.

"But if we know what you have and we know what your conditions are, and we can combine them with the information that we got from all of those sensors, then we can figure out what's going on with you, and again from the comfort of your home we can tell you what's going on."

Surgical advancements
Advances in urology include the uroscopy. Instead of getting big cuts to look at one of the most common problems - ureteric stones, or stones of the kidney tract - physicians can do minimally invasive surgery. Back in the day, surgeons would have to cut open the kidney or the urethra, to get the stone out, something they no longer have to do.

When doing a transurethral resection of the prostate, instead of cutting, surgeons can now go through the urethra (the urinary hole) and shave some of the prostate to allow men to pass urine. Other techniques include transurethral microwave thermal technology in which microwave is used to burn the prostate with a special microwave device. Minimally invasive procedures are done when cancer is not present.

Gynecology

Gynecology is the specialty that first employed a lot of the laparoscopic techniques. A wide range of conditions can be treated through minimally invasive surgery, including cysts on ovaries; tumors and cancers;  ectopic pregnancies (pregnancies in the wrong places); pelvic infections; endometriosis (abnormal tissue deposits from the womb in the abdomen which can cause problems) and pelvic adhesive disease.

Orthopedic surgery

According to Downes, doctors are now able to operate on more joints using minimally invasive techniques, including the shoulder, the knee and the hip.

"All we do is make three little tiny holes, one is a camera. We look at the joint, find where those problems are, and are able to shave cartilage that is in the wrong place; we're able to look at tears in the tissues of the joints and fix those. And we can do that without getting a big incision that used to traditionally cause you to have a lot of problems, as well as be in hospital for extended times."

Spinal surgery is another advancement that he said has been made. Back in the day spine patients had to get long cuts along their spine for medical practitioners to fix problems, especially when they were at multiple levels.

General surgery

In general surgery, removal of the gallbladder was one of the first advancements that they saw in general surgery. Minimally invasive surgery he said has allowed for people to no longer have to get that centipede cut on their belly to have their gallbladder removed, or have to ingest the nasty tasting liquid in hopes that the stones would dissolve. Gallbladder surgery, he said, can now be done laparoscopically through four tiny holes and the gallbladder taken out without a problem.

In 2004 at Doctors Hospital, 32 patients had gallbladder surgery using minimally invasive surgery, in an average time of 38 minutes per surgery. The total number of gallbladders removed numbered at 100. Dr. Downes said they still do open surgery to remove gallbladders because they are forced to, but that the overwhelming majority of cases that are complicated with stones in their ducts get an ERCP (endoscopic retrograde cholangiopancreatography). He said doctors found that they had better outcomes using ERCP and that patients went home in just over a day as compared to two to three days if they had open surgery.

Of the 78 appendectomies performed that year at Doctors Hospital, 38 were done laparoscopically, and the patients showed better outcomes and less operative time. The average operating time was 22 minutes.

The general surgeon said they have also done seven colectomies, three done in the single port laparoscopic group. The rest were done with traditional laparoscopy; they've done liver resections, at least one splenectomy every six months, using the single port technique. Dr. Downes said that the next stage in evolution is single port laparoscopy and the ability to do all surgeries through one little tiny hole in the belly button.

Hernias are also now being repaired using minimally invasive surgery with a little cut by the belly button, and two little cuts on the side. They no longer need to do the big cut on the belly to fix hernias. Because of the equipment that is required for the procedure, Dr. Downes said The Bahamas is still not at the point in time where they can perform minimally invasive surgery on everyone. It is only done in special cases -- if a person has hernias on both sides, a hernia that was fixed before and came back, or an athlete who needs to get their feet fixed quickly. Bowel resection surgery he said is advantageous minimally invasive because all surgeons have to do is be able manipulate it, cut it out and put it back together.

Dr. Downes said minimally invasive surgery is also advantageous with bariatric surgery, which is essentially weight-loss surgery. He said extra weight on a person makes it difficult to perform surgeries, as the patient is at risk for a number of complications. With laparoscopic surgery he said they are able to reduce the complications while giving the patient the benefit of treating their obesity. According to the general surgeon, nine procedures using laparoscopy was done last year at Doctors Hospital, even though he knows there are many more that need the surgery.

Notes
Natural orifice translumenal endoscopic surgery (NOTES) he said is another advancement that medical evolution has seen, but which hasn't really caught on as it takes a high level of expertise to perform. A hole is made in the patient's intestine -- usually the stomach, or the vagina, according to Dr. Downes, and they're able to go into the abdominal cavity and do surgery. But he said the surgery involves specialized expensive equipment.

"In 2000 they started seeing us doing this kind of procedure for people who had reflux, and then they decided if we can do it inside the stomach, inside the intestine, why can't we go through the intestine and do something outside. In 2004 in India, they decided they would go through the stomach and take out the gallbladder, and they would go through the vagina and take out the appendix, and then they decided to do it the other way -- they went through the stomach and took out the appendix, and went through the vagina and took out the gallbladder.

"Initially when they started to do those things they had a lot of complications, as expected. If you make a hole in the stomach for no reason it can leak, so with the advances that they've done, this is something that they're trying to push a little more, so this is a true version of scar-less surgery. There is no scar that can be seen on the body."

Dr. Downes said medical practitioners are also now employing robotics. When the robot first came on it was done in the tradition of laparoscopy with multiple holes, but they've married the ideas, so they now use the robot and they also have single port access. He says robots also allow a doctor who may have a fine tremor to eliminate the errors.

"The good thing about it is it almost mimics the natural hands. The robot allows us to do this and it's almost like we're doing surgery with our natural hands. It's faster surgery and more precise."

With the 22nd century approaching, Dr. Downes said medical evolution in The Bahamas needs to keep abreast of the advancements, but he said in The Bahamas, the robot is something that is probably not achievable right now as it costs more than $1 million to purchase the robot and $150,000 a year to maintain.

"It [robot] might not be appropriate for our environment, but certainly, a lot of these other advances are things we should be implementing today," he said.

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