Cutting-edge medicine on wheels | April 29, 2011 | Mountain View Voice | Mountain View Online |

Mountain View Voice

News - April 29, 2011

Cutting-edge medicine on wheels

Surgical tech company's 'mobile operating truck' makes stop at El Camino

by Nick Veronin

Doctors at El Camino Hospital tried their hands at a relatively new surgical method Monday.

The technique, known as single-incision laparoscopic surgery — or SILS — employs a miniature camera, tiny light and a variety of tools attached to the ends of long wires, which allow surgeons to perform a wide array of procedures, such as appendectomies, hysterectomies, and hernia operations, all through a single opening in a patient's belly button.

According hospital doctors, as well as officials from the medical technology company running the event, the technique is gaining popularity in the field of minimally invasive medical procedures.

Weighing in at about 40 tons and measuring 85 feet in length, a massive big rig parked its 18 wheels behind El Camino Hospital on April 25. Inside the 1,200-square-foot trailer, there was a small screening room and a larger demonstration floor. Doctors were invited to come to the "mobile operating truck," watch an orientation video and then move into the next room to try the Covidien SILS technology hands-on.

The El Camino demonstration is just one of 90 stops the Covidien Innovation Tour will be making in cities across the country, according to Chuck Flora, regional manager for the surgical technology company.

Single-incision laparoscopy had been considered impossible by many medical professionals as recently as four years ago, and many surgeons remain skeptical about the practicality of operating through one tiny opening.

But, as Flora tells it, the technique is not only possible, it is the wave of the future. Traditional laparoscopy, the predecessor to single-incision, required multiple incisions to be made up and down a patient's torso, to allow doctors access to internal organs from various angles.

The new technology, however, allows for a much broader range of motion — all through a single entry point in a patient's belly button. The SILS multiple-instrument access port, a round plug that is inserted into the belly button incision, has three holes arranged like the grips of a bowling ball. These allow for the insertion of the laparoscopy instruments, which have been improved, and allow doctors to move small scissors and grabbers a full 360 degrees around, as well as up, down and side-to-side slightly more than 180 degrees.

Both patients and doctors are fans of the technique, Flora said, for a variety of reasons.

"The patients like it because the cosmetic effects are that it looks like you didn't have surgery," Flora said. "We've also heard from surgeons that there is faster recovery time and perhaps less pain associated with the procedure."

Dr. Patricia Rogers, a gynecologist and surgeon practicing at El Camino, said she was dubious of the claims made in the invitation she received to the Covidien truck.

"I couldn't believe you could do surgery through one incision," Rogers said. "The angles didn't sound like they would work."

After working with the instruments, however, Rogers said she is convinced. She is planning on making some time to train with the technology and may start performing SILS procedures herself.

Rogers agreed with Flora that patients usually prefer fewer incisions, as it means fewer scars. "But what people have to remember is that they have just had a big organ removed," and just because things look good on the outside, doesn't necessarily mean they can jump right off the operating table and go on a 10-mile hike.

She added, that while doctors generally want to please their patients, laparoscopy "has a pretty steep learning curve. Nobody likes a steep learning curve."

If Rogers had her druthers, she said all surgeries would be wide-open surgeries, where visibility is better and the chance of error is lower.

However, Dr. Homero Rivas, assistant professor of minimally invasive surgery at Stanford, said that fewer incisions does translate to a quicker recovery by reducing the psychological trauma that often accompanies large scars, and by lowering the risk of those incisions becoming infected.

Rivas, it should be noted, was working with Covidien at the El Camino stop — demonstrating how to use the SILS equipment. But Rivas said he is not invested in the company in any way, insisting that as a medial innovator, "it is actually very rewarding as an academic and physician to see other people performing this surgery." But convincing others to adopt the technique can be tricky.

"The No. 1 barrier to adoption is changing the mindset of surgeons," Rivas said. "When I was introduced to this concept, I said, 'This is nonsense.'" But after taking a closer look at the problem with colleagues, "We found out it is something very doable, something very safe, and it brings a valuable proposition to patients," he said.


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