Surgery Today - Surgical innovations



Researchers and surgeons have begun to view the best surgical techniques as those that manage to dispense with the typical symbols of their craft—the knife and scalpel. Advanced technology is changing the way a surgeon plans and executes an operation.

Videoscope Surgery & Imaging Techniques

One of the primary reasons why overall health care has improved in the last decade is the development of slender, fiber-optic tubes, or scopes , that can be inserted deep inside the body through nearly invisible incisions. Fitted with cameras, telescopic lenses, and lights and hooked up to video screens, scopes enable surgeons to see images of a patient's internal organs, usually with greater clarity than if they were looking directly at the organ. The appeal of videoscope surgery to both surgeons and patients is simple; while it enables doctors to pinpoint the location and type of the problem they're facing, it dramatically reduces surgical trauma for the patient. Conventional “open” surgery results in high levels of stress to the patient's body. Surgeons must cut through skin, muscles, fat and, depending on the surgery, bone. The use of videoscopes dramatically lowers the number of conventional operations, especially in the area of exploratory surgery, in which surgeons perform an operation to discover the nature of a patient's problem. Some doctors predict that the day will come when making any kind of incision will be viewed as a failure.

Various scopes are named for the area of the body in which they are generally used. Laparoscopes are used in the abdomen, arthroscopes are applied to the joints, thoracoscopes or endoscopes are used in the chest, and angioscopes are used inside the walls of blood vessels.

Improved imaging techniques such as computerized tomography ( CT ) and magnetic resonance imaging ( MRI ) have also moved the science of surgery forward. The CT scan provides surgeons with cross-section x-ray images of the inside of the body. All of the organs can be seen and evaluated. The MRI, on the other hand, creates three-dimensional images of the body's interior using a magnetic field and radio waves instead of X rays. Using these improved methods, surgeons can narrow the scope of the procedure considerably and meticulously plan every aspect of the operation.

Laser Surgery

First used in eye surgery in the 1960s, laser technology is coming to be regarded as a conventional surgical technique. Laser surgeons are the new breed of surgeons and precision separates their tools from the traditional knife and scalpel. Without even cutting skin, a surgeon can often completely eradicate a problem with absolute precision even in the most inaccessible areas of the body. Lasers cause little trauma, if any, to the patient, thus offering less invasive, even noninvasive, solutions.

An acronym for Light Amplification by Stimulated Emission of Radiation, the laser is a precisely controlled light beam that is narrowly focused and then aimed at a minute target. In each laser, various frequencies of light are converted into an intense beam of single wavelength, or color. The color determines how the beam will interact with particular kinds of tissue, and may be different for different kinds of surgery. Lasers may function continuously or in pulsed bursts. The type of laser determines the number of pulses per second, the duration of the pulses and whether the light will be used to cut through tissue, vaporize it, or seal it.

Various lasers take their names from the different substances that produce the beam.

The carbon dioxide laser , with a wavelength in the far infrared spectrum, penetrates tissue to a depth of only one millimeter. CO 2 's ability to turn the body's water content into steam allows it to sear, cook, or cut tissue to a precisely controlled depth, sealing blood vessels and nerve endings in a bloodless procedure. The CO 2 laser has been used widely to treat some types of cancer, gynecological disorders, and brain tumors.

The argon laser , functioning in the blue-green frequencies, reacts with the color red and will penetrate the skin until it comes in contact with blood. Because it readily coagulates with blood in the operating area, the argon laser has been particularly useful in the fields of opthalmology, plastic surgery, and dermatology.

The YAG laser , with a wavelength in the near infrared spectrum, is used to cook or vaporize tissue that will then be removed from the body. The most invasive of all surgical laser devices, the YAG laser can penetrate 4 to 5 millimeters.

Dye lasers can be tuned to react to different wavelengths of light, simply by adding or diluting tint. The free-electron laser , also tunable, uses magnets to stimulate pulsed light from a stream of electrons.

The excimer laser breaks up inter-molecular bonds and decomposes matter, allowing precise surgery through holes so small no stitches are necessary. When certain gases are stimulated and combined and then returned to a disassociated state, their electrons emit photons of light in ultraviolet wavelengths. For example, patients undergoing excimer laser surgery to repair corneal damage do not experience the thermal effects or shock waves of conventional lasers. Without even touching the cornea, the excimer vaporizes with cool UV light the molecular links that bond the tissue.

Microscopic Surgery

The development of microsurgery—the use of operating microscopes—allows surgeons access to parts of the body that would otherwise be too small to see. Many tumors, formerly considered inoperable, now can be removed through microsurgery. Often the use of microscopes is paired with another innovative technology, such as the use of lasers, because what the surgeon can't see with the naked eye, he also can't cut with a scalpel. Using the microscope to locate and isolate a tumor, the surgeon then destroys it with a laser beam. Microsurgery is often used on brain tumors with success.

Cryosurgery & Hypothermic Arrest

Precancerous skin conditions, such as acute keratosis, as well as skin cancers, are being treated with extreme cold in a procedure called cryosurgery. Liquid nitrogen, applied to the growth, freezes and kills the abnormal cells. Once it thaws, the dead tissue falls off or is easily removed. Anesthesia is not necessary in cryosurgery, but patients may experience pain after treatment. Scarring may also occur.

The human body's vulnerability to extreme temperature fluctuations and how it has reacted in past cases has provided surgeons and researchers with valuable information that they have been able to use to develop new surgical techniques. The notion that the human body can survive without circulation at very low temperatures arose from cases in which children who lost consciousness in extremely cold water were later revived after hours of submersion. Normally, the brain only lasts three to five minutes without oxygen. In a new, experimental procedure called hypothermic arrest , the body is cooled to approximately 40 degrees below normal, where it needs much less energy and the brain can actually survive for up to sixty minutes without oxygen. Hypothermic arrest has been used almost exclusively for brain surgery.



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