Minimal Procedures, Maximum Benefits

New minimally invasive techniques make recovery easier for all types of patients.

Nearly 30 years ago, when highschool sweethearts Robin and David Hughes got married, they vowed to stay together in sickness and in health. But the young couple couldn't predict the challenges they would face on the sickness side years later.

David, now 51, has diabetes, and the disease was damaging his kidneys. In July 2005 he started dialysis, yet his kidneys continued to weaken. Before long, he qualified for a kidney transplant. He didn't have to look farther than his side to find a qualified donor in his wife, Robin, also 51.

In early January, the Sanger, Texas, couple had their near- simultaneous operations at Baylor University Medical Center at Dallas. "I was never afraid," Robin says. "The Bible says you will become one, and now we truly are one."

Thanks to minimally invasive techniques, doctors could remove Robin's kidney without a full, open incision. She was home two days after the operation and back to work about two weeks later. That's much faster than the typical four- to five-day hospitalization and three to six-week recovery with similar open operations.

Transplanting her kidney into David required an open incision and a short stay in intensive care for him, as well as a longer hospital stay. Still, he was driving just a few weeks later and returned to work part time a month after the surgery. "It's so much better than being on dialysis," says Robin. "He looks better, he feels better, he sleeps better- he's just better."

Better Options for Many
Kidney donors aren't the only ones who benefit from minimally invasive surgery. "At Baylor, laparoscopic techniques are used to operate on every organ in the abdomen, and most are done routinely that way," explains Matthew Westmoreland, M.D., a surgeon on the medical staff at Baylor Dallas.

The laparoscope is a tiny camera, inserted through a ½- to 1-inch incision, that displays the surgical site on a video screen. Surgeons can operate through one or more incisions, viewing the operation on screen, rather than opening the patient up to see.

Less pain and quicker recoveries are the hallmarks of minimally invasive surgery. "Recovery in some cases is probably 50 percent to 75 percent faster than it would be with traditional treatments," says Sina Matin, M.D., a surgeon on the medical staff at Baylor Medical Center at Irving. "Patients have shorter hospital stays and return to work more quickly."

There are also benefits that the patient doesn't necessarily see or feel. For example, there's an immune response triggered by the stress and trauma of surgery, which is lessened in laparoscopic surgeries. The intestines begin functioning and the bowels move sooner with these techniques, and people can eat earlier.

Dr. Westmoreland acknowledges that some procedures offer more benefits than others. "When you take an operation that normally requires a big incision, like extracting a kidney or an adrenal gland, the benefits can be dramatic. But all of the operations have benefits to some extent," he says.

Making Surgery Simpler
Gallbladder surgery was the pioneering laparoscopic procedure performed at Baylor Dallas back in 1990. What used to require two to three days in the hospital is now an outpatient procedure. Other surgeries that can be performed laparoscopically are:

• appendectomies
• bowel and colon surgery
• acid reflux surgery and other esophageal surgeries
• adrenalectomy and splenectomy
• colon cancer surgery
• kidney donation surgery

While Robin Hughes would have donated her kidney regardless, Dr. Westmoreland says that the benefits of minimally invasive surgery have doubled the number of people willing to donate.

And it's not just abdominal operations where the laparoscope can help. At Baylor Medical Center at Waxahachie, minimally invasive techniques and smaller incisions are used for many hip and knee operations, including hip fractures. "It cuts down on blood loss, tissue damage and muscle damage, and gets people off walkers earlier," explains Marcus Roux, M.D., an orthopaedic surgeon on the medical staff at Baylor Waxahachie.

Keeping Options Open
There are, of course, situations when traditional open surgery is preferred. Dr. Westmoreland cites emergency procedures with very ill patients as one example. "You may not know what you're dealing with until you get in there." Surgeries with multiple cancer sites might be better open as well.

"You have to use your judgment, but for most elective surgeries in the abdomen, laparoscopic surgery is a good option," Dr. Westmoreland says.

The surgery certainly helped Robin and David Hughes. Now, they can celebrate their 30th anniversary in June, and look forward to sharing many more happy years together.

By Stephanie Thurrott