Surgeons using less invasive technique
By Robbie Dingeman
Advertiser Health Writer
Doctors in Hawai'i see a growing number of operations done in a style known as minimally invasive surgery, a technique that involves much smaller incisions than conventional surgery.
A dozen years ago, patients undergoing relatively common procedures such as gall bladder surgery would have to cope with the pain, longer hospitalization and slower healing process that would accompany large incisions. Experts say at least 90 percent of such operations are now done with less-invasive techniques that require shorter hospital stays.
Dr. Mark Yamamura, a surgeon at Kaiser Permanente, said patients can heal faster, spend less time in the hospital and get back to their normal lives faster because of improvements made through minimally invasive surgery (MIS).
Yamamura said the technique (also known as laparoscopic surgery) involves a tiny video camera, which acts as a scope, and bright lights inserted through small incisions. A video screen helps guide the medical team through the surgery.
Yamamura is one of many surgeons in Hawai'i adapting these techniques to different specialties, with the help of some instruments as tiny as the tip of a ballpoint pen. "It's really revolutionary," he said.
At Kaiser Permanente in Honolulu, officials said surgeons last year used minimally invasive surgery for 1,667 patient operations involving 51 different kinds of procedures. The techniques are used on a variety of operations from the common appendectomy to kidney and prostate removal linked to cancer.
Yamamura said last year, Kaiser surgeons did 19 open appendectomies versus 288 laparoscopic appendectomies. But he and other specialists were not aware of a central database to track the numbers statewide or nationwide.
Kaiser urologist Dr. Randal Aaberg said that MIS has had "a huge positive impact" for patients. Even though the technology is expensive, the shorter stays and recovery time offset the cost, he said.
While MIS doesn't eliminate the need for hospital stays, it does reduce the patient's recovery time, Aaberg said. "It's just a much nicer way to heal up. It's got a real benefit for people."
Aaberg's patient, Guy Davis, 70, is a believer after he had his prostate removed (because of cancer) using the MIS techniques.
The East O'ahu resident said that Aaberg explained the choices and he opted for MIS. "I had my share of pain, but it wasn't so great," he said. "I'm amazed."
Davis, who worked until recently as a corporate pilot, runs to stay fit. He got out of Kaiser just a few days after checking in and was back training within weeks.
"I did go back to triathlon training and I did do the Tinman," Davis said. "I even came in third place in my age group."
Dr. Danny M. Takanishi Jr., associate professor and chairman of the UH medical school's Surgery Department, said the medical school is teaming up with The Queen's Medical Center to help develop an MIS surgery center over the next three years.
Takanishi said there is no central national set of statistics on the number of procedures done with less-invasive techniques than with traditional surgery, but it's clear that the need has grown and the medical school saw it as a key part of future training.
Dr. Whitney Limm, chief of general surgery for Queen's, estimates the new center will cost up to $2 million to create and will help to train doctors and others from across the state and the Pacific. "We have to make sure that we're inclusive," he said.
Limm said the surgery presents a challenge to doctors who are motivated to learn the new techniques and help patients' recovery time.
He sees it as a natural next step in surgery. Sixty years ago, he said, the aim was to have a patient survive the operation, then the focus was for long-term survival. This shift to an operation that causes less discomfort for the patient is right up there in the top 10 of important surgical developments, he said.
Limm said the operations also are offering relief to people with long-term health problems.
He cites an operation that eliminates what's called reflux or a kind of severe heartburn that most people treat with medication.
Takanishi said that gastric bypass surgery for obesity also has become much more common with MIS technology.
Takanishi and Dr. Kenric Murayama, an expert in the new techniques, will develop a minimally invasive program that will include a simulation center and provide training for surgical residents. "This is a trend that's going to stay," Takanishi said. "This is not something that's a fad."
Reach Robbie Dingeman at rdingeman@honoluluadvertiser.com or 535-2429.
