Achievements of surgery without a scalpel

By Gilles Rousset

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Highly skilled surgeons are increasingly practicing non- invasive surgery, without using scalpels and without opening up the body, to the benefit of patients. _________________________________________________________________

PARIS: The surgeon hardly casts a glance at the sleeping body lying on his operating table. His eyes are glued to the video screen giving him a detailed picture of the patient's insides.

He follows the path of the tiny syringe which, after entering via the femur artery, will reach the heart in order to dissolve a blood clot.

When the patient wakes up, the only sign that he will see of the operation will be a small red spot, about the size of a lentil, halfway up his thigh.

This feat is now accomplished everyday by modern surgeons. Heavy, traumatic surgery is increasingly being replaced by light operations which are carried out without opening up the body. It is far less of a shock to the patient's system and treats the organs and tissues much more gently. Moreover, the patients can go home sooner.

For a long time, French surgeons have been pioneers in this field. Already, in Paris in 1940, Raoul Palmer was the first person to insert a piece of equipment bearing a source of light (an endoscope) inside the abdomen of a patient via the navel. It was the beginning of celioscopy. It was no longer necessary to open up people's abdomens to see what was happening inside.

From simple examinations, endoscopy then started being used for actual operations. It was to give France the opportunity for some fine surgical successes.

Laser

As early as 1973, in Clermont-Ferrand, Professor Bruhat operated on an extra-uterine pregnancy without opening up the patient. Ten years after this world first, his team was to develop an endoscope bearing a laser, able to destroy internal lesions by vaporization.

Endoscopic surgery developed further with the invention, about 20 years ago, of optic fibers diffusing a cold light. It thus became possible to build a kind of miniature torch which, after being inserted into the body via the natural orifices or through a tiny incision, enabled a patient's insides to be explored.

Catheters, which are tubes that are sometimes thinner than a hair, carry extremely miniaturized instruments on a real expedition through the vessels to the part of the body that is to be treated. It can bear probes, scissors, brushes, files, planes, suction devices, lasers, etc.

They thread their way through the organs and hunt around in the nooks and crannies that are very difficult to reach, perforating, cutting, scraping, sewing, pulverizing, etc.

Today 210 kinds of surgical operations can be carried out by endoscopy whereas 20 years ago only a single operation was performed in this way (in the articulation of the knee).

Heart and brain operations are carried out without opening the thorax and without cutting windows in the skull. "In gynecology," a surgeon at La Pitie-Salpetriere hospital in Paris explains, "in more than 80 percent of cases, the traditional scalpel can be left in its drawer."

The digestive system is operated on without opening up the body, for instance in the case of obstruction of the bowels. Excision of the vesicles is practiced. Slipped disks are treated by destroying the part of the disk trapping the sciatic nerve.

Tiny balloon

In the area of blood circulation where, in the past, any operation was reputedly impossible, surgeons now insert a catheter bearing a tiny balloon into the blocked artery. When the balloon is inflated, it stretches the inside walls of the artery and clears the way for the blood to circulate again. Hence, one can see patients in a coma who suddenly regain consciousness.

When it is not possible to use the natural orifices of the body, the tiny instruments are inserted through an incision in the skin. This system is used to unblock bile or urinary ducts which are obstructed by a tumor. Milling tools scrape the arteries and remove the fatty plaques in atherosclerosis which cause heart attacks.

In men, it is possible to operate on the prostate gently without opening up the body, by reducing the part that is to be suppressed, a sliver at a time, using a tiny plane.

The results offered by endoscopic surgery are at least as good as those obtained using traditional methods. The advantages are tremendous, according to a professor at the Paris School of Medicine.

It reduces the patient's trauma, helps him recover more quickly and avoids scarring. The surgeon operates in more comfortable conditions. For the community, there is an important advantage in that the operations cost less and the stay in hospital is shorter.

But surgeons are thinking of doing better still, by extending the applications of the lithotriptor, that machine which, using shock waves, reduces kidney stones and gall stones to dust. This means operating at a distance without touching the human body: the surgeons' dream.

Using the same principle, could it not be possible to succeed in eliminating or resorbing tumors, blood clots, fatty plaques in blood arteries, faulty appendixes, etc.? With the dawning of the 21st century, a new revolution is appearing in operating theaters.

-- AFI