Major Surgery Advancements of the last Twenty Years

The new millennium has brought amazing medical advancements to the world. There are now cures for some formally fatal cancers, pharmaceutical research has provided new life saving medications, controversial stem cell research is predicted to provide the cures for incurable diseases, AIDS is no longer a death sentence with the introduction of the highly viral therapy, and we now have a complete set of human genetic information and are discovering what over 23,000 genes on each chromosome do in humans.  The introduction of Information technology allows physicians instant access to patient records and the latest breakthroughs in medical research are but a few mouse clicks away. Major surgical advances have been the most dramatic of recent medical advancements.

One of the most exciting major medical advancements in the last 20 years is the introduction and use of robotic surgery. Minimally invasive robotic techniques have revolutionized surgery. Seeming like science fiction, tiny metal hands can suture inside the human heart. Surgeries of the not that distant past, often required large incisions. These incisions were necessary for surgeons to reach organs for repair or removal. These surgeries had a higher risk of infection, post surgical recovery was much longer, post surgical pain was much greater, and patients were left with large scars. Nearly all surgical procedures are now done with endoscopes.

The da Vinci robotic surgical system allows surgeons to perform a minimally invasive technique for complex surgical procedures. Incisions are even smaller than those made by endoscopes. This results in significantly less pain, a much shorter hospital stay, and a much faster recovery. Patients are able to return to their daily activities much more quickly. The da Vinci system uses miniature tools and a 3D camera through tiny surgical incisions. The physician sits at the da Vinci console where he views magnified 3D images of the surgical site. Robotic and computer technologies translate the surgeons hand movements into precise micro-movements of the da Vinci instruments. The da Vinci instruments move in a more precise manner than the surgeon’s hands. During the surgery, the system performs millions of self checks. It is safer than traditional surgery.

Endoscopy is a surgical procedure that uses an endoscope which is a long flexible tube that is inserted into the patient’s body through a very small incision. While endoscopy surgery is not new, a new fiber optic light system allows the surgeon to use microscopes to see inside the body and pass small instruments through the endoscope to perform microscopic lsurgical procedures. Surgical endoscopies can be done on the G.I. tract, the respiratory tract, the ear, the urinary tract, and the female reproductive system. Orthopedic surgery and endodontic surgery can also be performed through endoscopy.

Bleeding and blood loss occurs with surgeries. In the past, surgeons had to suture or cauterize (burn) cut blood vessels. Now surgeons can use a computerized controlled bipolar electrical current to fuse vessels together. This helps minimize blood loss and makes surgery faster, safer, and less painful.

Another surgical advancement in the past 20 years is the ability to perform surgery on fetuses. Fetal intervention is going inside the uterus to help a fetus who has a problem. Many diseases in the fetus can now be diagnosed because of advances in genetic studies and in sonography. Surgical intervention now allows the fetus to be born without life threatening anomalies. There are 3 types of fetal surgery. Open fetal surgery is where the uterus is opened and the surgeon performs fetal surgery. Fetuses with heart anomalies,that are incompatible with life, can have life saving heart surgery using open fetal surgery. Another type of fetal surgery is Fetendo, which is a fetoscopic intervention that was developed to avoid making an incision into the uterus. Fetendo allows surgical manipulation of the fetus with very small instruments guided by direct fetoscopic view on a television monitor. There are some surgical procedures that still require open fetal surgery, however. The newest development in fetal surgery is Fetal Image-Guided Surgery (FIGS-IT). It does not require an incision into the uterus or an endoscopic view into the uterus. The surgery is done entirely under real-time cross-sectional view provided by the sonogram and is used to guide surgical instruments through a small incision in the mother’s skin.

New advances in medical technology are growing by leaps and bounds. This is an exciting time in medicine, especially with the major surgical advances of the past 20 years. It was not so long ago that no one would have believed that robotic or fetal surgery would be performed routinely throughout the world today.