General Surgery Services: Minimally Invasive

Minimally Invasive Surgery, General Surgery

Minimally invasive surgery (MIS), commonly referred to as laparoscopy for the abdomen and thoracoscopy for the chest, has dramatically changed the way many different operations can be performed today. Since the introduction of the laparoscopic cholecystectomy in the early 1990s, virtually every classical open operation has been adapted and modified to the minimally invasive approach. Minimal access techniques using small incisions significantly reduce trauma, operative bleeding, respiratory dysfunction and cardiovascular distress (among others).

MIS yields better clinical outcomes and the possibility to offer surgical treatments to populations of higher risk, notably elders and individuals with compromised life expectancy. The most tangible advantages of MIS for the patient include:

• Less pain and decreased use of narcotics
• Faster return to bowel function and earlier institution of medical therapies
• Shorter hospital stay
• Prompt return to normal activities and work
• Less disability and dependence on ancillary services (rehabilitation)
• Better cosmesis (physical appearance)
• In summary, better quality of life

Minimally invasive procedures commonly offered by the surgical teams at UTMB Health include:

• Diagnostic laparoscopy
• Esophago-gastric surgery:
  • Antireflux procedures (Nissen and partial fundoplications)
  • Heller myotomy for achalasia
  • Gastrectomy
• Bariatric surgery:
  • Roux-Y gastric bypass
• Bilio-pancreatic procedures:
  • Cholecystectomy
  • Common bile duct exploration
  • Pancreatic cyst-gastrostomy or jejunostomy
• Solid organ and endocrine surgery:
  • Adrenalectomy
  • Splenectomy
  • Radiofrequency ablation of liver metastases
  • Nephrectomy (living donor)
• Colorectal surgery for benign and malignant disease:
  • Colectomy (right, left, or subtotal colectomy, sigmoidectomy, low anterior resection, and abdomino-perineal resection), colostomy
    formation or closure, rectopexy for prolapse
  • Transanal Endoscopic Microsurgery (TEM)
• Hernia surgery
• Splachnicectomy and neurinectomy for chronic pain

Robot-assisted Surgery

UTMB surgeons were the first in the Southwest to practice computer-enhanced robotic surgery. This revolutionary technology allows the surgeon to perform minimally invasive surgery in cases that otherwise would be performed by conventional open surgery due to current limitations of conventional laparoscopic surgery.

Many abdominal procedures are moving from traditional laparoscopic techniques to the more advanced robotic system. One major advantage of robotic surgery is the enhanced dexterity obtained by using articulated endoscopic instruments which possess 7-degree of freedom, tremor filtration, and scale of motion.

The second great improvement is the use of real, magnified 3-dimensional optical system. The apparatus has two main components—a seven-foot tall tower with robotic arms and a console where a surgeon is seated looking down at a three-dimensional view of the organs on which he or she is working.

From the console, the surgeon controls the four robotic arms that position and maneuver the endoscopic instruments that the surgeon inserts into the patient through small incisions. Organs or systems approached using robotic technology at UTMB include: esophagus, stomach, gallbladder, pancreas, adrenal gland, spleen, kidney, colon and rectum, uterus and adnexa, urinary bladder, and prostate.

The advantages of robotic surgery for the patient are similar to what we see with other minimally invasive procedures.