ADVANCES IN SURGERY

Samuel Vincent G. Yrastorza, MD, FPUA

DIAGNOSTICS

Has grown leaps and bounds for the past years

Symptomatic disease

- history and PE still accounts for 80-90% in clinching the diagnosis

Asymptomatic diseases

- screening procedures detect early diseases

- e.g. colonoscopy for colon cancer

DIAGNOSTIC ADVANCES

Stool exam

Colonoscopy, Abdominal CT scan

Signs and Symptoms + PE

Diagnostic Exam/Imaging

Diagnosis

Before

Abdominal pain, Diarrhea

PE = abdominal mass

Colonic Cancer

DIAGNOSTIC ADVANCES

Reaching 40 y/o

Screening Colonoscopy

Colonic Cancer

Presently

Without any signs or symptoms of disease

Small colonic mass noted and biopsy done

DIAGNOSTIC ADVANCES

- Has become more sensitive and specific

- Diagnostic modality of choice for a majority of surgical cases with the advent of

- 3D reconstruction

- CT angiography

CT Scan

DIAGNOSTIC ADVANCES

CT Scan

prototype 256 slice CT scanEMI CT scan

IMAGING

CT before 256 slice with 3D reconstruction

COLON

IMAGING

Colonoscopy 256 slice with 3D reconstruction

IMAGING

CT before 128 slice with 3D reconstruction

KIDNEYS

IMAGING

Conventional angiogram

CT angiogram

Radiotherapy

Brachytherapy- Greek brachy meaning “short”

- radioactive source placed inside or next to the area of treatment

- not just for adjunctive therapy or pallation

- as first line treatment for various forms of cancer

- commonly used for prostate cancer, cervical cancer , head and neck cancer

- radioactive sources

- strontium plaque

- iridium wires

- iodine 125 seeds

PROSTATE BRACHYTHERAPY

PROSTATE BRACHYTHERAPY

PROSTATE BRACHYTHERAPY

- for early and localized cancer

- not for locally advanced or metastatic prostate cancer

- comparable result to radical prostatectomy

- out patient procedure

- lesser complications than radical prostatectomy

- uses iodine 125 seeds

LOCALIZED PROSTATE CA TREATMENT

Radical prostatectomy

brachytherapy

CRYOTHERAPY

Freezing ---- thawing---- freezing

Probes/needles directed at organ or tissue

cellular disruption

cell death

CRYOTHERAPY

Used for

- benign and malignant skin conditions

- early and localized cancers

- liver

- prostate

- hemorrhoids

CRYOTHERAPY

Used for

- benign and malignant skin conditions

- early and localized cancers

- liver

- prostate (widespread use)

- hemorrhoids

CRYOTHERAPY

ice balls

RADIOFREQUENCY ABLATION

Radiofrequency waves passed through probe into tumor

RFA probe (needle) placed inside the tumor

(guided by CT scan or ultrasound or through open procedures)

increased in temperature within tumor

tumor necrosis

RADIOFREQUENCY ABLATION

Indications

- tumors of the lung, liver, bone

- used for primary and metastatic tumors

- recurrent atrial fibrillation and supraventricular

tachycardia

- varicose veins

RADIOFREQUENCY ABLATION

RFA probe (needle) RFA generator

RADIOFREQUENCY ABLATION

RADIOFREQUENCY ABLATION

Percutaneous approach Laparoscopic approach Open approach

HIGH INTENSITY FOCUS ULTRASOUND (HIFU)

HIFU

directed at tissue/tumor (by ultrasound or MRI)

increase temperature at target tissue/tumor

tissue/tumor destruction

HIGH INTENSITY FOCUS ULTRASOUND (HIFU)

used for:

- uterine fibroids

- solid tumor of the brain, bone, breast, liver, pancreas, rectum, kidney, testes, prostate

- earliest and widest use = for prostate cancer

- atrial fibrillation, arrhythmia

HIGH INTENSITY FOCUS ULTRASOUND (HIFU)

SURGICAL PROCEDURES

- Trend toward less invasive procedures

The “old way” NOW

LAPAROSCOPIC SURGERY

- Minimally invasive surgery

- Minimal access surgery

- Key hole surgery

- Pinhole surgery

- Band-aid surgery

*** part of a broader field of ENDOSCOPY

LAPAROSCOPIC SURGERY

Access

LAPAROSCOPIC SURGERY

Used for:

- diagnostic

- cancer surgery

- donor organ harvest ( donor nephrectomy)

- vascular surgeries

- practically any abdominal surgery

LAPAROSCOPIC SURGERY

Advantages

- smaller incisions (smaller scars)

- fast recovery (short hospital stay)

- better visualization of abdminal structures

LAPAROSCOPIC SURGERY

Disadvantages

- more expensive

- requires expertise

- steep learning curve

- longer operating time (gap is slowly closing with that of open surgery)

ARTHROSCOPIC SURGERY

- Cystoscopic surgery of the joints

- Similar advantages and disadvantages as laparoscopy

Open Knee

surgery

arthroscopic

THORACOSCOPIC SURGERY

- Cystoscopic surgery of the THORAX

- Similar advantages and disadvantages as laparoscopy

- Instruments basically the same

Open thoracic surgery thoracoscopic

OthersCranioscopy???

Not enough space

Microlaparoscopy

- 3mm port instead of the usual 5 and 10 mm ports

- Smaller instruments

- Lesser pain and scar

ROBOTIC SURGERY

ROBOTIC SURGERY

ROBOTIC SURGERY

ROBOTIC SURGERY

ROBOTIC SURGERY

Telementoring

- Teaching/mentoring through the internet

- “out of school students”

- Open universities

Telementoring

Telementoring

- Surgical training though internet or other forms of telecommunications

Telesurgery

Stem Cell Therapy

- Use of stem cells to treat certain diseases

- To create new tissues/organs to replace/augment the existing ones

Stem Cell Therapy

- Use of stem cells to treat certain diseases

- To create new tissues/organs to replace/augment the existing ones

DM type 1 New pancreatic cells transplanted into patient

Stem Cell Therapy

Stem cells

- unspecialized cells capable of renewing themselves through cell division

- can be induced to become tissue or organ specific cells

- in gut and bone marrow

= stem cells regularly divide to repair and replace worn out or damages tissues

- pancreas and heart

= stem cells divide only under special

conditions

Stem Cell Therapy

Categories

1) Non embryonic

- somatic or adult stem cell

2) Embryonic- use of human embryo

Stem Cell Therapy

Non embryonic

e.g. Bone Marrow transplant

- for luekemia

- replacing the old marrow with new Bone Marrow

- new marrow will produce new and normal blood cells

(leukocytes, macrophages etc)

Stem Cell Therapy

Embryonic

Stem Cell Therapy

The Promise of stem cells

1) Understanding the development of specialized cells and eventually the evolution of diseases

2) Possibility of renewable source of replacement cells and tissues to treat diseases

What Else?

Penile Transplant???!!

END