|
Minimally Invasive Surgical Techniques
The goals of the "minimally invasive surgical techniques" are to reduce surgical trauma, reduce postoperative pain, and decrease hospital stays and the recovery period.
In addition to the traditional or conventional surgery that uses long open incisions, the evolution in the field of vascular surgery as created three distinct new branches.
Endovascular Surgical Procedures use instruments, like introducers, guide wires, and catheters that are inserted into the blood vessel. These procedures may include balloon dilation of an artery or placement of a stent in the artery. Common places for a stent to be placed are the femoral arteries in the legs and the renal arteries leading to the kidney. The arortic stent graft is placed in the aorta to bypass an aneurysm.
Endoscopic Surgical Procedures use instruments inserted through very small incisions under the guidance of a small video camera. Types of procedures include Subfacia Endoscopic Perforator surgery (SEPS) for venous ulcers and Endoscopic First Rib Resection for Thoracic Outlet syndrome.
Laparoscopic surgery is a type of endoscopic procedure performed in the abdomen, usually below the diaphragm. Instruments are inserted through small incisions under the guidance of a video camera and a graft can be inserted to bypass an area of obstruction or an aneurysm.
Robotics Surgery is a new technique to enhance the quality of surgical procedures by minimizing their side effects (smaller incisions, lesser trauma, more precision) thus increasing patient benefit while decreasing the surgical cost. These techniques are being successfully introduced in several areas of surgery: urology, cardiovascular, general surgery and vascular.
Endovascular and Endoscopic procedures require the development of technical expertise by the surgeon beyond the routine surgical training.
Arterial Disease
What is Atherosclerosis?
Atherosclerosis (hardening of the arteries) is a build up of fatty plaque and calcium in the inner lining of an artery. It frequently occurs in the medium and large blood vessels of the body. when it occurs in the legs, it is called Peripheral Arterial Disease (PAD). When it occurs in the aorta (the largest blood vessel in the body), it is called Aortic Occlusive Disease.
If the plaque grows large enough it can lead to a significant reduction in the flow of blood through the artery especially to the legs and feet. Many people have symptoms when they walk. These symptoms can include pain or cramping in the calves, thighs or hips. The pain usually goes away when the person stops to rest. If the feet are injured, the wound or sore may not heal.Atherosclerosis can also lead to formation so aneurysms in the blood vessels especially in the abdominal aorta (AAA).
What is AAA?
An abdominal aortic aneurysm is a weakening and expansion in the wall of the aorta like an inflated balloon. This bulge is usually caused by cellular changes due to a build-up of plaque along the inside of the artery that damages and weakens it. If not caught in the early stages, the aneurysm can rupture, often resulting in death.
Most people do not have any signs or symptoms of an aortic aneurysm. It is frequently diagnosed on a physical exam or a work up for another condition. However, a rapid growth of the aneurysm can result in back pain or abdominal pain.
Treatment
Initial treatment of PAD/Aortic Occlusive Disease will be based on your symptoms. It may include non-surgical treatments such as diet changes, blood pressure control, stopping smoking, foot care and a walking program.
If surgery is indicated, a team member will discuss the options with you. Conventional surgery for PAD can include using a vein or artificial graft to bypass the area of blockage or to replace the section of the blood vessel that has the aneurysm. Minimally Invasive alternatives will be offered if appropriate for your condition.
Procedures
Endovascular Aortic Stent Graft
The newest procedure offered at the Center is the Endovascular aortic stent graft. Performed by Dr. Martinez and the MIVS team since February 2000, the procedure is geared toward high risk, elderly patients with aortic aneurysms. Specific criteria for this procedure must be met.The goal of the Endovascular Aortic Stent graft is to give the patient the best care, leading to a faster recovery and shorter hospital stay.
Each patient is requested to have either a CTA or MRA for evaluation of his or her vascular anatomy. The information gained is carefully manipulated by state of the art equipment by an imaging specialist, to provide 3-D images of the vascular anatomy. Critical measurements of the Abdominal Aorta and Iliac arteries are also taken. The team carefully reviews these images and measurements for patient and stent selection.
An incision is made in each groin and a stent graft is inserted in the femoral artery and guided through the aorta to the aneurysm site.
Once the stent is placed, it is expanded to fit within the diameter of the aorta providing a new path of blood flow.
Follow up after this procedure is necessary to check the placement of the aortic stent graft. Your physician will order a CTA for specific intervals after the surgery (usually 3 mo., 6 mo. and 12 months). Additional testing may be indicated.
Endolaparoscopic Aortic Surgery
Endolaparoscopic aortic surgery is an alternate way of treating Atherosclerosis in the aorta, as well as aortic aneurysms.
In the Endolaparoscopic approach, three to four small incisions are made in the lower abdomen for the endoscope and instruments. A custom fitted graft is inserted to provide blood flow again or to exclude the aneurysm.
If a minimally invasive approach is used, the recovery time in the hospital is frequently decreased from the conventional procedure.
The side effects of minimally invasive procedures are generally less severe than those associated with open surgery. However, they can include infection, bleeding, fever, and numbness in the legs and additional clotting (thrombosis) of the blood vessel or rupture of the aneurysm.
Venous Disease
What is Chronic Venous Insufficiency?
An estimated 2.5 million people in the US have Chronic Venous Insufficiency. Using a system of blood vessels, valves and muscle contractions. The venous system is responsible for returning blood from the tissue back to the heart for oxygen. When you walk the muscles in your calf pump the blood upward, through an open value.
The valves close and prevent blood from flowing back into the legs. If the veins or valves are damaged, blood back-flows into the veins. Swelling of the leg occurs. Varicose veins can form as the veins stretch and weaken. The skin in the area may become brownish in color and ulcers may form. These ulcers frequently occur at the ankle or lower calf. This condition may be chronic and is called Chronic Venous Insufficiency.
Treatment
Treatment varies based on the severity of the conditions. It can involve use of support hose, elevation of the legs, maintaining ideal body weight, avoiding prolonged standing or sitting; local wound care or surgical intervention.
Sub-Facial Endoscopic Perforator Surgery
Sub-facial Endoscopic Perforator Surgery is a minimally invasive approach for the treatment of Chronic Venous Insufficiency. Small incisions are made in the thigh and an endoscope is inserted to visualize and ligate perforator veins in the lower calf. This eliminates venous back-flow and promotes wound healing.
Thoracic Outlet Syndrome
Thoracic Outlet Syndrome is a condition in which the clavicle, first rib and the muscles in the base of the neck compress the subclavian artery, the subclavian vein and the Brachial nerve.
The symptoms depend on which of the structures are being irritated. Most of the time it is related to the chronic irritation of the nerve.
TOS appears more frequently in young women, but it may also be found in men and women of all ages. Symptoms include: Pain in the shoulderPain that radiates to the forearm and hand especially if the arm is elevatedNumbness/"pins and needles" sensation in arm and fingersHeadaches
Treatment
The most common treatment method for TOS is physical therapy and a special home exercise program that extends the exercises learned in therapy into the home.
Endoscopic Transaxillary First Rib Resection
Surgery is only utilized when physical therapy fails to relieve the symptoms. An endoscopic approach is used to remove the first rib and possibly part of the scalene muscle. Constricting bands of connective tissue are released to remove the constricting elements around the nerve, artery and vein.
Thoracic Outlet Syndrome with da-Vinci System
Since February 2003, dissection of the thoracic outlet area has been performed using the daVinci Surgical System® (Intuitive Surgical, Inc, Sunnyvale, CA USA). Once the engagement of the daVinci Robotic system has been completed, the dissection of the soft tissue and first rib is performed from the surgical console. Once the rib has been completely excised, careful attention is made to complete exision of the cervical bands. Computer-enhanced instrumentation has provided dual benefits: the 3D optical view and the Endowrist® (Intuitive Surgical, Inc, Sunnyvale, CA USA) allowing gently manipulation of the soft tissue structures. The ability to work in a smaller anatomical working space is dramatically enhanced. This translates into less traction on the arm providing for a safer and complete operation for the patient.
Living with TOS
If you are diagnosed with TOS, avoid heavy lifting, repetitive motions elevating the arms for long periods and carrying bags with straps on the affected shoulder. In addition, patients should decrease tension on should with exercises and have rest periods to decrease fatigue.
|
