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Shorter Hospital Stays And Quicker Recoveries at Carolinas:
Less Invasive Surgery Is the Key
For eight long years, day and
night, Faith Quarterman struggled with
heartburn and acid reflux. At work, the
Florence resident found herself constantly,
uncomfortably clearing her throat. At
home she couldnt even find solace in
sleep. I would wake up gagging and was
afraid of drowning in my sleep, she
recalled. Acid from Quartermans
stomach, which is intended to digest food, was backing up into her esophagus. In addition to the
burning sensation she felt from the acid, food would back up as well.
Though Quarterman had been treated for the problem with a variety of medications, over
time her condition
continued to worsen. When her doctor decided that another approach was
needed, she found herself in the care of general surgeon Dr. Mark Harris. The recommendation?
Laparoscopic gastric reflux surgery. The resolution? Quarterman was out of the hospital the
next day and back to work the following week.
Quatermans experience at Carolinas Hospital System is not an unusual one. In fact,
shorter hospitalizations and abbreviated recovery times are becoming the norm
as more and more
types of surgeries are being performed at the hospital on a minimally invasive basis. While
laparoscopy is not new, surgeons are continually discovering increasing uses for it in specialties
ranging from urology and cardiology to orthopaedics and gynecology. The volume and variety
of operations we do laparoscopically is growing daily, said Dr. Harris.
Unlike traditional surgery, laparoscopy does not require a large incision. Depending on
the type of procedure being done, the surgeon makes between two and five little incisions in the
abdomen. These tiny holes, or access ports, are each one to two centimeters in length. The
patients abdomen is then filled with carbon dioxide gas to provide space for the surgeon to
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operate. A laparoscope, equipped with a light source and a miniature camera, is inserted into one
of the ports. Surgical instruments are inserted into the other ports, which allow the doctor to cut,
grab and remove the diseased organs as necessary for the particular procedure. While the
surgeon operates, the images produced by the camera are viewed on a video screen.
Dr. Harris is quick to mention the sophisticated camera equipment utilized at Carolinas.
With the hospitals chip on a stick technology, the camera is located at the very front of the
laparoscope, unlike most systems in which the camera is at the back. The difference is
equivalent to the difference between normal TV and high definition TV, Dr. Harris explains.
The clarity is better and there are no focus problems since it is digital.
While Dr. Harris is pleased with the laparoscopic technology available at the hospital, hes
also sold on the benefits of minimally invasive surgery for his patients. Using small incisions
means less trauma to the body and hence less pain. Patients require less medication and the risk
of infection is decreased. Scarring is minimal, and time spent in the hospital and recovering at
home are both reduced greatly.
Faith Quarterman will attest to the ease of her laparoscopic gastric reflux surgery. In
explaining what she should expect, Dr. Harris told her that she could spend up to two days as an
inpatient at Carolinas Hospital System. He described to her how the valve separating her
esophagus and stomach was not closing properly, which was allowing acid and food to rise up
into her esophagus. During the surgery, called fundoplication, he would wrap the upper part of
her stomach around the bottom of the esophagus. He would also remove an abdominal hernia
that was contributing to the problem as well. Faith was more than pleased when she received a
clean bill of health from the surgeon the day after surgery. I didnt have any more acid reflux.
Dr. Harris and I high-fived, and he told me that I could go home, she recalled.
In addition to gastric reflux surgery, Dr. Harris and the other surgeons on staff at
Carolinas Hospital System perform an impressive array of minimally invasive surgical
procedures. Theres not a lot that Im not doing laparoscopically, he said of his surgical
practice. A small sampling of these procedures is outlined below.
Laparoscopic Hernia Repair
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While Dr. Harris repaired a hiatal hernia in Quarterman, he also utilizes laparoscopic
surgery to address a number of other types of hernias. A hernia is a defect in the normal
anatomy that allows protrusion of other organs to enter, he explained. One of the most common
is an inguinal hernia, in which part of the intestines push through a tear or weak point in the
lower abdomen. If hernias get large enough, they can cause serious complications such as bowel
obstructions.
Hernia repair is done by closing the defect using a synthetic mesh
.
In the past, we just
used native tissue. Since it was a natural defect to begin with, if you put two pieces together of
this native tissue with compromised muscle, the chance of recurrence is a lot higher. The mesh
decreases this rate, Dr. Harris said.
Depending on the type of hernia, patients either have the laparoscopic surgery done on an
outpatient basis or spend a day or two at the hospital. There is still significant discomfort in
some of these procedures, said Dr. Harris, though not as much as experienced in traditional
open surgery.
With traditional hernia repair surgery, patients face a four to six-week recovery after the
procedure. A patient having a laparoscopic hernia repair could return to work anywhere from a
few days to a couple of weeks after surgery. Our goal is to get the patient back to normal
activity as soon as possible. Yet, every patient is different and every hernia is different, said Dr.
Harris.
Laparoscopic Gallbladder Surgery
From its distinction as one of the first types of surgery performed laparoscopically,
laparoscopic gallbladder surgery has become the gold standard of care for gallbladder removal.
While some patients end up requiring traditional surgery, Dr. Harris routinely attempts to do the
operation laparoscopically first. Thats the way I approach most of my patients, not just those
with gallbladder disease, he said. Once a laparoscopic procedure is underway, certain
conditions may warrant conversion to an open procedure, such as patients with a very inflamed
gallbladder, abnormal bleeding or abnormal anatomy.
An open surgery requires a large incision under the right rib. Its a very painful incision
since it involves cutting through multiple muscle layers, Dr. Harris said. Since this area is in
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motion every time an individual breathes, the pain experienced
after surgery is significant.
Patients generally stay between three days to a week in the hospital following an open procedure,
with a standard four to six-week recovery time at home.
Conversely, patients go home the same day after having a gallbladder removed
laparoscopically. During the 15 to 20-minute procedure, the gallbladder is placed in a small
retrieval bag and pulled out through one of the port sites. There is really more of a soreness for
three or four days afterwards than anything else, Dr. Harris noted, adding that, patients can go
back to work whenever they can tolerate it.
Over the years, gallbladder removal has become the most common laparoscopic surgery,
and, Dr. Harris has seen the technology available to surgeons continue to evolve. The
equipment has come a long way. The medical industry has given us better scopes with better
visualization, and we are using smaller and smaller ports to access the abdominal and chest
cavities, he said.
Laparoscopic Colon Resection
Surgery on the bowel or intestines for patients suffering from conditions such as Crohns
disease, diverticulitis, and certain colorectal cancers traditionally involved considerable
discomfort. Were talking about a 6 to 12-inch incision with a lot of manipulation of the large
and small bowel, Dr. Harris said.
Although a laparoscopic tumor removal, colon repair and/or colon removal may require a
four to five-day hospitalization, this still shaves a few days off the hospitalization involved in a
traditional surgery. We expect far less pain than an open surgery since we are not having to cut
a large incision with a lot of muscle thats violated, Dr. Harris said. He added that, The
requirements for strong pain medication are far less and the return to normal activity is a lot
quicker.
Scarring is reduced since the surgeon is only using three to four small incisions for the
access ports. This is significant to a lot of people since cosmetic appeal is important as well,
Dr. Harris said.
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Sentinel Node Biopsy
For a patient with cancer, day-to-day life becomes a series of tests and treatments, some
more complex and involved than others. At Carolinas Hospital System, the availability of a
minimally invasive procedure known as sentinel node biopsy simplifies the treatment process for
women with small cancers in the breast.
After a lumpectomy has been performed to remove the part of a breast containing a
cancerous tumor, physicians still need to determine if the cancer has spread. Traditionally, all the
lymph nodes were removed and examined microscopically. Instead, surgeons can perform a
sentinel node biopsy, focusing on the first lymph node to which cancer is likely to spread. The
sentinel node is identified using an injection of a radioactive substance with a dye. It is removed
using a small incision and then examined for cancerous cells.
If the sentinel node is negative there is no indication for removing the remainder of the
lymph nodes, Dr. Harris said. This would be necessary only if additional cancer was found. In
that case, the stage of the cancer would be determined and an appropriate treatment plan devised.
Women with a negative sentinel node biopsy can go home from the hospital on the same
day. Without more extensive lymph node removal, they are able to avoid additional pain and
scarring, along with potential side effects such as swelling and numbness. And the cosmetic
appeal is obviously much better for women, Dr. Harris adds.
The Future of Laparoscopy at Carolinas Hospital System
As Carolinas continues to invest in surgical technology, Dr. Harris notes, The hospital
offers the best in state-of-the-art digital equipment that is the Cadillac in its field. We also have a
group of surgeons who are committed to providing the highest standard of care and a supportive
technical staff assisting in the operating room.
As the use of laparoscopy increases at Carolinas Hospital System, so does patient
awareness of the options available to them in the operating room. You can search the internet
for anything these days, and I think that patients in general are more informed. So theyre also
more inclined to seek out procedures that are less invasive and that are going to return them to
their normal activities sooner, Dr. Harris said.
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As the surgeon looks ahead, he sees a trend that will continue to grow. With the exception
of certain emergency situations in which we need to proceed quickly, the vast majority of general
surgery cases are going to be done laparoscopically. I think we will do a tremendous amount
more.
For Faith Quarterman, laparoscopic surgery was a quick and uncomplicated process of
restoring her to good health. I am happy to say that I have not taken one pill for acid reflux
since my surgery, she said. Her recovery brought an additional bonus. I love to sing, but
couldnt hold a note for more than a verse
because of all the acid in my throat. Maybe I can get
back into singing in church again, she said.
By Diane J. Epperly, Contributing Writer
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