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UT doctors offer abdominal surgery with less pain and scarring


Few patients look forward to going under the knife. For Ouida Gernentz, however, abdominal surgery turned out to be a much better experience than she ever could have imagined.

Abdominal surgeries typically require large incisions that leave physical—and sometimes emotional marks—including scars at the wound site, pain, lengthy recoveries and a delayed return to normal, everyday activities.

Gernentz did not experience the usual, postoperative pain, thanks to a pioneering surgical technique performed by The University of Texas Medical School at Houston’s Minimally Invasive Surgeons of Texas (MIST).

Gernentz had a “single-incision” laparoscopic procedure so named for its one incision. In her case, surgeons made a small cut through her belly button to remove a mass from her colon. This minimally invasive technique led to a speedy recovery with less pain and almost no scarring.

“I spent much less time in the hospital following surgery and had a much quicker recovery time,” says Gernentz, 57. “I had very little pain, too.”

Committed to giving patients the latest surgical therapies using the least invasive, most advanced and safest techniques, MIST is at the forefront of a rising field in surgery.

“Single-incision laparoscopic surgery is probably one of the leading topics in surgery right now,” says Todd Wilson, MD, assistant professor of surgery. “Our group has taken a leadership role on single-incision surgery. In all of Houston, MIST has probably done more of the bigger cases than anyone else.”

Gernentz landed in the care of MIST after a suspicious mass was identified through colonoscopy. The concern was that the mass could be cancerous.

“In order to remove the mass, which they couldn’t take out using colonoscopy, we had to remove part of the colon,” says Wilson, who performed Gernentz’s single-incision surgery. “We did a right hemicolectomy where we made a small incision through her umbilicus or belly button.”

A special device allowed Wilson and his surgical team to insert four different surgical instruments all through the same incision.

“THis way, we were able to completely dissect and take out the mass in the colon,” he says.
After closing the incision, “we did a little bit of plastic surgery to close up the umbilicus and minimize our footprint,” Wilson adds.
Gernentz’s procedure took about one hour, and Wilson says the normal postoperative care is a hospital stay of three days.

“Patients are usually out of work for about a week and have reduced activity levels for about a month,” he adds. Not so for Gernentz who needed only minimal pain medication at the hospital and was discharged after two days. She was back on her feet and working out at the gym after two weeks.

“One month after the surgery, I played golf on Pebble Beach with my husband,” she adds.

More than meets the eye

A faster recovery and limited pain aren’t the only advantages for patients who have single-incision laparoscopic surgeries. Wilson says these less-invasive procedures are often “virtually scarless.”

“For a lot of these cases, we can put almost the entire incision into the umbilicus,” he says. “When you look at a patient’s abdomen, sometimes you just can’t see a scar. For someone like Ouida, who has a very small abdomen and a tiny belly button, you can see a little bit of a scar above and below. It’s really insignificant relative to an open surgery. She doesn’t have the four different scars that she would have had if we had done the conventional laparoscopic technique.”

MIST tailors its surgical techniques to the procedure and the patient. “We really have a lot of variability in how we approach the situation,” he says.

MIST is currently using the single-incision laparoscopic technique for appendectomies, cholecystectomies (gall bladder removal), ventral hernia repairs, partial colectomies (removal of part of the colon) and bariatric (weight loss) laparoscopic adjustable banding surgery.
While the single-incision laparoscopic technique yields several returns for the patient, it is technically more challenging for the surgeon.

“From a surgical standpoint, we can anticipate longer case times,” Wilson says, and “it’s more difficult to teach residents. I think it takes a slightly different skill set than traditional laparoscopic techniques.”

Nonetheless, Wilson says he hopes the great outcomes they’ve seen with single-incision surgeries and recoveries will continue.

“Ultimately, we’re hoping to find that it causes less pain and that it helps patients into their normal activities faster,” he says. “In the same sense that laparoscopic surgery has a huge impact on getting patients back on their feet after surgery compared to the open technique, we’re hoping to see the same advantage doing the single-incision laparoscopic technique versus the traditional laparoscopic technique.”

Both doctor and patient were pleased with the outcomes. “The mass was found to be precancerous,” Willson says. “Had we let it go for too long, it would have turned cancerous.”

Gernentz admits, “Having surgery is not what people want to do. But, if you have to have surgery and there’s ever any way to have it like I did, I think that’s the optimal way to go.”

STORY BY Camille Webb

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