Surgery Without Scars
Surgery has to be invasive, right? Not according to Cleveland Clinic, where new techniques allow for faster recoveries and fewer scars.
Your standard minimally invasive surgery requires three to six small incisions, or ports, but at Cleveland Clinic, surgeons are using single-port surgery that is done through a belly-button incision, leaving little or no scarring. For example, the single-incision gallbladder removal, called a laparoscopic cholecystectomy, is done under general anesthesia and takes about an hour, followed by a two-hour recovery. Patients typically return to work in one or two days with little to no scarring.
But not just gallbladder patients benefit from the less invasive approaches at Cleveland Clinic. In December 2007, surgeons Daniel Geisler, MD, and Feza Remzi, MD, completed a single-port colon removal on a 72-year-old woman who had large colon polyps. A conventional colectemy used to require a foot-long incision, and even a laparoscopic approach involves three to five small abdominal incisions. This patient? “She had just one small incision about four centimeters long and since most of it is in the navel, you can barey see it,” explains Dr. Geisler. Four days later, she was back at home.
We’ve all heard about how difficult kidney replacement surgery can be, especially for the donor. But when Scott Bolender, 39, received a kidney from his niece, Chanda Calentine, her operation at Cleveland Clinic involved just a single-port procedure through her navel, leaving her virtually scarless. Mrs. Calentine was in the hospital for only a few days after the procedure and a few weeks later she returned to her active career as a theater director and dance teacher.
There are many more inspiring tales like these, including the story of Carolyn Morrison, who had a hysterectomy in 2008. She saw Pedro Escobar, MD, a surgeon in Cleveland Clinic’s gynecologic oncology department, and he asked if she would like to undergo a single-port procedure through her navel. “The absence of blood vessels and muscles around the navel area virtually eliminates the risk of certain complications that can occur with conventional minimally invasive surgery,” says Dr. Escobar. Mrs. Morrison, now 60, was thrilled with the results. “I had a C-section 30 years ago and couldn’t stand for six weeks,” she says. “With this procedure, I had medication only while I was in the hospital, which was just for one day. The best part: I had no pain!”
If single-port surgeries sound amazing to you, this next technique will really blow your mind. Natural orifice transluminal endoscopic surgery, or NOTES, is an approach by which a diseased organ is removed through a natural orifice—no port entry required. In other words, this is scarless surgery with a very quick recovery time.
In March of this year, a female patient with a diseased kidney underwent a procedure to remove the organ through her vagina—the entire surgery was performed transvaginally. Cleveland Clinic surgeon Jihad Kaouk, MD, and his team developed the procedure. A traditional approach involves performing some aspects of the surgery through the back, leaving a long scar. A laparoscopic approach involves performing part of the surgery through the belly button, leaving a small scar. This new option is scarless, and the patient was discharged less than 24 hours after the procedure.
Even some heart patients are receiving innovative treatment at Cleveland Clinic; they’re undergoing percutaneous techniques, performed by going through or under the skin. “There are a lot of patients, especially older patients, who we find are very risky for open heart surgery for various reasons,” says Cleveland Clinic cardiac surgeon Lars Svensson, MD, PhD. “We’ve been able to develop techniques without having to open the patient’s chest.”
Some percutaneous procedures are still experimental, but others, such as robotic surgery and percutaneous valve repair, are part of everyday clinical practice. Cleveland Clinic has played a role in developing some key percutaneous treatments and operates one of the largest hospital-based robotic heart surgery programs in the nation.
These less invasive techniques allow Cleveland Clinic patients like 13-year-old Max Byer, who needed his entire colon and rectum removed because of an inherited condition, to leave the hospital with a scar the size of a coin. His mother’s colon removal, which took place 25 years ago, left a foot-long scar along her abdomen. Cleveland Clinic surgeon Daniel Geisler, MD, removed Max’s entire large intestine and rectum through what is believed to be the world’s first single-incision proctocolectomy. The procedure, which also created a j-shaped pouch from his small intestine to reconnect the digestive tract, significantly reduces his risk of developing colon cancer from a condition called familial adenomatous polyposis, or FAP, which causes the growth of hundreds of precancerous polyps in the colon and rectum.
“This is just so different,” marvels his mother at the results. Not only did her son experience less pain, a quicker recovery and less visible scarring than she did two decades ago, he also faces a dramatically lower chance of developing scar tissue and complications later in life.
“At Cleveland Clinic, we are always researching better ways to deliver what is truly the least invasive option for patients,” says Dr. Geisler.