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High-Tech Health Care: Baton Rouge surgeons successful with experimental laparoscopic vascular surgery

LAURIE SMITH ANDERSON. Advocate. Baton Rouge, La.

The operating room resembled a carefully orchestrated, high-tech video game.

Surgeons, nurses and technicians took their places around the patient who was draped for a bypass operation to stitch a graft around a blocked artery in his lower abdomen that was obstructing blood flow to his legs.

However, instead of cutting the patient's abdomen wide open, Dr. Andy Olinde was using a new, experimental procedure, making seven tiny keyhole incisions to insert instruments and a laparoscope, which is a tiny video camera mounted on a lighted tube. Manipulating the instruments from outside the abdominal cavity, he and his team watched a nearby monitor rather than the patient to determine their progress.

A muted rendition of "Black Magic Woman" by Santana played on a nearby radio. Otherwise, the room was mostly quiet as the surgical team moved in competent harmony with only occasional need for instruction.

Minutes ticked by and then hours as Olinde and his partner filled the cavity with gas, lifted intestines out of the way and meticulously worked to expose the artery, clamp it off and stitch the new graft in place.

"I can't leave now. We're just getting to the good part," a nurse said as time came to change shifts.

Laparoscopic techniques have been used by surgeons in a variety of procedures for years, but this particular operation has only been reportedly performed by two other doctors to date. Other surgeons attempted to perform the surgery with different techniques in the past, but were not successful.

Olinde, a vascular surgeon and former general surgeon with experience in laparoscopy, trained with Dr. Yves M. Dion of Quebec. He began practicing on pigs at the LSU School of Veterinary Medicine about a year ago. When they felt they were ready, they asked Drs. Dion and Carlos Gracia to come and supervise their first two patient procedures at Baton Rouge General Medical Center.

The first patient was an elderly woman. The procedure went well initially; however, when her blood pressure dropped in recovery, she had to go back into surgery where a small blood leak around the graft site was discovered. A conventional open bypass was done. More than a week later, she died after suffering a stroke not directly related to her surgery.

The next patient, a 56-year-old man, was a perfect case with a smooth recovery. He went home after only four days in the hospital. As a maintenance worker, he said he was anxious to have the new procedure so he could recover more quickly and return to his job, which is physically demanding.

"The difference between the two patients the day after their surgeries was remarkable," Olinde said. The first patient was still in intensive care on a ventilator. The second was sitting up in a chair talking and ready to eat.

A third patient, Allie Rheams, 74, of St. Francisville, has since undergone the surgery. He, too, experienced some bleeding around the graft site and a 4-inch incision was made to allow surgeons direct access. He went home after six days in the hospital and his recovery has been good.

"He (Rheams) is doing great," said his wife, Bonnie Rheams. "He's up and walking. He has no pain. And his leg looks great. Before the surgery, he had almost no circulation in one leg and a lot of pain."Peripheral artery disease, or lower extremity occlusion, occurs when blood flow through the arteries in the abdomen, groin or legs is narrowed or blocked by plaque. Symptoms may include leg pain when walking, changes in skin color and slow-healing sores. Long-term smokers and people with diabetes are among many of the patients who suffer from peripheral artery disease.

Conventional treatment involves bypass surgery, or stitching a graft (synthetic blood vessel) around the site of the blockage. It's like creating a detour around a traffic jam. A 15-inch incision from chest to groin is made and recovery can mean a seven- to 10-day hospital stay, followed by six to eight weeks at home. Complications may include hernias around the incision site, intestinal blockages from scar tissue and respiratory problems.

Patients who undergo laparoscopic bypass surgery generally suffer less blood loss and require less anesthesia during surgery and less pain medication during recovery, said Dion, who has performed more than 30 cases in Canada. The hospital stay is usually reduced to three or four days, and recovery at home is shorter as well, decreasing both health-care costs and absenteeism from work.

Hernias, intestinal blockages, respiratory problems and surgical stress are less likely to occur, and complications are few, although there may be some patients who will still have to undergo an open or partially open bypass.

"We (doctors) are under pressure to reduce costs, and this (laparoscopic bypass) should do that, but the bottom line for me is what's best for my patients," Olinde said. "I believe this procedure will become a viable option for many patients in the future because they will demand it."Gall bladder surgery used to be done as an open procedure, and surgeons initially resisted the idea of doing them laparoscopically, he said. Today, 95 percent of gall bladder surgeries are done by laparoscope. Olinde said he believes vascular surgeons (particularly young surgeons who have laparoscopic experience) will follow that same route.

Meanwhile, there are several other candidates among Olinde's patients scheduled to undergo laparoscopic bypass surgery in coming weeks.