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NEW SURGICAL TOOLS
Medical tools have come a long way, surgery of the future is even starting to make objects as simple as a scalpel redundant. Medicine has progressed from alchemy and shamanism to a science of the human body. But without tools such as X-rays, anti-biotic, anaesthetics, scalpels and forceps, and without any in depth knowledge of human anatomy, it's easy to see why early doctors doubled as barbers, shear man and even butchers.
Of course, medicine today is a far cry from the days of Hippocrates, but new developments in the field of medical technology are occurring at such a rapid rate...that very soon even theatres that are in use today will be a thing of the past. Take mimeograph for instance. Until recently a surgical removal of a lump in the breast was pretty much of a hit or miss affair.
Dr M Lange a Surgeon at Netcare shares, " The mammograms will show a lesion that cannot be seen or felt and needs to be removed for a pathologist to make a complete diagnosis.
But because the surgeons couldn't see the tiny lesions while they were operating - it wasn't always completely successful.
Dr Louella Ritz explains," Up to know we could do fine needle aspiration and call biopsies, with a call biopsy which we can do very comfortably on an ultra sound machine if we can see the lesion on the ultra sound. We also get a very nice specimen but it is done on a 14 gage core needle so the specimens are still small and you can still miss an area of carcinomatosis which is what you are looking for.
A new machine designed to combat this problem is the ABBI system, which allows the doctor to see the lesion inside the breast during surgery.
During the procedure, the breast represented is compressed to allow the needle to locate the lesion. The image shows the exact location, and its coordinates are locked by the computer. Under local anaesthetic, a cannula is advanced into the breast until it reaches those coordinates, and a tiny blade actually removes the lesion inside the breast. The entire process can be monitored on the screen, and the surgeon can confirm that the entire lesion was successfully removed.
Nicole Petyt from Marcus Medical explains the procedure," Abby Marry radiology and surgery together, give the patient the best of both worlds, it is important as well that this is done in one step, where currently if the procedure was done in an operating room the localisation of the lesion would be done in radiology and then the patient would walk through to theatre
Dr M Lange comments, "The Abby machine does the procedure of localising the lesion, fixing it and removing it in one operation under local anaesthetic and in almost real time. This means you don't have to wait for extra films to be developed, shown and decided on, it is all demonstrated on the computer screen and you can see there and then under local, as an out patient.
AB. is just one example of how surgeons can treat problems more efficiently because they can see what's going on inside the body. Medical imaging has come a long way since the simple X-ray.
Take a collection of consecutive two dimensional images, add them together in a computer, and the result is a radical breakthrough in medical imaging - a 3D view inside the patient's body. These new volumetric 3D images can be navigated by the surgeon in his own time, greatly speeding up the accuracy of diagnoses.
Professor Elliot Fishman explains," The patients know with 3D or 3D medical imaging all becomes important because it has capabilities that allows the physician to diagnose things much more accurately than ever before.
Seeing the problem is one thing, but to cure the patient, sometimes the only solution is surgery, and this is where science and medicine come. In previous episodes we've explored the advantages of endoscopic cameras and laparoscopic, or key-hole surgery over traditional open surgery. Sometimes even the most accurate scalpel can remove tissue it isn't supposed to. One of the most critical operations where there is very little margin for error, is the removal of a tumour from the brain.
The Neurosurgeon puts it across in a nut shell, " The main danger of removing a tumour with an old instrument or the old traditional way is that you damage the normal brain so our principals are to remove the tumour off the brain and not the brain off the tumour.
New medical technology has made this possible: The CASA is a surgical tool which can differentiate between hard and soft tissue, so the tumor can be targeted alone, while the blood vessels and other ducts are left intact. This means less bleeding during the surgery and excellent visibility for the surgeon. The hollow tip vibrates at ultrasonic frequencies which touch the tissue - causing the cells to fragment. Fine spray is then used to gently flush out the site. This innovation has changed an eight hour operation to four hours - greatly improving recovery time.
Soon medical technologies will become small enough to be mobile, and that means more can be done for a patient on the scene of the accident, or even while on route to the hospital than ever before - and that might make all the difference between life and death
The doctor of the future may have to spend as much time learning about new medical technologies as he does studying anatomy, but the result will be improved medical care, and a better quality of life for his patients. Hippocrates would certainly have approved
CONTACTS
M Lange - Surgeon - tel 788-8010 fax- 442-7654 e-mail-myronl@global.co.za
Dr Louella Ritz tel-447-2770 fax - 447-4222
Nicole Petyt tel 886-1950 fax - 886-1289 e-mail jhb@marcusmed.co.za
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