With one type of minimally invasive technique, surgeons cut through that muscle to gain direct access. During a portion of this surgery, the endoscope enables the surgeon to better see obscure spots such as the very top of the gland and incoming blood vessels. "For the most part we are just looking through a smaller incision," says Dr. Terris.
A newer technique, fine-tuned by Dr. Paolo Miccoli of the University of Pisa, Italy, enables the surgery through an incision less than an inch by pairing the straw-size endoscope with the equally slender harmonic scalpel.
"The harmonic scalpel allows us to safely secure blood vessels in small spaces without needing to tie the vessels," Dr. Terris says. "You reach up and ligate vessels through endoscope guidance."
Slender instruments also enable surgeons to push aside muscles rather than cut through them. Video monitoring equipment attached to the endoscope magnifies the anatomy about 20 times so surgeons actually can see better than they can through the typical glasses with integrated magnification that enlarge the image about two and one-half times.
In addition to an improved cosmetic result, minimally invasive approaches reduce surgical trauma and recovery time with most patients going home within a few hours of surgery. "We don't even use stitches on the skin," Dr. Terris says of the endoscopic approach. "We use a little bit of medical-grade glue."
He notes as the incision gets smaller, surgery time typically gets slightly longer and the surgery team gets larger, including someone to operate the camera with the endoscopic approach.
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Contact: Toni Baker
tbaker@mcg.edu
706-721-4421
Medical College of Georgia
15-Mar-2006