CENTER FOR MINIMALLY INVASIVE SURGERY ESTABLISHED: Offering Patients More Options and Benefits

We are very pleased to announce the establishment of the Stony Brook Center for Minimally Invasive Surgery.* The specially-trained surgeons who staff the new Center are dedicated to the performance and advancement of the most sophisticated care using minimally invasive laparoscopic procedures, which offer eligible patients considerable benefits when compared with conventional "open" surgery.

Also known as videoscopic or endoscopic surgery, this high-tech form of surgical care is not a specific type of operation. It is an expanding group of different kinds of operations performed with newly developed surgical instruments and methods that cause the least amount of physical stress to patients. It involves the use of a small scope (laparoscope) which magnifies the body's internal structures and projects the image onto a video monitor in the operating room.

That laparoscopic surgery requires only small incisions—and thus is minimally invasive—is a distinguishing feature of this revolutionary approach to surgical care.

Without the trauma of the large incision used in conventional operations, both pain and healing time are greatly reduced. There are also smaller scars as a consequence of the smaller incisions. Other appealing benefits include shorter hospital stays or no hospital stays at all, less need for postoperative pain medication, and earlier returns to work and normal activity/diet.

Reduced hospitalization, it should be noted, means reduced costs. The total hospital cost of a laparoscopic operation is generally less than what conventional surgery requires.

Surgery to treat a variety of common abdominal problems such as gallbladder disease, hernias, appendicitis, and chronic heartburn caused by reflux disease used to require large incisions, about a week in the hospital, and a six- to eight-week recovery time.

In most cases, laparoscopic surgery has reduced the treatment of these problems to same-day outpatient surgery with just one- to two-week recovery time at home; some patients can return to work in just a couple days after their operation.

Minimally Invasive Laparoscopic Surgery We Perform The physicians of the Center for Minimally Invasive Surgery are specialists in performing the following minimally invasive laparoscopic operations: n Adrenalectomy (removal of one or both adrenal glands) n Anti-reflux fundoplication (Nissen and Toupet procedures; treatment of gastroesophageal reflux disease) n Appendectomy (removal of appendix) n Cholecystectomy (removal of gallbladder) n Colectomy (removal of part or all of the colon) n Common bile duct exploration (identification and removal of bile duct stones) n Feeding jejunostomy (insertion of feeding tube in small intestine, as well as cancer staging) n Inguinal hernia repair (treatment of groin hernia) n Liver biopsy (diagnosis of liver disease) n Myotomy (Heller procedure; treatment of achalasia) n Paraesophageal hernia repair (treatment of stomach hernia) n Peritoneal dialysis catheter placement (abdominal catheter for dialysis) n Small bowel resection (removal of part of intestine) n Splenectomy (removal of spleen) n Ventral hernia repair (treatment of abdominal wall hernia) Note: As the range of different laparoscopic operations continues to expand, more minimally invasive options will be available in the future.

Louis T. Merriam, MD, assistant professor of surgery, is currently directing the development of the Center for Minimally Invasive Surgery, and comments: "The proven effectiveness of laparoscopic surgery has led to its expanding use. Because the stress to the body is greatly reduced by this minimally invasive approach, our patients—both adults and children—are extremely satisfied with the operative outcomes, in particular the minimal pain, scarring, and recovery time."

Dr. Merriam works closely with John S. Brebbia, MD, assistant professor of surgery, in providing the Center's clinical services. Other members of the Department's General/Gastronintestinal Surgery Service who have laparoscopic expertise contribute as well.

Our Multidisciplinary Approach to Managing Esophageal Disease

The expanded use of minimally invasive laparoscopic surgery has become particularly important in the treatment of esophageal diseases, including gastroesophageal reflux disease (GERD) and motility (muscle function) disorders such as achalasia (severe swallowing difficulty).

To provide the best possible patient care, our surgeons work closely with Stony Brook's gastroenterologists — in particular, Peter F. Ells, MD, Joseph Anderson, MD, John W. Birk, MD, Douglas L. Brand, MD, and Bonnie J. Pollack, MD — who maintain a sophisticated endoscopy laboratory as well as the only esophageal motility laboratory in Suffolk County, which is run by Dr. Brand. These laboratories use state-of-the-art equipment to evaluate patients with symptoms of esophageal disease.

GERD, for instance, is a chronic, recurrent disorder that results when stomach contents reflux into the esophagus. It is characterized by heartburn, eructation, and epigastric pain. Diagnosis is normally presumptive and made by the physician based on recognition of common symptoms. But the symptoms cannot reliably predict the severity of the disorder or indicate the patient's risk of developing complications, including reflux esophagitis, stricture formation, and Barrett's esophagus which is associated with cancer.

University Hospital's endoscopy and motility laboratories provide the information needed for the most accurate diagnosis of GERD and gastroesophageal motility disorders, and for determining the appropriate treatment plan. "Anyone with intractable heartburn needs evaluation," Dr. Merriam says, adding that "our multidisciplinary approach to managing esophageal disease ensures patients of the best possible evaluation."

Using the Laparoscope

Use of the laparoscope and similar scopes (e.g., endoscope, thoracoscope), among other new high-tech surgical instruments, has been the hallmark of minimally invasive surgery.

The laparoscope is a slender tube, less than three-eighths of an inch in diameter, with magnifying lenses at both ends, like a telescope. However, instead of gazing into outer space, a laparoscope looks at inner space.

When used for instance in abdominal surgery, a small incision is made in the abdomen through which the laparoscope is inserted via a hollow trocar-tube into the abdominal cavity. There it enables surgeons to look at a hernia, diseased gallbladder, inflamed appendix, or other problems.

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The new "videoscopic" approach, which adds to the laparoscope a video camera and light source, has revolutionized simple laparoscopic surgery.

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Surgeons perform surgery using microsurgical instruments inserted through trocar-tubes placed in similar incisions. The elimination of the large incision used in conventional operations makes this type of surgery less traumatic and, therefore, less painful. Thus, a patient can avoid or lessen a hospital stay and recover much faster.

The major limitation of laparoscopic surgery used to be that the surgeon was only able to see in just two dimensions. The lack of depth perception slowed many operations, and made certain tasks, such as suturing, difficult. To resolve this problem, surgeons use a video-computer system to perform in three dimensions.

Now, surgeons can see images from the laparoscope just as if they were viewing through a large incision. The new videoscopic approach, which adds to the laparoscope a video camera and light source, has revolutionized simple laparoscopic surgery.

For appointments/consultations with a surgeon of the Stony Brook Center for Minimally Invasive Surgery, please call 631-444-4545.

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