Advanced Technology in Minimally Invasive Surgery

August 23, 2006
Peter Dragonas, MD
Peter Dragonas, MD

OBGYN.net Conference CoverageFrom the 31st Annual Meeting of the American Association of Gynecological Laparoscopists (AAGL)

Peter Dragonas, MD: I’m Doctor Peter Dragonas and I’ve been in practice in Boston for many years and I’ll be in New York in the near future. It’s a great pleasure to be here and I know we’re going to talk about a new product from the Olympus company. I’m very proud to say that I’ve been with Olympus in terms of a practitioner in gynecology and laparoscopy using their equipment from the moment it was born and delivered to our operating rooms and I’m delighted to be here today to help discuss and bring along the new ideas with my colleague we’ll be discussing with you.

Joe Sanfilippo, MD: Thank you. I’m Joe Sanfilippo, Vice-Chairman, Reproductive Sciences at Magee Women’s Hospital which is part of the University of Pittsburgh School of Medicine and my period with minimally invasive surgery really dates back to the early ‘70s when diagnostic laparoscopy was evolving, if you will, and hysteroscopy, again in a diagnostic capacity, was making its way to the omnitariam of the gynecological surgeon. Most recently, we have had a unique opportunity to look at new instrumentation, cutting edge instruments that really have allowed us to forge ahead with new procedures, doing minimally invasive surgery and in a sense taking it to the next level and I look forward to the opportunity to discuss new and innovative ideas in minimally invasive surgery.

Peter Dragonas, MD: What is the process that, the new technology that you’re prepared to talk about, Dr Sanfilippo?

Joe Sanfilippo, MD: Most recently, we’ve had experience with what is called the SonoSurge. The SonoSurge in my opinion is an innovative and very, very unique instrument that I think is going to revolutionize what we’re doing in minimally invasive surgery. Specifically, it takes the principle that many of us are familiar with, the harmona scappel, and brings it to a new level. Specifically, if you can envision a laparoscope is put into place and then all of the secondary ports no longer require a disposable instrument but now a reusable and a small incision is made in the skin, followed by placement of the SonoSurge, which allows us to both cauterize and advance the trocar under direct visualization. Around this device is a trocar sleeve, so if you can envision a reusable trocar sleeve is attached to the SonoSurge and it allows me to place additional ports, all of which are reusable instrumentation, it takes a matter of seconds to place it, it’s all done under a very controlled environment where I can access things under direct visualization and it really has been a revolutionary new tool that I am personally very impressed with.

Peter Dragonas, MD: Well, of interest to the patient and the general public, we’ve heard about surgical endoscopy, now that the general surgeons are doing it with gall bladder surgery. Does this lie in the field of classical laparoscopy or is it in the field of using the newer micro-laparoscopy and flexible laparoscopes and when you say, I’m trying to get you, actually, to tell me what you mean and to find minimally invasive so the public understands what we’re talking about.

Joe Sanfilippo, MD: Absolutely. Well, let me just answer that from several aspects. First of all, I think this new instrumentation has a role with routine diagnostic procedures with the next level, such as tubal ligation, as well as advanced minimally invasive surgery. I always look at minimally invasive surgery as taking a procedure that perhaps you and I were traditionally taught to do by laparotomy when we were resident physicians and replacing that through the laparoscope. It has all of the marked advantages of outpatient surgery, recovery is a lot less, return to the workforce is that much quicker and there are so many advantages of trying to approach it from the minimally invasive perspective, where we can utilize the tools of the laparoscopes, specifically. The other point of which is we have now tools through the SonoSurge that allow us to apply energy and, at the same time, light adhesions, restore normal anatomy in a sense in an unprecedented way, all of which I think are going to positively affect our practice.

Peter Dragonas, MD: Okay, so the person out there who wants to know more, initially when we did tubal interruptions, if you will, we used a couple of methods. One was burning tubes and you get a smoke, a cloud of smoke, and then you went to bipolar which was another electrical system that burned, but we didn’t see the cloud of smoke and we had blunt damage to tissue and other conditions which were easy to do, like even pulverating, burning, cauterizing, endometriosis or other similar, small areas. Now we’re talking about electricity and then laser, lasering with CO2 laser, which is using light beams that you train to do a certain thing. Now how does this differ and for the average person who says, oh my god, I’m afraid to have this done on my body, what are you going to tell them because you said minor interruption is what I’m getting from you, but the average women doesn’t understand how minor it is. How long will it take her to recover from having it this way rather than the old way?

Joe Sanfilippo, MD: Well, that’s a very, very good question and a very interesting, if you will, historical perspective, which I certainly support in the capacity that we’ve come a long way with electrical energy in surgery. I, too, was, if you will, brought up with the monopolar circuitry and we did worry about sparks to bowel and problems that can have very negative, profound effects.

Peter Dragonas, MD: Complications, in other words.

Joe Sanfilippo, MD: Absolutely. No other word can be used but complications. Then we moved into the realm of bipolar where the energy was confined which remains popular but now we’ve taken the traditional Klezinger forceps and made that micro, if you will, with a micro-bipolar. As you mentioned, we have Falope-Rings®, we have Hulca clips.

Peter Dragonas, MD: We’ve used silicone and plastic and different types of clips that the body doesn’t react to, that’s an area I left out. But now you’re going to give us something really outstanding that might replace all those things.

Joe Sanfilippo, MD: You’re exactly right and I think this SonoSurge is the next generation and the next generation, in my opinion, has a very confined distension of the electrical re-energy so it’s very, very confined, so the layman can now understand that it’s in a sense theoretically an even safer tool to use.

Peter Dragonas, MD: Because it’s not going to burn a lot of tissue where you work.

Joe Sanfilippo, MD: Compared to the monopolar, for instance. So I think as the public looks at innovation in terms of minimally invasive surgery, this is clearly cutting edge, it’s going to allow us to do more with less equipment, okay, in a cost-effective manner.

Peter Dragonas, MD: Now, just for further clarifications because remember, it took us four years to get through medical school, another four years for surgical, for training in this field, another four years to really know what we should know, and in a few minutes we’re trying to put it together here and it’s taken thirty years to really say that I’m very good at what I do and I say that with pride and Olympus has helped us, by the way. Because they’ve been our partners in this and a partner with the patient, so the next question is, I hear the word, SonoSurge. Does that mean that you’re really taking sound and sound is now being translated into heat and then the heat is used to do the job? Am I close?

Joe Sanfilippo, MD: You’re very close. Now I am not a physicist and I wouldn’t pretend to understand all of the details of how it works, but I think you’re exactly right. It is a sound wave principle converted to a thermal energy, if you will, but it apparently does this in a very confined manner that I, as an operating surgeon, feel a lot more comfort and safety than with some of other more traditional instrumentation.

Peter Dragonas, MD: Then it needs the, the thing we were taught in medical school when it comes to patient care, which is supposedly the law of medicine: first, do no harm. So that’s our mission here and I’m focused, using the best methods, Olympus and other good companies can develop, but Olympus has done a great job to find the quickest, the best, the most professional ways to do the job, but let us make no mistake in this, that you’ve got to be trained. I was told when I was being trained by John Leventhal, who came to Boston from Chicago, and Robert Kistner, my mentor in Boston, that it took 500 laparoscopies and doing something with them to at least be called somewhat of an expert. But I’ve done over 7,000 and I’m sure you’ve done 10,000.

Joe Sanfilippo, MD: Unfortunately, I think you’re right. But it’s all an interesting point that you address and now I find that we are teaching residents, and even attending physicians, not in an operating room but in a laboratory and so we truly confined and reduced that learning curve to a more efficient model and it’s something that I say is the wave of the future. Olympus has been very instrumental in assisting the educational goals and objectives of all of us who participate in not only resident but fellow training and attending physicians. So if you can imagine the public gains by this because now all of a sudden we walk into an operating room with the confidence and with the knowledge and expertise to truly come full circle.

Peter Dragonas, MD: But do you think, Dr Sanfilippo, that the average patient, even the educated patient, because today’s patients read a lot so we hope they’re all educated and the should continue reading because an educated patient makes the best patient, but do you think the average patient walking into your office knows how serious the companies that develop these instruments, the doctors who work with them, do they know what it takes in order for us to prepare to bring to the operating room the instrumentation you’re talking about? This morning I went and heard a quick, a saw a quick film on what they’re doing at your former alma mater, the University of Louisville, with cadavers in training residents and I think it’s a wonderful, wonderful thing that they’re learning how to use this equipment early and we will be able to make even greater progress. So do you think the average patient understands how much work is entailed in bringing this technology to them?

Joe Sanfilippo, MD: I don’t think they have a clue.

Peter Dragonas, MD: It’s unfortunate, isn’t it?

Joe Sanfilippo, MD: It is, but I also think that they come to a physician and provide a trust and the fact that the doctor-patient relationship and, as basic as I can convey that, where we all learned in medical school, so they feel that they come to their doctor with the safety, with the understanding that he or she will provide their trust …

Peter Dragonas, MD: That’s a key word.

Joe Sanfilippo, MD: Absolutely, and provide for them absolute best quality care, and then it’s up to us as the physicians to keep updated, to learn about SonoSurge . . .

Peter Dragonas, MD: Absolutely, and that’s why we’re here. Could you give us again before we sign off on this a capsule of what this procedure is so that the people watching or listening to this can take home the idea and really keep in their minds.

Joe Sanfilippo, MD: Absolutely. First of all, I think it follows what is called the cutting-edge advances in instrumentation and if you can envision we have a generator and the generator produces the energy to get the job accomplished and to this energy source is, it allows us to have the equipment to make a small quarter-inch incision to provide a 5mm, very small incision and allow, again, gall bladders to be removed.

Peter Dragonas, MD: And that’s only a quarter of an inch.

Joe Sanfilippo, MD: Exactly, for practical purposes, and the bottom line of this is that people, that the layman, need to understand that this cutting-edge technology has allowed us to take new advances in terms of what we can accomplish laparoscopically and the SonoSurge is certainly one specific device that is cost-savings, number one, and allows us to provide more efficiency in what we do and allows us to again try to restore normal anatomy, which is always the goal of surgery at hand and to do that in the most succinct and efficient manner.

Peter Dragonas, MD: Well, I thank you for participating with me and my being asked to interview you although I think we’ve both accomplished several things. I’ve learned a lot by listening to you and I’ve learned a lot about myself by asking you questions and you’ve learned something about me and the by-product is always giving to the best we have to the patient that walks in our door, and I find when a patient walks in, I say it’s a two-way street, you’ve got to trust me and I’ve got to trust you and I think Olympus can stand behind it. There are a lot of other fine companies, too, but Olympus has done a great job.

Joe Sanfilippo, MD: I couldn’t agree more. It’s a privilege to have the opportunity to speak with you.

Peter Dragonas, MD: My privilege, too.

Joe Sanfilippo, MD: Thank you very much.