Key-Hole Surgery
As in any progress in science and technology, the advancement in medicine and surgery is predicated upon, and systematically aimed at, improvement, simplification, and streamlining of any diagnostic or therapeutic procedure, to increase safety, efficacy, comfort and convenience for the patients.
Modern endoscopy, the act of inserting a slim lighted fiberoptic telescope (hallow cylindrical metal tube about the size of the index finger) into a body cavity, like the skull, thru the nose, or into the chest, the abdomen, or the knee or wrist or groin) to do the necessary operation (using specially designed instrument to apply sutures, cut tissues, etc.) for diagnosis or treatment, is one such innovative development in the new field of minimally-invasive (less traumatic) surgery.
The scope is also equipped with a built-in “camera” that transmits fiber-optic images to a “TV” monitor, so the surgeon (and the patient, if not under general anesthesia) can see what is going on inside the patient’s body cavity.
Historical records show that it was Aranzi, in 1585, who first used a light source for an endoscopic procedure, but technically, it was Hippocrates, the Father of Medicine, who lived 400 years before the birth of Christ (Born in 460 B.C. - Died in 377 B.C.) who first performed an endoscopic procedure where he inserted a speculum to examine the rectum. That was the exact principle and concept of endoscopy, which advances in technology have impressively refined to its current state of awesome sophistication.
Laparoscopy, or popularly called keyhole abdominal surgery among the lay people, is a technique under the broad category of endoscopy. For the chest, it is called Thoracoscopy, for the knee, Arthroscopy, etc., named after the body cavity accessed. Surgeons have to undergo additional specialized endoscopy training, on top of their regular surgical residency, to be able to do the procedure.
Modern laparoscpy was first introduced in 1983, when a German Gynecologist performed the first laparoscopic appendectomy, followed two years later by a lap cholecystemctomy (removal of gall bladder) by another German surgeon. Nicknamed “lap,” for short, among medical people, laparoscopy is actually a technical word for a “giant” surgical technique that has been simplified to a “midget” procedure, metaphorically speaking. This is a much less invasive procedure that allows surgery to be done through 2-4 small ports (8-10 mm, key-hole incisions) in the abdomen, instead of the usual long abdominal incision. In cases where a safe lap is not feasible for any medical reason, or when a complication develops that requires a large incision, which is not too frequent, the procedure could be converted easily to the standard abdominal incision. Some Lap procedures are done as outpatient procedures, where patients go home within 24 hours.
In 1994, a robotic arm was introduced to hold the telescope to improve safety and reduce the need of skilled camera operator. Two years later, the first live telecast of laparoscopic surgery performed remotely via the Internet (Robotic Telesurgery was held.
Laparoscopy was introduced in the Philippines for the first time in December of 1990 by two Filipino-American friends of mine, both general and vascular surgeons from Milwaukee, Wisconsin, Drs. Rolando M. Mendiola (a UST graduate) and Thomas Y. Chua (an FEU alumnus), when they conducted a Workshop on Laparoscopic Cholecystectomy at the Manila Doctors’ Hospital. Their goal was to effect an instant transfer of cutting-edge technology from the United States to the Philippines by helping inspire and tutor our surgical colleagues in the Philippines and make available to our fellow Filipinos this state-of-the-art technique in surgery, and thus help improve the quality of healthcare in our country.
The workshop was followed by another one a year later. An outstanding FEU graduate, Dr. Kim Shi C. Tan, currently Chief of Surgery at FEU-NRMF Medical Center in West Fairview, Quezon City, and an Awardee of the Philippine Medical Association, had completed those workshops. Today, he is one of the most experienced laparoscopic surgeons in the Philippines, conducting his own seminars. Dr. Tan organized on June 7, 1991 the Philippine Society of Laparoscopic Surgeons, and was elected as its first president. Since then, the PSLS has grown and remained at the forefront of laparoscopic surgery in the country.
Dr. Mendiola also visited Cebu Doctors’ University Hospital on April 28, 2004, demonstrated laparoscopic hernia repair for the local surgeons. There are now at least a dozen surgeons in Cebu who do laparoscopic surgery.
Where applicable, laparoscopic surgery, just like other endoscopic procedures, provides the patients of today the wonderful option of a minimally-invasive (safe, less traumatic, less painful) surgical alternative, thanks to the advances in medical science and technology and the pioneering spirit and foresight of all visionaries of the past and the present, around the world, including these three Filipinos surgeons and many others physician Filipino trailblazers in all fields of human endeavors. To all of them around the globe, our appreciation and gratitude. May God bless them. |
