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March 24, 2000     Cape Gazette
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March 24, 2000

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CAPE GAZETTE, Friday, March 24. March 30, 2000 - 39 HEALTH & FITNESS Beebe doctors introduce new surgical technique Hand-assisted !aparoscopic procedure is state'of-the-art By Kerry Kester Two Lewes physicians, both skilled in advanced laparoscopic techniques, have introduced a new pro- cedure to the Beebe Medical Center community. The board certified surgeons, Dr. Paul Taiganides and Dr. Erik Stancofski, are now performing hand- assisted laparoscopic sigmoid colectomies - surger- ies that minimize invasion to the body when a por- tion of the colon is removed. The surgical technique combines using laparo- scopes - tubelike scopes inserted through small inci- sions - with a an open incision that is protected by a device known as a Pneumo Sleeve. The surgeon's hand enters the body cavity through the sleeve, pre- venting the bowels from coming in contact with the environment, which is the main cause of many post- operative complications. The new technique drastically reduces patients' recovery time. According to Stancofski, inpatient time at the hospital is one or two days shorter, and outpatient recovery time is reduced by one, two or even more weeks. "By two weeks, most people are playing golf, playing tennis, whatever they were doing before," said Taiganides. With an open colectomy, however, patients might have a six-week recovery time in which they may not even be able to work. When the procedure was first introduced to sur- geons several years ago, said the physicians, there was controversy about whether in cases of cancerous colons the removed specimens contained enough lymph nodes to ensure the cancer's removal and whether wound sites had higher incidents of metas- tases. Both issues have since been dispelled, said Taiganides and Stancotski. Stancofski said an investigatory team in Cleveland, Ohio, found specimens taken with the new procedure were as good or better titan those taken thxough open surgical methods. The research team also found no higher rate of metastases at inci- sion sites. The technique can be used for several types of sur- geries: splenectomies - removing the spleen; simple gastric-related surgeries; antireflux procedures; and liver surgeries requiring removal of small amounts of tissue. "The biggest application by far is for bowel surgery, though," said Taiganides. Patients who might he most likely to benefit from the procedure are those who have polyps too large to he removed through colonoscopies, those with acute or chronic diverticulitis, and those with diverticulo- sis or voivulus. Diverticulitis is a condition that develops when pouches in the colon become inflamed and some- times abscess. Fecal matter can steep through the thin tissue and block the colon. Diverticulitis is very painful and sometimes requires patients to have at least temporary colostomies. Diverticulosis is a bulging through the colon but without the inflamma- tion; it often leads to diverticulitis. Volvulus is a condition that develops when a bowel becomes enlarged and twists on itself. The intestine can become blocked, and if the problem is not rectifed, the bowel can become damaged, and result with a person's death. Local man benefits William Snead, 41, of the Cape Region, was admitted to Beehe Medical Center Tuesday, March 7, complaining of acute pain in his abdominal area. The pain had begun Sunday and progressively got worse. "Monday I got up, and was considerably worse, but I was still thinking it was gastrointesti- nal," said Snead. Although he worked his construction job Monday, by evening it was clear his problem was something needing attention. His primary care physician diag- nosed diverticulitis and scheduled Snead for surgery Continued on page 42 I I Above, Dr. Paul Taig- anides' left hand manipu- lates the bowel through the Pneumo Sleeve, which pro- tects the abdominal cavity from exposure to the envi- ronment, while his right hand manipulates a scope. Michele Sprinkle, RN, first assistant, assists Talganides by using another scope to keep the colon cavity lit and the camera focused during a laparoscopic sigmoid colee- tomy at Beebe Medical Center. Kerry Kuter photos At right, Taiganides re- moves a diseased eelon from a patient. DR, JOHN WAHL clear, they unfortunately shrink those images very slightly. This is an optical effect of the spectacle lens sitting an inch away from the eyeball. Contact lenses do this less so because they rest on the surface of the eye." "Because LASIK reshapes the cornea itself- the clear surface of the eye - it doesn't make images smaller. Objects are seen in their normal size. So it's possible Tiger Woods senses distant shapes as slightly larger, that is, their normal size," Wahl said. Wahl has performed 1,000 LASIK procedures over the past five years. He uses the VISX laser at the Johns Hopkins outpatient pavilion. Wahl's patients are examined before and after surgery at the Laser Center for Sight on Savannah Road in Lewes. The VISX laser is one of sever- al excimer lasers FDA-approved for LASIK. "It's the market leader for good reason," Wahl said. He has worked with five different lasers in the past, and feels the VISX is the best. More and more people seem to agree. Model Cindy Crawford is the latest celebrity to undergo LASIK, as reported in the February issue of "In Style" magazine. To prepare for surgery, the patient is first given Valium to reduce anxiety. Numbing eye drops are instilled and a soft, flexible eyelid holder is put in place. An automated machine called a microkeratome is used to shave a superficial flap of corneal tissue 160 microns thick. A micron is one one-thou- sandth of a millimeter. The flap is then peeled back, exposing the bed of corneal stroma underneath. The flap is still attached by a hinge of corneal tissue superiorly. The bed of cornea is then 'zapped' with an excimer laser. The laser vaporizes a 6.5 mm diameter area of central cornea. It flattens a steep cornea for near- sightedness, rounds an oblong cornea for astigmatism or steeps a flat cornea for farsightedness. The laser vaporizes from 5 to 100 microns of corneal tissue, more for strong eyeglass prescrip- tions and less for weak prescrip- tions. The actual laser treatment lasts from five to 50 seconds, dur- ing which time it is important for the patient to stare at a red blink- ing light. This light is the aiming beam of the laser. The flap is then laid back and self-seals. The same 'flap and zap' procedure is then performed in the second eye. An antibiotic/steroid eye drop is used three times a day for three days. Artificial tears are used as needed. If it all sounds confusing, don't worry. Patients can watch their surgery at home afterwards on their VCR. A TV monitor is attached to the operating micro- scope such that family members or friends can watch the surgery live, and patients are given a videotape if they desire one. The patient usually returns to work the next day. The patient is examined in about a week, and again a month or two later. If all is well, the patient resumes routine eye exams every two years. Most patients are able to do away with eyeglasses after surgery. However, those ages 45 or older will still need a pair of drugstore reading glasses. "LASIK should be thought of an a means of becoming independent of glasses or contacts, rather than necessari- ly achieving perfect vision," Wahl said. Many people have probably heard of LASIK surgery to reduce dependence on eyeglasses, but it's likely most do not know exactly what LASIK is. LASIK is short for laser-assisted in-situ keratomi- lieusis. It can he thought of as "flap and zap." Tiger Woods underwent LASIK eye surgery in October, 1999, on the VISX laser, enabling him to play golf without wearing contact lenses. Woods credits his improved vision with contributing to his recent winning streak, telling "USA Today" in November, "My images are big- ger. It was very difficult for me to hit long putts, for instance, or to read slopes. Now that I'm, I guess, normal, one of the things that appears to me is the slopes are bigger. Objects are bigger. The hole is bigger." Dr. John Wahl, Delaware's most experienced LASIK surgeon, says it may not be simply Woods' imagination. "While eyeglasses that correct high degrees of near- sightedness make blurry images Dr. John Wahl of Robinson, Cook & Lubkeman may be reached at 645.2300. HEALTH TOPICS IASIK surgery good choice for vision correction