ADVANCES IN SURGERY

1. ADVANCES IN SURGERY Samuel Vincent G. Yrastorza, MD, FPUA

2. Has grown leaps and bounds for the past years DIAGNOSTICS Symptomatic disease - history and PE still accounts for 80-90% in clinching the diagnosis Asymptomatic diseases - screening procedures detect early diseases - e.g. colonoscopy for colon cancer

3. Before • Signs and Symptoms + PE • Abdominal pain, Diarrhea • PE = abdominal mass DIAGNOSTIC ADVANCES • Diagnostic Exam/Imaging • Stool exam • Colonoscopy, Abdominal CT scan • Diagnosis • Colonic Cancer

4. Presently • Reaching 40 y/o DIAGNOSTIC ADVANCES • Without any signs or symptoms of disease • Screening Colonoscopy • Small colonic mass noted and biopsy done • Colonic Cancer

5. CT Scan • - Has become more sensitive and specific • Diagnostic modality of choice for a majority of surgical cases with the advent of • 3D reconstruction • CT angiography DIAGNOSTIC ADVANCES

6. CT Scan DIAGNOSTIC ADVANCES • prototype • EMI CT scan • 256 slice CT scan

7. CT before • 256 slice with 3D reconstruction IMAGING • COLON

8. Colonoscopy • 256 slice with 3D reconstruction IMAGING

9. CT before • 128 slice with 3D reconstruction IMAGING • KIDNEYS

10. Conventional angiogram • CT angiogram IMAGING

11. Brachytherapy - Greek brachy meaning “short” - radioactive source placed inside or next to the area of treatment - not just for adjunctive therapy or pallation - as first line treatment for various forms of cancer - commonly used for prostate cancer, cervical cancer , head and neck cancer - radioactive sources - strontium plaque - iridium wires - iodine 125 seeds Radiotherapy

12. PROSTATE BRACHYTHERAPY

13. PROSTATE BRACHYTHERAPY

14. - for early and localized cancer - not for locally advanced or metastatic prostate cancer - comparable result to radical prostatectomy - out patient procedure - lesser complications than radical prostatectomy - uses iodine 125 seeds PROSTATE BRACHYTHERAPY

15. LOCALIZED PROSTATE CA TREATMENT brachytherapy Radical prostatectomy

16. Probes/needles directed at organ or tissue CRYOTHERAPY Freezing ---- thawing---- freezing cellular disruption cell death

17. Used for - benign and malignant skin conditions - early and localized cancers - liver - prostate - hemorrhoids CRYOTHERAPY

18. Used for - benign and malignant skin conditions - early and localized cancers - liver - prostate (widespread use) - hemorrhoids CRYOTHERAPY

19. CRYOTHERAPY ice balls

20. RFA probe (needle) placed inside the tumor (guided by CT scan or ultrasound or through open procedures) RADIOFREQUENCY ABLATION Radiofrequency waves passed through probe into tumor increased in temperature within tumor tumor necrosis

21. Indications - tumors of the lung, liver, bone - used for primary and metastatic tumors - recurrent atrial fibrillation and supraventricular tachycardia - varicose veins RADIOFREQUENCY ABLATION

22. RADIOFREQUENCY ABLATION RFA probe (needle) RFA generator

23. RADIOFREQUENCY ABLATION

24. Percutaneous approach RADIOFREQUENCY ABLATION Laparoscopic approach Open approach

25. HIGH INTENSITY FOCUS ULTRASOUND (HIFU) HIFU directed at tissue/tumor (by ultrasound or MRI) increase temperature at target tissue/tumor tissue/tumor destruction

26. HIGH INTENSITY FOCUS ULTRASOUND (HIFU) used for: - uterine fibroids - solid tumor of the brain, bone, breast, liver, pancreas, rectum, kidney, testes, prostate - earliest and widest use = for prostate cancer - atrial fibrillation, arrhythmia

27. HIGH INTENSITY FOCUS ULTRASOUND (HIFU)

28. - Trend toward less invasive procedures SURGICAL PROCEDURES • The “old way” • NOW

29. Minimally invasive surgery • Minimal access surgery • Key hole surgery • Pinhole surgery • Band-aid surgery • *** part of a broader field of ENDOSCOPY LAPAROSCOPIC SURGERY

30. LAPAROSCOPIC SURGERY • Access

31. Used for: • - diagnostic • - cancer surgery • - donor organ harvest ( donor nephrectomy) • - vascular surgeries • - practically any abdominal surgery LAPAROSCOPIC SURGERY

32. Advantages • - smaller incisions (smaller scars) • - fast recovery (short hospital stay) • - better visualization of abdminal structures LAPAROSCOPIC SURGERY

33. Disadvantages • - more expensive • - requires expertise • - steep learning curve • - longer operating time (gap is slowly closing with that of open surgery) LAPAROSCOPIC SURGERY

34. Cystoscopic surgery of the joints • Similar advantages and disadvantages as laparoscopy ARTHROSCOPIC SURGERY • arthroscopic • Open Knee • surgery

35. Cystoscopic surgery of the THORAX • Similar advantages and disadvantages as laparoscopy • Instruments basically the same THORACOSCOPIC SURGERY • Open thoracic surgery • thoracoscopic

36. Cranioscopy??? • Not enough space Others

37. 3mm port instead of the usual 5 and 10 mm ports • Smaller instruments • Lesser pain and scar Microlaparoscopy

38. ROBOTIC SURGERY

39. ROBOTIC SURGERY

40. ROBOTIC SURGERY

41. ROBOTIC SURGERY

42. ROBOTIC SURGERY

43. Teaching/mentoring through the internet • “out of school students” • Open universities Telementoring

44. Telementoring

45. Surgical training though internet or other forms of telecommunications Telementoring

46. Telesurgery

47. Use of stem cells to treat certain diseases • To create new tissues/organs to replace/augment the existing ones Stem Cell Therapy

48. Use of stem cells to treat certain diseases • To create new tissues/organs to replace/augment the existing ones Stem Cell Therapy • New pancreatic cells transplanted into patient • DM type 1

49. Stem cells • - unspecialized cells capable of renewing themselves through cell division • - can be induced to become tissue or organ specific cells • - in gut and bone marrow • = stem cells regularly divide to repair and replace worn out or damages tissues • - pancreas and heart • = stem cells divide only under special • conditions Stem Cell Therapy

50. Categories • 1) Non embryonic • - somatic or adult stem cell • 2) Embryonic • - use of human embryo Stem Cell Therapy