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Medicine has progressed dramatically over the past 20 years, but perhaps no area has evolved more quickly than surgery. “In the 1990s, we performed surgery totally differently,” said Marian McDonald, MD, Chief, General Surgery, St. Luke’s University Health Network. “The change is as great as the difference between a rotary phone and the latest smart phone.” Today, the majority of surgeries are performed using minimally invasive procedures. To describe the impact, Dr. McDonald referenced gall bladder surgery. In the 1990s, surgeons reached the organ by cutting through the patient’s skin and muscle. As a result, patients spent many days in the hospital and needed several weeks to recover.
“It was like being at the top of the mountain and needing to reach the road in a tunnel below,” she said. “Today, we insert a tiny video camera and special surgical tools through four small incisions. This allows us to see deep within the abdomen and remove the gallbladder.”
Such revolutionary improvements in imaging technology have led to more effective screening, diagnosis and treatment with less harm to the patient. Advances in imaging technology, such as CT scans, MRIs, PET scans, allow earlier and more accurate diagnoses. They enable surgeons to more precisely locate and better assess the diseased or injured area before surgery, which reduces surgical time and creates better outcomes. With today’s imaging, some procedures require no incision at all. Rather flexible scopes with cameras enter the body through natural openings in the human body – such as the mouth, rectum, vagina or urethra. Patients recover more quickly, experience less pain and have no visible scars because the procedure avoids cutting through the skin, muscle and nerves.
When a patient has a colonoscopy for example, the doctor inserts a scope into the anus and up through the rectum into the colon. A small camera transmits an image that enables the physician to examine the intestinal lining and detect and remove any abnormalities, including growths called polyps that can be – or later become – cancerous. These growths are then studied. If cancer exists, treatment begins right away.
“Through colonoscopy, I catch polyps when they are minute and prevent them from ever developing into cancer,” she said.
Another growing area of surgery is robotics. The robot acts as an extension of the surgeon’s hands with a wrist that turns 360 degrees. Combined with imaging technology that projects real-time pictures of the patient’s interior onto screens, the robot enables the surgeon to guide the surgical instruments around corners and deep into the areas that would be impossible to reach with human hands.
The electronic medical record has also transformed health care, providing physicians access to the patient’s medical history and test results from home or nearly anywhere in the developed world. Physicians can share patient records and images with experts across town or across the globe – and can even watch and offer expert guidance while the surgery is happening.
Meanwhile, surgical culture has changed radically during her career, said Dr. McDonald, who has nearly 30 years of surgical experience. Then, the surgeon was the sole authority in the operating room. “I’m still the leader, but today we have a more holistic approach. Every member of the surgical team is responsible for the well-being of the patient and is expected to ask questions and speak up within the scope of their practice.” Similarly, the patient, who is much better educated today, is encouraged to be an active participant in making decisions regarding their care.
“Despite all the technological advances, however, it comes back to the human connection between the person in need of healing and the healer,” she said. “I have the knowledge and skill to lead them. I let my patients know that I’m here to walk with them in their journey.”