Category Archives: General surgery
Since we’ve talked about single incision laparoscopic surgery (SILS) here at Bogotá Surgery after interviewing several of the surgeons performing this surgical technique in Bogotá, Colombia – I wanted to bring readers more information about the technique itself.
I have added some links to published articles discussing this technique and how it can be used as treatment for different surgical conditions. (all case reports are from 2011.) This is just a limited selection – there are hundreds of articles on this technique, and it is now being for a wide variety of abdominal conditions.
Case report from Japan – treatment of giant liver cyst (with color photos and radiographic information.)
Single port laparoscopy for adnexal surgery – 22 cases: this study has a photo that demonstrates the sterile glove technique that I’ve mentioned previously (that allows for a smaller peri-umbilical incision than when using a commercial instrument holder.)
an Indian study discussing this technique for kidney donors (for organ harvesting) – has a nice post-operative photo of kidney donor.
Note: while this Turkish study is descriptive and colorful - it’s not true single incision laparoscopic surgery – as observed in Bogotá, Colombia and other facilities. (It’s only single incision surgery if there’s just one incision..)
Thanks to the eagle-eyed reader who notified me that portions of one of my articles “Bogotá hospital offers hope to abdominal cancer patients” (originally published on Colombia Reports.com) was featured in the article, “Agencies promote Central and Southern American medical tourism.”
I’ve asked them to provide a link to the original article so readers can get more information on the topic.
Update: 29 June 2011: Here’s a link to the new article on Treatment Abroad (which is an International Medical Travel Journal sister site) that gives their readers the information they really need. (The name of the doctor, of course!) It’s a summary of the original Colombia Reports.com article. They still haven’t cited the ‘borrowed’ content on the original article, or provided the name of the physician doing the treatment (Dr. Fernando Arias) but I guess it’s an improvement.
Another article on the effectiveness of HIPEC (cytoreductive surgery with intraoperative hyperthermic chemotherapy) in the news. This story comes out of India and highlights doctors there and the HIPEC procedure for treatment of abdominal cancers (intestinal and ovarian cancers.)
The Future is Now.. in an article on Medscape, dated December of 2010 and originally published in Future Oncology, Dr. Ze Lu et. al discusses the future of cancer treatment. (The article is several pages in length – so I haven’t re-posted but reference information is provided below). Dr. Ze Lu and his colleagues believe the future of oncology treatment is…. Intraperitoneal Hyperthermic Chemotherapy (HIPEC)..
In August, we’ll check back in with Bogotá’s resident expert on HIPEC, Dr. Fernando Arias.
Lu, Z., Wang, J., Wientjes, G., & Au, J. (2010). Intraperitoneal therapy for peritoneal cancer. Future Oncology. 2010 (6) 10; 1625 -1641
As we’ve seen several times before, Bogotá surgeons stay ahead of the curve on cutting edge treatments. In the last several weeks, HIPEC or Hyperthermic intraperitoneal chemotherapy (Sugarbaker procedure) has been dotting the news headlines in the United States, and across the globe.
But as my readers here at Bogotá Surgery know, not only have we talked about HIPEC in the past - Dr. Arias has been performing this procedure at Fundacion Santa Fe de Bogota since 2009. He reports he did eight cases in May alone. (This is considered fairly high volume if you review the amount of cases being done at other centers.)
Planning to catch up with Dr. Arias and check in later this summer..
One of my new articles on Dr. Borraez has been published to Yahoo! (associated content section) – it’s shared content with the site.. I’ve also written two other articles, one of original content, so I’ll let you know if they get published. I thought it might get a little more exposure this way. I’ve written this trio of articles for Yahoo! as a trial run, so we’ll see how it goes..
Most of you will never meet Dr. Borraez, a trauma surgeon at hospital San Blas, one of the public hospitals in the poorest neighborhood in Bogota, but now you will have heard about him. In March of 1984, when he was a second year surgical resident Dr. Borraez , training at San Juan de Dios, Dr. Borraez was assisting in a surgical case with a patient that had a serious infection preventing closure of the abdomen.
(In cases of severe abdominal trauma, infection or necrosis closure of the abdomen can lead to the patient’s death due to compression of the abdominal compartment – leading to a sequelae of abdominal compartment syndrome —> internal organ hypoperfusion —-> organ failure —-> respiratory distress —> death. So basically all the swollen abdominal organs crush the blood vessels and other structures..)
During this case, the attending surgeon and the other operating room staff were looking for something to use to close the abdomen*. Sometimes surgeons used sterile operating room towels but that increased infection and allowed for massive fluid losses, and the synthetic films were prohibitively expensive (and not without their own problems.)
So while he was in the OR, Dr. Borraez spies the IV bag, and starts thinking.. He then took the largest bag made (a urology fluid bag – 3 liters) sterilized it, and placed it in the abdomen. And it worked – perfectly, as if it had been designed for that purpose.. It was clear, which allowed surgeons to monitor the wound, it was hypoallergenic, it prevented infection, it’s strong yet flexible and most of all – it was cheap (about 2 dollars) and available in any hospital – world-wide.
Since then, he has been recognized internationally for its use, especially after noted Atlanta trauma surgeon, Dr. David Feliciano came to Bogotá and saw this technique in use. He wrote about it in standard American trauma textbooks used worldwide, gaining some well deserved recognition for this kind Bogotá physician, who continues to work and innovate (for the last 27 years) in this humble hospital serving Bogotá’s neediest patients.
He now speaks at conferences world-wide, talking about the Bogotá bag – and different ways it is now being used. Hundreds of research studies and case reports have confirmed his findings. His contribution was recognized as one of Colombia’s top ten innovations in Medicine, along with the Hakim valve (which we mentioned in another post.)
He has successfully used the Bogotá bag as a permanently implanted internal closure device (placed between the muscle and the intestines) in 55 patients with no problems.
He continues to innovate for more affordable and practical wound closure devices. Currently, he has adapted a colostomy bag, along with a natural sponge and a suction canister as an effective wound-vacuum closure device, which mimics the success of the cost-prohibitive ‘wound vac’ (KCI) but only costs about a dollar to implement. (Wound vacs can be several hundred dollars per day of use.)
Yet, somehow, in between seeing patients, surgery, creating affordable solutions and teaching residents – he found time to sit down, explain all of this to me – and show me several patients with their “Borraez bag” in place.
* a temporary measure until swelling / infection subsides and allows for surgical closure.
In other news, I want to say hello to one of ‘my patients’ – (I know he is reading this) Cristian, a very nice thoracic surgery patient that I met during rounds one day. I tried to take a picture (he was very gracious and granted permission instantly) to show what a great guy he was – I met him as he was walking down the hall, chest tube canister in one hand, and puffing on his incentive spirometer in the other.)
He, too, made time for me, a strange American nurse, speaking bad Spanish – to answer my questions and tell me all about why he was walking the halls and puffing on this little box.. He gave me a tour of the hospital while we walked, and he puffed intermittently, as I thought about how everyone, doctors, nurses and patients have been so welcoming to me here. This kindness has certainly made this project not only possible, but a wonderful experience, that I will greatly miss when I return to the USA in a few days.
is a gastroenterologist and general surgeon here in Bogota, who specializes in the detection and treatment of digestive cancers. Along with his clinic, he has also created two separate divisions; a foundation for promote the prevention and detection of digestive cancers, and a medical education division – which supports training physicians world-wide in the endoscopy techniques he currently uses.
Currently, Dr. Emura is the only physician outside of China, Korea and Japan (where gastric cancer is endemic, and accounts for 20% of all cancers) who is treating early stage (stage I) cancers with endoscopic surgery versus a more radical gastrectomy. This procedure has already been well validated in Asia, where it has been used for over a decade.
Dr. Emura has also created and implemented a classification system for the grading and staging of digestive lesions.
By using chromography endoscopy (or chromoendoscopy) and a wax dye, doctors such as Dr. Emura are better able to visualize lesions that might otherwise be missed.
His research has also focused on differentiating colon lesions endoscopically, (to prevent unnecessary surgery for benign lesions).
He is currently working on screening guidelines (particularly for populations with higher incidence of gastric cancers such as in Colombia) because one of the main problems that still exists – is that the majority of patients with stomach cancer – are diagnosed late – when treatment options are limited and noncurative.
Interviewed the father and son, Dr. Ruben Francisco Luna Romero and Dr. Ruben Daniel Luna Alvaro this morning, before following Dr. Luna (Alvaro) to the operating room. Dr. Luna was joined by the remaining doctor in the Grammo practice, Dr. Cesar Guevara.
Due to some technical issues – i will post photos later.
Update: 21 April 2011: Photos