Well Being — 02 July 2015
One incision,  no scar, and one happy patient

By Jana Soeldner Danger

Helene Jolicoeur was looking forward to a vacation in the Bahamas, and she planned to look great in her bikini. Then, to her dismay, she discovered she had gallstones, and her gallbladder needed to be removed.

She definitely didn’t want any abdominal scars.

As nurse manager of the operating room at Holy Cross Hospital, Jolicoeur knew about single-site laparoscopic surgery being performed there by Dr. Christopher Seaver. It is a new procedure in which the surgeon makes a single, inch-long incision in the patient’s navel and removes the gallbladder through it, leaving virtually no scar.

The single-site technique is an improvement over earlier laparoscopic surgery developed in the 1980s. With that procedure, which is still widely used, the surgeon makes four incisions that are one-half to one inch long: one in the center of the abdomen under the sternum, two under the rib cage and one in the navel. The doctor inserts instruments through tubes, or trocars, into each of the four incisions and then manipulates the instruments directly. The resulting scars are small, but they are visible.

The single-site procedure enlists the technological help of a da Vinci robot. With this technique, one trocar encases four smaller trocars, each of which holds a surgical instrument. The doctor inserts the single trocar, which is attached to the robot, through the incision in the navel.

“The instruments are flexible, which allows them to move within the trocar,” Seaver says.

The doctor performs the surgery seated at a console, viewing a magnified, high-resolution 3D image of the site. It is the surgeon, not the robot, who performs the procedure, with computer technology translating his hand movements to the tiny instruments.

“Patients think it’s the robot that does the operation, but it’s not,” Seaver says.

The ailing gallbladder is drawn into a bag.

“You pull a drawstring to close the bag, and then pull it out through the incision,” Seaver says. “If the stones are too big, you crush them.”

Not everyone is a candidate for the single-site procedure. It’s important to see a doctor as soon as symptoms like abdominal pain, bloating or nausea during a meal appear, Seaver says.

“Once a gallbladder gets too sick and too infected, it gets hard and is too inflexible for the procedure.”

Jolicoeur had her surgery on a Thursday, went home the same day and was back to work on Monday. Shortly after that, she left for her vacation with a bikini-ready body.

“I had no scars,” she says. “And I had a wonderful week in the Bahamas.”

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