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Publications

Small incisions. Cutting recovery time

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One summer evening, Tim B. was strolling down a supermarket aisle when he felt a tearing sensation in his abdomen. A former football player, Tim was no stranger to pain, but says: “It was the worst I’d ever felt in my life.” Then he collapsed. “All I remember is my wife yelling: ‘Call an ambulance.’”

Tim was clinging to life when Constantine Andrew, MD, Virtua vascular surgeon, swept into the Virtua Marlton emergency room.

There he and his team swiftly evaluated Tim and determined that he had a ruptured abdominal aortic aneurysm, or AAA (pronounced Triple-A). Within minutes, Tim was in the operating room, and Dr. Andrew was positioning a stent graft through Tim’s largest artery, the aorta, creating a new passageway for blood to flow through.

Tim’s aorta had ruptured, and the doctor was rushing to stop massive internal bleeding.

How does an aneurysm happen?
Every beat of your heart unleashes a torrent of blood down your aorta, the garden-hose sized artery that runs from your heart to your abdomen. The abdominal section of this critical artery supplies oxygen to the lower half of your body and the body’s vital organs. An aortic aneurysm occurs when a small section of the aorta swells and weakens. “If diagnosed early, a smaller aortic aneurysm can be managed through careful observation and, when appropriate, a scheduled surgery,” says Dr. Andrew. “If left unchecked, an aneurysm swells. As the aneurysm increases, the wall of the aorta gets thinner until it ruptures.”

In many cases, Virtua surgeons and interventional radiologists can now repair the aneurysm tear using a minimally invasive approach.

Virtua’s Acute Vascular Emergency Service
“Patients must seek immediate medical attention for sudden severe abdominal pain or back pain – a common symptom of a ruptured aneurysm,” says Dr. Andrew.

Virtua’s Acute Vascular Emergency Service at Marlton provides rapid diagnosis and treatment for these and other vascular emergencies, 24 hours a day, seven days a week. A small diagnosed aneurysm is much easier to treat than one that has ruptured, and the outcomes are better. However, aortic aneurysms often have no symptoms.

Therefore, Dr. Andrew recommends ultrasound screenings for people at risk including those over 60 who smoke.
 

The best surgical hands: human or robot

The chest cavity is the grand central station of the body. It houses the heart, lungs, esophagus and many critical blood vessels. Because so many vital organs overlap each other in this complex region, performing surgery here has always been technically challenging.

An example: Not too long ago, a routine lung biopsy required a six-inch incision so the surgeon could safely operate on the lungs and obtain a proper tissue sample. “For patients, a long, uncomfortable recovery followed,” explains Christopher Derivaux, MD, an experienced Virtua thoracic surgeon.

With robot-assisted surgery, Virtua surgeons now perform many types of thoracic surgery treating lung and esophageal disease with a minimally invasive procedure. A one-to-three inch incision is all that is needed. Patients recover with far less pain.

Dr. Derivaux says: “What’s amazing is that, with robot-assisted surgery, we actually get a better view of the chest cavity. We can more comfortably operate on hard-to-reach areas, like certain regions of the lung or esophagus.”

The camera used during the surgery offers a 3-D image that allows for very precise robotic surgery. The robotic arms – controlled by the surgeon – refine his hand movements providing remarkable precision and dexterity.

The best approach for any chest surgery is to tailor the procedure to the patient’s needs and safety. Either way, it’s reassuring to know that, at Virtua, patients are in the best surgical hands: human or robotically assisted.