MDNews - Greater Boston

Orthopedics and Sports Medicine Scott Sigman, MD, Chief of Orthopedics at Lowell General Hospital and team physi- cian at the University of Massachusetts Lowell, notes that Lowell General's Orthopedic Department includes sub- specialists who use minimally invasive techniques to perform surgical orthopedic and sports medicine procedures, such as arthroscopic repair of anterior cruciate ligaments, rotator cuffs and shoulder insta- bility, minimally invasive spine surgery, hand surgery such as endoscopic carpal tunnel, as well as arthroscopic procedures for the ankle. The Orthopedic Department is proud to provide a full-service spectrum of minimally invasive surgeries, comparable to those provided at the hospitals in Boston. Rotator cuff repair exemplifies the move- ment toward minimally invasive techniques in orthopedics. A decade ago, open surgery was the standard method to mend a dam- aged rotator cuff. Surgeons made an incision in the front of the shoulder and repaired the tear while looking directly at the anatomy. Patients were admitted to the hospital and sometimes remained for two days because of the pain associated with the operation, Dr. Sigman explains. But the field has evolved. Minimally invasive approaches to rotator cuff repair have been facilitated, in part, by the intro- duction of better equipment. As with the da Vinci platform, cameras used in arthroscopy offer surgeons superior visualization of the damaged anatomy. "Arthroscopic repair reduces the pain associated with the procedure, and preop- erative nerve blocks allow patients to leave the hospital with markedly reduced pain and discomfort," Dr. Sigman says. "This provides more rapid rehabilitation progress. Patients regain function more quickly fol- lowing arthroscopic or other minimally invasive procedures when compared with traditional surgical approaches." Urological Surgery Practicing in one of the first specialties to embrace the robot-assisted laparoscopic approach, urologists at Lowell General use the da Vinci Surgical System to perform any procedure that can be addressed laparoscopically. An advanced approach used for bladder reconstructions — such as fistula repair or reimplantation of the ureter into the bladder — as well as complex stone removal, pyeloplasty, and some kidney reconstructions, the da Vinci platform has revolutionized prostate cancer surgery, according to Matthew Cohen, MD, urologic surgeon at Merrimack Urology Associates. "Traditionally, it was difficult to remove the prostate without leaving large scars and causing notable blood loss and complications such as incontinence and erectile dysfunction," Dr. Cohen explains. "The da Vinci platform has refined the technique, and over the past five years, we've noticed faster recovery times, reduced pain and less blood loss during surgery. The articulation the modality offers allows us to preserve our patients' continence and erectile function." In addition to robot-assisted laparos- copy, Dr. Cohen uses the hand-assisted laparoscopic approach for kidney cancer surgeries. Instead of traditional open approaches that sometimes necessitate removal of a rib, he makes a 3- to 4-inch incision and inserts a hand port. A small camera introduced into the surgical area provides visualization, and Dr. Cohen touches t he k id ney to a ssess t he surgical site. "Especially for complex kidney tumors, there is no better feedback than you get with your own hand," he explains. "This modality offers benefits associ- ated with both open and laparoscopic approaches, and I can also introduce a small ultrasound probe to assess the tumors' borders." Collaborative Approach The range of minimally invasive procedures available at Lowell General would not be possible without the hospital leadership's forward-thinking invest- ment in the most valuable technologies, Dr. Estella notes. Of equal importance is the collaboration between highly skilled surgeons and specially trained operating room nurses, who work to ensure each surgery goes smoothly. In addition, surgi- cal recovery nurses provide follow-up care to optimize the categorical benefits of advanced minimally invasive proce- dures — among them reduced pain and shorter recovery times and hospital stays. "The nursing team is fantastic," Dr. Estella says. "We're able to send most patients home the same day or the day after surgery because our nurses adhere to the highest standards. These procedures require a team, and we couldn't do it without them." For more information about Lowell General's minimally invasive surgical offerings, visit lowellgeneral.org/surgery. ■ Scott Sigman, MD, readies a patient for orthopedic surgery. Matthew Cohen, MD, consults with a patient. 8 | Greater Boston MD NEWS ■ M D N E W S . CO M

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