Tuesday, 26 July 2011

Are Laser & Laproscopic Surgeries Overdone

Published in Panorama

Are Laser and Laparoscopic Surgeries Overdone

Laser surgery and Laparoscopic surgery or the minimally invasive keyhole surgery seem boons for patients requiring surgery for various reasons since they entail minimum blood loss, reduced post operative pain, reduced hospitalization costs, quicker return to work and improved cosmetics as compared to conventional surgeries involving large abdominal and other incisions.

However, not all surgical problems are amenable to laser or laparoscopic procedures and it is important that patients and the lay public are educated on the applicability of these procedures since both forms of surgeries, in recent times, are being undertaken in areas best left to conventional surgery and oftentimes by personnel who are not qualified to do
the procedures!

Dr.Suhail Mohamad Kazim,a national of Dubai and CEO, Medical Director and Consultant Surgeon, Canadian Specialist Hospital, who is also a member of the Emirates Medical Association reveals, "Talking of lasers, just about everyone is using it. Unfortunately, people have started abusing it. You've got some doctors just opening some clinic and saying they do laser surgery. In fact, they are not even surgeons! They just put some sort of a light probe and the patient thinks he's had a major surgery done by laser! That's where the mentality of the patient gets completely corrupted and it's a big issue for many surgeons who really know what they're talking about, to clear off this notion in the minds of people.

Very often we get patients who just ask whether the surgery is being done by laser or not without having any clue as to what a laser surgery exactly denotes! I am a member of Emirates Medical Association and the association has sent warning letters to several people for misleading the public by saying this is laser, especially in the field of general surgery and for haemorrhoids or piles surgery. It is important for people to know that laser surgery has its own dangerous side effects as well. I have seen people who've sufferred from burns due to lasers because the person doing it was not qualified!

Unfortunately, many private clinics have abused the terms of laser. Even in the case of laser for hair removal, it has to be done by a qualified dermatologist or a plastic surgeon. But unfortunately, it is being used by beauty technicians and hair dressers and even in those clinics with licenced doctors , it is sometimes handed over to nurses to do it! But now the Department of Health has begun toughening its laws and only a practiced doctor with a license from the Department of Health is allowed to use a laser machine."

Dr.Kazim emphasizes that people should first and foremost understand the concept of laser use and its implications before plunging into the procedure. Laser technology has been extremely successful in the treatment of certain eye conditions, for the removal of hair and removal of small skin lesions. "But if you are going to talk of laser treatment for piles, in the real sense it is only that a laser beam rather than a knife, is used to cut the affected tissues! The principles of surgery and surgical management are absolutely the same as for conventional surgery, except that the use of laser beam instead of the knife, reduces the bleeding at the site of operation and a certain amount of reduced postoperative pain. Both procedures are done under general anesthesia and produce the> same results."

The major mishaps with misdirected laser beams are burns in the area, fibrosis in the area due to the burns and failure of the procedure to accomplish its objective. While laser does have an edge over conventional surgical techniques, it must be performed by an experienced surgeon, emphasizes Dr.Kazim. "The biggest problems of lasers are the hazards its entails. For example whenever laser treatment is being done, if adequate precautions are not taken, it can damage the eye. All staff in the operation theatre where> laser procedure is being undertaken, should be adequately protected, wear special eye protection and the room outside has to be illuminated to indicate that laser is on so that no one comes inside at that moment."

Laparoscopy came of age with its successful use as a diagnostic tool in the field of gynaecology. The technique which has since then been use extensively to tackle various other gynaecological problems including removal of ovarian cysts, of the uterus, of tubal pregnancy, endometriosis, its scope has crossed the realms of the pelvic region to be the preferred mode of surgery in removing diseased gall bladder, predominantly. Explaining the scope of laparoscopic surgery, Dr.Kazim reveals, "The Golden Rule that every case should be done laparoscopically is, until proved otherwise, it is valid only for one condition, which is the removal of the gall bladder. At various times it has been used for the removal of the appendix, treating hernias and I myself have done some of these. But not every case of appendix or hernia can be treated laparoscopically; surgical technique has to be decided on a case by case basis to enable best outcome for the patient. But the only condition, apart from gynaecology, where laparoscopy has had stunning success, is in the area of gall bladder removal."

Used indiscriminately, what damage can a laparoscopic procedure cause? Dr.Kazim explains that the first step in a laparoscopic procedure involves inflating the abdomen with a harmless gas through a small incision. This enables the surgeons to have a clear view of the organs within. The laparoscope is then inserted through another small cut on the abdomen. This is when the injuries could happen wherein the surgeon may puncture a blood vessel and get bleeding or he could puncture one of the bowels or the organs inside and get leaking from them. "But then these are the complications that a surgeon may experience in what we call the Learning Curve period, during his/her first 25 - 50 cases. But having said this, no surgeon should be pompous and over confident because complications can happen at any stage in his career because of the abdomen being a Pandora's Box, throwing up surprises at the most unexpected of times."

Another condition which has unfortunately not been understood well by the layman is the laparoscopic surgery for morbid obesity like banding or dividing the stomach. In the West this is a very carefully planned out procedure and involves many specialities including the physician, endocrinologist, dietician and even the psychiatrist. In fact , it is the psychiatrist who eventually decides which person should procede for surgery depending on the motivation and will power .The role of the surgeon is at the very end after the entire team have thoroughly evaluated the case and considered it ok to proceed for surgery. Sadly , over here and in many other countries, many patients have been taken for a hurried decision for surgery and with very devastating results. Morbid obesity is a very, very serious subject and the choice of which patient is a candidate for surgery has to be taken after careful evaluation and good team work.

The thumb rule then, whether for laser or laparoscopic surgery to be undertaken and produce the optimal benefit for the patient is, first and foremost, it should be handled by a qualified, experienced surgeon licensed to practice the procedure, on a case-by-case basis of patients, and difficult cases are best dealt in multi-specialty hospitals involving team work including, both, laparoscopic General Surgeon as well as the laparoscopic Gynaecology surgeon, emphasizes Dr.Kazim.


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