Advanced Surgery Performed In Los Angeles Will Be Seen Live At American College Of Surgeons Convention In Orlando

October 20, 1998

LOS ANGELES (October 20, 1998) -- During a surgical procedure that will take place at Cedars-Sinai Medical Center next week, the director of endoscopic surgery will demonstrate the use of new tools and techniques to physicians attending the American College of Surgeons Clinical Congress in Orlando, Fla.

During the live "TeleSurgery" session, scheduled to begin at 7:30 a.m., Pacific Time, on Oct. 26, Edward H. Phillips, M.D., a specialist in laparoscopic general surgery at Cedars-Sinai, will perform a laparoscopic Nissen fundoplication. This procedure corrects esophageal reflux, a condition in which the body's natural one-way "valve" between the esophagus and the stomach allows digestive acids to back up from the stomach into the esophagus. Sufferers may experience heartburn and serious complications.

"Patients can have difficulty swallowing and eventually develop a stricture in the esophagus from the repeated acid reflux," said Dr. Phillips. "Some people may experience nighttime asthma when the fluid comes up. Others are chronically hoarse or have a chronic cough or suffer from chronic sinus and ear infections because of the reflux affecting the eustachian tubes. Reflux can also be complicated by a hiatal hernia. These patients may feel short of breath or experience chest pain after eating."

When medication and dietary modifications fail to provide relief, surgeons wrap the upper stomach around the end of the esophagus "like a hot dog within a hot dog bun" to create a valve, said Dr. Phillips. Traditionally, this has been accomplished through a large abdominal incision, but since the laparoscopic method became available about six years ago, the same results can be achieved in a much less invasive way, allowing most patients to leave the hospital after only an overnight stay.

"It is a very elegant and sophisticated surgery with only five small tubes placed through the abdominal wall," said Dr. Phillips. A tiny lens inserted through one of the tubes produces a picture on a high-definition TV monitor, and the surgeon and assistant surgeon work in unison with instruments inserted through the other ports.

"Patients recover very quickly and are able to return to work in one to two weeks," said Dr. Phillips. "For people who have been on medications that can cost up to $20 a day for their whole lives, this makes a dramatic difference."

During the upcoming operation, Dr. Phillips will introduce two new pieces of technology: a miniaturized version of an instrument that uses ultrasound vibration frequencies to seal blood vessels; and a device that improves suturing within the abdomen, "automatically tying the knots for you and saving about 20 minutes in the operation," according to Dr. Phillips.

Surgeons in Orlando also will see that Dr. Phillips has modified the laparoscopic technique for added safety. He inserts the instruments in slightly different locations and changes the order in which the procedure is usually performed.

"Most surgeons approach the dissection of the esophagus and the stomach from the right side. I approach it on the left," said Dr. Phillips. "We divide the short gastric vessels first, rather than later in the operation. We do it when we're fresher. When we then go to the right side, the encirclement of the esophagus is quite easy."

Physicians in Orlando will not only witness the operation, they will be able to ask questions. In fact, in addition to demonstrating the latest advances in the surgical procedure, the TeleSurgery session will show off the latest technologies in video conferencing.

Using advanced telephone lines to connect computers at each end, the teleconference will take place in real time, without the "ghosting" of the image that often occurred during satellite transmissions, said Pemon Rami, manager of Medical Media and Conference Services at Cedars-Sinai.

"One of the benefits of this being done at Cedars-Sinai is that all of our surgical suites and our conferencing rooms are wired to the Medical Media television production studio," said Rami. "We can put a camera in any of the surgical suites, send the signal to Medical Media and broadcast it with two-way audio, two-way video to four sites simultaneously anywhere in the world."

In this instance, the signal will be delivered to the Ethicon Endo-Surgery Theater that will be set up at the 84th Clinical Congress of the American College of Surgeons. Ethicon Endo-Surgery, a Johnson & Johnson company, will provide the videoconferencing system and technical expertise for the live transmission.

Cedars-Sinai Medical Center

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