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Retired postal worker Laurent Fournier was lucky from the moment doctors first discovered his aortic aneurysm.
The condition, marked by a dangerous bulge in the large blood vessel that carries blood from the heart to the lower body, is often fatal since it tends to develop with few symptoms.
Researchers call it a “silent killer” because many people are unaware they have an aortic aneurysm until it suddenly ruptures — an event that is fatal about three-quarters of the time. The condition mostly afflicts men over the age of 65, and it kills hundreds of them every year in Canada.
Fortunately, in Fournier’s case, the aortic aneurysm in his abdomen was discovered by accident during an ultrasound on his kidneys in mid-March — a measure related to his diabetes.
“That’s when they noticed something very unusual,” said his daughter, June. “The aneurysm was quite large.”
Within weeks, Fournier, 81, a father of seven, was admitted for surgery to the Ottawa Hospital, where his luck continued to hold.
Laurent Fornier, ready for surgery.
On April 1, he was wheeled into the hospital’s newest operating room — purpose-built for a high-tech brand of surgery that’s faster, safer and easier on a patient’s body. It’s known as minimally invasive surgery (MIS), and it allows doctors to effect repairs without making large incisions to gain access to a problem.
In Fournier’s case, surgeons will take advantage of the body’s network of blood vessels, in an approach known as endovascular surgery. Using miniaturized tools, and guided by computer-assisted tracking and real-time X-rays, doctors will navigate through Fournier’s blood vessels to the site of the aneurysm and brace the walls of his aorta.
Minimally invasive surgery does not look like traditional open surgery.
There’s almost no blood. Surgeons face a large TV monitor to watch the progress of their instruments inside the body. In an adjoining room banked with computers, a technician orchestrates what the surgeon sees on his screen.
Minimally invasive surgery, sometimes known as keyhole surgery, is part of today’s technology-driven medical revolution. Some believe it’s a breakthrough on par with the introduction of antibiotics.
For patients, MIS procedures mean less pain, shorter hospital stays and better outcomes because of the computer-guided precision with which they’re conducted. Surgeons do not have to cut through muscle so recovery times are faster, and there’s less scarring.
“It reduces the impact on patients’ lives,” explains Dr. Joseph Mamazza, one of the key architects of the Ottawa Hospital’s drive to join the MIS revolution.
The success of the revolution wasn’t always assured.
Twenty-five years ago, many surgeons resisted the advance of MIS, in part because it required a dramatically different set of skills. Some derided it as “circus surgery.”
“In the surgical community, there was a fair bit of pushback,” says the Sicilian-born Mamazza, who vividly remembers the first time he encountered MIS.
It was a few years after he had completed his surgical residency at McGill University. At a conference of gastrointestinal surgeons in 1990, Mamazza came across a packed meeting room and found a place against a back wall.
The presenter, Nashville surgeon Dr. Eddie Reddick, was showing a video of a cholecystectomy, a gall bladder removal, that was done using keyhole incisions and laparoscopic tools. The technique had been developed in Germany: It meant that instead of making a 10 to 16-centimetre incision in the abdomen, doctors could remove a patient’s gall bladder using four keyholes.
Mamazza instantly recognized it as a quantum leap forward. “It was a light switch,” he says. “I went to my chief of surgery and said, ‘We need to do this.’”
A pan-Canadian working group formed to train doctors in the technique. The surgeons learned to inflate the abdomen with carbon dioxide, insert a fibre optic light and camera, and operate through keyholes, all while watching their actions on screen.
Mamazza and a Laval colleague, Dr. Eric Poulin, pioneered the surgery in Quebec, and soon began to expand its use. In 1992, they teamed up to perform one of the world’s first splenectomies (spleen removals) using minimally invasive techniques. They applied the same skills to other stomach and colorectal procedures.
A plethora of tools used during minimally invasive surgery.
For surgeons, the most dramatic benefit of MIS flowed from the new optical instruments. By attaching a micro-camera to the end of a surgical scope, biomedical engineers gave doctors a powerful new tool. Now, they didn’t have to squint through a hand-held scope to see what was going on inside a human body.
Instead, the image could be projected onto a TV screen, and shared with others in the operating room. What’s more, surgeons could insert the camera into tissue folds, and behind organs, offering an unprecedented view of the body’s interior.
It made decision-making easier and dissections more precise.
“Dr. Poulin always used to say that laparoscopic surgery is surgery of the eyes: It’s what you see,” says Mamazza. “If you can’t see it, you can’t do it, no matter how good you are, no matter how well trained you are.”
The approach had the added benefit of freeing up a surgeon’s two hands since it was no longer necessary to hold a scope.
In the mid-1990s, Poulin moved to the University of Toronto and recruited Mamazza, who was named director of minimally invasive surgery at St. Michael’s Hospital. Ten years later, Poulin was recruited as surgeon-in-chief by the Ottawa Hospital’s president and CEO, Dr. Jack Kitts, who wanted to make the institution a leader in MIS. In 2005, Poulin again convinced Mamazza to join him.
During the following decade, Poulin and Mamazza worked to ensure the Ottawa Hospital joined the MIS revolution. They retrained staff, recruited MIS specialists and fought for resources.
Poulin was forced to retire in 2013 because of health issues, and he died in March of this year. Mamazza delivered the eulogy for his longtime friend and colleague.
“He had an uncompromising vision of where surgery should go,” Mamazza said. “It never wavered over the years no matter how much pushback there was.”
Poulin’s legacy continues to unfold.
An X-ray during surgery.
Last year, the first of four high-tech operating rooms, custom built for minimally invasive surgery, opened at the Civic Campus. The $9-million renovation included the installation of a moveable, laser-guided GE Discovery IGS 730, the first of its kind in Canada. The device produces high-resolution, real-time X-ray images that can be fused with CT scans to make three-dimensional pictures of organs and blood vessels. (Everyone calls the machine “Eve” because the technician who trained them on it was named “Adam.”)
It’s into this operating room that Laurent Fournier is wheeled early on the morning of April 1.
“I don’t even know why I’m here,” Fournier jokes, before going on to explain the danger of the aneurysm in his abdomen. “If it explodes, it can kill you.”
The operation begins with a checklist. The surgeon, surgical resident, anesthesiologist and nurses go through a list to ensure everyone knows their precise roles, and that everyone has the tools they need to do their jobs.
Fournier is conscious while they go through the list, and he’s asked if he has anything he wants to add or to ask. He doesn’t.
Dr. Sudhir Nagpal, chief of vascular and endovascular surgery, will conduct the operation with Fournier only partially sedated.
It’s another benefit of MIS: patients do not have to endure the general anesthesia required for open surgery.
To fix an abdominal aortic aneurysm using open surgery, doctors would make a large incision from just below the ribcage to a patient’s belt buckle. The aorta would be clamped, and the aneurysm repaired with a graft sewn into place to bridge the weakened artery.
The method can put considerable stress on a patient’s body, and often demands a week-long hospital stay. Typically, full recovery takes several months.
Dr. Napgal expects a different result from Fournier’s minimally invasive surgery. “If everything goes as expected,” he says, “he should go home tomorrow.”
The set-up during minimally invasive surgery.
Nagpal has already studied the CT scans of Fournier’s aneurysm, and has ordered the stent grafts that fit his anatomy. His primary concern today will be ensuring the stent graft does not interfere with blood flow to Fournier’s kidneys. Normally, each kidney is fed by one blood vessel, but Fournier’s kidneys each have two (a common variation).
The surgery begins with two small incisions in Fournier’s groin, about one-centimetre each, near the femoral arteries.
A needle provides access to the arteries, and a guidewire is fed into them. It is followed by a catheter sheath that allows for the introduction of a catheter — the long, thin tube that will be used to carry the stent grafts to the aneurysm site.
The wires and tubes are clearly visible on the TV monitor that projects a real-time X-ray, and surgeons carefully advance one catheter into the aorta, just below the blood vessels that feed the kidneys.
The aneurysm bulges from the aorta like a snake that has swallowed a mouse. After studying the site to ensure its architecture is consistent with what they found on earlier scans, surgeons begin to push the first stent graft through the catheter, towards the aneurysm site.
The stent graft is tightly compressed in a plastic sheath in the tip of a delivery system that looks like a small fishing rod. Tiny metal markers, embedded in the stent graft, help surgeons place it exactly right: with the anchor pins above the renal arteries, and with the mesh and fabric of the stent below, in the body of the aneurysm.
When Nagpal is satisfied with its position, the stent graft is deployed by unwinding a thumbscrew on the handle of the delivery system. The stent graft then expands into the aorta, a blood vessel that’s about the size of a garden hose.
The stent graft acts like a pipe liner in the damaged blood vessel, funnelling blood through the device and protecting the aorta’s weakened walls.
The first stent graft looks like a pair of pants with one leg cut short. A second must be added through the catheter in the left femoral artery to complete the pants.
Again, precision is vital. Nagpal must ensure the two stents overlap by three-centimetres to provide enough friction so that the device doesn’t migrate inside the body. Metal markers visible on screen help him align the two properly then the second stent graft is deployed, providing “pant legs” in both iliac arteries.
When the catheters are removed, the small holes in Laurent’s groin are sewn up.
The entire operation takes less than two hours.
Surgeons during minimally invasive surgery.
After the surgery, Nagpal declares himself happy with the result. An angiogram shows there’s no blood outside the stent graft, which means the aneurysm can’t re-inflate. “That’s what we want to see,” he says.
There were no surprises. “The best way to treat a problem is to avoid it,” Nagpal says. “That’s why it’s so important to plan. Planning is absolutely as important as the deployment.”
Fournier was out of hospital the next morning.
“The next day, he was up and complaining to everybody,” said his daughter, June. “That was normal: ‘You’re late. I’m hungry.’ It was amazing the recovery time was so little.”
Fournier walked the two blocks to his daughter’s parked car that morning.
He plans to spend most of the summer at his cottage near Dacre.
Said June: “I’m very grateful to the surgeons because they gave me my father back.”
查看原文...
The condition, marked by a dangerous bulge in the large blood vessel that carries blood from the heart to the lower body, is often fatal since it tends to develop with few symptoms.
Researchers call it a “silent killer” because many people are unaware they have an aortic aneurysm until it suddenly ruptures — an event that is fatal about three-quarters of the time. The condition mostly afflicts men over the age of 65, and it kills hundreds of them every year in Canada.
Fortunately, in Fournier’s case, the aortic aneurysm in his abdomen was discovered by accident during an ultrasound on his kidneys in mid-March — a measure related to his diabetes.
“That’s when they noticed something very unusual,” said his daughter, June. “The aneurysm was quite large.”
Within weeks, Fournier, 81, a father of seven, was admitted for surgery to the Ottawa Hospital, where his luck continued to hold.
Laurent Fornier, ready for surgery.
On April 1, he was wheeled into the hospital’s newest operating room — purpose-built for a high-tech brand of surgery that’s faster, safer and easier on a patient’s body. It’s known as minimally invasive surgery (MIS), and it allows doctors to effect repairs without making large incisions to gain access to a problem.
In Fournier’s case, surgeons will take advantage of the body’s network of blood vessels, in an approach known as endovascular surgery. Using miniaturized tools, and guided by computer-assisted tracking and real-time X-rays, doctors will navigate through Fournier’s blood vessels to the site of the aneurysm and brace the walls of his aorta.
Minimally invasive surgery does not look like traditional open surgery.
There’s almost no blood. Surgeons face a large TV monitor to watch the progress of their instruments inside the body. In an adjoining room banked with computers, a technician orchestrates what the surgeon sees on his screen.
Minimally invasive surgery, sometimes known as keyhole surgery, is part of today’s technology-driven medical revolution. Some believe it’s a breakthrough on par with the introduction of antibiotics.
For patients, MIS procedures mean less pain, shorter hospital stays and better outcomes because of the computer-guided precision with which they’re conducted. Surgeons do not have to cut through muscle so recovery times are faster, and there’s less scarring.
“It reduces the impact on patients’ lives,” explains Dr. Joseph Mamazza, one of the key architects of the Ottawa Hospital’s drive to join the MIS revolution.
The success of the revolution wasn’t always assured.
Twenty-five years ago, many surgeons resisted the advance of MIS, in part because it required a dramatically different set of skills. Some derided it as “circus surgery.”
“In the surgical community, there was a fair bit of pushback,” says the Sicilian-born Mamazza, who vividly remembers the first time he encountered MIS.
It was a few years after he had completed his surgical residency at McGill University. At a conference of gastrointestinal surgeons in 1990, Mamazza came across a packed meeting room and found a place against a back wall.
The presenter, Nashville surgeon Dr. Eddie Reddick, was showing a video of a cholecystectomy, a gall bladder removal, that was done using keyhole incisions and laparoscopic tools. The technique had been developed in Germany: It meant that instead of making a 10 to 16-centimetre incision in the abdomen, doctors could remove a patient’s gall bladder using four keyholes.
Mamazza instantly recognized it as a quantum leap forward. “It was a light switch,” he says. “I went to my chief of surgery and said, ‘We need to do this.’”
A pan-Canadian working group formed to train doctors in the technique. The surgeons learned to inflate the abdomen with carbon dioxide, insert a fibre optic light and camera, and operate through keyholes, all while watching their actions on screen.
Mamazza and a Laval colleague, Dr. Eric Poulin, pioneered the surgery in Quebec, and soon began to expand its use. In 1992, they teamed up to perform one of the world’s first splenectomies (spleen removals) using minimally invasive techniques. They applied the same skills to other stomach and colorectal procedures.
A plethora of tools used during minimally invasive surgery.
For surgeons, the most dramatic benefit of MIS flowed from the new optical instruments. By attaching a micro-camera to the end of a surgical scope, biomedical engineers gave doctors a powerful new tool. Now, they didn’t have to squint through a hand-held scope to see what was going on inside a human body.
Instead, the image could be projected onto a TV screen, and shared with others in the operating room. What’s more, surgeons could insert the camera into tissue folds, and behind organs, offering an unprecedented view of the body’s interior.
It made decision-making easier and dissections more precise.
“Dr. Poulin always used to say that laparoscopic surgery is surgery of the eyes: It’s what you see,” says Mamazza. “If you can’t see it, you can’t do it, no matter how good you are, no matter how well trained you are.”
The approach had the added benefit of freeing up a surgeon’s two hands since it was no longer necessary to hold a scope.
In the mid-1990s, Poulin moved to the University of Toronto and recruited Mamazza, who was named director of minimally invasive surgery at St. Michael’s Hospital. Ten years later, Poulin was recruited as surgeon-in-chief by the Ottawa Hospital’s president and CEO, Dr. Jack Kitts, who wanted to make the institution a leader in MIS. In 2005, Poulin again convinced Mamazza to join him.
During the following decade, Poulin and Mamazza worked to ensure the Ottawa Hospital joined the MIS revolution. They retrained staff, recruited MIS specialists and fought for resources.
Poulin was forced to retire in 2013 because of health issues, and he died in March of this year. Mamazza delivered the eulogy for his longtime friend and colleague.
“He had an uncompromising vision of where surgery should go,” Mamazza said. “It never wavered over the years no matter how much pushback there was.”
Poulin’s legacy continues to unfold.
An X-ray during surgery.
Last year, the first of four high-tech operating rooms, custom built for minimally invasive surgery, opened at the Civic Campus. The $9-million renovation included the installation of a moveable, laser-guided GE Discovery IGS 730, the first of its kind in Canada. The device produces high-resolution, real-time X-ray images that can be fused with CT scans to make three-dimensional pictures of organs and blood vessels. (Everyone calls the machine “Eve” because the technician who trained them on it was named “Adam.”)
It’s into this operating room that Laurent Fournier is wheeled early on the morning of April 1.
“I don’t even know why I’m here,” Fournier jokes, before going on to explain the danger of the aneurysm in his abdomen. “If it explodes, it can kill you.”
The operation begins with a checklist. The surgeon, surgical resident, anesthesiologist and nurses go through a list to ensure everyone knows their precise roles, and that everyone has the tools they need to do their jobs.
Fournier is conscious while they go through the list, and he’s asked if he has anything he wants to add or to ask. He doesn’t.
Dr. Sudhir Nagpal, chief of vascular and endovascular surgery, will conduct the operation with Fournier only partially sedated.
It’s another benefit of MIS: patients do not have to endure the general anesthesia required for open surgery.
To fix an abdominal aortic aneurysm using open surgery, doctors would make a large incision from just below the ribcage to a patient’s belt buckle. The aorta would be clamped, and the aneurysm repaired with a graft sewn into place to bridge the weakened artery.
The method can put considerable stress on a patient’s body, and often demands a week-long hospital stay. Typically, full recovery takes several months.
Dr. Napgal expects a different result from Fournier’s minimally invasive surgery. “If everything goes as expected,” he says, “he should go home tomorrow.”
The set-up during minimally invasive surgery.
Nagpal has already studied the CT scans of Fournier’s aneurysm, and has ordered the stent grafts that fit his anatomy. His primary concern today will be ensuring the stent graft does not interfere with blood flow to Fournier’s kidneys. Normally, each kidney is fed by one blood vessel, but Fournier’s kidneys each have two (a common variation).
The surgery begins with two small incisions in Fournier’s groin, about one-centimetre each, near the femoral arteries.
A needle provides access to the arteries, and a guidewire is fed into them. It is followed by a catheter sheath that allows for the introduction of a catheter — the long, thin tube that will be used to carry the stent grafts to the aneurysm site.
The wires and tubes are clearly visible on the TV monitor that projects a real-time X-ray, and surgeons carefully advance one catheter into the aorta, just below the blood vessels that feed the kidneys.
The aneurysm bulges from the aorta like a snake that has swallowed a mouse. After studying the site to ensure its architecture is consistent with what they found on earlier scans, surgeons begin to push the first stent graft through the catheter, towards the aneurysm site.
The stent graft is tightly compressed in a plastic sheath in the tip of a delivery system that looks like a small fishing rod. Tiny metal markers, embedded in the stent graft, help surgeons place it exactly right: with the anchor pins above the renal arteries, and with the mesh and fabric of the stent below, in the body of the aneurysm.
When Nagpal is satisfied with its position, the stent graft is deployed by unwinding a thumbscrew on the handle of the delivery system. The stent graft then expands into the aorta, a blood vessel that’s about the size of a garden hose.
The stent graft acts like a pipe liner in the damaged blood vessel, funnelling blood through the device and protecting the aorta’s weakened walls.
The first stent graft looks like a pair of pants with one leg cut short. A second must be added through the catheter in the left femoral artery to complete the pants.
Again, precision is vital. Nagpal must ensure the two stents overlap by three-centimetres to provide enough friction so that the device doesn’t migrate inside the body. Metal markers visible on screen help him align the two properly then the second stent graft is deployed, providing “pant legs” in both iliac arteries.
When the catheters are removed, the small holes in Laurent’s groin are sewn up.
The entire operation takes less than two hours.
Surgeons during minimally invasive surgery.
After the surgery, Nagpal declares himself happy with the result. An angiogram shows there’s no blood outside the stent graft, which means the aneurysm can’t re-inflate. “That’s what we want to see,” he says.
There were no surprises. “The best way to treat a problem is to avoid it,” Nagpal says. “That’s why it’s so important to plan. Planning is absolutely as important as the deployment.”
Fournier was out of hospital the next morning.
“The next day, he was up and complaining to everybody,” said his daughter, June. “That was normal: ‘You’re late. I’m hungry.’ It was amazing the recovery time was so little.”
Fournier walked the two blocks to his daughter’s parked car that morning.
He plans to spend most of the summer at his cottage near Dacre.
Said June: “I’m very grateful to the surgeons because they gave me my father back.”
查看原文...
