Improvements Made In Surgery, Recovery
As a surgeon, my job isn’t just to make my patients well again. It’s also to find better ways of accomplishing that goal.
One of the most important areas for this is gastrointestinal (GI) surgery to treat colorectal cancer. Last week, my colleague Dr. Wissam Bleibel wrote about the importance of preventing colorectal cancer by doing screening colonoscopies. At the same time we work to prevent cancer, physicians like myself also are working to do a better job of treating and healing patients with a cancer diagnosis.
That means a career in surgery is a never-ending quest to do our job better than ever before, for the benefit of our patients and their loved ones.
Cut Less, Heal More
The way we do surgery today has changed a great deal compared to methods from even five or 10 years ago. We’ve learned that there are not only better ways to do the surgery itself, but better pathways to help patients recover afterward.
Doing a surgery means making incisions so we can access the inside of the body. One of the biggest changes in operating rooms revolves around using minimally invasive techniques whenever possible. The principle behind minimally invasive surgery is simple: Cut less, heal more.
Minimally invasive surgeries, including those for colorectal cancer, use smaller incisions than the traditional open procedures. We do that through the use of sophisticated instruments and specialized techniques. A few tiny incisions, usually about an inch long, are all it takes to give me the access I need to do a minimally invasive surgery.
Surgeons even have the option of using a specially designed robot to help them perform operations. Instead of standing over the patient to do surgery, a console a few feet away allows me to control a robot, equipped with various surgical tools to do the same procedure. The robot also uses a special 3-D camera, which allows me to actually see inside the patient.
Because we cut less using these methods, patients bleed and hurt less and have a shorter, easier recovery process. Recovery times that used to be measured in weeks can now be measured in days.
Though we have made great strides in surgical technique, we can’t always use minimally invasive methods. Sometimes the patient’s condition or needs don’t allow it. Fortunately, minimally invasive surgery isn’t the only advance that helps us do a better job for the patient, and we can still get patients back home in similar time frames compared to minimally invasive techniques.
One of the most important aspects of surgical care is keeping the patient as comfortable as possible. That’s why pain control is essential. When a patient’s pain is well managed, it increases the chances that the patient will heal faster and have a better outcome. In the past, we relied more heavily on the use of narcotic pain medications, which block pain signals as they travel through the body to the brain.
These medications are great at helping reduce pain, but there are drawbacks. These medications can be habit-forming, so we have to take care with how we prescribe and use them. This is especially important because of the serious prescription painkiller addiction problems in Kentucky. These medications also have the unfortunate side-effect of slowing down the way your digestive system works, because narcotics also inhibit the signals to your gut. This can slow the healing process, especially for GI surgeries.
For patients who are undergoing colorectal surgery, we want to get the gut back to doing its job as soon as we can, because that promotes healing and gets the patient out of the hospital and back to life more quickly. As a result, we found that we can target the of use non-narcotic medications in the abdomen. This controls pain, but doesn’t stop normal signals that operate the digestive tract. That means the patient has the same (or better) pain control and a speedier recovery.
Up & At ‘em
Many modern computers have a “sleep” function, where leaving them idle for a long enough time causes them to turn off their screen and power down. Your body does that too. If you are less active, your body’s processes slow down.
Years ago, we believed that patients needed rest after surgery to promote recovery. Today, we know that getting patients up and on their feet is actually better for them. Your physical strength operates on the principle of “use it or lose it.” Likewise, your body’s ability to repair itself is improved by physical activity.
At the end of February, I surgically removed several inches of a patient’s colon (which is about five feet long). Their condition didn’t allow me to operate using a minimally invasive technique, but that didn’t make their recovery any less impressive. Mere hours after I finished the surgery, they were on their feet and walking around. A few days later, I discharged them so they could go home and continue recovering. Even a few years ago, a hospital stay from an open surgery would have been a week or even more. Today, it’s not uncommon to send the patient home in half the time and get better results.
As a surgeon, I can offer years of education, training and experience to help treat and cure patients with cancer. But the best thing I have to offer patients with a cancer diagnosis is a team approach. When I care for a patient with cancer, I work cooperatively with Gastroenterologists like Dr. Bleibel, medical and radiation oncologists who use chemotherapy and radiation therapy, and many more specialists. We are also partners with primary care providers, fellow surgeons and the patient themselves.
Today, no doctor is an island. We will pool our talents, resources and our knowledge to try and give the patient the best possible outcome. We are going to work smarter, harder and together to beat this disease and get our patients back to living their life.
If you have questions about preventive screenings for colorectal cancer and surgical options for cancer or other conditions, make an appointment to talk to a medical provider. Whether it’s a surgeon, specialist or primary care provider, we are all here to help you get the care you need, when you need it.
Dr. Chris Nebel is a board certified general surgeon with Owensboro Health Medical Group - Surgical Specialists. For more information or to request an appointment with Dr. Nebel, call 270-683-3720.
This article originally ran in the Owensboro Messenger-Inquirer in the March 10, 2016 edition.