who now runs a minimally invasive surgical device manufacturer in
Columbus, Ohio. "They cut a little bit into the plane of what's reflecting
the light. The entire teaching of surgery is how to identify and isolate
tissue while operating."
Being as sure as possible that you know what you're cutting into is
the key to minimizing damage, says Dr. Poll. Keep in mind, however,
that each patient's anatomy is, to a certain extent, subject to variabili-
ty and ambiguity. "The entire experience of surgery is how to get out
of trouble," he adds. "The ability to see things has great value."
The ability to see things, and to avoid accidentally nicking or slicing
them, is image enhancement technology's contribution to reducing
surgical risk and the rate of post-op complications in minimally inva-
sive surgery. "It's a cadence to minimize damage to tissue you can't
see," says Dr. Poll. The real-time road map it provides of blood ves-
sels, ureters, the biliary tree, nerve bundles and other critical anatomy,
and the electronic adjustments it provides to brighten and clear that
view, offer a major safety benefit over even the soundest techniques.
Consider, for example, laparoscopic cholecystectomy's techniques.
The rate of common bile duct injuries increased to 0.5% nationally fol-
lowing the development and introduction of the lap chole procedure,
according to a survey reported in a 2001 issue of the Annals of
Surgery (osmag.net/PhyAK6). Santiago Horgan, MD, chief of the minimal-
ly invasive surgery division at the University of California San Diego
School of Medicine and director of its Center for the Future of
Surgery, has described this complication as "the Achilles heel of
laparoscopic surgery."
"These injuries occur when you don't expect them," he remarked in
a demonstration of image enhancement technology at the Society of
American Gastrointestinal and Endoscopic Surgeons' annual meeting
in March. "Common bile duct injuries never happen when it's difficult.
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