Originally created 01/16/97

Cutting edge



It's just after lunch in a University Hospital operating room. Giant lights hover above the surgery table like oversized Frisbees.

Heart surgeon G. Lionel Zumbro Jr. stares into a television monitor showing the detailed workings of his patient's heart. A tiny tubular camera inserted into the woman's body through a small incision allows the doctor to see the heart cavity.

"We're really in the midst of a revolution in heart surgery," Dr. Zumbro said, before the surgery. "We believe it will result in shorter hospital stays, faster recovery and lower costs."

The revolution is being driven by Dr. Zumbro and other surgeons nationwide who are practicing a less intrusive and less traumatic heart surgery method known as "keyhole" surgery.

University Hospital has performed about 40 of the approximately 500 Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) surgeries that have been done worldwide. The procedure's name is derived from the series of small incisions that have replaced the large 10-inch cut in the chest that is still standard in most heart surgeries.

Traditional heart bypass surgery also requires a sternotomy - the pulling apart of the ribs to gain access the heart. But the video camera, or laparoscope, and developments in surgical tools have made the less intrusive procedure possible.

Instead of using a heart-and-lung machine to slow the heart, the keyhole surgery is done while the heart is beating, a method that requires more precision, Dr. Zumbro said.

This, plus the smaller incisions, cause less trauma on the patient, resulting in shorter hospital stays, lower costs and smaller scars.

"Many patients say they like it just for cosmetic benefits," Dr. Zumbro said. "The (large) scar is a badge and it has a stigma."

Heart and chest surgeons aren't the first to use small incisions and video images in the operating room. The techniques started in general surgery about a decade ago and are commonplace today in various gallbladder, hernia, spleen, liver and esophagus surgeries.

Dr. Thomas R. Gadacz, a gastrointestinal surgeon at Medical College of Georgia, helped develop small incision procedures in both neurosurgery and chest surgery. Dr. Gadacz said many small incision techniques have replaced traditional surgery methods, some of which were used for decades.

He said the notion that an operation required large incisions and lengthy recovery periods prevented some patients from seeking surgery as a remedy to lingering, painful ailments.

"Patients would have (medical) problems, but there was a reluctance to go into surgery," said Dr. Gadacz, MCG's chairman of the Department of Surgery. "The perception was that some effects of surgery were just as bad as the disease."

The shorter hospital stays should change those perceptions, Dr. Gadacz said. Heart patients undergoing keyhole surgery spend days, not weeks in the hospital.

Willie Fulmer was home in Belvedere nine days after his Aug. 1 heart-bypass surgery.

Mr. Fulmer, 71, first suspected something was wrong when he broke out in a sweat over Sunday lunch, the first sign he was in the early stages of a heart attack.

His family rushed him to the hospital and Dr. Zumbro performed the surgery using the keyhole method. Mr. Fulmer was back home in nine days and spent a healthy holiday season with his family.

The retiree has resumed his active lifestyle - fishing and doing yard work - and plans to hunt again next season. The only exterior sign of his surgery is a four-inch scar just on the left side of his chest.

"Lately, I've pretty much been doing anything," Mr. Fulmer said. "If you've got to have (surgery), this is the thing to have."

For now, the MIDCAB procedure is only applicable in 10 percent of heart cases. Its reliance on small incisions done with the heart beating doesn't allow doctors to fix the hard-to-reach parts of the heart.

But Dr. Zumbro believes market forces and technological advances will eventually allow small incision surgery to be used in 90 percent of heart surgeries.

Dr. Gadacz believes similar advances will continue in general surgery and that the wave of change that forced surgeons to re-learn certain techniques will continue.

Dr. Gadacz said more precise cameras fused with fiber-optic technology will eventually allow doctors to perform remote surgeries.

Such a procedure would allow a gallbladder specialist in California to view a surgery in Augusta and assist with advice. He said even with all this change, open surgeries will probably remain the standard in some types of operations.

"A lot of the (technological) barriers have been met," Dr. Gadacz said. "Now, the challenge is when to apply this technology."