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Superior Surgery: Less Invasive, Laparoscopic and Robotic Procedures Produce Safer, Scarless Results

Some people are huggers. Others really don't like to be touched. Oddly enough, body parts are also like that.

This unexpectedly became a serious issue a couple of years ago for Paradise Valley businessman Vince Lizama.

An outgoing, friendly man who was born to warmly welcome the public to his popular restaurant, he's a hugger. But his intestines most definitely are in the "touch me not" camp. And that's how his health problem almost became a crisis.

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Who's the doctor? Robotic surgery patient Vince Lizama, right, had to put on surgical scrubs in order to have his photo taken in the operating room with his surgeon, Rick Low, MD, who used the da Vinci S surgical robot, left, to remove Lizama's internal scar tissue and repair his intestinal blockage.

"We're not sure why some people's organs are more problematic than others," said Phoenix surgeon Rick Low, MD. "But sometimes abdominal surgery leads to development of cobwebby scar tissue that causes internal organs to adhere to each other. When it becomes severe, the cobwebs can get as thick and tough as rubber bands."

The scar tissue, called adhesions, can cause all sorts of other problems, including intestinal blockages and severe pain. Lizama had all that and more. It started with what should have been a relatively uncomplicated surgery for diverticulitis, an infection that occurs when tiny intestinal pouches trap seeds or other bits of food that fester.

Unbelievable Pain

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Lizama's doctor sent him to Dr. Low, who operated and fixed the problem. But Lizama's extreme, touch-me-not small intestine went into adhesion-building overdrive. The adhesions were so extensive that they caused a bowel obstruction and unbelievable pain.

Lizama ended up back in the hospital. Surgeons can go back into the abdomen to cut out the scar tissue and resolve the problem, but it's a temporary fix. Surgical repairs get rid of the existing problems, but they generate more adhesions.

For some reason, however, Dr. Low said, laparoscopic surgery — the kind that's done through tiny incisions, guided by a camera — doesn't generate adhesions the way that open surgery through a large incision does.

But cutting out the adhesions with traditional laparoscopic surgery is a huge challenge, Dr. Low explained.

"Imagine," he said, "a long, skinny balloon that's used to make toy animals. Fill it with water, bend it in half and superglue the two sides together. Then take a scalpel and try to cut the two sides apart, guided only by a two-dimensional televised picture, without puncturing the balloon. It's not easy! In fact, in some cases, it's virtually impossible."

The da Vinci Surgical Robot

Enter Dr. Low's friend, the da Vinci surgical robot at John C. Lincoln North Mountain Hospital. The 3-D view through the da Vinci's screen is magnified 10 times, and the flexibility and precision of the robot's "wrists" far exceed that of a mere human. It makes adhesion removal — if not easy — possible.

The robot's capabilities are enhanced by Dr. Low's experience — he's done more than 400 procedures with the da Vinci in the past two years. "It's like anything you learn," he said. "When you start, it's painfully slow. But with proficiency, things go more quickly."

For Lizama, that meant his last surgery to repair the intestinal blockage and remove the adhesions, done by Dr. Low.

Who's the doctor? Robotic surgery patient Vince Lizama, right, had to put on surgical scrubs in order to have his photo taken in the operating room with his surgeon, Rick Low, MD, who used the da Vinci S surgical robot, left, to remove Lizama's internal scar tissue and repair his intestinal blockage.

Staying in the Forefront

The positive nature of Lizama's experience, however, illustrates only a small part of the resources that Dr. Low and his partners at Valley Surgical Clinics bring to John C. Lincoln. By staying at the forefront of medicine's move toward less invasive, laparoscopic and robotic surgery, they're bringing safer and more creative procedures to North Mountain Hospital patients.

"Start with what's been proven superior with laparoscopic surgery," Dr. Low said. "It wasn't that many years ago that many were saying that you simply couldn't remove gall bladders laparoscopically."

"There was a learning curve," Dr. Low said. "At first, it did take longer and there were more risks. But now the procedure takes less time, is safer and causes less blood loss. Patients recover more quickly and with less pain. The same thing is true with appendectomies and hernia repairs — these should not be done with open surgery."

"With da Vinci," he said, "procedures you should not get done with open surgery include removal of benign and cancerous colon growths, splenectomies and adrenalectomies, pancreatic, stomach and esophageal surgery."

Single-Incision Surgery

Sophisticated procedures that now can be done with da Vinci, he said, include removing thyroid and parathyroid glands through the patient's armpit, liver resections to remove cancerous tumors, and the Whipple, a complex procedure to remove cancerous pancreatic tissue and reattach the stomach to the small intestine.

Most of the basic procedures can be done through a single incision, through the belly button, which means the surgery can be done with no visible scar.

"The new device for single incision laparoscopic surgery, called Gel Point, is a clear spherical insert that gives us better access and better vision than any of the earlier applications. It's a huge advance."

But what really gets Dr. Low excited is that in the very near future, an application that allows da Vinci to work through a single incision is expected to be approved by the federal government.

"We're just waiting for that," he said with a grin.

Surgical Expertise

John C. Lincoln North Mountain Hospital has physicians specializing in general, urological and gynecological robotic surgery. For a referral, call 602-331-7831. For more information, visit JCL.com/scarlessurgery.

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