May 06, 2010
Smart people don't choose surgery lightly. They ask questions, they do their research and they make sure they understand why an operation is the right decision for them.
But once the decision is made that surgery is the best way to solve a serious health problem, some patients get an unexpected bonus: No scar!
Sometimes a lot of creativity goes into making surgery scarless, and sometimes it offers additional health benefits. Ask Kimyacta Gaines. Or Jeanina Stratton.
John C. Lincoln surgeon Francisco Rodriquez, MD, FACS, and scarless surgery patient Kimyacta Gaines.
Neither of them would have chosen surgery unless it was necessary, but when offered a scarless option they were both enthusiastic.
Scarless Thyroid Surgery, Through the Armpit
For Gaines, problems started after she gave birth to her second child. She couldn't understand why she was so tired all the time — she just couldn't seem to bounce back like she had after her first child was born. She also was plagued with other major symptoms including severe backaches and a vitamin B deficiency.
Finally, she went to her doctor, who ran a battery of tests that showed her levels of thyroid, a hormone produced by a small gland in the front of Gaines' neck, were below the norm.
An endocrinologist diagnosed Hashimoto's disease, a condition that develops when the thyroid gland doesn't produce enough of its hormone. He put Gaines on a medication that seemed to work fairly well for the next five or six years.
But then, Gaines' insurance no longer was accepted by the endocrinologist and she had to find a new thyroid specialist. "I'm glad I did," she said, "because the new doctor seemed much more attentive and the office was better equipped for testing."
The new endocrinologist, concerned about the size and sudden growth of Kim's thyroid, did an ultrasound right in the office and told her its growth spurt and appearance in the ultrasound image were "consistent with cancer."
"I'm a young mom who needs to be around with my kids," Gaines said. "I went into survival mode. My first and only reaction was, 'Get it out!' I wasn't frightened by the thought of surgery. I just wanted my thyroid gland gone."
Her family doctor referred her to Francisco Rodriguez, MD, at Valley Surgical Associates. "I was so impressed," she said. "Dr. Rodriguez was not only very knowledgeable, but he was so kind. He seemed to care so much."
Gaines, who has been doing her own online medical research about her condition since it was first diagnosed, liked the fact that Dr. Rodriguez gave her all the facts, good and bad, and all her options.
The da Vinci robotic surgical system has enabled John C. Lincoln surgeons, including Dr. Rodriguez (above), to pursue alternatives to traditional laparoscopy and invasive open surgical procedures.
"He gave me the whole scenario," she said, "and then he suggested something innovative that I hadn't seen on the Internet. He suggested removing my thyroid gland with the da Vinci surgical robot through my armpit!"
Gaines had read about the complications other patients had while recovering from thyroid surgery done the traditional way, through an incision in the neck, and they were of concern. "I had never really thought about how important the neck muscles are to all kinds of activity," she said. "That cut in the neck impairs your ability to move, to drive and to pick things up. It's a problem."
So Gaines was delighted with the idea of avoiding an incision in her neck, even before she thought about the cosmetic benefits. But when she considered the esthetic advantages of going scarless, she was sold. She also liked the fact that recovery from robotic thyroid surgery through the armpit takes half the time that is required for recovery from standard thyroid surgery through a neck incision.
"The one thing I worried about was waking up with a sore throat," she said. "I hate sore throats. I always have. It hurts to swallow.
"But when I woke up after surgery, I was incredibly thirsty and I was hungry! They brought me lunch — fresh strawberries and cantaloupe, and a chicken walnut salad sandwich. I wolfed it all down without thinking, and then I was shocked. No pain! It didn't hurt to swallow. I was so happy."
Although Gaines never felt what she would call "pain," the incision in her armpit was uncomfortable for a few days. "But it wasn't bad. I just had to be careful of it for two or three days. I was only in the hospital for one night after my surgery and then I was allowed to go home."
Now Gaines is thrilled with the idea of being scarless. "The incision was in the fold of my arm, so you really can't see it. I can wear tank tops and nobody can tell I had surgery. All I can say is 'Wow.'"
Scarless Gall Bladder Surgery, Through the Navel
Jeanina Stratton's surgeon took a different path — her gall bladder was removed with a procedure called SILS, single incision laparoscopic surgery, which is done through the belly button.
"I'd been having all the symptoms, the abdominal pain and other uncomfortable problems associated with gall bladder disease," Stratton said. "Testing showed I had eight spots on my gall bladder, so it definitely had to come out.
"I'd done the research on laparoscopic surgery, and I knew there would be one scar where they inserted the camera and others where they held the gall bladder steady while they worked through another incision to actually remove it," she said. She knew she needed the operation, but she was not thrilled by the thought of all those scars decorating her abdomen.
So when her surgeon, Rick Low, MD, FACS, suggested the scarless belly button approach, "I said, 'Go for it!' I did not want those (traditional laparoscopic) scars!"
In the SILS approach, special equipment is used to install a port that temporarily stretches the belly button to accommodate the various laparoscopic instruments. Stratton came into John C. Lincoln North Mountain Hospital first thing in the morning, had the procedure and was able to go home late that afternoon.
"It took about a week for the gas (used by laparoscopic surgeons to expand the internal abdominal surgical field so they can see what they're doing) to dissipate, but that was the worst part," she said. "After a few days, I was feeling pretty good. I don't even think I took all the pain pills they prescribed. I didn't need them.
"And I love not having any scars!"
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This article appears in the May/June 2010 edition of HealthBeat, our bimonthly health newsletter.
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