Laparoscopic surgery keeps evolving

Nathan Liewicki
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Cadili performs province's first SILS colon procedure

Dr. Ali Cadili continues to push the laparoscopic surgical envelope.

Dr. Ali Cadili holds a couple of instruments used to perform Saskatchewan's first Single Incision Laparoscopic Surgery of the colon. Dr. Cadili performed the surgery at the Moose Jaw Union Hospital about eight weeks ago.

Approximately one year after becoming the first Saskatchewan surgeon to perform the new Single Incision Laparoscopic Surgery (SILS) on a gallbladder, Dr. Cadili has turned to colons.

A general and laparoscopic surgeon in the Five Hills Health Region (FHHR), Dr. Cadili performed SILS on a woman’s colon about eight weeks ago.

“We have done single incision surgeries for gullbladders and appendixes in the past … and the goal is to disseminate that technique,” Dr. Cadili told the Times-Herald on Tuesday.

The procedure is gaining steam in the U.S., as well as in Ontario, but Dr. Cadili is playing a big role in its continued progression in Western Canada.

The traditional approach to colon surgery involves a big incision, which is referred to as the “nipples to knees” incision. That surgical technique advanced into laparoscopic surgery – with four or five small incisions – and now there is SILS.

“This is generally considered the next step in the evolution of laparoscopic surgery,” Dr. Cadili said. “It is a very technically demanding technique, which requires some extra training and thought.”

The SILS approach performs the laparoscopic colon resection the same as an open laparoscopic surgery, but with only one small incision around the belly button.

He admitted that plenty of mental preparation is needed before a SILS procedure takes place.

“We had gained quite a bit of experience with the single incision technique doing less complex operations like on the gallbladder and appendix,” said Dr. Cadili. “To go through the steps in your mind and make sure you have a contingency plan if you hit trouble is important, as it is to rehearse the steps in your mind and be confident that you think you can do it.”

Although only one minimally invasive colon surgery has been performed in the province, Dr. Cadili says there are plans to start doing the procedure more frequently.

Despite that, Dr. Cadili says this new surgical procedure is done on a case-by-case basis. There are plenty of complex factors involved in the selection of a patient for this type of surgery, including a patient’s medical history, the type of disease they have and body habits.

“There is no specific formula,” said Dr. Cadili. “And we are very carefully selecting patients to make sure (the surgery) is successful.”

It’s only one surgery and thus cannot be fully measured yet. But according to Dr. Cadili, the procedure should save the health-care system a lot of money over the long haul.

With open surgery, a patient is expected to remain in the hospital for about seven days following surgery. Following the SILS procedure, patients are generally discharged after only three or four days – a major advantage of the procedure.

“Less (hospital) time shouldn't be necessarily emphasized as being a big cost-cutting factor. Less time reflects patient mobility and a patient's mobility indicates wellness,” said Dr. Fred Wigmore, senior medical officer for the FHHR.

He added that there are fewer complications with better post-operation mobility for patients.

“If you can produce the same operation, but with less scarring, less pain and a shorter hospital stay, that's the goal,” said Dr. Cadili.

The FHHR has provided Dr. Cadili with the specialized instruments needed to perform SILS on a colon, and at a few hundred dollars, they are not very expensive – despite the fact they are disposed as biomedical waste following the procedure.

It took some planning and discussion to acquire the instruments from Covidien, a global health-care products conglomerate, but more of these successful surgeries can be performed at the Moose Jaw Union Hospital.

“I think regional hospitals have a duty to keep pace with changing techniques and changing technologies,” said Dr. Wigmore. “On this occasion, we've been able to be at the forefront of this changing technique, which speaks well for the progressive medical care we hope to provide in the future.”

Nathan Liewicki can be reached at 306-691-1256 or follow him on Twitter @liewicks.

Organizations: Times-Herald, Moose Jaw Union Hospital

Geographic location: Saskatchewan, U.S., Ontario Western Canada

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  • Nata Seager
    July 24, 2014 - 07:55

    Moose Jaw...first again!