Unique dual laparoscopic surgical procedure

Jul 21 2004

The skill and teamwork of two physicians at Scripps Clinic, combined with the expertise of the surgical staff at Scripps Green Hospital, recently led to a unique surgery that changed the life of a local woman.

The procedure involved both a hysterectomy and a bowel resection to remove a colon obstruction. Both procedures were done laparoscopically, a minimally invasive technique that allows a much shorter recovery period than traditional surgery. Hysterectomies and gastrointestinal surgeries are performed laparoscopically regularly at Scripps Green Hospital, but never before had both procedures been done for one patient at the same time.

Pamela Ellis McDonald, 54, had been suffering from excessive bleeding caused by uterine fibroids. She had also been diagnosed with Crohn’s disease, a chronic inflammatory disease of the bowel.

An active former school teacher who has traveled around the world, McDonald’s health declined to the point where she had to quit her job as vice president of a national wall décor company. "I just kept getting sicker and sicker," McDonald remembered. "I was in terrible pain."

McDonald was scheduled to receive a traditional hysterectomy when her gastrointestinal condition worsened. She was hospitalized with severe abdominal pain and tests confirmed that she had a massive blockage in her colon.

Mathew E. Brunson, M.D., former head of the Division of General Surgery at Scripps Clinic, has experience performing advanced laparoscopic surgery. Knowing that McDonald required two major surgical procedures, Brunson sought out his Scripps Clinic colleague Bruce Kahn, M.D., who has expertise performing laparoscopic hysterectomies, and invited him to consult on the case. Together with McDonald, the physicians examined the possibility of performing both procedures at one time using the laparoscopic technique.

"Without laparoscopy, Pamela’s other option would have been to undergo surgery to remove the colon obstruction, wait to heal from that procedure, then undergo traditional hysterectomy," explained Brunson. "Alternatively, we could have performed both surgeries at the same time using traditional techniques, but with a much larger incision," he added. Either approach would have required a long recovery period.

"We all decided it would have been too much stress on my body," said McDonald, referring to traditional surgery. After discussing the dual laparoscopic procedure, McDonald and her physicians decided to go with the less invasive technique. The procedure involved the insertion of a tiny video camera and surgical instruments through four small incisions in the abdomen. The uterus and diseased section of colon were removed through a four-inch incision on the bikini line.

In addition to the skill of the surgeons, the expertise of nurses and other operating room staff at Scripps Green Hospital was critical to the success of the procedure. "Advanced laparoscopic surgery is truly a team effort. It requires a staff that is familiar with the specialized equipment and knows how to use it," pointed out Dr. Kahn.

Advantages of laparoscopy over traditional surgery include shorter hospitalization, less pain and subsequent pain medications, reduced scarring and most importantly, a much faster recovery time and resumption of normal activities. In addition, researchers have recently found that minimally invasive laparoscopy is a safe and effective method for treating colon cancer.

"Results of recent studies are very encouraging," according to Dr. Brunson. "In the future, more and more procedures will be done laparoscopically because patients will demand it."

"This type of procedure is a win/win for everybody," agreed Dr. Kahn. "The physicians, hospitals and insurance companies are happier because we are getting more done with fewer resources. But most important, the patients are happier because they feel better and are able to resume their normal activities much sooner than with traditional surgery."

McDonald knows firsthand the benefits of minimally invasive surgery. She credits doctors Brunson and Kahn with saving her life. "I’m totally amazed. I’m feeling better all the time and plan to go back to work soon," said McDonald, who recently returned from a 10-day family reunion. Now that her health has improved, McDonald is also better able to care for her mother, who has multiple sclerosis. "It’s been like a miracle. I cannot give the doctors enough accolades for what they did."