SURGERY

Central Illinois "Firsts"

OSF St. Joseph has pioneered many medical advancements to benefit central Illinois residents, among them the area's first sucessful birth by cesarean section, nuclear medicine, and hospital laser surgery. In 1990, OSF St. Joseph was the first hospital in McLean County to offer open heart surgery and remains the only area provider of open heart services, coronary angioplasty (balloon therapy) and a broad range of cardiac diagnostic tests.

Heart Surgery Without Stopping the Heart

What: Beating Heart Surgery

How: A new surgical technique allows surgeons at OSF St. Joseph Medical Center to perform coronary artery bypass surgery on a beating heart. The Medtronic Octopus(r)2 allows surgeons to stabilize a portion of the beating heart while they suture the vessels. As vacuum cups gently lift the sewing site and hold it steady, the heart continues to beat beneath.

Benefits: Compared to traditional open-heart bypass surgery, studies show off-pump surgery results in shorter hospital stays, shorter time spent on a ventilator, fewer transfusions and decreased risk of stroke.

When: January 2000

Who: G. Bradley Smith, M.D., a surgeon with Illinois Cardiac Surgery Associates, first performed beating heart surgery at OSF St. Joseph Medical Center.

New Approach to Aneurysm Repair

What: A less invasive procedure to repair abdominal aortic aneurysm (AAA)

How: Using the ANCURE (tm) system, developed by Guidant Corporation and approved for use by the U.S. Food and Drug Administration on September 28, 1999, surgeons can repair AAA via small incisions in two arteries in the groin. Until now, AAA has been repaired surgically via an incision running roughly from the patient's sternum to below the navel.

Benefits: Mortality and complication rates, hospital length of stay and recovery time are substantially improved following AAA repair using the Guidant product compared to conventional AAA repair.

When: December 1999

Who: Dr. Ruel Wright, a cardiovascular surgeon with Illinois Cardiac Surgery Associates, S.C., was the first surgeon to earn certification in the new procedure.

MIDCAB
Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) was first performed at OSF St. Joseph Medical Center in April 1996 by Ruel N. Wright, MD, an OSF St. Joseph cardiovascular surgeon. It was one of the first MIDCAB procedures performed in the country.

The techniques were developed by Dr. Federico Benetti of Buenos Aires, Argentina, as an alternative to traditional open heart surgery utilizing a heart-lung machine because of the economic constraints on medical care in his country. His work has gained worldwide recognition and is being increasingly applied in an effort to reduce hospital stays and the complications of coronary artery bypass surgery. MIDCAB has also become an alternative to balloon angioplasty, a procedure that carries a high risk for a repeat procedure.

"MIDCAB procedures offer a number of advantages over conventional open heart surgery," said Dr. Wright. Rather than a sternal split, which is a vertical incision along the patient's chest, "we can access the heart through an incision between the ribs or through the upper abdomen. The risk of sternal infection is eliminated and these incisions heal faster, allowing earlier resumption of full activities. In addition, the MIDCAB procedures can frequently be done without using the heart-lung machine."

During conventional open heart surgery, patients are placed on a heart-lung bypass machine which keeps oxygenated blood circulating through the body while the heart is stopped to sew on the bypasses. If the heart-lung machine is not used during a MIDCAB procedure, potential complications can be avoided. Complications include stroke, disorders of blood clotting, need for blood transfusion, increased risk of infection because of the effects on the patient's immune response and need for prolonged respirator support.

Good candidates for the MIDCAB procedures are those patients needing only one or two coronary bypasses who also have fairly good lung function. "We can offer a less invasive procedure with a shorter hospital stay and more rapid recovery. While it is unrealistic to expect a three day hospital stay following conventional open heart surgery using the heart-lung machine, discharge in two or three days is a reasonable goal for MIDCAB patients," said Dr. Wright.

Endoscopic Saphenous Vein Harvest
A new, less invasive procedure for harvesting leg veins for heart bypass surgery results in less post-operative pain for the patient and may help shorten hospital stays. The procedure was first performed at OSF St. Joseph in February 1997 and was among the first such procedures in the country.

Leg veins are often harvested and used to bypass coronary arteries blocked by cholesterol plaque. Rather than making an incision the length of the vein to be harvested, which may run from ankle to mid-thigh, the new procedure uses a miniature video camera and a retractor inserted into the leg through a two- to three-inch incision. A bypass patient may require just two or three of those small incisions to harvest enough vein to complete the surgery.

Because the incisions are considerably smaller, they heal more quickly and patients report less pain and swelling. Patients are typically able to walk on their own sooner and for longer distances, which may mean they go home sooner. One of the discharge criteria for open heart surgery patients is the ability to walk on their own a distance of about 100 feet.

 Posterior Interbody Spinal Fusion
An OSF St. Joseph Medical Center orthopedic surgeon was among the first 100 surgeons in the U.S. trained to perform a new procedure that alleviates low back pain, has a 92 percent success rate and costs about half as much as conventional procedures.

Lawrence A. Nord, MD, is the first surgeon in downstate Illinois to be trained in the procedure known as Posterior Interbody Spinal Fusion using the Ray Threaded Fusion Cage. The Cage was approved for use by the U.S. Food and Drug Administration in late October 1996. Good candidates for this type of surgery are those suffering from low back pain as a result of degenerative disc disease who have tried nonsurgical treatments for at least six months but whose pain continues.

"The surgical solution for stopping low back pain involves fusing together the vertebrae above and below the affected disc," said Dr. Nord. "In the past, that has meant making an incision over the spine, retracting the muscle away from the spine, using a burr to clean the bone, then using a combination of wire, a small battery, bone grafts, screws and plates to stabilize the vertebrae. In some cases, the procedure needed to be repeated on the front side of the patient's spine, requiring a second incision to more definitively stabilize and fuse the vertebral bodies. The new procedure is safer and can be performed more quickly," he said.
The new procedure uses special instruments to create threads in the facing sides of the vertebrae to be fused. A threaded, porous titanium cage is screwed into the space between the vertebrae, packed with bone graft taken from the patient's pelvis and capped. The grafted bone is allowed to penetrate the pores in the cage, and over time, fuse with the vertebrae above and below, thus stabilizing them.

The average cost of the conventional fusion surgery is $41,000. The average cost using the new technique is about $25,000. "I see the cost savings as having a major impact on the decision to use this type of fusion surgery more often, especially in the growing managed care environment," said Dr. Nord, who also noted that about 90 percent of adults will suffer some sort of back pain during their lifetime. Of that number, 50 percent will require treatment by a physician. And of those seeing a physician, 10 percent will require surgical intervention, be it a lumbar discectomy (removal of a ruptured portion of vertebral disc), lumbar laminectomy (removal of a portion of the bony vertebra) or spinal fusion or a combination of the above. Dr. Nord estimates that about 90 percent of patients needing spinal fusion will be candidates for the new procedure.

"The procedure is less invasive and it causes less trauma to the body because it doesn't require as much tissue dissection as conventional spinal fusion surgery," said Dr. Nord. "As a result, patients recover more quickly and can return to work and resume normal activities much sooner."

More than 90 percent of patients undergoing the surgery have been discharged within one to two days following surgery.