 Dennis Filippone, M.D., Chairman of the Department of Surgery at Saint Barnabas Medical Center since 1964, met with Family Health Magazine to discuss the ever changing field of surgery. During the interview, Dr. Filippone was joined by Frank Nami, M.D.,Senior Surgical Resident.
During a discussion of new technology, Dr. Nami demonstrated a new piece of equipment called the Endostitch, which dramatically decreases operative time for internal suturing during laparoscopic surgery. Endostitch uses a tiny needle to sew a stitch, then automatically flips the needle to the other side of the two-pronged head. "The equipment enables the surgeon to do a suture in 10 seconds that might take seven or eight minutes otherwise," says Dr. Nami. Both surgeons were very enthusiastic about the role of new technology in surgery.
| Question: How has the surgical department grown at Saint Barnabas? |
| Answer: Since 1964, when Dr. Filippone arrived at Saint Barnabas, the number of operating rooms has doubled and the surgical volume has quadrupled. Less complicated procedures, such as a D&C, breast biopsy or hernia repair, are now performed as same day surgical procedures, says Dr. Filippone. The Medical Center’s operating rooms are now used for more serious operations or complicated cases. |
| Question: What is the fastest growing area of surgery? |
| Answer: Dr. Filippone chooses gastric bypass surgery as the area with the greatest growth potential, in light of our nation’s obesity statistics. The ideal candidate for gastric bypass surgery is 100 pounds over ideal body weight. While 10 years ago this procedure carried with it a high mortality rate because of the large incision, laparoscopic surgery now allows surgeons to perform this procedure with much greater success. (For more about gastric bypass surgery, see Gastric Bypass Gives Patients New Lease on Life). |
| Question: How has the field of surgery changed in the last two decades? |
Answer: Dr. Filippone lists preoperative evaluation of patients as one of the major advances. Patients are led through a sophisticated, streamlined process of medical tests, such as ultrasounds, CAT scans and studies from Nuclear Medicine, before they reach the Medical Center on the day of the procedure. "All that didn’t happen 20 years ago. The patient came in for the surgery and then was evaluated. Today we are 95 percent certain of the patient’s status through diagnostics. The expression ‘exploratory surgery’ no longer exists."
Another major advance in the field of surgery, says Dr. Filippone, is the use of computers as both diagnostic and therapeutic tools. Dr. Filippone describes how a 3-D mapping device is used for sinus surgery and gives the surgeon greater accuracy during critical maneuvers. The device provides a variety of computer-generated images of the surgeon’s instrument as it moves through the sinus passage.
"Sinus surgery is performed through the nose and a probe is used to scrape the sinus. If the probe is pushed even 2 or 3 millimeters too far, it enters the brain. Knowing the exact location of the instrument at all times is critical. |
| Question: How do surgeons learn to use this new technology, much of which has probably emerged since they left medical school? |
| Answer: Surgeons are either trained for weeks at a time by the company that created the technology, or they train as a "preceptor" to another surgeon who is experienced with the new process, relates the Surgical Chairman. |
| Question: In addition to the computer, what other new technologies are assisting surgeons? |
Answer: Aneurysms, a big bubble on the major abdominal artery, are now treated by endovascular surgery. Surgeons use stenttubes inserted through blood vessels and guided into place with the use of x-rays.
These stents are fixed in place by expansion and isolate the aneurysm with an internal bypass. Patients often go home in one or two days. Before this procedure was available, repair of abdominal aneurysms was associated with major blood loss, large incisions, and seven to ten days of difficult recovery.
In cardiac surgery, HEART HOSPITAL surgeons use a new robotic instrument, called the da Vinci System. By offering the surgeon more mobility and 3-D vision it represents a major improvement over conventional laparoscopic surgery, extending minimally invasive surgery to cardiac surgery.
Eye surgeons use LASIK surgery to reshape the cornea of the eye thus eliminating the need for eyeglasses. "New technology in every branch of surgery has lowered morbidity (incidence of disease), made operations more readily available, and enhanced the skill of the surgeon," says Dr. Filippone. "You can’t remain a surgeon if you do not welcome new technology." |
| Question: Years ago so much depended on the skill and experience of the practitioner who did not have computer guides and aides. Does new technology take away any of the excitement of surgery for the surgeon? |
| Answer: "The more skillful you are, the better the outcome, no matter what you do," says Dr. Filippone. "Surgery is even more exciting today because the surgeon can do more things, more accurately, less |
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