First, there was laparoscopic surgery, which allowed a surgeon to remove the gallbladder through small incisions in the abdomen. Though much less invasive than traditional open surgery, it still required making several cuts in the abdominal wall.

Now, some surgeons are trying a new method, called single-port access or reduced-port access surgery, that allows the entire procedure to be done through a one-inch incision in the patient’s belly button.

“This procedure is still investigational at this point,” says Dr. Benjamin Schneider, a surgeon at Beth Israel Deaconess Medical Center in Boston and an instructor at Harvard Medical School. “But it holds great potential.”

In an open cholecystectomy (the technical term for surgery to remove the gallbladder), the surgeon makes a single, large incision in the abdomen. Traditional laparoscopic surgery for gallbladder removal typically requires four small incisions. But with the reduced-port surgery, the instruments and camera are threaded through one small incision in the belly button.

As is the case with traditional laparoscopic surgery, the procedure is performed under general anesthesia with the aid of a laparoscope. This technique is also being tested for other types of surgeries, such as appendectomies and hernia repair.

One of the major benefits of the reduced-port surgery, Dr. Schneider says, is cosmetic. Since the entire surgery is performed through the navel, it does not leave any visible scars like the traditional multi-port approach.

“The advantages are theoretical, and the cosmetic benefit seems to be the biggest advantage at this point,” he says. “But with more research, we may find that patients experience less post-operative pain and a return to work or activity sooner than other methods.”

Currently, candidates for the reduced-port approach cannot be suffering from an infected gallbladder, and they cannot have a BMI over 30 or have lots of scar tissue in the abdominal area.

Dr. Schneider also points out that there is the chance that, once the surgeon begins surgery, conditions may require that the operation be converted to traditional surgery.

But so far, patients seem pleased with the results.

Jennifer Shumaker, 32, had just had her second baby when she underwent a reduced-port cholecystectomy in 2009. She had had gallbladder problems throughout her pregnancy, and was thrilled to be offered this minimally-invasive approach.

“I was very pleased with the results,” she says. “I had no pain, and I was up and around the next day.”

“I didn’t need any pain medication,” says the Framingham mom. “And since I was nursing, that was a huge factor for me.”

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

On a sunny spring day in 2009, Mary Ann Tosi was sitting in a Needham church, attending a memorial mass for her parents. As she sat with her family in a back pew, a pain crept up the back of her head.

“I had been having chronic headaches for years, so I thought that’s what it was,” Tosi says. “But then it started to get more intense.”

Minutes later she was in an ambulance, and on the way to the hospital, the pain became excruciating.

“When I got to the hospital, the doctor told me it was serious,” Tosi says.

Tosi was suffering from a ruptured brain aneurysm, an abnormal ballooning of an artery that supplies blood to the brain. Approximately thirty percent of patients with a ruptured aneurysm die instantly, and of those who survive, about half are left with some permanent disability.

Tosi was quickly transferred to Beth Israel Deaconess Medical Center in Boston, where she had emergency surgery using a minimally-invasive technique that doesn’t require cutting open a patient’s skull.

“This is a major breakthrough,” says Dr. Ajith Thomas, Chief of Cerebrovascular Surgery at Beth Israel Deaconess Medical Center. “The majority of aneurysm patients here at BIDMC are now treated using this technique.”

Called endovascular coiling, the procedure uses tiny coils to block blood flow into the aneurysm, effectively sealing it off. The coils are inserted using a catheter that is threaded through the groin up into the artery, with no cutting required.

Coiling is less invasive than surgical clipping, the traditional method for treating an aneurysm. During the clipping procedure, the surgeon must cut open the skull to place a small metal clip on the neck of the aneurysm to stop the blood flow.

“There is still a small subset of aneurysms that have to be clipped,” Dr. Thomas says, “but that number is dropping.”

Patients who have the coiling procedure enjoy many benefits, not the least of which is avoiding the potential complications of brain surgery.

“When you do surgery on the skull, it can be difficult to see all of the very small arteries (perforators) clearly, which can cause devastating complications,” says Dr Thomas. “With coiling, that’s less of a problem.”

Patients are also spared any disfigurement of the head or face (which often results from cutting into the skull), and they typically enjoy a shorter hospital stay.

There are few drawbacks to the coiling treatment. The main problem is that the procedure may need to be repeated down the line, but since it’s so minimally invasive, that’s not too much of a concern, according to Dr. Thomas. And, though very small, there is also the risk of stroke, which Dr. Thomas puts at less than 2%.

“Here at BIDMC, we have had minimal complications (from coiling unruptured aneurysms) in the last four years,” he says. “It’s a great tool to have available to us.”

Mary Ann, for one, is grateful for having had the procedure–and is grateful to Dr. Thomas as well.

“He can’t believe I’m doing as well as I am.”

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Charlie Fischer was driving home from a high school basketball game he had officiated in late November of last year when he started to suffer from a sudden onset of severe, stabbing pain in his back.

At sixty-five years old, Fischer was in relatively good health, but the pain was so persistent that it led him straight to a local hospital. The diagnosis was a kidney stone, confirmed by a CAT scan. Two days later, Fischer’s doctor called with some shocking news – the scan had also detected a mass in his left kidney. An MRI confirmed it was probably cancer.

“I was surprised but not shocked,” said Fischer. “My dad had cancer so in my mind it was not if, but when for me. I knew my chances were pretty good.”

Local doctors determined that the best course of treatment would be to remove the entire kidney. Weary of the major surgery, Fischer and his son Chris, an emergency room physician at Beth Israel Deaconess Medical Center, decided to get a second opinion.

Dr. Andrew Wagner, Director of Minimally Invasive Urologic Surgery at BIDMC, determined that the tumor was in a tough spot, but felt confident he could remove it via laparoscopic surgery, and save the rest of the kidney, something he and his team have been performing for 5 years.

“Few other centers in the country are doing more advanced kidney surgery than we are,” explains Wagner.

As recently as five to ten years ago, surgery to treat kidney cancer required long incisions and lengthy hospital stays. But thanks to exciting advances in laparoscopic and robotic technology, most tumors can now be approached through minimally invasive surgery. The benefits are impressive, cutting down on post-op pain, risk of infection, and recovery time. But the procedure has yet to become mainstream. BIDMC, however, remains on the leading-edge of care.

“If you look at kidney surgery at hospitals across the country – only about 20-30% are being done minimally-invasive and many patients are undergoing removal of the entire kidney when they would be better served by a partial nephrectomy,” said Wagner. “Over 90% of our patients are able to undergo minimally invasive kidney surgery, whether it be for small or very large tumors”.

If a tumor is detected and the cancer has not spread, a partial nephrectomy, during which part of the organ is removed, can often be performed, which was the case for Fischer.  Four half-inch incisions are made, instead of the traditional eight- to twelve-inch scar, and Dr Wagner uses robotic assistance to carefully remove the tumor laparoscopically, while preserving the remaining kidney. In many cases where the tumor is very large, the entire kidney can be removed this way, as well.

“I had the surgery on a Monday, went home from the hospital on Wednesday, and by the end of the week I was back to normal,” Fischer said. “I hope everyone has the same experience. I’m a walking endorsement.”

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

A minimally-invasive procedure has been shown to successfully treat uterine fibroids while requiring little downtime for the patient and preserving the woman’s uterus.

“This is another treatment option for women to consider,” says Dr. Yvonne Gomez-Carrion, an OB/GYN at Beth Israel Deaconess Medical Center in Boston and an assistant professor of obstetrics and gynecology at Harvard Medical School. “It’s a great option for a woman who is an appropriate candidate and doesn’t want to have surgery.”

Called uterine fibroid embolization (UFE), this non-surgical procedure is performed while the patient is conscious but sedated, and typically requires only an overnight hospital stay. An abdominal hysterectomy, the traditional treatment for fibroids, typically requires a 1-2 day hospital stay and a recovery period of about two weeks, compared to six weeks if performed laparoscopically versus an open incision. Also, a total hysterectomy removes the entire uterus, while UFE does not.

Fibroids are tumors made up of muscle cells and other tissue that grows within the wall of the uterus. According to the National Institutes of Health, uterine fibroids are the most common non-cancerous tumors in women of childbearing age.

Most fibroids don’t cause any discomfort; only about 10 to 20 percent of women who have fibroids require some form of treatment. Depending on the location, size and number of fibroids, a patient may experience heavy, prolonged menstrual periods and unusual monthly bleeding, pressure on the bladder or bowel, an abnormally enlarged abdomen, pelvic pain, and pain during sexual intercourse.

In UFE, also referred to as uterine artery embolization, the doctor makes a small incision (usually in the groin area) and inserts a thin, flexible tube. Tiny pellets of glycerin are injected through the tube into the arteries that feed the fibroids. The pellets block the vessels supplying blood to the fibroids, cutting off their blood supply and causing them to die.

While UFE is an effective treatment option for uterine fibroids, the effects on future fertility and development of the growing fetus have not been fully determined. There have been cases of successful pregnancies following this procedure, but there have also been problems with conception and possible placental issues (such as the location and functioning of the placenta).

The procedure has other risks as well. “UFE can put you into an earlier menopause, though that can be a positive for some women who have been experiencing extreme symptoms with their fibroids,” says Dr. Gomez-Carrion. And, though small, there is also the risk of infection.

Dr. Gomez-Carrion points out that UFE is not an option for every patient. If you suffer from uterine fibroids, she advises that you discuss all of the options with your doctor.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

“I’ve never had a humble opinion. If you’ve got an opinion, why be humble about it?” – Joan Baez

It’s a great phrase, isn’t it? “In my humble opinion…” In my own experience if there is one thing that most often follows those four words it is the expression of an opinion that is rarely humble. So I give Joan Baez credit for honesty.

Frankly whether an opinion is humble or not doesn’t make much difference to me. What I am most often in search of is an informed opinion. And there are those who would suggest that even one of those is not always enough, especially when it comes to questions of your health.

“My job”, according to Dr. Dan Jones, Chief of Minimally Invasive Surgery at Beth Israel Deaconess Medical Center and Professor of Surgery at Harvard Medical School, “is to provide the best information possible to my patients and to help them make informed decisions. Sometimes that means getting a second opinion. And by the way, patients aren’t the only ones who look for them.”

For Dr. Jones a second opinion is appropriate whenever the patient feels the need to seek one. Some patients may get the benefit of a second opinion of their case even though they never asked.

“When I have a potentially complex case I often seek opinions from colleagues and gather information. Or I might tell my patient that if during surgery we encounter something unexpected, such as tumor that didn’t show up in any of our scans or test, I will call in a specialist and get their opinion on the best way to proceed.”

If that doesn’t sound like the popular characterization (or perhaps caricaturization) of the doctor as all knowing and arrogant, that’s because it is not what Dr. Jones’ experiences in his conversations with both peers and patients.

“We know that we have to get the ego out of the way for the moment. When patients ask about a second opinion don’t discourage that. Make sure they get it from somebody who can provide good information. Someone whose opinion matters even though it may differ from your own.”

Speaking of information, there is a wealth of it available to patients these days. Some of it is very good, which can be helpful. Some of it may be erroneous, confusing or at the very least, need a little professional interpretation.

“It’s great when the patient can get some straightforward, relevant information but there is a reason to be wary of being your own doctor.” Here Dr. Jones speaks from experience. “My mother will have a cough, go online and an hour later she’s convinced she has a rare form of tuberculosis. I think it’s fair to say that I offer her a second opinion in situations like that.”

I may be going on out a limb here, but I don’t think Dr. Jones’ mother pays anything out of pocket for that second opinion. You may not be so fortunate.

As a patient you certainly have the right to seek a second opinion. Indeed your physician may encourage it. But the insurance company might not pay for it, so it’s always a good idea to check on your benefits.

“If it is a straightforward medical issue you may not get the insurance company to pay for a second opinion simply because you want one. They may require a referral. I say that knowing that when it’s happening to you not everything seems straightforward. Patients want to know if what I am suggesting is the best standard of care, whether I have done similar procedures before and if so how many. I do think that often it’s as much a matter of reassurance as it is seeking other treatment options.”

Dr. Jones knows that people have questions and they want information that will provide answers. It’s why he himself sought out a colleague for advice on an issue that was troubling his own 12 year old daughter.

“She’s a lacrosse player and she wanted to know which fall sport would be better for her lacrosse development – soccer or cross-country. I asked one of our anesthesiologists who had played college lacrosse what she thought and she said that soccer would likely help her footwork more. I came home and told my daughter and you know what she said? ‘I want a second opinion’.”

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

For the 16,000 people who are diagnosed each year with cancer of the esophagus – the tube that carries food from the mouth to the stomach – the surgery many face is complicated. It often involves major incisions to open the chest, abdomen and neck in order to remove the esophagus and craft a new tube, fashioned from the stomach.

For the past seven years, surgeons at Beth Israel Deaconess Medical Center (BIDMC) have been developing and implementing minimally-invasive procedures to reduce the size of incisions necessary to perform the complex operation.

“The idea was that we can do this less invasively and that patients would get better, faster,” says Dr. Jonathan Critchlow, BIDMC’s Associate Chief of General Surgery.

Dr. Critchlow and his team work hand-in-hand with doctors in BIDMC’s department of gastroenterology to treat patients with esophageal disease, who come to them with symptoms such as bleeding, difficulty swallowing and hoarseness.

In pre-cancerous conditions or early stages of cancer, patients often undergo endoscopic procedures to detect and remove lesions in the esophagus.  “By inserting a tube with a camera attached, our GI doctors are able to discover whether there is deeper cancer lurking and that helps us decide on our surgical procedures. If no invasive cancer is found, treatment may be purely endoscopic.”

Dr. Critchlow says if the removal of the esophagus is indicated, there is no singular way to perform the operation. “There isn’t one perfect incision that will get you where you want to go and deciding on the procedure used depends on the skill and training of particular surgeons.”

In minimally-invasive procedures, a laparoscope with camera is inserted through small incisions and transmits pictures from inside the body to a video monitor, allowing surgeons to see and operate without large painful incisions.

Minimally-invasive procedures at BIDMC are done with small incisions in the chest, abdomen and sometimes neck.

One procedure used allows for incisions to be made in only the neck and abdomen and the work in the chest area to be done from above and below, while viewing the images on the screen.

“We have good instruments that afford us a magnified view of the stomach so we can free it up from its attachments, form a tube and connect it to the neck without directly cutting into the chest,” says Dr. Critchlow.

The minimally-invasive surgery is a lengthy one, says Dr. Critchlow.  “We usually perform it with a team of two expert surgeons from the divisions of minimally invasive and thoracic surgery.  Each one brings their specialty to the table and it keeps the length of time in the operating room down.”

It is difficult to gather comparative data on all surgical techniques, since randomized trials can’t be conducted, says Dr. Critchlow.  “Some patients may, by the time we see them, have already undergone radiation or chemotherapy or other procedures.  It’s like comparing apples and oranges.”

There is evidence, however that “those undergoing the minimally-invasive procedures get their energy back quicker and are more active.  There has been discussion that there may be a lower incidence of pneumonia, as well, but not everyone agrees that is true.”

Dr. Critchlow says minimally-invasive surgery is now the procedure of choice.

“We use it on all who are decent candidates for the surgery and we do very few open esophagectomies anymore.”

Minimally-invasive surgical techniques are greatly improving the options, he says, and “we are enthusiastic about it.”

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Patients with failed kidneys typically have to spend about five years on dialysis waiting for a transplant from a deceased person to become available. But those lucky enough to have a family member or friend who will donate one of their kidneys can skip the wait–and generally do better in the long run.

“We’re trying to do as many of these as we can,” says Dr. Didier Mandelbrot, a nephrologist and director of the Live Kidney Donor Program at Beth Israel Deaconess Medical Center in Boston.

“There are now studies showing that the longer somebody is on dialysis, the less well they will do with their transplant. The other major reason to try and preempt dialysis is that patients don’t like it. They have to go three times a week and must live with a fistula or catheter for access.”

So far, BIDMC’s program has performed about 150 of the “preemptive” kidney transplants from live donors. The program’s success is due, in part, because all related services – surgeons, nephrologists, hepatologists, psychologists, social workers, nurses and nutritionists – are all located in one area, making the evaluation, pre-transplant and post-transplant care easy for patients and more efficient.

Contrary to popular belief, donors do not have to be siblings or even relatives. A genetic match is not necessary. The donor and recipient merely have to be compatible blood types.

People don’t need two kidneys to live a healthy life, so the risks to the donors are minimal. If the donor should later develop kidney disease, he or she would go to the top of the waiting list for a kidney from a deceased donor — sort of a reward for his or her good deed.

Generally, kidneys from live donors last 15-20 years, while those from deceased donors last only 10-15. The difference may be because the deceased donor kidney is typically on ice for 15 hours or so before being transplanted or because the recipient has been on dialysis for years, said Dr. Scott Johnson, lead surgeon for the program.

“The live donor program gives us the best opportunity to have the best outcome,” says Dr. Johnson. “They are getting a kidney of the best quality. The program allows us to stack the deck in the recipient’s favor.”

Another new wrinkle to the live donor transplant program is the so-called “paired exchange program.” It works like this: say a man wants to donate a kidney to his wife, but he is not compatible due to improper blood type. At the same time, there is another couple in the same boat. So the first man donates his kidney to the second man’s wife, while the second man donates his to the first man’s wife.

“You have benefited four people,” says Dr. Mandelbrot. “Two people get kidneys and two people get healthy spouses.”

The people involved don’t have to know each other — they can be found by computer through a data bank.

While it appears that donors generally do quite well, suffering few if any ill effects of having a kidney removed, BIDMC has received a National Institutes of Health grant to study this matter.

“We’re enrolling donors right before donation,” he says. “We plan to do a careful follow-up on these patients — surgical outcomes, medical outcomes, psycho-social outcomes, costs. We’re taking a comprehensive look.”

Typically, the insurance company for the recipient pays the costs associated with the donor’s surgery.

Also, donors are carefully screened by psychologists to make sure they are good candidates mentally to make such a donation — and to make sure they are not being coerced to donate against their true wishes. And if they want an “out,” they are given one — a letter saying they are not an acceptable donor. The letter does not say why.

Potential recipients are also coached on the best ways to go about finding a live donor. “The biggest thing is to get the word out there that you need one,” he says. “You don’t want to pressure anybody, but you have to let family and friends know you need one.”

Blacks tend to have worse luck in finding live donors, according to Dr. Mandelbrot. And they have higher rates of kidney disease. So BIDMC is conducting another NIH-funded study seeking to reduce racial disparities in live donor transplantation. A representative from the program is going into homes of people with kidney disease to inform people about the program and to see if more living donors can be recruited.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

More than 50,000 people have turned to it to treat hard to reach cancers: Cyberknife RadioSurgery uses real-time, image-guided robotics to accurately target tumors and lesions that may otherwise be untreatable.

“This is a real breakthrough,” says Dr. Anand Mahadevan, of the Keith C. Field Cyberknife Center at Beth Israel Deaconess Medical Center, the first center in New England to offer Cyberknife therapy. ”In the past, we’ve been limited to how much radiation we can give to treat cancers because it scatters around the tumor and causes collateral damage to nearby structures. This therapy pinpoints the exact location, sparing surrounding tissue.”

Cyberknife was first approved by the Food and Drug Administration in 1999 and is now used to treat tumors and lesions of the brain, optic areas, neck, spine, pancreas, lung, liver and prostate. The treatment delivers high doses of radiation with sub-millimeter accuracy, adjusting for any tumor or patient movement.

“Even lung cancers, which move as you breathe, are targeted with unprecedented accuracy,” says Dr. Mahadevan. “Because of its precision in hitting moving targets, the chances of controlling small lung cancers are very high, over 80-90 percent.”

Patients are awake during the hour-and-a-half to two hour painless procedure. Side effects are rare and include fatigue, Dr. Mahadevan says. Most patients undergo one to five treatments over a week’s time, as opposed to five to six weeks of conventional radiation. The risks with Cyberknife are also much less than conventional radiation, but include scarring of treated areas, and other local effects like ulcers in the stomach when treating tumors in the abdomen.

Terry Barden, RN, one of the Cyberknife Coordinators at the BIDMC Cyberknife center, says they’ve seen almost 1,000 patients since they began offering Cyberknife treatment in 2005. Referrals are received from around the world and people travel a great distance for the therapy.

“Most patients find us because we are their last hope,” she says.

Barden explains one of its main benefits is treating tumors that have recurred—so the patient does not need to subject themselves to more toxic radiation. Many who have had traditional radiation and then Cyberknife say the latter is a far better experience because of the minimal side effects and the decreased amount of treatments that they need to receive, according to Barden.

But while there are stories of cancers being cured with Cyberknife, for most patients it’s a way to buy some time by shrinking tumors, and better their remaining quality of life. For some cancers, that extension can also be a life-saver.  Barden points to a liver cancer case, for example, where the therapy kept the disease from progressing long enough for a liver transplant. That patient is doing well today.

“We try to think of it this way – if this was a member of our family, of course we’d do everything we could to keep them with us as long as possible,” says Barden. “We try to streamline the process as best we can to make it the least stressful for the patient and their family.”

Then she adds, “we’ve had patients that have short-term goals and say ‘I just want to see my daughter graduate.’ With Cyberknife, we have helped them do that.”

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.